Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

2014 ◽  
Vol 120 (6) ◽  
pp. 1484-1495 ◽  
Author(s):  
Paulo Roberto Lacerda Leal ◽  
Charlotte Barbier ◽  
Marc Hermier ◽  
Miguel Angelo Souza ◽  
Gerardo Cristino-Filho ◽  
...  
Keyword(s):  
High Resolution ◽  
Trigeminal Neuralgia ◽  
Clinical Outcomes ◽  
Pearson Correlation ◽  
P Value ◽  
Neurovascular Compression ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Trigeminal Nerves ◽  
Grade Iii

Object The aim of this study was to prospectively evaluate atrophic changes in trigeminal nerves (TGNs) using measurements of volume (V) and cross-sectional area (CSA) from high-resolution 3-T MR images obtained in patients with unilateral trigeminal neuralgia (TN), and to correlate these data with patient and neurovascular compression (NVC) characteristics and with clinical outcomes. Methods Anatomical TGN parameters (V and CSA) were obtained in 50 patients (30 women and 20 men; mean age 56.42 years, range 22–79 years) with classic TN before treatment with microvascular decompression (MVD). Parameters were compared between the symptomatic (ipsilateralTN) and asymptomatic (contralateralTN) sides of the face. Twenty normal control subjects were also included. Two independent observers blinded to the side of pain separately analyzed the images. Measurements of V (from the pons to the entrance of the nerve into Meckel's cave) and CSA (at 5 mm from the entry of the TGN into the pons) for each TGN were performed using imaging software and axial and coronal projections, respectively. These data were correlated with patient characteristics (age, duration of symptoms before MVD, side of pain, sex, and area of pain distribution), NVC characteristics (type of vessel involved in NVC, location of compression along the nerve, site of compression around the circumference of the root, and degree of compression), and clinical outcomes at the 2-year follow-up after surgery. Comparisons were made using Bonferroni's test. Interobserver variability was assessed using the Pearson correlation coefficient. Results The mean V of the TGN on the ipsilateralTN (60.35 ± 21.74 mm3) was significantly smaller (p < 0.05) than those for the contralateralTN and controls (78.62 ± 24.62 mm3 and 89.09 ± 14.72 mm3, respectively). The mean CSA of the TGN on the ipsilateralTN (4.17 ± 1.74 mm2) was significantly smaller than those for the contralateralTN and controls (5.41 ± 1.89 mm2 and 5.64 ± 0.85 mm2, respectively). The ipsilateralTN with NVC Grade III (marked indentation) had a significantly smaller mean V than the ipsilateralTN with NVC Grade I (mere contact), although it was not significantly smaller than that of the ipsilateralTN with NVC Grade II (displacement or distortion of root). The ipsilateralTN with NVC Grade III had a significantly smaller mean CSA than the ipsilateralTN with NVC Grades I and II (p < 0.05). The TGN on the ipsilateralTN in cured patients had a smaller mean CSA than that on the ipsilateralTN of patients with partial pain relief or treatment failure (p < 0.05). The same finding was almost found in relation to measurements of V, but the p value was slightly higher at 0.05. Conclusions Results showed that TGN atrophy in patients with TN can be demonstrated by high-resolution imaging. These data suggest that atrophic changes in TGNs, which significantly correlated with the severity of compression and clinical outcomes, may help to predict long-term prognosis after vascular decompression.

scholarly journals An age-dependent outcome analysis of microvascular decompression and percutaneous thermocoagulation in trigeminal neuralgia

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Naureen Keric ◽  
Darius Kalasauskas ◽  
Sophia L. Kreth ◽  
Martin B. Glaser ◽  
Harald Krenzlin ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Complication Rate ◽  
Age Groups ◽  
Treatment Strategies ◽  
The Elderly ◽  
Outcome Analysis ◽  
Neurovascular Compression ◽  
Duration Of Symptoms ◽  
Ganglion Gasseri

