Comparison between Computed Tomography & Fluoroscopy Guided Facet Joint Block in Lumbar Spine

Background Data: Facet joint disorders are main source of chronic low back pain with a prevalence of 16.7%. Facet joint block is performed for diagnostic or therapeutic purposes and generally is carried out under computed tomograpy (CT) or fluoroscopy. Facet joint block is the gold standard in diagnosis of facet joint syndrome. It can also relief pain for up to 6 months. Purpose: To identify which imaging modality (CT or fluoroscopy) is more suitable to guide the procedure of lumbar facet joint block, and results in better relieve of symptoms. Study Design: Prospective analytic clinical case study. Patients and Methods: Sixty eight lumbar facet joints representing 24 patients were injected in the radiology department, Suez Canal University Hospital, Ismailia, Egypt from 1/2005 to 12/2010. All cases were suspected of having facet joint disorders based on clinical and radiological data. After clinical examination and reviewing lumbar images to identify target facets, every patient underwent facet joint block under either CT or fluoroscopy. Visual Analogue Scale was used to assess improvement of symptoms. Results: Fluoroscopy was more successful in guiding the injections (success rate 77.7% compared with 31.25% in CT guidance). It is also faster (6:37 minutes per joint compared with 10:54 minutes for CT guidance). Less number of trials were required (1.7 trial compared with 6.6 trials with CT guidance). Fluoroscopy exposed the patients and the radiologist to much irradiation (21.3 rad compared to 0.3 rad in CT guidance). Decreased bone density and laminectomy impair fluoroscopy guidance. CT guidance is difficult in patient with marked arthropathy and coronally oriented joints (8 trials compared with 5.6 for normally appearing joints). Both groups showed significant improvement of symptoms. Conclusion: Fluoroscopy should be the primary choice for guiding lumbar facet joint block. It is more successful and faster. Its disadvantages include much irradiation to patients and radiologists, and difficulty in patients with laminectomy and decreased bone density. CT can then be used to guide the block. Both techniques are effective in pain reduction. (2012ESJ035

SHARM: Segmented Head Anatomical Reference Models

Reliable segmentation of anatomical tissues of human head is a major step in several clinical applications such as brain mapping, surgery planning and associated computational simulation studies. Segmentation is based on identifying different anatomical structures through labeling different tissues through medical imaging modalities. The segmentation of brain structures is commonly feasible with several remarkable contributions mainly for medical perspective; however, non-brain tissues are of less interest due to anatomical complexity and difficulties to be observed using standard medical imaging protocols. The lack of whole head segmentation methods and unavailability of large human head segmented datasets limiting the variability studies, especially in the computational evaluation of electrical brain stimulation (neuromodulation), human protection from electromagnetic field, and electroencephalography where non-brain tissues are of great importance. To fill this gap, this study provides an open-access Segmented Head Anatomical Reference Models (SHARM) that consists of 196 subjects. These models are segmented into 15 different tissues; skin, fat, muscle, skull cancellous bone, skull cortical bone, brain white matter, brain gray matter, cerebellum white matter, cerebellum gray matter, cerebrospinal fluid, dura, vitreous humor, lens, mucous tissue and blood vessels. The segmented head models are generated using open-access IXI MRI dataset through convolutional neural network structure named ForkNet+. Results indicate a high consistency in statistical characteristics of different tissue distribution in age scale with real measurements. SHARM is expected to be a useful benchmark not only for electromagnetic dosimetry studies but also for different human head segmentation applications

