In this paper we demonstrated an unusual location for sphenopalatine ganglion (SPG) in the pterygopalatine fossa in a 33-year-old woman with intractable atypical trigeminal autonomic cephalalgia, who was a candidate for radiofrequency (RF) thermocoagulation of SPG. The classic radiographic target point is deeply situated in the uppermost part of the sphenopalatine (SP) fossa. This point can be classically addressed in the superomedial angle of the maxillary sinus, adjacent to the lateral wall of the nasal cavity in the AP view of C-Arm fluoroscopy images. In this patient placing the needle deeply in the SP fossa was not possible. However, sensory stimulation of SPG was associated with a satisfactory response and subsequent RF denervation led to adequate pain reduction. This report demonstrated that in difficult technical situations, when advancing the needle deeply in the SP fossa is not easily possible; adequate outcome of the sensory stimulation of the area, may justify accomplishing the procedure. This technique used in a more superficial location in SP fossa will reduce frequent attempts of needle manipulation, hematoma formation, vascular and neural injury, X-Ray exposure and eventually intranasal placement of the needle.
Transforaminal epidural block (TEB) is a widely accepted technique and minimally invasive procedure for the treatment of lumbosacral radicular pain. This study aimed to evaluate the accuracy, efficacy, and safety of ultrasound and nerve stimulator guidance lumbar transforaminal epidural block (UNTEB) for the patients with unilateral lower lumbar radicular pain. The accuracy of this method was evaluated by fluoroscopy. Using UNTEB via axial and the in-plane approach technique was performed in 42 segments of 25 patients who presented with lumbosacral radicular pain to lower extremities. The contrast medium was injected to evaluate the needle tip at the intervertebral foramen under fluoroscopic guidance. The numerical rating scale was used to assess pain before and after treatment. The success ratio of UNTEB in L3/L4 level was 100%, in L4/L5 was 95.4% and in L5/S1 was 100%. The numerical rating scale (NRS) for lumbosacral radicular pain improved from a mean from 7.8 to 2.8 1 day after procedure (p = 0.01) and from a mean from 7.8 to 2.4 1 week after UNTEB (p = 0.01). None of our subjects experienced any complications during and after the procedure. UNTEB with fluoroscopic validation is an accurate, effective, and safe method for short-term pain relief of the patients with unilateral lumbosacral radicular pain.
Review question / Objective: The aim of this systematic review is to evaluate AI-based models in identifying predictors of cardiovascular events and risk predtion in patients with diabetes mellitus type2. Condition being studied: T2DM patients have an increased risk of macrovascular and microvascular complications, lead to decreased quality of life and mortality. Considering the significance of cardiovascular complications in these patients, prediction of such events would be important. Different traditional statistical methods(such as regression) and new AI-besed algorithms are used to predict these complications in diabetic patients.
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