Posterior Branches of Lumbar Spinal Nerves – Part III: Spinal Dorsal Ramus Mediated Back Pain – Pathomechanism, Symptomatology and Diagnostic Work-up

2017 ◽  
Vol 19 (4) ◽  
pp. 0-0
Author(s):  
Katarzyna Kozera ◽  
Bogdan Ciszek ◽  
Paweł Szaro
Keyword(s):  
Back Pain ◽  
Iliac Crest ◽  
Spinal Nerve ◽  
The Body ◽  
Spinal Nerves ◽  
Spinal Dorsal ◽  
Diagnostic Work ◽  
Lumbar Spinal ◽  
Work Up ◽  
Diagnostic Work Up

Spinal Dorsal Ramus Mediated Back Pain is the second most frequently described condition (the first one being Lumbar Facet Syndrome) originating from pathology involving posterior branches of lumbar spinal nerves. Spinal Dorsal Ramus Mediated Back Pain was described as “thoracolumbar junction syndrome” by Maigne in 1989. As a rule, Spinal Dorsal Ramus Mediated Back Pain presents unilaterally within posterior branches at the levels Th11-12 and L1-2. The pain is triggered by extension and/or rotation. Typical symptoms include pain that may radiate towards the gluteal area and posterior iliac crest and does not cross the body midline. Clinical symptoms may correlate with the area supplied by the whole spinal nerve of the given segment, including both the posterior and anterior branch. For this reason, patients may report not only low back pain, but also pseudovisceral pain in the hypogastric area, false sciatic neuralgia, tenderness of the pubic symphysis and hypersensitivity of the intestines. The above symptoms may lead to diagnostic difficulties. Diagnostic work-up may benefit from performance of the Kibler Fold Test to determine sensitivity of the tissues surrounding the iliac crest. Patients with Spinal Dorsal Ramus Mediated Back Pain respond well to manual manipulative techniques if these are delivered in a technically correct manner and address the appropriate segment. A recommended approach for patients with absolute contraindications to manipulation, i.e. advanced osteoporosis or osteogenesis imperfecta, is a block of the po­sterior branch of the spinal nerve involved.

scholarly journals Bradycardia in elderly patient: look at the body temperature

2019 ◽  
Vol 13 (4) ◽  
pp. 241-243
Author(s):  
Alfonso Sforza ◽  
Maria Viviana Carlino ◽  
Costantino Mancusi ◽  
Emanuela Catapano ◽  
Graziella Castellano ◽  
...  
Keyword(s):  
Body Temperature ◽  
Sinus Bradycardia ◽  
The Body ◽  
Emergency Team ◽  
Level Of Consciousness ◽  
Passive Rewarming ◽  
Diagnostic Work ◽  
Work Up ◽  
Electrocardiographic Abnormalities ◽  
Diagnostic Work Up

ABSTRACT We describe a case of a 83-year-old man who presented to the Emergency Department for bradycardia and reduced level of consciousness. His conditions had progressively worsened in the last few days and bradycardia induced his relatives to call on emergency team. He presented with hypoxia, cough, bradycardia and a reduced Glasgow Coma Scale value. The body temperature was not detected by standard thermometer and the electrocardiogram showed sinus bradycardia with prominent Osborne wave in the lateral precordial leads. His rectal temperature was 30.1 °C and the diagnostic work up showed a right lung pneumonia. He underwent active and passive rewarming treatment and sepsis treatment. Electrocardiographic abnormalities disappeared after rewarming and the patient was admitted to sub-intensive care unit.

scholarly journals Bone Marrow Trephine Biopsies from Posterior Superior Iliac Crest in Living Neonates.

2020 ◽  
Author(s):  
Sandip Bartakke ◽  
Umesh Lukade ◽  
Shrividya Sethuratnam
Keyword(s):  
Bone Marrow ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Iliac Crest ◽  
Underlying Mechanism ◽  
Neonatal Intensive Care Units ◽  
Diagnostic Work ◽  
Work Up ◽  
First Time ◽  
Diagnostic Work Up

Cytopenias are common among neonates in neonatal intensive care units (NICU). Although, bone marrow aspirations (BMA) are often performed as part of diagnostic work up but trephine marrow biopsies (BMB) have not been reported from living neonates. BMB is indispensable to accurately assess the cellularity and architecture. There is paucity of literature regarding the technique of BMB in neonates. In this report, for the first time, we describe trephine BMB from Posterior superior iliac crest (PSIC) using 18 guage BMA needle in six living neonates admitted to NICU where bone marrow biopsy findings helped in understanding the underlying mechanism and diagnosis of cytopenias.

