Does Local Infiltration of Anesthesia Reduce Port-site Pain in Gynecological Laparoscopic Surgeries? A Pilot Study.

Objectives: The objectives of this study were to evaluate the visual analog scale (VAS) score in patients receiving port-site bupivacaine infiltration in gynecological laparoscopic surgeries and to compare it with those receiving placebo and to evaluate the additional analgesic requirement in the first 24 h after surgery. Materials and Methods: A prospective interventional study was conducted on 60 women scheduled for benign gynecological laparoscopic surgeries. Patients were randomized into two groups using an alternative sequential method of allocation. Approval from the Institute's Ethics Committee was sought. Informed written consent was taken from all the patients. All laparoscopic surgeries were performed under general anesthesia. Double-blinding was done. A VAS with a 10 cm vertical score ranging from "no pain" to "worst possible pain" was used to assess the postoperative pain when the patient awakened in the operating room (2 h after surgery), then after 6 and 24 h. The primary outcome measured was pain perception by the patient (as VAS scores), and the secondary outcome was the need for additional analgesia. Results: Comparison of both groups with the VAS score shows P > 0.001, i.e., nonsignificant in all the groups. Additional analgesics were required in 56% of the patients in the intervention group and 60% of the patients in the control group; however, 44% and 40% of the patients from the intervention and control groups, respectively, do not require any additional analgesic in the postoperative period. Conclusion: The local infiltration of bupivacaine does not significantly reduce the port-site postoperative pain in gynecological laparoscopic surgeries.

Effectiveness of platelet-rich plasma in partial-thickness rotator cuff tears: a systematic review.

IMPORTANCE: Partial-thickness rotator cuff tears (PTRCTs) commonly affect overhead athletes, leading to a decline in sports performance. Platelet-rich plasma (PRP) is being explored as an alternative treatment modality for individuals with PTRCTs to reduce discomfort and enhance functional recovery. We conducted a systematic review study of randomized controlled clinical trials to determine the effectiveness of PRP in treating PTRCTs. AIM: To determine the effectiveness of PRP in treating PTRCTs. EVIDENCE REVIEW: We conducted a comprehensive literature search for randomized controlled trials (RCTs) that compared the effectiveness of PRP with eccentric exercise and placebo injections as treatments for PTRCTs. We searched databases such as the Cochrane Library, Web of Science, PubMed, and EMBASE. The visual analog scale (VAS) score, American Shoulder and Elbow Surgeon (ASES) score, and Constant-Murley Score (CMS) was utilized as an outcome measure. Statistical analysis was performed using RevMan 5.3 software. FINDINGS: Our meta-analysis included 12 studies involving 762 patients. At six weeks post-treatment, the PRP group had significantly higher VAS scores compared to the control group, indicating improvement (standard mean difference (SMD): -2.04 [95% confidence interval (CI): -4.00 to -0.08], I2 â€‹= â€‹97%, P-value â€‹= â€‹0.04). Patients who received PRP showed statistically significant improvements in VAS scores at 3 months and 6 months follow-up (SMD, -1.78 [95% CI: -3.03 to -0.52], I2 â€‹= â€‹96%, P-value â€‹= â€‹0.005) (SMD: -2.26 [95% CI: -3.77 to -0.76], I2 â€‹= â€‹97%, P-value â€‹= â€‹0.003). A statistically significant difference was also observed in VAS scores at the long-term 1-year follow-up (SMD: -2.27 [95% CI: -4.07 to -0.47]; I2 â€‹= â€‹98%; P-value â€‹= â€‹0.031). There were statistically significant differences in ASES scores and CMS scores in the short-term (SMD: 1.21 [95% CI: 0.19 to 2.24], I2 â€‹= â€‹96%, P-value â€‹= â€‹0.02) (SMD, 2.01 [95% CI: 0.14 to 3.88], I2 â€‹= â€‹97%, P-value â€‹= â€‹0.04). However, in the long-term ASES and CMS scores did not show any statistical significance (SMD: 2.06 [95% CI: -0.54 to 4.65], I2 â€‹= â€‹99%, P-value â€‹= â€‹0.12) (SMD: 4.36 [95% CI: -5.48 to 14.21], I2 â€‹= â€‹99%, P-value â€‹= â€‹0.39). CONCLUSIONS AND RELEVANCE: Our findings suggest that PRP treatment is effective in reducing pain for individuals with PTRCTs, providing benefits in the short and long term. However, its impact on functional recovery appears somewhat constrained and doesn't endure over time. Additionally, significant heterogeneity exists among studies, encompassing variations in PRP composition and control group treatments. Consequently, we conclude that compelling evidence for symptom improvement in PTRCT patients following PRP treatment remains elusive. LEVEL OF EVIDENCE: Level I.

