Visual Analog Scale Scores Scores Research Articles

Comparison of efficacy between unilateral biportal endoscopic lumbar fusion versus minimally invasive transforaminal lumbar fusion in the treatment of lumbar degenerative diseases: A systematic review and meta-analysis.

To evaluate the clinical efficacy and prognosis of unilateral biportal endoscopic lumbar fusion (ULIF) and minimally invasive transforaminal lumbar fusion (MIS-TLIF) for lumbar degenerative diseases. Chinese and English databases were retrieved for the period from database creation to December 31, 2022. Case-control studies on unilateral biportal endoscopic lumbar fusion were collected. The observation indexes consisted of operation times, intraoperative blood loss, postoperative drainage volume, length of hospital stay, postoperative pain score, postoperative oswestry disability index score, postoperative MacNab excellent and good rate, imaging fusion rate at the last follow-up, and complications. The NO rating table was employed to assess the quality of the included literature, and a meta-analysis was conducted using Revman5.4.1 and Stata17. Ten studies with 738 surgical patients were considered, including 347 patients in the ULIF group and 391 in the MIS-TLIF group. This Meta-analysis demonstrated statistically significant differences in mean operation duration, intraoperative blood loss, postoperative drainage volume, length of hospital stay, and early postoperative (1-2W) visual analogue scale/score (VAS) scores for back pain. No significant differences were observed in the final follow-up postoperative VAS scores for back pain, postoperative leg VAS score, postoperative oswestry disability index score, excellent and good rate of postoperative modified MacNab, imaging fusion rate, and complications. Compared with the MIS-TLIF group, the ULIF group had longer operation time, lower intraoperative blood loss and postoperative drainage volume, lower lumbar VAS score in the early postoperative period, and shorter hospital stay. ULIF is less invasive than traditional MIS-TLIF, making it a trustworthy surgical option for lumbar degenerative diseases with comparable fusion efficiency, superior MacNab rate, and complication rate.

Midterm Outcomes of Endoscopic Plantar Fascia Debridement in 125 Patients: A 5-Year Follow-Up

Plantar fasciitis is one of the most common pathologies addressed by foot and ankle surgeons. Despite advances and overall success rates for conservative therapy, many of the recalcitrant cases proceed to require surgical correction. Partial to complete release of the fascia is often performed altering foot biomechanics and severing the windlass mechanism. Endoscopic debridement of the plantar fascia allows for direct visualization and removal of the inflammatory tissue while leaving the fascia and its function intact. A total of 125 feet were evaluated with a minimum follow-up time of 5 years. Gender, body mass index, and duration of symptoms were all evaluated and documented. Visual analog scale scores (VAS), American Orthopedic Foot and Ankle Score (AOFAS), and Foot Function Index (FFI) were collected both pre- and postoperatively. AOFAS, FFI, and VAS scores improved from a pre-operative mean of 57.6, 89.4%, and 8.6-89.1, 13.4%, and 0.7 respectively (p < .05) at final follow-up. Of the 125 patients, 98% stated they were satisfied with the operative outcome and would undergo the procedure again. At final follow-up, no patient suffered rupture of the fascia or recurrence. Patients were able to bear weight immediately following the surgery in a walking boot and on average patients were able to return to work at 3.4 days following surgery. This is a novel technique that does not compromise the plantar fascia or alter foot biomechanics with promising 5-year outcomes.

Comparative Study of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Treating Cauda Equina Syndrome

Objective: The purpose of this study is to evaluate the clinical outcome of cauda equina syndrome (CES) using percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM).Methods: Fifteen patients with CES either underwent PELD or OLM from January 2017 to December 2019. The patients were divided into 2 groups according to the surgical methods: the PELD group (with 7 patients, 5 males and 2 females) and the OLM group (with 8 patients, 6 males and 2 females). The clinical outcomes were evaluated by the Visual Analogue Scale score (VAS), motor grade of lower extremities, perineal sensation, anal tone, and bladder dysfunction. Results: Both groups reported a significant postoperative reduction of VAS score for back and leg pain. When comparing the two groups, there was no significant difference in the improvement of leg pain. However, the improvement in back pain was significantly higher in the PELD group than in the OLM group (p=0.05). In the PELD and OLM groups, all 15 patients showed an improvement in preoperative CES symptoms including impaired lower limb motor power, perineal sensations, anal sphincter tone and bladder function at the one-year follow-up. The operation time (p=0.01) and length of hospital stay (p=0.01) were shorter in the PELD group compared with the OLM group. In the PELD group, the intraoperative bleeding was negligible whereas in the OLM group.Conclusion: The advantages of PELD, indicate it is a good alterative or option for the treatment of CES patients considering the appropriate indication.

