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[Interest of a biopsychosocial approach in the management of a patient with chronic pain : a narrative review].

Pain is generally perceived as a sensory, emotional and cognitive aggression by the patient who suffers from it and as the enemy that must be defeated by the physician. It may become chronic, and the passage from the acute phase to the chronic phase cannot be explained in a single way. Indeed, multiple factors come into play: biological, psychological and socio-professional. The patient's quality of life then deteriorates and places him/her in a vicious cycle of pain. The assessment of the different components of pain (sensory, emotional, cognitive and behavioural) and its maintenance factors allow for the implementation of therapeutic strategies, both physical and psychological, adapted to every patient. Due to the complexity of chronic pain management, a multidisciplinary strategy is being developed, with a global approach according to the biopsychosocial perspective, including non-pharmacological approaches, with the objective of allowing the patient to be autonomous in the management of his/her symptoms.

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The Cecum Revisited: A Multimodality Imaging Case-based Review of Common and Uncommon Cecal Diseases.

A wide range of conditions involving the cecum may be found in patients undergoing imaging work-up for conditions as various as right lower pain, diarrhea, fever, and weight loss. The cecum may be the only area of involvement by a particular disease. However, it may also be affected by a more diffuse process of the gastrointestinal tract or even as part of systemic diseases. Imaging provides an excellent evaluation of the cecal region and its surrounding planes, with an impactful clinical application in multiple scenarios. While typical features in many situations allow establishing a confident diagnosis, there are also challenging entities with overlapping features, making it critical for the radiologist awareness of the whole gamut of these conditions, as well as the ability to correlate imaging findings with other clinical data. Additional challenges to the imaging evaluation include anatomical variations of the cecal position and the absence of proper colonic distention in some cases. This article aims to revisit the spectrum of cross-sectional imaging features of common and uncommon pathologies involving the cecum, ranging from inflammatory and infectious to vascular and neoplastic ones.

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Cerebral syphilitic gumma mimicking a brain tumor that enlarged temporarily after commencing antibiotic treatment.

In this case report, we describe a 60-year-old man who presented with headaches for 1 year and mild confusion for 3 weeks and was initially diagnosed as having a cerebral tumor on the basis of finding a round lesion in the right lenticular nucleus with ring enhancement on gadolinium-enhanced T1-weighted brain magnetic resonance imaging. However, the discovery of positive serology for infection on routine tests on admission prompted analysis of cerebrospinal fluid, which was also positive on hemagglutination (TPHA), rapid plasma reagin (RPR), and treponemal antibody absorption (FTA-ABS) tests. Thus, he was diagnosed as having an intracranial syphilitic gumma. After commencing treatment with penicillin G, the lesion temporarily increased in size, but subsequently resolved completely with continuing antibiotic treatment. In the present era of increasing prevalence of syphilitic infection and because they are eminently treatable, syphilitic gummas should be included in the differential diagnosis of apparent brain tumors. Additionally, temporary enlargement of a probable gumma after instituting antibiotic treatment should not prompt cessation or change of the antibiotics.

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From the identification of biopsychosocial risk factors to an increase in pain-related self-efficacy (IDRIS) – The online-based conveyance of an explanatory model for chronic back pain: Study protocol of a cohort multiple randomized controlled trial.

Back pain has a high global prevalence and carries a substantial risk for chronification. Biopsychosocial factors are assumed to be critical in the transition from acute to chronic back pain. Digital interventions are a promising tool to educate patients about their complaints. Thus, providing patients with an explanatory model regarding their individual risk factors in the early stage of their complaints via the internet might thus be a valuable approach in treatment.

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Setmelanotide: A Novel Targeted Treatment for Monogenic Obesity.

