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Tanyel Saraçoğlu T, Akbaş F, Onay M, Bilir A, Güleç S. Prolonged Effect of Repetitive Erector Spinae Plane Block in Reducing Thoracic Pain Caused by Lung Cancer. Cureus 2024; 16:e57130. [PMID: 38681332 PMCID: PMC11055569 DOI: 10.7759/cureus.57130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Pain significantly affects the quality of life of lung cancer patients. We aimed to evaluate the effect of the erector spinae plane block (ESPB) on pain in these patients. METHODS We reviewed the medical records of patients with primary lung and bronchial cancer who experienced refractory pain in the thoracic region and underwent repeated ESPBs (three blocks at 24-hour intervals) between 2019 and 2020 in this single-center retrospective study. Visual analog scale (VAS) scores recorded before the procedure and on the first day (first day after the third block) and the first and third months of follow-up in 43 patients were analyzed. Results: The study population consisted of 31 male and 12 female patients, with a mean age of 56.7 years. The mean pre-procedure VAS score was 8.9±0.8, which showed a significant decrease on the first day (2.9), first month (3.6), and third month (4.6) of the follow-up. Four patients experienced minor complications (pain at the procedure site and hypotension); however, no major complications were observed. CONCLUSION We observed a prolonged effect of repeated ESPBs for ≥3 months. The block efficacy decreased with time; however, an approximately 50% reduction in the VAS score persisted even in the third month. Repetitive ESPBs may be regarded as a straightforward, safe, and replicable intervention to complement medical treatment and diminish the need for opioids in managing lung cancer-related pain.
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Affiliation(s)
- Tuba Tanyel Saraçoğlu
- Department of Pain Management, Başakşehir Çam ve Sakura City Hospital, İstanbul, TUR
| | - Fırat Akbaş
- Department of Pain Management, Gaziantep City Hospital, Gaziantep, TUR
| | - Meryem Onay
- Department of Anesthesiology and Reanimation, Eskisehir Osmangazi University, Eskişehir, TUR
| | - Ayten Bilir
- Department of Pain Management, Eskisehir Osmangazi University, Eskişehir, TUR
| | - Sacit Güleç
- Department of Pain Management, Eskisehir Osmangazi University, Eskişehir, TUR
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Incze-Bartha Z, Russo AP, Pastorello Y, Vunvulea V, Stanciu N, Mattarocci M, Dénes L. Cough-Induced Multiple, Bilateral, Asymmetrical Rib Fractures in a Scoliosis Patient: A Case Report. Cureus 2023; 15:e49251. [PMID: 38143673 PMCID: PMC10744169 DOI: 10.7759/cureus.49251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Cough-induced rib fractures represent infrequent complications of strenuous and prolonged coughing, mostly provoked by respiratory tract infections, with localized chest pain being the most indicative component of the clinical picture. This paper reports a case of a 27-year-old female patient who presented with four cough-induced rib fractures following the contraction of an upper respiratory tract infection. The unique character of this case is provided by the young age of the patient, the presence of multiple and bilaterally located rib fractures, and the absence of predisposing factors related to her bone physiology. Furthermore, three of the four fractures were revealed on the left side, where a scoliotic sinistro-convex thoracic curvature is described. Following conservative treatment, the patient experienced a complete resolution of symptoms and favorable clinical outcomes. Even in the seemingly low-risk category, the diagnosis of cough-induced rib fractures should be taken into consideration, and their correlation to pre-existing rib deformities, such as the ones secondary to scoliosis, should be thoroughly investigated.