Use of Navigable Ablation Decompression Treatment (L-DISQ) for Contained Cervical Disc Herniation - Technical Note and Literature Review.

Introduction: A new navigable percutaneous disc decompressor (L'DISQ-C, U&I Co., Uijeongbu, Korea), introduced in 2012, is designed to allow direct access to herniated disc material. The L'DISQ device can be curved by rotating a control wheel, directed into disc herniation treats, and decompresses contained herniated discs with minimal collateral thermal damage. This study reports the case of contained central disc herniation in a 34-year-old male with a 2-year follow-up successfully treated with navigable ablation decompression treatment (L-DISQ). Case Report: A 34-year-old man presented to the outpatient department with a 6-month history of neck pain and bilateral upper limb radiation. His neck pain had increased progressively. At the time of presentation, his neck pain visual analog scale score was 7/10, and his neck disability index score was 30. The magnetic resonance images showed a single fluid-containing lesion with a hyperintense zone at the C4-5 levels with central disc herniation. The patient was successfully treated with the navigable ablation decompression treatment (L-DISQ) procedure. Conclusion: The navigable ablation decompression treatment (L-DISQ) is a valuable technique in treating contained cervical disc herniation with rapid pain relief and improvements in functional outcomes without any significant injury to surrounding structures. It is safe, precise, and effective in the treatment of symptomatic cervical disc herniations. Large, randomized, and multicenter trials are needed to explore the potential of the same technique further.

Efficacy of ultrasound­guided platelet rich plasma injection for the management of de Quervain's tenosynovitis.

De Quervain's tenosynovitis (DQT) is a painful stenosing tenosynovitis of the first dorsal compartment of the wrist, which may be refractory to conservative treatments. The present study aimed to evaluate the efficacy of ultrasound (US)-guided platelet-rich plasma (PRP) injection for the management of DQT. For this purpose, from January, 2020 to February, 2021, 12 patients with DQT who received the US-guided PRP injection were studied prospectively. All patients were evaluated clinically for pain intensity using the visual analog scale and sonographically prior to treatment. The patients were followed-up at 1 and 3 months after the procedure to evaluate the efficacy of the treatment. In total, 12 hands of 12 female patients with DQT were analyzed in the present study. The post-treatment clinical evaluation revealed complete recovery in 4 (33.3%) of the patients, and 6 (50%) of them had recovered and returned to their daily activities. The sonographic evaluation revealed a significant reduction in the mean retinaculum thickness from 1.84 to 1.069 mm, and mean tendon sheath effusion from 2.06 to 1.25 mm, with only 58% of the cases having tendon sheath effusion at 3 months post-treatment. On the whole, the findings of the present study demonstrate that US-guided PRP injection with needle tenotomy can be used as an alternative non-surgical therapy for patients who do not respond to conventional conservative treatments, particularly in cases with sub-compartmentalization. The use of US may play a crucial role in the treatment of DQT, as improved clinical outcomes can be obtained with US-guided injections, particularly in cases with sub-compartmentalization.

Transportal Tibiotalocalcaneal Nail Ankle Arthrodesis: A Systematic Review of Initial Series.

Background: There is currently a scarcity of information and consensus for transportal (arthroscopic or fluoroscopic) joint preparation during tibiotalocalcaneal (TTC) fusion, and therefore this review aims to summarize the available techniques and to evaluate the outcomes after this procedure. Methods: A systematic electronic search of MEDLINE, EMBASE, and Web of Science was performed for all English-language studies published from their inception to April 4, 2022. All articles addressing arthroscopy in TTC nailing were eligible for inclusion. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics are presented. Result: A total of 5 studies with 65 patients were included for analysis. All studies used arthroscopic portals for tibiotalar and subtalar joint preparation (in 4 studies) prior to TTC nailing, with 4 studies using an arthroscope and 1 study using fluoroscopy. The overall major complication rate was 13.8%; however, there was only 1 instance of deep wound infection (1.5%) and 4 instances of surgical site infections (6.2%). Full fusion was achieved in 86% of patients with an average time to fusion of 12.9 weeks. The mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score preoperatively was 34.0 and postoperatively was 70.5. Conclusion: Although limited by the number of studies, transportal joint preparation during TTC nail ankle fusion is associated with good rates of complications and successful fusion. Level of Evidence: Level III, systematic review of Level III-IV studies.

