scholarly journals Impact of Perioperative Hypnosedation on Postmastectomy Chronic Pain: Preliminary Results

2019 ◽  
Vol 18 ◽  
pp. 153473541986949
Author(s):  
Camille Lacroix ◽  
Francois P. Duhoux ◽  
Julie Bettendorff ◽  
Christine Watremez ◽  
Fabienne Roelants ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Lower Incidence ◽  
Reconstructive Surgical Procedures ◽  
Small Sample ◽  
Breast Cancer Patients ◽  
Preliminary Results ◽  
Shoulder Range Of Motion ◽  
Potential Benefits ◽  
Shoulder Range

Objectives: The main aim of this prospective nonrandomized study was to evaluate if mastectomy performed with perioperative hypnosedation led to a lower incidence of chronic pain compared with mastectomy under general anesthesia. Methods: Forty-two breast cancer patients who underwent mastectomy either under GA (GA group, n = 21) or HYP (HYP group, n = 21) associated with local and/or regional anesthesia were included. The type of adjuvant therapy as well as the number of reconstructive surgical procedures were well balanced between the 2 groups. The average age of the patients and the type of axillary surgery were also equivalent. Incidence of postmastectomy chronic pain, lymphedema, and shoulder range of motion (ROM) were evaluated after a mean 4-year follow-up. Results: The study shows a statistically significant lower incidence of postmastectomy chronic pain in HYP group (1/21, 1 patient out of 21 experiencing pain) compared with GA group (9/21) with 9 patients out of 21 experiencing pain ( P = .008). ROM for shoulder was also less frequently affected in the hypnosedation group, as only 1 patient had decreased ROM, instead of 7 in the other group ( P = .04). Conclusions: Our study is the first to hint at the potential benefits of hypnosedation on postmastectomy chronic pain. Despite the limitations of this study (nonrandomized, small sample), preliminary results merit further study of hypnosedation.

scholarly journals Electronic Moxibustion for Breast Cancer-Related Lymphedema: A Pilot Clinical Trial

2020 ◽  
Vol 19 ◽  
pp. 153473542096285
Author(s):  
Kyungsun Han ◽  
Ojin Kwon ◽  
Hyo-Ju Park ◽  
Ae-Ran Kim ◽  
Boram Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Range Of Motion ◽  
Upper Limb ◽  
Life Questionnaire ◽  
Breast Cancer Patients ◽  
Shoulder Range Of Motion ◽  
Breast Cancer Related Lymphedema ◽  
Shoulder Range

This is a preliminary study to investigate the feasibility of electronic moxibustion in breast cancer patients with upper limb lymphedema. As current treatment options for lymphedema are unsatisfactory and time consuming, there have been attempts to manage symptoms using integrative treatments. Electronic moxibustion was developed to compensate for the shortcomings of conventional moxibustion and is widely used in clinical practice. However, there have been no studies on using electronic moxibustion in breast cancer-related lymphedema. To investigate the feasibility of electronic moxibustion in treating breast cancer-related lymphedema, this study included subjects who completed primary cancer treatment at least 6 months ago and had more than 10 mm difference in arm circumference of upper limbs. All subjects were assigned to the treatment group. Subjects were treated with 16 sessions (30 minutes/session) of electronic moxibustion for 8 weeks followed by 4 weeks of follow-up. For outcome measures, upper limb circumferences, shoulder range of motion, bioimpedance analysis, and quality of life questionnaire were assessed. All 10 subjects completed the study. The effective index showed 38.21% reduction after treatment ( P = .0098) and 29.35% ( P = .0039) after 4 weeks of follow-up compared to the baseline. The reduction of lymphedema was most prominent at 10 cm above the elbow crease, where the mean reduction of circumference difference was 7.5 mm ( P = .0430) and continued to improve after treatment (mean reduction of 8.3 mm, P = .0156). There was significant improvement in shoulder range of motion only in flexion and internal rotation at week 9. There were 7 adverse events, and most were irrelevant to the treatment. Only 1 participant had a mild burn on the acupuncture point. Here, we demonstrate for the first time that electronic moxibustion treatment is a feasible treatment for breast cancer-related lymphedema. Electronic moxibustion may reduce differences in upper limb circumference and improve shoulder range of motion. A future comparative clinical trial is needed to confirm the clinical efficacy of this treatment.

