Rejected

Accumulating evidence indicates that P2X receptors may serve an important role in pain and nociceptive sensations. However, recent studies of regulation of P2X receptor expression following nerve injury have produced variable or conflicting results. In the present study the alteration of expression of P2X1-6 receptor subunits in retrograde Flurorogold (FG)-labeled L4+L5 dorsal root ganglion (DRG) neurons were evaluated following unilateral chronic constriction injury (CCI) of the rat sciatic nerve using immunohistochemistry combined with a retrograde fluorescence-tracing method. It was demonstrated that there was no significant difference in the proportion of FG-labeled DRG neurons between the sham and CCI groups (P>0.5). The percentages of P2X1-immunoreactive (IR) and P2X2-IR FG-labeled DRG neurons were not significantly different between the sham and CCI groups (41.5±8.2 vs. 45.2±7.4% and 58.1±6.2 vs. 69.1±3.5%, P>0.05). The percentages of P2X3-IR and P2X6-IR FG-labeled DRG neurons significantly increased in the CCI group compared with the sham group (51.6±4.1 vs. 28.5±3.4% and 41.8±2.2 vs. 22.6±3.3%, P>0.01). By contrast, the percentage of P2X4-IR FG-labeled DRG neurons significantly decreased in the CCI group compared with the sham group (29.4±3.3 vs. 45.0±3.7%, P<0.01). The P2X5-IR positive FG-labeled neurons were not detected in the CCI and sham groups. The results of the present study provided the first evidence regarding the regulation of the expression of the P2X1-6 receptor in sensory neurons being directly associated with chronic nerve injury in rats and also suggest that compared with the P2X3 receptor, the P2X2/3 heteromeric receptor is not the major receptor involved in peripheral neuropathic pain sensation. In addition, the possible functional role of P2X6 receptors in peripheral neuropathic pain requires further investigation.

Chronic asymptomatic pancreatic hyperenzymemia (CAPH) was described as a benign disease. However, we already described clinically relevant findings requiring surgery or follow-up in a half of subjects. The aim of this study was to evaluate the long-term outcome of CAPH in terms of symptoms and evolution toward chronic pancreatitis.

Retroperitoneal fibrosis (RPF) is a rare disease characterized by proliferation of fibro-inflammatory tissue in the retroperitoneum. Multiple studies have reported on the idiopathic cases of the disease, but reports of RPF secondary to irradiation are very limited. Herein, we report the case of a 47-year-old woman who complained of lower abdominal pain 14 months after chemo-radiotherapy for cervical cancer. Computed tomography showed a soft-tissue mass spreading in the presacral space. Biopsy of the lesion revealed fibro-inflammatory tissue without malignancy. Retrospective imaging findings showed that the lesion was consistent with the irradiation field. We diagnosed the patient with RPF caused by radiotherapy. We started oral administration of prednisolone at a dose of 30 mg/day. After 3 months, scans showed a remarkable reduction in lesion size. Prednisolone was tapered to a maintenance dose of 5 mg/day, which is ongoing. The patient is doing well with no recurrence to date.

Acute pancreatitis (AP) is a potentially life-threatening common gastrointestinal disorder with increasing incidence around the globe. Although the majority of cases will take an uneventful, mild course, a fraction of patients is at risk of moderately severe or severe pancreatitis which is burdened with substantial morbidity and mortality. Early identification of patients at risk of a severe disease course and an adopted treatment strategy are crucial to avoid adverse outcomes.

Three-dimensional, high-definition images, small instruments with endowrist technology, ergonomic position and the easiness to teach, are possibly the main reasons why robotic surgery will continue to gain ground to others forms of surgery. The current applications of robotics in functional urology are: the correction of pelvic organ prolapse, the correction of female stress urinary incontinence (artificial urinary sphincter) and the treatment of chronic pelvic pain (pudendal nerveneurolysis). In this paper, we explain our robotic techniques in these three scenarios, as well as, provide the most updated data of our series.

The majority of patients with multiple sclerosis (MS) suffer from central neuropathic pain (CNP). Using experimental autoimmune encephalomyelitis (EAE) model, only a few experiments were performed to assess pain behaviors in MS. To address this issue, complete Freund's adjuvant (CFA) was replaced with an acylated triterpene glycoside saponin adjuvant named quillaja saponin-21 (QS-21) to develop CNP in the EAE mouse model. The deacylated form of QS-21, named QT-0101, has been suggested to have an immunomodulatory effect. Thus, QT-0101 was used as a vaccine adjuvant to modulate the immune system against myelin oligodendrocyte glycoprotein (MOG35-55) antigen.

Iatrogenic injuries due to intramuscular (IM) injection, although less frequently reported than before, are still common. The sciatic nerve is the most commonly injured nerve because of an IM injection owing to its large size and the buttock being a common injection site. Iatrogenic injury to the sciatic nerve resulting from a misplaced gluteal IM injection is a persistent problem worldwide affecting patients in economically rich and poor countries alike. The consequences of sciatic nerve injection injury (SNII) are potentially devastating and may result in serious neurological and medico-legal problems. A 68-year-old male presented with intractable neuropathic pain from SNII that occurred during gluteal IM injection of an analgesic for post-appendectomy pain. This chronic SNII pain did not improve despite his gradual recovery from weakness in the left foot. Partial improvement was seen following an external neurolysis, performed three months post-appendectomy. SNII is a preventable complication of gluteal IM injection. While the complete avoidance of gluteal IM injection is desirable, should need arise, the use of an appropriate administrative technique is recommended.

A new indication of ultrasound – guided Erector spinae plane block for perioperative analgesia is orthopaedic surgery. We report here the use of this paraspinal block in the case of a 68-yr-old female with multiple systemic disorder for total hip replacement surgery.

Poorly managed postoperative pain decreases patient satisfaction, impedes early patient mobilization, lengthens inpatient hospital stay, and increases healthcare costs. Multimodal analgesia with local anesthetics is considered most effective for postoperative pain management. This study compared patients undergoing lumbar fusion who received plain bupivacaine from May 2011 until August 2012 with those who received liposomal bupivacaine from September 2012 until May 2013. The aim was to determine which preparation reduced postoperative opioid use the most. All lumbar spinal fusion surgeries in the periods indicated were included in the study. Ninety-three patient charts were reviewed: 47 for the plain bupivacaine group and 46 for the liposomal bupivacaine group. The study found no statistical difference between liposomal and plain bupivacaine in providing postoperative pain control from lumbar fusion surgery. Liposomal bupivacaine is as effective as plain bupivacaine for postoperative pain control after lumbar fusion. However, a continuous infusion system carries substantial inherent drawbacks: need for training and setup, pump cost, risk of infection at the insertion site, or catheter migration. Therefore, liposomal bupivacaine becomes the logical and attractive choice to manage postoperative pain following lumbar fusion.