tag:blogger.com,1999:blog-51194493921015107072024-03-20T05:20:50.908+01:00Terapia del Dolore Interventistica Vertebrale - OzonoterapiaDott Emanuele Sbacchi Anestesia Rianimazione e TdDoloreAnonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.comBlogger75125tag:blogger.com,1999:blog-5119449392101510707.post-47043138238931776532017-05-29T00:11:00.001+02:002018-02-04T13:43:31.920+01:00Ernia del Disco: Trattamento con Ossigeno-Ozono Intradiscale<br />
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">L’ernia del disco lombare classica tende gradualmente con il passare del tempo a risolversi spontaneamente. </span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">Questo con l’aiuto della terapia medica e fisica. Il fenomeno della <u style="background-color: transparent; margin: 0px; padding: 0px;"><strong style="margin: 0px; padding: 0px;">guarigione spontanea</strong></u> è dovuto al fatto che <b>l’ernia</b>, inizialmente <b>imbibita di liquido e quindi di volume più grosso, passando le settimane si riduce perdendo liquido e riassorbendosi.</b> Nello stesso tempo viene in parte <b>disgregata e digerita dai macrofagi.</b> Quando anche, oltre a quanto detto, non si sposti e liberi la radice nervosa dal suo contatto diretto . </span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;"><b>Se la sintomatologia non regredisce e si protrae oltre i 2-3 mesi allora si può iniziare a valutare la soluzione chirurgica.</b></span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">La tecnica chirurgica più corretta è quella <b>mini-invasiva </b>che utilizza il microscopio operatorio. <b>Ciò non vuol dire incisioni piccole</b> bensì manipolazione dell’ernia e delle strutture nervose con estrema precisione e delicatezza potendosi eseguire un emostasi accuratissima. Nella maggior parte dei casi il giorno dopo tale tecnica chirurgica il paziente è in piedi e può anche essere dimesso.</span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">Nonostante ciò la chirurgia è gravata di possibili <b>complicazioni</b> che non possono essere taciute: <b>infezioni, recidive dell’ernia, fibrosi peridurale ipertrofica, maggior induzione di degenerazione discale e instabilità segmentaria. </b></span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">In casi particolarmente sfortunati si può arrivare a quella che viene definita come <b>“failed back surgery syndrome” - FBSS !</b></span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">Un insuccesso globale cui si associano quasi tutte le complicazioni prima elencate con problematiche difficilissime circa il cosa fare dopo soprattutto in presenza di <b>pazienti giovani e in piena attività lavorativa.</b></span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">Per questi motivi sono state ideate <b>nuove tecniche percutanee</b> applicabili in anestesia locale o ambulatoriamente.</span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">Alcune ormai sono abbandonate e tra quelle ancora in uso segnaliamo :</span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">-La nucleotomia meccanica attraverso canule e mezzi motorizzati</span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">-La nucleotomia con laser</span></div>
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-L’Ossigeno-Ozono terapia (O2O3).</div>
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<strong style="color: #333333; font-family: Verdana, Geneva, sans-serif; font-size: 14px; margin: 0px; padding: 0px;"><strong style="margin: 0px; padding: 0px;">Sono tecniche relativamente poco invasive.</strong></strong><br />
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">Hanno una <b>ridotta percentuale di complicazioni.</b> Sono ripetibili. <b>In caso di insuccesso si può sempre ricorrere alla terapia chirurgica.</b></span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">Agiscono tutte <b>riducendo l’entità volumetrica dell’ernia e del disco ma con l’ozonoterapia si può anche associare anche un effetto antiinfiammatorio.</b></span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">L’<u style="background-color: transparent; margin: 0px; padding: 0px;"><strong style="margin: 0px; padding: 0px;">Ozono</strong></u> tende a ridurre il volume dell’ernia per un fenomeno di disidratazione e di fibrosi del disco e riduce la flogosi radicolare, uno dei fattori principali del quadro clinico legato al <u style="background-color: transparent; margin: 0px; padding: 0px;"><strong style="margin: 0px; padding: 0px;">conflitto disco-radicolare</strong></u>. Questo dipende da fattori meccanici e infiammatori (immuno-mediati e secondari a fattori bioumorali ).</span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;"><b>L’Ozono iniettato provoca disidratazione e fibrosi del nucleo polposo e tessuto erniario con conseguente diminuzione del conflitto con il nervo.</b></span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">Inoltre indurrebbe un aumento di cessione di ossigeno da parte dei globuli rossi, riduce l’ipossia dei tessuti e stasi linfatica e venosa. Migliora in tal senso la circolazione ematica locale con rimozione di sostanze tossiche.</span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;"><b>L’Ozono avrebbe altre qualità:</b> inibisce il rilascio di proteinasi da parte dei macrofagi e dei neutrofili polimorfonucleati e aumenta la liberazione di citochine immunosoppressive. Inibisce la sintesi delle prostaglandine e la liberazione delle bradichinine, neutralizza i ROS endogeni e stimola la produzione locale di enzimi antiossidanti.</span><br />
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">L’infiltrazione attiverebbe per via riflessa il sistema antinocicettivo mediante la liberazione di peptidi oppiodi, di endorfine e di cortisolo.</span><span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;"> </span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">( da : Bertini G. e coll. : L’ernia del disco lombare: il trattamento con ozono e con le altre tecniche percutanee. Lo Scalpello, 26, 112-117, 2012 ).</span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;"><b>Le principali casistiche riportano risultati molto buoni che si aggirano su percentuali dell’80% .</b> </span></div>
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<span style="background-color: white; color: #333333; font-family: "verdana" , "geneva" , sans-serif; font-size: 14px;">Noi riteniamo quindi che sia una tecnica applicabile quasi in tutte le ernia discali lombari resistenti ai primi trattamenti. Se la sintomatologia non recede dopo 20/30 giorni allora prima di passare alla fase chirurgica preferiamo proporre questa soluzione percutanea e ambulatoriale. </span></div>
Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-75989090762612120842017-01-15T23:07:00.001+01:002017-09-26T17:42:13.421+02:00ho mal di schiena aspetto? eseguo degli esami? quali?<div class="separator" style="clear: both; text-align: center;">
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<span style="color: blue; font-size: x-large;"><b><i>ho mal di schiena </i></b></span></div>
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<span style="color: blue; font-size: x-large;"><b><i>aspetto? eseguo degli esami? quali?</i></b></span></div>
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<span style="font-size: large;"><span style="-webkit-text-stroke: rgb(0, 0, 0);">quando insorge il mal di schiena con eventuale dolore agli arti, a seconda della gravita e dell’intensità, </span><b style="-webkit-text-stroke: rgb(0, 0, 0);"><i>per il paziente può iniziare un periodo molto complesso durante il quale saranno diverse le domande e poche le certezze.</i></b></span></div>
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<span class="s1"><span style="font-size: large;">aspetto? eseguo degli esami? mi rivolgo ad uno specialista? quale? inizio delle terapie? quali?</span></span></div>
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<span class="s1"><span style="font-size: large;">cerchiamo di fare un po' di chiarezza riguardo gli esami diagnostici</span></span></div>
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<span class="s1"><span style="font-size: large;">La storia naturale indica che le <b><i>ernie del disco lombari si riassorbono spesso</i></b>, del tutto o in parte e che <b><i>la sintomatologia ad esse associata regredisce di frequente con i trattamenti conservativi</i></b>.</span></span></div>
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<span class="s1"><span style="font-size: large;">Inoltre ernie del disco lombare <b><i>vengono riscontrate dalla diagnostica per immagini con frequenza elevata anche in persone del tutto asintomatiche</i></b>. </span></span><br />
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<a href="http://emanuelesbacchi.blogspot.it/2016/12/dove-ricevo-terapia-del-dolore.html" target="_blank"><span style="font-size: x-large;">DOVE</span></a></div>
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<span class="s1"><span style="font-size: large;"><b><i>L’ernia discale è dunque un fenomeno dinamico</i></b>, nonché una condizione relativamente comune e a prognosi favorevole nella maggior parte dei casi<b><i>.</i></b></span></span></div>
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<span class="s1"><b><i><span style="font-size: large;">La clinica e le indagini diagnostiche strumentali sono molto importanti per stabilire il percorso terapeutico</span></i></b></span></div>
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<span class="s1"><span style="font-size: large;">Spesso infatti <b><i>TC e/o RM diagnosticano le immagini di più ernie, di cui una sola è responsabile della sintomatologia</i></b> e non di rado radiologicamente meno evidente di altre che sono invece asintomatiche.</span></span></div>
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<a href="https://1.bp.blogspot.com/-ZA2FpMwA684/WFxbQFmLKaI/AAAAAAAAGHg/b569NPbpKGUWlT-dfAPA6q2SuYWpgmV1wCPcB/s1600/farruggia.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="177" src="https://1.bp.blogspot.com/-ZA2FpMwA684/WFxbQFmLKaI/AAAAAAAAGHg/b569NPbpKGUWlT-dfAPA6q2SuYWpgmV1wCPcB/s400/farruggia.png" width="400" /></a></div>
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<span class="s1"><b><i><span style="font-size: large;">Non è infrequente riscontrare una voluminosa ernia del disco, mentre il paziente riferisce una sintomatologia controlaterale a quella delle immagini radiologiche.</span></i></b></span></div>
