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We report a case of Trousseau’s syndrome with cholangiocarcinoma complicated by a fatal pulmonary embolism after liver biopsy. A 69-year-old man who presented with right upper quadrant pain was found to have portal vein thrombosis and nonspecific liver hypodensities after imaging by computerized tomography. Following four days of anticoagulation, heparin was held for percutaneous liver biopsy. After the biopsy, he developed acute hepatic failure, acute kidney injury, lactic acidemia, and expired. Autopsy revealed intrahepatic cholangiocarcinoma and a pulmonary embolism. Trousseau’s syndrome with cholangiocarcinoma is rarely reported and has a poor prognosis. This case highlights a fundamental challenge in the diagnosis and early management of intrahepatic cholangiocarcinoma with hypercoagulability. Diagnostic biopsy creates an imperative to reduce post-operative bleeding risk, but this conflicts with the need to reduce thrombotic risk in a hypercoagulable state. Considering the risk of withholding anticoagulation in patients with proven or suspected cholangiocarcinoma complicated by portal vein thrombosis, physicians should consider biopsy procedures with lesser bleeding risks, such as transjugular liver biopsy or plugged percutaneous liver biopsy, to minimize interruption of anticoagulation.

This study aimed to compare the effectiveness of triamcinolone vs. dexamethasone used in transforaminal epidural steroid injections for the treatment of cervical radiculopathy.This is a retrospective cohort study of patients with cervical radiculopathy who underwent cervical transforaminal epidural steroid injections performed by a single physician from February 2005 through January 2010. Data from the subjects were divided into two groups on the basis of the type of corticosteroid preparation used during treatment. A two-sample t test with equivalent variance was used to compare the effectiveness of dexamethasone to triamcinolone.Triamcinolone (40 mg per injection) was used in 220 subjects during the period of February 2005 through August 2007, with a mean reduction in pain score of 2.33 points on a 10-point scale. Dexamethasone (15 mg per injection) was used in 221 subjects during the period of September 2007 through January 2010, with a mean reduction in pain score of 2.38 points on a 10-point scale. A two-sample F test for variance showed no statistically significant difference in the variance of these two groups. The two-sample t test with equivalent variance showed no statistically significant difference in the mean reduction in pain score between the two groups.The mean reduction in pain score in this set of 441 patients with cervical radiculopathy treated with transforaminal epidural steroid injections was independent of the type of corticosteroid formulation used. Triamcinolone (40 mg) and dexamethasone (15 mg) produced similar benefits as measured by the patients' self-reported pain scores.

Objective This study aimed to determine whether the distribution of radicular pain has predictive value in identifying patients who would benefit from transforaminal cervical epidural steroid injections. Design Retrospective cohort study of subjects with cervical radiculopathy who underwent cervical epidural steroid injections from February 2005 to January 2006. Data from subjects were divided into groups based on pain distribution, imaging-based diagnosis of cervical disk herniation or stenosis, and their response to treatment. χ tests were used to assess the relationships between distribution and benefit. Results Of the 117 charts reviewed, complete data were available for 94 subjects. Forty-eight subjects had cervical disk herniations and, of these, 52% had pain above the elbow with 60% benefit, and 48% had pain below the elbow with 61% benefit. Forty-six subjects had cervical stenosis and, of these, 57% had pain above the elbow with 62% benefit, and 43% had pain below the elbow with 80% benefit. Benefit was defined as 70% or greater reduction in pain. χ testing demonstrated no statistically significant difference in beneficial response to cervical epidural steroid injections based on pain distributions. Conclusions The likelihood of subjects to report a positive benefit from cervical epidural steroid injections as a treatment of their cervical radicular pain was independent of the distribution of their pain. Although our results did not show pain distribution to have a predictive value, additional research is needed in identifying predictive factors to improve outcomes and reduce cost.