Effectiveness of arthroscopic management of idiopathic shoulder stiffness: A meta-analysis

2021 ◽  
pp. 1-8
Author(s):  
Ya-Dong Wang ◽  
Yu-Xiang Ming ◽  
Yong-Hua Pang ◽  
Wei-Nan Chen ◽  
Xu-Hua Zong ◽  
...  
Keyword(s):  
Range Of Motion ◽  
External Rotation ◽  
Meta Analysis ◽  
Eligibility Criteria ◽  
Shoulder Stiffness ◽  
Capsular Release ◽  
Shoulder Range Of Motion ◽  
Arthroscopic Capsular Release ◽  
Shoulder Range

BACKGROUND: Persisting shoulder stiffness adversely affects quality of life by causing pain and motion restrictions especially in patients with diabetes. OBJECTIVE: The aim of this study was to evaluate the outcomes of arthroscopic capsular release in patients with idiopathic shoulder stiffness. METHOD: A literature search was conducted in electronic databases and studies were selected by following precise eligibility criteria. Random-effects meta-analyses were performed to estimate the changes at latest follow-up in scores of the Constant, American Shoulder and Elbow Surgeons (ASES), and University of California at Los Angelis (UCLA) scales, Visual Analogue Scale (VAS), and shoulder range of motion. RESULTS: Nineteen studies were included. The follow-up duration was 42 months [95% confidence interval (CI): 32, 51]. Improvements in scores of the Constant, ASES, UCLA scales, and VAS were 48.3 [95% CI: 38.0, 58.6], 44.6 [95% CI: 24.6, 64.6], 19.3 [95% CI: 16.6, 22.0], and -6.1 [95% CI: -6.9, -5.4] respectively (P< 0.05 all). Improvements in the shoulder range of motion were: abduction 82.0 [95% CI: 65.0, 98.9]; forward flexion 75.9 [95% CI: 59.7, 92.1]; external rotation 43.2 [95% CI: 37.5, 49.0]; and internal rotation 25.4 [95% CI: 15.2, 35.5] degrees; P< 0.05 all). CONCLUSION: Arthroscopic capsular release effectively improves shoulder function in patients with idiopathic shoulder stiffness.

Radiographic and clinical outcomes of second generation Trabecular Metal™ glenoid components in total shoulder arthroplasty

2020 ◽  
pp. 175857322090998
Author(s):  
Raymond E Chen ◽  
Alexander M Brown ◽  
Alexander S Greenstein ◽  
Sandeep Mannava ◽  
Ilya Voloshin
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Second Generation ◽  
Total Shoulder Arthroplasty ◽  
Implant Survival ◽  
Trabecular Metal ◽  
Metal Debris ◽  
Shoulder Range Of Motion ◽  
Shoulder Range

Background Total shoulder arthroplasty with second generation porous tantalum glenoid implants (Trabecular Metal™) has shown good short-term outcomes, but mid-term outcomes are unknown. This study describes the clinical, radiographic, and patient-rated mid-term outcomes of total shoulder arthroplasty utilizing cemented Trabecular Metal™ glenoid components. Methods Patients who underwent anatomic total shoulder arthroplasty with cemented Trabecular Metal™ glenoid components for primary osteoarthritis were identified for minimum five-year follow-up. The primary outcome measure was implant survival; secondary outcome measures included patient-rated outcome scores, shoulder range of motion findings, and radiographic analysis. Results Twenty-seven patients were enrolled in the study. Twenty-one patients had full radiographic follow-up. Mean follow-up was 6.6 years. There was 100% implant survival. Shoulder range of motion significantly improved and the mean American Shoulder and Elbow Society score was 89.8. There was presence of metal debris radiographically in 24% of patients. Twenty-nine percent of patients had evidence of radiolucency. Fourteen percent of patients had moderate superior subluxation. Conclusion Total shoulder arthroplasty with second generation cemented Trabecular Metal™ glenoid components yielded good outcomes at mean 6.6-year follow-up. Metal debris incidence and clinical outcomes were similar to short-term findings. The presence of metal debris did not significantly affect clinical outcomes. Continued observation of these patients will elucidate longer-term implant survival.

scholarly journals Range of motion of diabetic frozen shoulder recovers to the contralateral level

2016 ◽  
Vol 44 (6) ◽  
pp. 1191-1199 ◽  
Author(s):  
Heidi Vastamäki ◽  
Leena Ristolainen ◽  
Martti Vastamäki
Keyword(s):  
Range Of Motion ◽  
Frozen Shoulder ◽  
Functional Results ◽  
Shoulder Range Of Motion ◽  
Constant Murley Score ◽  
Patients With Diabetes ◽  
The Mean ◽  
Shoulder Range

