Violent Pain Research Articles

Black Women Watchers

Black Women Watchers Wendy M. Thompson (bio) I remember the first time I went into labor. It was as though I was being forced to dance to a new choreography. The pain gripped and twisted the whole of my body, my lower back folding inward, my five-foot body contorting to music only I could hear, moving on a stage only I could access. Each sudden lightning strike of pain reminded me that in that moment, my body was not my own but was shared by the small thing—a girl, they told me, who might have a congenital anomaly, so we were on high alert—pushing inside. My mother, who had given birth multiple times without anesthesia, reminded me of her mother, who had also given birth multiple (nine) times without anesthesia in a foreign country, and told me I was not the first woman to go into labor. She said this to me while panicked and driving to a hospital in Fremont at night, where I had intentionally chosen a young Asian American female doctor and knew that there would be Black female medical staff present, among many other nurses of color who would at the very least, see me and attend to my body. Unlike in the videos and manuals I was given by the birthing center, there was no defining marker between the beginning of real labor and the moment when pain arrived to fight me for my body. There was no breaking of water. There was no voice outside of me that gently guided me into the golden meadow of motherhood. Just sharp violent pains that, if I were to describe it to a counselor later, had no color, no smell, and weren't even five minutes apart. I barely remember standing in front of two panicked male front desk staff with swollen legs and feet, wearing a loose-flowing housedress while I struggled to pull my driver's license out of my wallet. One of the staff [End Page 165] members, a young Chinese man, ran—literally, ran!—to get me a wheelchair and quickly wheeled me up to my room. Then someone helped me onto the bed before leaving me alone. Everything that came after that, the breathing, the rotating nursing staff, the pushing, the family members who stopped by, the white female doctor who came in to get my signature in the event that I died during delivery, ran together like watching a movie in fast-forward. Everything except for the Black nurse who I never saw at first but who came to me after I let out what I can only now describe as a wild animal sound. Alone in a room on the labor and delivery floor in this hospital, a cry was heard through my open door by another Black woman, a nurse, who wasn't even assigned to me but was conveniently (or divinely) right outside my room and who I would never see again during the rest of my stay at the hospital. I will never forget how she came in, looked at me, and immediately said, "Don't worry, honey. I'm going to go call the anesthesiologist to come right now." No need to explain on a scale of one to ten. No need to prove my pain according to a white man's threshold. Just a matter-of-fact acknowledgment that a baby was coming, her mama was in great pain, and there needed to be some immediate action taken. With a little sugar on top. Honey. ________ I thought about this birthing experience and the traumatic one that would follow seven years later in Minnesota after reading a post made by writer Kiese Laymon on social media on January 4, 2021. Kiese wrote: My mother had major spine surgery. It was terrifying. She's still trying to recover. When she finally woke up, all she could talk about was this Haitian nurse who told her it would be okay because there would be a Black resident in the operation room watching. We talked more and she made it clear that even if she would have had a Black surgeon, she really wanted a...

A survey over the undergraduate students' approaches toward the management of endodontic emergencies at the Dakar Dental School: A descriptive cross-sectional study

Introduction: Endodontic emergencies are characterized by violent or disabling pain. The management of these emergencies requires a precise diagnosis and an emergency act with or without a prescription. This study primarily aimed to determine undergraduate students' knowledge on the management of endodontic emergencies at the dental school. Materials and Methods: In this cross-sectional descriptive study, students of the dental school have received questionnaires with two main parts: a first part dealing with students' identification and a second part dealing with students' knowledge and attitudes on endodontic emergency management. Participants were asked to choose the appropriate option (s) for the appropriate management of each type of endodontic emergency. Data were statistically analyzed. Results: Of the 176 students included in this study, 171 questionnaires (97.2%) were completed and returned to the authors. For each emergency, most of the respondents recommended options that are consistent with the standard protocol. The statistical analysis showed a significant correlation between correct responses according to the standard protocol and academic levels of students who attended a conference or training on endodontic emergencies and students who dealt with endodontic emergency during their training (P Conclusion: The study showed that the students' level of knowledge is high. However, they recommended inappropriate antibiotic prescriptions. This shows the need to improve student-training programs on endodontic emergencies.

