经皮球囊压迫与射频热凝半月神经节治疗老年人原发性三叉神经痛的疗效比较

目的 探讨经皮球囊压迫与射频热凝半月神经节治疗老年人原发性三叉神经痛的疗效.方法 选择原发性三叉神经痛老年患者87例,按治疗方法不同分为两组,经皮球囊压迫半月神经节治疗(球囊压迫组)42例,经皮射频热凝半月神经节治疗(射频热凝组)45例,对两种方法疗效进行分析评价.结果 (1)球囊压迫组和射频热凝组早期有效率分别为92.9%(39/42)和95.6%(43/45),治愈率分别为88.1%(37/42)和88.9%(40/45),两组比较差异无统计学意义(χ2分别为0.292、0.198,均P＞0.05);(2)出现三叉神经抑制反应球囊压迫组69.0%(29/42),多于射频热凝组35.6%(16/45)(χ2=9.759,P＜0.05),其中球囊压迫组1例患者出现心搏骤停;(3)术后两组均有不同程度的颜面部麻木及感觉障碍,球囊压迫组有效39例三支支配区均有麻木;射频热凝组有效43例主要为患支支配区麻木,选择性较高;球囊压迫组咀嚼肌无力的发生率(71.8%)高于射频热凝术组(20.9%),差异有统计学意义(χ2=5.106,P＜0.05); (4)术后随访6个月,两组均无复发病例.结论 经皮球囊压迫和经皮射频热凝术治疗老年人原发性三叉神经痛,都具有微创、高效的优点.经皮球囊压迫在全身麻醉下进行,无需患者配合,具有较高的舒适性,对于无法合作的患者较为合适;而经皮射频热凝术对三叉神经毁损的选择性更强,三叉神经抑制反应较轻,并且对咀嚼肌功能影响较小.

Abstract：

Objective To compare the effect of percutaneous balloon compression (PBC) versus percutaneous radiofrequency thermocoagulation treatment (PRFT) on idiopathic trigeminal neuralgia in elderly patients. Methods The 87 patients with idiopathic trigeminal neuralgia were enrolled, 42 patients were treated by PBC (PBC group), and the other 45 patients were treated by PRFT (PRFT group). The effects of two therapies were evaluated after treatment. Results The early response rate (92.9% vs. 95.6%) and cure rate (88.1% vs. 88.9%) of PBC group versus PRFT group had no significant differences (both P＞0.05). The inhibitory response rate of trigeminal nerve was significantly greater in PBC group than in PRFT group after treatment (69.0% vs. 35.6%, P＜0.05), and 1 patient had cardiac arrest in PBC group. The two groups had different degrees of facial numbness and sensory dysfunction. The 39 patients treated by PBC had numbness in three divisions of trigeminal nerve, while 43 patients treated by PRFT had the high selection and showed the main numbness in the ill division of trigeminal nerve. The chewing gravis rate was higher in PBC group than in PRFT group (71.8% vs. 20.9%, P＜0.05). There was no neuralgia recurrence in both groups during 6 monthe′ follow-up. Conclusions The effect of treating the elderly patients with idiopathic trigeminal neuralgia is similar by PBC and PRFT. The PBC therapy under general anesthesia is more convenient for patients who can not cooperate.The PRFT has much higher selectivity in trigeminal nerve damage, lower inhibition rate of the trigeminal nerve, and less influence on the masticatory muscle function.     

3D Image-Guided Percutaneous Radiofrequency Thermocoagulation of the Maxillary Branch of the Trigeminal Nerve Through Foramen Rotundum for the Treatment of Trigeminal Neuralgia

Percutaneous radiofrequency thermocoagulation of the trigeminal ganglion through the foramen ovale is a well-established procedure for the treatment of trigeminal neuralgia (TN). However, this approach can be tricky when individual trigeminal sub-branch nerve block is required. We report our initial experience of image-guided radiofrequency thermocoagulation of the maxillary branch through the use of foramen rotundum.From February 2012 to February 2015, we treated 25 patients with isolated TN of the maxillary branch. Radiofrequency thermocoagulation of the maxillary branch through the foramen rotundum was performed under fluoroscopy. TN pain was evaluated using the visual analogue scale both before and after the procedure.The mean preoperative visual analogue scale score was 8.6 ± 0.8. The pain completely disappeared after the initial procedure in 22 patients and after a second procedure in 2 patients. An additional patient had a postoperative visual analogue scale score of 2 and did not undergo further treatment. Facial numbness occurred in 23 patients but was tolerable. Patients were followed up for a mean of 14.74 months (range, 1–29 months). Recurrence was observed in 9 patients (36%) during the follow-up period. All recurrences were well managed with repeat procedures.Percutaneous radiofrequency thermocoagulation of the maxillary branch through the foramen rotundum under fluoroscopy is a safe and effective procedure for the treatment of isolated TN of the maxillary branch.     

