• Title/Summary/Keyword: non-surgical interventional treatment

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Clinical Characteristics of Cervical and Thoracic Radiculopathies: Non-Invasive Interventional Therapy (목 및 가슴신경뿌리병증의 임상적 고찰: 비침습적 중재시술치료)

  • Roh, Hakjae;Lee, Sang-Heon;Kim, Byung-Jo
    • Annals of Clinical Neurophysiology
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    • v.10 no.2
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    • pp.83-97
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    • 2008
  • Cervical and thoracic radiculopathies are among the most common causes of neck pain. The most common causes are cervical disc herniation and cervical spondylosis in patients with cervical radiculopathy, and diabetes mellitus and thoracic disc herniation in thoracic radiculopathy. A thorough history, physical examination, and testing that includes electrodiagnostic examination and imaging studies may distinguish radiculopathy from other pain sources. Although various electrodiagnostic examinations may help evaluate radiculopathy, needle electromyography is the most important, sensitive, and specific method. Outcome studies of conservative treatments have shown varying results and have not been well controlled or systematic. When legitimate incapacitating symptoms continue despite conservative treatment attempts, more invasive spinal procedures and intradiscal treatment may be appropriate. Surgery has been shown to have excellent clinical outcomes in patients with disc extrusion and neurological deficits. However, patients with minimal disc herniation have fair or poor surgical outcomes. In addition, conventional open disc surgery entails various inadvertent surgical related risks. Although there has not yet been a non-surgical interventional procedure developed with the therapeutic efficacy of open surgery, conservative procedures can offer substantial benefits, are less invasive, and avoid surgical complications. While more invasive procedures may be appropriate when conservative treatment fails, prospective studies evaluating cervical and thoracic radiculopathies treatment options would help guide practitioners toward optimally cost-effective patient evaluation and care.

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Lumbar foraminal neuropathy: an update on non-surgical management

  • Choi, Young Kook
    • The Korean Journal of Pain
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    • v.32 no.3
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    • pp.147-159
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    • 2019
  • Lumbar foraminal pathology causing entrapment of neurovascular contents and radicular symptoms are commonly associated with foraminal stenosis. Foraminal neuropathy can also be derived from inflammation of the neighboring lateral recess or extraforaminal spaces. Conservative and interventional therapies have been used for the treatment of foraminal inflammation, fibrotic adhesion, and pain. This update reviews the anatomy, pathophysiology, clinical presentation, diagnosis, and current treatment options of foraminal neuropathy.

The Controversy Regarding the Optimal Management of Chronic Low Back Pain: Interventional vs. Medical Treatment (만성요통의 적정 치료를 둘러싼 논란: 중재적 치료 대 보존적 치료)

  • Kwon, O-Hyun
    • Annals of Clinical Neurophysiology
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    • v.12 no.1
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    • pp.1-2
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    • 2010
  • Chronic non-specific low back pain (CLBP) is one of the major health problems casting substantial amount of economic expenses and negative impact on quality of life onto an individual as well as society. On contrary to public familiarity, the ways of management of CLBP are diverse and there is yet no general consensus about which approach is better than others or to whom the specific management should be applied. Some hold the negative point of view on the efficacy of the invasive maneuver such as epidural injection because there is no controlled clinical trial (RCT) yielding better long term outcome of those invasive managements over conservative ones. But the experts of interventional or surgical treatment stress the methodological difficulty in performing RCT and assert that those invasive treatments can bring the prompt and complete resolution of low back pain and restoration of function in appropriately selected cases. These seemingly opposite views on the invasive management on CLBP are rather complimentary each other than to be contradictory.

