Prurigo excoriée treated with low dose naltrexone

A 53-year-old woman presented with a 25-year history of acne excoriée and prurigo excoriée. Her symptoms began in 1988 coinciding with her husband’s death from a brain tumour when she was 27. The pruritus affected her quality of life and disturbed her sleep. She had scarring on her face and body resulting from persistent scratching. The pruritus proved refractory to treatment despite a multi-modal treatment approach including multiple topicals, phototherapy and systemic agents such as isotretinoin, antibiotics, anxiolytic agents and neuromodulators. She was extremely frustrated that various treatments had been ineffective at controlling the itch-scratch cycle. She was commenced on low dose naltrexone (LDN), 3 mg nocte, and she became itch free within a few weeks. She reports that the LDN has had a beneficial impact on her quality of life.

Outcomes in Establishing Individual Vessel Patency for Pediatric Pulmonary Vein Stenosis

The purpose of this study was to determine what patient and pulmonary vein characteristics at the diagnosis of intraluminal pulmonary vein stenosis (PVS) are predictive of individual vein outcomes. A retrospective, single-center, cohort sub-analysis of individual pulmonary veins of patients enrolled in the clinical trial NCT00891527 using imatinib mesylate +/− bevacizumab as adjunct therapy for the treatment of multi-vessel pediatric PVS between March 2009 and December 2014 was performed. The 72-week outcomes of the individual veins are reported. Among the 48 enrolled patients, 46 patients and 182 pulmonary veins were included in the study. Multivariable analysis demonstrated that patients with veins without distal disease at baseline (odds ratio, OR 3.69, 95% confidence interval, CI [1.52, 8.94], p = 0.004), location other than left upper vein (OR 2.58, 95% CI [1.07, 6.19], p = 0.034), or veins in patients ≥ 1 y/o (OR 5.59, 95% CI [1.81, 17.3], p = 0.003) were at higher odds of having minimal disease at the end of the study. Veins in patients who received a higher percentage of eligible drug doses required fewer reinterventions (IRR 0.76, 95% CI [0.68, 0.85], p < 0.001). The success of a multi-modal treatment approach to aggressive PVS depends on the vein location, disease severity, and drug dose intensity.

Pain Management Strategies Postoperatively in Arthroscopy of Foot & Ankle: A Review Article

Foot & Ankle arthroscopy is an increasingly rapid field in the treatment of multiple hip conditions, owing to its important diagnostic and therapeutic benefit. As these patients lack a consistent pain relief plan, effective post-operative pain control appears to be a concern. Several methods were used to identify a method that decreases post-operative pain, narcotic intake and hospital and treatment system costs. This article aims to study and report the relevant findings of the previous paper “Post-operative pain management strategies in hip arthroscopy.” Latest research encourages the use of a multimodal approach to the treatment of postoperative pain in hip arthroscopic patients. In tandem with peripheral nerve blocks or intraoperative anesthetic injection a pre- and after-operative analgesic regimen is used, patients experience lower discomfort and post-operative narcotic use. Different methods are similar in post-operative pain and opioid use. However, of those undergoing Intraarticular (IA) or Local Anesthetic Infiltration (LAI), postoperative risks relative to peripheral nervous blocks are smaller. Latest trials have demonstrated that the best and most reliable, multi-modal treatment for the reduction of postoperative pain in these patients may be intraoperative techniques such as IA injection or LAI in combination with a pre and postoperative analgesy. Furthermore, failure to use the peripheral nerve block can result in lower anesthesia procedural fees and operating room turnover, thereby lowering patients’ costs and increasing facility effectiveness.

The current treatment landscape in the UK for stage III NSCLC

For stage III non-small cell lung cancer (NSCLC), approximately a third of patients survive up to 5 years, with decreasing 5-year survival rates for stage IIIB and stage IIIC disease. Although curable, stage III NSCLC encompasses a diverse range of disease presentation, with an equally complex range of multi-modal treatment options, including systemic and local therapies for distant and local disease control, respectively. This complexity results in a number of challenges for the multi-disciplinary team (MDT) in achieving optimal treatment outcomes for patients. As multi-modality treatment is the preferred treatment strategy for all stage III disease, the focus of this article is the key surgical, chemotherapy and radiotherapy clinical trials as well as guidelines that currently outline radical therapy options for patients with both potentially resectable and unresectable stage III NSCLC.

