Pain Shock Research Articles

230 Essential role of fibroblast growth factor receptor 2 (FGFR2) in tumorigenesis of human cancers harboring FGFR2 amplification demonstrated by a functional blocking antibody

Breast cancer is characterised by genomic alterations. We did a multicentre molecular screening study to identify abnormalities in individual patients with the aim of providing targeted therapy matched to individuals' genomic alterations.From June 16, 2011, to July 30, 2012, we recruited patients who had breast cancer with a metastasis accessible for biopsy in 18 centres in France. Comparative genomic hybridisation (CGH) array and Sanger sequencing on PIK3CA (exon 10 and 21) and AKT1 (exon 4) were used to assess metastatic biopsy samples in five centres. Therapeutic targets were decided on the basis of identified genomic alterations. The primary objective was to include 30% of patients in clinical trials testing a targeted therapy and, therefore, the primary outcome was the proportion of patients to whom a targeted therapy could be offered. For the primary endpoint, the analyses were done on the overall population registered for the trial. This trial is registered with ClinicalTrials.gov, number NCT01414933.423 patients were included, and biopsy samples were obtained from 407 (metastatic breast cancer was not found in four). CGH array and Sanger sequencing were feasible in 283 (67%) and 297 (70%) patients, respectively. A targetable genomic alteration was identified in 195 (46%) patients, most frequently in PIK3CA (74 [25%] of 297 identified genomic alterations), CCND1 (53 [19%]), and FGFR1 (36 [13%]). 117 (39%) of 297 patients with genomic tests available presented with rare genomic alterations (defined as occurring in less than 5% of the general population), including AKT1 mutations, and EGFR, MDM2, FGFR2, AKT2, IGF1R, and MET high-level amplifications. Therapy could be personalised in 55 (13%) of 423 patients. Of the 43 patients who were assessable and received targeted therapy, four (9%) had an objective response, and nine others (21%) had stable disease for more than 16 weeks. Serious (grade 3 or higher) adverse events related to biopsy were reported in four (1%) of enrolled patients, including pneumothorax (grade 3, one patient), pain (grade 3, one patient), haematoma (grade 3, one patient), and haemorrhagic shock (grade 3, one patient).Personalisation of medicine for metastatic breast cancer is feasible, including for rare genomic alterations.French National Cancer Institute, Breast Cancer Research Foundation, Odyssea, Operation Parrains Chercheurs.

Cardiac Tamponade Caused by a Swallowed Metallic Wire

![Figure][1] [![Graphic][3] ][3] A 56-year-old man with chest pain and cardiogenic shock was admitted for suspected aortic dissection. Transthoracic echocardiogram showed small pericardial effusion causing right atrial diastolic compression. One week before, sudden severe epigastric

Diagnosis and therapy of acute abdominal pain with septic shock in elderly people

Objective To explore diagnosis and treatment of acute abdominal pain with septic shock in elderly people to lower the mortality rate. Methods The clinical data on 32 elderly patients with acute abdominal pain and septic shock who had been hospitalized from January 2007 to December 2009 were retrospectively analyzed. Results 29 of 32 elderly patients (90.06%) received surgery while the remaining 3 only received medical treatment and died of MODS. Conclusions Treatment of shock should be the first therapy for acute abdominal pain with septic shock. The proper surgical timing, infection control, and early prevention and treatment of MODS are the important factors for life-saving. Key words: Acute abdominal pain; Septic shock; Surgery; Elderly

Acute retroperitoneal bleeding due to inferior mesenteric artery aneurysm: Case report

BackgroundVisceral artery aneurysms (VAA), although uncommon, are increasingly being detected. We describe a case of spontaneous retroperitoneal hemorrhage from a ruptured IMA aneurysm associated with stenosis of the superior mesenteric artery (SMA) and celiac trunk, successfully treated with surgery.MethodsA 65-year-old man presented with abdominal pain and hypovolemic shock. Abdominal CT scan showed an aneurysm of the inferior mesenteric artery with retroperitoneal hematoma. In addition, an obstructive disease of the superior mesenteric artery and celiac axis was observed.ResultsUpon emergency laparotomy a ruptured inferior mesenteric artery aneurysm was detected. The aneurysm was excised and the artery reconstructed by end-to-end anastomosis.ConclusionsThis report discusses the etiology, presentation, diagnosis and case management of inferior mesenteric artery aneurysms.

Epicardial Ablation of Ischemic Ventricular Tachycardia.

Endocardial catheter ablation for ventricular arrhythmias in patients with ischemic cardiomyopathy decreases ventricular tachycardia (VT) episodes, and painful implantable defibrillator shocks and can be lifesaving in the context of VT storm. Unfortunately, up to approximately one-third of postinfarction VTs are not accessible for ablation from the endocardium. Percutaneous access to the epicardial space has allowed ablation of a portion of these circuits, although anatomic barriers, such as the phrenic nerve, coronary arteries, and intramural circuits, still limit success in some cases. Adhesions, most often due to prior cardiac surgery, frequently necessitate a surgical approach to the pericardial space.

