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Biomedical subjects

Larry H Chou

Publications and source records attributed to Larry H Chou.

18 recordsLinked to original sources
PubMed2005

Intradiscal electrothermal annuloplasty.

Low back pain is a common problem, and although the majority of cases of low back pain resolve, a subset of patients will continue to have intractable pain despite appropriate conservative treatments. Intradiscal electrothermal annuloplasty is a minimally invasive spinal procedure that has been proposed to treat provocation discography-proven internal disk disruption syndrome. The early uncontrolled and nonrandomized intradiscal electrothermal annuloplasty literature suggests it may provide some relief in a small proportion of strictly defined patients; however, more recent randomized, placebo-controlled trials have not substantiated these initial findings. This article will review the published literature, indications, contraindications, safety, and efficacy of the intradiscal electrothermal annuloplasty procedure for the treatment of chronic, intractable, axial back pain.

Contraindications↗
PubMed2004

Sports and performing arts medicine. 1. General considerations for sports and performing arts medicine.

UNLABELLED: This self-directed learning module highlights general considerations in sports and performing arts medicine. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. OVERALL ARTICLE OBJECTIVE: To discuss similarities and differences of injuries sustained in sports and performing arts using case vignettes.

Anxiety↗
PubMed2004

Sports and performing arts medicine. 4. Traumatic injuries in sports.

UNLABELLED: This self-directed learning module focuses on injuries often seen in contact sports. It includes information on trauma to the cervical spine, wrist, shoulder, knee, ankle, foot, and chest and also discusses concussion in sport. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the etiology, differential diagnoses, treatment, and return-to-play criteria for traumatic sports injuries. OVERALL ARTICLE OBJECTIVE: To summarize the approach to common traumatic sports injuries.

Algorithms↗
PubMed2004

Sports and performing arts medicine. 3. Lower-limb injuries in endurance sports.

UNLABELLED: This self-directed learning module highlights new advances in this topic area. It is part of the study guide on sports medicine and performing arts in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article uses case vignettes as a vehicle to elaborate on (1) ankle pain in a runner, (2) heel pain in an adolescent, (3) anterior knee pain in a runner, (4) lateral knee pain in a cyclist, (5) shin splints in a runner, (6) buttock pain in a hiker, and (7) collapse of a marathoner from hyponatremia. OVERALL ARTICLE OBJECTIVE: To summarize lower-limb injuries commonly seen in endurance sports.

Athletic Injuries↗
PubMed2004

Sports and performing arts medicine. 2. Shoulder and elbow overuse injuries in sports.

UNLABELLED: This self-directed learning module discusses classic topics and highlights new advances in this area. This article discusses upper-limb sports injuries as part of a section of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article uses case vignettes as a vehicle to elaborate on shoulder and elbow pain in the athlete. OVERALL ARTICLE OBJECTIVE: To discuss shoulder and elbow overuse injuries in sports.

Athletic Injuries↗
PubMed2004

Sports and performing arts medicine. 6. Issues relating to dancers.

UNLABELLED: This self-directed study module highlights biomechanics unique to dance that predispose to common injuries of the lower extremity and discusses preventative strategies. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. OVERALL ARTICLE OBJECTIVE: To summarize lower-limb and back injuries commonly seen in dancers.

Biomechanical Phenomena↗
PubMed2004

Sports and performing arts medicine. 5. Issues relating to musicians.

UNLABELLED: This self-directed learning module discusses classic topics and highlights new advances in this topic area. This article, which discusses upper-limb injuries in musicians, is a section of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article uses case vignettes to elaborate on issues relating to musicians. OVERALL ARTICLE OBJECTIVE: To summarize overuse injury, nerve entrapment, and focal dystonia in instrumental musicians.

Cumulative Trauma Disorders↗
PubMed2004

Inciting events initiating injection-proven sacroiliac joint syndrome.

