Friday, September 23, 2011

[sehat] Digest Number 16097

Messages In This Digest (25 Messages)

1.
The Location of Headache Matters - it's a clue to Diagnosis. From: Laksmi Purwitosari
2a.
What Causes Headache? From: Laksmi Purwitosari
2b.
Re: What Causes Headache? From: Inta
3.
Headache Back of Head From: Laksmi Purwitosari
4.
Treatment of lumbar disc herniation: Evidence-based practice From: Laksmi Purwitosari
5.1.
Re: Talkshow Milis Sehat di SocMedFest From: Ade Novita Juliano
5.2.
Re: Talkshow Milis Sehat di SocMedFest From: titrin@gmail.com
5.3.
Re: Talkshow Milis Sehat di SocMedFest From: khonsaa1771@gmail.com
5.4.
Re: Talkshow Milis Sehat di SocMedFest From: caishiesabrina
5.5.
Re: Talkshow Milis Sehat di SocMedFest From: Dwiana
6a.
Re: Anak 10m22d demam batpil pup sering ampas wrn putih From: F.B.Monika
6b.
Re: Anak 10m22d demam batpil pup sering ampas wrn putih From: purnamawati.spak@cbn.net.id
6c.
Re: Anak 10m22d demam batpil pup sering ampas wrn putih From: F.B.Monika
7a.
Evidence based radiofrequency for back pain From: Laksmi Purwitosari
7b.
Re: Evidence based radiofrequency for back pain From: F.B.Monika
7c.
Re: Evidence based radiofrequency for back pain From: F.B.Monika
8a.
KELAS PERSIAPAN KELAHIRAN & MENYUSUI BANDUNG 29-30 Oktober 2011 From: klasibdg@yahoo.com
9.
Re: HOME MADE LOCAL CONTEXT ... Was ...  Mpasi instant From: purnamawati.spak@cbn.net.id
10.
Tanya obat Cacing kremi(pinworm) From: Ira Wardhani
11a.
Mohon doa operasi tumor azwar 3 hari lagi From: Ira Wardhani
11b.
Mohon doa operasi tumor azwar 3 hari lagi From: Ira Wardhani
11c.
Re: Mohon doa operasi tumor azwar 3 hari lagi From: khonsaa1771@gmail.com
11d.
Mohon doa operasi tumor azwar 3 hari lagi From: Ira Wardhani
11e.
Re: Mohon doa operasi tumor azwar 3 hari lagi From: F.B.Monika
11f.
Re: Mohon doa operasi tumor azwar 3 hari lagi From: niea_152@yahoo.com

Messages

1.

The Location of Headache Matters - it's a clue to Diagnosis.

Posted by: "Laksmi Purwitosari" laksmipurwitosari@yahoo.com   laksmipurwitosari

Thu Sep 22, 2011 2:41 pm (PDT)



The Location of Headache Matters - it's a clue to Diagnosis.

http://www.severe-headache-expert.com/location-of-headache.html

The location of headache can be helpful when trying to make a headache diagnosis.
While there is some overlap, some headaches are more likely in one area than another.

Pain in the back of the head
The most common cause of a headache in the back of head is pain stemming from the joints at the top of the neck. This is called cervicogenic headache, but there are several other causes.
Pain in the Temple, or one side of the head only
Migraine is the leading cause of this. However there is a long list and some have specific treatments with a good chance of success.
Cervicogenic Headache can also cause pain that spreads round the side of the head instead of staying at the back.

Nummular Headache is a recently described, non-serious, cause of pain in the side of the head, sometimes associated with a small area of hair loss over the painful spot.

Temporal Arteritis classically causes pain in the temple, and often a feeling of tenderness of the scalp when combing your hair. Temporal arteritis requires prompt medical attention, and affects people over the age of 50 years.

PS - The technical, medical term for a one-sided headache isUnilateral Headache

Headaches in both Temples or Both Sides of the Head at once
If the location of headache is in both temples, as opposed to just one temple, there is a slightly different list of causes.
If a pressure type pain is probably tension-type headache, especially if both sides.

Ice-pick headaches will often cause repeated sharp pains in the temples, as can pain from cervicogenic headache.

Headaches due to changes in your environment or body's metabolism can cause this type of headache.

Pain Behind The Ear
It is important that ear disease and disease of the bones around the ear are ruled out.
I've listed about 16 different headache conditions in the link above.

Headache on Top of Head
This is not that common location of headache in my own practice, but the link will tell you about 34 different causes!
Provoked headaches from exercise also cause pain on top of the head and will need investigated.

Pain in Eye
Just like the ear, eye disease, especially iritis or glaucoma should be excluded before going down the line of looking for a headache condition.
Ice-pick pains were once called "ophthalmodynia fugax" meaning a brief sharp pain in the eye, and this is the most common location of an ice-pick pain.

Face Pain
Migraine will involve the face in about 40% of cases at some time, and this would be the leading neurological cause.
Trigeminal neuralgia is an extremely intense shooting pain in the face, usually the jaw or cheek - it usually responds very well to Carbamazepine tablets.

Some people with cluster headache report a lot of pain into the face, as well as being focussed around the eye.

Chronic unexplained facial pain is fairly common and difficult to treat. Other causes of increasing facial pain include acute maxillary sinus infection - the pain of this usually follows a recent cold, and there is a discharge from the nose.

Laksmi Purwitosari

[Non-text portions of this message have been removed]

2a.

What Causes Headache?

Posted by: "Laksmi Purwitosari" laksmipurwitosari@yahoo.com   laksmipurwitosari

Thu Sep 22, 2011 2:44 pm (PDT)



What Causes Headache?

http://www.severe-headache-expert.com/what-causes-headache.html

What causes headache?
If you get headaches, you should know that about 99% of all headaches come down to one of these 6 common causes

2 types of Migraine
Episodes of Migraine
Chronic Migraine
2 types of Tension Headache
Episodes of Tension-type Headache
Chronic Tension-type Headache
Ice-pick Headache
Cervicogenic Headache (sometimes called occipital neuralgia)
Of these 6 types, Migraine Episodes are the ones most likely to make you want to to see a doctor, especially if you are in your teens, twenties or early thirties.

Chronic Migraine is the one most likely to have you referred to a specialist headache clinic. Chronic migraine is the most common headache diagnosis made in specialist headache clinics.

People over 50 or people who have a previous neck injury are most likely to have cervicogenic headache.

What causes headache? The Top 6 headaches and how often they occur.

Tension-Type Headache
35-80% of people each year will have at least one episode.

Symptoms of Tension Headache are really just a bland pain on both sides of the head.

Even though it is very common, the Cause of Tension Headaches is still poorly understood.

Cases where there is uncertainty should be given the benefit of the doubt as migraine usually responds well to lifestyle change and targetted migraine medication.

For example what is called Tension Stress Headache is often migraine.

Some migraine medicines will help many cases of tension-type headache, but here are the main Tension Headache Medicines.

Migraine
6% of men and 16% of women will get symptoms of migraine each year.

Typically migraine is a headache-nausea-symptom that is bad enough to make you want to lie down.

About 85% of migraine sufferers will just have headache and no aura, and about 15% wiill have Migraine with Aura.

Migraine affects people from all across the world - read aboutMigrana

Ice-pick Headache
Ice-pick headaches affect at least 2% of all people, and one study extimated that as many as 35% of people will get these brief sharp pains in the head.

They can be a sharp pain in eye or in the head. They last seconds but can have a lingering dull ache for several minutes afterwards.

People with migraine are more likely than average to get these nuisance head pains.

Cervicogenic Headache
A Scandanavian Survey estimated that about 4% of adults have symptoms of cervicogenic headache.

Cervicogenic Headache is a cause of pain in the back of the head, pain in the side of the head and pain above the eye.

It is due to wear-and-tear change in the facet joints of the upper cervical spine (neck).

Nerves in the facet joints travel via the spine into the brain where they merge with nerves from the whole of the same side of the head. (The pathway is called the trigeminocervical complex.)

This causes referred pain in the head that is actually coming from the neck. Treating this headache means treating the cervical spine.

Chronic Tension-Type Headache
About 2% of all people will experience a daily dull ache or pressure in the head that never seems to go away.

