Intraarticular STP Radiofrequency for Painful Osteoarthritis in the Knee: A Retrospective Single Center Analysis

OBJECTIVE

Osteoarthritis (OA) is the most common cause of chronic knee pain, often a debilitating condition that can cause a significant reduction in functional capacity. Radiofrequency is a form of neuromodulation that modulates pain signal transmission and has become progressively more common as a treatment for knee pain. This retrospective study aims to evaluate the efficacy of intraarticular radiofrequency in patients with chronic knee OA pain.

MATERIALS AND METHODS

In this retrospective study, we included 129 patients undergoing intraarticular pulsed radiofrequency using the Poisson curve for energy distribution (Sluijter-Teixeira Poisson radiofrequency) (STP) from March 2018 to November 2019. Knee osteoarthritis severity was assessed prior to the procedure using the Lequesne Index, classifying patients into six groups based on level of severity. Pain intensity was assessed through a 10-cm visual analog scale (VAS), and level of patient satisfaction was assessed through a questionnaire.

RESULTS

In the sample, pain reduction as measured by VAS compared to baseline prior to the procedure was statistically significant immediately following the procedure, at 30 days and at 90 days (p<0.001); this difference was less significant at 180 days (p<0.005). Efficacy in patients with moderate to severe disability was considerably greater than in patients with very severe to extremely severe disability. 57.36% reported that they were very satisfied, 29.46% satisfied, 9.3% neither satisfied nor dissatisfied, 2.33% dissatisfied, and 1.55% very dissatisfied.

CONCLUSION

Our results suggest that STP radiofrequency may be a safe and effective procedure for knee OA, able to significantly reduce VAS scores at 1 month and 3 months compared to baseline. Based on our results, a key factor to consider when treating knee OA with STP radiofrequency is that it is more effective among patients with a lower level of disability. Due to the retrospective observational study design, prospective longitudinal investigation is required to further support the recommendation of STP radiofrequency for knee OA.

Chronic Chest Pain Control after Trans-Thoracic Biopsy in Mediastinal Lymphomas

Chest pain following a trans-thoracic biopsy often has multiple etiologies, especially in patients with lymphomas. Pathological neuronal mechanisms integrate with an overproduction of IL-6, TNF-α, IL1-β by macrophages and monocytes, which amplifies inflammation and pain. In consideration of this complex pathogenesis, international guidelines recommend diversified analgesia protocols: thoracic epidural, paravertebral block, and systemic administration of opioids. This study reports an attempt to reduce chest pain and prevent chronic pain in 51 patients undergoing trans-thoracic biopsy for mediastinal lymphoma. The entity of pain, measured 72nd hour after biopsy by the Numerical Rating Scale (NRS), was compared with that seen at a 6th month checkpoint in 46 patients. The pain decreased in all cases. At the 6th month checkpoint, among 31 opioid-treated patients, none of the 16 patients with NRS < 6 within the 72nd hour post biopsy had developed chronic chest pain, while 8 of the 15 with higher values did (p < 0.01). Of 10 patients undergoing thoracotomy and treated with opioids, eight had a NRS of no more than 2, of which six had no chronic pain. Of the twenty-one patients who underwent VATS biopsy and were treated with opioids, fifteen had NRS no greater than 2, of which ten had no chronic pain. Subgroups of patients biopsied under mediastinotomy or video-assisted thoracoscopic surgery (VATS) and treated with thoracic epidural analgesia (TEA) or PVB were too small for such analysis.

Effect of extrudate swell on extrusion foam of polyethylene terephthalate

The effect of extrudate swell on extrusion foam of thermoplastic polymers is presented using an experimental approach supported by a modelling of the phenomenon. Its understanding is fundamental in designing the geometry of a die for extrusion foam and to predict foaming. The extrudate swell is the swelling of a viscoelastic material due to a fast elastic recovery after being subjected to stresses. We show that there exists a link between the extrudate swell and foaming, performing experiments with simple and complex extrusion dies to measure the expansion ratio. It was found that the expansion ratio is anisotropic and the anisotropy in the expansion of the foam is due to the extrudate swell that affects strongly the final shape of the product and it cannot be neglected in standard application for extrusion foam. A simple heuristic model was developed to predict the extrudate swell from geometrical parameters and rheological characterization of the fluid. It was found that the foaming mechanism of polyethylene terephthalate, blown with cyclopentane, changes as function of extrudate swell and the lowest density foam is achieved using the die that has the bigger extrudate swell.

