Rejected

A 75-year-old man with chronic cholangitis and a common bile duct stone that was not previously identified was admitted for right upper quadrant pain. Acute cholecystitis with cholangitis was suspected on abdominal computed tomography (CT); therefore, endoscopic retrograde cholangiopancreatography with endonasal biliary drainage was performed. On admission day 5, hemobilia with rupture of two intrahepatic artery pseudoaneurysms was observed on follow-up abdominal CT. Coil embolization of the pseudoaneurysms was conducted using percutaneous transhepatic biliary drainage. After several days, intrahepatic artery pseudoaneurysm rupture recurred and coil embolization through a percutaneous transhepatic biliary drainage tract was conducted after failure of embolization via the hepatic artery due to previous coiling. After the second coil embolization, a common bile duct stone was removed, and the patient presented no complications during 4 months of follow-up. We report a case of intrahepatic artery pseudoaneurysm rupture without prior history of intervention involving the hepatobiliary system that was successfully managed using coil embolization through percutaneous transhepatic biliary drainage.

Syncope is defined as a transient loss of consciousness and postural tone, characterized by rapid onset, short duration, and spontaneous recovery. Stellate ganglion block (SGB) is a nerve block method that is used for treatment of neuropathic pain in the head, neck and upper extremities, especially trigeminal neuralgia, postherpetic neuralgia and complex regional pain syndrome. SGB can modulate and stabilize the sympathetic nervous system, which prevents it from overexcitation and improves symptoms of syncope. The authors report a patient who was treated for pain and edema of both upper extremities with SGB, then showed improvement in recurrent syncope followed by chest pain and overall quality of life.

Applied health science research commonly measures concepts via multiple-item tools (scales), such as self-reported questionnaires or observation checklists. They are usually validated in more detail in separate psychometric studies or very cursorily in substantive studies. However, methodologists advise that, as validity is a property of the inferences based on measurement in a context, psychometric analyses should be performed in substantive studies as well. Until recently, performing comprehensive psychometrics required expert knowledge of different, often proprietary, software. The increasing availability of statistical techniques in the R environment now makes it possible to integrate such analyses in applied research. In this tutorial, I introduce a 6-step protocol which allows detailed diagnosis of core psychometric properties (e.g. structural validity, internal consistency) for scales with binary and ordinal response options aiming to measure differences in degree or quantity, the most common in applied research. The protocol includes investigations of (1) item distributions and summary statistics, item properties via (2) non-parametric and (3) parametric item response theory, (4) scale structure using factor analysis, (5) reliability via classical test theory, and (6) calculation and description of global scores. I illustrate the procedure on a measure of self-reported disability, the 24-item Sickness Impact Profile Roland Scale (RM-SIP), administered in a survey of 222 chronic pain sufferers. An R Markdown script is provided that generates reproducible reports. In this sample, 15 of 24 RM-SIP items formed a unidimensional ordinal scale with good homogeneity ( = 0.43) and reliability ( = .86[.84-.89];  = .87[.85-.88]). The two versions were highly correlated ( = .96), and regression models predicting RM-SIP disability produced comparable results. The example analysis illustrates how psychometric properties may be assessed in substantive studies and identify avenues for measure improvement. Applied researchers can adapt this script to perform and communicate these analyses as part of questionnaire validation and substantive studies.

Recessive dystrophic epidermolysis bullosa (RDEB) is a rare, hereditary mucocutaneous disorder that can involve renal insufficiency. If a vascular access for hemodialysis is unavailable, peritoneal dialysis can be utilized. This report describes an anesthetic management with ultrasound-guided transversus abdominis plane block (TAPB) in a patient with RDEB for peritoneal dialysis catheter replacement.

