Semidirect targeting–based stereotactic mesencephalotomy for the treatment of refractory pain: a case series

2021 ◽  
pp. 1-11
Author(s):  
Rômulo A. S. Marques ◽  
Helioenai S. Alencar ◽  
Matheus A. Bannach ◽  
Osvaldo Vilela-Filho
Keyword(s):  
Pain Relief ◽  
Case Series ◽  
The Body ◽  
Morbidity Rate ◽  
Intractable Pain ◽  
Recurrence Rates ◽  
Refractory Pain ◽  
Increased Risk ◽  
Ablative Surgery ◽  
Mixed Pain

OBJECTIVE One of the few resources for treating medically intractable pain is ablative surgery, but its indications have fallen dramatically over the last decades. One such procedure is mesencephalotomy. This study aims to determine current risks and benefits of MR-guided semidirect targeting–based stereotactic mesencephalotomy. METHODS This was a retrospective study based on a review of the medical records of 22 patients with nociceptive (n = 5), neuropathic (n = 10), or mixed (n = 7) refractory pain treated with unilateral mesencephalotomy alone (17 patients) or associated with bilateral anterior cingulotomy (5 patients) between 2014 and 2021 in the authors’ institutions. The confidence interval adopted in this study was 95%. RESULTS The sample included 12 women and 10 men with ages ranging from 23 to 80 years (mean 55.1 ± 17.1 years). Using MR-guided semidirect targeting, the following structures were targeted: spinoreticulothalamic (neuropathic/mixed pain, n = 17), trigeminothalamic (nociceptive/mixed pain in the face, n = 5), and neospinothalamic (nociceptive/mixed pain in the body, n = 7) pathways. The most common response to macrostimulation was central heat/moderate discomfort. Radiofrequency thermocoagulation was made with 70°C–75°C/60 sec. A total of 86.3% (3 months) and 76.9% (12 months) of the patients achieved excellent or good results (improvement of pain > 50%), presenting with a significant mean pain relief of 80.1% at 3 months and 71.4% at 12 months postoperatively. The addition of bilateral anterior cingulotomy did not improve the results. Patients with upper limb, cervicobrachial, and face pain did significantly better than those with trunk pain. The worst results were seen in patients with neuropathic and/or trunk pain. The surgical failure (pain relief ≤ 25%) and recurrence rates were 9.1% each, apparently related to the use of lower lesioning parameters (70°C/60 sec) and to the presence of neuropathic and/or trunk pain. The morbidity rate was 8%, with both complications (vertical diplopia and confusion/agitation) happening in patients lesioned with 75°C/60 sec. There were no deaths in this series. CONCLUSIONS These results show that contemporary stereotactic mesencephalotomy is an effective, relatively low-risk, and probably underused procedure for treating medically intractable pain. Careful semidirect determination of the target coordinates associated with close attention to electrical macrostimulation responses certainly plays an important role in avoiding complications in most of the procedures. A higher lesioning temperature (75°C) apparently prevents recurrence, but at the cost of an increased risk of complications.

scholarly journals Ultrasound Guided Peripheral Nerve Stimulation Implant for Management of Intractable Pain after Inguinal Herniorrhaphy

2015 ◽  
Vol 18;1 (1;1) ◽  
pp. E31-E38 ◽  
Author(s):  
Foad Elahi
Keyword(s):  
Inguinal Hernia ◽  
Pain Relief ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Case Series ◽  
Peripheral Nerve Stimulation ◽  
Intractable Pain ◽  
Ultrasound Guided ◽  
Inguinal Herniorrhaphy ◽  
Significant Pain

