Sciatic nerve and sacral 2 nerve root decompression by aberrant hypogastric vein branch causing persistent sciatica

2018 ◽  
Vol 10 (4) ◽  
pp. 224-226
Author(s):  
Ahmet Kale ◽  
Gulfem Basol ◽  
Dogus Navdar Uzun ◽  
Taner Usta
Keyword(s):  
Sciatic Nerve ◽  
Scale Score ◽  
Visual Analog Scale ◽  
Pelvic Pain ◽  
Nerve Root ◽  
Chronic Pelvic Pain ◽  
Visual Analog Scale Score ◽  
Analog Scale ◽  
Numeric Scale

Introduction: The aim of this case to present a woman with neurovascular entrapment causing persistent sciatica. We presented the surgical management and the feasibility, safety, and early postoperative outcomes, as well as step-by-step explanation of the surgical technique that it was enriched via original video footage. Case description: A 29-year-old woman has been suffering from chronic pelvic pain and sciatica for 1 year. She had received medical physical treatment for 6 months and did not have any response to pain. Her visual analog scale score was 8/10 points. Neurovascular entrapment was considered as a preliminary diagnosis. The laparoscopic approach showed that an aberrant hypogastric vein branch compressing the sciatic nerve and sacral 2 nerve root. The decompression of these nerves was performed successfully. The total operation time was 50 min. There was no intraoperative and postoperative complication. The visual analog scale score on the postoperative 24th-h was 1/10 point (on 11-point numeric scale). The patient was discharged on the second day postoperatively. In the first-month follow-up, patient’s visual analog scale score was 7/10 point (on 11-point numeric scale). In the 12th-month follow-up, patient’s pelvic pain has decreased dramatically (visual analog scale score rate was 0/10 point) and also had no dyspareunia. Conclusion: A gynecologist should be aware of diagnosis of vascular entrapment in the chronic pelvic pain. Moreover, knowledge of pelvic neuroanatomy and clinical neurology is mandatory for surgeons. The surgical management of neurovascular entrapment is a safe, feasible, and curative option when performed by experienced surgeons.

RADIOSURGERY IN THE TREATMENT OF SPINAL METASTASES

Neurosurgery ◽  
2009 ◽  
Vol 65 (6) ◽  
pp. 1052-1062 ◽  
Author(s):  
Jason P. Sheehan ◽  
Christopher I. Shaffrey ◽  
David Schlesinger ◽  
Brian J. Williams ◽  
Vincent Arlet ◽  
...  
Keyword(s):  
Scale Score ◽  
Visual Analog Scale ◽  
Oswestry Disability Index ◽  
Spinal Metastases ◽  
Visual Analog Scale Score ◽  
Analog Scale ◽  
Metastatic Tumors ◽  
Oswestry Disability Index Score ◽  
The Mean

Abstract OBJECTIVE The effectiveness and limitations of spinal radiosurgery using a helical TomoTherapy system for the treatment of spinal metastases are reviewed in this article. METHODS This is a retrospective review of patients who underwent stereotactic radiosurgery for spinal metastases between July 2004 and December 2007. Radiographic follow-up consisted of magnetic resonance imaging to assess tumor growth control as well as pre- and posttreatment x-rays, which were used to measure changes in segmental angulation and deformity. Clinical performance was assessed using the Karnofsky Performance Scale, Oswestry Disability Index, and visual analog scale. RESULTS Forty patients were treated for 110 metastatic tumors (range, 1–6 tumors per patient). The mean age at the time of radiosurgical treatment was 67 years (age range, 35–81 years). Twenty-three patients (57.5%) had undergone previous surgical resection. Pain was the most common presenting symptom, seen in 32 patients (80%). The mean Oswestry Disability Index score at presentation was 43 (range, 20–90), and the mean visual analog scale score was 6.2 (range, 0–10). The mean radiosurgical dose to the tumor was 17.3 Gy (range, 10–24 Gy). At a mean follow-up duration of 12.7 months (range, 4–32 months), decreased or stable tumor volume was seen in 90 (82%) of the tumors treated. There was improvement in pain in 34 patients (85%). The mean postradiosurgical Oswestry Disability Index score was 25 (range, 10–90), whereas the postradiosurgical visual analog scale score was 3.2 (range, 0–9). Progression of kyphosis was the most common radiographic sequela, experienced by 73% of patients alive at 12 months, with a mean change in angulation of 7.3 ± 4.5 degrees. CONCLUSION Radiosurgery is effective as either primary or adjunctive treatment of metastatic tumors of the spine.

