scholarly journals Long-term Follow-up of Trigger Point Injections for Abdominal Wall Pain

2005 ◽  
Vol 19 (9) ◽  
pp. 561-565 ◽  
Author(s):  
Jose Nazareno ◽  
Terry Ponich ◽  
Jamie Gregor
Keyword(s):  
Abdominal Pain ◽  
Abdominal Wall ◽  
Diagnostic Tests ◽  
Primary Outcome ◽  
Trigger Point ◽  
Long Term Outcome ◽  
Abdominal Wall Pain ◽  
Secondary Analyses

OBJECTIVE: Abdominal wall pain (AWP) is a common yet often overlooked source of abdominal pain. Trigger point injections (TPI) into the abdominal wall have been tried in the past. Few studies have looked at the long-term outcome from these injections.METHODS: A retrospective chart review was performed on 110 consecutive patients who received TPI for abdominal pain at the University of Western Ontario, London, Ontario. Outcomes from patients whose pain was due to AWP were determined. AWP was defined as fixed or localized pain and superficial or point tenderness (less than 2.5 cm diameter) or a positive Carnett sign (increased pain with tensing abdomen). The primary outcome was long-term efficacy of TPI. The number of diagnostic tests ordered to exclude AWP and the cost of investigating it were determined. Secondary analyses were done to determine if there were significant predictors of response to TPI.RESULTS: Eighty-nine of 110 patients who received TPI met the criteria for AWP. In those who met the criteria for AWP, the average age was 42 years, 84% were female, and the average length of follow-up was 25 months. The primary outcome shows that, at follow-up, 77% had some or complete relief and 23% had no relief. An average of 4.3 diagnostic tests per patient were ordered to exclude other causes of abdominal pain. Secondary analyses show that meeting the criteria for AWP ( P<0.0005), the absence of gastrointestinal symptoms ( P<0.025), and an upper abdominal location of pain ( P<0.025) were statistically significant predictors of a positive response to TPI.CONCLUSIONS: This study demonstrates that TPI, in patients who meet criteria for AWP, are effective over the long term.

scholarly journals Two-component surface replacement implants compared with perichondrium transplantation for restoration of Metacarpophalangeal and proximal Interphalangeal joints: a retrospective cohort study with a mean follow-up time of 6 respectively 26 years

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Muder ◽  
Nils P. Hailer ◽  
Torbjörn Vedung
Keyword(s):  
Primary Outcome ◽  
Statistical Significance ◽  
Surface Replacement ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Two Component ◽  
Pip Joint

Abstract Background The aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints. Methods We evaluated 163 joints in 124 patients, divided into 138 SR implants in 102 patients and 25 perichondrium transplantations in 22 patients. Our primary outcome was any revision surgery of the index joint. Results The median follow-up time was 6 years (0–21) for the SR implants and 26 years (1–37) for the perichondrium transplants. Median age at index surgery was 64 years (24–82) for SR implants and 45 years (18–61) for perichondium transplants. MCP joint survival was slightly better in the perichondrium group (86.7%; 95% confidence interval [CI]: 69.4–100.0) than in the SR implant group (75%; CI 53.8–96.1), but not statistically significantly so (p = 0.4). PIP joint survival was also slightly better in the perichondrium group (80%; CI 55–100) than in the SR implant group (74.7%; CI 66.6–82.7), but below the threshold of statistical significance (p = 0.8). Conclusion In conclusion, resurfacing of finger joints using transplanted perichondrium is a technique worth considering since the method has low revision rates in the medium term and compares favorable to SR implants. Level of evidence III (Therapeutic).

scholarly journals 747 Long-term effects of pharmacological treatment in patients with takotsubo syndrome with or without hypertension: a report from the takotsubo Italian network

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Angelo Silverio ◽  
Serena Migliarino ◽  
Giuseppe Iuliano ◽  
Eduardo Bossone ◽  
Michele Bellino ◽  
...  
Keyword(s):  
Pharmacological Treatment ◽  
Lower Risk ◽  
Primary Outcome ◽  
Takotsubo Syndrome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Study Population ◽  
Secondary Outcomes

