Harefuah
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Malignant hyperthermia syndrome (MHS) is rare, inherited, and triggered by volatile anesthetics and depolarizing muscle relaxants. While potentially fatal, if recognized and treated early recovery is usual. However, the condition is often not recognized until an extreme increase in temperature develops with profound circulatory depression. ⋯ Until our malignant hyperthermia diagnostic center was opened, such tests could not be performed in Israel. Since then we encountered a 22-year-old man who developed the partial picture of malignant hyperthermia syndrome during anesthesia for inguinal herniorrhaphy. He received dantrolene and recovered. 4 months later in vitro contracture tests with caffeine and halothane performed on biopsied muscle confirmed the diagnosis.
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Combinations of lithium carbonate and tricyclic antidepressants are effective in the treatment of resistant unipolar depression. We present a case in which addition of lithium carbonate to a maximal dose of desipramine provided rapid and sustained improvement in a severely depressed 57-year-old woman. She had previously failed to respond to maximum doses of antidepressant drugs of 2 different classes. Although the lithium-tricyclic combination was successful in our case, we caution against its routine use.
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Popliteal artery entrapment syndrome (PAES), a rare cause of lower limb ischemia, is due to an anomalous relationship between the popliteal artery and the gastrocnemius muscle in the popliteal fossa. Hypertrophy of the muscle, or its anomalous insertion, can displace or compress the artery, leading to stenosis or obstruction. ⋯ Due to its high spatial and density resolution, CT scan can differentiate between bony structures, vessels, muscles, and fatty tissue in the popliteal fossa. It is therefore a very useful supporting examination in PAES and can demonstrate whether or not stenosis or occlusion of the artery results from causes outside the artery itself.