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1.
Acta Cir Bras ; 34(7): e201900705, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31531527

RESUMO

PURPOSE: The denervation of the intestine with benzalkonium chloride (BAC) reduces mortality and improves weight gain in rats with short bowel syndrome (SBS). Nevertheless, translating these promising findings from bench to bedside is not feasible because BAC promotes peritonitis and irreversible denervation which may be followed by an uncontrolled dilatation of the viscera. The use of botulinum toxin (BT) instead of BAC to achieve the denervation of the remaining small intestine in SBS could be an interesting option because it leads to a mild and transient denervation of the intestine. METHODS: Here we evaluated the effects of the ileal denervation with BT in rats with SBS by verifying the body weight variation and intestinal morphological parameters. Four groups with 6 animals each were submitted to enterectomy with an ileal injection of saline (group E) or BT (group EBT). Control groups were submitted to simulated surgery with an ileal injection of BT (group BT) or saline (group C - control). RESULTS: We observed that the treatment of the remaining ileum with BT completely reversed the weight loss associated to extensive small bowel resection. CONCLUSION: This may provide a new promising approach to the surgical treatment of SBS.


Assuntos
Toxinas Botulínicas/farmacologia , Denervação/métodos , Íleo/inervação , Síndrome do Intestino Curto/cirurgia , Animais , Compostos de Benzalcônio/farmacologia , Peso Corporal/efeitos dos fármacos , Modelos Animais de Doenças , Íleo/patologia , Jejuno/inervação , Debilidade Muscular/patologia , Ratos , Ratos Wistar , Síndrome do Intestino Curto/patologia
2.
Kidney Blood Press Res ; 44(4): 628-642, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291627

RESUMO

BACKGROUND/AIMS: Catheter-based renal denervation (RDN) has emerged as an innovative interventional approach for reducing blood pressure (BP), suppressing ventricular substrate remodeling, and attenuating heart failure, which suggests that it might reduce kidney fibrosis in a canine model of high-fat diet-induced hypertension. This study thus sought to assess whether RDN could reduce kidney fibrosis and halt the progression of renal impairment in a canine model of high-fat diet-induced hypertension. METHODS: Thirty-two beagles were randomized into either the normal control group (normal diet, n = 10) or the hypertension group (high-fat diet, n = 22). After successful establishment of the model, the hypertension model group was randomized to either the RDN group (n = 9) or the sham-surgery group (n = 8). Renal artery angiography, BP, heart rate (HR), and blood and urine biochemistry results were assessed at 1, 3, and 6 months after surgery. Canines were sacrificed at 6 months after surgery. The extent of kidney interstitial fibrosis, transforming growth factor-beta 1, alpha-smooth muscle actin, connective tissue growth factor, and E-cadherin protein were measured. RESULTS: The group fed a high-fat diet had significantly (p ˂ 0.05) increased body weight, BP, and HR and higher levels of urine albumin, serum noradrenaline (NE), and angiotensin II (AngII) than the control group. The sham-surgery group and RDN group also had higher levels than the control group (p ˂ 0.05). Compared with the sham-surgery group, the RDN group had lower BP, urine albumin, serum NE, and AngII and less fibrotic tissue (all p ˂ 0.05). CONCLUSION: RDN reduced BP, slowed progression of albuminuria, and suppressed renal remodeling in a canine model of high-fat diet-induced hypertension.


Assuntos
Denervação/métodos , Dieta Hiperlipídica/efeitos adversos , Fibrose/prevenção & controle , Hipertensão/etiologia , Nefropatias/patologia , Rim/cirurgia , Albuminúria , Animais , Pressão Sanguínea , Cães , Frequência Cardíaca , Rim/patologia , Nefropatias/cirurgia
3.
Einstein (Sao Paulo) ; 17(3): eAO4489, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31271607

RESUMO

OBJECTIVE: To analyze the anatomical variations of the innervation of the flexor digitorum superficialis muscle and to determine if the branch of the median nerve that supply this muscle is connected to the branches to the extensor carpi radialis brevis and the pronator teres muscles, without tension, and how close to the target-muscles the transfer can be performed. METHODS: Fifty limbs of 25 cadavers were dissected to collect data on the anatomical variations of the branches to the flexor digitorum superficialis muscle. RESULTS: This muscle received innervation from the median nerve in the 50 limbs. In 22 it received one branch, and in 28 more than one. The proximal branch was identified in 22 limbs, and in 12 limbs it shared branches with other muscles. The distal branch was present in all, and originated from the median nerve as an isolated branch, or a common trunk with the anterior interosseous nerve in 3 limbs, and from a common trunk with the flexor carpi radialis muscle and anterior interosseous nerve in another. It originated distally to the anterior interosseous nerve at 38, in 5 on the same level, and in 3 proximal to the anterior interosseous nerve. In four limbs, innervation came from the anterior interosseous nerve, as well as from the median nerve. Accessory branches of the median nerve for the distal portion of the flexor digitorum superficialis muscle were present in eight limbs. CONCLUSION: In 28 limbs with two or more branches, one of them could be connected to the branches to the extensor carpi radialis brevis and pronator teres muscles without tension, even during the pronation and supination movements of the forearm and flexion-extension of the elbow.


