Biomedical subjects

Duane M Ilstrup

Publications and source records attributed to Duane M Ilstrup.

15 recordsLinked to original sources

PubMed2004

Comparison of the relative sensitivity of CT colonography and double-contrast barium enema for screen detection of colorectal polyps.

BACKGROUND & AIMS: In a population reflective of a screening setting, our aim was to compare the relative sensitivity and specificity of computed tomography (CT) colonography with double-contrast barium enema (DCBE) for detection of colorectal polyps and to assess the added value of double reading at CT colonography, using endoscopy as the arbiter. METHODS: This prospective, blinded study comprised 837 asymptomatic persons at higher than average risk for colorectal cancer who underwent CT colonography followed by same-day DCBE. Examinations with polyps > or =5 mm in diameter were referred to colonoscopy. RESULTS: CT colonography readers detected 56%-79% of polyps > or =10 mm in diameter. In comparison, the sensitivity at DCBE varied between 39% and 56% for the 31 polyps > or =1 cm. All of the readers detected more polyps at CT colonography than DCBE, but the difference was statistically significant for only a single reader (P = 0.02). Relative specificity for polyps > or =10 mm on a per-patient basis ranged from 96% to 99% at CT colonography, and 99%-100% at DCBE. Doubly read CT colonography detected significantly more polyps than DCBE (81% vs. 45% for polyps > or =1 cm [P = <0.01], and 72% vs. 44% for polyps 5-9 mm [P < or = 0.01]). CONCLUSIONS: Double-read CT colonography is significantly more sensitive in detecting polyps than single-read double contrast barium enema. DCBE was significantly more specific than CT colonography.

Aged↗

PubMed2004

Operative management of primary retroperitoneal sarcomas: a reappraisal of an institutional experience.

OBJECTIVE: To review our recent experience with primary retroperitoneal sarcomas, determine prognostic factors for disease recurrence and patient survival, and compare them to our previous results. BACKGROUND: Medical therapies have shown little efficacy in the management of retroperitoneal sarcomas, making total surgical extirpation the best chance for patient cure. METHODS: The case histories of all patients operated upon for retroperitoneal sarcomas between January 1983 and December 1995 were retrospectively reviewed. RESULTS: Ninety-seven patients underwent attempted surgical resection of a primary retroperitoneal sarcoma. There were 54 (56%) men and 43 (44%) women, with a mean age of 59 years. Seventy-six (78%) patients underwent gross total resection, 13 (14%) had residual disease, and 8 (8%) underwent biopsy only with an actuarial 1-year survival of 88%, 51%, and 47%, respectively (P = 0.001). The actuarial 5- and 10-year survivals for patients who underwent gross total resection were 51% and 36%, respectively. Thirty-three patients (43%) developed locoregional recurrence, and 20 patients (26%) developed distant metastases at a median time of 12 months. The cumulative probability at 5 years was 44% for locoregional recurrence and 29% for distant metastases. On univariate analysis, factors associated with improved survival were complete resection of the tumor (P = 0.001), nonmetastatic disease at presentation (P = 0.01), low-grade tumors (P = 0.02), liposarcomas (P = 0.003), and no disease recurrence (P = 0.0001). Contrary to previous reports, the histologic subtype (P = 0.04) was the only significant factor predicting survival on multivariate analysis. CONCLUSIONS: Compared with our earlier experience, the rates of complete resection and overall survival have improved. Local control continues to be a significant problem in the management of retroperitoneal sarcomas. Because new surgical options for this problem are limited, further outcome improvement requires novel adjuvant therapies.

Adolescent↗

PubMed2004

Long-term results of segmental prosthesis fixation by extracortical bone-bridging and ingrowth.