The Past, Present, and Future of Unilateral Biportal Endoscopy with a Technical Note on Novel Endoscopic Visualization Pedicle Screw Insertion Technique and UBE-transforaminal Lumbar Interbody Fusion Technique with Literature Review.

Introduction: Over the past two decades, unilateral biportal endoscopy (UBE) has brought a new paradigm shift in the surgical treatment of spinal disorders with its innovative technique. This study aims to review the development of the UBE technique with a technical note on the novel endoscopic visualization pedicle screw (EVPS) insertion technique and UBE-transforaminal lumbar interbody fusion technique (UBE-TLIF). Case Report: A 66-year-old female presented with severe back pain (Visual Analog Scale [VAS] 8/10) and radicular pain in both legs (left > right) (left VAS 7/10 and right VAS 7/10) for one year with an Oswestry disability index (ODI) score of 70%. Her pain aggravated when bending forward and performing daily routine activities. She also complained of severe intermittent neurological claudication at a distance of <50 m. On physical examination, power in the lower limbs was 5/5 as per the Medical Research Council grading, and deep tendon reflexes were normal. She had a known case of diabetes mellitus and hypertension and was on treatment with oral medications. Pre-operative X-ray and magnetic resonance imaging showed dynamic instability with spondylolisthesis at L4-5. We performed UBE-TLIF with the EVPS insertion technique to resolve her symptoms. The operative time was 122 min; blood loss was 40 mL. After surgery, the patient was followed up at one week, six weeks, three months, six months, 12 months, and two years. The pain and tingling sensation in the legs improved at the 1-week follow-up, with a VAS score of 0/10 and an ODI score of 10% at the 2-year follow-up. Patient satisfaction was surveyed using Macnab's criteria at the final follow-up visit of 2 years and was found to be excellent. Post-operative imaging showed a good reduction and canal decompression at L4-5. Conclusion: The novel EVPS insertion technique and UBE-TLIF have the advantages of minimally invasive spine surgery; they are a safe and effective treatment option for treating lumbar spine pathologies.

Endoscopic Plantar Fascia Release Combined With Calcaneal Spur Resection: A Case Series of 40 Patients.

PURPOSE: To review the cases of patients treated using endoscopic plantar fascia release (PFR) with calcaneal spur resection (CSR) and examine why the combined procedures cause complications. METHODS: The medical records of patients treated with endoscopic PFR with CSR from November 2017 to December 2019 with a follow-up of >2 years were reviewed. RESULTS: A total of 40 feet in 40 patients (22 females, 18 males) were enrolled. The mean age and body mass index were 51.1 years and 24.7 kg/m2, respectively. The mean follow-up duration was 5.7 years. The visual analog scale for pain improved from 80.7 to 8.8 mm, and the Japanese Society for Surgery of the Foot score improved from 44.7 to 95.6 points (Wilcoxon signed rank test, P < .001 for both). Complications occurred in 8 patients (20%): 3 had flatfoot, 3 had an injury to the first branch of the lateral plantar nerve, 1 had scar pain, and 1 had a wound infection. CONCLUSION: The 40 patients treated with endoscopic PFR with CSR for plantar fasciitis had good outcomes with a high complication rate; the invasiveness of creating the working space for the combined procedures was thought to be responsible. LEVELS OF EVIDENCE: Level IV: Case series.

Efficacy of Spirulina 500 mg vs Triamcinolone Acetonide 0.1% for the Treatment of Oral Lichen Planus: A Randomized Clinical Trial.

