Analgesic radiation therapy for bone metastasis in Dakar

Background: Three-dimensional conformal radiotherapy is a new tool in the Senegalese therapeutic arsenal. Symptomatic bone metastases affect the quality of life of patients. Analgesic radiotherapy is proposed to patients to relieve them. Patients and methods: A prospective descriptive study was carried out on all patients with symptomatic bone metastasis. Hypo-fractionated radiotherapy was performed on the painful site. The visual analogue scale was used to assess pain before radiotherapy, 72 hours and one week after. Results: The sex ratio was 0.5. The median age at diagnosis of symptomatic metastasis was 53 years. All patients received 8 Gy (Gray) in one session. A complete response was noted one week post radiotherapy. Conclusion: Analgesic radiotherapy improves the quality of life of patients with symptomatic bone metastasis.

Result of electrophysiological study in patients with undocumented suspected paroxysmal supraventricular tachycardia: the BELIEVE-SVT registry

Funding Acknowledgements Type of funding sources: None. Introduction Paroxysmal supraventricular tachycardias (PSVT) are common arrhythmias and catheter ablation is considered its first-line treatment. However, the duration of the episodes frequently precludes ECG documentation. Thus, patients may not be referred for ablation until the tachycardia is documented, leading to recurrences, emergency room visits and often unnecessary tests or treatments. Our objective was to evaluate the results of electrophysiological study (EPS) followed or not by ablation in patients with suspected but not documented PSVT. Methods Multicenter, retrospective, observational registry of consecutive patients undergoing EPS due to clinical suspicion of PSVT, but with no prior ECG documentation. Collection of clinical and EPS data, along with data regarding ablation, when performed. Results 427 patients of 12 centers were included. Mean age was 46.3 ±16.1 and 297 (69.6%) were females. Most frequent symptoms consisted on sudden onset (n = 360; 84.9%) and abrupt end (n = 304; 72.0%), with median episode duration of 10 minutes (interquartile range 5-20 min). Sustained arrhythmias were induced in most patients (n = 255; 59.7%). Specific types are summarized in Table 1. Ablation was performed in 274 (64.2%) patients. A total of 10 complications (2.3% of procedures) were reported: 3 transient AV block, 2 PR interval prolongation, 2 puncture-related hematoma, 2 painful site of puncture and 1 catheter entrapment in mitral chordae. Conclusions Electrophysiological study in patients with palpitations highly suggestive of PSVT is an effective and safe diagnostic and therapeutic tool that may be considered as a first-choice even in the absence of documented tachycardia. Results of EP study Results of electrophysiological study Typical AVNRT 183 (42.9%) Orthodromic AVRT 38 (8.9%) Dual AV nodal physiology 30 (7.0%) 1 nodal echo beat 21 (4.9%) Atrial tachycardia 19 (4.5%) >1 nodal echo beat 17 (4.0%) Atrial fibrillation 7 (1.6%) Atypical AVNRT 7 (1.6%) Atrial flutter 1 (0.2%) No abnormal findings 104 (24.4%) AVNRT atrioventricular nodal reentran tachycardia AVRT atrioventricular reentrant tachycardia

Distribution of Number, Location of Pain and Comorbidities, and Determinants of Work Limitations among Firefighters

Introduction. The unique demands of firefighting results in acute, recurrent, or chronic pain complications. We aimed to describe the percentage distribution of number and location of painful sites among FFs and determine whether work limitations differed based on the number or location of painful sites, age, and/or sex. Methods. About 325 firefighters completed a work limitation questionnaire (WLQ-26) and a checklist to indicate painful regions of the body using either a paper format or an online survey. A one-way ANOVA was employed to analyze the transformed work limitation scores; this was a two-sided test with a significance level of <0.05, to determine if work limitations differed among firefighters based on the number or location of painful sites, age, and/or sex. Results. The data analyzed consisted of 325 ( men = 216 , women = 109 ) FFs in total. The percentage distribution of the number of painful sites in our study cohort was 43% no pain, 17% one painful site, 19% two painful sites, and 21% three or more painful sites. The percentage distribution of the locations of painful sites was 43% no pain, 41% spine, 9% lower extremity, and 7% upper extremity. An estimated 31% of FFs ( n = 102 ) reported non-MSK comorbidities with 23% ( n = 76 ) reporting at least one non-MSK comorbidity and 8% ( n = 26 ) reported having two or more comorbidities. FFs > 45 years of age experienced more physical work limitations than FFs ≤ 45 years (mean difference: 0.74/10; 95% CI .19-1.29; p = 0.008 ). Conclusions. The majority of firefighters reported having at least one painful site and indicated the spine as the most common painful location. Age, the number of painful sites, and location of pain were identified as a potential contributor to physical/mental and work output limitations.

