Original Articles : Interventional Pain Management in Rheumatological Diseases -A Three Years Physiatric Experience in a Tertiary Medical College Hospital in Bangladesh

( Md Abu Bakar Siddiq ),( Suzon Al Hasan ),( Gautam Das ),( Amin Uddin A Khan ) 대한통증학회 2011 The Korean Journal of Pain Vol.24 No.4

Background: Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped x-ray and anatomical landmarks. Interventional physiatry is a branch of Physical Medicine and Rehabilitation that treat painful conditions by intervention in peripheral joints, spine, and soft tissues. Methods: A cross - sectional study was conducted using three years hospital records (2006 to 2008) of Physical Medicine and Rehabilitation Department, Chittagong Medical College Hospital, Bangladesh with a view to highlight current interventional pain practice in a tertiary medical college hospital. Results: Maximum intervention was done in degenerative peripheral joint disorders (600, 46.0%) followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred low back conditions (100, 8.0%). Knee was the most commonly intervent peripheral joint. Motor stimulation guided intralesional injection methylprednisolone into piriformis muscle was given in 10 cases of piriformis syndrome refractory to oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%) and discussed separately. Epidural steroid was practiced in different causes of lumbar radiculopathy except infective discitis. Conclusions: All procedures were performed using anatomical landmark as there was no facilities for c-arm/diagnostic ultrasound required for accurate and safe intervention. Dedicated IPM set up is required in all PMR departments for better pain management and reduce burden on other specialities.

방사선 시술: 환자의 불안감, 통증의 공포심, 시술에 대한 이해도, 그리고 약제에 대한 만족도-전향적 연구

김태훈 대한영상의학회 2006 대한영상의학회지 Vol.55 No.4

Purpose: I wanted to prospectively assess patients' anxiety, their understanding of the procedure being performed, the perception of the pain level and the satisfaction with the administered medication for interventional procedures. Materials and Methods: I investigated 78 patients before and after they underwent 93 interventional procedures. The patients responded to a series of questions by using a visual analogue scale (VAS). Two different procedures were performed on 15 patients at different times. Based on the patient's body weight, a combination of sedative and analgesic was intravenously administered. Results: The mean anxiety VAS score for the interventional procedures was about 5.3. The mean anxiety score of the experienced patients was about 3.8 and that of the inexperienced patients was about 5.5 (p <.001). The mean score for the understanding of the procedure, which was recorded both before and after the procedure, was about 4.1 and 7.1, respectively. The mean scores for the understanding of the procedure were about 7.0 in the experienced patients and about 3.6 in the inexperienced patients (p< .001). The anticipated level of pain recorded before the procedure was about 5.2 and the level of pain during the procedure was 2.9, and the latter was recorded after the procedure (p< .001). The level of satisfaction with the medication provided during the procedure was about 8.0 on the VAS score. Conclusion: The patients had a moderate amount of anxiety about the interventional procedures. Most patients had a high level of satisfaction with the medication despite the amount of pain they experienced during the procedure. The patients who were experienced with a procedure tended to have less anxiety and anticipated pain, and they had a greater understanding of the procedure. 목적: 방사선 시술 전 환자가 느끼는 불안감, 시술에 대한 이해도, 시술로 인한 통증의 정도, 그리고 시술 시 주어진 약제에 대한 만족도를 전향적으로 분석하였다. 대상과 방법: 총 78명의 환자에게 93회의 인터벤션 시술 전후에 시술에 대한 불안감, 시술에 대한 이해도, 시술로 인한 통증의 정도, 그리고 시술 중 사용된 약제에 대한 만족도를 (시각상사척도)Visual analogue scale(VAS)을 이용하여 조사하였다. 15명의 환자는 2번의 시술을 받았고, 모든 환자는 몸무게에 비례하여 진정제 및 진통제 주사를 복용하였다. 결과: 시술에 대한 불안감은 VAS 상 평균 약 5.3이었고, 이전에 시술을 받은 경험이 있었던 경험자는 평균 3.8, 비 경험자는 평균 5.5이었다(p < .001). 시술에 대한 이해도는 시술 전에 평균 4.1 그리고 시술 후에 평균 약 7.1이었고, 경험자가 평균 7.0, 비 경험자가 3.6이었다 (p <.001). 통증은 시술 전 조사한 예상되는 통증의 정도는 평균 5.2 그리고 시술 후에 조사한 시술 중에 느낀 통증의 정도는 평균 2.9이였다(p < .001). 약제에 대한 만족도는 평균 약 8.0을 보였다. 결론: 환자들은 방사선 시술 전 시술로 인해 느끼는 불안감은 중등도 정도였다. 대부분의 환자는 시술 중 통증을 경험하지만 사용한 약제에 대해서 높은 만족도를 보였다. 인터벤션 시술을 경험하였던 환자는 시술에 대한 불안감 및 예상되는 통증의 정도는 낮았고 그리고 시술에 대한 이해도는 높았다.

