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81
المؤلفون: Lucia Perez, Frédérque Chouet-Girard, Emmanuelle Dernis, Christelle Darrieutort-Laffite, Claire Lassalle
المصدر: Joint Bone Spine. 80:226-227
مصطلحات موضوعية: Pathology, medicine.medical_specialty, biology, medicine.diagnostic_test, business.industry, interests, Magnetic resonance imaging, biology.organism_classification, Body piercing, Rheumatology, Medicine, Immunocompetence, business, Candida albicans, interests.hobby
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::66eed3fef97747a5b6960c5d778482edTest
https://doi.org/10.1016/j.jbspin.2012.07.013Test -
82
المصدر: Annals of the Rheumatic Diseases. 73:298.1-298
مصطلحات موضوعية: Sciatica, medicine.medical_specialty, Cobb angle, Injection Procedure, business.industry, Visual analogue scale, Immunology, Ultrasound, General Biochemistry, Genetics and Molecular Biology, Epidural space, Surgery, medicine.anatomical_structure, Lumbar, Rheumatology, medicine, Clinical endpoint, Immunology and Allergy, medicine.symptom, business
الوصف: Background Ultrasound (US) is widely used in rheumatology to study and guide infiltration of peripheral joints. This imaging modality can also provide useful information about the anatomy of the lumbar spine. Studies have shown that US examination of the spine was an useful tool to help perform epidural anesthesia [1]. Objectives To determine if the identification of the optimum puncture level by a pre-puncture US examination of the lumbar spine may facilitate epidural corticosteroid injection in patients with a presumed difficult puncture. Methods We performed a prospective randomized single-blind controlled study (NCT01832844). All patients referred to our unit for the treatment of sciatica due to lumbar disc herniation were evaluated. Inclusion criteria were a BMI >30 kg/m 2 and/or age >60 years and/or lumbar scoliosis (Cobb angle >10°). Patients were randomized to a US (n=40) or a control (n=40) group. The US group underwent a pre-procedure spinal US (Esaote Mylab 70; 3-11 MHz probe). Interspinous spaces and depth of the epidural space were measured. Visibility and accessibility of the epidural space was thus rated as “poor”, “moderate” or “good”. The best lumbar level to perform the injection was selected according these results. Patients of the control group underwent a fake US examination to remain blind to the group allocation and the level of injection was selected using the traditional landmark technique. An interspinous injection of 5 ml of Hydrocortisone was thus performed. Primary endpoint was the pain during the procedure assessed using the Visual Analogue Scale (VAS). Each redirection of the needle was counted. Data are presented as the mean (±SD). A Student t-test and a Pearson correlation test were used for the statistical analysis. Results Mean age was 62,5 (±16) and 33% were men. 47/80 (58%) patients were over 60 years, 41/80 (51%) had a BMI>30 kg/m 2 and 14/80 (17%) had a lumbar scoliosis. Among the 80 patients, 21 (26%) had 2 or more criteria of presumed difficult puncture. Mean epidural space depth was 49.2 mm (±13.8) and mean interspinous distance was 14.22 mm (±5.1). We found a positive correlation between epidural space depth and BMI (p Conclusions US evaluation of the interspinous space and epidural depth is feasible even in obese or old patients. Identification of the optimum puncture level by a pre-puncture US decreased the pain during the epidural injection procedure. This benefit was greater in patients over 60 years. US of the lumbar spine represents an additional technique at the rheumatologist9s disposal to help guiding lumbar spine injections. References Grau T, Leipold RW, Conradi R, et al. Efficacy of ultrasound imaging in obstetric epidural anesthesia. J Clin Anesth. 2002;14:169-75. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.3841
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::35b63463ea002c96002f5a82ee949b48Test
https://doi.org/10.1136/annrheumdis-2014-eular.3841Test -
83
المؤلفون: Y. Maugars, B. Le Goff, Christelle Darrieutort-Laffite
المصدر: Annals of the Rheumatic Diseases. 72:A721.4-A722
مصطلحات موضوعية: Sciatica, medicine.medical_specialty, business.industry, Immunology, Ultrasound, General Biochemistry, Genetics and Molecular Biology, Sagittal plane, Epidural space, Rheumatology, Surgery, Lumbar, medicine.anatomical_structure, Interquartile range, Internal medicine, medicine, Immunology and Allergy, medicine.symptom, Ultrasonography, business, Nuclear medicine
