Epidural analgesia for acute ischemic pain after intra-arterial zolpidem injection in opioid-addicted patient-A case report.

A patient taking opioid maintenance therapy unintentionally injected dissolved zolpidem pills into the femoral artery and suffered acute limb ischemia. High amounts of opioids with supplemental therapies were inefficient for intractable ischemic pain, suggesting the presence of opioid-induced hyperalgesia (OIH). Epidural analgesia efficiently relieved pain and symptoms of OIH.

Rare Case of Multiple Aneurysms with Rupture of the Deep Femoral Artery Aneurysm.

Profunda femoris artery aneurysms (PFAA) are very rare and easily overlooked. Currently, around 100 PFAA and 20 ruptured PFAA have been described in the literature. This is a report on a case of ruptured PFAA with thoracoabdominal aortic aneurysm. A ligation of the profunda femoris artery (PFA) and a femoropopliteal supragenicular bypass with vascular prosthesis were performed in the surgical treatment, which showed good results on the further follow-ups. A month after the procedure the patient had a rupture of the thoracoabdominal aortic aneurysm with fatal result. Therefore, it is recommended to perform a search for another aneurysm, especially on the aortoiliac segment, in every diagnosed PFAA case.

Reducing pain and improving quality of life for patients suffering the acetabular fracture.

The rationale for this paper was to find out assessment tools and relevant factors that may reduce pain, and improve the quality of life and ability to perform activities of daily living in surgically and conservatively treated patients who sustained the acetabular fracture. One hundred and three patients with the acetabular injury were analysed during the 10-year retrospective case-control study. The case group consisted of 21 patients in whom the posterior acetabular wall was fractured and who were treated surgically. The control group comprised 82 patients with complex acetabular fracture in whom conservative treatment was applied. In order to assess post injury and postoperative quality of life different factors, such as the intensity and chronicity of pain, as well as the ability to resume activities of daily living, the patients were surveyed by anamnestic questionnaire to acquire the results. The quality of life was mostly better in patients from the case group who were operated on. At the follow-up, the features of pain were lower, management overall length shorter, and return to normal daily life activities faster in the surgically treated patients, compared to those who were not. In conclusion, based on our research we assume that surgery may notably decrease features of pain and improve the quality of life in patients with the acetabular injury.

The role of the nutrition in the pathogenesis of gastroesophageal reflux disease, Barrett's oesophagus and oesophageal adenocarcinoma.

This paper aims at evaluating the role of improper nutrition in the pathogenesis of gastroesophageal reflux disease (GERD), Barrett's oesophagus (BE), and oesophageal adenocarcinoma (EADC). It also tries to examine the influence of the alcohol, nicotine and coffee consumption in the development of the mentioned diseases. There were 180 subjects included in the trial, 109 males and 71 females, which were divided in the four groups (70 patients with GERD, 20 patients with BE, 20 patients with EADC, and 70 healthy examinees composing a control group). Their dietary habits were investigated by the usage of the dietary questionnaires. The results show that the fast eating and the insufficient mastication were present in 64.3-85.0% patients with GERD, BE, and EADC in comparison with only 15% of the examinees from the control group. Furthermore, very hot was preferred by 25.0-42.9% of the mentioned patients in comparison with only 12.9% from the control group. Similarly, 60.0-75.0% of them preferred strongly spiced food on contrary with 17.1% of the healthy examinees. Moreover, strong alcoholic beverages were consumed three or more times per week by 55.0-75.0% of the mentioned patients in comparison with only 15.7% from the control group. Finally, there were 15.7-55.0% heavy smokers among the patients with GERD, BE, and EADC contrary to 1.4% in the control group.

The effects of gluten-free diet on body weight in children with celiac disease.

This study was aimed at monitoring and controlling of body weight in children with diagnosis of celiac disease when established and after introducing gluten-free diet. Prospective clinical study included 42 children with celiac disease whose body weight was measured before introducing gluten-free diet, and after the period of six and 18 months of introducing gluten-free diet. The children were divided into three age groups. The first group consisted of 16 children, 8 females and 8 males in the age from 6 to 18 months, the second group consisted of 14 children, 8 females and 6 males ranging from the age of 20 to 111 months and the third group consisted of 12 children, 6 females and 6 males ranging from the age of 115 to 204 months. The measured body weight was compared with the centile tables of children of the same age. After introducing gluten-free diet the body weight was significantly higher at first, especially at the second control examination in comparison to the centile table of children of the same age and gender When comparing the results at the time of establishing the diagnosis and at the first and second control examination of the body weight of children the results showed no difference concerning gender and the age of children. In conclusion it can be said that is very important to diagnose celiac disease as soon as possible because the introduction of gluten-free diet prevents the pathological conditions mucosal lesion of small intestine and the physical retardation of children.

Abdominal angina caused by kinking of the superior mesenteric artery.

Abdominal angina followed by an active vascular intervention constitutes an infrequent sequence of events. The limited experience in the active management of this, potentially lethal, condition prompted us to present the case of a 54 year old man with an exceedingly rare etiology of mesenteric ischemia. The underlying cause was kinking of the superior mesenteric artery in combination with ostial stenosis of the celiac trunk. The initial management strategy included an interventional radiological procedure because patient initially declined the surgical treatment. The second intervention was a surgical revascularization of the diseased segment of the abdominal vasculature. The surgical treatment led to complete resolution of his symptoms.