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Affiliation(s)
- Zsuzsánna Incze-Bartha
- Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
- Department of Orthopedic Surgery and Traumatology, Dr. Fogolyán Kristóf Emergency County Hospital, Sfântu Gheorghe, ROU
| | - Aurelio Pio Russo
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Ylenia Pastorello
- Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Vlad Vunvulea
- Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
- Department of Radiology, Emergency County Hospital Târgu Mureș, Târgu Mureș, ROU
| | - Nicolae Stanciu
- Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
- Department of Orthopedic Surgery and Traumatology, Emergency County Hospital Târgu Mureș, Târgu Mureș, ROU
| | | | - Lóránd Dénes
- Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
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3
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Scherer MJ, Kampe S, Fredebeul-Beverungen J, Weinreich G, Costabel U, Bonella F. Thoracic pain in patients with chronic interstitial lung disease-an underestimated symptom. Front Med (Lausanne) 2023; 10:1147555. [PMID: 37215705 PMCID: PMC10196162 DOI: 10.3389/fmed.2023.1147555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Prevalence and predisposing factors for the development of thoracic pain (TP) in patients with chronic interstitial lung disease (cILD) are largely unknown. Underestimation and insufficient therapy of pain can lead to worsened ventilatory function. Quantitative sensory testing is an established tool for characterization of chronic pain and its neuropathic components. We investigated frequency and intensity of TP in cILD patients and the potential association with lung function and quality of life. Materials and methods We prospectively investigated patients with chronic interstitial lung disease to analyze risk factors for the development of thoracic pain and quantify thoracic pain through quantitative sensory testing. In addition, we studied the relationship between pain sensitivity and lung function impairment. Results Seventy-eight patients with chronic interstitial lung disease and 36 healthy controls (HCs) were included. Thoracic pain occurred in 38 of 78 patients (49%), most frequently in 13 of 18 (72%, p = 0.02) patients with pulmonary sarcoidosis. The occurrence was mostly spontaneous and not related to thoracic surgical interventions (76%, p = 0.48). Patients with thoracic pain showed a significant impairment of mental well-being (p = 0.004). A higher sensitivity to pinprick stimulation during QST can be observed in patients with thoracic pain (p < 0.001). Steroid treatment was associated with lower sensitivity within thermal (p = 0.034 and p = 0.032) and pressure pain testing (p = 0.046). We observed a significant correlation between total lung capacity and thermal (p = 0.019 and p = 0.03) or pressure pain sensitivity (p = 0.006 and p = 0.024). Conclusion This study was performed to investigate prevalence, risk factors and thoracic pain in patients with chronic interstitial lung disease. Thoracic pain mostly occurs spontaneous as a frequent symptom, and seems to be an underestimated symptom in patients with chronic interstitial lung disease, especially those with pulmonary sarcoidosis. Timely identification of thoracic pain may allow starting symptomatic treatment at early stage, before impairment in quality of life occurs. Clinical Trial Registration https://www.drks.de/drks_web/, Deutsches Register Klinischer Studien (DRKS) DRKS00022978.
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Affiliation(s)
- Manuela J. Scherer
- Department of Anaesthesiology and Pain Medicine, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Sandra Kampe
- Department of Anaesthesiology and Pain Medicine, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Jonas Fredebeul-Beverungen
- Department of Anaesthesiology and Pain Medicine, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Gerhard Weinreich
- Pneumology Department, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Ulrich Costabel
- Pneumology Department, Center for Interstitial and Rare Lung Diseases, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Francesco Bonella
- Pneumology Department, Center for Interstitial and Rare Lung Diseases, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
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4
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Mottin L, Kassimy II, Girot H, Leguillon R, Joly LM, Brunel V. [Real-life evaluation of hypersensitive I-troponin on a point-of care analyser in an emergency unit]. Ann Biol Clin (Paris) 2023; 81:145-155. [PMID: 37144775 DOI: 10.1684/abc.2023.1804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
European Society of Cardiology (ESC) guidelines allow to perform rapid rule-in and rule-out algorithm with rapid troponin kinetics for the management of suspected Non ST-elevation acute coronary syndrome. These recommendations allow the use of point-of-care testing (POCT) systems provided that they have sufficient analytical performance. The aim of our study was to evaluate in real life the feasibility and performance of using a high sensitivity cardiac troponin I POCT system assay (hs-cTnI, Atellica® VTLi, Siemens) compared to high sensitivity cardiac troponin T values (hs-cTnT, e602®, Roche) obtained for patients admitted to emergency department. Analytical verification showed a coefficient of variation below 10% for hs-cTnI. Comparison of both troponins was moderate (r = 0.7). The study included 117 patients with a median age of 65 years, 30% had renal failure and 36% presented with chest pain. In this study, the hs-cTnT value was, more often, higher than the 99th percentile than the hs-cTnl value, even for an age-adjusted 99th percentile hs-cTnT value. The concordance of the results was moderate (Cohen's Kappa: 0.54), age remaining the most important explanatory value of discordance. Only hs-cTnT had a predictive value for hospitalization. We did not observe any interpretation discrepancies for patients who had troponin kinetics. This study confirms the feasibility of using a POCT analyzer in the emergency department, provided that it performs high sensitivity troponin. However, some data are missing to be able to use it in the framework of rapid algorithm. Finally, the implementation of POCT requires collaboration between biologists and emergency physicians in terms of organization and interpretation of values, for the overall benefit of the patient.