Assuntos
Denervação/métodos , Dedos/inervação , Antebraço/inervação , Nervo Mediano/anatomia & histologia , Músculo Esquelético/inervação , Punho/inervação , Adulto , Cadáver , Dissecação , Dedos/cirurgia , Humanos , Masculino , Nervo Mediano/cirurgia , Músculo Esquelético/cirurgia , Tendões
4.
Cardiovasc Intervent Radiol ; 42(9): 1363-1365, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31187230

RESUMO

The sacroiliac joint is the culprit in 15-30% of patients with chronic lumbar back pain. Ablation of the posterior sensory nerves supplying the joint is an established treatment option before arthrodesis. We report the successful application of MR-HIFU in a patient with therapy-refractory pain using the Sonalleve MR-HIFU system. The outpatient procedure was performed under spinal anaesthesia and analgosedation. The ramus dorsalis of L5 as well as the lateral branches of the ramus dorsalis S1-S3 was targeted, and tissue peak temperature per sonication was controlled using MR-thermometry. There were no post-interventional complications. Clinical improvement began 4 days post-intervention with complete resolution of the pain after 1 month.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Dor Lombar/cirurgia , Imagem por Ressonância Magnética Intervencionista/métodos , Articulação Sacroilíaca/cirurgia , Idoso , Denervação/métodos , Feminino , Humanos , Articulação Sacroilíaca/inervação
5.
BMC Musculoskelet Disord ; 20(1): 302, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31238925

RESUMO

BACKGROUND: For patients with painful knee osteoarthritis, long-term symptomatic relief may improve quality of life. Cooled radiofrequency ablation (CRFA) has demonstrated significant improvements in pain, physical function and health-related quality of life compared with conservative therapy with intra-articular steroid (IAS) injections. This study aimed to establish the cost-effectiveness of CRFA compared with IAS for managing moderate to severe osteoarthritis-related knee pain, from the US Medicare system perspective. METHODS: We conducted a cost-effectiveness analysis utilizing efficacy data (Oxford Knee Scores) from a randomized, crossover trial on CRFA (NCT02343003), which compared CRFA with IAS out to 6 and 12 months, and with IAS patients who subsequently crossed over to receive CRFA after 6 months. Outcomes included health benefits (quality-adjusted life-years [QALYs]), costs and cost-effectiveness (expressed as cost per QALY gained). QALYs were estimated by mapping Oxford Knee Scores to the EQ-5D generic utility measure using a validated algorithm. Secondary analyses explored differences in the settings of care and procedures used in-trial versus real-world clinical practice. RESULTS: CRFA resulted in an incremental QALY gain of 0.091 at an incremental cost of $1711, equating to a cost of US$18,773 per QALY gained over a 6-month time horizon versus IAS. Over a 12-month time horizon, the incremental QALY gain was 0.229 at the same incremental cost, equating to a cost of US$7462 per QALY gained versus IAS. Real-world cost assumptions resulted in modest increases in the cost per QALY gained to a maximum of US$21,166 and US$8296 at 6 and 12 months, respectively. Sensitivity analyses demonstrated that findings were robust to variations in efficacy and cost parameters. CONCLUSIONS: CRFA is a highly cost-effective treatment option for patients with osteoarthritis-related knee pain, compared with the US$100,000/QALY threshold typically used in the US.