OBJECTIVE: To determine the inciting events leading to the development of sacroiliac joint syndrome (SIJS). METHODS: This was a retrospective descriptive cohort series from an academic interdisciplinary spine center. Consecutive patients presenting with low back or buttock pain with or without leg symptoms who met specific inclusion and exclusion criteria for the diagnosis of SIJS were included in the study. Inciting events leading to the development of SIJS in these patients were categorized into traumatic, cumulative, and idiopathic events. RESULTS: Of 194 patients who were included in the study, 54 patients had symptom resolution with one or more therapeutic intraarticular sacroiliac joint injections, following a positive diagnostic injection. Those patients were given the diagnosis of SIJS. Of these, 24 (44%) had had a traumatic event (13 motor vehicle accidents, six falls onto the buttock, three immediately postpartum, one severe football tackle, and one pelvis fracture). Eleven (21%) patients were considered to have a cumulative injury (four lifting, two running, three altered gait due to lower extremity disorder, one crew training injury, and one forceful hip extension injury). Nineteen (35%) patients had spontaneous or idiopathic onset of sacroiliac joint pain. CONCLUSION: SIJS can occur following a traumatic event or cumulative shear events, or can occur spontaneously.

Adult↗
PubMed2003

Sacral stress fracture in a female field hockey player.

We report a collegiate field hockey player who sustained a sacral fatigue-type stress fracture that manifested as persistent low back and leg pain. The diagnosis of sacral stress fracture was suggested by history and physical examination and confirmed by magnetic resonance imaging. Our patient experienced complete resolution of symptoms after a 3-mo interval of activity restriction. This article describes the first reported case of a sacral stress fracture in a field hockey player.

Adult↗
PubMed2003

Randomized controlled trials in interventional spine: perils and pitfalls.

It is the responsibility of clinician investigators to advance clinical knowledge and specifically its application to patient care. Randomized controlled trials remain near the top of the hierarchy of evidence based medicine. The acquisition of evidence based medicine by means of randomized controlled trials presents general difficulties and additional pitfalls specific to interventional treatments. The nature of interventional procedures makes the performance of these studies more difficult to plan and execute. To generate clinically useful research results requires an understanding of the mechanics of performing studies and the reporting of methodologies to ensure appropriate interpretation. Placebo arms and sham interventions present serious ethical issues, which must be analyzed on a case by case basis. The conscientious researcher must always abide by the principles of ethical research and the tenets of human subject protection.

Journal Article↗
PubMed2002

Dysphonia associated with epidural steroid injection: a case report.

A 46-year-old patient with left-side low back pain developed symptoms of dysphonia and throat irritation 24 hours after receiving a fluoroscopically guided steroid injection into the epidural space. A direct laryngoscopy performed before a second injection detected no abnormalities. When dysphonia reappeared 48 hours after that injection, laryngoscopy revealed edema in the anterior vocal cord with thick surrounding mucous. Full clinical resolution of the dysphonia was apparent by laryngoscopy 15 days after the second injection. The mechanism of dysphonia after epidural steroid injection is unknown, but it may result from a systemic steroid effect.

Anti-Inflammatory Agents↗
PubMed2002

Painless foot drop: an atypical etiology of a common presentation.

Weakness of the dorsiflexor muscles of the foot is a relatively common presentation. In most cases, the etiology involves a peripheral injury to the common peroneal nerve. These patients usually present with lower motor neuron findings on evaluation. In contrast, if upper motor neuron findings were present a central lesion should be suspected and appropriate imaging studies are performed. We describe a patient with painless foot drop and lower motor findings on examination that was diagnosed with multiple sclerosis. This case demonstrates that multiple sclerosis can masquerade as a peripheral process in some patients.

Journal Article↗
PubMed2002

Interventional spine research: the evolution of informed consent.

The future success of the field of interventional pain medicine depends on proof of positive outcomes. Evidence based medicine has an increasing relationship to insurance reimbursement. This makes new modes of pain management dependent upon human subject research. To succeed physicians must fulfill the ethical and regulatory requirements of research, specifically informed consent. History makes clear the importance of these ethical principles. Reliance on the beneficence and ethics of investigators has failed to protect subjects. This has led to ethical codes and governmental intervention. The basis of human research regulation is the Nuremberg Code and its underlying ethical principles. This code elucidates the requirements of Understanding and Voluntariness in informed consent for research. An analysis of these principles helps researchers fulfill the spirit of the governmental regulations and highlights the importance of protecting individual's rights. The current system of federal oversight of human research is cumbersome and inadequate. It leaves large groups of subjects unprotected and its lumbering pace often impedes investigators progress in spite of their compliance with ethical principles. Reform of these systems, is long overdue and physicians must play a role if we are to have efficient ethical human subject research in the future.

Journal Article↗
PubMed2002

Clinical evidence of chemical radiculopathy.

