Rejected

Median arcuate ligament syndrome (MALS), is an uncommon condition caused by the extrinsic compression of the celiac trunk (CT) and celiac ganglion, secondary to an anatomical abnormality of the median arcuate ligament fibres. It is characterized by postprandial epigastric pain, chronic abdominal pain, weight loss, nausea and vomiting. MALS is typically diagnosed after the exclusion of other, more common conditions; however, a variety of imaging and diagnostic modalities, including duplex ultrasonography, computed tomography angiography, magnetic resonance angiography, gastric tonometry and angiography can suggest findings consistent with MALS.

Opioid treatment for chronic pain has garnered heightened public attention and political pressure to control a devastating public health crisis in the United States (U.S.). Resulting policy changes, together with ongoing public and political attention, have pushed health care systems and providers to lower doses or deprescribe and taper patients off opioids. However, little attention has been paid to the impact of such practice changes on patients who had relied on opioid treatment to manage their chronic pain. The aim of this article is to explore experiences with opioid-related care under aggressive tapering efforts and concomitant heightened monitoring and institutional oversight among patients with chronic pain in an integrated delivery system through in-depth interviews.

This study aimed to estimate risk factors associated with recurrence after radiofrequency thermocoagulation (RFT) of the gasserian ganglion among a large sample of patients with trigeminal neuralgia (TN) during a long-term follow-up.

We report the case of a 70-year-old woman with metastatic lung adenocarcinoma and meningioma on daily treatment with brigatinib 180mg/day for 6 months and levetiracetam for 10 years. She presented with a 2,5 months history of a pruritic eczematous eruption resembling an exaggerated sunburn involving the face, neck, forearms and hands, sparing non-sun-exposed areas. Limits were not very sharp and pruritus was minor (Fig. 1). She denied exposure to known photosensitizing drugs or airborne chemicals. Routine laboratory tests, antinuclear antibodies, including anti-Ro, were normal. Brigatinib was discontinued and treatment with methylprednisolone 0.5mg/kg/day allowed significant improvement. This article is protected by copyright. All rights reserved.

Early surgical debridement of nonviable tissue within 48 hours of burn injury is the standard of care (SOC) for burns extending into and beyond the deep dermis. Early debridement has been reported to reduce infection and complication rates, shorten hospital stays, and improve burn wound healing compared with delayed debridement of these burns.1 However, surgical debridement challenges patients with considerable pain, blood and heat loss, and poor differentiation between viable and dead tissue resulting in unnecessary excision of healthy tissue.2 Alternative debridement interventions, such as larval, enzymatic, hydrosurgical, or autolytic, have improved outcomes of chronic necrotic wounds3,4 and may offer ways to spare healthy tissue and minimize the recognized challenges of surgical debridement in patients with deep dermal or full-thickness burns. This installment of Evidence Corner reviews recent research exploring hydrosurgical5 or bromelain-based enzyme6 interventions reported to improve burn debridement or repair beyond the current SOC.

Reversible cerebral vasoconstriction syndrome (RCVS) is often accompanied by thunderclap headaches. Although symptoms usually resolve spontaneously within 2 months, it can cause fatal complications, such as cerebral hemorrhage, and is difficult to differentiate from a migraine and other headaches on the basis of symptoms and Imaging study. In this case report, we explore clinical findings and appropriate treatment methods for RCVS through the case study of a female patient who experienced severe headache upon defecation PATIENT CONCERNS:: A 42-year-old female patient complained of a severe throbbing headache with a Numeric Rating Scale (NRS) score of 10 after defecation. The pain subsided temporarily after treatment with diclofenac 75 mg and Tridol 50 mg propacetamol 1 g, but the headache returned upon defecation; soon after, the patient complained again of regular headaches at 4 to 6-hour intervals irrespective of defecation.

Cortical spreading depression (SD) is a spreading disruption of ionic homeostasis in the brain during which neurons experience complete and prolonged depolarizations. SD is the basis of migraine aura and is increasingly associated with many other brain pathologies. Here, we study the role of glutamate and NMDA receptor dynamics in the context of an ionic electrodiffusion model. We perform simulations in one (1D) and two (2D) spatial dimension. Our 1D simulations reproduce the "inverted saddle" shape of the extracellular voltage signal for the first time. Our simulations suggest that SD propagation depends on two overlapping mechanisms; one dependent on extracellular glutamate diffusion and NMDA receptors and the other dependent on extracellular potassium diffusion and persistent sodium channel conductance. In 2D simulations, we study the dynamics of spiral waves. We study the properties of the spiral waves in relation to the planar 1D wave, and also compute the energy expenditure associated with the recurrent SD spirals.

We present 4 cases of Wilkie's syndrome (WS) diagnosis in our Hospital between 2014-2019. WS is an infrequent disease, whose diagnosis can be challenging for patients suffering recurrent digestive symptoms. Our patients refered a history of chronic postprandial abdominal pain associated with vomiting, intestinal transit disorders or an uncontrolled weight loss. Abdominopelvic angio-CT was part of the research in all the cases, objectifying a decrease in the angle between Superior Mesenteric Artery (SAM) and Aorta below 25°. In case of chronic or refractory cases, the surgical treatment may be an option. Laparoscopic duodenojejunostomy constitutes the treatment of choice due its low rate of complications and acceptable results.

The Editor-in-Chief has retracted this article [1] because an investigation by Keio University has concluded that there are inaccuracies in the data reported.

The combined immunotherapy of nivolumab and ipilimumab causes a variety of autoimmune-related adverse events (irAEs). The current report details a 70-year-old woman with clear cell renal cell carcinoma metastasis in the lung. Two weeks after two courses of treatment, the patient complained of headache, dizziness and nausea. Cerebrospinal fluid (CSF) analysis revealed an elevated protein level of 195 mg/dl and a significantly elevated white blood cell (WBC) count of 830/mm (lymphocytes, 825/mm; neutrophils, 5/mm). The results excluded malignancy and infection. The patient was diagnosed with aseptic meningitis and was administered intravenous prednisolone (1 mg/kg/day). On the 49th day of the 2nd course of treatment, no recurrence of clinical symptoms was exhibited during maintenance oral steroid treatment (prednisolone 10 mg/day) and CSF analysis revealed that the WBC count had dropped to 44/mm (lymphocytes only). Therefore, the 3rd course of treatment was readministered the next day. After two weeks, the patients again complained of nausea, anorexia and fatigue. CSF analysis demonstrated that the WBC count was not increased from the result obtained previously. However, brain MRI scans revealed the mild diffuse enlargement of the pituitary and endocrine system tests revealed reduced adrenocorticotropic hormone (ACTH; 2.0 pg/ml) and cortisol (1.12 µg/dl) levels. The patient was diagnosed with isolated ACTH deficiency and oral hydrocortisone was administered after prednisolone cessation. On the 25th day of the 3rd course of treatment, the patient complained of headache and anorexia. CSF examination revealed that the WBC count had increased a second time (53/mm; lymphocytes only) and laboratory data revealed hepatic dysfunction. The patient was then diagnosed with relapse of aseptic meningitis and liver dysfunction. While continuing oral hydrocortisone treatment, the administration of intravenous prednisolone was started. The observed liver dysfunction and aseptic meningitis gradually improved. The current report may be useful for avoiding delays in the diagnosis and treatment of this life-threatening and uncommon irAE, in which CSF examinations are useful for diagnosis and management.