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Background@#Low back pain secondary to discopathy is a common pain disorder.Multiple minimally invasive therapeutic modalities have been proposed; however, to date no study has compared percutaneous laser disc decompression (PLDD) with intradiscal injection of radiopaque gelified ethanol (DiscoGel® ). We are introducing the first study on patient-reported outcomes of DiscoGel® vs. PLDD for radiculopathy. @*Methods@#Seventy-two patients were randomly selected from either a previous strategy of PLDD or DiscoGel® , which had been performed in our center during 2016-2017. Participants were asked about their numeric rating scale (NRS) scores, Oswestry disability index (ODI) scores, and progression to secondary treatment. @*Results@#The mean NRS scores in the total cohort before intervention was 8.0, and was reduced to 4.3 in the DiscoGel® group and 4.2 in the PLDD group after 12 months, which was statistically significant. The mean ODI score before intervention was 81.25% which was reduced to 41.14% in the DiscoGel® group and 52.86% in the PLDD group after 12 months, which was statistically significant. Between-group comparison of NRS scores after two follow-ups were not statistically different (P = 0.62) but the ODI score in DiscoGel® was statistically lower (P = 0.001). Six cases (16.67%) from each group reported undergoing surgery after the follow-up period which was not statistically different. @*Conclusions@#Both techniques were equivalent in pain reduction but DiscoGel®had a greater effect on decreasing disability after 12 months, although the rate of progression to secondary treatments and/or surgery was almost equal in the two groups.
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Introduction: Thermal ablation by microwave [MWA] has proven efficacy in treatment of primary and metastatic cancers. Soft tissue tumors could be ablated completely using MWA. However, bony tissue metastasis particularly spinal vertebral metastasis ablation has not reported yet
Case presentation: A 50 year old male patient with primary diagnosed colon cancer undergone surgical resection of tumor. Recently, he was diagnosed with metastasis to liver and spinal vertebral bone. He was referred to pain clinic with severe non-radiating back pain. In MRI Imaging, hyperdensity lesions were identified on body of L5 and T12 and in spinal canal of L1 indicating metastatic involvement. Under fluoroscopy guidance, the metastatic tumor was ablated by MWA and the generator was powered to 20 Watt/3 minutes in the temperature control mode. Patient had no low back pain afterward
Conclusion: MWA could be used to ablate vertebral bone metastasis without any complications and with good prognosis
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Background and Aim: Ferula gummosa Boiss. [Barije] is an Iranian indigenous plant that has medical and antifungal properties. The current study was done to determine the effect of aqueous an alcoholic extracts of Ferula gummosa Boiss root on in vitro growth of fungi
Materials and Methods: In this experimental study, the plant was dried in the dark and aqueous, alcoholic extracts of its root powder were prepared using Soxhlet method. Then, the efficacy of 0.1 dilutions of different quantities of the extracts on strains of Candida albicans [PTCC 5027], Trichophyton rubrum [PTCC5143], and Aspergillus fumigatus [PTCC 5009] were evaluated employing Disk diffusion, Agar-well diffusion, Minimum Inhibitory Concentration [MIC], and Minimum Fungicidal Concentration [MFC] methods
Results: No inhibited effect was observed in Disk diffusion and Agar-well diffusion methods. MIC and MFC values of all extracts for Aspergillus fumigatus and Trichophyton rubrum were more than 5×104mg/ml. The MIC values of ethanol and methanol extract for Candida albicans were 3.12×103 and 1.25×104mg/ml, respectively but the MFC values were 1.25×104 and 2.5×104mg/ml, respectively
Conclusion: Methanol and ethanol extracts proved to have antifungal activity against Candida albicans yeast in vitro while the fungi of Aspergillus fumigatus and Trichophyton rubrum had no sensitivity to these types of extracts
