Rejected

Spontaneous epidural hemorrhage is one of the rare neuropathic pain etiologies. In this case, a 68-year-old patient, who had atrial fibrillation and cardioversion history, is evaluated for neuropathic pain due to spontaneous epidural hemorrhage that arose from oral anticoagulant therapy. As well as being unique in etiologic terms, we thought it is an uncommon occasion for management worth sharing.

Lipomatous tumors herniating through the sciatic foramen are extremely rare with less than 6 cases reported in the existing literature. We report a case of gluteal well differentiated liposarcoma that presented as sciatic hernia.

Horner's syndrome is an unusual side effect of epidural analgesia. We report an unusual symptom after epineural axis analgesia for labor, which happened three times in the same patient. Horner's syndrome occurrence following epidural catheterization should lead the anesthetic team to search for a subdural position of the catheter because of its potentially threatening complications.

Trigeminal neuralgia (TN) is one of the most common cranial neuropathies. Pathologies located alongside the long nerve can also cause its mechanical compression or secondary involvement in the inflammatory process, and thus cause pain. TN is characterised by severe paroxysmal unilateral facial pain in the innervation area of branches I-III of the nerve V when provoked by light touch or slight movement. Multiple therapeutic methods are available, but most of them yield unsatisfactory results. According to guidelines (AAN and EFNS) the first-line therapy in trigeminalgia is carbamazepine/oxcarbazepine, and if there is a poor response – surgical treatment [1]. The array of surgical options includes percutaneous retrogasserian glycerol injection, radiofrequency thermocoagulation, balloon decompression, thermal rhizotomy, and stereotactic radiosurgery [2-4]. This paper presents our own experiences with CyberKnife (CK), a new type of radiosurgical (RS) treatment of 64 TN patients. CONCLUSIONS: CyberKnife radiotherapy is characterised by high efficacy in 80% of patients with trigeminalgia, minimal invasiveness, and subsiding mild side effects. Radioablation of nerve V root in patients with neuralgia allows us to entirely stop antiepileptic therapy or reduce its doses, which in turn reduces the risk of potential side effects. CyberKnife can be a therapeutic option in those patients who have been offered ineffective therapies, or treatments with limited efficacy, and/or in older patients with comorbidities.

Cognitive dysfunction in the early postoperative course is common for the elderly population. Anesthetic management may affect postoperative cognitive decline. Effective analgesia, early recovery and modulation of the stress response are advantages of neuraxial blocks. This study aims to compare the effects of general anesthesia and the combination of general anesthesia with epidural analgesia for postoperative cognitive dysfunction (POCD). We hypothesized that neuraxial block combined with general anesthesia (GA) would have a favorable influence on POCD prevention.

There is a wide differential diagnosis for intraabdominal tumors. Surgical resection and microscopic analysis of tissue structure can identify tumor origin in most cases. Most rapidly growing invasive tumors are neoplastic. Inflammatory pseudotumors are a subcategory of intraabdominal tumors that are non-neoplastic and can be rapidly growing. Urachal cysts originate from the dome of the bladder; however they are typically not invasive. There is limited literature on the appropriate management of these tumors.

Osteoarthritis (OA) is a degenerative articular disorder manifested by cartilage destruction, subchondral sclerosis, osteophytes, and synovitis, resulting in chronic joint pain and physical disability in the elderly. The purpose of this study was to investigate mitochondrial DNA copy number (mtDNA) and inflammatory cytokines in primary knee OA patients and healthy volunteers. A total of 204 knee OA patients and 169 age-matched healthy volunteers were recruited. Their relative blood leukocyte mtDNA was assessed by quantitative real-time polymerase chain reaction (qRT-PCR), and ten inflammatory cytokines in their plasma were detected by multiplex immunoassay. Blood leukocyte mtDNA in the OA group was significantly lower than that in the control group. Leukocyte mtDNA in the control group was negatively correlated with their age (r=-0.380, P<0.0001), whereas mtDNA in the OA group was positively correlated with their age (r=0.198, P<0.001). Plasma interleukin-4 (IL-4) and IL-6 were significantly higher in the knee OA group than in the control group. The plasma IL-6 level was positively correlated with blood leukocyte mtDNA in the OA group (r=0.547, P=0.0014). IL-5 showed as a major factor (coefficient 0.69) in the second dimension of principle components analysis (PCA)-transformed data and was significantly higher in the OA group (P<0.001) as well as negatively correlated with mtDNA (r=-0.577, P<0.001). These findings suggest that elevation of plasma IL-4 and IL-6 and a relative reduction in mtDNA might be effective biomarkers for knee OA. IL-5 is a plausible factor responsible for decreasing blood leukocyte mtDNA in knee OA patients.