An unusual cause of cardiogenic shock

A 76-year-old man with a history of coronary artery bypass grafting presented with acute onset of chest pain and cardiogenic shock. The ECG showed atrial fibrillation (AF) and severe ST-segment depression in the anterolateral leads. Cardiac angiography revealed an occluded native right coronary artery (RCA) and left anterior descending …

Hepatic artery pseudo aneurysm rupture precipitated by pneumonia: An Unusual Case

We present a unique case of hepatic artery pseudo aneurysm rupture associated with pneumonia. A 67 year old woman admitted to our hospital with productive cough, pleuritic chest pain and shortness of breath. She was diagnosed to have community acquired pneumonia and was treated with antibiotics. On third day of admission she developed acute abdominal pain and haemorrhagic shock. Contrast CT scan showed left hepatic artery pseudo aneurysm rupture, a rare emergency condition associated with high mortality rate. She underwent percutaneous endovascular coiling and made a complete recovery.

Prospective multicenter randomized trial of fast ventricular tachycardia termination by prolonged versus conventional anti-tachyarrhythmia burst pacing in implantable cardioverter-defibrillator patients-Atp DeliVery for pAiNless ICD thErapy (ADVANCE-D) Trial results

PurposeThe purpose of the trial was to quantify and compare the efficacy of two different sequences of burst anti-tachycardia pacing (ATP) strategies for the termination of fast ventricular tachycardia.MethodsThe trial was prospective, multicenter, parallel and randomized, enrolling patients with an indication for implantable cardioverter-defibrillator implantation.ResultsFrom February 2004, 925 patients were randomized and followed-up for 12 months. Eight pulses ATP terminated 64% of episodes vs. 70% in the 15-pulse group (p = 0.504). Fifteen pulses proved significantly better in patients without a previous history of heart failure (p = 0.014) and in patients with LVEF ≥ 40% (p = 0.016). No significant differences between groups were observed with regard to syncope/near-syncope occurrence.ConclusionIn the general population, 15-pulse ATP is as effective and safe as eight-pulse ATP. The efficacy of ATP on fast ventricular arrhythmias confirmed once more the striking importance of careful device programming in order to reduce painful shocks.

Postpartum intra-abdominal haemorrhage: Case report

The most frequent cause of gynaecological haemoperitoneum is ruptured ectopic pregnancy. Haemoperitoneum after a normal vaginal delivery is rare and it is associated with high maternal mortality. A 22-year-old primipara had a normal vaginal delivery. She experienced acute abdominal pain and hypovolemic shock ten hours after the delivery and was referred to our hospital twenty one hours after the delivery. An urgent ultrasound profile was done, which revealed free fluid in pelvis and in the whole abdomen. An immediate laparotomy was done and 2 litres of blood were found within the peritoneal cavity. The uterine wall was intact. We found a haematoma on the anterior wall of rectum and livid colours of broad ligament. The peritoneal cavity was cleaned and revised. Any injury of the spleen or liver was excluded. Haematoperitoneum after a normal vaginal delivery is rare but life threatening to mothers. It is important to recognize this condition to avoid delay in diagnosis and treatment because of high maternal mortality. Our patient was bleeding from superficial rectal vessels. Only a few cases with undefined aetiologies have been reported in literature.

Successful Laparoscopic Management of Spontaneous Hemoperitoneum at 15 Weeks of Pregnancy: Case Report and Review of Literature

We present a case report of laparoscopic management of a spontaneous hemoperitoneum in the second trimester of pregnancy. The patient was a 40-year-old woman at 15 weeks of gestation. At laparoscopic surgery, the hemoperitoneum was evacuated, and the right-sided uterine vessels were closed with diathermocoagulation. Every pregnant woman with severe abdominal pain, vomiting, and imminent hypovolemic shock should be carefully evaluated. After ruling out the most prevalent causes of hemoperitoneum, idiopathic spontaneous hemoperitoneum should be considered. Rapid diagnosis and aggressive fluid replacement together with prompt surgical intervention may be the only chance for a favorable outcome for both mother and child in the presence of such a rare complication. Moreover, in early stages of pregnancy, the laparoscopic approach should be considered but only in the hands of experienced laparoscopic surgeons.