scholarly journals A versatile method for dorsal-approach plantar plate repair using standard operative instruments

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Shun-Min Chang ◽  
Peng-Ju Huang ◽  
Chui Jia Farn ◽  
Shin-Yiing Lin ◽  
Chen-Chie Wang ◽  
...  
Keyword(s):  
Scale Score ◽  
Visual Analog Scale ◽  
Visual Analog Scale Score ◽  
Analog Scale ◽  
Dorsal Approach ◽  
Link Type ◽  
Plantar Plate ◽  
Unique Method ◽  
The Mean

Abstract Background The plantar plate is an important static stabilizer of the lesser metatarsophalangeal joints, and disruptions of the plantar plate can lead to significant instability and lesser toe deformities. In recent years, direct plantar plate repair has been proposed. Although direct repair via a dorsal approach is attractive, a torn plantar plate is small and difficult to access using regular instruments in a restricted operative field. Methods In this report, a unique method for plantar plate repairs was used to repair various configurations of plantar plate tears with standard operative instruments that are available in most operating rooms. Results Using this method, 10 patients underwent plantar plate repairs, and the mean follow-up period was 24 (range, 14–38) months. The mean visual analog scale score for pain preoperatively was 4.1 (range, 0–6) and decreased to 0.6 (range, 0–3) at last follow-up. Postoperatively, the mean visual analog scale score for satisfaction was 9.6 (range, 8–10) and the mean American Orthopedic Foot and Ankle Society forefoot score was 88.8 (range, 75–100). Conclusions Our study proposes an inexpensive and versatile method for plantar plate repair via a dorsal approach that uses standard operative instruments. Trial registration ClinicalTrials.gov, NCT04949685. July 2, 2021 - Retrospectively registered, Level of clinical evidence 4

scholarly journals Pruritus is common in patients with chronic liver disease and is improved by nalfurafine hydrochloride

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shuhei Yoshikawa ◽  
Takeharu Asano ◽  
Mina Morino ◽  
Keita Matsumoto ◽  
Hitomi Kashima ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Scale Score ◽  
Visual Analog Scale ◽  
Visual Analog Scale Score ◽  
Chronic Liver ◽  
Common Complication ◽  
Analog Scale

AbstractPruritus is known to be a common complication in hepatitis patients, but the exact frequency and degree are not fully elucidated. Thus, we evaluated pruritus of 450 patients with chronic liver disease at our hospital. Pruritus was observed in 240 (53%) of the patients. Pruritus was significantly associated with males (OR = 1.51, P = 0.038) and patients with alkaline phosphatase (ALP) ≥ 200 U/L (OR = 1.56, P = 0.0495) and was significantly less in HBsAg-positive patients (OR = 0.449, P = 0.004). Seasonally, there was no difference in the frequency of pruritus between summer and winter. Of the 24 refractory pruritus patients treated with nalfurafine, 17 (71%) indicated improvement of itch, which is defined as a decrease in the visual analog scale score ≥ 30 mm. Pruritus was improved by nalfurafine both during daytime and nighttime in the Kawashima’s scores evaluation. All patients who received nalfurafine exhibited improved Kawashima’s scores ≥ 1 point during the daytime or nighttime. In conclusion, pruritus occurred in > 50% of patients with chronic liver disease, and predictors of pruritus were males and ALP ≥ 200 U/L. Nalfurafine may be useful for pruritus, regardless of whether daytime or nighttime.

scholarly journals Awake Fiberoptic or Awake Video Laryngoscopic Tracheal Intubation in Patients with Anticipated Difficult Airway Management

2012 ◽  
Vol 116 (6) ◽  
pp. 1210-1216 ◽  
Author(s):  
Charlotte V. Rosenstock ◽  
Bente Thøgersen ◽  
Arash Afshari ◽  
Anne-Lise Christensen ◽  
Claus Eriksen ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Difficult Airway ◽  
Scale Score ◽  
Visual Analog Scale ◽  
Difficult Intubation ◽  
Visual Analog Scale Score ◽  
Difficult Tracheal Intubation ◽  
Fiberoptic Intubation ◽  
Analog Scale ◽  
Intubation Success

