Secondary spontaneous pneumothorax (SSP), a complication of chronic obstructive pulmonary disease (COPD), recurs more frequently in underweight patients. This case report describes a 63-year-old malnourished man with COPD presenting with recurrent left-sided SSP shortly after hospital discharge for a previous episode. Following chest tube reinsertion and complete lung re-expansion, chemical pleurodesis was performed using 1000 mg doxycycline in saline. Transient pleuritic pain was controlled with intravenous ketorolac and intrapleural lidocaine. No other immediate or delayed adverse events occurred. In parallel, pulmonary rehabilitation, including breathing exercises, posture correction, moderate-intensity endurance and inspiratory muscle training, was initiated alongside nutritional repletion with a respiratory-specific oral nutritional supplement. Over a 22-month follow-up, the patient remained free of SSP recurrence, with improved functional capacity and weight gain. This report describes a long-term recurrence-free outcome after doxycycline pleurodesis combined with pulmonary rehabilitation and nutritional support in an underweight patient with COPD.

This study introduces a novel method for recording afferent renal nerve activity (ARNA) in unanaesthetised rats. A bipolar electrode was surgically implanted on the left renal nerve to record renal nerve activity (RNA), and efferent renal nerve activity (ERNA) was selectively blocked by administering 5% lidocaine via a polyurethane catheter placed over the renal artery-aorta junction. Lidocaine administration reduced RNA by approximately 82% relative to pre-lidocaine values, enabling the isolation of afferent nerve signals. Intrarenal arterial infusion of increasing doses of bradykinin (10, 20, 40, and 80 µg/kg) following lidocaine infusion produced a significant increase in ARNA, confirming preserved afferent function. This demonstrates the feasibility of this approach for investigating reno-renal reflexes and the dynamic interplay between ARNA and ERNA, with implications for understanding homeostatic regulation and the pathophysiology of conditions such as hypertension and kidney disease.

Background and Objectives: High-speed digital imaging (HSDI) is the most advanced method of phonation process analysis. Hoarseness is the most common indication for HSDI, and laryngopharyngeal reflux (LPR) is an etiological cofactor of hoarseness in 50% of cases. Clinical practice in HSDI includes the elective use of topical anesthesia (TA), but without defined recommendations and indications for use, and a potential altering effect of TA on the phonation process has not been unequivocally proven. The aim of this prospective, randomized, double-blind, placebo-controlled study was to examine the effect of TA application on the phonation process by analyzing Voice-Vibratory Assessment with Laryngeal Imaging (VALI) form parameters in subjects with LPR. Materials and Methods: A total of 70 volunteer subjects were included in the study; 50 subjects who completed both recording sessions were included in the final analysis. All subjects were recorded in two modalities, with TA application (lidocaine spray 100 mg/mL) and without it, on two consecutive days. Results: By evaluating phonation process parameters according to the VALI form, we determined that TA application during HSDI in subjects with LPR was not associated with statistically significant changes in the evaluated phonation process parameters. Conclusions: TA application during HSDI in subjects with LPR was not associated with significant changes in the analyzed phonation process parameters. Further research is needed to determine the benefit of TA in reducing pain and discomfort during examination, weighed against the risk of potentially life-threatening side effects, in order to individualize the approach to each patient.

