Complaints Of Pain Research Articles

Musculoskeletal disorders and quality of life of artisanal fishermen from riverside localities in the Brazilian Amazon.

Artisanal fishing is widely practiced in the Amazon region. However, the exhaustive labor demand impacts on the health of fishermen. Thus, this study aimed to evaluate the prevalence of musculoskeletal disorders (MSDs) and the relationship with the quality of life (QoL) of artisanal fishermen. A cross-sectional study was carried out, evaluating male fishermen from two rural communities bordering Janauacá lake, Amazonas. Data were collected through interviews, using REDCap installed on smartphones. The Nordic Musculoskeletal Questionnaire was utilized to identify the body regions with the greatest pain complaints, and QoL was assessed using the mental and physical components of the SF-12. After the descriptive analysis, linear regression analysis was performed to evaluate the association between the occurrence of MSDs and the components of QoL. The analyses were performed using Stata SE software, version 17. In total, 115 fishermen were evaluated. MSDs were reported in all of the body regions assessed, with a higher prevalence in the lower (80.0%) and upper (43.5%) back, and knee (40.9%). Lower QoL scores were observed in emotional performance (20.7 ± 4.0), physical performance (25.1 ± 4.3), and mental health (29.0 ± 13.6). It was observed that individuals with any MSD presented worse QoL in the physical component (βadj=-5.0; 95%CI=-9.7; -0.3). The findings showed a high prevalence of MSDs in the study population, as well as its impact on the QoL of artisanal fishermen. This highlights the need to reorganize health services to prevent the occurrence of MSDs, as well as for their treatment and rehabilitation.

The effectiveness of intramuscular dry needling stimulation in treating trigger points: A case series

Myofascial trigger points are a common presentation in clients with chronic spinal pain. Various techniques are used to manage trigger points and are considered a vital part of chronic spinal pain management. Reducing pain caused by trigger points may be effective in improving function. Case series can provide preliminary evidence and assist in feasibility assessment. The objective of this case series is to document the feasibility of intramuscular dry needling stimulation in managing trigger-point-induced chronic pain. Three individuals aged 35, 33, and 28 years presented to a private clinic with chief complaints of scapular region muscular pain, and their management is reported in this case series. Initial physical examination revealed tenderness over D6 and D8. There was a palpable para spinal muscle hypertonicity and reduced thoracic spine mobility to both sides in all the three clients. The presence of multiple trigger points bilateral to the spine indicated postural dysfunction, which altered pain on changing thoracic posture. Clients were treated with dry needling with intramuscular stimulation over trigger points, paraspinal muscle and inferior to scapula by a therapist trained in the technique. The frequency was kept at 1.5 Hz and intensity was as tolerated by the patient. Outcome measures were taken using VAS, RMDQ and digital inclinometer for thoracic spine rotation. Subject one reported a change of 22 mm in VAS after the first week and 40 mm in the fourth week. It also reported an improvement in mobility to both side rotations by 20 degrees in the first week and full towards the fourth week. Subject two and three improved VAS by 10 mm in week one and 35 mm towards the fourth week. Full mobility was achieved in the fourth week in both cases. RMDQ scores improved significantly in the three cases. The three cases demonstrate significant improvement in both symptoms and function based on outcome measures. This indicates the efficacy of treating thoracic spine myofascial trigger points with dry needling and intramuscular stimulation, but a large-scale study is recommended.

Pyogenic liver abscess due to Burkholderia pseudomallei in immunocompetent patient from Garhwal region of Uttarakhand – A case report

We report a case of liver abscess due to Burkholderia pseudomallei in a 45-year-old, non-diabetic patient from the Garhwal region of Uttarakhand. The patient reported chief complaints of abdominal pain and fever. Ultrasonography and contrast-enhanced computed tomography of the whole abdomen were suggestive of the left liver lobe abscess. Pus was aspirated from the abscess and sent for culture and sensitivity. Growth on the culture plate was identified as B. pseudomallei; the patient was then treated with appropriate antibiotics and discharged in stable condition. Diagnosis of pseudomallei infection requires a high index of suspicion among clinicians as well as laboratory specialists. Early identification of organisms helped clinicians initiate appropriate management in our case.

