Tertiary Care University Hospital (tertiary + care_university_hospital)

Distribution by Scientific Domains

Selected Abstracts

Use of Botulinum Toxin Type A Injection for Neuropathic Pain after Trigeminal Nerve Injury

PAIN MEDICINE, Issue 4 2010
Seung Hyun Yoon DDS
Abstract Objective., To present a case that neuropathic pain following traumatic injury of the inferior alveolar nerve, which was relieved by the injection of BTX-A. Design., Case report. Setting., Tertiary care University hospital. Subject., A 62-year-old female was referred by her general dentist to our clinic due to numbness and pain over the left side of her lower lip and chin region. Intervention., Botulinum toxin type A injected into the middle of chin area subcutaneously. Results., At 1 month after BTX-A injection, the affected area had decreased in size. And at 2 months, the patient reported a slight decreased in pain, and CPT differences being sustained at a reduced level. Conclusions., This case report suggests an effective new modality for treating neuropathic pain after trigeminal nerve injury. A further randomized controlled study involving a large number of patients is needed. [source]

Simplifying head and neck microvascular reconstruction

Eben Rosenthal MD
Abstract Background. Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources. Methods. This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital. Results. Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%). Microvascular anastomoses were performed with a continuous suture technique or an anastomotic coupling device for end-to-end venous anastomoses. A single vein was anastomosed in 97% of tissue transfers. There were five flaps (4%) requiring exploration for vascular compromise, and the overall success rate was 97.6%. The major complication rate was 13%. Mean hospital stay was 7 days for all patients and 5 days for those with cutaneous defects. Combined ablative and reconstructive operative times were 6 hours 42 minutes, 7 hours 40 minutes, and 8 hours 32 minutes for forearm, rectus, and fibular free grafts, respectively. A subset of this patient series with oral cavity and oropharynx defects (76 patients; 58%) available for follow-up (74 patients) was assessed for deglutition. Forty-three patients (58%) had a regular diet, 22 patients (30%) had a limited diet or required supplemental tube feedings, and nine patients (12%) were dependent on tube feedings with a severely limited diet. Conclusions. This series suggests that most head and neck defects can be reconstructed by use of a simplified microvascular technique and a limited number of donor sites. Analysis of operative times and length of stay suggest improved efficiency with this approach to microvascular reconstruction. Complications and functional results are comparable to previously published results. 2004 Wiley Periodicals, Inc. Head Neck26: 930,936, 2004 [source]

Urinary Colic During Low-Back Treatment: Out of the Frying Pan into the Fire?

PAIN MEDICINE, Issue 4 2009
Bayram Kaymak MD
ABSTRACT Objective., The objective of this study was to present a possible discrete effect of heat therapy on the urinary system during physical therapy of a patient with lumbar discopathy. Design., This is a case report. Setting., This study was carried out in a a tertiary care university hospital. Patients and Interventions., A 33-year-old man with the diagnosis of lumbar discopathy undertook physical therapy including heat. On the third day of treatment, he had suffered colic low-back (flank) pain with quite a different nature from his initial painful complaints. In addition to conservative management of the renal stone, we continued heat therapy. Outcome Measures and Results., After 10 days of physical therapy, he was found to have improved both with regard to his low-back and urinary complaints. Conclusions., The physicians should be aware of the effects of heat therapy on the urinary system when treating patients with musculoskeletal pathologies of the lumbar region. [source]

