Rejected

To review causes of pelvic pain among adolescents and discuss surgical techniques for safe and effective resection of juvenile cystic adenomyomas.

Xiang-lian pill, consisting of Coptis chinensis Franch. coprocessed with Tetradium ruticarpum (A.Juss.) T.G.Hartley (Yu-huang-lian) and Aucklandia lappa DC. (Mu-xiang), is traditionally used to relieve fever, abdominal pain, and gastrointestinal inflammatory symptoms observed in patients with malignancies of the gastrointestinal tract. Each of the three herbs contained in Xiang-lian pill has been indicated to have anticancer effects on a variety of cancers, but its effects on pancreatic cancer remain unexplored. The main extracts of these herbs have anti-pancreatic cancer effects, but the comprehensive mechanism of this compound prescription of Xiang-lian pill in pancreatic cancer remains to be revealed.

To investigate predictors of intervention of acute type B aortic penetrating ulcer (PAU) and intramural hematoma (IMH). We conducted a retrospective chart review of all patients admitted for acute type B PAU or IMH in a tertiary referral hospital. Indications to intervention were "complicated" (rupture, impending rupture, malperfusion) or "high risk for unfavorable outcome" (refractory hypertension and/or pain despite best medical treatment, morphologic aortic evolution, transition to a new aortic syndrome, or increase in IMH/PAU depth >5 mm) during the acute/subacute phase. The primary outcomes were overall mortality, aortic-related mortality, and freedom from intervention. Time-dependent outcomes were estimated with Kaplan-Meier curves. Cox proportional hazards models were used to identify predictors of intervention and mortality. There were 54 acute aortic syndromes, 37 PAUs and 17 IMHs. Mean age was 69±14 years and 33 patients (62.2%) were male. Six (11.5%) patients had complicated aortic syndromes and underwent urgent repair. Two (3.7%) additional patients developed an impending rupture during the acute phase. Eleven (21.1%) patients were classified as at "high risk" during the initial hospitalization. Overall, 22 (40.7%) patients required an aortic intervention during the initial admission (n=16, 72.7% during the acute phase; n=6, 27.3% during the subacute phase). In-hospital mortality was 5.5% (1 PAU and 2 IMH), and was aorta-related in all cases. For IMH, disease extension in >3 aortic zones (HR 1.94, 95%CI 1.17-32.6; P=.038) and presence of ulcer-like projections (ULPs) (HR 1.23, 95%CI 1.02-9.41; P=.042) were associated with the need for intervention. There were no aortic-related deaths or intervention during the chronic phase. PAU width > 20 mm (HR 1.68, 95%CI 1.07-16.08; P=.014), PAU depth >15 mm (HR 6.74, 95%CI 1.31-34.18; P=021), PAU depth/total aortic diameter >0.3 (HR 4.31, 95%CI 1.17-20.32; P=.043), and location at the level of the paravisceral aorta (HR 2.24, 95%CI 1.23-4.70; P=.035) were significantly associated with need for intervention. Six additional (16.2%) PAUs required intervention during the chronic phase owing to PAU growth. Maximum aortic diameter >35 mm was significantly associated with intervention (HR 1.45, 95%CI 1.00-2.32; P=.037). Acute symptomatic type B IMHs and PAUs are characterized by a high risk of complications during the first month from presentation. Morphologic features associated with intervention were IMH with ULPs or extension in more than 3 aortic zones, as well as PAUs with depth>15 mm, width >20 mm, or depth/aortic diameter ratio>0.3. A strict follow-up protocol or consideration for early intervention within 30 days from presentation should be taken into account for these high-risk patients. During the chronic phase imaging follow-up is particularly important for PAUs in order to identify progression to saccular aneurysms.

Slipped capital femoral epiphysis (SCFE) is commonly managed by in situ screw fixation. However, higher grades of slips require restoration of normal anatomy of the femoral head without compromising the blood supply.

Cervical spondylotic myelopathy (CSM) is the leading cause of acquired spinal cord dysfunction worldwide and may be expected to increase in prevalence due to an aging global population. Clinical features of CSM are highly variable, and chiropractors frequently manage patients with common signs and symptoms of CSM such as neck pain, extremity weakness, and gait imbalances. Early recognition of signs consistent with myelopathy may mitigate future disability and improve quality of life. Key predictors of patient outcome are the age of initial presentation, baseline CSM severity (as measured by mJOA score), and the presence of gait disturbances. This report describes three cases of CSM presenting to a chiropractic clinic. Each case illustrates a unique manifestation of CSM, including myelopathy, myeloradiculopathy, and distal neuropathic pain (funicular referral). In addition, a review of CSM terminology, epidemiology, pathobiology, clinical features, imaging, and management is provided.

Fascia is a continuous membrane (fasciomembrane) that enables differentiation of fluid pressure on either side. Fascia membrane also enables an internal increased fluid pressure at all muscle levels (fibers, fiber bundles, skeletal muscles, compartments), and the author introduces a new unifying term for these pressures, regardless of the anatomical level – the intrafasciomembranal fluid pressure (IFMFP). Swelling, pain, and loss of tissue function are identified as common cardinal symptoms in trigger point (TrP), chronic exertional compartment syndrome (CECS), overtraining syndrome (OTS), and delayed onset muscle soreness (DOMS). Existing literature and an overall assessment indicate that intramuscular conditions related to fluid flow and pressure play a central role in different conditions, providing a common biomechanical explanation of the etiology and influence, supporting the article's theory that an increased IFMFP plays a key role in these conditions.

The present study was deliberated to assess the pre-emptive analgesic efficacy of diclofenac sodium and ketoprofen transdermal patches following open treatment of mandibular fractures.

Minimally invasive surgery is the standard treatment for early-stage thymoma. We compared the perioperative outcomes between robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) for thymoma.

More than 70 million Americans suffer from chronic pain; many cases are related to sports injuries. This type of injury often involves soft tissues (muscles, tendons, and ligaments). Direct-force injury (e.g., impact trauma) and indirect-force injury (e.g., repetitive motion) are normally the cause of strained muscles, sprained ligaments, and tendonitis. The standard of acute care is RICE [rest, ice, compression, and elevation] plus anti-inflammatory medication. While this regimen often relieves acute pain, the consequence of the long-term use is chronic pain due to un-remodeled scar-tissue formation. The goal of this article is to show how a combination of integrative modalities can be used to relieve the pain caused by such injuries and their sequelae.

Chronic pancreatitis is (CP) is a progressive inflammatory disease of the pancreas associated with disabling abdominal pain and gradual deterioration of exocrine and endocrine function. Up to 50% of patients with CP may require surgery during the course of the disease. The main indication for surgery is intractable abdominal pain not amenable to medical and endoscopic therapy. The type of surgery depends on pancreatic ductal diameter and associated parenchymal pathology like inflammatory head mass. Frey procedure (FP) is an effective method for control of pain in patients with enlarged pancreatic head. FP can be performed with a very low mortality and an acceptable morbidity. Compared with pancreaticoduodenectomy (PD), FP has favourable outcomes in terms of operation time, blood loss, morbidity, post-operative hospital stay, intensive care unit stay, and quality of life. FP has shorter operation time and lower morbidity in comparison to Beger procedure. But, long-term pain control and exocrine and endocrine dysfunctions are comparable between PD, Beger and FP. FP is technically easier than PD and Beger procedure. FP is thus a widely acceptable procedure for CP with enlarged pancreatic head in absence of a neoplasia.