This narrative review evaluated the potential of nanotechnology platforms(DepoFoam bupivacaine^(R),DepoDur^(R),Exparel^(R),Zynrelef^(R),NeuroCuple™)in the control of postoperative pain following orthopedic procedures....This narrative review evaluated the potential of nanotechnology platforms(DepoFoam bupivacaine^(R),DepoDur^(R),Exparel^(R),Zynrelef^(R),NeuroCuple™)in the control of postoperative pain following orthopedic procedures.In individuals experiencing bunionectomy DepoFoam bupivacaine^(R)120 mg and placebo via wound infiltration before wound closure was compared.The area under the curve for numeric rating scale scores was substantially less in individuals treated with DepoFoam bupivacaine^(R)vs individuals receiving placebo at 24 h and 36 h.In individuals undergoing total hip arthroplasty,a single dose of 15 mg,20 mg,or 25 mg DepoDur^(R)[extended-release epidural morphine(EREM)]and placebo were compared.All EREM dosages diminished the mean fentanyl usage vs placebo and delayed the median time to first dose of fentanyl.All EREM cohorts had substantially improved pain control at rest for up to 48 h post-surgery compared with placebo.No supplementary analgesia was required in 25%of individuals treated with EREM and 2%of individuals treated with placebo at 48 h.In individuals undergoing total knee arthroplasty,iPACK(local anesthetic infiltration of the interspace between the popliteal artery and the posterior knee capsule)adductor canal block was compared to adductor canal block with Exparel^(R).Individuals in the Exparel^(R)cohort experienced an improvement in numeric rating scale pain scores at all postsurgical time points.These individuals also utilized a lower dose of inpatient opioids.In individuals undergoing bunionectomy a single intraoperative dose of Zynrelef^(R)prolonged release(PR)was compared to bupivacaine HCl 0.5%via wound infiltration before wound closure.Zynrelef^(R)PR diminished pain intensity by 18%compared with bupivacaine HCl.Opioid consumption was reduced by 37%in the Zynrelef^(R)PR cohort vs 25%in the bupivacaine HCl cohort.In individuals experiencing total knee arthroplasty and total hip arthroplasty,the use of a nanotechnology-based NeuroCuple^(TM)device diminished postoperative pain at rest by 34%and reduced pain with movement by 18%.展开更多
BACKGROUND: Fluid intervention and vasoactive pharmacological support during hepatic resection depend on the preference of the attending clinician, institutional resources, and practice culture. Evidence-based recomme...BACKGROUND: Fluid intervention and vasoactive pharmacological support during hepatic resection depend on the preference of the attending clinician, institutional resources, and practice culture. Evidence-based recommendations to guide perioperative fluid management are currently limited. Therefore, we provide a contemporary clinical integrative overview of the fundamental principles underpinning fluid intervention and hemodynamic optimization for adult patients undergoing major hepatic resection. DATA SOURCES: A literature review was performed of MEDLINE, EMBASE and the Cochrane Central Registry of Controlled Trials using the terms 'surgery', 'anesthesia', 'starch', 'hydroxyethyl starch derivatives', 'albumin', 'gelatin', 'liver resection', 'hepatic resection', 'fluids', 'fluid therapy', 'crystalloid', 'colloid', 'saline', 'plasma-Lyte', 'plasmalyte', 'hartmann's', 'acetate', and 'lactate'. Search results for MEDLINE and EMBASE were additionally limited to studies on human populations that included adult age groups and publications in English. RESULTS: A total of 113 articles were included after appropriate inclusion criteria screening. Perioperative fluid management as it relates to various anesthetic and surgical techniques is discussed.CONCLUSIONS: Clinicians should have a fundamental understanding of the surgical phases of the resection, hemodynamic goals, and anesthesia challenges in attempts to individualize therapy to the patient's underlying pathophysiological condition. Therefore, an ideal approach for perioperative fluid therapy is always individualized. Planning and designing large-scale clinical trials are imperative to define the optimal type and amount of fluid for patients undergoing major hepatic resection. Further clinical trials evaluating different intraoperative goal-directed strategies are also eagerly awaited.展开更多