골반 외상 인터벤션

Jung Han Hwang,Jeong Ho Kim,Suyoung Park 대한영상의학회 2023 대한영상의학회지 Vol.84 No.4

Traumatic pelvic injuries usually include high-energy crush injuries and are associated with significant morbidity and mortality. Mortality rates range from 6% to 15% and increase to 36%– 54% in cases of fractures that result in increased pelvic volume. Therefore, retroperitoneal hemorrhage can spiral and progress to hemorrhagic shock. Pelvic hemorrhage most commonly occurs secondary to disrupted pelvic veins or fractured bones, and 10%–20% of cases involve arterial injuries. Owing to extensive bleeding and limitations of surgery for pelvic hemorrhage, interventional treatment is at the forefront of pelvic hemorrhage management. CT is an accurate indicator of active hemorrhage in patients with pelvic trauma that affects the diagnosis and management, including interventions. Identification of the site of hemorrhage is necessary for focused interventional treatment. The current trend toward a more conservative approach for treatment of pelvic trauma and advances in interventional radiology in the field of pelvic trauma may favor widespread use of interventional treatment for patients with pelvic injuries. In this review, we discuss therapeutic modalities available to the interventional radiologist and common angiographic treatment strategies and techniques. 골반 외상은 대부분 고에너지 손상을 동반하며, 이에 따른 치명률 및 사망률이 높은 편이다. 관련된 출혈은 대부분 골반내 정맥이 손상되거나 해면골이 골절되어 발생하고 혈종에 의해안정화되지만, 10%–20%에서 동맥 출혈이 동반되며, 골반 용적이 증가된 상태에서 동맥 출혈이 지속된다면 이로 인한 사망률은 36%–54%까지 증가한다. 골반의 해부학적 구조상 다양하고 풍부한 혈관이 분포되어 있고, 골반 외상 환자 대부분이 많은 양의 혈종을 동반하기때문에, 수술적 치료는 시야 확보의 어려움과 눌림 효과에 따른 지혈효과를 없애 출혈을 더조장할 수 있어, 1차적으로 인터벤션 치료가 권고되고 있다. 또한 출혈의 위치가 대부분 골절된 부분이기 때문에 CT를 통해 시술 전 출혈 부위를 특정하여 빠른 시간 내에 출혈에 대한 색전술을 시행할 수 있다. 이처럼 올바른 진단과 치료를 동시에 할 수 있다는 장점으로 인해 골반 외상 환자에 있어 인터벤션 치료는 중추적인 역할을 담당하고 있다. 본 연구에서는 문헌고찰을 통해 골반 외상에 대한 올바른 진단 및 인터벤션 치료의 유용성과 고려 사항에 대해알아보고자 한다.

