联合方案治疗儿童遗尿症临床疗效观察

目的:观察以盐酸奥昔布宁为主的联合治疗方案对儿童遗尿症(nocturnal enuresis,NE)的疗效.方法:将2006年10月～2007年10月收治的60例NE按就诊时间先后随机分为治疗组、对照组,每组30例.治疗组给予联合治疗方案,包括应用盐酸奥昔布宁、激光照射肾俞及三阴交穴、心理干预及膀胱功能训练;对照组仅口服盐酸奥昔布宁.疗程12周(其中激光治疗7天为一疗程),停止治疗后观察12周,共观察24周.比较两组治疗后近期疗效、远期疗效、起效时间及不良反应.结果:治疗后3个月,治疗组治愈率76.75,对照组治愈率60.0%;6个月后随访,治疗组治愈率66.7%,对照组治愈率33.3%,两组比较差异均有显著性意义(P＜0.05,P＜0.01).治疗组起效时间明显短于对照组(P＜0.05).治疗过程中两组均无明显不良反应.结论:联合治疗方案治疗儿童NE,不但在短期内达到较高疗效,远期疗效亦佳.     

Evaluation of Dalbavancin in Vancomycin Allergic Patients: A Case Series

PurposeThere is a paucity of data regarding dalbavancin use in patients with a vancomycin allergy because of potential cross-reactivity between the 2 glycopeptide antibiotics.MethodsA retrospective medical record review was performed between February 2016 and February 2021 in patients with a listed vancomycin allergy who received dalbavancin as an outpatient infusion and had a listed vancomycin allergy in the electronic health record.FindingsThere were 559 unique patients during the study period who received dalbavancin as an outpatient infusion, 10 of whom had a documented vancomycin allergy in the electronic health record. Four of the 10 patients had a history of a type I IgE-mediated reaction to vancomycin, 1 patient reported delayed rash, 2 patients reported a vancomycin infusion reaction, 2 patients reported acute kidney injury, and 1 patient reported intolerance with general malaise. All 10 patients received at least 1 dose of dalbavancin with no reported adverse events.ImplicationsThis case series displays that all patients who received dalbavancin tolerated the infusion well with no adverse events reported. Dalbavancin may be a viable option for patients with a listed vancomycin allergy.     

Phantom Limb Pain Treatment with Mirtazapine: A Case Series

Objectives: To pilot the efficacy of mirtazapine for relief of phantom limb pain (PLP); to correlate the putative drug mechanism with theoretical PLP mechanisms; and to develop a rationale for further study of mirtazapine in this population. Design: Open‐label case series. Subjects/Patients: Four individuals with PLP for at least 3 months after amputation. Methods: All subjects received oral mirtazapine between 7.5 and 30 mg/day. An 11‐point numeric rating scale (0 to 10) measured pain intensity and relief during monitored outpatient follow‐up visits. Results/Discussion: Mirtazapine use improved the PLP experienced by these subjects by at least 50%. Subjects with PLP‐related sleeping difficulties reported the greatest pain relief concomitant with improved sleep quality. One subject was able to eliminate the use of a selective serotonin reuptake inhibitor antidepressant while using mirtazapine for PLP and depression without change in mood or affect. Mirtazapine enhances noradrenergic and serotonergic activity and may modulate PLP by central mechanisms. Current concepts of the proposed pathophysiology of PLP and the hypothetical impact of mirtazapine are discussed. Conclusion: Mirtazapine may be an effective treatment for PLP that can also potentially enhance sleep and mood. This information provides preliminary reinforcement for more formal, controlled studies concerning mirtazapine use in PLP.     

Nocturnal Bruxism and Hypnotherapy: A Case Study

This article describes a case study of a hypnotherapeutic treatment of nocturnal bruxism. The author saw the client for a total of 7 sessions. Hypnotherapy was interspersed with an exploration of tacit and initially denied hostility in the client's life as well as aspects of a somewhat difficult childhood. At the end, the bruxism had disappeared. Follow-up 1 year later indicated that the bruxism had not returned, and the client had become more assertive in her relations with others and had more exploratory activities in her life directions. The latter had not been dealt with in therapy. Thus, there appeared to be a “ripple effect” of successful therapy from one part of her life into its other aspects.     

Ultrasound‐Guided Serratus Plane Block for Treatment of Postmastectomy Pain Syndromes in Breast Cancer Patients: A Case Series

Postmastectomy pain syndrome is common after surgical treatment for breast cancer and may be challenging to manage. Currently, there are a wide variety of approaches to treat this type of pain, including medications, physical therapy, and interventional procedures. However, because of the complexity of innervation of the breast, the serratus plane block may better target the web of nerves innervating the anterior chest wall including the breast. We present a case series of 8 patients who were successfully treated with serratus plane block for pain after treatment for breast cancer. We feel that this particular application for the serratus plane block deserves further investigation, as it is relatively easy to perform and has good clinical utility for this type of pain.     

Metacognitive Therapy in the Treatment of Hypochondriasis: A Systematic Case Series

Hypochondriasis is a debilitating condition which can have profound psychological and functional effects. The most effective psychological treatments are cognitive and behavioural therapies. However, the degree of improvement across these treatments is variable, often with modest recovery and a high dropout rate. The aim of this study was to provide a preliminary investigation of effects associated with metacognitive therapy (MCT) applied to DSM-IV hypochondriasis. Four consecutively referred patients were treated using established A–B single case series methodology. Following MCT all patients demonstrated large and clinically meaningful improvements in specific hypochondriacal symptoms and more general negative affect measures. Treatment gains were maintained at 6-month follow-up. Substantial changes were also observed in metacognitive beliefs. Overall this case series provides preliminary evidence that MCT can be applied to hypochondriasis and it supports a move towards a more definitive evaluation of the treatment in this group.     

