Alum instillation: A management option for intractable hemorrhagic cystitis / Philippine Journal of Obstetrics and Gynecology

@#Intractable hemorrhagic cystitis is an uncommon but significant treatment complication of concurrent chemoradiation therapy for cervical cancer. Alum instillation is regarded as a safe and effective option for its treatment. This case presentation will discuss a patient who presented with postradiation cystitis and was treated with alum irrigation. The aim of this report is to offer alum irrigation as a management option for intractable hematuria.

Use of intravenous lidocaine in a patient with refractory chest pain secondary to Takayasu arteritis. Case report / Uso da lidocaína endovenosa em paciente com dor torácica refratária secundária à arterite de Takayasu. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Takayasu's arteritis (TA) is a rare form of chronic inflammatory disease involving large vessels, with uncertain etiology, with chest pain as a common and challenging symptom, resulting from inflammation in the aortic root or arch, pulmonary artery or coronary arteries. The objective of this study was to describe the use of intravenous lidocaine to treat severe and refractory chest pain secondary to TA. CASE REPORT: A 33-year-old female patient diagnosed with TA, with severe chest pain that was difficult to manage, was admitted after consulting an emergency department. The pain was unresponsive to traditional treatment after a week of drug adjustments. As a therapeutic option, a Sympathetic Venous Blockade (SVB) with lidocaine was chosen, achieving a reduction in pain from 10 to 3 on the Visual Analog Scale. Infliximab was administered before discharge. The patient was re-evaluated at an outpatient appointment after 30 days. CONCLUSION: This strategy for the treatment of severe chest pain allowed for pain reduction and relief.

RESUMO JUSTIFICATIVA E OBJETIVOS: A arterite de Takayasu (AT) é uma forma rara de doença inflamatória crônica envolvendo grandes vasos, com etiologia incerta, tendo a dor torácica como um sintoma comum e desafiador, consequente à inflamação na raiz ou arco aórtico, artéria pulmonar ou coronárias. O objetivo deste estudo foi relatar a utilização da lidocaína por via endovenosa na abordagem da dor torácica intensa e refratária secundária à AT. RELATO DO CASO: Paciente do sexo feminino, 33 anos, com diagnóstico de AT, dor torácica intensa de difícil manejo, internada após consulta em serviço de emergência. Dor não responsiva ao tratamento tradicional após uma semana de ajustes em fármacos. Como opção terapêutica, foi escolhido o Bloqueio Simpático Venoso (BSV) com lidocaína, obtendo redução da dor de 10 para 3 na Escala Analógica Visual. Antes da alta hospitalar foi administrado infliximabe. Paciente foi reavaliada em consulta ambulatorial após 30 dias. CONCLUSÃO: Esta estratégia fora tratamento da dor torácica intensa permitiu redução e alívio da dor.

A Case of Acute Withdrawal Symptoms Due to Unplanned Interruption of Buprenorphine Transdermal Patch: With a Discussion Including Social Aspects of Home Medical Care Patients

Introduction: Since the commercial availability of buprenorphine extended-release transdermal patches (BTDP) from the early 2010’s, the therapeutic indications for opioids have widely expanded to include chronic benign diseases. We report a case of a home health care patient with acute opioid withdrawal symptoms due to self-interruption of BTDP. Case: An 84-year-old man using home health care services due to worsening of lumbar spinal canal stenosis had been receiving analgesia with a BTDP, a mixed opioid agonist/antagonist analgesic, for the preceding five months. Since the patient's spouse thought that his pain and symptoms were gradually improving, she secretly replaced the BTDP with an NSAID patch without informing the patient. About 50 hours later, the patient experienced a variety of symptoms, including frequent urination with incontinence every five minutes, watery diarrhea, sweating, decreased blood pressure, discomfort in the feet, and insomnia. Evaluation of the Clinical Opiate Withdrawal Score (COWS) by the home health care physician indicated a score of 12, corresponding to mild withdrawal symptoms. About 12 hours after symptom onset, the severe abnormalities were barely noticeable and completely disappeared after two days. Conclusion: Few previous case reports have described withdrawal symptoms due to rapid discontinuation of BTDP. In addition to the medical considerations, we report the social issues associated with onset of the condition in a home environment. Opioid use for non-cancer pain requires medication management from a different perspective than that for cancer pain.