Assuntos
Artralgia/terapia , Dor Crônica/terapia , Denervação/métodos , Hipotermia Induzida/métodos , Osteoartrite do Joelho/terapia , Ablação por Radiofrequência/métodos , Artralgia/economia , Artralgia/etiologia , Dor Crônica/economia , Dor Crônica/etiologia , Análise Custo-Benefício , Estudos Cross-Over , Denervação/economia , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Hipotermia Induzida/economia , Injeções Intra-Articulares , Articulação do Joelho/inervação , Masculino , Medicare/economia , Medicare/estatística & dados numéricos , Bloqueio Nervoso/economia , Bloqueio Nervoso/métodos , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/economia , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Ablação por Radiofrequência/economia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto Jovem
6.
Turk Neurosurg ; 29(4): 576-583, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31049919

RESUMO

AIM: To investigate the effects of lumbar stabilization exercises on pain severity, functional disability, and physical performance after two weeks following radiofrequency denervation in patients with lumbar facet joint syndrome (LFJS). MATERIAL AND METHODS: Thirty-nine patients diagnosed with LFJS and had radiofrequency denervation were assigned to study and control groups. The study group (n=20) received a six-week stabilization exercise program and was informed about spine biomechanics, while the control group (n=19) received only informations about spine biomechanics. Pain severity with visual analogue scale, perceived disability with Oswestry disability index, physical performance with physical performance tests and gait speed test were applied before and after radiofrequency denervation, and after six weeks of intervention program. RESULTS: Despite the similar improvements were shown in terms of all outcomes in both groups following radiofrequency denervation (p > 0.05), the improvements were more in favor of study group after six week intervention program (p < 0.05). CONCLUSION: These results indicate that radiofrequency denervation is effective in improving the pain, disability, and physical performance in patients with LFJS and this effect is further enhanced by the stabilization exercises following this procedure. Adding stabilization exercises to radiofrequency denervation yielded positive outcomes and these exercise are strongly advised in physiotherapy and rehabilitation program.


Assuntos
Terapia por Exercício/métodos , Dor Lombar/terapia , Vértebras Lombares/inervação , Terapia por Radiofrequência/métodos , Articulação Zigapofisária/inervação , Adulto , Idoso , Denervação/métodos , Feminino , Humanos , Dor Lombar/diagnóstico , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Articulação Zigapofisária/patologia
7.
Orthop Clin North Am ; 50(3): 345-356, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31084837

RESUMO

Wrist denervation is a safe and effective procedure for the treatment of chronic wrist pain that can delay or eliminate the need for salvage or anatomically distorting procedure, such as proximal row carpectomy. The traditionally more extensive wrist denervation has evolved to procedures requiring fewer incisions. Efficacy of this procedure is corroborated by multiple publications either as a stand-alone procedure or as an adjunct to other procedures. This review provides an update on the status of wrist denervation.


Assuntos
Dor Crônica/cirurgia , Denervação , Osteoartrite/cirurgia , Articulação do Punho/cirurgia , Dor Crônica/etiologia , Contraindicações de Procedimentos , Denervação/efeitos adversos , Denervação/métodos , Dissecação , Humanos , Osteoartrite/complicações , Articulação do Punho/inervação
8.
Curr Pain Headache Rep ; 23(6): 38, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31044316

RESUMO

PURPOSE OF REVIEW: Percutaneous radiofrequency (RF) denervation of articular sensory nerves of the hip joint is a minimally invasive neurotomy technique that can provide pain relief in patients with chronic hip pain. There has been an increase in the number of publications on RF denervation of the hip over the last few years although many questions remain regarding anatomical targets, technical aspects, selection criteria, and evidence for effectiveness. RECENT FINDINGS: For this updated review, publications were identified by searching MEDLINE and other medical literature databases from inception through November 30, 2018. Existing knowledge of hip joint innervation was reviewed and data on patient selection, prognostication of analgesic benefit from ablation by using local anesthetic blocks, current techniques of performing hip joint ablation, analgesic success, functional outcomes, and adverse effects were critically reviewed and analyzed. Sensory denervation of the anterior hip joint using RF current is a viable treatment option for management of chronic hip pain after conservative methods fails to do so. We have synthesized knowledge from papers on techniques of ablation and from recently elaborated anatomical details. We also provide suggestions regarding anticipated outcomes of the procedure. Our review of existing literature indicates evidence for analgesic benefits, improvement in function, and a low incidence of adverse effects of RF ablation of sensory innervation to the hip joint. Future research should focus on refining the technique of ablation and monitoring of long-term outcomes.