Preventing unnecessary echocardiograms in de novo patients referred to the cardiology outpatient clinic using electrocardiogram-based deep learning

Abstract Introduction The growing demand on European echocardiography labs, driven by the rise in structural heart disease (SHD), is further complicated by a shortage of skilled sonographers, necessitating resource optimisation strategies. Electrocardiogram (ECG)-based deep learning models may assist in streamlining the echocardiography workflow. Purpose This study sought to develop a deep learning model capable of identifying patients at very low risk of SHD in a population of de novo patients referred to the cardiology outpatient clinic. Methods We identified all adult patients who underwent a 12-lead ECG and echocardiogram at a Dutch academic teaching hospital between 2011 and August 2023. Echocardiogram outcomes were extracted from reports, including left ventricular systolic dysfunction (LVSD), left ventricular dilatation (LVD), aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR), and tricuspid regurgitation (TR), from which a composite outcome label was derived. A cohort of patients newly referred to our cardiology outpatient clinic with a primary complaint of chest pain, dyspnea, palpitations, dizziness, a murmur, or an abnormal ECG was held out as a test set, while the remaining dataset was split patient-wise into training (90%) and validation (10%) sets. A convolutional neural network was trained using only the ECG tracing as input and the composite label as outcome. Results We included 92,210 ECG-echo pairs from 44,785 patients (19,717 female) with 25,543 (27.7%) abnormal ECG-echo pairs. Among 2724 newly referred patients in the test set, 210/1389 males (15.1%) and 201/1335 females (15.1%) were diagnosed with SHD. In the test set, the model for predicting composite outcome demonstrated an area-under-the-curve, negative predictive value, and specificity of 0.74 (95% confidence interval [CI] 0.71-0.79), 0.94 (95% CI 0.92-0.95), and 0.47 (95% CI 0.45-0.49), respectively. Conclusion This study demonstrates the feasibility of employing deep learning models based solely on electrocardiogram (ECG) data to identify patients at very low risk of structural heart disease (SHD). Further validation and prospective studies are warranted to confirm the generalizability and clinical utility of our findings in diverse patient populations and healthcare settings.

Language barrier as social determinant of health: unmasking the disparities in the emergency department evaluation for patients with chest pain at a community hospital

Abstract Background/Introduction Patients with limited English proficiency (LEP) constitute 8.6% of the United States population. They may have lower health literacy related to cardiovascular disease, reluctance to seek care, and communication difficulties in reporting symptoms, posing challenges to care provision. Throughout medical literature, these barriers reportedly lead to increased utilisation of diagnostic testing, hospital admission rate, and length of stay. Purpose Language barrier appears to negatively impact individuals' healthcare experience. The goal of this study is to examine whether disparities exist in the emergency department (ED) evaluation and management of chest pain in LEP patients by comparing their wait time and admission rate to that of English-proficient (EP) counterparts. Methods This retrospective cohort study included adults age 18 or older that presented to our hospital ED with a chief complaint of chest pain from 1/9/2022 to 30/9/2023. We identified all LEP patients during this period and matched a random sample of EP patients in a 1:2 ratio. We treated each encounter as an independent subject and eliminated those that left prior to disposition. Our primary outcomes were time from arrival to provider evaluation, and admission rate. Covariates were sex, age, race, acuity level, arrival mode, and insurance status to adjust for characteristic difference between cohorts. Descriptive comparisons between cohorts and bivariate outcomes were conducted using independent samples t-tests for continuous variables and chi-squared tests for categorical ones. Multivariable linear and logistic regression models were used to compute adjusted mean wait time for provider and adjusted odds of admission, respectively. All analyses were done on SAS 9.4. Results Our study sample included 690 encounters, with 239 LEP and 451 EP patients. The two cohorts were similar in sex, age, and acuity level, but there were significant disparities in insurance status, arrival mode, and race. A higher proportion of EP patients were admitted to the hospital or observational unit than LEP patients (45.0% vs. 28.0%, respectively, P<0.001). After multivariable adjustment, LEP patients were half as likely to be admitted compared to EP patients (adjusted odds ratio, 0.51 [95% CI, 0.35-0.74], P<0.001). LEP patients waited longer for provider evaluation from the point of ED arrival, though this was not statistically significant when adjusting for acuity and arrival mode (19.6 minutes, [95% CI, 5.9-45.1], P=0.132). Conclusions Whilst we did not observe a significant difference in wait time for provider between LEP and EP patients, LEP patients were less likely to be admitted when presenting with chest pain at the ED. One possibility is that language barrier may limit a patient’s ability to convey cardiac versus non-cardiac chest pain, adversely influencing downstream management and outcomes. To address this, further large-scale investigation is needed.

