Cases reported "Pain"

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1/22. Case report: paraarticular soft-tissue osteoma of the hip.

    A case of paraarticular soft-tissue osteoma of the hip is presented. The patient is a 30-year-old white male with a two year history of progressive left hip pain. Plain film and cross-sectional imaging in conjunction with pathologic correlation are used to make the diagnosis. The lesion lacks the typical zoning pattern of myositis ossificans, shows no direct communication with native bone, and is extraarticular in location as opposed to synovial osteochondromatosis. Soft tissue osteomas most commonly occur around the knee, the foot, and the ankle. Soft tissue osteomas are rare tumors and this case is unusual in that it occurs around the hip.
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2/22. Perineural tumor spread along the auriculotemporal nerve.

    BACKGROUND AND PURPOSE: Evaluation of images of perineural tumor spread in patients with head and neck malignancies is essential for planning treatment and determining the patient's prognosis. Although the communications between the facial and trigeminal nerves are not widely known, they may provide a route for tumor growth. The purpose of this study was to elucidate the course of the auriculotemporal nerve, as well as the clinical and imaging findings that suggest involvement of the communication between the facial nerve and the mandibular division (V(3)) of the trigeminal nerve. methods: Images in 15 patients with clinical or radiologic findings suggestive of perineural tumor spread along the auriculotemporal nerve were reviewed. Involvement of the main trunk of the facial nerve, auriculotemporal nerve, V(3), trigeminal cistern, and ganglion and adjacent anatomic structures were noted in each patient. RESULTS: The course of the auriculotemporal nerve was described in detail. More than 50% of patients with perineural tumor spread along the auriculotemporal nerve had clinical signs of auriculotemporal nerve dysfunction, including periauricular pain and temporomandibular joint (TMJ) dysfunction or tenderness. Images in 13 of 15 patients with such tumor spread demonstrated findings of tumor growth along V(3.). CONCLUSION: knowledge of the course of the auriculotemporal nerve is critical in evaluating images for findings of tumor spread along this nerve. Periauricular pain, TMJ dysfunction or tenderness, and imaging signs of V(3) involvement are important indicators of potential involvement of the auriculotemporal nerve.
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3/22. Care study: the effect of pain on a patient with leg ulcers.

    The following care study aims to explore the effects of wound-related pain on a patient with leg ulceration. The study illustrates current deficits within the author's clinical area, a day hospital for elderly people, in relation to how both a patient's pain and quality of life are measured. It suggests means by which this could be overcome, e.g. by the use of appropriate pain and quality of life pain measurement scales. The case study also highlights the hospital-community divide, with reference to communication and the exchange of information relating to a patient's pain. It advocates optimizing interdisciplinary team communication and discusses how developing closer working relationships and improving education can play a part in enhancing communication. While this case study is concerned with an individual patient, it aims to demonstrate that the problems identified and the resulting indications for clinical practice will promote an increasingly holistic view of the patient and benefit all future patients with leg ulceration.
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4/22. The need for organizational development in pain clinics: a case study.

    PURPOSE: This study describes the practical implementation of an interdisciplinary rehabilitation model for patients with long-term, non-malignant pain. The main purpose was to explore the organizational prerequisites for interdisciplinary function. The pragmatic aim was to extend our understanding of the management of these patients. METHOD: The subjects (n =24) were seven insurance representatives, four work leaders, seven nurses, three doctors, one psychologist and two physiotherapists. Data sources included focus group interviews, participant observation (field notes) and a review of written documents. The constant comparative method for grounded theory was used to analyse the data. RESULTS: The data showed that the rehabilitation of chronic pain patients should be organized as an "integrated wholeness", requiring an "agile organization" to promote solutions tailored to suit the needs of each patient. Moreover, a "common core knowledge" of chronic pain and "mission clarity" are important as guidance for the interdisciplinary practical rehabilitation work. This kind of interdisciplinarity requires "interdisciplinary roles" and "integrational leadership"'. The practical implication of this was the development of communication structures, internally as well as externally, promoting collaboration and integration. CONCLUSION: Approval at organizational level is necessary to transform the ideas of interdisciplinarity to reality and create integrated cooperation between professionals. A lack of attention to this question may account for repeated failures in terms of health care service integration and positive rehabilitation outcomes among the patients concerned.
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5/22. Multidimensional continuous pain assessment chart (MCPAC) for terminal cancer patients: a preliminary report.