Assuntos
Artralgia/cirurgia , Dor Crônica/cirurgia , Articulação do Quadril/inervação , Articulação do Quadril/cirurgia , Animais , Artralgia/diagnóstico , Dor Crônica/diagnóstico , Denervação/métodos , Articulação do Quadril/patologia , Humanos , Ablação por Radiofrequência/métodos
9.
Urology ; 130: 181-185, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31063763

RESUMO

OBJECTIVE: To assesses the efficacy of ultrasound-guided targeted cryoablation (UTC) of the perispermatic cord as a salvage treatment for patients who failed microsurgical denervation of the spermatic cord. METHODS: Retrospective review of 279 cases (221 patients: 58 bilateral) undergoing UTC between November 2012 and July 2016, performed by 2 fellowship trained microsurgeons. UTC was performed using a 16-gauge cryo needle (Endocare, HealthTronics, Austin, TX). Branches of the genitofemoral, ilioinguinal, and inferior hypogastric nerves were cryoablated medial and lateral to the spermatic cord at the level of the external inguinal ring. Level of pain was measured preoperatively and postoperatively using the visual analog scale and Pain Index Questionnaire-6 (QualityMetric Inc., Lincoln, RI). RESULTS: Median age was 43 years, operative duration 20 minutes, and postoperative follow-up 36 months (24-60). Subjective visual analog scale outcomes: 75% significant reduction in ain (11% complete resolution and 64% ≥50% reduction in pain). Objective Pain Index Questionnaire-6 outcomes: 53% significant reduction at 1 month (279 cases), 55% at 3 month (279 cases), 60% at 6 month (279 cases), 63% at 1 year (279 cases), 65% at 2 years (275 cases), 64% at 3 years (232 cases), 59% at 4 years (128 cases) and 64% at 5 years (53 cases) post-op. COMPLICATIONS: 2 wound infections, 4 penile pain cases (resolved in a few months). CONCLUSION: UTC of the perispermatic cord is a safe potential treatment option for the salvage management of persistent chronic scrotal pain in patients who have failed microsurgical denervation of the spermatic cord.


Assuntos
Dor Crônica/cirurgia , Criocirurgia/métodos , Denervação/métodos , Doenças dos Genitais Masculinos/cirurgia , Dor Pélvica/cirurgia , Complicações Pós-Operatórias/cirurgia , Escroto , Cordão Espermático/inervação , Cordão Espermático/cirurgia , Ultrassonografia de Intervenção , Adulto , Humanos , Masculino , Microcirurgia , Estudos Retrospectivos , Terapia de Salvação/métodos , Cirurgia Assistida por Computador , Resultado do Tratamento
10.
Urology ; 131: 144-149, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31136771

RESUMO

OBJECTIVE: To improve the technique and results of microsurgical denervation of the spermatic cord (MDSC) for men with chronic scrotal content pain, we describe a novel approach at the level of the internal inguinal ring for the complete transection of the nerves running both inside and outside the spermatic cord for adults and children. METHODS: A retrospective review of 52 patients (64 testicular units) who underwent high inguinal MDSC was performed. Visual analogue scale (VAS, 1-10) scores were compared with before and every 3 months after the surgery. Depressive symptoms were assessed by the Beck Depression Inventory. Hormonal evaluations were performed before and 6 months after the surgery. RESULTS: The average patient age was 52.4 years (12-78); including 6 pediatric cases. The mean operative time was 67 minutes per testicular unit, and there were no major complications. The mean pre- and post-MDSC VAS scores were 8.3 and 2.5, respectively (P < .0001). Forty-six (88%) cases showed positive responses after MDSC, and multivariate analysis showed that pain outside the scrotum and depressive symptoms were predictors of MDSC failure (P < .05, odds ratio: 15.27 and 12.56, respectively). CONCLUSION: For both adult and pediatric patients, high inguinal MDSC is an effective and safe management option, including testicular function, for the chronic scrotal content pain that is refractory to medical management. We find that the high inguinal approach is easier in our experience than the subinguinal approach because of fewer divisions of veins, a larger diameter of the spermatic artery.


Assuntos
Dor Crônica/cirurgia , Denervação/métodos , Doenças dos Genitais Masculinos/cirurgia , Microcirurgia , Escroto , Cordão Espermático/inervação , Cordão Espermático/cirurgia , Adolescente , Adulto , Idoso , Criança , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto Jovem
11.
World Neurosurg ; 129: e128-e133, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31102773

RESUMO

BACKGROUND: Radiofrequency rhizotomy (RFR) is a commonly used, effective procedure for trigeminal neuralgia (TN), but a subset of patients experiences pain recurrence and requires subsequent surgeries. Currently, the rhizotomy temperature and duration of application are empirically determined, and there is no consensus on what settings are most beneficial. In this study, we analyzed patients who underwent trigeminal RFR and had subsequent surgeries to identify whether rhizotomy parameters were associated with the duration of pain relief. METHODS: Single-center, retrospective analysis of patients undergoing RFR for TN from 1995 to 2016. The primary endpoint was subsequent procedure. Associations with rhizotomy parameters and covariates were assessed using Cox regression analysis. RESULTS: The study included 338 patients, average age 65 years; 61% were women. Temperature was significantly associated with both the degree of immediate postoperative pain relief and the duration of pain relief, and in subgroup analyses by multiple sclerosis status and RFR procedural count. Ablation duration was also independently significant, though not when analyzed alongside age, sex, and race. Duration of pain relief was generally shorter in patients with multiple sclerosis and in repeated RFR. CONCLUSIONS: Higher temperatures may be necessary to achieve pain relief in some patients, given the progressive nature of the facial pain, but they are not associated with longer duration of pain relief in patients who have recurrent pain. Modulation of the ablation duration does not seem to affect the short-term or long-term outcomes.