Changes in Regional Oxygenation At the Site of Sickle Cell Vaso-Occlusive Pain

Abstract 4773 Background: The pathophysiology of sickle cell disease (SCD) is commonly thought to be in part a result of sickled red blood cells obstructing blood flow leading to hypoxic cellular injury. The most common SCD complication is painful vaso-occlusive crisis (VOC). However, the physiologic changes that occur at the site of VOC are poorly understood and there are no objective measurements of VOC. We hypothesized that regional oxygenation at the site of pain would be decreased from the patient's asymptomatic baseline and could be used as an objective measurement of the VOC process. Methods: Subjects were enrolled at the time of hospitalization for unilateral painful VOC. The subjects completed the adolescent pediatric pain tool (APPT) to assess the location, severity and quality of their pain. Regional oxygenation (RSO2) was measured by near infrared spectroscopy (NIRS) at the site that the subject identified as where they experienced the most severe VOC related pain. NIRS measurements were also made on the contralateral body site. NIRS measurements were made for 15 minutes with the subject in the supine position. Measurements were made in the first 24 hours of hospitalization. Blood pressure, heart rate, pulse oximetry, hematologic parameters and use of oxygen were determined. The subject returned 4 weeks after discharge for repeat testing to determine their physiologic post VOC RSO2 baseline. Mean values for the NIRS testing period were determined and the change in RSO2 during VOC from post VOC baseline were calculated. Results: 5 female subjects with SCD were studied, mean age 15.8±3.0years. There was an average pain score of 7.4/10+1.9. Pain occurred in the back of 2 subjects and the lower extremities in the others. The RSO2% in the painful and not painful sites was increased from baseline by an average of 10.6±4.0% and 16.6±5.6%, respectively. The painful site had a decreased RSO2% in comparison to the contralateral side in 2 of 5 subjects (see figure). The RSO2% VOC baseline at the painful site post was higher in 3 of 5 subjects. There was no difference from baseline in blood pressure, heart rate, or arterial oxygen saturations during VOC. There were changes in the hematologic parameters consistent with VOC and active hemolysis. Conclusions: The SCD subjects demonstrated increased regional oxygenation at both the painful and contralateral not painful sites during VOC compared to the post VOC baseline. During VOC there was no predictable difference in regional oxygenation at the site of VOC pain contrary to our original hypothesis. Disclosures: Wood: Ferrokin Biosciences: Consultancy; Shire: Consultancy; Apotex: Consultancy, Honoraria; Novartis: Honoraria, Research Funding. Coates:Novartis: Speakers Bureau; Apopharma: Consultancy.

Inter-Rater Reliability of the Adolescent Pediatric Pain Tool (APPT) for Pediatric Sickle Cell Disease (SCD) Patients.