The efficacy and safety of low-intensity extracorporeal shock wave treatment combined with or without medications in Chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta-analysis.

We performed this systematic review and meta-analysis to investigate the efficacy and safety of Li-ESWT combined with or without medications for patients with Chronic prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). A comprehensive search was conducted of PUBMED, Cochrane Library, and Web of Science databases from inception to February 2022 for randomized controlled trials (RCTs) assessing the efficacy and safety of Li-ESWT with or without the combination of medications compared with the control group. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), Visual Analogue Scale/Score (VAS), International Index of Erectile Function (IIEF), and International prostate symptom score (IPSS) were used to assess the improvements of symptoms in CP/CPPS patients. 651 patients from 12 randomized controlled studies were included in this study. The total NIH-CPSI scores, pain domain scores, and quality of life (QOL) scores were significantly lower in the Li-ESWT group than those in the control group at the termination of treatment, and 1, 4, 12, and 24 weeks after treatment. And these scores were significantly reduced in the Li-ESWT group than in baselines. In the subgroup analysis, reductions of these scores lasted longer and were greater in Li-ESWT combined with medications than in Li-ESWT alone. In the Li-ESWT group, the VAS score; IIEF score; and IPSS score were significant improvements than those in control group at the termination of treatment, and 1, 4, and 12 weeks after treatment; 4, 12, and 24 weeks after treatment; and 1, 4, and 12 weeks after treatment, respectively. Li-ESWT is a safe, non-invasive, and effective option for patients with CP/CPPS, whether combined with medications or not, should be recommended for widespread use in clinical practice.

Arthroscopic-assisted fracture reduction combined with robot-navigated nail placement to treat talar neck fractures

This study aims to explore the clinical efficacy of arthroscopic-assisted reduction combined with robot-navigated nail placement in the treatment of talar neck fractures. The clinical data of 13 patients with talar neck fracture in Xuzhou Benevolent Hospital from January 2018 to January 2021 were analyzed in the retrospective study. Among them, there were 9 males and 4 females, aged (36±12) years; there were 8 cases suffered on the right and 5 cases on the left. All patients were reset under arthroscopy and cannulated screws were placed in combination with three-dimensional navigation and positioning of orthopedic robot. The wounds and complications were observed in the postoperative follow-up. The activities of bilateral ankle dorsiflexion and plantar flexion were measured in the last follow-up. The visual analogue scale score (VAS) of pain in the affected feet before operation were compared with that at the last follow-up. The ankle and hind foot work energy scale of American Foot and Ankle Association (AOFAS) was used to assess the ankle function. The results showed that the wounds of 13 patients healed in one stage. The operation time was (95±45) min and the blood lose was (45±10) ml. All the patients were followed-up for (15.0±3.5) months. Two cases developed subtalar arthritis without talus necrosis and fracture nonunion. At the last follow-up, there was no significant difference in the dorsal extension and plantar flexion of the ankle between the affected side and the healthy side (25.8°±1.9° vs 26.2°±2.3°, 44.2°±2.7° vs 44.7°±2.8°, both P>0.05). The VAS score of pain in the affected foot at the last follow-up was 0.53±0.18, it was significantly lower than that before operation (0.87±0.29) (P<0.001). The mean AOFAS ankle and hind foot energy scale of the ankle function was 93.5 at the last follow-up. It's showed that treatment of talus neck fracture with arthroscopy assisted and robot guided nail placement is satisfactory and is worthy of clinical promotion.

Comparative outcomes between a new robotically assisted and a manual technique for total knee arthroplasty in patients with osteoarthritis: a prospective matched comparative cohort study.

