Horner's syndrome (HS) is based on dysfunction of symphathetic nervous system at the cervical canal. The signs of the syndrome occur on the same side as the lesion of the sympathetic trunk and include: a constricted pupil, a weak-droopy eyelid, apparent decreased sweating, and with or without inset eyeball. HS has been observed as a rare complication of epidural anaesthesia in obstetrics during labour or cesarean section. In parturients, it warrants further investigation as other serious causes must be excluded, such as pancoast tumours, thoracic aortic aneurysms, carotid dissection, neuroblastoma, and brainstem vascular malformation. Management involves early diagnosis of the underlying benign condition while treatment is based on appropriate conservative observation, as most often the syndrome resolves spontaneously. However in very rare cases immediate medical or surgical management is needed.
Purpose: The Patient Neurotoxicity Questionnaire (PNQ) represents a diagnostic tool concerning patients with chemotherapy-induced peripheral neuropathy (CIPN). The application of such a tool in the Greek clinical praxis requires validation. Methods: Validation consists of three stages - translation, reverse translation, and patient application. Hundred oncologic patients were assessed by comparing the PNQ to the National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE) at the chemotherapy onset and second, fourth, and sixth sessions. The diagnostic tool's specific requirements (compliance, validity, concordance, sensitivity, specificity, reliability) were statistically evaluated. Results: Differences between translated texts and between the reverse translation and the original were considered negligible. At the second, fourth, and sixth session compliance was 98%, 95%, and 93% while Cronbach’s α was 0,57 0,69, and 0,81, respectively. Cohen’s weighted κ was 0,67 and 0,58, Spearman’s ρ was 0,7 and 0,98, while the area under the curve (AUC) of the receiver operating characteristic (ROC) was 1 and 0,9 for the sensory and the motor part, respectively. The variance’s linear regression analysis confirmed CIPN worsening over time (P<0.0001). Discussion: The Greek version remains close to the original English version. Compliance rates reflect easy PNQ applications. Cohen’s κ values highlight the physicians’ tension to underestimate the patients’ condition. Spearman’s ρ, Cronbach’s α, and AUC values reflect good validity, reliability, and specificity of the PNQ respectively. Finally, the linear analysis confirmed the PNQ sensitivity over time. Conclusions: The PNQ validation in Greek adds a crucial tool to the physicians' armamentarium. It can now delineate the necessary information to modify the chemotherapy and analgesic treatment regimens at both preventive and acute levels.
Introduction: Cancer patients are usually subjected to numerous surgeries during their course of treatment. Recent studies suggest that anesthetic drugs such as propofol, benzodiazepines, and opioids are linked to cognitive impairment. Aim: The aim of the study was to show and compare the cognitive function of oncology patients who have undergone surgery and have been sedated with propofol, fentanyl and benzodiazepines. Materials and methods: In order to determine whether the cognition of oncological patients is being impaired, a mini-mental state examination (MMSE) test was obtained 6 to 24 hours pre- and postoperatively for the duration of one month from 8 eligible oncological patients and 7 non-oncological ones. Afterwards, the data were statistically processed with SPSS version 25.0 (Chicago, Ill. the USA). Results: The analysis shows that there is statistically significant difference in the preoperative MMSE scores between oncological and non-oncological patients. Conclusions: Oncological patients compound a sensitive group for cognitive dysfunction, and indeed, MMSE test could be useful for cognitive evaluation. The present sample, however, is small, and the results could not be generalized. Therefore a more extensive study is needed.
The purpose of this study is to report a case in which standard medication protocols for postherpetic neuralgia (PHN) led to adverse effects and insufficient results. The dead end that occurred in association with the patient's deteriorating general condition and hesitation to comply with oral medication due to fear led to the application of transdermal buprenorphine (TDB) after written informed consent was obtained. TDB application in acute cases is still under study, and the literature is limited.A 78-year-old female presenting with intense PHN was treated with pregabalin and paracetamol but complained of inadequate pain control and intense somnolence. TDB 35 μg/hour was applied after written consent was given. Six hours later, the situation improved, while five days later, the patient recovered completely. The patch was removed on the sixth day after application. In the follow-up after two weeks, no neuropathic symptoms or adverse effects were reported.The optimal results of TDB application were substantially represented by excellent and continuous pain control, improved quality of life, and patient compliance due to the pharmacological properties of buprenorphine and easy patch application. The patient's rapid response to TDB's soothing action is an encouraging factor for its application in studies regarding PHN and acute pain attacks in general.
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