Curēus
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Corneal abrasions are one of the most common ocular injuries seen in the emergency department. While most patients with corneal abrasions complain of excruciating pain, permanent sequelae may develop if not managed properly. The use of topical antibiotics and other standards of treatment have greatly reduced the incidence of complications. ⋯ Unfortunately, the power of these studies is largely limited by small sample sizes. Larger studies must be conducted before topical analgesics can be recommended or discouraged for pain management in corneal abrasions. However, based on this review of the literature, the use of topical NSAIDs does not appear to complicate wound healing, and thus remains a safe option in patients desiring medical treatment.
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Patients with metastatic spinal disease are affected by disabling pain. The treatment of spinal metastases is focused on pain reduction and improvement in quality of life. Until recently, many patients with metastatic spinal disease did not qualify as surgical candidates due to the risks of surgery and length of recovery period. ⋯ The studies reviewed here suggest that vertebral augmentation is successful in reducing pain and disability scores in patients with painful metastases and multiple myeloma and are a safe modality to provide lasting pain relief. As the use of kyphoplasty and vertebroplasty for treatment of vertebral metastases is becoming more common, new combinations of cement augmentation with other techniques such as percutaneous pedicle screws and radiofrequency ablation are being explored. The implementation of kyphoplasty and vertebroplasty, in conjunction with other minimally invasive surgical techniques as well as nonsurgical modalities, may lead to the best palliative management of cancer patients with spinal metastases and help them ultimately achieve a better quality of life.
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Case Reports
Coexistence of Right Nonrecurrent Nerve and Bifurcated Recurrent Laryngeal Nerve Pointed by Zuckerkandl's Tubercle.
The recurrent laryngeal nerve (RLN) has many anatomical variations and various relations with adjacent structures. Identification and total exposure of the cervical part of the RLN was performed during operations on the thyroid gland. An extremely rare anatomical variation of the nerve was encountered during the surgical procedure. ⋯ A Zuckerkandl's tubercle has pointed out the junction of the two nerves. In this period, the incidence of coexistence of non-RLN and RLN was 0.2% in our series. A non-recurrent course is a rare anatomical variation of the inferior laryngeal nerve. The coexistence of both non-RLN and RLN is an extremely rare anatomical finding which should be taken into account during thyroid surgery.
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A small subset of patients who underwent successful vertebral compression fracture (VCF) augmentation procedures may develop subsequent pain requiring spinal injections. In a retrospective analysis, we determined whether the pain was related to the original fracture site or to another area within the lumbar or thoracic spine. The pain occurred either at the same/adjacent level and/or non-adjacent level as the VCF. Interventional treatments primarily targeted the facet joints, specifically in the form of facet joint blocks and/or radiofrequency ablation to the medial branches. The pattern of facet injections relative to the original fracture level was studied. Additionally, the elapsed time between the vertebral augmentation and the subsequent interventional blocks was also evaluated. ⋯ Pain after a successful vertebral augmentation is typically non-acute (i.e., beyond six weeks). Mechanisms other than the primary VCF are usually responsible for non-adjacent level pain, which are present a majority of the time on reviewing the patients' diagnostic studies. These mechanisms usually take many weeks to develop and subsequently elicit pain that requires additional interventional pain procedures. In our study, the pain is usually related to the pre-existing degenerative spondylosis and stenosis rather than the fracture site. This study shows that the facet joints in closely related lumbar degenerative changes are the cause of pain in this patient group. These procedures should be explored with pain after vertebral augmentation, especially in those patients with known or suspected spinal degeneration and/or poor biomechanics.
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We report three patients with corneal bee sting at our tertiary care center in a three-year period starting from 2014 to 2016. All patients sustained a bee sting injury to the cornea. All patients received early preoperative topical antibiotics, topical cycloplegic and intensive topical steroids. However, the timing of the initial presentation, the duration, and the location of the retained stinger differed in each case leading to different postsurgical outcomes.