CT-Guided Percutaneous Radiofrequency Thermocoagulation for Recurrent Trigeminal Neuralgia After Microvascular Decompression: A Cohort Study

This article evaluates the long-term outcomes of computed tomography (CT)-guided percutaneous radiofrequency thermocoagulation (PRT) for patients with recurrent trigeminal neuralgia (TN) after microvascular decompression (MVD).This is a retrospective study of 41 patients with intractable TN who after MVD underwent CT-guided PRT procedures between 2002 and 2012.The mean length of follow-up after PRT was 44.4 months. Immediate pain relief was in 37 patients (90.2%); the percentage of patients who remained in “excellent” or “good” pain relief condition after CT-guided PRT procedure was 85% at 1 year, 80% at 2 years, 51% at 5 years, and 41% at 10 years. Six patients received the second PRT and all achieved “excellent” or “good” pain relief. In total, 34 of these patients (82.9%) received multi-PRT procedure and remained satisfied with their pain relief during the follow-up period. Postoperative complications included facial numbness in 36 patients, limited eyes opening in 1 patient, ear paresthesia in 1 patient, no tears in 1 patient, and taste hypesthesia in 1 patient; these symptoms were all improved in the process of follow-up and their life had not severely affected. No mortality was observed during and after CT-guided PRT procedures.CT-guided PRT should be considered as an alternative treatment for patients with recurrent TN after MVD.     

Serine Protease Inhibitor Kazal Type 1 (SPINK1) c.194+2T > C Mutation May Predict Long-term Outcome of Endoscopic Treatments in Idiopathic Chronic Pancreatitis

Endoscopic interventional is a commonly used treatment method for idiopathic chronic pancreatitis. Serine protease inhibitor Kazal type 1 (SPINK1) 194+2T>C mutation is most frequently observed in Chinese pancreatitis patients and influences the clinical course of idiopathic chronic pancreatitis patients. We conducted this study to determine the impacts of this mutation on the outcome of endoscopic treatments.In this study, we enrolled 423 patients. Among them, 101 idiopathic chronic pancreatitis patients without other relevant mutations had a successful endoscopic procedure and completed follow-up. Clinical characteristics including Izbicki pain score, exocrine and endocrine function, were evaluated. Genetic sequencing was conducted to detect SPINK1 194+2T>C mutations.The c.194+2T>C mutation was found in 58 (57.43%) patients. Factors relevant to pain relief are c.194+2T>C mutation (P = 0.011), severe pain before treatment (P = 0.005), and necessary subsequent endoscopic treatments (P < 0.001). More patients with the intronic mutation had deteriorated endocrine function (P = 0.001) relative to those patients without the mutation.Patients carrying the c.194+2T>C mutation were less likely to achieve pain relief through endoscopic treatments. They also have a higher risk of endocrine function deterioration. SPINK1 c.194+2T>C mutation may be applied as a pretreatment predictor in idiopathic chronic pancreatitis patients.     

伽玛刀放射治疗原发性三叉神经痛的长期随访分析

目的总结分析伽玛刀（GKS）治疗原发性三叉神经痛（PTN）的手术经验。 方法回顾性分析山东大学第二医院神经外科自2016年5月至2019年12月经GKS治疗的53例PTN患者的临床资料,评估疗效、安全性及影响预后的因素。 结果伽玛刀术后疼痛缓解的起效时间约为35（7.5,85）d,疼痛缓解率为90.57%。伽玛刀治疗术后BNI分级比术前BNI分级明显改善,其差异具有统计学意义（Z=-5.961,P<0.001）。并发症发生率为18.87%,主要为面部麻木及眼干。单因素分析显示病程的长短和既往手术治疗影响术后PTN的改善,而多因素分析仅病程影响GKS的预后。 结论GKS治疗PTN疗效显著、定位精准、并发症少,是PTN患者的主要治疗方式,对于确诊的PTN患者应建议其早期首选GKS治疗,如果GKS治疗后效果欠佳可再次GKS治疗或结合其他治疗方式综合治疗。     