AIM: The present study aimed at evaluating the efficacy of spirulina 500 mg in reducing the burning sensation and lesion size in oral lichen planus (OLP). MATERIALS AND METHODS: A total of 60 subjects who attended the oral medicine specialty clinic with histopathologically confirmed OLP and having symptoms of burning sensation were recruited for the study. They were randomly divided into two groups: group A (30) subjects were prescribed Spirulina 500 mg twice daily along with only a week application of topical triamcinolone acetonide 0.1% thrice daily; group B subjects were prescribed topical triamcinolone acetonide 0.1% alone thrice daily for 8 weeks. Both the groups were followed up posttreatment monthly for three consecutive months. RESULTS: Data were recorded, and statistical analysis by using ANOVA one-way test, and Chi-square test were performed, which showed statistically significant p-value (<0.005) for the parameters "burning sensation" and "size of the lesion". When compared between groups, group A showed a favorable outcome of the intervention. CONCLUSION: Spirulina 500 mg supplementation twice daily could be effective adjunct therapy with steroids to treat OLP. CLINICAL SIGNIFICANCE: This research allowed us to delve into spirulina as one of the treatment modalities for OLP. Further studies are needed as it is a rich source of proteins and vitamins and demonstrates potent anti-inflammatory, immunomodulatory, and antioxidant actions.

Fluoroscopic and Endoscopic Calcaneal Spur Resection Without Plantar Fascial Release for Recalcitrant Plantar Fasciitis.

Background: Studies on endoscopic calcaneal spur resection (CSR) without plantar fascial release (PFR) are limited. This study aimed to review the data of patients who underwent fluoroscopic and endoscopic CSR without PFR for plantar fasciitis with a calcaneal spur to assess the effectiveness of CSR. Methods: Medical records of consecutive patients with plantar fasciitis with ≥2 mm calcaneal spur who underwent endoscopic CSR without PFR from November 2017 to December 2019 were reviewed. Patients with ≥2 years of follow-up were included, whereas those who underwent another surgery on the operated foot were excluded. Age, body mass index (BMI), follow-up duration, calcaneal spur length, duration to full weightbearing postoperatively, Japanese Society for Surgery of the Foot (JSSF) score, visual analog scale (VAS) score for pain, and complications were assessed. Results: The mean follow-up duration was 2.7 years. A total of 47 patients (31 female, 16 male; mean age, 56.4 years; mean BMI, 25.5) were included. The mean calcaneal spur length was 5.7 mm. The VAS score improved from 79.6 ± 12.9 mm preoperatively to 5.3 ± 7.3 mm postoperatively. The JSSF score improved from 54.0 ± 19.1 points preoperatively to 97.5 ± 5.7 points postoperatively (Wilcoxon signed-rank test, P < .001, respectively). The mean duration to full weightbearing postoperatively was 4.4 ± 4.2 days. Two patients presented with tenderness, and one presented with hypesthesia at the portal site. Conclusion: Endoscopic CSR without PFR resulted in good outcomes, early return to full weightbearing, and few complications in patients with plantar fasciitis with ≥2 mm calcaneal spur. The results suggested that CSR was sufficient to relieve symtoms and improve function. PFR may not be necessary for treating plantar fasciitis with calcaneal spur. Level of Evidence: Level IV, retrospective case series.

Assessment of Pain During Nerve Conduction Studies in Patients With Carpal Tunnel Syndrome.

Purpose: Patients with suspected carpal tunnel syndrome (CTS) often undergo nerve conduction studies (NCSs). Although patients sometimes complain of NCS-related discomfort, including severe pain, pain evaluations during such NCSs are lacking. We aimed to measure the pain experienced by patients with CTS during NCSs. Methods: This prospective study included 30 patients with CTS who underwent NCSs between April 2018 and March 2019. Pain because of electrical stimulation during NCSs was evaluated using a visual analog scale, and we statistically analyzed pain-related factors such as age, sex, complications, severity grading scale, the intensity of maximum stimulation, and examination time. Results: The mean visual analog scale score for NCSs was 5.2, and the visual analog scale score increased as the intensity of maximum stimulation and examination time increased. Conclusions: We measured the pain because of electrical stimulation experienced by patients with CTS during NCSs. Our findings indicate that medical staff must be mindful of the potential pain experienced by patients during NCSs and educate patients regarding the necessity of the examination and its procedures. Type of study/level of evidence: Diagnostic Ⅳ.

Ultrasonographic Evaluation of Osteoarthritis-affected Knee Joints: Comparison with Kellgren-Lawrence Grading and Pain Scores.

