Morpho-Histological Study of Myocardial Bridges and Their Association with Atherosclerosis

Coronary arteries supply blood to the heart. They run through the epicardial adipose tissue during their course. Occasionally a band of myocardial tissue overlies a segment of the coronary arteries. This band of myocardium overlying the coronary artery is named as Myocardial Bridge (MB). There have been numerous instances of sudden and unexpected cardiac death where the presentation of myocardial bridging was the main clinically pertinent finding post-mortem. We wanted to study the distinct morphological aspects of MBs along with the structural composition of the coronary vessel present beneath, in front of and past the myocardial bridge. METHODSMicroscopy and morphometry were utilized to detail the distinct morphological characteristics of myocardial bridges as well as to take a closer look at the structural composition of the coronary vessel present beneath, in front of and past the myocardial bridge being evaluated. Three segments of the left anterior descending artery (LAD) were utilized to glean testable samples. These samples are as follows: (A) located proximally to the bridge at a distance of 8 mm, (B) alongside the bridge and (C) located distally from the bridge at a distance of 8 mm. RESULTSPrevalence of MB was found to be 40 %. Male to female ratio was 7:1. 87.5 % of the hearts have single MB, 10 % have double MB, 2.5 % have triple MB. Most common vessel affected is LAD. The MBs ranged in length from 4.4 mm to 45 mm with a length of 12.67 mm being the quantifiable mean. Thickness of MB ranged from 0.4 to 1.9 mm with mean thickness of 1.11 mm. The component of the coronary artery that was bridged often showed a diminished tunica intima compared to similar segments taken from proximal and distal sites. It should be noted that the proximal segment is predisposed to atherosclerotic presentation on account of myocardial bridging. CONCLUSIONSA myocardial bridge leads to detrimental changes in the vessel which in turn leads to early presentation of atherosclerosis, arrhythmias, myocardial infarctions and in severe cases, sudden death. Myocardial bridging is frequently localized in the LAD. It can have significant effects on the overall health.

Ultrasound-guided facet block to low back pain: a case report / Bloqueio facetário guiado por ultrassom para lombalgia: relato de caso / Bloqueo facetario guiado por ultrasonido para lumbalgia: relato de caso

BACKGROUND: Osteoarthrosis is a common cause of low back pain. The diagnosis is clinical and can be confirmed by imaging studies. Pain treatment and confirmation of diagnosis are made by intra-articular injection of corticosteroid and by local anesthetic use, due to clinical improvement. A direct monitoring of the procedure can be done under fluoroscopy, a classic technique, or else by an ultrasound-guided procedure. CASE REPORT: Female patient, 88 years old, 1.68 m and 72 kg, with facet osteoarthrosis at L2-L3, L3-L4 and L4-L5 for two years. On physical examination, she exhibited pain on lateralization and spinal extension. We opted in favor of an ultrasound-guided facet joint block. A midline spinal longitudinal scan was obtained, with identification of the desired joint space at L3-L4. A 25 G needle was inserted into the skin by the echographic off-plane ultrasound technique. 1 mL of contrast was administered, with confirmation by fluoroscopy. After aspiration of the contrast, 1 mL of solution containing 0.25% bupivacaine hydrochloride and 10 mg of methylprednisolone acetate was injected. Injections into L3-L4, L2-L3 and L1-L2 to the right were applied. CONCLUSIONS: The visualization of the facet joint by ultrasound involves minimal risk, besides reduction of radiation. This option is suitable for a large part of the population. However, fluoroscopy and computed tomography remain as monitoring techniques indicated for patients with specific characteristics, such as obesity, severe degenerative diseases and anatomical malformations, in which the ultrasound technique is still in need of further study. .

