A&A practice
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Central pain syndromes affect several million people worldwide. A 52-year-old woman had central pain manifest as burning pain from her left foot to the knee for 12 years after treatment for a medullary cavernoma diagnosed after a right-sided brainstem bleeding episode. ⋯ Her baseline pain stayed at 2/10 at 140 days with spikes only to 5/10, and no additional medications. Scrambler (Calmare) Therapy deserves further study in central pain.
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Prolonged cardiac arrest (CA) in patients with acute myocardial infarction can be associated with poor prognosis. Successful revascularization with primary percutaneous coronary intervention (pPCI) remains the reference therapy for these patients. However, performing a pPCI during CA is challenging and the use of automatic chest compression devices or mechanical support systems might be warranted to facilitate the pPCI procedure and achieve good outcomes. We present a patient with inferior myocardial infarction and cardiogenic shock, followed by refractory CA who underwent successful pPCI with a novel approach integrating the simultaneous use of an automated chest compression system and intra-aortic balloon pump counterpulsation.
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We report persistent postoperative paraplegia on recovery from anesthesia after emergent exploratory laparotomy for large bowel obstruction in a cachectic patient with an abdominal aortic aneurysm. Postoperative cervical, thoracic, and lumbar spine magnetic resonance imaging revealed only cervical spinal stenosis. We hypothesize that intraoperative embolization possibly caused by manipulation of an atherosclerotic aorta, and a brief episode of intraoperative hypotension resulted in spinal cord ischemia. This report highlights the importance of maintaining intraoperative hemodynamic stability and careful handling of the abdominal aorta, especially in underweight patients with an abdominal aortic aneurysm.
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Juvenile polyposis syndrome is an autosomal-dominant disorder characterized by the presence of hundreds of gastrointestinal polyps. The genes most commonly found are BMPR1A and SMAD4. ⋯ We present the case of a young woman diagnosed with juvenile polyposis syndrome and SMAD-4 mutation, who developed embolic strokes from an atrial septal aneurysm and patent foramen ovale. This case highlights the propensity of patients with juvenile polyposis syndrome and SMAD-4 mutations to develop atrial septal aneurysm and patent foramen ovale, and warrants appropriate cardiac workup in at-risk individuals.
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Sternotomy pain is a common complication after cardiac surgery. We present a 77-year-old patient with severe acute sternal pain after coronary artery bypass graft surgery who was successfully treated with a novel peripheral regional anesthetic technique, the pecto-intercostal fascial block. This interfascial plane block may represent an effective regional anesthetic component of a multimodal analgesic strategy for cardiac surgery patients who suffer from significant pain after a median sternotomy and are typically anticoagulated.