Background: Coccydynia is also known as coccygodynia or coccygeal neuralgia. Coccyx is a triangular bone located within the vertebral column. The cause of coccydynia is unknown in the literature; however, it is found to be common among obese individuals, particularly females. The probability of women having coccydynia is five times higher than among men, which may result from larger pressure during pregnancy and child delivery. It is treated well with ganglion impar block. The aim of our study was to assess pain relief after Ganglion Impair Block with subsequent improvement in quality of life. Methods: A single-arm study was done in the department of Pain Medicine, Fauji Foundation Hospital, Rawalpindi from July 2021 to June 2022. A total of 50 patients with ≥3 months coccygeal pain of either gender aged between 20–60 years unresponsive to analgesics & anti-inflammatory medications with no laboratory abnormalities were included. Fluoroscopic guided trans-sacro‑coccygeal ganglion impair block was done with alcohol neurolysis. The patients were observed for 1 hour in the recovery room to record post-intervention complications that may occur like hypotension, bradycardia, signs, and symptoms of cardiotoxicity or neurotoxicity etc. and evaluated for pain scores on the basis of the numeric rating scale (NRS). Data collected was analyzed using the statistical package for social scientists (SPSS) version 21. The quantitative data, i.e., age and NRS score were analyzed using mean and standard deviation and compared between pre and post-intervention periods. Results: The data from 50 patients who completed the follow-up period were used for analysis. The average age of the patients was 42.9±8.39 years, with a range of 38–60 years. Based on the data obtained, 30% of the patients experienced trauma (that is falling on the coccyx region). The mean score from NRS before intervention was 7.80±0.16 which decreased to 0.96±0.35, respectively, and this difference was statistically significant (p-value, <0.001). Conclusions: Ganglion Impar neurolysis is highly effective in the treatment of Chronic coccydynia.
SummarySilicon granuloma is one of the benign complications of breast implant failure but this is rarely reported. We report a 66-year-old lady presented to respiratory department with history of weight loss and a chest x-ray was highly suggestive of a lung malignancy. Further investigation including CT thorax and breast ultrasound suggested siliconoma that was later on confirmed on tissue biopsy. BACKGROUND
Introduction Intraoperative neurophysiological monitoring (IONM) helps in better patient outcomes by minimizing risks related to the functional status of the nervous system during surgical procedures. An IONM alert to the surgical team during the surgery can help them identify the cause and take immediate corrective action. IONM confers possible benefits, including improved surgical morbidity and mortality, better patient care, minimal neurological deficits, reduced hospital stay, medical costs, and litigation risk. In addition, a highly skilled IONM team will make a better patient outcome. Methods We retrospectively reviewed 62 consecutive patients who underwent intracranial and spinal neurosurgical procedures. Multimodality IONM was utilized, including somatosensory evoked potentials, transcranial electrical motor evoked potential, spontaneous and triggered electromyography, electroencephalography, electrocorticography, cortical sensory mapping, and direct electrical cortical stimulation. Of a total of 62 patients, two patients revealed neurotonic EMG discharges during IONM, and most patients woke up without any new neurological deficit. Results Sixty-two patients were included, ranging from age 5 to 77 years (mean 43.5 years), with 54.8% men and 45.2% female. Multimodality IONM was used in all patients. Two EMG alerts were recorded during IONM, during a brain tumor resection, and right acetabular hip surgery with postoperative right foot drop. Conclusion Multimodality IONM is the gold standard of care for any surgical services and is used as real-time monitoring of functional integrity of neural structures at risk. If utilized by trained and expert teams, numerous surgeries may benefit from multimodality intraoperative neurophysiologic monitoring.
Aim: To analyze the post mastoidectomy complications in patients presenting at tertiary care hospital. Methods: This case series study was conducted at Department of ENT, DG Khan Hospital, DG Khan from March 2020 to September 2020 over the period of 6 months. Total 65 patients came for open cavity mastoidectomy either male or female having age between 20-60 years were selected for this study. Results: In present study 65 patients had undergone open cavity mastoidectomy. Mean age of the patients was 39.95 ± 12.57 years. Out of 65 patients, cavity complications was found in 20 (31%) patients. Among the 20 patients who had cavity problems, the most common problem was prolonged discharge found in 19 (95%) patients followed by accumulation of wax in the cavity was found in 5 (25%) patients, Vertigo persisting beyond the immediate postoperative period was found in 3 (15%) patients, perichondritis of pinna was seen in 1 (5%) patients, development of facial palsy was found in 5 (50%) patients, recurrent cholesteatoma was found in 3 (15%) patients and wound infection was found in 2 (10%) patients. Conclusion: Results of present study showed higher rate of post operative complications after mastoidectomy. Sclerotic mastoid was most common. Higher rate of complications was seen after 40th decade of life. Most of the patients were male as compared to female. Prolonged discharge was the most common problem. Keywords: Mastoidectomy, Cavity, Meatoplasty, Pneumatisation, Cholesteatoma
SummaryWe present the case of a 28-year-old gentleman who presented with weakness and wasting in the right arm. He complained about painful cramps in his left leg but there were no sensory, visual or swallowing problems. Neurological examination was significant for asymmetric weakness of both upper and lower limbs and deep tendon reflexes were asymmetrically brisk. Initial laboratory investigations, MRI brain and MRI spine were normal. Electromyography revealed active denervation and chronic neurogenic motor unit action potential. Myokymic discharges were noted in the left deltoid muscle. BACKGROUND
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