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Affiliation(s)
- Léo Mottin
- Service de Biochimie Générale, Institut du Biologie Clinique, CHU de Rouen, 1 rue de Germont, 76031 Rouen cedex
| | | | - Hélène Girot
- Service de Biochimie Générale, Institut du Biologie Clinique, CHU de Rouen, 1 rue de Germont, 76031 Rouen cedex
| | - Romain Leguillon
- Département d'Information et d'Informatique, CHU de Rouen, 1 rue de Germont 76031 Rouen cedex
| | - Luc Marie Joly
- Service des Urgences, CHU de Rouen, 1 rue de Germont, 76031 Rouen cedex
| | - Valery Brunel
- Service de Biochimie Générale, Institut du Biologie Clinique, CHU de Rouen, 1 rue de Germont, 76031 Rouen cedex
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5
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Sforza C, Margelli M, Mourad F, Brindisino F, Heick JD, Maselli F. Spontaneous spleen rupture mimicking non-specific thoracic pain: A rare case in physiotherapy practice. Physiother Theory Pract 2023; 39:641-649. [PMID: 35704038 DOI: 10.1080/09593985.2021.2021578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The prevalence of Thoracic Pain (TP) is estimated to be low compared to other common musculoskeletal disorders such as nonspecific low back pain (LBP). Notably, compared to LBP, TP or referral pain to the thoracic area potentially may involve serious pathologies. Visceral referral of pain may present to the thoracic spine or anteriorly in the abdomen or chest. Rupture of the spleen in the absence of trauma or previously diagnosed disease is rare and rarely documented in emergency medicine literature. The incidence of red flags are higher in the thoracic area in comparison to the lumbar or cervical regions, but TP can also be of musculoskeletal origin and for this reason it is important to assess the origin of pain. CASE DESCRIPTION This case report describes the clinical history, evaluation and management of a 60-year-old complaining of upper thoracic, bilateral shoulder, and right upper quadrant abdominal pain. The patient's clinical findings from a physiotherapist's assessment led to a referral to a physician to explore a potential non-musculoskeletal origin. A splenectomy was required due to a non-traumatic rupture of the spleen. After 20 days of hospitalization from the surgery, the patient returned to all normal activities of daily living. DISCUSSION AND CONCLUSION The purpose of this current case report is to describe the clinical reasoning of a physiotherapist screening a patient who presented with thoracic pain due to a spontaneous rupture of the spleen, that resulted in a referral to another health practitioner.
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Affiliation(s)
- Carla Sforza
- Faculty of Medicine and Surgery, Department of Clinical Science and Translation Medicine, University of Rome "Tor Vergata", Roma, Italy.,Department of Physiotherapy, Sport Clinic Center, Firenze, Italy
| | - Michele Margelli
- Faculty of Medicine and Surgery, Department of Clinical Science and Translation Medicine, University of Rome "Tor Vergata", Roma, Italy.,Faculty of Medicine and Surgery, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.,Department of Physiotherapy, Studio Andreotti-Margelli Terapika, Ferrara, Italy
| | - Firas Mourad
- Faculty of Medicine and Surgery, Department of Clinical Science and Translation Medicine, University of Rome "Tor Vergata", Roma, Italy.,Department of Physiotherapy, Lunex International University of Health, Exercise and Sports, Differdange, Luxembourg.,Luxembourg Health and Sport Sciences Research Institute A.s.b.l, Differdange, Luxembourg
| | - Fabrizio Brindisino
- Faculty of Medicine and Surgery, Department of Clinical Science and Translation Medicine, University of Rome "Tor Vergata", Roma, Italy.,Department of Medicine and Health Science "Vincenzo Tiberio," University of Molise C/o Cardarelli Hospital, ; Campobasso, Italy
| | - John D Heick
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ, USA
| | - Filippo Maselli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (Dinogmi), University of Genova - Campus of Savona, Savona, Italy.,Sovrintendenza Sanitaria Regionale Puglia INAIL, ; Bari, Italy
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6
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Hrkać A, Perković R, Krišto B, Puljak L. Prevalence of spinal pain in a population of Bosnia and Herzegovina. AIMS Public Health 2022; 9:790-804. [PMID: 36636151 PMCID: PMC9807413 DOI: 10.3934/publichealth.2022053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives To determine the prevalence and risk factors of spinal pain in the population of Bosnia and Herzegovina (BiH). Methods This was a cross-sectional survey conducted online in November/December 2018. Participants were inhabitants of BiH of both sexes, aged ≥ 16 years. The sample was stratified based on region and demographic characteristics. Current pain was analyzed; point prevalence was measured. Results We received 1048 responses, of which data from 1017 could be used. The prevalence of spinal pain in BiH was 70.9%: 75.5% in women (n = 440) and 64.7% in men (n = 281). Low back pain (LBP) was more common compared to neck pain (NP) and thoracic pain (TP) in both sexes and all age groups. Significant associations with spinal pain in the bivariate analysis were found for the following groups: women, aged from 30 to 50 years, with high school education, employed persons and retirees, spinal pain in parents, smoking, irregular physical activity, longer use of TV or computer/mobile phone per day. Conclusion To our knowledge, this is the first study of the prevalence of spinal pain in BiH. Some factors associated with spinal pain are modifiable. Therefore, public health interventions should target those factors to reduce the burden of spinal pain in BiH.
