Day 1 :
Keynote Forum
Guy H Fontaine
Universite Pierre et Marie Curie, Paris
Keynote: New technique of brain protection by adiabatic expansion of carbon dioxide and first fortuitous clinical case of sudden death at home: 6 minutes of no flow with absolutely no neurologic deficit
Time : 10:05-10:45
Biography:
Guy H Fontaine has made 15 original contributions in the design and the use of the first cardiac pace makers in the early 60s.He has serendipitously identified ARVD during antiarrhythmic surgery in the early 70s. He has developed the technique of Fulguration to replace surgery in the early 80s. He has been one of the 216 individual who has made a significant contribution to the study of cardiovascular disease since the 14th century and one of the 500 greatest geniuses of the 21th Century (USA Books), one of the 100 life time of achievement (UK Book). He has more than 900 publications including 201 book chapters. He is a Reviewer of 17 scientific journals both in basic and clinical science. He is currently developing new techniques for brain protection in OHCA, stroke and spinal cord injury by hypothermia.
Abstract:
The technique of brain protection has started in 2007 after the presentation of the method proposed by a neurologist from Cornell University NY City by evaporation of perfluorocarbon in fossa nasalis. This method was studied on a pig model at the Weil Institute of Cardiac Care Medicine (WICCM) in Rancho Mirage California. I immediately suspected that it was possible to obtain the same result, faster and stronger by expansion of highly compressed gas. After several experiments and discussions with experts it was found that carbon dioxide was the most appropriate gas. This was confirmed on a pig model able to reproduce the work performed at WICCM. It was during this experiment, that my wife experienced sudden cardiac death beside me while watching TV in June 2011. She had no femoral pulse which prompted to perform chest compression. Because of my work on the Fulguration procedure 30 years before, I had a defibrillator in the basement of my house. The third shock proved successful but without return to consciousness. I then used the prototype of a bottle filled with compressed CO2 used for my experiments. In the following days in La Salpêtrière hospital she had 4 more episodes of VF explained by an old asymptomatic myocardial infarction seen on coronarography. She was able to awake after 6 days of coma and recovered completely without absolutely no brain deficit despite 6 minutes of no flow. She subsequently had an ICD and had two other episodes of syncope in the street before proper pharmacologic therapy. She never had release of troponin demonstrating that the arrhythmia was a pure electric phenomenon. The work made on the pig model suggested that it was possible to cool the brain by the mouth as well as the fossa nasalis. This opened the possibility to create a new device with a CO2 bottle on top of a tripod with injector in the mouth and make usable in stroke, brain trauma and children hyperthermia. The final device is so simple that it can be used by everybody. The next step is to perform a pilot study of two subgroups of cooled and non-cooled patients.
- Cardiology | Oncology | Obstetrics and Gynecology | Neurology | Endocrinology
Chair
Guy Huges Fontaine
Universite Pierre et Marie Curie, France
Co-Chair
Erich T Wyckoff
Universty of Florida, USA
Session Introduction
Erich T Wyckoff
Universty of Florida, USA
Title: The Bartholin Cyst that Wasn’t: A Case Report of Metastatic Cancer
Time : 11:00-11:30
Biography:
Erich Tyrone Wyckoff has obtained his Medical degree from the University of Alabama at Birmingham School of Medicine before completing his Residency in Obstetrics & Gynecology at Wright State in Dayton, Ohio. He has joined the Faculty of the University of South Florida where he focused on minimally invasive surgery. He later joined the Faculty at the University of South Florida, where his interests include medical diversity, education and robotic surgery. He is board certified in Obstetrics & Gynecology and engaged in surgical technologies and has published peer-reviewed articles in his specialty. He is the author of “God’s Physician: Word’s of my life”.
Abstract:
Bartholin gland cysts and abscesses are common disorders of the female genital tract. Carcinomas and benign tumors of the gland are rare. However, in certain patient populations it can be argued that patients presenting with suspected Bartholin gland cyst or abscess should undergo both drainage and biopsy of the lesion in order to exclude potential carcinoma. While metastatic disease have been documented in primary cancers of the Bartholin gland secondary to its extensive vascular and lymphatic network, we present a case report of a poorly differentiated endometrial carcinoma metastasis to the Bartholin gland that initially presented as a Bartholin gland abscess. This case also serves as a useful reminder that when treating disease of the female genital tract, no matter how minor, a level of vigilance and attention to managing the whole patient is of upmost importance.