The sociocultural context of pediatric pain: an examination of the portrayal of pain in children's popular media.

Pain (eg, needle injections, injuries, and chronic pain) is highly prevalent in childhood and occurs in social contexts. Nevertheless, broader sociocultural influences on pediatric pain, such as popular media, have not been empirically examined. This study examined how pain is portrayed and gendered in children's popular media. A cross-section of children's media targeted towards 4- to 6-year-old children was selected based on popularity, including 10 movies and the first season of 6 television shows. Pain instances were extracted and coded using 2 established observational coding systems assessing sufferer pain characteristics and observer responses (eg, empathic responses). Findings identified 454 instances of pain across the selected media. Violent pain (ie, intentionally inflicted) and injuries were most commonly represented, whereas everyday, chronic-type, and procedural pains were infrequently portrayed. Pain instances were more commonly experienced by boy characters, who also expressed greater distress; yet, observers were more responsive (eg, expressed greater concern) towards girl characters' pain. Overall, observer responses to pain were infrequent, with observers witnessing but not responding to nearly half of pain instances. Observers who did respond expressed an overall lack of empathy towards sufferers. These findings reveal a very narrow depiction of pain presented in children's popular media, with an overall underrepresentation of pain, numerous maladaptive portrayals of pain, and gender differences in both sufferer and observer responses. This study underscores the need for further research to inform how children's popular media is perceived by parents and children and how media may be transformed and harnessed for effective pain education in childhood.

Polymyalgia rheumatica following intravesical bacillus Calmette-Guerin instillation: coincidence or true association? A case report and literature review

We report the case of a 73-year-old male patient suffering from non muscle invasive bladder cancer (NMIBC) who had violent pains in his neck and shoulders associated with general discomfort and fever, following the second intravesical instillation of bacillus Calmette-Guerin (BCG), with further worsening after the third instillation. During his hospitalization, laboratory tests showed a significant raise of inflammatory markers. An ultrasound (US) examination of his shoulders showed bilateral longhead-biceps exudative tenosynovitis and subdeltoid bursitis. An 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) associated with total body computed tomography (CT) showed pathological inflammatory findings in neck and shoulders, with exclusion of pathological findings in other sites. Cystoscopy was negative for NMIBC recurrence. Polymyalgia rheumatica (PMR) was diagnosed and BCG instillations was stopped. The patient had fast improvement of clinical manifestations and laboratory tests, but when he resumed them a few weeks later, the same manifestations recurred.

Pyelonephritis: A Historical Reappraisal.

There is no human knowledge which cannot lose its scientific character when we forget the conditions under which it originated, the questions it answered and the function it was created to serve.[1][1] As with most diseases of the kidney, pyelonephritis is an old ailment, which as a diagnosis, is a

Ipoestesia del nervo mentoniero causata da infezioni odontogene: casi clinici

ObjectivesWe describe a case series in which the presence of Numb Chin Syndrome (NCS) was the most relevant symptom related to odontogenic infections and cystic lesions. This neuropathy of the mental nerve is characterized by the presence of hypoesthesia or paresthesia of the lower lip and chin. Materials and methodsWhen not related to iatrogenic causes, the condition is clinically significant because of its frequent association with malignant diseases, especially lymphoma and metastatic lesions. However, several cases have been ascribed to dental pathologies, such as dentoalveolar abscesses or benign tumours. Three cases of NCS are described. A 59-year-old man (case I) presented with violent pain in the right premolar region; after a few days, hypoesthesia of right mental nerve also appeared. Clinical and radiologic examinations confirmed the presence of an osteolytic infective lesion originated from 4.5. A 45-year old-woman (case II) reported a continuous not evoked pain at 3.5, 3.6 and hypoesthesia of left mental nerve; dental panoramic tomography revealed an expanding lytic lesion involving the mandibular canal suggesting a cystic lesion in relation to 3.6. A 63-year-old man (case III) reported a violent pain in the right lower molar and premolar region; hypoesthesia of the right mental nerve soon followed. In the CT imaging, signs of osteitis with sequestrum originated from apical periodontitis of 4.7 and 4.5 were found. Discussion and conclusionsAlthough the mental nerve neuropathy is considered a “red flag” symptom of a distant malignant neoplasm, odontogenic infective causes or benign tumours should be considered.

