Rejected

Actinomycosis can be one of the causes of persistent periradicular lesions. This is the report of a patient who was first referred with complaint of pain in maxillary right incisors. A standard root canal therapy was carried out. Unluckily, the patient returned with recurrent symptoms; therefore, surgical endodontic retreatment was decided. While the large periradicular lesion was curetted, a whitish yellow granule-like material came out from the periapical area that was submitted for histopathological examination. The apices of both maxillary right incisors were resected. Root-end cavities were sealed with calcium-enriched mixture (CEM) cement. Finally, the remaining large defect was filled with natural bone substitutes. Since the histopathological diagnosis revealed actinomycotic infection, oral penicillin V was prescribed for four weeks. At two-year recall, the bone healing process was completed. Apical actinomycosis can cause therapy-resistant lesions. Root-end surgery employing CEM and bone substitutes might be an effective method to help bone healing in large periradicular lesions.

The recent data have shown that in addition to biological and psychosocial mechanisms, individual pain perception can be altered by satiety level as well. Some studies confirm that there is a relationship between being fed by sucrose and hyperalgesia in animals, while others show that ketogenic diet can be associated with decreased pain sensitivity to thermal stimuli. It can be argued that the effect of satiety level on pain perception is mediated by gastrointestinal hormones and endogenous opioids. Pharmacological stimulation of kappa-opioid receptors decreases stress and promotes analgesia. Accordingly, these changes can be inhibited by applying antagonists. Our study aims to assess pain perception induced by mechanical experimental irritation in women during different satiety levels in follicular phase of ovarian-menstrual cycle. The sample of the study was comprised of volunteer students aged 18-23 (women, mean age 19,5±2,9). Ovarian-menstrual cycle of the women participating in the research were evaluated using the questionnaires. All the studies were performed in the follicular phase of menstrual cycle (7-11 days of the cycle). At the first stage, study was conducted in starvation state – after 10-12 hours after the last meal, the second stage – in primary, sensory-motor satiety 20-30 minutes after a mixed meal intake. Every participant has been offered a standard, mixed meal (including proteins, fats, carbohydrates). Mechanical pain sensitivity was evaluated using computerized algometer – AlgoMed (Medoc, Ltd, Ramat Yishai, Israel), which was delivering mechanical stimuli to the participants; Meanwhile, mechanical pressure threshold, mechanical pain threshold and pain tolerance threshold were determined. According to this data, the reason of relatively diminished pain perception during primary satiety should be alterations of gastrointestinal tract that take place after food ingestion: Mechano- and chemoreceptors of initial segments in digestive system, particularly in stomach and in duodenum get irritated; that is followed by activation of several humoral factors and duodenal afferentation. In addition, by some authors duodenal release of cholecystokinin is believed to be hypothetical cause of decreased pain sensitivity after 20-30 minutes from the last mixed meal and is thought to have antinociceptive effect on endogenous opioid system.

Cardiovascular drugs are used to treat arterial hypertension, hyperlipidemia, arrhythmias, heart failure, and coronary artery disease. They also include antiplatelet and anticoagulant drugs that are essential for prevention of cardiogenic embolism. Most neurologic complications of the cardiovascular drugs are minor or transient and are far outweighed by the anticipated benefits of treatment. Other neurologic complications are more serious and require early recognition and management. Overtreatment of arterial hypertension may cause lightheadedness or fatigue but often responds readily to dose adjustment or an alternative drug. Other drug complications may be more troublesome as in myalgia associated with statins or headache associated with vasodilators. The recognized bleeding risk of the antithrombotics requires careful calculation of risk/benefit ratios for individual patients. Many neurologic complications of cardiovascular drugs are well documented in clinical trials with known frequency and severity, but others are rare and recognized only in isolated case reports or small case series. This chapter draws on both sources to report the adverse effects on muscle, nerve, and brain associated with commonly used cardiovascular drugs.

Inhalational anesthesia and propofol-based total intravenous anesthesia (TIVA) are the two most popular methods of general anesthesia with distinct characteristics that may affect quality of recovery (QOR) differently. This study compared QOR after corrective lower limb osteotomy between desflurane-based inhalational anesthesia and propofol-based TIVA.