Esophageal Cancer and Treatment Modalities

Esophageal cancer is eighth most common cancer worldwide with high biological aggressiveness and poor prognosis. Switching of predominant type from squamous cell carcinoma to adenocarcinoma in Western population, ethnic discrepancies and increased occurrences have identified it as major public health problem. Though monotherapy includes – surgery, radiotherapy and chemotherapy, optimal therapy for esophageal cancer is still debated. Treatment requires a multi-modal approach which includes chemotherapy, radiation therapy with or without surgical follow-up for most patients and chemoradiation for those with inoperable disease; endoscopic therapies, including radiofrequency ablation, endoscopic mucosal resection and endoscopic sub mucosal dissection for Barrett’s esophagus/ early carcinoma patients and minimally invasive surgical approaches are standards for esophagectomy. Advancement in diagnostic techniques and the multi-modal treatment approach has led to an improvement in the overall survival of esophageal cancer patients.

Multi-modal treatment strategy for achieving an aesthetic lower face

Background Most women consider an oval-shaped face to be youthful and beautiful. In recent years, demand has grown for surgical procedures with a shorter downtime and fewer complications. These minimally invasive procedures include botulinum toxin type A (BoNTA) injection, filler injection, suction-assisted liposuction (SAL), laser-assisted lipolysis (LAL), thread lifting, and fat grafting. This study aims to introduce an effective method for creating an aesthetically pleasing lower face using a combination of minimally invasive procedures.Methods From March 2017 to March 2019, 94 patients simultaneously underwent LAL, SAL, and thread lifting. Ancillary procedures such as BoNTA injections, hyaluronic acid filler injections, and removal of the buccal fat pad (BFP) were selectively performed according to the patient’s condition.Results Patients rated their postoperative satisfaction as very satisfied, satisfied, dissatisfied, or very dissatisfied. Approximately 83% of all respondents were satisfied with the results, whereas the remaining respondents had complaints regarding the outcomes. The most common reasons for dissatisfaction were a longer-than-expected recovery time and undercorrection, and the most severe complaint was skin depression as a result of overcorrection.Conclusions Our method of simultaneously performing LAL, SAL, and thread lifting, while adding BoNTA, filler injections, and BFP removal as needed, was capable of producing consistent and reliable aesthetic outcomes for the lower face.

Study of the medium term outcome in corrosive upper gastrointestinal strictures managed in one unit by combined endoscopic and surgical modalities

Background: Corrosive substances can cause serious injuries of the upper gastrointestinal tract and may lead to death. Acute corrosive poisonings are caused by ingestion of corrosive chemicals which are mostly used as household agents and are ingested accidentally or suicidal intentionally. The objectives of the present study were to evaluate and compare the medium term outcomes of the multi modal treatment used for patients presenting with corrosive upper gastrointestinal strictures and to study the demographic and clinico- pathological profile of the patients of corrosive upper gastro intestinal tract strictures.Methods: A combined retrospective and prospective study was carried out on departmental database and patient presenting with corrosive upper gastrointestinal stricture from December 2010 to July 2019 in the Department of Surgical Gastroenterology at King George's Medical University for a period of 9 years.Results: Corrosive ingestion was found to be more prevalent in age group of 15-65 years with higher incidence to be found in females compared to males. Majority of ingestion of corrosive substances are found to be suicidal by adults.Conclusions: India has high incidence of corrosive ingestion mainly suicidal and homicidal indent. Endoscopic dilatation of esophageal strictures is safe and effective therapy and should be first line therapy in patients with esophageal strictures and surgery should be considered only in patients who have technical and clinical failure on endoscopic dilatation.