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Gowd AK, Plate JF, Lichtig A, Gencer A, Yanmis O, D'Agostino R, Poehling GG. Favourable mid-term outcomes following unicompartmental knee arthroplasty with wider patient selection: A single-centre experience. J ISAKOS 2023; 8:255-260. [PMID: 37004741 DOI: 10.1016/j.jisako.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/17/2023] [Accepted: 03/11/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine surgical outcomes of robotic-assisted UKAs utilizing a wider set of indications than traditionally utilized. Additionally, we seek to determine alternate predictive factors as potential surgical indications and contraindications. METHODS A prospectively maintained institutional joint registry was queried at a single academic centre for all patients that underwent robotic-assisted UKA between January 2010-December 2016. Surgical indication included isolated medial or lateral compartment degenerative disease with a stable knee based on physical exam. In 2013, haemoglobin A1C levels over 7.5% were considered contraindications, which was lowered to 7.0% in 2015. Preoperative alignment, age, activity level and degree of pain were not contraindications for surgery. Preoperative demographics, Oxford scores, radiographic (joint space), comorbidities and operative data were collected and reviewed to determine factors related to conversion to TKA and survivorship of the primary implant. RESULTS In total, 1878 cases were performed; however, excluding multi-joint knees, there were a total of 1186 knees in 1014 patients with a minimum 4-year follow-up. The mean age was 63.4 ± 10.7 years and mean follow-up was 76.4 ± 17.4 months. Mean BMI was 32.3 ± 6.5 kg/m2. (52.9% females, 47.1% males). There were 901 patients undergoing medial UKA, 122 patients undergoing lateral UKA and 69 patients undergoing patellofemoral UKA. In total, 85 (7.2%) knees underwent conversion to TKA. Preoperative factors such as the degree of preoperative valgus deformity (p = 0.01), greater operative joint space (p = 0.04), previous surgery (p = 0.01), inlay implant (p = 0.04) and pain syndrome (p = 0.01) were associated with increased risk of revision surgery. Factors associated with decreased implant survivorship included patients with history of previous surgery (p < 0.01), history of pain syndrome (p < 0.01) and greater preoperative joint space (>2 mm) (p < 0.01). There was no association of BMI to conversion to TKA. CONCLUSION Robotic-assisted UKA with wider patient selection demonstrated favourable outcomes at 4 years with survivorship greater than 92%. The present series agree with emerging indications that do not exclude patients based on age, BMI, or degree of deformity. However, increased operative joint space, inlay design, history of surgery and coexistence of pain syndrome are factors that increase risk of conversion to TKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Anirudh K Gowd
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Johannes F Plate
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Asher Lichtig
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Ahmet Gencer
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Orhan Yanmis
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Ralph D'Agostino
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Gary G Poehling
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
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Honda Pazili T. Treatment of postherpetic neuralgia by bone marrow aspirate injection: A case report. World J Clin Cases 2023; 11:3619-3624. [PMID: 37383904 PMCID: PMC10294184 DOI: 10.12998/wjcc.v11.i15.3619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/27/2023] [Accepted: 04/17/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is the most frequent and a difficult-to-treat complication of herpes zoster (HZ). Its symptoms include allodynia, hyperalgesia, burning, and an electric shock-like sensation stemming from the hyperexcitability of damaged neurons and varicella-zoster virus-mediated inflammatory tissue damage. HZ-related PHN has an incidence of 5%–30%, and in some patients, the pain is intolerable and can lead to insomnia or depression. In many cases, the pain is resistant to pain-relieving drugs, necessitating radical therapy.
CASE SUMMARY We present the case of a patient with PHN whose pain was not cured by conventional treatments, such as analgesics, block injections, or Chinese medicines, but by bone marrow aspirate concentrate (BMAC) injection containing bone marrow mesenchymal stem cells. BMAC has already been used for joint pains. However, this is the first report on its use for PHN treatment.
CONCLUSION This report reveals that bone marrow extract can be a radical therapy for PHN.
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Affiliation(s)
- Takahiro Honda Pazili
- Regenerative Medicine, Department of Cell Therapy, Japan Tokyo Stem Cell Transplant Research Institute, Tokyo 104-0061, Japan
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Dräger DL, Steinicke A, Hake K, Kriesen U, Hakenberg O. [Pitfalls in communicating with patients with chronic pain in urology-from pain games to loss of authority]. Urologie 2023:10.1007/s00120-023-02085-6. [PMID: 37076604 DOI: 10.1007/s00120-023-02085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/21/2023]
Abstract
Patients with chronic pain syndromes are often referred to as "difficult" patients. In addition to positive expectations of the physicians' competence, pain patients often express understandable doubts about the appropriateness and efficiency of new treatment options and are afraid of rejection and devaluation. Hope and disappointment, idealization and devaluation alternate in a characteristic way. This article demonstrates the pitfalls of communicating with patients suffering from chronic pain and provides recommendations for improving physician-patient interaction based on acceptance, honesty and empathy.