Background Awake flexible fiberoptic intubation (FFI) is the gold standard for management of anticipated difficult tracheal intubation. The purpose of this study was to compare awake FFI to awake McGrath® video laryngoscope, (MVL), (Aircraft Medical, Edinburgh, Scotland, United Kingdom) intubation in patients with an anticipated difficult intubation. The authors examined the hypothesis that MVL intubation would be faster than FFI. Methods Ninety-three adult patients with anticipated difficult intubation were randomly allocated to awake FFI or awake MVL, patients were given glycopyrrolate, nasal oxygen, topical lidocaine orally, and a transtracheal injection of 100 mg lidocaine. Remifentanil infusion was administered intravenously to a Ramsay sedation score of 2-4. Time to tracheal intubation was recorded by independent assessors. The authors also recorded intubation success on the first attempt, investigators' evaluation of ease of the technique, and patients reported intubation-discomfort evaluated on a visual analog scale. Results Eighty-four patients were eligible for analysis. Time to tracheal intubation was median [interquartile range, IQR] 80 s [IQR 58-117] with FFI and 62 s [IQR 55-109] with MVL (P = 0.17). Intubation success on the first attempt was 79% versus 71% for FFI and MVL, respectively. The median visual analog scale score for ease of intubation was 2 (IQR 1-4) versus 1 (IQR 1-6) for FFI and MVL, respectively. The median visual analog scale score for patients' assessment of discomfort for both techniques was 2, FFI (IQR 0-3), MVL (IQR 0-4). Conclusions The authors found no difference in time to tracheal intubation between awake FFI and awake MVL intubation performed by experienced anesthesiologists in patients with anticipated difficult airway.

Flexor Tendon Sheath as a Source of Pain in Lesser Metatarsal Overload

2009 ◽  
Vol 99 (2) ◽  
pp. 129-134 ◽  
Author(s):  
Hugo R. Perez ◽  
Joshua Roberts
Keyword(s):  
Scale Score ◽  
Visual Analog Scale ◽  
Flexor Tendon ◽  
Metatarsophalangeal Joint ◽  
Visual Analog Scale Score ◽  
Tendon Sheath ◽  
Pain Scale ◽  
Analog Scale ◽  
Scale Scores ◽  
Flexor Tendon Sheath

Background: Lesser metatarsal overload may lead to pathologic conditions ranging from plantar metatarsophalangeal joint pain to dislocation. The flexor tendon sheath lies directly plantar to the joint. The increased pressure associated with lesser metatarsal overload may lead to synovitis and pain of the flexor tendon sheath. Methods: Fifteen consecutive patients with lesser metatarsal overload had visual analog scale scores determined at three metatarsophalangeal joint areas to determine the source of pain. The patients underwent seven maneuvers to determine the pain scale score: single-leg heel raise and palpation of the second and third metatarsophalangeal joints on the plantar proximal, plantar distal, and dorsal aspects. The patients were then injected with 0.5 mL of lidocaine, 2%, into the second and third flexor tendon sheaths, and the maneuvers were repeated. Results: Before the injection, the second metatarsophalangeal joint had a significantly greater visual analog scale score plantar than dorsal (6.9 and 2.6, P ≤ .01). The flexor tendon sheath injection significantly improved all seven pain scale scores. Conclusions: Patients with lesser metatarsal overload experienced significantly greater visual analog scale pain scores on the plantar than the dorsal aspect of the second metatarsophalangeal joint. The scores significantly improved after diagnostic injection in the flexor tendon sheaths. The flexor tendon sheaths are probably involved in patients with primarily plantar pain. (J Am Podiatr Med Assoc 99(2): 129–134, 2009)

Ultrasound-Guided BoNT-A (Botulinum Toxin A) Injection Into the Subscapularis for Hemiplegic Shoulder Pain: A Randomized, Double-Blind, Placebo-Controlled Trial

Stroke ◽  
2021 ◽  
Author(s):  
Botao Tan ◽  
Lang Jia
Keyword(s):  
Quality Of Life ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Scale Score ◽  
Visual Analog Scale ◽  
Visual Analog Scale Score ◽  
Analog Scale ◽  
Modified Ashworth Scale ◽  
Ashworth Scale

