Articles: cations.
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Facet or zygapophysial joint blocks are used extensively in the evaluation of chronic spinal pain. However, there is a continuing debate about the value and validity of facet joint blocks in the diagnosis of chronic spinal pain. The value of diagnostic facet joint injections may have been overlooked in the medical literature. ⋯ The diagnostic accuracy of controlled local anesthetic facet joint blocks is high in the diagnosis of chronic spinal pain.
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Interventional pain management dates back to the origins of neural blockade and regional analgesia. Over the years, it evolved into a distinct specialty with the application of interventional techniques beyond those of simple neural blockade. The first therapeutic nerve block in pain management was described in 1899 by Tuffer. ⋯ Diagnostic blockade in pain management was pioneered by von Gaza with the use of procaine for determining the pathways of obscure pain. Interventional pain management has entered into the modern era in the twenty-first century, driven by contributions from pioneers including Bonica, Winnie, Raj, Racz, Bogduk, and others. This historical review examines the origins of interventional pain management, its pathophysiologic basis, the role of precision diagnostic interventional techniques, therapeutic interventional techniques, and the future of interventional pain management.
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Radiofrequency heat lesioning has been advocated to prolong the duration of therapeutic effect of lumbar sympathetic block in Complex Region Pain Syndrome (CRPS) of the lower extremity. Prior to radiofrequency lesioning of the lumbar sympathetic trunk, sensory and motor stimulation may be used to verify that the active needle tip is not adjacent to a spinal nerve to avoid unwanted neural injury. However, the value of sensory stimulation to aid in precise needle positioning at the desired target remains controversial. ⋯ Motor stimulation did not occur up to the maximum voltage tested (2.0 V at 2 Hz) Sensory stimulation of the lumbar sympathetic trunk may be used to aid in localization of the active tip of the radiofrequency needle, in preparation for lesioning. A dermatomal sensory pattern was observed, suggesting that afferent sensory fibers travel in the lumbar sympathetic trunk. The implications of this observation for understanding the mechanism of CRPS-related pain are discussed.
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Semin Respir Crit Care Med · Oct 2003
Bronchiolar disorders: classification and diagnostic approach.
Bronchiolitis is a process in which inflammatory cells and mesenchymal tissue are both present, mainly centered in and around membranous and/or respiratory bronchioles, with sparing of a considerable portion of the other parenchymal structures. The distribution and amounts of the cellular and mesenchymal components vary from case to case, which accounts for the variety of histopathologic, radiographic, and clinical aspects of bronchiolitis. The clinical classification of bronchiolar diseases considers the causes or the clinical settings in which bronchiolitis develops: inhalation of toxic fumes, irritant gases or organic dusts, infectious and postinfectious bronchiolitis, collagen-vascular disease-associated bronchiolitis, posttransplant bronchiolitis, or rarer associations. ⋯ High-resolution computed tomographic scanning (HRCT) is currently the best imaging technique for the evaluation of patients suspected of having bronchiolitis. HRCT findings in bronchiolar diseases with a good correlation with histopathologic changes are classified as follows: centrilobular tubular branching or nodular opacities; ground-glass attenuation or consolidation; mosaic perfusion; a mixed pattern. This article presents and briefly discusses the diagnostic approach to these diseases.