BACKGROUND: The technique of extracortical bone-bridging and ingrowth fixation with a porous coating over the shoulder region of the implant and augmentation by autogenous bone-grafting was introduced to improve the longevity of implant fixation. The potential advantages of this technique are that new-bone formation across the bone-prosthesis junction may share stress and may prevent osteolysis by sealing off this critical region against the infiltration of wear particles. The objectives of this study were to examine the prevalence of stem-loosening with use of the extracortical bone-bridging and ingrowth technique, the amount of bone formation over the porous-coated region of this prosthesis, and the characteristics of bone formation over the porous-coated region and adjacent bone. METHODS: Forty-three patients who had prosthetic reconstruction with the extracortical bone-bridging and ingrowth technique from 1976 to 1990 were included in this retrospective study. The mean length of follow-up was 9.7 years (range, two to twenty-one years). All but one patient were managed with autogenous bone graft; five, with allograft and autograft; and one, with allograft only. Extracortical bone formation was measured over a 2-cm length of the porous-coated region of the prosthesis in four zones (the medial and lateral aspects on anteroposterior radiographs and the anterior and posterior aspects on lateral radiographs) and was reported as the percentage of the total length (8 cm) covered by extracortical bone with a thickness of >1 mm. The Spearman rank coefficient was used to assess the correlation between pairs of continuous variables. RESULTS: The final average percentage of the porous-coated region that was covered by extracortical bone formation was 76% +/- 34% for all patients and anatomical sites of reconstruction. Use of bone cement was associated with less bone formation (p = 0.04), and this value remained lower at the final measurement (p = 0.06). One stem had aseptic loosening, but no sign of osteolysis was found. The radiographic appearance of the bone formation had stabilized at two years of follow-up. All patients with allograft augmentation had greater bone formation. The amount of extracortical bone formation did not differ in relation to the type of porous coating, anatomical sites, pathological disorder, sex or age of the patient, or length of reconstruction. CONCLUSIONS: As shown by the low prevalence of stem-loosening (two of fifty-six stems or one of forty-three patients), the use of the extracortical bone-bridging and ingrowth fixation technique is associated with improved stem fixation in segmental bone-replacement prostheses applied for limb salvage. In the demanding biomechanical environment and with the risk of stress and particle-related bone resorption, the extracortical bone-bridging and ingrowth fixation is an attractive method to provide long-lasting implant fixation.

Adolescent↗

PubMed2004

Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture.

OBJECTIVES: To ascertain whether acute aortic dissection (AAD) remains the most common aortic catastrophe, as generally believed, and to detect any improvement in outcomes compared with previously reported population-based data. PATIENTS AND METHODS: We determined the incidence, operative intervention rate, and long-term survival rate of Olmsted County, Minnesota, residents with a clinical diagnosis of AAD initially made between 1980 and 1994. The incidence of degenerative thoracic aortic aneurysm (TAA) rupture was also delineated. We compared these results with other population-based studies of AAD, degenerative TAA, and abdominal aortic aneurysm (AAA) rupture. RESULTS: During a 15-year period, we identified 177 patients with thoracic aortic disease. We focused on 39 patients with AAD (22% of the entire cohort) and 28 with TAA rupture (16%). The annual age- and sex-adjusted incidences were 3.5 per 100,000 persons (95% confidence interval, 2.4-4.6) for AAD and 3.5 per 100,000 persons (95% confidence interval, 2.2-4.9) for TAA rupture. Thirty-three dissections (85%) involved the ascending aorta, whereas 6 (15%) involved only the descending aorta. Nineteen patients (49%) underwent 22 operations for AAD, with a 30-day case fatality rate of 9%. Among all 39 patients with AAD, median survival was only 3 days. Overall 5-year survival for those with AAD improved to 32% compared with only 5% in this community between 1951 and 1980. CONCLUSIONS: In other studies, the annual incidences of TAA rupture and AAA rupture are estimated at approximately 3 and 9 per 100,000 persons, respectively. This study indicates that AAD and ruptured degenerative TAA occur with similar frequency but less commonly than ruptured AAA. Although timely recognition and management remain problematic, these new data suggest that recent diagnostic and operative advances are improving long-term survival in AAD.

Adult↗

PubMed2003

Late follow-up of 1095 patients undergoing operation for complex congenital heart disease utilizing pulmonary ventricle to pulmonary artery conduits.