Pulsed Radiofrequency of Pudendal Nerve for Treatment in Patients with Pudendal Neuralgia. A Case Series with Long-Term Follow-Up

Pudendal neuralgia (PN) is an impairing neuropathic disorder, affecting both men and women, involving a severe burning and sharp pain along the course of the pudendal nerve. Treatment is often insufficient, and options are limited. Pulsed radiofrequency (PRF) is a technique which might be useful in therapy. This case series aims to determine the effectiveness of PRF in patients with PN in the context of evaluation of care. Between 2010 and 2016, all female patients of University Medical Center Utrecht diagnosed with PN who experience insufficient pain relief after common treatment were offered PRF. Patient Global Impression of Improvement (PGI-I) scores were assessed at 3-month follow-up and at long-term follow-up (median 4 years). PGI-I scores were recorded to evaluate our quality of care. Twenty patients with PN consented to undergo PRF. We lost one patient in follow-up. Seventy-nine percent of the patients described their condition as “(very) much better” at 3-month follow-up. At long-term follow-up, 89% of the patients described their condition as “(very) much better.” No serious side effects were observed. In conclusion, PRF is a successful treatment option in patients not responding to standard treatment options, including pudendal nerve blocks. PRF of the pudendal nerve can be used for PN to provide relief in patients’ chronic pelvic pain.     

Intravenous Lidocaine in the Treatment of Refractory Headache: A Retrospective Case Series

Background.— New treatments are needed to treat chronic daily headache (CDH) and chronic cluster headache (CCH). New treatments are needed to treat this population and intravenous (IV) lidocaine is a novel treatment for CDH.
Objective.— The aim of this study was to examine the use of IV lidocaine for refractory CDH patients in an inpatient setting.
Methods.— This was an open-label, retrospective, uncontrolled study of IV lidocaine for 68 intractable headache patients in an inpatient setting. We reviewed the medical records of patients receiving IV lidocaine between February 6, 2003 and June 29, 2005.
Results.— Pretreatment headache scores averaged 7.9 on an 11-point scale and posttreatment scores averaged 3.9 representing an average change of 4. Average length of treatment was 8.5 days. Lidocaine infusion was generally well tolerated with a low incidence of adverse events leading to discontinuation of treatment.
Conclusions.— This study suggests benefit of lidocaine treatment and the need for further prospective analyses. The mechanism of lidocaine in treating headache is unknown.     

Botulinum Toxin Occipital Nerve Block for the Treatment of Severe Occipital Neuralgia: A Case Series

▪ Abstract:   Persistent occipital neuralgia can produce severe headaches that are difficult to control by conservative or surgical approaches. We retrospectively describe a series of six patients with severe occipital neuralgia who received conservative and interventional therapies, including oral antidepressants, membrane stabilizers, opioids, and traditional occipital nerve blocks without significant relief. This group then underwent occipital nerve blocks using the botulinum toxin type A (BoNT-A) BOTOX® Type A (Allergan, Inc., Irvine, CA, U.S.A.) 50 U for each block (100 U if bilateral). Significant decreases in pain Visual Analog Scale (VAS) scores and improvement in Pain Disability Index (PDI) were observed at four weeks follow-up in five out of six patients following BoNT-A occipital nerve block. The mean VAS score changed from 8 ± 1.8 (median score of 8.5) to 2 ± 2.7 (median score of 1), while PDI improved from 51.5 ± 17.6 (median 56) to 19.5 ± 21 (median 17.5) and the duration of the pain relief increased to an average of 16.3 ± 3.2 weeks (median 16) from an average of 1.9 ± 0.5 weeks (median 2) compared to diagnostic 0.5% bupivacaine block. Following block resolution, the average pain scores and PDI returned to similar levels as before BoNT-A block. In conclusion, BoNT-A occipital nerve blocks provided a much longer duration of analgesia than diagnostic local anesthetics. The functional capacity improvement measured by PDI was profound enough in the majority of the patients to allow patients to resume their regular daily activities for a period of time. ▪     

Cannabinoid Hyperemesis: A Case Series

Background: Cannabinoid use is prevalent in the United States, with recent reports of increased usage among younger Americans. Traditionally, cannabinoids have been used recreationally or as antiemetics; however, recent reports suggest that chronic abuse can result in the paradoxical effect of a cyclic vomiting syndrome, termed cannabinoid hyperemesis. Objective: We report on this recently described clinical syndrome characterized by severe nausea and hyperemesis in the setting of chronic cannabinoid use. Case Reports: We report the cases of 3 patients who presented to two academic emergency departments (EDs) on multiple occasions with nausea and vomiting in the setting of chronic cannabinoid use. There were extensive medical evaluations and frequent inpatient hospital admissions before the diagnosis of cannabinoid hyperemesis was considered. Conclusion: With the relatively high prevalence of cannabinoid use in the United States and increasing interest in the applications of marijuana for therapeutic purposes, this entity may be encountered in the ED. Cannabinoid hyperemesis should be considered in the differential diagnosis of patients presenting with similar symptoms.