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Affiliation(s)
- Antonija Hrkać
- Faculty of Health Studies, University of Mostar, Mostar, Bosnia and Herzegovina,* Correspondence: ; Tel: +38763408127; Fax: +38736337051
| | - Roberta Perković
- Faculty of Health Studies, University of Mostar, Mostar, Bosnia and Herzegovina,Cantonal Hospital, Dr. Fra Mihovil Sučić, Livno, Bosnia and Herzegovina
| | - Branko Krišto
- Cantonal Hospital, Dr. Fra Mihovil Sučić, Livno, Bosnia and Herzegovina,School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia
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7
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Määttä J, Takatalo J, Leinonen T, Pienimäki T, Ylinen J, Häkkinen A. Lower thoracic spine extension mobility is associated with higher intensity of thoracic spine pain. J Man Manip Ther 2022; 30:300-308. [PMID: 35257630 PMCID: PMC9487940 DOI: 10.1080/10669817.2022.2047270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives To evaluate the association of thoracic spine (TS) posture and mobility with TS pain. Methods Participants with TS pain reported maximum, average, and night pain in TS area, and pain summary score was calculated. Upright and sitting TS postures were evaluated by inspection. TS posture and mobility (flexion and extension) were recorded using an inclinometer and a tape measure, respectively. Correlations between posture and mobility assessments were calculated using Spearman rank correlation, the association of TS posture and mobility with TS pain by logistic regression analysis. Results The participants’ (n = 73, 52 females, age range 22–56) TS pain duration was 12 weeks on average. The correlations for measurements of TS posture and flexion mobility were higher than correlations of other TS measurements being between 0.53 and 0.82. Decreased extension mobility of the upper (from 1st to 6th TS segments; Th1–Th6) TS was associated with higher worst pain (OR 1.04, 95% CI 1.00–1.07) and whole TS with pain sum score (OR 1.05, 95% CI 1.01–1.08). Less kyphotic whole TS was associated with lower pain sum score (OR 0.96, 95% CI 0.92–1.00). Greater flexion mobility of upper and lower (Th6–Th12) TS were associated with lower pain sum score (OR 0.96, 95% CI 0.91–1.00, and OR 0.96, 95% CI 0.91–1.00, respectively). Conclusions Reduced thoracic extension mobility was associated with higher pain scores and the greater flexion mobility with lower pain scores. Future research is warranted to evaluate if treatments geared toward TS extension mobility improvements would result in lower TS pain.
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Affiliation(s)
- Juhani Määttä
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Loisto Terveys, Oulu, Finland
| | - Jani Takatalo
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Loisto Terveys, Oulu, Finland.,Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tero Leinonen
- Loisto Terveys, Oulu, Finland.,Fysios Oulu, Oulu, Finland
| | - Tuomo Pienimäki
- Department of Physical and Rehabilitation Medicine, University of Oulu, Oulu, Finland
| | - Jari Ylinen
- Central Hospital of Central Finland, Jyväskylä, Finland
| | - Arja Häkkinen
- Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Central Hospital of Central Finland, Jyväskylä, Finland
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8
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Rojas-Mendizabal V, Castillo-Olea C, Gómez-Siono A, Zuñiga C. Assessment of Thoracic Pain Using Machine Learning: A Case Study from Baja California, Mexico. Int J Environ Res Public Health 2021; 18:2155. [PMID: 33672112 DOI: 10.3390/ijerph18042155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 01/19/2023]
Abstract
Thoracic pain is a shared symptom among gastrointestinal diseases, muscle pain, emotional disorders, and the most deadly: Cardiovascular diseases. Due to the limited space in the emergency department, it is important to identify when thoracic pain is of cardiac origin, since being a symptom of CVD (Cardiovascular Disease), the attention to the patient must be immediate to prevent irreversible injuries or even death. Artificial intelligence contributes to the early detection of pathologies, such as chest pain. In this study, the machine learning techniques were used, performing an analysis of 27 variables provided by a database with information from 258 geriatric patients with 60 years old average age from Medical Norte Hospital in Tijuana, Baja California, Mexico. The objective of this analysis is to determine which variables are correlated with thoracic pain of cardiac origin and use the results as secondary parameters to evaluate the thoracic pain in the emergency rooms, and determine if its origin comes from a CVD or not. For this, two machine learning techniques were used: Tree classification and cross-validation. As a result, the Logistic Regression model, using the characteristics proposed as second factors to consider as variables, obtained an average accuracy (μ) of 96.4% with a standard deviation (σ) of 2.4924, while for F1 a mean (μ) of 91.2% and a standard deviation (σ) of 6.5640. This analysis suggests that among the main factors related to cardiac thoracic pain are: Dyslipidemia, diabetes, chronic kidney failure, hypertension, smoking habits, and troponin levels at the time of admission, which is when the pain occurs. Considering dyslipidemia and diabetes as the main variables due to similar results with machine learning techniques and statistical methods, where 61.95% of the patients who suffer an Acute Myocardial Infarction (AMI) have diabetes, and the 71.73% have dyslipidemia.
