Conservative Treatment for Spontaneous Resolution of Postoperative Symptomatic Thoracic Spinal Epidural Hematoma-A Case Report.

Introduction: Postoperative epidural hematomas of the cervical and thoracic spine can pose a great risk of rapid neurological impairment and sometimes require immediate decompressive surgery. Case Report: We present the case of a young patient operated on for stabilization of a two-level thoracic vertebra fracture who developed total paralysis due to an epidural hematoma postoperatively. The course of epidural hematoma was quickly reversed with the help of a conservative technique that prevented revision surgery. The patient regained complete neurologic function very rapidly, and has been well on every follow-up to date. Conclusion: There is a role of similar maneuvers as described in this case to be employed in the management of postoperative epidural hematomas. However, prolonged watchful waiting should still be discouraged, and patients should remain ready for revision surgery if there are no early signs of rapid recovery.

Psychological Factors in Experience of Pain During Childbirth.

Pain during delivery is unique because it is accompanied by powerful emotions. Emotions that occur in women during labor and delivery are closely tied to upbringing and culture in which they were raised and consequently with the sensation of experienced pain. According to the Melzack-Wall Theory of Pain, general mood is directly related to the intensity and quality of pain and it is therefore justifiable to presuppose that certain psychosocial factors will be linked with the intensity and quality of pain experienced during childbirth. (Melzack et al., 1981). We endeavored to show the effect of psychosocial factors that influence the intensity and quality of labor pain. Data was collected in a sample of 176 parturient women who delivered without Cesarean sections or epidural anesthesia. The intensity and quality of pain were obtained through the administration of the McGill Pain Questionnaire-Short Form. Psychosocial factors included: number of births, presence of partner, self-evaluation of knowledge of physio-anatomical aspects of birth and the completion of a pregnancy course. Labor and delivery pain is of high intensity anl the quality of pain is most frequently characterized as smarting, cramping, exhausting, and sharp. The presence of a partner and the completion of a pregnancy course is exercised by a small number of parturients. Self-evaluation of preexisting knowledge of physio-anatomical aspects of delivery is predictive of the affective component of intensity of childbirth pain. Psychosocial factors have been shown as significant for the intensity and quality of experienced childbirth pain.

Quality of pain in herpes zoster patients.

Pain typically accompanies acute herpes zoster and persists well beyond rash healing. Different types of pain are reported by patients with herpes zoster. Current studies show that these types of pain vary with respect to their presence, location, duration, intensity and quality, hence pain needs to be analyzed more thoroughly. The aim of the study was to assess different components of pain in patients with herpes zoster. The study subjects were 46 patients diagnosed with herpes zoster and selected out of 493 patients treated at the Pain Therapy Clinic, the outpatient facility of Zagreb Clinic for Traumatology, in 2010. Measures used to assess pain and daily activities were the following: SF McGill Pain Questionnaire, Visual Analogue Scale, Self-Assessment of Life Satisfaction, Health Satisfaction and Enjoyment in Life. Analgesic treatment together with demographic and clinical characteristics of patients were also taken into account. The results have shown that the patients report about spontaneous pain mostly in terms of the following qualities of high level pain intensity: throbbing, aching, hot-burning and sharp. The results also demonstrate that herpes zoster pain significantly affects the patients' everyday living quality and their emotional health. Comprehensive assessment of pain is necessary for clinical research about the epidemiology, natural history, pathophysiologic mechanisms, treatment, and prevention of pain in herpes zoster.

Quality and intensity of low back pain in cronic PTSD patients.