BACKGROUND: The objective was to compare ultrasonographic findings with clinical and radiographic findings in osteoarthritis (OA)-affected knee joints. METHODS: This prospective study was conducted in Subharti Medical College, Meerut, after getting clearance from the ethical committee. Eighty-five symptomatic knees fulfilling American College of Rheumatology criteria for OA were included in the study. Patients with trauma, inflammatory, and infective conditions of the knee and with a history of intra-articular interventions and surgery were excluded. Demographic data, body mass index (BMI), visual analog scale (VAS), and Western Ontario and McMaster Universities Arthritis (WOMAC) questionnaire score were obtained. Kellgren-Lawrence (K-L) score was obtained on radiography. Ultrasonographic findings which were recorded include effusion, meniscal extrusion, femorotrochlear cartilage grading, maximum length of osteophytes at medial and lateral compartments, and presence or absence of Baker cyst. RESULTS: A total of 85 consecutive symptomatic knees were examined. The male: female ratio was 22:63, with a mean age of 54.52 ± 9.44 years, mean duration of disease of 24.24 ± 19.14 months, mean BMI of 28.91 ± 3.69 kg/m2, and mean score of VAS and WOMAC pain scale of 6.27 ± 1.45 and 62.45 ± 10.96, respectively. K-L grading of 1, 2, 3, and 4 was reported in 12.9%, 21.2%, 25.9%, and 40% of the knees, respectively. The mean VAS score and WOMAC score showed statistically significant correlation with KL grading (P < 0.05). Knees with the presence of osteophytes, medial meniscal extrusion, effusion, and medial femoral trochlear cartilage grading showed statistically significant correlation with VAS and WOMAC scores (P < 0.05). However, the correlation was not significant for lateral meniscus extrusion and lateral femoral trochlear cartilage grading. CONCLUSION: Our study found that K-L grading and few ultrasonographic criteria showed a significant positive correlation with pain scores, while few other ultrasonographic criteria did not. Both imaging modalities are complementary to each other, rather than one being superior to the other.

Assessment of Insertion Torque of Mini-implant and Its Correlation with Primary Stability and Pain Levels in Orthodontic Patients.

AIM: The aim of this study was to assess the insertion torque of the mini-implant used in orthodontic patients and to assess the correlation between the insertion torque, primary stability, and perception of pain in patients undergoing orthodontic therapy with mini-implant-augmented anchorage. MATERIAL AND METHODS: Among the patients undergoing orthodontic therapy, 31 samples who required mini-implant for anchorage purpose were selected. A total of 59 mini-implants were placed in these patients. This included interradicular mini-implants and extra-alveolar mini-screws. Immediately after placement, the insertion torque in all these was measured using a digital torque meter and primary stability was assessed by identifying any mobility of the implant placed. Primary stability was noted at two time intervals immediate post-placement and 1 week after that. All the mini-implants that were considered in this study were immediately loaded. Patients were asked to record any pain experienced on the visual analog scale (VAS) score sheet at 24 hours and 1 week post-placement. RESULTS: Among the mini-implants placed, those with 2 mm diameter needed higher placement torque, i.e., infrazygomatic crest mini-implants and buccal shelf mini-implants were placed with average placement torque of 10.08 and 10.25 N cm, respectively. Extra-alveolar screws caused more pain, especially higher in the mandible than the maxilla. Decrease in pain scores was noted from T0 to T1 in almost all the cases. CONCLUSION: Thicker mini-implant needed more insertion torque and highest insertion torque was recorded with extra-alveolar screws. No direct correlation could be obtained with the pain levels experienced by the patients and with the primary stability of the mini-implants. CLINICAL SIGNIFICANCE: Mini-implants placed with an insertion torque above the recommended range tend to fail and break more often. Patients placed with extra-alveolar bone screws reported more pain than that of the smaller-dimension mini-implant.

Feasibility and efficacy of modern minilaparoscopy with 2.9 mm laparoscope for diagnostic and level II gynaecological procedure.

