Successful Treatment of Chronic Neuropathic Pain With Subcutaneous Peripheral Nerve Stimulation: Four Case Reports

Introduction. Chronic pain is a prevalent medical condition in the general population and is one of the most common reasons patients visit their primary care doctors. When the pain is resistant to the common treatment modalities, it presents a challenge for the physician and may have profound consequences for the quality of life of the patient. Methods. We present four case reports in which subcutaneous peripheral nerve stimulation was successfully used to treat chronic neuropathic pain after all other treatment efforts had failed. Results. In all cases, the patients underwent a trial of peripheral nerve stimulation with good results. The patients reported decreased use of pain medications, increased quality of life, and high satisfaction with the procedure results. Conclusion. The use of subcutaneous peripheral nerve stimulation as a viable treatment alternative in certain cases of chronic neuropathic pain should continue to be rigorously evaluated.     

High spectral and spatial resolution MRI of age‐related changes in murine prostate

The purpose of this work was to evaluate high‐resolution echo‐planar spectroscopic MRI of normal and precancerous prostatic changes in a transgenic mouse line. Simian virus large T‐antigen transgenic male mice (N = 7, age = 34 ± 3.7 weeks) with prostatic hyperplasia and intraepithelial neoplasia (PIN) were studied. High spectral and spatial resolution (HiSS) MRI of the water proton signal was compared to the free induction decay (FID) integral image and conventional gradient‐echo and spin‐echo imaging. Water peak‐height images of the prostate produced from HiSS datasets showed improved contrast‐to‐noise ratio (CNR) (P < 0.03), and greater morphological detail (P < 0.004) based on texture analysis. Despite the high spectral resolution of the HiSS datasets, signal‐to‐noise ratio (SNR) compared favorably with that of the FID integral and conventional images. Lobular features in HiSS images of older mice were consistent with hyperplasia seen on histology. A partially deuterated water‐filled catheter was inserted in the mouse rectum for susceptibility matching between the colon interior and exterior to minimize image artifacts. These preliminary results suggest that HiSS MRI provides detailed morphology of the murine prostate and can detect early changes associated with the development of cancer. HiSS MRI of patients may have similar advantages. Magn Reson Med 60:575–581, 2008. © 2008 Wiley‐Liss, Inc.     

Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-centre observational study

OBJECTIVE: To determine how frequently life support is withheld or withdrawn from adult critically ill patients, and how physicians and patients families agree on the decision regarding the limitation of life support. DESIGN: Prospective multi-centre cohort study. SETTING: Six adult medical-surgical Spanish intensive care units (ICUs). PATIENTS AND PARTICIPANTS: Three thousand four hundred ninety-eight consecutive patients admitted to six ICUs were enrolled. MEASUREMENTS AND RESULTS: Data collected included age, sex, SAPS II score on admission and within 24 h of the decision to limit treatment, length of ICU stay, outcome at ICU discharge, cause and mode of death, time to death after the decision to withhold or withdraw life support, consultation and agreement with patient's family regarding withholding or withdrawal, and the modalities of therapies withdrawn or withheld. Two hundred twenty-six (6.6%) of 3,498 patients had therapy withheld or withdrawn and 221 of them died in the ICU. Age, SAPS II and length of ICU stay were significantly higher in patients dying patients who had therapy withheld or withdrawn than in patients dying despite active treatment. The proposal to withhold or withdraw life support was initiated by physicians in 210 (92.9%) of 226 patients and by the family in the remaining cases. The patient's family was not involved in the decision to withhold or withdraw life support therapy in 64 (28.3%) of 226 cases. Only 21 (9%) patients had expressed their wish to decline life-prolonging therapy prior to ICU admission. CONCLUSIONS: The withholding and withdrawing of treatment was frequent in critically ill patients and was initiated primarily by physicians.     

A review of referrals of new patients to the paediatric department of a teaching hospital during a six-month period in 2004.

AIMS: The aims of this review were to assess the reasons why patients were referred to a specialist dental paediatric unit and the quality of the referral letters received. MATERIAL AND METHOD: All patients referred to the paediatric consultation clinic at the Liverpool University Dental Hospital from January 2004 to July 2004 were included in the review. The reasons for their referral, as stated by the referring practitioners, were compared with the clinical findings from initial assessments in the consultation clinic and the quality of referral letters was assessed. RESULTS: Ninety-nine out of a total of 102 referrals were from general dental practitioners. Sixty were girls and 42 boys. Their mean age was 9.5 years. The commonest reason (25 patients) was for treatment under general anaesthesia. In 90 (88.2%) cases the main reason for referral stated in the letters was consistent with the findings of the clinical assessment in the consultant clinic. All 102 letters included the patient's name, address, date of birth and telephone number and 89 (87.3%) were dated. However, only 25 (24.5%) included any mention of medical history and fewer than 30% included details of any treatment provided by the referring practitioner. CONCLUSIONS: The vast majority of patients were referred for good reasons. The quality of the referral letters was generally poor. The use of a structured referral pro forma could improve the quality of the referral.