Kongsberg sykehus

Though rare, sphenoid sinusitis can cause abducens nerve palsy because of the anatomical proximity of the sphenoid sinus and the abducens nerve. A male patient in his late seventies presented with double vision and left abducens nerve palsy. Imaging revealed sinus opacifications later identified as due to Scedosporium apiospermum, a rare fungal pathogen. Despite being immunocompetent, the patient developed invasive fungal sinusitis involving the sphenoid sinus. Treatment included systemic antifungal therapy with voriconazole and sinus surgery. Follow-up imaging showed sinus recovery and bony healing. Clinical improvement was noted, with resolution of abducens nerve palsy at the four-month follow-up. This case highlights the importance of assessing relevant imaging findings outside the central nervous system on routine brain imaging, as well as the role of effective antifungal therapy and surgical management in rare cases of invasive fungal infection in immunocompetent patients. Prompt intervention can significantly improve outcomes.

Acute haematoma on the neck can cause potentially life-threatening compression of the upper airways. Such patients must therefore be examined quickly and carefully observed with regard to compromised airways. An elderly male patient with obesity, known obstructive sleep apnoea and heart failure, non-severe chronic renal failure, and anticoagulation treatment presented with an acute subcutaneous haematoma of the neck. The patient had recently started an NSAID therapy regime for acute back pain. As part of the ENT examination endoscopy was performed. The airways were open and the patient had no respiratory distress. A CT scan confirmed open airways but revealed an additional circumferential haematoma in the pharynx of the patient. Blood work showed no anaemia or obvious infectious process. The unfortunate combination of the patient's regular medications and recent acute analgesic therapy with simultaneous renal failure was likely to have contributed to the development of an acute haematoma. Acute pharyngeal haematoma has been described in the literature in patients receiving anticoagulation therapy and one or more of the above-mentioned conditions that this patient had. The haematoma was controlled and resolved without further intervention.

Exposure to opioid analgesics due to surgery increases the risk of new persistent opioid use. A mechanistic hypothesis for opioids' abuse liability rests on the belief that, in addition to pain relief, acute opioid treatment improves well-being (e.g. via euphoria) and relieves anxiety. However, opioids do not consistently improve mood in laboratory studies of healthy non-opioid users. This observational study determined how two commonly used opioid analgesics affected patients' subjective well-being in standard clinical practice. Day surgery patients rated how good and how anxious they felt before and after an open-label infusion of remifentanil (n = 159) or oxycodone (n = 110) in the operating theatre before general anaesthesia. One minute after drug injection, patients reported feeling intoxicated (> 6/10 points). Anxiety was reduced after opioids, but this anxiolytic effect was modest (remifentanil Cohen's d = 0.21; oxycodone d = 0.31). There was moderate to strong evidence against a concurrent improvement in well-being (Bayes factors > 6). After remifentanil, ratings of 'feeling good' were significantly reduced from pre-drug ratings (d = 0.28). After oxycodone, one in three participants felt better than pre-drug. Exploratory ordered logistic regressions revealed a link between previous opioid exposure and opioid effects on well-being, as only 14 of the 80 opioid-naïve patients reported feeling better after opioid injection. The odds of improved well-being ratings after opioids were higher in patients with previous opioid exposure and highest in patients with > 2 weeks previous opioid use (adjusted OR = 4.4). These data suggest that opioid-induced improvement of well-being is infrequent in opioid-naïve patients. We speculate that peri-operative exposure could increase risk of persistent use by rendering subsequent positive opioid effects on well-being more likely.