Evaluation

Purpose: To evaluate the fluoroscopic guided injection, local injection, conservative treatment and surgery in managing coccygodynia. Methods: Fifty chronic coccygodynia patients were evaluated. All patients complained of pain while sitting and had tenderness localized to the coccyx. All patients were offered conservative management initially, then they were assigned into four groups: 5 patients underwent coccygectomy, 22 patients had fluoroscopic guided injection, 11 patients had local injection, and 12 patients were treated only conservatively. Patients’ satisfaction with treatment was assessed by a visual analog scale (VAS). The follow-up period ranged from 7 to 32 months (mean 17.3 months). Results: The initial conservative therapy had the lowest improvement rate (7/50, 14%). All patients subjected to coccygectomy or fluoroscopic guided injections improved and were satisfied. Nine patients of the local injection group (9/11, 82%) improved and 2 patients (18%) were stationary. Fourteen of the 16 patients with hypermobility (88%) required fluoroscopic guided injection, while 60% (12/20) of patients with normal mobility were treated conservatively. All patients with spicule required surgery. Conclusions: Fluoroscopic guided injection and surgery have the highest efficacy and satisfaction rates in managing chronic coccygodynia. Hypermobility and spicules are predictors of failure of conservative therapy

A current update on the rule of alternative and complementary medicine in the treatment of liver diseases

There is a vast body of knowledge which is ever-increasing about the treatment of liver disease with alternative and complementary medicine for which hundreds of thousands of literatures have been documented. Liver disease is a general term. This term covers all the potential problems that cause the liver to fail to perform its specified operations. Liver disease has a variety of presentations and causes a great public health problem worldwide which threatens the wellness of billions of people. Incidences of many types of liver disease are currently rising. Although there is still a debate about the entity of alternative and complementary medicine, it is now widely used and it is improving. And it covers the shortages and compensates for the weaknesses of conventional methods in the treatment of liver diseases. Alternative and complementary medicine for liver diseases provides benefits by regulating immunity, controlling disease progression, improving quality of life, and prolonging survival. This paper reviews the increasing interest and growing research into alternative and complementary medicine for liver diseases, with a look at the rough classification, principle of management, evidence-based applications, and issues for prescription and perspectives

Plants Consumption and Liver Health

The liver is a very important organ with a lot of functions for the host to survive. Dietary components are essential for and can be beneficial or detrimental to the healthy or diseased liver. Plants food is an essential part of the human diet and comprises various compounds which are closely related to liver health. Selected food plants can provide nutritional and medicinal support for liver disease. At the present, the knowledge of the effects of plants on the liver is still incomplete. The most urgent task at the present time is to find the best dietary and medicinal plants for liver health in an endless list of candidates. This review article updates the knowledge about the effects of plants consumption on the health of the liver, putting particular emphasis on the potential beneficial and harmful impact of dietary and medicinal plants on liver function

Systematic approach by computed tomography and magnetic resonance imaging in cochlear implantation candidates in Suez Canal University Hospital

Objectives: To create a systematic approach using computed tomography (CT) and magnetic resonance imaging (MRI) findings to facilitate identifying the etiology of hearing loss, evaluating the anatomy for surgery, and predicting complications. Methods: Twenty nine pediatric patients with congenital or acquired sensory-neural hearing loss (SNHL) requiring cochlear implant (CI) were included. They underwent combined CT, 3D DRIVE MRI axial plane and axial T2WIs for the whole brain. The inner ear, cochlear nerve development, temporal bone anatomy, operative window, normal variants and causes of central hearing loss were assessed. Results: CT showed that 100% of the patients are suitable for CI while MRI showed that 96.5% of studied patients are suitable. The examined ears were categorized into 4 groups according the candidacy for operation; 86.2% were suitable for CI, 5.1% were suitable for CI but with expected poor response, 1.7% of examined ears were suitable for CI with modification of surgical procedure and 6.8% were not suitable for CI. Conclusion: In Suez Canal area, the combined CT/MRI approach categorized the majority of patients with SNHL (96.6%) as good candidates for CI

Hepatocellular Carcinoma: Carcinogenesis, Establishment, Progression, and Therapies

International audienceDécret n° 2005-677 du 17 juin 2005 modifiant le livre III du code des juridictions financières,JO 18 juin 2005, p. 1036