The West Virginia medical journal
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Torsade de pointes (TdP) is a life threatening cardiac arrhythmia that is typically associated with prolongation of the QT interval. A wide variety of nonantiarrthymic medications may trigger TdP in patients with prolonged QT interval, only a few reports have described an association between TdP and methadone. We report a case of TdP caused by a large dose of methadone in a patient with presumably normal QT interval at baseline prior to his presentation at the hospital.
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Case Reports
Chronic subdural hematoma presenting as headache and cognitive impairment after minor head trauma.
Although relatively uncommon, a chronic subdural hematoma carries a high incidence of morbidity and potential mortality. An aging population combined with an increased usage of anti-platelet and anticoagulation drugs enhances the likelihood that physicians will encounter this condition in routine practice. A heightened index of suspicion, coupled with a thorough clinical and diagnostic examination, is necessary to uncover this sometimes indolent problem. This case study highlights the presentation of an unusual case and discusses the diagnosis, evaluation and treatment of chronic subdural hematomas.
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Randomized Controlled Trial Clinical Trial
Utilizing CIWA-Ar to assess use of benzodiazepines in patients vulnerable to alcohol withdrawal syndrome.
To determine whether use of the revised Clinical Institute Withdrawal Assessment (CIWA-Ar) would better guide treatment for the Alcohol Withdrawal Syndrome (AWS), we prospectively studied 16 patients identified as alcohol dependent or with a positive blood alcohol level on admission. All patients were administered the CIWA-Ar. If it was > or = 10, the patient was randomized to a benzodiazepine. ⋯ The remaining nine patients had an initial CIWA-Ar < 10, with a mean score of 3.8 +/- 2.4. We safely withheld detoxification regimens in 9 of 16 patients based on CIWA-Ar scores. The CIWA-Ar may obviate over-utilization of benzodiazepines in patients with AWS.
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Sacral neuromodulation provides a new option for the management of voiding dysfunction. For patients with intractable urge-incontinence, interstitial cystitis and non-obstructive urinary retention, this procedure has resulted in significant improvement in urinary frequency, voided volume and pelvic pain. We provide a review of the current literature on sacral neuromodulation and the West Virginia University experience with this procedure.