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61.
《Journal of vascular and interventional radiology : JVIR》2019,30(6):781-789
Pelvic venous disorders (PeVDs) in women can present with chronic pelvic pain, lower-extremity and vulvar varicosities, lower-extremity swelling and pain, and left-flank pain and hematuria. Multiple evidence gaps exist related to PeVDs with the consequence that nonvascular specialists rarely consider the diagnosis. Recognizing this, the Society of Interventional Radiology Foundation funded a Research Consensus Panel to prioritize a research agenda to address these gaps. This paper presents the proceedings and recommendations from that Panel. 相似文献
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Background
Total knee arthroplasty is a treatment option for debilitating arthritis. In the postoperative period, patients experience moderate to severe pain affecting the rehabilitation, hospital stay, and patient satisfaction. This study aims at utilizing current best evidence to determine whether adductor canal block (ACB) or periarticular injection (PAI) is a better modality for managing short-term postoperative pain and opioid consumption.Methods
Embase, MEDLINE, HealthStar, Emcare, and PubMed were searched for randomized controlled trials from 1946 to August 2018, for literature addressing the comparison of ACB and PAI for pain management in the setting of total knee arthroplasty. A systematic review and meta-analysis were performed.Results
Six studies were included in our meta-analysis. When examining the combined visual analog scale (VAS) pain values for each group, analysis demonstrated greater reduction in scores for the PAI group, and the difference was statistically significant (P = .001). When comparing the VAS scores of subgroups analyzed at specific periods in time, there was a trend toward lower VAS scores in subgroups analyzed at 24 hours and 48 hours postoperatively (at rest and at movement) in the PAI group. Overall opioid consumption was lower in the PAI group, with demonstrated statistical significance (P = .03). When comparing the postoperative subgroups, there was a trend toward decreased opioid use in the PAI group, with 13.25% less opioid use at 48 hours and 9.5% less opioid use at 24 hours.Conclusion
PAI could significantly improve postoperative pain and opioid consumption when compared with ACB. Additional, high-quality studies are required to further address this topic. 相似文献65.
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ABSTRACTObjective: The purpose of this study was to examine the within and between-group effects of segmental and distal dry needling (DN) without needle manipulation to a semi-standardized non-thrust manipulation (NTM) targeting the symptomatic spinal level for patients with non-specific low back pain (NSLBP).Methods: Sixty-five patients with NSLBP were randomized to receive either DN (n = 30) or NTM (n = 35) for six sessions over 3 weeks. Outcomes collected included the oswestry disability index (ODI), patient specific functional scale (PSFS), numeric pain rating scale (NPRS), and pain pressure thresholds (PPT). At discharge, patients perceived recovery was assessed.Results: A two-way mixed model ANOVA demonstrated that there was no group*time interaction for PSFS (p = 0.26), ODI (p = 0.57), NPRS (p = 0.69), and PPT (p = 0.51). There was significant within group effects for PSFS (3.1 [2.4, 3.8], p = 0.018), ODI (14.5% [10.0%, 19.0%], p = 0.015), NPRS (2.2 [1.5, 2.8], p = 0.009), but not for PPT (3.3 [0.5, 6.0], p = 0.20).Discussion: The between-group effects were neither clinically nor statistically significant. The within group effects were both significant and exceeded the reported minimum clinically important differences for the outcomes tools except the PPT. DN and NTM produced comparable outcomes in this sample of patients with NSLBP.Level of evidence: 1b 相似文献
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Niki Oikonomopoulou Concepción Míguez-Navarro Arístides Rivas-García Mercedes García Gamiz Rosario López-López Paloma Oliver-Sáez Bibiana Riaño-Méndez Tamara Farfan-Orte Zulema Lobato-Salinas Júlia Rúbies-Olives Priscila Llena-Isla Encarnación María Lancho-Monreal 《The American journal of emergency medicine》2019,37(7):1289-1294
