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The mechanism of ipsilateral shoulder pain (ISP) after thoracic surgery remains unexplained definitively in the literature. Regional techniques targeting specific nerves more precisely will provide practitioners with a better understanding of the pain source. We report the case of a 51-year-old woman who underwent robotic-assisted plication of the right hemidiaphragm. ISP was adequately managed using a low-volume infusion through a continuous phrenic nerve block in addition to a thoracic epidural for her chest pain. ISP after thoracic surgery likely originates from diaphragm manipulation. Phrenic nerve blockade is a successful strategy that does not worsen subjective dyspnea in this setting.Background Disparities in access to care and proper treatment can have significant implications in patient survival outcome and mortality. This retrospective study of prostate cancer patients from the National Cancer Database (NCDB) between the years 2004 and 2014 and follow-up to the end of 2015 analyzed such effects that variation in payer status might have on outcome. Methods This study used the data of 696,321 diagnosed prostate cancer patients from the NCDB for the years 2004 to 2014 and follow-up to the end of 2015 to analyze the effect that payer status would have on prostate cancer survival. Multivariable cox regression was used to study the hazard ratios (HRs) of payer status and other variables along with the Charlson Comorbidity Index to analyze their associated increased risk of death. Statistical software SAS 9.4 for Windows was used to analyze the overall survival (OS) of patients on different insurance plans along with variations in prostate-specific antigen (PSA) levels and treatment type. Rescare, the uninsured, and those with Medicaid demonstrated significantly greater risks of death at 43%, 58%, and 69% increased risk of death, respectively. Studies have suggested that those without insurance or on Medicaid are less likely to undergo screening and have worse health-related quality of life, while those on Medicare may be deterred from continuing treatment due to high out-of-pocket costs. However, the complete mechanism behind the improved survivorship of those on private insurance is unclear. The effect of payer status on quality of life may be an interest that needs to be further studied. Further research will be required to provide definite reasons for these observations and mediation analysis of other factors could prove to be valuable.Background Urinary stone disease is associated with renal impairment because of obstruction and infection. Comorbidities include hypertension, dyslipidemia, diabetes, and impaired renal function. Furthermore, as recurrences are common in urolithiasis, such patients undergo many treatments throughout their life. Percutaneous nephrolithotomy (PCNL) is an effective treatment for renal stones with a diameter greater than 2 cm. Rutin The primary objective of this study was to observe the mean changes in estimated glomerular filtration rate (GFR) in patients undergoing PCNL having renal stone disease. Methodology This cross-sectional study was conducted for six months between June and November 2020 at a tertiary care hospital in Karachi, Pakistan. All male and female patients aged between 15 and 70 years who were diagnosed with renal stones using X-ray of the kidney, ureter, and bladder or using ultrasound of the abdomen and planned for PCNL were selected. Patients with any duration of kidney stone disease were included. Statistical Package for Social Sciences version 20.0 (IBM Corp., Armonk, NY, USA) was used to statistically analyze the data. Results The mean age of the patients was 41.11 ± 14.30 (17-70) years. A total of 61 (38.1%) patients were female and 99 (61.9%) were male. Mean preoperative GFR was 91.22 ± 5.88 mL/min which decreased to 83.64 ± 5.70 mL/min at 48 hours post-PCNL. GFR significantly decreased after surgery (p = 0.0001). Conclusions During early postoperative days, GFR was decreased in patients undergoing PCNL. Factors that may impair renal function should be avoided during the first few days after undergoing PCNL. Further large-scale studies are needed to investigate these changes in GFR in post-PCNL patients.A 17-year-old female presented to the physical therapy clinic with bilateral lower leg pain that worsened with activity. The patient experienced numbness, tingling, and cramping along the lateral and posterior portions of her legs during basketball practice, and her symptoms had gradually worsened over the past eight months. She obtained minimal relief with conservative treatments such as stretching and rest. X-rays and MRI of the lower limbs were obtained six months after symptoms began and were unremarkable. Further evaluation included compartment pressure testing taken before and after exercise. The patient demonstrated diagnostic pressures indicative of compartment syndrome in two compartments bilaterally. The patient was subsequently diagnosed with exertional compartment syndrome. Exertional compartment syndrome is a cause of muscle pain that occurs due to increased tissue pressure within the confinement of the closed fascial space during exercise. Patients are often misdiagnosed or there is a significant delay in the correct diagnosis. The gold standard for diagnosis is measurement of intracompartmental pressures with the Stryker catheter. Clinicians should consider exertional compartment syndrome in active patients who present with generalized muscle pain or sensation deficits that worsen with activity and are relieved with rest. Surgical intervention is a reasonable intervention and the only definitive option for an athlete with chronic exertional compartment syndrome who wants to continue high-level competition. Endoscopic fasciotomies are the new preferred techniques compared to more invasive open surgeries, which require a full incision. Endoscopic fasciotomy has a quicker healing time and has been shown to be as effective at relieving compartment syndrome symptoms as invasive open techniques. After surgical intervention, the patient reported a 90% reduction in symptoms and had returned to full sport participation within two months.
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