Studies comparing clinical outcomes between manual (mTKA) and robotic-assisted TKA (raTKA) are limited. This prospective comparative cohort study aimed to compare early postoperative outcomes, satisfaction, and patient-reported outcome measures (PROMS) between patients undergoing mTKA and ROSA raTKA (Zimmer Biomet, Warsaw, IN) performed by one surgeon. Thirty ROSA raTKAs and 30 mTKAs performed by one surgeon during 2020-2021 were prospectively evaluated. Groups were matched for age, sex, and body mass index. All procedures were primary unilateral TKAs using the same posterior-stabilized prosthesis (Nexgen Legacy, Zimmer Biomet, Warsaw, IN). Length of hospital stay (LOS) and blood transfusion rate were recorded. Complications, visual analogue scale score (VAS), and Oxford Knee Score (OKS) were assessed preoperatively and for six postoperative months. The Forgotten Joint Score (FJS) and patient satisfaction were evaluated 6months postoperatively. No complications and similar blood transfusion rate were recorded between groups (p = 0.228). The LOS was non-significantly shorter in raTKA than in the mTKA group (p = 0.120). Mean preoperative and third-month OKS and VAS scores were comparable between groups. However, the mean 6-month OKS (p = 0.006) and VAS score (p = 0.025) were significantly better for the raTKA group. The 6-month FJS was significantly greater for raTKA than the mTKA group (p< 0.001). One patient was unhappy in raTKA, and three in the mTKA group (p = 0.301). Significantly more raTKA patients answered that they would undergo surgery again (p = 0.038). raTKA was associated with the same complication risk, less pain level, better patient satisfaction, and PROMs on 6-month follow-up than the mTKA group.

Posterior screw-rod fixation fusion for the treatment of atlantoaxial dislocation due to rheumatoid arthritis

Objective To investigate the clinical effect of posterior screw-rod fixation fusion for the treatment of atlantoaxial dislocation due to rheumatoid arthritis. Methods From January 2011 to December 2015, 15 patients with atlantoaxial dislocation due to rheumatoid arthritis were treated, including 6 males and 9 females, aged 35 to 75 years (mean 55 years). All cases were evaluated about the difficulty of relocation by extension-flexion X-ray and treated with posterior screw-rod reduction, fixation and autogenous bone grafting under general anesthesia. Atlantodental interval (ADI) was measured and collected before and after surgery. Visual Analogue Scale/Score (VAS), American Spinal Cord Injury Association (ASIA) and Japanese Orthopaedic Association (JOA) scores were comprehensively used to evaluate the clinical effect. 1 week, 3, 6, 12 months postoperatively and the annual review of the X-ray and CT were checked, in order to evaluate the reduction, internal fixation and bone graft fusion. Results All patients were reducible dislocation and successfully performed the posterior screw-rod fixation fusion surgery. The patients were followed up for 3 to 24 months (average, 15 months). Atlantoaxial solid bony fusion was obtained from 3 to 6 months. ADI reduced from preoperative 6.3±1.7 mm to postoperative 2.2±0.8 mm, VAS score reduced from preoperative 5.4±2.7 to postoperative 1.7±1.0, ASIA motor score improved from preoperative 82.3±15.6 to 95.3±4.5 at 6 months after the surgery, JOA score increased from preoperative 13.8±2.9 to 15.5±1.4 at 6 months after the surgery, and the statistical significance was revealed between preoperation and postoperation. Nine cases were in D grade of ASIA, 3 cases improved from D to E grade after surgery, 2 cases reached E grade in the other 6 cases after 6 months, 2 cases recovered to E grade after 12 months and other 2 cases in D grade got uniformity after surgery. Well internal fixation and no redislocation were found on X-ray and CT during follow-up period. Conclusion Atlantoaxial dislocation because of rheumatoid arthritis was numerously reducible genre. Posterior screwrod fixation and autogenous bone grafting can gain satisfying clinical efficacy. Key words: Cervical atlas; Axis; Dislocations; Arthritis, Rheumatoid; Spinal fusion

Factors predicting chronic pain after open mesh based inguinal hernia repair: ​A prospective cohort study

IntroductionChronic postherniorrhaphy pain is the foremost setback of today's inguinal hernia repair. Finding predictors for it affects implants, operative techniques and allows for preventive measures. MethodsProspectively collected data from 932 outpatient open inguinal hernia operations between 2003 and 2010 were subjected to regression analysis. Visual analogue scale score (VAS) at least a year after operation and a measurement of chronic pain at one year were the target variables. ResultsChronic pain was present in 99 (11.5%) patients one year after operation. Independent predictors for the occurrence of chronic pain were positively recurrence (Odds ratio, OR 6.77 vs. no recurrence, P = 0.005), complication (OR 5.16 vs. no complication, P = 0.002), mid-density mesh (OR 2.28 vs. lightweight mesh, P = 0.012), higher preoperative VAS score (OR 1.15, P = 0.006) and negatively higher age (OR 0.98, P = 0.027).Predictors for a higher postoperative VAS score were recurrence (regression coefficient, RC, 1.49 vs. no recurrence, P = 0.001), complication (RC 0.76 vs. no complication, P = 0.016), heavyweight mesh (RC 0.50 vs. lightweight mesh, P = 0.046) and higher preoperative VAS level (RC 0.10, P < 0.001). ConclusionsRecurrence, complication, mesh weight, preoperative VAS score and age are predictors for the occurrence chronic pain after open mesh based inguinal hernia repair. Recurrence, complication, mesh weight and preoperative VAS score are predictors of postherniorrhaphy VAS level.

