Iatrogenic Lesions Research Articles

Pityriasis rubra pilaris: A review

Pityriasis rubra pilaris (PRP, syn.: Devergie's disease) is a rare idiopathic papulo-squamous inflammatory skin disease characterized by follicular papules, palmar-plantar keratoderma, scaling plaques of orange-red color with characteristic foci of unaffected skin. Histologically, the alternating pattern of orthokeratosis and parakeratosis is considered a distinctive feature of PRP (staggered hyperkeratosis). A violation of the regulation of innate immunity is a component of the pathogenesis of PRP. Congenital mutations of CARD 14 or concomitant antigens, which can take the form of iatrogenic lesions, infections or malignant neoplasms, can be the initial triggers of the disease, although the etiology is often idiopathic. There are classically five subtypes of the disease, depending on the age of onset and clinical picture. Type VI PRP is associated with infection caused by the human immunodeficiency virus. CARD 14-associated papulosquamous rash and discoid dermatitis of the face represent new clinical phenotypes of PRP. Devergie's disease has a pronounced negative impact on the quality of life, and those who become ill are at increased risk of depression and suicide. Ixekizumab, methotrexate and secukinumab can be considered as systemic drugs of the first choice. If there is a contraindication to immunosuppressive therapy, high doses of isotretinoin are recommended. Topical agents, including calcipotriene, calcineurin inhibitors, emollients and topical corticosteroids, are used as additional therapy.

Anatomical Position of the Mentonian Foramen in Relation to the Alveolar Ridge and Mandibular Base using Cone Beam Computed Tomography in Dentate Patients

Introduction: The mentonian foramen is an important structure of the anterior part of the mandible, referent in surgical procedures of the mandible, mainly of the interforaminal area. Therefore, for a more precise analysis of this anatomical structure we use Cone Beam CT scans, since it provides us with a three-dimensional image of higher quality of the maxillofacial massif as it does not present overlapping images, geometric distortion and false negatives that could increase the risk of iatrogenic lesions. Objective: To determine the distance of the mentonian foramen in relation to the alveolar ridge and the mandibular base by means of Cone Beam Computed Tomography of dentate patients. Methodology: The study was descriptive, cross-sectional and retrospective; 109 Cone Beam Computed Tomography scans of dentate patients were evaluated from March to October 2020, taken from the Maxillofacial Diagnostic Institute (IDM) Lima, Peru; between 18 and 50 years old, distributed in three age groups: 18 to 28 years old, 29 to 39 years old and 40 to 50 years old. The distances from the upper edge of the mentonian foramen to the alveolar ridge and from the lower edge of the mentonian foramen to the mandibular base were analyzed, taking into account sex and age group. For the statistical analysis, SPSS Statistics version 26.0 was used and the T student test for related tests was applied to evaluate the differences between the right and left sides, T student for independent tests to analyze the measures with the male and female sexes and ANOVA of one factor for the analysis with the age groups. All tests were performed at a significance level of 5%. Results: The mentonian foramen is closer to the mandibular base than to the alveolar ridge, whose means are 13.81mm and 14mm, respectively. The average distance was shorter in the 40 to 50 years age group and the female sex presented shorter distances. Conclusion: The mentonian foramen is 13.81mm above the mandibular base, the greatest distances were found in the male sex and the shortest distances in the 40 to 50 years age group.

Predicting Nerve Course Variations to Prevent Iatrogenic Lesions: A Surgical Perspective on Sural Nerve Variations.

There are several documented variations of the sural nerve noted within the literature. This cadaveric study was conducted to provide a surgical perspective to either directly addressing the sural nerve, or avoiding it depending on the injury or pathology being surgically addressed. Twenty-five preserved cadaveric limbs were dissected from the popliteal fossa to the foot. Three locations of the course of the sural nerve data were analyzed. The first location (M1) was from the head of the fibula to the sural nerve. The second location (M3) was from 2.54 cm proximal to the distal tip of the lateral malleolus to the sural nerve. The third location (M2) was from the shaft of the fibula at the halfway point between measurements 1 and 2 to the course of the sural nerve. The types of variations were noted as well, compared to previous studies, highlighting the abundance of sural nerve variations in the lower limb that clinicians and surgeons need to be aware of and ready to address. The sural nerve courses 4.6 cm posterior from the fibula at the proximal fibula and mid fibula and 4.5 cm at the distal fibula. The 25 sural nerve variations are not reflective of what has been previously published in the literature. The data can be utilized in preoperative planning in addressing or avoiding the sural nerve involving the posterior superficial compartment of the leg.