Objective To determine whether frozen shoulder heals equally well in patients with and without diabetes and whether dependency on insulin affects the outcome. Methods We retrospectively examined 178 patients with idiopathic frozen shoulder; 27 patients had diabetes. We evaluated range of motion, pain, and functional results. The mean follow-up was 9.7 years (SD, 7.1 years). Results In the presence of frozen shoulder, range of motion did not differ between patients with and without diabetes. At follow-up, range of motion in all directions of both the affected and unaffected shoulders of patients with diabetes was inferior to that of patients without diabetes. Among patients with diabetes, range of motion of the once-frozen shoulder reached the level of the unaffected shoulder. Patients with and without diabetes experienced similar pain except during exertion. The Constant–Murley score was not significantly different between the two groups, and insulin dependency did not lead to worse outcomes. Conclusion Frozen shoulder heals well in patients with diabetes.

scholarly journals Prolonged continuous infraclavicular brachial plexus perineural infusion following replantation of a mid-humeral amputation

2019 ◽  
Vol 7 ◽  
pp. 2050313X1882309
Author(s):  
Sean P Clifford ◽  
Brittany D Maggard ◽  
Kelly M Hines
Keyword(s):  
Chronic Pain ◽  
Brachial Plexus ◽  
Complex Process ◽  
Peripheral Nerve Blockade ◽  
Brachial Plexus Blockade ◽  
Potential Benefits ◽  
Post Traumatic ◽  
Repeat Visits ◽  
Extremity Amputation

Replantation of a traumatic upper extremity amputation is a complex process accompanied by prolonged hospitalization, extended rehabilitation, and potential for graft failure secondary to poor perfusion to the distal extremity. The patient is faced with repeat visits to the operating room in addition to severe acute and chronic pain issues. We present the case of an 18-year-old male treated with prolonged continuous peripheral nerve blockade following traumatic left mid-humeral amputation and subsequent replantation. The patient maintained infraclavicular brachial plexus catheterization until hospital discharge, a course spanning 33 days and six follow-up surgical procedures. The patient was pain free and had been weaned off all opioids at a 4-week outpatient surgical debridement. Prolonged continuous infraclavicular brachial plexus blockade following replantation surgery has numerous potential benefits including augmentation of perfusion to the injured extremity, management of severe acute post-traumatic pain, and prevention of the chronic pain associated with transected nerves.

scholarly journals Microwave ablation of 105 T1 renal tumors: technique efficacy with a mean follow-up of two years

2020 ◽  
pp. 028418512095628
Author(s):  
Vanessa Acosta Ruiz ◽  
Pär Dahlman ◽  
Einar Brekkan ◽  
Maria Lönnemark ◽  
Anders Magnusson
Keyword(s):  
Microwave Ablation ◽  
Small Sample ◽  
Renal Tumors ◽  
Efficacy Rate ◽  
Primary Efficacy ◽  
Curative Intent ◽  
Renal Masses ◽  
Contrast Enhanced Ct ◽  
Potential Benefits

Background Thermal ablation (TA) with radiofrequency (RFA) or cryoablation (CA) are established treatments for small renal masses (≤4 cm). Microwave ablation (MWA) has several potential benefits (decreased ablation time, less susceptibility to heat-sink, higher lesion temperatures than RFA) but is still considered experimental considering the available small-sample studies with short follow-up. Purpose To evaluate technique efficacy and complications of our initial experience of renal tumors treated using percutaneous MWA with a curative intent. Material and Methods A total of 105 renal tumors (in 93 patients) were treated between April 2014 and August 2017. MWA was performed percutaneously with computed tomography (CT) guidance under conscious sedation (n=82) or full anesthesia. Patients were followed with contrast-enhanced CT scans at six months and yearly thereafter for a minimum of five years. The mean follow-up time was 2.1 years. The percentage of tumors completely ablated in a single session (primary efficacy rate) and those successfully treated after repeat ablation (secondary efficacy rate) were recorded. Patient and tumor characteristics as well as complications were collected retrospectively. Results The median patient age was 70 years and median tumor size was 25 mm. Primary efficacy rate was 96.2% (101/105 tumors). After including two residual tumors for a second ablation session, secondary efficacy was 97.1% (102/105). Periprocedural complications were found in 5.2% (5/95) sessions: four Clavien-Dindo I and one Clavien-Dindo IIIa. One postprocedural Clavien-Dindo II complication was found. Conclusion MWA has high efficacy rates and few complications compared to other TA methods at a mean follow-up of two years.

