Personalized multitarget biologic injection in the spine: prospective case series of multitarget platelet-rich plasma for low back pain

Aim: To evaluate the use of a multitarget platelet-rich plasma (PRP) injection approach for the treatment of chronic low back pain (LBP). Materials & Methods: Forty-six patients with more than 12 weeks of LBP who failed conservative treatments were injected with PRP into the facet joints, intervertebral discs, epidural space and/or paravertebral muscles. Visual analog pain scale and Roland-Morris Disability Questionnaire scores were measured at baseline and predefined intervals. Results: Mean visual analog pain scale was reduced from 8.48 to 5.17 and mean Roland-Morris Disability Questionnaire from 18.0 to 10.98 at 12 weeks (p < 0.001). These statistically significant improvements were sustained over 52 weeks. No adverse effects were observed. Conclusion: Our PRP approach demonstrated clinically favorable results and may be a promising treatment for chronic LBP.

Bupivacaine-lidocaine versus Ropivacaine-lidocaine Retrobulbar Anesthesia in Vitreoretinal Surgery

Purpose: To compare efficacies of bupivacaine-lidocaine and ropivacaine-lidocaine mixtures in terms of inducing retrobulbar anesthesia during vitrectomy.Methods: Sixty patients who underwent retrobulbar anesthesia during vitrectomy were divided into two groups. Patients in group 1 received a mixture of bupivacaine and lidocaine (n = 30); patients in group 2 received a mixture of ropivacaine and lidocaine (n = 30). The effects of the two combinations were retrospectively compared and analyzed. The onset times of analgesia and akinesia were measured. Two hours after surgery, sensory blockade was assessed by touching the corneas with cotton swabs and by communicating with patients. Ocular movement was evaluated in four gaze direction quadrants. A 10-point visual analog pain scale was used to assess pain during and 2 hours after surgery. Intra- and postoperative complications were recorded.Results: The mean analgesia onset times in groups 1 and 2 were 94.62 ± 28.87 and 92.32 ± 35.53 seconds, respectively (p = 0.071); the mean akinesia onset times were 147.89 ± 59.35 and 132.57 ± 76.38 seconds (p = 0.223), respectively. Patients in group 2 reported significantly less postoperative pain and exhibited less postoperative ocular movement, compared with patients in group 1 (both p = 0.002). One patient in group 1 experienced respiratory depression after retrobulbar blockade.Conclusions: When retrobulbar anesthesia is required during vitrectomy, a ropivacaine-lidocaine mixture and a bupivacaine-lidocaine mixture induce anesthesia with similar rapidity. However, the ropivacaine-lidocaine mixture is safer and affords better-quality intra- and postoperative anesthesia.

Efficiency of gravitational therapy in complex rehabilitation of patients after arthroscopic knee operations

An analysis of the effectiveness of the complex of medical rehabilitation of patients with minimally invasive knee operations in the early and late postoperative periods, which provides for the use of gravity therapy with dosed muscle work of the lower extremities. To assess the effectiveness of the rehabilitation complex, patients of the studied groups were subjected to knee joint goniometry, rheovasography and electrothermometry of the lower extremities, as well as evaluation by the visual-analog pain scale and the total algofunctional Leken index. The result of the study shows that earlier inclusion of the gravitational factor in combination with dosed physical activity in the rehabilitation complex increases its effectiveness and can significantly reduce negative manifestations due to pathogenetic action in patients who have undergone arthroscopic knee surgery.