One of the causes of tension headaches is depression.

Unfortunately it is difficult to get relief from tension headache.

Chronic Migraine
My own estimate of the frequency of chronic migraine is about 0.2% of people.

However, recent studies have shown that about 4-5% of people experience a pain in their head on the majority of days ie >50% of the time.

How much of this is migraine is uncertain, but a fair amount of it is.

Managing chronic migraine is process that takes several months.

Following a headache friendly lifestyle, and keeping powerful painkillers to a minimum, is an essential part of treatment.

Less Common Causes of Severe Headache

There are other 4 other causes of severe headaches, which turn up fairly regularly in my own clinics. Let's look at these:
Cluster Headache Symptoms are also extremely severe, but are hundreds of times more rare (10/100,000 per year) than migraine (12000/100,000 per year).
In their true form, cluster headache is relatively rare at about 100 cases per million people each year.
Most people refered to me with suspected cluster headache actually have migraine with some watering of the eye.

True cluster headache is a severe, fairly sudden eye/forehead or upper face pain that can waken from sleep.

Within about 5 minutes of the start there is an intense boring pain, the eye is watering and the nose feels congested.

Usually the person with cluster headache is agitated, paces the floor, bangs their head off the wall or presses the eye very hard to try and get relief.

A cluster attack lasts about 30-180 minutes. The proven treatments include oxygen, sumatriptan and verapamil.

Hypnic Headaches
These are also intense headaches that waken from sleep. The person with these "Alarm Clock Headaches" is woken at the pretty much the same time most nights.
The pain is fairly non-descript, but can be throbbing and mistaken for Migraine. Usually it is dull, diffuse intense pain that prevents further sleep. It usually lasts 15-120 minutes.

Lithium Carbonate seems to help the majority of people.

However, until the diagnosis is made, these pains may go undiagnosed and untreated for years.

Exercise Induced Headache
Indometacin or a migraine drug called a triptan can be helpful if you are not one of the 20-40% of people who present to hospitals with an underlying cause.
Headache During Orgasm
A Headache during orgasm is upsetting, if not very painful. It can be sudden and severe. A serious cause is rare, but any sudden severe headache requires urgent medical attention
What causes headache? "Sinus" ? "Stress"?

So if you are not one of these 10 scenarios, how do we work out what causes headache?
2 very common things people say to me in my clinics are that they think they have severe sinus headache, or they have stress headache symptoms.

When you try to make a diagnosis in people who talk about "Sinus" or "Stress" headaches, almost all of them turn out to be suffering from (you guessed it) Migraine.

People with migraine will also describe it as a "sick headache".

The quality of the pain can be helpful in trying to work out what causes headache too.

A very broad generalisation is that pressure in the head is most commonly a Tension Headache Symptom, and Throbbing Headache is usually a Symptom of Migraine.

Recently, there has been a lot of controversy about whether mobile phone headache is a legitimate cause of headaches.

The best scientific studies suggest that electromagnetic irradiation from mobile phones is unlikely to cause a headache.

Some Headaches Only Affect Women

What Causes Headache at a woman's period time?
Menstrual Headache affects at least 10% of women, but most will be best managed as having migraine.

It is possible to target migraine medication like naproxen or frovatriptan to co-incide with the menstrual cycle.

The pattern of the headache is useful, especially when considering the onset of pain.

What causes headache in pregnancy?

In pregnancy, most headaches are due to migraine(the vast majority in fact). There are some rarer serious disorders of arteries and veins in the head that will require further investigation.

There are even Breast Feeding Headaches.

What Causes Headache that is Frequent?

Frequent short lived neuralgiform headaches that are very brief usually turn out to be ice-pick headaches. Frequent headaches lasting several hours are most often migraine.
What Causes Headache that is Constant?

Constant headaches that never go away, and make you want to visit a doctor for pain relief are usually chronic migraine.
However, care needs to be taken to exclude a different underlying cause of constant severe headaches.

Causes of constant severe headaches that are not migraine and might be treatable include:

Idiopathic Intracranial Hypertension
Intracranial Hypotension
Isolated Sphenoid Sinusitis
Carbon Monoxide Poisoning
Cervicogenic Headache
Systemic Illness Headche eg due to underactive Thyroid Gland
That's a lot to take in on what causes headache.
There are many factors to consider, but even then 99% are still one of 6 common causes.

Laksmi Purwitosari

[Non-text portions of this message have been removed]

2b.

Re: What Causes Headache?

Posted by: "Inta" dini.maesarinta@gmail.com

Thu Sep 22, 2011 4:54 pm (PDT)



Thanks for share dok. Langsung saya save buat dibaca2 dalam tenang *tsaaah* secara saya sering banget nih sakit kepala gak jelas.

Cheers, Inta
terkirim dari henponkuh

3.

Headache Back of Head

Posted by: "Laksmi Purwitosari" laksmipurwitosari@yahoo.com   laksmipurwitosari

Thu Sep 22, 2011 2:49 pm (PDT)



Headache Back of Head

http://www.severe-headache-expert.com/headache-back-of-head.html
Cervicogenic Headache
The most common of these is a pain referred from the joints of the upper spine. This is called cervicogenic headache (cervic = neck, genic = caused by).

The classic cervicogenic headache causes a pain in the back of the head - on one side only.

The pain can spread up the back of the head and round the side towards the ear or over the top into the forehead.

Most people with cervicogenic headache will have previously injured their neck (a whiplash injury is typical) or will have restricted neck movements due to "wear and tear" of the joints of the upper neck bones.

Cervicogenic headache is very common - as many as 4% of adults will have this pain at some point.

Fortunately Cervicogenic Headache Treatment can be effective.

Occipital Neuralgia
This another severe, sharp "headache back of head" that spread up to the top of head or into the eye on the same side.

Nerve block, anti-inflammatories or Gabapentin are worth trying. Most people who are diagnosed with occipital neuralgia will actually be suffering from cervicogenic headache.

There is still controversy about whether cervicogenic headache and Occipital Neuralgia are the same or different conditions - I suspect in most they are the same.

Migraine
Migraine is not, in my experience, a common diagnosis in people who ask me for advice about their "headache back of head".

One survey from the 1970s (Olesen, Denmark) found that only 6% of people with acute migraine took pain in the back of the head.

A more recent survey in 2005 (Kelman, Atlanta) found that about 39% of people with migrainewould report pain in the back of head or even in the neck.

The real figure, I think, is somewhere in between, probably more like 10-15%.

A "headache back of head" might be migraine if it is severe enough to make you want to lie down, and you feel nauseated with it.

People with migraine don't always have pain in one location.

Usually in migraine pain can be experienced in different locations during different migraine attacks.

Ice-pick Headache
About 35% of all people will get these brief intense pains in the head lasting a few seconds (This information is from a large Norwegian Study called the Vaga Study).

They appear out of the blue, and may make you wince, or feel briefly weak at the knees if they are very intense. In a small number of people, these ice-pick pains are located, exclusively, in the neck or very back of the head.

It can be very difficult to tell the difference between cervicogenic headache and ice-pick pains.

Usually ice-pick pains can occur anywhere in the head, whereas cervicogenic headache are locked to one side of the head only.

Ice-cream headache
This is felt in the temples in most cases, but about 6% of young people feel this pain exclusively in the back of the head!
Serious Causes of "Headache Back of Head" - Harm may occur if not treated promptly.

Temporal Arteritis
The occipital arteries run up the back of the head, and are often affected in temporal arteritis. As the occipital arteries lie right next to the greater occipital nerve, temporal arteritis can cause a "headache back of head".

(I've made this mistake once before, but the penny dropped at follow-up and a good recovery ensued on prednisolone!).

About 30 people per 100,000 will get temporal arteritis in any given year.

Vertebral Artery Dissection
This may present with a sudden severe "headache back of head", but is even more rare than arteritis at about 5 people per 100,000 each year with this rare condition.

This is one condition which if not considered, it could lead to harm from a stroke. The best way to distinguish vertebral artery dissection from cervicogenic headache is to listen to the onset of pain.

In dissection it is usually much more rapid - onset over seconds.

In cervicogenic there will usually have been a smaller amount of pain in the preceding months or years.