Abstract Background Trigeminal neuralgia (TN) is a severe pain condition and the most common facial neuralgia. While microvascular decompression (MVD) presents an excellent treatment in neurovascular compression cases, percutaneous thermocoagulation (PT) of the ganglion Gasseri is an alternative option. This study aimed to evaluate post-operative complication rate and outcome of both treatment strategies related to the patient’s age. Methods The medical records of all patients with the diagnosis of trigeminal neuralgia undergoing an MVD or PT of the ganglion Gasseri (between January 2007 and September 2017) were reviewed to determine the efficacy and the complication rate of both methods in regard to the patient’s age. Results Seventy-nine patients underwent MVD surgery and 39 a PT. The mean age of patients in the MVD group was 61 years and 73 years in the PT group. There were 59 (50%) female patients. Nerve-vessel conflict could be identified in 78 (98.7%) MVD and 17 (43.6%) PT patients on preoperative MRI. Charlson comorbidity index was significantly higher in PT group (2.4 (1.8) versus 3.8 (1.8) p < 0.001). The Barrow pain score (BPS) at the last follow-up demonstrated higher scores after PT (p = 0.007). The complication rate was markedly higher in PT group, mostly due to the facial hypesthesia (84.6% versus 27.8%; p < 0.001). Mean symptom-free survival was significantly shorter in the PT group (9 vs. 26 months, p < 0.001). It remained statistically significant when stratified into age groups: (65 years and older: 9 vs. 18 months, p = 0.001). Duration of symptoms (OR 1.005, 95% CI 1.000–1.010), primary procedure (OR 6.198, 95% CI 2.650–14.496), patient age (OR 1.033, 95% CI 1.002–1.066), and postoperative complication rate (OR 2.777, 95% CI 1.309–5.890) were associated with treatment failure. Conclusion In this patient series, the MVD is confirmed to be an excellent treatment option independent of patient’s age. However, while PT is an effective procedure, time to pain recurrence is shorter, and the favorable outcome (BPS 1 and 2) rate is lower compared to MVD. Hence MVD should be the preferred treatment and PT should remain an alternative in very selected cases when latter is not possible but not in the elderly patient per se.

Outcome of Corticosteroid Injection in De Quervain's Tenosynovitis

2021 ◽  
Vol 15 (11) ◽  
pp. 3288-3292
Author(s):  
Wahid Bakhsh ◽  
Asad Ullah Jan ◽  
Muhammad Shafiq ◽  
Naveed Iqbal ◽  
Muzafar Hussain Buriro ◽  
...  
Keyword(s):  
Pain Score ◽  
Triamcinolone Acetonide ◽  
Corticosteroid Injection ◽  
Mean Value ◽  
Injection Pain ◽  
P Value ◽  
Duration Of Symptoms ◽  
De Quervain’S Tenosynovitis ◽  
Minimum Age ◽  
The Mean

Background: De Quervain's tenosynovitis is a painful and swollen stenosing tenosynovitis of the first dorsal compartment of the wrist. After analysing the patient's medical history and doing a physical examination, a diagnosis is made. Finkelstein's test is almost always positive. Objective: The goal of this study was to investigate the effectiveness of local corticosteroid injections in the treatment of de Quervain's tenosynovitis. Material & Methods: The study enrolled fifty patients with De Querven's Tenosynovitis. NSAIDs were provided orally and topically to all patients for an average of six weeks with no obvious improvement. Using a visual analogue scale, it was determined how much soreness would be felt in the first dorsal compartment and how much pain would be felt during the Finkelstein test. The edoema was removed by injecting a mixture of 1 mL (10 mg) triamcinolone-acetonide and 1 mL of 1% lidocain hydrochloride into the affected wrist's first dorsal compartment. They were subsequently examined every two weeks for twenty-four weeks. After a local triamcinolone acetonide injection, pain and discomfort on the radial side of the wrist were alleviated, and a negative Finkelstein test was done. Results: The mean age among the patients was 36.6 years with 12.4 SD. The maximum age was 60 years and the minimum age was 25 years old. The duration of symptoms in 4-8 weeks was observed, the mean value was 6 weeks with 1.4 as SD the minimum duration recorded was 4 weeks with 8 weeks as maximum duration. At the start of the week of appearance of symptoms the pain score was 6.44 with 1.6 as SD. The minimum pain score was 4 and maximum pain score was 8. Pain score at 4 weeks was 0.66 with 1.6 as SD. As per the independent t-test the p value was less than 0.05 so the test was significant statistically. Conclusion: One or two local steroid injections in the first dorsal compartment can give considerable pain and inflammation alleviation in people with de Quervain's tenosynovitis.

