Stewart's approach

bstract Surgery is the only curative treatment for primary hyperparathyroidism (pHPT). Surgical exploration is recommended for all patients with biochemically documented pHPT and signs or symptoms of the disease. Some patients are asymptomatic, others have subtle symptoms that disappear after parathyroid surgery. Felix Mandl successfully performed the first parathyroidectomy in 1925, using a bilateral neck exploration (BNE) with examination of all four glands and this remained the procedure of choice for pHPT into the 1990s. As over 80% of pHPT cases are due to a single parathyroid adenoma, many authors have questioned the need of BNE and have proposed directed unilateral approaches, termed "mini-invasive parathyroidectomies". The aim of this report is to define which is the actual role of the conventional surgical approach to pHPT

The roles of media, language, and practice on solving the Tower of Hanoi problem

The current study presents findings of a study conducted on the Tower of Hanoi problem. The Tower of Hanoi problem is a logical puzzle involving recursion in which there are three pegs with discs stacked in ascending order on the left peg. The object is to restack the discs on the right peg in ascending order, moving one disc at a time and never having a larger disc placed on top of a smaller one. The fewer the moves to accomplish this, the more successful the trial is judged to be. Subjects were randomized into one of eight cells and all were measured on their ability to solve the 4-disc version of the Tower of Hanoi in terms of three dependent variables: total number of moves, total moves-to-optimal moves ratio, and completion time. In a 2 X 2 X 2 between subjects factorial design, subjects were assigned to three different conditions with two levels each. Subjects performed either a computerized or physical version of the TOH; verbalized their strategies while doing so or were instructed to remain silent; and were allowed to practice on easier two-disc and three-disc versions or were not given the benefit of doing so. Main effects were found in that subjects completing the physical TOH did so more efficiently than those completing it on the computer. Subjects also benefitted from verbalizing their strategies over remaining silent. Interaction effects were also found for practice and verbalization. (Author abstract)Worth, E., Mercieri, A., and Douglas, A. (2014). The roles of media, language, and practice on solving the Tower of Hanoi problem. Retrieved from http://academicarchive.snhu.ed

Drug-resistant chronic cluster headache successfully treated with supraorbital plus occipital nerve stimulation. A rare case report

Chronic cluster headache (CCH) is a rare and extremely disabling headache syndrome with a recent clinical systematization of its clinical frame from the European Headache Federation [1]. We present a case of a young man affected by drug-resistant chronic CH (rCCH) who showed improvement after a two-time combined supraorbital and occipital nerve stimulation (S-ONS). The clinical improvement was still present at 6-month follow-up

Optical fiber technology enables smart needles for epidurals. An in-vivo swine study

Nowadays, epidural space identification is made by using subjective and manual techniques characterized by failure rates up to 7%. In this work, we propose a fiber optic sensor technology based needle guidance system, that is directly inspired by the most common technique currently used for epidurals; through real-time strain measurements, the fiber Bragg grating integrated inside the needle lumen is able to effectively perceive the typical force drop occurring when the needle enters the epidural space. An in vivo swine study demonstrates the validity of our approach, paving the way for the development of lab-in-a-needle systems

Low-dose buprenorphine infusion to prevent postoperative hyperalgesia in patients undergoing major lung surgery and remifentanil infusion: a double-blind, randomized, active-controlled trial

Abstract Background Postoperative secondary hyperalgesia arises from central sensitization due to pain pathways facilitation and/or acute opioid exposure. The latter is also known as opioid-induced hyperalgesia (OIH). Remifentanil, a potent μ-opioid agonist, reportedly induces postoperative hyperalgesia and increases postoperative pain scores and opioid consumption. The pathophysiology underlying secondary hyperalgesia involves N-methyl-D-aspartate (NMDA)-mediated pain pathways. In this study, we investigated whether perioperatively infusing low-dose buprenorphine, an opioid with anti-NMDA activity, in patients receiving remifentanil infusion prevents postoperative secondary hyperalgesia. Methods Sixty-four patients, undergoing remifentanil infusion during general anaesthesia and major lung surgery, were randomly assigned to receive either buprenorphine i.v. infusion (25 μg h −1 for 24 h) or morphine (equianalgesic dose) perioperatively. The presence and extent of punctuate hyperalgesia were assessed one day postoperatively. Secondary outcome variables included postoperative pain scores, opioid consumption and postoperative neuropathic pain assessed one and three months postoperatively. Results A distinct area of hyperalgesia or allodynia around the surgical incision was found in more patients in the control group than in the treated group. Mean time from extubation to first morphine rescue dose was twice as long in the buprenorphine-treated group than in the morphine-treated group: 18 vs 9 min ( P =0.002). At 30 min postoperatively, patients receiving morphine had a higher hazard ratio for the first analgesic rescue dose than those treated with buprenorphine ( P =0.009). At three months, no differences between groups were noted. Conclusions Low-dose buprenorphine infusion prevents the development of secondary hyperalgesia around the surgical incision but shows no long-term efficacy at three months follow-up

Manuale illustrato di Dolore-Immunologia-Reumatologia

In questo volume della collana presentiamo l'argomento dolore, seguito da una premessa sulle basi fisiopatologiche del sistema immunitario, per concludere con la trattazione delle principali malattie reumatologiche. Il dolore rappresenta una sfida per il medico, trattandosi di un capitolo complesso e ramificato, interdisciplinare, affrontato sia nell'urgenza che nella pratica clinica quotidiana. La Reumatologia è una disciplina particolarmente ricca di scenari in cui il dolore rappresenta, insieme alle limitazioni funzionali, uno dei sintomi che affligge la persona malata

Manuale illustrato di Gastroenterologia - Epatologia

In questo volume della collana presentiamo le malattie dell'apparato digerente, fegato, pancreas e vie biliari. Nella prima parte tratterremo le malattie digestive, nella seconda le malattie del fegato e nella terza parte le malattie del pancreas e delle vie biliari. Come è nostra abitudine l'esposizione degli argomenti si fonda su solide basi anatomiche e fisiologiche in modo che le malattie possano poi essere studiate con il necessario bagaglio fisiopatologico da cui deriva il razionale diagnostico e terapeutico