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<span class="s1"><span style="font-size: large;">Analogamente, una piccola ernia discale ad un determinato livello topografico (es. L5-S1) può essere responsabile di una lombosciatalgia attribuita per errore ad un’ernia più voluminosa (ma silente) ad un livello differente (es. L3-L4).</span></span></div>
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<span class="s1"><span style="font-size: large;">Da quanto detto, emerge che <b><i>non vi è rapporto tra volume dell’ernia ed entità della sintomatologia.</i></b></span></span></div>
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<span class="s1"><span style="font-size: large;">Pertanto, anche<b><i> le ernie molto voluminose non devono essere operate se la sintomatologia è in regressione e non sono presenti deficit neurologici.</i></b></span></span></div>
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<span class="s1"><span style="font-size: large;">Il medico deve accuratamente raccogliere <b><i>l’anamnesi ed effettuare l’esame obiettivo nel paziente con dolore lombare semplice o irradiato</i></b>. Vanno in particolare ricercati quei sintomi (sciatica e dolore irradiato sotto il ginocchio) dotati di buona accuratezza diagnostica nei confronti dell’ernia del disco lombare. <b><i>Devono soprattutto essere ricercati sintomi e segni indicanti i c.d. semafori rossi, suggestivi di malattie sistemiche, infiammatorie, neoplastiche o infettive e della sindrome della cauda equina.</i></b></span></span></div>
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<span class="s1"><span style="font-size: large;">Considerando l’<b><i>alta frequenza di ernie discali asintomatiche</i></b> e la possibile <b><i>regressione di ernie sintomatiche</i></b>, è opportuno <b><i>attendere almeno 4-6 settimane dall’insorgenza dei sintomi</i></b> (dolore lombare, radicolopatia e limitazione funzionale)<b><i> in assenza di semafori rossi, prima di effettuare gli esami di diagnostica per immagini.</i></b> </span></span></div>
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<span class="s1"><span style="font-size: large;">TC o RM sono invece da effettuare con urgenza in caso di sospetta malattia sistemica, neoplastica o infettiva, e di sospetta sindrome della cauda equina.</span></span></div>
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<span class="s1"><span style="font-size: large;">Benché <b><i>TC e RM, se di ultima generazione, si equivalgano per potenzialità diagnostica </i></b>dell’ernia del disco lombare, la <i><b>RM è preferibile per la mancanza </b></i><i><b>di esposizione alle radiazioni ionizzanti</b></i> (temibili in particolare per le donne in età fertile), per la possibilità di diagnosi di lesioni intradurali e per la superiore <b><i>panoramicità.</i></b></span></span></div>
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<span class="s1"><span style="font-size: large;"><b><i>La radiografia della colonna non è indicata come esame di routine in pazienti con dolore radicolare, salvo che in caso di sospetta frattura o crollo vertebrale.</i></b></span></span></div>
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<span class="s1"><span style="font-size: large;">La radiografia della colonna e del bacino, ed eventualmente la RM, sono indicate nei pazienti con lombalgia e/o lombosciatalgia “tronca” (irradiazione fino al ginocchio) da sospetta spondilite anchilosante.</span></span></div>
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<span class="s1"><span style="font-size: large;">Non vi è sufficiente evidenza per raccomandare l’effettuazione di routine dei<b><i> test elettrofisiologici, </i></b></span></span><span style="-webkit-text-stroke-width: initial; font-size: large;">incluso </span><b style="-webkit-text-stroke-width: initial;"><i><span style="font-size: large;">elettromiografia</span></i></b><span style="-webkit-text-stroke-width: initial; font-size: large;"> , potenziali evocati, se non in casi selezionati dallo specialista.</span></div>
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<span class="s1"><span style="font-size: large;">La <b><i>TC e la RM con mezzo di contrasto non sono indicate di routine</i></b> per la diagnosi di ernia del disco lombare, ad <b><i>eccezione dei pazienti già sottoposti a chirurgia del rachide o con sospetto di sindrome della cauda equina o di patologia intradurale.</i></b></span></span></div>
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<span class="s1"><span style="font-size: large;">I medici responsabili della gestione clinica del paziente che si sottopone a diagnostica per immagini per mal di schiena devono <b><i>correlare le informazioni contenute nei referti della diagnostica per immagini con la situazione clinica</i></b>, spiegando che il riscontro radiologico di<b><i> protrusioni discali asintomatiche è frequente.</i></b></span></span></div>
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<span style="font-size: large;"><a href="http://emanuelesbacchi.blogspot.it/2016/12/dove-ricevo-terapia-del-dolore.html" target="_blank">DOVE RICEVO E INFO</a></span><br />
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<a href="https://4.bp.blogspot.com/-0uYqIRSBZe8/WF5hn77LauI/AAAAAAAAGIU/T3px-vmdQlQvLaOfeL0ZqQuNkljaZP9rACPcB/s1600/emanuele%2Bsbacchi%2Bfoto%2Bblog%2Bsito%2Bcopia.jpg.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="223" src="https://4.bp.blogspot.com/-0uYqIRSBZe8/WF5hn77LauI/AAAAAAAAGIU/T3px-vmdQlQvLaOfeL0ZqQuNkljaZP9rACPcB/s400/emanuele%2Bsbacchi%2Bfoto%2Bblog%2Bsito%2Bcopia.jpg.jpg" width="400" /></a></div>
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<span style="font-size: large;"><span class="s1">fonti: </span><span class="s2"><a href="http://www.snlg-iss.it/cms/files/LG_ernia_disco.pdf" target="_blank">appropriatezza della diagnosi e del trattamento chirurgico dell’ernia del disco lombare sintomatica”</a></span></span></div>
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<span class="s1"><span style="font-size: large;"><a href="https://www.progettoasco.it/riviste/rivista_simg/2005/05-06_2005/9.pdf">https://www.progettoasco.it/riviste/rivista_simg/2005/05-06_2005/9.pdf</a></span></span></div>
Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-11876439355792317342017-01-08T00:10:00.001+01:002017-01-08T20:42:35.760+01:00Paziente operato laminectomia: Trattamento di recidiva - Gela (Calatanissetta) Peridurolisi e Radiofrequenza Midollare<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-fMzVeoKdhC8/VtNv5bCYHsI/AAAAAAAAE_k/dAVDno4_PdgzaMIkfp-jNIjlymvlvlVwgCPcB/s1600/logo%2Bsbacchi.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://1.bp.blogspot.com/-fMzVeoKdhC8/VtNv5bCYHsI/AAAAAAAAE_k/dAVDno4_PdgzaMIkfp-jNIjlymvlvlVwgCPcB/s1600/logo%2Bsbacchi.png" /></a></div>
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<a href="https://4.bp.blogspot.com/-0uYqIRSBZe8/WF5hn77LauI/AAAAAAAAGIU/T3px-vmdQlQvLaOfeL0ZqQuNkljaZP9rACPcB/s1600/emanuele%2Bsbacchi%2Bfoto%2Bblog%2Bsito%2Bcopia.jpg.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="epidurolisi/periduolisi con trattamento radiofrequenza midollare L5 e S1 lombare rx guidata" border="0" height="179" src="https://4.bp.blogspot.com/-0uYqIRSBZe8/WF5hn77LauI/AAAAAAAAGIU/T3px-vmdQlQvLaOfeL0ZqQuNkljaZP9rACPcB/s320/emanuele%2Bsbacchi%2Bfoto%2Bblog%2Bsito%2Bcopia.jpg.jpg" title="terapia del dolore ozonoterapia palermo trapani gela san giovanni gemini" width="320" /></a></div>
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<span style="color: blue; font-size: x-large;"><i><b>un caso interessante</b></i></span></div>
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<b><i><span style="color: blue; font-family: "times" , "times new roman" , serif; font-size: x-large;"><a href="http://emanuelesbacchi.blogspot.it/2016/12/dove-ricevo-terapia-del-dolore.html" style="background-color: cyan;" target="_blank">Terapia del Dolore - Santa Barbara Hospital Gela</a></span></i></b></div>
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<b><i><span style="font-family: "times" , "times new roman" , serif; font-size: large;">visita 12 ottobre 2016</span></i></b></div>
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<b><i><span style="font-family: "times" , "times new roman" , serif; font-size: large;">uomo, aa 55, dolore lombosciatalgico destro"lancinante" (l'ha definito cosi)</span></i></b></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">alla visita: </span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">- Lasegue positivo a 20 gradi a destra</span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">- Wasserman positivo a destra</span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">- Riflessi osteotendinei ridotti ma presenti a destra (rotuleo, medioplantare, achilleo)</span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">- Forza: NESSUN DEFICIT DI FORZA (QUADRICIPITE, SPE E SPI)</span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">- Sensibilità: ridotta sensibilità al freddo, normale allo sfioramento e alla puntura di spillo</span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;"><b>Conclusioni:</b> anamnesi, sintomatologia, segni e sintomi coincidenti con quanto riscontrato alla risonanza magnetica del 23 settembre 2016 ovvero ernia di dimensioni 1,87 cm x 1,42 cm x 1,14 cm che non sembra oltrepassare il legamento longitudinale posteriore</span></div>
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<a href="https://3.bp.blogspot.com/-Lywd9GLyCdA/WHFq_kRs2bI/AAAAAAAAGSE/2vs7Jf44XXwDI11GNSy581Vou3hF08aOACLcB/s1600/farruggia.png.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black; font-family: "times" , "times new roman" , serif; font-size: large;"><img border="0" height="179" src="https://3.bp.blogspot.com/-Lywd9GLyCdA/WHFq_kRs2bI/AAAAAAAAGSE/2vs7Jf44XXwDI11GNSy581Vou3hF08aOACLcB/s320/farruggia.png.jpg" width="320" /></span></a></div>