95 Evaluating The Rate, The Predictors And The Outcomes Of Patients With Negative Appendectomy(NAR)

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Noureldin ◽  
A Ayantunde ◽  
M Elkholy ◽  
H S Shah Heer Shah ◽  
A Hatim
Keyword(s):  
Serum Bilirubin ◽  
Lower Abdominal Pain ◽  
Inflammatory Cells ◽  
Female Gender ◽  
P Value ◽  
Negative Appendectomy ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Negative Appendicectomy ◽  
Definition Of

Abstract Introduction Appendectomy is associated with complications and negative appendicectomy. We evaluated the rate and predictors of NAR in a cohort. Method Patients' data who underwent emergency appendicectomies over a year was analysed. A definition of NA; absence of inflammatory cells in the appendix. The NAR was calculated using (NAR-SDC) and (NAR-STC). Leucocytosis was a total WBC &gt;11000/mm3, elevated CPR &gt;5 mg/L. Results 372 patients were included. Median durations of symptoms 2 days. The mean admission WBC, CRP and serum bilirubin levels were 12,600 (3000-38000)/mm3, 66.9 (1-323) mg/L and 12.7 (4-38) µmol/L respectively. Laparoscopic appendectomy was performed in 93.5% with a conversion rate of 4.6%.NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower WBC (p-value 0.014), CRP (p-value 0.0001) levels on admission. Female gender, duration of symptoms more than 3 days, lower WBC were found to be predictors of NAR. Conclusions NA is a problem in management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, symptoms more than 3 days, lower WBC were predictors of NA.

scholarly journals Outcomes and Complications after Intraarterial Thrombolysis for Limb Ischemia: a 4 Year Study at a Single Centre

2016 ◽  
Vol 16 (2) ◽  
pp. 3-7
Author(s):  
Arturs Ligers ◽  
Patricija Ivanova ◽  
Gvido Bergs ◽  
Andris Levis ◽  
Sanita Ponomarjova ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Thrombolytic Therapy ◽  
Clinical Outcomes ◽  
Abdominal Aorta ◽  
High Mortality ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Duration Of Symptoms ◽  
Intraarterial Thrombolysis ◽  
The Mean

SummaryIntroduction.The reason for using thrombolytic therapy is to eliminate vascular thrombosis and promote vascular permeability. Acute limb ischemia is associated with significant morbidity and mortality. ROCHESTER, STILE and TOPAS studies showed that thrombolytic therapy for acute limb ischemia decreases the rate of surgical interventions and significantly increases the rate of limb salvage.Aim of the Study.The purpose of this study is to assess the efficacy and outcomes of intra-arterial thrombolysis in the treatment of acute occlusions of the lower limb over a four-year period.Material and Methods.We analysed 103 patients who had been treated in our department. There were acute ischemias of stage IIa and IIb according to the Rutherford classification. The data prior to, and after thrombolysis was analysed. We usedAlteplaseas a thrombolytic agent (mean dose 62 mg ±23.5). Procedural success was based on angiographic and clinical outcomes. Statistics were calculated by SPSS 16.Results.The mean duration of symptoms prior to hospitalisation was 2.5 days (IQR 5-96 hours). The mean age at the time of thrombolysis was 63±11 for males 69±10 years for females. The success of intraarterial thrombolysis was defined by angiographic and clinical outcomes (successful in 86.4% and failed in 13.6%). Adjunctive angioplasty was performed on 39 (37.9%) patients, and immediate reconstructive surgery was required on 19 (18.4%) patients. The incidence of complications was 17,4 %, with the most common being-bleeding from the puncture side, the urinary tract or the gastrointestinal tract. Overall mortality was 8.7%. The women who required thrombolysis were older (p=0,034) and with a higher death rate (p=0.047). A CDT (catheter-directed thrombolysis) for an abdominal aorta thrombosis carries a significantly high mortality rate (p=0.00013). There were no statistically significant differences between the duration of symptoms and limb amputation and between other analysed data.Conclusions.Intraarterial thrombolysis is an effective treatment method in acute limb ischemia for selected patients, as long as accurate procedural monitoring is ensured. Thrombolysis often leads to the discovery of underlying vascular lesions. A CDT for an abdominal aorta thrombosis carries a significantly high mortality rate.