Effects of different analgesic methods of hydromorphone on analgesic efficacy and sleep quality in patients with refractory cancer pain / 中国基层医药

Objective:To investigate the effects of different analgesic methods of hydromorphone on analgesic efficacy and sleep quality in patients with refractory cancer pain.Methods:Sixty patients with refractory cancer pain who received three-step analgesic treatment in Quzhou People's Hospital from August 2018 to December 2019 and acquired poor analgesic effects were included in this study. They were randomly assigned to undergo either an intravenous patient-controlled analgesia with hydromorphone (HV group, n = 30) or an intrathecal patient-controlled analgesia with hydromorphone (HI group, n = 30) for 10 consecutive days. The analgesic efficacy in each group was evaluated using the numerical rating scale (NRS) before and 2, 4, 24, 48 hours, and 10 days after administration. The frequency of breakthrough pain (BTP) at each time point was recorded. The sedation effect of medication was evaluated using the Ramsay score. The sleep quality of patients was evaluated using the Pittsburgh sleep quality index (PSQI). The activities of CD 3+, CD 4+, and CD 4+/CD 8+ lymphocyte subsets were measured by flow cytometry at different time points. The adverse reactions within 10 days after treatment were observed and recorded. Results:Before and at each time point after treatment, there were no significant differences in NRS score, the frequency of BTP, Ramsay score, and PSQI score between the two groups (NRS score: t = 0.45, 0.91, 0.52, 1.19, 0.97, 1.92, all P > 0.05; frequency of BTP: t = 0.34, 1.88, 0.86, 1.71, 1.22, 0.76, all P > 0.05; Ramsay score: t = 0.56, 0.46, 0.63, 0.22, 0.99, 0.14, all P > 0.05; PSQI: t = 0.86, 1.25, 1.46, 1.05, 0.57, 1.93, all P > 0.05). At each time point after treatment, the activities of CD 3+, CD 4+, and CD 4+/CD 8+ cells increased in each group, and the activities of CD 3+, CD 4+, and CD 4+/CD 8+ cells in the HI group were significantly higher than those in the HV group (CD 3+: t = 3.72, 3.12, 2.85, 3.13, 2.44, all P < 0.05; CD 4+: t = 3.62, 2.45, 3.31, 3.19, 2.70; all P > 0.05; CD 4+/CD 8+: t = 3.10, 2.74, 2.83, 3.24, 3.41, all P < 0.05). The total incidence of adverse reactions was slightly, but not significantly, lower in the HI group than the HV group [14.00% (7/30) vs. 26.00% (13/30), χ2 = 2.70, P = 0.100]. Conclusion:Compared with intravenous administration of hydromorphone, intrathecal administration of hydromorphone can better effectively relieve pain, decrease the frequency of BTP, improve sleep quality, has a good sedative effect, improve immune function, and has fewer adverse reactions.

The characteristics of stereoelectroencephalography in drug-resistant epileptic spasms / 中华实用儿科临床杂志

Objective:To analyze the characteristics of stereoelectroencephalography (SEEG) in children with drug-resistant epileptic spasms (ES), and to explore the surgical strategy of children with spastic seizure under the guidance of SEEG.Methods:The clinical data of 156 children with ES who were preoperatively evaluated in the Department of Neurosurgery Ward 3, Tsinghua University Yuquan Hospital from January 2014 to December 2021 were retrospectively reviewed.All children were evaluated in the second stage of stereotactic electrode placement after a non-invasive preoperative evaluation.The characteristics of intracranial EEG, surgical strategy and prognosis were analyzed.Results:A total of 19 eligible children were included, involving 13 boys and 6 girls.The age of first onset and surgical age of them ranged 1 month to 4 years, and 2 years to 13 years, respectively.The SEEG was divided into 3 types in children with ES at the onset.Five children were SEEG type A, presenting with the focal seizure discharges at the beginning and a gradual propagation to widespread fast-wave bursts.Ten children were SEEG type B, presenting a focal leading spike followed by diffused fast-wave bursts.Four children were SEEG type C, presenting a diffuse fast wave rhythm onset.Although some electrode discharges appeared slightly " leading", they covered more than one brain region.After focal resection or thermocoagulation, 13/19 patients did not have the onset of seizures, and 5/19 and 8/19 were graded as SEEG type A, and B, respectively.During the intermittent period of SEEG attacks in children with SEEG type A and B, a significant phenomenon of focal epileptic discharge consistent with the onset of the attack was observed, and surgical removal of these areas effectively controlled spastic seizures.Conclusions:Epileptic spasms may be triggered by a focal neocortical discharge.Intracranial EEG showed that the focal seizure onset evolves into spasm or a focal " leading spike" is a good indicator of surgical prognosis.

