Visual Analog Scale Score Mean Research Articles

Comparison of two methods of greater occipital nerve block in patients with chronic migraine: ultrasound-guided and landmark-based techniques

BackgroundMigraine is a primary headache defined as moderate-to-severe pain lasting 4 to 72 h, ranking 2nd among the disabling conditions for both genders regardless of the age and the greater occipital nerve (GON) block has been reported as an efficient treatment method for migraine. The present study aims to evaluate and compare the efficiency of the two methods of GON block, i.e., the ultrasound (US)-guided technique and the landmark-based technique.MethodHaving a prospective and randomized design, the study assigned the patients with chronic migraine into two groups after which a neurologist performed landmark-based GON block in the first group while an algologist performed US-guided GON block in the second group. During the 3-month follow-up period, the number of days with pain, the duration of pain, the number of analgesic drugs taken in a month, and Visual Analogue Scale (VAS) scores were compared with the values ​​before treatment and at the 1st week, 1st month, and 3rd month after treatment.ResultsUS-guided GON block group included 34 patients while there were 32 patients in the landmark-based GON block group. US-guided GON block group showed significantly reduced VAS scores and frequency of attacks compared to the landmark-based GON block group at Month 1 after the procedure. After a 3-month follow-up period of the two groups, the frequency of attacks, analgesic intake and the duration of attacks were lower in both groups compared to the baseline. At 3-month follow-up, the mean of VAS scores decreased from 9,47 ± 2,69 to 4,67 ± 1,9 in US-guided GON block group and from 9,46 ± 0,98 to 7 ± 2,5 in the landmark-based GON block group.ConclusionIt was determined that both US-guided and landmark-based GON block were efficient techniques in patients with chronic migraine. US-guided GON block technique resulted in lower VAS scores, shorter durations of pain, lower frequencies of attack, and lower intake of analgesics compared to the landmark-based GON block technique.

Delta Wiring Technique to Treat Bony Mallet Finger: No Need of Transfixation Pin.

Extension-block pinning is a popular surgical treatment method for mallet fractures but is associated with several pitfalls. Transfixation Kirschner wires used in the extension-block pinning technique may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine the result of the delta wiring technique in mallet fractures with fracture fragment involving more than one-third of the distal phalanx articular surface. The authors are reporting 5 cases of mallet fractures treated with delta wiring technique with good functional and radiologic outcomes. Radiologic outcomes were evaluated on the basis of postoperative and follow-up x-rays and functional outcomes were evaluated using Crawford's criteria. Five patients (4 males, 1 female) with a mean age of 26.8 years (range, 20 to 33 y) were included. The mean time between the injury and surgery was 5 days (range, 3 to 7 d), and the mean follow-up period was 8.6 months (range, 8 to 10 mo). Radiographic bone union was achieved in all patients within an average of 6.4 weeks (range, 6 to 7 wk). At the final follow-up, the distal interphalangeal joint had an average degree of flexion of 73 degrees (range, 70 to 75 degrees) and an average extension deficit of 5.40 (range, 0 to 8 degrees). According to Crawford's criteria, 1 patient had excellent results and 4 patients had good results. No patient reported pain at the final follow-up with a visual analog scale score mean of 0.6 (range, 0 to 2). Satisfactory clinical and radiologic outcomes were obtained with the delta wiring technique. Future prospective and randomized studies are justified to confirm the efficacy of this technique.

Surgical strategies for cervical spine fracture combined with ankylosing spondylitis and cervicothoracic junction kyphosis