Effect of ultrasound-guided pulsed radiofrequency on intercostal neuralgia after lung cancer surgery: A retrospective study

This retrospective study investigated the effect of ultrasound-guided pulsed radiofrequency (UGPRF) on intercostal neuralgia (ICN) after lung cancer surgery (LCS).This retrospective observational study analyzed the outcome data of UGPRF on ICN in 80 patients with LCS. All those patients were allocated into a treatment group (n = 40) and a control group (n = 40). All patient data were collected between January 2018 and November 2019. The primary outcome was pain intensity (measured by numerical rating scale, NRS). The secondary outcomes were sleep quality (measured by Pittsburgh Sleep Quality Index, PSQI), anesthetic consumption, and treatment-related adverse events.After treatment, patients in the treatment group showed better outcomes in NRS (P < .01), PSQI (P < .01), and anesthetic consumption (P < .01), than patients in the control group. No treatment-related adverse events were documented in both groups in this study.The results of this study found that UGPRF may benefit patients for pain relief of ICN after LCS.     

Analysis of the curative effect of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture with intravertebral clefts

Kummell''s disease is a delayed vertebral collapse fracture caused by posttraumatic osteonecrosis. It is a special type of osteoporotic vertebral fracture in the elderly. This study compares and analyzes the difference in the curative effect of 2 kinds of osteoporotic vertebral compression fracture (OVCF) in the presence of fracture or not in the vertebral body, and provides a clinical reference for the application of percutaneous kyphoplasty (PKP).This research is a kind of retrospective analysis from January 2012 to January 2015, PKP was used to treat 165 patients with osteoporotic vertebral compression fracture. The patients were divided into 2 groups: Intravertebral clefts group (group A) and none-intravertebral clefts group in vertebral body (group B). Bone mineral density (BMD), bone cement injection (BCI), Visual analogue scale (VAS) score before and after surgery, anterior, central and posterior height of vertebral body (before and after surgery) and Cobb angle of injured vertebra (before and after surgery) were compared between the 2 groups.Surgeries for 165 patients in the 2 groups were successfully completed, and 226 fractured vertebrae were performed through bilateral puncture approach to strengthen the vertebral body. Intraoperative injection of bone cement (ml) was 4.25 + 1.29 (range: 2.6–7.8). There were statistically significant differences in bone cement injection quantity between the 2 groups (P < .05), and in bone cement leakage (P > .05) as well as the Postoperative VAS score (P < .05). However, There was no statistical difference in VAS score before surgery between the 2 groups (P > .05). The results indicated that the pain relief degree of OVCF patients without intravertebral clefts is better than that in the vertebral body. No statistical difference was found in Cobb Angle before and after surgery (P > .05), as well as the correction rate of the injured vertebrae before and after surgery (P > .05). There was no statistical difference in the degree of recovery of the anterior, middle and posterior margins of the injured vertebrae after surgery (P > .05).PKP treatment led to better degree of pain relief in OVCF patients without intravertebral clefts, and less bone cement was injected into the surgery.     

