Chiropractic Response to a Spontaneous Vertebral Artery Dissection

OBJECTIVE: The purpose of this case report is to describe a case in which early detection and proper follow-up of spontaneous vertebral artery dissection led to satisfactory outcomes. CLINICAL FEATURES: A 34-year old white woman reported to a chiropractic clinic with a constant burning pain at the right side of her neck and shoulder with a limited ability to turn her head from side to side, periods of blurred vision, and muffled hearing. Dizziness, visual and auditory disturbances, and balance difficulty abated within 1 hour of onset and were not present at the time of evaluation. A pain drawing indicated burning pain in the suboccipital area, neck, and upper shoulder on the right and a pins and needles sensation on the dorsal surface of both forearms. Turning her head from side-to-side aggravated the pain, and the application of heat brought temporary relief. The Neck Disability Index score of 44 placed the patient’s pain in the most severe category. INTERVENTION AND OUTCOME: The patient was not treated on the initial visit but was advised of the possibility of a vertebral artery or carotid artery dissection and was recommended to the emergency department for immediate evaluation. The patient declined but later was convinced by her chiropractor to present to the emergency department. A magnetic resonance angiogram of the neck and carotid arteries was performed showing that the left vertebral artery was hypoplastic and appeared to terminate at the left posterior inferior cerebellar artery. There was an abrupt moderately long segment of narrowing involving the right vertebral artery beginning near the junction of the V1 and V2 segments. The radiologist noted a concern regarding right vertebral artery dissection. Symptoms resolved and the patient was cleared of any medications but advised that if symptoms reoccurred she was to go for emergency care immediately. CONCLUSION: Recognition and rapid response by the chiropractic physician provided the optimum outcome for this particular patient

A Hand-held Fiber-optic Implement for the Site-specific Delivery of Photosensitizer and Singlet Oxygen

We have constructed a fiber optic device that internally flows triplet oxygen and externally produces singlet oxygen, causing a reaction at the (Z)-1,2-dialkoxyethene spacer group, freeing a pheophorbide sensitizer upon the fragmentation of a reactive dioxetane intermediate. The device can be operated and sensitizer photorelease observed using absorption and fluorescence spectroscopy. We demonstrate the preference of sensitizer photorelease when the probe tip is in contact with octanol or lipophilic media. A first-order photocleavage rate constant of 1.13 h−1 was measured in octanol where dye desorption was not accompanied by readsorption. When the probe tip contacts aqueous solution, the photorelease was inefficient because most of the dye adsorbed on the probe tip, even after the covalent ethene spacer bonds have been broken. The observed stability of the free sensitizer in lipophilic media is reasonable even though it is a pyropheophorbide-a derivative that carries a p-formylbenzylic alcohol substituent at the carboxylic acid group. In octanol or lipid systems, we found that the dye was not susceptible to hydrolysis to pyropheophorbide-a, otherwise a pH effect was observed in a binary methanol-water system (9:1) at pH below 2 or above 8

Clinical trials with thiazolidinediones in subjects with Type 2 diabetes - is pioglitazone any different from rosiglitazone?

The thiazolidinediones, rosiglitazone and pioglitazone are used in the treatment of Type 2 diabetes (T2DM). Both have been shown to decrease glycated haemoglobin levels, fasting plasma glucose, insulin, and free fatty acids levels in subjects with T2DM. However, these agents have markedly different effects on lipids. Rosiglitazone increases total, low- and high-density lipoprotein (LDL and HDL) cholesterol, and triglycerides, whereas pioglitazone has no effect on total or LDL cholesterol, increases HDL cholesterol and decreases triglycerides. Both rosiglitazone and pioglitazone decrease inflammatory markers. Furthermore, both rosiglitazone and pioglitazone may cause a small decrease in blood pressure, improve endothelial function and reduce restenosis. Microalbuminuria is also reduced by both rosiglitazone and pioglitazone. Despite the improvements in surrogate end points, there is little clear evidence that either rosiglitazone or pioglitazone cause major improvements in cardiovascular outcomes. Thus, rosiglitazone has no effect or may even increase cardiovascular outcomes, whereas, in high-risk subjects, pioglitazone has a marginal ability to decrease cardiovascular outcomes. Unless the thiazolidinediones are shown to improve cardiovascular or other outcomes (e.g., renal) in the next few years, their continued use in T2DM should be questioned