Background: We set out to examine incidence of chronic headache and back pain in women with PDPH after accidental dural puncture during labor.Methods: Chronic headache, backache, and disability were assessed 18-24 months postpartum. Women with PDPH treated with epidural blood patch (PDPH-EBP) were identified and matched with women who had a PDPH without epidural blood patch (PDPH-no EBP), with women with uncomplicated epidural analgesia and with women without epidural analgesia. Our primary outcome was incidence of chronic headache and backache. Secondary outcome was the effect of epidural blood patch on chronic pain development. We used Chi-square or Fisher's exact test to calculate odds ratios.Results: There was no statistically significant difference in demographic characteristics between groups. In the no epidural group, no women reported chronic headache and 2/116 (1.7%) reported chronic backache. In the uncomplicated epidural group, no women reported chronic headache and 7/116 (6.0%) reported chronic backache.In the PDPH-no EBP group, 9/56 (16.1%) women reported chronic headache and 10/56 (17.9%) reported chronic backache. In the PDPH-EBP group, 12/59 (20.3%) had chronic headache and 14/59 (23.7%) had chronic backache. No women in the no epidural or uncomplicated epidural group reported disability (chronic pain score of 3 or 4). High disability was reported by 8.9% of women in the PDPH-no EBP group and by 8.4% in the PDPH-EBP group. Conclusion:Women with PDPH had a high incidence of chronic headache, back pain, and disability. We did not find a statistically significant difference in chronic pain development between conservatively treated and EBP-treated patients. Editorial CommentThere is limited evidence concerning long-term effects of post-dural puncture headaches in the obstetric patient. In this prospective, observational case-control study, PDPH was associated with chronic backache and headache disability, but not to choice of headache treatment, conservative versus epidural blood patch. Parturients suffering from PDPH may need long-term follow up.How to cite this article: Binyamin Y, Heesen P, Orbach-Zinger S, et al. Chronic pain in parturients with an accidental dural puncture: A case-controlled prospective observational study.
Detailed study of the synthesis parameters of silver doped with the organic dye Congo-red (CR@Ag) have led to an understanding of the origins of the superior performance of this novel-type methanoloxidation catalyst (compared to pure silver) as demonstrated by the significant lowering of the temperature needed to reach maximal conversion by more than 100 1C. The origins of the effect of the organic dopant on the catalytic properties of silver are suggested and discussed in terms of its effects on morphology, on oxygen chemisorption properties, on the surface area, on the thermal behavior and on the sinterability of the silver aggregated crystallites. For instance, the organic dopant affects the surface area dramatically, increasing it from 600-3000 cm 2 g À1 for undoped silver to 46 000 cm 2 g À1 for CR@Ag; and oxygen chemisorption, crucial for this catalytic process, increases from 32 cm 2 g À1 for Ag to 893 cm 2 g À1 for CR@Ag. Preliminary work with CR@copper provides a positive outlook for the general use of organic dopants to improve catalytic properties of other metals.
IntroductionA gastrosplenic fistula (GSF) is a very rare complication that arises mainly from a splenic or gastric large cell lymphoma. The proximity of the gastric fundus to the enlarged fragile spleen may facilitate the fistulisation. This complication can lead to massive bleeding, which, though uncommon, may be lethal. We present a patient with massive upper gastrointestinal bleeding secondary to a GSF.Case presentationWe present a 48-year-old man with a refractory diffuse large B-cell lymphoma who was admitted to our hospital due to hematemesis. On arrival, he was in hemorrhagic shock, and was taken directly to the intensive care unit. The source of bleeding could not be identified on gastroscopy, the patient remained hemodynamically unstable and a laparotomy was performed.A fistula between a branch of the splenic artery and the stomach was identified. The stomach appeared to be involved in the malignant process. After subtotal gastrectomy and splenectomy, the bleeding was controlled. After stabilization, the patient was admitted to the intensive care unit, and 24 hours later was discharged in stable condition.DiscussionWe describe a fistula between a branch of the splenic artery and the stomach, which was accompanied by massive bleeding. An emergency laparotomy saved the patient's life.ConclusionThe purpose of this report is to alert physicians that surgical intervention can be lifesaving in this rare malignant condition. A literature review focusing on the presenting symptoms and the epidemiology of GSF is presented.
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