Efficacy of Coblation Technology in Treating Cervical Discogenic Upper Back Pain

Upper back pain originating from the cervical disk itself is defined as cervical discogenic upper back pain. Coblation procedures can provide therapeutic effects for neck and radicular pain related to contained cervical disk herniation. However, no studies have reported the performance of coblation procedures, particularly for treating cervical discogenic upper back pain. The purpose of this study was to evaluate the efficacy of coblation procedures in treating cervical discogenic upper back pain.In a prospective, clinical, observational study, 28 consecutive patients with discogenic upper back pain underwent coblation procedures on the cervical disk with a percutaneous anterior approach. Pain visual analogue scale (VAS) scores, patient responses stating significant (≥50%) pain relief, significant (≥50%) reduction in pain medicine intake and Modified MacNab criteria were adopted to evaluate the pain intensity, degree of pain relief, and functional status after 12 months of follow-up.The preoperative pain VAS score was 6.5 ± 1.1 (95% confidence interval [CI] 6.085–6.915), and the pain VAS score significantly decreased to 2.4 ± 1.3 (95% CI 1.929–2.928), 2.5 ± 1.5 (95% CI 1.963–3.109), 2.7 ± 1.4 (95% CI 2.157–3.271), 3.1 ± 1.6 (95% CI 2.457–3.686), and 3.1 ± 1.6 (95% CI 2.471–3.743) at 1 week and 1, 3, 6, and 12 months postoperatively, respectively (P < 0.05). Twenty-two (78.6%), 21 (75.0%), 20 (71.4%), 19 (67.9%), and 18 (64.3%) of the patients expressed significant pain relief at 1 week and 1, 3, 6, and 12 months postoperatively, respectively. 24 (85.7%), 23 (82.1%), 23 (82.1%), and 22 (78.6%) reported significant reduction in pain medication intake at 1, 3, 6, and 12 months postoperatively, respectively. According to the Modified MacNab criteria, the numbers of patients with “excellent” or “good” ratings were 22 (78.6%), 21 (75.0%), 20 (71.4%), and 18 (64.3%) at 1, 3, 6, and 12 months postoperatively, respectively. No serious complications were observed.The findings of this study showed that coblation is an effective, safe, minimally invasive, and less uncomfortable procedure for the treatment of discogenic upper back pain.     

戴全口义齿继发三叉神经痛的临床分析

目的探讨全口义齿压迫导致三叉神经痛的病因及机制。方法对5例佩戴全口义齿继发三叉神经痛的患者拍摄锥形束CT,发现颏孔区牙槽脊完全吸收,颏孔暴露,将颏孔区黏膜对应的基托组织面进行调磨,并且磨除该区域由于牙槽嵴吸收造成的义齿过长的边缘,若疼痛无缓解,重新制作义齿,颏孔区充分缓冲。结果1例经过第2次义齿调磨后,三叉神经痛消失。2例通过5次调磨后症状消失。2例经过重新制作义齿,颏孔区充分缓冲后,症状消失。结论下颌牙槽嵴加速吸收后,颏孔暴露,颏部三叉神经及其分支颏神经受到义齿压迫,引起疼痛。该区域压力及刺激解除后,疼痛消失。     

Does polydeoxyribonucleotide has an effect on patients with tendon or ligament pain?: A PRISMA-compliant meta-analysis

Background:Pain in the tendons or ligaments is extremely common, accounting for 30% of the causes of visiting general practitioners. Polydeoxyribonucleotide (PDRN) is emerging as a new treatment for musculoskeletal pain. However, the effects of PDRN in patients with tendon or ligament pain are unclear. Therefore, this study aimed to determine the impact of PDRN in patients with tendon or ligament pain through a meta-analysis.Methods:Electronic literature search of PubMed, Embase, SCOPUS, and Cochrane Library databases of all articles on PDRN treatment for patients with tendon or ligament pain published in the English language from inception until January 31, 2020. The search identified 262 citations.Results:One randomized controlled trial and 3 retrospective observational studies were included. Pain due to tendon or ligament disorders showed significant improvement after PDRN injection (standardized mean difference [SMD] = −1.43, 95% confidence interval [CI] = −1.80 to −1.06, P < .00001). In the subanalysis of patients with rotator cuff tendinopathy, rotator cuff tendinopathy-induced pain significantly improved (SMD = −2.34, 95% CI = −3.61 to −1.07, P = .0003) after PDRN injection. However, there was no difference in shoulder pain and disability index score and strength of shoulder abduction in patients with rotator cuff tendinopathy (shoulder pain and disability index score, SMD = 1.16, 95% CI = −1.20 to 3.52, P = .34; strength of shoulder abduction, SMD = 0.42, 95% CI = −0.03 to 0.88, P = .07).Conclusion:Effective pain relief was achieved in patients with tendon or ligament disorders after PDRN injection. To more precisely determine this effect, a meta-analysis with a larger number of clinical trials is warranted.     

