Patients´ experiences in a newly established clinic for late complications after colorectal and anal cancer treatment: a qualitative study

Purpose Treatment of late complications is not systematically provided in Denmark. We therefore established a clinic to treat patients´ late complications. With this study we wanted to explore patients´ experiences with treatment and care in the clinic, including their recommendations for the future organization and structure of the clinic. Methods We conducted a qualitative semi-structured interview study with patients who had attended our late complication clinic after treatment for colorectal or anal cancer. Results We included 14 patients. We found two main categories: 1: benefitting from the late complication clinic and 2: preparation and delivery of the consultations. Patients benefitted from attending the late complication clinic and some experienced complete relief from symptoms. Others did not, but they gained hope that they might be able to receive treatment in the future. Patients wished for more information about late complications, preferring that the most common symptoms were described along with patient-friendly treatment options. The patients were satisfied with telephone consultations, as they were easy to fit into a daily schedule, and patients found it easy to express themselves openly. Conclusions Patients were satisfied with the late complication clinic as they felt it gave them a safety net. For the future, patients recommended provision of more information about late complications and possible treatments.

Scrambler Therapy for the Treatment of Pain in Schwannomatosis

Purpose: Schwannomatosis patients (SP) suffer from chronic nerve pain that is often inadequately relieved. Scrambler Therapy (ST) can relieve neuropathic pain quickly, safely, and inexpensively. We successfully treated a patient with Scrambler Therapy, adding another tool to the methods used to treat SP pain.Methods: We treated her with 5 daily sessions of ST, each for 40 minutes.Results: Complete relief of pain and hyperalgesia, with return to normal function, by day 5, that has persisted.Conclusion: Scrambler Therapy may be an effective way to treat schwannomatosis pain, and deserves further research.

Surgical removal of a foreshortened right innominate vein Wallstent causing venous outflow obstruction

Objectives: Stenting of central venous stenosis to preserve upper extremity hemodialysis access is well-described, though upper extremity complications secondary to these stents are less frequently discussed. Methods: We present the case of a 43-year-old male with a right brachiocephalic fistula who developed symptoms of venous hypertension following placement of a Wallstent for central venous stenosis. Workup demonstrated venous outflow obstruction secondary to stent foreshortening into the right subclavian vein. Results: The Wallstent was removed in a piecemeal fashion using an open surgical technique and a HeRO graft was placed for dedicated fistula outflow with complete relief of the patient’s symptoms. Conclusion: In situations where a stent has migrated and endovascular removal is not possible, individual Wallstent fibers can be removed through a limited venotomy.

Management of Vataja abhishyanda (Allergic conjunctivitis) with Gutika anjana and Punarnavadi eye drops: A comparative clinical study

Background: Vataja Abhishyanda is characterized by Toda (Pricking pain), Sangharsha (foreign body sensation), Achchasruta (watery discharge), Alpa Shopha (mild chemosis), Vishushka Bhava (feeling of dryness), Parushya (roughness) etc which are very similar to the most of signs and symptoms of the Allergic Conjunctivitis. It is one of the most common type of eye allergy and is widely experienced by global population. Aims and Objective: . To evaluate and compare the efficacy of Punarnavadi eye drops and Gutika Anjana in the management of Vataja Abhishyanda(Allergic conjunctivitis). Materials and methods: Total 104 patients diagnosed with symptoms and signs of Vataja Abhishyanda were selected from the outpatient department of Shalakya tantra. The selected patients were assigned randomly into two groups, group A (Punarnavadi eye drop) having 51 and group B (Gutika Anjana) having 50 patients. Duration of treatment was 8weeks with follow up for one month after the trial. Result: In Group A, 96.08% got complete relief after the completion of treatment, 03.92% got marked improvement. In Group B, 98% got complete relief after the completion of treatment, 2% got marked improvement. Conclusion: Gutika Anjana shows better relief in all sign and symptoms on the basis of percentage. The reason may be Anjana has maximum absorption due to more contact of time with the tissue which is responsible for better bioavailability.

Challenges and Potential in Targeted Muscle Reinnervation in Pediatric Amputees

Targeted muscle reinnervation (TMR) is a powerful new tool in preventing and treating residual limb and phantom limb pain. In the adult population, TMR is rapidly becoming standard of care; however, there is a paucity of literature regarding indications and outcomes of TMR in the pediatric population. We present 2 cases of pediatric patients who sustained amputations and the relevant challenges associated with TMR in their cases. One is a 7-year-old patient who developed severe phantom and residual limb pain after a posttraumatic above-knee amputation. He failed pharmacologic measures and underwent TMR. He obtained complete relief of his symptoms and is continuing to do well 1.5 years postoperatively. The other is a 2-year-old boy with bilateral wrist and below-knee amputations as sequelae of sepsis. TMR was not performed because the patient never demonstrated evidence of phantom limb pain or symptomatic neuroma formation. We use these 2 cases to explore the challenges particular to pediatric patients when considering treatment with TMR, including capacity to report pain, risks of anesthesia, and cortical plasticity. These issues will be critical in determining how TMR will be applied to pediatric patients.

