Prospective, Multicenter, Randomized, Crossover Clinical Trial Comparing the Safety and Effectiveness of Cooled Radiofrequency Ablation With Corticosteroid Injection in the Management of Knee Pain From Osteoarthritis
BACKGROUND AND OBJECTIVES/OBJECTIVE:Osteoarthritis (OA) of the knee affects the aging population and has an associated influence on the health care system. Rigorous studies evaluating radiofrequency ablation for OA-related knee pain are lacking. This study compared long-term clinical safety and effectiveness of cooled radiofrequency ablation (CRFA) with intra-articular steroid (IAS) injection in managing OA-related knee pain. METHODS:This is a prospective, multicenter, randomized trial with 151 subjects with chronic (â‰¥6 months) knee pain that was unresponsive to conservative modalities. Knee pain (Numeric Rating Scale [NRS]), Oxford Knee Score, overall treatment effect (Global Perceived Effect), analgesic drug use, and adverse events were compared between CRFA and IAS cohorts at 1, 3, and 6 months after intervention. RESULTS:There were no differences in demographics between study groups. At 6 months, the CRFA group had more favorable outcomes in NRS: pain reduction 50% or greater: 74.1% versus 16.2%, P < 0.0001 (25.9% and 83.8% of these study cohorts, respectively, were nonresponders). Mean NRS score reduction was 4.9 Â± 2.4 versus 1.3 Â± 2.2, P < 0.0001; mean Oxford Knee Score was 35.7 Â± 8.8 vs 22.4 Â± 8.5, P < 0.0001; mean improved Global Perceived Effect was 91.4% vs 23.9%, P < 0.0001; and mean change in nonopioid medication use was CRFA > IAS (P = 0.02). There were no procedure-related serious adverse events. CONCLUSIONS:This study demonstrates that CRFA is an effective long-term therapeutic option for managing pain and improving physical function and quality of life for patients with painful knee OA when compared with IAS injection. CLINICAL TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov (NCT02343003).
Derivation and preliminary validation of a risk score to predict 30-day ED revisits for sickle cell pain
BACKGROUND: Emergency department (ED) revisits and 30-day readmissions have been proposed as markers for quality of ED care for sickle cell disease (SCD). OBJECTIVE: To create a scoring system that quantifies the risk of 30-day revisit after ED discharge for SCD vaso-occlusive pain METHODS: This was a dual-center retrospective derivation and validation cohort study. The derivation was performed at an academic, tertiary care center and the validation at an urban community hospital. The primary outcome was revisit to the ED within 30 days after an ED discharge for SCD pain. Recursive partitioning was used to derive a scoring system to predict 30-day revisits. RESULTS: Of a total of 1456 ED visits for SCD pain, there were 680 ED discharges (admission rate of 53%) in 193 unique individuals included in the derivation cohort. There were 240 (35.3%) 30-day revisits. Of a total of 126 ED visits for SCD, there were 79 ED discharges in 41 unique individuals in the validation cohort. The final risk score included 4 variables: (1) age, (2) insurance status, (3) triage pain score, and (4) amount of opioids administered during the ED visit. Possible scores range from 0 to 6. The areas under the receiver operating characteristic curves were 0.746 (95% confidence interval, 0.71-0.78-derivation cohort) and 0.753 (95% confidence interval, 0.65-0.86-validation cohort). A cutoff of 4 or greater identified 60% of 30-day ED revisits in the derivation cohort and 80% of revisits in the validation cohort. CONCLUSIONS: A risk score can identify ED visits for SCD pain with high risk of 30-day revisit.
Pediatric ethmoid sinus desmoplastic fibroma: Case report and review of pediatric bony sinus tumors
While intraosseous tumors of the pediatric sinonasal tract are rare and tend to be slow growing, they can be locally aggressive and have a tendency to recur. Due to the possibility of devastating outcomes secondary to mass effect, it is important for physicians to promptly diagnose and properly manage these tumors. We report an extremely rare case of a desmoplastic fibroma of the ethmoid sinus in a pediatric patient and review its clinical findings, methods of diagnosis, and treatment
Giant calculus of the submandibular salivary duct [Case Report]
Spontaneous retropharyngeal emphysema [Case Report]
Endoscopic management of benign tumors extending into the infratemporal fossa: a two-surgeon transnasal approach
OBJECTIVES/HYPOTHESIS: Preliminary results of the endoscopic two-surgeon technique for the management of benign infratemporal fossa tumors are presented. METHODS: Four patients with juvenile nasopharyngeal angiofibroma, a patient with an inverting papilloma, and a patient with a maxillary nerve schwannoma were reviewed. The average age was 22.7 years; the male-to-female ratio was 5:1. The endoscopic anatomy and surgical technique are presented. RESULTS: The two-surgeon technique allowed complete resection of all six tumors extending into the infratemporal fossa. There has been no recurrence of tumor within the infratemporal fossa, after a mean follow-up of 31.3 months (SD = 11.2 mo). CONCLUSION: The two-surgeon transnasal technique allows benign infratemporal fossa tumors to be resected endoscopically
A patient-benefit evaluation of unilateral congenital conductive hearing loss presenting in adulthood: should it be repaired? [Case Report]
OBJECTIVE: To evaluate subjective and objective outcomes of surgical therapy in congenital conductive hearing loss (HL) presenting in adulthood. The impact of hearing restoration on quality of life (QOL) for these patients may differ from those with acquired HL. STUDY DESIGN: Retrospective review of five patients treated surgically. METHODS: Standard audiometry was completed. Patients completed a subjective questionnaire as well as subjective (open-set) questions. A seven-point Likert scale was used for closed-set responses with 1 representing the worst possible outcome and 7 being best. RESULTS: The average four-frequency improvements in pure-tone average and air-bone gap were 18 dB (range, 7-29 dB) and 16 dB (range, 2-30 dB), respectively. An average score was obtained for each closed-set question. The highest-scoring items were for overall improvement of QOL (average score, 6), followed by perceived improvement in hearing (average score, 5.6). Other positive responses were improved ability to use the telephone (four of five patients) and improved localization of sound (four of five patients). Negative subjective responses included prolonged dysequilibrium in two of five, prolonged adjustment period in three, and dysgeusia in one patient. CONCLUSION: Important components of outcome are likely to escape our review if only objective measures are used to evaluate surgical outcomes. These results suggest that improved hearing in this population provides specific improvements in lifestyle and is perceived as a significant improvement in overall QOL.