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<a href="https://3.bp.blogspot.com/-75nNIfhUxHA/WHFq_GzeNGI/AAAAAAAAGSA/W2IszhMsDlEPiJ4pLlELJuLy6rPOZeDIwCEw/s1600/farruggia%2B2.png.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black; font-family: "times" , "times new roman" , serif; font-size: large;"><img alt="epidurolisi/periduolisi con trattamento radiofrequenza midollare L5 e S1 lombare rx guidata" border="0" height="180" src="https://3.bp.blogspot.com/-75nNIfhUxHA/WHFq_GzeNGI/AAAAAAAAGSA/W2IszhMsDlEPiJ4pLlELJuLy6rPOZeDIwCEw/s320/farruggia%2B2.png.jpg" title="terapia del dolore ozonoterapia palermo trapani gela san giovanni gemini" width="320" /></span></a></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">Date le dimensioni e la sintomatologia, pur non essendo indicato un intervento chirurgico urgente o in elezione in quanto non presente alcun segno/sintomo importante di compressione e sofferenza nervosa (<b><i>la dimensione dell'ernia non è mai menzionata fra i fattori che indicano l'esecuzione di un intervento chirurgico</i></b>) si propongono al paziente dei trattamenti infiltrativi eco-guidati e poi, se non dovessero esitare in un beneficio, rx guidati; <b><i>tuttavia si segnala al paziente che potrebbe essere un percorso inutile e che potrebbe dovere prendere in considerazione un intervento chirurgico</i></b></span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">il paziente rifiuta in quanto <b><i>già operato 11 mesi prima </i></b>di ernia del disco (come si evince dalle precedenti immagini rmn)</span></div>
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<b><span style="font-family: "times" , "times new roman" , serif; font-size: large;">rmn 01 ottobre 2015</span></b></div>
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<a href="https://2.bp.blogspot.com/-UgVRlvuYytM/WHFwjXKkOFI/AAAAAAAAGSw/NUDF_uIXDxwjkH5DoABLpzdPeAT1SyHVwCLcB/s1600/farruggia%2B3.png.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black; font-family: "times" , "times new roman" , serif; font-size: large;"><img alt="epidurolisi/periduolisi con trattamento radiofrequenza midollare L5 e S1 lombare rx guidata" border="0" height="180" src="https://2.bp.blogspot.com/-UgVRlvuYytM/WHFwjXKkOFI/AAAAAAAAGSw/NUDF_uIXDxwjkH5DoABLpzdPeAT1SyHVwCLcB/s320/farruggia%2B3.png.jpg" title="terapia del dolore ozonoterapia palermo trapani gela san giovanni gemini" width="320" /></span></a></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">si effettuano n. 2 infiltrazioni eco-guidate con modesto/scarso beneficio, comunque non soddisfacente</span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">si effettua quindi <i><b>epidurolisi/periduolisi con trattamento radiofrequenza midollare L5 e S1 lombare rx guidata</b></i> in regime di ricovero con completa <i><b>risoluzione della sintomatologia</b></i> (con stupore del paziente e dell'operatore)</span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">si sospendono i trattamenti e si invita il paziente a contattare il medico se dovessero comparire sintomi come dolore e, piu importante, deficit neurologici (anche in assenza di dolore)</span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;"><b><i>conclusioni: </i></b></span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">indagando sulla comparsa dei primi sintomi il paziente riferisce che prima della laminectomia (intervento precedente) erano presenti importanti deficit della dorsiflessione del piede di conseguenza è stato <b><i>corretto eseguire l'intervento chirurgico</i></b></span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">in questa sede non si vuole, ancora una volta, contestare l'indicazione chirurgica<b><i> ribadendo che la terapia del dolore non si pone in antitesi o conflitto con la neurochirurgia</i></b></span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;"><b><i>sono differenti le indicazioni: </i></b></span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">- se presenti deficit neurologici importanti o severi o ingravescenti il paziente va operato chirurgicamente (non contano le dimensioni dell'ernia)</span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">- se presenti dolore e/o modesti deficit neurologici non va posta indicazione chirurgica e il paziente deve essere invitato ad attendere ed eventualmente tentare di risolvere con trattamenti conservativi e monitorando il decorso, si potrà valutare l'opzione chirurgica dopo insuccesso di questo percorso</span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;"><br /></span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;">inoltre, <b><i>un disco ormai lesionato può in qualunque momento espellere materiale intradiscale determinando ricomparsa della sintomatologia, il giorno dopo, anni dopo o tecnicamente mai</i></b></span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: large;"><b><i>Questo vale per i pazienti operati chirurgicamente, trattati con tecniche conservative o non sottoposti ad alcun trattamento</i></b></span></div>
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<b><i><span style="font-family: "times" , "times new roman" , serif; font-size: large;"><a href="http://emanuelesbacchi.blogspot.it/2016/12/dove-ricevo-terapia-del-dolore.html" target="_blank">Terapia del Dolore - Palermo - Trapani - Gela - San Giovanni Gemini</a></span></i></b></div>
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Sciatalgia arto inferiore destro</div>
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trattamento infiltrativo rx guidato L4 L5 DX con mezzo di contrasto</div>
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ernia espulsa L4 L5 in paziente già operato un anno prima</div>
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<br />Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-9561866107924629752016-10-27T22:58:00.001+02:002016-10-27T23:09:57.482+02:00CORSO: OSSIGENO-OZONO TERAPIA NELLE PATOLOGIE DELL'APPARATO LOCOMOTORE<div style="text-align: center;">
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INTENSIVE WORKSHOP TRAPANI</div>
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Intervento: ozono transforaminale rx guidato e periforaminale ecoguidato (tecnica lamino-foraminale)</div>
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Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-29109586835549347092016-09-18T01:28:00.001+02:002016-09-22T16:28:56.033+02:00TESTIMONIANZA TRATTAMENTO LASER ERNIE C5 C6 - C6 C7 IN CONVENZIONE SSN - PALERMO - TRAPANI - GELA<div style="font-family: Calibri; font-size: 11.0pt; margin: 0in;">
Donna, aa 35 </div>
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Da circa 3 anni
<b>cervicobrachialgia severa bilaterale</b> (maggiore sinistra)</div>
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sintomatologia insorta dopo incidente autostradale</div>
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<b>Protrusioni/ernie</b> C5 C6 - C6 C7</div>
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trattamento: Discecomia <b>Laser</b> Percutanea Rx Guidata</div>
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terapia eseguibile in regime di <b>convenzione con il SSN</b> presso</div>
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- Casa di Cura Villa dei Gerani <b>Trapani</b></div>
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- Casa di Cura Santa Barbara Hospital <b>Gela</b><br />
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<b>(prima visita ambulatoriale a pagamento)</b></div>
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Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-27368906537298588632016-07-27T23:17:00.000+02:002016-11-25T22:02:37.844+01:00Recensioni Terapia del Dolore Vertebrale Ozonoterapia: Palermo - Gela - Trapani - San Giovanni Gemini<br />
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<span style="font-family: "times" , "times new roman" , serif;">______________ 16 11 2016 _____________</span><br />
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Donna, aa , lombalgia severa da un anno</div>
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A letto meglio ma
dolore quando si muove</div>
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<span style="font-size: 11pt;">No dolore alle
gambe, solo stanchezza e affaticamento</span></div>
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<span style="font-size: 11pt;">risonanza quasi negativa</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 10 11 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Donna, aa 34, </span><span style="font-family: "calibri"; font-size: 11pt;">lombosciatalgia
destra severa</span></div>
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<span style="font-family: "calibri"; font-size: 11pt;">Ernia L5 S1</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 07 10 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Uomo, aa 43, Lombalgia cruralgia meralgia sinistra </span></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 06 10 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Uomo, aa 37, </span><span style="font-family: "times" , "times new roman" , serif;">Dal 2013 Dolore
lombare con sciatalgia sinistra, sente "tirare il nervo" lungo la faccia </span><span style="font-family: "times" , "times new roman" , serif;">laterale
della coscia</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 28 09 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Donna, aa 34, Lombosciatalgia
sinistra severa da alcuni anni che si irradia alla pianta del piede</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">il dolore peggiora con impossibilità a mantenere posizione supina a letto la notte</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 27 09 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Uomo, aa 40, dolore severo sciatalgico gamba destra da 2 mesi dopo uno sforzo importante </span></div>
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<b>Ernia L4 - L5 Espulsa 1,07 x 2,07</b></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 25 09 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Lombalgia con
irradiazione arto inferiore sinistro fino alla caviglia</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">A letto dolore</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Ha preso cortisone
ed effettuato ozono paravertebrale senza grandi risultati</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Neurochirurgo consiglia intervento di stabilizzazione </span></div>
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<a href="https://3.bp.blogspot.com/-M8ibtahR-KU/V-mD76X1E3I/AAAAAAAAF2I/WBmUFvU5RrUdcoI-HZwrE1qygQuIBpmIwCLcB/s1600/Screenshot%2B2016-09-26%2B22.22.35.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "times" , "times new roman" , serif;"><img border="0" height="142" src="https://3.bp.blogspot.com/-M8ibtahR-KU/V-mD76X1E3I/AAAAAAAAF2I/WBmUFvU5RrUdcoI-HZwrE1qygQuIBpmIwCLcB/s320/Screenshot%2B2016-09-26%2B22.22.35.png" width="320" /></span></a></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 25 09 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Da circa 5 aa
addietro dolore lombare; <span style="font-size: 11pt;">sempre presente, a