To review clinical data regarding the newly approved drug setmelanotide, an injectable melanocortin 4 receptor (MC4R) agonist, for chronic weight management in adults and children aged 6 years and older with monogenic obesity. A literature review was performed by searching MEDLINE, SCOPUS, and EMBASE for all relevant English-language articles published between January 1, 1996, and November 30, 2021, using search terms obesity, setmelanotide, Imcivree, and MC4R agonist. This review included two phase 2, two phase 3, and one ongoing clinical trial evaluating the efficacy and/or safety of setmelanotide. Setmelanotide demonstrates statistically significant weight loss with at least a 10% decrease in body weight after 1 year and decreased appetite in phase 2 and phase 3 clinical trials. The most common adverse effects included injection site reaction (96%), skin hyperpigmentation (78%), nausea (56%), headache (41%), and diarrhea (37%). Setmelanotide is the first and only Food and Drug Administration-approved medication for the treatment of proopiomelanocortin, proprotein convertase subtilisin/kexin type 1, and leptin receptor deficiency in patients with obesity. It may be used in children and adults who have received genetic testing and exhibited extreme obesity before age five. Setmelanotide is a daily subcutaneous injection and may be difficult to afford for patients. Setmelanotide is an effective treatment in patients with obesity and indicated genetic disorders.

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Physiology of the Weight-Reduced State and Its Impact on Weight Regain.

Obesity is a chronic disease characterized by long duration, slow progression, and periods of remission and relapses. Despite the development of effective medical and surgical interventions and millions of people conducting tremendous personal efforts to manage their weight every year, recidivism remains a significant barrier to attaining long-term weight maintenance. This review aimed to explain the underlying physiology of the weight-reduced state including changes in energy balance, adipose tissue, genetic, environmental, and behavioral factors that may predispose individuals to weight regain following weight loss.

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Severe Intrahepatic Cholestasis Pregnancy Is Associated With Maternal Endothelial Dysfunction: A Case-Control Study.

The aim of the present study was to evaluate maternal serum endocan levels, which are markers of vascular pathologies and strongly associated with vascular inflammation and endothelial dysfunction, in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP).

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Membranous desquamation of the hand in a 7-year-old boy with mild COVID-19.

A 7-year-old Japanese boy was diagnosed with coronavirus disease 2019. He developed intermittent fever and headache, and the symptoms improved by Day 3. However, he developed membranous desquamation without erythema or swelling on the right hand on Day 4, which improved without treatment.

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Editorial Commentary: Arthroscopic Debridement of Tennis Elbow Nonresponsive to Nonoperative Measures Is a Good Option and Clinical Outcomes Are Associated With Radiographic Outcomes.

Chronic lateral epicondylitis, or "tennis elbow," is rare and affects 1% to 3% of adults annually. The initial treatment should be nonoperative and include physical therapy, nonsteroidal anti-inflammatory medication, rest, bracing, extracorporeal shock wave therapy, and injection therapy with various agents such as autologous blood, dextrose, corticosteroids, or platelet-rich plasma. The condition is self-limited, and approximately 80% of cases resolve. In refractory cases, arthroscopic release with debridement is a good surgical option but is not superior to open or percutaneous techniques. Recent research shows that a reduction in magnetic resonance imaging signal intensity in patients who respond to arthroscopic treatment correlates with pain reduction and functional outcome improvement.

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Mechanical extraction of chronic venous thrombus using a novel device: a report of two cases.

In deep vein thrombosis (DVT), the structure and composition of the venous thrombus can change rapidly over time. Studies have shown mixed results with anticoagulant and thrombolytic therapies, and the issue will be exacerbated in the case of chronic DVT (defined as thrombus still present after ≥4 weeks of failed treatment after a DVT diagnosis), with no well-accepted interventions. In the present report, we have described two patients in whom mechanical thrombectomy with a novel device was used to remove extensive, chronic thrombus. At follow-up, both patients showed improved blood flow and patency with resolution of their edema and pain. Because thrombus can often be more chronic than expected from a patient's medical history alone, mechanical intervention as the first approach might be warranted.

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