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Multidisciplinary pain

Christine M Warrick, Mark D Rollins
Placenta accreta spectrum is becoming more common and is the most frequent indication for peripartum hysterectomy. Management of cesarean delivery in the setting of a morbidly adherent placenta has potential for massive hemorrhage, coagulopathies, and other morbidities. Anesthetic management of placenta accreta spectrum presents many challenges including optimizing surgical conditions, providing a safe and satisfying maternal delivery experience, preparing for massive hemorrhage and transfusion, preventing coagulopathies, and optimizing postoperative pain control...
October 11, 2018: Clinical Obstetrics and Gynecology
Melike Elif Teker, Önder Teskin
BACKGROUND: Primary cardiac sarcoma is a rare and atypical clinical entity. We present a patient with long-term remission after primary cardiac sarcoma resection. CASE REPORT: A 42-year-old previously healthy female presented to the emergency department after an effort-induced 30-minute episode of chest pain and extreme shortness of breath. Physical examination upon admission was remarkable for a pulse of 99/minute; blood pressure was 101/73 mmHg. Transthoracic echocardiography showed a mass measuring 5...
September 25, 2018: Heart Surgery Forum
Gretchen Glaser, Sean C Dowdy, Abraham Peedicayil
Enhanced recovery protocols consist of a bundle of concepts including early feeding, opioid-sparing multimodal pain management, and euvolemia, with the overarching goal of hastening postoperative recovery. Enhanced recovery after surgery has been shown to reduce hospital length of stay, reduce costs, and decrease perioperative opioid requirements in benign and oncologic gynecologic surgery. Interventions without supporting evidence of benefit, such as the use of mechanical bowel preparation, routine use of nasogastric tubes and surgical drains, caloric restriction, routine use of intravenous opioid analgesics, and over-vigorous intravenous hydration should be discouraged to improve broader endpoints such as patient satisfaction and overall recovery...
October 2018: International Journal of Gynaecology and Obstetrics
Linda J Rogers, Mauricio A Cuello
Vulvar cancer is an uncommon gynecological malignancy primarily affecting postmenopausal women. There is no specific screening and the most effective strategy to reduce vulvar cancer incidence is the opportune treatment of predisposing and preneoplastic lesions associated with its development. While vulvar cancer may be asymptomatic, most women present with vulvar pruritus or pain, or have noticed a lump or ulcer. Therefore, any suspicious vulvar lesion should be biopsied to exclude invasion. Once established, the most common subtype is squamous cell carcinoma...
October 2018: International Journal of Gynaecology and Obstetrics
Olga Di Fede, Vera Panzarella, Rodolfo Mauceri, Vittorio Fusco, Alberto Bedogni, Lorenzo Lo Muzio, Sipmo Onj Board, Giuseppina Campisi
Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents; it is a potentially painful and debilitating condition that can considerably affect the quality of life of patients. Furthermore, even if its epidemiology and pathogenesis have still not been fully clarified, several risk factors related to MRONJ have been recognized in prevention protocols. Three main risk factors are as follows: (i) the type of ONJ-related medications: antiresorptive (e...
2018: BioMed Research International
Ali-Asgar Najefi, Luckshmana Jeyaseelan, Matthew Welck
Turf toe is a condition that describes injury to the plantar metatarsophalangeal-sesamoid complex of the great toe.It is a relatively rare and debilitating condition, particularly seen in American footballers after the introduction of harder, artificial 'turf' surfaces.Turf toe represents a significant injury to the hallux and requires a high index of suspicion.If unrecognized, it can lead to chronic problems including reduced push-off strength, persistent pain, progressive deformity and eventual joint degeneration...
September 2018: EFORT Open Reviews
Hiroyuki Inoue, Atsushi Toma, Nobuyuki Watanabe, Hiroshi Ito, Toshiya Ochiai, Eigo Otsuji
A 42-year-old male was referred to our hospital with bloody feces and lower back pain. He was diagnosed with unresectable gallbladder cancer with rectal metastasis (T3aN1M1, Stage IVB). The patient was administered gemcitabine plus cisplatin (GC). After nine courses of GC, computed tomography showed regression of the tumor and the patient's tumor marker levels had decreased. Therefore, curative resection was performed. Ten months after the operation, recurrence was observed in the rectal margin and GC was restarted...
