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1.
Curr Probl Diagn Radiol ; 53(4): 507-516, 2024.
Article in English | MEDLINE | ID: mdl-38341368

ABSTRACT

Pathologies affecting the spinal epidural space (SES) comprise various abnormalities. However, they all have the potential to cause thecal sac narrowing or spinal cord compression. In this review, we group these pathologies into degenerative, infective, neoplastic, vascular, traumatic, and others, focusing on their imaging features. Degenerative pathologies of the SES range from disc to facet disease, with a particular emphasis on the less common degenerative pathologies in this review. Infective pathologies affecting the epidural space include spondylodiscitis and associated epidural phlegmon and abscess. Neoplasms arising from typical SES components include neurofibroma, hemangioma, and liposarcoma. MRI is the best modality to assess the anatomy and abnormalities of the epidural space. MRI, combined with computed tomography, or a radiograph, is useful for the evaluation of bones or radiopaque foreign bodies.


Subject(s)
Epidural Space , Spinal Diseases , Humans , Epidural Space/diagnostic imaging , Spinal Diseases/diagnostic imaging , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods
2.
J Arthroplasty ; 38(7 Suppl 2): S426-S430, 2023 07.
Article in English | MEDLINE | ID: mdl-36535438

ABSTRACT

BACKGROUND: Iliopsoas tendonitis can cause persistent pain after total hip arthroplasty (THA). Nonoperative management of iliopsoas tendonitis includes anti-inflammatory drugs and image-guided corticosteroid injections. This study evaluated the efficacy of ultrasound-guided corticosteroid injections (US-CSIs) for iliopsoas tendonitis following THA. METHODS: We retrospectively reviewed 42 patients who received an US-CSI for iliopsoas tendonitis after primary THA between 2009 and 2020 at a single institution. Outcomes including reoperation, groin pain at last follow-up, additional intrabursal injection, and Harris Hip Score (HHS) were evaluated at a minimum of 1 year. Cross-table lateral radiographs (36 patients) or computed tomography scans (6 patients) were reviewed to determine if anterior cup overhang was present, indicating a mechanical etiology of iliopsoas tendonitis. Descriptive statistics and univariate comparison of HHS preinjection and postinjection were performed, with alpha < 0.05. RESULTS: Among the 22 patients who did not have cup overhang, four (18.2%) had persistent groin pain at mean follow-up of 40 months (range, 14-94) after US-CSI. Three patients had a second injection; none had groin pain at most recent follow-up. No patients required acetabular revision. Mean HHS improved from 74 points (range, 52-94 points) to 91 points (range, 76-100 points; P < .001) at last follow-up. Among the 20 patients who had anterior cup overhang, five underwent acetabular revision after only temporary pain relief from injection. Groin pain was resolved in all revised patients at mean follow-up of 43 months (range, 12-60) after revision. Of the remaining 15 patients, five had persistent groin pain at mean follow-up of 35 months (range, 12-83). Mean HHS improved from 69 points (range, 50-96 points) preinjection to 81 (range, 56-98 points; P = .007) at last follow-up. CONCLUSION: Resolution of groin pain was demonstrated in 78.6% of patients in the cohort; however, those who did not have acetabular overhang had higher rates of success. The overall revision rate was 11.9%. US-CSI appears to be safe and effective in the diagnosis and treatment of iliopsoas tendonitis following primary THA. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Subject(s)
Arthroplasty, Replacement, Hip , Bursitis , Tendinopathy , Humans , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/methods , Retrospective Studies , Psoas Muscles/diagnostic imaging , Psoas Muscles/surgery , Pain/surgery , Bursitis/drug therapy , Bursitis/etiology , Bursitis/surgery , Tendinopathy/drug therapy , Tendinopathy/etiology , Tendinopathy/surgery , Adrenal Cortex Hormones/therapeutic use , Ultrasonography, Interventional/adverse effects , Treatment Outcome
4.
J Digit Imaging ; 30(5): 534-536, 2017 10.
Article in English | MEDLINE | ID: mdl-28523622
5.
Curr Hypertens Rep ; 18(1): 8, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26747265

ABSTRACT

Diabetic nephropathy, or diabetic kidney disease (DKD), is the most serious complication of diabetes mellitus (DM). Despite recent advances in therapy, DKD still often progresses to end-stage renal disease (ESRD). Recent studies have suggested that pentoxifylline (PTX) may be efficacious in the treatment of DKD. PTX is a rheologic modifier approved for use in the USA for the symptomatic relief of claudication. It competitively inhibits phosphodiesterase (PDE), resulting in increased intracellular cyclic AMP (cAMP), activation of protein kinase A (PKA), inhibition of interleukin (IL) and tumor necrosis factor (TNF) synthesis, and reduced inflammation. PTX improves red blood cell deformability, reduces blood viscosity, and decreases platelet aggregation. In combination with renin-angiotensin-aldosterone (RAAS) blockers, PTX may help prevent progression to ESRD in patients with DKD. This review focuses on the possible mechanisms of action of PTX in DKD and studies suggesting possible efficacy of this old drug for a new indication.


Subject(s)
Diabetic Nephropathies/drug therapy , Pentoxifylline/therapeutic use , Animals , Clinical Trials as Topic , Disease Progression , Humans , Kidney Failure, Chronic/drug therapy , Kidney Failure, Chronic/etiology
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