Lignocaine is an essential drug on World Health Organisation essential drug list, considered efficacious, safe and cost-effective for any health-care system. Despite its ubiquitous use in medicine and surgery, there a...Lignocaine is an essential drug on World Health Organisation essential drug list, considered efficacious, safe and cost-effective for any health-care system. Despite its ubiquitous use in medicine and surgery, there are few detailed reviews of its pharmacokinetics and pharmacodynamics. Being an amide-type local anesthetic and Class 1b antiarrhythmic, lignocaine is most frequently used clinically for its anesthetic and antiarrhythmic benefits. However, lignocaine has important antinociceptive, immuno-modulating, and antiinflammatory properties. Information pertaining to the pharmacokinetics and pharmacodynamics of lignocaine was examined by performing a literature search of Pub Med, Embase and MEDLINE(via Ovid), pharmacology textbooks and online sources. We present a focused synopsis of lignocaine's pharmacological composition, indications for use and mechanisms of action, focusing on its anti-inflammatory, immuno-modulating and analgesia effects. In addition we review the dosing regimes and infusion kinetics of lignocaine in the clinical setting. Finally, we review the evidence for ligocaine's modulation of the inflammatory response during major surgery and its specific effects on cancer recurrence. These indirect effects of local anesthetics in tumor development may stem from the reduction of neuroendocrine responses to the stress response elicited by major surgery and tissue damage, enhanced preservation of immune-competence, in addition to opioid-sparing effects of modulating tumor growth.展开更多
目的:研究NADPH氧化酶4(Nox4)在骨癌痛(CIBP)大鼠背根神经节(DRG)中的表达。方法:48只成年雄性SD大鼠随机分为4组:假手术组(Sham)、骨癌痛组(CIBP)、空病毒对照组(Lenti-NC)与Nox4基因沉默组(Lenti-shNox4)。通过鞘内注射方法给予大鼠...目的:研究NADPH氧化酶4(Nox4)在骨癌痛(CIBP)大鼠背根神经节(DRG)中的表达。方法:48只成年雄性SD大鼠随机分为4组:假手术组(Sham)、骨癌痛组(CIBP)、空病毒对照组(Lenti-NC)与Nox4基因沉默组(Lenti-shNox4)。通过鞘内注射方法给予大鼠重组慢病毒处理,通过胫骨骨髓腔接种Walker256细胞的方法建立大鼠骨癌痛模型,通过胫骨HE染色及行为学检测鉴定大鼠CIBP模型,应用real time RT-PCR检测大鼠DRG中Nox4 mRNA的表达,利用Western Blot和免疫组织荧光染色检测Nox4蛋白在大鼠DRG中的表达和细胞定位,利用商品化试剂盒检测大鼠DRG中H2O2的含量,应用real time RT-PCR和Western Blot检测Nox4基因沉默对大鼠DRG中神经型一氧化氮合酶(n NOS)、超氧化物歧化酶(SOD)及N-甲基-D-天冬氨酸受体2D(NMDAR2D)和γ-氨基丁酸A型γ2受体(GABAA-γ2)表达的影响。结果:大鼠接种Walker256细胞可造成胫骨破坏及肿瘤细胞生长,PWT减少和TWL缩短;在骨癌痛大鼠DRG中,Nox4的表达显著升高;免疫组织荧光染色结果表明Nox4主要表达于DRG小胶质细胞中;敲减DRG中Nox4表达能减轻骨癌痛大鼠的机械痛敏和热痛敏,降低DRG中H2O2的水平,下调nNOS和NMDAR2D表达,上调SOD和GABAA-γ2表达。结论:敲减DRG中Nox4表达可通过减轻氧化应激反应缓解大鼠骨癌痛。展开更多
"Although few people die of pain,many people die in pain and even more live in pain"——IASP On October11,2004,International Association for the Study of Pain(IASP)
AIM To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness,surgery and perioperative medicine.METHODS We performed an el...AIM To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness,surgery and perioperative medicine.METHODS We performed an electronic literature search from Medline and Pub Med(via Ovid),anesthesia and pharmacology textbooks,and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions.The following keywords were used:"surgery","anaesthesia","anesthesia","anesthesiology","anaesthesiology","fluids","fluid therapy","crystalloid","saline","plasma-Lyte","plasmalyte","hartmann's","ringers""acetate","gluconate","malate","lactate".All relevant articles were accessed in full.We summarized the data and reported the data in tables and text.RESULTS We retrieved 104 articles relevant to the choice of Plasma-Lyte 148 for fluid intervention in critical illness,surgery and perioperative medicine.We analyzed the data and reported the results in tables and text.CONCLUSION Plasma-Lyte 148 is an isotonic,buffered intravenous crystalloid solution with a physiochemical composition that closely reflects human plasma.Emerging data supports the use of buffered crystalloid solutions in preference to saline in improving physicochemical outcomes.Further large randomized controlled trials assessing the comparative effectiveness of PlasmaLyte 148 and other crystalloid solutions in measuring clinically important outcomes such as morbidity and mortality are needed.展开更多
