RESUMO
BACKGROUND: Back pain is a common problem and a burden for the patient. MR-morphologically proven pain-causing changes of the spine is often successfully treated utilizing CT-guided pain therapy. The CT-guided execution enables a controlled and reproducible therapy. Nevertheless, treatment results can differ even with the same patient; the physician is a possible influencing factor of the outcome. Accordingly, the present study analyzes the different behaviors and forms of communication of the treating physicians during the course of the intervention as factors influencing the outcome of treatment. METHODS: 67 patients suffering from specific back pain were included in this study. 5 treating physicians (2 female, 3 male) of different age (29-63 years), and experience and a total of 244 CT-guided treatments were included in this study. In every case a psychologist observed the treatment based on a standardized observation protocol. Observed were both the verbal and non-verbal interactions as well as the reaction of patient and physician. The success of the therapy was measured in the course of the treatment using the visual analogue pain scale. The technical comparability of the performed CT-guided periradicular therapy was ensured by the distribution of the drug mixture. RESULTS: The outcome is significantly better if the patient considers the treating physician to be competent (correlation coefficient: 0.24, p < 0.006) and feels understood (correlation coefficient: 0.29, p < 0.001). In addition, the outcome is better when the physician believes that the treatment brings a positive reduction of pain, underlining his belief with positive statements of affirmation before the intervention thus creating a positive atmosphere [correlation coefficient: 0.24 (p < 0.009)]. In contrast, the outcome is worse if the patient complains about pain during the intervention [average pain reduction M = 0.9 (pain group) vs. M = 2.0 (no-pain group)]. CONCLUSION: Our study shows that with comparable implementation of CT-guided periradicular therapy, the outcome of the patient with specific back pain can be significantly improved by certain behavioral patterns of the performing physician and this without side effects and without significant additional time expenditure. Our findings indicate that there is a non-negligible psychological factor linking confidence in therapy to actual therapy success. TRIAL REGISTRATION: The study was designed as an observational study, therefore a trial registration was not necessary.
Assuntos
Dor nas Costas/diagnóstico por imagem , Dor nas Costas/terapia , Competência Clínica , Manejo da Dor/métodos , Relações Médico-Paciente , Tomografia Computadorizada por Raios X , Adulto , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
To report a case of a ruptured mycotic abdominal aortic aneurysm (MAA) after intravesical Bacille Calmette-Guerin (BCG) therapy because of bladder carcinoma. A 57-year-old male patient was admitted to our hospital for follow-up computed tomography 14 months after transurethral resection of a papillary carcinoma of the bladder and intravesical BCG therapy. The CT scan revealed a ruptured MAA aneurysm and the patient underwent an endovascular repair with an aorto-bi-iliac stent graft. A ruptured MAA is a rare but lethal complication after BCG instillation therapy. The standard therapy is the open reconstruction but according to the literature an endovascular therapy in combination with long-term antibiotics should be considered as a bridging or a definite solution.
Assuntos
Aneurisma Infectado/microbiologia , Antineoplásicos/efeitos adversos , Aneurisma da Aorta Abdominal/microbiologia , Ruptura Aórtica/microbiologia , Vacina BCG/efeitos adversos , Carcinoma Papilar/tratamento farmacológico , Infecções por Mycobacterium/microbiologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/cirurgia , Antineoplásicos/administração & dosagem , Antituberculosos/uso terapêutico , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/cirurgia , Aortografia/métodos , Vacina BCG/administração & dosagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Carcinoma Papilar/patologia , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/cirurgia , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologiaAssuntos
Derivação Arteriovenosa Cirúrgica/métodos , Diálise Renal/métodos , Insuficiência Renal/terapia , Dispositivos de Acesso Vascular , Anestesia/métodos , Antibioticoprofilaxia/métodos , Anticoagulantes/uso terapêutico , Perda Sanguínea Cirúrgica , Prótese Vascular , Cateteres de Demora , Tomada de Decisão Clínica , Constrição Patológica/prevenção & controle , Terapia por Exercício/métodos , Extremidades/irrigação sanguínea , Oclusão de Enxerto Vascular , Humanos , Complicações Intraoperatórias/prevenção & controle , Isquemia/prevenção & controle , Imagem Multimodal/métodos , Agulhas , Cuidados de Enfermagem/métodos , Doenças do Sistema Nervoso Periférico/prevenção & controle , Exame Físico/métodos , Inibidores da Agregação Plaquetária/uso terapêutico , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Recidiva , Encaminhamento e Consulta , Higiene da Pele/métodos , Instrumentos Cirúrgicos , Infecção da Ferida Cirúrgica/prevenção & controle , Suturas , Trombose/prevenção & controle , Fatores de Tempo , Ultrassonografia de Intervenção/métodos , Procedimentos Cirúrgicos Vasculares/educaçãoRESUMO
History and admission findings A 69-year-old patient was initially hospitalized because of a 1.5âcm ulceration at the back of the right foot which had existed for the last year and become increasingly swollen and painful. Medical history revealed PmScl-positive systemic sclerosis presenting with a massive calcinosis cutis, advanced pulmonary fibrosis and peripheral artery disease. Examinations Inflammatory markers were normal. MR-Angiography of the lower extremities revealed a multi-segmental high-grade stenosis of the aortic bifurcation due to extensively calcified plaques. Considering the high operative risk and potential excessive scar formation the indication for an interventional procedure was established. Treatment and course After uncomplicated aorto-biiliac stent implantation peripheral pulses had significantly improved and wound debridement led to healing of the ulcer. After additional nutritional advice and caloric substitution the patient was dismissed from the hospital in good condition and without complications. Conclusion Endovascular reconstruction of the aortic bifurcation is a safe alternative to surgery especially when patients present with a severe generalized disease and a high operative risk. Interdisciplinary cooperation is crucial for an optimal treatment regimen.
Assuntos
Aorta/cirurgia , Procedimentos Endovasculares/métodos , Salvamento de Membro/métodos , Procedimentos de Cirurgia Plástica/métodos , Escleroderma Sistêmico/cirurgia , Idoso , Feminino , Humanos , Escleroderma Sistêmico/diagnóstico , Resultado do TratamentoRESUMO
PURPOSE: We aimed to analyze the extent of microvascular obstruction (MO) after the index event compared with the follow-up at a median of three months. METHODS: We identified 31 patients with MO after primary percutaneous coronary intervention of acute myocardial infarction by cardiac magnetic resonance imaging. The initial examination was performed after the index event, and 27 patients had the follow-up exam after a median of three months (interquartile range, 2-4 months). In addition, we examined 10 patients without MO after transmural myocardial infarction, as a control group. RESULTS: MO disappeared in 23 of 27 patients (85%) in the follow-up and transformed into transmural late gadolinium enhancement. In patients with persistent MO, mean MO size decreased from 2.25% to 1.25%. In patients with MO, mean infarct size decreased significantly from 20.8% to 14.7% (P < 0.001). In the control group, mean infarct size decreased from 12.7% to 10.5% in the follow-up scan (P = 0.137). CONCLUSION: MO is significantly reduced during the follow-up after acute myocardial infarction.