Archive for the ‘Disease’ Category

14
Oct

Sigmoid perforation with retroperitoneal abscess and retroperitoneal air tracking into mediastinum

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What would be your next step in managing this patient?

What is the most likely source of mediastinal air? What is the diagnosis?

Pulmonary and Critical Care Pearls

Answers: Exploratory laparotomy; perforated viscus.

Diagnosis: Sigmoid perforation with retroperitoneal abscess and retroperitoneal air tracking into mediastinum.

Discussion

Pneumomediastinum, or air in the mediastinum, was first described as a complication of trauma in 1819 by Laennec. Spontaneous pneumomediastinum as an entity was initially introduced into the medical literature in 1939 by Hamman, from which “Hamman sign” (air crepitus heard on auscultation with each heart beat) is derived. Pneumomediastinum is usually regarded as a benign, self-limited process that does not require medical intervention, although the etiology must be assessed to exclude rare life-threatening causes. Typical causes of pneumomediastinum are as follows:

1. Secondary to increased intrathoracic pressure, ie, Valsalva maneuver, strenuous exercise, weight lifting, vaginal delivery, and vomiting.
2. Sniffing cocaine or other Viagra pills Australia.
3. Barotrauma.
4. Status asthmaticus.

Unusual causes include arthroscopy, dental extraction, and adenotonsilectomy, scuba diving, trombone playing, and performing a maximal expiratory pressure maneuver.

Pneumomediastinum of a GI origin has been described in the medicalliterature. It can occur after GI instrumentation, endoscopy, endoscopic retrograde cholangiopancreatography, colonoscopy, or laparoscopic surgery. It may occur with or without evidence of perforation. In most cases, the condition is self-limited and resolves without surgical intervention, although a possible life-threatening etiology should be considered. A known life-threatening cause of pneumomediastinum is spontaneous esophageal rupture (Boerhaave’s syndrome). An esopha-gogram should, therefore, be included in the routine workup of pneumomediastinum and subcutaneous emphysema in the appropriate clinical setting.

22
Sep

Alcohol and Drugs: Disease Cannabis

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Cannabis

Ho w Does It Work?

Cannabis affects special areas of the brain called cannabinoid receptors, which are mainly found in areas of the brain that influence pleasure, thoughts, and sensory and time perception.

Cannabis gets into the bloodstream quickly after being taken and tends to build up in fatty tissues throughout the body. It is stored there and it can take several weeks for the body to eliminate it. This is why cannabis can sometimes be detected in urine up to 56 days after it has last been used.

What Are Its Effects?

Short-term use of cannabis can affect people in different ways. These can include a temporary ‘high’, a sense of relaxation or contentment (of being ‘stoned’), becoming more talkative and sometimes having a sense of time slowing down. Changes in awareness can make colours seem more intense and music sound better. Cravings for food (having the ‘munchies’) and hallucinations (when you see or hear something that isn’t there) may occur. Short-term memory, concentration and learning can be affected. Cannabis can also cause feelings of nausea, fatigue and loss of energy and can affect your coordination. The feelings are usually only temporary, although the drug can stay in the system for some weeks.

Long-term cannabis use can have a depressant effect, reducing motivation and leading to apathy. Short-term memory, concentration and learning can be affected. This can lead to poor performance at work or school.

Health Risks of Cannabis

Smoking cannabis damages your throat and lungs just like cigarettes do. It can cause hoarseness, a chronic cough and bronchitis as well as lung damage, including lung cancer. Indeed, smoking cannabis is thought to be even worse for your lungs than cigarettes. Cannabis can affect male fertility by leading to a decreased sperm count and reduced sperm mobility.

Mental health problems can include confusion, anxiety, panic, depression, paranoia and schizophrenia. Regular use of the drug increases the risk of developing a psychotic episode or long-term schizophrenia.

Speed

Speed (amphetamine) is a man-made stimulant that is usually swallowed in pill form. It can also be a powder that is dissolved in liquid for injection or drinking. Amphetamine is a stimulant, which quickens the heartbeat and can increase energy levels, making the user feel more confident. It can also cause anxiety, panic and paranoia, as well as impaired memory and concentration. The ‘come down’ period, when the effects wear off, can last for days, with users feeling very tired and depressed and having symptoms of anxiety and panic. Sleep disturbance is very common and can keep users awake for days afterwards.