Chronic pruritus seriously affects the quality of life of patients, which is closely related to stress, anxiety and depression. Prolonged and repeated pruritus can induce negative emotions such as anxiety and depression, while continued increased negative emotions can also promote exacerbation of pruritus, which drives the itch scratch cycle, thereby further aggravating skin damage. More and more studies have explored the mechanism of pruritus, anxiety and depression. This article mainly reviews the clinical relationship between pruritus and anxiety, depression and the new progress of its possible mechanism, providing reference for the prevention, control and effective treatment of chronic pruritus, anxiety and depression.
Humans ; Depression ; Quality of Life ; Anxiety ; Pruritus/psychology*

BACKGROUND AND OBJECTIVES: The posterior branch of the greater auricular nerve is a sensory nerve that serves the skin over the mastoid process and the postero-inferior region of the auricle. The greater auricular nerve is often sacrificed in parotidectomy, even though its posterior branch can be preserved. By cautious dissection of the greater auricular nerve it is possible to preserve the posterior branch in 69 per cent of the operations. However, the efficiency of this procedure is not clear. So, we have compared the patients whose nerve had been preserved with those sacrificed, to evaluate the validity of the posterior branch of greater auricular nerve preservation during parotidectomy. SUBJECTS AND METHOD: Thirty patients undergoing parotidectomy were divided into two groups. Fifteen patients underwent parotidectomy with preservation of the posterior branch of the greater auricular nerve (group A) and they were compared with fifteen patients who underwent parotidectomy with sacrificing the nerve (group B). Using questionnaire, we have researched about numbness, pain or other subjective symptoms on peri-auricular area after parotidectomy and the function of the nerve has been tested by two point tactile discrimination test and temperature sensitivity test. RESULTS: Postoperatively, twenty-nine patients felt lack of sensitivity, pain, itching or other symptoms. These symptoms recovered within 12 months, subjectively. However, in group B, permanent sensory loss was found in three patients. The two-point discrimination test revealed in group B, the decreased sensitivity on the operated side in comparison with the unoperated side (p=0.008). It also showed the decreased sensitivity on operated side in group B, compare with group A (p=0.012). CONCLUSION: From this study, despites of no significant difference on subjective symptoms, there was objective improvement on function of the greater auricular nerve. It seems reasonable to spare the greater auricular nerve during parotidectomy.
Discrimination (Psychology) ; Humans ; Hypesthesia ; Mastoid ; Parotid Gland ; Pruritus ; Surveys and Questionnaires ; Sensation* ; Skin

BACKGROUND: In esthetic surgery, understanding the factors that influence patient satisfaction is important for successful practice. We hypothesize that the factors that influence patient satisfaction include not only aesthetic and functional outcomes, but also personal factors such as the level of familiarity with factors affecting wound healing and expectations regarding aesthetic outcome. METHODS: One hundred patients who underwent esthetic closure after thyroidectomy were included in this study. In order to evaluate the individual characteristics of the patients, a preoperative survey was administered to the patients. We estimated the patient satisfaction six months postoperatively and assessed the aesthetic and functional outcomes using the Patient and Observer Scar Assessment Scale. RESULTS: According to the results of correlation analysis, level of familiarity with wound healing factors had a positive correlation with satisfaction. High expectations, pain, itching, and high observer scale score had negative correlations with satisfaction. The factors that were correlated with satisfaction were included in the multiple regression analysis. Level of familiarity with wound healing factors was found to have a positive relationship with satisfaction, while itching and observer scale were found to have a negative relationship with satisfaction. After excluding 10 patients who had hypertrophic scars, only level of familiarity with wound healing factors and expectations affected satisfaction. CONCLUSIONS: The level of familiarity with factors affecting wound healing and expectations were found to independently affect satisfaction. Improving patients' level of familiarity with wound healing factors and reducing their expectations by providing suitable preoperative education has the potential to improve patient satisfaction.
Cicatrix ; Cicatrix, Hypertrophic ; Esthetics ; Female ; Humans ; Patient Satisfaction ; Personal Satisfaction ; Pruritus ; Recognition (Psychology) ; Surgery, Plastic ; Sutures ; Thyroidectomy ; Wound Healing

The rapid onset of epidural fentanyl could be used to cover the latency period of epidural marphine, thus potentiating analgesia during anesthesia regression after short acting local anesthetics and possibly extending the morphine analgesia for longer duration. The study was designed to determine whether epidural fentanyl given before epidural morphine improves the quality of intraoperative epidural anesthesia without worsening postoperative analgesia provided by epidural morphine. Epidural anesthesia was established using 2% lidocaine with epinephrine 5 ug/ml. Patients scheduled for study was assigned to two groups (n=20 for each). Group 1 receiving epidural normal saline-control 10 ml, and Group 2 receiving epidural fentanyl 100 ug (10 ug/ml) through epidural catheter after delivery. After uterine repair epidural morphine 10 ml (0.3 mg/ml) was injected through epidural catheter. Patients were surveyed regarding their impression on intraoperative analgesia, nausea and postoperative analgesia, vomiting, pruritis, sedation. No significant difference was found in the two groups for intraoperative analgesia, nausea and vomiting. Postoperatively, visual analogue score for pain, vomiting, pruritis, sedation were similar at 1,2,4,8 hours in the two groups. In conclusion, epidural fentanyl 100 ug after delivery did not improve the intraoperative pain, nausea and early postoperative pain.
Analgesia* ; Anesthesia ; Anesthesia, Epidural ; Anesthetics, Local ; Catheters ; Epinephrine ; Fentanyl* ; Humans ; Latency Period (Psychology) ; Lidocaine ; Morphine* ; Nausea ; Pain, Postoperative ; Pruritus ; Vomiting

