Articles: outcome.
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Since the early 1990s, advances in endoscopic equipment and the commercial availability of micro-catheters, mini-balloons, tiny laser fibers and other ingenious tools have set the trend toward the development of minimally invasive fetoscopic surgical techniques for the treatment of some congenital malformations that progress in severity over the course of gestation and may destroy entire organ systems of the unborn. The purpose of this review is to provide a state-of-the-art overview of these new procedures for the anesthesiologist. ⋯ An increasing spectrum of congenital malformations can be treated by fetoscopic surgery. Compared to open fetal surgery, fetoscopic surgery results in significantly less maternal trauma. Like the open procedures, the efficacy of the fetoscopic procedures to improve fetal outcome over postnatal treatment strategies will have to be assessed in further studies under close supervision of committees for human research.
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Based on responses to controlled diagnostic blocks of cervical facet joints, the prevalence of cervical facet joint pain in chronic neck pain has been shown to range from 54% to 67%, with false-positive results of 27% to 63% with a single diagnostic block. Other confounding factors claimed to influence the diagnostic validity of cervical facet joint blocks include administration of anxiolytics and narcotics prior to or during the procedure. ⋯ The administration of sedation with midazolam or fentanyl is a confounding factor in the diagnosis of cervical facet joint pain in patients with chronic neck pain. However, if > or = 80% pain relief with ability to perform prior painful movements is used as the standard for evaluating the effect of controlled local anesthetic blocks, the diagnostic validity of cervical facet joint nerve blocks may be preserved.
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The use of epidural steroid injections as a treatment for patients with degenerative lumbar scoliotic spinal stenosis and radiculopathy has received sparse attention in the literature. Even though it has been reported that patients with scoliosis may respond differently than other patient groups to conservative therapeutic interventions for low back pain and radiculopathy, patients with scoliosis have rarely, if ever, been excluded from clinical studies of epidural steroid injections. To date, there are no studies investigating the efficacy of fluoroscopic transforaminal epidural steroid injections as a treatment for patients with radiculopathy and radiographic evidence of degenerative lumbar scoliotic stenosis. ⋯ Fluoroscopic transforaminal epidural steroid injections appear to be an effective nonsurgical treatment option for patients with degenerative lumbar scoliotic stenosis and radiculopathy and should be considered before surgical intervention.
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Baseline and 12-month follow-up data from a prospective controlled study on patients treated with SCS for neuropathic limb pain (NLP) are analyzed critically. The outcome on pain, use of medication, and quality of life are reported and compared with the literature. Patients enrolled from April 1999 to December 2001 were part of a quality system study by the Dutch Working Group on Neuromodulation. ⋯ The difference between baseline and 12-m follow-up is statistically significant for all measures. We conclude that the outcome measures indicate that SCS significantly reduces pain and enhances quality of life in patients having NLP not responding to other adjuvant therapy. Recommendations are proposed to make studies more comparable.
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Ever since its initial development in the late 1960s, spinal cord stimulation (SCS) has been used to treat a number of painful conditions. European practice, in contrast to that in North America, has used peripheral arterial disease (PAD) as a primary indication for SCS. First employed in patients with PAD in 1976, SCS was shown by Cook et al. to heal chronic leg ulcers. ⋯ Recent randomized prospective studies have questioned some of the conclusions from these preceding retrospective data. In addition to the questions related to outcomes, theories regarding exact mechanisms by which SCS improves circulatory parameters remain unclear. A thorough Medline literature review on the subject of SCS in peripheral vascular disease was thus undertaken to attempt to clarify questions regarding which patients are best suited for SCS therapy, pinpoint possible methodologic flaws in previous studies, and to review the background, outcomes, mechanisms of action, complications, and alternatives for SCS in patients with PAD.