- Contrast Media Extravasation in CT and MRI - A Literature Review and Strategies for Therapy. [Journal Article]
- ROFORofo 2018 Jun 18
- CONCLUSIONS: After detailed literature review, we suggest early (plastic) surgical consultation when non-ionic, low-osmolar contrast medium extravasation is about 150 cc or more. In case of extravasation less than 150 cc but in presence of additional symptoms such as impaired perfusion or altered sensibility, the (plastic) surgeon should also be consulted instantly. We do not recommend any invasive first line therapy when contrast media extravasation is less than 150 cc and the patient presents no additional symptoms, besides swelling and local pain. Nevertheless continuous monitoring and accurate conservative management such as active cooling and elevation, splinting of the affected extremity are mandatory as early detection of critical symptoms helps to initiate prompt surgical intervention and avoid sequelae. · Morbidity after contrast media extravasation is extremely rare.. · Predicting sequelae after contrast extravasation is difficult at first sight.. · Treatments such as hyaluronidase injection, suction/aspiration, squeeze technique have been described.. · Surgical consultation is recommended for extravasation > 150 cc or when additional symptoms occur..
- Wrist malpractice claims in Northern Norway 2005-2014. Lessons to be learned. [Journal Article]
- IJInt J Circumpolar Health 2018; 77(1):1483690
- Rough weather conditions in the subarctic areas of Norway may influence on the risk of wrist fracture. We implemented data from the Norwegian System of Patient Injury Compensation (NPE). All claims d...
Rough weather conditions in the subarctic areas of Norway may influence on the risk of wrist fracture. We implemented data from the Norwegian System of Patient Injury Compensation (NPE). All claims due to wrist surgery, performed at the public hospitals in Northern Norway, during 2005-2014 were analyzed. We employed the ICD-10 classification codes S52.5 (fracture of distal end of radius) and S52.6 (fracture of distal end of radius and ulna). Treatment was defined by NCSP codes. 84 patients (0.3%) complained. Females complained four times more often than males did (P = 0.005) and received five times more frequently a compensation (P < 0.001). NPE accepted 34 claims (40%) for injury compensation (0.1% of patients). The percentage of claims accepted for compensation decreased from 48% to 30% during study period, probably due to delay in filling claims. The main causes of complains were pain, reduced range of motion, malfunction and weakness (35/84). The main causes of compensation were "operative treatment should have been performed" (14/34) and "wrong operative method applied" (13/34). The mean amount per compensation was €14,927 (€0-€52,995). Stonger focus on quality of care, updated guidelines and shared decission-making may reduce the number og complains and compensations.
- A Novel Algorithmic Approach to Chronic Forearm Longitudinal Instability. [Journal Article]
- THTech Hand Up Extrem Surg 2018 Jun 14
- Essex-Lopresti Lesions are rare injuries that are often missed in the acute setting. Delayed intervention may lead to chronic wrist and elbow pain and overall poor outcomes. The literature currently ...
Essex-Lopresti Lesions are rare injuries that are often missed in the acute setting. Delayed intervention may lead to chronic wrist and elbow pain and overall poor outcomes. The literature currently supports treatments that involve shortening of the ulna to reduce the relative degree of ulnar impaction, followed by attempted reduction of the distal radioulnar joint. Although such techniques may help to temporarily reduce wrist pain secondary to ulnar impaction, they do not address the proximal migration of the radius and ipsilateral radial head dislocation at the elbow. Subsequent procedures are often needed to replace or resect the radial head. We present a novel approach to chronic Essex-Lopresti lesions resulting in anatomic restoration of forearm length with return of elbow and wrist flexion/extension as well as improved forearm pronation/supination.
- Mid-Air Tactile Stimulation for Pain Distraction. [Journal Article]
- ITIEEE Trans Haptics 2018 Apr-Jun; 11(2):185-191
- Using the human sense of touch, pain control has been studied for decades. With the rise of Virtual Reality (VR) and haptic technologies, creating VR and haptic sensations provide a unique opportunit...
Using the human sense of touch, pain control has been studied for decades. With the rise of Virtual Reality (VR) and haptic technologies, creating VR and haptic sensations provide a unique opportunity for pain distraction. In this paper, we present an experimental study to test whether VR and mid-air ultrasound tactile stimulation reduce perceived pain simulated via the cold pressor test, i.e., submerging a human hand in cold water (2 C) for as long as the test subject can. Fifty right-handed subjects participated in the study and three tasks were considered: task 1 involved experiencing the cold pressor test with no distraction (considered as the control task), task 2 involved playing a simple VR game with no tactile feedback, and task 3 utilized the same VR game with tactile feedback; tasks 2 and 3 were assigned in random order after task 1. The tolerance time, perceived pain rating, and quality of experience were evaluated and compared for the three tasks. Results demonstrated that when a VR task involves physical (touch) interaction, tactile stimulation plays a significant role in increasing pain tolerance time. Furthermore, the study demonstrated that for high pain tolerance participants, tactile stimulation is more effective for pain distraction compared to low pain tolerance participants. Although there are no significant differences in perceived pain and quality of experience between VR and VR+Tactile tasks, there are significant differences in tolerance time (Wilcox signed rank test, p 0.05). It is presumed that VR and the tactile stimulation induces positive emotions when utilized (for both valence and arousal).
- Coping with painful sex: Development and initial validation of the CHAMP Sexual Pain Coping Scale. [Journal Article]
- SJScand J Pain 2017 Dec 29; 9(1):74-80
- Background and purpose Recurrent vulvar pain is a common and debilitating condition which has received remarkably little attention in pain research. For instance, little is known about how these wome...