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9
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Fanous SN, Saleh EG, Abd Elghafar EM, Ghobrial HZ. Randomized controlled trials between dorsal root ganglion thermal radiofrequency, pulsed radiofrequency and steroids for the management of intractable metastatic back pain in thoracic vertebral body. Br J Pain 2020; 15:270-281. [PMID: 34381612 DOI: 10.1177/2049463720942538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Bone metastasis is a complication of various cancers causing severe pain. The current modalities for the treatment of metastatic axial pain include pharmacological, surgical and vertebral augmentation techniques, each of which has its own challenges. OBJECTIVES To evaluate the effectiveness of pulsed radiofrequency (PRF), thermal radiofrequency (RF) and steroids on dorsal root ganglion (DRG) in patients with thoracic axial pain due to vertebral metastasis. METHODS In this randomized controlled prospective study, 140 patients were assessed for eligibility, of which only 69 fulfilled the criteria. Patients were randomly divided into three equal groups, PRF, RF and steroid. RESULTS During the assessment of pain using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Opioid consumption using oral Morphine Equivalence (OME) and Analgesic Quantification Algorithm (AQA) - at baseline, 1 week, 1 month and 3 months - 81 patients were assessed for final eligibility, of which 12 were excluded before intervention due to drop-out. The remaining 69 were randomized (mean age: 53.87 ± 10.55, 55.78 ± 7.34 and 59.39 ± 13.72) for PRF, RF and steroid, respectively with no statistical difference. VAS% and ODI% decreased significantly at 3 months in RF group (p <0.001, 0.014, respectively), as did the AQA (p <0.027). Steroid group was the worst. DISCUSSION RF on DRG is the main stay for controlling intractable metastatic pain. PRF is a good alternative.
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Affiliation(s)
- Sherry Nabil Fanous
- Department of Anaesthesia, ICU and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Emad Gerges Saleh
- Department of Anaesthesia, ICU and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ekramy Mansour Abd Elghafar
- Department of Anaesthesia, ICU and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hossam Zarif Ghobrial
- Department of Anaesthesia, ICU and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
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10
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Hershkovich O, Koch JEJ, Grevitt MP. Schmorl Node-A Cause of Acute Thoracic Pain: A Case Report and Pathophysiological Mechanism. Int J Spine Surg 2020; 14:441-446. [PMID: 32699769 DOI: 10.14444/7058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose We report a case of a patient with an acute symptomatic Schmorl node (SN) that spontaneously resolved with characteristic imaging findings. The extensive hematological investigations also allow some insight as to the likely pathophysiology of the painful lesion. Methods Case report of an acute symptomatic SN. Results A fit and athletic 44-year-old female participant in a competitive paddling event developed atypical thoracic pain and was admitted for further investigation. Normal blood results included complete blood cell count, clotting, and D-dimer. Creatine phosphokinase was 63 U/L (reference < 167 U/L) and troponin I levels were not raised. Her only hematological abnormality was an elevated C-reactive protein (CRP) at 60.2 mg/L (reference < 5 mg/L). Magnetic resonance imaging (MRI) scan showed signal hyperintensity involving T7 vertebral body, surrounding an enlarged SN. Patient was given oral nonsteroidal anti-inflammatory drugs, opioid analgesia, and gradually mobilized. After 3 days, the pain had sufficiently subsided and CRP was 17.8 mg/L. Follow-up MRI scan showed some reduction in the T2 hyperintensity and size of the intraosseous herniation. Patient gradually returned to full activities and had no recurrence of symptoms. MRI scan 8 months after the initial scan showed almost complete resolution of the T2 hyperintensity and pan-vertebral marrow edema. Conclusion Symptomatic SN should be part of the differential diagnosis of unexplained thoracolumbar pain. Modality of choice for diagnosis would be MRI. Once diagnosed, several treatment options are available with the most likely being spontaneous resolution of symptoms and bone healing within a few months. The conservative approach is recommended when the symptoms can be medically well controlled.
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Affiliation(s)
- Oded Hershkovich
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Jonathan E J Koch
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Michael P Grevitt
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, United Kingdom
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11
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Anyfantakis D, Symvoulakis EK. Insisting Pain on the Mid-scapular Line. Cureus 2019; 11:e6192. [PMID: 31890396 PMCID: PMC6919947 DOI: 10.7759/cureus.6192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022] Open
Abstract
Neoplastic diseases are commonly paired with a wide range of non-specific clinical symptoms. Even the most alarming complaints pose a low positive predictive value making diagnosis of an underlying malignancy a major detective challenge for the primary care physician. Therefore, although cancer may be suspected for not be missed, as management failure within primary care, diagnosis usually occurs in the context of a secondary care setting. Here we present a case of a patient seeking medical advice from his general practitioner due to a two-week history of back thoracic pain. Following investigations, the patient was early diagnosed with myeloma. Current notion of target-driven laboratory tests utility that may be used as possible clues for the detection of multiple myeloma at a primary care level is also discussed to enhance capacity.
