ABSTRACT
Introduction: Thromboangiitis obliterans (TAO) or Buerger's disease (BD) is a small and medium-sized arteriovenous segmental occlusive inflammatory disease frequently occurring in men as compared to women. Although a common etiological agent is smoking or tobacco consumption, it has also been reported infrequently in non-smokers. Except for smoking other etiological agents, HLA, autoimmune diseases like systemic lupus erythematosus, and periodontitis have also been suggested. Minimally invasive pain and spine intervention (MIPSI) like stellate ganglion neurolysis with 8% phenol, 10 days apart in patients suffering from bilateral digital ischemia of both hands is a safe and effective treatment. Case Report: Fifty-five-year-old female with chief complaints of burning pain, swelling, and blackening of all five fingers of the right and four fingers of the left hands excluding the thumb for the past 3 months. On examination, pulse was almost absent at the wrist in both hands. There was no history of smoking. Under aseptic precautions, fluoroscopy and radiocontrast guidance stellate ganglion neurolysis with a 22G spinal needle, 2 ml of 8% phenol, 2 ml of 0.25% bupivacaine and 4 mg of dexamethasone were given at C7 vertebral level 10 days apart on both sides. After 3-4 months of stellate ganglion phenol chemical neurolysis, involved fingers were saved except the gangrenous part which was autoamputated itself in due course of time. Conclusion: Bilateral interval (10 days apart) chemical neurolysis of stellate ganglion in Buerger's disease involving both hands is a safe and effective technique in terms of control of disease progression, pain, cardiac complications, and recurrent laryngeal nerve-related complications.
ABSTRACT
Introduction: Buerger's disease is common in 74.70% of cases in the lower limb but in 20.20% of cases, it is found in the upper limb or hand. The disease usually starts from pain in the finger/thumb or hand and then to more centrally.Patients presented with pain in the hand with gangrene of fingers. Pain aggravated on lifting hand above the shoulder level or above heart level in upright or lying in the bed, respectively. Case Report: In almost all patients, there was a history of smoking except one and all patients had involvement of digits of the right or left hand. Diagnosis of Buerger's disease was made based on the history of smoking, weak or absent pulse, lack of bleeding, swelling, edema, blackening, stony hard fingers or thumb on clinical examination, and color Doppler study of the limb.In all patients, Stellate ganglion chemical neurolysis with 8% phenol was done at C7-T1 under fluoroscopic and radiocontrast dye (Iohexol 300) guidance.After successful neurolysis patients got excellent pain relief, their wounds started healing, the vascularity of the diseased part increased and the disease stopped progressing. Conclusion: Stellate ganglion chemical neurolysis with phenol in Peripheral vascular disease or Buerger's disease of hand is an effective method to stop the disease procession, promoting wound healing, controlling ischemic pain, and avoiding surgical amputation.
ABSTRACT
ETHNOPHARMACOLOGICAL RELEVANCE: Safed musli (Chlorophytum borivilianum) is an eminent medicinal plant of India and considered as a 'white gold' or 'divya aushad' in Indian systems of medicine. In Ayurveda, Chlorophytum borivilianum belongs to the group of "Vajikaran Rasayana" corroborated to its rejuvenating, aphrodisiac, natural sex tonic properties and effective in alleviating sexual disorders. It is largely used as ethnic medicine by local healers of indigenous communities of India. MATERIALS AND METHODS: A thorough bibliographic investigation was carried out by analyzing worldwide accepted scientific data base (Pub Med, SciFinder, Scopus and Web of Science), thesis, recognized books, non impact and non indexed journals. RESULTS: Traditionally, Chlorophytum borivilianum is well known for treating male impotency in India. The multi therapeutic and nutritional importance of Chlorophytum borivilianum is attributed to the rich source of phytochemicals particularly saponins. Recently, Chlorophytum borivilianum has gained a well established domestic (Indian) and international market for being the herbal alternative of "Viagra" without any side effects. Under the trade name 'Nai Chetna', the state government of Gujarat, India, has launched a novel potency drug from Chlorophytum borivilianum. Modern pharmacological studies of Chlorophytum borivilianum have demonstrated a wide range of pharmacological activities, most importantly aphrodisiac, immunomodulatory and anticancer activities. CONCLUSION: The increased commercial exploitation of Chlorophytum borivilianum and low productivity of this endangered plant has raised the concern over its conservation. It has been envisaged that efforts should be made to standardize, encourage and popularize the cultivation of Chlorophytum borivilianum as a commercial crop. The analysis of previous pharmacological investigations suggested lack of substantial scientific evidences in various studies and do not stand the test of critical assessment. Due to high economic value, Chlorophytum borivilianum has also encountered a problem of adulteration with closely resembling medicinally inferior species. The studies available on toxicity, safety and quality of Chlorophytum borivilianum are inadequate for providing information on commercial utilization. Thus, the present review summarizes comprehensive information on Chlorophytum borivilianum and possible scope for future research to fill the existing lacunae on its different aspects of the study.
