Facet Joint Injections in Patients with Low Back Pains and Facet Arthropathies - Our Experience

Chronic back pain is a common and frequent clinical presentation in any population. Presence of disc disease, facet syndrome, and vertebral body disease are usually addressed by the radiologists. Facet joints are proven to be the culprit in 15 – 45 % of patients with low back pain. We wanted to compare effectiveness of fluoroscopy and computed tomography guided lumbar facet injections for pain relief in patients with facet arthropathies and mild canal stenoses. METHODSThis is a retrospective cross-sectional study performed in the Department of Radiology at our Hospital in Dhahran. This record-based study was performed in our department from Jan. 2015 - 2020. All patients (N = 112) who underwent fluoroscopy and computed tomography (CT) guided facet injections (either alone or with epidural injections) for relief of chronic back pains (due to facet arthropathies and mild canal stenoses) were included, and grouped as (i) facet injections under fluoroscopy (F), and (ii) facet injections under CT guidance (C). Patients with acute disc prolapse, trauma to spine, lumbar surgeries, moderate to severe lumbar stenoses, spondylolisthesis, known systemic arthritides, those not suitable for the procedures, and those lost to follow-up were excluded. Repeat procedure within one year for recurrent complaints was used as a measure of effectiveness of the procedure. Proportional Z-test was used, and a p-value less than 0.05 was considered to be significant. RESULTSOut of a total of 112 patients, 64 were females (57 %) and 48 were males (43 %). The mean age was 56.4. Twenty out of 78 patients with facet injections under fluoroscopy and 3 out of 34 patients with facet injections under CT underwent repeat procedures (P = 0.042). CONCLUSIONSCT guided facet injections combined with epidural injections may be more effective in relief of lower back pain in patients with facet arthropathies and mild canal stenoses

To Study the Association between Splenic Size and Grades of Oesophageal Varices in Patients of Cirrhosis of Liver with Portal Hypertension.

Chronic liver disease develops when the functional capacity of the liver is deranged, and it is not able to maintain normal physiological conditions. This study was carried to find out the association of portal vein size with gastro-oesophageal varices in diagnosed cases of cirrhosis of liver, so that this parameters can be used in predicting propensity to oesophageal varices non-invasively, and thus help in starting prophylactic therapy earlier to prevent bleeding and other complications of varices.METHODS100 patients previously or newly diagnosed with cirrhosis of liver with portal hypertension without history of hepatic encephalopathy, variceal bleeding, EVL, use of beta blockers, were included for the study. Ultrasonography was done in all cases to find out the spleen size. Routine blood testing including platelet count was done and UGI-Endoscopy was performed to see the presence of oesophageal varices of different grades. The data obtained was analysed using mean, SD, Student’s t-test and chi square correlation coefficient. p Value of <0.05 was considered for significant.RESULTSAmong 100 patients studied, 90% patients were found to have oesophageal varices. Based on endoscopic grading, incidence of grade 2 and grade 3 oesophageal varices predominated, accounting to 48% and 23 % respectively. On correlation of splenic diameter with grades of oesophageal varices, it was found that patients with splenic diameter >13 cm had higher grades of oesophageal varices i.e. 32 patients were grade 2 and 18 patients were grade 3, with p<0.001 and was found highly significant.CONCLUSIONSIn this study, we found that with increasing spleen size there are chances of formation of higher grades of oesophageal varices and both are also having positive association.

¿Por qué no diagnosticamos el cáncer gástrico incipiente? ¿Cómo podemos mejorar? / Why do we fail in the diagnosis of early gastric cancer? How can we improve?

Detection and treatment of gastric cancer (GC) in early stages is the most effective approach for improving prognosis. Patients with early gastric cancer (EGC), defined as a type of cancer affecting only mucosa and submucosa, has a good prognosis in the long-term, and if some criteria are met, endoscopic therapy is curative. Unfortunately EGC diagnosis is rare, except in case of some Asian countries, where more than 50% of tumors are diagnosed in this stage. In Japan, the main technique for early diagnosis is opportunistic screening, i.e. endoscopy performed for different reasons. Some of the factors that affect endoscopic diagnose include: characteristics of the lesion (some cases slight changes in color or in the surface, a location that is difficult to detect, except in retro view); elements associated with the endoscopic technique (lesions hidden underneath gastric contents, non-systematic visualization, not enough time for exploration); and early access to the procedure (long waiting lists, lack of clinic or epidemiology screening criteria, lack of risk-stratification looking for pre-malignant lesions to establish endoscopic follow-up). Know and act upon the mentioned factors is a path that has proven to improve EGC diagnosis and therefore, improve prognosis.