CyberKnife Radiosurgery for refractory bilateral trigeminal neuralgia. Case report

Case description: A case of a 37-year-old female patient suffering from refractory bilateral trigeminal neuralgia is presented, who underwent various interventions such as acupuncture, block therapies and even microvascular decompression without effective pain relief. Clinical findings: Paresthesias and shooting-like twinges of pain intensity 10/10 in bilateral maxillary and mandibular branches of the trigeminal nerve, with nasal and intraoral triggers that made eating impossible, becoming increasingly severe since refractoriness to microvascular decompression and carbamazepines, triggering the twinges even during sleep, generating somnolence, depressive mood and social isolation. Treatment and results: The patient was evaluated by an interdisciplinary neuro-oncology team, where, in accordance with the analysis of the brain magnetic resonance imaging and the patient's history, it was indicated to perform Cyberknife® radiosurgery in monofraction on the left trigeminal and subsequently treat the contralateral trigeminal. When treated with Cyberknife® radiosurgery, the patient reported absolute improvement in her pain for 2 years. Clinical relevance: Radiosurgery by CyberKnife is not yet the first line of management in trigeminal neuralgia, however, it should be considered since several studies have managed to demonstrate an increase in the quality of life of patients and pain relief in refractory or severe cases. of said pathology.

Descripción del caso: Se presenta un caso de paciente femenino de 37 años que padecía neuralgia del trigémino bilateral refractaria, tratada con terapias alternativas, cirugía de descompresión microvascular, analgesia multimodal y terapias de bloqueo sin alivio efectivo del dolor. Hallazgos clínicos: Parestesias y punzadas tipo disparo de intensidad del dolor 10/10 en ramas maxilar y mandibular bilaterales del nervio trigémino, con gatillos nasales e intraorales que imposibilitaban comer, tornándose cada vez más severa desde refractariedad a descompresión microvascular y carbamazepinas, desencadenándose las punzadas incluso en el sueño, provocando somnolencia, animo depresivo y aislamiento social. Tratamiento y resultados: La paciente fue sometida a valoración por equipo interdisciplinario de neurooncología, donde en concordancia con el análisis de la resonancia magnética cerebral y los antecedentes de la paciente, se indicó realización de radiocirugía por Cyberknife en monofracción sobre trigémino izquierdo y posteriormente tratar el contralateral. Al ser tratada con radiocirugía Cyberknife® la paciente refiere mejora absoluta de su dolor desde hace 2 años. Relevancia clínica: La Radiocirugía por Cyberknife aún no es primera línea de manejo en neuralgia del trigémino, sin embargo, debería considerarse ya que diversos estudios han logrado demostrar un aumento en la calidad de vida de los pacientes y alivio del dolor en casos refractarios o graves de dicha patología.

Enteropatías congénitas y la implicación diagnóstica en la displasia intestinal o enteropatía en penacho

RESUMEN Introducción: la displasia epitelial intestinal o enteropatía en penacho, es una rara y grave enfermedad debido a mutaciones genéticas, categorizada como enteropatía congénita por defecto del transporte de los enterocitos y su polaridad. Objetivo: Examinar los conocimientos más recientes para la orientación diagnóstica de las enteropatías congénitas en el contexto clínico de las diarreas crónicas intratables del período posnatal y primeros meses de vida. Métodos: Análisis de publicaciones en español e inglés en PubMed, Scimago, ScIELO hasta abril 2021 relacionadas con esta temática. Se usaron los términos diarreas intratables, enteropatías congénitas, displasia epitelial intestinal, enteropatía en penacho y enfermedades para diagnóstico diferencial. Análisis e integración de la información: Se describieron criterios sobre diarreas intratables, enteropatías congénitas; su clasificación. Se revisaron rasgos de la displasia epitelial intestinal y sus manifestaciones de formas clínicas, histopatológicas y mutaciones genéticas, epidemiología, diagnóstico de certeza y diferencial por afecciones debido a defectos congénitos relacionados con el tránsito epitelial y polaridad; tratamiento, pronóstico y actualización sobre trascendencia de las enfermedades raras. Conclusiones: Se revisan los conocimientos más recientes relacionados con enfermedades raras por enteropatías congénitas y en particular sobre la displasia epitelial intestinal o enteropatía en penacho. Se describen sus manifestaciones clínicas, histopatológicas y genéticas. La epidemiología, el tratamiento y sus retos. Se enfatizó en criterios sobre la trascendencia diagnóstica de enfermedades raras relacionadas con enteropatías congénitas.