The aim of this study was to analyze the association between chronic low back pain (LBP) in chronic post-traumatic stress disorder (PTSD) with quality and intensity of pain experience. A total of 406 war veterans from 1991-1995 war in Croatia participated in this study. They were divided into four groups, according to psychiatric interview, psychometric testing and the presence of LBP verified by the imaging of lumbar area, into: (i) war veterans suffering from PTSD and LBP (N = 102), (ii) war veterans suffering from PTSD only (N = 108), (iii) war veterans suffering from LBP only (N = 99) and (iv) healthy controls (N = 97). On the basis of medical records, interviews and different types of self-assessment questionnaires the inter-relationship between chronic pain and chronic PTSD was analyzed. PTSD was assessed by TSI-A (Trauma symptom Inventory, whereas pain was measured by Melzack-McGill Pain Questionnaire - short form (MPQ-SF) and Visual Analogue Scale (VAS). The patients with chronic PTSD had significantly higher total pain scores as well as affective and sensory pain components when compared to the patients without PTSD. No significant association was found between chronic LBP and symptoms of PTSD. Chronic LBP as functional painful syndrome in PTSD could be result of altered neuroanatomical and neurophysiological pain pathway and one of the markers of PTSD.

Do IL-1B and IL-1RN modulate chronic low back pain in patients with post-traumatic stress disorder?

The aim of this study was to analyze the association between single nucleotide polymorphism (SNP) in IL1B (rs1143 634) and IL1RN (rs2234677) with chronic low back pain (LBP) in chronic post-traumatic stress disorder (PTSD). A total of 406 war veterans from 1991-1995 war in Croatia participated in this study. They were divided into four groups, according to psychiatric interview, psychometric testing and the presence of LBP, verified by the imaging of lumbar area, into: (i) war veterans suffering from PTSD and LBP (N = 102), (ii) war veterans suffering from PTSD only (N = 108), (iii) war veterans suffering from LBP only (N = 99) and (iv) healthy controls (N =97). Each subject provided a blood sample for IL1B and IL1RN polymorphism testing. We found no association of rs1143634 in IL1-B with LBP Permutation test showed significant association of rs1143634 in IL1-RN with LBP group and presence of wild type allele A was protective in LBP group. The same SNP (rs1143634) in IL1-B was associated with the intensity of pain. No other associations were observed between these two markers and self-reported measures evaluating PTSD and pain symptoms. These results suggest the potential role of cytokine network in the pathogenesis of chronic PTSD and LBP, although the direct causative pathway remains unclear. The alteration of cytokine network on the level of the brain, spinal medulla and the spine may be responsible for modulation of pain and the occurrence of LBP

A quality of life in chronic combat related posttraumatic stress disorder--a study on Croatian War veterans.

The main objective of this study was to examine an association of various symptoms in chronic combat-related post traumatic stress disorder (PTSD) and the quality of life in this population. 248 Croatian male war veterans all diagnosed with chronic PTSD were consecutively enrolled in this study as they showed up at the routine check-up. They were given self report questionnaires Trauma Symptom Inventory (TSI-A) evaluating different PTSD symptoms and WHO Quality of Life-BREF assessing four different domains of the quality of life. After independent sample t- test was performed, the presence of each symptom defined by Trauma Symptom Inventory indicated the impairment of all four quality of life domains in a group of subject suffering from it, except of intrusive experience not being associated with the lesser quality in social domain. All quality of life domains were significantly correlated with various PTSD symptoms; however Pearson correlation factors ranged from small to medium value. As expected, PTSD symptoms are associated with lesser quality of life in the affected population. The further research is needed to show possible causal relationship between PTSD and, especially, physical health of these patients.

The efficacy of a brief supportive psychodynamic therapy in treating anxious-depressive disorder in Daily Hospital.

Study objective is to determine the efficacy of brief supportive psychodynamic therapy in treating anxious-depressive disorder in Daily hospital within the Psychological Medicine Clinic. The study comprised a total of 45 male subjects, in which an admission to the Daily Hospital was indicated. On the occasion of the hospital admission, as well as following the completion of a one month-lasting partial hospitalisation within the Daily Hospital, the subjects had undergone testing using a number of psychological instruments. There weren't established statistically significant differences in clinical presentations of the treated patients. A partial, one month-lasting hospitalisation, did not yield any changes in clinical presentation an anxious-depressive disorder. Due to the fact that this psychotherapeutic method should be applied for quite some time in order to yield results, and is not expected to be effective in a close range, a one-month lasting treatment is definitely not long enough to be effective.