Cholangiosepsis Caused by Neutrophilic Cholangitis in Plaque Psoriasis

Psoriasis is a common inflammatory skin disease with many comorbid conditions. We present a 37-year-old male patient with a history of plaque psoriasis, status febrilis, violent umbilical pain, elevated inflammatory markers and liver parameters. Blood cultures were tested positive for E. coli. Diagnostic findings indicated that mechanical icterus and cholangiosepsis in the context of neutrophilic cholangitis were caused by inflammatory stenosis. Neutrophilic cholangitis is often found in combination with skin diseases with intense cutaneous infiltration with polymorphonuclear leucocytes and peripherial blood neutrophilia. Interleukin-8 may play a role in the pathogenesis of neutrophilic cholangitis occurring in patients with psoriasis [1]. We showed that complications of psoriasis can also occur at unusual locations. To date no case of neutrophilic cholangitis as an elicitor of cholangiosepsis has been reported.

Hyperglycemia is a risk factor for high-grade envenomations after European viper bites (Vipera spp.) in children

Context: Hyperglycemia has been described in severe scorpion envenomation, we wanted to analyze if it was applicable to viper bites in children. Aim: To describe clinical, biological, and therapeutic characteristics of 83 children bitten by European viper (Vipera spp.) and to confirm that hyperglycemia is a risk factor for high-grade envenomation. Material and methods: A retrospective study was conducted between 2001 and 2014 in the pediatric emergency department of a tertiary level children’s hospital. Collected data were: age and sex of children; day and time of admission; day, time and circumstances of the accident; snake identification; bite location; envenomation severity; presence of fang marks; prehospital care; laboratory abnormalities, use of specific immunotherapy, associated treatments; length of stay; hospital course. Results: Eighty-three children were included (62 boys, 21 girls). The mean age was 7.4 ± 3.9 years. Bites were most often located on the lower extremities (66%). The classification of envenomation was: 83% low grade (absent or minor envenomation) and 17% high grade (moderate to severe envenomation). All high-grade envenomations received specific immunotherapy (ViperfavTM, (Aventis Pasteur, MSD, Lyon, France). Being bitten on an upper extremity (odds ratio [OR] 51.1 95% class interval [CI] [6.1–424], p < 0.0001), during the afternoon (OR 13.4 95% CI [1.7–107.9], p = 0.015), feeling violent pain (OR 4.2 95% CI [1.1–16.5], p = 0.023), and high initial plasma glucose level (6.5 ± 1.7 mmol/L versus 5.0 ± 0.9 mmol/L, p = 0.027) were associated with a significant risk of high-grade envenomation. Conclusion: We have confirmed a potential link between initial hyperglycemia and the risk of progression to high-grade envenomation as well as its association with other published predictive factors.

Origins of the Concept of Vasospasm.

Celsus may have described subarachnoid hemorrhage (SAH) when he wrote in A.D. 30, “The characteristic marks… are strong shivering, nervous relaxation, dimness of sight, delirium, vomiting together with a suppression of voice, besides these symptoms there is a violent pain chiefly about the temples or occiput”.1 Hippocrates in Aphorisms on Apoplexy probably described a case: “When persons in good health are suddenly seized with pains in the head, and straightway are laid down speechless, and breathe with stertor, they die in seven days.” Neglecting the patient who would in those days die rapidly without articulating their history, could this be a description of “vasospasm,” or in current terminology, delayed cerebral ischemia (DCI)? Aneurysms were well known to the ancients, but those located intracranially eluded detection by virtue of being encased in the cranium and not palpable or large and easily accessible to clinical or postmortem assessment. McDonald and Korb2 credited Biumi with describing in 1778 the first pathologically verified case of ruptured intracranial aneurysm. Weir wrote that Gull may have been the first to describe DCI in a 30-year-old female in 1859: “while walking, she suddenly called out, ‘Oh, my head’ and put up her left hand. She vomited, and her friend thought, fainted. After a brief interval she partially recovered, and was able to walk back to her residence with the support of two men. When admitted to the hospital at noon the following day, only a slight impression could be made by any attempt to rouse her. The right arm was quite paralysed, the muscles flaccid; the right leg in the same condition….”3 The text goes on to describe improvement in her condition such that on day 4 she could talk and eat. However, on the fifth day she deteriorated and died and was found …