ABSTRACT Introduction: Intestinal epithelial dysplasia or plume enteropathy is a rare and serious disease due to genetic mutations, categorized as congenital enteropathy due to the defect of enterocyte transport and their polarity. Objective: Examine the most recent knowledge on the diagnostic orientation of congenital enteropathies in the clinical context of intractable chronic diarrhea of the postnatal period and first months of life. Methods: Analysis of publications in Spanish and English in PubMed, Scimago, ScIELO until April 2021 related to this topic. The terms intractable diarrhea, congenital enteropathies, intestinal epithelial dysplasia, plume enteropathy and diseases were used for differential diagnosis. Analysis and integration of information: Criteria on intractable diarrhea, and congenital enteropathies were described; and their classification. Features of intestinal epithelial dysplasia and its manifestations of clinical, histopathological forms and genetic mutations, epidemiology, diagnosis of certainty and differential for conditions due to congenital defects related to epithelial transit and polarity were reviewed; treatment, prognosis and update on the importance of rare diseases. Conclusions: The most recent knowledge related to rare diseases due to congenital enteropathies and in particular about intestinal epithelial dysplasia or plume enteropathy is reviewed. Its clinical, histopathological and genetic manifestations are described, epidemiology, treatment and its challenges. Emphasis was placed on criteria on the diagnostic significance of rare diseases related to congenital enteropathies.

La Vagotomía Altamente Selectiva es aún un adecuado tratamiento para la úlcera péptica duodenal / Highly Selective Vagotomy is still a suitable treatment for duodenal peptic ulcer

RESUMEN Introducción: El tratamiento de la úlcera péptica duodenal (UPD) ha cambiado radicalmente en el transcurso de los últimos 50 años debido a la efectividad del tratamiento médico. Sin embargo, la cirugía todavía tiene un importante papel en el tratamiento de la úlcera duodenal; y dentro de éste la vagotomía. Objetivo: Describir el origen y evolución de la vagotomía altamente selectiva (VAS), y su papel en el tratamiento quirúrgico de la UPD. Material y métodos: Se revisó la bibliografía publicada durante los últimos 50 años relacionada con la VAS en el tratamiento quirúrgico de la UPD. La fuente de los datos utilizados fue obtenida de Clinical Key, Pubmed, Google, Scopus y Scielo, desde 1970 hasta 2020. Desarrollo: La VAS se aplicó por primera vez en el humano en 1967 por Holle y Hart. Posteriormente, Johnston y Wilkinson y Amdrup y Jensen en 1970, informan sus resultados, conservando el píloro. La única debilidad que se le atribuye a la VAS es una alta tasa de recurrencia de la úlcera; sin embargo, su mortalidad y morbilidad son mínimas, por lo que es la intervención de elección para la úlcera duodenal intratable o complicada. Conclusiones: Debido a la disminución en la necesidad del tratamiento quirúrgico, pocos cirujanos están entrenados y experimentados en esta operación técnicamente difícil; lo que ha sido el principal factor para las altas tasas de recurrencia. Sin embargo, consideramos que la VAS tiene vigencia actual en manos de cirujanos entrenados y experimentados.

ABSTRACT Introduction: The treatment of duodenal peptic ulcer (DPU) has radically changed over the last 50 years due to success of medical treatment. However, surgery still has an important role in the treatment of duodenal ulcer; and with this, vagotomy. Objective: To describe the origin and evolution of highly selective vagotomy (HSV), as well as its role in the surgical treatment of DPU. Material and Methods: We reviewed the bibliography published during the last 50 years in relation to highly selective vagotomy (HSV). The data used were obtained from the search carried out in Clincal Key, Pumed, Google, Scopus and Scielo databases during the period 1970-2020. Development: Highly Selective Vagotomy was first performed in humans by Holle and Hart in 1967. Later, their results were informed by Johnston and Wilkinson and Amdrup and Jensen in 1970, preserving the pylorus. The only weakness attributed to HSV is a higher ulcer recurrence rate; however, mortality and morbidity are minimal, so it is the intervention of choice for intractable or complicated duodenal ulcers. Conclusions: Because of the decline in the need for surgical management, fewer surgeons are trained and and have enough experince to perform this technically challenging surgery, which has been the main factor associated with higher recurrence rates. However, we consider that HSV has a current relevance when it is performed by trained and experienced surgeons.