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Affiliation(s)
| | - Emmanouil K Symvoulakis
- Clinic of Social and Family Medicine/Faculty of Medicine, University of Crete, Heraklion, GRC
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Mion F, Marjoux S, Subtil F, Pioche M, Rivory J, Roman S, Zerbib F. Botulinum toxin for the treatment of hypercontractile esophagus: Results of a double-blind randomized sham-controlled study. Neurogastroenterol Motil 2019; 31:e13587. [PMID: 30974039 DOI: 10.1111/nmo.13587] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Botulinum toxin injection is known to be efficient to treat achalasia. We conducted a randomized trial in order to evaluate its efficacy to treat symptomatic hypercontractile esophageal disorders as characterized by esophageal high-resolution manometry. METHODS Patients with significant dysphagia and/or thoracic pain related to an hypercontractile esophageal motility disorder as defined by the Chicago Classification were randomized to receive an injection of botulinum toxin (100 U in 10 points in the distal part of the esophageal wall) or a sham procedure. Symptoms were assessed at 3 months with the Eckardt score. Patients could receive a first or second botulinum toxin injection 1 month later if symptoms persisted. RESULTS Twenty-three patients (13 women, mean age 60 years) were included: 13 received botulinum toxin injection, and 10 a sham procedure. The improvement of symptoms at 3 months was significant compared to baseline, but similar in the active treatment and sham procedure arms. However, there was no change in quality of life scores. Seventeen patients received a second injection at 4 months. There was a significant trend toward improvement of symptoms up to the end of follow-up at 12 months, without a significant relationship with the administration of botulinum toxin. DISCUSSION Botulinum toxin injection is not superior to a sham procedure to improve symptoms related to hypercontractile esophageal disorders, suggesting an important placebo effect in for this type of disease. This observation must be taken into account when evaluating more aggressive therapies such as endoscopic myotomy (clinicaltrials.gov: NCT01955174).
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Affiliation(s)
- François Mion
- Hospices Civils de Lyon, Hospital E. Herriot, Digestive Physiology, Lyon, France.,Physiology Department, Université de Lyon, Lyon, France.,LabTau, INSERM U1032, Lyon, France
| | - Sophie Marjoux
- Hospices Civils de Lyon, Hospital E. Herriot, Digestive Physiology, Lyon, France
| | - Fabien Subtil
- Biostatistics Department, Hospices Civils de Lyon, Hospital E. Herriot, Lyon, France
| | - Mathieu Pioche
- Gastroenterology, Hospices Civils de Lyon, Hospital E. Herriot, Lyon, France
| | - Jerome Rivory
- Gastroenterology, Hospices Civils de Lyon, Hospital E. Herriot, Lyon, France
| | - Sabine Roman
- Hospices Civils de Lyon, Hospital E. Herriot, Digestive Physiology, Lyon, France.,Physiology Department, Université de Lyon, Lyon, France.,LabTau, INSERM U1032, Lyon, France
| | - Frank Zerbib
- CHU Bordeaux, Gastroenterology, Université de Bordeaux, Bordeaux, France
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Tamburrelli FC, Perna A, Meluzio MC, Albisinni U. A thoracic pain of difficult diagnosis. Unusual localization of osteoid osteoma. J BIOL REG HOMEOS AG 2019; 33:141-145. XIX Congresso Nazionale S.I.C.O.O.P. Societa' Italiana Chirurghi Ortopedici Dell'ospedalita' Privata Accreditata. [PMID: 31172731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Osteoid Osteoma (OO) is a benign tumor that can affect any age, but it occurs mostly in adolescents. Only few cases are reported in early infancy but very rare in advanced age. From our series of OO of the spine, we selected a rare case that combines many unusual features that makes diagnosis very difficult. A case of a painful thoracic syndrome in an old female patient due to an OO localized in the inferior edge of the left pedicle of T11 with engagement of the foramen was reported. The age of the patient, the absence of any typical clinical and diagnostic signs, such as nocturnal pain or side effects to NSAIDs administration, are unusual at presentation of OO. She presented instead, a type of pain to the chest that was stabbing, fulminating and radiating. The interest of the case is due to the association of a variety of clinical aspects that stimulate discussion as well as to the role of the modern investigative diagnostic process.