Primary adrenal insufficiency is relatively common in children, but primary presentation with acute shock/adrenal crisis is rare. Congenital adrenal hyperplasia (CAH) is the most common cause in children and is part of the newborn diagnostic screening programme in Norway. We admitted a schoolgirl with a history of nausea and morning sickness for the previous three weeks. Shortly after admission she was somnolent, tachycardic (148 beats per minute) and pale. After initial administration of a 500ml bolus of Ringers acetate she was transmitted to the ICU. She responded poorly on IV fluids and epinephrine alone. Arterial blood gas test showed metabolic acidosis with hyponatraemia 122 mmol/L, hyperkalaemia 5,6 mmol/L and hypoglycaemia 2,2 mmol/L, and adrenal insufficiency was suspected. She responded well to treatment with hydrocortisone and was transferred to a university hospital for further examination and diagnosis. Acute adrenal crisis is a rare primary presentation of adrenal insufficiency, especially in the paediatric population. It is an important differential diagnosis of shock and has high morbidity and mortality.

Repeatability and robustness are the key factors that the automotive producers are demanding in connectionwith the crash performance of bumper beam systems. Bumper beam systems are important structures of an automotive that protect the passengers from front and rear collisions. Assessing the impact performance of only a bumper beam system through full-scale crash tests of a car is not easy. Thus, this paper presents experimental investigations on the bumper beam–longitudinal systems subjected to 40% offset impact. Bumper beam systems that are generally fitted to the automotives include ‘crashboxes’ besides the longitudinals. In the current study, the bumper beam system does not include any ‘crashboxes’. This is also the preferred system for some automotive producers. A longitudinal will offer higher resistance to deformation and thus gives higher energy absorption than if crashboxes are used. Using SIMLab's kicking machine, experiments were performed on rotary stretch–bent aluminium bumper beams, which were connected to two longitudinals at both ends and an experimental database was established. The repeatability and robustness of the bumper beam–longitudinal systems were studied by varying the material and temper condition of the longitudinals. Experimental investigations revealed that the longitudinal members with considerable strain-hardening would change the collapse mode into a global mode and reduce the energy absorption capability, due to the random development of lobes along the length.

A 76-year-old man with prostate cancer T3N0M0 and increasing PSA was treated with goserelin three times in a half year. As soon as the first treatment, he described subjective muscle weakness. After the third treatment, he developed complex motoric symptoms and atypical central pain with a likely association to goserelin. His left arm had signs of spastic movement; pain deteriorated after relaxation. The right hand showed muscle cramps under passive movements of the left arm that were not typical for rigor. He felt aching and partial burning pain in his whole body. There were few allodynic areas, mainly in the left arm. Several treatment approaches failed and the patient died some weeks after the first contact with our pain clinic due to pneumonia.

In a prospective, randomized and masked study the quantitative effect of sodium hyaluronate (Healon) on early postoperative intraocular pressure after cataract surgery was evaluated. At the end of planned extracapsular cataract extraction with implantation of posterior chamber lens, 0.1 ml or 0.2 ml of Healon was injected into the anterior chamber. The intraocular pressure was measured preoperatively, 3-6 h and 24 h postoperatively. All patients received topical timolol at the end of surgery. The results were compared to eyes operated with identical techniques where Healon was aspirated at the end of surgery. Three to six hours postoperatively a significant drop in mean intraocular pressure from preoperative pressure occurred when Healon was aspirated, but no statistical differences in mean intraocular pressure appeared when 0.1 ml or 0.2 ml of Healon was injected. The frequencies of pressure rise above 30 mmHg show no differences among the groups. Twenty-four hours postoperatively a significant pressure elevation from mean preoperative pressure occurred when 0.1 ml or 0.2 ml Healon was injected compared to the group were Healon was aspirated at the end of surgery. Similar results are seen when pressure rise above 30 mmHg are concerned.

In a prospective, randomized, masked study the effect of sodium hyaluronate (Healon) and timolol on the acute intraocular pressure rise after extracapsular cataract extraction with implantation of a posterior chamber lens were evaluated. Intraocular pressure was measured preoperatively and 3-6 h and 24 h postoperatively. When no timolol was used, a significant rise in intraocular pressure was observed at 3-6 h, whether or not Healon was aspirated. Timolol reduced the intraocular pressure rise, especially during the first 3-6 h after surgery. When timolol was not applied at the end of surgery, IOP exceeded 30 mmHg in 28% 3-6 h postoperatively, compared to only 4% when timolol was applied.