Microsurgical central lymphatic reconstruction-the role of thoracic duct lymphovenous anastomoses at different anatomical levels.

In recent years advances have been made in the microsurgical treatment of congenital or acquired central lymphatic lesions. While acquired lesions can result from any surgery or trauma of the central lymphatic system, congenital lymphatic lesions can have a variety of manifestations, ranging from singular thoracic duct abnormalities to complex multifocal malformations. Both conditions may cause recurrent chylous effusions and downstream lymphatic congestion depending on the anatomical location of the thoracic duct lesion and are associated with an increased mortality due to the permanent loss of protein and fluid. We present a case series of eleven patients undergoing central lymphatic reconstruction, consisting of one patient with a cervical iatrogenic thoracic duct lesion and eleven patients with different congenital thoracic duct lesions or thrombotic occlusions. Anastomosis of the thoracic duct and a nearby vein was performed on different anatomical levels depending on the underlying central lymphatic pathology. Cervical (n = 4), thoracic (n = 1) or abdominal access (n = 5) was used for central lymphatic reconstruction with promising results. In 9 patients a postoperative benefit with varying degrees of symptom regression was reported. The presented case series illustrates the current rapid advances in the field of central microsurgical reconstruction of lymphatic lesions alongside the relevant literature.

OnyxTMGel or Coil versus Hydrogel as Embolic Agents in Endovascular Applications: Review of the Literature and Case Series.

This review focuses on the use of conventional gel or coil and "new" generation hydrogel used as an embolic agent in endovascular applications. In general, embolic agents have deep or multidistrict vascular penetration properties as they ensure complete occlusion of vessels by exploiting the patient's coagulation system, which recognises them as substances foreign to the body, thus triggering the coagulation cascade. This is why they are widely used in the treatment of endovascular corrections (EV repair), arteriovenous malformations (AVM), endoleaks (E), visceral aneurysms or pseudo-aneurysms, and embolisation of pre-surgical or post-surgical (iatrogenic) lesions. Conventional gels such as Onyx or coils are now commercially available, both of which are frequently used in endovascular interventional procedures, as they are minimally invasive and have numerous advantages over conventional open repair (OR) surgery. Recently, these agents have been modified and optimised to develop new embolic substances in the form of hydrogels based on alginate, chitosan, fibroin and other polymers to ensure embolisation through phase transition phenomena. The main aim of this work was to expand on the data already known in the literature concerning the application of these devices in the endovascular field, focusing on the advantages, disadvantages and safety profiles of conventional and innovative embolic agents and also through some clinical cases reported. The clinical case series concerns the correction and exclusion of endoleak type I or type II appeared after an endovascular procedure of exclusion of aneurysmal abdominal aortic (EVAR) with a coil (coil penumbra released by a LANTERN microcatheter), the exclusion of renal arterial malformation (MAV) with a coil (penumbra coil released by a LANTERN microcatheter) and the correction of endoleak through the application of Onyx 18 in the arteries where sealing by the endoprosthesis was not guaranteed.

Comparison of methods of non-mechanical pressure measurement in the cuff of an endotracheal tube