Retrieval of fragmented peripherally inserted central catheter (PICC) with a double transfemoral access technique

Retrieval of central venous catheters fragments often puts us in front of different situations. Having more techniques available for strategic planning of the procedure is important. The authors propose the simultaneous use of two different approaches for the recovery of a CVC fragment from the pulmonary artery.

All-in-One Spinal Cord Stimulation in Lymphoproliferative Diseases

Even patients with lymphoproliferative diseases may develop a persistent chronic pain not responsive to usual treatments due to changes in antibody production and to some treatments like radiotherapy, chemotherapy, and the administration of monoclonal antibodies, which further impair the immune defense and induce chronic inflammatory phenomena acting as a substrate for a persistent chronic pain. Five patients with indolent lymphoproliferative diseases were treated for severe pain nonresponsive to other pain reliever treatments with SCS applied with an All-in-One Shot (OS) procedure. For all patients, the estimated survival time was of 5 years or more. All patients showed a significant reduction of the intensity of pain: the mean Numerical Rating Scale was 7.4 before treatment and 2.2 after. No patient developed adverse events. Supported by the data of this study, we believe that the habit to deprive patients with an indolent form of lymphoproliferative diseases of the possibility to reduce the intensity of chronic pain by SCS treatment is extremely reductive and frustrating.

Dorsal Root Ganglion Stimulation for Chronic Postoperative Pain Following Thoracic Surgery: A Pilot Study

OBJECTIVES

Post-thoracotomy pain syndrome (PTPS) is defined as persistent pain following a thoracotomy and has an incidence of 21-61%. Dorsal root ganglion stimulation (DRG-S) is a form of neuromodulation that modulates pain signal transmission to the spinal cord. The aims of this study were to investigate the efficacy of DRG-S for the management of PTPS and to assess the role of thoracic paravertebral blocks (t-PVB) as a tool for prediction of success of DRG-S.

MATERIALS AND METHODS

In this prospective study, we included all patients undergoing thoracic surgery, with PTPS not responding to pharmacotherapy and treated with DRG-S from September 2018 to February 2019. t-PVB followed by a percutaneous DRG-S trial was performed on all patients. Pain intensity was assessed through a numeric rating scale (NRS) and Douleur Neuropathique en 4 Questions (DN4) at baseline, post-trial, at 14 days, 90 days, and at one year after DRG-S implantation. Data summarized as continuous variables were expressed as means and standard deviations (SDs), and categorical variables were expressed as raw numbers and percentages.

RESULTS

Four patients out of 51 who underwent thoracic surgery at our institution surveyed were included (mean age ± SD, 56 ± 16 years old). Mean NRS and DN4 were, respectively, 7.2 ± 0.96 SD and 8.2 ± 0.5 SD at baseline, 2.5 ± 0.6 SD and 3.2 ± 0.5 SD after t-PVB, 2.2 ± 0.5 SD and 2.2 ± 0.5 SD at 14 days, 90 days, and at one year after DRG-S implantation. No complications or side effects were reported.

CONCLUSIONS

Our preliminary results show that DRG-S is an effective therapy for PTPS after thoracic surgery. In addition, thoracic paravertebral blocks performed prior to DRG-S correlated with a positive outcome with treatment.

Differential Diagnosis: Retroperitoneal Fibrosis and Oncological Diseases

Retroperitoneal fibrosis is a connective disease of the auto-inflammatory/auto-immune type of the retroperitoneum with unknown etiology and pathological mechanism. The manifestations of the pathology can be local or systemic. Amongst the local symptoms, the dull and constant pain in the hips, back or abdomen is the most frequent.

We report here a case of a 47-year-old woman, whose pathogenic mechanism could be related to an “IgG4-related disease” disorder as suggested by an increased serum level of this subclass of IgG and the positive immunohistochemistry.