letto meno</span></span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: 11pt;"><br /></span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: 11pt;">sente le gambe pesanti</span></div>
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<span style="font-family: "times" , "times new roman" , serif;"><a href="https://3.bp.blogspot.com/-i8lIOdlloIY/V-mC9Sb2nHI/AAAAAAAAF2A/SpnXHCJ29B4TwYhfw-BzDQp79yC_cpz_wCLcB/s1600/Screenshot%2B2016-09-26%2B22.17.34.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="142" src="https://3.bp.blogspot.com/-i8lIOdlloIY/V-mC9Sb2nHI/AAAAAAAAF2A/SpnXHCJ29B4TwYhfw-BzDQp79yC_cpz_wCLcB/s320/Screenshot%2B2016-09-26%2B22.17.34.png" width="320" /></a> </span></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 25 09 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Uomo, aa 52,Dolore al collo e cefalea occipitale dopo trauma (colpo di frusta circa 13 aa addietro</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Dolore alle spalle</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Parestesie ad
entrambe le mani</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 19 09 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Donna, aa 33, Sciatalgia severa a destra fino alla caviglia</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">A letto meglio ma
non sempre</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Da circa 1 mese dolore lancinante,
precedente episodio a marzo</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 19 09 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Uomo, anni 27, calciatore professionista</span></div>
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<span style="font-family: "times" , "times new roman" , serif;"> Siatalgia severa <span style="font-size: 11pt;">con parestesie al </span><span style="font-size: 14.6667px;">piede</span><span style="font-size: 14.6667px;"> </span><span style="font-size: 11pt;"> e dolore severo </span></span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: 11pt;">Ernia espulsa L4 L5 e
ernia severa L5S1</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Prima seduta 24 Agosto 2016, il 18 Settembre ha giocato in campionato la prima partita (95 min)</span></div>
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<a href="https://4.bp.blogspot.com/-Lpuhayzkxik/V-LyjQsj07I/AAAAAAAAF0Y/YLPsey6v4XIhfYV85ISqQNGYKV-_Xt0GgCLcB/s1600/Screenshot%2B2016-09-21%2B22.48.38.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "times" , "times new roman" , serif;"><img border="0" height="135" src="https://4.bp.blogspot.com/-Lpuhayzkxik/V-LyjQsj07I/AAAAAAAAF0Y/YLPsey6v4XIhfYV85ISqQNGYKV-_Xt0GgCLcB/s320/Screenshot%2B2016-09-21%2B22.48.38.png" width="320" /></span></a></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 18 09 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Donna, da circa 5 anni
lombosciatalgia severa e sciatalgia destra anche a riposo</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">black disc bulging
L4 L5 - L5 S1</span></div>
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<a href="https://2.bp.blogspot.com/--LIloAr7MnI/V-LxkU_WIAI/AAAAAAAAF0I/vn5g2k4YuPYjpeKUg_SwXko4_4z6roAyACLcB/s1600/Screenshot%2B2016-09-18%2B13.27.07.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "times" , "times new roman" , serif;"><img border="0" height="143" src="https://2.bp.blogspot.com/--LIloAr7MnI/V-LxkU_WIAI/AAAAAAAAF0I/vn5g2k4YuPYjpeKUg_SwXko4_4z6roAyACLcB/s320/Screenshot%2B2016-09-18%2B13.27.07.png" width="320" /></span></a></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 16 09 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Lombalgia severa, scosse inguine sinistro, sente "tirare" le
dita dei piedi</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Nel 2013 ernia L5 S1
mediana sinistra</span></div>
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<a href="https://4.bp.blogspot.com/-IYmphrQSnbs/V-LxMEho4QI/AAAAAAAAF0A/VeA9i40GGaYm4wSvfVv5BM0F2XhZ0teaQCLcB/s1600/torres%2Bloredana.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "times" , "times new roman" , serif;"><img border="0" height="256" src="https://4.bp.blogspot.com/-IYmphrQSnbs/V-LxMEho4QI/AAAAAAAAF0A/VeA9i40GGaYm4wSvfVv5BM0F2XhZ0teaQCLcB/s320/torres%2Bloredana.png" width="320" /></span></a></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 16 09 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Donna, aa 38, meralgia destra e
sciatalgia bilaterale</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">parestesie piede sinistro</span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: 11pt;">Dolore anche la notte a riposo</span></div>
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<span style="font-family: "times" , "times new roman" , serif; font-size: 11pt;">Ernia L5 S1 - Radicolopatia lombare</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">______________ 16 09 2016 _____________</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Donna, aa 41, lombalgia severa da 18 anni !!!</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Ernia discale lombare L5 S1</span></div>
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______________ 10 09 2016 _____________</div>
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Donna, aa 53, Cervicobrachialgia severa bilaterale (maggiore a destra) con parestesia alla mani; </div>
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dolore anche a riposo</div>
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Ernia discali cervicali multiple</div>
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<a href="https://1.bp.blogspot.com/-YNragumW6-M/V9sQYXrSoOI/AAAAAAAAFu0/y9oYTaO41FAaJlD2sPHFnhYRzaTrKAO9gCLcB/s1600/urzi.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="110" src="https://1.bp.blogspot.com/-YNragumW6-M/V9sQYXrSoOI/AAAAAAAAFu0/y9oYTaO41FAaJlD2sPHFnhYRzaTrKAO9gCLcB/s320/urzi.png" width="320" /></a></div>
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______________ 10 09 2016 _____________</div>
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Donna, aa 48, lombosciatalgia severa destra, parestesie; </div>
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dolore anche a riposo</div>
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Ernia L3 L4 - L4 L5</div>
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<a href="https://1.bp.blogspot.com/-rs-3vX83pLw/V9XIHwxtifI/AAAAAAAAFuQ/cIauXJ_dovo1MQuMbkW5ubly1hkG7Fn4QCLcB/s1600/nocera.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://1.bp.blogspot.com/-rs-3vX83pLw/V9XIHwxtifI/AAAAAAAAFuQ/cIauXJ_dovo1MQuMbkW5ubly1hkG7Fn4QCLcB/s320/nocera.png" width="256" /></a></div>
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______________ 06 09 2016 _____________</div>
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Uomo, aa 34, lombosciatalgia severa, parestesie; dolore anche a riposo</div>
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Ernia L5 S1</div>
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<a href="https://3.bp.blogspot.com/-5gkTVXecTXE/V9GZpiBx_MI/AAAAAAAAFto/so4055anT4ktjkPQZsPJ3vYOcy7wpenZACLcB/s1600/Cilluffo%2Bcopia.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="170" src="https://3.bp.blogspot.com/-5gkTVXecTXE/V9GZpiBx_MI/AAAAAAAAFto/so4055anT4ktjkPQZsPJ3vYOcy7wpenZACLcB/s320/Cilluffo%2Bcopia.png" width="320" /></a></div>
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______________ 06 09 2016 _____________</div>
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Uomo, aa 46, lombalgia severa e sensazione di fatica alle gambe, dolore anche a riposo</div>
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black disc ernia L4 L5 - L5 S1</div>
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______________ 05 09 2016 _____________</div>
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Uomo, aa 31, lombalgia severa ernia L4 L5 - L5 S1</div>
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______________ 29 08 2016 _____________</div>
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Donna, aa 36, lombosciatalgia severa ernia L4 L5 sinistra</div>
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______________ 29 08 2016 _____________</div>
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Donna, aa 43, lombosciatalgia sinistra severa</div>
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______________ 01 08 2016 _____________</div>
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______________ 26 07 2016 _____________</div>
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______________ 04 11 2016 _____________</div>
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______________ 01 11 2016 _____________</div>
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______________ 13 11 2016 _____________</div>
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______________ 05 11 2016 _____________</div>
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______________ 30 10 2016 _____________</div>
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______________ 13 11 2016 _____________</div>
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<span style="font-family: "times";">______________ 29 10 2016 </span><span style="font-family: "times";">_____________</span></div>
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<span style="font-family: "times";">______________ 09 07 2016 </span><span style="font-family: "times";">_____________</span></div>
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<span style="font-family: "times";">______________ 14 02 2016 </span><span style="font-family: "times";">_____________</span></div>
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<span style="font-family: "times";">______________ 04 03 2016 </span><span style="font-family: "times";">_____________</span></div>
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<span style="font-family: "times";">______________ 22 06 2016 </span><span style="font-family: "times";">_____________</span></div>
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<span style="font-family: "times";">______________ 28 05 2016 </span><span style="font-family: "times";">_____________</span></div>
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<span style="font-family: "times";">______________ 23 12 2015 </span><span style="font-family: "times";">_____________</span></div>
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<span style="font-family: "times";">______________ 29 04 2015 </span><span style="font-family: "times";">_____________</span></div>