Background and Purpose: This study aimed to assess the efficacy of an ultrasound-guided lateral approach for BoNT-A (botulinum toxin A) injections into the subscapularis in patients with hemiplegic shoulder pain. Methods: This single-center trial used a randomized, double-blind, placebo-controlled design. The key inclusion criteria were a visual analog scale score of ≥4 cm and a modified Ashworth scale score of ≥1+. The patients were randomized to receive either BoNT-A injections or a placebo. The outcomes included the visual analog scale score, modified Ashworth scale score, pain-free passive range of motion of the hemiplegic shoulder, Fugl-Meyer assessment score for the upper extremities, and Stroke-Specific Quality-of-Life score. Results: A total of 49 hemiplegic shoulder pain patients were screened, and 36 were included. The participants receiving the BoNT-A injection reported a significant decrease in pain (visual analog scale, −1.39 [95% CI, −2.41 to −0.36]; P =0.002) and spasticity (modified Ashworth scale score for shoulder internal rotation, −0.72 [95% CI, −1.10 to −0.35]; P =0.001; modified Ashworth scale score for shoulder abduction, −0.44 [95% CI, −0.90 to −0.01]; P =0.026) and improved pain-free passive shoulder internal rotation range of motion (14.56 [95% CI, 6.70–21.41]; P <0.001) and quality of life (Stroke-Specific Quality-of-Life upper extremity subscale, P =0.025) compared with those receiving the placebo at the end point. The shoulder abduction range of motion did not significantly improve after the BoNT-A injection at the end point ( P =0.127). In addition, the patients in the BoNT-A group showed significant improvements in the visual analog scale score and shoulder external rotation range of motion at the 12-week follow-up. No injection-related adverse events were observed during or after the interventions in either group. Conclusions: The ultrasound-guided lateral approach for BoNT-A injections into the subscapularis is a precise and reliable method for reducing pain and spasticity and improving quality of life in stroke survivors with hemiplegic shoulder pain. Registration: URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR1900023513.

scholarly journals Rapid titration of opiate doses via patient-controlled intravenous analgesia for patients with severe cancer pain

2018 ◽  
Vol 16 ◽  
pp. 205873921877420 ◽  
Author(s):  
Suming Tian ◽  
Minjun Liu ◽  
Shina Qiao ◽  
Yue Wu
Keyword(s):  
Cancer Pain ◽  
Scale Score ◽  
Visual Analog Scale ◽  
Subcutaneous Injection ◽  
Pain Treatment ◽  
Visual Analog Scale Score ◽  
Analog Scale ◽  
Injection Group ◽  
Intravenous Analgesia ◽  
Time Required

This study was to investigate the feasibility and safety of patient-controlled intravenous analgesia for opiate titration in patients with severe cancer. Eligible patients with cancer pain were randomly divided into two groups, which were titrated with a subcutaneous injection of morphine and patient-controlled intravenous analgesia, respectively. The time required for patients to begin titration to reach visual analog scale score ⩽ 3, the adverse reactions during titration, the time spent by nurses in titrating each patient, and the time to complete the titration with a delayed-release dosage form analgesic effect and adverse reaction. The mean titration time of patient-controlled intravenous analgesia group (1.09 ± 0.82 vs 2.97 ± 1.98) and morphine dosage (18.78 ± 12.32 vs 13.23 ± 8.07) were significantly lower than those in the subcutaneous group ( P < 0.05). The incidences of nausea, vomiting, pruritus, urinary retention, and sedation in the subcutaneous injection group were significantly lower than those in the subcutaneous injection group ( P < 0.05). The assessment times of the two groups (10.19 ± 3.72 vs 10.25 ± 4.88) were similar ( P > 0.05). However, the time required for subcutaneous injection in patients under patient-controlled intravenous analgesia was significantly lower than that in the subcutaneous injection group (36.36 ± 12.15 vs 132.36 ± 32.79), which was statistically significant ( P < 0.05). After the titration, the controlled release opioid was used to treat cancer pain. The visual analog scale score of the patient-controlled intravenous analgesia group was significantly lower than that of the subcutaneous group (2.44 ± 1.37 vs 2.73 ± 0.91) at 7 days after treatment in the subcutaneous group (1.05 ± 0.30 vs 2.45 ± 1.29; P < 0.05). Patient-controlled intravenous analgesia technique can effectively and quickly complete the titration of cancer pain treatment with less occupational care resources and is better than the subcutaneous injection titration.