Bronchoscopy is a diagnostic and follow-up procedure. Despite the fact that this manipulation itself is minimally invasive, it can be a difficult test for both the patient and the doctor. Therefore, this manipulation definitely requires anesthesia and sedation. This study compared dexmedetomidine and propofol sedation methods during diagnostic bronchoscopy to assess their safety, effectiveness, and satisfaction. The results show a high level of safety of both methods, although some significant differences affecting the choice of sedation method were found. 32 patients participated in the study, divided into two groups depending on the used method of sedation: propofol or dexmedetomidine. Pulse oximetry, heart rate, capnography parameters were measured, the number and severity of iatrogenic lesions of the trachea, as well as the satisfaction of care and doctors were assessed. In some groups, there was a high level of safety of sedation. Dexmedetomidine sedation was associated with fewer cough episodes and greater satisfaction, but had a longer induction time with propofol. A low incidence of serious complications was observed in both groups. Dexmedetomidine can be considered a safe and effective sedation option for diagnostic bronchoscopy, offering additional benefits such as reduced cough episodes and increased patient satisfaction. The choice of the sedation method is based on the individual characteristics of the patient and the available resources of the hospital.

Medial dorsal cutaneous nerve entrapment following inversion ankle sprain

The medial dorsal cutaneous nerve is one of the terminal branches of the superficial peroneal nerve that provides sensory innervation to the dorsum of the foot. It may be prone to injury by direct blow, iatrogenic surgical lesion or in rare situations secondary to ankle sprains. The authors report a case of persistent ankle pain in a female patient caused by a post- traumatic compressive neuropathy of the medial dorsal cutaneous nerve secondary to an ankle sprain which was successfully surgically treated with complete resolution of the symptoms.

Anatomical Bases of the Temporal Muscle Trigger Points.

Temporal muscles of 14 adult cadavers were studied. The muscle bellies were divided into six areas, three superior (1.2 and 3) and three inferior areas (4, 5, and 6) lower, according to a Cartesian plane to analyze and describe the entry points of the branches of the deep temporal nerves into the muscle. The branching distribution was analyzed using Poisson log-linear tests with Bonferroni post hoc tests for comparison between groups (sextants) (p < 0.05). Deep temporal nerve entry points were found in the temporal muscle in all areas. Most of the branches were observed in areas 2 and 5, which coincide with the muscle fibers responsible for mandible elevation and related to the previously described MTPs. Fewer branches were found in areas 1 and 6, where contraction produces mandible retraction. There is an anatomical correlation between the branching pattern of the deep temporal nerve and temporal muscle trigger points. Adequate knowledge of the innervation of the temporal muscle may help elucidate the pathophysiology of myofascial syndromes and provide a rational basis for interventional or conservative approaches and help surgeons avoid iatrogenic lesions to the deep temporal nerve lesion.

The Impact of Patient-Specific Positions on the Relationship between Iliac Blood Vessels and Lumbar Intervertebral Discs: Anatomical Significance and Clinical Implications

This study explores the anatomical relationship between iliac blood vessels and the lower lumbar spine during supine and prone patient positions. The average height of participants was 174.02 cm ± 9.01, while the average weight was 80.38 kg ± 13.48. Body mass index (BMI) analyses showed differences (p = 0.002), with 34.7% classified as normal weight, 53.1% as overweight, and 12.2% as moderately obese. The study examined the distances between iliac arteries and veins in relation to intervertebral anterior and posterior disc contours. Patient positioning significantly affected these measurements at both L4/L5 and L5/S1 levels. The findings highlight the critical influence of body position on anatomical relationships in the context of lower lumbar spine surgery. The study underscores the importance of preoperative awareness of vascular anatomy to prevent iatrogenic lesions during spine surgery, contributing valuable insights for optimizing surgical approaches and minimizing complications in spine surgery, particularly microdiscectomy.

Functional Outcome of Peripheral Nerve Injury after Pediatric Supracondylar Humerus Fracture: Comparison of Surgical and Conservative Treatment