TERAPI AKUPRESUR SEBAGAI EVIDENCE BASED NURSING UNTUK MENGURANGI NYERI DADA PADA PASIEN SINDROM KORONER AKUT

Abstrak Penyakit jantung koroner secara klinis ditandai dengan nyeri dada akibat sumbatan di arteri coroner. Akupresur merupakan bagian terapi komplementer yang mampu meningkatkan kadar endorfin untuk merangsang penurunan nyeri. Pelaksanaan evidence based nursing akupresur ini diberikan pada 8 pasien dengan teknik pemilihan purposive sampling. Instrument penerapan menggunakan skala penilaian nyeri visual analog scale. Penerapan akupresur diberikan selama 20 menit pada titik akupresur L14 dengan skala nyeri 0 sampai 5. Hasil dari 8 sampel yang diberikan akupresur semua pasien mengalami penurunan skala nyeri. Penekanan atau sentuhan pada titik akupresur dapat meningkatkan kadar endorfin dalam darah maupun sistemik. Endorfin merupakan opiat tubuh secara alami dihasilkan oleh kelenjar pituitary yang berguna untuk mengurangi nyeri, mempengaruhi memori dan mood yang kemudian akan memberikan perasaan relaks. Terapi akupresur terbukti mampu menurunkan nyeri sehingga bermanfaat untuk diterapkan pada pasien akut koroner sindrom dengan keluhan nyeri dada. Abstract Coronary heart disease is clinically characterized by chest pain due to a blockage in the coronary arteries. Acupressure is part of complementary therapy that is able to increase endorphin levels to stimulate pain reduction. The implementation of evidence based nursing acupressure was given to 8 patients with a purposive sampling technique. The application instrument uses a visual analog pain scale rating scale. The application of acupressure was given for 20 minutes at the L14 acupressure point with a pain scale of 0 to 5. The results of the 8 samples given acupressure all patients experienced a decrease in pain scale. Emphasis or touch on the acupressure point can increase blood and systemic endorphin levels. Endorphins are the body's opiates naturally produced by the pituitary gland which are useful for reducing pain, affecting memory and mood which will then relax. Acupressure therapy has been proven to reduce pain so it is useful to apply to acute coronary syndrome patients with chest pain.

Safety and Efficacy of Ultrasound-Guided Cryoablation for Benign Breast Fibroepithelial Lesions

Objective The purpose of this study is to evaluate the safety and efficacy of cryoablation for benign breast fibroepithelial lesions (FELs) that otherwise warrant surgical excision, including symptomatic fibroadenomas, growing fibroadenomas, and cellular FELs. Methods All patients from 2016–2018 who had ultrasound-guided cryoablation of a symptomatic and/or growing fibroadenoma or cellular fibroepithelial lesion were reviewed. The electronic medical record was reviewed for any procedure-related complications and reduction in mass volume by ultrasound and was recorded to assess for efficacy. Patients were surveyed using a seven-point Likert scale to assess satisfaction with the procedure and a ten-point visual analog pain scale to assess level of discomfort. Results Twenty-four women (average age 37.1 years, range 19–57 years) with 26 FELs were treated with no adverse events and 100% technical success. Thirteen cellular FELs and 13 symptomatic and/or growing fibroadenomas were ablated. Twenty-two patients had an average imaging follow-up of 11.7 months (range 5–23 months), and 18 patients completed the follow-up survey. There was 92% (22/24) clinical success, defined as a greater-than-50% reduction in mass volume. Average reduction in mass volume was 86% overall. Eighty-five percent (17/20) would recommend the procedure to others and reported pain during the procedure to be minimal (average 2.4 out of 10) with overall satisfaction rating of 6.2 out of 7. Twelve symptomatic masses demonstrated a significant reduction in pain after cryoablation (P = 0.01). Conclusion Cryoablation is a safe and efficacious minimally invasive nonsurgical alternative for the treatment of benign breast FELs.

Effects of pilates method in low back back pain.

Introduction: Back pain is all pain conditions, located in the lower back, between the last rib and the gluteal fold. The main goal of Pilates is to strengthen the center of the body, improving spinal stabilization. Objective: This study aimed at examining the effects of Pilates on low back pain, checking their effect on low back pain, using a visual analog pain scale, assess the quality of life through the Quality of Life Questionnaire - WHOQOL Bref and measure flexibility by Test FINGER-FLOOR. Method: This study was submitted to the CEP of a private college in Teresina, PI (no. 18441813.0.0000.5211). The sample was not random type, consisting of six participants with low back pain box. They were assessed before and after treatment by means of an evaluation form (age, weight, height, BMI, visual analog pain scale - EVA Test and finger-floor) and the Quality of Life Questionnaire - WHOQOL Bref . 10 individual sessions were conducted with the Pilates method, often two weekly visits lasting one hour each. Data were analyzed using parametric test "t" test, with significance level of p ≤ 0.05. Results: The results showed that treatment significantly reduced pain, with p = 0, 0048 Regarding quality of life, we can observe significant improvements in the Physical Domain with p = 0.0288, and p = Psychological Domain. 0.0477. Already in Social Domains, Domain Environment and overall quality of life, the results were not significant with p = 0.2894, p = 0.6357 and p = 0.0830, respectively. Flexibility in the analysis of observed significant improvement, with p = 0.0039. Conclusion: Therefore, the Pilates Method can be an effective treatment option in the treatment of lumbago, acting globally.