Pain control following posterior spine fusion: patient-controlled continuous epidural catheter infusion method yields better post-operative analgesia control compared to intravenous patient controlled analgesia method. A retrospective case series.

Pain management following posterior spinal fusion surgeries is a challenging topic. Continuous epidural analgesia (CEA) technique has been invented to resolve some deleterious effects related with conventional intravenous patient-controlled analgesia (IV-PCA) method. However, studies for effectiveness and safety of CEA are scarce in adult population. Our aim was to compare effectiveness and safety of patient-controlled CEA with conventional IV-PCA method in adult patient population. Chart review of patients, scheduled for elective posterior spine fusion to treat spinal stenosis, degenerative disc disease, spondylolisthesis or spinal instability from May 2012 to March 2015, was performed. Patients with spinal infection, cancer, inflammatory disease, and ASA higher than class III, allergy to analgesic medications were excluded from the study. One hundred and nine patients were enrolled into the study. 80 out of 109 patients (40 in CEA group, 40 in IV-PCA group) were matched for age, gender, BMI, type of surgery, level of fusions. Visual Analog Scale scores (VAS) and Ramsay Sedation Scale (RSS) scores were evaluated following surgeries until post-operative 24th hour. There were 58 female patients (72.5%). The mean age of the patients was 59.85years (range 24-82years). When VAS and RSS scores were compared between the groups, there were statistically significant differences between the groups in respect of VAS scores at every time point following surgery (lower in CEA group), whereas there was no significant difference between the groups in respect of RSS scores. More additional analgesia medication was needed in IV-PCA group (16 vs. 5 patients), which was significantly higher than CEA group (p=0.029). Patient-controlled CEA method is as safe as IV-PCA method and is even more effective than that in controlling immediate post-operative pain in patients treated with posterior spinal fusion.

Effects of house dust mite sublingual immunotherapy in children with allergic rhinitis and asthma

To evaluate the efficacy of SLIT with Dermatophagoides farinae drops in children with allergic rhinitis and allergic asthma according to its different duration. The efficacy of Dermatophagoides farinae SLIT in 100 children (aged 3-14 yr) with allergic rhinitis and allergic asthma induced by house dust mites was retrospectively analyzed. All children were treated with Dermatophagoides farinae drops for 4 years and followed-up at the interval of 3 months. Total nasal symptom scores (TNSS), total rhinitis symptomatic medication scores (TRMS), daytime asthma symptom scores (DASS), nighttime asthma symptom scores (NASS), total asthma symptomatic medication scores (TAMS), visual analog scale scores (VAS) and lung function were assessed during follow-up visit. SPSS 20.0 software was used for data analysis. After 2 years' SLIT, compared with 1-year duration, besides NASS (0.00[0.00;0.00], 0.00[0.00;0.00]; Z = 1.811; P > 0.05), TNSS (2.00[1.00;2.00], 0.00[0.00;0.00]; Z = 7.021, P < 0.01), TRMS (2.00[2.00;2.00], 0.00[0.00;0.00]; Z = 8.855; P < 0.01), VAS scores (3.00[2.00;4.00], 1.00[0.00;1.00]; Z = 4.494, P < 0.01), DASS (1.00[0.00;1.00]; 0.00[0.00;0.00]; Z = 4.383, P < 0.01) and TAMS (0.00[0.00;1.00], 0.00[0.00;0.00]; Z = 8.944; P < 0.01) all showed significant improvement. After 3-year duration, compared with 2-year duration, VAS scores (1.00[0.00;1.00], 0.00[0.00;0.00]; Z = 3.645, P < 0.05) in patients were significantly decreased. Other results showed no significant difference. The comparison of efficacy between 3 and 4-year duration showed no significant difference in global clinical outcomes (all P > 0.05). Patients receiving 2 year' SLIT achieve more clinical benefits than those who receiving 1-year duration. The higher efficacy of 3-year duration compared with 2-year duration is supported by a significant improvement in VAS. Besides, the comparison between 3 and 4-year duration shows no significant difference in global clinical outcomes. Therefore, 3 years' duration is optimal in this study.