Supracondylar humerus fractures are the most common elbow fractures in children up to 10 years of age. The incidence of associated nerve injuries varies up to 15% depending on the data. Traumatic and iatrogenic lesions mainly affect the ulnar nerve. The regeneration of peripheral nerves is comparatively better in childhood. In the present study, the functional results after surgical and conservative treatment of nerve injuries in children after supracondylar fractures were compared and analyzed for influencing factors. In this retrospective comparative study, clinical data of pediatric nerve injuries following supracondylar humerus fractures treated over a period of 13 years (2008-2021) were analyzed. Children who were treated surgically (neurolysis, autologous reconstruction) due to insufficient clinical/neurophysiological improvement within 6 months after trauma or who were followed up conservatively in case of regression of symptoms within 6 months after trauma were included. All patients underwent multidisciplinary follow-up. 48 patients (26 female/22 male) with nerve injuries were included in this study. All patients had a history of surgical treatment with K- wire fixation due to severe dislocated fractures. The mean age was 7±2 years. The initial symptoms were severe motor deficits in all patients and sensory deficits in 87.5% (n=42). Isolated lesions of the ulnar nerve were most common (n=24, 50%). The nerve was neurolysed in 21 patients and additionally transferred to the volar side in 15. Nerve grafting was performed in 7 children and split repair in 2. Postoperatively, there was a significant improvement in motor function in all patients. Despite comparably severe motor deficits at initial presentation, further 20 children were treated conservatively due to the regression of neurological deficits. They showed comparably good functional results. No serious complications were recorded in either group. The average follow-up time was 377.25±524.87 days. The presented study shows excellent functional results after surgical treatment of pediatric nerve injuries without severe complications. Children with comparatively high-grade lesions at initial presentation have a good chance of complete spontaneous remission even without surgery. For this reason, the indication for surgery in children should be very carefully considered.

Meralgia Paresthetica-An Approach Specific Neurological Complication in Patients Undergoing DAA Total Hip Replacement: Anatomical and Clinical Considerations.

Introduction: Mini-invasive surgical (MIS) approaches to total hip replacement (THR) are becoming more popular and increasingly adapted into practice. THR via the direct anterior approach (MIS DAA) has become a rather controversial topic in hip arthroplasty literature in the last decades. Our retrospective observational study focuses on the prevalence of one approach-specific complication-lateral femoral cutaneous nerve (LFCN) iatrogenic lesion-and tries to clarify the possible pathogenesis of this injury. Methods: This is a retrospective single-cohort observational single-center and single-surgeon study. Our patient records were searched for the period from 2015 to 2017-after a safe period of time after the learning curve for MIS DAA. All intra- and post-operative lesions of the LFCN were recorded. Lesion of the LFCN was confirmed by a neurological examination. Minimum patient follow-up was 2 years. Results: This study involved 417 patients undergoing single-side THR via MIS DAA. Patients were examined on follow-up visits at 6 weeks, 6 months, 1 year, and 2 years after surgery. There were 17 cases of LCFN injury at the 6 weeks early follow-up visit (4.1%). All cases of clinically presenting LFCN injury resolved at the 2-year follow-up ad integrum. Discussion: Possible explanations of such neurological complications are direct iatrogenic injury, vigorous traction, hyperextension, or extreme external rotation of the operated limb. Use of a traction table or concomitant spinal pathology and deformity also play a role. Prevention involves stepwise adaptation of the approach during the learning curve period by attending cadaver lab courses, rational use of traction and hyperextension, and careful surgical technique in the superficial and deep fascial layers. Dynamometers could be used to visualise the limits of manipulation of the operated limb. Conclusions: Neurological complications are not as rare but questionably significant in patients undergoing THR via the DAA. Incidental finding of LFCN injury has no effect on the functional outcome of the artificial joint. It can lead to lower subjective satisfaction of patients with the operation, which can be avoided with careful education and management of expectations of the patients.

Improvement in Central Neck Dissection Quality in Thyroid Cancer by Use of Tissue Autofluorescence.

Risk of postoperative transient or permanent hypoparathyroidism represents one of the most common complications following total thyroidectomy. This risk increases if a cervical lymphadenectomy procedure must also be performed, as is usually the case in thyroid carcinoma patients. Parathyroid autofluorescence (AF) is a non-invasive method that aids intraoperative identification of parathyroid glands. In this prospective study, 189 patients with papillary thyroid cancer who underwent total thyroidectomy with central neck dissection were included. Patients were randomly allocated to one of two groups: NAF (no AF, surgery was performed without AF) and the AF group (surgery was performed with AF-Fluobeam LX system, Fluoptics, Grenoble, France). The number of excised lymph nodes was significantly higher in the AF compared to the NAF group, with mean values of 21.3 ± 4.8 and 9.2 ± 4.1, respectively. Furthermore, a significantly higher number of metastatic lymph nodes were observed in the AF group. Transient hypocalcemia recorded significantly lower rates in the AF group with 4.9% compared to 16.8% in the NAF group. AF use during total thyroidectomy with central neck dissection for papillary thyroid carcinoma patients, decreased the rate of iatrogenic parathyroid gland lesions, and increased the rate of lymphatic clearance.