OBJECTIVE: Laparoscopy has now become a state-of-the-art technique for many diagnostic and therapeutic procedures with known advantages over laparotomy. There is scarce literature from India regarding minilaparoscopy, as per our literature review. Therefore, we performed this study with a 2.9-mm laparoscope to determine its feasibility and efficacy for diagnostic purposes and level II surgeries with the aim of reducing postoperative pain and better cosmesis. METHODS: This was a prospective study conducted from June 2019 to March 2020. Diagnostic modern minilaparoscopy with a 2.9-mm telescope was performed under general anesthesia by a single surgeon. Operative intervention was performed depending on the intraoperative findings. RESULTS: The mean age was 29.3 years. The most common indication for laparoscopy was infertility (98%). Only diagnostic laparoscopy was performed in 76% of patients, while 24% underwent operative laparoscopy. The various operative procedures performed were cystectomy, salpingectomy, ovarian drilling, and adhesiolysis. The mean visual analog scale scores at 1 hour and 2 hours postoperatively and discharge were 1.57±0.59, 1.41±0.51, and 1.29±0.47, respectively. Mild pain was present in 70 (72.2%) patients at the time of discharge, and only one patient had severe pain. Five or more analgesic tablets were required in only 16.5% of patients in the postoperative period. There was no wound infection or port-site hernia at follow-up. CONCLUSION: Modern minilaparoscopy with a 2.9-mm laparoscope is a feasible and safe option for diagnostic laparoscopy and level II gynecological procedures with minimal postoperative morbidity, such as pain and wound infection, and provides good cosmetic outcomes.

The Clinical Effect of Digital Dorsal Fascial Island Flap Combined With Crossfinger Flap for Repairing Distal Degloving Injury and Sensory Reconstruction.

BACKGROUND: To explore the clinical effect of digital dorsal fascial island flap combined with crossfinger flap to repair distal degloving injury and sensory reconstruction. METHODS: A total of 19 patients with distal fingertip degloving injuries treated with digital dorsal fascial island flap combined with crossfinger flap in our hospital from April 2018 to August 2020 were retrospectively included. Semmes-Weinstein (SW) monofilament and static two-point discrimination (S-2PD) tests, active range-of-motion (ROM) of the fingers, cold intolerance, visual analog scale (VAS) score patient complications, and patient satisfaction were evaluated. RESULTS: Five cases with post-operative flap blisters were treated at the time of dressing changes until successful scab formation. Three cases with post-operative arterial crisis of finger arterial dorsal branch vessel were relieved after suture removal and tension reduction. All other skin flaps and skin grafts survived. Nineteen patients received follow-up between 3 and 26 months (average 14.6 months). The active ROM of metacarpophalangeal (MCP) and interphalangeal (IP) joints of the injured fingers were satisfactory. CONCLUSION: The digital dorsal fascial island flap combined with the crossfinger flap for repairing the distal degloving injury of the distal segment of the finger is a good surgical method, which is simple and easy to operate, can repair a large area of soft tissue defect, and obtain a satisfactory effect.

Effectiveness of Misoprostol in Office Hysteroscopy in Premenopausal Nulliparous Women: A Prospective Randomized Double-Blind Placebo-Controlled Trial.

STUDY OBJECTIVE: The objective of this was to evaluate the effectiveness of misoprostol in premenopausal nulliparous women with 200-mcg single vaginal dose 4 h before the procedure. DESIGN: This was a prospective randomized double-blind placebo-controlled trial. SETTING: This study was conducted in a tertiary care and academic research center. PATIENTS: One hundred patients were included in the study: 50 in misoprostol group and 50 in placebo. INTERVENTIONS: Patients underwent office hysteroscopy 4 h after vaginal application of misoprostol or placebo. MEASUREMENTS AND MAIN RESULTS: Ease of doing hysteroscopy was significantly better in the misoprostol group (difficulty score: 2.74 ± 1.20) as compared to placebo (difficulty score: 4.20 ± 1.10), P = 0.001. The time taken for negotiating the internal os (cervical passage time) was found to be significantly shorter in the misoprostol group (6.20 ± 5.21 s) as compared to placebo (14.78 ± 11.84 s), P = 0.001. The overall Visual Analog Scale (VAS) score was significantly lower in the intervention group (2.64 ± 1.62) as compared to placebo (4.90 ± 1.90), P = 0.001. Moreover, the VAS score at the point of passing internal os was significantly lower in the misoprostol group (2.82 ± 1.39) as compared to placebo (4.94 ± 1.96), P = 0.001. Misoprostol had a significant positive effect on satisfaction level of patients; 76% (n = 38) of women in the misoprostol group expressed their willingness to undergo the procedure again if required versus 18% (n = 9) in placebo, P = 0.001. Furthermore, 78% (n = 39) of women in the misoprostol group would recommend the procedure to their friends and relatives versus 36% (n = 18) in placebo, P = 0.001. CONCLUSION: Preoperative cervical preparation with 200 mcg of misoprostol vaginal application 4 h before office hysteroscopy in premenopausal nulliparous women significantly reduces the difficulty encountered in negotiating the cervical canal. Further, it significantly reduces the pain experienced by the patient at the point of passage through internal os as well as throughout the entire procedure.