Background: Inguinal hernia repair is one of the most common operations performed worldwide. Intractable pain following this operation is a potential debilitating complication. The exact etiology of this complex pain is unknown and the treatment of chronic pain after inguinal herniorrhaphy can be a difficult task for both the patient and the clinician. Objectives: The objectives of this study are to identify the ability of peripheral nerve electrical stimulation to decrease post inguinal herniorrhaphy pain, increase patients’ functionality, and decrease pain medication use. Study Design: Three patients with intractable pain after inguinal herniorrhaphy were included in this case series. Two patients had right-sided inguinal repair and one had a leftsided repair. Pain in these patients all began after the inguinal repair and had an average pain duration of 3.4 years after surgery. All 3 patients had been treated with multiple pain management modalities without significant pain improvement. We will describe the clinical course of these patients who presented with chronic intractable pain. After a period of failed conservative medical management and repetitive successful nerve blocks, we decided to proceed with utilizing electrical nerve stimulation as a treatment modality. Setting: This retrospective study was done at the university hospital and has an IRB assigned number. Results: After careful consideration of the patients’ history and physical examination and a thorough psychological assessment, we proceeded with a temporary percutaneous electrical neurostimulation that provided significant pain relief. Ultrasound guided permanent percutaneous electrical neurostimulation implant was shown to provide significant pain relief at 12-month follow-ups. We reviewed all existing pertinent medical literature related to the management of post herniorrhaphy pain. This case series adds to our current knowledge for chronic intractable post herniorrhaphy pain management. Limitations: This study is a retrospective assessment of a new technique that was applied to a limited number of cases. It remains to be determined whether this technique is superior to the classical open surgical technique in the future. Our findings warrant further studies on the utilization of peripheral nerve stimulation with chronic post herniorrhaphy pain. Key words: Peripheral nerve stimulation, ilioinguinal nerve, iliohypogastric nerve, nerve block, inguinal hernia repair, ultrasound guided procedure

scholarly journals Peripheral Field Nerve Stimulation in Refractory Subcutaneous Persistent Postsurgical Pain

2021 ◽  
pp. 85-88
Author(s):  
Benjamin S. Chaney
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Nerve Stimulation ◽  
Spinal Cord Stimulation ◽  
Intractable Pain ◽  
Electric Stimulation Therapy ◽  
Nerve Stimulator ◽  
Thoracic Pain ◽  
Transcutaneous Electric Nerve Stimulation ◽  
Refractory Pain

Background: The mechanistic underpinnings of nerve stimulation technology is an area of active debate in interventional pain literature. Whether the technology is transcutaneous, subcutaneous, or directly on the spinal cord/dorsal root ganglion, there are ample theories without substantive evidence. Although, these technologies have been proven to be invaluable for pain relief. Direct spinal cord stimulation is purported to be effective for peripheral pain through centrally mediated stimulation. However, in select cases, there is evidence for superior analgesia from a peripherally directed device, such as a subcutaneously placed peripheral field nerve stimulator (PFNS), when compared to spinal cord stimulators (SCS). Case Report: An 81-year-old man was referred for left upper thoracic pain exacerbated by lipoma excision with diagnostic imaging unsupportive of musculoskeletal etiology. The patient was found to have soft tissue tenderness to palpation worsened by activity. He failed numerous conservative treatments and procedures. An epidural SCS was trialed, with appropriate paresthesia mapping, but was unsuccessful in providing significant relief. Ultimately, a PFNS was trialed and found to provide adequate relief. A PFNS was later implanted, resulting in successful pain relief. Conclusion: The case demonstrates the importance of developing evidence-based guidelines for the application of PFNS. Additionally, it is important to delineate the shared and unique targets of nerve stimulator technologies so that patients may minimize risk through trial-and-error procedures. Key words: Surgical procedures, operative, spinal cord stimulation, refractory pain, paroxysmal nerve pain, intractable pain, electric stimulation therapy, back pain without radiation,transcutaneous electric nerve stimulation