If your doctor considers a diagnosis of Vertebral Artery Dissection this is ruled out using an MRI scan.

It would be prudent to talk to your doctor before starting physiotherapy or spinal manipulation therapy for a "headache back of head" that came on abruptly.

Unfortunately there is no way to distinguish between cervicogenic headache and vertebral dissection with 100% certainty - it comes down to a clinical judgement, erring on the side of caution with investigations if symptoms are in any way unusual.

Subarachnoid Haemorrhage
About 10% of people with very sudden onset severe pain in the back of the head a brain haemorrhage (Subarachnoid haemorrhage) is diagnosed. This sudden severe headache is called"thunderclap headache".

If this pain happens out of the blue it requires immediate medical attention. If at the time of onset of pain there is vomiting or a faint, the risk of there being an underlying brain haemorrhage is higher than in those who had pain and no other symptom.

"Headache Back of Head" - Provoked by physical stimulus

Headache During Orgasm
The majority of these are experienced as sudden severe pains in the occipital area.
In one paper, 77% of 30 cases were occipital orgasmic pain, lasting an average of 30 minutes, occurring in >50% of intercourse in 93% of cases, and remitting after an average of 2 months.

It is now thought that these headaches are almost all due to a condition called reversible cerebral vasoconstriction syndrome.

High Altitude Headache
4/98 mountain climbers at high altitude experienced their pain in the back of the head. Most of the headaches involved the entire head. and about half were made worse with exertion.
Cough Headache
One series of 83 cases of headaches triggered by coughing found no cause in 74 cases. Of these 74 cases, 35% were in the back of the head.
In the 9 cases with a cause found, 4 had occipital pain (44%).

Cough Headache requires investigation to exclude an underlying cause such as Chiari malformation of posterior fossa mass.

Dialysis Headache
About 50% of people on dialysis for kidney failure will get a headache after dialysis sessions.
In 8/30 dialysis headaches in one paper, the back of head was the site of the pain.

Pool Players Headache
People who play pool for prolonged periods of time may experience pain in the head and neck after playing for between 3-6 hours. There is one report of this, and the problem is presumably from the joints of the neck, such as over extension at the atlanto-axial joint.
Cardiac Cephalalgia
Pain referred from the heart can be felt in the back of the head. 11/32 published cases, reviewed in 2008, had occipital pain during either an angina attack or heart attack proper.
This is one of the causes of an Exercise Induced Headache, although it can also cause aThunderclap Headache

Treating the heart disease fixes the headaches.

Hypnic Headache
In one series 3/20 cases of this "alarm clock" headache are in the back of the head.
The provoking factor is sleep!

Usually they are a whole of head pain that wakens from sleep. Lithium Carbonate helps about 70%.

Neck Tongue Syndrome
This is an unusual back of the head syndrome. It is provoked by rotation of the neck which irritates the C2 nerve and produces a sensory disturbance in the tongue.
Some will get a spasm of tongue muscle.

There are nerve fibres which run in the nerve to the tongue (hypoglossal nerve) which join with fibres from the upper neck (C2 nerve), so pain from the neck can produce symptoms in the tongue.

Low pressure headache, usually due to Intracranial Hypotension
Pain in a low pressure headache can be experienced anywhere, but most commonly it is onboth sides of the head.
Some people will report a severe dull ache in the back of the head that is worse while up and about, and is relieved by lying down flat for 15-30 minutes.

Low pressure headaches are often associated with a muffling of hearing or buzzing in the ears that is also better on lying down.

The common cause of low pressure is due to a spinal tap or lumbar puncture procedure. About 20-30% of post-lumbar puncture headaches in one large series were located at the back of the head.

Some people will get a spontaneous leak of spinal fluid within the spine. The spontaneous cases are called Spontaneous Intracranial Hypotension.

Low pressure headache that is very severe and incapacitating can be treated with a anepidural blood patch procedure, which has a 70-80% success rate in typical cases.

Nerve Palsies Causing "Headache back of Head"

C-2 Neuralgia, from Lateral Atlanto-axial joint disease
Disease of this joint can irritate the C2 nerve and cause intense sharp pains going up the back of the head. They can even cause the eye to water.
Rheumatoid arthritis is the most common serious cause of this problem.

Other conditions that can affect this joint or the C2 nerve include a neuroma, meningioma or pressure from a nearby blood vessel. This condition will require specialist investigation and treatment.

Occipital Condyle Syndrome
This is severe occipital pain due to spread of cancer into the occipital bone at the base of the skull. The XIIth cranial nerve passes through this bit of bone and supplies the muscles of the tongue.
Almost everyone who gets occipital condyle syndrome will have a known history of cancer elsewhere eg prostrate or breast. Severe headache usually comes on a few weeks before the tongue movements start to cause speech or swallowing difficulty.

Hypoglossal Nerve Palsy
Even without an occipital condyle syndrome hypoglossal nerve palsy can be painful. This may be due to compression of the inflamed nerve in the hypoglossal canal, but the exact mechanism is not certain.
Accessory Nerve Palsy
Pain in the neck and shoulder are common if the Accesory Nerve is damaged - the usual cause is surgery in the neck to biopsy or remove a lymph gland.
The pain can spread into the back of the head. The shoulder on the affected side loses its contour compared to the other and drops down.

Vascular Loop Compression of Upper cervical nerve Roots
A low lying course of the posterior inferior cerebellar artery has been identified in persistent occipital neuralgia.
Structural Disease of the Junction Between Headache and Neck Causing a "Headache Back of Head"

Chiari Malformation
The brain in this condition sits much lower within the skull and can block flow of spinal fluidcausing bouts of bad headache.
Technically speaking, low lying cerebellar tonsils could stretch the upper cervical nerve rootsand contribute to pain in the back of the head.

The classic pain of Chiari Malformation is in the back of the head and is provoked by coughing or exertion, so without these provoking factors a Chiari is less likely to be the cause.

Extra-bone connecting occiput to cervical spine
One case of a teenage girl with fixed, one sided severe pain due to an accessory bone joining head to neck, which was relieved when the accessory bone was removed surgically
Bulbocervical Cavernoma
Single case of severe occipital pain associated with a vascular lesion in the upper spinal cord.
"Headache Back of Head" caused by Primary or Idiopathic Conditions

Epicrania Fugax
Epicrania Fugax is a variant of ice-pick pains. What is different is that these are even shorter in duration and seem to "zig-zag" through the head. 4 out of 10 cases in one series had pain starting in one side, at the back of the head and zig-zag their way through to the front of the head.
No serious cause is found.

Nummular Headache
This is a localised, fixed area of pain the size and shape of a coin. It is thought to be due to inflammation of one of the cutaneous nerves of the scalp, and is more a nuisance than a serious disorder.
Cluster Headache
26% of one series of 652 cases experienced cluster pains in the back of the head.
There are other features of cluster that must be present for this diagnosis - watery eye, nasal symptoms, agitation and strictly one-sided pain.

Oxygen and Sumatriptan injections work best for acute attacks. Verapamil is the best preventative drug

Hemicrania Continua
This is a strictly one-sided headache and in most cases is at the front and side of the head. In one series 1/18 had the occiput as the main site of pain. In another 5/18 there was some pain there, but it was not the main site of pain.
New Daily Persistent Headache
80% of these people recall the onset of new headache several months earlier and the pain seems to persist, and no cause is found.
Some of these are associated with a viral infection.

64% have bilateral pain and 60% have occipital pain. In 55% the pain is described as throbbing at times and 54% report pressure symptoms at times, and some experience both throbbing and pressure

"Headache Back of Head" associated with other Diseases

Retropharyngeal Tendinitis
This pain in the back of the head is severe to the point of preventing sleep. It has its onset over about 1-2 days and is associated with pain on swallowing.
Parkinson's Disease
35% of people with previously known Parkinson's Disease in one survey had a non-descript bilateral posterior neck and head pain
Brain Tumour Headache
11/51 people in one series of people with brain tumours reported pain in the back of the head.
However, occipital pain is not a distinctive feature of brain tumours.

