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1.
Pain Pract ; 14(6): 577-80, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24433360

ABSTRACT

Cervical radicular pain presents itself as pain radiating from the neck to the arm. If conservative treatment fails, a cervical epidural steroid injection can be considered. A rare but possible complication resulting from the interlaminar approach is unintentional cervical dural puncture that may result in post-dural puncture headache (PDPH). Dural puncture from an interlaminar cervical epidural injection reportedly range from 0.25% to 2.65%. An epidural blood patch is a possible treatment option when conservative treatment fails. Relief could be secondary to 'sealing' of the dural tear from the clotted blood and reestablishment of physiological intracranial pressure. Another theory is an increase in the subarachnoid pressure from the injected blood. The increased pressure may restore normal intracranial pressure. We describe 2 cases of cervical PDPH treated with lumbar epidural blood patch. In 1 case, there was complete resolution of the symptoms and in the other case, there was great improvement of symptoms and a high thoracic blood patch was performed to resolve the remaining headache.


Subject(s)
Blood Patch, Epidural , Dura Mater/injuries , Post-Dural Puncture Headache/therapy , Adult , Cervical Vertebrae , Female , Humans , Lumbosacral Region , Male , Post-Dural Puncture Headache/physiopathology , Thoracic Vertebrae , Treatment Outcome
2.
Pain Pract ; 11(5): 492-505, 2011.
Article in English | MEDLINE | ID: mdl-21676159

ABSTRACT

Chronic pancreatitis is defined as a progressive inflammatory response of the pancreas that has lead to irreversible morphological changes of the parenchyma (fibrosis, loss of acini and islets of Langerhans, and formation of pancreatic stones) as well as of the pancreatic duct (stenosis and pancreatic stones). Pain is one of the most important symptoms of chronic pancreatitis. The pathogenesis of this pain can only partly be explained and it is therefore often difficult to treat this symptom. The management of pain induced by chronic pancreatitis starts with lifestyle changes and analgesics. For the pharmacological management, the three-step ladder of the World Health Organization extended with the use of co-analgesics is followed. Interventional pain management may consist of radiofrequency treatment of the nervi splanchnici, spinal cord stimulation, endoscopic stenting or stone extraction possibly in combination with lithotripsy, and surgery. To date, there are no randomized controlled trials supporting the efficacy of radiofrequency and spinal cord stimulation. The large published series reports justify a recommendation to consider these treatment options. Radiofrequency treatment, being less invasive than spinal cord stimulation, could be tested prior to considering spinal cord stimulation. There are several other treatment possibilities such as endoscopic or surgical treatment, pancreatic enzyme supplementation and administration of octreotide and antioxidants. All may have a role in the management of pain induced by chronic pancreatitis.


Subject(s)
Pain Management/methods , Pain/etiology , Pancreatitis, Chronic/complications , Pancreatitis, Chronic/therapy , Algorithms , Analgesics/therapeutic use , Anesthesia , Chronic Disease , Enzyme Replacement Therapy , Evidence-Based Medicine , Humans , Life Style , Nerve Block , Pain/diagnosis , Pain/epidemiology , Pancreatic Function Tests , Pancreatitis, Chronic/epidemiology , Physical Examination , Treatment Outcome
4.
Ann Thorac Surg ; 77(5): 1841-3, 2004 May.
Article in English | MEDLINE | ID: mdl-15111207

ABSTRACT

A 64-year-old man presented with clinical features and echocardiographic diagnosis of an acute type A dissection. He underwent median sternotomy for definitive surgical treatment. On external examination of the aorta, other intrapericardial structures, and the right lung, it was evident that the patient had an advanced lung tumor. This was confirmed by frozen-section and histopathologic examinations. Epiaortic scanning showed beyond doubt the presence of a mobile intraaortic mass that had misled us in making the preoperative diagnosis of an acute type A dissection.


Subject(s)
Adenocarcinoma/diagnosis , Aortic Aneurysm, Thoracic/diagnosis , Aortic Dissection/diagnosis , Lung Neoplasms/diagnosis , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Aged , Aortic Dissection/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnostic imaging , Fatal Outcome , Frozen Sections , Humans , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Ultrasonography
5.
Eur J Cardiothorac Surg ; 21(3): 564-5, 2002 Mar.
Article in English | MEDLINE | ID: mdl-11888787

ABSTRACT

Mediastinal lipomatosis is a rare benign condition characterized by a large amount of mature adipose tissue in the mediastinum. We present the case of an 86-year-old male who was admitted to the hospital for analysis of his progressive dyspnea. After careful examination, the patient was diagnosed with severe aortic valve stenosis and extensive mediastinal lipomatosis. This rare coincidence of aortic valve disease and mediastinal lipoma was treated by aortic valve replacement and an extensive debulking procedure.


Subject(s)
Aortic Valve Stenosis/complications , Lipomatosis/complications , Mediastinal Diseases/complications , Aged , Aged, 80 and over , Aortic Valve Stenosis/surgery , Heart Valve Prosthesis Implantation , Humans , Lipomatosis/diagnostic imaging , Lipomatosis/surgery , Male , Mediastinal Diseases/diagnostic imaging , Mediastinal Diseases/surgery , Radiography
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