Assuntos
Denervação/métodos , Manejo da Dor/métodos , Rizotomia/métodos , Neuralgia do Trigêmeo/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Temperatura Ambiente , Fatores de Tempo , Resultado do Tratamento
12.
Cell Physiol Biochem ; 52(4): 769-786, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30933441

RESUMO

BACKGROUND/AIMS: The aim of this study was to confirm the beneficial effects of electrical stimulation on denervated skeletal muscle and explore a novel underlying mechanism. METHODS: Morphological and contractile analyses were performed on rats allocated to three groups: sham operation (SHAM), denervated (DN), and denervated and electrical stimulation (DN-SM). Proteomics, transcriptomics, bioinformatics, and skeletal muscle functional modules analysis were conducted to determine the changes in molecular expression resulting from electrical stimulation. RESULTS: Rats in the DN-SM group maintained a greater muscle mass, muscle fiber diameter, and contractile properties than those of the DN group. A total of 66 proteins and 402 mRNAs were differentially expressed between groups. Bioinformatics analysis suggested that the FoxO and p53 signaling pathways play significant roles in structural protection. Skeletal muscle function modules analysis suggested that anti-apoptosis proteins (KCNA7, KCNJ11), muscle fiber type related proteins (TNNI1, TNNT1, ACTN2, MYOZ2, MYLK2, and MYOM2), M-line structural protein (MYOM2), dystrophin combined with glycoprotein complex proteins (SGCB, SGCD, and DTNA), and anti-fibrosis-related proteins (POSTN, COL1A1, COL1A2, COL6A1, COL6A2, COL6A3, FN1, and LUM), may be related to the effects of electrical stimulation. CONCLUSION: Electrical stimulation can maintain the denervated muscle morphology and function. Anti-apoptosis, inhibition of muscle fiber type differentiation, protection against dystrophin-associated-glycoprotein complex mutation, and anti-fibrosis are potential mechanisms of the beneficial effects of electrical stimulation.


Assuntos
Denervação/métodos , Músculo Esquelético/metabolismo , Proteoma/análise , Proteômica , Transcriptoma , Animais , Estimulação Elétrica , Masculino , Microscopia Eletrônica de Transmissão , Contração Muscular , Fibras Musculares Esqueléticas/ultraestrutura , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , RNA Mensageiro/metabolismo , Ratos , Ratos Sprague-Dawley , Proteína Supressora de Tumor p53/genética , Proteína Supressora de Tumor p53/metabolismo
13.
Dev Biol ; 449(2): 122-131, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30826398

RESUMO

Axolotls have amazing abilities to regenerate their lost limbs. Nerve and wound epidermis have great impacts on this regeneration. Histone deacetylases (HDACs) have been shown to play roles in the regeneration of amphibian tails and limbs. In this study, a bi-phasic up-regulation of HDAC1 was noted before early differentiation stage of axolotl limb regeneration. Limb regeneration was delayed in larvae incubated with an HDAC inhibitor MS-275. Local injection of MS-275 or TSA, another HDAC inhibitor, into amputation sites of the juveniles did not interfere with wound healing but more profoundly inhibited local HDAC activities and blastema formation/limb regeneration. Elevation of HDAC1 expression was more apparent in wound epidermis than in mesenchyme. Prior denervation prohibited this elevation and limb regeneration. Supplementation of nerve factors BMP7, FGF2, and FGF8 in the stump ends after amputation on denervated limbs not only enabled HDAC1 up-regulation but also led to more extent of limb regeneration. In conclusion, nerve-mediated HDAC1 expression is required for blastema formation and limb regeneration.


