Rejected

We present a case of a woman who received a left single-injection supraclavicular brachial plexus block for analgesia to facilitate upper extremity orthopaedic surgery. Before tracheal extubation she desaturated, was noted to have a low tidal volume and reduced left-sided air entry on auscultation of the chest. A chest x-ray taken 1 h following tracheal extubation revealed elevation of the left hemidiaphragm and a rightward shift of the trachea and mediastinal structures, with no evidence of pneumothorax. Findings were in-keeping with phrenic nerve palsy complicating the brachial plexus block performed. The patient was asymptomatic and discharged home the next day following repeat chest x-rays. We believe this is the first report of tracheal deviation contralateral to the side of an elevated hemidiaphragm secondary to phrenic nerve palsy from a brachial plexus block.

Patients with classic trigeminal neuralgia (CTN) have abnormalities in white matter integrity of the corpus callosum (CC). However, in CTN patients, it is unclear whether the CC substructure region is affected to varying degrees.

Around 50 million people in the United States live with-and suffer from-chronic pain. While some pain patients receive relief from physical therapy, medication, or surgery, others aren't helped by these treatments. "It's a debilitating situation," says Ryan Lakin, divisional vice president of R&D at Abbott. "Patients have trouble just living a normal life, doing a lot of things that we take for granted."

Subarachnoid hemorrhage (SAH) due to a solitary spinal aneurysm is extremely rare. Early diagnosis of spinal SAH is challenging, particularly when the spinal cord has not been compressed. We report a case of a 45-year-old male who presented with sudden onset of abdominal pain, followed by severe headache, vomiting, and generalized seizure. Three days after admission to the hospital, he developed progressive paraparesis. Magnetic resonance imaging (MRI) revealed spinal SAH with hematoma resulting in cord compression at the level of T9. Diagnostic spinal angiography identified a ruptured aneurysm of a radiculomedullary artery. In conclusion, rupture of a spinal aneurysm should be considered a possible cause of SAH in appropriate clinical settings, and clinicians must be aware of the possibility of cord compression.

Chronic pain is a lifelong issue, being one of the main causes of disability, affecting a great number of people worldwide, many of which often avoid seeking medical advice from pain experts and/or demonstrate poor adherence to their therapeutic plan. One of the most important steps in achieving a manageable course of disease, is the ability of self-management. We aimed at applying a method of systematic patient education and self-management through the use of Virtual Patients (VPs), a well-established method for educating medical doctors and students but never before targeting patients. Two VPs scenarios were designed, tested and evaluated by patients with rheumatic disorders, achieving a SUS score of 88/100 "Best Imaginable", alongside with positive reviews from the participants. The positive feedback from the patients supports the potential of VP educational paradigm to educate these patients and equip them with disease coping skills and strategies.

stembark decoction has been extensively employed in folkloric medicine in many parts of Nigeria as a remedy for pain as well as inflammation. The plant was studied for its anti-inflammatory as well as analgesic potency using standard biological models.

There is very little published literature on Enhanced Recovery Principles (ERP) used in primary joint replacements applied to revision hip and knee arthroplasty (rTHA, rTKA).

This case describes the prolonged treatment of a 38-year-old man with a transpelvic gunshot wound requiring a diverting ostomy and cystostomy for damage control procedures with a comminuted acetabular and femoral head fracture. The team used a ketamine drip for prolonged field care over 48 hours. The benefit of using a ketamine drip included low supply requirement, excellent analgesia, and ease of administration, but side-effects included somnolence and atelectasis necessitating oxygen supplementation before evacuation.

Sclerosing extramedullary hematopoietic tumor (SEMHT) is a rare disease that was originally named fibrous hematopoietic tumor or myelosclerosis. The process typically occurs in patients with a history of chronic myeloproliferative disorders and may afflict the skin, lung, breast, gastrointestinal tract, breast, kidney, lymph node, and thyroid gland. In this article, we report the case of a 37-year-old female with more than 5 years history of acute B-cell lymphoblastic leukemia who presented with right upper quadrant pain and tenderness. Computed tomography scan showed multiple new ring-enhancing low-density lesions within the right and left hepatic lobes. A computed tomography-guided liver core biopsy was performed on one of the new liver lesions and showed extramedullary hematopoiesis with atypical megakaryocytes and sinusoidal capillarization with associated fibroblastic proliferation. Numerous atypical megakaryocytes were scattered in the background of haphazard collagen deposition. No significant blasts or a leukemic process were identified. Bone marrow aspiration and biopsy showed extensive reticulin fibrosis (MF-3), trilineage dysplasia, increased blasts (10% to 19%), and hypercellularity (close to 100%), which was consistent with MDS-EB-2. Cytogenetics was reported as follows: 44~46,XX,-3,add(3)(p13),-5,-6,-7,17,del(17)(p12),+1~5mar[cp9]/46,XX. Molecular analysis was negative for both JAK2 V617F and CALR exon 9 activating mutations. In summary, we contributed a new case of SEMHT diagnosis in a synchronous presentation with poor clinical evolution associated chromosome 7 deletion and intact JAK2 and CALR exon 9. Care should be taken when diagnosing intraabdominal and retroperitoneal soft tissue masses with the history of hematological disorders.

Total pancreatectomy with islet autotransplantation (TPIAT) is a promising treatment for refractory chronic pancreatitis (CP). Pathological features of CP include progressive fibrosis in pancreas parenchyma, atrophy, and/or ductal occlusion. Complete acinar atrophy (CAA) caused by chronic fibrosis and necroinflammation results in exocrine sufficiency and may influence islet isolation characteristics during TPIAT. In this analysis of patients who underwent TPIAT at our center, we compared transplant outcomes among those with CAA ( = 5) vs non-acinar atrophy (NAA; matching controls, = 36). Data were analyzed using one-way analysis of variance with Bonferroni post hoc test or Student's test. Pancreas digestion was longer in CAA than in NAA cases (18.6 vs 14.6 min) despite a lower pancreas weight (55.2 vs 91.2 g). Obtained tissue volume was 1.0 ml in the CAA group and 12.1 ml in the NAA group. Both groups had similar islet viability (96%) and islet dose (CAA, 3,391 IEQ/kg; NAA, 4141.1 IEQ/kg). During islet infusion, serum cytokine (IL-6, IL-8, and MCP-1) levels and plasma hsa-miR-375 levels were lower in the CAA group than in the NAA group, but not significantly. Serum tumor necrosis factor α levels at 3 h after infusion were significantly higher in CAA group than in NAA group. After TPIAT, the metabolic outcomes of the CAA group were comparable with that of the NAA group. Narcotics usage decreased significantly over 24 months in both groups, with the CAA group reporting being pain free at 12 months. Complete atrophy of acinar cells of pancreas did not significantly impact islet yield or endocrine function after TPIAT.