Inflammatory breast cancer (IBC) in native Hawaiians and Pacific Islanders: Frequency of IBC and impact of socioeconomic status on survival outcomes.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19083-e19083
Author(s):  
Kyle S.Y. Miyazaki ◽  
Jared David Acoba ◽  
Takeo Fujii
Keyword(s):  
Breast Cancer ◽  
Socioeconomic Status ◽  
Racial Differences ◽  
Small Sample Size ◽  
Medical Center ◽  
Small Sample ◽  
Survival Outcomes ◽  
Breast Cancer Patients ◽  
Epidemiological Characteristics

e19083 Background: IBC is one of the most aggressive types of breast cancer, accounting for only 1-4% of all breast cancer cases while causing 8-10% of breast cancer related deaths. Previous studies have demonstrated that IBC has distinct epidemiological characteristics, but the prevalence of IBC particularly in Native Hawaiian (NH) and Pacific Islander (PI) populations, and the socioeconomic disparities related to survival outcomes, are not fully understood. Our primary objective was to determine the frequency at which NH and PI breast cancer patients are diagnosed with IBC, and the association between socioeconomic status and overall survival (OS). Methods: Patients with newly-diagnosed primary invasive breast cancer were identified from January 1, 2000 through December 31, 2018 using Queen’s Medical Center Tumor Registry. Clinical T4d was used to differentiate IBC and non-IBC. OS was defined as the time from diagnosis to death or last follow-up. Patients who were alive at the date of last follow-up were censored. Univariate and multivariate cox proportional hazard models were used to assess the effects of variables of interest on OS. Results: A total of 3,715 patients were included in analysis. There were 98 (2.6%) patients with IBC and 3,617 (97.4%) with non-IBC. Proportion of IBC relative to non-IBC was significantly higher in PI (9.0%) than in White (W) (2.7%) (P < 0.001). Proportion of IBC was higher in NH (4.7%) than W but the difference was not statistically significant (P = 0.08). In multivariate analysis among the non-IBC group, OS was significantly shorter for both PI and NH than W (HR 1.72, [95%CI, 1.13-2.6]; P = 0.01, HR 1.48 [95% CI, 1.14-1.93]; P = 0.003, respectively). There were no significant racial differences seen in OS among IBC patients. Being under or uninsured was also significantly associated with short OS outcomes among patients with non-IBC but not those with IBC. Conclusions: PI have a significantly high proportion of IBC relative to non-IBC. Race and insurance status were not associated with OS in IBC although they were significantly associated with short OS in non-IBC. This result suggests that in IBC, the potential effect of racial disparity on OS is negated by the aggressive and insidious nature of the cancer. The effect of a relatively small sample size cannot be excluded, and further study in a larger population is warranted.

Early Detection of Local Recurrences in the Follow-Up of Primary Breast Cancer

1984 ◽  
Vol 70 (2) ◽  
pp. 179-183 ◽  
Author(s):  
Stefano Ciatto ◽  
Marco Rosselli Del Turco ◽  
Paolo Pacini ◽  
Carla De Luca Cardillo ◽  
Paolo Bastiani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Distant Metastases ◽  
Small Sample ◽  
Biased Sampling ◽  
Breast Cancer Patients ◽  
Actuarial Survival ◽  
Local Recurrences ◽  
The Mean ◽  
Asymptomatic Phase

The results of physical examination (PE) in the detection of local recurrences (LR) from breast cancer are reviewed in the follow-up experience of 1139 breast cancer patients. A minimum follow-up time of 5 years was considered. LR accounted for 40 % of total first relapses and isolated (without distant metastases) LR represented about 1/3 of total relapses. The chest wall was the most frequent site of LR. The extent of LR was correlated with the probability of associated distant metastases detectable at the time of LR diagnosis, whereas no correlations were found with the presence or absence of subjective symptoms at diagnosis. The mean free interval from primary surgery was 3 months shorter for LR detected in asymptomatic phase than in the symptomatic phase. This difference increased to 5 months for recurrences detected in the first 2 years, when PE controls were repeated every 6 months whereas a smaller difference of 2 months was observed over 2 years with yearly controls. The mean and 5-year actuarial survival was better (75.5 vs. 64.9 months and 54 % vs. 40 %) for cases detected in the asymptomatic phase than in the symptomatic phase; however, the difference was not statistically significant for the small sample considered and could be even partially due to length biased sampling. On the basis of the reported results, PE should still be recommended as a follow-up test, although further studies are needed to assess its real impact on prognosis.

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