What matters most to healthy older adults in treatment decision making: a discrete choice experiment

Abstract Introduction Shifting to a patient centered approach is crucial for a sustainable healthcare system. Understanding individuals’ priorities is essential for personalized care, especially in critical illness. Treatment decisions are often aimed at disease-specific outcomes such as life extension or survival, while patient-specific outcomes like maintaining independence may be equally vital. How healthy older adults prioritize treatment outcomes in case of a critical illness is currently unknown. Enhanced insight into their priorities can refine healthcare policy, for more personalized care. This study investigated outcomes (attributes) prioritized in hypothetical decision-making by healthy adults over 50 yr. Methods We conducted a Discrete Choice Experiment with individuals aged ≥50, comparing six pairs of hypothetical treatments with five attributes: life expectancy, independence, pain, memory complaints and societal costs. Attribute utility was analyzed using a conditional logit model, and latent class analyses were employed to explore preferences in groups. Results In 333 participants (mean age 70 +/- 7.7) all attributes emerged as impactful with independence being strongest (p < 0.05). Increased life expectancy had positive utility, but only for a two-year increase. Negative utility was found for all other attributes except mild pain and memory complaints. Latent class analyses identified two groups (22.4% and 77.6%). Group one valued life expectancy more (p .019 vs .940), whereas the second group valued independence (p .058 vs.<.001 and societal costs (p.053 vs. <.001) more. Conclusions In a hypothetical case of life-threatening disease, for people aged ≥ 50 life expectancy was not the sole relevant outcome for treatment decisions; pain, independence and societal costs are important and should be discussed in clinical decision making or healthcare policy. Key messages • Older adults find patient-specific outcomes relevant for decision making. • Societal costs are found relevant for decision making for treatment by older adults.

Efficacy of Arkadi Agada Lepa in Honey Bee Sting in Albino Mice

In Samhita Granthas many Keetas are explained, some of them are never heard before. Today not only their existence but also their availability is difficult. Due to honey bee sting patient initially complaints of pain, swelling, redness of skin around sting. Severe side effects as nausea, fainting & in extreme cases patient may get die due to anaphylactic shock. According to Ashtang Hruday Uttarsthan for all type of kita visha Arkadi Agad is beneficial. Honey Bee is included in kita visha .considering the importance of local application (lepa) in all types of poisoning. Arkadi Agad Lepa selected to study its effectiveness in honey bee sting in Albino Mice.

Osteochondroma of the distal tibia with associated varus deformity of ankle

Osteochondroma or exostosis is a bony developmental anomaly, which arises from exophytic outgrowth on bone surfaces characteristically. The most common site is the distal femur followed by the proximal humerus and proximal tibia. It is made up of a bony protrusion that is covered by a cartilage cap. Osteochondroma is asymptomatic and grows away from the nearby joint. It is very common in kids and young adults. Sometimes patient comes in 2nd decade with complaints of pain and swelling. This paper reports a presentation of osteochondroma present over the right distal tibia.