Ultrasound-guided (UG) mandibular nerve block is effective for providing postoperative analgesia in mandibular fracture surgeries. The pre-emptive nerve blockade prolongs the duration of postoperative analgesia and reduces the consumption of intraoperative opioids. The aim of this prospective, randomized, single-blinded study was to compare the efficacy of pre-emptive and postoperative UG mandibular nerve block for postoperative analgesia in mandibular fracture surgeries.

Rupture of a liver haemangioma is extremely rare, with less than 100 cases reported in the literature. This is the first case known to date reporting a rupture occurring with direct oral anticoagulant therapy. A 76-year-old woman presented with acute abdominal pain and syncope in the context of commencing apixaban 4 weeks prior. Abdominal computed tomography and angiography demonstrated a large heterogenous mass in the left liver lobe with contrast blush suggestive of a bleeding tumour. Urgent transcatheter arterial embolization successfully ceased haemorrhage. Due to persistent compressive symptoms, a left lateral hepatectomy was performed. CD34 immunostaining of the tissue revealed variably sized vessels, which was consistent with a ruptured giant hepatic haemangioma. Our case substantiates the limited available literature regarding ruptured haemangiomas. Combined with previous case reports, this report will significantly contribute to our understanding of the risk factors, diagnosis and surgical indications for ruptured hepatic haemangiomas.

Encephalitis associated with anti-N-Methyl-D-aspartate (NMDA) receptor is a rare form of autoimmune encephalitis. We report the first case of anti-NMDAR encephalitis in an unmarried 16-years old female who was admitted to the Neurology Emergency Unit Faculty of Medicine, Udayana University, Sanglah General Hospital Bali, Indonesia due to decreased consciousness, repetitive talking, headache, involuntary movements in the mouth and feet, and seizures. She was initially diagnosed with viral encephalitis and symptomatic epilepsy. After four weeks of treatment, she was referred to the Gynecology Department. Rectal ultrasound revealed a cystic lesion with a solid component measuring 3.6×2.64×3.18 cm from the left ovary. Laparotomy cystectomy was performed, and the histopathological examination revealed glial cells and mesoderm components in the form of cartilage tissue. Serum and cerebrospinal fluid were positive for anti-NMDA receptor antibodies. She was treated with human intravenous immunoglobulin and rituximab. Her condition was improved gradually. She recovered fully after almost six weeks of hospitalisation.

Data on adverse events from research bronchoscopy with bronchoalveolar lavage (BAL) in patients with cystic fibrosis (CF) is lacking. As research bronchoscopy with BAL is useful for isolation of immune cells and investigation of CF lung microbiome, we sought to investigate the safety of bronchoscopy in adult patients with CF. Between November 2016 and September 2019, we performed research bronchoscopies on CF subjects (32) and control subjects (82). Control subjects were nonsmokers without respiratory disease. CF subjects had mild or moderate obstructive lung disease (FEV1 > 50% predicted) and no evidence of recent CF pulmonary exacerbation. There was no significant difference in the age or sex of each cohort. Neither group experienced life threatening adverse events. The number of adverse events was similar between CF and control subjects. The most common adverse events were sore throat and cough, which occurred at similar frequencies in control and CF subjects. Fever and headache occurred more frequently in CF subjects. However, the majority of fevers were seen in CF subjects with FEV1 values below 65% predicted. We found that CF subjects had similar adverse event profiles following research bronchoscopy compared to healthy subjects. While CF subjects had a higher rate of fevers, this adverse event occurred with greater frequency in CF subjects with lower FEV1. Our data demonstrate that research bronchoscopy with BAL is safe in CF subjects and that safety profile is improved if bronchoscopies are limited to subjects with an FEV1 > 65% predicted.

A 31-year-old pregnant woman presented with headache, fever and left-sided focal motor seizures, which progressed to bilateral tonic-clonic seizures. Her medical history included Crohn's disease treated with azathioprine and adalimumab, which were discontinued when she became pregnant. Her cerebro-spinal fluid was entirely normal and viral PCR negative. Extensive testing for infectious, autoimmune or malignant causes of encephalitis were non-revealing. MRI head showed unilateral cortical FLAIR-hyperintensity which on interval scans was seen bilaterally. Anti-myelin-oligodendrocyte glycoprotein (MOG)-IgG was positive leading to a diagnosis of cortical FLAIR-hyperintense lesions in Anti-MOG-associated Encephalitis with seizures (FLAMES).