Interventional Management of Malignant Esophagorespiratory Fistula and Bronchopleural Fistula (악성 기관지호흡기루와 기관지흉강루에 대한 인터벤션 치료)

  • Shin, Ji-Hoon;Kim, Kyung-Rae;Kim, Jin-Hyoung;Song, Ho-Young
    • Korean Journal of Bronchoesophagology
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    • v.14 no.1
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    • pp.8-13
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    • 2008
  • Malignant esophagorespiratory fistula is a devastating and life-threatening complication of esophageal and bronchogenic carcinomas. As a non-surgical treatment, peroral stent placement into the esophagus or airway can close-off the fistula and prevent progression of the pneumonia. Although reopening of the fistula is not uncommon despite stent placement, interventional treatment is effective for sealing off reopened ERFs. Bronchopleural fistula is a well-recognized complication of pneumonectomy. There have been several reports to occlude the fistula with use of stents and much more experience is required.

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The Application of Interventional Radiology in Living-Donor Liver Transplantation

  • Gi-Young Ko;Kyu-Bo Sung;Dong-Il Gwon
    • Korean Journal of Radiology
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    • v.22 no.7
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    • pp.1110-1123
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    • 2021
  • Owing to improvements in surgical techniques and medical care, living-donor liver transplantation has become an established treatment modality in patients with end-stage liver disease. However, various vascular or non-vascular complications may occur during or after transplantation. Herein, we review how interventional radiologic techniques can be used to treat these complications.

Intervention for Chest Trauma and Large Vessel Injury (흉부 및 대혈관 외상의 인터벤션)

  • Hojun Lee;Hoon Kwon;Chang Won Kim;Lee Hwangbo
    • Journal of the Korean Society of Radiology
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    • v.84 no.4
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    • pp.809-823
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    • 2023
  • Trauma is an injury to the body that involves multiple anatomical and pathophysiological changes caused by forces acting from outside the body. The number of patients with trauma is increasing as our society becomes more sophisticated. The importance and demand of traumatology are growing due to the development and spread of treatment and diagnostic technologies. In particular, damage to the large blood vessels of the chest can be life-threatening, and the sequelae are often severe; therefore, diagnostic and therapeutic methods are becoming increasingly important. Trauma to nonaortic vessels of the thorax and aorta results in varying degrees of physical damage depending on the mechanism of the accident and anatomical damage involved. The main damage is hemorrhage from non-aortic vessels of the thorax and aorta, accompanied by hemodynamic instability and coagulation disorders, which can be life-threatening. Immediate diagnosis and rapid therapeutic access can often improve the prognosis. The treatment of trauma can be surgical or interventional, depending on the patient's condition. Among them, interventional procedures are increasingly gaining popularity owing to their convenience, rapidity, and high therapeutic effectiveness, with increasing use in more trauma centers worldwide. Typical interventional procedures for patients with thoracic trauma include embolization for non-aortic injuries and thoracic endovascular aortic repair for aortic injuries. These procedures have many advantages over surgical treatments, such as fewer internal or surgical side effects, and can be performed more quickly than surgical procedures, contributing to improved outcomes for patients with trauma.

Thyroid Radiology Practice: Diagnosis and Interventional Treatment of Patients with Thyroid Nodules (갑상선 영상의학 진료: 갑상선 결절 환자의 진단과 중재적 치료)

  • Jung Hwan Baek;Dong Gyu Na
    • Journal of the Korean Society of Radiology
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    • v.81 no.3
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    • pp.530-548
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    • 2020
  • Thyroid radiology practice is a medical practice in which thyroid diseases are diagnosed using imaging modality and treated by imaging-based interventional techniques, and the primary care target is thyroid nodular disease. Diagnosis of thyroid nodules is primarily done by ultrasound imaging and biopsy; thyroid nodules can be treated by non-surgical interventional treatment and thyroidectomy. Ethanol ablation is the first-line treatment for cystic benign nodules, and radiofrequency ablation is used for the treatment of benign solid nodules and recurrent thyroid cancers. Thyroid radiology practice has an essential clinical role in diagnosis and nonsurgical treatment of thyroid nodular diseases, and treatment should be performed based on standard care guidelines for proper patient care. In order to provide the best care to patients with thyroid nodular disease, it is desirable to treat patients in the radiology outpatient clinic. Thyroid radiology practice centered on outpatient clinic practice needs to be expanded.