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Affiliation(s)
- Désirée Louise Dräger
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
| | - Angela Steinicke
- Klinik und Poliklinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Karsten Hake
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Ursula Kriesen
- Medizinische Klinik III für Hämatologie, Onkologie und Palliativmedizin, Zentrum für Innere Medizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Oliver Hakenberg
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
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Corley JA, Charalambous LT, Mehta VA, Wang TY, Abdelgadir J, Than KD, Abd-El-Barr MM, Goodwin CR, Shaffrey CI, Karikari IO. Perioperative Pain Management for Elective Spine Surgery: Opioid Use and Multimodal Strategies. World Neurosurg 2022; 162:118-125.e1. [PMID: 35339713 DOI: 10.1016/j.wneu.2022.03.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
Abstract
In recent years, physicians and institutions have come to recognize the increasing opioid epidemic in the United States, thus prompting a dramatic shift in opioid prescribing patterns. The lack of well-studied alternative treatment regimens has led to a substantial burden of opioid addiction in the United States. These forces have led to a huge economic burden on the country. The spine surgery population is particularly high risk for uncontrolled perioperative pain, because most patients experience chronic pain preoperatively and many patients continue to experience pain postoperatively. Overall, there is a large incentive to better understand comprehensive multimodal pain management regimens, particularly in the spine surgery patient population. The goal of this review is to explore trends in pain symptoms in spine surgery patients, overview the best practices in pain medications and management, and provide a concise multimodal and behavioral treatment algorithm for pain management, which has since been adopted by a high-volume tertiary academic medical center.
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Affiliation(s)
- Jacquelyn A Corley
- Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
| | | | - Vikram A Mehta
- Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Timothy Y Wang
- Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jihad Abdelgadir
- Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Khoi D Than
- Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Muhammad M Abd-El-Barr
- Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - C Rory Goodwin
- Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher I Shaffrey
- Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Isaac O Karikari
- Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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Dong XX, Guo M, Huang LX, Chen C, Hu JH. The efficacy of manipulation as a treatment for myofascial pelvic pain. Int Urol Nephrol 2021; 53:1339-43. [PMID: 33797710 DOI: 10.1007/s11255-021-02840-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the effect of myofascial manipulation by observing the changes in pelvic floor myofascial scores and electromyography (EMG) data before and after treatment. METHODS A total of 106 patients with myofascial pelvic pain (MFPP) were enrolled in a treatment group, and 50 healthy women were enrolled in a control group. The changes in the pelvic floor EMG data in the two groups were monitored by using Myo Trac before and after treatment. Pelvic trigger points and their distribution in the MFPP patients were examined using a finger pressure test. The visual analogue scale was used to assess the severity of pain in both groups. After one course of manipulation (twice per week for a total of 10 times), the effectiveness of the manipulation was analyzed by comparing the changes in pain scores before and after treatment. RESULTS The main symptoms of MFPP in the study sample consisted of lower abdominal pain, lumbosacral pain, or mixed pain, which together accounted for 67% of all symptoms. Patients often had multiple trigger points, covering 47.17% of the body. The differences between the treatment group and control group in the changes in pelvic floor muscle strength, number of pain points, pain scores, resting EMG of pelvic floor muscles, and relaxation time after muscle contraction were all statistically significant (P < 0.05). The differences between the pre-treatment and post-treatment groups in the changes in pelvic floor muscle strength, number of pain points, pain scores, resting EMG of pelvic floor muscles, and relaxation time after muscle contraction were all statistically significant (P < 0.05) CONCLUSION: Manipulation is an effective treatment for MFPP and is worthy of further clinical promotion.
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Abstract
PURPOSE OF REVIEW Pain is a multi-faceted symptom. Effective pain assessment involves properly defining the pain syndrome, utilizing various assessment tools, and recognizing different conditions which may affect the expression and the management of pain. RECENT FINDINGS Pain results from multiple physical and psychosocial etiological interplay. It has traditionally been categorized as acute or chronic with chronic pain having been categorized further into 6 categories in ICD 11. At the same time, the opioid epidemic and the recent surge in cannabis popularity further complicates pain assessment and effective pain management. Adequate management of pain begins with proper assessment including conducting extensive medical and psychosocial history and physical examination, and utilizing various pain and substance risk assessment tools. An interdisciplinary team approach may be more effective in managing complex pain behaviors compared to a solo approach.
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Affiliation(s)
- Michael Tang
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1414, Houston, TX, 77030, USA.
| | - Kimberson Tanco
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1414, Houston, TX, 77030, USA
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Lammek K, Tretiakow D, Skorek A. The first bite syndrome after parotidectomy. Oral Oncol 2020; 113:105028. [PMID: 33008728 DOI: 10.1016/j.oraloncology.2020.105028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Katarzyna Lammek
- Department of Otolaryngology, Medical University of Gdansk, Poland
| | - Dmitry Tretiakow
- Department of Otolaryngology, Medical University of Gdansk, Poland.