High frequency of T helper type 9 cells in Chinese patients with allergic rhinitis.

T helper type 9 cells (Th9) are the most recently discovered subset of Th cells, and are involved in the pathology of several autoimmune and allergic diseases. The significance of Th9 cells in allergic rhinitis (AR) in Chinese patients is unclear. The aim of this study was to investigate the possible role of Th9 cells in AR in Chinese patients. Th9 cells and related factors were assessed by measuring levels of interleukin-9 (IL-9), PU.1, interferon-regulatory factor 4 (IRF4), and numbers of Th9 cells. A Th9-polarized milieu was evaluated by determining the levels of IL-4 and transforming growth factor-β1 (TGF-β1). Disease severity was assessed by rhino-conjunctivitis quality of life questionnaires (RQLQ), visual analog scale scores (VAS), and peripheral eosinophils (EOS) count. Levels of IL-4 and TGF-β1 were elevated in AR groups versus healthy controls (P < 0.05). Levels of IL-9, PU.1, IRF4, and the numbers of Th9 cells were also significantly higher in the AR groups (P < 0.05). Furthermore, positive correlations were identified between IL-9 levels and EOS expression, RQLQ, and VAS scores (P < 0.01). Th9 cells and their relative factors were elevated in AR patients. Levels of Th9 polarization-related factors were much higher in AR patients, and the severity of disease was associated with a more severe Th9 response. These results suggest that AR patients present a favorable environment for Th9 differentiation, and that Th9 cells may play a crucial role in the pathology of AR in Chinese patients.

The effect of vitamin D on nonspecific low back pain

Nonspecific low back pain is known as one of the most common reasons for chronic low back pain (CLBP) that burdens healthcare systems with high costs. According to a hypothesis, CLBP has been associated with vitamin D3 deficiency, the goal of this study is to evaluate the effect of vitamin D3 administration on improvements in CLBP. This double blind randomized clinical trial included 53 patients aged between 18-40 years with nonspecific CLBP. Pain was measured using the pain visual analogue scale score (VAS), and serum 25-OH-vitamin D level was measured using an enzyme-linked immunosorbent assay kit. The patients were randomly divided into two groups based on sex and weight. Pearl of vitamin D(3) (50 000 IU) or placebo was administered orally every week for 8 weeks. Data were analyzed via SPSS 17th edition software using two-tailed paired t-test and chi-square test. There were 26 and 27 patients in drug and placebo groups respectively. Out of 53 subjects, 75.47% were female. There was no statistically significant difference in the mean age, sex, and mean weight between the two groups. The mean serum 25-OH-vitamin D level was 18.86 ± 9.24 nmol/L on the first visit. After 8 weeks of intervention, the mean serum 25-OH-vitamin D level changed from 17.88 ± 9.04 to 27.52 ± 9.04 (P = 0.043) and from 19.81 ± 9.60 to 18.91 ± 7.84 (P = 0.248) in drug and placebo groups, respectively. The mean VAS score for pain decreased from 5.42 ± 1.65 to 3.03 ± 3.14 (P = 0.001) and from 6.42 ± 1.62 to 3.11 ± 3.08 (P = 0.001) among drug and placebo groups, respectively. The mean changes in chronic pain were 2.38 ± 2.62, 95% confidence interval (CI) = 1.32-3.44 in the drug group and 3.33 ± 3.67, 95%CI = 0.61-2.55 in the placebo group. No significant statistical difference between the two groups was observed. According to our results, both vitamin D(3) and placebo treatments improved CLBP and there was no significant difference between vitamin D(3) and placebo groups.

Sa1518 Evaluation of Carbon Dioxide Insufflation During ERCP Using Visual Analogue Scale Sores; a Prospective, Single-Blind, Randomized, Controlled Trial