Objective To discuss the operative strategies for cervical spine fracture combined with ankylosing spondylitis and the deformity of cervicothoracic kyphosis. Methods Retrospectively analyzed 21 cases of cervical spine fracture combined with ankylosing spondylitis and the deformity of cervicothoracic kyphosis, who underwent surgeries from January, 2007 to August, 2014. Twenty males and 1 female were included. Mean age was (48.6±7.5) years (range, 36-65 years). The preoperative American Spine Injury Association (ASIA) classification distribution: 2 cases of Grade A, 6 cases of Grade B, 7 cases of Grade C, 5 cases of Grade D, and 1 case of of Grade E. The investigative surgical methods including posterior cervical open reduction, internal fixation and bone graft fusion; posterior cervical open reduction/decompression, internal fixation and bone graft fusion; or combined posterior and anterior cervical decompression, bone graft fusion and instrumentation. The operative time and blood loss were recorded, the clinical therapeutic effect was evaluated by visual analogue scale (VAS) score, ASIA grade improvement, cervical curvature (the angle between a line drawn parallel to the inferior endplate of C2 and a line drawn parallel to the inferior endplate of C7 in the lateral plane of an X-ray image) and radiological assessment (including bone graft fusion condition and internal fixation position). Results One case died from severe pulmonary infection and respiratory failure at the 45th day after operation. All the other 20 patients obtained complete follow-up with a mean time of (39.4±8.76) months (range, 25-59 months). 7 cases received posterior cervical open reduction, internal fixation and bone graft fusion, average operative time was (92.1±5.4) minutes and average blood loss was (96.1+23.7) ml. 9 cases received the posterior cervical open reduction and decompression, internal fixation and bone graft fusion, mean operation time was (121.4±14.0) minutes and blood loss was (250.0±38.9) ml. 3 cases experienced combined posterior and anterior cervical decompression, bone graft fusion and fixation, average operative time was (222.4±14.9) minutes and average blood loss was (354.3+46.7) ml. Mean of VAS scores at the 3th month postoperatively was 2.76±0.46, significantly lower than the preoperatively VAS scores (8.95±0.36). Mean of VAS scores at the 24th month postoperatively was 1.77±0.39, significantly lower than those at the 3th month postoperatively. The neurological function of spinal cord achieved significant improvement after operations and continued recovered gradually in the subsequent follow up. ASIA Classification distribution at the 24th month postoperatively was: 0 case of Grade A, 0 case of Grade B, 3 cases of Grade C, 8 cases of Grade D, 9 case of Grade E. Mean of the cervical curvature after operation was -7.1°±1.9°, significantly higher than preoperatively(-13.4°±3.3°) and did not have any loss of Cobb's angles at 24th month after operation. All the surviving cases achieved solid bone graft fusion. Mean bone graft fusion time was 5.8 months (range, 4-9 months). There was no internal fixation loose, fracture and dislocation occurred during follow up. Conclusion All procedures can significantly relieve the painful symptoms, effectively restore the normal cervical alignment and stability, and remarkably improve the neural function of the patients suffering cervical spine fracture combined with ankylosing spondylitis and the deformity of cervicothoracic junction kyphosis. Key words: Spondylitis, ankylosing; Cervical vertebrae; Spinal fractures; Thoracic vertebrae; Kyphosis

Quality of life of old people living in the community

We have reported an annual improvement in self-care independence of old people living in a rural Japanese town, Kahoku, from 1991 to 1995. 1 Matsubayashi K Okumiya K Wada T Osaki Y Doi Y Ozawa T Secular improvement in self-care independence of old people living in community in Kahoku, Japan. Lancet. 1996; 347: 60 Summary Full Text PDF PubMed Scopus (54) Google Scholar The proportion of the independent elderly aged 65 years or more in this community increased from 1991 to 1997. However, not only independence in activities of daily living (ADL) but also subjective quality of live (QOL) of the elderly themselves is important. To address the annual trend in subjective QOL of the community-living elderly, since 1992 we have conducted each year an assessment of QOL, especially subjective healthiness and life satisfaction, with validated self-reported visual analogue scale (VAS). 2 Morrison DP The Crichton Visual Analogue Scale for the assessment of behaviour in the elderly. Acta Psychiatr Scand. 1983; 68: 408-413 Crossref PubMed Scopus (47) Google Scholar The VAS questionnaire ended with a summing-up graph in the form of a 100 mm bar, graded with subjectively worst condition on the left and best one on the right. The subject was asked to mark on 100 mm bar how his condition was. We defined the distance (mm) from the left to the marked position as the score of VAS (0–100), with high scores indicating high QOL. We investigated the annual trend in the mean of VAS scores of subjective healthiness and life satisfaction as well as independent rate in ADL of community-living elderly people from 1992 to 1997. The numbers interviewed in 1992-97 were 1578, 1618, 1643, 1710, 1770, and 1873, these numbers being, respectively, 90%, 91%, 91%, 92%, 90%, and 91% of Kahoku residents aged 65 years or more.