Most brain tumours present with other neurological symptoms such as epileptic seizures

Sleep Apnoea Headaches
Sleep apnoea and heavy snoring increase the risk of chronic headaches. 22% of headaches associated with sleep aponea in one series were located in the back of the head.
Treating sleep apnoea will often help the headache.

Idiopathic Intracranial Hypertension
In 8/58 cases = 14%, headaches were occipital. The quality of pain is pulsatile or throbbing in 83% and assoc with nausea in 57% and a feeling of stiff neck in 59%.
The biggest risk for developing this condition is obesity and weight reduction through a properly directed exercise and diet programme can be curative

Overactive Thyroid Gland
One case of a relapse of Graves Disease (thyrotoxicosis) was associated with 2 months of severe occipital pain
Dengue Fever
Dengue Fever causes a febrile illness which is usually present for about a week before diagnosis.
97% of Dengue Fever cases will have a prominent headache, of which about one in five will be in the back of the head.

Headache is more pronounced in ordinary Dengue fever than in its more dangerous counterpart Dengue Haemorrhagic Fever.

Adult Aqueductal Stenosis
This is a cause of thunderclap headache, and like most thunderclap headache is experienced in the back of the head

Laksmi Purwitosari

[Non-text portions of this message have been removed]

4.

Treatment of lumbar disc herniation: Evidence-based practice

Posted by: "Laksmi Purwitosari" laksmipurwitosari@yahoo.com   laksmipurwitosari

Thu Sep 22, 2011 3:00 pm (PDT)



http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915533/
Treatment of lumbar disc herniation: Evidence-based practice
Andrew J Schoenfeld1 and Bradley K Weiner2
Int J Gen Med. 2010; 3: 209–214.
Published online 2010 July 21.

Abstract
Clinical question:
What is the best treatment for lumbar disc herniations?
Results:
For patients failing six weeks of conservative care, the current literature supports surgical intervention or prolonged conservative management as appropriate treatment options for lumbar radiculopathy in the setting of disc herniation. Surgical intervention may result in more rapid relief of symptoms and restoration of function.
Implementation:
While surgery appears to provide more rapid relief, many patients will gradually get better with continued nonoperative management; thus, patient education and active participation in decision-making is vital.
Keywords: lumbar disc, herniation, back pain, spine
Other Sections▼