BACKGROUND: Pulmonary ventricle (PV) to pulmonary artery (PA) conduits have made possible the correction of many complex congenital cardiac anomalies. METHODS: Between April 1964 and January 2001, 1270 patients underwent operation with conduit placement from the PV to PA. The present study evaluates late outcome of 1095 patients (612 males, 483 females) having an operation before July 1992. Mean age was 9.6 +/- 8.2 years old. Diagnoses included pulmonary atresia/tetralogy of Fallot (459), transposition of the great arteries (TGA) (232), truncus arteriosus (193), double outlet right ventricle (DORV) (121), corrected TGA (49), septated univentricular heart (36), and other (5). A porcine-valved Dacron conduit was used in 730, homograft in 239, and non-valved conduit in 126. RESULTS: Early mortality decreased from 23.5% prior to 1980 to 3.7% for the most recent decade. Mean follow-up was 10.9 years (maximum, 29 years). Actuarial survival for early survivors at 10 and 20 years was 77.0% +/- 1.5% and 59.5% +/- 2.6%. On univariate analysis, clinical and hemodynamic factors associated with late mortality were male gender, older age at operation, higher post-repair PV/systemic ventricle (SV) pressure ratio, higher distal PA pressure, and longer bypass time (p < or = 0.01 for all). On multivariate analysis, independent risk factors for late mortality were male gender, older age at operation, diagnosis of TGA, corrected TGA, truncus, or univentricular heart, and PV/SV pressure ratio > or = 0.72 (p < or = 0.03 for all). Freedom from reoperation for conduit failure at 10 and 20 years was 55.5% +/- 2.0% and 31.9% +/- 2.7%. On multivariate analysis, independent risk factors for conduit failure were homograft conduit, diagnosis of TGA, younger age at operation, and smaller conduit size (p < or = 0.007 for all). Reoperation for one conduit replacement was performed in 306 patients, two conduit replacements in 55 patients, three in 6 patients, and four in 3 patients. Overall early mortality for conduit replacement in this series was 4.9%; it was 1.7% for patients operated on from 1989 through 1992. At follow-up, 84% of survivors were in NYHA class I or II. CONCLUSIONS: Operations that include conduit placement and replacement can be performed with low early mortality. Younger age at operation was associated with improved late survival. The diagnosis of TGA was associated with increased risk for conduit failure, and the durability of the homograft, in this series, was inferior to the porcine-valved Dacron conduit. Quality of life was excellent for most patients despite the need for reoperation.

Adolescent↗

PubMed2003

Prospective blinded evaluation of computed tomographic colonography for screen detection of colorectal polyps.

BACKGROUND & AIMS: This study used a low lesion prevalence population reflective of the screening setting to estimate the sensitivity and specificity of computerized tomographic (CT) colonography for detection of colorectal polyps. METHODS: This prospective, blinded study comprised 703 asymptomatic persons at higher-than-average risk for colorectal cancer who underwent CT colonography followed by same-day colonoscopy. Two of 3 experienced readers interpreted each CT colonography examination. RESULTS: Overall lesion prevalence for adenomas >/=1 cm in diameter was 5%. Seventy percent of all lesions were proximal to the descending colon. With colonoscopy serving as the gold standard, CT colonography detected 34%, 32%, 73%, and 63% of the 59 polyps >/=1 cm for readers 1, 2, 3, and double-reading, respectively; and 35%, 29%, 57%, and 54% of the 94 polyps 5-9 mm for readers 1, 2, 3, and double-reading, respectively. Specificity for CT colonography ranged from 95% to 98% and 86% to 95% for >1 cm and 5-9-mm polyps, respectively. Interobserver variability was high for CT colonography with kappa statistic values ranging from -0.67 to 0.89. CONCLUSIONS: In a low prevalence setting, polyp detection rates at CT colonography are well below those at colonoscopy. These rates are less than previous reports based largely on high lesion prevalence cohorts. High interobserver variability warrants further investigation but may be due to the low prevalence of polyps in this cohort and the high impact on total sensitivity of each missed polyp. Specificity, based on large numbers, is high and exhibits excellent agreement among observers.

Aged↗

PubMed2003

Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival.

BACKGROUND: Hepatic metastases from neuroendocrine tumors have a protracted natural history and are associated with endocrinopathies. Resection is indicated for symptom control. Previous reports have suggested improvement in survival for patients undergoing debulking procedures. STUDY DESIGN: The records of all consecutive patients undergoing resection of hepatic metastases from neuroendocrine tumors between 1977 and 1998 were reviewed. Tumors were classified according to histology, endocrine activity, and primary location. Patients lost to followup before 1 year were excluded. Followups were based on outpatient evaluations and were updated by correspondence. The Kaplan-Meier method was used to generate survival and recurrence curves, and the log-rank test was used for comparison. RESULTS: A total of 170 patients fulfilled the inclusion criteria, of whom 73 were men. Mean age (+/-SD) was 57 (+/-11.5) years. Carcinoid (n = 120) and nonfunctioning islet cell tumors (n = 18) predominated; the ileum (n = 85) and the pancreas (n = 52) were the most common primary sites. Major hepatectomy (one or more lobes) was performed in 91 patients (54%). The postoperative complication rate was 14%, and two patients died (1.2%). Operation controlled symptoms in 104 of 108 patients, but the recurrence rate at 5 years was 59%. Operation decreased 5-hydroxyindoleacetic acid levels considerably, and no patient experienced carcinoid heart disease postoperatively. Recurrence rate was 84% at 5 years. Overall survival was 61% and 35% at 5 and 10 years, respectively, with no difference between carcinoid and islet cell tumors. CONCLUSIONS: Hepatic resection for metastatic neuroendocrine tumors is safe and achieves symptom control in most patients. Debulking extends survival, although recurrence is expected. Hepatic resection is justified by its effects on survival and quality of life.