scholarly journals The witness of the patient’s relatives increases the anxiety of the physician, but decreases the anxiety of the relatives of the patient

2019 ◽  
pp. 102490791986063
Author(s):  
Caner Celik ◽  
Gulden Sinem Celik ◽  
Fatih Buyukcam
Keyword(s):  
Scale Score ◽  
Trait Anxiety ◽  
Visual Analog Scale ◽  
Healthcare Providers ◽  
Visual Analog Scale Score ◽  
Anxiety Score ◽  
Healthcare Team ◽  
State Trait Anxiety Inventory ◽  
Analog Scale ◽  
The Mean

Background:We generally keep relatives out of the area while a critical intervention so they cannot observe the management. Recent studies recommend witnessing of the resuscitation by arguing that it supports the patient’s relatives’ beliefs that everything that could be done had been done.Objective:We investigated the influence of family witness on the anxiety of patients’ relatives and on the healthcare team.Methods:This study was planned as a prospective observational study. The critical patients who were managed in the resuscitation room with or without intubation were included in the study. The State-Trait Anxiety Inventory survey form was given to patients’ relatives. Healthcare providers were given a survey, including a visual analog scale of anxiety.Results:The mean visual analog scale score of healthcare providers was 4.37 ± 2.5. The mean visual analog scale score of allied health personnel was similar to resident doctors but lower than consultant doctors. The anxiety of healthcare providers was higher during witnessed management. In the witnessed management group, the anxiety of healthcare providers was higher in patients who received cardiopulmonary resuscitation. The mean State-Trait Anxiety Inventory anxiety score of patients’ relatives was 50.2 ± 10.3. In witnessed management, the mean anxiety score was 49.5 ± 11.3; in non-witnessed management, the score was 51.0 ± 9.3. The anxiety of patients’ relatives was not higher, but rather slightly lower during witnessed management of patients.Conclusion:In our study, the anxiety of healthcare providers was higher in family-witnessed management. It was argued that consultant physicians were more anxious because they have more responsibility about the patients. With witnessed management, the anxiety of patients’ relatives could be reduced, but it is more ominous for healthcare professionals.

scholarly journals Superior gluteal vein syndrome: an intrapelvic cause of sciatica

2019 ◽  
Vol 6 (2) ◽  
pp. 104-108
Author(s):  
Nucelio Lemos ◽  
Laura Cancelliere ◽  
Adrienne L K Li ◽  
Renato Moretti Marques ◽  
Gustavo L Fernandes ◽  
...  
Keyword(s):  
Success Rate ◽  
Scale Score ◽  
Visual Analog Scale ◽  
Task Force ◽  
Case Series ◽  
Visual Analog Scale Score ◽  
Neurovascular Conflict ◽  
Analog Scale ◽  
Retrospective Case ◽  
Pain Scores

Abstract The role of malformed or dilated branches of iliac vessels in causing pelvic pain is not well understood. Such vessels may entrap nerves of the lumbosacral (LS) plexus against the pelvic sidewalls, producing symptoms not typically encountered in gynecological practice, including sciatica and refractory urinary and/or anorectal dysfunction. We describe cases of sciatica in which laparoscopy revealed compression of the LS plexus by variant superior gluteal veins (SGVs). In demonstrating an improvement in patient symptoms after decompression, we identify this neurovascular conflict as a potential intrapelvic cause of sciatica. This study is a retrospective case series (Canadian Task Force Classification II-3). Nerve decompression laparoscopies were performed in São Paulo, Brazil. Thirteen female patients undergoing laparoscopy for sciatica with no clear spinal or musculoskeletal causes were included in this study. In all cases, we identified LS entrapment by aberrant SGVs, and performed decompression by vessel ligation. The average preoperative visual analog scale score of 9.62 ± 0.77 decreased significantly to 2.54 ± 2.88 post-operatively (P < 0.001). The success rate (defined as ≥ 50% improvement in visual analog scale score) was 92.3%, over a follow-up of 13.2 ± 10.6 months. Our case series demonstrates a high success rate and significant decrease in pain scores after laparoscopic intrapelvic decompression, thereby identifying pelvic nerve entrapment by aberrant SGVs as a potential yet previously unrecognized cause of sciatica. This intrapelvic neurovascular conflict—the SGV syndrome—should be considered in cases of sciatica with no identifiable spinal or musculoskeletal etiology.

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