Pain caused by brachial plexopathy (BP) represents a challenging clinical problem with few effective therapeutic options. Here, we present a patient with severe, painful BP after a high-impact motor vehicle accident who failed conservative treatments. A trial of cervical spinal cord stimulation was completed using multiple waveforms (tonic, BurstDR, and 10 kHz) over 14 days with only 30% to 40% pain reduction. Subsequently, he underwent dorsal root entry zone lesioning with a significant decrease in his pain 1 year later. Surgical exploration revealed extensive damage and avulsion of his cervical roots that was not observed on a previous brachial plexus magnetic resonance imaging. We discuss the etiology and diagnosis of traumatic BP, possible reasons for the failed spinal cord stimulation trial, and implications for management.
Background: Oesophagoscopy with biopsy is considered the gold standard for diagnosing and monitoring eosinophilic oesophagitis (EoE). Therefore is important to discover less-invasive diagnostic methods. Methods: Cytology specimens were obtained in patients with active EoE (AEoE) (!15 eos/hpf) and EoE in remission (EoER) (<15 eos/hpf). The samples were assessed by two independent pathologists and were compared with biopsy samples. EoE cytology specimens were compared with specimens obtained from patients with GERD. Results: Specimens of 36 patients (69.4% male, mean age 30.88 years) were included. AEoE (17, 47.2%), EoER (11, 30.5%) and GERD (22.2%). eos/hpf in cytology (AEoE 9.23 vs. EoER 1.54 vs. GERD 2, p ¼ 0.01). Linear correlation between eos/hpf average biopsy and cytology eos/hpf: r ¼ 0.57, p < 0.001. For diagnosis of EoE !3 eos/hpf in cytology obtained a sensitivity of 70%, specificity 81%, PPV 86% and NPV 60% (AUC ¼ 0.81, p ¼ 0.01). For detection of AEoE, !3 eos/hpf in LBC obtained a sensitivity of 70%, specificity 82%, PPV 81% and NPV 66% (AUC ¼ 0.87, p ¼ 0.001). Conclusions: LBC in oesophageal aspirate seems to be effective for the diagnosis and monitoring activity in EoE. These results support the usefulness of non-invasive methods for the diagnosis and monitoring of EoE.
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