Articles: cations.
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Percutaneous epidural adhesiolysis, lysis of epidural adhesions, percutaneous neuroplasty, or epidural neurolysis is an interventional pain management technique which emerged during the latter part of the 1980s. It is becoming established as a common treatment modality in managing chronic low back pain that is nonresponsive to other modalities of treatment. ⋯ Percutaneous lysis of epidural scar tissue, followed by the injection of hypertonic saline neurolysis, has been shown to be cost effective in multiple studies. This review discusses various aspects of percutaneous nonendoscopic adhesiolysis and hypertonic saline neurolysis including clinical effectiveness, complications, rationale, and indications.
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The relationship between joint pain and hyperalgesia has been explored in animal models of articular inflammation, but is yet to be shown in the most common rheumatologic condition: osteoarthritis. In this study, cutaneous thermal and mechanical pain thresholds were measured over the thumb of patients with osteoarthritis of the hands. In symptomatic patients, pain was manipulated through resisted active movement of the thumb. ⋯ Increased mechanical sensitivity after exacerbation of MP was alleviated by A beta fiber blockade. It appears that superficial tenderness over the osteoarthritic thumb fluctuates with pain arising from movement of the joint. It is concluded that dorsal horn mechanisms contribute to MP-related hyperalgesia in osteoarthritis of the hands.
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Internal jugular vein cannulation has become a routinary and clinically important aspect of medical care in critically ill patients. The landmark-guided technique usually affords rapid and easy vascular access, but it is not always successful and may be complicated by arterial puncture, hematoma, pneumothorax. A prospective, descriptive study is reported on the use and success of ultrasound-assisted central vein catheterization in dialysis patients who had an indication for internal jugular vein catheterization. ⋯ In all cases, the left internal jugular vein could be cannulated without difficulties. Our results confirm that ultrasound-guided cannulation of the internal jugular vein offers several advantages over the external landmarks technique: higher success rate in both vein puncture and catheter placement, lower complications, lower patient discomfort during the procedure because of a low number of needle passes. Ultrasound-assisted cannulation of the internal jugular vein may become the standard approach to dialysis catheter placement in the future.
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The authors report their experience with 42 patients in whom anterior lumbar fusion was performed using titanium cages as a versatile adjunct to treat a wide variety of spinal deformity and pathological conditions. These conditions included congenital, degenerative, iatrogenic, infectious, traumatic, and malignant disorders of the thoracolumbar spine. Fusion rates and complications are compared with data previously reported in the literature. ⋯ The complication rate mirrors the low morbidity rate associated with the anterior approach. A detailed study of clinical outcomes is in progress. Patient selection and strategies for avoiding complication are discussed.
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Percutaneous tracheostomy is now established in intensive care practice. However, discussion continues on many aspects of the procedure. ⋯ The introduction of percutaneous tracheostomy into an intensive care unit has training implications, particularly for surgeons. The timing of percutaneous tracheostomy in critically ill patients, and the use of the technique in children remain controversial.