JUSTIFICATIVA: a osteoartrose facetária é causa frequente de dor lombar. O diagnóstico é clínico e pode ser confirmado por imagem. O tratamento da dor e a confirmação do diagnóstico são feitos pela injeção intra-articular de corticosteroide e anestésico local, por causa da melhoria clínica. A monitoração direta do procedimento pode ser feita por fluoroscopia, técnica clássica, ou guiada por ultrassom. RELATO DE CASO: paciente do sexo feminino, 88 anos, 1,68 m e 72 kg, com osteoartrose facetária em L2-L3, L3-L4 e L4-L5 havia dois anos. No exame físico, dor à lateralização e à extensão da coluna. Optou-se pelo bloqueio da articulação facetária guiado por ultrassom. Foi feito escaneamento longitudinal na linha média da coluna vertebral e identificado o espaço articular desejado em L3-L4. Uma agulha 25G foi introduzida na pele pela técnica fora de plano ecográfico. Foi administrado 1 mL de contraste, confirmado com fluoroscopia. Após aspiração do contraste, foi injetado 1 mL de solução contendo cloridrato de bupivacaína 0,25% e 10 mg de acetato de metilprednisolona. Foram feitas injeções nos espaços L3-L4, L2-L3 e L1-L2 à direita. CONCLUSÕES: a visualização da articulação facetária pelo ultrassom determina mínimo risco e redução da radiação e é indicada para grande parte da população. Ainda assim a fluoroscopia e a tomografia computadorizada permanecem como monitoração indicada para pacientes com características específicas, como obesidade, doenças degenerativas intensas e malformações anatômicas, nas quais o ultrassom ainda necessita de mais estudos. .

JUSTIFICACIÓN: la osteoartrosis facetaria es causa frecuente de dolor lumbar. El diagnóstico es clínico y puede ser confirmado por imagen. El tratamiento del dolor y la confirmación del diagnóstico se hacen mediante la inyección intraarticular de corticosteroides y anestésico local para la mejoría clínica. La monitorización directa del procedimiento puede hacerse por fluoroscopia, técnica clásica, o guiada por ultrasonido. CASO CLÍNICO: paciente del sexo femenino, de 88 años, de 1,68 m y 72 kg, con osteoartrosis facetaria en L2-L3, L3-L4 y L4-L5 hacía ya 2 años. En el examen físico se constató dolor a la lateralización y a la extensión de la columna. Optamos por el bloqueo de la articulación facetaria guiado por ultrasonido. Se hizo un escaneo longitudinal en la línea media de la columna vertebral y se identificó el espacio articular deseado en L3-L4. Una aguja 25G se introdujo en la piel por la técnica fuera del plano ecográfico. Se administró 1 mL de contraste, confirmado con la fluoroscopia. Después de la aspiración del contraste, se inyectó 1 mL de solución conteniendo clorhidrato de bupivacaína al 0,25% y 10 mg de acetato de metilprednisolona. Se administraron inyecciones en los espacios L3-L4, L2-L3 y L1-L2 a la derecha. CONCLUSIONES: la visualización de la articulación facetaria por el ultrasonido determina un mínimo riesgo y una reducción de la radiación y está indicada para gran parte de la población. Pero incluso así, la fluoroscopia y la tomografía computadorizada permanecen como la monitorización indicada para pacientes con características específicas, como obesidad, enfermedades degenerativas intensas y malformaciones anatómicas, para las cuales el ultrasonido todavía necesita más estudios. .

Eficacia del bloqueo facetario en pacientes con síndrome facetario lumbar / Efficacy of facet block in patients with lumbar facet joint syndrome