Radiotherapy Combined With Androgen Deprivation for Bone Oligometastases After Primary Curative Radiotherapy for Prostate Cancer: A Retrospective Study

To evaluate the effects and toxicity of radiotherapy (RT) combined with androgen deprivation (AD) for bone oligometastases after primary curative RT for prostate cancer (PCa).We retrospectively analyzed 30 consecutively treated PCa patients with bone oligometastases from April 2005 to July 2014. All patients underwent RT combined with AD for oligometastatic bones after curative RT for PCa. Measured outcomes included overall survival (OS) rate, local control (LC), progression-free survival (PFS), pain relief, and toxicities. Statistical analysis was performed with SPSS17.0.The median follow-up was 32.5 months (range, 0.6–50.3). The 3-year PFS and OS rates were 22.8% (95% CI, 13.4–37.5%) and 69% (95% CI, 51.7–81.1%), respectively. The number of bone oligometastases and RT schedule were found to be significantly associated with OS on univariate analysis (P < 0.05, respectively). The 3-year OS for patients with 1 and >1 metastases was 78.8% versus 42.2%, respectively (P = 0.037). The long-course RT was associated with better 3-year OS compared with short-course (76.4% vs 44.1%, P = 0.03). A total of 15 (83.3%, 15/18) patients achieved pain relief. No grade 3 toxicity was observed.Long-course RT combined with ADT was effective and well-tolerated in PCa patients with bone oligometastases after curative RT for PCa. Further randomized controlled trials are needed to corroborate the findings.     

Radiosurgery for trigeminal neuralgia using a linear accelerator with BrainLab system: report on initial experience in Lausanne, Switzerland

BACKGROUND/AIMS: Radiosurgery is an effective treatment for trigeminal neuralgia (TN) with minimal complications. Most experience is based on gamma knife radiosurgery (GKRS) and to a lesser extent on linear accelerators. METHODS: We report our initial experience in 17 patients with TN treated by an adapted linear accelerator using the BrainLab system. The trigeminal root entry zone immediately adjacent to the pons (target volume: 0.01-0.09 cm3, mean: 0.02 cm3) was targeted by use of a multileaf collimator to deliver 40-45 Gy to the 80% isodose (dose max 50-56 Gy). Median follow-up was 12 months (range: 1-60). RESULTS: All patients reported some initial improvement in level of pain after treatment (mean time: 1 month). Initial pain responses were as follows: 6 patients (35%) had complete pain relief and required no medication, 6 (35%) had occasional pain but were off medication, and 5 (30%) experienced partial relief of pain but still required medication, usually in lower doses. Five patients (29%) who experienced initial pain relief had recurrences ranging from 4-13 months after procedure. There were no major or minor complications of radiosurgery except one case of mild facial itching. CONCLUSION: Stereotactic radiosurgery using a linear accelerator appears to be effective and can be a favourable alternative to other procedures, including GKRS. The procedure is very safe and side effects are rare and minor. However, a randomised trial with a longer follow-up comparing radiosurgery to other surgical procedures is needed to assess the long term effectiveness of this treatment.     

An Audit of Changes in Outcomes of Acute Pain Service: Evolution Over the Last 2 Decades

Acute pain services (APS) have evolved over time. Strategies nowadays emphasize multimodal analgesic regimes using a combination of nonopioid adjuvant analgesic drugs, peripheral nerve blocks, and local anaesthetic wound infiltration where appropriate. APS should be assessed over time to evaluate changes in outcomes which form the basis for future development.In this audit, data of patients under APS care in Queen Mary hospital, Hong Kong, between 2009 and 2012 were analyzed and compared with data from a previous audit between 1992 and 1995. The use of patient-controlled analgesia (PCA) was increased (from 69.3% to 86.5%, P < 0.001), while the use of epidural analgesia reduced (from 25.3% to 8.3%, P < 0.001) significantly. Although postoperative pain scores did not improve, PCA opioid consumption and the incidence of analgesia-related side effects were significantly less (all P < 0.001). More patients graded their postoperative analgesic techniques used as good when the results from these 2 audit periods were compared (P < 0.001 and P = 0.001 for PCA and epidural analgesia, respectively). In conclusion, there has been a change in analgesic management techniques, but there has been no improvement in overall pain relief. While changes over time have led to improvement in important parameters such as the incidence of side effects and patient satisfaction, further and continuous efforts and improvements are warrant to reduce acute pain relief and suffering of the patients after the surgery.     