Assuntos
Ambystoma mexicanum/fisiologia , Extremidades/fisiologia , Histona Desacetilase 1/metabolismo , Regeneração/fisiologia , Ambystoma mexicanum/cirurgia , Amputação , Animais , Benzamidas/farmacologia , Proteína Morfogenética Óssea 7/farmacologia , Denervação/métodos , Extremidades/inervação , Extremidades/cirurgia , Fator 2 de Crescimento de Fibroblastos/farmacologia , Inibidores de Histona Desacetilases/farmacologia , Larva/efeitos dos fármacos , Larva/fisiologia , Células-Tronco Pluripotentes/efeitos dos fármacos , Células-Tronco Pluripotentes/metabolismo , Piridinas/farmacologia , Regeneração/efeitos dos fármacos , Cicatrização/efeitos dos fármacos , Cicatrização/fisiologia
14.
Pain Physician ; 22(2): E127-E132, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30921990

RESUMO

BACKGROUND: The facet joints contribute to chronic cervical spine pain in an estimated 55% of chronic neck pain cases and can be treated with percutaneous radiofrequency neurotomy (PRN). Damage to surrounding structures during treatment or successful treatment of the primary pain source leading to unmasking could lead to new onset of pain, including cervicogenic headache (CGH). In this study, we aimed to define the incidence of headache in patients who have been previously treated with PRN for lower cervical facet pain. SETTING: All patients treated at a single academic institution's pain management clinic from 2014 to 2016 with cervical PRN were reviewed. METHODS: All patients treated at a single institution's pain management clinic from 2014 to 2016 were reviewed. Those treated with lower cervical PRN were identified, and incidence of CGH was described as a percentage of the study population. Patient age and pain scores between those with and without headaches following treatment were compared by unpaired T-tests. Gender, presence of comorbid disease and levels involved, quality of pain, exacerbating and alleviating factors, location of referred pain, and previous treatments between those with and without headaches following treatment were compared using chi-square tests. RESULTS: Among the 88 patients in the study group, 12 were found to have only moderate relief of their pretreatment pain as well as a new onset headache meeting the diagnostic criteria for cervicogenic headache. Compared to those without a headache after treatment, those diagnosed with cervicogenic headache were more likely to be female (P = 0.041), report a higher maximum pain level on presentation (P = 0.015), have a diagnosis of diabetes prior to presentation (P = 0.011), and have had the procedure performed at levels which included C3 (P = 0.013) (Table 1). LIMITATIONS: The limitations of this study include its single-center design, as this cohort may not be truly representative of the population of patients receiving cervical PRN as a whole, and as a result, these results may not be generalizable. Due to the small size of the cohort, more subtle differences in presenting signs and symptoms between those with and without headaches may not be detectable. Finally, as previously mentioned, the lack of data on some of the patients who presented with headache may have led to underdiagnosis of the true incidence of cervicogenic headache. Future work should look to re-examine the incidence of CGH in a larger cohort to validate the findings here and further define risk factors for post-procedural CGH. CONCLUSIONS: This retrospective review of all patients seen over 2 years in an academic pain clinic found a 13.6% incidence of cervicogenic headache following cervical radiofrequency neurotomy at levels C3-C7. This supports the possibility of the unmasking phenomenon following the procedure, though contributing mechanisms underlying this phenomenon may be multifactorial and require further study.IRB: This study was approved by the institution's Institutional Review Board (IRB2010601795). KEY WORDS: Cervical spine, facetogenic pain, percutaneous radiofrequency neurotomy, cervicogenic headache, chronic pain, zygapophysial joints, innervation convergence, retrospective chart review.


Assuntos
Denervação/efeitos adversos , Cervicalgia/cirurgia , Cefaleia Pós-Traumática/epidemiologia , Adulto , Vértebras Cervicais/cirurgia , Estudos de Coortes , Denervação/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Manejo da Dor/efeitos adversos , Cefaleia Pós-Traumática/etiologia , Estudos Retrospectivos , Fatores de Risco , Articulação Zigapofisária/inervação
15.
Dan Med J ; 66(3)2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30864544

RESUMO

INTRODUCTION: Radio-frequency (RF) denervation of the facet joints is a procedure aimed at the nociceptive median branch nerves of the lumbar dorsal rami. Pain signals from the facet joints are carried through these fibres; by ablating these fibres, central signalling can be prevented. This pilot study investigated the clinical effect and feasibility of the procedure at our institution, the Spine Centre of Southern Denmark. METHODS: Patients with at least 50% pain relief after initial medial branch diagnostic blocks were candidates for RF denervation. Patients were divided into two groups: 1) patients with at least 80% pain relief and 2) patients with between 50% and 79% pain relief after diagnostic blocks. Denervation was performed bilaterally on the three lowest facet joints in the lumbar spine. The primary outcome parameter was visual analogue scale (VAS). Follow-up questionnaires were answered after one week and after three, six and 12 months. RESULTS: For the whole sample, we found a mean reduction of 43 VAS points after one week. At three months, we found a mean reduction of 25 points. Six-month data showed a mean 19-point reduction. Twelve-month data showed a mean reduction of 17 points. Group 1 showed superior improvements at all follow-up points and after 12 months, we found a mean VAS reduction of 22 points for this group. CONCLUSIONS: This pilot cohort study found RF denervation of the facet joint to be a promising alternative for patients with chronic low-back pain. The effect persisted at the one-year follow-up; however, the effect diminished over time. FUNDING: The Danish Rheumatism Association, The A.P. Møller Foundation for the Advancement of Medical Science. TRIAL REGISTRATION: The study protocol was approved by the ethical committee of Southern Denmark with registration number S-20160070.


