J Postgrad Med
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Review
Changing trends in the management of hypotension following spinal anesthesia in cesarean section.
Hypotension during cesarean section under spinal anesthesia remains a frequent scenario in obstetric practice. A number of factors play a role in altering the incidence and severity of hypotension. Counteracting aortocaval compression does not significantly prevent hypotension in most singleton pregnancies. ⋯ Thus, the focus has changed toward co-hydration and use of colloids. Among vasopressors, phenylephrine is now established as a first line drug, although there is limited data in high-risk patients. Though ephedrine crosses the placenta more than phenylephrine and can possibly cause alterations in the fetal physiology, it has not been shown to affect the fetal Apgar or neurobehavioral scores.
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Case Reports
Diffusion weighted MR imaging of 5-fluorouracil and oxaliplatin-induced leukoencephalopathy.
A 55-year-old man treated with 5-fluorouracil and oxaliplatin for advanced sigmoid colon cancer presented with seizures, progressive gait and balance difficulties with frequent falls and slurring of speech. After three cycles of chemotherapy, brain magnetic resonance imaging using diffusion-weighted imaging clearly revealed the presence of high signal intensity in the deep white matter of the bilateral cerebral hemispheres, including the corpus callosum symmetrically. ⋯ Early detection of drug-induced leukoencephalopathy is important as the clinical symptoms can be reversed by early discontinuation of the causative drug. Diffusion-weighted magnetic resonance imaging is a useful modality for the early detection and definitive diagnosis of this characteristic encephalopathy.
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Fibromyalgia (FM) may t cause a decrease in bone mineral density (BMD) because of decreased mobility. The condition is relatively frequent in rheumatoid arthritis (RA) and RA patients with FM have more disability than those without FM. We evaluated the effect of FM on BMD and investigated the effect of FM on BMD in RA patients. ⋯ In spite of functional disability, FM does not cause a decrease in BMD. The presence of FM in RA patients does not result in a change in BMD.