Articles: treatment.
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Epidural fibrosis with chronic low back pain, nonresponsive to traditional measures of treatment including surgery, is a common entity in modern medicine. Traditionally, epidural steroid injections have been employed to treat chronic low back pain and radiculopathy associated with failed back surgery. Due to the poor effectiveness of epidural steroid injections in post lumbar laminectomy syndrome, epidural adhesiolysis was introduced in the early 1980s. ⋯ Transforaminal ventral epidural adhesiolysis was performed on an outpatient basis in all patients. The results showed 93% improvement initially, which decreased to 71% at 1 month, 57% at 3 months, 43% at 6 months and 21% at 1 year. The results of this case study show that ventral epidural lysis of adhesions with hypertonic saline neurolysis is safe and effective in managing chronic low back and lower extremity pain in patients who failed to respond to other conservative modalities of treatments, including fluoroscopically directed transforaminal epidural steroid injections.
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Spinal endoscopy with epidural adhesiolysis is an interventional pain management technique which emerged during the 1990s. It is an invasive but important treatment modality in managing chronic low back pain that is nonresponsive to other modalities of treatment, including percutaneous spring guided adhesiolysis and transforaminal epidural injections. ⋯ Percutaneous endoscopic lysis of epidural scar tissue has been shown to be cost effective and a safe modality. This review discusses various aspects of endoscopic adhesiolysis, including clinical effectiveness, complications, rationale, and indications.
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Humidification is a time-honoured therapy for childhood croup (acute laryngotracheobronchitis). Despite a paucity of evidence supporting its use, many physicians, nurses and parents still apply this treatment. Our objective was to summarize available evidence and assess the rationale for the ongoing use of humidity to treat childhood croup. ⋯ There is no strong evidence supporting the use of humidity in the treatment of croup. Although such treatment is still widely used, it is not without risk, and further trials are required to address its efficacy.
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Atenolol, a selective beta(1)-adrenergic antagonist, is commonly used to treat hypertension, ischemic heart disease and cardiac dysrhythmias. Few cases of severe atenolol intoxication have been described, and only one of these reports discussed the use of calcium chloride as a treatment. We present a case of atenolol overdose associated with shock and first-degree heart block, in which administration of calcium chloride led to dramatic improvement after failure of conventional treatment. In addition, we discuss the pharmacokinetics, toxicology and management of beta-blocker overdose, focusing on the possible role of calcium chloride.
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Background: Insomnia is a prevalent health complaint that is often difficult to evaluate reliably. There is an important need for brief and valid assessment tools to assist practitioners in the clinical evaluation of insomnia complaints. Objective: This paper reports on the clinical validation of the Insomnia Severity Index (ISI) as a brief screening measure of insomnia and as an outcome measure in treatment research. ⋯ In addition, there is a close convergence between scores obtained from the ISI patient's version and those from the clinician's and significant other's versions. Conclusions: The present findings indicate that the ISI is a reliable and valid instrument to quantify perceived insomnia severity. The ISI is likely to be a clinically useful tool as a screening device or as an outcome measure in insomnia treatment research.