The Relationship Between Tramadol Use and Cardio Electrophysiological Balance for Postoperative Pain Treatment in General Surgery Patients

Background and Objective: This study aimed to investigate the relationship between tramadol use and cardio electrophysiological imbalance (iCEB/iCEBc) in general surgery patients with complaints of acute postoperative pain (APP). Materials and Methods: In this prospective cross-sectional study, a total of 218 consecutive patients over the age of 18, who underwent surgical procedures in our clinic (postoperative), were included. For analgesic effect, tramadol was administered with an initial total max dose not exceeding 2 mg/kg. A single max dose (100 mg) was given intravenously, infused in 100 cc of saline over 60 min. In all patients requiring analgesia, electrocardiography (ECG) was performed in the supine position with 12 leads at 25 mm/s and 10 mm/mV, immediately before and after tramadol administration. iCEB was calculated as QT/QRS and iCEBc as QTc/QRS. Results: A total of 218 patients were included in this study, with 98 of them being male (45%) and the average age being 46.20 ± 17.19 years. The average tramadol dose for analgesic effect was 98.21 ± 7.62 mg. The QT interval (339.17 ± 36.27 vs. 349.88 ± 30.86, p = 0.001), QTc interval (407.07 ± 26.36 vs. 419.64 ± 31.78, p < 0.001), QRS duration (80.82 ± 11.39 vs. 78.57 ± 9.80, p = 0.018), iCEB (4.26 ± 0.69 vs. 4.52 ± 0.70, p < 0.001), and iCEBc (5.14 ± 0.86 vs. 5.42 ± 0.79, p = 0.001) values significantly increased compared to the baseline immediately after drug administration. Furthermore, the drug dose was identified as an independent predictor that increased iCEBc (β = 0.201, p = 0.003). Conclusions: Even at single and therapeutic doses, tramadol increases iCEB and iCEBc. Additionally, the drug dose is an independent predictor of increased iCEBc.

Case Report of Phacolytic Glaucoma in the Eye Department of Dr. M. Djamil Hospital Padang

A 68-year-old man came to the polyclinic at a type A hospital in West Sumatra with complaints of pain in the right eye since 3 weeks before coming to the hospital. Anamnesis and physical examination were performed on the patient and a diagnosis of phacolytic glaucoma was established. This article aims to report a case of phacolytic glaucoma which is a rare case of secondary open-angle glaucoma.

Typical tactics of treatment of patients with chronic non-specific back pain and tension-type headaches

Non-specific (musculoskeletal) back pain (NBP) and tension-type headache (THA) are among the most common conditions in neurological practice that significantly impair patients' ability to work. The typical practice of treating patients with NBP and THA has not been sufficiently investigated, which formed the basis for conducting this study.Objective: to evaluate the quality of diagnosis and treatment of chronic NBP and THA in real-life neurological practice.Material and methods. The study included 120 patients with chronic NBP and combined THA of different frequency (32 men and 88 women, mean age 38.4±9.6 years) who were treated in A.Ya. Kozhevnikov Clinic of Neurologic Diseases (CND) of Sechenov University with complaints of back pain and headache and who had previously been examined and treated by neurologists and therapists in other medical institutions on an outpatient and/or inpatient basis. All patients underwent a clinical interview to establish a diagnosis and analyze previous treatment, a neurological and neuro-orthopedic examination and a psychometric examination to assess anxiety and depression symptoms.Results. Prior to contacting CND, only 10% of patients had a diagnosis of chronic NBS, only 7% had a diagnosis of THA and the remaining patients had other misdiagnoses. All patients had previously undergone additional examinations, mainly neuroimaging of the spine and brain, ultrasound examination of the neck vessels, even if there were no "red flags" – signs of danger in back pain and headache. None of the patients had previously had their emotional state assessed, while 75% of patients had symptoms of depression of varying severity and all patients suffered from anxiety of varying severity. Neuro-orthopaedic examination was performed in only 10% of patients. All patients received nonsteroidal antiinflammatory drugs for back pain, and most patients received vascular and nootropic medication for headaches. Of the non-pharmacological methods, massage and passive physiotherapy were most frequently prescribed. Only 9% of patients were recommended kinesiotherapy, and only 5% of patients performed it.Conclusion. In real-life medical practice, chronic NBP and THA are inadequately diagnosed, excessive and unjustified additional examinations are prescribed, unsatisfactory level of treatment, and patients with chronic NBP and THA are rarely prescribed kinesiotherapy.

