ABSTRACT
Uromodulin kidney disease (UKD) is a subtype of autosomal dominant tubulointerstitial kidney disease (ADTKD), and is a rare cause of renal failure and gout in young people. Although it is inherited in an autosomal dominant fashion, the gene mutation exhibits variable expressivity so the phenotype varies dramatically among affected individuals. While it is rare, it is important for physicians in the primary care setting to be able to recognize the disorder, initiate proper workup, and refer patients to nephrology teams that are equipped to manage the long-term needs of these patients. Eventually, most will progress to renal failure with necessary renal dialysis or kidney transplant. Kidney transplant is curative as the new kidney does not have the defective tubule cell gene. The case series that follows highlights the variable presentations of the disorder among members of the same family and the necessary long-term follow-up that will often be handled by the primary care provider in conjunction with the specialist team.
ABSTRACT
Spinal fusion surgery is a major surgery that results in severe postoperative pain, therefore pain reduction is a primary concern. New strategies for pain management are currently under investigation and include multimodal treatment. A 3-year retrospective analysis of patients with idiopathic scoliosis undergoing spinal fusion surgery was performed at our hospital, assessing patient pain scores, opioid use, and recovery. We evaluated the effect of adding continuous infusion of local anesthetics (CILA) to a postoperative pain management protocol that includes intraoperative intrathecal morphine, as well as postoperative patient-controlled analgesia and oral opioid/acetaminophen combination. The study compared 25 patients treated according to the standard protocol, with 62 patients treated with CILA in addition to the pain management protocol. Patients in the CILA group used nearly 0.5 mg/kg less opioid analgesics during the first 24 hours after surgery.
ABSTRACT
Resistant tennis elbow has been an enigma for orthopaedic surgeons. Several treatment methods have been suggested. We assessed the outcome of open release in the management of resistant tennis elbows, based on patient satisfaction. Eighteen patients (24 elbows) who underwent open release were followed up. Surgery was done after a mean waiting time of 23 months from the onset of pain and an unsuccessful trial of non operative methods. Post operatively they were followed up for clinical improvement and complications. They were later contacted to assess effectiveness from the surgery. In fifteen patients (83%) excellent pain relief was achieved and they regained normal use of the limb. One patient (6%) had moderate improvement and two (11%) gained minimal benefit with persistent symptoms. There were no complications in this series. We conclude that despite recent advances, this time tested procedure still remains an excellent option when non-operative management has failed.