Epiduroscopy (EDS) allows diagnosis and treatment of spinal nerve root pathology by a fiberoptic device inserted percutaneously in the epidural space. Transient global amnesia syndrome (TGA) is defined by an abrupt on...Epiduroscopy (EDS) allows diagnosis and treatment of spinal nerve root pathology by a fiberoptic device inserted percutaneously in the epidural space. Transient global amnesia syndrome (TGA) is defined by an abrupt onset of an anterograde and retrograde amnesia that lasts up to 24 h, although mild subclinical neuropsychological deficits, with concomitant vegetative symptoms, can last for days after the episode. To our knowledge no cases of TGA in association with EDS have been recognized. We present a case of a 54-year-old man who was admitted for EDS, having experienced two times the failed surgery for spinal and left leg pain. During the EDS, 10 ml of non-ionic contrast media (CM) was injected to confirm the inside lesions. The epidural adhesions were gently broken down and drugs were injected around any inflamed nerve roots. Immediately after EDS, the patient experienced a TGA with loss of memory for the recent procedure and an impaired ability to retain new information. There were no signs of confusion or altered conscious level or seizure activities and neurological examination was normal. At 24 h a cranial computerized tomography (cCT) without CM showed “abnormal contrast enhancement at subarachnoid liquoral spaces levels”, then at 72 h cCT control was normal. The patient was discharged on the seventh day with perioperative lacunar amnesia persisting at this time. Herein, we sought a possible relationship between neurotoxic effect of CM and TGA in a patient emotionally stressed, even if the CM dose was given as a normal clinical range.展开更多
Background: The authors present the personal results of the review of a group of cases treated for Morton’s neuroma with continuous radiofrequency (CRF) thermo-ablation of the plantar intermetatarsal nerve. Methods: ...Background: The authors present the personal results of the review of a group of cases treated for Morton’s neuroma with continuous radiofrequency (CRF) thermo-ablation of the plantar intermetatarsal nerve. Methods: This retrospective review consisted of 29 patients treated between January 2008 and December 2011, with a minimum 1 year follow-up. Three patients underwent bilateral treatment and 10 patients underwent concomitant treatment procedures for associated foot disorders: hallux valgus (7), tailor’s bunion (2) and hammertoe (5). The procedure was performed in a day hospital setting under direct fluoroscopic control. Results: The follow-up protocol used a visual analog scale (VAS) for pain (0 = no pain, 10 = worst pain) and a visual analog scale (VAS) for patient satisfaction (0 = no satisfaction, 10 = complete satisfaction). Success was defined by a decrease of 5 points in pain at 1 year after the treatment procedure. From these 29 cases, with a VAS pain score between severe and worst pain ever, treatment with CRF thermo-ablation at one year follow-up yielded these results: 14 cases with no pain (48%), 7 cases with mild pain (24%), 5 cases with moderate pain (17%), 3 cases still with severe pain (10%). The overall benefit was that 88% of the patients had significant pain improvements. From another point of view, 26 cases (89.6%) had a decrease of the VAS score between 5 and 10 points and in only 3 cases (10.3%) severe pain was reported, even though it was slightly diminished after the procedure. Conclusion: Continuous radiofrequency (CRF) thermo-ablation of Morton’s neuroma (Entrapment) was a safe and minimally invasive surgical procedure which gave these patients great satisfactions and a rapid return to normal activity.展开更多
Riboflavin, which improves energy metabolism similarly to coenzymeQ10(CoQ10), is effective in migraine prophylaxis. We compared CoQ10 (3×100 mg/day) and plac ebo in 42 migraine patients in a double-blind,randomiz...Riboflavin, which improves energy metabolism similarly to coenzymeQ10(CoQ10), is effective in migraine prophylaxis. We compared CoQ10 (3×100 mg/day) and plac ebo in 42 migraine patients in a double-blind,randomized, placebo-controlled t rial.CoQ10 was superior to placebo for attack-frequency, headache days and days -with-nausea in the third treatment month and well tolerated; 50%-responder -rate for attack frequency was 14.4%for placebo and 47.6%for CoQ10 (number-n eed- ed-to-treat: 3).CoQ10 is efficacious and well tolerated.展开更多
