Postoperative spinal infection mimicking systemic vasculitis with titanium-spinal implants

<p>Abstract</p> <p>Background</p> <p>Secondary systemic vasculitis after posterior spinal fusion surgery is rare. It is usually related to over-reaction of immune-system, to genetic factors, toxicity, infection or metal allergies.</p> <p>Case Description</p> <p>A 14 year-old girl with a history of extended posterior spinal fusion due to idiopathic scoliosis presented to our department with diffuse erythema and nephritis (macroscopic hemuresis and proteinuria) 5 months post surgery. The surgical trauma had no signs of inflammation or infection. The blood markers ESR and CRP were increased. Skin tests were positive for nickel allergy, which is a content of titanium alloy. The patient received corticosteroids systematically (hydrocortisone 10 mg) for 6 months, leading to total recess of skin and systemic reaction. However, a palpable mass close to the surgical wound raised the suspicion of a late infection. The patient had a second surgery consisting of surgical debridement and one stage revision of posterior spinal instrumentation. Intraoperative cultures were positive to Staphylococcus aureus. Intravenous antibiotics were administered. The patient is now free of symptoms 24 months post revision surgery without any signs of recurrence of either vasculitis or infection.</p> <p>Literature Review</p> <p>Systemic vasculitis after spinal surgery is exceptionally rare. Causative factors are broad and sometimes controversial. In general, it is associated with allergy to metal ions. This is usually addressed with metal on metal total hip bearings. In spinal surgery, titanium implants are considered to be inert and only few reports have presented cases with systemic vasculitides. Therefore, other etiologies of immune over-reaction should always be considered, such as drug toxicity, infection, or genetic predisposition.</p> <p>Purposes and Clinical Relevance</p> <p>Our purpose was to highlight the difficulties during the diagnostic work-up for systemic vasculitis and management in cases of posterior spinal surgery.</p

Relationship between breakthrough cancer pain, background cancer pain and analgesic treatment – case series and review of the literature

The assessment and treatment of breakthrough cancer pain (BTcP) remain a major challenge in medicine due to its high impact on several aspects of health-related quality of life. BTcP should be carefully monitored in all cancer care settings by a multidisciplinary team to provide an appropriate and personalized clinical approach. The aim of this paper is to provide healthcare professionals involved in cancer pain management with a review of the relevant literature on the relationship between background cancer pain and BTcP which, by definition, occurs despite adequately controlled background cancer pain. The clinical cases presented contribute to a better understanding of this issue and underline its impact in daily clinical practice. This article is part of the Management of breakthrough cancer pain Special Issue: https://www.drugsincontext.com/special_issues/management-of-breakthrough-cancer-pai

Effectiveness of a hybrid arts-based Cognitive Behavioral Therapy intervention for patients with non-malignant chronic pain.

Chronic Pain (CP) is defined as pain that persists or recurs for more than 3 to 6 months and may be conceived as a health condition in its own right. CP is a frequent condition, affecting an estimated 20% of people worldwide and requires special treatment and care. CP can contribute to depression, anxiety, sleep disturbances, poor quality of life and increased health care costs. Psychosocial approaches based on a cognitive conceptualization of pain can provide a solid foundation for research and clinical work. The development of a 10 week-session group treatment was based on key principles from the literature on Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) and Creative Arts Therapy, integrated with advances in research on CP management framework. The aim of this study is to evaluate a CBT-CP arts-based group intervention for patients with non-malignant CP addressing the biopsychosocial factors that influence pain perception. A total of 100 University Pain Management Unit outpatients participated, 50 in the intervention group and 50 in the control group (treatment as usual). In analyses of the pretest-posttest research design intervention including all participants, treatment gains were observed in almost all domains examined: severity of pain measured by the Brief Pain Inventory, conceptualization of mental pain measured by the Orbach and Mikulincer Mental Pain Scale, tolerance for psychological pain measured by the Tolerance for Mental Pain Scale, anxiety and depression levels measured by the Hospital Anxiety and Depression Scale, and quality of life measured by the WHO Quality of Life-BREF Questionnaire. The participants’ mean age was 52.3 years and most were female (84%). Findings suggest that postprogram, there was significant reduction in pain intensity (p&lt;0.001), depressive symptoms (p&lt;0.001), confusion about pain (p=0.037), and improvement of emotional distress tolerance (p=0.012) and global health-related quality of life (p&lt;0.001) in the intervention group. Beneficial effects can be expected from the implementation of an integrated CP intervention (including: creative and CBT techniques) reappraising some of the coping responses defined as adaptive within current psychosocial non-malignant CP regimens

Patient-controlled epidural analgesia with and without basal infusion using ropivacaine 0.15% and fentanyl 2 gamma/mL for labor analgesia: a prospective comparative randomized trial

BACKGROUND: Patient-controlled epidural analgesia (PCEA) is a common practice for labor pain relief. This study aimed to compare two different settings of a PCEA device using the same solution to obtain labor analgesia. METHODS: Fifty-two parturients were randomly allocated to receive ropivacaine 0.15% and fentanyl 2 gamma/mL via a PCEA device either as a background infusion of 5 mL/h plus 5 mL demand bolus doses with 10-minute lockout (group B/D, N.=26) or as only demand bolus doses of 5 mL with 10-minute lockout (group D, N.=26). The primary outcome was the total volume of local anesthetic administrated during labor, secondary outcomes included the analgesic efficacy and the effects on maternal and neonatal outcomes. RESULTS: No statistical difference was observed between the groups concerning demographic characteristics, duration of first and second stages of labor, administration of oxytocin and ephedrine, rescue doses, instrumental delivery, Brom-age Scale, maternal side effects and satisfaction, neonatal Apgar scores and pH. The total volume of local anesthetic was greater in group B/D compared to group D (P=0.015). A statistically significant difference was detected in VAS scores only at the end of the second stage (P=0.036) and at 60 minutes from the test dose administration (P=0.022) and with group D exhibited higher pain scores than group B/D. The incidence of breakthrough pain (VAS&gt;4) was higher in group D compared with group B/D (P=0.035). CONCLUSIONS: The addition of background infusion plus PCEA demand bolus doses increased local anesthetic consumption and reduced breakthrough pain without affecting maternal satisfaction and neonatal outcomes