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Ultrasound image-guided tumescent local analgesia (TLA) is an effective technique in prepectoral pacemaker implantation surgery. The technique provides enough analgesic effect, at the same time, the pocket creation procedures become easy because of the hydrodissection effect of TLA solution. This technique relieves patients from intra-operative pain and relieves physicians from stresses during pocket creation.

Lesser toe plantar plate injuries at the metatarsophalangeal (MTP) joint are a common source of metatarsalgia. Chronic pain with weight-bearing is the common presentation of lesser toe instability. Deformity occurs when the plantar plate is torn or attenuated. Crossover toe and MTP instability often occur with multiplane deformity, most commonly with dorsal contracture of the second toe and medial drift over the Hallux. In this article, the authors present a comprehensive stepwise approach to diagnosing and treating plantar plate injuries using both dorsal and plantar approach techniques.

While most women with migraine improve during pregnancy, a subset may remain unchanged or even become more severe. Given the limited evidence for the use of prescription medications during pregnancy, many look to other treatment modalities. We seek to review complementary and integrative medicine, procedural interventions, and neurostimulation to empower women with safe and effective treatment options during pregnancy.

Neurokinin-1 (NK1) and calcitonin gene-related peptide (CGRP) play a vital role in pain pathogenesis, and these proteins' antagonists have attracted attention as promising pharmaceutical candidates. The authors investigated the antinociceptive effect of co-administration of the CGRP antagonist and an NK1 antagonist on pain models compared to conventional single regimens.

The potential correlation between patent foramen ovale (PFO) and migraine has been previously reported, but whether PFO closure plays a role in reducing migraine burden has not reached an agreement.

Upper extremity injuries are frequent in athletes which may require surgeries. Regional anesthesia for postoperative analgesia is important to aid recovery, and peripheral nerve blocks for surgical anesthesia enable surgeries to be performed without general anesthetics and their associated adverse effects. The relevant nerve block approaches to anesthetize the brachial plexus for elbow, wrist and hand surgeries are discussed in this article. There is very limited margin for error when performing nerve blocks and multimodal monitoring approach to reduce harm are outlined. Lastly, the importance of obtaining informed consent prior to nerve block procedures should not be overlooked.

To observe the effect of non-bracket invisible appliance and self-locking bracket appliance on periodontal health and subgingival flora in patients with periodontitis.

The paradigm in the treatment of arthritis pain is shifting for previously open surgical denervations of the hip and shoulder, as it already has for the geniculate nerves in knee arthritis. Interventional radiology is poised to contribute to this space with the use of CT guidance to provide safe, fast, and effective targeting of the target nerves for unequivocal diagnostic nerve block and definitive cooled radiofrequency denervation. The authors provide the background of which nerves are targeted for hip and shoulder denervation and the normal CT appearance of these blocks.

We present the case of a 13-year-old Japanese girl with no previous medical history who presented with a gradually worsening series of orthostatic headaches. We diagnosed spontaneous intracranial hypotension, which worsened by playing the trombone and its Valsalva maneuver effect. She was admitted to our hospital and treated with rest and hydration, and discharged on day 14 without any headaches during the admission. However, her headache recurred when she played trombone, so she stopped it. She now plays percussions, and no headaches recurred for a year. Our case's headache may have been further exacerbated by cerebrospinal fluid (CSF) leakage due to CSF pressure increase by the Valsalva maneuver while playing the trombone.

necrotizing fasciitis is a rare emergency and has a high mortality rate condition occurring among patients with cirrhosis, iron overload states, chronic renal failure, malignancy, HIV, or immunosuppressive medications. Here, we report a case of nonfoodborne infection caused by presenting as bilateral necrotizing fasciitis on the hands and lower arms after a pinch injury by a mud crab in a 64-year-old man with hypertension presenting with acute fever, bilateral hand swelling, and pain. The patient was treated with emergency fasciotomy and intravenous antibiotics. The outcome of such cases depends on early diagnosis and appropriate surgical and medical management.