Metaphorical Narrative in the Context of Life and Health: Taking Intractable Diseases in Children as an Example / 中国医学伦理学

Metaphorical narrative, as a kind of image, has a remarkable effect on the research of children’s psychological intervention. It is an important way of human cognition of the world, and its essence is the cross-domain mapping between the source domain and the target domain. Taking intractable diseases in children as an example, this paper illustrated the importance of metaphorical narrative in children’s diseases narrative, life and health education, disease science popularization, diseases notification, as well as the treatment communication. This paper aimed to arouse more researchers’ attention to the metaphorical narrative, actively apply metaphorical narrative to clinical practice, guide disease subjects to eliminate fear, accept diseases, so as to achieve the doctor-patients’ vision fusion and positively cooperate with clinical treatment. Not only can an appropriate metaphor help people get out of psychological difficulties, but it can renew a healthy life story.

The assessment of fukuda stepping test results in prognosis of benign paroxysmal postural vertigo / Avaliação dos resultados do teste da marcha de Fukuda no prognóstico da vertigem posicional paroxística benigna

Abstract Introduction Benign paroxysmal postural vertigo originating from the peripheral vestibular system is characterized by brief vertigo spells triggered by the sudden head motion. Usually, vestibular dysfunction in benign paroxysmal postural vertigo is unilateral. Fukuda stepping test which is helpful in the diagnosis of unilateral vestibular dysfunction, may also be valuable in the prediction of prognosis of benign paroxysmal postural vertigo. Objective The purpose of this study is to evaluate the relevance of Fukuda stepping test results with resistant and/or recurrent benign paroxysmal postural vertigo cases. Methods We evaluated 62 patients with unilateral, idiopathic benign paroxysmal postural vertigo of posterior and/or lateral canals. The Fukuda stepping test was performed prior to the Dix-Hallpike and head-roll tests. Two groups were created according to the Fukuda stepping test results. In Group 1 Fukuda stepping test results were positive with a deviation angle >45°, while in Group 2 the results were negative with no apparent deviation. Two groups were compared by the number of canalith repositioning manuevers performed and the frequency of recurrences. Results We found Fukuda stepping test to be invaluable in the diagnosis of benign paroxysmal postural vertigo since the ratio of Fukuda stepping test positivity and negativity were similar in benign paroxysmal postural vertigo patients. However, the need for multiple canalith repositioning manuevers was significantly higher in Group 1 (p= 0.0103). In addition, the recurrence frequency was found significantly lower in the Group 2 (p= 0.0441). Conclusion Although the sensitivity of Fukuda stepping test in detecting mild/moderate unilateral vestibular dysfunction is poor, it may be valuable in prediction of the prognosis of benign paroxysmal postural vertigo. We suggest that positive Fukuda stepping test results in benign paroxysmal postural vertigo patients indicate poor prognosis, the need for multipl canalith repositioning manuevers and the higher possibility of recurrences.

Resumo Introdução A vertigem posicional paroxística benigna com origem no sistema vestibular periférico é caracterizada por breves crises de vertigem desencadeadas pelo movimento súbito da cabeça. Geralmente, a disfunção vestibular na vertigem posicional paroxística benigna é unilateral. O teste da marcha de Fukuda, útil no diagnóstico de disfunção vestibular unilateral, também pode ser valioso para prever o prognóstico da vertigem posicional paroxística benigna. Objetivo Avaliar a relevância dos resultados do teste da marcha de Fukuda em casos de vertigem posicional paroxística benigna resistente e/ou recorrente. Método Avaliamos 62 pacientes com vertigem posicional paroxística benigna unilateral idiopática dos canais posterior e/ou lateral. O teste da marcha de Fukuda foi feito antes dos testes de Dix‐Hallpike e head‐roll (giro da cabeça). Dois grupos foram criados de acordo com os resultados do teste de Fukuda. No Grupo 1, os resultados do teste de Fukuda foram positivos com um ângulo de desvio > 45°, enquanto no Grupo 2 os resultados foram negativos sem desvio aparente. Dois grupos foram comparados pelo número de manobras de reposicionamento canalicular feitas e pela frequência de recorrências. Resultados Observamos que o teste de Fukuda é inestimável no diagnóstico de vertigem posicional paroxística benigna, pois a relação entre a positividade e a negatividade do teste de Fukuda foi semelhante nos pacientes com vertigem posicional paroxística benigna. No entanto, a necessidade de múltiplas manobras de reposicionamento canicular foi significantemente maior no Grupo 1 (p = 0,0103). Além disso, a frequência de recorrência encontrada foi significantemente menor no Grupo 2 (p = 0,0441). Conclusão Embora a sensibilidade do teste de Fukuda para detectar disfunção vestibular unilateral leve/moderada seja baixa, o teste pode ser valioso na previsão do prognóstico de vertigem posicional paroxística benigna. Sugerimos que os resultados positivos do teste da marcha de Fukuda em pacientes com vertigem posicional paroxística benigna indicam mau prognóstico, necessidade de múltiplas manobras de reposicionamento canicular e maior possibilidade de recorrências.