scholarly journals Survival prognostic and recurrence risk factors after single pulmonary metastasectomy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Céline Forster ◽  
Amaya Ojanguren ◽  
Jean Yannis Perentes ◽  
Matthieu Zellweger ◽  
Thorsten Krueger ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Surgical Resection ◽  
Recurrence Risk ◽  
Pulmonary Metastasectomy ◽  
Morbidity Rate ◽  
Recurrence Rates ◽  
Term Survival ◽  
Colorectal Tumour ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background Identification of the prognostic factors of recurrence and survival after single pulmonary metastasectomy (PM). Methods Retrospective analysis of all consecutive patients who underwent PM for a single lung metastasis between 2003 and 2018. Results A total of 162 patients with a median age of 64 years underwent single PM. Video-Assisted Thoracic Surgery (VATS) was performed in 83.9% of cases. Surgical resection was achieved by wedge in 73.5%, segmentectomy in 7.4%, lobectomy in 17.9% and pneumonectomy in 1.2% of cases. The median durations of hospital stay and of drainage were 4 days (IQR 3–7) and 1 day (IQR 1–2), respectively. During the follow-up (median 31 months; IQR 15–58), 93 patients (57.4%) presented recurrences and repeated PM could be realized in 35 patients (21.6%) achieved by VATS in 77.1%. Non-colorectal tumour (HR 1.84), age < 70 years (HR 1.77) and previous extra-thoracic metastases (HR 1.61) were identified as prognostic factors of recurrence. Overall survival at 5-year was estimated at 67%. Non-colorectal tumour (HR 2.40) and mediastinal lymph nodes involvement (HR 3.42) were significantly associated with an increased risk of death. Conclusions Despite high recurrence rates after PM, surgical resection shows low morbidity rate and acceptable long-term survival, thus should remain the standard treatment for single pulmonary metastases. Trial registration: The Local Ethics Committee approved the study (No. 2019–02,474) and individual consent was waived.

Dental Implant Placement in Patients with a History of Medications Related to Osteonecrosis of the Jaws: A Systematic Review

2020 ◽  
Author(s):  
Judd Sher ◽  
Kate Kirkham-Ali ◽  
Denny Luo ◽  
Catherine Miller ◽  
Dileep Sharma
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Drug Therapy ◽  
Dental Implant ◽  
Case Series ◽  
Cochrane Central Register ◽  
Bisphosphonate Treatment ◽  
Implant Placement ◽  
Increased Risk ◽  
History Of

The present systematic review evaluates the safety of placing dental implants in patients with a history of antiresorptive or antiangiogenic drug therapy. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. PubMed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and OpenGrey databases were used to search for clinical studies (English only) to July 16, 2019. Study quality was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using a modified Newcastle-Ottawa scale and the Joanna Briggs Institute critical appraisal checklist for case series. A broad search strategy resulted in the identification of 7542 studies. There were 28 studies reporting on bisphosphonates (5 cohort, 6 case control, and 17 case series) and one study reporting on denosumab (case series) that met the inclusion criteria and were included in the qualitative synthesis. The quality assessment revealed an overall moderate quality of evidence among the studies. Results demonstrated that patients with a history of bisphosphonate treatment for osteoporosis are not at increased risk of implant failure in terms of osseointegration. However, all patients with a history of bisphosphonate treatment, whether taken orally for osteoporosis or intravenously for malignancy, appear to be at risk of ‘implant surgery-triggered’ MRONJ. In contrast, the risk of MRONJ in patients treated with denosumab for osteoporosis was found to be negligible. In conclusion, general and specialist dentists should exercise caution when planning dental implant therapy in patients with a history of bisphosphonate and denosumab drug therapy. Importantly, all patients with a history of bisphosphonates are at risk of MRONJ, necessitating this to be included in the informed consent obtained prior to implant placement. The James Cook University College of Medicine and Dentistry Honours program and the Australian Dental Research Foundation Colin Cormie Grant were the primary sources of funding for this systematic review.

Working conditions and occupational pathology of coal miners in the Arctic

2019 ◽  
pp. 452-457 ◽  
Author(s):  
S. A. Gorbanev ◽  
S. A. Syurin ◽  
N. M. Frolova
Keyword(s):  
Coal Mining ◽  
Working Conditions ◽  
Occupational Diseases ◽  
Climatic Factors ◽  
Coal Mines ◽  
The Arctic ◽  
Morbidity Rate ◽  
Coal Miners ◽  
Increased Risk ◽  
The Impact

