Mechanisms of acute and chronic pain after surgery: update from findings in experimental animal models

Purpose of review Management of postoperative pain is still a major issue and relevant mechanisms need to be investigated. In preclinical research, substantial progress has been made, for example, by establishing specific rodent models of postoperative pain. By reviewing most recent preclinical studies in animals related to postoperative, incisional pain, we outline the currently available surgical-related pain models, discuss assessment methods for pain-relevant behavior and their shortcomings to reflect the clinical situation, delineate some novel clinical-relevant mechanisms for postoperative pain, and point toward future needs. Recent findings Since the development of the first rodent model of postoperative, incisional pain almost 20 years ago, numerous variations and some procedure-specific models have been emerged including some conceivably relevant for investigating prolonged, chronic pain after surgery. Many mechanisms have been investigated by using these models; most recent studies focussed on endogenous descending inhibition and opioid-induced hyperalgesia. However, surgical models beyond the classical incision model have so far been used only in exceptional cases, and clinical relevant behavioral pain assays are still rarely utilized. Summary Pathophysiological mechanisms of pain after surgery are increasingly discovered, but utilization of pain behavior assays are only sparsely able to reflect clinical-relevant aspects of acute and chronic postoperative pain in patients. Correspondence to Esther Pogatzki-Zahn, Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany. Tel: +49 251 8347261; fax: +49 251 88704; e-mail: pogatzki@anit.uni-muenster.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Pitfalls in anaphylaxis

Purpose of review Anaphylaxis is an acute medical emergency characterized by sudden presentation of life-threatening respiratory and cardiovascular symptoms. Rapid diagnosis of anaphylaxis is crucial to implement an appropriate treatment and management plan. However, mistakes in the diagnosis of anaphylaxis may occur because of the limited time during which the diagnosis must be made, the stressful environment of the emergency room, the often aspecific or incomplete clinical features of early anaphylaxis and the lack of useful laboratory markers. Recent findings Several disorders may mimick anaphylaxis and cause wrong or delayed diagnosis increasing chances of fatal outcomes. In addition, certain clinical situations, like general anesthesia, may complicate detection of early signs of anaphylaxis. Drugs like beta-blockers, angiotensin converting enzyme-inhibitors, antihistamines or steroids may hide or blunt initial clinical manifestations of anaphylaxis. Summary A careful evaluation of clinical signs in all organs is mandatory to quickly establish and confirm a diagnosis of anaphylaxis. Alternative diagnosis should be considered, particularly in the case of unresponsive patients. Avoiding pitfalls in anaphylaxis diagnosis will help to establish rapidly effective treatments and would further reduce the rate of fatal events. Correspondence to Massimo Triggiani, MD, PhD, Division of Allergy and Clinical Immunology University of Salerno, Via S. Allende Baronissi, Fisciano, Salerno, Italy. Tel: +39 089 965056; fax: +39 089 965056; e-mail: mtriggiani@unisa.it Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Methodological empiricism and the choice of measurement models in social sciences

Abstract

Realism is generally assumed as the correct position with regards to psychological research and the measurement of psychological attributes in psychometrics. Borsboom et al. (Psychological Review, 110(2), 203–219 2003), for instance, argued that the choice of a reflective measurement model necessarily implies a commitment to the existence of psychological constructs as well as a commitment to the belief that empirical testing of measurement models can justify their correspondence with real causal structures. Hood (Erkenntnis, 78(4):739–761 2013) deemphasized Borsboom et al.'s position and argued that the choice of a reflective measurement model does not necessarily require ontological commitments, though, in his view, it does necessitate a commitment to minimal epistemic realism. Although these arguments are formulated with regard to psychological research, they can actually be generalized to other disciplines in social sciences that use similar methodologies and statistical techniques. In Hood's opinion, empiricism does not suffice to provide an adequate account of the choice of reflective measurement models given that this choice requires an appeal to causal explanations. In this paper, we argue against Hood and answer this challenge, providing epistemic foundations for social science research that do not appeal to realism.

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Intrathoracic scapular dislocation following lung cancer resection

Abstract

A 64-year-old man underwent right upper lobectomy combined resection with third-fifth rib for lung cancer and reconstruction of chest wall using Dual Mesh. Six days after surgery, he experienced acute severe pain in the right shoulder. The purulent drainage through the drainage tube was also found. Chest CT showed that the inferior angle of the scapula protruded into the right intrathoracic cavity. We performed a removal of Mesh. Although we did not want to use synthetic materials because of infection, we performed titanium plate fifth rib fixation to avoid the recurrent dislocation of the scapula. After the redo surgery, continuous lavages with physiologic saline of the thoracic cavity was also performed. Patient is now doing well without recurrences of cancer, infection and scapular dislocation, 14 months after the redo surgery.

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Concomittant fibrous dysplasia with aneurysmal bone cyst formation within the skull, humerus and rib

Abstract

Polyostotic fibrous dysplasia (FD) is a rare pathology characterized by the abnormal and gradual replacement of normal bone (calcium hydroxylapatite of osteoid matrix) with fibrous connective tissue. Aneurysmal bone cyst (ABC) is a tumor-like benign lesion with blood-filled cavities that can affect virtually any bone in the body. We report on a 20-year-old male presenting with an extremely rare pathology of FD with ABC formation of the skull, fourth rib and humerus. Our case report represents a novel literary addition to rare FD with ABC pathologies. Optimal diagnosis of this rare pathology can be achieved by a full body evaluation for clinical and radiographic FD with or without ABC, and optimal treatment for this rare pathology is the maximum surgical excision of the tumor and/or soft tissue.

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Case report: irreducible medial subtalar dislocation with incarcerated anterior talar head fracture in a young patient

Abstract

Subtalar dislocations are rare injuries that typically occur from high-energy injuries. All subtalar dislocations should be attempted to be closed reduced, however, ~32% are irreducible requiring open reduction. We present an irreducible medial subtalar dislocation following a motor vehicle accident with no associated fractures demonstrated on radiograph. However, open reduction revealed an incarcerated anterior talar head fracture that was reduced and stabilized with retrograde K-wires.

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Food protein-induced eosinophilic enteritis with intestinal stricture in a neonate: a case report and review of the literature

Abstract

The case of a 21-day-old boy with eosinophilic enteritis with intestinal stricture due to a food protein-induced allergy is reported herein. For the first 4 days of life, he was both breast-fed and formula-fed, after which he was exclusively breast-fed. At the age of 24 days, he underwent laparotomy to investigate the possibility of intestinal obstruction for bilious vomiting, and an ileal stricture was detected and resected. Pathologic analysis showed the presence of eosinophil accumulation in the lesions presented more than 20 eosinophils per high-power field and the eosinophils were oriented towards the epithelium and diffusely distributed throughout the tissue, but the margins of resection showed a few infiltration of eosinophiles. Allergen-specific lymphocyte stimulation testing showed a markedly increased lymphocyte response to lactoferrin. He was finally diagnosed as eosinophilic enteritis with intestinal stricture due to a food protein-induced allergy. The patient remained asymptomatic during a follow-up period of 12 months.

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