ABSTRACT
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
ABSTRACT
Aim: The primary aim of our study was to assess the effectiveness of beta blockers in non bleeding portal hypertensive children. The secondary objective was to evaluate whether the newer generation beta blockers were superior compared to conventional ones. Methods: Conventional propranolol and newer generation carvedilol were administered to 31 subjects each, after stratifying them into nearly equal subgroups according to etiology (sinusoidal or presinusoidal). Results: At the end of 2 years study period, 3 children (4.83%) had breakthrough bleeding. A decrease, increase and no alteration in grade of oesophageal varices was seen in 40, 9 and 13 cases respectively. Of the 9 children with associated gastroeosophageal varices (GOV), the severity of lesions was reduced in 8 of them. Both the drugs had efficacious outcome in sinusoidal as well as presinusoidal cases, having a significant coefficient of correlation (r>0.5) with time. Carvedilol was more effective than propranolol statistically (p = 0.035 and p = 0.034 respectively), only at 4 and 5 month follow-up period. Conclusion: Beta blockers are effective in preventing variceal bleed in children with portal hypertension. Long term efficacy of carvedilol and propranolol was similar.
ABSTRACT
Introduction: Endoscopic glue (N-butyl-2-cyanoacrylate) injection has emerged as promising therapy for bleeding gastric varices (GV). We evaluated safety and long term efficacy of this technique in patients with portal hypertension and large bleeding GV. Patient and Methods: 170 patients (mean age 40.9±14y; 132 male; 142 had cirrhosis, 40 Child A, 62 Child B, 40 Child C) underwent glue injection into GV (F3 140, F2 30; fundal 114) as emergency procedure for active bleeding in 62 and electively for prevention of rebleeding in 108. Glue was injected intra-variceally under endoscopic vision, 0.5-4ml/aliquot, repeated at 3 weeks till varices were eradicated/solidified. The efficacy was assessed by hemostasis at 48 h, primary, secondary, definitive success and treatment failure. Results: The overall hemostasis rate at 48h was 82.3% (51/62). Follow up was available in 158 patients for mean of 30.7 + 17.2 months. Repeat injections were performed in 76. The mean number of injections were 1.9±1.0 (1-4); total volume was 2.5±1.7 ml / patient. The status of GVs at last follow up was : disappeared in 32 (22.6%); F1 solidified in 46 (32.3%); F2 solidified in 64 (45.0%). Bleeding recurred in 14.5% (23/158); 60% within 2 weeks of injection. The primary, secondary and definitive success rates were 85.4% (135/158), 4.4% (7/158) and 89.9% (142/158) respectively and treatment failure rate was 10% (16/158). No significant complications were noticed except for injection site ulceration in 32. Twenty patients died on follow up (9 died of uncontrolled bleeding, 11 died of liver failure) Conclusion: Endoscopic glue injection into bleeding GVs was effective in achieving hemostasis in 82% with a definitive success rate of 90% and had a good safety profile on long term follow up.