Symptoms In Acute Patients Research Articles

Antipsychotics and emotionally unstable personality disorder: a literature review

Introduction This reviews aim was to explore the evidence base for the use of antipsychotic medications in the management of acute symptoms in patients with emotionally unstable personality disorder. Methods Relevant databases and grey literature were searched for relevant papers. Inclusion/exclusion criteria were applied which resulted in the retrieval of eight papers pertinent to the literature review. The papers were critically appraised, and a thematic analysis was undertaken to collate relevant data. Findings Five themes emerged from this literature review: different outcome measures, symptom domains (anger, impulsivity, mood instability, pseudopsychotic symptoms, self-harm and suicidal behaviours, adverse effects, the quality of the evidence and bias). Conclusions The evidence base is not robust enough to allow conclusions to be drawn. Any positive results must be weighed up against the potential for adverse events. This review lays the foundations for further research, which is needed to explore antipsychotic treatment.

Perioperative management in a patient with type 1 diabetes mellitus who presented severe hypoglycemia during dental implant surgery: a case report

BackgroundPatients with type 1 diabetes mellitus (DM) have poor glycemic control owing to extreme impairments in glucose tolerance. There are few reports regarding dental implant surgery in patients with type 1 DM. We describe herein the perioperative glycemic management in an outpatient with type 1 DM who experienced a rare case of severe hypoglycemia during dental implant surgery. Only one such case has previously been reported.Case presentationA 60-year-old male patient diagnosed with type 1 DM was scheduled for dental implant primary surgery. Premedication with peroral antibiotics was carried out to prevent possible systemic infection as a complication of DM. The patient was treated to control intraoperative hypertension with diligent attention to cardiovascular conditions by using a bolus administration of nicardipine and diltiazem. During surgery, he abruptly complained of hypoglycemic symptoms and had a blood glucose level of 32 mg/dL. Following oral administration and electrolyte-combined infusion of glucose, he immediately recovered from the critical situation. The surgical procedure, involving a lower jaw implant fixture placement, was performed as planned and resulted in less invasion, limited to the area of implant fixture placement within the right mandibular region of the two molars, compared to implant surgery that spans the entire lower jaw.ConclusionsThe present case suggests that it is essential to promptly monitor possible signs of hypoglycemia-precipitated acute symptoms in patients with DM. In addition, it is also necessary to appropriately administer insulin with an electrolyte-combined infusion of glucose for deliberate glycemic control; this is particularly true in patients with type 1 DM undergoing relatively highly-invasive oral surgical manipulation such as commonly performed dental implant surgery spanning the entire jaw.

An Audit of the Use of Gonadorelin Analogues to Prevent Recurrent Acute Symptoms in Patients with Acute Porphyria in the United Kingdom.

Severe recurrent acute attacks of porphyria have traditionally been treated with either prophylactic human haemin or gonadorelin analogues (GnA) in females. Evidence on the most effective treatment for this patient subgroup is lacking. This audit surveyed the use of prophylactic GnA in the UK.Twenty female patients (who experienced between 2 and 45 acute attacks of porphyria requiring hospitalisation and treatment with human haemin prior to GnA prophylaxis) were included in the audit. Data was retrospectively collected based on patient history and case review.Twenty three treatment courses were given lasting a median period of 12 months. Monthly subcutaneous Goserelin was most commonly used. In three patients in whom timing with the menstrual cycle was not considered, an acute attack occurred after initiation of the first dose. The majority of patients experienced oestrogen deficiency symptoms during treatment. Fifty percent of the prescribed courses of GnA resulted in a degree of clinical benefit. This successfully treated group experienced between 3 and 20 acute attacks prior to and between 0 and 6 acute attacks during GnA treatment.The audit revealed large variation in practice in the United Kingdom regarding indication, duration of treatment, specific drug used and management of side effects. In view of the limited treatment options available for this cohort and the mixed outcome successes reported, we believe it is reasonable for porphyria specialists to continue offering GnA treatment to women with severe recurrent debilitating acute attacks of porphyria associated with the menstrual cycle, and we propose best practice guidelines to standardise management.