Nimat Alam
Texas Tech University Health Science Center, USA
Title: Upper and Lower Extrimity paralysis: Case Report
Time : 11:30-12:00
Biography:
Nimat Alam is a Physician associated with Family and Community Medicine at Texas Tech University Health Sciences Center. Her specialization is with geriatrics, clinical expertise include diabetic care, geriatric medicine, hospital medicine, nursing home ambulatory procedures and preventive medicine.
Abstract:
Case Presentation: A 31 year old Hispanic male arrived to Emergency Room by Emergency Medical Service with complaint of lower and upper extremities weakness that started about 5 days prior to admission, which progressively worsened. On the day of admission, he was unable to ambulate. Apart from the weakness the patient denied dyspnea, fever, neck pain, no recent history of travel with no recent upper respiratory infection or gastrointestinal infection or sick contacts. His past medical history includes Grave’s disease which was previously treated with methimazole but he discontinued the medication a few weeks ago. Patient denied any recreational drugs, over the counter medications, prescription medications including laxatives or diuretics. He did however admit to recent tobacco abuse. Discussion: One of the main goals of medical management is to replenish the potassium levels as imbalances in potassium can lead to arrhythmia and cardiovascular complications. Potassium chloride is a good choice for supplementation and is dosed between 40 and 200 mmols. Judicious replacement of potassium is necessary as rebound hyperkalemia is a common problem because potassium can undergo a transcellular shift from extracellular to intracellular space. Oral or IV preparations of propranolol are beneficial in aiding in potassium homeostasis. Nonspecific beta antagonistic properties of propranolol allow for increase in potassium levels and resolve the paralysis without the rebound effect of hyperkalemia. Oral propranolol can be dosed at 60 mg every six hours. Conclusion: There is much other differential diagnosis that could present with lower extremity weakness such as Guillain-Barre syndrome, meningitis, medication side effects or even malignancy. But HPP is one of the diagnoses often missed due to its low occurrence. The combination of paralysis with hypokalemia should prompt to any physician the possibility of this disease. The prompt diagnosis of this condition will help to avoid expensive laboratory studies and invasive procedures. It will also help to soon provide the patient with the appropriate treatment such as moderate potassium replacement in addition with propranolol to correct the hypokalemia, thus improving the extremity weakness.
Reena Bansal
Crozer Chester Medical Center, USA
Title: Interesting case of Hyponatremia unmasking a lung cancer
Time : 12:00-12:30
Biography:
Reena Bansal has completed her MBBS from Mysore Medical College and Research Institute in the year 2008 and Masters from Rajiv Gandhi University of Health Sciences in the year 2011. She is currently associated as Resident Physician with Crozer Chester Medical Center since 2014.
Abstract:
Introduction: Hyponatremia is a common condition seen in clinical practice. SIADH is a common cause of this hyponatremia, especially in small cell lung cancer. It usually accompanies but can also precede the diagnosis of the tumor with an incidence of about 3.7% to 5%. We report this interesting case of hyponatremia, which led to the diagnosis of lung cancer. Case Report: A 78 year old Caucasian female was admitted with complaints of intermittent nausea and vomiting for 3 months. She was found to have sodium levels of 119. She denies being on any water pills, excessive fluid intake or recent medication changes. She had a 50 pack year smoking history. Management: Severe hyponatremia in the setting of nausea in a patient who has been a chronic smoker with no hx of diabetes, heart failure, cirrhosis or kidney disease and with normal thyroid functions and lipids and the increased urine osmolality, led us to the diagnosis of SIADH. However, work up for the cause of SIADH, in the setting of 50 pack year history of smoking made us to a CAT scan of the lung, which revealed a dominant 2.0×1.6 cm medial right lower lobe pulmonary nodule with multiple smaller bilateral pulmonary nodules with mediastinal and hilar lymphadenopathy. She has given a few doses of tolvaptan with appropriate response in sodium. Discussion: Hyponatremia secondary to SIADH is a known paraneoplastic manifestation of lung cancer. The incidence of hyponatremia in lung cancer is reported to be only 1% in NSCLC and 15% in SCLC. It is important to treat hyponatremia but it is equally important to evaluate the cause of hyponatremia. In our patient, the single complaint of nausea led us to the diagnosis of lung cancer eventually.
Jesús Alcaraz-Rubio
Hospital Mesa del Castillo, Spain
Title: Platelet-Rich Plasma in a Patient with Cerebral Palsy
Time : 13:15-13:45
Biography:
Jesus Alcaraz is currently associated with Department of Hematology and Oncology at Hospital Mesa del Castillo in Spain.