Definition: Lumbar disc herniation is a common condition that frequently affects the spine in young and middle-aged patients.1,5,11 The lumbar intervertebral disc is a complex structure composed of collagen, proteoglycans, and sparse fibrochondrocytic cells that serve to dissipate forces exerted on the spine. As part of the normal aging process, the disc fibrochondrocytes can undergo senescence, and proteoglycan production diminishes. This leads to a loss of hydration and disc collapse, which increases strain on the fibers of the annulus fibrosus surrounding the disc. Tears and fissures in the annulus can result, facilitating a herniation of disc material, should sufficient forces be placed on the disc. Alternatively, a large biomechanical force placed on a healthy, normal disc may lead to extrusion of disc material in the setting of catastrophic failure of the annular fibers.5
Regardless of etiology, herniations represent protrusions of disc material beyond the confines of the annular lining and into the spinal canal. Back pain may occur due to disc protrusions that do not enter the canal or compromise nerve roots.5The more treatable condition of lumbar radiculopathy, however, arises when extruded disc material contacts, or exerts pressure, on the thecal sac or lumbar nerve roots.5,11 The pain associated with lumbar radiculopathy occurs due to a combination of nerve root ischemia and inflammation resulting from local pressure and neurochemical inflammatory factors present within the disc material.5,7,9,11
Incidence: Lumbar disc herniations exist on a continuum of degenerative spinal processes that include intervertebral disc degeneration and lumbar spondylosis.5Many studies have demonstrated that lumbar herniations, protrusions, and annular tears are present in asymptomatic individuals and, in certain instances, can represent normal aging of the intervertebral disc. The incidence of lumbar disc herniations, albeit asymptomatic, within certain populations has been estimated to be greater than 50%.5 The true incidence of symptomatic lumbar disc herniations, however, has not been satisfactorily characterized due to a lack of consensus regarding what constitutes a symptomatic herniation (ie, back pain alone versus radicular pain versus back pain and radicular pain), as well as a lack of ability to quantify a specific at-risk population. Furthermore, the complete natural history of this disorder is inadequately described, although a variety of anecdotal as
well as Level IV–V evidence exists, suggesting that 90% of patients with lumbar disc herniations will resolve their symptoms without substantial medical intervention.5,7
Economics: Disc disorders, back pain, and/or radiculopathy are often grouped together in terms of economic considerations, and a discrete estimation of the effect of symptomatic lumbar disc herniation on the economic system, in terms of days lost to work and reduced productivity, is hard to obtain. Nonetheless, back-related conditions are a common cause of disability, and the US health care system spends over $1 billion annually to redress these disorders. Recently, annual Medicare spending on lumbar discectomy procedures has been estimated to exceed $300 million.
Level of evidence: The evidence presented in this article is largely derived from recent prospective, randomized, controlled trials (RCTs) as well as prospective case-control studies. These include the Spine Patient Outcomes Research Trial (SPORT)19 as well as the Maine Lumbar Spine Study.2–4 Therefore, the evidence presented in this paper can be graded as Level I–II.
Search sources: Sources used in the preparation of this manuscript included PubMed, MedLine, and the Cochrane Library. An advanced search was performed using the PubMed database and key words, including "intervertebral disc herniation", "lumbar disc herniation", and "lumbar disc displacement". The PubMed search revealed 2370 articles that were potential matches. A similar search method on the Cochrane database returned 6153 potential articles, and a like number was obtained with a search using MedLine. Articles with Level I or II evidence were selected for use in the preparation of this article, as well as other publications found to contain pertinent or unique information.
Outcomes: Outcomes considered in the preparation of this manuscript included the relief of radicular pain, resolution of associated motor and sensory deficits, and restoration of preinjury work-related status and level of function.
Consumer summary: Radicular pain in the lower extremities results from the herniation of disc material into the spinal canal and resultant pressure on a nerve root. The constellation of symptoms can include numbness and weakness, but most often consists solely of leg pain that radiates posterolaterally below the knee from nerves L5 and S1 (sciatica); or, less commonly, into the anterior thigh or groin from nerves L2, L3, and L4 (femoralgia). Sensory abnormalities in the genitals, anus, or perineum often coupled with loss of bladder control (cauda equina syndrome), as well as progressive loss of sensation or motor function in the legs, are ominous signs and warrant urgent evaluation and treatment. In situations where leg pain is the primary symptom, conservative management including physical therapy, judicious use of pain medication and epidural steroid injections, as well as surgical intervention (lumbar discectomy) have been shown to be
effective.1–9,12–21 Most of the literature supports earlier relief of pain-related symptoms, and possibly earlier restoration of function, in patients who undergo surgery.1–5,8,17,18,20,21 The four-year as treated analysis of the SPORT trial, documented advantages for surgical intervention over conservative management that persist for up to four years following surgery.21 Additionally, if symptoms have already been present for an extended period of time, discectomy may be more likely to relieve symptoms than continued nonoperative management.12 While both conservative and surgical options are shown to be efficacious, the ultimate decision regarding initial and definitive management should be made by the patient based on their desires and individualized requirements, following a frank discussion regarding risks and benefits of the various treatments with their surgeon.7
Other Sections▼
The evidence
Systematic reviews: 11
RCTs : 5 (presented in 6 publications)6,13–15,18,19
Cohort studies: 4 (presented in 7 publications)2–4,8,17
Retrospective series: 116
Prior to the mid-1990s there was a paucity of high quality literature supporting the treatment of radicular symptoms resulting from lumbar disc herniation. Since 1996, a number of prospective studies have reported their findings comparing conservative with nonoperative treatments and, in addition, several prospective RCTs have been performed. Many spinal surgeons and medical researchers hoped that well constructed, scientifically rigorous RCTs would definitively answer the question regarding optimal treatment for lumbar disc herniation. However, due to methodologic issues and difficulties with "patient crossover" between treatment groups in these studies, no gold standard treatment has yet been established.
Results from the five RCTs are summarized in Table 1. All of the randomized investigations experienced methodologic difficulty because more than one-third of their randomized patients did not adhere to the treatment that they were assigned to and "crossed over" to the other treatment group. This was most significant in the highly touted SPORT trial,19 in which 40% or more of patients in the surgical and conservative treatment groups declined to have the treatment that they were assigned. This becomes problematic, especially in light of the fact that these randomized investigations were conducted with "intent to treat analysis". Therefore, patients who were assigned to conservative management but decided to undergo surgery were still considered part of the nonoperative.
Although many of these studies showed some early benefit for surgery, with faster relief of symptoms and return to preinjury functional levels, the findings were not statistically significant.6,14,15,19 It is important to note, however, that significant differences between groups become difficult to identify in intent to treat analyses once patient crossover approaches 50%.1 Only Weber's study from 1983 was able to show significant advantages for surgery at time points up to one year.18
Several publications reporting outcomes for prospective cohorts undergoing discectomy documented satisfactory results, including symptomatic relief and global health benefits for up to two years after surgery (Table 2). The most elaborate prospective study conducted to date remains the report of the Maine Lumbar Spine Study Group, published in a series over the course of 10 years by Atlas et al.2–4 Over 500 individuals were included in this investigation, although decisions regarding course of treatment were left to the patients. Evaluations at the 1-2, 5-3, and 10-year4 time points following treatment revealed a continued benefit for surgical intervention, although the two groups approximated each other after a decade.
In 2008, Anderson et al systematically reviewed the results of prospective RCTs investigating treatments for lumbar disc herniation.1 These authors found that the degrees of crossover, as well as the performance of intent to treat analyses, in these investigations were severe limitations. Anderson et al felt that, in the absence of intent to treat analysis, the effect of surgery would have been more substantial in the randomized trials.1 These authors also maintained that the way in which most RCTs, and SPORT in particular, were conducted did not examine the effects of the surgical and nonoperative treatments under study in a valid manner.
The 1989 study by Saal and Saal is often quoted as evidence for the effectiveness of nonoperative management.16 In this retrospective investigation, the authors reported that 90% of 58 patients treated with a conservative regimen achieved good results or better. An important drawback regarding this series is that, of 347 patients initially identified for enrollment, only 58 were able to be followed to the study's completion. Therefore, while Saal and Saal clearly demonstrated the feasibility of positive outcomes from conservative management, a fact which has been demonstrated in several more recent investigations, the results might represent nothing more than an ideal scenario. Only the most positive outcomes may have been presented in this report, and failures of conservative management in potentially 289 patients were possibly not available to the researchers, or excluded due to the study's inclusion criteria.
Conclusion
The literature supports both conservative management and surgical intervention as viable options for the treatment of radiculopathy caused by lumbar disc herniation. Methodological drawbacks limit the effect that published RCTs can have on informing clinical practice for this condition. Surgical intervention may result in faster relief of symptoms and earlier return to function, although long-term results appear to be similar regardless of type of management. The ultimate decision regarding type of treatment should be based on a surgeon-patient discussion, in light of proper surgical indications, duration of symptoms, and patient wishes.
Other Sections▼
The practice
The patient who presents initially with an acute episode of lumbar radiculopathy can be managed by a primary care practitioner. Primary treatments should include judicious use of pain medication, a short course of rest if indicated, physical therapy, and possible epidural steroid injections. Injections can be ordered, or referral to physiatry or pain management made, prior to considering consultation with a spinal surgeon, unless the patient exhibits certain red flags, such as sensory or motor deficits, progressive neurologic deterioration, or saddle anesthesia with bowel and bladder incontinence. Magnetic resonance imaging (MRI) is indicated to confirm that the patient's symptoms are attributable to appropriate lumbar disc pathology. The following treatment recommendations are not necessarily applicable to those patients who have disc herniations identified on MRI, but present only with back pain.
Potential pitfalls
Patients with progressive neurologic deficits, saddle anesthesia, and/or bowel or bladder issues should be sent to the emergency room or referred urgently to a spinal surgeon. These patients should not be considered candidates for nonoperative management. Patients with paresthesias or motor weakness in the setting of radicular pain should likely be evaluated by a spine care practitioner prior to the determination of a conservative course of treatment. Patients with symptoms present for greater than six months should be referred to a spinal surgeon because nonoperative management may not be indicated in these individuals.5,12 Those patients with only back pain, even with MRI evidence of disc herniation, should not be treated using an algorithm for patients with radicular symptoms.
Management
Initial management should include rest as indicated, physical therapy, and appropriate use of pain medication. In most instances, radicular symptoms will abate or resolve within six weeks.5,7 If symptoms persist, consideration can be given to ordering epidural steroid injections. Patients with symptoms that persist beyond six weeks in the setting of demonstrable MRI disc pathology are also candidates for surgical referral.
Assessment
Assessment by the primary care practitioner consists of taking a history documenting the onset of symptoms and any symptomatic progression. Evaluation should focus on the presence of predominantly back-related symptoms as well as true radicular pain (ie, radiating pain that extends below the knee in the affected extremity). Primary care physicians must also perform a neurologic evaluation to assess for the presence of sensory or motor deficits. Patients with a history of saddle anesthesia must also have a perineal examination and a rectal examination to determine true sensory loss and/or sphincter involvement. Straight leg raise testing and a slump test, as described by Majlesi et al,9 are also useful adjuncts. It is important to remember that a true positive straight leg raise test should reproduce the patient's radicular pain, with radiation below the knee in the affected extremity.
Treatment
Initial treatment can begin with a short course of rest as indicated for the patient with acute lumbar radiculopathy in the setting of a lumbar disc herniation. Pain management may include either a prescription for a moderate nonsteroidal anti-inflammatory, such as ibuprofen 800 mg every eight hours as needed, or tramadol 50 mg every 4–6 hours as needed. Patients with more substantial pain can be treated with mild narcotic pain medication, such as hydrocodone-acetaminophen 5 mg/500 mg every 4–6 hours on an as-needed basis. Physical therapy referral can be made at the initial office visit, to include mild stretching and pain relief modalities, such as ultrasound, whirlpool, ice and heat pack therapy, electrical stimulation, and/or massage. Those individuals found to have perineal anesthesia, an incompetent rectal sphincter, or significant neurologic deficits by examination should be sent to the emergency room or have an urgent consultation with a
surgeon. Those with significant, but stable, sensory or motor deficits may be referred to a spine surgical specialist on an urgent basis. Individuals with a history of more than six months of persistent symptomatology can be referred to a spinal surgeon without consideration for conservative management, because surgical results have been shown to deteriorate after 6–12 months of persistent symptomatology.12
Patients who have failed a short course of conservative management (ie, 3–4 weeks) can be considered candidates for epidural steroid injection. Those who have failed six weeks of conservative management and/or derived no relief from steroid injection, may consult with a spine specialist as a routine referral.
Indications for specialist referral
Urgent specialist referral should be made in the setting of progressive neurologic deficits, saddle anesthesia, or bowel and/or bladder deficits if these issues are acute. Urgent referral to a spinal surgeon can be made if the patient has sensory or motor findings on physical examination but these deficits are stable. Once a patient has failed six weeks of nonoperative treatment, surgical referral is appropriate if symptoms persist and the patient is amenable.


[Non-text portions of this message have been removed]

5.1.

Re: Talkshow Milis Sehat di SocMedFest

Posted by: "Ade Novita Juliano" ade.novita.juliano@gmail.com   novita_ade

Thu Sep 22, 2011 4:01 pm (PDT)



Pagi semuaaa

ditunggu ya... di booth @milissehat Yayasan Orangtua Peduli hari ini di
@SocmedFest FX lantai 5

butuh bantuan banget nih dari para smart parents disini, antusiuas
pengunjungnya luar biasa,

hayoo yg udah lulus pesat, yang tiap hari rajin jawabin milis, giliran kita
berbagi ilmu ke pengunjung booth milissehat

slain itu, mari kita ngeriung bareng di mini stage nya mulai jam 3 sore

junior2 kita bisa main seru seruan di rumah main cikal

oh iya di booth ada flyer panduan sederhana utk demam, batuk, diare lohh...
juga ada tips memperbanyak ASI dan weaning with love

see u all there ya

salam,
@Ade_Novita
KLASI YOP

[Non-text portions of this message have been removed]

5.2.

