The role of mesotherapy in the management of spinal pain. A randomized controlled study.

Background: Mesotherapy is a technique through which active ingredients are administered into the thickness of the skin in order to increase the local analgesic effect. Methods: 141 patients with spinal pain not responding to systemic therapy with NSAIDs were randomized to receive one or more intra-cutaneous drugs on a weekly basis. Results: All patients achieved a pain reduction of at least 50% compared to baseline, and all tolerated the therapy without having to resort to systemic drug dose increases. Conclusions: The data from our study show that the active ingredients infiltrated into the skin induce a mesodermal modulation between the infiltrated liquid and the cutaneous nervous and cellular structures from which the typical drug-saving effect of mesotherapy arises. Although further studies are needed to establish how to integrate mesotherapy in various clinical settings, it appears to be a useful technique available to the practicing physician. This research is also useful in guiding future clinical research.

Intradermal therapy (mesotherapy): the lower the better.

BACKGROUND: Intradermal therapy (mesotherapy) is a technique used to inject drugs into the surface layer of the skin. The intradermal micro deposit allows to modulate the kinetics of drugs, slowing down its absorption and prolonging the local mechanism of action. This technique is applied in the treatment of some forms of localized pain when a systemic drug-saving effect is useful, when it is necessary to synergize with other pharmacological or non-pharmacological thera-pies, when other therapies have failed or cannot be used. AIM: The purpose of our study was to evaluate the effect of a mixture with respect to its lower concentration. We also wanted to evaluate the number of sessions needed to reach the therapeutic goal (50% reduction in pain from baseline) in patients with acute or chronic neck pain. METHOD: We analyzed retrospectively data from 62 patients with cervicobrachial pain treated with intradermal drugs. Group A received a mixture of drugs; group B received half the dose of drugs. RESULTS: Patients who received a lower concentration of drugs achieved similar results to those who received a higher dose. The therapeutic goal was achieved on average with 3.5 + 1.7 sessions on a weekly basis (min 1; max 9). Subjects in group A required 4+1.7 treatments (min 1; max 9), while subjects in group B required 3+1.5 treatments (min 1; max 7). CONCLUSIONS: Our study confirms that even a lower dose of drugs can induce a clinically useful result. This study confirms that the useful effect of mesotherapy is only partly due to the pharmacological action. Further randomized prospective studies are needed to standardize the technique in the various pain syndromes, but it is recommended to follow the guidelines of the Italian Society of Mesotherapy to ensure patients receive appropriate treatment.

Evidence based recommendations on mesotherapy: an update from the Italian society of Mesotherapy.

INTRODUCTION: Mesotherapy, also known as local intradermal therapy, widely used all over the world, is a technique used to inject substances into the surface layer of the skin. There are no international guidelines for the correct use of this technique and in many countries, it is still applied empirically without valid patient consent. The Italian society of mesotherapy has planned a study to assess the rationale and clinical applications based on current evidence. METHODS: An independent steering committee, based on the available scientific literature, has formulated a series of clinical questions. 21 experts responded by writing an evidence-based document. From this document 30 statements were obtained which were presented to 114 experts using the Delphi method. RESULTS: 28 statements reached a broad agreement on definition, technique, pharmacological rationale, indications and some crucial ethical aspect. CONCLUSIONS: Although further studies are needed to establish the clinical role of this technique in each field of application, our statements recommend the correct application according to the needs of the individual patient in full respect of ethics.

"Klingon headache" - a case report of mimic new daily persistent headache associated to primary essential cutis verticis gyrata.

BACKGROUND: Primary essential cutis verticis gyrata is a condition that usually affects healthy subjects associated to convoluted folds and furrows formed from thickened skin of the scalp resembling cerebriform pattern. CASE: we describe a case of association between primary essential cutis verticis gyrata and new daily persistent headache. DISCUSSION/CONCLUSIONS: In our knowledge this is the first description of new daily persistent headache associated with primary essential cutis verticis gyrata. We think that primary essential cutis verticis gyrata could be considered as a possible trigger factor, never described before, for the development of new daily persistent headache.

Errors in Medicine: perception of healthcare professionals in the Lazio Region.

INTRODUCTION: The error in medicine is always the subject of debate in the scientific debates. The purpose of this study is to evaluate the degree knowledge, attitudes and behaviors of health workers towards the error in the health sector. METHODS: A survey was carried out involving 435 health profes- sionals working in health facilities of the Lazio region, of which 312 females (71%) and 123 males (28%) with an age between 21 and 68 years. A structured questionnaire was administered for investigating the experiences and opinions about the errors found in medical prac- tice, the causes underlying them and the mistakes that should never be committed. Data were collected, stratified by sex, age, marital status, year of graduation, years of service and the workplace (medical or surgical). The statistical significance was set at p≤0.05. RESULTS: The 5 errors found more frequently in the clinical prac- tice by health professionals were as follows: errors related to the request for examination (60.9%); errors in the collection of samples (37.5%); errors relating to the delivery of the reports (35.2%); errors due to reporting of examinations (31.7%); errors of history (29.2%). The five cases considered to be the most frequently responsible for such errors were: disorganization (52%); fast (46.4%); tiredness due to excessive workloads, stress (44.6%); negligence and carelessness (41.6%); inattention (41.1). With regard to the errors that you should never commit they were more frequently: exchange of patient or misidentification of the patient (49.2%); administration errors of therapies or medications (47.6%); errors related to surgery (41.6%); errors of prescription therapies or medications (39.3); errors in the reporting of exams (33.6%). CONCLUSIONS: The results of this study shows the importance of a culture of error in medicine among healthcare professionals, those who have already gained practical experience in health care and therefore better able to perform a critical analysis and evaluation of the errors that occur every day. The continuous training of health professionals is fundamental for promoting patient safety and quality in the healthcare sector.

Anaesthesia for caesarean section in a Marfan patient with recurrent aortic dissection.

PURPOSE: We report the anaesthetic management of a 34-yr-old pregnant woman with recurrent aortic dissection and Marfan syndrome for Caesarean section. CLINICAL FEATURES: She presented at 28 wk gestation with recurrent aortic dissection and had undergone aortic valve replacement and coronary ostia reimplantation (Bentall procedure) in the first trimester of pregnancy. She was treated in hospital with labetalol, anticoagulants and steroids and daily echocardiographic examination until 34 wk when caesarean section was planned. After positioning radial artery and CVP catheters and a transoesophageal echocardiographic probe, general anaesthesia was induced with thiopentone and maintained with isoflurane, and endotracheal intubation was facilitated with vecuronium. The site of incision was infiltrated with lidocaine before surgery which was uneventful. The patient was discharged at 10 days. CONCLUSIONS: With appropriate preoperative care and monitoring, uneventful general anaesthesia for caesarean section was achieved in a patient with Marfan syndrome in the presence of recurrent aortic dissection.

[Propofol for the induction and maintenance of anesthesia in ophthalmic surgery]. / Il propofol come ipnoinduttore e agente di mantenimento nell'anestesia per l'oftalmochirurgia.

After brief mention of the chemical and pharmacodynamic properties of diisopropylphenol, personal experience on the administration of propofol for induction and maintenance of anaesthesia for ophthalmic surgery is reported. The results have shown that induction of anaesthesia by propofol injection is associated with a significant and useful reduction of IOP more than TPS induction. Continuous infusion of Diprivan provides satisfactory conditions for intraocular surgery and could be a real choice to thiopentone combined with enflurane.