Cases reported "Pain"

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1/61. Use of transdermal amitriptyline gel in a patient with chronic pain and depression.

    A man with severe inflammatory bowel disease suffered from chronic abdominal pain and depression. A transdermal amitriptyline gel preparation was compounded since he was unable to take drugs orally serum concentrations of amitriptyline and its active metabolite nortriptyline were measured over 24 hours. Symptoms of depression were monitored before starting transdermal therapy and at the end of 6 weeks. Pain symptoms and amitriptyline adverse drug events were monitored daily Steady-state serum concentrations of drug and metabolite were within the therapeutic range over 24 hours. The patient reported that his mood was improved but his abdominal pain remained unchanged. Transdermal amitriptyline gel was well tolerated and is an alternative delivery system in patients unable to take drugs orally.
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2/61. hypnosis: an alternative in pain management for nurse practitioners.

    hypnosis and the trance phenomenon is an age-old tool for the treatment of a variety of conditions, including pain. Medically accepted for over 50 years as a legitimate therapy, research continues into its mechanisms and actions. In this article, its origins, history, theoretical basis, and various uses are discussed. Case presentations from the author are provided, showing its use for a variety of pain management scenarios. Sample hypnotic scripts allow the reader to better visualize the applicability of hypnotic suggestion to general inductions and pain management. References are provided for individuals seeking further information and/or training in hypnosis.
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3/61. What if your patient prefers an alternative pain control method? Self-hypnosis in the control of pain.

    Despite the availability of specialized treatments for chronic pain, including biofeedback training, relaxation training, and hypnotic treatment, most physicians rely on the traditional approaches of surgery or pharmacotherapy. The patient in this case study had severe and chronic pain but found little relief from pain medications that also caused side effects. She then took the initiative to learn and practice self-hypnosis with good results. Her physician in the resident's internal medicine clinic supported her endeavor and encouraged her to continue self-hypnosis. This patient's success shows that self-hypnosis can be a safe and beneficial approach to control or diminish the pain from chronic pain syndrome and can become a useful part of a physician's therapeutic armamentarium.
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4/61. Nosocomial transmission of hepatitis b virus infection through multiple-dose vials.

    The source of acute hepatitis b virus (HBV) infection in two women (55 and 72 years old) was investigated. They displayed no risk factors for acquiring HBV infection, other than treatment with local anaesthetic injections some months previously. The HBV strains were sequenced and showed distinct homology to strains seen in Swedish intravenous drug users (IVDU). Prior to these patients' acute infection, an outbreak of HBV had occurred among IVDU in the same county. Analysis of the HBV strains from six of these IVDUs showed their core promoter, precore and pre-S sequences (679 nucleotides) to be identical to those from the two patients. Cross-contamination between samples was excluded and the most likely source of infection was thought to be multiple-dose vials of local anaesthetic that had been contaminated with the HBV strain circulating among the IVDU population in the community. We believe that multiple-dose vials have no place in modern healthcare and recommend sequence homology analysis as an alternative or additional way to trace a source of HBV infection.
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5/61. Treatment of multiple cutaneous leiomyomas with CO2 laser ablation.

    BACKGROUND: Cutaneous leiomyomas are benign tumors that can be exquisitely painful. Symptomatic lesions often necessitate treatment, but many options are inadequate or create substantial morbidity. Without a definitive therapy of first choice, the search continues for alternative methods to alleviate discomfort in affected patients. OBJECTIVE: To describe the use of CO2 laser ablation for the symptomatic treatment of a 73-year-old woman with multiple cutaneous leiomyomas in whom pharmacologic therapy was contraindicated and surgical excision was impractical. methods: CO2 laser ablation of six symptomatic cutaneous leiomyomas was performed under local anesthesia. After initial success, all remaining symptomatic lesions were treated. RESULTS: There was complete pain relief in the originally treated lesions 9 months postoperatively, and in all remaining treated lesions 3 months postoperatively. CONCLUSION: CO2 laser ablation may be an effective alternative treatment for symptomatic cutaneous leiomyomas.
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6/61. Partial splenic embolization in the treatment of hypersplenism.

    Transcatheter embolization of the spleen has been associated with serious complications, such as splenic abscess, rupture of the spleen, pneumonia, and septicemia. These complications, with their grave consequences, have prevented the use of this procedure as an alternative to operative splenectomy in selected cases. A detailed description of our method, which consists of partial splenic embolization, antibiotic prophylaxis, adequate pain control, and careful pre- and postembolization, is reported. Thirteen patients with hypersplenism were successfully treated with transcatheter partial embolization of their spleen.
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7/61. Acute painful diabetic neuropathy: two patients with recent insulin-dependent diabetes mellitus.

    Two young men developed an acute painful peripheral neuropathy a few weeks after being diagnosed to suffer from an insulin-dependent diabetes mellitus. In both cases, peripheral nerve biopsy exhibited a few features of acute axonal degeneration. Additionally, in the first case there was a lymphocytic infiltrate around an endoneurial capillary, and in the second case there were several mast cells in the endoneurium of every fascicle examined. A few months later, the acute pain had disappeared in both cases. Only a few cases of acute painful diabetic neuropathy have been reported so far. A vascular origin seems unlikely and metabolic disorders are probably due to a contemporary severe weight loss. An auto-immune mechanism is an alternative explanation.
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8/61. Successful management of pleuritic pain with thoracic paravertebral block.

    BACKGROUND AND OBJECTIVES: Thoracic paravertebral block (TPVB) is a unilateral analgesic technique that has been advocated in both acute and chronic thoracic and abdominal pain. Other blocks such as interpleural and epidural can be effectively used in pleuritic pain. This report illustrates that TPVB could also be effective for this kind of pain. methods: A 45-year-old man with acute pancreatitis was referred to the critical care unit 11 days after emergency admission with severe left pleural effusion and acute respiratory failure. His medical history revealed hypertension and chronic obstructive pulmonary disease (COPD); in addition, he was a heavy drinker and smoker. A pleuritic pain that only slightly improved with nonopioid analgesics and opioids resulted in the patient's increasing inability to eliminate bronchial secretions. In an attempt to avoid endotracheal intubation, the pain unit recommended a continuous paravertebral block. The block was performed at T9 on the left side. An initial bolus of 15 mL bupivacaine 0.25% was administered and a continuous infusion, initially at 5 mL/h, was increased up to 10 mL/h to achieve the desired analgesic effect. RESULTS: After the block the verbal analogue scale decreased from 9 to 3, and this level of pain relief was maintained until the end of the treatment 48 hours after the block. The patient improved and was discharged to the ward without the need for endotracheal intubation. CONCLUSIONS: This case report supports the notion that, in practice, the paravertebral block could be an effective and safe alternative to relief of pleuritic pain.
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9/61. An unusual case of vascular dysplasia related to knee arthroscopy.

    Acquired or traumatic arteriovenous fistula (AVF) following arthroscopic surgery is a rare complication. This case presents a patient who developed symptoms suggestive of an AVF following arthroscopic partial menisectomy and anterior cruciate ligament reconstruction. Evaluation and diagnostic procedures of choice as well as treatment alternatives are discussed herein.
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10/61. Random assignment and patient choice in a study of alternative pain relief for sickle cell disease.

    This article presents two case examples in which women with sickle cell disease, when invited to participate in a nursing experiment, requested assignment to the experimental group. This experience stimulated the authors to explore the ethics of random assignment relative to equipoise, informed consent, patient choices, study validity, the clinician-patient relationship, patient support networks, and other issues. There is a need for in-depth discussion about random assignment and its implications within the nursing research and advanced practice communities.
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