Re: Talkshow Milis Sehat di SocMedFest

Posted by: "titrin@gmail.com" titrin@gmail.com   artriniaarianto

Thu Sep 22, 2011 4:17 pm (PDT)



Utk ikut talkshownya ada biayanya ga? Aku ga pernah muncul soalnya nih, pinginnya nanti ikutan....
Mudah2an bs sih...
Sent from BlackBerry� on 3
5.3.

Re: Talkshow Milis Sehat di SocMedFest

Posted by: "khonsaa1771@gmail.com" khonsaa1771@gmail.com

Thu Sep 22, 2011 4:39 pm (PDT)



Dear all

Semoga sakses ya acaranya.
Selamat menikmati sharing ilmu dan kopdar dg sesama member milis sehat.

*nahan iri sampe mules*

-elona-

Powered by Telkomsel BlackBerry�

-----Original Message-----
From: Ade Novita Juliano <ade.novita.juliano@gmail.com>
Sender: sehat@yahoogroups.com
Date: Fri, 23 Sep 2011 06:00:52
To: <sehat@yahoogroups.com>
Reply-To: sehat@yahoogroups.com
Subject: Re: [sehat] Talkshow Milis Sehat di SocMedFest

Pagi semuaaa

ditunggu ya... di booth @milissehat Yayasan Orangtua Peduli hari ini di
@SocmedFest FX lantai 5

butuh bantuan banget nih dari para smart parents disini, antusiuas
pengunjungnya luar biasa,

hayoo yg udah lulus pesat, yang tiap hari rajin jawabin milis, giliran kita
berbagi ilmu ke pengunjung booth milissehat

slain itu, mari kita ngeriung bareng di mini stage nya mulai jam 3 sore

junior2 kita bisa main seru seruan di rumah main cikal

oh iya di booth ada flyer panduan sederhana utk demam, batuk, diare lohh...
juga ada tips memperbanyak ASI dan weaning with love

see u all there ya

salam,
@Ade_Novita
KLASI YOP


[Non-text portions of this message have been removed]



[Non-text portions of this message have been removed]

5.4.

Re: Talkshow Milis Sehat di SocMedFest

Posted by: "caishiesabrina" caishie_sabrina@yahoo.com

Thu Sep 22, 2011 4:51 pm (PDT)



Ngikuttt akhh.. Meski pnya wktu mefettszzz sblm cuusss ke gambir... Untung cma ke gambir jd bs ikut dehh.... :)

@mba lolo: hanyokkkk atuhh ccuussss ke jekardah

Caishie
Sent from my BlackBerry�
powered by Sinyal Kuat INDOSAT

-----Original Message-----
From: khonsaa1771@gmail.com
Sender: sehat@yahoogroups.com
Date: Thu, 22 Sep 2011 23:39:00
To: <sehat@yahoogroups.com>
Reply-To: sehat@yahoogroups.com
Subject: Re: [sehat] Talkshow Milis Sehat di SocMedFest

Dear all

Semoga sakses ya acaranya.
Selamat menikmati sharing ilmu dan kopdar dg sesama member milis sehat.

*nahan iri sampe mules*

-elona-

Powered by Telkomsel BlackBerry�

-----Original Message-----
From: Ade Novita Juliano <ade.novita.juliano@gmail.com>
Sender: sehat@yahoogroups.com
Date: Fri, 23 Sep 2011 06:00:52
To: <sehat@yahoogroups.com>
Reply-To: sehat@yahoogroups.com
Subject: Re: [sehat] Talkshow Milis Sehat di SocMedFest

Pagi semuaaa

ditunggu ya... di booth @milissehat Yayasan Orangtua Peduli hari ini di
@SocmedFest FX lantai 5

butuh bantuan banget nih dari para smart parents disini, antusiuas
pengunjungnya luar biasa,

hayoo yg udah lulus pesat, yang tiap hari rajin jawabin milis, giliran kita
berbagi ilmu ke pengunjung booth milissehat

slain itu, mari kita ngeriung bareng di mini stage nya mulai jam 3 sore

junior2 kita bisa main seru seruan di rumah main cikal

oh iya di booth ada flyer panduan sederhana utk demam, batuk, diare lohh...
juga ada tips memperbanyak ASI dan weaning with love

see u all there ya

salam,
@Ade_Novita
KLASI YOP


[Non-text portions of this message have been removed]




[Non-text portions of this message have been removed]



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5.5.

Re: Talkshow Milis Sehat di SocMedFest

Posted by: "Dwiana" dwiana7179@yahoo.com

Thu Sep 22, 2011 4:55 pm (PDT)



Wadoh blm ketemu alasan buat kabur nih..mikir otak nyari alasan biar bs datang. :(

Ana
power by RedBerry�
6a.

Re: Anak 10m22d demam batpil pup sering ampas wrn putih

Posted by: "F.B.Monika" f_monika_b@yahoo.com   f_monika_b

Thu Sep 22, 2011 4:08 pm (PDT)



Dear Mba Meeiin,

Jadi ada 2 hal yg perlu di follow up:

1.Pneumonia
Penegakan diagnosa untuk pneumonia melalui kondisi klinis anak,anamnesa n pemeriksaan melalui stetoskop, dimana untuk pneumonia dominan Ronchi.Pemeriksaan penunjangnya melalui rontgen.
Perlu diingat Pneumonia penyebabnya bisa virus bisa bakteri. Ada sharing anak Dinny kaa n Mba Neta bagaimana menyusun puzzle menentukan penyebabnya virus/bakteri.

2.Pup warna putih
Bagaimana saat ini apa masih putih.
Sekedar info:

From Michael F. Picco, M.D.
White stool at any age is not normal and should be evaluated promptly by a doctor. White stool is caused by a lack of bile, which may indicate a serious underlying problem in the liver, gallbladder or small intestine.

Bile is a digestive fluid produced by the liver and stored in the gallbladder. Stool gets its normal brownish color from bile, which is excreted from the liver into the small intestine during the digestive process. If the liver doesn't produce bile or if bile is obstructed from leaving the liver, stool will be white.
Medical conditions that may cause light-colored or white stool include:
Liver infections, such as hepatitis
Biliary cirrhosis
Gallstones
Anatomic abnormalities of the intestines or bile ducts present at birth (congenital)
Inborn errors of metabolism
Sclerosing cholangitis
Narrowing (strictures) of bile ducts
Cysts
Tumors
A side effect of certain medications, such as some antibiotics, antifungal drugs and antacids.

Lengkapnya yg mudah dibaca ada di mayoclinic.

HTH
F.B.Monika
6b.

Re: Anak 10m22d demam batpil pup sering ampas wrn putih

Posted by: "purnamawati.spak@cbn.net.id" purnamawati.spak@cbn.net.id

Thu Sep 22, 2011 5:04 pm (PDT)



Dear Monik n all
Boleh nimbrung sedikit perihal pup putihnya ya

Kalau tanpa disertai kuning (kolestasis, dimana terbukti ada peningkatan bilirubin direk), maka tinja putih saja TIDAK bisa dikaitkan dg kondisi yg disebutkan di artikel tsb

Wati
Patient Safety, first

6c.

Re: Anak 10m22d demam batpil pup sering ampas wrn putih

Posted by: "F.B.Monika" f_monika_b@yahoo.com   f_monika_b

Thu Sep 22, 2011 5:09 pm (PDT)



Dear Bunda,

Thx, lengkapnya memang harus baca keseluruhan penjelasan (mayoclinic yg saya post tsb).

Thx again
F.B.Monika

7a.

Evidence based radiofrequency for back pain

Posted by: "Laksmi Purwitosari" laksmipurwitosari@yahoo.com   laksmipurwitosari

Thu Sep 22, 2011 4:08 pm (PDT)



http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004058/abstract
Radiofrequency denervation for neck and back pain
Leena Niemisto1,*, Eija A Kalso2, Antti Malmivaara3, Seppo Seitsalo4, Heikki Hurri5
Editorial Group: Cochrane Back Group
Published Online: 17 MAR 2010
Assessed as up-to-date: 27 FEB 2002

Background

The diagnosis of cervical or lumbar zygapophyseal joint pain can only be made by using local anaesthesia to block the nerves supplying the painful joint. There is a lack of effective treatment for chronic zygapophyseal joint pain or discogenic pain. Radiofrequency denervation appears to be an emerging technology, with substantial variation in its use between countries.

