Rejected

Pain related to pregnancy can occur anytime between conception to the postpartum period. Pregnancy and the following months after birth are a time of physical change to the woman's body, with significant hormonal effects. We present a case of a young female with chronic pain several years after her second pregnancy that presented a diagnostic challenge. She was initially diagnosed with persistent pelvic girdle pain (PGP) type 2, responded somewhat to appropriately targeted pelvic floor therapy, with a plateau in her progress. The diagnosis was revised to PGP type 4, with some improvement in pain with customized therapy. Her treatment again changed with a focus on sacroiliac joint (SIJ) dysfunction and iliopsoas tendinopathy with excellent and complete resolution of her pain. The overlapping nature of these diagnoses caused a significant challenge in creating a tailored physical therapy approach to her pain that eventually led to her final diagnosis being one of exclusion. Treatment was focused on optimization of joint mobility and tissue lengthening, with the resolution of her pain.

This research aimed to analyze the effects of stellate nerve block with different drugs on the curative effect, stress responses, and the circulatory system of patients with hypertensive trigeminal neuralgia (TN).

Pelvic venous disease (PeVD) in women encompasses a wide variety of entities all resulting in pelvic pain and varices. Successful treatment with percutaneous interventions is dependent on identifying underlying factors contributing to the disease and addressing them with either embolization of incompetent veins or stenting for venous stenoses. There are a multitude of embolization methods with marked practice heterogeneity. Moreover, with the ongoing development of dedicated venous stents in the treatment of chronic venous disease, there are more opportunities to consider this modality for the treatment of PeVD, as many patients present with combined vein reflux and central venous stenosis. The necessity to address both and the order of interventions in these patients is still to be elucidated. Here, we describe when to choose stenting or embolization for PeVD, their limitations, and our practice and identify further areas of research in this field.

In Asian countries, acupuncture with gold threads has been widely used in the treatment of pain. However, several reports have suggested that the implanted gold threads can become fragmented and migrate to other parts of the body, damaging surrounding tissues. A 75-year-old female presented with diffuse erythematous edema with multiple vesicles on the right lower leg for 3 days. She had previously suffered from cellulitis on the same region twice for the last 1 year. Her past medical history included acupuncture with gold threads on the back due to lumbar herniated nucleus pulposus (HNP) about 10 years ago. Histopathological examination demonstrated marked subepithelial edema and diffuse perivascular infiltrate of inflammatory cells in the dermis. Simple radiography of the leg revealed numerous radiodense threads in the soft tissue. Since the patient did not receive acupuncture on any other sites except on the back, we hypothesized that the gold threads injected on the back may have migrated through the vessels to the leg. These metal fragments can cause inflammatory reaction and make the tissues more susceptible to secondary infections. The lesion gradually improved after treatment with systemic steroid and antibiotics for 1 week.

To investigate the costs of low-back pain associated sick leave of workers in the Netherlands from 2015 to 2017.

Among Uterine Artery Embolization (UAE) complications, vaginal discharge is considered very frequent, especially for submucosal fibroids. Until now, it was reported as clear odorless viscous material. To our knowledge, we describe the first report of intrauterine microsphere migration after UAE. A 45-year-old-woman was admitted to our hospital complaining metromenorrhagia, menstrual cramping, pelvic pain and dyspareunia. After a preprocedural Magnetic Resonance Imaging (MRI) study, she underwent a superselective transradial UAE using 500-700 µm and 700-900 µm microspheres with a good morphological results. At 2-month follow-up, she complained viscous vaginal discharge with "strange pink stiff sphere of about 2 mm in diameter". A post-procedural-MRI showed fibroid migration towards the uterine cavity, a frequent occurrence especially for submucosal fibroids. The microspheres transvascular migration outside the vessel wall was already reported in a study performed in sheep. Our hypothesis is that the phenomenon of transvascular migration along with the fibroid migration towards the uterine cavity after UAE, may have led the migration of the microspheres directly into the vaginal cavity causing chronic vaginal discharge with pink stiff sphere. Vaginal discharge mixed with "sphere of particles" should be included among the UAE late complication especially for intramural and/or submucosal fibroids with distance to the endometrium less than 2.4 mm at pre-procedural MRI.

The relevance of the study included that scarcity of evidence about the burdens of diseases in Ethiopia, in particular to non-communicable diseases along with the impact of COVID-19.

Immune-mediated adverse events are commonly seen with immune checkpoint inhibitors like nivolumab. Oncology specialists usually have to screen patients for risk factors for autoimmune diseases, since immune checkpoint inhibitors can potentially exacerbate these events. Some of the immune-mediated side effects include polyneuropathies, colitis, and cutaneous adverse effects. Non-specific maculopapular rash, pruritus, lichenoid reactions, eczema, and vitiligo are the most common dermatologic side effects. It is thought that these adverse events are due to the blocking of the programmed cell death protein-1 (PD-1) pathway and are mediated by the cytotoxic T cells. Psoriasis has been previously reported as a side effect in a few case reports and most commonly presented as an exacerbation of preexisting psoriasis. However, de novo psoriasis occurrence as a result of nivolumab is a rare entity, especially in a non-melanoma patient. Here, we present a case of renal cell carcinoma treated with immunotherapy with nivolumab, who developed de novo psoriasis with palmoplantar involvement.

To analyze the incidence patterns of nervous system diseases in survivors of carbon monoxide (CO) poisoning using nationwide claims data from South Korea.

Nonthrombotic iliac vein lesions (NIVLs) most frequently result from extrinsic compression of various segments of the common or external iliac vein. Patients develop symptoms associated with chronic venous insufficiency (CVI); female patients may develop symptoms of pelvic venous disease. Given that iliac vein compression can be clinically silent, a thorough history and physical examination is mandatory to exclude other causes of a patient's symptoms. Venous duplex ultrasound, insufficiency examinations, and axial imaging are most commonly used to assess for the presence of a NIVL. Catheter venography and intravascular ultrasound (IVUS) are the mainstay for invasive assessment of NIVLs and planning prior to stent placement. IVUS in particular has become the primary modality by which NIVLs are evaluated; recent evidence has clarified the lesion threshold for stent placement, which is indicated in patients with moderate to severe symptoms. In appropriately selected patients, stent placement results in improved pain, swelling, quality of life, and, when present, healing of venous stasis ulcers. Stent patency is well preserved in the majority of cases, with a low incidence of clinically driven need for reintervention. In this article, we will discuss the clinical features, workup, endovascular management, and treatment outcomes of NIVL.