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Pain has been one of the most debilitating symptoms of cancer. The aim of this study was to evaluate residents' knowledge, attitude, and practice regarding pain control in cancer patients. In a descriptive study, 69 randomly selected third-year various residents practicing in teaching hospitals of Shahid Beheshti School of medicine participated in this study. They have provided their demographic characteristics and completed a questionnaire, based on their "knowledge", "attitude" and "practice" regarding cancer pain and its management. Data analysis has performed using SPSS v.19. A p value of less than 0.05 has considered as significant. Obtained Data from 69 participants including 32 anesthesiology residents has included to our study. The average scores were 35.8 +/- 6.1 [ranging from 20 to 49] for the residents' attitude, 25.1 +/- 9.1 [ranging from 0 to 53] for their knowledge and 11.2 +/- 4.1 [ranging from 0 to 17] for their practice. The overall scores of the questions have related to attitude and knowledge were higher for residents of anesthesiology but the difference was not statistically significant [A: 37.1 +/- 4.9 vs. 34.7 +/- 6.8, p=0.106, K: 27.2 +/- 11.8 vs. 23.3 +/- 5.6, p=0.076]. The average score for questions on physician' practice was significantly higher in residents of anesthesiology [P: 12.8 +/- 3.2 vs. 9.7 +/- 4.2, p=0.001]. In order to provide patients with adequate pain relief, it has seemed advisable for medical schools to focus on improving the educational curriculum and integrating it into clinical practice
Subject(s)
Humans , Female , Male , Physicians , Internship and Residency , Pain/prevention & control , Neoplasms , Surveys and QuestionnairesABSTRACT
Ischaemic pain counts among the most difficult to treat pains in palliative care. Ischemic pain is frequently severe, and usually resistant to available analgesics. Treatment of this condition is difficult, especially when the condition is inoperable. A 36-year-old woman with the diagnosis of systemic lupus erythematosus with severe ischemic pain in the lower leg due to vascular problems presented to Akhtar Hospital. The patient was arranged for lumbar sympathetic block which was performed in two stages with one week interval. In the procedure, a long needle with No.22 gauge and the length of 15 cm was used. Under view of fluoroscopy guide, 10 cc marcaine 0.125% was injected. In the second stage, 5 cc of marcaine 0.25% and 5 cc of phenol 0.6% were used. Pain improvement was observed immediately after neurolytic lumbar sympathetic block. Three-month follow up period revealed improvement of quality of life. Lumbar sympathetic block is considered as a safe and useful technique. Clinically, the technique is effective for pain relief in patients who develop lower leg pain due to vasculitis.
Subject(s)
Humans , Female , Adult , Lumbosacral Plexus , Ischemia , Leg/blood supply , Pain , Disease Management , Lupus Erythematosus, Systemic , VasculitisABSTRACT
Conservative treatment needs to be tried prior to surgical treatment of knee osteoarthritis. This study was designed to evaluate the short-term effects of dextrose prolotherapy on pain relief and functional improvement in knee osteoarthritis in comparison with intra-articular hyaluronic acid injections. In this double blind clinical trial, 100 patients, aged 40-70 years, with complaints of knee pain lasting >3 months were recruited in Akhtar hospital during the years 2010 to 2011. The patients met the criteria proposed by the American College of Rheumatology [ACR] for knee osteoarthritis. 50 patients in hyaluronic acid group received five 2 ml injections of hyaluronic acid [Synocrom Forte[R] 1%] weekly and 50 patients in dextrose prolotherapy group received three 2 ml bimonthly injections of 25% dextrose. The patients were evaluated before and after treatment in terms of pain and functionality using the Knee injury and Osteoarthritis Outcome Score [KOOS] self-questionnaire. The patients were followed up for 12 weeks and were examined 12 weeks after the injections by an observer unaware of group assignments. The data were recorded for statistical analysis. The mean age of the patients was 60.6 +/- 8.2 years. No significant differences were found between the two groups with respect to pre- and post-treatment KOOS scores. The scores showed significant improvements in all items following treatment in both groups [P<0.001]. It seems that intra-articular injections of 25% dextrose prolotherapy could be as effective as hyaluronic acid injections for the treatment of knee pain due to OA
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Celiac and splanchnic plexus blocks are considered as terminal approaches for pain control in end stage pancreatic cancer. It may be done temporarily [using local anesthetics] or as a permanent act [using alcohol and/or phenol]. Like every other interventional procedure, celiac plexus block has its own potential complications and hazards among them pneumothorax and ARDS are very rare. In this case report we present an end stage patient with adenocarcinoma of ampulla of Vater with involvement of both abdomen and thorax who presented with severe intractable abdominal pain. Bilateral celiac plexus block in this patient resulted in left side pneumothorax and subsequent development of ARDS. We discuss the rare complications of celiac plexus block as well