Acute Abdomen Due to a Foreign Body in the Urinary Bladder in an Adolescent

A foreign body in the urinary bladder can cause an acute abdomen in an adolescent. A 14-year-old girl presented to the emergency department with severe suprapubic pain, dysuria, hematuria, and hypovolemic shock. An ultrasound examination revealed liquid in the abdomen. An X-ray study of the abdomen revealed an 8-cm-long metallic object located in the urinary bladder. The patient underwent an emergent laparotomy with the diagnosis of acute abdomen. At laparotomy, approximately 2000 cc of widely dispersed serohemorrhagic fluid was removed. Clearing of the abdomen exposed a nail; it had perforated the bladder and 5 cm of it was in the abdominal cavity. A vertical incision was made to the urinary bladder. A 10-penny caliber, 8.2-cm-long steel nail was gently removed and the perforation was closed primarily. The outcome was uneventful and the patient was discharged from the hospital on the seventh postoperative day. A foreign body can cause severe problems and should be kept in mind in the differential diagnosis of acute abdomen in an adolescent.

A rare clinic presentation of abdominal pain: rupture of splenic artery aneurysm: a case report

BackgroundSplenic artery aneurysms (SAA) are uncommon but the most common visceral artery aneurysm. Splenic artery aneurysms are important to recognize because up to 25% may be complicated by rupture and the mortality rate after rupture is between 25% and 70%.Case reportWe present a patient who have abdominal pain. Previously healthy 22-year-old female admitted to emergency department with abdominal pain. Her physical examination reveals only left upper quadrant tenderness. Suddenly she developed hypovolemic shock. On emergent laparotomy massive blood collection within peritoneal cavity and retroperitoneal space at the left upper quadrant was detected. The source of bleeding was evident as rupture of splenic artery aneurysm. Splenectomy was performed following the ligation of splenic artery proximal to lesion. On the tenth day she was discharged from the hospital with complete recovery.ConclusionIt is important to remember rupture of splenic artery aneurysm in patients with abdominal pain and hypovolemic shock status.

Takotsubo Cardiomyopathy: A Nurse’s Guide

Takotsubo Cardiomyopathy: A Nurse’s Guide

Coping With My Partner’s ICD and Cardiac Disease

The Implantable Cardioverter Defibrillator (ICD) is an implantable biomedical device that monitors and treats abnormal heartbeats when they occur. The device is attached to the heart with 1 to 3 leads that carry information from the heart to the ICD, allowing it to record heart function, selectively provide pacing if the heart beats too fast or too slowly, and/or administer high-energy shocks if more serious heart rhythms are detected. The primary purpose of the ICD is to prevent premature sudden cardiac death. However, the device can also provide a sense of security, which allows resumption of normal life activities. Current research has suggested that psychological distress can occur in ICD patients and their partners. Anxiety may be more prevalent in ICD partners than in ICD patients.1 ICD partners are particularly worried about ICD shocks, even more so than the patients themselves.2 This Patient Page describes common challenges associated with the psychological adjustment of ICD partners and offers possible strategies to consider in managing these difficulties. A summary is provided in the Table. View this table: Table. Summary of Suggested Strategies for the Partners of Patients With ICDs Once the ICD has been implanted, lifestyle adjustments can be made that promote health and well-being. However, such adjustments may take time and a bit of work; most people take about 3 months to adjust to such major life changes. A patient’s adjustment often mirrors the partner’s adjustment, so effective coping can improve both of your lives. ### Patient Acceptance Patient acceptance refers to how well an individual adapts to the ICD and accepts its pros and cons. Patients and partners may differ on how well they accept the device. The hope for ICD patients is that they reengage with the confidence of having “an emergency room in the chest”; yet some patients experience difficulty and …

Use of traditional Chinese medicine in the management of urinary stone disease

To assess the evidence-based literature supporting the use of traditional Chinese medicine Kampo herbal and Acupuncture in stone disease management. Four of the most commonly used herbal components of Kampo medicine in the treatment of stone disease are described according to their in vitro and in vivo effects. We also reviewed the role of Acupuncture in urologic clinical setting as well as its proposed mechanisms of action and results. Medline database was assessed using isolated and conjugated key words (Chinese Medicine, Kampo, Chinese Herbal, Calculi, Stone Disease, Kidney, Acupuncture, Herbal Medicine). Articles were reviewed and summarized. Herbal medicine has been proven to be free from side-effects and therefore suitable for long term use therapy. Its antilithic beneficial effects include increased urinary volume, increased magnesium excretion (Takusya), inhibitory activity on calcium oxalate aggregation (Takusya, Wulingsan and Desmodyum styracyfolium), inhibition of calcium oxalate nucleation and hydroxyapatite internalization (Wulingsan). In contrast, acupuncture, has shown to be effective as a pre-treatment anxiolytic and analgesic during colic pain and extracorporeal shock wave lithotripsy treatment, reducing the need for complementary sedative drugs. Chinese traditional medicine is promising as regards its role in stone prevention. An effort must be made in order to standardize study protocols to better assess acupuncture results since each procedure differs in regards to selected acupoints, electrostimulation technique and adjunct anesthetics. Similarly, standardization of Kampo formulations and acceptable clinical endpoints (imaging vs. symptomatic events) is needed.