Factors predicting the occurrence of syringomyelia in patients with Chiari I malformations

2019 ◽  
Vol 7 (8) ◽  
pp. 2967
Author(s):  
Vijayan Peettakkandy ◽  
Bijukrishnan Rajagopalawarrier ◽  
Sreenath Kuniyil ◽  
Jithin Veliyath Thankaraj
Keyword(s):  
Foramen Magnum ◽  
P Value ◽  
Tonsillar Herniation ◽  
Duration Of Symptoms ◽  
Medical College ◽  
Chiari I ◽  
The Mean ◽  
Time Of Presentation ◽  
Common Association ◽  
Cerebellar Tonsils

Background: Chiari I malformations are defined as the downward herniation of cerebellar tonsils more than 5 mm through the foramen magnum. Syringomyelia is a common association of Chiari I malformation.Methods: This purpose of this study was to determine the various factors predicting the occurrence of syringomyelia in patients with Chiari I malformations. This retrospective study was conducted in Government medical college, Thrissur, Kerala, India. 27 patients admitted with diagnosis of symptomatic Chiari I malformations during the period of January 2015 to January 2019 were selected for the study.Results: The mean age was 22.8 years and syringomyelia was more common in patients older than 10 years (p value0.005). Females were 17(63%) and males were 10(37%) but there no difference in occurrence of syringomyelia among both sexes(p value is 0.16). Syringomyelia was present in 17(63%) cases. Association between various factors and syringomyelia measured by calculating P value which was 0.005 for age >10 years, 0.16 for sex, 0.093 for duration of symptoms >12 months, 0.05 for tonsillar descend >10mm and 0.097 for hypertension. The p value for the association of duration of symptoms >12months and extend of tonsillar descend is 0.001 Mean duration of symptoms (onset of first symptom to the time of presentation) was 16.3 months and syringomyelia was more common in patients with duration of symptoms more than 12 months but this difference was statistically not significant (p value 0.093). Mean tonsillar descend from the level of foramen magnum was 11.3 mms and syringomyelia was more common in patients with tonsillar herniation more than 10mm (p value 0.05). There is a statistically significant relationship between duration of symptoms more than 12 months and tonsillar descend more than 10mm(p value 0.001).There is no significant association between hypertension and occurrence of syringomyelia in patients with Chiari I malformation.Conclusions: Incidence of Chiari I Malformations is more among adults and it is slightly higher in females. Syringomyelia is a common association of Chiari I Malformations. The occurrence of syringomyelia in patients with Chiari I Malformations associated with increasing age of patients and extend of tonsillar herniation. There is no statistically significant association between syringomyelia and duration of symptoms or hypertension.

scholarly journals Hematological profiles of visceral leishmaniasis patients before and after treatment of anti-leishmanial drugs at University of Gondar Hospital; Leishmania Research and Treatment Center Northwest, Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elias Shiferaw ◽  
Fadil Murad ◽  
Mitikie Tigabie ◽  
Mareye Abebaw ◽  
Tadele Alemu ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Blood Cell ◽  
Pearson Correlation ◽  
Hematological Parameters ◽  
Parasite Load ◽  
Treatment Center ◽  
Rank Test ◽  
P Value ◽  
Before And After ◽  
The Mean

Abstract Background Visceral leshimaniasis is a parasitic disease characterized by systemic infection of phagocytic cells and an intense inflammatory response. The progression of the disease or treatment may have an effect on hematological parameters of these patients'. Thus, the current study sought to compare the hematological profiles of visceral leishmaniasis patients before and after treatment with anti-leishmaniasis drugs. Method An institutional-based retrospective cohort study was conducted among visceral leishmaniasis patients admitted to the University of Gondar comprehensive specialized referral hospital leishmaniasis research and treatment centre between September 2013 and August 2018. Hematological profiles were extracted from the laboratory registration book before and after treatment. Data were entered to Epi-info and exported to SPSS for analysis. Descriptive statistics were summarized using frequency and percentage to present with the table. The mean, standard deviation, median, and interquartile range were used to present the data. Furthermore, using the paired t-test and the Wilcoxon Signed rank test, the mean difference for normally and non-normally distributed data was compared. Spearman and Pearson correlation analysis were used to describe the relationship between hematological parameters and various variables. A P value of 0.05 was considered statistically significant. Result With the exception of the absolute neutrophil count, all post-treatment hematological parameters show a significant increase when compared to pre-treatment levels. Prior to treatment, the prevalence of anemia, leukopenia, and thrombocytopenia was 85.5, 83.4, and 75.8%, respectively, whereas it was 58.3, 38.2, and 19.2% following treatment. Furthermore, parasite load was found to have a statistically significant negative correlation with hematological profiles, specifically with white blood cell and red blood cell parameters. Conclusion According to our findings, patients with visceral leishmaniasis had improved hematological profiles after treatment. The effect of treatment on parasite proliferation and concentration within visceral organs, in which the parasite load could directly affect the patient's hematological profiles, may be associated with the change in hematological profiles.

