Author: Jon Mikel Iñarritu

Thrombosed Hemorrhoid

Thrombosed Hemorrhoid

Thrombosed external hemorrhoids often occurs in grade III-IV internal hemorrhoids, and can cause excruciating pain, and patients will often present acutely. In such cases, surgical evacuation of the hemorrhoid can produce immediate relief.
The treatment of choice is hemorrhoidectomy with partial lateral internal sphincterotomy, which consists in incised the mucosa on each side of the hemorrhoid and extended outward toward the anoderm. The anoderm and the hemorrhoidal mass are elevated off the transverse fibers of the internal sphincter muscle. Then the mucosa is approximated with continuous 3-0 absorbable sutures, leaving 2 to 3 mm of the anoderm left open for drainage.

hemorrhoidectomy

Regards,

Jon Mikel Iñarritu, M.D.

Link to: Hemorrhoidal Prolapse

Complications of subclavian venopuncture

This is a rare complication of subclavian venopuncture:

Inadvertent subclavian arterial puncture

Inadvertent subclavian arterial puncture

In inexperienced hands it could be a fatal procedure. So, in this case, it was too late when we try to stop that massive bleeding after a surgery interconsultation.

Regards,

Jon Mikel Iñarritu, M.D.

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New AACE guideline to achieve glycemic goals

Via AACE from J Davidson, P Jellinger, L Blonde, H Lebovitz, C Parkin (2005):

The new position statement is this: Even if the initial A1C is from 6 to 7%, you should start pharmacotherapy.

This aggressive treatment has proved that mortality diminishes considerably.

Regards,

Jon Mikel Iñarritu, M.D.

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Enteryx injection can cause death

Boston Scientific ENTERYX Procedure Kits and Injector Single Packs .

via FDA Safety I nformation Alerts:

For those who haven’t consider endoscopic procdedures for the treatment of GERD, well, at least, you shouldn’t think in Enteryx treatment.

FDA and Boston Scientific notified healthcare professionals and patients about serious adverse events, including death, occurring in patients treated with ENTERYX, a liquid chemical polymer which is intended to be injected into the lower esophageal sphincter for treatment of gastroesophageal reflux disease. The serious adverse events involve unrecognized transmural injections of ENTERYX into structures surrounding the esophagus. On September 23, 2005, Boston Scientific issued a recall of all ENTERYX Procedure Kits and ENTERYX Injector Single Packs from commercial distribution. Physicians should stop injecting ENTERYX immediately and follow the manufacturer’s procedures for returning unused product. FDA also provided recommendations on avoiding future occurrences and advice for patients.

Last month, Aggravated Doc Surg has made an excellent review of this treatments and recalls.

Regards,

Jon Mikel Iñarritu, M.D.

Grand Rounds 2.08 hosted by Doc Shazam

This week’s Grand Rounds is hosted by Doc Shazam, she starts with a nice gruop categorization, the conclusion of this roundup is to let us know that in medicine’s blogsphere there is not all about medicine. Here we have the categories.

  • Specific Diseases
  • Training
  • Technology
  • Ethics
  • Humor
  • Delivery
  • Geek Stuff
  • Psychology
  • Medical Trivia, and
  • Narrative

So please, be sure to visit her site and stay up-to-date in all the medical blogs.

Next week’s Grand Rounds, will be hosted by CodeBlog, tales from  a nurse. Please, submit your stories.

Regards,

Jon Mikel Iñarritu, M.D.

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Acetaminophen-aspirin-caffeine better than Sumatriptan in early migraine?

via Reuters Health and Headache 2005;45:973-982:

National Headache Foundation guidelines for abortive treatment of migraine aren’t right?

This study states that the combination of acetaminophen, aspirin, and caffeine (AAC) is superior to sumatriptan in migraine’s early treatment.

Goldstein et al, compared the combination treatment with 50mg sumatriptan in 171 subjects treated when the first symptoms ofmigraine occurred. Patients taking AAC experienced significantly greater pain intensityreduction than did those taking sumatriptan beginning 2 hours afterdosing and continuing throughout the 4-hour treatment period.

More patients in the AAC group experienced a sustained response and fewer patients in the AAC group required rescuemedication by 4 hours postdose.

This results suggests that migraine sufferers can use AACto treat their migraine episodes at the first sign of an attack.

In my very own personal experience i’ll rather preffer to use Sumatriptan. What do you think?

Regards,

Jon Mikel Iñarritu, M.D.


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Link of Obstructive Sleep Apnea and Stroke/Death

We all know those evidence linking OSA to systemic hypertension (even if your patient is not obese), because the vasoconstriction and activation of renin-angiotensin-aldosterone axis. But now there is new evidence that OSA is an important risk factor for stroke.

A new observational cohort study of NEJM by Yaggi et al, states that OSA increases significantly the risk of stroke, TIA or sudden death.

REFERENCES:
Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V.Obstructive sleep apnea as a risk factor for stroke and death. N Engl JMed 2005;353:2034-2041.

Regards,

Jon Mikel Iñarritu, M.D.

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Another Tension-type Pneumothorax

Here is another chest x-ray that shouldn’t have been taken:

Tension-type Pneumothorax

As reference, you can trackback this earlier post.

Regards,

Jon Mikel Iñarritu, M.D.

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This week on the medblogsphere: Grand Rounds 2.7

This week, Grand Rounds 2.07 is hosted by MSSP Nexus Blog.

MSSP

Rita is the creator and she is a natural born story teller. Now she comes with a StarTrek story very funny and so complete.

Next week’s GR will be hosted by Doc Shazam, be shure to update him her.

Regards,

Jon Mikel Iñarritu, M.D.

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