Bupivacaine and Glucocorticoid-Induced Myonecrosis

2018 ◽  
Author(s):  
David Gordon ◽  
Ahmad Khattab ◽  
Magdalena Anitescu
Keyword(s):  
Chronic Pain ◽  
Synergistic Effect ◽  
Young Patients ◽  
Repeated Administration ◽  
Tissue Reaction ◽  
Time Dependent ◽  
Muscle Breakdown ◽  
The Common ◽  
Altered Metabolism

The most frequently used medications for chronic pain are local anesthetics (LA) and glucocorticoids. Common adverse events from LA, such as seizures and cardiotoxicity, are well known. A lesser known side effect is local tissue reaction to the LA concentration. Myotoxicity is one of the common denominators of direct tissue reaction to LA; it results from the disruption of the mitochondria in the muscle cells. All LA produce some degree of myotoxicity; bupivacaine has the greatest effect and procaine the least. If LA is combined with glucocorticoid, muscle breakdown is even more extensive showing a synergistic effect. Myotoxicity depends primarily on LA concentration, is time dependent, and is enhanced by preexisting altered metabolism. It affects mostly young patients. Potential effects of long-term or repeated administration of the combination LA/glucocorticoids medications should always be considered and discussed with patients.

scholarly journals Non-functioning neuroendocrine tumors of the common hepatic duct: a case report and literature review

2017 ◽  
Vol 4 (3) ◽  
pp. 1101
Author(s):  
Maroun Abou-Jaoude ◽  
Haydar A. Nasser
Keyword(s):  
Neuroendocrine Tumors ◽  
Epigastric Pain ◽  
Hepatic Duct ◽  
Young Patients ◽  
Pancreatic Head ◽  
Long Term Results ◽  
Common Hepatic Duct ◽  
The Common ◽  
Well Differentiated

Extra-hepatic biliary tree neuroendocrine tumors are not common, accounting for about 0.1 % of all carcinoid tumors. Those affecting the common hepatic duct are very rare and their diagnosis is usually made post-operatively. Poorly differentiated tumors or neuroendocrine carcinomas are commonly seen in elderly, whereas well differentiated tumors, tend to occur in young patients, for whom surgery will lead to good long term results. About 100 cases have been reported in the English medical literature, showing good long term results after surgery for well differentiated (Grades 1 and 2) tumors. Herein, we report a case of an 18-year-old female, complaining from a dull epigastric pain related to a nodule compressing the common hepatic duct. After complete investigation, a laparotomy has been performed and showed a nodular tumor located in the common hepatic duct just above the insertion of the cystic duct with close contact with the pancreatic head distally. En bloc cholecystectomy with bile duct resection was performed and followed by a Roux-en-Y hepatico-jejunostomy. The pathology of the nodule came back to be a neuroendocrine tumor grade 2.

Revision of a dual-modular stem in patients with adverse tissue reaction

2019 ◽  
Vol 30 (4) ◽  
pp. 452-456 ◽  
Author(s):  
Carl T Talmo ◽  
Claire E Robbins ◽  
Ahmed Siddiqi ◽  
Sumon Nandi ◽  
James V Bono ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Revision Surgery ◽  
Survival Rates ◽  
Tissue Reaction ◽  
Harris Hip Score ◽  
Modular Stem ◽  
Revision Tha ◽  
Adverse Tissue Reaction ◽  
Postoperative Dislocation

Background: Dual-modular femoral components with exchangeable cobalt-chrome neck segments have had higher than expected failure rates due to corrosion and adverse local tissue reaction (ALTR). Complications, survival rates and early clinical outcomes of revision surgery for the treatment of corrosion and ALTR as a result of these implants are underreported. Methods: We identified 44 cases of revision THA for corrosion and ALTR resulting from the same dual modular stem. All revision procedures were performed using a modular tapered fluted titanium stem, ceramic heads and highly cross-linked polyethylene. Results: Complications included: dislocation, infection, reoperation, and chronic pain. Mean Harris Hip Score was 84 following revision surgery. Conclusions: Patients undergoing revision surgery for ALTR related to this prosthesis should be aware of the risk of postoperative dislocation and other complications and the potential long-term risk of some chronic pain.

The foundations of peaceful coexistence after the war ... Mosul is a model

2019 ◽  
pp. 178
Author(s):  
Omar Hashim Thanon
Keyword(s):  
Ethnic Diversity ◽  
Psychological Consequences ◽  
Peaceful Coexistence ◽  
Negative Effects ◽  
Mass Displacement ◽  
The Common ◽  
Near Term ◽  
Post War ◽  
Common Destiny

