Psychophysic-psychological dichotomy in very early acute mTBI pain: A prospective study.

OBJECTIVE: To characterize the pain-related somatosensory and psychological presentation of very early acute patients with a mild traumatic brain injury (mTBI). METHODS: Patients with an mTBI participated in a prospective observational study undergoing clinical, psychophysic, and psychological assessment within 72 hours after the accident. Healthy controls underwent similar protocol. RESULTS: One hundred acute patients with an mTBI (age 36 ± 12.5 [SD] years, range 19-67 years, 42 women) and 80 healthy controls (age 43 ± 14.3 years, range 24-74 years, 40 women) participated. Patients with an mTBI demonstrated a pronociceptive psychophysic response in most tests such as less efficient pressure-pain threshold-conditioned pain modulation (0.19 ±0.19±.09 vs. 0.91±.10 kg, p < 0.001) and lower temperature needed to elicit a Pain50 response (44.72 ± 0.26°C vs 46.41 ± 0.30°C, p < 0.001). Their psychophysic findings correlated with clinical pain measures, e.g., Pain50 temperature and mean head (r = -0.21, p = 0.045) and neck (r = -0.26, p = 0.011) pain. The pain-catastrophizing magnification subscale was the only psychological variable to show a difference from the controls, while no significant correlations were found between any psychological measures and the clinical or psychophysic pain measures. CONCLUSIONS: There appears to be a dichotomy between somatosensory and psychological findings in the very early acute post-mTBI stage; while the first is altered and is associated with the clinical picture, the second is unchanged. In the context of the ongoing debate on the pathophysiologic nature of the post-mTBI syndrome, our findings support its "physical" basis, free of mental influence, at least in the short time window after the injury.

Epidemiology of Kite Surfing Injuries among Recreational Athletes.

BACKGROUND: Kite surfing is one of the trendiest water sports worldwide. With its growing popularity evidence has begun to accumulate regarding its potential for injuries which range from minor insults to death. OBJECTIVES: To define the epidemiology and distribution of common kite surfing injuries among recreational athletes. METHODS: An open letter was published on the web calling for surfers to report injuries inflicted during recreational kite surfing. In addition, we received data from the National Center for Trauma and Emergency Medicine Research. RESULTS: Our survey yielded only a small series of 48 injuries. Most kite surfing injuries are isolated injuries, although some are life threatening as occurred in two surfers who died due to severe head injuries. Among the injuries, 72.9% are related to the musculoskeletal system, followed by head and chest injuries (18.7% and 14.6%, respectively). Of the orthopedic injuries 48.6% are fractures, the majority in the lower limbs (58.8%). CONCLUSIONS: Our findings combined with those of previous articles on kite surfing-associated injuries contribute to a better understanding of such injuries, raise awareness among emergency department personnel, and indicate precautions needed to avoid or lessen incapacitating and potentially life-threatening injuries.

IgG4-related disease manifesting as an acute gastric-pericardial fistula.

IgG4-related disease is a recently recognized entity linked initially to autoimmune pancreatitis and has been subsequently described in nearly every organ system. Men over the age of 50 represent the most affected demographic group and a comprehensive set of diagnostic criteria has been developed to aid treating clinicians. Though elevated levels of IgG4 in the serum are suggestive of the disease, definitive diagnosis is made on histopathology. Treatment is tailored to the clinical presentation with corticosteroid therapy known to have proven efficacy. Gastric manifestations of the IgG4-related disease primarily come in two varieties, notably chronic ulceration or pseudotumor formation. Autoimmune pancreatitis conveys increased risk for IgG4-related disease of the stomach, which is independent of Helicobacter pylori status. In this case report, we present an acute gastric-pericardial fistula secondary to IgG4-related disease that required urgent operative management. To our knowledge, this is the first report in the medical literature describing this complication of IgG4-related disease.

Adenocarcinoma in colonic interposition.

A 59-year-old female with dysphagia presented to our clinic. In childhood, she underwent colonic interposition due to anastomotic stricture after a previous proximal gastrectomy for gastric ulcer perforation. Imaging studies revealed a space-occupying lesion obstructing the distal interposed colon. At surgery, completion gastrectomy with segmental colectomy was carried out, and Roux-en-Y coloenterostomy and enteroenterostomy were performed.

Transanal endoscopic microsurgery for the resection of submucosal and retrorectal tumors.

BACKGROUND: Transanal endoscopic microsurgery (TEM) was originally designed for local endoscopic excision of benign and low-grade mucosal rectal lesions through an endoscopic system. The procedure is particularly challenging for submucosal and retrorectal lesions, as the tumor margins are not well defined. OBJECTIVE: To investigate patient and surgical characteristics of TEM as a treatment for submucosal rectal and retrorectal lesions. METHODS: All the patients in our department of general surgery who underwent TEM for a submucosal rectal or retrorectal lesion, between the years 2001 and 2011, were identified. Their charts were reviewed and data pertaining to demographic characteristics and medical history, including tumor characteristics, were collected. Operative notes and histopathology reports were also reviewed. The adequacy of the tumor resection, that ism attainment of free margins, endoscopic completion of the procedure, and perioperative complications, were assessed. RESULTS: Fifteen patients (5 females, 10 males), mean age 53.9 ± 16.9 years, were identified. The main indications for surgery were gastrointestinal stromal tumor (5 patients) and tailgut or duplication cyst (4 patients). All procedures were completed endoscopically. The median distance from the anal verge was 7.3 cm (range, 5 to 10 cm), and the mean diameter of the tumors was 3 ± 1.1 cm. The one patient in whom the margins presented tumoral involvement underwent repeated TEM. No intraoperative complications were reported. The postoperative complication rate was 13.3%, and the mean length of hospital stay was 1.85 ± 1.77 days. CONCLUSIONS: TEM for retrorectal and submucosal rectal lesions is feasible and safe. A remarkably low morbidity rate and limited surgical injury favor TEM in selected patients.

Ganglioneuroma of the adrenal gland: a rare tumor in a rare location.

A 62-year-old man presented to his general practitioner complaining of non-specific back pain. He underwent a computerized tomography scan and magnetic resonance imaging that revealed a large left adrenal mass. A thorough investigation of this mass revealed it to be a non-secreting tumor. At surgery, a large tumor of the left adrenal was found. The final pathology report revealed a ganglioneuroma of the adrenal gland.