Aïnhum et « kératodermies acrales africaines » : trois cas

Ainhum, or spontaneous dactylitis, involves the formation of a gradual constriction in the digital-plantar fold of the fifth toe that leads, after several years, to autoamputation of the digit. This condition is classically distinguished from "true" ainhum, of unknown aetiology and affecting only subjects of African origin, from "pseudo-ainhum", resulting from different causes such as inflammatory constriction or constriction by a foreign body, and finally from ainhumoid palmoplantar keratoderma, which is of genetic origin and occurs for instance in Vohwinkel syndrome. Herein, we report three cases of ainhum in women of sub-Saharan African origin; in addition, all three subjects were also presenting various forms of hyperkeratosis of the hands and feet known to primarily affect subjects of African origin. The three patients, aged 30, 48 and 44years, were respectively from Mali, Guinea and Senegal. They had consulted a dermatologist for violent pain in the fifth toe, which frequently prevented sleep and was inexplicable despite several consultations, and even in one case in spite of surgical investigation. Once the diagnosis had been made, relief was promptly provided for all three patients through Z-plasty to remove the circular constriction around the toe in question. In addition to ainhum, the first patient was also presenting diffuse palmoplantar keratoderma, together with an aspect of acrokeratoelastoidosis on the edges of her hands and feet, and knuckle pads, while the second was presenting diffuse palmoplantar keratoderma and an aspect of marginal acrokeratoelastoidosis, and the third was presenting small knuckle pads. A recent study has confirmed the high incidence of several forms of palmoplantar keratoderma of African origin, as well as frequent association of these different varieties with one another. These consist of diffuse keratoderma having a relatively non-specific aspect, keratoderma punctata of the palmar creases, marginal keratoderma known also as focal acral hyperkeratosis, and acrokeratoelastoidosis, despite the absence of histological evidence, and finally, inverted keratoderma, i.e. affecting the dorsal aspects of the extremities, such as knuckle pads. In the three cases presented here, ainhum was associated with these different forms of acral keratoderma seen chiefly in subjects of African origin. So-called "true" ainhum may be included in a broader group of African acral keratoderma, further reinforcing the unity of this group. Genetic studies are required to enable validation and refinement of these clinical findings.

Risk Factors for High-Grade Envenomations After French Viper Bites in Children

Viper bites and subsequent evolution to severe envenomations are more frequent in children. The aims of this study were to describe the clinical, biological, and therapeutic characteristics of children bitten by vipers in France and to identify risk factors associated with severe envenomations. A retrospective study was conducted between 2001 and 2009 in the pediatric emergency department of a tertiary-level children hospital. Collected data were age and sex of children; day and time of admission; day, time, and circumstances of the accident; snake identification; bite location; envenomation severity; presence of fang marks; prehospital care; use of specific immunotherapy and associated treatments; length of stay; and hospital course. Fifty-eight children were included (43 boys, 15 girls). The mean age was 7.8 ± 4.1 years. Bites were most often located on the lower extremities (77%). The classification of envenomation was: 83% low grade (absence or minor envenomation) and 17% high-grade (moderate to severe envenomations). All high-grade envenomations received specific immunotherapy (Viperfav). Being bitten on an upper extremity (P < 0.001), during the afternoon (P = 0.025), feeling violent pain (P = 0.037), and high initial glucose level (P = 0.016) were associated with a significant risk of high-grade envenomation. In the multivariate analysis, 3 factors remained significant: upper-extremity location (relative risk [RR], 60.5 [3.5-1040]; P = 0.005), immediate violent pain (RR, 21.5 [1.3-364.5]; P = 0.03), and female sex (RR, 17.5 [0.9-320.3]; P = 0.053). A certain number of criteria seem related to more significant risk of progression to high-grade envenomation. Bites to the upper extremities should be carefully observed because of the risk of evolution to a high-grade envenomation.