We have previously shown that during muscle pain induced by infusion of hypertonic saline (HS), concurrent application of vibration and gentle brushing to overlying and adjacent skin regions increases the overall pain. In the current study, we focused on muscle-muscle interactions and tested whether HS-induced muscle pain can be modulated by innocuous/sub-perceptual stimulation of adjacent, contralateral, and remote muscles. Psychophysical observations were made in 23 healthy participants. HS (5%) was infused into a forearm muscle (flexor carpi ulnaris) to produce a stable baseline pain. In separate experiments, in each of the three test locations ( = 10 per site)-ipsilateral hand (abductor digiti minimi), contralateral forearm (flexor carpi ulnaris), and contralateral leg (tibialis anterior)-50 μl of 0.9% normal saline (NS) was infused (in triplicate) before, during, and upon cessation of HS-induced muscle pain in the forearm. In the absence of background pain, the infusion of NS was imperceptible to all participants. In the presence of HS-induced pain in the forearm, the concurrent infusion of NS into the ipsilateral hand, contralateral forearm, and contralateral leg increased the overall pain by 16, 12, and 15%, respectively. These effects were significant, reproducible, and time-locked to NS infusions. Further, the NS-evoked increase in pain was almost always ascribed to the forearm where HS was infused with no discernible percept attributed to the sites of NS infusion. Based on these observations, we conclude that intramuscular infusion of HS results in muscle hyperalgesia to sub-perceptual stimulation of muscle afferents in a somatotopically unrestricted manner, indicating the involvement of a central (likely supra-spinal) mechanism.

To evaluate spasticity and below-level spinal cord injury neuropathic pain after spinal cord injury in patients with, or without, damage to the lumbar spinal cord and roots.

Pain conditions, such as neuropathic pain (NP) and persistent inflammatory pain are therapeutically difficult to manage. Previous studies have shown the involvement of glutamate receptor in pain modulation and in particular same of these showed the key role of the AMPA ionotropic glutamate receptor subtype. Antiseizure medications (ASMs) are often used to treat this symptom, however the effect of perampanel (PER), an ASM acting as selective, non-competitive inhibitor of the AMPA receptor on the management of pain has not well been investigated yet. Here we tested the potential analgesic and anti-inflammatory effects of PER, in acute and chronic pain models. PER was given orally either in acute (5 mg/kg) or repeated administration (3 mg/kg/d for 4 days). Pain response was assessed using models of nociceptive sensitivity, visceral and inflammatory pain, and mechanical allodynia and hyperalgesia induced by chronic constriction injury to the sciatic nerve. PER significantly reduced pain perception in all behavioral tests as well as CCI-induced mechanical allodynia and hyperalgesia in acute regimen (5 mg/kg). This effect was also observed after repeated treatment using the dose of 3 mg/kg/d. The antinociceptive, antiallodynic and antihyperalgesic effects of PER were attenuated when the CB antagonist AM251 (1 mg/kg/i.p.) was administered before PER treatment, suggesting the involvement of the cannabinergic system. Moreover, analyses showed that PER significantly increased CB receptor expression and reduced inflammatory cytokines (i.e. TNFα, IL-1β, and IL-6) in the spinal cord. In conclusion, these results extend our knowledge on PER antinociceptive and antiallodynic effects and support the involvement of cannabinergic system on its mode of action.