Female↗

PubMed2003

Evaluation of the MagNA pure LC instrument for extraction of hepatitis C virus RNA for the COBAS AMPLICOR Hepatitis C Virus Test, version 2.0.

The COBAS AMPLICOR system has played a major role in the transition of molecular diagnostics from research to routine clinical laboratory use by automating the nucleic acid amplification and detection processes. However, sample preparation remains a labor-intensive portion of the procedure. In this study, we evaluated the performance of the COBAS AMPLICOR Hepatitis C Virus Test, version 2.0 (Roche Molecular Systems, Branchburg, N.J.) following manual hepatitis C virus (HCV) RNA extraction versus automated extraction with the MagNA Pure LC instrument (Roche Applied Science, Indianapolis, Ind.). Parallel replicate testing was performed with standard dilutions of 100, 75, 60, and 0 HCV IU/ml and 153 clinical specimens. An analytical sensitivity of 75 IU/ml was achieved with either the manual or the standard-volume (200 microl) automated extraction methodologies (25 of 26 [96.2%]; 95% confidence interval [95% CI], 80.4 to 99.9), whereas the clinical sensitivity and specificity were both 100% with either extraction method. A large-volume (1 ml) automated extraction method was also evaluated with standard dilutions of 40, 25, 10, and 0 IU/ml and the same 153 clinical specimens. The analytical sensitivity of the COBAS AMPLICOR assay with the large-volume extraction method was 25 HCV IU/ml (26 of 26 [100%]; 95% CI, 86.8 to 100), whereas the clinical sensitivity and specificity were both 100%. The MagNA Pure LC instrument is a versatile, labor-saving platform capable of integration with minimal modification of the existing assay procedure. The increased sensitivity of the COBAS AMPLICOR Hepatitis C Virus Test, version 2.0 performed in conjunction with large-volume HCV RNA extraction may be important in HCV diagnostic testing as new therapeutic strategies evolve.

Hepacivirus↗

PubMed2003

Factors affecting the durability of primary total knee prostheses.

BACKGROUND: Failure of total knee arthroplasty is problematic. The purpose of this study was to evaluate the factors that influence the durability of a primary total knee prosthesis. METHODS: A survivorship analysis of 11,606 primary total knee arthroplasties carried out between January 1, 1978, and December 31, 2000, was performed. An analysis of patient and implant-related factors affecting survivorship was done with use of a multivariate Cox model. RESULTS: The survivorship was 91% (95% confidence interval, 90% to 91%) at ten years (2943 knees), 84% (95% confidence interval, 82% to 86%) at fifteen years (595 knees), and 78% (95% confidence interval, 74% to 81%) at twenty years (104 knees) following the surgery. Prosthetic survivorship at ten years was 83% for patients fifty-five years of age or less compared with 94% for those older than seventy years of age (p < 0.0001), 90% for those with a diagnosis of osteoarthritis compared with 95% for those with inflammatory arthritis (p < 0.005), and 91% for those with retention of the posterior cruciate ligament compared with 76% for those with substitution of the posterior cruciate ligament (a posterior stabilized prosthesis) (p < 0.0001). Survivorship at ten years was 92% for nonmodular metal-backed tibial components, 90% for modular metal-backed tibial components, and 97% for all-polyethylene tibial components (p < 0.0001). Survivorship at ten years was 92% for prostheses fixed with cement compared with 61% for those fixed without cement (p < 0.0001). CONCLUSIONS: Significant risk factors for failure of total knee arthroplasty were the type of implant, age and gender of the patient, diagnosis, type of fixation, and design of the patellar component. In the ideal situation-treatment of a woman over the age of seventy years who has inflammatory arthritis with a nonmodular, metal-backed tibial component, cement fixation, an all-polyethylene patellar component, and retention of the posterior cruciate ligament-the ten-year survivorship of the prosthesis was estimated to be 98% (95% confidence interval, 97% to 99%).