scholarly journals Correlation between Occurrence of Psychosomatic Disorders and Age during COVID-19 Lockdown

2021 ◽  
Author(s):  
Hetvi Bharatbhai Jethloja ◽  
Priyanka Birjubhai Unadkat ◽  
Radhika Kanaiyalal Raichura ◽  
Janvi Narendrasinh Rana ◽  
Nidhi Sudhir Ved
Keyword(s):  
Significant Positive Correlation ◽  
Pearson Correlation ◽  
P Value ◽  
Psychosomatic Disorders ◽  
Psychosomatic Disorder ◽  
Cross Sectional ◽  
Positive Correlation ◽  
Scale Scores ◽  
The Mean ◽  
Group 2

Introduction: The Coronavirus Disease-2019 (COVID-19) has caused a serious threat to people’s mental health causing psychosomatic disorders such as panic disorder, anxiety, and depression. Aim: To find out the correlation between the occurrence of psychosomatic disorders and age during the COVID-19 lockdown phase. Materials and Methods: This cross-sectional, observational study was conducted in Department of Physiotherapy at RK University, Rajkot, Gujarat, India. Males and females of age ≥21 years, with an ability to understand and fill Google form were recruited for the study. The subjects were divided into four groups according to age 21-34 years, 35-54 years, 55-64 years, and 65 years and older. There were 250 participants in each group. The subjects were asked to fill the COVID-19 Peritraumatic Distress Index (CPDI). Data were analysed by using software Statistical Package for the Social Science (SPSS) version 20. The normality of data was checked by the Shapiro Wilk test. Data followed parametric type so; Pearson correlation test was applied to find out the correlation between age and CPDI score. Results: The mean age of the population was 49.24±18.14 years. The mean CPDI scale scores were 27.572, 31.948, 31.364, and 35.328, respectively from groups 1 to 4. There was a significant positive correlation (p-value=0.031) in group 4, while no significance was found in group 1 (p-value=0.074), group 2 (p-value=0.067), and group 3 (p-value=0.062) Conclusion: There was a significant positive correlation between age and psychosomatic disorder occurrence in the geriatric age group (65 years and older) in the Rajkot city.

scholarly journals TP9.2.1Evaluating the incidence, the predictors and the outcomes of patients with negative appendicectomy

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Khaled Noureldin ◽  
Mohamed Elkhouly ◽  
Heer Shah ◽  
AliAsgar HatimAli ◽  
Bolu Ayantunde ◽  
...  
Keyword(s):  
Lower Abdominal Pain ◽  
Inflammatory Cells ◽  
Female Gender ◽  
P Value ◽  
Duration Of Symptoms ◽  
Standard Definition ◽  
Significant Pathology ◽  
The Mean ◽  
Negative Appendicectomy ◽  
Definition Of

Abstract Introduction Negative appendicectomy (NA) is still a major issue following appendicectomy. We evaluated the rate and predictors of negative appendicectomy in a cohort. Patients and Methods Data of patients who underwent emergency appendicectomies over a year was collected and analysed. The absence of inflammation and/or other significant pathology in the appendix was considered negative by standard definition. A stricter definition of NA was the absence of inflammatory cells in the appendix. Negative appendicectomy rate (NAR) was calculated using the standard criteria (NAR-SDC) and the strict criteria (NAR-STC). Results 372 patients were included, 179 males and 193 females with a median age of 27 (5-94) years. Median duration of symptoms and waiting time to surgery were 2 days and 1 day respectively. The mean admission WBC and CRP were 12,600 (3000-38000)/mm3 and 66.9 (1-323) mg/L respectively. Laparoscopic appendicectomy was performed in 93.5% of patients with a conversion rate of 4.6%. NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was significantly higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower mean total WBC (p-value 0.014) and CRP (p-value 0.0001) on admission. Independent predictors of negative appendicectomy are female gender, duration of symptoms more than 3 days, and lower total WBC. Conclusion NA is still a major problem in the management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, symptoms duration more than 3 days, lower WBC are independent predictors of NA.

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