Prehospital management and outcomes of patients calling with chest pain as the main complaint

BackgroundChest pain is a frequent cause of health care contacts. We examined the prehospital management, in-hospital discharge diagnoses, and mortality of patients calling a non-emergency and emergency medical service with chest pain.MethodsThe Copenhagen Emergency Medical Services (EMS) consists of a non-emergency medical helpline (calls to 1813) and emergency medical service (1-1-2 calls). We included all calls to the Copenhagen EMS with a primary complaint of chest pain from 2014 to 2018 in Copenhagen, Denmark. The outcomes were: emergency response (ambulance dispatch, other transports/self-transport/home visits, self-care, and unknown/cancelled response), in-hospital diagnosis within 7 days after the call (cardiovascular, pulmonary, or other non-cardiovascular/pulmonary) and 30-day mortality.ResultsAmong 4,834,071 calls, 91,671 were registered with chest pain at the Copenhagen EMS. The first call for each patient was kept for analysis (n = 66,762). In total, 91.4% were referred to the hospital, 75.8% (n = 50,627) received an ambulance and 15.6% (n = 10,383) received other transport/self-transport/home visits. Overall, 26.9% (n = 17,937) were diagnosed with a cardiovascular disease, 5.2% (n = 3,490) a pulmonary disease, 52.8% (n = 35.242) other non-cardiovascular/pulmonary disease, and 15.1% (n = 10,093) received no diagnosis. Among ambulance-transported patients, the prevalence of cardiovascular discharge diagnoses was higher (32.1%) and fewer received no diagnosis (11.0%). Cardiovascular disease was less prevalent among patients not transported by ambulance and patients not referred to hospital at all (2-13.4%) and in patients ≤ 40 years of age (< 10%). The 30-day mortality was below 5% regardless of diagnosis (0.6-4%), and 65,704 (98.4%) were still alive 30 days later.ConclusionNearly all patients calling with chest pain were referred for treatment. Among ambulance-transported patients, around half of the patients did not have a cardiovascular/pulmonary disease. While current practices appear reasonable, improved differentiation of chest pain patients in telephone consultations could potentially both improve the treatment and management of these patients and reduce the in-hospital burden of non-acute chest pain consultations.

Extensive Synovial Chondromatosis of the Temporomandibular Joint Extending to the Cranial Base.

A 42-year-old male presented to the Department of Oral and Maxillofacial Surgery with the chief complaint of pain and stiffness in the right temporomandibular joint (TMJ). The patient's height was 174 cm and his body weight was 65 kg. The patient's occupation was heavy equipment operator. According to the patient, the pain had initiated a week prior to his first visit and was exacerbated during mastication. Evaluation of the range of motion revealed extensive crepitus along the right TMJ. The active and passive range of motion were measured at 45 mm and 42 mm, respectively, indicating adequate mouth-opening capacity. Occlusion was also favorable, and no other clinical symptoms were shown intraorally.

Neurosarcoidosis Masquerading as Spinal Stenosis.