Adolescent↗

PubMed2002

Short-term outcomes of acute knee injuries: does the provider make a difference?

OBJECTIVE: To compare the short-term outcomes of acute knee injuries treated by specialists and generalists. METHODS: Using patient logs, 168 adults with acute knee injuries were identified; 131 (78%) completed a questionnaire 3 months after initial presentation. RESULTS: The mean age of the 77 male and 54 female responders was 34.6 years (range 18-73 years). The injuries were classified as mild (n = 35), moderate (n = 75), or severe (n = 21). Most responders were satisfied with their care and outcome, but 22% noted some functional limitations. The 59 patients seeing an orthopedist were more likely to have had a severe injury, more physician visits, activity limitations, lost time from work or recreation, and more pain when compared with the 72 patients who never saw an orthopedist. Excluding surgical patients, however, satisfaction was not significantly different by provider. After multivariate modeling (adjusting for age, sex, injury severity, and diagnosis), there was no significant association between having seen an orthopedist and either treatment success or satisfaction. CONCLUSION: With the exception of time lost for recuperation in our community there is little difference in short-term outcome for patients with acute knee injury not undergoing surgery, regardless of the specialty of the treating physician.

Adolescent↗

PubMed2002

Early and long-term results of the surgical treatment of tetralogy of Fallot with pulmonary atresia, with or without major aortopulmonary collateral arteries.

OBJECTIVE: We sought to determine the results of surgical treatment of patients with tetralogy of Fallot and pulmonary atresia with or without major aortopulmonary collateral arteries, to clarify variables affecting early and late mortality, and to expose late, nonfatal events affecting surgical patients. METHODS: The records of 495 patients operated on from 1977 to 1999 were reviewed. Patients were separated into those who did not undergo complete repair (group A) and those who did (group B). RESULTS: Group A consisted of 160 patients. Eighty-one (51%) had palliative procedures, 45 (28%) had preliminary surgical stages (unifocalization and right ventricular outflow tract reconstruction) as initial operations, and 34 (21%) had all surgical stages but were rejected for complete repair. Early and late mortality were 16.3% (n = 26) and 23.1% (n = 31), respectively. Mean follow-up was 72.3 months. The presence of major aortopulmonary collateral arteries was a risk factor for late mortality (P =.0182). Group B consisted of 335 patients. Mean age at complete repair was 11.3 years (SD, 9.2). One hundred three (30%) patients had single-stage complete repair, whereas 232 (69%) had staged reconstruction. Twenty-two (6.6%) patients underwent reopening of the ventricular septal defect for high right ventricular pressure. Early and late mortality were 4.5% (n = 15). Risk factors were a peak right ventricular/left ventricular pressure ratio of greater than 0.7 and reopening of the ventricular septal defect (P < or = .05). Late mortality was 16% (n = 51). Mean follow-up was 11.4 years (SD, 7.5). Risk factors included male sex, nonconfluent central pulmonary arteries, reopening of the ventricular septal defect, and postrepair conduit exchange (n = 137). Ten- and 20-year results were an actuarial survival of 86% and 75% and freedom from reoperation of 55% and 29%, respectively. CONCLUSIONS: Surgical repair of patients with simple or complex forms of tetralogy of Fallot with pulmonary atresia can be achieved with low early mortality. Late mortality and need for reoperation, especially conduit replacement, continue to affect the long-term well-being of these patients.

Actuarial Analysis↗

PubMed2002

Comparative evaluation of the VERSANT HCV RNA 3.0, QUANTIPLEX HCV RNA 2.0, and COBAS AMPLICOR HCV MONITOR version 2.0 Assays for quantification of hepatitis C virus RNA in serum.