2018: Nihon Shokakibyo Gakkai Zasshi, the Japanese Journal of Gastro-enterology
Minji K Lee, Kathleen J Yost, Karlyn E Pierson, Shanda H Blackmon
BACKGROUND: Health-related quality of life (QoL) deteriorates immediately after esophagectomy. Patients may benefit from periodic assessments to detect increased morbidity on the basis of subjective self-reports. Using input from patients and health care providers, we developed a brief prototype for the esophageal conduit questionnaire (Mayo Clinic Esophageal Conduit Outcomes Noting Dysphagia/Dumping, and Unknown outcomes with Intermittent symptoms over Time after esophageal reconstruction [CONDUIT] Report Card) and previously used it in comparative research...
October 10, 2018: Health and Quality of Life Outcomes
Christian Blume, Izabela Tuleta, Kay Nolte, Klaus W Eichhorn, Mark Jakob, Hans Clusmann, Thorsten Send
OBJECTIVE: Sarcoidosis is a multisystemic granulomatous disease of unknown cause which affects the lung or bilateral hilar lymphadenopathy in over 90% of the cases. Neurosarcoidosis (NS) is rare and accounts for approximately 5 - 15% of the cases. Involvement of all parts of the central and peripheral nervous system is possible with various clinical symptoms, e. g. seizures, hydrocephalus, optic/facial nerve palsy or hearing loss. METHODS: We screened the neuropathological data bases and the medical records of two neurosurgical university hospitals for cases of NS...
October 8, 2018: British Journal of Neurosurgery
Aleksandra Szybalska, Katarzyna Broczek, Przemysław Slusarczyk, Ewa Kozdron, Jerzy Chudek, Monika Puzianowska-Kuznicka, Tomasz Kostka, Anna Skalska, Malgorzata Mossakowska
Background: Rehabilitation tailored to older adults' needs might improve their functional performance and quality of life, as well as increase social participation. The aim of the study was to evaluate the use of medical rehabilitation services among older Poles in relation to socio-economic and health-related determinants. Materials and methods: Data regarding medical rehabilitation were obtained from the nationwide, multidisciplinary PolSenior project (2007-2012) conducted on representative sample of 4813 respondents (48...
2018: European Geriatric Medicine
Dipesh H Vasant, Ramya Kalaiselvan, Joanne Ablett, Ashley Bond, Arun Abraham, Antje Teubner, Darren Green, Peter A Paine, Simon Lal
BACKGROUND & AIMS: Severe gastrointestinal dysmotility (GID) is a significant cause of chronic intestinal failure (CIF) with unclear benefits of sub-classifying into Chronic Intestinal Pseudo-obstruction (CIPO) and non-CIPO sub-types. We compared outcomes between CIPO and non-CIPO sub-types in a tertiary cohort of patients with CIF resulting from severe GID. METHODS: Adults with primary GID, commenced on home parenteral nutrition (HPN) over a 16-year period at a national referral centre, were included...
September 22, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Reni M A van Erp, Ivan P J Huijnen, Marluuke L G Jakobs, Jos Kleijnen, Rob J E M Smeets
BACKGROUND AND OBJECTIVE: Recent systematic reviews show promising effects for multidisciplinary biopsychosocial (BPS) interventions in patients with chronic low back pain (CLBP). Nowadays, BPS interventions have also been developed for primary care physiotherapy settings. Our aim was to systematically review the evidence on the effectiveness of primary care BPS interventions in improving functional disability, pain and work status for patients with CLBP. Secondly, we aimed to provide an elaborated overview of BPS intervention designs, physiotherapist-training programs and process-related factors (practical implementation)...
October 5, 2018: Pain Practice: the Official Journal of World Institute of Pain
Karl Balsara, Andrew Jea, Jeffrey S Raskin
Spasticity is a hypertonic segmental reflex pathway caused by a central nervous system injury. Spasticity of the upper extremity causes loss of function, joint contracture, pain, and poor cosmesis. Treatment aims to reduce or change the pathophysiology underlying the hyperactive reflex from dorsal sensory rootlets through the intrinsic machinery of the spinal cord to the neuromuscular junction. There are many treatments for upper extremity spasticity including oral medication, physiotherapy, intrathecal baclofen, and lesional or neuromodulatory surgical approaches...