Outcome of manipulation under anesthesia with or without intra-articular steroid injection for treating frozen shoulder: A retrospective cohort study

Manipulation under anesthesia (MUA) combined with intra-articular steroid injection (ISI) is preferred in management of the refractory frozen shoulder (FS). This study aimed to evaluate the effect of MUA with ISI or not on pain severity and function of the shoulder.Data on 141 patients receiving MUA with primary FS refractory to conservative treatments for at least 1 month were retrospectively obtained from medical records. We performed propensity score matching analysis between patients receiving MUA only and those receiving MUA plus ISI, and then conducted logistic regression analysis to identify the risk factors for the need to other treatments during 6-month follow-up.More improvement in terms of the SPADI pain scores and passive ROM at 2 weeks after first intervention remained in patients receiving MUA plus ISI after matching. The need to other treatments during 6-month follow-up occurred in 10.6% patients (n = 141). Logistic regression analysis revealed that a repeat MUA 1 week after first intervention was a protective factor (OR 0.042; 95% CI 0.011–0.162; P = .000) and duration of disease was the only one risk factor (OR 1.080; 95% CI 1.020–1.144; P = .008) for the need to other treatments during follow-up.ISI immediately following MUA provided additional benefits in rapid relief of pain and disability for patients with refractory FS. Pain and disability of the shoulder may be rapidly alleviated by an earlier MUA from the onset of the symptoms and a repeat MUA 1 week after first intervention.     

Steroid Injection and Nonsteroidal Anti-inflammatory Agents for Shoulder Pain: A PRISMA Systematic Review and Meta-Analysis of Randomized Controlled Trials

Advantages and possible risks associated with steroid injection compared with nonsteroidal anti-inflammatory drugs (NSAIDs) for shoulder pain are not fully understood.To compare the efficiency and safety of steroid injection versus NSAIDs for patients with shoulder pain.PubMed, Embase, and the Cochrane Library were searched through July 2015.Study eligibility criteria, participants, and interventions: randomized controlled trials (RCTs) that assessed steroid injection versus NSAIDs for patients with shoulder pain.Study appraisal and synthesis methods: predefined primary efficacy outcome was functional improvement; and secondary efficacy outcomes included pain relief and complications. Relative risks (RRs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model accounting for clinical heterogeneity.Eight RCTs involving 465 participants were included in the meta-analysis. Five trials compared steroid injection with oral NSAIDs, and 3 compared steroids injection with NSAIDs injection. Compared with steroid injection, oral NSAIDs were less effective in 4 or 6 weeks for functional improvement (SMD 0.61; 95% CI, 0.08–1.14; P = 0.01), while there was no significant difference in pain relief (SMD 0.45; 95% CI, −0.50–1.40; P < 0.00001) or complication rate (RR 1.10; 95% CI, 0.26–4.58; P = 0.29). Meta-analysis was not performed for NSAIDs injection due to considerable heterogeneity. Conflicting results were observed in favor of either steroid or NSAIDs injection.Not all diseases that can lead to shoulder pain were included, detailed intervention protocols were inconsistent across studies, and some estimated data were input into comparison while some data were lost, which could exert an influence on pooled results.Steroid injection, compared with oral NSAIDs, provides slightly more improvement in shoulder function without superiority in pain relief or risk of complications at 4 to 6 weeks.Treatment decision should be made based on diseases. NSAIDs injection might be a treatment method for shoulder pain.     

Electrocardiographic changes in young patients with spontaneous pneumothorax: A retrospective study

Primary spontaneous pneumothorax (PSP) commonly occurs in adolescents. PSP symptoms can mimic cardiac event. We aimed to examine electrocardiography (ECG) changes that accompanied PSP in relation to side and size of pneumothorax.A retrospectively reviewed 57 adolescents presented with PSP and underwent a cardiac evaluation.Overall, 49 patients (86%) were male, median age of 16 years. Of these, 1 patient had a known mitral valve prolapse. In 56 patients the initial episode of PSP was unilateral (16 left sided and 40 right sided), and 1 was bilateral. The main initial symptom was chest pain or dyspnea and chest pain 66.6% and 33.3% respectively. Small pneumothorax was right and left sided in 1and 8 patients respectively, medium right (n = 8) medium left (n = 22), large right (n = 7) and large left (n = 10). One additional patient had medium bilateral pneumothorax. ECG findings were abnormal in 12 patients (21%) and included ST elevation in 5 patients, inverted T wave in 2 patients, incomplete right bundle branch block in 2 patients, poor R wave progression, left axis deviation and low QRS voltage in 1 patient each. Only 2 patients had abnormal echocardiography findings, MPV (n = 1) and minimal mitral and tricuspid regurgitation (n = 1). Serum troponin-T levels were normal in all patients.ECG changes were found in 21% among pediatric patients with PSP. No correlation was observed between ECG changes and side/size of pneumothorax. It is important to rule out pneumothorax among children presented with chest pain, dyspnea and ECG changes.     