| | - Andrzej Skorek
- Department of Otolaryngology, Medical University of Gdansk, Poland
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Imani F, Hemati K, Rahimzadeh P, Kazemi MR, Hejazian K. Effectiveness of Stellate Ganglion Block Under Fuoroscopy or Ultrasound Guidance in Upper Extremity CRPS. J Clin Diagn Res 2016; 10:UC09-12. [PMID: 26894152 DOI: 10.7860/jcdr/2016/14476.7035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/18/2015] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Stellate Ganglion Block (SGB) is an effective technique which may be used to manage upper extremities pain due to Chronic Regional Pain Syndrome (CRPS), in this study we tried to evaluate the effectiveness of this procedure under two different guidance for management of this syndrome. AIM The purpose of this study was to evaluate the effectiveness of ultrsound guide SGB by comparing it with the furoscopy guided SGB in upper extermities CRPS patients in reducing pain & dysfuction of the affected link. MATERIALS AND METHODS Fourteen patients with sympathetic CRPS in upper extremities in a randomized method with block randomization divided in two equal groups (with ultrasound or fluoroscopic guidance). First group was blocked under fluoroscopic guidance and second group blocked under ultrasound guidance. After correct positioning of the needle, a mixture of 5 ml bupivacaine 0.25% and 1 mL of triamcinolone was injected. RESULTS These data represent no meaningful statistical difference between the two groups in terms of the number of pain attacks before the blocks, a borderline correlation between two groups one week and one month after the block and a significant statistical correlation between two groups three month after the block. These data represent no meaningful statistical difference between the patients of any group in terms of the pain intensity (from one week to six months after block), p-value = 0.61. These data represent a meaningful statistical difference among patients of any group and between the two groups in terms of the pain intensity (before the block until six months after block), p-values were 0.001, 0.031 respectively. CONCLUSION According the above mentioned data, in comparison with fluoroscopic guidance, stellate ganglion block under ultrasound guidance is a safe and effective method with lower complication and better improvement in patient's disability indexes.
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Affiliation(s)
- Farnad Imani
- Professor, Department of Anesthesiology, Pain Fellowship, Rasool Akram Hospital, Iran University of Medical Sciences , Tehran, Iran
| | - Karim Hemati
- Associate Professor, Department of Anesthesiology, Pain Fellowship, Imam Khomeini Hospital, Ilam University of Medical Sciences , Ilam, Iran
| | - Poupak Rahimzadeh
- Associate Professor, Department of Anesthesiology, Pain Fellowship, Rasool Akram Hospital, Iran University of Medical Sciences , Tehran, Iran
| | - Mohamad Reza Kazemi
- Anesthesiologist, Pain Fellowship, Rasool Akram Hospital, Iran University of Medical Sciences , Tehran, Iran
| | - Kokab Hejazian
- Anesthesiologist, Pain Fellowship, Rasool Akram Hospital, Iran University of Medical Sciences , Tehran, Iran
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Ukrainets IV, Petrushova LA, Dzyubenko SP, Sim G, Grinevich LA. The Effective Synthesis of N-(Arylalkyl)-1-R-4-hydroxy-2,2-dioxo- 1H-2λ(6),1-benzothiazine-3-carboxamides as Promising Analgesics of a New Chemical Class. Sci Pharm 2015; 83:549-66. [PMID: 26839838 PMCID: PMC4727766 DOI: 10.3797/scipharm.1506-04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 07/17/2015] [Indexed: 11/22/2022] Open
Abstract
A new, effective preparative method has been proposed and the synthesis of a series of N-(arylalkyl)-1-R-4-hydroxy-2,2-dioxo-1H-2λ(6),1-benzothiazine-3-car-boxamides has been carried out. It has been shown that amidation of alkyl 1-R-4-hydroxy-2,2-dioxo-1H-2λ(6),1-benzothiazine-3-carboxylates with arylalkyl-amines in boiling xylene proceeds with good yield and purity to the corresponding N-(arylalkyl)-amides. However, the presence of water in the reaction mixture has been shown to cause the formation of specific impurities: N-(arylalkyl)-1-R-2,2-dioxo-1H-2λ(6),1-benzothiazin-4-amines. According to the results of the pharmacological studies, powerful analgesics have been found among the substances synthesized.
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Affiliation(s)
- Igor V Ukrainets
- Department of Pharmaceutical Chemistry, National University of Pharmacy, 53 Pushkinska St., 61002, Kharkiv, Ukraine
| | - Lidiya A Petrushova
- Department of Pharmaceutical Chemistry, National University of Pharmacy, 53 Pushkinska St., 61002, Kharkiv, Ukraine
| | - Sergiy P Dzyubenko
- Department of Pharmaceutical Chemistry, N. I. Pirogov Vinnitsa National Medical University, 56 Pirogov St., Vinnitsa, 21018, Ukraine
| | - Galina Sim
- Department of Pharmaceutical Chemistry, Far Eastern State Medical University, 35 Murav'eva-Amurskogo St., 680000, Khabarovsk, Russia
| | - Lina A Grinevich
- Department of Pharmaceutical Chemistry, National University of Pharmacy, 53 Pushkinska St., 61002, Kharkiv, Ukraine
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