Objectives

To assess the effectiveness of radiofrequency denervation for the treatment of musculoskeletal pain disorders.

Search strategy

We searched MEDLINE, PsycLIT, and EMBASE from start to February 2002, plus the Cochrane Library 2002, Issue 2. The references of identified articles were checked and three experts in the field of radiofrequency treatment were consulted to identify studies we might have missed.

Selection criteria

Randomized controlled trials (RCTs) of radiofrequency denervation for musculoskeletal pain disorders, with no language or date restrictions.

Data collection and analysis

Two authors selected RCTs that met predefined inclusion criteria, extracted the data, and assessed the main results and methodological quality of the selected trials, using standardized forms. Qualitative analysis was conducted to evaluate the level of scientific evidence.

Main results

We found only nine articles, reporting on seven relevant RCTs. Six of the seven were considered to be high-quality. The selected trials included 275 randomized patients, 141 of whom received active treatment. One study examined cervical zygapophyseal joint pain, two cervicobrachial pain, three lumbar zygapophyseal joint pain, and one discogenic low-back pain. The study sample sizes were small, follow-up times short, and there were some deficiencies in patient selection, outcome assessments, and statistical analyses. The level of scientific evidence for the short-term effectiveness of radiofrequency denervation was limited for cervical zygapophyseal joint and cervicobrachial pain, and conflicting for lumbar zygapophyseal joint pain. There was limited evidence suggesting that intradiscal radiofrequency thermocoagulation was not effective for discogenic low-back pain.

Authors' conclusions

The selected trials provide limited evidence that radiofrequency denervation offers short-term relief for chronic neck pain of zygapophyseal joint origin and for chronic cervicobrachial pain; conflicting evidence on the short-term effect of radiofrequency lesioning on pain and disability in chronic low-back pain of zygapophyseal joint origin; and limited evidence that intradiscal radiofrequency thermocoagulation is not effective for chronic discogenic low-back pain. There is a need for further high-quality RCTs with larger patient samples and data on long-term effects, for which current evidence is inconclusive. Furthermore, RCTs are needed in non-spinal indications where radiofrequency denervation is currently used without any scientific evidence.

Plain language summary
Radiofrequency denervation for neck and back pain

Radiofrequency denervation can relieve pain from neck joints, but may not relieve pain originating from lumbar discs, and its impact on low-back joint pain is uncertain.

Ongoing neck or back pain can be caused by a joint or damaged disc between two vertebral joints. Injections to block these specific joint nerves can pinpoint if this is the source of the pain. Radiofrequency denervation aims to de-activate the nerve responsible by applying electric current to cauterise it (damage with heat).

The review found that radiofrequency denervation can provide short-term pain relief for a small proportion of people with specific joint problems in the neck. There is conflicting evidence about effects for low-back joint pain, and some evidence that it does not relieve pain from low-back disc problems.

Laksmi Purwitosari

[Non-text portions of this message have been removed]

7b.

Re: Evidence based radiofrequency for back pain

Posted by: "F.B.Monika" f_monika_b@yahoo.com   f_monika_b

Thu Sep 22, 2011 4:35 pm (PDT)



Dear dr Laksmi,

Really thanks a bunch buat semua artikelnya, maaf masi nyicil bacanya dan baru baca yg ini.
Quote sedikit :

"Radiofrequency denervation can relieve pain from neck joints, but may not relieve pain originating from lumbar discs, and its impact on low-back joint pain is uncertain."
There is conflicting evidence about effects for low-back joint pain, and some evidence that it does not relieve pain from low-back disc problems."

Pertanyaan saya:
1.Jadi saat ini trial n penelitian mengenai radiofrequency dengan greater sample size masih dijalankan/belum dijalankan?
2.Maaf takut saya kelewat baca, side effect nya apa ya dari radiofrequency ini (radiasi?)

Thx again

F.B.Monika

7c.

Re: Evidence based radiofrequency for back pain

Posted by: "F.B.Monika" f_monika_b@yahoo.com   f_monika_b

Thu Sep 22, 2011 4:46 pm (PDT)



Oh ya dr tadi lupa menambahkan,

Saya penderita HNP , tahun 2005 operasi L5S1. Ketika hamil anak kedua tahun 2008 menderita HNP lebih parah, pasca melahirkan (SC) hasil MRI menunjukkan 2 tempat bermasalah : L5S1 again) dan L4L5.

Oleh dr syaraf saya tsb saya tidak diperbolehkan hamil lagi karena resti dan dianjurkan tubektomi tapi saya belum mau masih mengumpulkan smua informasinya dulu.
Begitu kira2 info kasus saya dr Laksmi.

Thx again
F.B.Monika

8a.

KELAS PERSIAPAN KELAHIRAN & MENYUSUI BANDUNG 29-30 Oktober 2011

Posted by: "klasibdg@yahoo.com" klasibdg@yahoo.com   klasibdg

Thu Sep 22, 2011 4:13 pm (PDT)



Dear Smart Parents,

Sadarkah kita bahwa ASI, TataLaksana Kehamilan & Kelahiran dan juga Penangananan Bayi Baru Lahir ternyata sangat berkaitan? Alangkah baiknya jika kesadaran itu kita munculkan sekarang, sebelum tugas sebagai orangtua kita jalani.

Yuk, maksimalkan setiap usaha dalam memberikan yang terbaik dan juga benar sesuai tata laksana kepada buah hati kita.

Klub Peduli ASI YOP hadir untuk memfasilitasi orangtua menjalani salah satu perannya dengan menyediakan informasi seputar persiapan kelahiran dan menyusui serta media support group orangtua peduli ASI.

KELAS PERSIAPAN KELAHIRAN & MENYUSUI BANDUNG

Pelaksanaan :Hari : Sabtu , 29 Okt  dan Minggu, 30 Okt 2011
Waktu : Pukul 09:00 – 14:00 WIB
Tempat : CAFE ASIX.
Jl. Telaga Bodas 25 Bandung. Jawa
Barat.
Tel : (022) 731 2460
Materi di dalam Kelas Persiapan Kelahiran & Menyusui ini adalah semua hal yang penting diketahui setiap orangtua/calon orangtua, atau siapapun yang berhubungan erat dengan pengasuhan anak. 

Kelas ini dibagi menjadi 2 Sesi.
Sesi I: ASI dan Seputar Kehamilan (29 Okt 2011)
- Inisiasi Menyusu Dini (IMD)
- Keuntungan ASI
- Posisi Menyusui (latch-on)
- Prinsip dasar
- Persiapan menjelang kelahiran
- Hamil ≠ sakit, suplemen, makanan, mitos-mitos
- Indikasi caesar
- Perawatanbayi baru lahir
- Kegawatdaruratan pada kehamilan 

Sesi II: Masalah-masalah Menyusui dan Pasca Kehamilan (30 Okt 2011)
- Memerah ASI
- ASI Perah dan Penyimpanannya
- Mastitis, Inverted Nipple , Cracked Nipple
- Nursing Strike
- Self Weaning
- Hal-hal penting dalam check-up bayi sampai dengan 6 bulan.
- Kecukupan ASI dari segi nutrisi, terutama ASI perah
- Mengenali dan mencegah gagal tumbuh pada neonatus
- Jaundice
- Cara memantau pertumbuhan dengan kurva pertumbuhan
- Cara memantau perkembangan dan milestones
- Prinsip Rational Use of Medicines (RUM) 

Materi akan disampaikan oleh dokter dan TIM ASI YOP disertai dengan praktek, pemutaran video dan diskusi grup.

Melalui kelas ASI ini diharapkan peserta akan memperoleh pengetahuan yang komprehensif mengenai persiapan kelahiran dan menyusui sekaligus mendapatkan kelompok support yang bisa saling mendukung dan berbagi.

