American Research Journal of Medicine and Surgery

Dr. Jason Seewoodhary1, Dr. Stephen Wong MD FRCP (UK)2

Positron Emission Tomography (PET) can visualise progression of Parkinsonian pathophysiology from early- through to end-stage disease generating objective quantitative longitudinal data, which enables assessing responses to treatment. The utility of PET scanning in the management of Parkinson's Disease is further exemplified by: refining the differential diagnosis of Parkinson's Disease as a distinct neurochemical entity; monitoring the efficacy of foetal nigral tissue transplantation; assessing the effects of surgical interventions such as deep brain stimulation; and guiding clinical management by studying the effects of drug-induced adverse effects. This concise review critically considers the role of PET scanning in the management of Parkinson’s Disease. 

Luciane Andrade Barreto1, João E Coin-Carvalho2, Luciane BC Carvalho3, Lucila BF Prado4, Gilmar F Prado5

Introduction: Sleep state misperception (SSM) intrigues sleep specialists as a disorder in which a complaint of insomnia is presented without any objective clinical evidence. International committees involved in producing sleep disorder classifications have included SSM in the insomnia group and classified this condition with a new name, paradoxical insomnia (PI). Objective: The aim of this work is to discuss the adoption of the term “paradoxical insomnia” by the last international classification. Method: To analyze the terms used in the international classification between 1979 and 2014, comparing literature and clinic experience. Results: Disease classification nomenclature represents health information for constructing meanings regarding the origin and evolution of the disease and the therapeutic process. The term PI allows the medical view of the patient to be glimpsed. Under this condition, there is a dissociation between physical sleep and sleep as a psychological experience. Conclusions: The new nomenclature (Paradoxical Insomnia) emphasizes the paradox that exists between objective and subjective data, but what needs to be considered is the patient’s experience of psychological deprivation of sleep. We believe that the term “sleep state misperception” is more appropriate, since it is closer to the subjective experience of patients, taking into consideration the psychological suffering and the physical and mental wastage.

Dr. Teodora Handjieva-Darlenska, MD, PhD1

Introduction: In the prevention and treatment of obesity dietary regiments plays a major role. Recently the benefits of different food supplements are pointed out. The aim of our study was to examine the effect of alginates on the weight loss and body mass index (BMI), and some metabolic parameters in adults and rodents. Materials and methods: The first study represented a clinical study. A total of 108 obese patients entered the trail. They received a diet with a 500 kcal/ daily deficit and alginates as a food supplements. Anthropometric measures were done at baseline and after 6 weeks. Lipid status was also measured. The second study was an experimental study on 48 male obese Wistar rats with previously developed nutritional model of obesity. Results: We found statistically significant reduction of BMI and waist circumference in the group, treated with alginates. Further, total cholesterol, LDL-cholesterol and triglycerides were also statistically significantly reduced in the treated group. Our experimental study showed that rats treated with alginate acid demonstrated a significant reduction of body weight. Moreover there were changes in the blood levels of ghrelin between those treated with/without alginates. Conclusions: Our study suggests that alginates could be useful for reduction of body weight and can reduce lipid cardiovascular risk factors in both humans and animals

Kambiz Farahmand1, Mahmoud Mostafa2, Satpal Singh Wadhwa3,Sudhindra Upadhyaya4, Vahid H Khiabani5

The purpose of this study is to model the arrival of patients to a level one surgical department in a large city for two large departments namely orthopedic and Podiatry, and the cost associated with the arrivals for the Podiatry patients. Podiatry patients were chosen for the cost modeling as to set the ground worker for analyzing the feasibility of increased remote capability specifically in thePodiatry department within the referral area to minimize travel time and cost for the patients and the provider

Carpal tunnel syndrome is the most common peripheral entrapment neuropathy in humans. Its incidence is 1% for the general population and 5% or more for workers with repetitive use of the hands and wrists(10). Women are three times more likely than men to develop CTS, which usually occurs only in adults. Most cases are idiopathic(23). The open surgical technique stills the gold standard procedure for the treatment of CTS (20). Objective: The aim of this study was to assess the results of the pre- and postoperative electromyographic studies and their relationship to its clinical symptomatology before and after carpal tunnel decompression. Methods: A retrospective study of 24 patients with CTS underwent open surgical decompression of median nerve at wrist and followed by electromyographic studies with assessment of post-operative clinical pictures. Conclusion: Electromyography studies for carpal tunnel syndrome before and after surgery is not conclusive for diagnosis of carpal tunnel syndrome or recurrent carpal tunnel syndrome alone, the most important point of diagnosis is the clinical diagnosis of carpal tunnel with support of electromyography studies.

