Clinical calcium
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Neural blocks are commonly used for patients with acute or chronic low back pain. It is important to do correctly technical procedure of neural blocks and more important to be well aware of the indication and clinical value of neural blocks. Neural blocks have two aspects of diagnostic and therapeutic value. In this article, the indication and clinical value of neural blocks were reviewed in trigger point blocks, epidural blocks, selective nerve root blocks, facet blocks and lumbar posterior medial branch blocks.
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Procalcitonin, a propeptide of calcitonin, is normally produced in the C-cells of the thyroid gland, but it's plasma level markedly increases, mostly due to extra-thyroidal production in cases of severe infections (bacterial, parasitic and fungal) with systemic manifestations, especially in the presence of septic shock. Since noninfectious inflammatory reaction, viral infection and localized bacterial infections manifest only small to modest increases of procalcitonin in plasma, procalcitonin levels may be useful in differentiating between these diseases and sepsis. In addition, it has been suggested that procalcitonin is an early and good marker of elevated cytokines in patients with sepsis, and that it's plasma level is correlated with Sepsis-related Organ Failure Assessment (SOFA) score. Since plasma procalcitonin is measured easily, quickly and accurately by immunoluminometric assay, it is useful for early diagnosis of sepsis in patients with severe systemic inflammatory response syndrome and as an indicator of severity of sepsis in such patients.
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Various spinal diseases that cause low back pain have two distinct pathologies, including mechanical disruption of the spinal column and compression of the cauda equina and the nerve roots. Although, the advancement in surgical techniques has brought satisfactory neural recovery, resolution of low back pain still remains unpredictable. The development of low back pain is affected by psychosocial factors besides pathological lesions in the lumbar spine leading to functional impairment. Surgical indication for low back should be carefully decided considering such nonorganic aspects of low back pain.
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In oriental medicine, not only the local pathological state but also disharmony within the body and the stagnation of Ki are examined. For this purpose, diagnoses in modern western medicine are also used as references. The pathological condition is evaluated by the 4 diagnostic methods as original methods of oriental medicine, treatment points are decided, and acupuncture and moxibustion are performed. If meridians and reactive points that appear with Ki stagnation impairing natural healing ability can be determined, not only low back pain but also symptoms such as constipation disappear, resulting in harmony of the body and improvement in constitutional symptoms.
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There are various causes of low back pain, but if the cause of low back pain was determined as a discogenic pain, anterior lumbar interbody fusion was indicated. The surgical treatment should be determined after MRI and other radiological imaging studies and pain response, and also it is important to examine the social factor and psychological status. Extra-peritoneal approach is selected for above L(4)-L(5) level, and trans-peritoneal approach is selected for L(5)-S(1). Recent endoscopic approaches to the anterior lumbar spine is also presented.