rome and Pain

The purpose of our study was to investigate the role of intra-articular pulse-dose radiofrequency in management of painful hallux valgus refractory to conservative therapies.. Between November 2010 and April 2012, 51 patients (15 male, 36 female) with a median age of 71.4 years were included in our clinical trial. Under fluoroscopic guidance we introduced a 22 gauge 10 cm length cannula by a percutaneous access in the first metatarsophalangeal joint and its tip was placed intra-articularly. After removing the spindle, a radiofrequency needle with a 5 mm active tip was introduced. The following parameters were used: 1200 pulses at high voltage (45 V) with 20 msec duration followed by 480 msec silent phases.. A great reduction in pain intensity was documented at 1 week, 1 month and 3 months after procedures. Pain intensity increased between 5 and 8 months after treatments, so we performed a second procedure in all patients between 7 months and 9 months since the first treatment. Also in this case we obtained a great reduction of pain intensity in the first 3 months after the procedure. Pain intensity returned at preprocedural values after 9 months after second procedure. No complications were observed.. Our experience shows pulse-dose radiofrequency is a safe, repeatable and effective technique for managing patients with symptomatic hallux valgus in the short and medium term. Pulse-dose radiofrequency may improve pain control and quality of life in patients with hallux valgus refractory to conservative therapies.

Topics: Aged; Aged, 80 and over; Feasibility Studies; Female; Hallux Valgus; Humans; Male; Middle Aged; Pain; Pain Measurement; Pulsed Radiofrequency Treatment; Rome; Time Factors; Treatment Outcome

To evaluate sample quality, prostate cancer detection rate and biopsy morbidity in transrectal ultrasound (TRUS)-guided prostate biopsy (PBx) using 16- or 18-gauge Tru-Cut needles.. Patients undergoing TRUS PBx were consecutively randomized with a 1:1 ratio into two study arms: group A (16-gauge needle) and group B (18-gauge needle). Core fragmentation and small specimen length (<10 mm) rate were the sample quality criteria. Three consecutive visual analog scale tests for pain and the Clavien surgical classification complications grading for rectal bleeding were used to evaluate TRUS PBx morbidity.. Overall, 250 patients were evaluated. No statistically significant difference between 16- and 18-gauge biopsy needles was recorded for cancer detection rate (29.6 vs. 30.4%, p = 0.890), core fragmentation rate (5 vs. 7%, p = 0.425) and shorter specimen (2 vs. 2%, p = 0.309). Pain control was similar in the two groups during the biopsy, 30 min after biopsy and the evening of the same day. Very small or absent bleeding was the more frequent complication observed in each group.. Prostate detection rate and sample quality were not influenced by needle size. A 16-gauge needle biopsy does not increase TRUS PBx morbidity.

Topics: Adult; Aged; Aged, 80 and over; Biopsy, Needle; Chi-Square Distribution; Equipment Design; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Needles; Nerve Block; Pain; Predictive Value of Tests; Prospective Studies; Prostate; Prostatic Neoplasms; Rectal Diseases; Rome; Single-Blind Method; Ultrasonography, Interventional

To compare 2.7- and 4-mm rigid optics, with 3- and 5-mm outer sheaths, respectively, in office diagnostic hysteroscopy by evaluating pain, patient tolerability, optical view and diagnostic accuracy of the procedure.. Three hundred seventy-one consecutive patients undergoing hysteroscopy were included in a prospective, randomized clinical trial, and the outcomes were analyzed. A saline solution was used as the distension medium. The t test for unpaired samples, chi2 tables of contingency and ANOVA 2 x 3 were used where appropriate. The study took place at Tor Vergata University Hospital of Rome, Rome, Italy. The 371 women were referred consecutively for suspected endometrial pathologies and were separated into 2 groups. Diagnostic accuracy of the hysteroscopic procedure, pain experienced by the 2 groups (as assessed by a visual analogue score) and patient acceptability were assessed with a questionnaire.. Satisfactory hysteroscopy was achieved in 253 of 310 patients with a 2.7-mm hysteroscope and in 47 of 61 patients with a 4-mm hysteroscope. This difference was not significant. Menopausal status was the most important factor influencing the practicability of the hysteroscopic procedure (p < 0.001).. The narrower-diameter hysteroscopes tended to lower the incidence of pain associated with office hysteroscopy, but this was not significant. Parity did not show any influence on hysteroscopic practicability. Menopausal status was the most important factor influencing the feasibility of the hysteroscopic procedure.

Topics: Adult; Aged; Ambulatory Care; Equipment Design; Feasibility Studies; Female; Humans; Hysteroscopes; Hysteroscopy; Menopause; Middle Aged; Office Visits; Optics and Photonics; Pain; Prospective Studies; Rome; Time Factors; Uterine Diseases

Pharmacologic treatments for irritable bowel syndrome (IBS) and medical management of symptoms are increasingly based on IBS subtype, so it is important to accurately differentiate patients. Few studies have classified subtypes of pediatric IBS, and conclusions have been challenged by methodologic limitations. We performed a prospective study to investigate the distribution of IBS subtypes among children and adolescents based on stool diary information, and compared subtypes according to demographic and pain characteristics.. We studied 129 subjects, ages 7 to 18 years (mean age, 11.4 ± 2.8 y; 60.5% female; 69.0% white) who met Pediatric Rome III IBS criteria and were part of larger studies of children with functional gastrointestinal disorders, recruited from primary and tertiary care centers. Children completed daily pain and stool diaries for 2 weeks. Participants were assigned IBS subtypes based on their reported stool information per adult Rome III criteria. IBS subtypes were compared for demographic variables and pain characteristics.. IBS with constipation was the most common subtype of the disorder (58.1% of subjects), whereas mixed IBS was the least common (2.3% of subjects); 34.1% of subjects were unsubtyped IBS and 5.4% had IBS with diarrhea. The groups of different IBS subtypes did not differ significantly by sex, age, ethnicity, or pain characteristics.. In contrast to adults, in children, IBS with constipation and unsubtyped IBS are the most common subtypes, whereas IBS with diarrhea and mixed IBS are less common. Demographic and pain characteristics cannot distinguish subtypes.

Topics: Adolescent; Child; Constipation; Diarrhea; Female; Humans; Irritable Bowel Syndrome; Male; Pain; Prospective Studies; Rome; Severity of Illness Index

The history of the treatment of childhood acute leukemia is a meaningful model of the ethical, bioethical and organizational implications of the technical progress in medicine. This experience provides indications and very useful tools to face the main topics of modern medicine: the risk of intense medicalization to the detriment of the quality of the care, the importance of psycho-emotive, ethical and spiritual aspects in the doctor-patient relationship, etc. The Authors report the difficulties and progresses until and after the first cures of children with leukemia in the Pediatric Clinic of the University "La Sapienza" of Rome (1964), the new features of treated leukemia (the real disease of cured child") and the psycho-emotive involvement of the pediatric staff a "parallel disease"). The necessity of a continuous activity aimed at the adaptation of services to scientific and medical progress and to the necessity of humanization of procedures and environment is stressed.

Topics: Child; Clinical Trials as Topic; Disease Management; Female; Hematology; History, 20th Century; History, 21st Century; Hospitals, University; Humans; Male; Outpatient Clinics, Hospital; Pain; Parents; Pediatrics; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rome; Societies, Medical; Stress, Psychological