Targeted etanercept for discogenic neck pain: uncontrolled,open-label results in two adults

BACKGROUND: Etanercept, a recombinant biologic anti-tumor necrosis factor (TNF)-alpha therapeutic, is approved for the treatment of certain autoimmune arthritides by subcutaneous (SC) injection. TNF-alpha has been suggested to play a central role in neuropathic pain and neuronal damage associated with intervertebral disc herniation. Directed local administration of etanercept, in anatomic proximity to the site of disc and neuronal abnormality, may result in an enhanced therapeutic response. OBJECTIVE: This study reviews findings from 2 patients with chronic, severe, discogenic cervical pain who were treated with a targeted cervical injection of etanercept with the objective of obtaining relief from their treatment-resistant pain. METHODS: In this uncontrolled, open-label study, the case histories of 2 patients (1 woman and 1 man) presenting with a history of chronic neck pain refractory to various treatments are reviewed. Both patients were treated with etanercept 25 mg by SC injection to the cervical region (case 1) or the posterior neck overlying the spine (case 2). RESULTS: Both patients experienced almost complete pain relief as assessed subjectively. In case 1, the Oswestry score decreased from 58 before treatment to 6 one day following treatment. In addition, 1 day after treatment the patient reported a subjective assessment of 98% pain improvement, 100% sensory improvement, and 100% weakness improvement. She has remained asymptomatic for >1 year. In case 2, the Oswestry score decreased from 44 before treatment to 4 two months after treatment. The patient reported 100% pain relief and 90% sensory improvement 1 day after treatment. At 8-month follow-up, pain improvement continued to be 100% and sensory improvements was 75%. CONCLUSIONS: Etanercept, delivered by targeted SC injection, may be of benefit for selected patients with resistant pain associated with cervical disc disease. Further study of this new treatment modality is warranted.     

鼻咽癌囊性肺转移2例

病例1:男,51岁,因活动时呼吸困难,咳嗽2月余,伴声嘶、咯血丝痰1个月入院.     

Adolescent endometriosis-related pelvic pain treated with acupuncture: two case reports

BACKGROUND: Chronic pelvic pain in adolescents accounts for 10% of outpatient gynecology visits, and 70% of adolescent patients whose pelvic pain is unresponsive to initial therapy have endometriosis. To date, there has been no published research investigating the use of acupuncture for adolescents with chronic pelvic pain and/or endometriosis. METHODS: This paper presents two case reports describing the impact of a course of acupuncture on adolescent girls with endometriosis-related chronic pelvic pain of more than 1 year. RESULTS: Both patients, undergoing between 9 and 15 treatments over a 7- to 12-week period, experienced modest improvement in pain as measured by oral self-reports of pain on a scale from 1 to 10, as well as self or family-reported improvement in headaches, nausea and fatigue. No adverse effects were reported. CONCLUSIONS: These case reports provide preliminary evidence that acupuncture may be an acceptable and safe adjunct treatment therapy for some adolescents with endometriosis-related pelvic pain refractory to standard antiendometriosis therapies. These observations suggest that a prospective, randomized controlled trial of the safety and efficacy of acupuncture for this population may be warranted.     

Renal colic due to spontaneous perirenal haematoma secondary to antiplatelet medication: two case reports.

We present two cases of spontaneous unilateral perirenal haematoma, following the administration of antiplatelet medication. Both patients reported no history of trauma. One patient was managed conservatively whereas the second patient needed an urgent nephrectomy. A spontaneous haematoma is a rare diagnosis that is easy to be missed. It is important to have a high index of suspicion as a prompt diagnosis can improve the morbidity and mortality of patients. The causes of spontaneous perirenal haematoma are quite varied and a bleeding diathesis can only be accepted as a cause only when all other causes have been excluded.     