PWE-050 A protocol to avoid corticosteroid exposure prior to crohn’s disease requiring luminal surgery

<h3>Introduction</h3> Corticosteroids (CS) are prescribed to control inflammatory and obstructive symptoms in Crohn’s disease (CD). Preoperative CS are associated with higher risk of all complications post-operatively including sepsis, anastomotic breakdown and venous thromboembolic disease.High doses of CS also preclude a primary anastomosis. In our institution, we have implemented a protocol to prevent CS administration or permit a rapid wean in patients requiring ileal/ileocaecal resection, maximising the use of exclusive enteral nutrition (EEN) or parenteral nutrition (PN). This study aimed to determine the achievability of CS avoidance in this setting. <h3>Method</h3> In patients selected for ileal/ileocaecal resection, EEN (with either Modulen IBD Nestle or Fortisip Nutricia, as tolerated) was prescribed to a target dose of 30 kcal/kg. Acute sepsis was controlled with intravenous and/or oral antibiotics. If EEN was not tolerated because of obstructive symptoms, PN was instituted or surgery expedited. Patients were not offered this protocol if they had minimal symptoms, adequate nutritional status and no CS exposure. <h3>Results</h3> In total, 39 patients with CD had IC resection over a period of 20 months from January 2013. 9 of these underwent urgent surgery due to symptom severity (severe obstruction or suspected cancer where delay not possible [4 of 9 on CS (45%)]. 8 patients with stable symptoms secondary to fibrotic stricture (4 on biologic, 4 on immunomodulator), adequate nutritional status and CS free were not suitable for the protocol. 22 patients with acute symptoms were therefore included. All had penetrating and/or stricturing disease. 8 patients were receiving CS of whom 7 (88%) successfully weaned off CS for greater than 4 weeks using EEN. 1 did not tolerate EEN and proceeded to surgery on CS. A further 11 of 22 patients successfully treated via protocol to avoid CS (EEN n = 7, PN n = 4) 3 patients did not tolerate/declined EEN/PN and proceeded to expedited surgery. Hence, in all patients suitable for the protocol, CS were successfully avoided (14/14 patients, 100%) and wean &gt;4 weeks successful in majority (7/8 patients, 87.5%). CS exposure was successfully avoided in 21 patients via protocol (95.5%). <h3>Conclusion</h3> Aggressive use of EEN or PN provides an effective approach to avoid CS exposure, optimise nutrition and control acute symptoms in patients selected for IC resection. The implementation of the protocol requires close liaison between gastroenterologists, colorectal surgeons and dieticians. The protocol does not delay emergency surgery. <h3>Disclosure of interest</h3> None Declared.

Sa1217 A Protocol to Avoid Corticosteroid Exposure Prior to Crohn's Disease Requiring Luminal Surgery