El bloqueo facetario es un procedimiento usado en aquellos pacientes con artrosis facetaria en los cuales han fallado los múltiples tratamientos médicos. En nuestro país se desconocen estudios o estadísticas que demuestren su efectividad, por lo que se consideró pertinente demostrarlo. Se realizó un estudio observacional retrospectivo de una cohorte de pacientes intervenidos en el período comprendido entre enero de 2005 y diciembre de 2009 en la Clínica CES. Se recolectó información de las historias clínicas mediante un formulario diseñado para tal fin; además se relacionó la existencia de mejoría del paciente posterior a la intervención con edad, sexo, ocupación, tiempo de evolución, síntomas motores y sensitivos previos y enfermedades asociadas. La población fue de 232 pacientes entre 21 y 92 años, con una edad promedio de 56,9 (± 14,6) años, con un tiempo de evolución del dolor lumbar de 2 años en el 40% de la población estudiada. La resonancia magnética fue el estudio más utilizado previo al procedimiento en 42,2% de los pacientes, la tomografía en 38,31% y los rayos X en 7,46%. El procedimiento fue eficaz en el 78% de los pacientes. En conclusión, el bloqueo facetario es un método terapéutico, ya que se vio mejoría de la sintomatología en la mayoría de los pacientes estudiados. Esto es coherente con otros estudios realizados, donde también se ha evidenciado disminución de las limitaciones físicas y funcionales de los pacientes. Además, es un procedimiento diagnóstico ya que la mejoría con esta técnica indica que la patología sí era facetaria.

Facet block is a procedure used in patients with facet arthrosis in which several other medical techniques have failed. In our country, there is no evidence or studies regarding its efficacy, thus the interest in its demonstration. A retrospective observational cohort study was carried out on patients intervened between January 2005 and December 2009 at Clínica CES. Data was collected from the patient's clinical records by means of a survey designed for that purpose. Also, positive clinical outcomes were correlated to age, gender, occupation, evolution time, motor and sensitive symptoms as well as comorbidities. The sample included 232 patients between the ages of 21 and 92, with an average age of 56.9 (± 14.6) years, and a lumbar pain evolution time of 2 years in 40% of the individuals in the sample. The most commonly used imaging test before the procedure was magnetic resonance imaging in 42.2% of patients, computed tomography scan was used in 38.31% and X-rays in 7.46%. The procedure was effective in 78% of patients. In sum, facet block is a therapeutic method, given that most patients improved after its completion. These findings are consistent with other studies that have showed a decrease in physical and functional limitations of the patients. Besides, improvement of the patient's state confirms a lumbar facet syndrome, so it is a diagnostic procedure as well.

The clinical therapeutic effect of facet block in the management of low back pain / 대한정형외과학회잡지

In spite of numerous clinical and patho-anatomical studies made in the past, there are still different opinions concerning the machanism of low back pain. We have focused attention on the posterior structures as an alternative source of low back pain with leg radiation, so we have studied and analyzed the effect of the injection of mixture methylprednisolone acetate suspension (20-40 mg) and local anesthetic (1% procaine, 1cc) into the posterior facet joint. In this paper, the records of 41 in-patients who have chiefly compalned of low back pain wlth leg radiation and have been treated at the Departmnt of Orthopedics, Han Yang University Hospital from May, 1979 to April, 1980 were studied. The following results are recognized by observing and analyzing their chief complalnts, physical examination, x-ray findings, the effect of facet block and the follow-up studies after facet block. 1. Low back pain with sciatica was 1.9 times more common in female than male, and frequently occured In 4th to 6th decades (75.7%). 2. The abnormal findings of plain x-rays were osteophyte (35.6%), marginal sclerosis (27.1%), narrowing of disc spce (18.6%), lumbarization (11.9%), spina bifida (3.4%), and tropism (3.4%). 3. The most frequent site of abnormal posterior facet joints was at the level between 4th and 5th lumbar vertebra (42.9%), and all were on lower lumber region. 4. The range of lumbar motion was decreased in the cases of abnormal posterior facet jolnt or degenerative changes, and it was especially more decreased in the combined cases. 5. The effect of facet block was as follows; In initial assessment, 29 of 41 cases (70.7%) showed complete rellef and one month later, 16 of 29 cases (55.2%) showed continuous rolief, 4 of 18 cases (22.2%) which were followed for 3 more months showed complete relief. 6. The effect of facet block according to pain character was as follows: 20 of 26 cases (76.9%) of numbness, 5 of 6 cases (83.3%) of dull pain and 4 of 8 cases (50.0%) of radlating pain were completely relleved and a case of burning pain was partially relleved.