Background: A pure intramuscular paraspinal schwannoma is extremely rare, with only few case reports in the literature. Due to low frequency, lack of specific clinical signs and symptoms and difficult radiological ass...Background: A pure intramuscular paraspinal schwannoma is extremely rare, with only few case reports in the literature. Due to low frequency, lack of specific clinical signs and symptoms and difficult radiological assessment, the pre-surgical workup leads to a broad differential diagnosis. The aim of the work carried out was therefore to search for evidence of common clinical and radiological signs of the intramuscular paraspinal schwannoma, useful in the diagnostic work-up, and to highlight possible standards of treatment. Methods: Starting from the analysis of our case, we have extended a search to similar cases on the databases PubMed and Google Scholar. The outcome of the analysis gathered, up to August 2021, six relevant papers. Result: We treated a 69-year-old female with a thoracic intramuscular paraspinal mass. The pre-operative MRI had identified two typical signs of schwannoma (“split-fat” sign and the “entry-exit” sign). Intraoperative nerve isolation was performed and complete surgical excision was achieved. At the pathological analysis, we could confirm a rare OMS grade I “ancient schwannoma”. The analysis of the literature data showed a homogeneous picture of radiological presentation of the pathology. Moreover, surgical treatment was always the treatment of choice. Conclusions: The proposed assessment and treatment were consistent with the standard collected in the literature. Typical radiological signs were also found in the other cases collected. Radical surgery is the preferred treatment.展开更多
Background:The heterogeneity of patients with COVID-19 may explain the wide variation of mortality rate due to the population characteristics,presence of comorbidities and clinical manifestations.Methods:In this study...Background:The heterogeneity of patients with COVID-19 may explain the wide variation of mortality rate due to the population characteristics,presence of comorbidities and clinical manifestations.Methods:In this study,we analyzed 5342 patients’recordings and selected a cohort of 177 hospitalized patients with a poor prognosis at an early stage.We assessed during 6 months their symptomatology,coexisting health conditions,clinical measures and health assistance related to mortality.Multiple Cox proportional hazards models were built to identify the associated factors with mortality risk.Results:We observed that cough and kidney failure triplicate the mortality risk and both bilirubin levels and oncologic condition are shown as the most associated with the demise,increasing in four and ten times the risk,respectively.Other clinical characteristics such as fever,diabetes mellitus,breathing frequency,neutrophil-lymphocyte ratio,oxygen saturation,and troponin levels,were also related to mortality risk of in-hospital death.Conclusions:The present study shows that some symptomatology,comorbidities and clinical measures could be the target of prevention tools to improve survival rates.展开更多
文摘This narrative review evaluated the potential of nanotechnology platforms(DepoFoam bupivacaine^(R),DepoDur^(R),Exparel^(R),Zynrelef^(R),NeuroCuple™)in the control of postoperative pain following orthopedic procedures.In individuals experiencing bunionectomy DepoFoam bupivacaine^(R)120 mg and placebo via wound infiltration before wound closure was compared.The area under the curve for numeric rating scale scores was substantially less in individuals treated with DepoFoam bupivacaine^(R)vs individuals receiving placebo at 24 h and 36 h.In individuals undergoing total hip arthroplasty,a single dose of 15 mg,20 mg,or 25 mg DepoDur^(R)[extended-release epidural morphine(EREM)]and placebo were compared.All EREM dosages diminished the mean fentanyl usage vs placebo and delayed the median time to first dose of fentanyl.All EREM cohorts had substantially improved pain control at rest for up to 48 h post-surgery compared with placebo.No supplementary analgesia was required in 25%of individuals treated with EREM and 2%of individuals treated with placebo at 48 h.In individuals undergoing total knee arthroplasty,iPACK(local anesthetic infiltration of the interspace between the popliteal artery and the posterior knee capsule)adductor canal block was compared to adductor canal block with Exparel^(R).Individuals in the Exparel^(R)cohort experienced an improvement in numeric rating scale pain scores at all postsurgical time points.These individuals also utilized a lower dose of inpatient opioids.In individuals undergoing bunionectomy a single intraoperative dose of Zynrelef^(R)prolonged release(PR)was compared to bupivacaine HCl 0.5%via wound infiltration before wound closure.Zynrelef^(R)PR diminished pain intensity by 18%compared with bupivacaine HCl.Opioid consumption was reduced by 37%in the Zynrelef^(R)PR cohort vs 25%in the bupivacaine HCl cohort.In individuals experiencing total knee arthroplasty and total hip arthroplasty,the use of a nanotechnology-based NeuroCuple^(TM)device diminished postoperative pain at rest by 34%and reduced pain with movement by 18%.