Introduction Corticosteroids (CS) are prescribed to control inflammatory and obstructive symptoms in Crohn’s disease (CD). Preoperative CS are associated with higher risk of all complications post-operatively including sepsis, anastomotic breakdown and venous thromboembolic disease.High doses of CS also preclude a primary anastomosis. In our institution, we have implemented a protocol to prevent CS administration or permit a rapid wean in patients requiring ileal/ileocaecal resection, maximising the use of exclusive enteral nutrition (EEN) or parenteral nutrition (PN). This study aimed to determine the achievability of CS avoidance in this setting. Method In patients selected for ileal/ileocaecal resection, EEN (with either Modulen IBD Nestle or Fortisip Nutricia, as tolerated) was prescribed to a target dose of 30 kcal/kg. Acute sepsis was controlled with intravenous and/or oral antibiotics. If EEN was not tolerated because of obstructive symptoms, PN was instituted or surgery expedited. Patients were not offered this protocol if they had minimal symptoms, adequate nutritional status and no CS exposure. Results In total, 39 patients with CD had IC resection over a period of 20 months from January 2013. 9 of these underwent urgent surgery due to symptom severity (severe obstruction or suspected cancer where delay not possible [4 of 9 on CS (45%)]. 8 patients with stable symptoms secondary to fibrotic stricture (4 on biologic, 4 on immunomodulator), adequate nutritional status and CS free were not suitable for the protocol. 22 patients with acute symptoms were therefore included. All had penetrating and/or stricturing disease. 8 patients were receiving CS of whom 7 (88%) successfully weaned off CS for greater than 4 weeks using EEN. 1 did not tolerate EEN and proceeded to surgery on CS. A further 11 of 22 patients successfully treated via protocol to avoid CS (EEN n = 7, PN n = 4) 3 patients did not tolerate/declined EEN/PN and proceeded to expedited surgery. Hence, in all patients suitable for the protocol, CS were successfully avoided (14/14 patients, 100%) and wean >4 weeks successful in majority (7/8 patients, 87.5%). CS exposure was successfully avoided in 21 patients via protocol (95.5%). Conclusion Aggressive use of EEN or PN provides an effective approach to avoid CS exposure, optimise nutrition and control acute symptoms in patients selected for IC resection. The implementation of the protocol requires close liaison between gastroenterologists, colorectal surgeons and dieticians. The protocol does not delay emergency surgery. Disclosure of interest None Declared.

Acupuntura de microsistemas para el dolor craneomandibular: un estudio aleatorizado y controlado

Background Patients suffering from craniomandibular disorders describe their problems not only as toothache, but also as facial pain. Limitation of movement and a tense feeling in the temporomandibular joint as well as pain in the vertebra are also possible. To treat such symptoms, an interdisciplinary approach (myofascial, stomatognath, lymphatic system) is necessary. Relieving the patientś symptoms as quickly as possible helps to improve the compliance with the patient, thereby facilitating further therapies. Aim To assess the effects of acupuncture on the acute symptoms in patients with craniomandibular disorder in comparison to placebo laser treatment. Primary end points are pain intensity (quantified using Visual Analogue Scale [VAS]), functional muscle test, ability to open the mouth, axiographic evaluation as well as the palpation and treatment of sensitive acupuncture points. Methods 23 patients with craniomandibular disorder were recruited for the randomised controlled double blind trial. They were divided into two groups: the verum group received acupuncture in the style of “very point”, as described by Gleditsch. The second group received treatment with a placebo laser on the same points as a control group. Before and after each session of treatment, the following diagnostic findings were recorded in each group: subjective pain (VAS), mouth opening ability (mm), pressure sensitivity of the face and neck muscles, and pressure sensitivity of the acupuncture areas (MAPS). The therapeutic intervention was not performed by the examiner. Results Muscle pain ranking from 0 (no pain) to 3 (very painful) in the acupuncture group (19,1 ± 11,9) was significantly reduced compared to the placebo group (6,2 ± 14,8): p = 0,03. Pressure-pain sensitivity of the neck and masticatory muscles was significantly reduced in most of the tested muscles (p < 0,05) among the acupuncture group. Patients in the acupuncture group showed a slight improvement of mandibular movement in comparison to the placebo group, but this observation remained without a statistical significance. Conclusion This RCT shows that acupuncture with the “very point” method can improve symptoms of craniomandibular disorders within a short period of time. Further studies are necessary and projected to prove the long term effect within a larger group of patients.

