Management of neuropathic pain in Senegal: Expertise of National Center of Orthopedic Equipment, Dakar

IntroductionNeuropathic pain is serious and its treatment difficult. Treatment is efficient, when quality of life is increased [1].ObjectiveTo determine the frequency of neuropathic pain at the National Centre of Orthopaedic Equipment, Dakar, Senegal and to study the difficulties of management of neuropathic pain according to international guidelines.MethodologyA prospective study was undergone in the National Centre of Orthopaedic Equipment in Dakar, Senegal. Study took place from October 2014 to January 2015. Patients with pain over one month answered the neuropathic pain questionnaire and those with over 4 points were enrolled. Pain intensity was evaluated with Visual Analogic Scale, motor function with Medical Research Council Test. Major function (prehension, work, daily activity, professional activity and sleep) were appreciated. We verified the conformity of complementary exams. Evaluation was done before treatment, three weeks and two months after. Treatment was based on international guidelines.ResultsForty-three patients suffered neuropathic pain. The sex-ratio was 0.96. The mean age was 52.22. The mean score of Visual Analogic Scale was 5.75. Working was difficult (33.96%), impossible (4 cases), and up and down stair climbing impossible (18.83%). Among the patients 18.86% could not walk more than 1000 meters and 13.20% of patients could not pick something up. Professional activity was stopped in 2 cases. Sleep disorders were noted in 33.96%. Complementary exams were done in 54.71% and 9.43% were not compliant with international guidelines. Most of the patients received Amitryptiline (54. 71%) and adverse effects were noted only in 3 cases. With a two months follow-up, dimensions of quality of life were improved in 94.53% of cases.Discussion and ConclusionTreatment of neuropathic pain improved quality of life. In African country, the choice of molecule must take into account its efficacy and its accessibility. Rehabilitation is important in management of neuropathic pain. It increases function and improves quality of life. The unnecessary complementary exams increase the cost, and general practitioners need a specific piece of information about the neuropathic pain and its treatment

Giant synovial cell sarcoma of the thorax in a 46-year-old man: a case report

Background:Although synovial cell sarcoma is a common tumor of the extremities, its occurrence in the thorax has been less frequently documented. Case Presentation: A 46-year-old Pakistani man presented with a 2 month history of progressively increasing cough and left lower chest pain. Initial evaluation was done using a chest x-ray, the Patient was found to have a large mass involving the lower portion of the left chest. A computed tomography scan was performed next which showed a large mass involving the left chest wall with invasion into the pericardium and left hemidiaphragm. En bloc surgical resection of the tumor was undertaken. Final pathology showed synovial cell sarcoma of the thorax. At one-year follow-up, the Patient has shown no recurrence of the disease. Conclusions: We have described a rare case of a large synovial cell sarcoma of the thorax. Surgical resection appears an appropriate modus operandi for managing giant synovial cell sarcomas of the thorax. However, there is a need to clearly define post-operative strategies for cases with extensive involvement of surrounding structures