BACKGROUND: Selective lumbar nerve root block (SNRB) is generally accepted as an effective treatment method for back pain with sciatica. However, it requires devices producing radioactive materials such as C-arm fluoroscopy. This study evaluated the usefulness of the longitudinal view of transverse process and needles for medial branch block as landmarks under ultrasonography. METHODS: We performed selective nerve root block for 96 nerve roots in 61 patients under the guidance of ultrasound. A curved probe was used to identify the facet joints and transverse processes. Identifying the lumbar nerve roots under the skin surface and ultrasound landmarks, the cephalad and caudal medial branch blocks were undertaken under the transverse view of sonogram first. A needle for nerve root block was inserted between the two transverse processes under longitudinal view, while estimating the depth with the needle for medial branch block. We then injected 1.0 mL of contrast medium and checked the distribution of the nerve root with C-arm fluoroscopy to evaluate the accuracy. The visual analog scale (VAS) was used to access the clinical results. RESULTS: Seven SNRBs were performed for the L2 nerve root, 15 for L3, 49 for L4, and 25 for L5, respectively. Eighty-six SNRBs (89.5%) showed successful positioning of the needles. We failed in the following cases: 1 case for the L2 nerve root; 2 for L3; 3 for L4; and 4 for L5. The failed needles were positioned at wrong leveled segments in 4 cases and inappropriate place in 6 cases. VAS was improved from 7.6 +/- 0.6 to 3.5 +/- 1.3 after the procedure. CONCLUSIONS: For SNRB in lumbar spine, the transverse processes under longitudinal view as the ultrasound landmark and the needles of medial branch block to the facet joint can be a promising guidance.
Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Female ; Humans ; Low Back Pain/etiology/*therapy ; Lumbar Vertebrae/anatomy & histology/*ultrasonography ; Male ; Middle Aged ; Nerve Block/*methods ; Sciatica/etiology/*therapy ; Spinal Stenosis/complications/*diagnosis ; Zygapophyseal Joint/anatomy & histology/ultrasonography

High-output cardiac failure is a rare complication of hereditary hemorrhagic telangiectasia (HHT) usually caused by shunting of blood through atriovenous malformations (AVMs) in the liver. We describe two cases of high output heart failure due to large hepatic AVMs. Clinical suspicion of HHT based on detailed history taking and physical examination is essential for early detection and proper management of heart failure associated with HHT.
Heart ; Heart Failure ; Liver ; Physical Examination ; Telangiectasia, Hereditary Hemorrhagic

OBJECTIVE: To investigate the risk factors for symptomatic knee osteoarthritis (OA) in Koreans METHODS: A total of 1,194 persons consisting of 588 men and 606 women (mean age+/-SD, 48.9+/-14.0 years) were enrolled in rural and urban areas or in a hospital of Korea between september 2000 and august 2001. All participants were interviewed about symptoms of knee OA and possible risk factors including age, sex, occupation, body mass index (BMI), smoking, age of menarche, menopause and hormone replacement therapy and examined. Knee radiograph was obtained in all participants with knee symptoms. Symptomatic knee OA was defined according to clinical criteria or clinical and radiographic criteria for classification of osteoarthritis of the knee by Altman. RESULTS: Of 1,194 participants, symptomatic knee OA was found in 189 persons (15.8%) and multivariate analysis showed that female (OR=5.66, 95% CI 3.42~9.38), aging (OR=1.10, 95% CI 1.08~1.12), living in rural area (OR=3.83, 95% CI 2.27~6.45) and BMI over 25 kg/m(2) (OR=2.26, 95% CI 1.42~3.59) were risk factors. Age (older than 70 years, OR=1.08, 95% CI 1.04~1.12) and living in rural area (OR=5.39, 05% CI 1.94~14.96) were associated with symptomatic knee OA in men and age (older than 40 years, OR=1.11, 95% CI 1.07~1.16), living in rural area (OR=2.46, 95% CI 1.17~5.17), and BMI over 25 kg/m(2) (OR=3.45, 95% CI 1.63~7.29) in women. CONCLUSION: The risk factors for symptomatic knee OA were aging, female, living in rural area and high BMI in Koreans.
Female ; Male ; Humans ; Risk Factors

The conventional approach to treatment of patients with ankylosing spondylitis (AS) have been rather limited in the last decades. Evidence is accumulating that tumor necrosis factor (TNF) blocker is highly effective in AS. This article reviews the most recent and the most pertinent advances in the treatment in AS. TNF blocker have been evaluated in a number of randomized controlled trials in AS and have been demonstrated to be effective in disease activity, function, and quality of life in these patients. TNF blocker is emerging as the best therapeutic option available for patients with AS.
Humans ; Quality of Life ; Spondylitis, Ankylosing* ; Tumor Necrosis Factor-alpha