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Archive for June, 2011

Tracheal Fistula Associated with Bevacizumab 20 Months after Mediastinal Radiation

29 Jun, 11 | by Emma

First of all I would like to commend the authors for providing us a pictorial evidence of bevacizumab induced loss of integrity of viscus.

This article reminds me of two quotes by Sir Robert Hutchison. The first one being, “It is always well, before handing the cup of knowledge to the young, to wait until the froth has settled”. The second one happens to be, “from too much zeal for the new and contempt for what is old, Good Lord deliver us”.

‘Targeted therapy’ may be the future of oncology. But at this day and age, it is more of a hype than real substance. These theoretically strong agents, which fail in vivo due to various factors, known and unknown, have been notorious for being ‘approved’ and then being either unused, because of cost, or pulled off because of lack of a cost-benefit ratio, or as in the recent case of the NICE rejection of bevacizumab in colorectal carcinoma, toxicity or ineffectiveness.

Inhibiting pathways with targeted therapy, without knowing the entire spectrum of activity of the agent within the body may turn out to be a sour experience.

This article depicts the side-effect of bevacizumab, a VEGF inhibitor, causing esophageal perforation which might have led to deterioration in quality of life of the patient involved. This small but educative pictorial depiction stresses upon the fact that targeted therapy has been at instances and situations, turning out to be a double edged sword, rather than the magic bullet it was hyped to be.

Swaroop Revannasiddaiah
Reviewer

Tracheal Fistula Associated with Bevacizumab 20 Months after Mediastinal Radiation

Undetected acute aortic dissection in a patient referred for primary coronary angioplasty: a successful treatment of perioperative bleeding after abciximab administration

22 Jun, 11 | by Emma

The authors should be acknowledged for presenting a very unusual case of acute aortic dissection mimicking an acute myocardial infarction.

This case report can be very useful to the practising physician, since it points out several crucial diagnostic points. First, a complete physical assessment as well as ‘simple’ examination tests should always be performed at arrival in ER in case of suspected acute myocardial infarction. Second, acute aortic dissection should always be considered a possible cause of acute myocardial ischemia. Third, a complete diagnostic work-up should be performed before administering potentially threatening drugs, such as i.v. IIb/IIIa glycoprotein inhibitors which may hardly be antagonized in case of emergency surgery.

Francesco Pelliccia
Reviewer

Undetected acute aortic dissection in a patient referred for primary coronary angioplasty: a successful treatment of perioperative bleeding after abciximab administration

Unusual Injuries: Locked bucket-handle tears of both medial and lateral menisci with simultaneous anterior cruciate and medial collateral ligaments injury

15 Jun, 11 | by Emma

The authors present a virtually unheard of case of BILATERAL (medial and lateral meniscus) locked bucket handles tears in the same knee. The patient had a signficant injury with associated ACL and MCL involvement; nonetheless, the finding of locked bucket handle tears is very unusual and the picture is amazing. It is unfortunate that both menisci were not repairable; nonetheless, the author’s describe how they managed this challenging injury…

Mark Hutchinson
Reviewer

Locked bucket-handle tears of both medial and lateral menisci with simultaneous anterior cruciate and medial collateral ligaments injury

Unusual Injuries: Traumatic hand amputation while wakeboarding

8 Jun, 11 | by Emma

We receive numerous reports of patients with unusual injuries with spectacular images and unexpected complications. Here is the first in a selection…

Amputation of a limb as a result of it being caught in a loop of rope is a well recognised hazard in heavy industry (eg. the deep-sea fishing industry). This case illustrates that it can also occur as a result of a sporting injury.

Traumatic amputations are rare in civilian practice and we need to look to the experience of the military for their management. An equally important lesson is that doctors should be concerned with injury prevention. This case should be publicised to water-sports enthusiasts who need to develop fail-safe methods of indicating when it is safe to start powerful machines.

Henry Guly
Reviewer

Traumatic hand amputation while wakeboarding

A pause for thought: exercise-induced sinus arrest causing syncope in a young male

2 Jun, 11 | by Emma

This case is a nice illustration of an uncommonly severe vasovagal event post exercise. Athletes can be very frustrated by these symptoms and management can be difficult, but as rightly pointed out, it is through education and reassurance that patients get the most benefit. It also emphasises the vital importance of a careful history, family history and exercise test in excluding malignant cardiac channelopathies in such patients.

Seema Biswas
Editor-in-Chief

A pause for thought: exercise-induced sinus arrest causing syncope in a young male

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