BackgroundAcute appendicitis (AA) is one of the most frequent surgical pathologies in pediatrics.ObjectivesTo investigate the utility of proadrenomedullin (pro-ADM) for the diagnosis of AA.MethodsProspective, analytical, observational, and multicenter study conducted in 6 pediatric emergency departments. Children up to 18 years of age with suspected AA were included. Clinical, epidemiological, and analytical data were collected.ResultsWe studied 285 children with an average age of 9.5 years (95% confidence interval [CI], 9.1–9.9). AA was diagnosed in 103 children (36.1%), with complications in 10 of them (9.7%). The mean concentration of pro-ADM (nmol/L) was higher in children with AA (0.51 nmol/L, SD 0.16) than in children with acute abdominal pain (AAP) of another etiology (0.44 nmol/L, SD 0.14; p < 0.001). This difference was greater in complicated cases compared with uncomplicated AA (0.64 nmol/L, SD 0.17 and 0.50 nmol/L, SD 0.15, respectively; p = 0.005). The areas under the receiver-operating characteristic curves were 0.66 (95% CI, 0.59–0.72) for pro-ADM, 0.70 (95% CI, 0.63–0.76) for C-reactive protein (CRP), 0.84 (95% CI, 0.79–0.89) for neutrophils, and 0.84 (95% CI, 0.79–0.89) for total leukocytes. The most reliable combination to rule out AA was CRP ≤1.25 mg/dL and pro-ADM ≤0.35 nmol/L with a sensitivity of 96% and a negative predictive value of 93%.ConclusionChildren with AA presented higher pro-ADM values than children with AAP of other etiologies, especially in cases of complicated AA. The combination of low values of pro-ADM and CRP can help to select children with low risk of AA. 相似文献
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Yueh-Ling Hsieh Ming-Ta Lin Chang-Zern Hong Hsin-Shui Chen 《Foot and Ankle Surgery》2019,25(2):186-192
Background
This study investigated the effects of percutaneous soft tissue release (PSTR) performed using a blunt cannula on (1) the inflammatory cells-count, (2) expressions of calcitonin gene-related peptide (CGRP) and (3) substance P (SP) in rabbits with chronic phase of collagenase-induced Achilles tendinopathy.Methods
Thirty-two adult male New Zealand rabbits were randomly divided into four groups: (1) collagenase and PSTR treatment; (2) collagenase and sham-operated PSTR treatment; (3) vehicle-only injection and PSTR treatment; and (4) vehicle-only injection and sham-operated PSTR treatment. Achilles tendon of adult male rabbits was injected with 10 μl of collagenase under ultrasonography localization. After 30 days, PSTR was performed using an 18G beauty cosmetic blunt tip micro cannula needle to release the soft tissue and paratenon above the inflamed Achilles tendon. The treated tendons and spinal cords of L5-S2 were harvested 5 days after treatment for histological assessment and immunohistochemical analysis.Results
Histopathological examination revealed that PSTR achieved significant reduction in hypercellularity with pronounced infiltration of immune cells at the site of paratenon in tendons injected with collagenase compared with sham operation (p < 0.05). Immunohistochemical analysis also showed marked decrease in expression of CGRP in tendon and SP in dorsal horns after PSTR (p < 0.05).Conclusions
This study showed positive effects in an animal model of chronic tendinopathy, and can be considered a treatment option, but that further research is necessary to determine its role in clinical practice. 相似文献70.
A groin hernia is a common presenting complaint for adults and surgical repair is usually recommended. Patients may present with swelling or pain in the groin and one should be cognisant of the surgical emergency of a strangulating or obstructing hernia. A careful history and examination will help determine differential diagnoses and with planning the potential approach for repair. Surgical techniques have developed in recent years with a swing towards favouring laparoscopy in the elective patient. For both open and laparoscopic approaches, there are recognized techniques to consider. It is crucial to have a clear understanding of the anatomy in order to develop the skills required for accurate dissection, reduction and repair. Complications, although rare, can lead to severe morbidity. Laparoscopy has the advantage of reducing postoperative chronic pain but requires greater skill and experience to perform successfully. This chapter outlines the key considerations and surgical techniques for groin hernia repair and should be used in conjunction with practical training. 相似文献