Morsures de vipères chez l’enfant

Adder bites and their progression to severe envenomations are more frequent in children than in adults. To describe the clinical, biological, and therapeutic characteristics of children bitten by adders and to identify risk factors associated with severe envenomations corresponding to grades II and III of the Audebert et al. classification (Toxicon 1992). A retrospective study was conducted between 2001 and 2009 in the pediatric emergency department of a tertiary children's hospital. The data collected were: age and sex of children; day and time of admission; day, time, and circumstances of the accident; snake identification; bite location; envenomation severity based on the Audebert et al. classification; presence of fang marks; prehospital care; use of specific immunotherapy (Viperfav(®)), associated treatments; length of stay; orientation, progression, and any complications. Fifty-eight children were included (43 boys, 15 girls). The mean age was 7.8 ± 4.1 years (range, 1.8-15 years). Bites occurred more often between 12:00 pm and 6:00 pm (62%), and were most often located in the lower extremities (77%). The classification of envenomation was: 83% low grade (grade 0, absence of envenomation, fang marks present; grade I, minor envenomation) and 17% high grade (grades II and III, moderate and severe envenomations). All high-grade envenomations received specific immunotherapy (Viperfav(®) F(ab')(2) fragments against Vipera aspis, Vipera berus, and Vipera ammodytes). The mean time from bite to Viperfav(®) injection was 23 ± 11 h (range, 8-36 h). Being bitten on the upper extremities (p < 0.001), during the afternoon (p = 0.025), feeling an immediate violent pain (p = 0.037), and high initial glycemia (p = 0.016) were associated with a significant risk of progressing to high-grade envenomation. There was no significant correlation between age, gender, and upper extremity bite. In the final model of the multivariate statistical analysis, three factors remained associated with this risk: bite location in the upper extremities (relative risk [RR] = 60.5 [3.5-1040[; p = 0.005), immediate violent pain (RR = 21.5 [1.3-364.5[; p = 0.03), and female gender (RR = 17.5 [0.9-320.3[; p = 0.053). A certain number of criteria seem related with a more significant risk of progression to high-grade envenomation following an adder bite. These results need to be studied on a larger cohort of patients. Bites to the upper extremities should be handled with caution because of the association with more severe envenomation.

Minimal invasive treatment options in pregnant women with ovarian vein syndrome

To describe the treatment modalities of symptomatic ovarian vein syndrome in pregnancy. In our study, we included 12 pregnant women with right ureter and kidney dilatation; caused by ureteric obstruction. In 11 out of 12, we insert a DJ stent and in one woman we applied percutaneous nephrostomy, because of intermittent abdominal pain, resistant on analgetic therapy or feverish pyelonephritis. DJ stents and nephrostomy were inserted under ultrasound guidance without anaesthesia. After insertion of DJ stents, respective percutaneous nephrostomy colic attacks went back immediately and the feverish pyelonephritis in few days. At no time during these procedures, there was a risk for pregnancy. Ovarian vein syndrome in pregnancy can lead to violent colic pain and can become complicated by accompanied pyelonephritis. In these cases insertion of a DJ stent or percutaneous nephrostomy under ultrasound guidance is possible and safe, and leads to an improvement of complaints immediately.

P0717 SPLENIC INFARCTION DURING INFECTIOUS MONONUCLEOSIS

P0717 – Table 1 Communication Virus Diagnosis Symptoms Predisposing factor Management Outcome Suzuki et al. EBV CT scan, pathology. Fever, icterus, left upper quadrant abdominal pain and tenderness. Hereditary spherocytosis Analgesia, antibiotics, splenectomy 2 months later. Cured Breuer et al. EBV CT scan Fever, left upper quadrant pain and abdominal tenderness. Hereditary spherocytosis, Protein C deficiency. Analgesia, antibiotics. Cured Ofotokun et al. CMV CT scan, pathology. Fever, Abdominal pain, rigors and diaphoresis. None Ganciclovir, splenectomy, thrombolisis Cured Benz et al. EBV CT scan Fever, tonsillitis, generalized lymphadenopathy and left pleuritic chest pain. None Acetaminphen Cured Van Haal et al. EBV CT scan Fever, generalised myalgias and abdominal pain with upper left quadrant tenderness. Transient antiphospholipid antibodies. Support therapy Cured Symeonidis et al. EBV CT scan Fever, upper respiratory tract infection symptoms, left upper quadrant pain, nausea and vomiting. Sickle cell trait Support therapy Cured Trevenzoli et al. EBV CT scan Fever, pharyngitis, left upper quadrant pain. None Support therapy Cured Guibaud et al EBV Clinically and confirmed after surgery. Violent pain in left hipocondria. Transient neutrophil aggregation, Elevated quantity of immune complexes. Splenectomy Cured Garten et al EBV CT scan Fever, chills, malaise and night sweats. None Splenectomy (made for diagnosis, lymphoma was suspected) Cured Boivin et al EBV Ecography Fever, jaundice, left upper quadrant abdominal pain. Pyruvate kinase deficiency, haemolytic anemia cold autoantibodies. Splenectomy Cured