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Affiliation(s)
- F C Tamburrelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - A Perna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - M C Meluzio
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - U Albisinni
- Diagnostic and Interventional Radiology, The "Rizzoli" Institute, Bologna, Italy
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Abstract
COPD is a progressive condition that leads to a pathological degeneration of the respiratory system. It represents one of the most important causes of mortality and morbidity in the world, and it is characterized by the presence of many associated comorbidities. Recent studies emphasize the thoracic area as one of the areas of the body concerned by the presence of pain with percentages between 22% and 54% in patients with COPD. This article analyzes the possible causes of mediastinal pain, including those less frequently taken into consideration, which concern the role of the fascial system of the mediastinum. The latter can be a source of pain especially when a chronic pathology is altering the structure of the connective tissue. We conclude that to consider the fascia in daily clinical activity may improve the therapeutic approach toward the patient.
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Affiliation(s)
- Bruno Bordoni
- Foundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Institute of Hospitalization and Care with Scientific Address, Milan, Italy
| | - Fabiola Marelli
- CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore, Italy
- CRESO, School of Osteopathic Centre for Research and Studies, Fano, Italy
| | - Bruno Morabito
- CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore, Italy
- CRESO, School of Osteopathic Centre for Research and Studies, Fano, Italy
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Castagna
- CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore, Italy
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Abstract
This case report describes a 42-year-old female who presented with complaints of diffuse pain in her thoracic paraspinal region from T2 to T7. Physical examination revealed tenderness, increased turgor and restriction of her superficial fascia. A potential first time description of successful management utilizing fascia dry needling is described in this report with improvements noted in pain, range of motion, and functional activities. The patient was discharged from physiotherapy after four treatment sessions, and a follow-up after 3 months revealed that she was pain free and fully functional. A grading system (Sudarshan and Murugavel Dry Needling Grading Scale©) is proposed describing the various grades of dry needling to guide clinical reasoning and decision-making.
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Affiliation(s)
- Sudarshan Anandkumar
- a Registered Physiotherapist , CBI Health Centre , Chilliwack , British Columbia , Canada
| | - Murugavel Manivasagam
- b Physiotherapist, Rehabilitation Department , Brunei Jerudong Park Medical Centre , Jerudong Park , Brunei Darussalam
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Masaracchio M, Kirker K, Collins CK, Hanney W, Liu X. AN INTERVENTION-BASED CLINICAL REASONING FRAMEWORK TO GUIDE THE MANAGEMENT OF THORACIC PAIN IN A DANCER: A CASE REPORT. Int J Sports Phys Ther 2016; 11:1135-1149. [PMID: 27999727 PMCID: PMC5159637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND AND PURPOSE As a result of the anatomical proximity of the thoracic spine to the cervical, lumbar, and shoulder regions, dysfunction in the thoracic spine can influence pain, mobility, and stability across these areas. Currently, a paucity of evidence exists addressing treatment of individuals with primary thoracic pain, especially in young, athletic patients. Furthermore, current research discussing clinical reasoning frameworks focus on the differential diagnostic process. The purpose of this case report was to present a framework that describes the clinical reasoning process for the implementation and sequencing of procedural interventions for the management of a dancer with thoracic pain. CASE DESCRIPTION A 21-year-old female dancer presented to physical therapy with a medical diagnosis of thoracic pain. The patient reported exacerbation of left thoracic pain with prolonged sitting, twisting/arching her back during dance, and lifting >15 lbs overhead. Examination revealed hypomobility with positive pain provocation during mobility testing of T1-T3 and the sternocostal junction of ribs 2-4, with associated muscle guarding palpated in the left iliocostalis thoracis and levator scapulae. OUTCOMES Following 10 visits, the patient had no pain, no functional deficits, and a Global Rating of Change (GROC) of + 6. She returned to full competition, and a 3-month follow-up revealed continued success with dancing and a GROC of +7. DISCUSSION This case report described the successful management of a dancer with primary thoracic pain using a clinical reasoning framework for the sequencing of procedural interventions, while incorporating Olson's impairment-based classification system. A combination of manual therapy techniques and neuromuscular control exercises were incorporated to address mobility, stability, mobility on stability, and skill level impairments, which allowed the patient to return to dance activities safely. Future studies should consider the development of further treatment-based clinical reasoning frameworks that illustrate the importance of the sequencing within a session and across the episode of care. LEVEL OF EVIDENCE 4.
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Abstract
Acute chest pain is a frequent consultation reason in general practice as well as in emergency departments. With the help of history, physical examination, ECG, laboratory and newly developed risk scores, potentially life-threatening diseases and high-risk patients may be detected and treated early, quickly and cost-effectively. New biomarkers and their combination with risk scores can increase the negative predictive value to exclude certain diseases.