A 65-year-old woman was admitted to the neurology department with a suspected demyelinating disease due to complaints of progressive pain and weakness in both upper and lower limbs, as well as urinary incontinence. MRI of the spine revealed complex disc osteophyte with compression of the spinal cord in the cervical and lumbar spine at several vertebral levels, and localized enhancement in the cervical spine at the site of maximal spinal canal stenosis. During her hospitalization, the patient underwent extensive evaluation to rule out any systematic inflammatory diseases, infections, and malignancy. Chest CT revealed bilateral mediastinal lymphadenopathy. Transbronchial mediastinal lymph node biopsy showed numerous non-necrotizing granulomas without evidence of malignancy. After a thorough and careful exclusion of a demyelinating, infectious, and paraneoplastic myelopathies, and based on clinical, radiographic, and pathological findings, the patient was diagnosed with both neurosarcoidosis and spondylotic myelopathy. She was then treated for neurosarcoidosis, including glucocorticosteroids, azathioprine, and a biosimilar of the anti-TNF alpha agent infliximab, resulting in both clinical and radiographic improvement. Intramedullary spinal neurosarcoidosis is very rare and may present with clinical features of spondylotic myelopathy, with typical imaging findings occurring only in areas of spinal canal stenosis.

Successful Subungual Glomus Tumor Removal: A Case Report and Future Guidance on Diagnosis and Treatment

Background: Glomus tumors are rare benign hamartomas of the glomus body that occur mostly – though not limited to - the distal phalanxes of the digits. This article provides a real-life example of successful rare disease identification and treatment. It also provides a guideline that may help serve as future guidance on diagnosis and treatment. Case: A 41-year-old male came to our hospital presenting with a chief complaint of episodes of throbbing pain, which occurred spontaneously on the left thumb for the past two years. The pain had worsened in the past two weeks. The patient was positive for Hildreth’s, Love’s pin, and cold sensitivity tests. The previous x-ray showed no abnormalities in the left thumb. MRI found a hyperdense subungual lesion in the dorsal interphalangeal joint of the left thumb. We then performed an excision using the transungual approach. Histopathological findings found a relatively well-circumscribed lesion of the glomus apparatus absent of abnormal mitosis and necrosis. Two months after the excision, the patient reported no symptoms of recurrency, nail deformity, or other adverse outcomes. Conclusion: Patients typically present a chief complaint of chronic paroxysmal throbbing nail pain that persists for years, increases following exposure to cold environments, and is disproportionately exacerbated with the slightest touch. Hildreth’s, Love’s Pin, and cold sensitivity tests are special examinations that elicit or suppress pain. As with most benign tumors, complete excision usually yields good results. Adequate knowledge about diagnostic methods will help patients achieve early intervention and cure.

Clinical spectrum and prevalence of temporomandibular joint disorder: A hospital-basedanalysis

Objective: The objective of this study was to determine frequency of temporomandibular joint disorders and its severity among patients presenting with complaints of pain at tempo mandibular joint. Materials and methods: A total of 205 patients were selected in this study, the research has been done in unit of oral and maxillofacial surgery at darul-sehat hospital, Karachi. Patients, age 18 to 40 years, with history of diabetes, hypertension, habits of pan/chalia and smoking presented with complain of pain at temporomandibular joint for a period of two weeks were recruited in study. Patients with history of bone &amp; neurological disorder, taking immunosuppressant drug, trauma or surgery of temporomandibular joint were excluded from study. Examinations were carried out by single researcher to ensure the continuity and reliability of answers and interpretation of results. This will also help to eliminate inter-observer biases. Data gathered using a questionnaire and analyzed using SPSS software version 20. Results: A total of 205 patients which fulfilled the inclusion criteria were included in the study, including 99(48.3%) males and 106(51.7%) females. The age ranged from 18-40 years were included, belonging to age 15-20 years n=73(35.3%), 21-25 years n=65(31.4%), 26-30 years n=2(1%), 31-35 years n=60 (29%), and 36-40% years n=5 (2.4%). Around 42 (20.5%) patients had history of hypertension while 40 (19.5%) had diabetes, for which they were taking their medicines. History of smoking was seen among 38 (18.5%) patients.Disease was categorized as mild in 98 (47.8%) patients, moderate in 88 (42.9%) patients and severe in 19 (9.3%) patients. Around 158 (77.1%) had unilateral and 47 (22.9%) had bilateral disorder. Out of 205 patients most of them had temporomandibular joint disorder 192(93.7%). Conclusion: temporomandibular joint disorder is most common cause of orofacial pain and requires thorough knowledge and adequate examination to diagnose the disorder.