Abstract:
Background: The use of platelet-rich plasma is a now a common medical technique known as regenerative medicine, through power cell activation and differentiation, which produces growth factors called platelets derived both locally and systematically. Here, we report the case of a cerebral palsy patient who received intravenous platelet-rich plasma. Case report: We administered an intravenous injection of concentrated platelet-rich plasma (25 cc) in a 6 year old boy with perinatal cerebral palsy, cognitive impairment and marked and severe generalized spasticity. We performed follow-up at 3 and 6 months after the injection. All serum samples for determination were obtained by ELISA technique. Cognitive scales (Bayley, Battelle, M.S.C.A, Kaufman ABC and Stanford-Binet Intelligence scale) were used before and after treatment. The determination protocol that was applied before the analysis was performed manually and the auto transfusion was considered suitable for treatment. We determined the plasma levels of factor similar to insulin-1 (IGF-1), platelet-derived growth factor (PDGF), vasculo-endothelial growth factor (VEGF) and transforming growth factor B (TGF-B) before and during treatment monitoring. Conclusions: No adverse effects were observed in the patient except for a small hematoma in the area channeling venous access. We observed a clear improvement in the cognitive sphere (memory, ability to perform more complex tasks and acquisition of new skills) and in language, maintaining stable levels of growth factor in plasma 3-5 times higher than average for his age group at both 3 and 6 month follow-up. Positron emission tomography (PET) images showed an evident increased demarcation in the cerebral cortex. We propose that this therapy is useful in these patients to harness the neurostimulative and neuroregenerative power of endogenous growth factors derived from platelets.
Caroline Tsimi Mvilongo
University of Yaoundé, France
Title: Bilateral retinoblastoma with extra retinal diffusion: 2 cases reports
Time : 13:45-14:15
Biography:
Caroline Mvilongo Tsimi has completed her MD degree from Yaounde Faculty of Medicine and Biomedical Sciences. She is an Ophthalmologist at Yaounde Central Hospital and has published some papers in reputed journals.
Abstract:
Introduction: Retinoblastoma is an embryonal tumor of neuroectodermal origin, highly malignant affecting the young child and the infant. It is bilateral in 40% of cases. It is of good prognosis if the diagnosis has been taken earlier. We report 2 clinical cases of bilateral retinoblastoma with extra retinal diffusion which is a poor prognosis factor. Case 1: DW , 20 months brought in our ophthalmology service in 2009 with a tumor of the left eye since one month with a past history of leucocoria since birth. A first CT scan has been ask 8 months before but not done by the family. At the ophthalmology exam, he was classified at stage V of Reese-Ellsworth for the contralateral right eye and orbital extension of the left eye. A CT scan has been done showing bilateral calcifications with bilateral orbital extension. He has been enucleated for the left eye and received 3 doses of chemotherapy. The patient was lost of view 2 months after the surgery. Case 2: HO, 3 years Centrafican refugee referred in our ophthalmology service on June 2015 for the care of a tumor of the right eye since 3 months. She had a leucocoria in the right eye since one year; she is the last of a family of 9 with past history of 1st degree consanguinity. The ophthalmology exam showed a great tumor with necrosis and inflammation of the right eye. At the left eye, sub-retinal with mass with retinal detachment stage V of Reese-Ellsworth, she has received neoadjuvant chemotherapy and exenteration of the right eye. She died few hours after the surgery. Discussion: These 2 cases have been seen late in an appropriate ophthalmology unit. The prognosis was poor because of the extra retinal diffusion of the tumor mainly through the optic nerve and the sclera. According to the literature, the mean age of diagnosis is 11 months for bilateral retinoblastoma. The factors that could explain the late of our patient are the using of traditional medicine, the socio-economic status, the ignorance of the gravity by the parents and the inadequate health care unit. Conclusion: Bilateral retinoblastoma is relatively present in our milieu. It should be taken care earlier and people at risk should be sensitized about the disease which is highly malignant and could lead to death if not adequately treated.
Moustafa Elsheshtawy
Coney Island Hospital, USA
Title: Hypothyroidism and Congenital long QT: Additive effect causing torsades?
