Serotonin syndrome: take a closer look at the unwell surgical patient.

Ann R Coll Surg Engl. 2011 Nov;93(8):569-72

Authors: Shaikh ZS, Krueper S, Malins TJ

Abstract
This article describes the sequence of acute clinical deterioration seen in a head and neck oncology patient who developed serotonin syndrome peri-operatively. It highlights the clinical dilemma that can be encountered when a septic picture masks the onset of serotonin syndrome and reinforces the importance of awareness of the potential interactions and side effects associated with drugs that surgeons prescribe. We discuss the pathophysiology, causal factors, clinical presentation and diagnosis of serotonin syndrome as well as highlighting some of the dilemmas that this condition presents in the surgical setting.

PMID: 22041229 [PubMed - indexed for MEDLINE]

D-Dimer in the diagnosis of deep vein thrombosis following total hip and knee replacement: a prospective study.

Ann R Coll Surg Engl. 2008 Mar;90(2):123-6

Authors: Rafee A, Herlikar D, Gilbert R, Stockwell RC, McLauchlan GJ

INTRODUCTION: The merit of using D-dimer estimations in patients following total hip and knee replacement has been previously questioned. A survey of radiology protocols in 70 hospitals ascertained that the test continues to be mandatory in 51 prior to formal radiological investigation of suspected deep vein thrombosis (DVT) in this patient population. PATIENTS AND METHODS: In this study, D-dimer levels were measured pre-operatively and during the first 7 days following primary total hip and knee replacement to estimate the range of normal values in these patients. RESULTS: All 78 patients were ultrasonographically shown to be clear of DVT. D-Dimer levels were significantly raised in all patients at all measurements during the first week. Levels after total knee replacement were higher than after total hip replacement. Comparison was made with an age-matched group who had a proven DVT. There was no difference in D-dimer levels between patients with or without a DVT. CONCLUSIONS: The use of this test in this patient group is a waste of resource and merely delays appropriate radiological investigation and treatment.

PMID: 18325211 [PubMed - indexed for MEDLINE]