Pediatric squamous cell carcinoma: Case report and literature review,,

Douglas Sidell MD
Abstract Objectives/Hypothesis: Describe a rare pediatric malignancy. Discuss the clinical, diagnostic, and therapeutic differences between squamous cell carcinoma (SCC) of the adult and pediatric population. Study Design: Case report including a detailed radiological and histopathologic analysis and review of the literature. Methods: A case report is described from a tertiary care university hospital. Histopathologic assessment and radiological details are reviewed. A literature review of the background, incidence, disease course, and treatment options are presented. Results: This case report presents a 6-year-old male with a 2-month history of an enlarging oral lesion. The patient denied dysphagia, pain, weight loss, bleeding, or loosening of the teeth. Biopsy demonstrated invasive, well-differentiated, exophytic squamous cell carcinoma with perineural and angiolymphatic invasion. Computed tomography and magnetic resonance imaging demonstrated a 2.7 3.0 cm poorly marginated infiltrative mass involving the gingival aspect of the superior alveolar ridge and the adjacent bony marrow, primarily to the right of midline. Multiple small subcentimeter lymph nodes were also identified in the bilateral level II to V posterior cervical triangles bilaterally. Conclusions: Pediatric SCC of the oral cavity is indeed a rare entity; however, its presence in the pediatric population should not be ignored. This case report describes the occurrence of SCC in the oral cavity of a 6-year-old male patient, the youngest case ever reported, and is a reminder that a multidisciplinary approach tailored to pediatric individuals is essential to obtain clear diagnoses and appropriate treatment plans. [source]

Immediate Percutaneous Medialization for Acute Vocal Fold Immobility With Aspiration,

Timothy D. Anderson MD
Abstract Objectives To determine the efficacy of immediate bedside or office percutaneous, trans-thyroidal injections of a bioabsorbable gelatin material (Gelfoam, Upjohn Co., Kalamazoo, MI) to decrease the risk of aspiration resulting from acute vocal fold immobility. Study Design Retrospective review of patients presenting with acute vocal fold immobility and aspiration or high aspiration risk at an urban, tertiary care university hospital. Methods All patients were evaluated by videostroboscopy, functional endoscopic evaluation of swallowing (FEES), and objective voice measures. Patients with acute vocal fold immobility and evidence of aspiration on history or FEES were given the option of medialization by Gelfoam injection. Injections were performed percutaneously in the office or at the bedside under laryngoscopic guidance. FEES was repeated after injection to verify improvement in aspiration. Results Eleven patients underwent Gelfoam injection for treatment of aspiration and vocal fold immobility. All were significantly improved on post-injection FEES study. All patients were returned to an oral diet, avoiding the need for long-term enteral access. Conclusion Percutaneous Gelfoam injections is a rapid, temporary solution to the common problem of aspiration resulting from acute vocal fold immobility. [source]

Sexuality and sexual activity in pregnancy

Elias Bartellas Clinical Assistant Professor
Objectives To evaluate women's sexual experience in pregnancy, and to describe their sources of information regarding sexuality during this period. Design Cross-sectional study. Setting The offices of obstetricians providing obstetric care in a tertiary care university hospital in St. John's, Newfoundland, Canada. Population One hundred and forty-one pregnant women. Methods Pregnant women anonymously completed self-administered questionnaires regarding sexuality and sexual activity during pregnancy. Responses were summarised using descriptive statistics, and comparisons were made between the trimesters of pregnancy. Multiple logistic regression was performed to assess the influences of a variety of factors on sexual activity. Results Vaginal intercourse and sexual activity overall decreased throughout pregnancy (P= 0.004 and 0.05, respectively) with the trimester of pregnancy being the only independent predictor. Most women reported a decrease in sexual desire (58%). Overall, 49% of women worried that sexual intercourse may harm the pregnancy. Concerns regarding sexual activity leading to preterm labour or premature rupture of membranes increased as the pregnancy progressed (P < 0.001 and P= 0.001, respectively). Only 29% of women discussed sexual activity in pregnancy with their doctor and 49% of these women raised the issue first, with 34% feeling uncomfortable in bringing up the topic themselves. Most women (76%) who had not discussed these issues with their doctor felt they should be discussed. Conclusions A reduction in sexual activity, vaginal intercourse and sexual desire occurs in many women as pregnancy progresses. Both the woman and her partner have concerns regarding complications in the pregnancy as a result of sexual intercourse. The majority of women wish to discuss these issues with their doctor, but are not always comfortable raising the topic themselves. [source]