Rejected

 Regardless of the operative approach, headache, cerebrospinal fluid (CSF) leaks, and pseudomeningoceles remain disproportionately common problems after surgery for vestibular schwannomas and have a significant negative impact on quality of life and potential to return to full employment. Recent work has raised the possibility that these problems may, in part, be related to acquired obstruction of cranial venous outflow. This article explores this idea further with respect to a group of patients with severe and intractable symptoms.  The main objective of this article is to describe our experience diagnosing, investigating, and treating cranial venous outflow obstruction following translabyrinthine resection of vestibular schwannomas.  Retrospective review of all patients (  = 9) at our institution referred for sigmoid sinus stenting following translabyrinthine surgery.  Headache resolved or improved after sigmoid stenting in all five patients in whom it was the primary symptom. CSF leak was the primary problem in two patients. In one, the leak was unchanged, but headache improved. In the other, the leak resolved, and headache improved. Two patients had symptomatic pseudomeningoceles and both resolved  Assuming a meticulous approach to wound closure, a CSF leak following surgery for vestibular schwannoma can be viewed as a pathological, but essentially homeostatic, response to raised intracranial pressure caused by acquired obstruction to cranial venous outflow. Postoperative headache (from high or low intracranial pressure) and CSF leaks, therefore, may all respond to measures aimed at eliminating the obstructing lesion.

Ectopic salivary glands have been found in both extracranial and intracranial locations, however, intrasellar symptomatic salivary gland is extremely rare and its clinical manifestation, radiological characteristics and outcome have not been systematically studied. Here we present a case series of intrasellar symptomatic salivary gland and perform a literature review to better characterize this disease.

This paper contains data that can be used in interpretation of the pharmacological effects of sinomenine combined with gabapentin or ligustrazine hydrochloride on chronic pain. The data can be divided into two parts. The first part is regarding if there were noticeable side effects accompanying drug applications of sinomenine plus gabapentin or ligustrazine hydrochloride. These side effects include sedation and change of core body temperature as well as tissue edema and sustained itch. The data were acquired from the open field test in mice, and provided insights for the effects of drug combination therapy on locomotive activities, rearing behaviors and body temperature. The second part is regarding whether sinomenine could be accumulated in the central nervous system (CNS) tissue following repeated drug administration. The data were acquired using microdialysis, which illustrated the pharmacokinetic properties of sinomenine, by showing relative concentrations of sinomenine in blood and CNS tissue, following single or repeated drug application. Data presented here is related to and supportive of the research article by Gao et al., "Sinomenine facilitates the efficacy of gabapentin or ligustrazine hydrochloride in animal models of neuropathic pain"[1], where interpretation of the research data presented here is available.

Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. The current strategies to treat AD in Japan from the perspective of evidence-based medicine consist of three primary measures: (i) the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice.

Pregnancy is associated with increased coarctation-associated complications. We report the successful management of emergency lower-segment cesarean delivery in a patient with coarctation of aorta. A parturient at 34 weeks of gestation of a twin pregnancy with uncorrected coarctation of aorta was taken for emergency lower-segment cesarean delivery to be performed using epidural anesthesia. A mixture of lignocaine (lidocaine), bupivacaine, and fentanyl was administered epidurally. In view of unsatisfactory motor action, general anesthesia had to be administered. However, because of sufficient analgesia due to the epidural drugs, optimal hemodynamic control was achieved. A combination of general and epidural anesthesia minimizes adverse effects of coarctation of aorta, with improved maternal and fetal outcomes.

Tramadol dependence became an increasing and alarming problem in the Egyptian community. Wide availability of tramadol as a pain killer and its role in the treatment of premature ejaculation may be the most apparent causes of increased magnitude of the problem among youth who believe that tramadol has a positive impact on their sexual functions. This study aimed to explore the real impact of chronic tramadol administration on sexual functions in males dependent on tramadol. The study was carried on 80 subjects (50 subjects were tramadol dependent group and 30 subjects represented the control group). Personal, family and past histories were obtained from all the participants in addition to the toxicological history from tramadol dependent group. Urine screening for tramadol was done for all cases of history of tramadol dependence then confirmation by HPLC technique to measure tramadol blood level was done. Both groups were investigated for serum testosterone and prolactin level. Curiosity (22%) and treatment of premature ejaculation (20%) were the main motives for dependence. Erectile dysfunction and decreased libido occurred in 44% and 48% of tramadol dependent group respectively. Significant increase in erectile dysfunction and decreased libido was noted as the duration of dependence increased. Additionally, significant decrease in serum testosterone level and increase in serum prolactin level as tramadol daily dose and duration increased was found. In conclusion, men who take tramadol for premature ejaculation or any other purpose must know that they are very susceptible to many sexual dysfunctions.

Irritable bowel syndrome (IBS) is a well diagnosed disease, thoroughly attributed to series of symptoms criteria that embrace a broad range of abdominal complainers. Such criteria help to diagnosis the disease and can guide controlled clinical trials to seek new therapeutic agents. Accordingly, a verity of mechanisms and pathophysiological conditions including inflammation, oxidative stress, lipid peroxidation and different life styles are involved in IBS. Predictably, diverse therapeutic approaches are available and prescribed by clinicians due to major manifestations (i.e., diarrhea-predominance, constipation-predominance, abdominal pain and visceral hypersensitivity), psychological disturbances, and patient preferences between herbal treatments versus pharmacological therapies, dietary or microbiological approaches. Herein, we gathered the latest scientific data between 1973 and 2019 from databases such as PubMed, Google Scholar, Scopus and Cochrane library on relevant studies concerning beneficial effects of herbal treatments for IBS, in particular polyphenols. This is concluded that polyphenols might be applicable for preventing IBS and improving the IBS symptoms, mainly through suppressing the inflammatory signaling pathways, which nowadays are known as novel platform for the IBS management. Graphical abstract.

Few studies have examined the epidemiology of herpes zoster (HZ) and postherpetic neuralgia (PHN) in China. The aim of this study was to estimate the prevalence of HZ and PHN in China, and to examine the clinical characteristics of patients identified with PHN.