الوصف: Background Epidural steroid injections are a common method used for the treatment of patients with sciatica. They are usually performed without imaging guidance using anatomical landmarks. However, injections are sometimes challenging resulting in prolonged procedure times, multiple needle passes and significant pain. Ultrasonography (US) is mainly used by rheumatologist for the guidance of peripheral joint injections. However, some studies have shown that US examination of the spine was useful before epidural anesthesia to predict which patients were at risk for a difficult procedure (1). Objectives The aim of our study was to evaluate the feasibility of a pre-procedure ultrasound examination of the spine before epidural steroid injections. Methods US examination of the lumbar spine was performed in 21 patients referred to our unit for the treatment of sciatica due to lumbar disc herniation. The scanning was performed with an Esaote My lab 70 unit using a curved-array, low-frequency (1–8 MHz) probe on a patient seated. L5-S1 intervertebral space was first located on a sagittal view, and the probe was then moved cranially. At each intervertebral level, we recorded our ability to depict the epidural space. We rated the visibility as ‘absent’, ‘poor’, ‘moderate’, ‘good’ with assigned numerical values of 0, 1, 2 and 3, respectively. We measured distance between spinous processes and depth of the epidural space in L3-L4, L4-L5 and L5-S1. Each measurement was performed 3 times and the mean was used for statistical analysis. Data are given as the median (+/- interquartile range). Differences between measurements at each lumbar levels was assessed with a Friedman’s Test and correlations between age, gender and Body mass index (BMI) and epidural visibility with a Pearson’s test. Results 21 patients (11 men and 10 women), mean age 46 years (38-60.5) were included in our study. Median weight was 73 kg (59-85) and median BMI 24.8 (20.85-27.05). Median depth of the epidural space was 44.5 mm (41.60-48.45) in L3-L4, 43.80 mm (41.35-45.85) in L4-L5 and 40.8 mm (39.2-46.9) in L5-S1. Median distance between spinous processes was 17.9 mm (12.95-20.75), 15.9 mm (13.15-17.8) and 16.4 mm (15.30-17.7) in L3-L4, L4-L5 and L5-S1, respectively. Visibility of the epidural space was significantly lower in L5-S1 (p Conclusions We accurately identified each intervertebral level, estimated depth to the epidural space, and located the most appropriate interspinous space for needle insertion. As expected, the distance between spinous processes and epidural accessibility was reduced in older patients. US might help us to predict which patients are at risk for a difficult epidural injection and help the physician to identify the optimal site of injection. Overall, US of the lumbar spine represents a new imaging modality available for the rheumatology to treat patients with lumbar conditions. References Weed JT, Taenzer AH, Finkel KJ, Sites BD. Evaluation of pre-procedure ultrasound examination as a screening tool for difficult spinal anaesthesia. Anaesthesia. 2011 Oct;66(10):925-30. Disclosure of Interest None Declared
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::99f7e0d8c5cd3b0b7330c572609a9dfaTest
https://doi.org/10.1136/annrheumdis-2013-eular.2135Test -
84
المؤلفون: Claire Le Jeunne, Alain Saraux, Gilles Hayem, Xavier Puéchal, Christelle Darrieutort-Laffite, Vincent André, Véronique Le Guern
المصدر: ResearcherID
مصطلحات موضوعية: Adult, medicine.medical_specialty, Urinary urgency, Cyclophosphamide, Urinary system, Cystitis, Interstitial, Azathioprine, Distension, Gastroenterology, Rheumatology, Internal medicine, medicine, Dysuria, Humans, Aged, business.industry, Interstitial cystitis, Cystoscopy, Middle Aged, medicine.disease, Surgery, Sjogren's Syndrome, Female, medicine.symptom, Sjogren s, business, Tomography, X-Ray Computed, Immunosuppressive Agents, medicine.drug, Follow-Up Studies