Cervical Cordotomy in Terminal Cancer: Pain Relieving in Oncological Treatment

Cordotomy consists in the discontinuation of the lateral spinothalamic tract (LST) in the anterolateral quadrant of the spinal cord, which aims to reduce the transference of nociceptive information in the dorsal horn of the gray matter of the spinal cord to the somatosensory cortex. The main indication is for patients with terminal cancer that have a low life expectancy. It improves the quality of life by relieving pain. The results are promising and the pain relief rate varies between 69 and 100%. Generally speaking, the complications are mostly temporary and not remarkable.

The role of the purinergic system in the acupuncture-induced analgesia / O papel do sistema purinérgico na analgesia induzida pela acupuntura

ABSTRACT BACKGROUND AND OBJECTIVES: Musculoskeletal disorders and acute and chronic pain are the main causes of disability. Acupuncture is a safe and well-tolerated treatment, and the understanding of the physiological basis of its effectiveness in the management of acute and chronic painful conditions is growing. The objective of this study was to describe the main components of the purinergic system involved in the acupuncture-mediated analgesia. CONTENTS: Review the literature relevant to the terms "acupuncture", "purinergic system", "purines", "pain" and "analgesia" found on the Pubmed platform. CONCLUSION: Several previous studies have shown relevant roles of purines and their derivatives on acupuncture-mediated analgesia, displaying promising results in the knowledge of the potential biological benefits of acupuncture. New experimental and clinical studies are warranted to further investigate the purinergic mechanisms involved in the acupuncture-mediated analgesia, addressing potential therapeutic benefits of acupuncture in different clinical settings.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os distúrbios musculoesqueléticos e a dor aguda e crônica são as principais causas de incapacidade. A acupuntura é um tratamento seguro e bem tolerado, e o entendimento sobre a base fisiológica de sua eficácia para o tratamento de quadros dolorosos agudos e crônicos está crescendo. O objetivo deste estudo foi descrever os principais componentes do sistema purinérgico envolvidos na analgesia mediada pela acupuntura. CONTEÚDO: Revisar a literatura pertinente aos temas "acupuntura", "sistema purinérgico", "purinas", "dor" e "analgesia" encontrados na plataforma Pubmed. CONCLUSÃO: Diversos estudos prévios têm evidenciado efeitos relevantes das purinas e seus derivados na analgesia mediada pela acupuntura, demonstrando resultados promissores no conhecimento dos potenciais benefícios biológicos da acupuntura. A ampliação da investigação dos mecanismos purinérgicos envolvidos na acupuntura deverá ser garantida por meio de novos estudos experimentais e clínicos, abordando potenciais benefícios terapêuticos da acupuntura em diversos cenários clínicos.

Trigeminal neuralgia recurrence: a comparison of microvascular decompression and percutaneous balloon compression: a five years follow-up study / Neuralgia do trigêmeo recorrente: uma comparação entre descompressão microvascular e compressão percutânea por balão: um estudo de acompanhamento de cinco anos

ABSTRACT Background: About 50% of patients that suffer from trigeminal neuralgia do not experience sustained benefit from the use of oral medication. For their adequate management, a few surgical procedures are available. Of these, percutaneous balloon compression (PBC) and microvascular decompression (MD) are two of the most performed worldwide. In this retrospective study, we present the outcomes of these techniques through estimation of initial pain relief and subsequent recurrence rate. Methods: Thirty-seven patients with medically refractory trigeminal pain surgically treated at Hospital Cajuru, Curitiba, Brazil, with PBC, MD or both between 2013 and 2018 were enrolled into this retrospective study. The post-procedural rate for pain relief and recurrence and associations between patient demographics and outcomes were analyzed. Results: MD had an earlier recurrence time than balloon compression. Of the 37 patients, the mean age was 61.6 years, approximately one third were male and most had type I neuralgia. The most affected branch was the maxillary (V2). The time for recurrence after surgery was on average 11.8 months for PBC and 9.0 months for MD. Complications were seen only with microsurgery. Conclusions: MD presented with a more precocious recurrence of pain than PBC in this article. Moreover, it had a higher recurrence rate than described in the literature as well, which is possibly explained by the type of graft (muscle) that was used to separate the neurovascular structures.

