RESUMEN
Intramedullary spinal cord tumors (IMSCT) are a rare subset of neoplasms classified based on anatomical location. The most common presenting symptom is pain; however, the high prevalence of back pain in the general public secondary to common causes including degenerative disc disease or osteoarthritis, makes diagnosing spinal cord tumors a challenge. We present a case of a 43-year-old male with a cervical intramedullary ependymoma to discuss the clinical presentation, diagnosis, and treatment of these spinal tumors.
RESUMEN
Contemporary pain medicine is a multimodality and multidisciplinary field. Many of the current ideas and styles of practice that influence the specialty today can be traced back to John Bonica, M.D., and his model of pain management introduced more than 50 years ago. Although much of the foundation that Bonica helped form involved several original concepts, historically, other anesthesiologists who were Bonica's predecessors also laid the groundwork for what the practice of pain medicine is today. In particular, Emery Rovenstine, M.D., and John Lundy, M.D., had early block clinics to treat painful conditions. While in the army during World War II, Bonica worked closely with his Chief of Surgery, Joel Deuterman, M.D., a physician who had trained at the Mayo Clinic, where he was exposed to Lundy and his techniques. Deuterman may have influenced Bonica's ideas concerning the treatment of chronic painful conditions.
Asunto(s)
Analgesia/historia , Anestesia de Conducción/historia , Clínicas de Dolor/historia , Dolor/historia , Grupo de Atención al Paciente/historia , Correspondencia como Asunto/historia , Difusión de Innovaciones , Francia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Estados Unidos , Segunda Guerra MundialRESUMEN
OBJECTIVE: To report cluster breathing pattern associated with a nonbrainstem lesion. DESIGN: Case report. SETTING: Neurointensive care unit, St Mary's Hospital, Rochester, Minn. PATIENT: A patient with subarachnoid hemorrhage developed severe, diffuse, distal bilateral middle cerebral artery vasospasm with resultant cortical laminar necrosis and transient cluster breathing. Intervention Magnetic resonance imaging revealed bihemispheric lesions but no brainstem lesion. CONCLUSION: Cluster breathing may occur with nonbrainstem lesions.
Asunto(s)
Infarto Encefálico/complicaciones , Tronco Encefálico/fisiología , Corteza Cerebral/patología , Insuficiencia Respiratoria/etiología , Anciano , Infarto Encefálico/diagnóstico , Infarto Encefálico/fisiopatología , Tronco Encefálico/anatomía & histología , Corteza Cerebral/fisiopatología , Femenino , Humanos , Infarto de la Arteria Cerebral Media/etiología , Infarto de la Arteria Cerebral Media/fisiopatología , Imagen por Resonancia Magnética , Centro Respiratorio/anatomía & histología , Centro Respiratorio/fisiología , Insuficiencia Respiratoria/fisiopatología , Hemorragia Subaracnoidea/complicaciones , Hemorragia Subaracnoidea/fisiopatología , Vasoespasmo Intracraneal/complicaciones , Vasoespasmo Intracraneal/fisiopatologíaRESUMEN
Unintentional intra-arterial injection of medication, either iatrogenic or self-administered, is a source of considerable morbidity. Normal vascular anatomical proximity, aberrant vasculature, procedurally difficult situations, and medical personnel error all contribute to unintentional cannulation of arteries in an attempt to achieve intravenous access. Delivery of certain medications via arterial access has led to clinically important sequelae, including paresthesias, severe pain, motor dysfunction, compartment syndrome, gangrene, and limb loss. We comprehensively review the current literature, highlighting available information on risk factors, symptoms, pathogenesis, sequelae, and management strategies for unintentional intra-arterial injection. We believe that all physicians and ancillary personnel who administer Intravenous therapies should be aware of this serious problem.