Evaluation of Carbon Dioxide Insufflation During ERCP Using Visual Analogue Scale Sores; a Prospective, Single-Blind, Randomized, Controlled Trial Tesshin Ban*, Yu Nojiri, Toshihiro Ohwaki, Takashi Yoshimine, Miho Aoki, Hiroyasu Iwasaki, Yasuki Hori, Satoshi Nomura, Takaaki Kanamoto, Atsunori Kusakabe, Hiroshi Kanie, Tomonori Yamada, Katsumi Hayashi, Etsuro Orito Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan Background: Recently, Some authors reported that CO2 insufflation during ERCP made the patients feel more comfortable after their procedure than air insufflation, but one author’s findings did not agree. Objective: To investigate the efficacy of CO2 insufflation during ERCP as compared with air insufflation for reducing visual analogue scale score (VAS) after procedure. Design: Single-blind, randomized, controlled trial. Setting: Single center. Patients and Methods: From August 22nd, 2011 to July 17th, 2012. One hundred candidates were included and allocated into the CO2 group or the air group equally using the randomized number table. Main outcome measure was VAS and abdominal circumference change 3 hrs after the procedure and in the next morning. The body movement requiring extra midazolam i.v. injection during the procedure was also investigated. VAS score were from 0 to 10. Midazolam 0.1mg/kg and pentazocine 10mg were i.v. injected at the beginning of the procedure. Scopolamine Butybromide or Glucagon was used simultaneously as an antispasmodic drug. Statistics: SPSS Statistics ver.19 was used. Results: The characteristics of 49 patients and 50 patients allocated to the air group and the CO2 group were analyzed. There were no significant differences in the backgrounds between the two groups. VAS 3hrs after the procedure in the air group and the CO2 group were 0.82 1.52 and 1.19 2.02 (p 0.336), respectively. VAS next in the morning in the air group and the CO2 group were 0.38 1.54 and 0.38 1.54 (p 0.458), respectively. There were no significant differences in VAS between the two groups. The Abdominal circumference changes 3 hrs after the procedure and in the next morning in the two groups were -0.25 3.29 % vs -0.70 2.84 % (p 0.487) and -1.18 % 4.00 vs -1.31 3.03 % (p 0.861), respectively. The rates of body movement requiring extra midazolam i.v. injections during the procedure were 27.7% and 38.0% (p 0.279), respectively. There were no differences between the two groups. Conclusion: Our results did not support the efficacy of carbon dioxide insufflation during ERCP for relieving abdominal pain after the procedure.

Effects of dorsal root ganglion destruction by adriamycin in patients with postherpetic neuralgia

To investigate the effects of dorsal root ganglion destruction in patients with postherpetic neuralgia (PHN). Seventy-two patients with PHN selected were randomly divided into two groups (n=36). Group A was the control group (treated by injection) and group B was the group of dorsal root ganglion destruction by adriamycin. Visual analog scale scores (VAS), SAS, SF-MPQ scores. Clinical effects and therapy safety were evaluated before therapy, one week, three and six months after therapy. Forty-four patients were available for intention-to-treat analysis. The average pain scores on the Likert scale were significantly reduced at each point in group B. Patients in group B reported clinical effectiveness at six months as excellent response, good response, improved but unsatisfactory or unchanged 16, 12 and 8.VAS scores at each time point after the operation were lower than that before operation and in group A, there was significant difference. Patients showed significant improvement in sleep scores in group B. There was significant difference at T2 in group A than T1. There was no significant difference in group A at T3, T4 after the operation than that before operation. Between group comparison: there was significant difference between group A and group B at each time point after the operation. Dorsal root ganglion destruction by adriamycin under guidance of C-arm perspective, the puncture operation was accurate without any adverse reaction or serious complications, which could effectively relieve pain of patients with postherpetic neuralgia, but the long-term effects needed further study.

The application of percutaneous lysis of epidural adhesions in patients with failed back surgery syndrome

To investigate the efficacy and the feasibility of application of percutaneous lysis of epidural adhesions in failed back surgery syndrome (FBSS) using a stiff type guide wire and 4F vascular catheter. Ninety two patients with FBSS were randomly divided into two groups, the control group (treated by injection dexamethasone only) and percutaneous lysis of epidural adhesions group. Visual analog scale scores (VAS) and therapeutic evaluation were observed in the preoperative, seven days postoperative, one month and six months postoperative. VAS scores for pain were significantly reduced in both groups at seven days. The VAS scores were in controlled group at one month, six months was significantly higher than that in epidural lysis group. However, there was no statistical difference in VAS scores of one month and six months when respectively compared to that of before operation in controlled group. Patients on epidural lysis reported clinical effectiveness rate was 50%. Patients on control was 5.26%, there was a statistical difference between two groups. Percutaneous lysis of epidural adhesions by using a stiff type guide wire and 4F vascular catheter is an effective method in the treatment of FBSS and it has a value in clinical application.

