Objective: Cervicogenic headache has been known to originate from the convergence of the upper 3 cervical and trigeminal afferents. The administration of conservative treatments, interventional procedures, and more recently, pulsed radiofrequency, has been used to relieve cervicogenic headache. In this study, the authors evaluated the clinical efficacy and safety of pulsed radiofrequency targeting the mid-cervical medial branches. Materials and Methods: From September 2012 until December 2017, 395 patients were diagnosed with cervicogenic headache based on the third edition of the International Classification of Headache Disorders. The authors treated them conservatively at first, and those patients with nonresolution of pain were treated with mid-cervical medial branches block applied from C3 to C5 twice. Subsequently, if any patient continued to experience persistent pain, the authors classified them as having intractable cervicogenic headache and performed pulsed radiofrequency treatment targeting the mid-cervical medial branches from C3 to C5 bilaterally. The authors analyzed their demographics and used a Visual Analogue Scale to assess their pain for 12 months. Results: Fifty-seven patients were enrolled in this study. The mean age was 49.8 years, and the mean duration of symptoms was 47.7 months. The mean Visual Analogue Scale score was 6.21 before pulsed radiofrequency treatment, and it improved to 1.54 immediately after the procedure without the symptoms recurring for a minimum of 12 months. There were no severe complications, such as vascular or nerve injuries. Conclusions: In patients with intractable cervicogenic headache, pulsed radiofrequency treatment targeting the mid-cervical medial branches resulted in a satisfactory, long-lasting outcome without serious complications.
Acute pancreatitis is a gastrointestinal disease with hyperamylase, hyperlipase and accompanied by symptoms such as epigastric ObjectiveTo evaluate the clinical characteristics of patients in neurointensive care unit (NICU) whose pancreatic enzyme has elevated and the appropriate cut off value of amylase, lipase for conducting the computerized tomography (CT) scans. MethodsThis was retrospective study of 66 patients in NICU unit who had elevated pancreatic enzymes from January 2008 to December 2013. We classified the subjects with two groups according to CT findings of pancreas -Balthazar score. Patients' demographic and clinical data was analyzed and level of amylase, lipase was evaluated using receiver operating characteristics curve. ResultsThe patients were categorized into 2 groups according to CT findings. Morphologic alteration of pancreas was classified in Group 1, and normal pancreas in CT findings was classified in Group 2. There were no statistical differences between groups, but peak serum lipase level was elevated in Group 1 with statistical significance (p=0.032). By receiver operating characteristics (ROC) curve, we could suspect pancreatitis more precisely in patients with elevated amylase levels > 2-fold the upper normal limit (207 U/L, 73.3% sensitivity and 60.6% specificity), or elevated lipase levels > 4-fold the upper normal limit (1243 U/L, 80% sensitivity and 60.6% specificity) calculated by maximum of the Youden index. Conclusions According to our results, serum lipase level is more significant value for pancreatitis. And abdominal CT should be considered if patient's amylase levels are more than 2-fold and lipase levels are more than 4-fold.
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