Early analgesia after periodontal treatment in dogs: a comparison of three analgesic protocols

The analgesic effects of carprofen, morphine and bupivacaine on early oral pain after periodontal treatment in dogs have been poorly investigated. Forty-five client-owned dogs (8.5 &plusmn; 6.4 kg and 7.8 &plusmn; 3.2 years) scheduled for periodontal treatment were allocated to carprofen, morphine and bupivacaine groups (n = 15 each). The study was designed as a prospective, randomised, double &ldquo;blinded&rdquo; clinical study. Carprofen (CAR, 4 mg/kg, subcutaneously) or morphine (MOR, 0.3 mg/kg, intramuscularly) was given thirty minutes before the dogs were placed under anesthesia. Bilateral maxillary and mandibular nerve blocks were performed with bupivacaine (BUP, 1 mg/kg), after the induction of anesthesia. Dogs were anaesthetised with medetomidine-propofol-isoflurane and reversal was carried out using atipamezole. Periodontal painful sub-gingival scaling was performed in all dogs. Periodontal treatment lasted for up to one hour. A modified University of Melbourne Pain Score (UMPS, 0&ndash;28&nbsp;points), Visual Analog pain Scale (VAS, 0&ndash;100 mm), plasma glucose (Glu) and serum cortisol (Cor) levels were assessed before administration of analgesics (MOR-0, CAR-0, BUP-0) and two hours thereafter, that is thirty minutes after atipamezole administration (MOR-2, CAR-2, BUP-2). Analgesia rescue with tramadol (2 mg/kg intramuscularly) was provided for animals with modified UMPS over 14 or VAS over 50 points. Differences in Glu and Cor values were analysed with analysis of variance (ANOVA) for repeated measures, in UMPS and VAS over time for each group with the Friedman test and pre- and postoperatively using the Mann-Whitney U-test. Differences were considered significant at P &lt; 0.05. Analgesia rescue was provided to one patient of the CAR group and one patient of the MOR group. No differences in UMPS values between groups were detected. A significant increase in VAS values after treatment was detected in all groups. Plasma glucose levels significantly increased in MOR-2 compared to MOR-0 and CAR-2. Serum cortisol levels significantly increased in MOR-2 compared to MOR-0, CAR-2 and BUP-2. The results of this study indicate that bupivacaine nerve blocks could be superior to carprofen, which in turn could be superior to morphine, for early analgesia (up to two hours) following sub-gingival scaling for periodontal treatment in dogs. &nbsp;

A Prospective, Randomized, Double-blinded Study with Crossover to Determine the Efficacy of Radio-frequency Nerve Ablation for the Treatment of Heel Pain

Background: Previous studies have demonstrated that radio-frequency nerve ablation (RFNA) can be an effective treatment for plantar fasciosis. This study provides additional evidence in support of this treatment, with statistically significant data that demonstrate the success of this technique. Methods: In this multicenter, randomized, prospective, double-blinded study with crossover, 17 patients were divided into two groups, with eight initially receiving RFNA treatment and nine initially receiving sham treatment. If no improvement was observed after 4 weeks, a crossover was offered. Results of the treatment were evaluated by the patient and by a blinded physician using a visual analog pain scale to rate first-step pain, average pain, and peak pain in the heel region. Results: We observed a statistically significant improvement in the symptoms of plantar fasciosis in patients actively treated with RFNA and no significant improvement in the sham-treated group. More important, those treated with sham subsequently demonstrated statistically significant improvement after subsequent RFNA treatment. Conclusions: Using a prospective, randomized study with sham treatment and crossover, this study demonstrates the efficacy of RFNA for the treatment of plantar fasciosis. (J Am Podiatr Med Assoc 103(1): 8–15, 2013)