It is universally accepted that an anatomic abnormality such as a herniated disc or spinal stenosis can lead to radicular leg pain. There is some controversy as to whether radicular pain can be caused by a non-structural, solely biochemical disorder. Prior studies using biochemical analysis of inflammatory mediators of the disc or surrounding structures have enumerated many possible biochemical mediators of radicular pain. However, such studies have not definitively demonstrated whether these inflammatory mediators are the causes of radicular pain or whether these mediators are simply products of the degenerative cascade. The purpose of this paper is to report upon patients who satisfy strict criteria affirming a diagnosis of radiculopathy in the presence of normal imaging studies. The study was designed as a prospective case series of patients fulfilling inclusion and exclusion criteria at a university hospital outpatient physiatric spine practice. Inclusion criteria consisted of symptoms of extremity pain greater than axial pain, examination findings demonstrating a new myotomal deficit that correlates with the root level predicted by the dermatomal pain distribution, and failure to improve after at least 4 weeks of active physical therapy. Magnetic resonance imaging void of local nerve root pathology as per review by the first author and the interpreting radiologist was required. Each patient had to have a positive electromyographic study for an acute radiculopathy. Each patient had to have a positive fluoroscopically guided diagnostic selective nerve root block. In summary, this paper provides clinical evidence that anatomic abnormalities are not required to cause radiculopathy, thus implying that a biochemical etiology is likely to play a significant role in radiculopathy and radicular pain.

Journal Article↗
PubMed2002

Vascular supply to the lumbar spine: an intimate look at the lumbosacral nerve roots.

The vascular supply of the lumbar vertebral column is a diverse collection of arteries originating from both central and peripheral sites. Until recently, the majority of these studies have been dedicated to the blood supply of the spinal cord and vertebral bodies. More recent effort has been directed toward the identification of the vascular supply to the lumbar nerve roots. These studies have conclusively documented the presence of a dual blood supply to the nerve roots. In addition, this dual vascular supply has been discovered to have the capability for bi-directional flow. This unique property may allow for prevention of localized, compressive ischemic symptoms secondary to either herniated disc material or osteophytes. The nutrient contributions of the cerebrospinal fluid and venous supply to nerve roots have also been investigated. Early studies indicate that they may play a greater role than suspected. The presence of multiple sources of nutrient supply to the lumbar nerve roots enables them to be resistant to the potential compressive phenomenon that may occur in the lumbar spine.

Journal Article↗
PubMed2002

The evolution of informed consent: failures of the current system of human protection.

The reliance of subjects and researchers on the current regulatory scheme for human subject protection is misplaced. Investigators often assume that compliance with the requirements of the Common Rule, including Institutional Review Board approval of their research project, adequately fulfills the spirit of the federal regulation and protects them from liability for lack of adequate informed consent. Subjects and physicians referring subjects, believe that institutional approval of studies assures that they are scientifically valid and ethical. Unfortunately the current scheme of human research protection has failed to fulfill the spirit of the Nuremberg Code and The Belmont Report. Not only are large numbers of studies left out of the current protection scheme but the scheme is also flawed on several levels. This leaves researchers at risk for liability and subjects may have their right to autonomy violated even while the requirements of the current regulatory scheme are satisfied. It is time for a wholesale restructuring of human subject protection. If physician researchers ignore the deficits of the current system we will lose control and input into the formulation of the new scheme.

Journal Article↗
PubMed2002

Cervicogenic headache.

Chronic headache is a significant medical and socioeconomic problem resulting in severe disability and impairment. The term "cervicogenic headache" was coined by Sjaastad in 1983, who also proposed criteria for its diagnosis. Cervicogenic headache as described by Sjaastad et al is characterized as recurrent, long lasting, severe unilateral headache arising from the neck. Exact pathoanatomic and pathophysiologic basis for cervicogenic headache is unclear. Numerous authors have proposed various theories ranging from neurophysiologic basis involving ascending fibers from the C1 and C2 nerve roots to multiple pain generators in pain-sensitive structures involved in head movement. Thus, cervicogenic headache should be considered as a descriptive term rather than a final diagnosis. Because of the numerous potential pain generators, neither uniform clinical findings, nor a pathophysiology has been defined for the entity known as cervicogenic headache. Sequential diagnostic injections may elucidate pain generators and differentiate it from other types of headaches. This review describes the epidemiological and clinical aspects of cervicogenic headache, pathophysiology, diagnostic strategies to differentiate it from other common headaches and describes various non-operative treatment strategies.

Journal Article↗