ОСМОТИЧЕСКИЙ ДЕМИЕЛИНИЗИРУЮЩИЙ СИНДРОМ В ПРАКТИКЕ ВРАЧЕЙ РАЗЛИЧНЫХ СПЕЦИАЛЬНОСТЕЙ

A clinical case of a rare, severe and difficult to diagnose iatrogenic lesion of the central nervous sys-tem - osmotic demyelinating syndrome (ODS) and a brief review of the literature is presented. Osmotic demyelinating syndrome with damage to the pons of the brain developed in a 36-year-old woman, HIV-infected, suffering from alcoholism with polyvisceropathy, drug addiction, chronic hepatitis of high activity and chronic pancreatitis in the acute stage. The condition was accompanied by moderate hyponatremia. This clinical observation will be of interest to doctors of various specialties, will expand the understanding of the clinical manifestations and treatment of ODS and will allow for the prevention or timely diagnosis of such a rare pathology.

Modern concept of differential diagnosis of colitis: from G.F. Lang to the present day. A review

The aim of the article is to improve the differential diagnosis of specific and nonspecific inflammatory bowel diseases. In Russia, this scientific direction is associated with the name of G.F. Lang, who performed in 1901-1902 the study "On ulcerative inflammation of the large intestine caused by balantidiasis". The etiology of specific colitis is associated with infection with parasites, bacteria and viruses that cause inflammation of the intestinal wall, diarrhea, often with an admixture of mucus, pus and blood. Specific colitis (SC) may be accompanied by fever, abdominal pain, and tenesmus. Bacterial colitis is commonly caused by Salmonella, Shigella, Escherichia coli, Clostridium difficile, Campylobacter jejuni, Yersinia enterocolitica, and Mycobacterium tuberculosis. Viral colitis is caused by rotavirus, adenovirus, cytomegalovirus, and norovirus. Parasitic colitis can be caused by Entamoeba histolytica and balantidia. In gay people, SC can cause sexually transmitted infections: Neisseria gonorrhoeae, Chlamydia trachomatis, and treponema pallidum, affecting the rectum. Stool microscopy, culture, and endoscopy are used to establish the diagnosis. Stool culture helps in the diagnosis of bacterial colitis in 50% of patients, and endoscopic studies reveal only nonspecific pathological changes. Differential diagnosis of SC should be carried out with immune-inflammatory bowel diseases (ulcerative colitis, Crohn's disease, undifferentiated colitis), radiation colitis and other iatrogenic bowel lesions. The principles of diagnosis and therapy of inflammatory bowel diseases associated with various etiological.

Increased risk of persistent neuropathic pain after traumatic nerve injury and surgery for carriers of a human leukocyte antigen haplotype.

It is not known why some patients develop persistent pain after nerve trauma while others do not. Among multiple risk factors for the development of persistent posttrauma and postsurgical pain, a neuropathic mechanism due to iatrogenic nerve lesion has been proposed as the major cause of these conditions. Because there is some evidence that the human leukocyte antigen (HLA) system plays a role in persistent postsurgical pain, this study aimed to identify the genetic risk factors, specifically among HLA loci, associated with chronic neuropathic pain after traumatic nerve injuries and surgery in the upper extremities. Blood samples were taken to investigate the contribution of HLA alleles (ie, HLA-A, HLA-B, HLA-DRB1, HLA-DQB1, and HLA-DPB1) in a group of patients with persistent neuropathic pain (n = 70) and a group of patients with neuropathy without pain (n = 61). All subjects had intraoperatively verified nerve damage in the upper extremity. They underwent bedside clinical neurological examination to identify the neuropathic pain component according to the present grading system of neuropathic pain. Statistical analyses on the allele and haplotype were conducted using the BIGDAWG package. We found that the HLA haplotype A*02:01-B*15:01-C*03:04-DRB1*04:01-DQB1*03:02 was associated with an increased risk of developing persistent neuropathic pain in the upper extremity (OR = 9.31 [95% CI 1.28-406.45], P < 0.05). No significant associations were found on an allele level when correcting for multiple testing. Further studies are needed to investigate whether this association is on a haplotypic level or if certain alleles may be causing the association.