November 2018: Hand Clinics
J Xu, A Nyga, W Li, X Zhang, N Gavara, M M Knight, J C Shelton
Many studies report the adverse responses to metal-on-metal (MoM) hip prostheses, with tissues surrounding failed MoM hip prostheses revealing abundant tissue necrosis and fibrosis. These local effects appear to be initiated by metal ions released from the prosthesis causing the secretion of inflammatory mediators. However, little is known about the effect of the metal ions on tissue remodelling and pseudotumor formation, which are also associated with the failure of MoM hip prostheses. The peri-prosthetic soft tissue masses can lead to pain, swelling, limited range of joint movement and extensive tissue lesion...
October 2, 2018: European Cells & Materials
Xue Gao, Phillipa McSwiney, Andrew Court, Aaron Wiggins, Susan M Sawyer
PURPOSE: There are only a few reports of adolescents with somatic disorders (SDs) whose symptoms are sufficiently severe to require hospital admission. The aim of this study was to describe the symptom profile, health service utilization, and outcome of adolescents with SDs admitted to a tertiary children's hospital. METHODS: A retrospective cohort study of all adolescents admitted to the Adolescent Medicine Unit of a tertiary children's hospital was undertaken from July 2013 to June 2014...
September 29, 2018: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
Ning Zhang, Yatong Li, Mengyun Zhao, Xiaoyan Chang, Feng Tian, Qiang Qu, Xiaodong He
RATIONALE: Sarcomatous intrahepatic cholangiocarcinoma is a rare histological variant of cholangiocarcinoma (ICC). Previous medical literature has not mentioned the prevalence of this kind of disease, but a poorer prognosis than that of ordinary ICC was indicated. The diagnosis of the sarcomatous ICC is established on histopathological and immunohistochemical examinations. In this article, we present a new case of a patient with sarcomatous ICC who had no radiographic sign of intrahepatic tumor preoperatively...
September 2018: Medicine (Baltimore)
N N M Razafimanjato, T H Ralaizafindraibe, A R Ramarolahy, T A Rajaonera, H J L Rakotovao
Acute mediastinitis, also called descending necrotizing mediastinitis and cervicomediastinal necrotizing fasciitis, is a disease due to the spread of severe cervical or oropharyngeal infection. Our retrospective study examined clinical records of patients admitted to the surgical intensive care unit for the management of acute mediastinitis during the four-year period 2009-2012. The records showed 14 cases admitted during these four years. The patients' mean age was 30 years and 8 months, and the M/F sex-ratio was 1...
August 1, 2018: Médecine et Santé Tropicales
Vasanthakumar Gunasekaran, Ashwin Rammohan, Srinivas Mettu Reddy, Mohamed Rela
Leiomyosarcoma (LMS) of primary vascular origin is a rare entity with only potentially curative option being complete surgical resection; despite which the prognosis remains dismal. Tumour recurrence is very common, and the benefits of adjuvant therapy are undefined. A 39-year-old woman presented with 6 months' history of abdominal pain, abdominal distension and pedal oedema. On evaluation, she was diagnosed to have chronic Budd-Chiari syndrome (BCS) secondary to a tumour arising from the inferior vena cava (IVC) on evaluation...
September 28, 2018: BMJ Case Reports
James Henderson
A multidisciplinary team representing 28 professional bodies has updated the guidelines for the management of complex regional pain syndrome (CRPS), published by the Royal College of Physicians (RCP) of England, 2018. The author represented the British Association of Plastic, Reconstructive and Aesthetic Surgeons in this process and is an author of the guidelines. This article summarises the updated guidelines and highlights aspects relevant to plastic and reconstructive surgery.
September 6, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Steven W Brose, Heather Schneck, Dennis J Bourbeau
BACKGROUND: The increasing use of prescription opioids has contributed to the epidemic of opioid abuse in the United States. Efforts to reduce opioid prescriptions and offer alternatives for pain management are needed. OBJECTIVE: To determine the success of a multidisciplinary project to manage chronic pain while reducing reliance on opioids in a population of patients with spinal cord injury. DESIGN: Retrospective analysis. SETTING: This study was conducted in an SCI system of care in northeast Ohio...
September 25, 2018: PM & R: the Journal of Injury, Function, and Rehabilitation
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