Abstract Aims Hypertension (HT) is one of the most frequent comorbidities reported in patients with Takotsubo syndrome (TTS). However, the clinical outcome as well as the effect of pharmacological treatment on long-term follow-up have never been investigated in this cohort. To investigate the impact of the pharmacological treatment with beta-blocker (BB) and/or renin–angiotensin–aldosterone system inhibitor (RAASi) on long-term outcome of TTS patients with and without HT. Methods and results This study included TTS patients prospectively included in the Takotsubo Italian Network register from January 2007 to December 2018. The study population was divided in two groups according to the presence or not of HT. The effect of BB and RAASi at discharge was evaluated in these groups. The primary outcome was the composite of all-cause death and TTS recurrence; secondary outcomes were the single components of the primary outcome. The propensity score weighting technique was employed to account for potential selection bias in treatment assignment at discharge. The study population included 825 patients [median age 72 (63–78) years; 8.1% were males]; 525 (63.6%) patients had history of HT and 300 (36.4%) patients did not. At median follow-up of 24.0 months (11.0–38.0), the primary outcome occurred in 102 patients (12.4%); all-cause death and TTS recurrence were reported in 76 (9.2%) and 33 (4.0%), respectively. There were no differences in terms of the primary outcome (adjusted HR: 1.082; 95% CI: 0.689–1.700; P = 0.733), all-cause death (adjusted HR: 1.214; 95% CI: 0.706–2.089; P = 0.483) and TTS recurrence (adjusted HR: 0.795; 95% CI: 0.373–1.694; P = 0.552) between patients with vs. without HT. Among patients with HT, those receiving BB at discharge showed a significantly lower risk of the primary outcome (adjusted HR: 0.375; 95% CI: 0.228–0.617; P &lt; 0.001) compared with patients not receiving BB. There was also a significantly lower risk of all-cause death (adjusted HR: 0.381; 95% CI: 0.217–0.666; P &lt; 0.001) and TTS recurrence (adjusted HR: 0.393; 95% CI: 0.155–0.998; P = 0.049) in patients treated with BB. Among patients without HT, there was no significant association of BB treatment with any of the study outcomes. RAASi treatment showed no significant effect on the primary and secondary outcomes. These results were consistent between patients with and without HT. Conclusions TTS patients with HT patients experienced a survival benefit from BB treatment in terms of both all-cause death and TTS recurrence; this effect was not confirmed in patients without HT. Conversely, RAASi did not affect long-term outcome, independently from the coexistence of HT. Albeit hypothesis-generating, a such evidence supports a tailored pharmacological therapy after discharge in TTS patients taking into account the coexistence of HT.

scholarly journals A Modified Treatment Through Point-to-Point Coil Embolization for Direct Carotid Cavernous to Fistula: A Single-Center Result

2021 ◽  
Vol 12 ◽  
Author(s):  
Zihuan Zhang ◽  
Jiaqiang Liu ◽  
Bingbing Zhang ◽  
Mengliang Zhou ◽  
Xintong Zhao ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Primary Outcome ◽  
Endovascular Embolization ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Efficacious Treatment ◽  
Point To Point ◽  
Direct Carotid Cavernous Fistula

This study aims to assess the safety and efficacy of the modified treatment through point-to-point coil embolization of direct carotid cavernous fistula (dCCF), and evaluate the long-term outcome of patients who underwent the above treatment. A total of 18 patients who suffered from dCCF (a total of 19 fistulas) between January 2013 to May 2020 were analyzed. Among these patients, 14 patients were treated through point-to-point coil embolization of the fistula, while four patients were treated through combined endovascular embolization (coils, a balloon, Onyx, and/or a stent). The number of coils that filled the fistulas was counted. The primary outcome was defined by post-operative digital subtraction angiography (DSA) or the signs after the recanalization of dCCFs during the follow-up period. For patients with dCCF who underwent point-to-point coil embolization, a minimum of three coils and a maximum of 16 coils were used for these 14 fistula patients, and an average of 7.9 coils were used for each fistula, but none of the fistulas was recanalized. Furthermore, two pseudoaneurysms were observed as a result of the compression of the coils. However, none of these 14 patients presented with signs of recanalization of fistulas or cranial paralysis. The procedure applied for the present study was shown to be a safe, economical and efficacious treatment approach for dCCFs through the point-to-point coil embolization of the fistula.

