Combined Effects of Extracorporeal Shockwave Therapy and Integrated Neuromuscular Inhibition on Myofascial Trigger Points of Upper Trapezius: A Randomized Controlled Trial

Objective@#To investigate the combined effect of extracorporeal shockwave therapy (ESWT) and integrated neuromuscular inhibition (INI) on myofascial trigger points in the upper trapezius. @*Methods@#Sixty subjects aged 18–24 years old with active myofascial trigger points in the upper trapezius were studied. Participants were assigned randomly to either group A who received ESWT one session/week, group B who received INI three sessions/week, or group C who received ESWT in addition to INI. All groups completed 4 weeks of intervention. The following main outcome measures were evaluated at baseline and after 4 weeks of intervention: pain intensity, functional disability, pressure pain threshold (PPT), sympathetic skin response (SSR), and neuromuscular junction response (NMJR). @*Results@#Within-group analysis revealed a significant decline in visual analog scale (VAS), Arabic neck disability index (ANDI), and NMJR and incline in PPT and SSR latency post-intervention (p<0.001). Multiple comparison analysis showed a substantial difference between the groups, while the major changes favored group C (p<0.05). @*Conclusion@#Combined treatment with ESWT and INI for treating myofascial trigger points in the upper trapezius is more effective than using only one of the two approaches in terms of clinical, functional, and neurophysiological aspects.

Combined Effects of Extracorporeal Shockwave Therapy and Integrated Neuromuscular Inhibition on Myofascial Trigger Points of Upper Trapezius: A Randomized Controlled Trial

Objective@#To investigate the combined effect of extracorporeal shockwave therapy (ESWT) and integrated neuromuscular inhibition (INI) on myofascial trigger points in the upper trapezius. @*Methods@#Sixty subjects aged 18–24 years old with active myofascial trigger points in the upper trapezius were studied. Participants were assigned randomly to either group A who received ESWT one session/week, group B who received INI three sessions/week, or group C who received ESWT in addition to INI. All groups completed 4 weeks of intervention. The following main outcome measures were evaluated at baseline and after 4 weeks of intervention: pain intensity, functional disability, pressure pain threshold (PPT), sympathetic skin response (SSR), and neuromuscular junction response (NMJR). @*Results@#Within-group analysis revealed a significant decline in visual analog scale (VAS), Arabic neck disability index (ANDI), and NMJR and incline in PPT and SSR latency post-intervention (p<0.001). Multiple comparison analysis showed a substantial difference between the groups, while the major changes favored group C (p<0.05). @*Conclusion@#Combined treatment with ESWT and INI for treating myofascial trigger points in the upper trapezius is more effective than using only one of the two approaches in terms of clinical, functional, and neurophysiological aspects.

Extent of Hyperostotic Bone Resection in Convexity Meningioma to Achieve Pathologically Free Margins

Objective@#: Hyperostosis in meningiomas can be present in 4.5% to 44% of cases. Radical resection should include aggressive removal of invaded bone. It is not clear however to what extent bone removal should be carried to achieve pathologically free margins, especially that in many cases, there is a T2 hyperintense signal that extends beyond the hyperostotic bone. In this study we try to investigate the perimeter of tumour cells outside the visible nidus of hyperostotic bone and to what extent they are present outside this nidus. This would serve as an initial step for setting guidelines on dealing with hyperostosis in meningioma surgery. @*Methods@#: This is a prospective case series that included 14 patients with convexity meningiomas and hyperostosis during the period from March 2017 to August 2018 in two university hospitals. Patients demographics, clinical, imaging characteristics, intraoperative and postoperative data were collected and analysed. In all cases, all visible abnormal bone was excised bearing in mind to also include the hyperintense diploe in magnetic resonance imaging (MRI) T2 weighted images after careful preoperative assessment. To examine bony tumour invasion, five marked bone biopsies were taken from the craniotomy flap for histopathological examinations. These include one from the centre of hyperostotic nidus and the other four from the corners at a 2-cm distance from the margin of the nidus. @*Results@#: Our study included five males (35.7%) and nine females (64.3%) with a mean age of 43.75 years (33-55). Tumor site was parietal in seven cases (50%), fronto-parietal in three cases (21.4%), parieto-occipital in two cases (14.2%), frontal region in one case and bicoronal (midline) in one case. Tumour pathology revealed a World Health Organization (WHO) grade I in seven cases (50%), atypical meningioma (WHO II) in five cases (35.7%) and anaplastic meningioma (WHO III) in two cases (14.2%). In all grade I and II meningiomas, bone biopsies harvested from the nidus revealed infiltration with tumour cells while all other bone biopsies from the four corners (2 cm from nidus) were free. In cases of anaplastic meningiomas, all five biopsies were positive for tumour cells. @*Conclusion@#: Removal of the gross epicentre of hyperostotic bone with the surrounding 2 cm is adequate to ensure radical excision and free bone margins in grade I and II meningiomas. Hyperintense signal change in MRI T2 weighted images, even beyond visible hypersototic areas, doesn’t necessarily represent tumour invasion.