Introduction. Due to the impact of adverse working conditions and climate, workers in coal-mining enterprises in the Arctic are at increased risk of occupational diseases (OD).The aim of the study was to study the working conditions, causes, structure and prevalence of occupational diseases in miners of coal mines in the Arctic.Materials and methods. Th e data of social and hygienic monitoring “Working conditions and occupational morbidity” of the population of Vorkuta and Chukotka Autonomous District in 2007–2017 are studied.Results. It was established that in 2007–2017 years, 2,296 ODs were diagnosed for the first time in 1851 coal mines, mainly in the drifters, clearing face miners, repairmen and machinists of mining excavating machines. Most often, the ODs occurred when exposed to the severity of labor, fibrogenic aerosols and hand-arm vibration. The development of professional pathology in 98% of cases was due to design flaws of machines and mechanisms, as well as imperfections of workplaces and technological processes. Diseases of the musculoskeletal system (36.2%), respiratory organs (28.9%) and nervous system (22.5%) prevailed in the structure of professional pathology of miners of coal mines. Among the three most common nosological forms of OD were radiculopathy (32.1%), chronic bronchitis (27.7%) and mono-polyneuropathy (15.4%). In 2017, coal miners in the Arctic had a professional morbidity rate of 2.82 times higher than the national rates for coal mining.Conclusions. To preserve the health of miners of coal mining enterprises, technical measures to improve working conditions and medical interventions aimed at increasing the body’s resistance to the effects of harmful production and climatic factors are necessary.

Safety and efficacy of stereotactic radiosurgery for tumors of the spine

2004 ◽  
pp. 413-418 ◽  
Author(s):  
Deborah L. Benzil ◽  
Mehran Saboori ◽  
Alon Y. Mogilner ◽  
Ronald Rocchio ◽  
Chitti R. Moorthy
Keyword(s):  
Spinal Cord ◽  
Single Dose ◽  
Pain Relief ◽  
Total Dose ◽  
Stereotactic Radiosurgery ◽  
Medical Center ◽  
Primary Tumors ◽  
Content Type ◽  
Increased Risk ◽  
Fine Print

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity. Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures. Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity. Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.

scholarly journals Death Rate Due to COVID-19 in Alzheimer’s Disease and Frontotemporal Dementia

2020 ◽  
Vol 78 (2) ◽  
pp. 537-541
Author(s):  
Jordi A. Matias-Guiu ◽  
Vanesa Pytel ◽  
Jorge Matías-Guiu
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Frontotemporal Dementia ◽  
Death Rate ◽  
Case Series ◽  
Care Homes ◽  
Relevant Factor ◽  
Increased Risk ◽  
Care Facilities ◽  
Probability Of Death

We aimed to evaluate the frequency and mortality of COVID-19 in patients with Alzheimer’s disease (AD) and frontotemporal dementia (FTD). We conducted an observational case series. We enrolled 204 patients, 15.2% of whom were diagnosed with COVID-19, and 41.9% of patients with the infection died. Patients with AD were older than patients with FTD (80.36±8.77 versus 72.00±8.35 years old) and had a higher prevalence of arterial hypertension (55.8% versus 26.3%). COVID-19 occurred in 7.3% of patients living at home, but 72.0% of those living at care homes. Living in care facilities and diagnosis of AD were independently associated with a higher probability of death. We found that living in care homes is the most relevant factor for an increased risk of COVID-19 infection and death, with AD patients exhibiting a higher risk than those with FTD.

scholarly journals The Association of Obesity and Liver Enzyme Activities in a Student Population at Increased Risk for Cardiovascular Disease / Veza Između Gojaznosti I Aktivnosti Jetrenih Enzima U Studentskoj Populaciji Sa Povećanim Rizikom Za Nastanak Kardiovaskularnih Bolesti

2013 ◽  
Vol 32 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Emina Čolak ◽  
Dragana Pap ◽  
Nada Majkić-Singh ◽  
Ivana Obradović
Keyword(s):  
Body Mass Index ◽  
Waist Circumference ◽  
Liver Enzyme ◽  
Body Mass ◽  
Statistical Processing ◽  
The Body ◽  
Control Group ◽  
Anthropometric Parameters ◽  
Nonalcoholic Fatty Liver ◽  
Increased Risk

