Background: Previous studies have demonstrated Ketamine to induced apoptosis in various cellular lines. Ketamine is commonly utilized during total intravenous anesthesia in patients undergoing brachytherapy for prostate cancer. The primary aim of this study was to determine if concomitant ketamine exposure during prostate brachytherapy improved outcomes evaluate through follow prostate specific antigen (PSA) levels. Methods: A retrospective analysis of 91 prostate brachytherapy performed at our institution from 2014-2016 was done identifying 31 procedures in which ketamine was administered during the procedure. Measured outcomes were the comparison reduction of PSA levels at 1 month, 6 months, and 12 months post procedural visits. Results: No statistical significant reduction in the prostatic specific antigen or the corresponding percent reduction of PSA levels were demonstrated between ketamine and non-ketamine exposed patient undergoing prostate brachytherapy. Conclusions: Concomitant ketamine exposure does not appear to enhance the therapeutic effect of prostate brachytherapy. When comparing the overall percent reduction of PSA levels between the two groups (ketamine exposed/ no exposure), the ketamine patients did have greater decrease in PSA levels, but was not statistically significant. With the limitation of our retrospective analysis, further double blinded prospective trials may be warranted.
Developing a broad differential for chronic back pain is important in terms of work-up, and eventual treatment. We present a case of a sixty-nine-year old male with chronic back pain, failing multiple treatments and medications, which were eventually diagnosed with non-obstructing renal calculi. We believe it is imperative that pain management physicians are cognizant of small stone syndrome, and that they widen their differential to include rarer causes of back pain when treatment modalities prove ineffective. As demonstrated by our case, ineffective treatment, unneeded procedures, and poor patient satisfaction, may result when a broad differential is not utilized.
Hydromorphone, unlike other opioids associated with histamine release, has never been reported to cause angioedema. We report a rare case of hydromorphone-induced angioedema in a 34-year-old woman with history of deep venous thrombosis and pulmonary embolism who presented with leg swelling and pain after trauma. Hydromorphone was administered with subsequent rapid development of stridor and edematous changes of the tongue, uvula, and surrounding mucosa. The difficult airway response team was activated, and the airway was secured by emergent awake fiberoptic intubation in the operating room. After being treated with antihistamines and steroids for 24 hours, the airway edema had resolved, leading to a successful extubation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.