Objectives/Hypothesis: The efficacy of conventional physiotherapy and antiinflammatory/analgesic drugs in the management of shoulder pain and functional disability following neck dissection is often disappointing. Acupuncture is a safe and well-tolerated method. We report the results regarding our pilot trial of acupuncture versus conventional care in the management of postoperative shoulder pain and dysfunction after neck dissection.Study Design: Pilot study.Methods: Patients at a tertiary university center with chronic pain or dysfunction attributed to neck dissection were randomly assigned to either weekly acupuncture or usual care (eg., physical therapy, analgesia, and/or antiinflammatory drugs) for 5 consecutive weeks. The Constant-Murley score, a composite measure of pain, function, and activities of daily living, was the primary outcome measure. As secondary end point, The Neck Dissection Impairment Index (NDII) was used to quantify site-specific, self-reported quality of life (QOL).Results: After randomization, 48 patients completed the study (23 and 25 patients on acupuncture and control arms, respectively). Constant-Murley scores improved more in the acupuncture group (gain difference between groups 13.6, P < 0.01), a statistically significant improvement in site-specific QOL was also recorded at NDII (gain difference between groups 11.5, P < 0.01).Conclusion: Acupuncture is safe and effective; it should be introduced and offered to patients suffering from neck pain and dysfunction related to neck dissection.
Acne fulminans, the most severe form of acne, comprises ulcerative nodulocystic lesions with general, abdominal, and skeletal symptoms acute in onset. In our case, the patient initially had been managed as acute appendicitis. Antibiotic therapy had been administered in full doses with systemic corticosteroids, usually recommended as primary treatment. Few days later, we observed the complete palette of clinical manifestations (vasculitis-like lesions and joint pain) and the classic signs (nodules and pustules on face and chest) allowing the correct diagnosis. Our treatment was peculiar: a systemic antibiotic therapy, based on cephalosporines, proved to be effective.
Trigeminal neuralgia (TN) is the most common cranial neuralgia, defined as sudden, usually unilateral, severe, brief, stabbing, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve; some patients experience also a degree of dull, burning, or tingling pain between attacks. TN may have a significant impact upon quality of life due to the associated depres sion and anxiety. TN's pain is generally managed with medical therapy alone, carbamazepine being the first-line medica tion. Pfeiffer syndrome is a rare inherited disorder associated with primary craniosynostosis, midface hypoplasia and other anatomical abnormalities. Acupuncture is a valid therapeutic option for painful conditions, including neuralgias. Hereby, we describe remission from trigeminal neuralgiarelated pain in a 37years old man with Pfeiffer Syndrome, after acupuncture.
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