Adenomatoid tumor of ovary – A rare case

Adenomatoid tumors are benign tumors of mesothelium and rare tumors found in male and female genital tract. They are more common in males than females. They account for 30% of all paratesticular neoplasm in males and 1.2% tumors of uterus. There are very few cases reported in ovaries. A 62 year old female presented with complaints of vague abdominal pain. Ultrasonography showed a unilateral tumor with of neoplastic etiology. The diagnosis of adenomatoid tumor of ovary postulated based on the distinct features numerous small vacuoles and cystic spaces of the neoplasm.

Congenital Appendiceal Atresia: An Extremely Rare Disorder Presenting with Acute Abdomen

Abstract Introduction/Objective Congenital malformations of the appendix are extremely rare and difficult to diagnose preoperatively. One of those anomalies include congenital appendiceal atresia (CAA) which mimics acute appendicitis and is usually ignored in the differentials of acute abdomen. Herein, we present a case study of congenital appendiceal atresia associated with periappendicitis. Methods/Case Report A 62-year-old female with past history of diverticulitis presented with complaints of crampy, diffuse and progressive lower abdominal pain and nausea for two days. She denied fevers, chills or change in bowel movements. Physical examination revealed vitally stable patient with soft, non-distended and tender abdomen in bilateral lower quadrants, worse on the right side and showing positive rebound test. Her complete blood count and chemistry were within normal limits. A computerized tomography arterial portography (CTAP) scan with contrast demonstrated inflammatory stranding around the appendix without abscess, concerning for acute appendicitis. She then underwent laparoscopic appendectomy. Grossly, the appendix consisted of a cylindrical portion of yellow-pink fatty tissue covered by peritoneum measuring 6.2 x 3.3 x 0.5 cm. The peritoneal surface displayed patchy fibrinous exudates. Sectioning revealed yellow adipose tissue with no identifiable appendix. Microscopically, the entire specimen demonstrated a poorly formed, mainly fatty appendix without a discernible lumen or submucosal lymphoid tissue. There were scattered sparsely distributed non-continuous bundles of smooth muscle (muscularis propria) at the periphery, which were highlighted by desmin and trichrome stains. This atretic appendix, mesoappendix and peritoneal covering were acutely inflamed. The final diagnosis was poorly formed, acutely inflamed fatty appendix consistent with congenital appendiceal atresia with accompanying acute periappendicitis. Results (if a Case Study enter NA) NA Conclusion This case would add to the very limited existing literature for congenital appendiceal anomalies and highlight the importance of thorough surgical intraoperative abdominal exploration and submission of the entire specimen for microscopic examination in order to render a definitive diagnosis.