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<span style="font-family: "times";">______________ 26 10 2016 </span><span style="font-family: "times";">_____________</span></div>
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<span style="font-family: "times";">______________ 16 02 2016 </span><span style="font-family: "times";">_____________</span></div>
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<span style="font-family: "times";">______________ 13 11 2016 </span><span style="font-family: "times";">_____________</span></div>
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<span style="font-family: "times";">______________ 1111 2016 </span><span style="font-family: "times";">_____________</span></div>
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<span style="font-family: "times";">______________ 26 09 2016 </span><span style="font-family: "times";">_____________</span></div>
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Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-13807278586783438302016-07-25T15:07:00.001+02:002016-09-18T17:48:14.117+02:00breve storia triste ;)<div class="separator" style="clear: both; text-align: center;">
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</span>Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-53240583675790739482016-05-28T22:45:00.001+02:002016-09-21T22:15:13.998+02:00Seduta "terapia del dolore - trattamenti percutanei rx guidati"<div style="background-color: white; color: #1d2129; letter-spacing: -0.24px; line-height: 19.32px; margin-bottom: 6px;">
Seduta "terapia del dolore - trattamenti percutanei rx guidati"</div>
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PALERMO/TRAPANI/GELA</div>
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- ernia del disco L5 S1 - discecotmia percutanea laser</div>
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- frattura vertebrale 3 livelli - vertebroplastica</div>
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ecc.....</div>
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Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-63044293733595777442016-03-10T23:55:00.002+01:002016-09-18T12:59:36.008+02:00ERNIA CERVICALE: UN ANNO DOPO DISCECTOMIA LASER PERCUTANEA - CASO CLINICO<div class="separator" style="clear: both; text-align: center;">
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<div class="p1" style="text-align: center;">
<span class="s1"><b><br /></b></span></div>
<div class="p1" style="text-align: center;">
<b>ERNIA CERVICALE: UN ANNO DOPO !!!</b></div>
<br />
<div class="p1" style="text-align: center;">
<span class="s1"><b>CASO CLINICO</b></span><br />
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<span style="font-size: large;"><br /></span><div class="p1">
<span class="s1"><br /></span>
<span class="s1">Anni 35, donna</span></div>
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<span class="s1"></span><br /></div>
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<span class="s1"><b>Sintomi: </b>dolore cervicale e brachialgia severa da circa un anno, parestesie ad entrambe le mani, sensazione di scosse, crampi, impossibilità a svolgere attività lavorativa </span></div>
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<span class="s1"><b></b></span><br /></div>
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<span class="s1"><b>Diagnosi: </b>Ernia del disco intervertebrale C5 C6</span></div>
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</span></div>
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<span class="s1"><b>Risonanza Magnetica Nucleare 19 Marzo 2015</b></span></div>
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<span class="s1"><b>Percorso Terapeutico:</b></span></div>
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<li class="li1" style="text-align: justify;"><span class="s2"></span><span class="s1"><b>n. 3 infiltrazioni Peridurali Cervicali RX Guidate ogni 20/30gg</b></span></li>
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<li class="li1" style="text-align: justify;"><b>Discectomia Laser Percutanea </b></li>
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<li class="li1" style="text-align: justify;"><span class="s2"></span><span class="s1"><b>n. 8 sedute ozonoterapia paravertebrale cadenza settimanale</b></span></li>
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<li class="li1" style="text-align: justify;"><span class="s2"></span><span class="s1"><b>Fisioterapia: 2 sedute settimanali per 2 mesi con fisioterapista esperto in riabilitazione cervicale</b></span></li>
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<span class="s1"><b>La Paziente riferisce remissione completa della sintomatologia e ripete su sua iniziativa Risonanza Magnetica Nucleare in data 09 Febbraio 2016 con evidente scomparsa dell’ernia discale</b></span></div>
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<span class="s1"><b>La scomparsa dell’ernia è dovuta alla decompressione del disco, alla lisi con laser del nucleo discale, all’attività dei farmaci antinfiammatori iniettati con le infiltrazioni, alla </b></span></div>
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<span class="s1"><b>ozonoterapia (grazie alla attività idrolitica e ossidante), all’ottima fisioterapia (che migliora la dinamica vascolare dello spazio peridurale favorendo il riassorbimento del materiale) e alla naturale disidratazione. </b></span></div>
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<span class="s1"><b>ovviamente il caso esposto ed i risultati ottenuti non rappresentano il 100% dei casi trattati</b></span></div>
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<span class="s1"><b>ps: per i più attenti, in risposta alla domanda che spesso mi viene posta “ma lei su sua sorella eseguirebbe questi trattamenti?”, be, la paziente è proprio lei.</b></span></div>
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</span>Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0Trapani TP, Italia38.0176177 12.53720199999997937.9675792 12.456520999999979 38.0676562 12.61788299999998tag:blogger.com,1999:blog-5119449392101510707.post-86054780603982093282016-02-28T23:33:00.004+01:002016-09-18T13:04:38.623+02:00CROLLO/FRATTURA VERTEBRALE RIMEDI: VERTEBROPLASTICA - CASO CLINICO<div class="p1">
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<b>CROLLO - FRATTURA - SCHIACCIAMENTO</b></div>
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<span class="s1"><b> VERTEBRALE</b></span><br />
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<span class="s1"><b>TERAPIA MEDICA E VERTEBROPLASTICA</b></span></div>
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<span class="s1"><b>CASO CLINICO</b></span><br />
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<span style="font-size: large;"><a href="https://files.acrobat.com/a/preview/1a6819fd-d216-4fa6-9724-f6f5e39d2b0e">Info - Prenotazioni - Dove </a></span></div>
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<b style="text-align: justify;">Sintomi:</b><span style="text-align: justify;"> improvvisa comparsa di dolore alla schiena (dorsale e/o lombare più spesso), associato o meno a trauma (anche di bassa entità); dolore acuto, severo, che impedisce qualunque tipo di attività fisica e che si attenua poco o nulla in scarico (riposo a letto) </span></div>
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<a href="https://3.bp.blogspot.com/-Se-KCvYLEVw/VtNwJ0dQh2I/AAAAAAAAE_U/zK9do-JE1zE/s1600/osteoporosi_vertebrale_evol.gif" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: justify;"><img alt="Ernia+del+disco+ernia+vertebrale+palermo+trapani+emanuele+sbacchi" border="0" height="250" src="https://3.bp.blogspot.com/-Se-KCvYLEVw/VtNwJ0dQh2I/AAAAAAAAE_U/zK9do-JE1zE/s320/osteoporosi_vertebrale_evol.gif" title="Ernia+del+disco+ernia+vertebrale+palermo+trapani+emanuele+sbacchi" width="320" /></a></div>
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<span class="s1"><b>Cause: Osteoporosi - Neoplasia</b></span></div>
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<span class="s1">il crollo (o frattura o collasso) vertebrale è un cedimento del corpo vertebrale, ricco di recettori, causa conseguente di dolore severo come molte fratture. Questo si verifica quando il corpo vertebrale è più fragile come nei pazienti affetti da osteoporosi (anziani) o neoplasia a seguito di localizzazione secondaria </span></div>
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<b>RIMEDI TERAPIA</b><br />
La <b>Vertebroplastica Percutanea</b> è una procedura terapeutica mini-invasiva per il trattamento delle fratture vertebrali dolorose sviluppata in Francia nella metà degli anni 80' ma che solo recentemente ha avuto diffusione in altri paesi europei e negli Stati Uniti. </div>
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<b><i>Essa consiste nell’iniezione attraverso un ago metallico appositamente conformato, introdotto sotto la guida della fluoroscopia digitale, di un cemento osseo a bassa viscosità già da tempo impiegato in interventi ortopedici.</i></b><span class="s1"></span></div>
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<span class="s1">Il cemento, denominato polimetilmetacrilato o PMMA, si diffonde all’interno del corpo vertebrale fratturato, prevenendo ulteriori cedimenti. <b><i>Ciò determina una </i></b></span><span class="s2"><b><i>immediata riduzione del dolore</i></b></span><span class="s1"><b><i> e consente a quei pazienti che hanno ridotto la propria attività fisica di riacquistare mobilità. </i></b></span></div>
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<a href="https://4.bp.blogspot.com/--j3TjivQd8g/VtNwp7BpbFI/AAAAAAAAE_g/O263ZCQSnbw/s1600/vertebroplastica-590x230.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Ernia+del+disco+ernia+vertebrale+palermo+trapani+emanuele+sbacchi" border="0" height="124" src="https://4.bp.blogspot.com/--j3TjivQd8g/VtNwp7BpbFI/AAAAAAAAE_g/O263ZCQSnbw/s320/vertebroplastica-590x230.jpg" title="Ernia+del+disco+ernia+vertebrale+palermo+trapani+emanuele+sbacchi" width="320" /></a></div>
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<span class="s1">E' necessaria l'introduzione di pochi ml di cemento che determina il consolidamento dell'osso con conseguente </span><span class="s2"><b><i>risoluzione del dolore</i></b></span><span class="s1">.</span></div>
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<span class="s1">Tale procedura ottiene ottimi risultati nel trattamento del dolore causato da <b>Osteoporosi</b> e <b>Metastasi vertebral</b>i. </span></div>