In Brief

Chronic postherniorrhaphy pain is the foremost setback of today's inguinal hernia repair. Finding predictors for it affects implants, operative techniques and allows for preventive measures.Prospectively collected data from 932 outpatient open inguinal hernia operations between 2003 and 2010 were subjected to regression analysis. Visual analogue scale score (VAS) at least a year after operation and a measurement of chronic pain at one year were the target variables.Chronic pain was present in 99 (11.5%) patients one year after operation. Independent predictors for the occurrence of chronic pain were positively recurrence (Odds ratio, OR 6.77 vs. no recurrence, P = 0.005), complication (OR 5.16 vs. no complication, P = 0.002), mid-density mesh (OR 2.28 vs. lightweight mesh, P = 0.012), higher preoperative VAS score (OR 1.15, P = 0.006) and negatively higher age (OR 0.98, P = 0.027).Predictors for a higher postoperative VAS score were recurrence (regression coefficient, RC, 1.49 vs. no recurrence, P = 0.001), complication (RC 0.76 vs. no complication, P = 0.016), heavyweight mesh (RC 0.50 vs. lightweight mesh, P = 0.046) and higher preoperative VAS level (RC 0.10, P < 0.001).Recurrence, complication, mesh weight, preoperative VAS score and age are predictors for the occurrence chronic pain after open mesh based inguinal hernia repair. Recurrence, complication, mesh weight and preoperative VAS score are predictors of postherniorrhaphy VAS level.

Paired comparison between water and nutrient drink tests in healthy volunteers

Drink tests constitute an inexpensive and non-invasive tool, which has been proposed to discriminate individuals with altered fluid intake, as dyspeptics. However, their use in everyday clinical practice is still limited as standardization still lacks. To perform a direct, paired comparison between the water and the nutrient drink test in normal volunteers. Thirty eight normal volunteers (19 males, 19 females, mean age 24.4 +/- 0.4 years) underwent drink test with water and nutrient (Nutridrink) within 7-10 days. Both tests included a loading (consumption of 100 mL/min for water and 15 mL/min for Nutridrink for the longest possible period of time) and a recuperation phase (observation after cessation of fluid intake), being separated by the maximal saturation point. During phases, satiety, fullness, discomfort, bloating, belching, nausea, pain and burning sensation (epigastric and thoracic) were recorded using a 0-100 visual analogue scale score (VAS). For the purpose of configuration, four variables were considered: time (t), VAS score (V), VAS slope (S) for a given time period, and probability of participation (Q) at a given timepoint. The loading phase lasted for 11.6 +/- 1.7 min in water (total VAS: 879 +/- 123, total VAS slope 72.6 +/- 10.9 min-1) and 93.3 +/- 18.4 min in Nutridrink test (total VAS: 1462 +/- 411, total VAS slope 15.9 +/- 3.2 min-1); P<0.001. The mean ingested volume recorded was 1155 +/- 164 mL for water and 1399 +/- 276 mL for nutrient; P = 0.076. Cessation of fluid intake was mainly attributed to fullness (76.3%) in water and satiety (69.2%) in Nutridrink test. Nausea was recorded only in Nutridrink test (15.4%). No volunteer reported substantial, persistent pain or burning sensation. The recuperation phase lasted 63.6 +/- 7.8 min in water (total VAS: 278 +/- 75, total VAS slope 3.97 +/- 0.95 min-1) and 123.2 +/- 17.5 min in Nutridrink test (total VAS: 841 +/- 126, total VAS slope 6.81 +/- 1.63 min-1); P<0.001. Concerning total VAS scores for both phases of the two tests, fullness and satiety represented a mere four fifths of the total (43% and 36%, respectively). Belching (8%), bloating (6%), nausea (4%), and discomfort (3%) followed, while pain and burning sensation represented <1% of the whole. However, intra- and intertest correlations concerning total and symptom-specific VAS scores revealed statistically significant variations underlying differences in physiology of liquid intake. A multiple regression model considering body mass index, gender and age as dependent variables, and total and symptom-specific VAS scores and slopes for both phases of the two tests as independent variables, did not reveal any primary correlation. The function linking the expected probability of participation Q and symptom-specific VAS score V with time t is approached by the formulas Q(t)=1/[1+(t/c);k] and V(t)=V0*e;(-t/c), respectively; V0 is the mean symptom-specific VAS score, c, and k are phase- and test- related constants, and e = 2.718 is the base of natural logarithms. The comparative standardization of both drink tests in normal individuals might provide a tool for clinical application, targeting the diagnosis and treatment of relevant functional disorders.