Unusual Presentation: Nephroblastoma/Wilms tumor in an Adult – A Case Report

Abstract Introduction/Objective Nephroblastoma/Wilms tumor is a common renal tumor primarily observed in children, and its occurrence in adults is exceedingly rare. This rarity contributes to the diagnostic challenges encountered in adults. Here, we present a case of a 32-year-old male diagnosed with biphasic nephroblastoma/Wilms tumor in the kidney, with liver and lung metastases. Methods/Case Report A 32-year-old male, without significant past medical history, presented with the chief complaint of abdominal pain for 2-3 weeks. Imaging studies revealed a substantial 17.5 cm kidney lesion accompanied by numerous lung and liver lesions. A liver biopsy indicated a small blue cell tumor, morphologically and immunophenotypically, (positive WT1) resembling nephroblastoma, with a strong suspicion of metastasis. Subsequent kidney biopsy confirmed a small blue cell malignant tumor demonstrating biphasic features, including blastema and epithelial components forming tubular structures similar to the liver biopsy, predominantly showing the blastemal component. The renal tumor biopsy supported the diagnosis of nephroblastoma. Despite chemotherapy, the patient passed away two months after the initial liver tumor biopsy. Results (if a Case Study enter NA) NA Conclusion Diagnosing nephroblastoma in adults poses significant challenges, particularly when initial presentations involve metastases. The occurrence of pediatric tumors in adulthood, though rare, should be considered in the diagnostic process after exhausting other possibilities. It is also important to note that the clinical presentation of pediatric tumors in adults may deviate from typical patterns. While Wilm’s tumor commonly presents as a painless, palpable abdominal mass in pediatric cases, adults may exhibit abdominal pain as the predominant symptom, as present in our case.

EXPERIENCE OF CLINICAL AND RADIOGRAPHIC CORRELATION IN PATIENTS WITH PAIN SYNDROME OF TMJ DYSFUNCTION IN ATRICULATION-OCCLUSIVE DISORDERS

This article examines the imaging anatomy of the temporomandibular joint (TMJ), describes the technique of calculating the gaps between the fossa and the head, their comparison based on TMJ computed tomography (CT) data, and their comparison with clinical signs of TMJ dysfunction. The aim was to determine CT diagnostic criteria for persistent functional displacement of the lower jaw in patients with TMJ functional disorders in occlusal-articulation disorders at the stage of orthopedic treatment planning. Research materials and methods. A clinical and radiological examination of 150 patients with functional disorders of the masticatory apparatus and occlusal disorders, who were included in the experimental group, and 30 practically healthy persons – the control group, was carried out. The results. The presence of a pain syndrome was primarily determined - 60 patients (40.00%) complained of pain in the TMJ area, masticatory muscles or headache, and in 19 (31.67%) of them, complaints of pain bothered more than half year TMJ pain was found in 30 (20.00%) patients, in masticatory muscles in 43 (28.67%), headache in 47 (31.33%). Hypertonus of the masticatory muscles was established - 94 - 62.67% with their hypertrophy - 46 - 30.67%, both unilateral and bilateral, which were observed simultaneously with the parafunction of the masticatory muscles (34 - 22.67%). Palpatory functional stable displacement of the lower jaw was determined in 135 (90.00%) patients of the research group, in 57 (42.22%) of them significant pain syndrome was present in 46 (80.70%). At the same time, deviation or deflexion was established in 74 (49.33%) patients of the experimental group, restriction of mouth opening in 52 (32.67%) patients; crunching and clicking in the TMJ - 112- 74.67%. The presence of bilateral posterior displacement of the heads of the lower jaw was established in 103 (68.67%) patients with TMJ dysfunction, of which 42 (40.77%) came to the doctor with complaints of orofacial pain, and in 22 (14.67%) significant displacement, 17 (77.27%) of them had a pain syndrome; unilateral posterior displacement of the heads of the lower jaw in 32 (21.33%) patients with TMJ dysfunction, 16 (50.00%) of them have a pain syndrome, and 11 of them have a significant displacement; in 16 (10.67%) one-sided posterior displacement with simultaneous anterior displacement in the contralateral joint was established with a subjective assessment of the absence of pain syndrome. Presence of a significant displacement in at least one joint was established in 72 (48.00%) patients with TMJ dysfunction, 63 (87.50%) of them had a pain syndrome. Conclusions. CT enables a comprehensive assessment of bone structures and their connection in the TMJ and is a valuable tool for planning orthopedic treatment and evaluating its effectiveness in dynamics.