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<span class="s1">La Vertebroplastica Percutanea viene eseguita in anestesia locale associata a sedazione o anestesia generale (a seconda dei casi) e richiede il ricovero del paziente per una o due notti.</span></div>
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<span class="s1"><b>La maggior parte dei pazienti (oltre il 90%) che hanno usufruito di tale terapia hanno riferito una cospicua o completa riduzione del dolore potendo così smettere di indossare il busto, ridurre o sospendere l'assunzione di farmaci analgesici e migliorare così la qualità della vita.</b></span></div>
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<span class="s1">La Vertebroplastica ha lo scopo di trattare e curare la frattura vertebrale che causa il dolore consolidando la frattura vertebrale; i pazienti con osteoporosi dovranno essere </span></div>
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<span class="s1">adeguatamente seguiti dallo specialista per l'osteoporosi per ridurre il rischio di insorgenza di nuove fratture su altre vertebre.</span></div>
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<span class="s1">Nei pazienti con Metastasi vertebrali la vertebroplastica non è in alcun modo da considerarsi come una terapia oncologica; i pazienti dovranno pertanto continuare ad eseguire le terapie oncologiche anche dopo di essa (es. Chemioterapia - Radioterapia)</span></div>
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<span class="s1"><b><a href="https://files.acrobat.com/a/preview/61a6ac25-7888-4343-8df7-70f491e6e742" target="_blank">---> Scarica PDF</a></b></span><br />
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<span class="s1"><b>CASO CLINICO</b></span></div>
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<span class="s1">Paziente Donna, 94 aa., non affetta da patologie degne di nota, autonoma ed indipendente, capaci di svolgere le comuni attività quotidiane fino all’insorgere di un dolore improvviso, senza trauma evidente ed importante. Dolore lancinante alla regione dorsolombare, che “impedisce il respiro profondo” e che non si attenua in nessuna posizione, nemmeno a letto.</span></div>
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<span class="s1">Contattato telefonicamente, dopo breve descrizione dei sintomi, richiedo radiografia e risonanza magnetica, di seguito le immagini:</span></div>
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<span class="s1">RX: si evidenziano multipli collassi vertebrali </span></div>
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<span class="s1">RMN Sequenza T2:</span></div>
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<span class="s1">RMN Sequenza STIR:</span></div>
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<span class="s1">si evidenzia area di reazione infiammatoria in D11 e L2 </span>(crollo recente) e non agli altri livelli ad indicare probabilmente crolli di vecchia data</div>
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<span class="s1"><b>Alla Visita: la paziente presenta dolore severo alla palpazione alla regione lombare indicando come attivo e sintomatico il crollo L2;</b> lieve dolore agli atri livelli </span></div>
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<span class="s1">Si richiede quindi studio TAC per valutazione caratteristiche della vertebra</span></div>
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<span style="text-align: center;">Si programma Vertebroplastica in anestesia locale e sedazione</span><br />
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<span class="s1">individuato il peduncolo si introduce ago apposito, dopo controllo in doppia proiezione si introducono 3 ml di cemento PMMA.</span></div>
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<span class="s1">si nota come il cemento medico si disponga secondo linea di frattura del corpo vertebrale con </span><span class="s2"><b><i>risoluzione immediata della sintomatologia dolorosa.</i></b></span></div>
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<span class="s1">Previa valutazione ambulatoriale (non in convenzione) presso i nostri ambulatori (Palermo, Trapani, Gela, San Giovanni Gemini) è possibile sottoporsi a questa procedura in regime di convenzione o privatamente presso Casa di Cura Villa dei Gerani - Trapani e Casa di Cura santa barbara Hospital gela (CL)</span></div>
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Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com1centro medico mantia38.1156879 13.36126709999996437.915870899999994 13.038543599999963 38.3155049 13.683990599999964tag:blogger.com,1999:blog-5119449392101510707.post-89823565836497444622016-01-24T22:29:00.001+01:002016-09-18T13:10:40.783+02:00<div class="separator" style="clear: both; text-align: center;">
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Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-72569978504960771412016-01-11T00:03:00.001+01:002016-09-18T13:12:14.295+02:00Patologia e Infiltrazioni ecoguidate della Caviglia <div style="font-size: 14.6667px; text-align: center;">
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<strong><span style="font-family: "times" , "times new roman" , serif;">Introduzione</span></strong></div>
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<span style="font-family: "times" , "times new roman" , serif;">La caviglia rappresenta la sezione della gamba posta immediatamente al di sopra del piede; comprende l’articolazione tibio-tarsica (di tipo a troclea o ginglimo) tra le estremità distali di tibia e fibula (o perone), superiormente, e dell’astragalo (o talo) del piede (articolazione talocrurale), inferiormente. L’articolazione della caviglia è responsabile della flessione sul dorso e della flessione plantare del piede mentre non permette la rotazione.</span></div>
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<strong><span style="font-family: "times" , "times new roman" , serif;">L’articolazione</span></strong></div>
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<span style="font-family: "times" , "times new roman" , serif;">Il malleolo laterale della fibula e quello mediale della tibia, insieme alla superficie caudale della tibia, si articolano con le tre faccette dell’astragalo. Tali superfici sono ricoperte da cartilagine. Nel complesso l’articolazione si chiama <strong>tibio-peroneo-astragalica</strong> o tibio-tarsica. Inoltre vi è la <strong>capsula articolare</strong>, manicotto di tessuto connettivo denso, che si inserisce tra i segmenti ossei in connessione rivestendo completamente l’articolazione; all’interno è contenuta la membrana sinoviale, che secerne li liquido sinoviale, la cui natura viscoelastica facilita lo scorrimento tra le due superfici a contatto e garantisce la protezione articolare dagli stress meccanici.</span></div>
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<strong><span style="font-family: "times" , "times new roman" , serif;">I legamenti</span></strong></div>
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<span style="font-family: "times" , "times new roman" , serif;">L’articolazione talocrurale è rinforzata dal legamento deltoideo (o mediale) di forma triangolare, e da tre legamenti laterali: il legamento fibuloastragaleo anteriore, quello posteriore e il fibulocalcaneale.</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">Il legamento deltoideo sorregge il lato mediale dell’articolazione, trae origine dal malleolo mediale della tibia e si espande in quattro fasci (due anteriori, uno mediale e uno posteriore) che si inseriscono in quattro punti differenti:</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">– il legamento tibionavicolare (posto anteriormente) si inserisce sullo scafoide</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">– il legamento tibioastragaleo anteriore (posto anteriormente) si inserisce sul collo dell’astragalo;</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">– il legamento tibiocalcaneale (posto medialmente) si inserisce sul sustentaculum tali del calcagno;</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">– il legamento tibioastragaleo posteriore si inserisce sulla faccia mediale dell’astragalo.</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">I legamenti ventrale e fibuloastragalei anteriore e posteriore rinforzano la parte laterale dell’articolazione talocrurale, dal malleolo laterale della fibula alle estremità dorsale dell’astragalo. Il legamento fibulocalcaneale si distacca dal malleolo laterale e si inserisce sulla superficie laterale del calcagno.</span></div>
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<span style="line-height: 22.4px;"><b><span style="font-family: "times" , "times new roman" , serif;">Terapia</span></b></span></div>
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<span style="line-height: 22.4px;"><span style="font-family: "times" , "times new roman" , serif;">La caviglia, a differenza del ginocchio, presenta una cartilagine articolare più compatta, risponde meglio agli stimoli pressori ed ha una capacità rigenerativa 10 volte superiore a quella del ginocchio. L’osteoartrosi della caviglia, che generalmente insorge in seguito ad una patologia di ordine traumatico o infiammatorio (es artrite), risulta la condizione patologica per la quale si ricorre più spesso ad un’infiltrazione. I prodotti maggiormente utilizzati sono l’acido ialuronico e i cortisonici ed i risultati migliori si ottengono se l’infiltrazione è eseguita sotto guida ecografica.</span></span></div>
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<span style="font-family: "times" , "times new roman" , serif;"><span style="line-height: 25.6px; text-align: start;">Ovviamente l'azione antinfiammatoria del cortisone determina quasi sempre un forte calo del dolore nel breve periodo, ma è sempre un effetto "a tempo". L'acido ialuronico per contro non manifesta subito dei risultati tangibili per il paziente. Le persone affette da diabete non vengono infiltrate con cortisone poichè</span><span style="line-height: 25.6px; text-align: start;"> innalz</span><span style="line-height: 25.6px; text-align: start;">a i valori glicemici e per questi pazienti si passa direttamente alla somministrazione di acido ialuronico. In tutti gli altri pazienti il ciclo di infiltrazioni è spesso associato da cortisone e acido ialuronico. Normalmente si eseguono le prime due infiltrazioni con il cortisone a cui seguono altre tre o quattro infiltrazioni di acido ialuronico. Le infiltrazioni possono essere ripetute ma non in tempi ravvicinati, bisogna infatti lasciar passare almeno sei mesi tra un ciclo e l'altro. Se la frequenze di richesta delle infiltrazioni si fa troppo breve siamo di fronte ad una persona che non risponde più alla terapia e quindi necessita di intervento .</span></span><br />
