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Objective: To examine the laparoscopic findings in patients with suspicion of endometriosis. Study Design: Retrospective study. Setting: Department of Obstetrics and Gynecology, University of Oulu, Finland. Sample: First-time laparoscopy, without any known surgical diagnosis, was made in 53 consecutive patients between January 2006 and November 2011. Main Outcome Measures: The laparoscopic findings, staging of endometriosis, the percentages of different symptoms linked with endometriosis. Results: Laparoscopy revealed endometriosis in 40% of cases. Most frequent symptoms were dysmenorrhea (86%) and dyspareunia (81%) followed with vibration pain (71%), urinary symptoms (29%) and lowered fertility (24%). Only 5% of patients with endometriosis complained of bowel symptoms, which were significantly more common in patients without endometriosis (28%) (p = 0.034). The median interval between the onset of symptoms and laparoscopic diagnosis was 1.9 years (SD 3.2, range 0.6 - 11). Conclusions: The interval between the onset of symptoms and laparoscopic diagnosis is short reflecting the prompt availability of the necessary facilities in specialist health care. Finally laparoscopy seems to be safe in cases of endometriosis suspicion.
Chronic low back pain has a huge impact on daily living and a negative economic and professional effect. It is a matter of debate and concern for all health professionals involved, particularly spine surgeons. Recent discoveries on the innervation and biochemical properties of the intervertebral disc clarify the role of this structure as a possible cause of chronic low back pain. However, multiple causes may be present in the same patient making the diagnosis a challenging process. Discogenic pain is defined as a chronic low back pain induced by a degenerative disc disease. There are no specific characteristics of discogenic pain, although it has a higher incidence in younger age, it is usually localized medially in the back, worsens with axial loading and improves with recumbence. In the last decades we have assisted the emergence of multiple treatment techniques. However, neither the conservative treatment nor the interventional management has strong evidence in treating discogenic pain. Randomized control clinical trials are sought to improve patient outcome. Meanwhile, we believe each patient should be approached on an individual base. Discogenic pain: we care.
Objective: the objective of this study was to evaluate the efficacy of the lidocaine patch 5% in different types of neuropathic pain. Methods: a prospective, longitudinal, observational study on a sample of 16 patients who consulted for neuropathic pain. A lidocaine patch 5% was applied to the painful area and as primary endpoint, the severity of the pain was studied using the Verbal Numeric Rating Scale (VNRS). Secondary quality of life-related endpoints were sleep during the night, mood and patient global impression of the treatment. Results: demographic data: 62.5% female and 37.5% male; mean age 55.31 ± 13.9 years; time since onset of the pain 8.4 months; and classified into 4 diagnosis groups: post-herpetic neuralgia 18.8%; complex regional pain syndrome 25%; surgical wound 50%; and others 6.3%. There was a reduction of more than 2 points in pain on the VNRS (median 6.5 to 3.5; p = 0.001), an improvement in sleep during the night, mood and relief (p < 0.05), less use of analgesics, no complications and over 30% of subjects reported improvement of over 50%. Conclusions: The lidocaine patch 5% could be a useful tool for the control of neuropathic pain, not only for post-herpetic neuralgia, and it has a good safety and tolerability profile.
We present a case of
a 22-year-old man with isolated neck pain due to pharyngeal gonorrhea.