RESUMO
STUDY OBJECTIVE: To determine the prevalence of persistent postsurgical pain (PPSP) and its influence on functional status, and to examine associations between PPSP and single nucleotide polymorphisms of the catechol-O-methyltransferase (COMT) gene and the guanosine triphosphate cyclohydrolase 1 (GCH1) gene following mastectomy and reconstruction. DESIGN: Retrospective study. SETTING: Two teaching hospitals. PATIENTS: From the population of women who had undergone breast reconstruction following mastectomy for breast cancer over a 6-year period, 42 women agreed to participate in the assessment (55.3% of the total sample). INTERVENTIONS: The Rand 36-Item Health Survey 1.0, the Patient-Specific Functional Scale, the McGill Pain Questionnaire (long form), visual analog scales for anxiety and pain, and the Hospital Anxiety and Depression Scale were administered. Blood was taken for genetic analysis. Quantitative sensory testing was performed using a standard electrical stimulus. MEASUREMENTS: Surgical procedures, perioperative analgesic requirements, pain scores, and adjuvant therapies were noted. Height, weight, menstrual status, and arm circumference also were recorded. MAIN RESULTS: 42 (55.3%) patients took part in the assessment, and 18 (43%) reported PPSP. Those with PPSP achieved lower scores on the Patient-Specific Functional Scale (P = 0.040) and had been given more morphine perioperatively. A trend was noted between occurrence of PPSP and the val158met polymorphism of the COMT gene (P = 0.06). CONCLUSIONS: Persistent pain after mastectomy and breast reconstruction has a high prevalence (43%). Genetic mutations may contribute to the development of persistent pain following surgery; however, larger studies are required for confirmation.
Assuntos
Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Dor Pós-Operatória/epidemiologia , Adulto , Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Ansiedade/epidemiologia , Ansiedade/psicologia , Catecol O-Metiltransferase/genética , Depressão/epidemiologia , Depressão/psicologia , Feminino , GTP Cicloidrolase/genética , Frequência do Gene , Humanos , Pessoa de Meia-Idade , Exame Neurológico , Medição da Dor , Limiar da Dor , Dor Pós-Operatória/genética , Dor Pós-Operatória/terapia , Polimorfismo de Nucleotídeo Único , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
Transcranial extension of frontal sinus infection is a rare, but not eradicated entity. We present a 21-year-old male, in whom a persistent scalp abscess heralded the discovery of skull vault osteomyelitis and extradural abscesses secondary to frontal sinusitis. Patients with prolonged or unusual symptoms with a history of sinusitis or trauma warrant further investigation as they may have developed serious intracranial complications. Urgent management, both surgical and antimicrobial, is indicated in such scenarios.