The Role of Interventional Radiology in Treatment of Patients with Acute Trauma: A Pictorial Essay (급성 외상 환자 치료에서 인터벤션 영상의 역할: 임상화보)

  • Kyung Sik Kang;Mu Sook Lee;Doo Ri Kim;Young Hwan Kim
    • Journal of the Korean Society of Radiology
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    • v.82 no.2
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    • pp.347-358
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    • 2021
  • Acute trauma is a common cause of mortality in individuals aged < 40 years. As organ preservation has become important in treating trauma patients, the treatment is shifting from surgical management to non-operative management. A multidisciplinary team approach, including interventional radiology (IR), is essential for the optimal management of trauma patients, as IR plays an important role in injury evaluation and management. IR also contributes significantly to achieving the best clinical outcomes in critically ill trauma patients. This pictorial essay aims to present and summarize various interventional treatments in trauma patients requiring critical care.

Clinical Application of a Newly Developed Basket Device for Interventional Heartworm Extraction in Three Dogs

  • Lee, Yooyoung;Kim, Hyesung;Yoon, Kwangyong;Park, Jihyeon;Oh, Younna;Oh, Miju;Ban, Jiyoung;Lee, Minju;Kim, Hakhyun;Kang, Byeong-Teck;Chang, Dongwoo
    • Journal of Veterinary Clinics
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    • v.39 no.4
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    • pp.177-184
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    • 2022
  • Caval syndrome is a severe complication of canine heartworm disease in which affected dogs present with various clinical signs that are often life-threatening. In cases of severe infection, adulticidal treatment has numerous complications as a result of a marked immune response against dead worms. Therefore, several surgical and non-surgical methods, including interventional extraction, have been applied in veterinary medicine. Despite the usefulness and efficiency of conventional retrieval devices, a few associated limitations must be addressed to reduce their risks and increase their applicability. Herein, we introduced a case of treating three dogs with caval syndrome by applying a newly developed heartworm basket device. The dogs were diagnosed with heartworm disease by heartworm antigen testing and direct smear. Imaging findings revealed remarkable remodeling of the right heart and pulmonary vessels and the presence of heartworms in the right heart. Additionally, heartworms were confirmed in the distal part of the abdominal aorta and femoral arteries in one dog, indicating aberrant systemic migration of the worms. Under general anesthesia, the heartworm basket device was introduced into the right heart via femoral venotomy and arteriotomy in one dog and jugular venotomy in the other two dogs. Although the number of cases in this study was small, the basket device was successful in gradual and cautious extraction of the heartworms in all three dogs. They exhibited good prognosis of clinical symptoms as indicated by imaging analyses.

Current Trends for Treating Lateral Epicondylitis

  • Kim, Gyeong Min;Yoo, Seung Jin;Choi, Sungwook;Park, Yong-Geun
    • Clinics in Shoulder and Elbow
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    • v.22 no.4
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    • pp.227-234
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    • 2019
  • Lateral epicondylitis, also known as 'tennis elbow', is a degenerative rather than inflammatory tendinopathy, causing chronic recalcitrant pain in elbow joints. Although most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, few refractory lateral epicondylitis are candidates for alternative non-operative and operative modalities. Other than standard conservative treatments including rest, analgesics, non-steroidal anti-inflammatory medications, orthosis and physical therapies, nonoperative treatments encompass interventional therapies include different types of injections, such as corticosteroid, lidocaine, autologous blood, platelet-rich plasma, and botulinum toxin, which are available for both short-term and long-term outcomes in pain resolution and functional improvement. In addition, newly emerging biologic enhancement products such as bone marrow aspirate concentrate and autologous tenocyte injectates are also under clinical use and investigations. Despite all non-operative therapeutic trials, persistent debilitating pain in patients with lateral epicondylitis for more than 6 months are candidates for surgical treatment, which include open, percutaneous, and arthroscopic approaches. This review addresses the current updates on emerging non-operative injection therapies as well as arthroscopic intervention in lateral epicondylitis.