Abstract 4618 Aim The Adolescent Pediatric Pain Tool (APPT) explores the patient's self-report of pain, and has been studied and validated as a pain assessment tool in pediatric patients as young as 8 years of age. This tool consists of three components: a pictorial body outline (pain location), a Word Graphic pain Rating Scale (WGRS; pain intensity), and a qualitative descriptive word list (pain quality and pain pattern). Although straightforward for the patient to complete, the interpretation of the APPT by the medical professional is subject to individual reader bias. This bias is particularly crucial when the APPT is used as a research tool in studies of SCD pain, where data must be transcribed into a form suitable for analysis across patients. The purpose of this study was to determine accuracy of APPT pain analysis and ensure meaningful data collection in a research setting. Methods APPTs submitted by 102 adolescent and young adult (mean age 14.2 years, range 8 to 27; 48 female, 54 male) SCD patients (75 SS, 24 SC, 3 S-beta thal) were independently analyzed and entered into Excel spreadsheets by two trained raters. For the analysis, the anterior and posterior body outlines were divided into a total of 43 body ‘segments’. Each mark drawn on the body outline was considered a painful ‘site’. Each rater recorded: 1) the number of painful sites; 2) the body segments involved in each painful site; 3) a numeric scale (ranging from 0.0 to 10.0) estimate of the WGRS; and 4, the word descriptors selected by the patient. The % disagreement between raters was calculated for each of 3 APPT components: location, intensity, and quality. Results Of the 102 APPTS submitted, 96 were found by the raters to be sufficiently complete for analysis. Regarding pain location - Over the span of 43 potentially involved body segments, the two raters disagreed in only 1.01% of instances. These disagreements appeared to arise primarily from ambiguity in interpreting the patient's drawing (e.g., circle not closed, or line circles area twice). Regarding pain intensity – For 83% of patients, the measurement of pain intensity differed by +/- 0.2 or less. Intensity errors arose primarily from irregularities in marking of the pain scale by the patient (62.5% of patients did not follow instructions in marking the scale, i.e., making a circle or an “X” instead of a vertical line), as well as differences in the interpretation of the mark by the raters (15.6% disagreement between raters on whether or not the scale was marked per instructions). Regarding pain quality and pattern – disagreement between raters in word selections occurred in 16.7% of APPTs. Of these, the two readers differed by 1 word, 2 words or 3 words in 53.8%, 23.1%, and 23.1% of instances, respectively. Quality discrepancies frequently arose from ambiguities in patient word recording (such as incompletely circling words, or placing a mark next to the word instead of circling), and rater interpretation of that recording (such as what markings to consider as purposeful selection of a word), but may potentially arise from data transcription errors. Conclusion In adaptation of the APPT as a research tool, multiple sources of error need to be addressed and minimized. These include ambiguities introduced by the patient (which may be improved by careful instruction or practiced use of the tool by the patient), the algorithms used by raters to interpret results (which may need detailed instructions for dealing with ambiguous results), and data transcription errors (which may be identified and corrected by double data entry). Disclosures: No relevant conflicts of interest to declare.

Reflex sympathetic dystrophy in a dog

Reflex sympathetic dystrophy is a well-recognized syndrome in human patients following injury to an extremity. The syndrome may include hyperesthesia and autonomic changes. The autonomic changes are initial vasodilatation followed by vasoconstriction (e.g., edema followed by cyanosis, and cool skin); hyper- or hypohydrosis; atrophic changes in the skin, subcutis, and muscles; and osteoporosis. Early treatment with a short course of steroids and infiltration of the painful site with lidocaine may alleviate symptoms. If that fails, sympathetic ganglionic block with lidocaine (and possibly steroids) or surgical sympathectomy may provide resolution. A case of reflex sympathetic dystrophy in a dog is presented, involving bilateral distal hind-limb edema and hyperesthesia.

Phase III placebo-controlled trial of capsaicin cream in the management of surgical neuropathic pain in cancer patients.

PURPOSE A minority of cancer survivors develops long-term postsurgical neuropathic pain. Based on evidence that capsaicin, the pungent ingredient in hot chili peppers, might be useful for treating neuropathic pain, we developed the present clinical trial. PATIENTS AND METHODS Ninety-nine assessable patients with postsurgical neuropathic pain were entered onto this study. After stratification, patients were to receive 8 weeks of a 0.075% capsaicin cream followed by 8 weeks of an identical-appearing placebo cream, or vice versa. A capsaicin/placebo cream was to be applied to the painful site four times daily. Treatment evaluation was performed by patient-completed weekly questionnaires. RESULTS During the first 8-week study period, the capsaicin-cream arm was associated with substantially more skin burning, skin redness, and coughing (P < .0001 for each). Nonetheless, treatment was stopped for patient refusal or toxicity just as often while patients were receiving the placebo as compared with the capsaicin. The capsaicin cream arm had substantially more pain relief (P = .01) after the first 8 weeks, with an average pain reduction of 53% versus 17%. On completion of the 16-week study period, patients were asked which treatment period was most beneficial. Of the responding patients, 60% chose the capsaicin arm, 18% chose the placebo arm, and 22% chose neither (P = .001). CONCLUSION A topical capsaicin cream decreases postsurgical neuropathic pain and, despite some toxicities, is preferred by patients over a placebo by a three-to-one margin among those expressing a preference.

Fish Bone Piercing Epiglottis: A Case Report

Pharyngoesophageal fish bone is a commonly encountered ORL emergency. Usually the patient is able to point the most painful site to suggest location of the foreign body, immediately after ingestion. We report a patient with chronic, severe odynophagia which later on was found to have a fish bone piercing through epiglottis. The symptoms were present for more than 10 months before definite diagnosis was made and removal was done. Keywords: Foreign body; Fish bone; Epiglottis. DOI: 10.3329/bjms.v9i1.5232 Bangladesh Journal of Medical Science Vol.09 No.1 Jan 2010 53-55