Thoracic neuropathic pain is a debilitating condition that is often poorly responsive to oral and topical pharmacotherapy. The benefit of interventional nerve block procedures is unclear due to a paucity of evidence and the invasiveness of the described techniques. In this report, we describe a novel interfascial plane block, the erector spinae plane (ESP) block, and its successful application in 2 cases of severe neuropathic pain (the first resulting from metastatic disease of the ribs, and the second from malunion of multiple rib fractures). In both cases, the ESP block also produced an extensive multidermatomal sensory block. Anatomical and radiological investigation in fresh cadavers indicates that its likely site of action is at the dorsal and ventral rami of the thoracic spinal nerves. The ESP block holds promise as a simple and safe technique for thoracic analgesia in both chronic neuropathic pain as well as acute postsurgical or posttraumatic pain.
Aim: Day surgery for thyroidectomy is uncommon in Hong Kong. Day hemithyroidectomy is rarely reported in the literature, whereas day total or completion thyroidectomy (TTCT) has not been discussed at all. To the best of our knowledge, this is the first report on the experience of TTCT. Patients and Methods: Using the computerized hospital system for operations performed, the details of patients who had been scheduled for TTCT between January 2015 and May 2018 were retrieved. Their hospital charts and operation records were retrospectively evaluated with respect to the indications of surgery, operation details, complications, conversion to inpatient admission and unplanned readmission. Results: Forty-two eligible patients (25 total and 17 completion thyroidectomies) were identified. Total thyroidectomies were all done under general anaesthesia, whereas 70.6 per cent of completion thyroidectomies were done under local anaesthesia. The overall conversion rate to inpatient admission was 19 per cent. After total thyroidectomy, one patient was unexpectedly readmitted. No patient suffered from symptomatic hypocalcaemia, neck haematoma or mortality. There was no statistical difference between the two groups (total vs completion thyroidectomy) in terms of inpatient conversion following operation, unplanned readmission or surgical complications. Conclusions: TTCT thyroidectomy is feasible and safe in properly selected patients. However, mitigation measures against the relatively high inpatient admission rate are worthy of consideration.
We present a 77-year-old Caucasian woman who presented with nephrotic-range proteinuria, microhematuria, renal impairment, and extremely elevated blood pressure. She had a long history of well-controlled type 2 diabetes. Renal biopsy revealed fibrillary deposits in the mesangium and glomerular basement membrane consistent with fibrillary glomerulopathy (FGN), with crescentic changes and thrombotic microangiopathy (TMA). We could not identify any radiological, clinical, or laboratory evidence of autoimmune disorders, lymphoproliferative disorders, and malignancy. It was decided not to offer her any immunosuppressive therapy, as she was frail with substantial renal damage on the biopsy. Five months after presentation, she gradually progressed to requiring renal replacement therapy and is currently on maintenance hemodialysis. Crescentic changes in FGN, though rare, have been previously described, but the concurrent presence of TMA has never been previously reported.
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