Creatine Derivatives: Rapid Complete Relief of Pain by Topical or Transcutaneous Administration

Our research reveals that non-toxic creatine derivatives, especially N-acetyl-creatine ethyl ester, to be therapeutically effective on topical application or by superficial subcutaneous injection over sites of pain to rapidly alleviate or eliminate pain associated with various inflammatory conditions including arthritis, acute common headache, osteoarthritis, psoriatic arthritis, rheumatoid arthritis and various other pains associated with inflammation.

A Case Report on Ayurvedic Management of Dushta Vrana

Dushta vrana is a commonly encountered problem in day-to-day practice. Contemporary progress in the field of surgery has reduced the incidence of wound infection to a great extent along with the use of antibiotics. But still the management of ulcer encounters many glitches. This case study discusses about a 58-year-old male patient who presented with a chronic non healing ulcer in the anterior aspect of the left ankle joint associated with pain, burning sensation, foul smelling and inflammation with no history of varicose veins. Patient was treated with Karaskara ksheera kashaya dhara followed by dressing with Jathyadi ghrta. Punarnavadi kashayam and Guggulupanchapala choornam was given internally for a period of 35days. Virechana with Avipathy Choornam was given once during the whole course of the treatment. Raktamokshana was done twice as Jaloukavacharana. In order to enhance the speedy recovery, traditional use of Kupeelu was considered. A highly potent drug among the Upavisha which is well known for properties like Vranahara, Soolahara, Kushtahara, Sothaghna etc. which augments the peripheral blood circulation, reduces pain, burning sensation and inflammation. The wound healed within a period of 35 days and got complete relief from pain, burning sensation and swelling. Thus, the patient was successfully treated with no complications.

AN OBSERVATIONAL STUDY TO ASSESS THE PARENTAL DOSHA PRAKRITI OF AUTISTIC CHILDREN

Prakriti refers to the genetically determined physical and mental constitution of an individual. Autism is a lifelong disability identified by impaired communication, social interaction and repetitive behaviours. The genetic, envi- ronmental and immunological factors play an important role in generating autism. Genetic factors are more pre- dominant in autism pathogenesis than the environmental factors that would modulate the phenotype. Until now, no interventions have proven widely effective in providing complete relief to autism. Therefore, the prevention of autism needs supreme attention. To a greater extent, prakriti of an individual can determine proneness to particu- lar diseases. To assess the prakriti of both parents of 30 diagnosed cases of autistic children attending the OPD and IPD of Govt. Ayurveda College, Kannur were randomly selected. They are subjected to detailed history taking based on specially prepared proforma and assessments were recorded. Their prakriti assessment was done using a validated computer-assisted questionnaire software Ayusoft developed by C-DAC Pune. The data was statistically analysed. In this study, Vata pitta prakriti was significantly seen in mothers of autistic children. Keywords: Prakriti, Autism

Robotic Modification of Epiglottis Trimming in the Treatment of Obstructive Sleep Apnea

Objective With the widespread use of drug-induced sleep endoscopy, it has been suggested that epiglottis pathologies are present at high rates in patients with sleep apnea. The aim of our study was to evaluate the efficacy of trimming the curled-inward epiglottis as an updated surgical technique in patients with omega epiglottis. Study Design Retrospective study. Setting Tertiary hospital. Methods Among the 283 patients with epiglottis pathology, 21 with isolated omega-shaped epiglottis (age, 33-53 years) fulfilled the inclusion criteria between May 2016 and April 2019. Drug-induced sleep endoscopy was used to detect epiglottic collapse compressed by the lateral parts during inspiration. An epiglottoplasty technique was applied as single-level sleep surgery in patients with an isolated omega-shaped epiglottis. The medical data were also reviewed. Results The mean pre- and postoperative total apnea-hypopnea index (AHI) scores were 27.89 and 10.58, respectively, and this difference was statistically significant ( P < .001). There was a statistically significant difference between the pre- and postoperative supine AHI scores (27.02 vs 10.48, P < .001). Surgical success, defined as AHI <20 and a decrease in AHI by 50%, was documented in 85.71% of patients (18/21), and 12 patients found complete relief from obstructive sleep apnea symptoms (AHI <5); the cure rate was 38.09% (8/21). Conclusion Trimming the curled-inward epiglottis may represent an excellent option for epiglottis surgery in patients with obstructive sleep apnea by being less invasive than techniques currently in use.

Radical surgery for complicated cholelithiasis in elderly patients: three clinical cases

Management of complicated cholelithiasis (gallstone disease) in elderly patients is often limited to the use of only minimally invasive interventions.Case report. We report three clinical cases of gallstone disease complications in patients over 75 years old who had previously undergone minimally invasive surgery and who was refused radical surgical treatment due to comorbidity. In two patients, this led to the development of purulent cholangitis and multiple organ failure, which required emergency hospitalization. At the first stage, biliary drainage was performed; then the multidisciplinary team managed to stabilize the condition of the patient; at the second stage, biliodigestive anastomoses were formed through laparotomic access on a loop turned off by the Ru. Complete relief of symptoms was achieved and no relapse was observed.In another case, cholecystoduodenal fistula with stone migration and complete obstruction of the small intestine was found during laparotomy in an asymptomatic patient hospitalized for elective surgery.Discussion. Comorbidity should not be considered as an absolute contraindication to radical surgery of complicated cholelithiasis in elderly patients: gallstone disease complications in most cases exceed the risks of surgical intervention. Radical surgery of complicated gallstone disease in patients over 75 years old is possible in condition of patient management by a multidisciplinary team.