Rejected

To investigate the efficacy and safety of percutaneous micro-balloon compression (PBC) assisted by Dyna-CT-based image fusion technique in the treatment of trigeminal neuralgia (TN). This study is the retrospective analysis of the efficacy and safety of 18 patients with TN treated by PBC assisted with Dyna-CT-based image fusion technique from May 2020 to May 2021. The puncture route from the skin to the foramen ovale（FO）was reconstructed after Dyna-CT scanning; and the puncture direction was adjusted according to the virtual puncture route until the puncture was completed. Dyna-CT-assisted puncture was successful in all 18 patients. The puncture was accurate and effectively shortened the operation time. Importantly, pain was relieved in all patients, and no puncture-related complications occurred. Dyna-CT-based image fusion real-time-assisted PBC for the treatment of TN is safe and effective, making the operation easier and faster, greatly improving the success rate of the puncture, and reducing the risk of operation-related complications. Key Words: Dyna-CT, Percutaneous micro-balloon compression, Trigeminal neuralgia.

Cirsoid aneurysms are arteriovenous malformations of the scalp region that usually manifest as a painless pulsatile mass. These are present in the younger age group and frequently associated with trauma.

A 64-year-old man presented 18 months after total hip arthroplasty complicated by vascular injury with a history of leg pain, inability to mobilize, and progressive chronic leg edema. It is presumed that there was persistent subtle bleeding over time with pseudoaneurysm formation and prosthetic hip dislocation secondary to the mass effect.

Advanced interventional pain management approaches seek to lesion neural targets to achieve desirable analgesia; however, equally important is preservation of motor and sensory function for regional bystander nerves. The topic of neuroprotection is also relevant for thermal ablation of metastatic bone tumors in the vicinity of neural structures. This report aims to provide an IR-directed framework of thermoprotective techniques available during thermal ablation.

"Pregnancy and multiple sclerosis Pregnancy is a possibility for a patient with multiple sclerosis, but it is best to anticipate and plan for it. Pregnancy does not worsen the disability in the long term. The risk of relapse in the 3 months postpartum depends on the risk of relapse in the year preceding the pregnancy; it is therefore preferable to plan a pregnan¬cy when the multiple sclerosis is stabilized. The main¬tenance of background treatment in preconception or during pregnancy depends on the type of medication, the risk for the child (miscarriage, malformations) but also the risk of rebound in the mother. Pregnancy fol-low-up and mode of delivery are comparable to those of the general population. Epidural analgesia is not contraindicated. The decision to breastfeed must take into account the patient's wishes and the severity of the disease (contraindication of breastfeeding with certain background treatments). There is no validated preventive treatment for postpartum relapses."

A 57 years old male presented in the emergency department of EAST Surgical Ward, MAYO Hospital Lahore in February 2021 with complaints of abdominal distension, pain and vomiting. He was a chronic smoker and diagnosed hypertensive for the last 14 years but was non-compliant with oral antihypertensive medications. He was a factory worker and took NSAIDs off and on for pain in the knee joint for the last five years. On examination, his abdomen was tense and tender with resonant percussion notes in the right hypogastrium and epigastrium. His chest x-ray showed free gas under the right diaphragm. Diagnosis of a perforated duodenal ulcer was made and exploratory laparotomy was done. Examination revealed a perforated ulcer in the first part of the duodenum with greenish gangrenous patches on the next 3 feet of the small gut. Graham's patch repair and resection of the diseased small gut was done and a jejuno ileostomy was performed. Unfortunately, the patient expired on 2nd postoperative day due to sudden cardiopulmonary arrest.

Background The management of pain in patients undergoing open reduction and internal fixation (ORIF) of distal radius fractures (DRFs) remains an area of debate for anesthesiologists due to a variety of block options and no definitive superior technique among these modalities. In this retrospective case series, we compare the efficacy of supraclavicular versus infraclavicular regional nerve blocks for surgical patients undergoing distal radial ORIF operations to determine if one approach was superior. Methodology This retrospective case series included patients undergoing ORIF of a DRF at a tertiary academic medical center between April 28, 2016, and August 23, 2021. In total, 54 patients undergoing ORIF of a DRF provided written consent for the nerve block(s) on the day of surgery. Of these 54 patients, 54 (100%) underwent primary procedures. Of the 54 primary ORIF patients, 28 (52%) received the supraclavicular block, while 26 (48%) received the infraclavicular nerve block. Results The infraclavicular and supraclavicular groups did not significantly differ regarding age, gender, American Society of Anesthesiologists, weight, or body mass index. The primary (intraoperative opioid use) and secondary (postoperative opioid use, postoperative nausea and vomiting in the post-anesthetic care unit, highest and average pain scores, and time to discharge) outcomes data were included in the study. The infraclavicular and supraclavicular groups did not significantly differ in any of the assessed outcomes except for time to discharge. Conclusions The supraclavicular block approach for distal radius ORIF offers an effective and non-inferior alternative to the infraclavicular block approach concerning effective analgesia and safety.

Chronic postoperative pain (CPOP) is prevalent, with particularly high rates in breast surgery, thoracotomy, and amputation. As the world emerges from the coronavirus disease 2019 (COVID-19) lockdowns, it is expected that there will be an increase in surgical procedures, elevating the importance of preventing CPOP in the coming years. Risk factors are emerging to better stratify patients at high risk for CPOP. Perioperative analgesia plays an important role in managing acute postoperative pain and in some cases may limit its transition to CPOP. Acute postoperative pain is adaptive, normal, expected, and has a well-defined trajectory, while CPOP is maladaptive and, as a form of chronic pain, is challenging to treat. Good analgesia, early ambulation, and rehabilitation efforts may be helpful in preventing CPOP following certain surgeries. Enhanced Recovery After Surgery (ERAS) protocols present guidance to help promote recovery and prevent CPOP.

According to the instructions of Iran's National Corona Response Committee in the Iranian Ministry of Health and Medical Education, patients undergoing treatments for their cancer are prioritized in Covid-19 vaccination. The present study was therefore conducted to investigate the toxicity and acute side-effects of a Covid-19 vaccine in cancer patients presenting to Medical Oncology Clinic of Kermanshah University of Medical Science. After excluding the patients with active infection and the recently-infected ones with Covid-19, they underwent the vaccination. The patients with cell counts exceeding 3,000 received two doses of the vaccine with a 21-day interval and treatment of their underlying disease was postponed for 7 days. The side-effects were mild and tolerable and included fever (case 10), pain at the injection site (7), dizziness (7), body pain (6), abdominal pain (6), myalgia (6), headache (6), chills (3), shortness of breath (3), diarrhea (1), runny nose (1) and dryness of the throat (1). No significant toxicity was reported in the patients who were safely vaccinated under the supervision of the medical oncology clinic.

Patient-controlled analgesia (PCA) has been widely used as an effective medical treatment for pain and for postoperative analgesia. However, improper dose errors in intravenous (IV) administration of narcotic analgesics from a PCA infusion pump can cause patient harm. Furthermore, opioid overdose is considered one of the highest risk factors for patients receiving pain medications. Therefore, accurate delivery of opioid analgesics is a critical function of PCA infusion pumps.