Iatrogenic spinal cord herniation

Introduction: Spinal cord herniation occurs idiopathically or is due to defective or weakened dura mater resulting from iatrogenic or traumatic lesions. Although there have been many reports of idiopathic cases, there are few reports of postoperative iatrogenic spinal cord herniation. The authors describe a rare case of postoperative spinal cord herniation in the cervical spine, with an extensive analysis of reported cases Materials and methods: This article reports a documented case of postoperative spinal cord herniation. The case description is followed by an analysis of the literature. Results: A 67-year-old woman who had cervical laminectomy 3 weeks before for cervical laminectomy, presented with neck pain and torticollis after coughing. The MRI findings showed a cervical medulla herniation with cerebrospinal fluid (CSF) leakage. The patient underwent surgery to reduce the herniation and duroplasty with subsequent complete resolution of symptoms. Over the previous 50 years (1973–2023), 16 post-operative spinal cord herniation cases were reported. The mean patient age was 43.3 years (range 15–67 years). There was a male predominance (80%). The mean onset period after surgery was 292 weeks (range, 1 week to 728 weeks). Clinical symptomatology was polymorphic with non-specific signs. Conclusion: Iatrogenic spinal cord herniation is an extremely rare occurrence after spine surgery. The diagnosis must be evoked in case of any neurological degradation after surgery of the cervical spine, thoracic spine or thoracolumbar junction. The surgical management gives satisfactory clinical results.

Minimally invasive ultrasound-assisted cutting thread tenotomy of the deep digital flexor tendon in horses: An ex vivo study.

To evaluate the feasibility and limitations associated with a minimally invasive ultrasound-assisted cutting thread technique for tenotomy of the deep digital flexor tendon (DDFT) in horses. Ex vivo study. Twenty cadaveric forelimbs. Forelimbs were placed on a jig to mimic a standing semiflexed position and the midmetacarpal region was prepared to perform tenotomy of the DDFT using a percutaneous technique with a cutting thread. For that purpose, the thread was placed percutaneously around the DDFT (first dorsally and then palmarly) with the aid of a curved 20 gauge spinal needle. Tendon palpation/manipulation and ultrasonographic assessment assisted thread placement. Procedure time and skin puncture size were recorded. Limbs were then dissected to evaluate the degree of DDFT transection and the presence of any iatrogenic lesions. The DDFT was completely transected in all cases. Minor lesions of the superficial digital flexor tendon were found in 11/20 limbs and considered clinically irrelevant. However, the neurovascular bundle was damaged in 6/20 limbs (four limbs had nerve damage and two limbs had a nerve and either a palmar artery or vein damaged). The skin puncture hole sizes ranged from undetectable to 5 mm long. The average duration of the procedure was 7 min and 38 s (range: 4 min 56 s to 10 min 19 s). A DDFT tenotomy can be performed reliably with a percutaneous cutting thread technique. However, refinement of the technique is required to minimize iatrogenic damage. The reported technique allows a DDFT tenotomy to be performed in a minimally invasive manner and has the potential to be clinically applicable.