P0718 DARWIN'S ILLNESS: A FASCINATING PROBLEM FOR INTERNAL MEDICINE

P0717 – Table 1 Communication Virus Diagnosis Symptoms Predisposing factor Management Outcome Suzuki et al. EBV CT scan, pathology. Fever, icterus, left upper quadrant abdominal pain and tenderness. Hereditary spherocytosis Analgesia, antibiotics, splenectomy 2 months later. Cured Breuer et al. EBV CT scan Fever, left upper quadrant pain and abdominal tenderness. Hereditary spherocytosis, Protein C deficiency. Analgesia, antibiotics. Cured Ofotokun et al. CMV CT scan, pathology. Fever, Abdominal pain, rigors and diaphoresis. None Ganciclovir, splenectomy, thrombolisis Cured Benz et al. EBV CT scan Fever, tonsillitis, generalized lymphadenopathy and left pleuritic chest pain. None Acetaminphen Cured Van Haal et al. EBV CT scan Fever, generalised myalgias and abdominal pain with upper left quadrant tenderness. Transient antiphospholipid antibodies. Support therapy Cured Symeonidis et al. EBV CT scan Fever, upper respiratory tract infection symptoms, left upper quadrant pain, nausea and vomiting. Sickle cell trait Support therapy Cured Trevenzoli et al. EBV CT scan Fever, pharyngitis, left upper quadrant pain. None Support therapy Cured Guibaud et al EBV Clinically and confirmed after surgery. Violent pain in left hipocondria. Transient neutrophil aggregation, Elevated quantity of immune complexes. Splenectomy Cured Garten et al EBV CT scan Fever, chills, malaise and night sweats. None Splenectomy (made for diagnosis, lymphoma was suspected) Cured Boivin et al EBV Ecography Fever, jaundice, left upper quadrant abdominal pain. Pyruvate kinase deficiency, haemolytic anemia cold autoantibodies. Splenectomy Cured

Life-threatening cervical necrotizing fasciitis after a common dental extraction

We report a case of cervical necrotizing fasciitis (NF) with severe sepsis occurring 8 hours after a banal dental extraction in a healthy adult. A 44-year-old man was admitted for cervical NF and severe sepsis in the emergency department. An early diagnosis was based on clinical examination (violent pain, swelling of face, and crepitation), confirmed by computed tomography scan, which showed subcutaneous gas and a fracture of the maxillary sinus in regard of the extracted tooth. Broad spectrum antibiotherapy was started quickly followed by surgical debridement. Operative and sinus pus cultures were positive for polymicrobial strains (aerobes and anaerobe). Ventilatory and hemodynamic supports (large fluid infusion and catecholamine) were mandatory during a week. Successful outcome occurred within 2 weeks. Cervical NF is a rare but life-threatening disease with fulminant course. The mortality rate is high if the diagnosis and treatment are not begun promptly and vigorously. Therefore, the emergency medicine community must be aware of its initial symptoms.

Douleurs abdominales atypiques au premier trimestre de la grossesse

We report the case of a 22-year-old woman who presented a violent epigastric pain at eight-weeks gestation. Superior mesenteric vein thrombosis was detected, with an extension to portal vein and remaining blood flow. Screening for thrombophilia revealed a heterozygote prothrombin gene mutation. Portal vein thrombosis is uncommon and difficult to diagnose. Diagnosis is made by Doppler ultrasound, a second intention test to be done in case of unusual upper abdominal pain during pregnancy.

