Pain physician
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Case Reports
Percutaneous Endoscopic Lumbar Discectomy for Far-Migrated Disc Herniation through Two Working Channels.
The technique of percutaneous endoscopic lumbar discetomy (PELD) in the transforaminal approach has evolved over the years due to the advances in endoscopic photology and instrumentation and become the most popular technique for lumbar disc herniation. Although PELD offers many advantages, the indications of PELD are limited mostly to non-migrated or low-migrated disc herniation. It is very difficult for PELD in the transforaminal approach to remove the highly migrated disc fragment successfully due to the anatomic barrier. Nowadays, with the advances of instruments and technique, it might be possible for PELD in the transforaminal approach to remove these high-grade migrated disc fragments. The purpose of this study was to describe a technique to effectively treat highly migrated disc herniation via 2 working channels. ⋯ Percutaneous endoscopic lumbar discectomy, far-migrated disc herniation, working channels.
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Chemotherapy-induced neuropathic pain is difficult to treat. Pentoxifylline inhibits the production of inflammatory cytokines including tumor necrosis factor α(TNF- α) and interleukin 1β (IL-1β). ⋯ Pentoxifylline alleviated chemotherapy-induced neuropathic pain in rats by reducing the levels of inflammatory cytokines in dorsal root ganglia and may be effective chemotherapy-induced neuropathic pain in patients.
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The objective of this manuscript was to report a case of a patient with extruded pulse generator 3 years after implantation of a spinal cord stimulator system.With the increasing incidence of chronic pain, spinal cord stimulation (SCS) is becoming more commonly utilized by pain physicians. SCS is a generally safe intervention with minimal adverse effects; however, there are risks of complications which practitioners should be aware of prior to and after placement of the SCS. We present a case of a patient with a late complication of extrusion of an implantable pulse generator (IPG) of a SCS that was promptly identified and successfully removed without any complications. A 60-year-old male truck driver with history of failed back syndrome and diabetes underwent a SCS system implanted with excellent relief of his pain. The SCS was implanted with 2 leads with the IPG being sutured 3 cm in depth in the superior gluteal region. Three years after the implantation, he developed pain over the site of the generator and presented to our clinic with extrusion of the non-rechargeable pulse generator from his gluteal region.The pulse generator was successfully removed with the battery not being infected. This late complication may have been related to his ongoing profession of daily driving with pressure necrosis from prolonged sitting and constant vibration during long rides associated. Structural size and design of the pulse generator may have had an important contribution as well. To our knowledge this complication has not been reported in the literature.Physicians that place or manage patients with SCSs should be aware of this rare complication and maintain vigilance even after remote implantation of the SCS systems. ⋯ Spinal cord stimulator, complication, extrusion, implantable pulse generator, neuromodulation, failed back syndrome, battery complication.
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Meralgia paresthetica refers to the entrapment of the lateral femoral cutaneous nerve at the level of the inguinal ligament. The lateral femoral cutaneous nerve - a purely sensory nerve - arises from the L2 and L3 spinal nerve roots, travels downward lateral to the psoas muscle, and then crosses the iliacus muscle. Close to the anterior superior iliac spine, the nerve courses in contact with the lateral aspect of the inguinal ligament and eventually innervates the lateral thigh. ⋯ Herewith, due to its several advantages, ultrasound imaging has been proposed as an alternative diagnostic method in the recent literature. It not only confirms the entrapment morphologically, but also uncovers a likely underlying cause and provides immediate interventional guidance. The pertinent sonographic findings would be hypoechoic and swollen lateral femoral cutaneous nerve.
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Comparative Study
Comparison of Intrathecal Concentrations of Acyclovir following Epidural and Intravenous Administration in Rats.
Herpes zoster is a disease caused by reactivation of varicella-zoster virus in sensory cranial nerves and dorsal root ganglion. Our presumption was that epidural administration of acyclovir near the viral burden could be more advantageous than intravenous (IV) administration. The cerebrospinal fluid concentration of acyclovir after epidural administration was determined to be higher than that after IV administration in rats. ⋯ Acyclovir, epidural injection, herpes zoster, varicella zoster virus.