الوصف: Objectives To characterize the interstitial cystitis (IC) associated with Sjogren's syndrome (SS). Methods Report of three new cases. Only cases fulfilling the American-European consensus criteria for SS and the European Society for the Study of Interstitial Cystitis criteria with positive histological findings for IC were included. Results Thirteen cases of SS and IC have been reported in women, including the three reported here, with a mean age of 54 years. SS appeared first in 77% ( n = 10) of cases, a mean of 6.6 years before IC. The symptoms of IC included pollakiuria ( n = 11), lower abdominal pain ( n = 8), urinary urgency ( n = 5), painful micturition ( n = 6), hematuria ( n = 3) and dysuria ( n = 3). Urinary dilatation occurred in three cases, leading to acute renal failure in two patients. The diagnosis of IC was confirmed by anatomical evidence of cystitis inflammation on bladder biopsy in all ( n = 13) patients. Treatment was reported for nine patients, seven of whom (78%) received corticosteroid treatment, which was partially or completely effective in six cases. Immunosuppressive treatment was added in three cases (cyclosporine, n = 2; azathioprine, n = 1; cyclophosphamide, n = 1). Local bladder treatments were performed, with hydraulic distension in five cases and DMSO instillation in one patient. A urinary catheter was inserted in the two cases of acute obstructive renal failure. Conclusions Urinary symptoms without infection should lead the physician to consider a diagnosis of IC in SS patients. Urinary dilatation may occur, leading to acute obstructive renal failure. Corticosteroid treatment may be effective and local treatments have been tried.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::edfdca807d466bce2e9d5c6a370be673Test
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=ORCID&SrcApp=OrcidOrg&DestLinkType=FullRecord&DestApp=WOS_CPL&KeyUT=WOS:000358821600007&KeyUID=WOS:000358821600007Test -
85رسالة جامعية
المؤلفون: Dalla-Torre, Romain
المساهمون: Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Christelle Darrieutort-Laffite
المصدر: https://dumas.ccsd.cnrs.fr/dumas-03781873Test ; Médecine humaine et pathologie. 2022.
مصطلحات موضوعية: Coiffe des rotateurs de l'épaule, Ténopathies, Radiographie, Scores en médecine, Thèses et écrits académiques, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
الوصف: Background: Calcific tendinitis of the rotator cuff (CTRC) is one of the most common causes of shoulder pain, affecting 10 to 42% of patients referred for a painful shoulder. The diagnosis is usually confirmed by standard radiographs. Various radiographic classifications have been developed, but none of them is considered satisfactory to date. Among other things, they are criticized for their lack of inter-observer reproducibility and the absence of radio-clinical correlation. Purpose: The aim was to evaluate the metric properties of a new scoring system for CTRC, by testing its intra- and inter-reader reliability, sensitivity to change and correlation with the clinical outcomes after treatment. Methods: This is a post hoc analysis of the CALCECHO trial, a double-blinded randomizedcontrolled trial assessing the effect of corticosteroid injections after UGPL. All patients received an ultrasound-guided puncture and lavage (UGPL) of their rotator cuff calcification. From this database, 276 radiographs of 69 patients were analyzed at baseline, 7 days (D7), 3 months (M3) and 12 months (M12) after the UGPL using the classifications of Molé, Gärtner and our new Darrieutort-Laffite score. We also collected the patients' clinical data at baseline and during follow-up. Inter-observer and intra-observer reliability were established between three independent investigators (2 experts and one junior) by weighted kappa. Construct validity was assessed between pain, function and radiological stages. Predictive validity was assessed to predict clinical improvement after UGPL. Finally, sensitivity to change was assessed by standardized response mean (SRM). Results: In this 12-month follow-up study, the reliability of the proposed scoring system for calcific tendonitis was tested. We found a substantial inter-reader reliability with 0.677, 0.744 and 0.656 at D7, M3 and M12 respectively, higher than for Molé and Gärtner classifications. Intra-reader agreement was between 0.577 and 0.836 for the two expert readers and between 0.519 ...
العلاقة: dumas-03781873; https://dumas.ccsd.cnrs.fr/dumas-03781873Test; https://dumas.ccsd.cnrs.fr/dumas-03781873/documentTest; https://dumas.ccsd.cnrs.fr/dumas-03781873/file/Dalla-torreMED22.pdfTest; PPN: 264459008