    Current use of pain measures is limited in clinical practice. The common pain measures neither target nor monitor the changes that occur with time with regard to the effect of other parameters associated with pain control. Changes in parameters, such as pain type, various pharmacological and nonpharmacological interventions, dosage of medications, and use of rescue doses, usually complicate pain control in terminal cancer patients. The authors propose use of a multidimensional, continuous pain chart that permits better assessment and control of pain. The chart integrates visual analogue pain assessment, special treatment techniques, regular medications and rescue doses, co-analgesics, pain categories, parameters relating to quality of life, sleep, and mobility. A total of 1,178 assessments were performed in 100 consecutive patients with full compliance. The chart permitted a continuous monitoring of patients 'most important needs concerned with pain control and was easily integrated into the hospice daily routines. We conclude that the chart represents an effective and friendly graphic tool to monitor pain and associated parameters that relate to the quality of the broad spectrum of pain control. The hope is that this tool may improve pain control by hospice professionals and facilitate communication between patients and the interdisciplinary team members.
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6/22. aneurysm of the profunda femoris artery manifested as acute groin pain in a child.

    Arterial aneurysms in children are extremely rare and can be of congenital, inflammatory, and infectious nature or secondary to trauma. The authors describe the case of a 8-year-old boy who was admitted in the hospital with fever and severe groin pain. He had a true saccular aneurysm of 4 cm in diameter originating from the profunda femoris artery with, according to the clinical and angiographic findings, arteriovenous communication with the femoral veins. Because the aneurysm was firmly adherent to the deep femoral vein, the latter was resected and the venous continuity was restored with a saphenous vein bypass graft. The patient recovered without any complication. The histologic examination showed a normal intimal layer and partially disrupted medial elastic fibers without inflammatory infiltrate, suggesting the diagnosis of a true arterial aneurysm.
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7/22. chronic pain in individuals with previously undiagnosed autistic spectrum disorders.

    The aim of this article is to heighten clinician awareness by describing 2 patients with signs and symptoms of a possible autistic disorder. Autistic spectrum disorders are neurodevelopmental disorders characterized by impairment in reciprocal social interaction skills or communication skills and/or by the presence of stereotyped behavior, interests, and activities. Pain can be the initial presenting symptom for individuals with a previously undiagnosed autistic spectrum disorder. Two case presentations show indicators, such as reported sensory abnormalities, impaired social behaviors, and unusual interests, that should lead the physician to consider a referral for further evaluation. An accurate diagnosis of autism or related disorder can lead to a greater understanding of the nature of the patient's pain, as well as to more appropriate and effective treatment strategies. In addition, such patients might benefit from therapeutic interventions to improve overall functioning and decrease distress and, consequently, to decrease pain and other symptoms. Finally, autism research might inform pain researchers on topics such as neurobiology, development, and treatment of chronic pain disorders. PERSPECTIVE: Pain experts might be underrecognizing signs and symptoms of autistic spectrum disorders (ASDs) in their patients. Clinical evaluation for ASDs should be considered in patients with specific unusual characteristics. research on the topic of ASDs and pain is encouraged.
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8/22. Profiles in patient safety: when an error occurs.

    Medical error is now clearly established as one of the most significant problems facing the American health care system. Anecdotal evidence, studies of human cognition, and analysis of high-reliability organizations all predict that despite excellent training, human error is unavoidable. When an error occurs and is recognized, providers have a duty to disclose the error. Yet disclosure of error to patients, families, and hospital colleagues is a difficult and/or threatening process for most physicians. A more thorough understanding of the ethical and social contract between physicians and their patients as well as the professional milieu surrounding an error may improve the likelihood of its disclosure. Key among these is the identification of institutional factors that support disclosure and recognize error as an unavoidable part of the practice of medicine. Using a case-based format, this article focuses on the communication of error with patients, families, and colleagues and grounds error disclosure in the cultural milieu of medial ethics.
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9/22. Intraspinal dural distraction inciting spinal radiculopathy: cranial to caudal and caudal to cranial.

    LaBan previously described the precipitous onset of lumbar radiculopathy in 12 patients who were receiving therapeutic, intermittent cervical traction for a primary complaint of cervical radiculopathy. Cranial-to-caudal traction of the intraspinal pia with cervical spine distraction was cited as the dynamic link believed to have provoked the lumbar radiculopathy. This present communication adds an additional case and describes an equal but opposite occurrence, a case of caudal-to-cranial dural distraction that provoked cervical radicular pain. In this instance, the complaint of elbow pain associated with a cervical radiculopathy could be attributed to caudal-to-cranial intraspinal pia traction acting on its intraforaminal thecal extension surrounding the C8 spinal root, previously sensitized by a herniated disc.
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10/22. Difficult cases in pain management: use of methadone in a multifactorial approach.

    Cancer pain management is a crucial aspect of patients' quality of life. During the course of the disease, patients with cancer may develop difficult pain management problems that do not respond to interventions that use the basic principles of pain management. Ongoing assessment, multiple approaches, and excellent communication among all care management team members are critical. pain management goals must be continually evaluated, reestablished if necessary, and negotiated by patients and the team. Difficult pain management cases demand the involvement of all team members, especially patients, to assist in determining acceptable approaches. nurses must recognize the challenge, advocate for better management, and provide ongoing assessment. Ultimately, pain management outcomes are determined by nursing advocacy. Through nurse leadership, suffering is minimized and quality of life is improved for this patient population.
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