scholarly journals Recognition and Treatment of Abdominal Wall Pain

1989 ◽  
Vol 82 (6) ◽  
pp. 343-344 ◽  
Author(s):  
N C Gallegos ◽  
M Hobsley
Keyword(s):  
Abdominal Pain ◽  
Abdominal Wall ◽  
Local Anaesthetic ◽  
Simple Test ◽  
Abdominal Wall Pain

In some patients with abdominal pain, the source of the pain may be the abdominal wall. A simple test is described which allows these patients to be identified and treated with injections of local anaesthetic and steroid. Twenty-six patients were studied, 20 of whom were available for follow-up. Sixteen of these 20 were symptom free or improved at a median follow-up period of 29 months. Failure to recognize abdominal wall pain may lead to unnecessary investigation.

LONG-TERM OUTCOME OF SUBCUTANEOUSLY PRESERVED AUTOLOGOUS CRANIOPLASTY

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 505-510 ◽  
Author(s):  
Alireza Shoakazemi ◽  
Thomas Flannery ◽  
Robert Scott McConnell
Keyword(s):  
Glasgow Coma Scale ◽  
Abdominal Wall ◽  
Decompressive Craniectomy ◽  
Glasgow Coma Scale Score ◽  
Bone Flap ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The Mean

Abstract OBJECTIVE Decompressive craniectomy for intracranial hypertension mandates later cranioplasty. Autologous cranioplasties can be preserved either by freezing or placement in a subcutaneous pocket. There are few data on the long-term follow-up of patients treated in such a fashion. METHODS A retrospective study was conducted on 100 consecutive patients who underwent decompressive craniectomy and placement of the bone flap in a subcutaneous pocket in the abdominal wall between 2000 and 2005. Initial diagnosis, Glasgow Coma Scale score on admission, complications, and Glasgow Outcome Score were recorded. RESULTS Of the 100 patients who underwent autocranioplasty, the primary diagnosis was traumatic brain injury (76%), subarachnoid hemorrhage (17%), primary intracerebral hemorrhage (3%), and tumor (4%). The mean age of the sample was 39 years (age range, 10–72 years). The mean follow-up duration was 25 months. The average Glasgow Coma Scale score on admission was 7. Eight patients died before replacement of the bone flap. The average time between craniectomy and replacement of bone flap was 42 days. The mean Glasgow Outcome Score was 4 at the time of the 1-year follow-up evaluation. Seven of the 79 patients (9%) for whom 1-year review data were available had a cosmetic result that was unacceptable and required removal of the flap (bone flap infections in 5 patients, unacceptable bone flap resorption in 2 patients) CONCLUSION Our study indicates that storage of a cranioplasty flap in a subcutaneous pouch in the abdominal wall has a favorable long-term outcome.

Postoperative Abdominal Wall Pain

2018 ◽  
Author(s):  
Dan Dirzu ◽  
Ovidiu Palea ◽  
Sarah Choxi
Keyword(s):  
Abdominal Pain ◽  
Abdominal Wall ◽  
Trigger Point ◽  
Bowel Function ◽  
The United States ◽  
Office Visits ◽  
Abdominal Wall Pain ◽  
Refractory Pain ◽  
Carnett’S Sign ◽  
Pain Generator

