Mark Davies

Use of aspirin as sole oral antiplatelet therapy in acute flow diversion for ruptured dissecting aneurysms

Subarachnoid hemorrhage secondary to rupture of a circumferential dissecting aneurysm continues to be a treatment dilemma. Vessel sacrifice, when possible, continues to be the safest option but in certain cases this is not possible due to lack of collateral supply. In such cases, coil assisted endovascular flow diversion has become a potential option but the requirement for dual antiplatelet therapy in an unsecured intracranial aneurysm continues to raise concern. We present a 48-year-old man with a World Federation of Neurological Surgeons grade 5 subarachnoid hemorrhage, secondary to a ruptured intradural left vertebral artery dissecting aneurysm, who was treated successfully with a pipeline embolization device with Shield technology using aspirin and a single intravenous loading dose of abciximab. To our knowledge, this is the first case of an acute flow diversion performed using only aspirin as the sole oral antiplatelet agent.

The lack of antidotes for new oral anticoagulants

Warfarin is a bit like great aunt Mabel’s old car—slow, uneconomical, temperamental, and often in need of repair—but still reasonably reliable. A classic motor that starts, stops, and shakes. Perhaps great aunt Mabel might be better with a new car from the nice garage down the road: the “NOAC (new oral anticoagulant) roadster” is more comfortable, more economical, and has much longer service …

An unusual case of a pituitary fossa aspergilloma in an immunocompetent patient mimicking infiltrative tumour

Sellar aspergillosis is a rare infection commonly mistaken for a pituitary tumour. We present a rare case of pituitary fossa Aspergillus fumigatus mycetoma in an immunocompetent 90-year-old female, who presented with headaches. Magnetic resonance imaging scans demonstrated an enhancing pituitary fossa mass that appeared to infiltrate the sphenoid sinus, suggestive of an invasive tumour. Stereotactic trans-sphenoidal resection confirmed localized A. fumigatus infection. The abscess was debrided and the dura was left intact. Her headaches resolved post-operatively and she was treated with voriconazole. This indicates that aspergilloma should be considered as a differential for an unexplained pituitary lesion even in elderly immunocompetent patients.

Should same day discharge general anaesthesia be a notifiable condition for being unfit to drive

Sokol uses pathos very effectively to highlight the dangers of driving when unfit.1 As anaesthetists, we routinely advise patients that they will be unfit to drive while their reactions are impaired by the residual effects of their anaesthetic drugs—usually for 24-48 …

Children who miss appointments were not brought rather than did not attend

Children who miss appointments might be at risk from lack of follow-up.1 The researchers concluded that communication between …

Every operation is a special event

Sokol shows that the solemn moments of medicine are more common than we think.1 “Is your birthday a special day for you?” I often ask trainees as we wait in the anaesthetic room for the next patient …