The connection between coping mechanisms, depression, anxiety and fatigue in multiple sclerosis.

The aim of this study was to show how different coping mechanisms influence the prevalence of anxiety and depression in people suffering from multiple sclerosis. We also aimed at showing how different coping mechanisms contribute to subjective prosperity of the patients emphasizing general health, cognitive functions and fatigue. A questionnaire was given to attendants of the VI Symposium of Patients Suffering From Multiple Sclerosis. Scales were taken from Multiple Sclerosis Quality of Life Inventory (MSQLI), Hospital Anxiety and Depression Scale (HADS) and COPE inventory. A total of 68 anonymous questionnaires were handed in. A total of 57.9% of examinees had symptoms of depression, and 63.2% suffered from symptoms of anxiety. However, majority of the examinees suffered from the combination of these entities. Hypothesis about impact of various coping factors on depression, anxiety, fatigue was validated except an impact on physical state was not proven significant. Predictors improving these states were positive reinterpretation, social emotional support and humor, Predictors worsening these states were planning, acceptance, focus on emotional ventilation and denial. Psychiatric comorbidity has a high prevalence in people suffering from MS. Different coping mechanisms can help in improvement of everyday life.

Coping with severe burns in the early stage after burn injury.

This study examined the relationship between coping strategies, anxiety and depression levels and burn injury characteristics in the early phase of the treatment in burn-injured patients. Seventy patients with severe burns were interviewed within two weeks of their burn trauma. Coping strategies were measured by the coping with burns questionnaire (CBQ). Anxiety and depression levels were assessed with the Beck Depression Inventory and the Beck Anxiety Inventory. There were no statistically significant gender differences in various coping strategies. Avoidance was associated with higher levels of anxiety, depression and hopelessness. The percentage of total body surface area (TBSA) and localization of burns were not associated with coping patterns. Implications for the assessment and management of burn injured patients were discussed.

Self-inflicted burns in patients with chronic combat-related post-traumatic stress disorder.

This study examined self-inflicted burns in case series of four patients with chronic combat-related post-traumatic stress disorder (PTSD). Those patients were hospitalized in the Burn Unit of the University Hospital of Traumatology in Zagreb because of severe burns and had a premorbid psychiatric history of PTSD. Demographic data and information regarding the circumstances surrounding the incident, burn severity, treatment and outcomes of these patients were collected. The authors have analyzed possible impacts of the sensationalistic way in which media present cases of self-inflicted burning that induce other, new cases of this suicide type, known in the literature as "Werther's syndrome". The importance of multidisciplinary approach in the treatment of burn patients is stressed with emphasis on the important role of liaison psychiatrist in treating these patients. It is necessary to educate media people to avoid sensational reporting on this kind of events. Continuous psychiatric treatment of vulnerable individuals could be useful in prevention of self-inflicted burns.

The relationships between burn pain, anxiety and depression.

This study examined the interrelationships between anxiety, depression and pain in burn injured patients. Seventy patients with severe burns were interviewed within two weeks of their burn trauma. The short form of McGill Pain Questionnaire and a visual analog scale were employed to measure the pain experienced at rest. Anxiety and depression levels were assessed with the Beck Depression Inventory and Beck Anxiety Inventory. The results showed that significant number of patients had suffered from depressive and anxious symptomatology. Higher levels of anxiety and depression were associated with higher pain scores. Percent of total body surface burned was associated with increased pain scores, anxiety and depression. The authors emphasises the need for accurate multidisciplinary assessment and treatment of pain and psychological disorders in burn injured patients which needs to be highly individualized and frequently adjusted according to the patients specific needs.