Time : 14:15-14:45
Biography:
Moustafa Elsheshtawy has earned his degree in Medicine from Tanta University, Tanta, El-Gharbia Governorate, Egypt and completed his Residency training at Coney Island Hospital, Brooklyn, New York, USA. He is currently beginning his Fellowship in Cardiovascular Medicine at Maimonides Medical Center, in Brooklyn as well. He has always been interested in clinical medical research and has participated in many national and international clinical trials, most notably with the National Heart, Lung and Blood Institute (NHLBI), Roche Pharmaceutical, Boehringer Ingelheim Pharmaceutical, Hospital Quality Foundation among others. His academic work has been recognized at the national American Medical Association (AMA) 2015 conference in Atlanta, Georgia.
Abstract:
Hypothyroidism can result in a myriad of cardiovascular effects. We present a rare instance of a young female patient with torsades de pointes (TdP), a fatal ventricular tachyarrhythmia, potentiated by hypothyroidism superimposing a congenital long QT syndrome. Although hypothyroidism has been linked to torsades de pointes in few case reports, none of the reported patients have been tested for congenital long QT syndrome. Reversing cardiovascular risk has been documented when patients regained their euthyroid state after levothyroxine replacement therapy. Patients should be given stress dose glucocorticoids while levothyroxine dose increases gradually to avoid precipitating acute coronary syndrome especially in patients with underlying coronary artery disease. Clinicians should be aware of life-threatening complications of hypothyroidism. Prompt diagnosis and treatment can lead to absolute recovery and a favorable long-term prognosis.
Märta Sund Levander
Linköping University, Sweden
Title: The cMeeting Hallenge of detecting infections in frail elderly individuals
Time : 15:00-15:30
Biography:
Marta Sund Levander has completed her PhD in Clinical Physiology at Linkoping University, Sweden in 2004. She is a Senior Researcher and University Lecturer at Linkoping University. She has published papers and textbooks about assessment and validation of body temperature in health and disease with focus on frail elderly. She is responsible for Swedish guidelines about body temperature measurement in healthcare and a Swedish Representant in ISO standards for thermometry.
Abstract:
It is well known that non-specific signs and symptoms and lack of specific ones are common in frail elderly individuals, especially nursing home residents (NHR), contributing to a delayed diagnosis and treatment and a risk of overuse of antibiotics and hence development of antibiotic resistant. Atypical signs and symptoms are observed as weakness, falling, weight loss, physical dysfunction and cognitive decline. As specific symptoms are often lacking, the presence of an increased body temperature in fever, in terms of ≥38 °C, is often evaluated as a significant symptom of illness and an important reason for taking further action in clinical practice. However, temperature in fever in frail elderly has been reported to be lower than traditionally stated. The complexity of detecting infections in this population can partly be explained by difficulties in understanding and interpreting non-specific signs and symptoms and co-existing chronic diseases that blur the clinical picture. In addition, as more than 50% of NHR are assessed as having chronic pain, the effects on body temperature from medication with paracetamol daily has to be considered. Furthermore, reference values for common biomarkers in blood/serum are based on samples from healthy, young individuals and do not consider the presence of chronic diseases, daily medication and ageing. The aim of this presentation is to raise and discuss the challenge of detecting infections early on in frail elderly.
Robin George Manappallil
National Hospital, India
Title: Diabetic ketoacidosis and acute pancreatitis: The masquerading conditions in a patient with chronic kidney disease
Time : 15:30-16:00
Biography:
Robin George Manappallil has completed his Bachelor of Medicine and Bachelor of Surgery degree from Father Muller Medical College, India and his MD in Internal Medicine from Pondicherry Institute of Medical Sciences, India. He has received three gold medals for being the highest scorer in his MD exams in college as well as university and for being the best outstanding post graduate. He has published around 15 papers in national and international journals. He is currently serving as a Consultant Physician at National Hospital, Calicut, India.
Abstract:
Diabetic patients are at the risk of developing acute pancreatitis, due to hypertriglyceridemia. Diabetic ketoacidosis in an acute life threatening complication of type-1 diabetes; an elevated serum amylase levels may be suggestive of acute pancreatitis, but these levels may also be elevated in diabetic ketoacidosis. In such cases, serum lipase levels aid in the diagnosis of acute pancreatitis. However, in patients with chronic kidney disease, the levels of amylase and lipase will be elevated, as the pancreatic enzymes are excreted by the kidneys. This is a case report of a young lady with type-1 diabetes and chronic kidney disease (stage 4), not on hemodialysis, who presented with diabetic ketoacidosis and had elevated levels of amylase and lipase, in the absence of pancreatitis.