Laparoscopic approach for renal denervation: an experimental study on animals

Aim. To study the efficacy and safety of laparoscopic mechanical renal denervation.Methods. Thirty sheep with mean weight 92.3±2.1 kg were divided in 2 groups: control group (group I, n=15) and mechanical laparoscopic renal denervation group (group II, n=15). The follow-up period was 6 months. The following parameters were assessed: blood pressure in response to high-frequency electrical intraluminal stimulation, creatinine, blood urea nitrogen test (BUN), damage to the renal arteries according to the result of angiography, the degree of destruction of nerve fibers according to histological examination.Results. All animals were alive during the entire observation period. The creatinine and BUN were within the normal ranges during the observation period. Angiography of the renal arteries did not reveal iatrogenic stenotic lesions. After 6 months in group 2 there was hypertensive response of blood pressure to high-frequency electrical stimulation (in-creased systolic blood pressure ∆70.27±5.31 (p&gt;0.005), diastolic blood pressure ∆49.87±6.05 (p&gt;0.005)). After 6 months, the animals were euthonised, further histological examination was completed. Histological examination: in the group II, there was swelling and vacuolization of the nerve fiber without signs of demyelination.Conclusions. Laparoscopic mechanical renal denervation is a safe technique. However, the hypotensive effect is short-term.

Venous malformation as a rare cause of sciatic neuropathy

Sciatic neuropathy is rare and difficult to diagnose in pediatrics and often associated with difficult to control neuropathic pain. The most common causes of sciatic nerve damage in children include trauma and iatrogenic lesions, less often the cause is tumor and vascular formations, among which intraneural venous malformations are the rarest. We present a clinical case of a 13-year boy suffered from right sciatic pain neuropathy with unexpressed neuropathic pain syndrome, asymmetry of the feet, scant impairment of motor and sensory function of the limb for five years, which changed the gait. Neurophysiological testing showed possible location of the process, an asymmetry of sensory and motor responses when testing the nerves of the legs, and abnormal EMG in sciatic-innervated muscles. The magnetic resonance imaging (MRI) showed focal enlargement of the right sciatic nerve in the pelvic region with enhancement upon administration of contrast. Due to the presence of pain in the limb and its forced position — bent at the knee joint, surgical treatment — endoneural neurolysis in combination with targeted therapy by immunosuppressant, was chosen as a therapeutic strategy. The histological study of the intraneural formation confirmed the presence of a venous malformation (VM) in the form of heterogeneous thick– and thin-walled vascular cavities by the presence of fibrosis and lymphocytic infiltration. The result of the treatment was the relief of neuropathic pain syndrome and the recovering of the child gait.

Laseroterapia w leczeniu jatrogennych urazów błony śluzowej jamy ustnej - przegląd piśmiennictwa i opis przypadku

Szczególną przyczyną zapalenia błony śluzowej jamy ustnej (&lt;i&gt;oral mucositis&lt;/i&gt;, OM) są uszkodzenia jatrogenne (chemiczne lub mechaniczne). W leczeniu OM wykorzystuje się laseroterapię biostymulacyjną/niskoenergetyczną (&lt;i&gt;low level laser therapy&lt;/i&gt;, LLLT) ze względu na działanie przeciwbólowe, przeciwzapalne i biostymulacyjne. W pracy przedstawiono przegląd literatury dotyczący wykorzystania LLLT w fizjoterapii stomatologicznej (także u pacjentów onkologicznych) oraz opis przypadku pacjentki (l. 42) z rozległym jatrogennym OM powstałym podczas leczenia endodontycznego. Zastosowano LLLT (830 nm, 400 mW, III B, 20 J/cm&lt;sup&gt;2&lt;/sup&gt;, emisja ciągła, 200 J; 8:20 min; 5 zabiegów). Przed każdym LLLT oraz po tygodniu od 1. zabiegu (w sumie 6 razy) dokonano oceny z wykorzystaniem autorskiej Skali Bólu Jamy Ustnej, Skali Laitinena oraz dokumentacji fotograficznej. Już po 1., a szczególnie wyraźnie po 2. LLLT, odnotowano spadek bólu zarówno w Skali Bólu Jamy Ustnej (odpowiednio o 20 pkt/% i 68 pkt/%), jak i Skali Laitinena (odpowiednio o 5 pkt. i 10 pkt.) w stosunku do stanu początkowego. Po 7 dniach od 1. LLLT pacjentka odczuwała jedynie lekki dyskomfort podczas jedzenia (1 pkt/% w Skali Bólu Jamy Ustnej). Wyniki przedstawionego leczenia oraz dane literaturowe zachęcają do wykorzystania LLLT w OM.