Background and Objectives: Hemodynamic instability during anesthesia induction and endotracheal intubation remains a clinically important concern. Low-dose ketamine and intravenous lidocaine may provide complementary effects that improve cardiovascular stability and peripheral perfusion. This pilot study evaluated effects of adding ketamine and lidocaine to a propofol-based induction regimen using mean arterial pressure (MAP) and perfusion index (PI) as monitoring parameters. Materials and Methods: In this prospective observational pilot study, 30 adult patients undergoing elective surgery requiring general anesthesia and endotracheal intubation were allocated to either a standard induction regimen (Group 1: propofol 2 mg/kg and fentanyl 2 μg/kg) or an adjunctive regimen (Group 2: propofol 2 mg/kg, ketamine 0.4 mg/kg, lidocaine 1 mg/kg, and fentanyl 1 μg/kg). Hemodynamic variables and PI were recorded at baseline, after induction, and after intubation. Postoperative sore throat and cough-reflex responses were also assessed. Results: No significant differences between-groups were observed in heart rate, systolic blood pressure, diastolic blood pressure, MAP, or oxygen saturation at any time point. However, MAP decreased significantly within Group 1 after induction (94.9 ± 10.1 vs. 76.9 ± 13.8 mmHg, p < 0.001) and remained lower after intubation (p = 0.001), whereas no significant MAP changes occurred within Group 2. PI increased in both groups but was significantly higher in Group 2 after induction (5.35 ± 2.34 vs. 3.46 ± 2.90, p = 0.043) and after intubation (7.02 ± 2.89 vs. 4.71 ± 2.22, p = 0.020). Postoperative sore throat scores were lower in Group 2 (0.53 ± 0.91 vs. 1.67 ± 1.76, p = 0.035), and cough-reflex scores were also reduced (p = 0.024). Conclusions: The addition of low-dose ketamine and intravenous lidocaine to propofol-based induction was associated with higher perfusion index values and reduced airway-related adverse effects. No statistically significant between-group difference in mean arterial pressure (MAP) was detected. These findings are hypothesis-generating and warrant confirmation in larger randomized trials.

Background: Application of the capsaicin 8% patch is commonly associated with treatment-related burning pain, which may necessitate rescue analgesia, compromise completion of the standardized 60 min application, and reduce acceptance of repeat treatment. Although capsaicin is an established therapy for painful diabetic peripheral neuropathy (PDPN), evidence supporting strategies to improve procedural tolerability remains limited. This study evaluated whether ultrasound-guided bilateral ankle nerve block (UGBANB) was associated with better procedural outcomes than topical eutectic mixture of lidocaine/prilocaine (EMLA) pretreatment or no pretreatment. Methods: This retrospective comparative cohort study included 90 adults with neurologist-confirmed PDPN who underwent capsaicin 8% patch therapy. Patients received no pretreatment (n = 30), topical EMLA pretreatment (n = 30), or UGBANB (n = 30). The primary outcome was cumulative procedural pain burden, quantified as the area under the Numeric Pain Rating Scale-time curve (AUC-NPRS) during the standardized 60 min application. Secondary outcomes included rescue tramadol requirements, treatment completion, early postprocedural pain intensity, procedural tolerability, willingness to undergo repeat treatment, and safety. Results: Cumulative procedural pain burden differed significantly among the three pretreatment strategies (one-way ANOVA: F = 289.8, p < 0.001; η[2] = 0.87). Mean AUC-NPRS was 481.5 ± 39.2 NPRS·min with no pretreatment, 429.2 ± 36.0 with topical EMLA, and 256.3 ± 38.4 with UGBANB, corresponding to approximately 47% and 40% lower cumulative pain burden with UGBANB than with no pretreatment and topical EMLA, respectively. No patient receiving UGBANB required intravenous rescue tramadol, compared with 60.0% receiving EMLA and 100.0% receiving no pretreatment (p < 0.001). Treatment completion was 100% with UGBANB, compared with 83.3% with EMLA and 73.3% with no pretreatment. UGBANB was also associated with lower early postprocedural pain, greater procedural tolerability, and greater willingness to undergo repeat treatment. No serious treatment- or block-related adverse events were observed during the available follow-up. Conclusions: UGBANB was associated with better procedural tolerability and treatment delivery during capsaicin 8% patch therapy than topical EMLA or no pretreatment in patients with PDPN. These findings relate specifically to procedural optimization and should not be interpreted as evidence that UGBANB enhances the intrinsic or long-term analgesic efficacy of capsaicin. Prospective multicenter randomized controlled trials are needed to confirm these associations and determine whether improved procedural tolerability translates into better long-term treatment adherence, clinical outcomes, health-related quality of life, safety, and cost-effectiveness.