Relation between uterine morphology and severity of primary dysmenorrhea.

OBJECTIVE: This study aimed to evaluate whether uterine dimensions including uterine volume, uterine shape, uterine length, cervix length, and cervix thickness measurements have a role in the severity of primary dysmenorrhea in virgin girls. MATERIALS AND METHODS: Enrollment included 90 virgin girls suffering from primary dysmenorrhea. The girls were divided into three groups according to the severity of dysmenorrhea, which was determined by the visual analog scale (VAS). Patients with VAS scores of 8-10 comprised the severe primary dysmenorrhea group (n=30), 4-7 the moderate primary dysmenorrhea group (n=30), and 1-3 the mild primary dysmenorrhea group (n=30). Uterine characteristics including uterine volume, uterine shape, uterine length, cervix length, and cervix thickness were measured by a high-resolution four-dimensional ultrasound device with real-time capacity. They were recorded to determine if they can be predictors of dysmenorrhea severity. RESULTS: Girls with severe primary dysmenorrhea were more likely to complain of midline pain as opposed to mild and moderate cases with lateral or diffuse pain. None of the uterine characteristics on ultrasonography examination were significant for predicting the severity of primary dysmenorrhea. There were no significant positive correlations between the dysmenorrhea severity and uterine corpus length, cervix length, and uterine volume degree. Any combination of the measured uterine features was not predictive for determining the severity of dysmenorrhea. CONCLUSION: Ultrasonographic measurements of uterine dimensions in virgins have low accuracy for predicting the severity of pain in primary dysmenorrhea.

Effect of Celiac Plexus Neurolysis for Pain Relief in Patients with Upper Abdominal Malignancy: A Retrospective Observational Study and Review of Literature.

BACKGROUND: Abdominal pain from primary cancer or metastatic disease is a significant cause of pain for patients undergoing treatment for the disease. Patient's pain may be resistant or non-responsive to the pharmacological management, hence minimal invasive pain intervention like celiac plexus neurolysis or splanchnic nerve rhizolysis may be required to relieve pain of such patients. OBJECTIVE: The aim of this retrospective study is to assess the effect of celiac plexus neurolysis for pain relief in patients with upper gastro-intestinal malignancies. STUDY DESIGN: This is a retrospective, observational study with short review. METHODS: This retrospective observational study was done in the Pain Medicine unit from 2016 and November 2018. Ninety-four patients with upper abdominal malignancy and unrelenting pain, non-responsive or poorly responsive to pharmacological treatment as per WHO ladder of analgesics, received fluoroscopy-guided celiac plexus neurolysis (CPN). All the patients underwent celiac plexus neurolysis through Trans-Aortic approach and the primary outcome measure was pain as assessed with Visual Analogue Scale (VAS) ranging from 0 to 10; the secondary outcome measures were morphine consumption per day (M), quality of life (QOL) as assessed by comparing the percent of positive responses and complications, if any. These were noted and analyzed prior to intervention and then on day 1, and months 1, 2, 3, 4, 5, 6 following CPN. RESULTS: Follow up was completed 6 months after the procedure. VAS score, daily morphine consumption, and the quality of life showed improvement for the duration of the study. There was some relapse in pain and deterioration in QOL during the fourth to sixth month of pain intervention due to disease progression. Some transient known side effects also occurred. CONCLUSION: Trans-Aortic celiac plexus neurolysis with low volume of alcohol is a safe procedure providing up to 6 months of pain relief and is an effective, well established, minimally invasive procedure for abdominal pain due to primary malignancy or metastatic spread.

Evaluation of Efficacy of Curcumin along with Lycopene and Piperine in the Management of Oral Submucous Fibrosis.

