Web Browsing: High-Speed Diagnosis and Treatment of Carotid Artery Web.

Background: Although carotid artery web (CaW) was initially described in 1973 as a potential etiology of ischemic stroke, it still remains underrecognized. Because CaW is a membrane affixed perpendicularly from the carotid wall that projects out into the lumen above the bifurcation, it typically is not stenotic, and hence, utilizing only 1 vessel imaging modality during conventional stroke workup may instead lead to a diagnosis of ESUS: embolic stroke of undetermined source. The term ESUS was created in 2014 by researchers to define a subset of cryptogenic, nonlacunar (embolic-appearing) strokes without clear cardiac or vascular cause. Purpose: In this review, we describe how, after multiple evaluations of vessels, CaW was diagnosed in relatively young patients (age 39-47 years old, without significant vascular risk factors) in whom otherwise were considered embolic stroke of undetermined source. This observation dovetails with the accompanying Neurohospitalist article entitled, "Delayed Thrombus Formation on Carotid Web and Its Medical and Endovascular Management for Secondary Stroke Prevention." Research Design: Not applicable. Case review. Results/Conclusion: This report demonstrates the futility of antiplatelet therapy for a young patient with CaW-related stroke. Based on these collective experiences and review of the literature, we postulate that: (1) multiple vascular imaging modalities during stroke workup may result in a CaW diagnosis instead of ESUS; (2) young stroke patients without traditional vascular risk factors are candidates for this "web browsing" of extended imaging of vessels; and (3) carotid artery stenting (CAS) or carotid endarterectomy (CEA) may be preferred as first-line over medical therapy alone (ie, antiplatelet or anticoagulation) because CEA/CAS addresses the stroke etiology, CaW, definitively.

Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders.

AIMS: To investigate the effects of dry needling over active trigger points (TrPs) in the masseter muscle in patients with temporomandibular disorders (TMD). METHODS: Twelve females, aged 20 to 41 years old (mean = 25, standard deviation +/- 6 years) diagnosed with myofascial TMD were recruited. Each patient attended two treatment sessions on two separate days and received one intervention assigned in a random fashion, at each visit: deep dry needling (experimental) or sham dry needling (placebo) at the most painful point on the masseter muscle TrP. Pressure pain threshold (PPT) over the masseter muscle TrP and the mandibular condyle and pain-free active jaw opening were assessed pre- and 5 minutes postintervention by an examiner blinded to the treatment allocation of the subject. A two-way repeated-measures analysis of variance (ANOVA) with intervention as the between-subjects variable and time as the within-subjects variable was used to examine the effects of the intervention. RESULTS: The ANOVA detected a significant interaction between intervention and time for PPT levels in the masseter muscle (F = 62.5; P < .001) and condyle (F = 50.4; P < .001), and pain-free active mouth opening (F = 34.9; P < .001). Subjects showed greater improvements in all the outcomes when receiving the deep dry needling compared to the sham dry needling (P < .001). CONCLUSION: The application of dry needling into active TrPs in the masseter muscle induced significant increases in PPT levels and maximal jaw opening when compared to the sham dry needling in patients with myofascial TMD.

Bilateral widespread mechanical pain sensitivity in women with myofascial temporomandibular disorder: evidence of impairment in central nociceptive processing.

UNLABELLED: Our aim was to investigate bilateral, widespread pressure-pain hypersensitivity in nerve, muscle, and joint tissues in women with myofascial temporomandibular disorders (TMD) without concomitant comorbid conditions. Twenty women with myofascial TMD (aged 20 to 28 years old), and 20 healthy matched women (aged 20 to 29 years), were recruited. Pressure-pain thresholds (PPT) were bilaterally assessed over supra-orbital (V1), infra-orbital (V2), mental (V3) nerves, median (C5), radial (C6) and ulnar (C7) nerve trunks, the C5-C6 zygapophyseal joint, the lateral pole of the temporo mandibular joint (TMJ), and the tibialis anterior muscle in a blinded design. The results showed that PPTs were significantly decreased bilaterally over the supra-orbital, infra-orbital, and mental nerves, median, ulnar, and radial nerve trunks, the lateral pole of the TMJ, the C5-C6 zygapophyseal joint, and the tibialis anterior muscle in patients with myofascial TMD as compared to healthy controls (all sites: P < .001). There were no significant differences in the magnitude of PPT decreases between the trigeminal and extratrigeminal test sites. PPT over the mental nerve, the TMJ, C5-C6 zygapophyseal joint and tibialis anterior muscle were negatively correlated to both duration of pain symptoms and TMD pain intensity (P < .05). Our findings revealed bilateral, widespread pressure hypersensitivity in women presenting with myofascial TMD, suggesting that widespread central sensitization is involved in myofascial TMD women. PERSPECTIVE: This article reveals the presence of bilateral and widespread pressure-pain hypersensitivity in women with myofascial TMD, suggesting that widespread central sensitization is involved in myofascial TMD. This finding has implications for development of management strategies.

Efectos de anéstesicos locales en el dolor postoperatorio en la cirugía de los terceros molares inferiores incluidos / No disponible

Se realizó un estudio comparativo en una muestra de 120 pacientes, para valorar el posible efecto de dos anestésicos, en el dolor postoperatorio de las intervenciones de cordales inferiores incluidos. La mitad de la población intervenida fue anestesiada con articaína y la otra mitad con lidocaína. A cada paciente se le rellenó una ficha estudiándose el tiempo de latencia, duración y profundidad del anestésico empleado, así como el número de analgésicos tomados el día de la intervención. Los resultados obtenidos fueron: Tiempo de Latencia de 1 minuto 21 segundos con lidocaína frente a 59 segundos con articaína. Profundidad de la Anestesia de 2 horas 8 minutos con lidocaína frente a 3 horas 8 minutos con articaína. Duración de la Anestesia de 3 horas 38 minutos con lidocaína frente a 3 horas 55segundos con articaína. No se encontraron diferencias significativas en el número de analgésicos tomados por los pacientes de los dos grupos (AU)

A comparative study of a sample of 120 patients was carried out, to calculate the possible effect of two an aesthetics in the postoperative pain after surgical removal of lower third molars. These patients were separated in two groups at random: a lidocaine group and an articaine group. A record card to each patient was filled in with the latency time, depth of action and the duration of anaesthetics data. Also, the amount of analgesic consumed in the day of the surgery was recorded. The results were: latency time of 1 minute 21 seconds with lidocaine versus 59 seconds with articaine. Depth of action of 2hours 8 minutes with lidocaine versus 3 hours 8 minutes with articaine. Duration of anaesthetic of 3 hours 38 minutes with lidocaine versus3 hours 55 seconds with articaine. There were no significant differences in the number of analgesics consumed in the day of the surgery (AU)