A Case of Fibroepithelial Polyp in Right Lower Ureter
Toru Sakatani1, Yasushi Adachi2,3*, Noriko Sakaida4,5, Noriyasu Takao6, Yoji Taki1, Susumu Ikehara7*Abstract: Fibroepithelial Polyps (FEPs) are rare tumors of the urinary tract. Here, we describe an adult case of FEP developing in the lower ureter. A 38-year old man consulted our hospital because of macrohematuria. Computed Tomography (CT) scan and retrograde urethropyelography revealed a tumor in the lower ureter. The tumor was transurethrally resected and was histologically diagnosed as an FEP. Urothelial carcinoma is the most commonly found tumor in the ureter. However, we also have to take benign tumors, such as FEPs, into account, when we find tumor(s) in the ureter.View PDF HTML View
Letter to the Editor
Effects of Positive End-Expiratory Pressure on Hemodynamic Indices
Luciana M. Moreno1, Denise T. Fantoni1, Aline M. Ambrosio1, Denise A. Otsuki3, Guilherme T. Goldfeder2, Lucas A. Gonçalves1*, Marco AA Pereira1Abstract: In view of the broad variety of diseases, lung protective ventilation with low tidal volumes and high positive end expiratory pressure are common during anesthesia. However, positive end expiratory pressure titration can decrease cardiac output because of the decrease in systemic venous return to the right side of the heart. As a result of this heart-lung interaction, PEEP titration can influence hemodynamic indices. Eight mechanically ventilated dogs undergoing hemodynamic monitorization as pulse pressure variation, central venous pressure and echocardiography variables were evaluated before and after PEEP administration. An increase in pulse pressure variation (23%) and central venous pressure (24,6%) were observed after PEEP administration. However, PEEP administration did not influence stroke volume and cardiac output. Hemodynamic indices are subject to changes after PEEP titration, which could misguide fluid therapy. In ventilated dogs a positive end expiratory pressure titration of 5 cmH20 can increase both pulse pressure variation and central venous pressure.View PDF HTML View
Letter to the Editor
Algorithmic Approach on Decision Making for Surgical and Non-Surgical Management of Common Hand Fractures Patterns
Othman D*, Bedford J, and Bains RDear Editor: A practical approach for decision making processes in hand fracture fixationrepresents an invaluable source of knowledge and practice for hand surgeons as well as their trainees.View PDF HTML View
Case of a STEMI presenting with Belching
Emily Clarke* and J Elizabeth NeumanAbstract:View PDF
Introduction: Acute coronary syndrome is a leading cause of death in the United States. Less common presenting symptoms occur however, and some patients may present with complaints that initially seem unrelated to cardiac disease.
Understanding the Brain-Heart Connection: The Occurrence of Ventricular Arrhythmias in Subarachnoid Haemorrhage
Chen ZY Chloe and Lateef Fatimah*Abstract:View PDF
Cardiac arrhythmias have been established as a possible complication of subarachnoid haemorrhage (SAH). The presence of arrhythmias contributes to a poorer outcome and higher mortality of patients with SAH. Malignant ventricular arrhythmias are especially important to detect promptly as they require timely interventions or else, they can be rapidly fatal.
Flashing Red Lights in ED Airway Management – a Case Report
Reisshauer AL1, Windgassen M1, Ehrlich E2, Kurz S3,4 and Buschmann C1*Abstract:View PDF
Airway management is crucial in emergencies, especially CPR. We report a case of repeated rough and violent endotracheal false intubation with following need for CPR, which remained unsuccessful. Especially in expected difficult airway, a structured approach for preservation of oxygenation is mandatory.
Activation Syndrome in a Male with Negative Symptoms of Schizophrenia Started on Sertraline
Mihir A. Upadhyaya1*, Katya Frischer2Abstract:View PDF HTML View
Activation syndrome is a psychiatric condition that may arise shortly after starting treatment with certain psychotropic medications, namely antidepressants. The condition is characterized by irritability, agitation, somatic manifestations of anxiety, panic attacks, restlessness, hostility, aggression, insomnia, disinhibition, emotional lability, impulsivity, social withdrawal, akathisia (psychomotor restlessness), odd behaviour, hypomania/mania, and paranoia. It can be debilitating to the point of driving individuals to committing suicide or other irrational acts. The incidence of activation syndrome is noted to be higher in certain populations, including individuals with personality disorder. This article illustrates the case of a 41-year-old male with negative symptoms of schizophrenia and schizoid personality disorder who developed activation syndrome after starting on an SSRI medication while hospitalized, then proceeded to assault his parents upon discharge, requiring re-hospitalization. It also offers possible modifications to treatment protocols that might reduce the incidence of the condition, or better mitigate symptoms once they are identified.
Contemplating Raising Fees: An Exercise in Therapist Disquiet
Jerome S. Gans*Abstract:View PDF
This paper discusses the experience of psychodynamically oriented therapists as they contemplate raising their fees. Raising fees stirs up competing self-interest, transference-countertransference reverberations, financial fantasies and realities, ethical concerns, and uncomfortable as well as satisfied self-reflection. These dynamics are discussed under the following categories: exercise of power; incurring guilt; inappropriate entitlement; fear of loss; modeling of self-care; rapaciousness; unconscious factors; and self-esteem. A cautionary case example is provided. Six suggestions are offered to make therapists’ contemplation of raising fees less stressful. The author hopes that this article will foster more open discussions among therapists about the tensions involved in raising fees and, in the process, lead to an enhanced understanding, acceptance and detoxification of the feelings involved.
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