의인성 혈관 손상의 방사선학적 소견과 중재적 시술

이경호 대한영상의학회 1998 대한영상의학회지 Vol.38 No.5

Purpose : To evaluate the radiological findings and effectiveness of radiological interventions in patientswith iatrogenic vascular injuries. Materials and Methods : We analyzed 50 patients with iatrogenic vascularinjuries treated with radiological intervention. The causes of injuries were surgery(n=20), cardiovascularintervention(n=15), non-cardiovascular radiological intervention(n=14), and endoscopic intervention(n=1). Theinjury had resulted in hemorrhage in 35 cases. The iliac and/or femoral, hepatic, and renal vessels were commonlyinjured. Angiography, ultrasonography with Doppler examination, CT, and CT angiography were performed to diagnosevascular injuries and guide the radiological intervention. The mean follow-up period was 23 months and in 16 caseswas more than one year. Results : The major radiological findings were extravasation, pseudoaneurysm,arteriovenous shunt, or vascular obstruction. To control these lesions, radiological interventions such asembolization(n=36), local urokinase administration, stent insertion, foreign body removal, ultrasonography-guidedcompression, or stent-graft insertion were performed. The clinical problems were immediately controlled by thesingle trials of radiological interventions and did not recur in 40 cases (80%). Conclusion : Radiologicalexaminations and interventions are useful in cases with iatrogenic vascular injuries.

Interventional Pain Management in Rheumatological Diseases - A Three Years Physiatric Experience in a Tertiary Medical College Hospital in Bangladesh

Md Abu Bakar Siddiq,Suzon Al Hasan,Gautam Das,Amin Uddin A Khan 대한통증학회 2011 The Korean Journal of Pain Vol.24 No.4

Background:Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped x-ray and anatomical landmarks. Interventional physiatry is a branch of Physical Medicine and Rehabilitation that treat painful conditions by intervention in peripheral joints, spine, and soft tissues. Methods:A cross - sectional study was conducted using three years hospital records (2006 to 2008) of Physical Medicine and Rehabilitation Department, Chittagong Medical College Hospital, Bangladesh with a view to highlight current interventional pain practice in a tertiary medical college hospital. Results:Maximum intervention was done in degenerative peripheral joint disorders (600, 46.0%) followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred low back conditions (100, 8.0%). Knee was the most commonly intervent peripheral joint. Motor stimulation guided intralesional injection methylprednisolone into piriformis muscle was given in 10 cases of piriformis syndrome refractory to oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%) and discussed separately. Epidural steroid was practiced in different causes of lumbar radiculopathy except infective discitis. Conclusions:All procedures were performed using anatomical landmark as there was no facilities for c-arm/diagnostic ultrasound required for accurate and safe intervention. Dedicated IPM set up is required in all PMR departments for better pain management and reduce burden on other specialities. (Korean J Pain 2011; 24: 205-215)

Interventional Pain Management in Rheumatological Diseases - A Three Years Physiatric Experience in a Tertiary Medical College Hospital in Bangladesh

Siddiq, Md. Abu Bakar,Hasan, Suzon Al,Das, Gautam,Khan, Amin Uddin A. The Korean Pain Society 2011 The Korean Journal of Pain Vol.24 No.4

Background: Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues. Methods: A cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital. Result: The maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis. Conclusion: All procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties.

성인간호학 영역에서의 간호중재논문 내용 분석

서문자,정재심,오효숙 대한기초간호자연과학회 2003 Journal of korean biological nursing science Vol.5 No.2

Purpose : This descriptive study was performed to analyse the trends of nursing interventional studies in adult nursing area. Method : All interventional studies of 'Journal of Korean Academy of Adult Nursing Society', fifty three articles, from 1989 to 2000 were collected and reviewed. Result : The research subject were patients in 38(66.7%) and 81.8% of researches was performed in hospital environment. There was only one true experimental design and most of articles(79.2%) were designed by quasi-experimental method. Only 17% of articles have theoretical framework and 73.6% of articles described research hypotheses. The data collection methods for variables were as follows : Psychosocial measurement 60.8%, physiological measurement 25.7%, and observation 13.5%, respectively. Lecture(16.7%), audio-visual(16.7%), and book, pamphlet, or leaflets(13.6%) were the most frequently used instniments of the interventions. Behavioral domain(60.3%) and Physiological : Basic domain(29.3%) were the most common, when the interventions were classified by Nursing Intervention Classification. Physiological(50.8%) and psychosocial variables(49.2%) were the two major dependent variables. Conclusion : Considering the above results obtained, the nursing intervention studies in adult nursing area have been tested with quasi-experimental studies through clinical trials. For the development of clinical nursing practice and advancement of nursing theories, the amount of interventional studies should be increased and the quality of research methods refined more to develop nursing science and practice in adult nursing area.