文摘BACKGROUND: Fluid intervention and vasoactive pharmacological support during hepatic resection depend on the preference of the attending clinician, institutional resources, and practice culture. Evidence-based recommendations to guide perioperative fluid management are currently limited. Therefore, we provide a contemporary clinical integrative overview of the fundamental principles underpinning fluid intervention and hemodynamic optimization for adult patients undergoing major hepatic resection. DATA SOURCES: A literature review was performed of MEDLINE, EMBASE and the Cochrane Central Registry of Controlled Trials using the terms 'surgery', 'anesthesia', 'starch', 'hydroxyethyl starch derivatives', 'albumin', 'gelatin', 'liver resection', 'hepatic resection', 'fluids', 'fluid therapy', 'crystalloid', 'colloid', 'saline', 'plasma-Lyte', 'plasmalyte', 'hartmann's', 'acetate', and 'lactate'. Search results for MEDLINE and EMBASE were additionally limited to studies on human populations that included adult age groups and publications in English. RESULTS: A total of 113 articles were included after appropriate inclusion criteria screening. Perioperative fluid management as it relates to various anesthetic and surgical techniques is discussed.CONCLUSIONS: Clinicians should have a fundamental understanding of the surgical phases of the resection, hemodynamic goals, and anesthesia challenges in attempts to individualize therapy to the patient's underlying pathophysiological condition. Therefore, an ideal approach for perioperative fluid therapy is always individualized. Planning and designing large-scale clinical trials are imperative to define the optimal type and amount of fluid for patients undergoing major hepatic resection. Further clinical trials evaluating different intraoperative goal-directed strategies are also eagerly awaited.
文摘Lignocaine is an essential drug on World Health Organisation essential drug list, considered efficacious, safe and cost-effective for any health-care system. Despite its ubiquitous use in medicine and surgery, there are few detailed reviews of its pharmacokinetics and pharmacodynamics. Being an amide-type local anesthetic and Class 1b antiarrhythmic, lignocaine is most frequently used clinically for its anesthetic and antiarrhythmic benefits. However, lignocaine has important antinociceptive, immuno-modulating, and antiinflammatory properties. Information pertaining to the pharmacokinetics and pharmacodynamics of lignocaine was examined by performing a literature search of Pub Med, Embase and MEDLINE(via Ovid), pharmacology textbooks and online sources. We present a focused synopsis of lignocaine's pharmacological composition, indications for use and mechanisms of action, focusing on its anti-inflammatory, immuno-modulating and analgesia effects. In addition we review the dosing regimes and infusion kinetics of lignocaine in the clinical setting. Finally, we review the evidence for ligocaine's modulation of the inflammatory response during major surgery and its specific effects on cancer recurrence. These indirect effects of local anesthetics in tumor development may stem from the reduction of neuroendocrine responses to the stress response elicited by major surgery and tissue damage, enhanced preservation of immune-competence, in addition to opioid-sparing effects of modulating tumor growth.