RESUMO Introdução: Cerca de 50% dos pacientes com neuralgia do trigêmeo não apresenta benefícios a longo prazo com o uso de medicação oral. Para a manutenção do tratamento, algumas opções cirúrgicas estão disponíveis, sendo a compressão percutânea por balão (CPB) e a descompressão microvascular (DM) algumas das modalidades mais realizadas em todo o mundo. Neste estudo retrospectivo, apresentamos os desfechos dessas técnicas por meio de estimativa da melhora inicial da dor e da taxa de recorrência subsequente. Métodos: Trinta e sete pacientes com dor trigeminal refratária ao tratamento medicamentoso tratados cirurgicamente no Hospital Cajuru, Curitiba, Brasil, com CPB, DM ou ambos entre 2013 e 2018 foram incluídos neste estudo retrospectivo. A taxa pós-procedimento para alívio e recorrência da dor e suas associações com a demografia e desfechos dos pacientes foram analisadas. Resultados: A DM foi associada a menor recorrência que a compressão por balão. Entre os 37 pacientes, a idade média foi de 61,6 anos, aproximadamente um terço eram do sexo masculino e a maioria apresentava neuralgia do tipo I. O ramo mais afetado foi o maxilar (V2). O tempo de recorrência após a cirurgia foi em média de 11,8 meses para CPB e 9,0 meses para DM. Foram vistas complicações apenas na microcirurgia. Conclusões: A DM apresentou recidiva mais precoce da dor em comparação à CPB. Além disso, apresentou uma taxa de recorrência mais alta do que a descrita na literatura, o que é possivelmente explicado pelo tipo de enxerto (músculo) usado para separar as estruturas neurovasculares.

Bibliometric analysis of refractory facial paralysis based on CNKI database / 中国针灸

The current development situation and the hotspot of the relevant research on refractory facial paralysis are explored. The articles on refractory facial paralysis are retrieved from CNKI database. The bibliographic items co-occurrence matrix builder (BICOMB) 2.0 is adopted to extract and analyze statistically literature characteristics and generate the high-frequency keywords matrix. The graphical clustering toolkit (gCLUTO) 1.0 is used to cluster the high-frequency keywords. A total of 750 articles are included, mostly published in

Research progress on the outcome of hypersplenism after liver transplantation for liver cirrhosis / 中华肝胆外科杂志

Hypersplenism is the most common splenic disease and usually refers to a clinical syndrome of increased splenic size and/or cytopenia due to various causes. Hypersplenism is most often secondary to cirrhotic hypertension. Liver transplantation can effectively relieve hypersplenism in patients with liver cirrhosis, but there are also some patients with persistent hypersplenism after liver transplantation or recurrence after remission. Other treatment modalities for postoperative intractable hypersplenism include splenectomy and partial splenic artery embolization. This article reviews the research progress of hypersplenism after liver transplantation for liver cirrhosis with hypersplenism.

A Case Report on Effect of Asenapine Sublingual Tablets on Intractable Nausea in a Patient of Terminal Malignant Lymphoma with Diabetes Who Cannot Take Oral Medicine

Introduction: We report a case of intractable nausea of a terminal malignant lymphoma patient with diabetes, which improved by sublingual administration of asenapine. Case: A 78-year-old man suffering from diffuse large B-cell lymphoma with diabetes presented intractable nausea and vomiting. Those symptoms were thought to be due to masses and nodules in the right frontal lobe and the cerebellum, and/or due to edema in the peripheral brain parenchyma. Because it was difficult to take medicines orally, we selected injections to control those symptoms. However, the combination of metoclopramide, haloperidol, and hydroxyzine injections failed to relieve nausea. Olanzapine is effective against nausea but is contraindicated for diabetic patients, so asenapine, one of the multi-acting receptor-targeted antipsychotics the same as olanzapine, was expected alternatively. The patient was administrated asenapine sublingually 5mg once a day before bedtime. This administration of asenapine remarkably improved his nausea. Discussion: Sublingual asenapine dose may be an effective therapeutic option for intractable nausea.

