Management of severe postpartum haemorrhage by uterine artery embolization

We report a case of postpartum haemorrhage which was successfully treated by embolization of the uterine artery. This technique is not well known and is thought to be underused in this condition. We wish to alert medical personnel to its role in this life-threatening situation.

Chest pain following oesophageal stenting for malignant dysphagia

AIM

The palliative use of self-expanding metallic stents has been widely reported to relieve dysphagia in cases of oesophageal carcinoma. Little has been documented on the severity of chest pain following oesophageal stenting. The aim of this study was to investigate the association of pain with oesophageal stenting for malignant dysphagia.

METHODS

Fifty-two patients with inoperable oesophageal carcinoma underwent stent placement between 1995-1999. Daily opioid analgesic requirements (mg of morphine equivalent doses) were monitored for 3 days before and 7 days after stenting. The degree of palliation was expressed as a dysphagia score (0-3). Hospital stay, readmission days, stent complications and patient survival time were also recorded.

RESULTS

Twenty-six patients (50%) required opioid analgesia for chest pain (median dose: 80 mg morphine/day) within 48 h of the procedure compared to 11 (21.2%) patients before stenting (P = 0.0041). A significant increase was evident in the analgesic consumption following stent deployment (P < 0.001). The dysphagia score improved by a median value of 1 (CI 0.25)P < 0.001, with a re-intervention rate of 11.5%. The median survival time was 40 days post stenting (range 1-120).

CONCLUSION

A significant proportion of patients developed chest pain after oesophageal stenting, requiring high dose opioid analgesia. As the origin of the pain is still unknown, pre-emptive analgesia may a play role in reducing stent-related morbidity and possibly in-hospital stay.

Sickle cell disease and silent avascular necrosis of the hip

We reviewed the prevalence of avascular necrosis (AVN) in a series of patients with sickle cell disease, using radiography and magnetic resonance imaging. We found AVN of at least one hip in 11 of 27 patients (41%). This is a significantly greater prevalence than reported. MRI was not as helpful in patients with sickle cell disease as it is in patients with AVN from other causes; it detected no more cases than radiography.

Numerous pulmonary metastases from renal cell carcinoma confined to the middle lobe

Numerous pulmonary metastases entirely confined to one lobe are rare. A case is presented in which numerous pulmonary metastases from renal cell carcinoma were initially confused radiologically with lobar pneumonia.

The Millon Behavioral Health Inventory: concurrent and predictive validity in a pain treatment center

The Millon Behavioral Health Inventory (MBHI) is one of only a few diagnostic instruments designed specifically for psychological evaluations of medical patients. However, despite being available for clinical use for several years, there are virtually no published research evaluations of this inventory. The present study evaluated the MBHI in light of Minnesota Multiphasic Personality Inventory (MMPI) and Beck Depression Inventory (BDI) scores and treatment outcomes of 52 chronic pain patients. MBHI scales were highly correlated with admission and denial of psychopathology, as well as emotional distress, but had little relationship to Hs and Hy of the MMPI. The Pain Treatment Responsivity scale (PP), Allergic Inclination scale (MM), and MMPI D scale predicted the outcome of pain treatment at comparable levels. The specificity of the MBHI scales seems questionable in that 10 of 19 intercorrelations between PP and other MBHI scales were between 0.70 and 0.86. A stepwise regression procedure did not select PP among MBHI variables used to predict treatment outcomes. Results were interpreted as supporting cautious clinical use with pain patients until further research has been carried out.

Occupational dream, relation to parents and depression in the early adult transition

Assessed the impact of difficulty forming an occupational dream and relating to parents on depression among college students in their late teens and early twenties. Becoming independent of parents and forming an occupational dream are seen as two central issues during this period of life. Results from 64 students suggest that having to give up a valued dream, viewing one's relation to mother as authority-obeyer, and doing little exploring of occupational choices are related significantly to depression (p less than .0004). The significance of these results is discussed in light of theories of depression and the possible importance of different parenting styles for young adults who are facing the early adult transition.