Pickwickian Syndrome:

It is a symptom complex presenting with the following symptoms:

1.Obesity 

2.Hypoventilation 

3.Somnolence 

4.Erythrocytosis

This comdition has been associated with sleep apnoea syndrome which has now been established as a separate entity.

Thoracic Aortic Aneurysm

Description:

Aabnormal dilatation of blood vessel

Pathogenesis:

Intimal tears progress to longitudinal intraluminal tears forming a lumen in the media.

There is collection of basophilic mucoid material in media and elastic tissue.

Most important factors promoting continued propagation of dissection are hypertension and velocity of left ventricular ejection.

Complications:

• Aortic rupture causing cardiac tamponade
  
• Leakage may cause pericarditis
  
• Dysphagia
  

Clinical Features:

• hypertension on initial presentation
  
• pericardial friction rub or AR murmur
  
• aortic insufficiency
  
• pulse deficit
  
• focal neurologic deficits may be present
  

Treatment:

1.Medical management for uncomplicated distal dissection

• sodium nitroprusside
• beta blockers
  

2.Surgery for acute proximal aortic dissection

• Operative repair to prevent rupture
  
• Emergency surgical repair for dissection of ascending aorta
  
• Cerebrospinal fluid drainage during and after surgery may reduce risk of neurological injury .
  

Idiopathic Intracranial Hypertension (IIH)

Description
Also called pseudotumor cerebri, benign intracranial and serous meningitis, it is a condition in which there is raised intracranial pressure in absence of space-occupying lesion, often presenting as headache and can potentially cause permanent visual loss.

Symptoms
Constant generalized severe headache
Transient visual obscurations (shadows, dark patches, or black spots in one or both eyes.
Pulsatile tinnitus
Visual sparkles (photopsia)
Diplopia

Signs
Papilledema
Enlarged blind spot.
Usually does not affect visual acuity.

Treatment
Most important aim of treatment is halting or preventing visual loss.
Weight reduction if obese.
Serial lumbar punctures can relieve syndrome.

Neonatal Resuscitation

Following is the algorithm in use for neonatal resuscitation:

Birth

•Clear of meconium?
•Breathing or crying?
•Good muscle tone?
•Colour pink?
•Term gestation?

Yes - Routine care [Provide warmth, Clear airway and dry]
No -

•Provide warmth
•Position, clear airway
•Dry, stimulate, reposition
•Give oxygen
Evaluate respirations, heart rate and colour.

If breathing, HR>100 and Pink, give supportive care.
If there is apnoea or HR<100

•Provide positive pressure ventilation

If ventilating, HR>100 and Pink, give supportive care.

If HR<60:

•Provide positive pressure ventilation

•Administer chest compressions 

If after this HR>60, go back to previous step (provide PPV).
If HR<60, administer epinephrine.

Malignant Glaucoma

Definition

Malignant glaucoma is characterised by a shallow anterior chamber associated with raise intraocular pressure and in the presence of a patent iridotomy. The condition usually follows intraocular surgery but has also been described following laser iridotomy and has even been associated with miotic therapy.

Mechanism

It is probably due to misdirection of the ciliary processes into or around the vitreous.

Anterior displacement of the lens iris diaphragm causes a shallow anterior chamber.

Diagnosis

1. Shallow anterior chamber with raised or normal IOP after a intraocular surgery.
2. Ultrasound biomicroscopy

Differential Diagnosis

1. Intumescent lens
   
2. Choroidal neoplasm
3. Central retinal vein occlusion
4. Secondary pupil block