Assuntos
Denervação/métodos , Dor Lombar/radioterapia , Articulação Zigapofisária/efeitos da radiação , Dor Crônica , Dinamarca , Feminino , Humanos , Vértebras Lombares , Masculino , Bloqueio Nervoso , Projetos Piloto , Estudos Prospectivos , Inquéritos e Questionários , Escala Visual Analógica , Articulação Zigapofisária/inervação
16.
Can J Gastroenterol Hepatol ; 2019: 3562492, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30854349

RESUMO

Experimental denervation of organs plays a key role in understanding the functional aspects of the normal innervation as well as the diseases related to them. In 1978 the experimental model of myenteric denervation of the rat gut by serosal application of benzalkonium chloride (BAC) was proposed. BAC is a positively charged surface-active alkylamine and is a powerful cationic detergent, which destroys bacteria after ionic attraction and for this reason is largely used as a surgical antiseptic. Since its initial report, the BAC-induced myenteric denervation model has been used to study many functional and pathological aspects of the enteric nervous system. So far this is the only pure method of myenteric denervation available for research in this area. Promising reports in the literature have shed light on the possibilities for the development of new uses of the BAC-denervation experimental model as a therapeutic tool in some pathological situations. This review aims to shed light on the main historical and recent findings provided by this experimental model.


Assuntos
Compostos de Benzalcônio/administração & dosagem , Denervação/métodos , Sistema Nervoso Entérico/efeitos dos fármacos , Animais , Compostos de Benzalcônio/farmacologia , Humanos , Modelos Animais , Ratos
17.
World Neurosurg ; 126: e109-e115, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30790724

RESUMO

OBJECTIVE: To compare the effectiveness of radiofrequency neurotomy (RN) and endoscopic neurotomy (EN) of lumbar medial branch (MB) for facetogenic chronic low back pain (FCLBP). METHODS: Forty patients with FCLBP were included and randomly assigned to the control group and the experimental group. The control group (20 cases) underwent X-ray-assisted RN and the experimental group (20 cases) underwent EN of the lumbar MB. The patients' Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI) score were evaluated and compared preoperatively, and at 3 weeks, 6 months, 1 year, and 2 years postoperatively. RESULTS: First, the RN group demonstrated successful treatment results (P < 0.05) at 3 weeks, 6 months, and 1 year after surgery. At 2 years, patients reported no significant effectiveness (P > 0.05). Second, the EN group demonstrated more prolonged successful treatment outcomes compared with the RN group. At 2 years, although the efficacy declined further, the VAS and ODI scores showed significant improvements compared with the preoperative data (P < 0.05). Third, there was no difference in VAS and ODI scores between the 2 groups at 3 weeks after surgery (P > 0.05). At 6 months and later, the EN group demonstrated better outcomes (P < 0.05). CONCLUSIONS: For FCLBP, EN and X-ray-assisted RN of lumbar MB are both effective treatments. However, endoscopic lumbar MB neurotomy has the better and longer effectiveness.


Assuntos
Denervação/métodos , Endoscopia/métodos , Dor Lombar/cirurgia , Região Lombossacral/cirurgia , Radiocirurgia/métodos , Articulação Zigapofisária/cirurgia , Adulto , Idoso , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Dor Lombar/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Medição da Dor , Complicações Pós-Operatórias/epidemiologia , Cirurgia Assistida por Computador , Resultado do Tratamento , Raios X , Adulto Jovem , Articulação Zigapofisária/diagnóstico por imagem
18.
Intern Med ; 58(10): 1507-1509, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-30713291

RESUMO

We herein report a teenage girl who had been taking oral contraceptive pills for three months and complained of left lower abdominal pain that had continued for two months. A physical examination indicated anterior cutaneous nerve entrapment syndrome (ACNES), although no abnormality was found in various biochemical and imaging examinations. The pain was only transiently ameliorated by trigger-point injection, and neurectomy surgery was eventually effective. Sex steroids can be involved in the progress of local tissue edema causing ACNES. ACNES should be considered in cases of abdominal pain in patients taking oral contraceptives.


