Irish journal of medical science
-
Chyle leakage from the thoracic duct or cisterna chyli is a relatively rare complication of oesophageal cancer surgery. The majority of cases settle with conservative measures, but high volume leaks may be refractory and result in significant morbidity and require intervention with reoperation or embolization. ⋯ This article is built around two recent cases, where interventional radiology to embolize and disrupt complex fistulae was successfully performed. The lessons from this experience will change practice at this centre to initial lymphangiography with a view to embolization or disruption of thoracic duct and cisterna chyli leaks as first line therapy for type III chyle leaks, with surgery reserved for where this fails.
-
Long-term usage of acid suppression drugs like proton pump inhibitors (PPIs) or H2 receptor blockers in the elderly population has been found to result in vitamin B12 deficiency. However, the reports are equivocal. ⋯ Prolonged acid suppression therapy with PPIs or H2 blockers may result in serum vitamin B12 deficiency. However, there was no class (PPIs vs. H2 receptor blockers)- or drug (pantoprazole vs. omeprazole vs. ranitidine)-based differences found in the vitamin B12 deficiency caused.
-
Internationally, the number of computerised tomographic pulmonary angiographies (CTPAs) being performed to rule out pulmonary embolism (PE) has caused some concern. ⋯ Application of the PERC rule, as per the ACP guidelines, would have reduced the number of CTPAs performed by 32 (6%) without missing any patient with a proven pulmonary embolus.
-
The COVID-19 pandemic has resulted in a significant disruption in the provision of healthcare globally. The aim of this study was to assess the implications of the COVID-19 pandemic on the provision of neuro-oncology surgery and comparison with a similar 3-month period in 2019. ⋯ The provision of neuro-oncological surgery can be safely continued during respiratory illness epidemic or pandemic if a rigorous testing and staffing framework is implemented.
-
Pain can be considered an early sign of COVID-19 infection. There are no studies that specifically investigate the frequency, characteristics, and presentation patterns of pain in COVID-19 infection. ⋯ The most common pain symptoms were myalgia/arthralgia and headache (69.17% and 50.37%) and found to be much higher than previously reported. Pain is one of the most common complaints of admission to the hospital in patients with COVID-19. Patients who apply to health institutions with pain complaints should be evaluated and questioned in suspicion of COVID-19 infection.