Percutaneous Femoroplasty, Ileoplasty and Sacroplasty in the Treatment of Bone Lytic Lesions in Advanced Multiple Myeloma Patients

Wide experience have been reported on vertebroplasty in multiple myeloma patients. Much less experience is available for the treatment of osteolytic lesions in other critical sites. The aim of this report is to evaluate feasibility, safety and efficacy of transcutaneous femoroplasty, ileoplasty and sacroplasty in advanced multiple myeloma patients with severe osteolytic lesions. From November 2004 to May 2008 8 consecutive advanced myeloma patients (3 males and 5 females, median age 75 years, range 50–78) with pelvis and femora bone lytic lesions entered the study. They received percutaneous bone-cement injection with a solution of 8 to 22 polymethylmethacrylate (PMMA) into supracetabular (4 cases), sacral (2 cases) and femoral bone cavities (2 cases). Lesion approach was performed by 10 g bone biopsy needle under Computed Tomography (CT) and fluoroscopic guidance. In two cases, characterized by large extraosseous lesions, tumour termoablation with radiofrequency was done before PMMA injection. Procedures were performed under local anaesthesia, conscious sedation and antibiotic profilaxis with intravenous ceftriaxone in all patients. Immediate complications were studied with post procedure CT control. Efficacy was evaluated in term of pain relief and mobility recovery. Pain and mobility were assessed by visual analogue scale score (VAS) system (grading 0–10) and functional mobility score system (grading 1–4) respectively (according with “CT-guided percutaneous vertebroplasty: personal experience in the treatment of osteoporotic fractures and dorsolumbar metastases” Radiol med (2008) 113:114–133). Evaluation was performed before and at determined time points after the procedure (at 24 hours, one week, one month and every 3 months). Technical success was achieved in all patients. No complication was recorded. Before the osteoplasty pain assessment by VAS score showed a median value of 6 (range 4–8) and all patients were on analgesic therapy with oppioids and NSAIDs before the procedure. The VAS score decreased to median value 0 (range 0–1.5) within 24 hours after the procedure. The score remained unmodified during the rest of follow-up (median 17.5 months range 2–43). Seven patients were pain free (VAS score 0). Persistence of mild pain was documented in a single patient (score 1,5). Functional mobility score before osteoplasty was 4 in all patients (all were unable to autonomous deambulation). Score became 1 in all (autonomous mobility) within one week after procedure and remained stable during the follow up. Percutaneous osteoplasty is a feasible and safe procedure in patients affected by multiple myeloma with pelvis and femora osteolytic painful lesions. The methylmetacrylate injection is a minimally invasive procedure providing immediate improvement of quality of life. This intervention can contribute to treatment of the multiple myeloma in association with conventional therapy.

Propofol-ketamine versus propofol-fentanyl for outpatient laparoscopy : Comparison of postoperative nausea, emesis, analgesia, and recovery

Study objective To compare postoperative nausea, emesis, analgesia, and recovery between propofol-ketamine and propofol-fentanyl in outpatient laparoscopic tubal ligations with general anesthesia. Study design Prospective, randomized, blinded study. Setting Tertiary-care women’s hospital. Patients 120 ASA physical status I and II ambulatory patients scheduled for elective laparoscopic tubal ligation. Interventions Patients were randomized to two groups to receive either ketamine (1-1.5 mg/kg) or fentanyl (3-5 μg/kg). Measurements Measured variables included total dose of ketamine, fentanyl, propofol, and operating time. Vital signs, pain visual analog scale scores (VAS), nausea VAS, presence of emesis, treatment for nausea and vomiting, pruritus, sedation, and presence of dreaming were recorded on postanesthesia care unit (PACU) admission, PACU discharge, stepdown unit admission, and hospital discharge. Results are expressed as means ± SD or medians and analyzed using t -test, Chi-square, or Mann-Whitney (p < 0.05). Main results No differences were noted with respect to propofol dose, operating times, pain or nausea VAS scores, emesis, treatment for nausea and vomiting, pruritus, and sedation on PACU admission, PACU discharge, stepdown unit admission, and hospital discharge. The ketamine group had a higher heart rate, required more pain medication, and had a higher frequency of dreaming on PACU admission than the fentanyl group. These differences became insignificant on PACU discharge. Conclusions For outpatient laparoscopic tubal ligations with general anesthesia, propofol-ketamine does not improve postoperative nausea, emesis, analgesia or recovery compared with the propofol-fentanyl combination.