Detectar y tratar el cáncer gástrico (CG) en una etapa inicial constituye la estrategia más efectiva para mejorar el pronóstico de esta patología. Pacientes con CG incipiente (CGI), definido como el que compromete sólo la mucosa y la submucosa, tienen un muy buen pronóstico a largo plazo y si se cumplen algunos criterios, el tratamiento endoscópico es curativo. Desgraciadamente el diagnóstico de CGI es infrecuente en todo el mundo, a excepción de algunos países asiáticos donde más de la mitad de los tumores se diagnostican en esta etapa. En Japón la principal vía por la que se realiza este diagnóstico precoz es mediante el tamizaje oportunista, es decir, la endoscopia que se realiza de manera cotidiana por diferentes motivos. Dentro de los factores que afectan la capacidad diagnóstica de la endoscopia destacan: las características de la lesión (algunos casos con discretos cambios de color o superficie, ubicación habitualmente en áreas de mejor visualización en retrovisión); factores asociados a la técnica endoscópica (contenido gástrico que puede ocultar lesiones, visualización no sistemática, tiempo insuficiente de exploración); y el acceso oportuno a ella (largas listas de espera, falta de criterios de selección clínicos o epidemiológicos, falta de estratificación del riesgo mediante la búsqueda de lesiones premalignas para definir intervalos de seguimiento endoscópico). Conocer y actuar sobre los factores descritos es un camino que ha demostrado su utilidad en mejorar el diagnóstico del CGI y así mejorar su pronóstico.

Trends and patterns of diagnosis by upper GI endoscopy in dyspeptic patients: A retrospective study

Background: Dyspepsia is described as recurrent upper abdominal discomfort and epigastric fullness after meals, often described by the patients as indigestion. The assessment of trending diagnostic patterns in upper GI endoscopy is important to validate the priority of endoscopic evaluation over other modalities of investigation for dyspepsia. The significant patterns may form a platform for new epidemiological studies to re-assess the risk factors and distribution of diseases causing dyspepsia in South Indian population. Aim: A retrospective study was done to assess the trends of diagnosis in upper GI endoscopy in adult dyspeptic patients in South Indian population. Materials and methods: Endoscopy database records of 3271 consecutive patients who underwent upper GI endoscopy between January 2014 and March 2016 were retrospectively analyzed from upper GI endoscopy register. The data was subjected to statistical analysis and compared with that of previous similar studies. Suspected malignant lesions were confirmed with histopathology reports. Results: Positive yield was 80.6%. Gastritis (51%), duodenitis (22%) and hiatus hernia (9%) were the leading endoscopy diagnoses. Esophageal growth was 3 times more common in females (p=0.009). Growth in stomach was reported in 2.3% patients. Carcinoma stomach was significantly higher in age above 40 years (p=0.0009). There was a positive correlation between Ca stomach and increasing age. The cumulative frequencies of gastric cancer by age group were as follows: 7 of 1000 OGDs in patients less than 40 years of age and 40 of 1000 OGDs in patients greater than 40 years of age. Conclusion: The results conclude that gastric malignancy is significantly higher in age>40 years. This recommends a routine upper GI endoscopy for patients>40 years. Esophageal growth is significantly higher in females warranting an epidemiological study on association with possibly

An Evaluation of 605 Endoscopic Examination in a Rural Setting, Lacor Hospital in Northern Uganda.

Introduction: The aim of this study was to evaluate the profile of esophagogastroduodenal (EGDS) diseases diagnosed by upper endoscopy in a rural area of Uganda in a retro-protective study of 605 patients. Results: The mean age of patients with digestive symptoms was 39.7yrs (SD +/-16.11) and female gender predominated by 60% compared to the male (P value 0.000). Peasant farmers were the commonest group with GI symptoms requiring EGDS compared to the rest 72.1% v 27.9%. Epigastric pain was the commonest indication (58%) for EGDS, followed by chest pain (11%), abdominal pain (8.8%), dyspahgia (7.6%) and hematemesis (7.3%). The commonest endoscopy finding was gastritis (47.9%) followed by esophagitis (14.4%), cancer esophagus (5.1%), esophageal varicose (4%), PUD (2.3%), gastric cancer (1%). However 19.5% of patients had normal EGDS. There was a significant correlation between the outpatient diagnosis and endoscopy finding (P value 0.01, r = 0.144) and between endoscopy finding and histology findings (P value 0.001, r = 0.236). H. pylori was positive in 53% of patients with gastritis. Conclusion: Gastritis is the commonest lesion (47.9%) of which 53% have H pylori and Cancer esophagus account for 5.1% of GI lesion in our setting. Cancer stomach is rare in our setting.