Mikrosystem-Akupunktur bei craniomandibulärer Schmerzsymptomatik: – eine randomisierte kontrollierte Studie

Background Patients suffering from craniomandibular disorders describe their problems not only as toothache, but also as facial pain. Limitation of movement and a tense feeling in the temporomandibular joint as well as pain in the vertebra are also possible. To treat such symptoms, an interdisciplinary approach (myofascial, stomatognath, lymphatic system) is necessary. Relieving the patients' symptoms as quickly as possible helps to improve the compliance with the patient, thereby facilitating further therapies. Aim To assess the effects of acupuncture on the acute symptoms in patients with craniomandibular disorder in comparison to placebo laser treatment. Primary end points are pain intensity (quantified using Visual Analogue Scale [VAS]), functional muscle test, ability to open the mouth, axiographic evaluation as well as the palpation and treatment of sensitive acupuncture points. Methods 23 patients with craniomandibular disorder were recruited for the randomised controlled double blind trial. They were divided into two groups: the verum group received acupuncture in the style of “very point”, as described by Gleditsch. The second group received treatment with a placebo laser on the same points as a control group. Before and after each session of treatment, the following diagnostic findings were recorded in each group: subjective pain (VAS), mouth opening ability (mm), pressure sensitivity of the face and neck muscles, and pressure sensitivity of the acupuncture areas (MAPS). The therapeutic intervention was not performed by the examiner. Results Muscle pain ranking from 0 (no pain) to 3 (very painful) in the acupuncture group (19,1 ± 11,9) was significantly reduced compared to the placebo group (6,2 ± 14,8): p = 0,03. Pressure- pain sensitivity of the neck and masticatory muscles was significantly reduced in most of the tested muscles (p < 0,05) among the acupuncture group. Patients in the acupuncture group showed a slight improvement of mandibular movement in comparison to the placebo group, but this observation remained without a statistical significance. Conclusion This RCT shows that acupuncture with the „very point” method can improve symptoms of craniomandibular disorders within a short period of time. Further studies are necessary and projected to prove the long term effect within a larger group of patients.

Non-Hodgkin's lymphoma of the appendix: clinical and CT findings with pathologic correlation.

The purpose of this report is to describe the clinical, CT, and pathologic features of non-Hodgkin's lymphoma of the vermiform appendix. Non-Hodgkin's lymphoma of the appendix typically manifests with acute symptoms in patients who have no prior history of lymphoma. Most patients with the disease present clinically with signs and symptoms suggestive of acute appendicitis. On CT, lymphomatous infiltration of the appendix produces markedly diffuse mural soft-tissue thickening (range of diameters, 2.5-4.0 cm; mean diameter, 3.2 cm). The vermiform morphology of the appendix is usually maintained, and aneurysmal dilatation of the lumen is sometimes seen. Stranding of the periappendiceal fat seen on CT may represent superimposed inflammation or even direct lymphomatous extension. Coexisting abdominal lymphadenopathy is not seen in all patients. Although appendiceal lymphoma is rare, the characteristic CT appearance could lead to a preoperative diagnosis.

Identification and quantification of mite allergens.

Allergens from the house dust mite are ubiquitous in house dust. Exposure to these allergens can cause acute symptoms in patients who are sensitized to house-dust mite and have asthma or other allergic diseases, such as rhinitis or atopic dermatitis. It is not clear how much mite-allergen exposure is a risk factor for the development of sensitization or for triggering acute symptoms. Therefore, it is important to be able to quantify accurately the amount of mite allergen present in the indoor environment in order to carry out studies to identify risk factors for exposure, to investigate exposure-response effects, and to monitor the progress of allergen-reducing regimens.

Early or delayed endoscopic papillotomy (EPT) in gallstone pancreatitis.

In 29 patients with gallstone pancreatitis, endoscopic papillotomy was performed during the first period (1976-1979) as elective procedure 1-8 weeks after the clinical symptoms had subsided. From 1979, endoscopic investigations and treatment were routinely done within 48 hours after the onset of clinical symptoms. The ERCPs and EPTs were well-tolerated and were performed without serious complications. The results of these series indicate that EPT can be safely performed in the acute stage of gallstone pancreatitis. Acute EPT gives effective drainage and relief of the acute symptoms in patients with obstructive pancreatitis.