Interventional Management after Gastrectomy: The Spectrum of Imaging Findings and Procedures

김효철,한준구,김경원,손규리,최병인 대한영상의학회 2008 대한영상의학회지 Vol.58 No.4

Gastric cancer is the most common cancer in Korea, and is often treated by surgical resection. Many postoperative complications or tumor recurrence, however, are managed by the use of imaging-guided interventions. This review describes the spectrum of postoperative complications that occur following gastrectomy, with an emphasis on the interventional procedures used to manage postoperative complications and tumor recurrence.

비뇨기계 외상 인터벤션

권훈,전창호,김창원 대한영상의학회 2019 대한영상의학회지 Vol.80 No.4

Urinary tract injuries occur in up to 10% of patients with abdominal trauma, and the kidney is the most commonly injured structure of the urinary system. The kidney is the third most common abdominal organ to be injured by trauma, following the spleen and liver, in that order. The American Association for the Surgery of Trauma kidney injury scale is the most commonly used classification system for blunt renal injuries, which grades renal injury based on the size of laceration and its proximity to the renal hilum on CT. CT aids in delineating the most important features of urological injury that affect the diagnosis and management, including interventions. The major renal injuries are usually surgical emergencies. The current trend toward a more conservative management of renal trauma and advances in interventional radiology in the field of trauma may increase the use of interventional procedures for patients with renal injury. Urethral injuries can be anterior or posterior depending on the injury site, and interventional urethral realignment plays an important role in the treatment of urethral injury and surgical repair or endoscopic urethral realignment. Therefore, in this paper, we provide a literature review and discuss the efficacy and clinical significance of intervention for urologic trauma. 비뇨기계 손상은 복부 손상 환자의 10% 정도에서 발생한다. 신장은 비뇨기계 손상 중에서 가장 흔히 침범되는 장기이고, 전체 복부 장기 손상 중에서는 비장과 간 다음의 빈도로 발생한다. 신장 손상에 대한 분류 체계 중 가장 일반적으로 사용되는 것은 미국 외상외과협회 분류로 열상의 크기와 신문부에 근접한 정도에 따라 신 손상을 평가하며, 전산화단층촬영 소견에기초한 비뇨기계 손상의 가장 중요한 특징을 나타내어, 외상환자의 진단 및 인터벤션을 포함한 치료에 영향을 준다. 주요 신손상의 경우 수술적 치료가 우선시되었으나 인터벤션 시술의효용성, 안전성이 지속적으로 발표됨에 따라 주요 신손상의 치료에 있어서도 비수술적 보존적 치료가 비뇨기계 외상 영역의 중요한 흐름으로 자리 잡아가고 있다. 요도 손상은 손상 부위에 따라 전부요손상과 후부요도손상으로 나눌 수 있다. 인터벤션 요도배열술은 수술적 봉합술이나 내시경적 요도재배열술과 함께 요도 손상의 치료에 있어 중요한 역할을 담당하고있다. 본 연구에서는 문헌 고찰을 통해 비뇨기계 외상에 대한 인터벤션 치료의 유용성과 고려 사항에 대해 알아보고자 한다.

Ultrasound-guided genitourinary interventions: principles and techniques

박병관 대한초음파의학회 2017 ULTRASONOGRAPHY Vol.36 No.4

Ultrasound (US) is often used to guide various interventional procedures in the genitourinary (GU) tract because it can provide real-time imaging without any radiation hazard. Moreover, US can clearly visualize the pathway of an aspiration or biopsy needle to ensure the safety of the intervention. US guidance also helps clinicians to access lesions via the transabdominal, transhepatic, transvaginal, transrectal, and transperineal routes. Hence, US-guided procedures are useful for radiologists who wish to perform GU interventions. However, US-guided procedures and interventions are difficult for beginners because they involve a steep initial learning curve. The purpose of this review is to describe the basic principles and techniques of US-guided GU interventions.