ABSTRACT
Entrapments of the intrapelvic portions of the lumbosacral plexus are an important extraspinal cause of sciatica and pudendal neuralgia. They can be treated using Laparoscopic Neuronavigation (LANN), a minimally invasive technique that has set the foundations of an emerging field in Medicine-Neuropelveology. This retrospective-prospective study analyzes the outcomes of 63 patients treated with the LANN technique over a 10 year time period. One year after surgery, 78.3% of patients reported clinically relevant pain reduction, defined as ≥ 50% reduction in Numeric Rating Scale (NRS) score; these results were maintained for a mean follow up of 3.2 years. Preoperative chronic opioid use (≥ 4 months of ≥ 10 mg morphine equivalents/day) was a predictor of poor surgical outcome-clinically relevant pain reduction was observed in only 30.8% in this group of patients, compared to 91.5% in patients not regularly taking opioids preoperatively (p < 0.01). Perioperative complication rate was 20%. Our results indicate that the LANN technique is an effective and reproducible approach to relieve pain secondary to intrapelvic nerve entrapments and that preoperative chronic opioid therapy significantly reduces the likelihood of a successful surgical outcome. This study provides detailed information on perioperative complication and postoperative course, which is essential for patient consenting.
Subject(s)
Analgesics, Opioid/administration & dosage , Decompression, Surgical/methods , Nerve Compression Syndromes/surgery , Pudendal Neuralgia/therapy , Sciatica/therapy , Adult , Analgesics, Opioid/therapeutic use , Female , Humans , Laparoscopy , Male , Middle Aged , Nerve Compression Syndromes/complications , Neuronavigation , Pain Measurement , Prospective Studies , Pudendal Neuralgia/etiology , Retrospective Studies , Sciatica/etiology , Treatment OutcomeABSTRACT
O teratoma congênito de orofaringe é o tipo mais raro de teratoma, compreendendo apenas 2 por cento desses tumores fetais. O diagnóstico deve ser realizado o mais precocemente possível, preferencialmente durante o pré-natal. O prognóstico irá depender do tamanho e localização da lesão, da velocidade de crescimento desta, do envolvimento de estruturas intracranianas e da ressecção adequada do tumor com equipe multidisciplinar. Relatamos o caso de uma paciente que teve diagnosticado durante a gestação feto com teratoma congênito de orofaringe (epignathus) por meio de ultra-sonografia. O feto evoluiu para óbito intra-uterino na 29ª semana de gestação, sendo então induzido o parto por via vaginal. O exame anatomopatológico revelou feto do sexo feminino, compatível com 27-28 semanas, teratoma orofaríngeo e outras malformações congênitas
Subject(s)
Humans , Female , Pregnancy , Adult , Fetal Diseases , Oropharyngeal Neoplasms/diagnosis , Teratoma , Fetal Diseases/diagnosis , Fetus , OropharynxABSTRACT
The immunological aspects of urinary tract infection are of great importance in patients with recurrent episodes. Host factors such as immune response to uropathogens and increased susceptibility are reported. The authors describe pathogenic aspects of bacteria, including determinants of aggressiveness and interactions with normal bacterial flora. Initial efforts with vaccines to prevent the recurrence of infection are also considered.
