RESUMO
BACKGROUND: Painful lumbar radiculopathy is a neuropathic pain condition, commonly attributed to nerve root inflammation/compression by disc herniation. The present exploratory study searched for associations between pain intensity and inflammatory markers, herniated disc size, infection, psychological factors and pain modulation in patients with confirmed painful lumbar radiculopathy scheduled for spine surgery. METHODS: Prior to surgery, 53 patients underwent the following evaluation: pain intensity measured on a 0-10 numeric rating scale (NRS) and the Short-Form McGill Pain Questionnaire; sensory testing (modified DFNS protocol); pain processing including temporal summation and conditioned pain modulation (CPM); neurological examination; psychological assessment including Spielberger's Anxiety Inventory, Pain Sensitivity Questionnaire and the Pain Catastrophizing Scale. Pro-inflammatory cytokine levels (IL-1b, IL-6, IL-8, IL-17, TNFα, IFNg) and microbial infection (ELISA and rt-PCR) in blood and disc samples obtained during surgery. MRI scans assessments for disc herniation size/volume (MSU classification/ three-dimensional volumetric analysis). RESULTS: Complete data were available from 40 (75%) patients (15 female) aged 44.8 ± 16.3 years. Pain intensity (NRS) positively correlated with pain catastrophizing and CPM (r = 0.437, p = 0.006; r = 0.421, p = 0.007; respectively), but not with disc/blood cytokine levels, bacterial infection or MRI measures. CPM (p = 0.001) and gender (p = 0.029) were associated with average pain intensity (adjusted R2 = 0.443). CONCLUSIONS: This exploratory study suggests that pain catastrophizing, CPM and gender, seem to contribute to pain intensity in patients with painful lumbar radiculopathy. The role of mechanical compression and inflammation in determining the intensity of painful radiculopathy remains obscure. SIGNIFICANCE OF STUDY: Pain catastrophizing, CPM and gender rather than objective measures of inflammation and imaging seem to contribute to pain in patients with painful radiculopathy.
Assuntos
Deslocamento do Disco Intervertebral , Radiculopatia , Citocinas , Feminino , Humanos , Inflamação , Deslocamento do Disco Intervertebral/complicações , Vértebras Lombares , Dor/complicações , Radiculopatia/complicações , Radiculopatia/diagnósticoRESUMO
OBJECTIVE. To evaluate the potential for surveillance of abdominal aortic aneurysms without ionizing radiation exposure and without the risks of iodinated contrast administration, the accuracy of fusion of CT angiography (CTA) with ultrasound (US) was compared with conventional US in 14 patients. CONCLUSION. The mean measurement difference between conventional US and CTA was 0.50 cm, compared with 0.13 cm between CT-US fusion and CTA (p < 0.0005). CT-US fusion was more accurate than conventional US, reduces operator dependence, and is promising for accurate measurement of aortic aneurysms.
Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Imagem Multimodal , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição à Radiação , UltrassonografiaRESUMO
Transthoracic parametric Doppler (TPD), unlike conventional ultrasonography, measures signals originating from movements of pulmonary blood vessel walls. In this pilot study, we tested TPD in 15 patients diagnosed with pulmonary embolism on computed tomography pulmonary angiography. Results were mapped to the upper, middle, and lower thirds of the right lung. In the lower third, TPD yielded 100% specificity and positive predictive value for acute pulmonary embolism. If validated in a larger series, this rapid bedside technique might obviate the need for computed tomography in specific cases. This could be advantageous in patients who are unstable, in intensive care, or have allergies to iodinated contrast material.