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Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-54317957205812215782015-12-20T21:02:00.001+01:002016-09-18T18:20:20.316+02:00Trapani Palermo Gela: Trattamento Ernia del Disco Cervicale 2 Livelli - Discectomia Percutanea Laser<div class="separator" style="clear: both; text-align: center;">
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Paziente: anni 36 donna</div>
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<b>SINTOMI:</b> Dal 2010 affetta CERVICOBRACHIALGIA con irradiazione spalla/braccio/mano BILATERALE</div>
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oltre a dolore: sensazione di CALORE e "SCOSSE ELETTRICHE"</div>
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<b>RISONANZA MAGNETICA NUCLEARE:</b> </div>
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- Ernia del disco C4 - C5 con severo impegno foraminale bilaterale prevalente destro</div>
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- Ernia del disco C5 - C6 con paramediana destra che cancella lo spazio peridurale</div>
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- Ernia del disco C6 - D1 severo bulging discale</div>
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Trattamento: <b><i>Discectomia Percutanea Laser bilivello C4 - C5 e C5 - C6</i></b></div>
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Casa di Cura Villa dei Gerani - Erice Casa Santa - Trapani</div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">La <b><i>Discectomia Percutanea Laser</i></b> (PLDD - Percutaneous Laser Disc Decompression) è una procedura chirurgica utilizzata per la cura dell'ernia del disco</span></span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">E' normalmente eseguita in <b>anestesia locale</b> per le <b>procedure lombari</b> e in <b>sedoanalgesia</b> per il trattamento delle <b>ernie discali cervicali; </b>durata 15 min per livello trattato;</span></span><br />
<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">Sotto guida fluoroscopica (raggi x) o sotto guida TAC, si introduce un sottile ago di calibro inferiore 0.80 mm nel disco intervertebrale erniato. <o:p></o:p></span></span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">Una volta controllatone il posizionamento, si introduce all'interno dell'ago una sottilissima fibra ottica connessa al laser.<o:p></o:p></span></span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">Normalmente priva di dolore, a differenza di altre tecniche che utilizzano il calore (coblazione, neucleoplastica, radiofrequenza), poiché il laser permette di concentrare elevatissime potenze senza alcuna dissipazione di calore. Le caratteristiche fisiche delle fibre ottiche utilizzate (silicio purissimo) e la loro modalità di emissione permettono di concentrare l'energia in pochi mm. nel disco intervertebrale, con un assorbimento dell'energia superiore al 90%.<o:p></o:p></span></span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">Nel caso in cui l'ernia del disco sia ancora contenuta è possibile rilasciare l'energia laser sia al centro del disco intervertebrale, che nella sua porzione posteriore.</span></span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">Questo permette di rilasciare l'energia laser in più punti del disco intervertebrale erniato, <b><i>ottenendo una maggiore vaporizzazione e "shrinkage" - retrazione - dell'ernia con una decompressione della radice nervosa ed una risoluzione dei sintomi (dolore irradiato all'arto, formicolii, alterazione della sensibilità)</i></b>. <o:p></o:p></span></span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">Il paziente viene dimesso un giorno dopo la procedura</span></span><span style="font-family: "times" , "times new roman" , serif;">. Non vi è alcuna ferita chirurgica, né vsono punti da rimuovere.</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">E' consigliato un giorno di riposo assoluto, con ripresa della normale vita lavorativa entro 20 gg circa. </span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">I risultati sono soddisfacenti in una percentuale di casi intono all'80%. In caso di insuccesso non è pregiudicato il ricorso alla chirurgia tradizionale o ad altri trattamenti conservativi (peridurali, peridurolisi, ozono ecc..). </span></span></div>
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<b><i>Discolisi con O2-O3 (Ossigeno-Ozono)</i></b><br />
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Consiste nel fare un’iniezione nel disco di Ossigeno e Ozono, con un sottilissimo ago indolore sotto monitoraggio radioguidato. La miscela Ozono-Ossigeno ha un effetto antalgico e miniflogistico che riduce il dolore e il volume dell’ernia e rinforza le strutture del disco. E’ applicabile in ernie del disco contenute.<br />
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- Richiede anestesia locale potenziata da sedazione-flash (solo procedure cervicali) in modo che il paziente non avverta alcun dolore;<br />
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- dura pochi minuti (mediamente 15 - 20 minuti per ciascun livello trattato);<br />
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- consente una deambulazione quasi immediata e può essere effettuato spesso anche in Day Hospital<br />
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Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0Palermo, Italia38.1156879 13.36126709999996437.915870899999994 13.038543599999963 38.3155049 13.683990599999964tag:blogger.com,1999:blog-5119449392101510707.post-79327958013207843082015-12-13T11:22:00.002+01:002016-09-18T13:17:12.517+02:00Trattamento Ernia del disco L5 S1: Discectomia Percutanea Laser<div class="separator" style="clear: both; text-align: center;">
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Paziente: anni 28 donna</div>
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Dal 2001 episodi di lombosciatalgia; da circa un anno severa lombalgia e sciatalgia con irradiazione al piede destro</div>
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Diagnosi: Ernia del disco L5 S1 mediana - paramediana destra</div>
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Trattamento: <b><i>Discectomia Percutanea Laser</i></b></div>
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Casa di Cura Villa dei Gerani - Erice Casa Santa - Trapani</div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">La <b><i>Discectomia Percutanea Laser</i></b> (PLDD - Percutaneous Laser Disc
Decompression) è una procedura chirurgica utilizzata per la cura dell'ernia del
disco</span></span></div>
<a name='more'></a><span style="font-family: "times" , "times new roman" , serif;"><o:p></o:p></span><br />
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;"><br /></span></span></div>
<div style="background: white; text-align: justify; text-justify: inter-ideograph;">
<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">E' normalmente eseguita in <b>anestesia locale</b> per le <b>procedure lombari</b> e
in <b>sedoanalgesia</b> per il trattamento delle <b>ernie discali cervicali</b>.
Sotto guida fluoroscopica (raggi x) o sotto guida TAC, si introduce un sottile ago di calibro inferiore 0.80 mm nel disco intervertebrale erniato. <o:p></o:p></span></span></div>
<div style="background: white; text-align: justify; text-justify: inter-ideograph;">
<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">Una volta controllatone il posizionamento, si introduce all'interno
dell'ago una sottilissima fibra ottica connessa
al laser.<o:p></o:p></span></span></div>
<div style="background: white; text-align: justify; text-justify: inter-ideograph;">
<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">Normalmente priva di dolore, a differenza di altre tecniche che
utilizzano il calore (coblazione, neucleoplastica, radiofrequenza), poiché il
laser permette di concentrare elevatissime potenze senza alcuna dissipazione di
calore. Le caratteristiche fisiche delle fibre ottiche utilizzate (silicio
purissimo) e la loro modalità di emissione permettono di concentrare l'energia
in pochi mm. nel disco intervertebrale, con un assorbimento dell'energia
superiore al 90%.<o:p></o:p></span></span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;"><br /></span></span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">Nel caso in cui l'ernia del disco sia ancora contenuta è possibile rilasciare l'energia laser
sia al centro del disco intervertebrale, che nella sua porzione posteriore.</span></span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;"><br /></span></span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">Questo permette di rilasciare l'energia laser in più punti del disco
intervertebrale erniato, <b><i>ottenendo una maggiore vaporizzazione e
"shrinkage" - retrazione - dell'ernia con una decompressione della radice
nervosa ed una risoluzione dei sintomi (dolore irradiato all'arto, formicolii,
alterazione della sensibilità)</i></b>. <o:p></o:p></span></span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;"><br /></span></span></div>
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<span style="font-family: "times" , "times new roman" , serif;">In caso di ernie non contenute, cioè di dimensioni maggiori, ma ancora connesse al disco intervertebrale, soddisfacenti risultati sono stati ottenuti eseguendo la procedura sotto guida RX rilasciando l'energia laser al centro del disco. <o:p></o:p></span></div>
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<span style="font-family: "times" , "times new roman" , serif;"><br /></span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">Il paziente viene dimesso un giorno dopo la procedura</span></span><span style="font-family: "times" , "times new roman" , serif;">. Non vi è alcuna ferita chirurgica, né vi sono punti
da rimuovere.</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">E' consigliato un giorno di riposo assoluto, con ripresa
della normale vita lavorativa entro 20 gg circa. </span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;"><br /></span></span></div>
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<span style="color: black;"><span style="font-family: "times" , "times new roman" , serif;">I risultati sono soddisfacenti in una percentuale di casi intono all'80%.
