Articles: chronic.
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The high prevalence of persistent neck pain due to involvement of cervical facet joints has been described in controlled studies. Therapeutic interventions utilized in managing chronic neck pain of facet joint origin include intraarticular injections, medial branch nerve blocks, and neurolysis of medial branch nerves by means of radiofrequency. ⋯ Cervical medial branch blocks were an effective modality of treatment in managing chronic neck pain secondary to facet joint involvement confirmed by controlled, comparative local anesthetic blocks.
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Over the past decade granulomas have been noted to occur at or near the tip of intrathecal catheters used for spinal infusions. The majority of cases involved morphine infusions, although other drugs have been implicated. Granulomas may be asymptomatic or cause significant neurological deficits. ⋯ Intrathecal granulomas were identified in 3% of patients imaged in this series. Eighty percent of the patients were asymptomatic. MRI imaging remains the diagnostic method of choice for most patients, and can be done safely when scans are taken at the level of the catheter tip. Given the low incidence of granulomas with intrathecal catheters, routine imaging to identify granulomas is not warranted.
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To discuss the pathophysiology, risk factors, and treatments for atrial fibrillation occurring after cardiac surgery. ⋯ Atrial fibrillation is one of the most common complications of cardiac surgery. There are three major aims for treating atrial fibrillation: conversion to sinus rhythm, heart rate control, and anticoagulation. Only beta-blockers can be recommended for prophylaxis against postoperative atrial fibrillation. Further refinements in surgical treatments for atrial fibrillation may allow for wider applications of this therapy with lower rates of complications.
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This was a pilot study to test the potential effectiveness of intradiscal restorative injection therapy and compare with intradiscal electrothermal therapy (IDET). Thirty-five patients for intradiscal injection and seventy-four for IDET took part in the study. All patients had intractable chronic discogenic low back pain, confirmed by discogram study. ⋯ However, the duration of pain flare-up was notably shorter for restorative injections (8.6 days) than for IDET (33.1 days). Biochemical intradiscal restorative injections may be useful to reduce pain and disability in patients with chronic discogenic low back pain, and have clinically similar efficacy to IDET, but with improved cost-benefit ratio. The results of this study indicate that controlled random prospective comparative studies need to be performed to establish the efficacy of this treatment.
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To evaluate accuracy of needle placement and flow patterns of fluoroscopically guided caudal epidural injections. ⋯ Caudal epidural injections are ideally performed with fluoroscopic guidance as the gold standard for accurate needle placement. However, this does not assure either targeted delivery or accurate placement of the drug.