文摘目的:研究NADPH氧化酶4(Nox4)在骨癌痛(CIBP)大鼠背根神经节(DRG)中的表达。方法:48只成年雄性SD大鼠随机分为4组:假手术组(Sham)、骨癌痛组(CIBP)、空病毒对照组(Lenti-NC)与Nox4基因沉默组(Lenti-shNox4)。通过鞘内注射方法给予大鼠重组慢病毒处理,通过胫骨骨髓腔接种Walker256细胞的方法建立大鼠骨癌痛模型,通过胫骨HE染色及行为学检测鉴定大鼠CIBP模型,应用real time RT-PCR检测大鼠DRG中Nox4 mRNA的表达,利用Western Blot和免疫组织荧光染色检测Nox4蛋白在大鼠DRG中的表达和细胞定位,利用商品化试剂盒检测大鼠DRG中H2O2的含量,应用real time RT-PCR和Western Blot检测Nox4基因沉默对大鼠DRG中神经型一氧化氮合酶(n NOS)、超氧化物歧化酶(SOD)及N-甲基-D-天冬氨酸受体2D(NMDAR2D)和γ-氨基丁酸A型γ2受体(GABAA-γ2)表达的影响。结果:大鼠接种Walker256细胞可造成胫骨破坏及肿瘤细胞生长,PWT减少和TWL缩短;在骨癌痛大鼠DRG中,Nox4的表达显著升高;免疫组织荧光染色结果表明Nox4主要表达于DRG小胶质细胞中;敲减DRG中Nox4表达能减轻骨癌痛大鼠的机械痛敏和热痛敏,降低DRG中H2O2的水平,下调nNOS和NMDAR2D表达,上调SOD和GABAA-γ2表达。结论:敲减DRG中Nox4表达可通过减轻氧化应激反应缓解大鼠骨癌痛。
文摘"Although few people die of pain,many people die in pain and even more live in pain"——IASP On October11,2004,International Association for the Study of Pain(IASP)
文摘AIM To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness,surgery and perioperative medicine.METHODS We performed an electronic literature search from Medline and Pub Med(via Ovid),anesthesia and pharmacology textbooks,and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions.The following keywords were used:"surgery","anaesthesia","anesthesia","anesthesiology","anaesthesiology","fluids","fluid therapy","crystalloid","saline","plasma-Lyte","plasmalyte","hartmann's","ringers""acetate","gluconate","malate","lactate".All relevant articles were accessed in full.We summarized the data and reported the data in tables and text.RESULTS We retrieved 104 articles relevant to the choice of Plasma-Lyte 148 for fluid intervention in critical illness,surgery and perioperative medicine.We analyzed the data and reported the results in tables and text.CONCLUSION Plasma-Lyte 148 is an isotonic,buffered intravenous crystalloid solution with a physiochemical composition that closely reflects human plasma.Emerging data supports the use of buffered crystalloid solutions in preference to saline in improving physicochemical outcomes.Further large randomized controlled trials assessing the comparative effectiveness of PlasmaLyte 148 and other crystalloid solutions in measuring clinically important outcomes such as morbidity and mortality are needed.
文摘Epiduroscopy (EDS) allows diagnosis and treatment of spinal nerve root pathology by a fiberoptic device inserted percutaneously in the epidural space. Transient global amnesia syndrome (TGA) is defined by an abrupt onset of an anterograde and retrograde amnesia that lasts up to 24 h, although mild subclinical neuropsychological deficits, with concomitant vegetative symptoms, can last for days after the episode. To our knowledge no cases of TGA in association with EDS have been recognized. We present a case of a 54-year-old man who was admitted for EDS, having experienced two times the failed surgery for spinal and left leg pain. During the EDS, 10 ml of non-ionic contrast media (CM) was injected to confirm the inside lesions. The epidural adhesions were gently broken down and drugs were injected around any inflamed nerve roots. Immediately after EDS, the patient experienced a TGA with loss of memory for the recent procedure and an impaired ability to retain new information. There were no signs of confusion or altered conscious level or seizure activities and neurological examination was normal. At 24 h a cranial computerized tomography (cCT) without CM showed “abnormal contrast enhancement at subarachnoid liquoral spaces levels”, then at 72 h cCT control was normal. The patient was discharged on the seventh day with perioperative lacunar amnesia persisting at this time. Herein, we sought a possible relationship between neurotoxic effect of CM and TGA in a patient emotionally stressed, even if the CM dose was given as a normal clinical range.