Background and purpose Recurrent vulvar pain is a common and debilitating condition which has received remarkably little attention in pain research. For instance, little is known about how these women cope with sexual activities, and there are no structured assessment tools. The purpose of this study was to explore coping strategies in this group, with a view to develop a measure to assess how women with vulvar pain cope with sexual activities. Methods The current study is based on a subsample from a longitudinal study about vulvar pain in a student sample consisting of women between 18 and 35 years old (N = 964). Only data from the ones reporting recurrent vulvar pain during the last six months (N = 289) were used in the analyses. First, the CHAMP Sexual Pain Coping Scale (CSPCS) was created, with the aim of assessing how women with vulvar pain cope with sexual activities. The scale was inspired by previous research on women with vulvar pain as well as well-known coping strategies in other pain populations. Second, the psychometric properties of the scale were explored by analyzing the factor structure and internal reliability. Third, validity features were examined in terms of criterion validity and construct validity. Results The analyses supported a three-factor solution, embracing the strategies endurance, avoidance and alternative coping. The internal reliability of the subscales turned out to be good, and the criterion validity was supported for all three subscales. The construct validity was clearly supported for the endurance and the avoidance subscales, but not for the alternative coping subscale. Conclusions The findings support the CSPCS as an instrument for assessing how women with vulvar pain cope with sexual activities. The strategies endurance, avoidance and alternative coping correspond with findings from earlier research. Endurance reflects a tendency to engage in and continue with sexual activities despite pain, while attempting to minimize or suppress thoughts of pain. Avoidance, on the other hand, involves efforts to stay away from sexual activities, in particular vaginal penetration, because of fear of pain. Alternative coping refers to endeavours to find alternative sexual activities that do not necessarily involve vaginal penetration. Even though this first study indicates that the CSPCS may be psychometrically sound, more studies are needed to confirm the psychometric properties and clinical application of this instrument. In particular, the construct validity of the alternative coping subscale needs to be further evaluated. Implications A valid instrument for assessing strategies for coping with sexual activities in this population has important clinical implications, since it provides a method that may enhance assessment procedures, be used in research, and stimulate the development of treatment.
- Effects of habituation to the testing facility on mechanical nociceptive thresholds of pigs. [Journal Article]
- SJScand J Pain 2017 Dec 29; 8(1):49
- Aims This study aimed to gain methodological knowledge about quantification of mechanical nociceptive thresholds in pigs stimulated on the hind legs. Methods Thirty-two castrated male pigs were used,...
Aims This study aimed to gain methodological knowledge about quantification of mechanical nociceptive thresholds in pigs stimulated on the hind legs. Methods Thirty-two castrated male pigs were used, weighing 50-60kg, 16 weeks of age and housed in standard pens (4.40m×4.40m) with ad libitum access to water and feed. Mechanical nociceptive testing (4 stimulations/pig) was done by an electronic von Frey anesthesiometer (IITC Life Science Inc., CA) with a rigid, hollow plastic tip (cut-off: 1000 gf) and an area of 0.3 mm2. Stimulations targeted caudal aspects of the metatarsus while the pigs were restrained in a cage measuring 35cm×40cm (length×width). During the last 3d before nociceptive testing, half of the pigs were habituated to the experimental set-up twice daily. Results Across the three days, the habituation procedure led to a reduction in time required to approach and release the pigs from the home pen (P<0.05) and to increased acceptance of the confinement (P<0.01). The habituated animals had a lower mechanical nociceptive threshold (median: 495gf (302-675) vs 745gf (479-1000); P<0.05), and a decreased occurrence of censored observations (0 vs 25%; P<0.05) compared to animals tested without habituation. Conclusions The present experiment focussed on methodological aspects of hand-held tests of mechanical nociceptive thresholds in pigs. The results show that the pigs responded to a 3-day habituation regime by increased ease of handling and tolerance of being confined in a test cage. In addition, habituation to the test environment and handling led to reduced mechanical nociceptive thresholds as well as a lowered proportion of censored observations. The current results reiterate the value of habituation in research involving animal behaviour. Further characterization of the methodology is needed to allow its application in the evaluation of clinical conditions in pigs.
- The Ottawa Panel guidelines on programmes involving therapeutic exercise for the management of hand osteoarthritis. [Journal Article]
- CRClin Rehabil 2018 Jun 01; :269215518780973
- CONCLUSIONS: Despite that many programmes involving exercise with positive recommendations for clinical outcomes are available to healthcare professionals and hand osteoarthritis patients that aid in the management of hand osteoarthritis, there is a need for further research to isolate the specific effect of exercise components.
- Retrospective study to evaluate the treatment of digital pulp lesions using a homodigital flap. [Journal Article]
- RBRev Bras Ortop 2018 Mar-Apr; 53(2):200-207
- CONCLUSIONS: The homodigital flap technique presented satisfactory esthetics and functional results regarding feasibility, sensation, and digital mobility in pulp lesions.
- Investigating the therapeutic potential of a probiotic in a clinical population with chronic hand dermatitis. [Journal Article]
- CCClin Cosmet Investig Dermatol 2018; 11:265-271
- CONCLUSIONS: It is feasible and safe to administer Bio-K+ for HD. Clinicians saw an improvement in most subjects' hands, and cases of significant improvement in dermatitis were documented. Pruritus was the most rapidly relieved symptom, as reported by patients.
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- Factors Associated With a Discretionary Upper-Extremity Surgery. [Journal Article]
- JHJ Hand Surg Am 2018 Jun 13
- CONCLUSIONS: People with a greater tendency to limit activity owing to pain are more likely to choose discretionary surgery.Interventions that help people remain active despite pain by addressing the psychological and social determinants of health might affect the rate of discretionary surgery.