Prophylactic Antibiotics, Anticoagulants and Antiplatelets for GI Endoscopy / 대한소화기내시경학회지

This review provides general recommendations, based on the literature, on antibiotic prophylaxis, anticoagulants and antiplatelets for GI endoscopy. Antibiotic prophylaxis is recommended for patients at high risk of infection - ERCP with incomplete drainage, ERCP with sterile pancreatic fluid collection (which communicates with the pancreatic duct), pancreatic pseudocyst drainage, EUS-FNA of cystic lesions, percutaneous endoscopic feeding tube placement and cirrhosis with acute GI bleeding. Prophylactic antibiotics are no longer recommended for GI endoscopy to prevent infectious endocarditis. To decide how to manage anticoagulants and antiplatelets during endoscopic procedures, the risk of an adverse ischemic event or a thromboembolic complication and the risk of bleeding must be weighed. For a low-risk procedure, no adjustments in anticoagulation and antiplatelets need to be made. For a high risk procedure, it is recommended to discontinue warfarin 3 to 5 days before the procedure and clopidogrel 7 to 10 days before. Low molecular weight heparin may be used as a bridge before endoscopy in patients with a high risk of a thromboembolism. In the absence of a pre-existing bleeding disorder, endoscopic procedures may be done in patients taking aspirin or other NSAIDs. Further controlled clinical studies are needed to clarify aspects of these recommendations.

A Study of Clinical Manifestations of Gastrointestinal Symptoms in Children with Henoch-Schnlein Purpura / 대한소아소화기영양학회지

PURPOSE: This study was undertaken to evaluate the factors correlated with the clinical course and outcome in patients of Henoch-Schnlein Purpura. METHODS: The medical records of 104 children diagnosed with Henoch-Schnlein Purpura (HSP) from January 1996 to April 2006 were reviewed retrospectively. The patients were divided into two groups: patients with Gastrointestinal (GI) symptoms and those without GI symptoms. When there were joint, scrotum, and renal symptoms except for skin lesion in whole HSP, those patients were excluded. The history of acute infection, duration of admission, treatment requirement, recurrence of HSP, CBC, stool occult blood test, abdominal ultrasonographic findings and GI endoscopic findings were reviewed. RESULTS: Among 104 patients, patients with GI symptoms included 66 cases (63.5%), those without GI symptoms accounted for 38 cases (36.5%). GI symptoms included: abdominal pain in 57 cases (54.8%), vomiting 21 cases (20.2%), GI bleeding 5 cases (4.8%), nausea 3 cases (2.9%) and diarrhea 3 case (2.9%). Positive GI symptoms and GI mucosal lesions on GI endoscopy had a statistically significant correlation with increased admission duration, treatment requirement, recurrence of HSP, and positive stool occult blood. Six cases with small intestinal wall thickening were noted on abdominal ultrasonography. Six cases of hemorrhagic gastritis and hemorrhagic duodenitis, 3 cases of duodenal ulcer, 3 cases of hemorrhagic gastritis and duodenal ulcer, 2 cases of hemorrhagic duodenitis and colitis, and 1 case of colitis were noted on GI endoscopy. CONCLUSION: These results suggest that GI endoscopic examination may be helpful for the diagnosis and treatment of children with HSP.

Gastrointestinal Foreign Bodies in Children: Experiences of 60 Cases in Kangwon, Korea / 대한소아소화기영양학회지

PURPOSE: Ingested foreign bodies present a common clinical problem. It is well known that most of them pass uninterrupted through the gastrointestinal tract. We evaluated the role of endoscopy and Foley catheter for removal of foreign bodies in the gastrointestinal tract. METHODS: We investigated retrospectively 60 cases with foreign bodies in the gastrointestinal tract. They had been treated at Wonju Christian Hospital, Yonsei University of Korea, from January, 1996 through December, 1999. RESULTS: The age of the patients ranged from 7 months to 13 years. Patients under 5 years were 57 cases (97%) and there was no significant difference in sex (M : F=1.07 : 1). 45 cases of the patients had no symptom. The most common foreign bodies were coins (43 cases). The most common location was esophagus (31 cases). The number of foreign body removal using flexible endoscopy and Foley catheter was 22 (36.7%) and 18 (30.0%) cases, respectively. In 18 cases (30.0%), foreign bodies passed spontaneously. Only 1 case (1.7%), curtain pin impaction at ileocecal region, required surgery. CONCLUSION: Early foreign body removal from esophagus and stomach is recommended to lessen the morbidity and complication. Fluoroscopic foley catheter technique and flexible endoscopy for removal of esophageal foreign bodies in children is safe and effective.