Hyperprolactinemia due to pituitary metastasis: A case report

BACKGROUNDPituitary metastasis is an uncommon manifestation of systemic malignant tumors. Moreover, hyperprolactinemia and overall hypopituitarism caused by metastatic spread leading to the initial symptoms are rare.CASE SUMMARYA 53-year-old male patient was admitted to our hospital with complaints of bilateral blurred vision, dizziness, polyuria, nocturia, severe fatigue and somnolence, decreased libido, and intermittent nausea and vomiting for more than 6 mo. During the last 7 d, the dizziness had worsened. Laboratory investigations revealed overall hypofunction of the pituitary gland, but the patient had an elevated serum prolactin level (703.35 mg/mL). Preoperative magnetic resonance imaging revealed a tumor in the sellar region, accompanied by intratumoral hemorrhage and calcification. Thus, transnasal subtotal resection of the lesion in the sellar region was performed. The histopathological and immunohistochemical examinations of the resected lesion revealed metastasis of lung adenocarcinoma to the pituitary gland. Oral hydrocortisone (30 mg/d) and levothyroxine (25 mg/d) were given both pre- and postoperatively. Post-operatively, the clinical symptoms were significantly improved. However, 4 mo following the surgery, the patient succumbed due to multiple organ failure.CONCLUSIONHyperprolactinemia is one of the markers of poor prognosis in patients with carcinoma that metastasizes to the pituitary gland. Exogenous hormone supplementation plays a positive role in relieving the symptoms of patients and improving quality of life.     

Rhabdomyolysis: two pediatric case reports

We report two pediatric cases of rhabdomyolysis. This disease involves the destruction of skeletal muscle, which can present with myalgia and a brown-pigmented urine. The first patient presented with acute renal failure, hypertension, and hyponatremia. The second patient was pyrexic, hypernatremic, and hypokalemic, and later developed hypertension. Evidence of rhabdomyolysis in both patients included dark, o-tolidine-positive urine, granular casts in the urinary sediment, and grossly increased activities of creatine kinase (greater than 60 000 U/L) in serum. An uncommonly recognized entity in the pediatric age group, rhabdomyolysis often presents as an acute disease with severe onset but can be diagnosed with relatively simple laboratory tests.     

联体双胎复杂畸形2例

我院在1个月时间里发现联头、联体双胎畸形2例,均经引产证实(图1),孕妇年龄分别为19岁、25岁.现将超声所见报告如下.     

Symptomatic hyponatremia in patients on oxcarbazepine therapy for the treatment of neuropathic pain: two case reports

Oxcarbazepine is an FDA approved anticonvulsant medication that has also been used clinically as a treatment for chronic neuropathic pain. Hyponatremia is occasionally seen with the older anticonvulsant carbamazepine, and oxcarbazepine is a derivative of that older drug. Two cases of hyponatremia associated with oxcarbazepine are reported and suggestions for monitoring for and managing this effect are provided.     

Severe metabolic alkalosis due to baking soda ingestion: case reports of two patients with unsuspected antacid overdose

Oral ingestion of baking soda (sodium bicarbonate) has been used for decades as a home remedy for acid indigestion. Excessive bicarbonate ingestion places patients at risk for a variety of metabolic derangements including metabolic alkalosis, hypokalemia, hypernatremia, and even hypoxia. The clinical presentation is highly variable but can include seizures, dysrhythmias, and cardiopulmonary arrest. We present two cases of severe metabolic alkalosis in patients with unsuspected antacid overdose. The presentation and pathophysiology of antacid-related metabolic alkalosis is reviewed.     

Supracondylar nail failure: two case reports

We describe two case reports of supracondylar nail failure in young patients who had sustained high energy, closed, comminuted supracondylar femoral fractures. These injuries had been successfully treated using retrograde intramedullary nails which failed several months later because of excessive activity on the part of the patient without the presence of full flexion at the knee. The failed implants were removed and dynamic condylar screws were inserted with bone graft to the fracture site. This revision procedure produced solid bony union. We recommend that these patients should not fully weight bear, or engage in strenuous physiotherapy after nailing, until the fracture has consolidated and a functional range of knee motion has been obtained. Failed implants should be managed by nail removal, bone grafting and insertion of a dynamic condylar screw.     

Dystonic reactions: two case reports.

Case reports of dystonic reactions to metoclopramide are presented. Dystonic reactions may occur after ingestion of many drugs and should be considered by accident and emergency staff in patients with a suggestive clinical presentation.