Summary Background: It has been reported that obesity is associated with metabolic syndrome, insulin resistance, cardiovascular risk but also with nonalcoholic fatty liver disease (NAFLD). The prevalence of obesity in children and adolescents is increasing rapidly all over the world. The aim of this study was to analyze the value of liver enzymes: AST, ALT and γGT in a group of obese students in order to establish their correlation to anthropometric parameters such as: BMI (body mass index), WC (waist circumference), HC (hip circumference), and WHR (waist-to-hip ratio) compared to non-obese students who comprised the control group (CG). Methods: In this study, 238 students from the University of Novi Sad of both sexes (126 men and 112 women) with a mean age of 22.32 ± 1.85 years were included. According to the body mass index (BMI) lower and higher than 25 kg/m2 and waist circumference (WC) lower and higher than 94 cm (80 cm for females) the whole group of 238 students was divided into 2 subgroups: the obese group at increased risk for CVD (Group 1) and the group at lower risk for CVD (Group 2). AST, ALT and γGT activities were determined in fasting blood samples. Results: Statistical processing data revealed significantly higher values of AST, ALT and γGT in the group of students with BMI>25 kg/m2, WC>94 cm for males and WC>80 cm for females, HC>108 cm for males and HC>111 cm for females, and WHR>0.90 for males and WHR>0.80 for females (P<0.001). Significant association was established between anthropometric parameters and liver enzyme levels (P<0.0001). Conclusions: Obese students with higher BMI, WC, HC and WHR values have higher liver enzyme activites and a higher chance to develop NAFLD in the future.

scholarly journals Life Course Predictors of Allostatic Load Among LGBTQ Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 735-735
Author(s):  
Charles Hoy-Ellis ◽  
Hyun Kim ◽  
Karen Fredriksen Goldsen
Keyword(s):  
Older Adults ◽  
Life Course ◽  
Interpersonal Violence ◽  
Allostatic Load ◽  
Identity Management ◽  
The Body ◽  
Linear Regression Models ◽  
Psychophysiological Stress ◽  
Increased Risk ◽  
Wear And Tear

Abstract LGBTQ older adults are at significantly increased risk for poor mental and physical health, likely consequential to lifelong bias. Allostatic load (AL), the net effect of “wear and tear” on the body resulting from repeated, chronic over-activation of the psychophysiological stress response system. Utilizing the Health Equity Promotion Model, the aim of this study was to test potential life course predictors of AL, including interpersonal violence, legal marriage, and identity management in a sample of LGBTQ adults 50 to 97 years of age (n=317). Results from a series of hierarchical linear regression models showed that adult physical abuse and late identity disclosure for those who had been in an opposite-sex marriage predicted higher AL in this sample of LGBTQ older adults, indicating need for increased research on bias over the life course as contributory to AL and biopsychosocial dysfunction among LGBTQ older adults.

scholarly journals Expression of Cancer Testis Antigens in Tumor-Adjacent Normal Liver Is Associated with Post-Resection Recurrence of Hepatocellular Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2499
Author(s):  
Lisanne Noordam ◽  
Zhouhong Ge ◽  
Hadiye Özturk ◽  
Michail Doukas ◽  
Shanta Mancham ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Normal Liver ◽  
Occult Metastasis ◽  
Recurrence Rates ◽  
Curative Intent ◽  
Cancer Testis Antigens ◽  
Negative Prognostic Factor ◽  
Increased Risk ◽  
Hcc Recurrence ◽  
Cancer Testis

High recurrence rates after resection of hepatocellular carcinoma (HCC) with curative intent impair clinical outcomes of HCC. Cancer/testis antigens (CTAs) are suitable targets for cancer immunotherapy if selectively expressed in tumor cells. The aims were to identify CTAs that are frequently and selectively expressed in HCC-tumors, and to investigate whether CTAs could serve as biomarkers for occult metastasis. Tumor and paired tumor-free liver (TFL) tissues of HCC-patients and healthy tissues were assessed for mRNA expression of 49 CTAs by RT-qPCR and protein expression of five CTAs by immunohistochemistry. Twelve CTA-mRNAs were expressed in ≥10% of HCC-tumors and not in healthy tissues except testis. In tumors, mRNA and protein of ≥ 1 CTA was expressed in 78% and 71% of HCC-patients, respectively. In TFL, CTA mRNA and protein was found in 45% and 30% of HCC-patients, respectively. Interestingly, CTA-expression in TFL was an independent negative prognostic factor for post-resection HCC-recurrence and survival. We established a panel of 12 testis-restricted CTAs expressed in tumors of most HCC-patients. The increased risk of HCC-recurrence in patients with CTA expression in TFL, suggests that CTA-expressing (pre-)malignant cells may be a source of HCC-recurrence, reflecting the relevance of targeting these to prevent HCC-recurrence.

Sign in / Sign up

Export Citation Format

Share Document