Assuntos
Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Anticoncepcionais Orais/efeitos adversos , Denervação/métodos , Síndromes de Compressão Nervosa/induzido quimicamente , Síndromes de Compressão Nervosa/cirurgia , Adolescente , Feminino , Humanos , Resultado do Tratamento
19.
Plast Reconstr Surg ; 143(5): 1483-1496, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30807497

RESUMO

BACKGROUND: To address functional and smile dysfunction associated with post-facial paralysis synkinesis, the senior author (B.A.) has offered "modified selective neurectomy" of the lower division of the facial nerve as a long-term solution. This article examines technical considerations and outcomes of this procedure. METHODS: A retrospective review was conducted of patients who underwent modified selective neurectomy of buccal and cervical branches of the facial nerve performed by a single surgeon over a 4½-year period. House-Brackmann facial grading scores, electronic clinician-graded facial function scale, and onabotulinumtoxinA (botulinum toxin type A) dosages were examined before and after the procedure. RESULTS: Sixty-three patients underwent modified selective neurectomy between June 20, 2013, and August 12, 2017. There were no serious complications. The revision rate was 17 percent. Temporary oral incompetence was reported in seven patients (11 percent) postoperatively. A statistically significant improvement was achieved in electronic clinician-graded facial function scale analysis of nasolabial fold depth at rest, oral commissure movement with smile, nasolabial fold orientation with smile, nasolabial depth with smile, depressor labii inferioris lower lip movement, midfacial synkinesis, mentalis synkinesis, platysmal synkinesis, static score, dynamic score, synkinesis score, periocular score, lower face and neck score, and midface and smile score. There was a significant decrease in botulinum toxin type A dosage and House-Brackmann score after surgery. CONCLUSION: Modified selective neurectomy of the buccal and cervical divisions of the facial nerve is an effective long-term treatment for smile dysfunction in patients with post-facial paralysis synkinesis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Denervação/métodos , Nervo Facial/cirurgia , Paralisia Facial/complicações , Sorriso , Sincinesia/cirurgia , Adulto , Idoso , Toxinas Botulínicas Tipo A/administração & dosagem , Músculos Faciais/inervação , Músculos Faciais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurotoxinas/administração & dosagem , Estudos Retrospectivos , Sincinesia/etiologia , Resultado do Tratamento , Adulto Jovem
20.
Basic Res Cardiol ; 114(2): 5, 2019 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-30635778

RESUMO

There is scarce evidence for pulmonary artery denervation (PADN) as a potential treatment for chronic postcapillary pulmonary hypertension (PH). We aimed to perform a proof-of-concept of PADN in a translational model of chronic PH. Nineteen pigs with chronic postcapillary PH (secondary to pulmonary vein banding) were randomized to surgical-PADN (using bipolar radiofrequency clamps) or sham procedure. Additionally, 6 healthy animals underwent percutaneous-PADN to compare the pulmonary artery (PA) lesion generated with both approaches. In the surgical-PADN arm, hemodynamic evaluation and cardiac magnetic resonance (CMR) were performed at baseline and at 2 and 3-month follow-up. Histological assessment was carried out at the completion of the protocol. Eighteen pigs (6 following surgical-PADN, 6 sham and 6 percutaneous-PADN) completed the protocol. A complete transmural PA lesion was demonstrated using surgical clamps, whereas only focal damage to adventitial fibers was observed after percutaneous-PADN. In the surgical-PADN arm, the hemodynamic profile did not significantly differ between groups neither at baseline [mean pulmonary artery pressure (mPAP) median values of 32.0 vs. 27.5 mmHg, P = 0.394 and indexed pulmonary vascular resistance (iPVR) 5.9 vs. 4.7 WU m2, P = 0.394 for PADN/sham groups, respectively] nor at any follow-up (mPAP of 35.0 vs. 35.0 mmHg, P = 0.236 and iPVR of 8.3 vs. 6.7 WU m2, P = 0.477 at third month in PADN/sham groups, respectively). Surgical-PADN was not associated with any benefit in RV anatomy or function on CMR/histology. In a large-animal model of chronic postcapillary PH, transmural PADN with surgical clamps was associated with a neutral pulmonary hemodynamic effect.


Assuntos
Denervação/métodos , Hipertensão Pulmonar , Artéria Pulmonar/inervação , Artéria Pulmonar/cirurgia , Animais , Modelos Animais de Doenças , Distribuição Aleatória , Suínos , Pesquisa Médica Translacional
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