A study of clinical profile of intractable epilepsy in children

Background: This study was undertaken to find out the prevalence and clinical features of intractable epilepsy (IE) in a tertiary referral center.Methods: Study was conducted in a tertiary care hospital on 60 children with intractable epilepsy. Cases includes' intractable epilepsy is when seizures continue to occur despite maximally tolerated doses of more than two antiepileptics, occurrence of an average of one seizure per month for 18 months with no more than a 3 month seizure free period during these 18 months. Controls: epileptic children who had good control of seizures for the previous 18 months.Results: The prevalence of intractable seizures was 10% with maximum number of children 25 (41.6%) belonged to the 5-12 years. 15 (50%) children had daily seizures. Myoclonic seizures proved to be an important predictor of intractability. 4 children among the cases had history of family seizures, 6 children in cases had history febrile seizure, whereas, 6 children among the controls had history of family seizures, 8 children in controls had history febrile seizure.' 23.3% of children presented with Status epilepticus in the cases and 16.6% of the children in the controls. Remote symptomatic etiology 12(40%) is the commonest cause of seizure. 13 (43.3%) children in cases and 3 (10%) children among the controls had a history suggestive of birth asphyxia. EEG was abnormal in 17 (56.6%) cases when compared to 11 (36.6%) children in the controls. CT scan was abnormal in 14 (46.6%) cases and 10 (33.3%) controls. MRI was abnormal in 16 (53.3%) children of the cases and 8 (26.6%) children of the controls.Conclusions: The commonest cause of intractable epilepsy was perinatal asphyxia. Perinatal asphyxia can be prevented by good nutrition during pregnancy, regular antenatal check ups with detection of high risk pregnancy, promoting hospital deliveries and prompt resuscitation of newborn when required.

Intractable epilepsy, growth failure, hypothyroidism, and cataract: rare clinical manifestations in a patient with ring chromosome 20 syndrome

@#Ring chromosome 20 [r(20)] syndrome is typically characterized by intractable epilepsy, variable degrees of behavior problems and cognitive deficits, and an absence of or minimal dysmorphic features. Here we report a case diagnosed with r(20) syndrome exhibiting rare clinical manifestations of intractable epilepsy, growth failure, hypothyroidism, and cataract. This 17-year-old female patient who showed growth failure and no dysmorphic features had the first seizure at the age of 8 years. The seizure pattern was described as periods of non-convulsive status epilepticus with prolonged confusional state, motionless stare, mutism, and subtle motor seizures, lasting for minutes to hours. The interictal EEG showed bilateral synchronous, rhythmic high voltage delta waves intermixed with occasional spikes over the bilateral frontal areas. The seizures were refractory to medical treatments. Hypothyroidism and cataract were subsequently diagnosed at the age of 16 years and 17 years, respectively. Chromosome study showed a female genome with r(20) mosaicism. In conclusion, r(20) syndrome might cause multisystemic involvement, and therefore, comprehensive surveys of the central nervous system, ophthalmologic system, and endocrine system, among others, are crucial.

Treatment of radiation-induced brachial plexopathy with omentoplasty

Radiation-induced brachial plexus neuropathy (RIBPN) is a rare and delayed non-traumatic injury to the brachial plexus, which occurs following radiation therapy to the chest wall, neck, and/or axilla in previously treated patients with cancer. The incidence of RIBPN is more common in patients treated for carcinoma of the breast and Hodgkin lymphoma. With the improvement in radiation techniques, the incidence of injury to the brachial plexus following radiotherapy has dramatically reduced. The currently reported incidence is 1.2% in women irradiated for breast cancer. The progression of symptoms is gradual in about two-thirds of cases; the patients may initially present with paresthesia followed by pain, and later progress to motor weakness in the affected limb. We present the case of a 68-year-old female patient with breast cancer submitted to surgery, chemotherapy, and radiotherapy in the year 2000. Eighteen years later, she developed symptoms and signs compatible with RIBPN and was successfully submitted to omentoplasty for pain control. Omentoplasty is an alternative treatment for RIBPN refractory to conservative treatment, which seems to be effective in improving neuropathic pain. However, postoperative worsening of the motor strength is a real possibility, and all candidates for this type of surgery must be informed about the risk of this complication.