Abdominal pain accounts for almost 1.5% of office visits and nearly 5% of emergency department admissions each year in the United States. In 2% to 3% of patients with chronic abdominal pain, the pain arises from the abdominal wall. Postoperative abdominal wall pain is chronic, unremitting pain unaffected by eating or bowel function but exacerbated by postural change. A localized, tender trigger point can be identified, although pain may radiate over a diffuse area of the abdomen. Thorough history and physical examination can distinguish abdominal wall pain from visceral intra-abdominal pain. A positive Carnett’s sign favors an abdominal wall pain generator and not a visceral source. Injection with a local anesthetic and steroid at the area of pain may provide relief and can function also as a diagnostic test for abdominal wall pain. Refractory pain may be treated with chemical neurolysis, radiofrequency ablation, peripheral nerve stimulators, or neurectomy.

scholarly journals Long term outcome of immunoglobulin A (IgA) nephropathy: A single center experience

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249592
Author(s):  
Rozita Mohd ◽  
Nur Ezzaty Mohammad Kazmin ◽  
Rizna Abdul Cader ◽  
Nordashima Abd Shukor ◽  
Yin Ping Wong ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Primary Outcome ◽  
Interstitial Fibrosis ◽  
Univariate Analysis ◽  
Tubular Atrophy ◽  
Term Survival ◽  
Long Term Outcome ◽  
Time Average

Introduction IgA nephropathy (IgAN) has a heterogeneous presentation and the progression to end stage renal disease (ESRD) is often influenced by demographics, ethnicity, as well as choice of treatment regimen. In this study, we investigated the long term survival of IgAN patients in our center and the factors affecting it. Methods This study included all biopsy-proven IgAN patients with ≥ 1year follow-up. Patients with diabetes mellitus at diagnosis and secondary IgAN were excluded. Medical records were reviewed for demographics, clinical presentation, blood pressure, 24-hour urine protein, serum creatinine, renal biopsy and treatment received. The primary outcome was defined as combined event of 50% estimated glomerular filtration rate (eGFR) reduction or ESRD. Results We included 130 (74 females; 56 males) patients of mean age 38.0 ± 14.0 years and median eGFR of 75.2 (interquartile range (IQR) 49.3–101.4) ml/min/1.73m2. Eighty-four (64.6%) were hypertensive at presentation, 35 (26.9%) had nephrotic syndrome and 57 (43.8%) had nephrotic range proteinuria (NRP). Median follow-up duration was 7.5 (IQR 4.0–13.0) years. It was noted that 18 (13.8%) developed ESRD and 34 (26.2%) reached the primary outcome. Annual eGFR decline was -2.1 (IQR -5.3 to -0.1) ml/min/1.73m2/year, with median survival of 20 years. Survival rates from the combined event (50% decrease in eGFR or ESRD) at 10, 20 and 30 years were 80%, 53% and 25%, while survival from ESRD were 87%, 73% and 65%, respectively. In the univariate analysis, time-average proteinuria (hazard ratio (HR) = 2.41, 95% CI 1.77–3.30), eGFR <45ml/min/1.73m2 at biopsy (HR = 2.35, 95% CI 1.03–5.32), hypertension (HR = 2.81, 95% CI 1.16–6.80), mean arterial pressure (HR = 1.02, 95% CI 1.01–1.04), tubular atrophy/interstitial fibrosis score (HR = 3.77, 95% CI 1.84–7.73), and cellular/fibrocellular crescent score (HR = 2.44, 95% CI 1.19–5.00) were found to be significant. Whereas only time-average proteinuria (TA-proteinuria) remained as a significant predictor in the multivariate analysis (HR = 2.23, 95% CI 1.57–3.16). Conclusion In our cohort, TA-proteinuria was the most important predictor in the progression of IgAN, irrespective of degree of proteinuria at presentation.

Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽  
2002 ◽  
Vol 31 (1) ◽  
pp. 36-42 ◽  
Author(s):  
. Bucek ◽  
Hudak ◽  
Schnürer ◽  
Ahmadi ◽  
Wolfram ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Stage ◽  
Ankle Brachial Index ◽  
Clinical Situation ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Term Outcome ◽  
Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

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