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Kent P, Kongsted A, Jensen TS, Albert HB, Schiøttz-Christensen B, Manniche C. SpineData - a Danish clinical registry of people with chronic back pain. Clin Epidemiol 2015; 7:369-80. [PMID: 26316820 PMCID: PMC4540159 DOI: 10.2147/clep.s83830] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Large-scale clinical registries are increasingly recognized as important resources for quality assurance and research to inform clinical decision-making and health policy. We established a clinical registry (SpineData) in a conservative care setting where more than 10,000 new cases of spinal pain are assessed each year. This paper describes the SpineData registry, summarizes the characteristics of its clinical population and data, and signals the availability of these data as a resource for collaborative research projects. Methods The SpineData registry is an Internet-based system that captures patient data electronically at the point of clinical contact. The setting is the government-funded Medical Department of the Spine Centre of Southern Denmark, Hospital Lillebaelt, where patients receive a multidisciplinary assessment of their chronic spinal pain. Results Started in 2011, the database by early 2015 contained information on more than 36,300 baseline episodes of patient care, plus the available 6-month and 12-month follow-up data for these episodes. The baseline questionnaire completion rate has been 93%; 79% of people were presenting with low back pain as their main complaint, 6% with mid-back pain, and 15% with neck pain. Collectively, across the body regions and measurement time points, there are approximately 1,980 patient-related variables in the database across a broad range of biopsychosocial factors. To date, 36 research projects have used data from the SpineData registry, including collaborations with researchers from Denmark, Australia, the United Kingdom, and Brazil. Conclusion We described the aims, development, structure, and content of the SpineData registry, and what is known about any attrition bias and cluster effects in the data. For epidemiology research, these data can be linked, at an individual patient level, to the Danish population-based registries and the national spinal surgery registry. SpineData also has potential for the conduct of cohort multiple randomized controlled trials. Collaborations with other researchers are welcome.
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Affiliation(s)
- Peter Kent
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark ; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Tue Secher Jensen
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark ; Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | | | - Berit Schiøttz-Christensen
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | - Claus Manniche
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
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Gräni C, Senn O, Bischof M, Cippà PE, Hauffe T, Zimmerli L, Battegay E, Franzen D. Diagnostic performance of reproducible chest wall tenderness to rule out acute coronary syndrome in acute chest pain: a prospective diagnostic study. BMJ Open 2015; 5:e007442. [PMID: 25631316 PMCID: PMC4316553 DOI: 10.1136/bmjopen-2014-007442] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Acute chest pain (ACP) is a leading cause of hospital emergency unit consultation. As there are various underlying conditions, ranging from musculoskeletal disorders to acute coronary syndrome (ACS), thorough clinical diagnostics are warranted. The aim of this prospective study was to assess whether reproducible chest wall tenderness (CWT) on palpation in patients with ACP can help to rule out ACS. METHODS In this prospective, double-blinded diagnostic study, all consecutive patients assessed in the emergency unit at the University Hospital Zurich because of ACP between July 2012 and December 2013 were included when a member of the study team was present. Reproducible CWT on palpation was the initial step and was recorded before further examinations were initiated. The final diagnosis was adjudicated by a study-independent physician. RESULTS 121 patients (60.3% male, median age 47 years, IQR 34-66.5 years) were included. The prevalence of ACS was 11.6%. Non-reproducible CWT had a high sensitivity of 92.9% (95% CI 66.1% to 98.8%) for ACS and the presence of reproducible CWT ruled out ACS (p=0.003) with a high negative predictive value (98.1%, 95% CI 89.9% to 99.7%). Conversely non-reproducible CWT ruled in ACS with low specificity (48.6%, 95% CI 38.8% to 58.5%) and low positive predictive value (19.1%, 95% CI 10.6% to 30.5%). CONCLUSIONS This prospective diagnostic study supports the concept that reproducible CWT helps to rule out ACS in patients with ACP in an early stage of the evaluation process. However, ACS and other diagnoses should be considered in patients with a negative CWT test. TRIAL REGISTRATION NUMBER ClinicalTrial.gov: NCT01724996.
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Affiliation(s)
- Christoph Gräni
- Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland
| | - Manuel Bischof
- Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Pietro E Cippà
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Till Hauffe
- Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Zimmerli
- Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Center of Competence Multimorbidity and University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Edouard Battegay
- Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Center of Competence Multimorbidity and University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Daniel Franzen
- Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
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Aruj PK, Lescano M, Rausch S, Mouesca V. [Intrathoracic schwannoma]. Medicina (B Aires) 2014; 74:225-226. [PMID: 24918672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
The schwannoma (neurilemmoma) is a slow-growing benign tumor originating from Schwann sheath whose location in the chest cavity is exceptional. It is generally asymptomatic and is discovered incidentally but can cause symptoms when the lesion grows or invade underlying structures. Its importance lies in the possibility of confusion with malignant tumors. We present a patient who complains of chest pain caused by a prolonged course schwannoma. The tomographic image is suggestive of extrapulmonary tumor, so the schwannoma in this location should be considered in the differential diagnosis of metastatic or primary pleural tumors such as lipoma, solitary fibrous tumor and mesothelioma.
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Affiliation(s)
- Patricia K Aruj
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires (UBA), Argentina. E-mail:
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