Biaya Rp 130.000,- per orang, atau Rp. 230.000 untuk pasangan. Biaya ini sudah termasuk handout materi, CDmateri, snack dan makan siang. Bagi yang berminat menjadi peserta, silakan mengisi dan mengirimkan formulir pendaftaran di bawah ini kirim ke
klasibdg@yahoo.com dengan Subject: "Kelas Persiapan Kelahiran & Menyusui".

Untuk informasi lebih lanjut dapat hubungi : Monika . Tlp : 081320678893

http://klasibandung.com/kelas-persiapan-kelahiran-dan-menyusui-29-30-oktober-2011

Tempat Terbatas!
Salam SEHAT, Tim KLASI YOP (Bandung) Proudly Supports Breastfeeding

FORMULIR PENDAFTARAN KELAS PERSIAPAN KELAHIRAN &MENYUSUI 29-30 Oktober 2011

Nama Lengkap 1 :_____ (diisi oleh peserta perorangan)

Nama Lengkap 2 :_____ (diisi apabila mengajak pasangan)

Alamat :_____

Telepon/HP :_____

Email aktif :_____ (untuk mengingatkan peserta)

Jumlah anak:_____

Usia anak:_____ bulan/tahun

Due Date (tanggal perkiraan kelahiran): ____ (jika sedang hamil)

Ibu bekerja di luar rumah:_____ (ya/tidak)

Apakah sudah pernah mengetahui ilmu tentang laktasi / menyusui?_____ (ya/tidak)

Jika ya, dari mana sumbernya?_____ (buku/milis/tenaga kesehatan/lainnya …)

Apakah sudah pernah menyusui?_____ (ya/tidak)

Jika ya, apakah berhasil melakukan ASI eksklusif?_____

Permasalahan yang sedang atau pernah dihadapi dalam proses menyusui:_____

Apa yang diharapkan dari kelas Persiapan Kelahiran dan Menyusui yang akan

diikuti?_____

Salam SEHAT,

Tim KLASI YOP (Bandung) Proudly Supports Breastfeeding

http://klasibdg.multiply.com/

klasibdg@yahoo.com

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9.

Re: HOME MADE LOCAL CONTEXT ... Was ...  Mpasi instant

Posted by: "purnamawati.spak@cbn.net.id" purnamawati.spak@cbn.net.id

Thu Sep 22, 2011 4:37 pm (PDT)



Dear Anind n all

Boleh nimbrung ya
Belakangan ini (1.5 tahun terakhir lah - kira2) .... mpasi sering jadi bahan diskusi yang ramai

Isu pertama ,
Kadang tersirat, seolah mempersiapkan mpasi itu ... ribeeet

Isu kedua, jenisnya
Ada yg menganjurkan mpasi instan (sedihnya justru yg banyak menganjurkan ini adalah ... Nakes nya. Baik dsa maupun ahli gizi)
Dalihnya "klasik" ... Yg instan kalorinya diukur jadi lebih "terjamin"
Seolah yang rumahan potensial membuat anak pertumbuhannya terancam tak seideal anak yug makan mpasi instan
Kalau boleh usul ... Please hati2 dan kritis!

WHO sendiri anjurannya adalah: HOME MADE and Local context!!

Tidak ada anjuran diukur-ukur dan ditimbang karena patokan nya adalah
1. Status pertumbuhan anak; BB dan TB nya
2. Status perkembangan anak
3. Status emosipsikologis anak (rasa puas alias satisfied, happy, enjoy, fun dlll)

Jadi, kenapa harus yg instant?
Coba deh ibu bapaknya makan instan rasa pisang misalnya; kan lebih enak pisang aslinya (apalagi kalau pisang ambon raja lumut yg hijau hehehe)

Maaf kalau tak berkenan

Wati

Patient Safety, first
10.

Tanya obat Cacing kremi(pinworm)

Posted by: "Ira Wardhani" ira_azwar@yahoo.com   ira_azwar

Thu Sep 22, 2011 4:48 pm (PDT)



Dear sp's dan dokter2 milis yg baik.mau tanya nich ttg mengobati cacing kremi(pinworm) pada anak.udah baca yg di arsip tp takut salah he he.jd,2 hari ini azwar ngeluh gatal di dubur.sempat aku lht..maaf trs keluar cacing kremi. Utk anak 2 th 7 bulan obat yg aman apa?pyrantel?kalo ga salah ada yg cair ya?terus utk saya yg hamil 14 minggu ga bisa minum obatnya ya?utk anggota keluarga lain apa mesti tes lab dulu atau langsung minum obat yg sama? Makasih.....ira(bunda azwar)

11a.

Mohon doa operasi tumor azwar 3 hari lagi

Posted by: "Ira Wardhani" ira_azwar@yahoo.com   ira_azwar

Thu Sep 22, 2011 5:04 pm (PDT)



Dear all.. Kami sekeluarga mhn doanya utk azwar.insy senin pagi tgl 26 sept akan menjalani operasi tumornya..mudah2an berjalan lancar dan hasilnya tentu kami berharap cukup dg pembedahan saja sudah selesai..hiks tdk bisa membayangkan jk hrs radiasi dsb..oh ya dlm hal ini bgm saya bisa menjadi smart parents ya..mengingat pasti byk obat yg diberikan?RUM atau tdk Rum spt sulit utk belajar dlm situasi begini...cuma bisa bersabar dan berdoa .makasih banyak utk semua...ira(bunda azwar)

11b.

Mohon doa operasi tumor azwar 3 hari lagi

Posted by: "Ira Wardhani" ira_azwar@yahoo.com   ira_azwar

Thu Sep 22, 2011 5:07 pm (PDT)



Dear all.. Kami sekeluarga mhn doanya utk azwar.insy senin pagi tgl 26 sept akan menjalani operasi tumornya..mudah2an berjalan lancar dan hasilnya tentu kami berharap cukup dg pembedahan saja sudah selesai..hiks tdk bisa membayangkan jk hrs radiasi dsb..oh ya dlm hal ini bgm saya bisa menjadi smart parents ya..mengingat pasti byk obat yg diberikan?RUM atau tdk Rum spt sulit utk belajar dlm situasi begini...cuma bisa bersabar dan berdoa .makasih banyak utk semua...ira(bunda azwar)

11c.

Re: Mohon doa operasi tumor azwar 3 hari lagi

Posted by: "khonsaa1771@gmail.com" khonsaa1771@gmail.com

Thu Sep 22, 2011 5:09 pm (PDT)



Dear mba ira..

Semoga operasinya berjalan lancar. Semoga azwar lekas pulih pasca operasi.

Salam
-elona-
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11d.

Mohon doa operasi tumor azwar 3 hari lagi

Posted by: "Ira Wardhani" ira_azwar@yahoo.com   ira_azwar

Thu Sep 22, 2011 5:09 pm (PDT)



Dear all.. Kami sekeluarga mhn doanya utk azwar.insy senin pagi tgl 26 sept akan menjalani operasi tumornya..mudah2an berjalan lancar dan hasilnya tentu kami berharap cukup dg pembedahan saja sudah selesai..hiks tdk bisa membayangkan jk hrs radiasi dsb..oh ya dlm hal ini bgm saya bisa menjadi smart parents ya..mengingat pasti byk obat yg diberikan?RUM atau tdk Rum spt sulit utk belajar dlm situasi begini...cuma bisa bersabar dan berdoa .makasih banyak utk semua...ira(bunda azwar)

11e.

Re: Mohon doa operasi tumor azwar 3 hari lagi

Posted by: "F.B.Monika" f_monika_b@yahoo.com   f_monika_b

Thu Sep 22, 2011 5:09 pm (PDT)



Dear Mba Ira,

Peluk cium untuk Azwar semoga diberi kelancaran dan diberi kesehatan. Amin..
F.B.Monika

11f.

Re: Mohon doa operasi tumor azwar 3 hari lagi

Posted by: "niea_152@yahoo.com" niea_152@yahoo.com   niea_152

Thu Sep 22, 2011 5:10 pm (PDT)



Mb ira,
Cuma bisa kirim doa mudah2an operasi berjalan lancar dan azwar cepet sembuh plus mb ira sekeluarga tetep kuat menjalani seluruh proses.

Hugs
-nia-

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