Since peaceful coexistence reflects in its various aspects the concept of harmony between the members of the same society with their different national, religious and sectarian affiliations, as well as their attitudes and ideas, what brings together these are the common bonds such as land, interests and common destiny. But this coexistence is exposing for crises and instability and the theft of rights and other that destroy the communities with their different religious, national, sectarian, ethnic aspects, especially if these led to a crisis of fighting or war, which produces only destruction and mass displacement, ttherefore, the process of bridging the gap between the different parts of society in the post-war phase through a set of requirements that serve as the basis for the promotion of peaceful coexistence within the same country to consolidate civil and community peace in order to create a general framework and a coherent basis to reconstruct the community again.      Hence the premise of the research by asking about the extent of the possibility and ability of the community of religious and ethnic diversity, which has been exposed to these crises, which aimed at this diversity, basically to be able to rise and re-integrate within the same country and thus achieve civil and community peace, and Mosul is an example for that, the negative effects of the war and the accomplices of many criminal acts have given rise to hatred and fear for all, leading to the loss of livelihoods, which in the long term may have devastating social and psychological consequences.        To clarify all of this, the title of the first topic was a review of the concept and origin of peaceful coexistence. While the second topic dealt with the requirements of peaceful coexistence and social integration in Mosul, the last topic has identified the most important challenges facing the processes of coexistence and integration in Mosul. All this in order to paint a better future for the conductor at all levels in the near term at the very least to achieve the values of this peaceful coexistence, especially in the post-war period.

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

Hemorrhoidal Laser procedure (HeLP) and Hemorrrrhoidal Laser procedure + mucopexy (HeLPexx) and other Emerging Technologies

2020 ◽  
Vol 15 ◽  
Author(s):  
Paolo Giamundo
Keyword(s):  
Laser Treatment ◽  
Dentate Line ◽  
Mucosal Prolapse ◽  
Daily Activities ◽  
Common Goal ◽  
Superior Rectal Artery ◽  
Doppler Probe ◽  
The Common ◽  
Probe Set

Background: Minimally-invasive treatments for hemorrhoids should be encouraged as they cause low morbidity, reasonable discomfort and quicker return to work. According to the “vascular theory” hemorrhoidal disease is mainly caused by blood overflow into hemorrhoidal plexus deriving from the superior hemorrhoidal arteries. Introduction: Many different procedures have been described in the literature with the common goal of reducing the blood flow into the hemorrhoidal piles. ‘HeLP’ (Hemorrhoids Laser Procedure) is a novel form of dearterialization to treat patients suffering from symptomatic hemorrhoids. Methods: The procedure consists of the closure of the terminal branches of the superior rectal artery approximately 2-3 cm above the dentate line by means of laser shots originated by a diode laser platform. The arteries, at that level, have variable location and distribution. Therefore, a doppler probe set at the frequency of 20MHz helps identifying the arteries that would be missed otherwise. The laser beam is well tolerated by patients. For this reason, anesthesia is not required in most cases and the procedure allows a quick return to daily activities. In case of concomitant severe mucosal prolapse, the laser treatment can be combined with suture mucopexy. Three to six running sutures allow a complete lifting of hemorrhoidal piles, securing long-term resolution of symptoms. Results and Conclusions: ‘HeLP’ is indicated in patients with symptomatic hemorrhoids where conservative treatment failed and when mucosal prolapse is scarce or not symptomatic. The addition of mucopexy to laser treatment (HeLPexx) contributes to overall resolution of symptoms when mucosal prolapse is an issue, Emborrhoid is another novel, ‘hi-tech’ form of selective dearterialization used in selected case of hemorrhoids where main symptom is bleeding. It is generally used in cases where surgery is contraindicated due to severe concomitant diseases.

The Co-Occurrence of Autism and Gender Diversity

2020 ◽  
pp. 197-211
Author(s):  
Jill C. Fodstad ◽  
Rebecca Elias ◽  
Shivali Sarawgi
Keyword(s):  
Gender Dysphoria ◽  
Gender Diversity ◽  
Gender Nonconforming ◽  
Medical Interventions ◽  
Gender Diverse ◽  
Nonbinary Gender ◽  
Psychiatric Conditions ◽  
The Common ◽  
And Gender

Gender diversity refers to gender expressions and/or gender identity experiences that vary from the common experiences of gender. Gender-diverse people may be gender nonconforming, gender nonbinary, gender fluid, gender exploring, transgender, and so forth. Some gender-diverse individuals experience gender dysphoria and/or gender incongruence and may require gender-affirming supports, including gender-affirming medical interventions. The co-occurrence of autism and gender diversity has been highlighted in a series of studies internationally as well as through rich community expressions. Studies in gender-referred individuals reveal high rates of autism traits as well as high rates of existing autism diagnoses. Studies in autistic populations reveal greater gender diversity characteristics. The long-term course of gender diversity in autistic individuals is poorly understood. Clinical guidelines have been developed for adolescents with the co-occurrence, but much work remains: No gender-related measures have been developed and tested for use in neurodiverse populations, no programs exist to support gender-diverse neurodiverse adults, and little is known about co-occurring mental health profiles, risks, or protective factors for people with the co-occurrence. The inclusion of this chapter on co-occurring autism and gender diversity within a book on “co-occurring psychiatric conditions” is problematic, because gender diversity is not a “psychiatric condition,” but instead a form of human diversity. The diagnosis of Gender Dysphoria is useful only insomuch as it allows individuals to obtain necessary gender-related supports. The authors’ choice to include this chapter in this book reflects a compromise, motivated by the need for educating both autism and gender specialists in this common co-occurrence.

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