CONTEXT: Oral submucous fibrosis (OSMF) is a high-risk premalignant condition of the oral cavity and oropharynx. Complete regression of the disease is still not possible with available treatment modalities. AIMS: The aim of the study was to evaluate the efficacy of curcumin, lycopene, and piperine as a combination in the management of OSMF. SETTINGS AND DESIGN: Efficacy was evaluated on the basis of improvement in clinical parameters (i.e., visual Analog Scale [VAS]) score for burning sensation, mouth opening (MO), mucosal flexibility (MF), and tongue protrusion [TP]). MATERIALS AND METHODS: Forty patients clinically and histopathologically diagnosed with OSMF were included in the study; patients were administered with the above-stated drug combination, and clinical parameters were evaluated at regular intervals to compare the pre- and post-treatment measurements. STATISTICAL ANALYSIS USED: Paired t-test was done to evaluate significance of the results. RESULTS: Highly significant improvement was observed for posttreatment reduction in VAS score for burning sensation and increase in MO (P < 0.001). Significant improvement was also observed in the increase of MF and TP. Posttreatment histopathological evaluation also revealed reepithelialization, indicated by significant increase in the epithelial thickness as found through quantitative image analysis. Immunohistochemical studies with Col1A1 showed decrease in collagen deposition. CONCLUSIONS: Taken together, the present study proposes the usage of combination drug therapy for the management of OSMF as an effective and affordable way.

Cluster Analysis of Chronic Rhinosinusitis Suggests Gender-Based Differences.

PURPOSE: We aimed to evaluate the interaction between the overall severity of chronic rhinosinusitis (CRS) before treatment and subjective improvement following surgical or medical treatment. PROCEDURES: A group of 97 patients with CRS completed the visual analog scale (VAS) symptom score and the Sino-Nasal Outcome Test 22 (SNOT-22) questionnaire in the moment of their sinus computerized tomography (CT) scan. Data were analyzed via a 2-step cluster analysis based on gender, polyp presence, CT scan, and VAS scores for symptoms. RESULTS: There were 3 clusters: the first cluster comprised 37 female patients with CRS without nasal polyps (CRSsNP), the second cluster comprised 30 patients with CRS and NP (CRSwNP; 15 males and 15 females); and third cluster had 30 male patients with CRS without NP (CRSsNP). Different symptom patterns between clusters were identified. After adjustment for polyp presence, gender, eosinophilia (p = 0.021), and the SNOT-22 score (p = 0.005) were found to be better outcome predictors than the CT score (p = 0.26). CONCLUSION: Long-term patient satisfaction is significantly associated with the subjective symptom severity prior to treatment, i.e., postnasal drip and overall disease severity (SNOT-22 score), but not with the objective severity of the disease (CT score and inflammation).

Gamma Knife Radiosurgery in Recurrent Trigeminal Neuralgia after Other Procedures / 고신대학교의과대학학술지

OBJECTIVES: Trigeminal neuralgia (TN) is undurable paroxysmal pain in the distribution of the fifth cranial nerve. Invasive treatment modalities for TN include microvascular decompression (MVD) and percutaneous procedures, such as, radiofrequency rhizotomy (RFR). Gamma Knife radiosurgery (GKRS) is a considerable option for patients with pain recurrence after an initial procedure. This study was undertaken to analyze the effects of gamma knife radiosurgery in recurrent TN after other procedures. METHODS: Eleven recurrent TN patients after other procedures underwent GKRS in our hospital from September 2004 to August 2016. Seven patients had previously undergone MVD alone, two underwent MVD with partial sensory rhizotomy (PSR), and two underwent RFR. Mean patient age was 60.5 years. We retrospectively analyzed patient's characteristics, clinical results, sites, and divisions of pain. Outcomes were evaluated using the Visual Analog Scales (VAS) score. RESULTS: Right sides were more prevalent than left sides (7:4). The most common distribution of pain was V1 + V2 division (n = 5) following V2 + V3 (n = 3), V2 (n = 2), and V1 + V2 + V3 (n = 1) division. Median GKRS dose was 80 Gy and the mean interval between the prior treatment and GKRS was 74.45 months. The final outcomes of subsequent GKRS were satisfactory in most cases, and at 12 months postoperatively ten patients (90.0%) had a VAS score of ≤ 3. CONCLUSIONS: In this study, the clinical result of GKRS was satisfactory. Invasive procedures, such as, MVD, RFR are initially effective in TN patients, but GKRS provides a safe and satisfactory treatment modality for those who recurred after prior invasive treatments.