Patients' Satisfaction from Pain Soothing after the Surgery in Kerman Hospitals (2005)

Introduction: Post-operative pains may lead to various side effects and patient ’ s dissatisfaction, and its control is essentially effective in the recovery process after the surgery, length of hospitalization and the amount of patients' satisfaction. The goal of this study is to investigate the amount of patients ' satisfaction from pain soothing after the surgery in Kerman Hospitals during 2005. Materials & Methods: The research is descriptive–cross sectional in which 720 patients undergone the orthopaedic and stomach surgeries during 3 months in Bahonar and Afzalipur hospitals of Kerman. To investigate the patients' satisfaction from soothing the pain, they were studied 24 hours after surgery through Ache Rating System (ARS) and Numerical Rating System (NRS). The sampling method carried out through census and questionnaire consisting two parts (demographic factors and patients ' ideas about their post-operative pains). To determine the questionnaires validity, content validity was used, and to determine their reliability, a preliminary study and α Kronbach was used which showed the correlation coefficient of 7%, and for data analysis, descriptive statistic (correlation coefficient and X Test) was employed. Results: The cases studied were 418 males and 302 females, ranging from 15 to 75 years old. The results revealed that 76.11% of patients experienced the surgery for the first time. According to the data analysis, 70.55% of patients were dissatisfied with their pain soothing during 24 hours after the surgery, and 29.45% of them had relative and poor satisfaction, while just 32 of them (4.44%) took anodyne without anaesthetists control, and 52 of them (7.22%) were visited by anaesthetists after the syrgery. Conclusion: Pain control after the surgery and its bad effects reduction and also the patients' satisfaction have been consistently considered by anaesthetists .The best way suggested for pain reduction after the surgery, is using painlessness methods. Based on research results, 87.35% of patients were clearly in the maximum of severe pain, violent pain and acute pain during 24 hours after the surgery, and nobody showed complete satisfaction of soothing the pain away after the surgery. According to the findings of other researches, patients ' satisfaction after the surgery is related to the severity of pain, and today pain after the surgery is considered as the best criterion for estimating patients ' satisfaction. Consequently, the formation of special teams in Iranian hospitals to manage severe pain and using methods of pain control are recommended to solve this problem.

Rupture de l’artère brachiale et paralysie radiale secondaire à une exostose proximale de l’humérus chez une enfant de 14 ans

Rupture of the brachial artery associated with radial nerve palsy in a context of exostosis of the proximal humerus has not been described to date in the literature. Our patient was a fourteen girl with a history of violent pain occurring suddenly with no prodrome or triggering factor. The pain was localized at the level of the proximal left humerus. Physical examination revealed the presence of a hematoma and complete motor radial nerve palsy. The diagnosis was not confirmed by computed tomography with contrast injection but was confirmed by magnetic resonance imaging which eliminated malignant transformation of the exostosis. After checking the neurovascular bundles and evacuating the hematoma, treatment consisted in resection of the exostosis and arterial repair with an autologous venous graft. We discuss the diagnostic and therapeutic challenges which present vascular complications due to exostosis.

Synovialosarcome rétropéritonéal révélé par un choc hémorragique

Primary retroperitoneal synovial sarcoma is a rare malignant neoplasm that typically arises in young adults. We report here an unusual presentation of this tumor during hemorrhagic shock and retroperitoneal hematoma. A 31-year-old man was admitted complaining of acute violent pain of the right lower abdominal quadrant. Physical examination was normal. The computed tomography scan showed a heterogeneous retroperitoneal mass near the iliac bifurcation, with a diameter of 3 cm and spontaneous contrast. The tumor ruptured shortly afterwards and the patient underwent emergency surgery for hemorrhagic shock and retroperitoneal hematoma. No metastases were observed. Although six cycles of doxorubicin and ifosfamide led to initial clinical and tomographic remission, relapse occurred 17 months later. Only 20 cases of primary retroperitoneal synovial sarcoma have been described. They are most often discovered following abdominal pain or anemia. Tumor rupture with retroperitoneal hematoma has not previously been reported. Surgical ablation remains the basis for management of this tumor, and survival appears to depend on its quality. Prognosis is poor. Our case is original by the tumor's location and mode of discovery.