BACKGROUND Low back pain(LBP)is a prevalent issue that orthopedic surgeons frequently address in the outpatient setting.LBP can arise from various causes,with stiffness in the paraspinal muscles being a notable contri...BACKGROUND Low back pain(LBP)is a prevalent issue that orthopedic surgeons frequently address in the outpatient setting.LBP can arise from various causes,with stiffness in the paraspinal muscles being a notable contributor.The administration of Botulinum toxin type A(BoNT-A)has been found to alleviate back pain by relaxing these stiff muscles.While BoNT-A is approved for use in numerous conditions,a limited number of randomized clinical trials(RCTs)validate its efficacy specifically for treating LBP.AIM To study the safety and the efficacy of BoNT-A in minimizing pain and improving functional outcomes in patients of chronic LBP(CLBP).METHODS In this RCT,adults aged 18-60 years with mechanical LBP persisting for at least six months were enrolled.Participants were allocated to either the Drug group,receiving 200 Ipsen Units(2 mL)of BoNT-A,or the Control group,which received a 2 mL placebo.Over a 2-month follow-up period,both groups were assessed using the Visual Analog Scale(VAS)for pain intensity and the Oswestry Disability Index(ODI)for disability at the start and conclusion of the study.A decrease in pain by 50%was deemed clinically significant.RESULTS The study followed 40 patients for two months,with 20 in each group.A clinically significant reduction in pain was observed in 36 participants.There was a statistically significant decrease in both VAS and ODI scores in the groups at the end of two months.Nonetheless,when comparing the mean score changes,only the reduction in ODI scores(15 in the placebo group vs 16.5 in the drug group,clinically insignificant)was statistically significant(P=0.012),whereas the change in mean VAS scores was not significant(P=0.45).CONCLUSION The study concludes that BoNT-A does not offer a short-term advantage over placebo in reducing pain or improving LBP scores in CLBP patients.展开更多
贲门失弛缓症(Achalasia,AC)临床上并不少见,主要临床表现是咽下困难、胸骨后疼痛和食物反流.由于摄食量不足,患者多伴有营养不良.过去,治疗本病的方法主要是口服解痉药和扩张疗法,但前者疗效欠佳,后者的治疗过程患者极其痛苦,且有发生...贲门失弛缓症(Achalasia,AC)临床上并不少见,主要临床表现是咽下困难、胸骨后疼痛和食物反流.由于摄食量不足,患者多伴有营养不良.过去,治疗本病的方法主要是口服解痉药和扩张疗法,但前者疗效欠佳,后者的治疗过程患者极其痛苦,且有发生出血、穿孔等并发症的可能.近年国外报告下食管括约肌(LES)注射 A 型肉毒毒素(Btulinum toxin A,BTXA)治疗本病取得了较好的效果.我们用该法治疗的10例如下.展开更多
胰胆管末端、共同通道及十二指肠乳头均有不同厚度的平滑肌环绕,即胆道口括约肌(sphincter of Oddi,SO),此段长4 mm～6 mm.如 SO 不能正常地舒张,胆汁或(和)胰液引流不畅,导致胆汁瘀积或(和)胰腺炎,表现为反复发作的上腹痛、黄疸、淀粉...胰胆管末端、共同通道及十二指肠乳头均有不同厚度的平滑肌环绕,即胆道口括约肌(sphincter of Oddi,SO),此段长4 mm～6 mm.如 SO 不能正常地舒张,胆汁或(和)胰液引流不畅,导致胆汁瘀积或(和)胰腺炎,表现为反复发作的上腹痛、黄疸、淀粉酶升高等,谓之 SO 功能失调(SOD).一般将 SOD 分为狭窄性和功能性,前者包括纤维化、肥大、慢性乳头炎或腺肌炎;后者包括 SO 运动过速、收缩期基础压升高、逆向收缩过多、SO 对 CCK 的反常反应.临床上 SOD 可分为3型:SOD-Ⅰ型:多为器质性狭窄,表现为典型的胆源性绞痛、肝酶(ALP,γ-GT)展开更多
基金Supported by All India Institute of Medical Sciences Bhubaneswar Research Grant,No.AIIMS/BBSR/RS/2022/372.
文摘BACKGROUND Low back pain(LBP)is a prevalent issue that orthopedic surgeons frequently address in the outpatient setting.LBP can arise from various causes,with stiffness in the paraspinal muscles being a notable contributor.The administration of Botulinum toxin type A(BoNT-A)has been found to alleviate back pain by relaxing these stiff muscles.While BoNT-A is approved for use in numerous conditions,a limited number of randomized clinical trials(RCTs)validate its efficacy specifically for treating LBP.AIM To study the safety and the efficacy of BoNT-A in minimizing pain and improving functional outcomes in patients of chronic LBP(CLBP).METHODS In this RCT,adults aged 18-60 years with mechanical LBP persisting for at least six months were enrolled.Participants were allocated to either the Drug group,receiving 200 Ipsen Units(2 mL)of BoNT-A,or the Control group,which received a 2 mL placebo.Over a 2-month follow-up period,both groups were assessed using the Visual Analog Scale(VAS)for pain intensity and the Oswestry Disability Index(ODI)for disability at the start and conclusion of the study.A decrease in pain by 50%was deemed clinically significant.RESULTS The study followed 40 patients for two months,with 20 in each group.A clinically significant reduction in pain was observed in 36 participants.There was a statistically significant decrease in both VAS and ODI scores in the groups at the end of two months.Nonetheless,when comparing the mean score changes,only the reduction in ODI scores(15 in the placebo group vs 16.5 in the drug group,clinically insignificant)was statistically significant(P=0.012),whereas the change in mean VAS scores was not significant(P=0.45).CONCLUSION The study concludes that BoNT-A does not offer a short-term advantage over placebo in reducing pain or improving LBP scores in CLBP patients.
文摘贲门失弛缓症(Achalasia,AC)临床上并不少见,主要临床表现是咽下困难、胸骨后疼痛和食物反流.由于摄食量不足,患者多伴有营养不良.过去,治疗本病的方法主要是口服解痉药和扩张疗法,但前者疗效欠佳,后者的治疗过程患者极其痛苦,且有发生出血、穿孔等并发症的可能.近年国外报告下食管括约肌(LES)注射 A 型肉毒毒素(Btulinum toxin A,BTXA)治疗本病取得了较好的效果.我们用该法治疗的10例如下.
文摘胰胆管末端、共同通道及十二指肠乳头均有不同厚度的平滑肌环绕,即胆道口括约肌(sphincter of Oddi,SO),此段长4 mm～6 mm.如 SO 不能正常地舒张,胆汁或(和)胰液引流不畅,导致胆汁瘀积或(和)胰腺炎,表现为反复发作的上腹痛、黄疸、淀粉酶升高等,谓之 SO 功能失调(SOD).一般将 SOD 分为狭窄性和功能性,前者包括纤维化、肥大、慢性乳头炎或腺肌炎;后者包括 SO 运动过速、收缩期基础压升高、逆向收缩过多、SO 对 CCK 的反常反应.临床上 SOD 可分为3型:SOD-Ⅰ型:多为器质性狭窄,表现为典型的胆源性绞痛、肝酶(ALP,γ-GT)