The rapid onset of epidural fentanyl could be used to cover the latency period of epidural marphine, thus potentiating analgesia during anesthesia regression after short acting local anesthetics and possibly extending the morphine analgesia for longer duration. The study was designed to determine whether epidural fentanyl given before epidural morphine improves the quality of intraoperative epidural anesthesia without worsening postoperative analgesia provided by epidural morphine. Epidural anesthesia was established using 2% lidocaine with epinephrine 5 ug/ml. Patients scheduled for study was assigned to two groups (n=20 for each). Group 1 receiving epidural normal saline-control 10 ml, and Group 2 receiving epidural fentanyl 100 ug (10 ug/ml) through epidural catheter after delivery. After uterine repair epidural morphine 10 ml (0.3 mg/ml) was injected through epidural catheter. Patients were surveyed regarding their impression on intraoperative analgesia, nausea and postoperative analgesia, vomiting, pruritis, sedation. No significant difference was found in the two groups for intraoperative analgesia, nausea and vomiting. Postoperatively, visual analogue score for pain, vomiting, pruritis, sedation were similar at 1,2,4,8 hours in the two groups. In conclusion, epidural fentanyl 100 ug after delivery did not improve the intraoperative pain, nausea and early postoperative pain.
Analgesia* ; Anesthesia ; Anesthesia, Epidural ; Anesthetics, Local ; Catheters ; Epinephrine ; Fentanyl* ; Humans ; Latency Period (Psychology) ; Lidocaine ; Morphine* ; Nausea ; Pain, Postoperative ; Pruritus ; Vomiting

PURPOSE: The aim of this study was to evaluate the effectiveness of functional magnetic stimulation (FMS) compared to biofeedback (BFB), with functional electrical stimulation (FES), in patients with recurrent or incurable female urethral syndrome. MATERIALS AND METHODS: Fifty women with female urethral syndrome, based on the criteria of the NIADDK (the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases), and refractory to antibiotics therapy for more than two months, were consecutively assigned to one of the two treatment modalities. The BFB, with FES, group (32 patients) was treated with biofeedback and electrical stimulation. The FMS group (18 patients) received functional magnetic stimulation. Sessions of 30min were performed twice a week for 6 to 8 weeks. A detailed clinical evaluation and cystoscopy were performed prior to treatment. The results were determined by obtaining pre and post Bristol female lower tract symptoms questionnaires and from the subjective overall satisfaction. RESULTS: The irritative and obstructive voiding symptom scores improved markedly in both groups (p<0.05). The score for the quality of life decreased from 4.97+/-1.0 to 2.25+/-1.74 in the BFB with FES group, and from 4.96+/-1.64 to 2.89+/-2.32 in the FMS group. Improvements in the quality of life and pain relief were shown in both groups. 13 of the 32 patients (40.6%) in the BFB, with FES, group and 5 of the 18 patients (27.8%) in FMS group, were subjectively satisfied with their treatments. Minor complications, such as discomfort, unpleasantness and a vaginal itching sense, were note in 30% of the patients in the BFB, with FES, group only. CONCLUSIONS: FMS, compared to BFB, with FES, results in a lesser improvement of the symptom and subjective satisfaction of patients with recurrent or incurable female urethral syndrome, but may be an acceptable alternative to other more invasive treatment modalities.
Anti-Bacterial Agents ; Arthritis ; Biofeedback, Psychology* ; Cystoscopy ; Electric Stimulation ; Female* ; Humans ; Kidney ; Magnetic Field Therapy* ; Pruritus ; Quality of Life ; Surveys and Questionnaires ; Urethra

INTRODUCTIONPruritus in elderly patients can have a significant impact on the quality of life but may be underestimated and poorly addressed by healthcare professionals.

MATERIALS AND METHODSFrom March to May 2010, a structured interview questionnaire including the Dermatology Life Quality Index (DLQI) was administered to all patients admitted to the geriatric ward in Changi General Hospital, Singapore, except for those with cognitive impairment.

RESULTSA total of 194 patients were enrolled in the study; 94 patients (48.5%) were experiencing itch at the point of the interview; mean DLQI score for patients with itch was 6.7; 35.1% of patients experienced sleep disruption whilst 30.9% reported impairment of concentration levels as a consequence of their itch. Of the patients who had informed their doctor about the problem, 73.7% felt that doctors had not adequately addressed the cause of the itch. Among patients who reported itch, the DLQI score correlates with the severity of pruritus with a regression coefficient of 0.2737 (P <0.001); 9.6% of patients with itch were independent with their activities of daily living compared to 21% of patients who did not experience itch.

CONCLUSIONAlmost half of the subjects in our study experienced itch and a third of them reported impairment of quality of life. Patients who were independent of their activities of daily living were also less likely to experience itch. This study highlights the importance of increasing awareness of pruritus among physicians as pruritus can have adverse consequences on patients' quality of life when left unaddressed.

Activities of Daily Living ; Aged ; Aged, 80 and over ; Attention ; Female ; Hospitalization ; Humans ; Male ; Prevalence ; Pruritus ; epidemiology ; psychology ; Quality of Life ; Severity of Illness Index ; Singapore ; epidemiology ; Sleep Wake Disorders ; epidemiology ; Surveys and Questionnaires