The Genesis of Multidisciplinary Health Professionals Teams for Pain Management. A History from the Hellenic Antiquity to Modern Palliative Medicine.

The aim of our article is to highlight the history of pain management. The multidisciplinary team (MDT) concept in confronting pain was first conceptualized by the Hippocratics, and has evolved through time and become a trend in medicine over recent decades. Documentary research was conducted to unveil the story of the evolution of MDTs. From the early 1950's the idea of an MDT approach to deal with various types of pain was sporadically introduced in medicine. Studies encouraged health institutions to support this concept by providing health professionals with training, alongside the necessary facilities and resources. Specialized care programs started with Dame Cicely Mary Strode Saunders as one of the pioneers. CONCLUSIONS: Team work and continuous interdisciplinary treatment of pain have rendered MDTs essential for health systems. Barriers in flexibility, information flow and personal issues give rise to the need for better organization and training. Pain and terminal disease palliation call for MDTs, and educated leaders to run them. Present and future health MDTs are considered necessary in all medical fields.

The Supratrochlear Artery Revisited: An Anatomic Review in Favor of Modern Cosmetic Applications in the Area.

The supratrochlear artery represents a terminal branch of the ophthalmic artery. Cosmetic interventions may traumatize it, resulting in a circulation in the lesion in glabellar region and in the medial aspect of the forehead. This review article aims to synopsise the existing knowledge of the anatomy of the supratrochlear artery in close correlation with minimally invasive cosmetic procedures in the facial area such as soft-tissue filler injections. Their possible adverse effects and their safe application based on the topographic anatomy were included. A literature review was performed in PubMed/Medline online medical database. The superficial course of the supratrochlear artery, as well as the rich, variable anastomotic network that it forms with the supraorbital, angular and dorsal nasal artery raise clinical questions in the case of soft-tissue filler injections in the nasoglabellar and central forehead area. Accidental cannulation of the supratrochlear artery and ultimately, the risk of embolization of the central retinal artery in a retrograde fashion might lead to injury with questionable cosmetic results. Although the risk of complications from the use of soft tissue fillers is considered rare, once happen, the results could be devastating for the quality of life. Thus, the comprehension of the anatomy of the supratrochlear artery is paramount for the health practitioners.

Degloving Injury of the Lower Extremity: Report of Two Cases.

OBJECTIVE: The aim of our article is to highlight the importance of the immediate treatment of lower extremity degloving injuries, in order to prevent complications. CASES PRESENTATION: Here we present two cases of degloving injury of the lower extremity, both resulting from motorway accidents. The first one concerned a 65-year-old man suffering from multiple limb fractures and a degloving injury of the right thigh, which was immediately treated with extensive debridement and primary full-thickness skin graft re-approximation. The second case involved a 63-year-old woman who presented with cervical vertebrae fractures and a degloving injury of the left posterior leg, which, due to the severity of her condition, was treated with a delayed approach resulting in skin necrosis, which required surgical debridement, alginate dressing and foam cover. CONCLUSIONS: The optimal approach to treatment of degloving injuries is challenging and they warrant immediate surgical attention. An early diagnosis and the evaluation of tissue viability are important in order to prevent limb-threatening situations.