Abstract
Introduction: Pain is a subjective experience. Perception of the pain intensity is influenced by multiple factors including genetic, socio-economic and psychological factors. Chronic non-cancer pain represents the socioeconomic burden. In adolescent population, osteoid osteoma has an incidence of 10-12% in all symptomatic benign bone tumors. Nonsteroid anti-inflammatory drugs (NSAIDs) are the most frequently used medications for non-cancer pain treatment. Case report: Male, 17 years old, complained about moderate low back pain. Clinical examination was performed and subsequent diagnostic procedures (ultrasound examination of abdomen, nuclear magnetic resonance examination, and radiographic examination of lumbal spine) revealed discopathia and left leg sensory neuropathy. After examination by a pediatrician, physical medicine specialist and an orthopedic surgeon, he started using analgesic (ibuprofen 600 mg), vitamins and physical treatment. Diclofenac 75 mg was added for severe pain management. Haematuria, eosinophylia, decreased creatinine clearance were consequences of NSAIDs toxic nephritis. NSAIDs were stopped and patient reffered to pain specialist - different focuses of pain were suspected. Subspecialist verified pricking and heating sensation in upper leg, severe hip pain without functional deficit and dominating neuropathic pain originating from spinal nerve compression. New radiography reveiled presence of osteoid osteoma of the hip, and after orthopedic consultation, surgery (biopsy of tumor and tumor extirpation) was performed. In the postoperative period, strong pain disappeared, pregabalin was introduced and neuropathic pain was reduced by 20% and low back pain by 30%. Discussion: NSAIDs are the first line treatment of wide range of pain states. NSAIDs can cause numerous serious side effects including acute interstitial nephritis. Conclusion: Multiple causes and types of pain can exist simultaneously, therefore detailed physical examination, followed by other diagnostic Pre primene analgetika, neophodno je izvršiti detaljan klinički pregled i dijagnostičke pretrage, čime bi se smanjila nekritična primena NSAIL.
Highlights
Non-cardiac surgery is usually performed on elective basis
Neither Mangano nor Lidsky in their studies found the association between preoperative coronary artery disease (CAD) and both major cardiac events and subsequent mortality after surgical intervention[2,19], our results showed statistically significant association with fatal events in short-term follow-up
In summary, this study has shown that preoperatively increased levels of cardiac biomarkers are positively associated with short-term mortality in postoperative period after major abdominal or vascular surgery, and they can serve as important predictors of fatal events
Summary
Non-cardiac surgery is usually performed on elective basis. This type of surgery can be associated with significant cardiovascular morbidity and mortality. One of the most important predictors of complications is Coronary Artery Disease (CAD)[1,2]. When a patient with ischemic cardiac disease undergoes a high-risk surgery, the risk of cardiac complications rises almost tenfold[3]. There are powerful biomarkers that reflect myocardial injury, heart failure, valvular heart disease, as well as CAD. From a group of potential biomarkers, B-type Natriuretic Peptide (BNP) and N-Terminal Pro B-type natriuretic peptide (NT-proBNP), and troponins seem to be the most important[4, 5]
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