This study aimed to determine whether the presence of type 2 diabetes impairs the therapeutic response to transforaminal cervical epidural steroid injections (TF-CESI) in the treatment of pain due to cervical radiculopathy. This is a retrospective cohort study of patients with cervical radiculopathy who underwent TF-CESI performed by a single physician. Single community-based multidisciplinary pain clinic and ambulatory surgery center. Patients underwent from one to three TF‐CESI with dexamethasone or triamcinolone. Change in self-reported numerical pain score. Out of 387 charts reviewed, complete data were available for 329 subjects who underwent TF-CESI from February 2006 through January 2010. The injections consisted of either 40 mg triamcinolone or 15 mg dexamethasone. Of the 329 total subjects, 35 had type 2 diabetes and 294 did not. The diabetic group had a mean age of 58.1 years with standard deviation (SD) of 11.2, mean body mass index (BMI) of 33.1 (SD 7.1), mean pre-procedure pain score of 6.7 (SD 2.2) and mean reduction in pain score of 2.5 (SD 2.4). The non-diabetic group had a mean age of 52.8 (SD 12.4), mean BMI of 28.2 (SD 5.4), mean pre-procedure pain score of 6.7 (SD 1.8), and mean reduction in pain score of 2.4 (SD 2.2). A two-sample t test with equivalent variance showed no statistically significant difference in the mean reduction in pain score between the diabetic and non-diabetic groups. The patients in the diabetic group were typically older and had higher BMIs. The efficacy of TF-CESI for treating cervical radicular pain in this set of 329 patients was independent of the presence of type 2 diabetes.

In this work we build on prior studies of the novel water-soluble cationic conjugated polymer known as "P2" (poly{2,5-bis[3-( N, N, N-triethylammonium bromide)-1-oxapropyl]-1,4-phenylenevinylene}) with a focus on its incorporation into thin films for such applications as photovoltaics or electroluminescent devices. Multilayer assemblies were constructed using P2, the anionic surfactant sodium dodecyl sulfate (SDS), and the polyanion poly(sodium 4-styrene-sulfonate) (PSS) using the technique of layer-by-layer electrostatic self-assembly (LBL-ESA). SDS was observed to affect the layer thicknesses and absorbance characteristics of the films. We show that the optical properties and photo-oxidative resistance can be improved by varying the SDS content in the assemblies. Specifically, the surfactant-complexed poly( p-phenylenevinylene) (PPV) shows an enhanced absorption at longer wavelengths as well as improved photostability. Therefore, our work may have broad implications on the development of stable PPV-based materials in general and their efficient integration into thin films technologies.

In this work, we investigate the emission and absorbance properties of the novel water-soluble cationic conjugated polymer poly{2,5-bis[3-(N,N,N-triethylammonium bromide)-1-oxapropyl]-1,4-phenylenevinylene}, denoted here as P2, in the presence of varying amounts of the anionic surfactant sodium dodecylsulfate (SDS). We show that the absolute photoluminescence quantum efficiency (PLQE), the absorption wavelength, and the emission wavelength of an aqueous solution of P2 can be adjusted according to the surfactant/polymer ratio in aqueous solution. In particular, we show that the addition of SDS to P2 increases the polyelectrolyte's PLQE to approximately 40%. An observed red shift in the emission spectra upon addition of the surfactant is attributed to the reduction in electrostatic repulsive interactions between side chains that minimize the benzene ring twisting along the backbone structure. At the surfactant's critical micelle concentration, the P2 chains wrap around the outer surface of the SDS micelles. This work has implications on the development of new stable poly(p-phenylenevinylene)-based photovoltaic and electroluminescent materials with tunable optical properties.

Objective To determine the relative incidence, prevalence, costs, and impact on disability of 8 common conditions treated by rehabilitation professionals. Data Sources Comprehensive bibliographic searches using MEDLINE, Google Scholar, and UpToDate , (June, 2013). Data Extraction Two review authors independently screened the search results and performed data extraction. Eighty-two articles were identified that had relevant data on the following conditions: Stroke, Spinal Cord Injury, Traumatic Brain Injury, Multiple Sclerosis, Osteoarthritis, Rheumatoid Arthritis, Limb Loss, and Back Pain. Data Synthesis Back pain and arthritis (osteoarthritis, rheumatoid arthritis) are the most common and costly conditions we analyzed, affecting more than 100 million individuals and costing greater than $200 billion per year. Traumatic brain injury, while less common than arthritis and back pain, carries enormous per capita direct and indirect costs, mostly because of the young age of those involved and the severe disability that it may cause. Finally, stroke, which is often listed as the most common cause of disability, is likely second to both arthritis and back pain in its impact on functional limitations. Conclusions Of the common rehabilitation diagnoses we studied, musculoskeletal conditions such as back pain and arthritis likely have the most impact on the health care system because of their high prevalence and impact on disability.