The diagnosis is not easy, because this pathology generates masses; adenomegalies with retro peritoneal development, that makes it similar to lymphomas or metastases from ovarian tumors.

Cancer- and Non-cancer Related Chronic Pain: From the Physiopathological Basics to Management

The prevalence of chronic pain is between 33% to 64% and is due to cancer pain, but it has also been observed in non-cancer patients. Chronic pain is associated with lower quality of life and higher psychological distress and depressive/anxiety disorders in patients without a history of disorder. In this study we evaluated in clinical practice the effectiveness of the intrathecal pump in 140 patients who underwent pain therapy at our Center. These patients were consecutively enrolled from January 2010 to July 2018. Follow-up was carried out over these eight years regarding the infusion modalities. Pain relief was obtained in 71 (50,7%) patients out of the 140 that experienced satisfactory pain control globally. Intrathecal therapy is one of the best options for chronic severe refractory pain. The greatest advantage of this therapy is due to the possibility of treating the pain with minimal dosages of the drug, avoiding the appearance of troublesome side effects.

A novel lab-scale batch foaming equipment: The mini-batch

In this paper, we report the design of a new experimental apparatus for the study of the foaming process of thermoplastic polymers with physical blowing agents. The novel lab-scale batch foaming equipment is capable of achieving accurate control of the processing variables, namely, the temperature, the saturation pressure and the pressure drop rate and, furthermore, of allowing the achievement of very high pressure drop rates, the observation of the sample while foaming and the very fast extraction of the foamed sample. By recalling the considerations discussed by Muratani et al. ( J Cell Plast 2005; 24: 15), the design converged into a simple, cheap, and very small pressure vessel, thereby denoted as mini-batch. We herein describe the overall design path of the mini-batch, its characteristics, configurations, together with some examples of use with polystyrene and CO2 as the blowing agent.

Bradycardic syncope in 2 patients who recently began gatifloxacin treatment

Gatifloxacin is a synthetic broad-spectrum 8-methoxyfluoroquinolone approved by the United States Food and Drug Administration in December 1999. Few side effects of this new antibiotic have been reported, and there are no previous case reports of bradyarrhythmias. We report 2 cases of syncope due to bradycardia in patients who recently began treatment with gatifloxacin.

Economic effects of community versus hospital-based faculty pneumonia care

To compare the length of stay and charges for patients with pneumonia admitted in 1995 to the teaching and nonteaching services of a Northeastern teaching hospital, we reviewed the charts of 237 patients. Patients cared for by hospital-based generalists working with housestaff (teaching service) were discharged more quickly and with lower or equivalent charges than patients cared for by community-based attending physicians working either with housestaff (private teaching service) or alone (nonteaching service). Academic teaching services staffed by general medicine faculty may provide efficient inpatient pneumonia care.

Physicians' utilization of health care

OBJECTIVE

To describe how physicians attend to their own health care needs.

SETTING

Rhode Island.

PARTICIPANTS

A random sample of Blue Cross/Blue Shield providers. The 306 respondents (67% of 458) primarily (92%) had MD or DO degrees. The nonphysician providers were chiropractors, dentists, optometrists, and podiatrists.

DESIGN

A mailed survey provided data describing the respondents' medical conditions and utilization of formal and informal care during a three-year period. Questions asked about provider visits, physical examinations, preventive and diagnostic tests, and medication use. The respondents indicated whether services had been initiated by themselves or by another physician.

MAIN RESULTS

The physicians' overall use of formal health services was low; their number of office visits was a fourth of the national average. Two-thirds of the respondents reported having a primary care physician, and one-third had sought informal care. The respondents' use of preventive services was high. During the three-year period, 82% of the women physicians had received a Pap test, and 81% of the women physicians over the age of 40 years had received mammography. Cholesterol levels were checked for more than two-thirds of all the respondents. Medical examinations and laboratory tests tended to be ordered by another physician, although self-prescribing was not uncommon. Furthermore, 61% of the respondents had self-prescribed at least one medication.

CONCLUSIONS

Physicians' care-seeking behavior covers a broad spectrum, ranging from self-care, to informal consultation, to formal treatment by another physician. Physicians appear to be low users of formal services overall, but high users of preventive care.