A comparison of quantitative results expressed in hepatitis C virus (HCV) international units per milliliter, obtained from the VERSANT HCV RNA 3.0 (bDNA-3.0) assay, the QUANTIPLEX HCV RNA 2.0 (bDNA-2.0) assay, and the COBAS AMPLICOR HCV MONITOR version 2.0 (HCM-2.0) test was performed. A total of 168 patient specimens submitted to the Mayo Clinic Molecular Microbiology Laboratory for HCV quantification or HCV genotyping were studied. Of the specimens tested, 97, 88, and 79% yielded quantitative results within the dynamic range of the bDNA-3.0, bDNA-2.0, and HCM-2.0 assays, respectively. Overall, there was substantial agreement between the results generated by all three assays. A total of 15 out of 29 (52%) of the specimens determined to contain viral loads of <31,746 IU/ml by the bDNA-3.0 assay were categorized as containing viral loads within the range of 31,746 to 500,000 IU/ml by the bDNA-2.0 assay. Although substantial agreement was noted between the results generated by the bDNA-2.0 and bDNA-3.0 assays, a bias toward higher viral titer by the bDNA-2.0 assay was noted (P = 0.001). Likewise, although substantial agreement was noted between the results generated by the HCM-2.0 and bDNA-3.0 assays, a bias toward higher viral titer by the bDNA-3.0 assay was noted (P < or = 0.001). The discrepancy between the HCM-2.0 and bDNA-3.0 results was more pronounced when viral loads were >500,000 IU/ml and resulted in statistically significant differences (P < or = 0.001) in determining whether viral loads were above or below 800,000 IU/ml of HCV RNA, the proposed threshold value for tailoring the duration of combination therapy. The expression of quantitative values in HCV international units per milliliter was a strength of both the bDNA-3.0 and HCM-2.0 assays.

Branched DNA Signal Amplification Assay↗

PubMed2002

Outcomes after withholding anticoagulation from patients with suspected acute pulmonary embolism and negative computed tomographic findings: a cohort study.

OBJECTIVE: To determine the outcome of withholding anticoagulation from patients with suspected acute pulmonary embolism in whom computed tomographic (CT) findings are interpreted as negative for pulmonary embolism. PATIENTS AND METHODS: This retrospective cohort study included 1512 consecutive patients referred from August 7, 1997, to November 30, 1998, for CT because of clinically suspected acute pulmonary embolism. All patients were examined by electron beam CT, and scanning was performed in a cephalocaudad direction from the top of the aortic arch to the base of the heart with 3-mm collimation, 2-mm table incrementation, and an exposure time of 0.2 second (130 peak kV, 620 mA, and standard reconstruction algorithm). Contrast material was infused at a rate of 3 to 4 mL/s through an antecubital vein with an automated injector. Findings on CT were interpreted as either positive or negative. The main outcome measures were deep venous thrombosis, pulmonary embolism, and vital status within 3 months after the CT scan and the cause of death based on medical record review, mailed patient questionnaires, and telephone interviews. RESULTS: In 1010 patients (67%) CT scans were interpreted as negative for acute pulmonary embolism. Seventeen patients were excluded because they received anticoagulation. Of the remaining 993 patients, deep venous thrombosis or pulmonary embolism developed in 8; 118 patients died, 3 of pulmonary embolism. Nineteen patients were known to be alive, but additional clinical information could not be obtained. The 3-month cumulative incidence of overall deep venous thrombosis or pulmonary embolism was 0.5% (95% confidence interval, 0.1%-1.0%) and of fatal pulmonary embolism, 0.3% (95% confidence interval, 0.0%-0.7%). CONCLUSIONS: The incidence of (1) overall deep venous thrombosis or pulmonary embolism or (2) fatal pulmonary embolism among patients with suspected acute pulmonary embolism, negative CT results, and no other evidence of venous thromboembolism is low. Withholding anticoagulation in these patients appears to be safe.

Acute Disease↗

PubMed1985

Sympathetic blocks for reflex sympathetic dystrophy.

Seventy-one patients with reflex sympathetic dystrophy of the lower extremities were studied during a 3-year period. Of the 27 patients managed by conservative means, 11 (41%) showed signs of improvement 3 years after the onset of syndrome. Of the 43 patients treated by sympathetic nerve blocks, 28 (65%) experienced progress at the 3-year evaluation. Data suggest that early treatment with repeated sympathetic nerve blocks appears to improve the long-term outcome.

Autonomic Nerve Block↗

PubMed1984

Prescription medication dependence and neuropsychologic function.

The abuse of prescription drugs is an insidious complication among patients with chronic pain. This study examines cognitive intellectual functions in patients with chronic pain who are using prescribed analgesics, sedatives and hypnotics. A comprehensive battery of psychologic tests measuring intelligence, learning, memory, sensory-perceptual integrity, motor skills and general adaptive abilities was administered to 47 subjects. The subjects were patients admitted to a chronic pain management program, and they were divided into drug-dependent, drug-abusing and non-drug-abusing groups according to strictly defined criteria. Findings indicated that the prescribed use of these medications for pain over a prolonged time is detrimental to the cognitive function of such patients and complicates their clinical management.

Adult↗