Telemedicine is the medical practice of caring for and treating patients remotely. With the advent of the COVID-19 pandemic, telemedicine has become increasingly prevalent. Although telemedicine was already in practice before the 2020 pandemic, the internet, smartphones, computers and video-conferencing tools have made telemedicine easily accessible and available to almost everyone. However, there are also new challenges that health care providers may not be prepared for, including treating and diagnosing patients without physical contact. We review current trends involving telemedicine, how pandemics such as COVID-19 affect the remote treatment of patients, and key concepts important to health care providers who practice telemedicine.
The authors report a secondary exudative vasoproliferative tumor of the retina associated with retinopathy of prematurity, managed by plaque radiotherapy. A 15-year-old girl with a history of mild, stable retinopathy of prematurity in both eyes noted progressively reduced visual acuity to hand motions in the left eye. Examination disclosed a vasoproliferative tumor of 10-mm base and 3.5-mm thickness with near total (macula-off) exudative retinal detachment. She was treated with iodine-125 plaque radiotherapy, giving apex dose of 40 Gy over 4 days. The tumor regressed to 1.9 mm and retinal detachment resolved 8 months following therapy. Epiretinal membrane with significant macular pucker and edema later developed and was managed with pars plana vitrectomy and membrane peeling. Visual acuity was counting fingers due to photoreceptor loss. Retinopathy of prematurity is a rare cause of vasoproliferative tumor. Iodine-125 plaque radiotherapy can lead to tumor regression and reattachment of the retina in such cases.
BACKGROUND: The American Society of Regional Anesthesia currently recommends ceasing antithrombotic medications for all spinal epidural steroid injections, however there is a paucity of data on the true risk of spinal epidurals via various approaches versus the risk of cessation of an agent as it relates to the underlying medical condition. OBJECTIVE: This study evaluated the complication rate of caudal epidural steroid injections in patients who remain on antithrombotic medications. STUDY DESIGN: Retrospective chart review. SETTING: Physiatric Spine Clinic in Orthopedic Specialty Office and Surgical Center. METHODS: A retrospective chart review was performed identifying patients (n = 335) who received a caudal epidural steroid injection (n = 673) from June 2015 through April 2020. Patients were included if they had received the injection while taking an antithrombotic medication. Patients were excluded if they were not taking an antithrombotic. The patient’s age, indication for the injection including magnetic resonance imaging or computed tomography findings, antithrombotic medication, the medical condition requiring an antithrombotic, and any complications following the injection were collected via chart review. RESULTS: Of the 443 injections included in the study, 51 encounters were lost to follow-up. Of the other 392 injections, there were no reported complications, regardless of the patient’s imaging findings, age, the antithrombotic medication used, or the underlying medical condition for which an antithrombotic medication was indicated. LIMITATIONS: This is a retrospective study. Therefore, a prospective study may have yielded fewer encounters lost to follow-up. Patients were not contacted directly after the procedure and chart reviews were utilized to evaluate for complications, which was limited to a patient’s reporting of perceived complications without any imaging. CONCLUSIONS: We conclude that caudal epidural steroid injections can be performed safely in patients while taking antithrombotic medications. Catastrophic events have been observed in patients who have discontinued antithrombotic agents preceding procedures. Thus, discontinuing antithrombotic medications may pose a greater risk than benefit for patients on an antithrombotic medication who have painful lumbar radiculopathy. KEY WORDS: Epidural injection, caudal, antithrombotic, safety, steroids, anticoagulant, antiplatelet, epidural hematoma
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