Adnan Bashir Bhatti1, Farhan Ali2, Siddique Akbar Satti3, Shuja Ur Rehman4, Muhammad Usman5, Maham Abbasi6 

Lutembacher syndrome is a combination of mitral stenosis and a left-to-right shunt at the atrial level due to atrial septal defect (ASD) and both of these defects can either be congenital or acquired. We report a case of a young female who presented with shortness of breath, palpitations, scanning speech and right sided weakness. Her clinical and laboratory features showed a case of right sided cerebellar infarct secondary to Lutembacher syndrome.

Diana Ch. Lalenoh, MD, Phd1

Background: Management of anesthesia in patients with ovarian cyst permagna is challenging because it is require careful preparation and have a high risk during the perioperative period. We report anesthetic management perioperatively in a woman,31 years,Gravid 5Para 2Abortus 2 (G5P2A2)with 19-20 weeks of pregnancy with ovarian cyst permagna and slight complaints of abdominal bloating,plan to elective surgery. We highlight the recent guideline for non-obstetric surgery in pregnancy Objective: To report management of anesthesia in a woman with cystoma ovarian permagna Case: A woman 31 years old attending with a growing abdomen experienced since the 19-20 weeks before admission. The patient complained of slight difficulty breathing. Her activity was mild decrease, with a slight difficult to walk.Abdominal circumference is 122 cm. Ultrasound exmination showed a large cystoma with ascites. CT scan of the abdomen showed a large cyst mass with the size of 30.5 x 33 x 55.6 cm with solid components are urging the intestine and minimal intraperitoneal ascites fluid Results: The surgery lasted for 2 hours and 30 minutes, cystoma successfully removed intact ovary weighed 23 kg. Intraoperative bleeding patients about 800 ml, and 1000 ml of urine production. After 32 hours of observation in the intensive care unit, patient was stable haemodynamic parameter, and allowed to be transferred in the ward

Karski Tomasz1, Karski Jacek2

It has been observed that the Syndrome of Contractures and Deformities (SofCD) is the causal influence of malformations in locomotor‟s system in children and the insufficiency and pain in adults patients. According to Prof. Hans Mau there exists a list of symptoms in newborns and babies. He describes this syndrome as 'the Seven Contracture Syndrome' (in German “Siebenersyndrom”). In the article the 8-th deformity, namely the varus deformity of shanks, is described by the authors in 2006. The article thoroughly presents the Syndrome of Contractures and Deformities and its influence to development of hip dysplasia, as the primary cause of wry neck (torticollis) and one of the four causes of Blount disease. Additionally, the explanation of the biomechanical etiology of the so-called idiopathic scoliosis is also provided.

Suresh Chandra Mandal1, Soumyakanti Barman2, Sandip Lahiri3, Sudip Ranjan Pal4

Background: After the recent publication of results from two large prospective studies, Women’s Health Initiativeand Heart and Estrogen/ Progestin Replacement Therapy (HERS) indicating increased risk with hormone replacement therapy (HRT) for menopausal symptoms, HRT is no longer recommended for asymptomatic postmenopausal women. Tibolone has emerged as an attractive alternative for treatment of perimenopausal women. Interest in the use of Isoflavones, the most common from of phytoestrogens for treatment of menopausal symptoms has been encouraged by observation of lower prevalence of menopausal symptoms.The present study attempts to evaluate the efficacy and side effects of tibolone and isoflavone in the treatment of menopausal symptoms. Methods: This prospective comparative study assessed the usefulness of tibolone and isoflavone for the management of menopausal symptoms among 80 postmenopausal symptoms .The patients were asked about symptomatic improvements ; detailed physical examination were carried out ; TVS and lipid profile were done initially and at 1 , 6 and 12 months. Result : Improvement in vasomotor , genitourinary symptoms and joint pain were significantly higher in tibolone group in comparison to isoflavone in most of the follow up visits and after the completion of treatment.Blood pressure records did not show any change with the use of both the drugs over 12 months. Incidence of breakthrough bleeding was nil in isoflavone and nominal in tibolone group . No significant adverse effect on lipid profile was found in both the groups . Conclusion: Efficacy of tibolone was found to be significantly better than the isoflavones in management of postmenopausal symptoms.