Macroanatomical Structure of the Lumbosacral Plexus and its Branches in the Indigenous Duck

2018 ◽  
Vol 52 (1-4) ◽  
pp. 1-9 ◽  
Author(s):  
MT Hussan ◽  
MS Islam ◽  
J Alam
Keyword(s):  
Hind Limb ◽  
Femoral Nerve ◽  
Morphological Structure ◽  
Spinal Nerve ◽  
The Body ◽  
Lumbar Plexus ◽  
Lumbosacral Plexus ◽  
Sacral Plexus ◽  
Spinal Nerves ◽  
Femoral Cutaneous Nerve

The present study was carried out to determine the morphological structure and the branches of the lumbosacral plexus in the indigenous duck (Anas platyrhynchos domesticus). Six mature indigenous ducks were used in this study. After administering an anesthetic to the birds, the body cavities were opened. The nerves of the lumbosacral plexus were dissected separately and photographed. The lumbosacral plexus consisted of lumbar and sacral plexus innervated to the hind limb. The lumbar plexus was formed by the union of three roots of spinal nerves that included last two and first sacral spinal nerve. Among three roots, second (middle) root was the highest in diameter and the last root was least in diameter. We noticed five branches of the lumbar plexus which included obturator, cutaneous femoral, saphenus, cranial coxal, and the femoral nerve. The six roots of spinal nerves, which contributed to form three trunks, formed the sacral plexus of duck. The three trunks united medial to the acetabular foramen and formed a compact, cylindrical bundle, the ischiatic nerve. The principal branches of the sacral plexus were the tibial and fibular nerves that together made up the ischiatic nerve. Other branches were the caudal coxal nerve, the caudal femoral cutaneous nerve and the muscular branches. This study was the first work on the lumbosacral plexus of duck and its results may serve as a basis for further investigation on this subject.

scholarly journals Stroke masquerading as cardiac arrest: the artery of Percheron

2021 ◽  
Vol 14 (1) ◽  
pp. e238681
Author(s):  
Megan Quetsch ◽  
Sureshkumar Nagiah ◽  
Stephen Hedger
Keyword(s):  
Cardiac Arrest ◽  
Clinical Assessment ◽  
Altered Consciousness ◽  
Cognitive Changes ◽  
Consciousness Level ◽  
Artery Of Percheron ◽  
Conscious Level ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

The artery of Percheron (AOP) is a rare arterial variant of the thalamic blood supply. Due to the densely packed collection of nuclei it supplies, an infarction of the AOP can be devastating. Here we highlight a patient who had an AOP stroke in the community, which was initially managed as cardiac arrest. AOP strokes most often present with vague symptoms such as reduced conscious level, cognitive changes and confusion without obvious focal neurology, and therefore are often missed at the initial clinical assessment. This case highlights the importance of recognising an AOP stroke as a cause of otherwise unexplained altered consciousness level and the use of MRI early in the diagnostic work-up.

scholarly journals Death of unknown cause? Post-mortem diagnosis of fulminant course of an EBV-associated secondary hemophagocytic lymphohistiocytosis

2021 ◽  
Author(s):  
Josia Fauser ◽  
Stefan Köck ◽  
Eberhard Gunsilius ◽  
Andreas Chott ◽  
Andreas Peer ◽  
...  
Keyword(s):  
Immune Response ◽  
Case Report ◽  
Macrophage Activation ◽  
Post Mortem ◽  
Life Threatening ◽  
Appropriate Therapy ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Secondary Hemophagocytic Lymphohistiocytosis

SummaryHLH is a life-threatening disease, which is characterized by a dysregulated immune response with uncontrolled T cell and macrophage activation. The often fulminant course of the disease needs a fast diagnostic work-up to initiate as soon as possible the appropriate therapy. We present herein the case of a 71-year-old patient with rapidly progressive hyperinflammatory syndrome, which post mortem resulted in the diagnosis of EBV-associated HLH. With this case report, we intend to highlight the relevance of the HScore in the diagnosis of HLH, to create a greater awareness for EBV as a trigger of HLH, and to demonstrate the importance of treating EBV-associated HLH as early as possible.

scholarly journals COVID-19 lung injury as a primer for immune checkpoint inhibitors (ICIs)-related pneumonia in a patient affected by squamous head and neck carcinoma treated with PD-L1 blockade: a case report

2021 ◽  
Vol 9 (2) ◽  
pp. e001870
Author(s):  
Angelo Dipasquale ◽  
Pasquale Persico ◽  
Elena Lorenzi ◽  
Daoud Rahal ◽  
Armando Santoro ◽  
...  
Keyword(s):  
Lung Injury ◽  
Head And Neck ◽  
Checkpoint Inhibitors ◽  
Experimental Therapy ◽  
Common Mechanism ◽  
Nasopharyngeal Swab ◽  
Immune Mediated ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

By the beginning of the global pandemic, SARS-CoV-2 infection has dramatically impacted on oncology daily practice. In the current oncological landscape, where immunotherapy has revolutionized the treatment of several malignancies, distinguishing between COVID-19 and immune-mediated pneumonitis can be hard because of shared clinical, radiological and pathological features. Indeed, their common mechanism of aberrant inflammation could lead to a mutual and amplifying interaction.We describe the case of a 65–year-old patient affected by metastatic squamous head and neck cancer and candidate to an experimental therapy including an anti-PD-L1 agent. COVID-19 ground-glass opacities under resolution were an incidental finding during screening procedures and worsened after starting immunotherapy. The diagnostic work-up was consistent with ICIs-related pneumonia and it is conceivable that lung injury by SARS-CoV-2 has acted as an inflammatory primer for the development of the immune-related adverse event.Patients recovered from COVID-19 starting ICIs could be at greater risk of recall immune-mediated pneumonitis. Nasopharyngeal swab and chest CT scan are recommended before starting immunotherapy. The awareness of the phenomenon could allow an easier interpretation of radiological changes under treatment and a faster diagnostic work-up to resume ICIs. In the presence of clinical benefit, for asymptomatic ICIs-related pneumonia a watchful-waiting approach and immunotherapy prosecution are suggested.

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