The choice of analgesic agents for the horse is limited, and many have side effects that can restrict their use for chronic and prolonged pain. Little information has been published on tramadol and acetaminophen use in the horse. The study evaluated the analgesic effects of coadministration of tramadol and acetaminophen compared to those of each drug individually in a crossover study. The study was performed on six healthy horses each infused with the following over 1 hour: control (normal saline), tramadol, acetaminophen, or both (acetaminophen and tramadol infused together). Nociception (using a pressure algometer) and any adverse effects were evaluated before the infusion, at 0, 10, 20, 30, 40, and 50 minutes during the infusion and at 15, 30, and 60 minutes after infusion completion. The pressure algometer was placed on the palmar surface of both the forelimbs. There was no difference in response to nociception between the control and single-agent (acetaminophen or tramadol) groups. However, coadministration of tramadol and acetaminophen resulted in a significant analgesic effect from 20 minutes after starting the infusion until the infusion was completed. Fifteen minutes after discontinuing the infusion, no significant differences remained between the groups. No side effects were seen, with the exception of one horse in the coadministration group which showed paroxysmal ventricular tachycardia 30 minutes after constant rate infusion (CRI) which resolved completely after discontinuing the infusion. Simultaneous infusion of tramadol and acetaminophen resulted in significant analgesia. Further research is required to evaluate its effect and possible side effects in clinical cases, such as horses suffering from laminitis.

Rett syndrome, which is a progressive, central nervous system disease that is caused by a gene mutation, is known to present with various symptoms. This case is that of a 15-year-old girl who was diagnosed with Rett syndrome at the age of 2 years. Laryngotracheal isolation under general anesthesia was planned due to recurrent aspiration pneumonia. Since the patient's nutritional status and control of convulsions were good, this was deemed an appropriate time for the surgery. Following careful preoperative evaluation of her airway, we performed oral endotracheal intubation using a video laryngoscope after rapid induction. Since postoperative pain control was important to prevent apneic attacks and convulsions, we used a multimodal analgesic regimen including carefully titrated fentanyl, acetaminophen, nonsteroidal anti-inflammatory drug, and wound infiltration with a local anesthetic. Postoperatively, the patient returned to the intensive care unit under spontaneous ventilation and followed a good course. Patients with Rett syndrome present several symptoms. Thus, several points must be considered during the preoperative evaluation, anesthetic management, and postoperative care of these patients.

Aortic aneurysms are usually asymptomatic until catastrophic rupture occurs. Ruptured abdominal aortic aneurysms classically present with acute back pain, shock, and a pulsatile abdominal mass. The natural history of some aortic aneurysms also includes a stage of contained rupture. This occurs when extravasation of blood from the ruptured aneurysm is contained by surrounding tissues. Here, the authors report the case of a chronic contained abdominal aortic aneurysm rupture that resulted in erosion of the spine.

To evaluate postoperative pain level using a supplemental peribulbar injection at the conclusion of retinal surgery.

Headaches are common presenting complaints in EDs throughout the United States. Most are benign and should be treated symptomatically. Certain historical risk factors and physical examination findings increase the likelihood of a secondary cause of headache and warrant further investigation with neuroimaging. Gross visual field testing is a critical component of the physical examination and should not be overlooked as a potential manifestation of a neurologic deficit. This article describes a patient whose headache and unilateral vision loss prompted neuroimaging that uncovered a pilocytic astrocytoma.

Alveolar soft-part sarcomas are clinically and morphologically distinct soft-tissue sarcomas, with an unknown histogenesis. When the tumors affect the region of the head and neck, they are often located in the orbit and tongue. We report a case of an alveolar soft-part sarcoma in the left masseter of a 28-year-old female. The patient had chronic pain and paresthesia of her left lower lip. Panoramic radiography and computed tomography showed a well-delimited radiolucent mass in the left ramus. An incisional biopsy was performed, and the sample submitted for histopathological study. The tumor showed positive periodic acid-Schiff diastase-resistant granules. Immunohistochemically, the tumor cells were diffusely positive for myoglobin, and focally positive for actin and desmin.