Sacral Magnetic Stimulation for Pain Relief from Pudendal Neuralgia and Sciatica

INTRODUCTION: Magnetic stimulation of the sacral nerve roots is used for neurologic examination. However, no one has reported therapeutic efficacy of pain relief from pudendal neuralgia with sacral magnetic stimulation. METHODS: Five patients with pudendal neuralgia or sciatica received 30 to 50 pulsed magnetic stimuli of the sacral nerve roots. The median age of the patients was 59 (range, 28–69) years; there were 3 females. RESULTS: Sacral magnetic stimulation immediately eliminated the pain. The pain relief lasted between 30 minutes and 56 days (median, 24 hours). Adverse effects were not observed. CONCLUSIONS: This pilot study indicates that magnetic stimulation of the sacral nerve roots may be a promising therapeutic modality for pain relief from pudendal neuralgia and sciatica. Further studies should be performed to determine the appropriate intensity and frequency, as well as the utility of a second course, of magnetic stimulation treatment.     

Two cases of rt-PA with dual antiplatelet therapies with capsular warning syndrome

Rationale:Capsular warning syndrome (CWS) is a term to describe stereotyped lacunar transient ischemic attacks (TIAs). Patients with CWS are at high risk of developing completed stroke. However, the exact pathophysiology of CWS is still unclear, and there is no conclusive clinical strategy for CWS patients.Patient symptoms:Two cases of middle-aged men with hypertension, hyperlipidemia, and diabetes mellitus presented with fluctuating right-sided weakness, numbness, and dysarthria.Diagnoses:These two patients were diagnosed with CWS.Interventions:Recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis (0.9 mg/kg) was administered first and treated with aspirin (100 mg) and clopidogrel (75 mg) after 24 h of rt-PA for 21 days following by aspirin (100 mg) alone.Outcomes:Both cases got favorable clinical outcomes of somatic symptoms. In addition, diffusion-weighted imaging (DWI or DW-MRI) showed that ischemic injury disappeared in case 1 while maintained within a reasonable range in case 2.Lessons:Early recognition and rt-PA/dual antiplatelet treatment may be an effective strategy for patients with CWS.     

Subacute Pain as a Predictor of Long-Term Pain Following Orthopedic Surgery: An Australian Prospective 12 Month Observational Cohort Study

The aim of this study was to document the level of pain and functionality in the 12 months following orthopedic surgery and identify if high pain levels following discharge were associated with pain persisting at 12 months.An observational prospective cohort study was undertaken, following 87 patients (mean age 62.4 years [18–92]; 47.1% male) who required orthopedic surgery at the Royal Hobart Hospital, Australia. Following an initial survey, patients were telephoned at 10 days, 6 weeks, 3 months, and 12 months after discharge.Postdischarge pain levels were high with 97.4% of patients suffering pain at 10 days, 81.2% at 6 weeks and 79.5% at 3 months. Pain affected the ability to undertake activities of daily living (ADLs) for 32.7% and 20.0% of patients at 10 days and 6 weeks, respectively. Twelve months after discharge, 65.5% of patients reported pain persisting at the surgical site, with 29.9% of all patients suffering moderate–severe incidental pain; and nearly one quarter of patients reported pain affected their sleep or ADLs. Average pain levels rated as moderate–severe at 10 days (P = 0.01) and 6 weeks (P = 0.02) and pain of neuropathic origin at 3 months (30.2% vs 10.3% P = 0.03) and 12 months (30.4% vs 4.9% P = 0.01) were associated with persistent pain at 12 months.Pain in the period following discharge from hospital is significant and undermanaged. Previous studies has shown that that acute pain, particularly in the first 48 hours following surgery is a predictor for long-term pain after surgery. This study adds to the current literature by showing that pain in the subacute period, following discharge from hospital is also associated with the pain persisting at 12 months. These findings have important implications for improving quality of life as well as potentially preventing persistent pain with increased follow-up and more intensive management of post-discharge pain.