A&A practice
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Patients with upper motor neuron disease, such as multiple sclerosis, can present with severe spasticity in the perioperative period. In most cases, this can be managed with a combination of preoperative oral medications, regional or neuraxial anesthetic techniques, and intravenous muscle relaxants. We describe the clinical presentation of a patient with multiple sclerosis and the successful use of intravenous dantrolene sodium postoperatively for the treatment of exacerbated spasticity refractory to traditional management.
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Case Reports
Treatment of Postherpetic Neuralgia With Intravenous Administration of Zinc Sulfate: A Case Report.
Gabapentinoids (gabapentin and pregabalin) are first-line drugs for postherpetic neuralgia (PHN), but some PHN patients have inadequate therapeutic response. Zinc deficiency has been identified as a risk factor for PHN. ⋯ The aforementioned findings provide a molecular pain-relieving basis for zinc supplements as an add-on therapy to pregabalin. We report 2 zinc-deficient PHN patients who received zinc sulfate intravenously as an add-on therapy to pregabalin and responded well.
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Case Reports
Naloxegol to Treat Constipation in a Patient Taking Opioids for Cancer Pain: A Case Report.
Opioid-induced constipation (OIC) is a common gastrointestinal adverse effect of opioids, which can severely affect compliance and adherence to pain medication regimens and quality of life. Naloxegol has demonstrated efficacy against OIC in several studies involving patients with nonmalignant chronic pain. Here we report efficacy and tolerability of naloxegol in a 68-year-old patient with metastatic lung cancer and severe pain, treated with opioids, who presented with OIC resistant to traditional measures. Addition of naloxegol produced rapid improvement in his OIC symptoms and no apparent adverse effects while taking extended-release morphine 130 mg orally every 12 hours.
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Case Reports
A Subarachnoid Hemorrhage Presenting as Massive Nasopharyngeal Bleeding: A Case Report.
Patients who present with a subarachnoid hemorrhage may have more than 1 intracranial aneurysm at risk, which may not be appreciated until a subsequent aneurysmal bleeding event occurs. We describe a patient who underwent successful aneurysmal clipping, but later presented urgently with large-volume epistaxis 48 hours after the procedure. After successful intubation of the patient, subsequent angiographic imaging determined that the massive intranasal/oral hemorrhage was due to bleeding through the former operative site, from rupture of a previously unrecognized aneurysm. This series of events demonstrates the importance of selecting the most at-risk aneurysm for surgical intervention.
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This is the first account of significant aortic injury during diagnostic rigid esophagoscopy in an adult with an esophageal stricture. We describe the resultant hemothorax and hemodynamic collapse and the successful treatment with massive volume resuscitation, vasopressors, and timely surgical intervention including thoracic endovascular aortic repair. We discuss the importance of rapid diagnosis, relevant anatomy, treatment modalities, and communication as cornerstones for learning.