Anticoagulation for cerebral venous thrombosis with subarachnoid hemorrhage: a case report

To report the success of anticoagulation [AC] treatment in a case of cerebral venous thrombosis [CVT] with subarachnoid hemorrhage [SAH] in view of the limited evidence seen in the literature supporting such a treatment option. A 38-year-old lady with CVT and SAH presented 12 h after the onset of symptoms. AC with low-molecular-weight heparin was started 4 days later, when the repeated brain CT showed regression of the SAH. Heparin was changed to warfarin, and she was asymptomatic over a 12-month follow-up period. In a limited number of small studies, AC has been found to be beneficial for cases of CVT with hemorrhagic complications. The proper time to start AC in such cases was not clearly defined, and a delay of 4-33 days was observed after the onset of symptoms. In cases of spontaneous intracranial hemorrhage [ICH] in general, active bleeding is usually confined to the first 6 h, and chances of hematoma enlargement are higher in the first 24 h. On the other hand, it has been advised to rule out a coincidental vascular malformation and to radiologically confirm regression [or at least non-progression] of the ICH before starting AC. AC for cases of CVT may remain beneficial in the presence of SAH. The time to start AC for CVT with hemorrhagic complications is unclear; however, AC was successful when given 4 days after the onset of symptoms in our case. It may be wise to repeat CT after at least 24 h from the onset of symptoms [to confirm regression or at least non-progression of the ICH] before starting AC. It may also be prudent to perform magnetic resonance angiography, or digital subtraction angiography to rule out a coincidental intracranial aneurysm before AC

Magnetic resonance imaging in evaluation of a lucent bony lesion on plain x-ray

To assess the ability of MFJ in characterization of lucent bony lesion noticed on plain x ray. The study was conducted on 43 patients with a lucent bony lesion on plain x ray and subjected to MRI examination. MRI showed homogenous signal in 26 lesions and heterogenous signal in 17 lesions. The signal was hypointense on T1WI in 37 patients and isointense in six patients. The signal was hyperintense on T2WI in 25 lesions, hypointense on T2WI in 12 lesions and isointense in 6 lesions. Contrast was injected in 18 patients and the lesions showed variable degree of enhancement. MI?J showed lobulation of the lesion in 17 patients, hypointense margins in 18 patients, fluid.fluid level in 12 patients, central hypointense signal in four patients, soft tissue mass in three patients and oedema adjacent to lesion in six patients. Final diagnosis confirmed presence of aneurysmal bone cyst in nine patients, non ossdying fibroma in seven patients, giant cell tumour in seven patients, osteoblastoma in four patients, osteoid osteoma, enchondroma, chondroblastoma, metastases and fibrous dysplasia in two patients for each pathology. Eosinophilic granuloma, chondromyxoid fibroma, arteriovenous malformation, Ewing's sarcoma, simple bone cyst and small cell sarcoma in one patient for each pathology. MRI was able to asses the fluid and cellular contents of lesions, presence of haemorrhage, necrosis, borders of the lesion, presence of soft tissue mass and oedema adjacent to lesion that could limit differential diagnosis and the need for histopathologic confirmation

Role of helicobacter pylori in the genesis of gastric ulcerations among smokers and non-smokers

H. Pylori infections were investigated by three different methods: Serologically, microbiologically and biochemically, in 210 male patients aged 20-40 years. Gastric ulcers were diagnosed in 126 patients with which H. Pylori infection showed significant high association [X2 = 162.8]. Smoking showed a positive role in magnifying such a problem. Smokers were carrying a higher rate of infection than non-smokers, among patients with gastric ulcers [99% compared to 79%]. The risk of getting H. Pylori infection was computed in different smokers categories. Heavy cigarette smokers were found to be on top of the list, followed by moderate to mild cigarette smokers and common hubble-bubble smokers while, neither private hubble-bubble nor cigar/pipe smokers showed significant risk [odds ratio = 8.2, 4.3, 4.1, 1.1 and 0.8, respectively]

Anaesthesia and intensive care for patients with morbid obesity

Fifty major surgical procedures were carried out on 48 morbidly obese patients in king Fahd Hospital -Jeddah and Jubail Hospital, Eastern Province, from year 1407 to year 1414. There were 44 females and 4 males. The age range was 14-52 Years [mean 31.8, S.D. 8.08]. The weights ranged from 97-183 kg [mean 126.97 kg, S.D 17.86]. All patients received general anaesthesia and they were all admitted to the Intensive Care Unit after operation. Fourteen patients needed prolonged endotracheal intubation with assisted ventilation after operation for an average of 9.7 hours. While the average stay in I. C. U. was 39.5 hours. No special anaesthesia tevhnique was recommended, the only emphasis was on careful monitoring during anaesthesia of all the vital signs, the arterial blood gases and acid base balance and on the necessity of having a central venous line and arterial line. In the I. C. U., hypoxaemnia occurred in 14 patients [simple in 9, severe and recurrent in 5]. Other metabolic changes included hyperglycaemia in [35 cases], hypocalcaemia [13 cases], elevation of the liver enzymes in [32 cases] and acidosis in [4 cases] We recommend post-operative extubation as early as possible and we reserve I. C. U. beds only for patients who have additional medical problems