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11.
Herpes zoster is a painful, eruptive, viral condition occurring with reactivation in immunosuppressed individuals. The selection of an effective analgesic method in the acute phase of herpes zoster can decrease the incidence of postherpetic neuralgia by reducing neural sensitization. The erector spinae plane block has been reported to provide diffuse and effective analgesia in the cervical, thoracic, and lumbar regions. We report an effective decrease in pain with the application of the high-thoracic erector spinae plane block in the emergency department in a patient with herpes zoster pain in the cervicothoracic and shoulder region.  相似文献   
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Epidermodysplasia verruciformis (EV) manifests early in childhood as pityriasis versicolor (PV)–like macules on sun-exposed sites such as the face. These hypopigmented lesions closely resemble commoner pediatric dermatoses such as PV or pityriasis alba. In this report of two cases, we describe the distinguishing dermoscopic features of PV-like macules in EV. Unfocused dotted vessels in a hypopigmented or erythematous background with whitish scales and pigment diluted vellus hairs on dermoscopy should raise the suspicion of EV in children presenting with PV-like lesions.  相似文献   
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Emotionality truly shapes critical thinking in the development of American health policy. President Obama has misgauged the emotions and thoughts of the Nation and Congress about the health care reform bill. Most Americans don??t approve of the design or impetus of health care legislation under the Obama administration. The enacted legislation provides health care insurance for all Americans. However, health care insurance for the lower class shows intense ??red lights?? for repeal of the legislation to members of the middle and upper classes. It violates their critical thinking processes and comes down to a kind of ??class warfare?? of poverty level and low income persons against the gut emotional feelings of the middle and upper classes to repeal the program. Sarah Palin and her Tea Party compatriots envision such ??class warfare?? with the implementation of the program, even ??death panels?? to mete out health care for those seriously or gravely ill.  相似文献   
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BackgroundIntravenous drug use is becoming an increasing problem in today’s society causing an enormous socio-economic burden. Any intravenous injection will carry a risk of vascular injury. However, this risk will be significantly increased with repeated injections. With ongoing injection drug misuse, individuals are at risk of serious complex vascular injuries that can masquerade as simple illnesses.MethodsA comprehensive Medline search was conducted to identify key articles related to vascular injuries in intravenous drug users (IVDUs).ResultsNumerous arterial and venous injuries have been described as a result of intravenous drug use. This article reviews the literature to identify appropriate management of the peripheral vascular injuries encountered more and more often in this group of patients. Recommendations for investigation and treatment are made.ConclusionIntravenous drug users are notoriously difficult to treat and present late in the course of their illnesses. Despite management problems, it is important to have a high index of suspicion for serious vascular problems. Education and awareness of both patients and health care professionals may lead to earlier diagnosis and treatment of these conditions which carry significant morbidity and mortality.  相似文献   
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Purpose

To evaluate extraocular orbital vessels with color Doppler ultrasound (CDU) and investigate the effects of severe obstructive sleep apnea (OSA) on retrobulbar blood flow.

Methods

Between February 2014 and September 2015, 30 patients with severe OSA (apnea–hypopnea index (AHI) > 30) and 28 controls were prospectively included in this study. Intraocular pressure (IOP) was measured with a Goldmann applanation tonometer, and CDU was used to evaluate the retrobulbar vessels.

Results

The mean AHI score for the OSA group was 63.2 ± 21.5 per hour. The IOP values were significantly higher in the severe OSA group (p < 0.05). The central retinal artery peak systolic velocity (PSV) (p < 0.05) and end-diastolic velocity (EDV) (p < 0.02), and the ophthalmic artery (OA) PSV and EDV, were found to be significantly lower in the OSA group (p < 0.05).

Conclusion

Severe OSA causes an increase in IOP and a decrease in flow velocity in the retrobulbar circulation.
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