A patient with recurrent episodes of abdominal pain and hypovolemic shock

A patient with recurrent episodes of abdominal pain and hypovolemic shock

Should implantable cardioverter-defibrillators and permanent pacemakers in patients with terminal illness be deactivated?

The recently published 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities1 include a discussion of ethical issues surrounding the deactivation of pacemakers, implanted cardioverter-defibrillator (ICDs), and CRT devices in patients who are terminally ill. The authors rightly note that most clinicians make an ethical distinction between deactivating an ICD and deactivating a permanent pacemaker. Programming an ICD so that it will not provide antitachycardia therapy in the event of ventricular tachycardia or ventricular fibrillation in a terminally ill patient who requests this action seems to be widely accepted as morally permissible.2–8 Many patients and physicians find the deactivation of an ICD in this situation as morally equivalent to a “do not resuscitate” order. Deactivation of an ICD in a patient who is dying of a terminal illness, whether cardiac or another condition, prevents the delivery of painful ICD shocks and allows the patient to die of the natural progression of their underlying disease. As such, this action seems a humane withdrawal of a futile medical treatment. Response by Zellner et al on p 336 In contrast to deactivating an ICD in a dying patient, there is more controversy regarding whether a pacemaker can be deactivated at the request of a terminally ill patient, especially if the patient is pacemaker dependent. Although some authors have suggested that it may be morally permissible to discontinue pacing therapy in patients who are hopelessly ill and request this action,5 we believe that there can be a fundamental difference between discontinuation of antitachycardia and antibradycardia therapies in some patients, depending on their degree of pacemaker dependency. For example, consider a patient with complete heart block who has long had a permanent pacemaker implanted. Pacing by itself does not prevent the patient from following the natural course of their disease and does …

Effects of Acute Alcohol Intoxication and Paroxetine on Aggression in Men

The purpose of this study was to examine the role of the serotonin (5-HT) system in alcohol-related aggression. Specifically, we experimentally examined the effects of 5-HT augmentation on alcohol-related aggression in men (n = 56). After consuming either alcohol (mean blood alcohol concentration of 0.10%) or a placebo (no alcohol) drink, and taking either 20 mg of paroxetine (Paxil) or a placebo pill, participants were provided the opportunity to administer electric shock to a (faux) opponent during a task disguised as a reaction-time game. Aggression was defined as the intensity of shock chosen and the frequency with which an extreme (clearly painful) shock was chosen. We predicted that 5-HT augmentation would be associated with lower aggressive behavior overall, and also reduce the aggression facilitating effects of acute alcohol intoxication. The results indicated that alcohol intoxication increased aggression, particularly under low provocation. Paroxetine decreased aggression, particularly during high provocation. These effects, however, occurred independently of each other. The effect of alcohol on extreme aggression was moderated by previous aggression history, with more aggressive individuals showing greater alcohol-related increases in extreme aggression.

Right Ventricular Pressure Changes During Induced Ventricular Tachycardias Predict Clinical Symptoms of Cerebral Hypoperfusion: Implications for a Reduction of Unnecessary, Painful ICD Shocks

ICD shocks occurring in conscious patients (as in the case of well-tolerated arrhythmias, electromagnetic interference, or oversensing) have a deleterious impact on the quality of life. We evaluated if a hemodynamic parameter, calculated from the right ventricular pressure (RVP) or systemic arterial pressure (AP) signals, could predict early clinical symptoms of cerebral hypoperfusion during induced ventricular tachycardias (VTs). We analyzed 42 tolerated (no symptoms) and 30 untolerated (syncope or severe symptoms within 30 seconds from the onset) VTs, induced during electrophysiological study. The cycle length (CL) and the hemodynamic data (mean AP and RVP, arterial pulse pressure and RV pulse pressure, and maximum AP and RVP dP/dT) were automatically sampled in two VT epochs: the "detection" window, from beat 24 to 32, and the "preintervention" window, immediately before the first therapeutic attempt. Although the CL and all the hemodynamic parameters (expressed as % change versus pre-VT values) were significantly lower in untolerated versus tolerated VTs both at detection and preintervention (with the exception of the mean RVP which progressively increased in both groups), ROC analysis demonstrated that only the preintervention RV pulse pressure showed no overlap between groups, providing 100% sensitivity and positive predictive value. The reduction of the RV pulse pressure is a better predictor of early cerebral symptoms than CL or other hemodynamic indexes during induced VTs. Since long-term RVP monitoring is feasible, this parameter could be incorporated into ICDs decisional path, in the perspective of reducing unnecessary, painful shocks.

Back Pain and Cardiogenic Shock: An Atypical Diagnosis for Typical Symptoms

Back Pain and Cardiogenic Shock: An Atypical Diagnosis for Typical Symptoms