文摘Background: The authors present the personal results of the review of a group of cases treated for Morton’s neuroma with continuous radiofrequency (CRF) thermo-ablation of the plantar intermetatarsal nerve. Methods: This retrospective review consisted of 29 patients treated between January 2008 and December 2011, with a minimum 1 year follow-up. Three patients underwent bilateral treatment and 10 patients underwent concomitant treatment procedures for associated foot disorders: hallux valgus (7), tailor’s bunion (2) and hammertoe (5). The procedure was performed in a day hospital setting under direct fluoroscopic control. Results: The follow-up protocol used a visual analog scale (VAS) for pain (0 = no pain, 10 = worst pain) and a visual analog scale (VAS) for patient satisfaction (0 = no satisfaction, 10 = complete satisfaction). Success was defined by a decrease of 5 points in pain at 1 year after the treatment procedure. From these 29 cases, with a VAS pain score between severe and worst pain ever, treatment with CRF thermo-ablation at one year follow-up yielded these results: 14 cases with no pain (48%), 7 cases with mild pain (24%), 5 cases with moderate pain (17%), 3 cases still with severe pain (10%). The overall benefit was that 88% of the patients had significant pain improvements. From another point of view, 26 cases (89.6%) had a decrease of the VAS score between 5 and 10 points and in only 3 cases (10.3%) severe pain was reported, even though it was slightly diminished after the procedure. Conclusion: Continuous radiofrequency (CRF) thermo-ablation of Morton’s neuroma (Entrapment) was a safe and minimally invasive surgical procedure which gave these patients great satisfactions and a rapid return to normal activity.
文摘Riboflavin, which improves energy metabolism similarly to coenzymeQ10(CoQ10), is effective in migraine prophylaxis. We compared CoQ10 (3×100 mg/day) and plac ebo in 42 migraine patients in a double-blind,randomized, placebo-controlled t rial.CoQ10 was superior to placebo for attack-frequency, headache days and days -with-nausea in the third treatment month and well tolerated; 50%-responder -rate for attack frequency was 14.4%for placebo and 47.6%for CoQ10 (number-n eed- ed-to-treat: 3).CoQ10 is efficacious and well tolerated.
文摘Background: A pure intramuscular paraspinal schwannoma is extremely rare, with only few case reports in the literature. Due to low frequency, lack of specific clinical signs and symptoms and difficult radiological assessment, the pre-surgical workup leads to a broad differential diagnosis. The aim of the work carried out was therefore to search for evidence of common clinical and radiological signs of the intramuscular paraspinal schwannoma, useful in the diagnostic work-up, and to highlight possible standards of treatment. Methods: Starting from the analysis of our case, we have extended a search to similar cases on the databases PubMed and Google Scholar. The outcome of the analysis gathered, up to August 2021, six relevant papers. Result: We treated a 69-year-old female with a thoracic intramuscular paraspinal mass. The pre-operative MRI had identified two typical signs of schwannoma (“split-fat” sign and the “entry-exit” sign). Intraoperative nerve isolation was performed and complete surgical excision was achieved. At the pathological analysis, we could confirm a rare OMS grade I “ancient schwannoma”. The analysis of the literature data showed a homogeneous picture of radiological presentation of the pathology. Moreover, surgical treatment was always the treatment of choice. Conclusions: The proposed assessment and treatment were consistent with the standard collected in the literature. Typical radiological signs were also found in the other cases collected. Radical surgery is the preferred treatment.
基金supported by the Innovation,Universities,Science and Digital Society Council through the Valencia Innovation Agency(AVI)grant 851255 from the European Research Council under the European Union’s Horizon 2020 research and innovation programfrom the Universitat de València.
文摘Background:The heterogeneity of patients with COVID-19 may explain the wide variation of mortality rate due to the population characteristics,presence of comorbidities and clinical manifestations.Methods:In this study,we analyzed 5342 patients’recordings and selected a cohort of 177 hospitalized patients with a poor prognosis at an early stage.We assessed during 6 months their symptomatology,coexisting health conditions,clinical measures and health assistance related to mortality.Multiple Cox proportional hazards models were built to identify the associated factors with mortality risk.Results:We observed that cough and kidney failure triplicate the mortality risk and both bilirubin levels and oncologic condition are shown as the most associated with the demise,increasing in four and ten times the risk,respectively.Other clinical characteristics such as fever,diabetes mellitus,breathing frequency,neutrophil-lymphocyte ratio,oxygen saturation,and troponin levels,were also related to mortality risk of in-hospital death.Conclusions:The present study shows that some symptomatology,comorbidities and clinical measures could be the target of prevention tools to improve survival rates.