In caso di insuccesso non è pregiudicato il ricorso alla chirurgia tradizionale
o ad altri trattamenti conservativi (peridurali, peridurolisi, ozono ecc..). </span></span></div>
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<b><i>Discolisi con O2-O3 (Ossigeno-Ozono) </i></b><br />
<br />
Consiste nel fare un’iniezione nel disco di Ossigeno e Ozono, con un sottilissimo ago indolore sotto monitoraggio radioguidato. La miscela Ozono-Ossigeno ha un effetto antalgico e miniflogistico che riduce il dolore e il volume dell’ernia e rinforza le strutture del disco. E’ applicabile in ernie del disco contenute. <br />
<br />
- Richiede anestesia locale potenziata da sedazione-flash in modo che il paziente non avverta alcun dolore;<br />
<br />
- dura pochi minuti (mediamente 20-30 minuti per ciascun livello trattato);<br />
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- consente una deambulazione quasi immediata e può essere effettuato spesso anche in Day Hospital, indossando per circa un mese un leggerissimo bustino lombostato.<br />
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....e chiamiamole tutte "infiltrazioni"... ;)</div>
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<span style="font-size: xx-small;">tags terapia del dolore trapani trattamento ernia del disco mal di schiena lombosciatalgia lombalgia ernia espulsa protrusione</span></div>
<br />Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-72405684234097257432015-11-01T20:51:00.000+01:002016-09-18T13:18:18.573+02:00Terapia del Dolore Vertebrale a Trapani<div class="separator" style="clear: both; text-align: center;">
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- Terapie ambulatoriali infiltrative e ozonoterapia ecoguidate per <b>patologie dolorose colonna vertebrale e grandi articolazioni</b></div>
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- Ricovero in regime di convenzione con il SSN per intervento di <b>discectomia percutanea laser per ernia del disco cervicale o lombare</b></div>
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- Ricovero in regime di convenzione con il SSN per intervento di <b>peridurolisi per lombosciatalgia e cervicobrachialgia</b></div>
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<span style="text-align: justify;">- In regime privato <b>Ozonoterapia Transformainale TAC - RX Guidata</b> per trattamento <b>ernie discali espulse</b> </span><br />
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<span style="text-align: justify;">- In regime privato <b>Radio Frequenze Spalla Ginocchio Anca</b> per pazienti con <b>dolore alle grandi articolazioni ma non operabili o già sottoposte ad intervento chirurgico</b></span><br />
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<span style="text-align: justify;"><span style="font-size: xx-small;">tags terapia del dolore vertebrale ozonoterapia ernia del disco ernia espulsa lombalgia sciatalgia cervicale cervicalgia cervicobrachialgia ozono transforaminale trapani marsala mazzara del vallo castelvetrano calatafimi</span></span><br />
<span style="text-align: justify;"><b><br /></b></span>Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com1tag:blogger.com,1999:blog-5119449392101510707.post-37093771808453083482015-10-26T23:58:00.001+01:002015-10-27T00:12:09.689+01:00Cervicalgia e Cefalea da faccette articolari infiammate: infiltrazioni ecoguidate e radiofrequenza<h4 style="background-color: white; box-sizing: border-box; color: #292929; display: inline-block; font-family: titillium-bold; font-size: 14px; font-weight: 300; line-height: 1.35em; margin-bottom: 8.5px; margin-top: 8.5px; text-transform: uppercase;">
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<a href="https://files.acrobat.com/a/preview/8fb465a7-9662-404a-b3e6-3eb342223328" target="_blank">--- > scarica il pdf</a></div>
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CAUSE DI CERVICALGIA</div>
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Le principali cause di cervicalgia che persiste nel tempo sono:</div>
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1) <b>Sindrome delle faccette articolari cervicali.</b> Le faccette articolari o articolazioni zigoapofisarie sono delle strutture di contatto tra una vertebra e l'altra. Questa causa sebbene sia abbastanza comune è talvolta trascurata perché non rilevata alla visita del paziente.</div>
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2) <b>Malattia del disco intervertebrale cervicale</b> con il cosiddetto dolore “discogenico”</div>
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3) La <b>protrusione o l'ernia del disco</b> che irrita o comprime una radice nervosa cervicale (di solito al di sotto della 4° vertebra cervicale). Il paziente sente dolore o fastidio cervicale con irradiazione all'arto superiore (parestesie/disestesie).</div>
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4) <b>Patologia dei legamenti longitudinali anteriori e posteriori</b> nell'ambito della sindrome da instabilità vertebrale</div>
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5) Patologia dei muscoli, con la frequentissima sindrome dei <b>trigger points miofasciali</b></div>
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L<span style="line-height: 1.7em;">e cause in percentuale del dolore cervicale sono:</span></div>
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<li style="box-sizing: border-box; text-align: justify;">23% Sindrome delle faccette articolari cervicali</li>
<li style="box-sizing: border-box; text-align: justify;">20% Dolore deriva dal disco</li>
<li style="box-sizing: border-box; text-align: justify;">41% Dolore da entrambe le sedi</li>
<li style="box-sizing: border-box; text-align: justify;">17% Dolore da altre sedi</li>
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LA SINDROME DELLE FACCETTE CERVICALI SUPERIORI E INFERIORI</h4>
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I paziente con dolore cervicale si dividono in tre gruppi:</div>
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1) Pazienti con dolore della parte più alta con dolore che si irradia alla testa (con la cosiddetta cefalea cervicogenica o nevralgia occipitale)</div>
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2) Pazienti con dolore della parte cervicale bassa con irradiazione alla zona del trapezio e scapolare.</div>
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3) Pazienti con i due quadri clinici associati</div>
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Queste sindromi possono esordire in seguito ad un trauma con colpo di frusta.</div>
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La cervicalgia spesso è accompagnata da fenomeni accessori come le vertigini. Il territorio di distribuzione del dolore che deriva dalle faccette articolari cervicali è visibile nella figura.</div>
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<a href="https://blogger.googleusercontent.com/img/proxy/AVvXsEgTMFavq-B8WLyu4c0XcxCoUX2MBc0fSBzeyU7qTdpj4KNnenJxjP3hUGKenTwGWagvTjx7hHCK9At2op5MyZQbAi80TVVV-8jfH_dwO807L_w4TqVW3UjGRpfQgvKRdY-rYc6U_XLHIdIMr6omsAvDdrxQ0_UrAdfXdO83sJBWz25hj1CBd2QvWzH_tac9mDrVPoCybMEYS6hGgZCe0ELUOlLX=" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Faccette articolari" border="0" src="http://www.medicitalia.it/public/uploadedfiles/minforma/l.canzoneri_sindrome_faccette_cervicali.jpg" height="404" style="border: 0px; box-sizing: border-box; margin-top: 4px; max-width: 100%; vertical-align: middle;" title="Faccette articolari" width="304" /></a></div>
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Le faccette possono essere visualizzate da una radiografia, da una TAC o da una risonanza magnetica cervicale.</div>
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TRATTAMENTO</h4>
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<a name='more'></a>Il primo approccio a un dolore cervicale legato alle faccette è quello di prendere dei farmaci e praticare una riabilitazione fisioterapica accompagnata da eventuali terapie fisiche.</div>
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Se questa strategia conservativa non funzionasse allora <i><u>è possibile praticare delle infiltrazioni con ago sottile (diametro uguale ad un ago da insulina) di una miscela di a. locale e antinfiammatorio previa visualizzazione delle articolazioni zigoapofisarie coinvolte (faccette articolari) con ecografia o raggi x; spesso un ciclo di 2 o 3 infiltrazioni di questo tipo, ambulatoriali, è sufficiente per ridurre il processo infiammatorio responsabile della sofferenza per un lungo periodo</u></i>. Per prolungare il periodo di benessere è fondamentale adottare comportamenti posturali corretti, un percorso di fisioterapia ed possibile integrare con delle sedute di ossigeno ozono terapia.</div>
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Nei casi in cui il pain relief (sollievo dal dolore) dovesse essere significativo ma avere breve durata, si può effettuare trattamento con<span style="line-height: 27.2px;"> radiofrequenza</span><span style="line-height: 1.7em;"> sulla branca mediale della faccetta stessa.</span></div>
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RADIOFREQUENZA DELLE FACCETTE CERVICALI</h4>
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E’ un intervento che consiste nel trattare con una radiofrequenza ossia del calore un piccolo nervo che controlla solo l’articolazione. Questa infiltrazione/intervento è facile e poco rischioso infatti tale nervo, chiamato branca mediale, è a solo 1-2 cm di profondità, in una zona relativamente lontana da strutture nervose e vascolari importanti.</div>
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Per poter raggiungere facilmente e con certezza assoluta quel punto si usano i raggi X.</div>
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Dopo aver posizionato il paziente sul fianco, si pratica la prima radiografia. Dopo l’anestesia della pelle, si entra con l’ago collegato al macchinario che produce la radiofrequenza. Si fanno quindi alcuni controlli radiografici muovendo l’ago molto lentamente per raggiungere la branca mediale.</div>
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Dopo aver messo l’ago nel punto giusto (manovra che impiega pochi minuti) si pratica una stimolazione sensitiva e motoria per essere ancora più certi della posizione già controllata radiograficamente. Infine si applica la radiofrequenza per circa un minuto per ognuno dei livelli trattati (di solito si trattano 3 livelli). Il benessere <span style="line-height: 1.7em;">derivante può durare più di un anno e deve essere comunque seguito da ulteriore fisioterapia, che verrà facilitata dalla riduzione del dolore.</span></div>
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CONCLUSIONI</h4>
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Il dolore cervicale cronico è un problema molto diffuso nella popolazione e produce in alcuni casi una notevole disabilità.</div>
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<a href="https://files.acrobat.com/a/preview/8fb465a7-9662-404a-b3e6-3eb342223328" target="_blank"><b>---> scarica il pdf</b></a></div>
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<h1 class="drawer-title" data-default="Inserisci il titolo qui" style="box-sizing: border-box; clear: left; float: left; font-family: KorolevBoldCompressed; font-size: 24px; font-weight: normal; line-height: 24px; margin-bottom: 1em; margin-right: 1em; margin-top: 0px; padding: 0px; text-rendering: optimizeLegibility;">
<img alt="Angologia" src="http://www.terapiadeldolorepalermo.it/polopoly_fs/1.610928.1427249773!/httpImage/img.jpeg_gen/derivatives/landscape_480/img.jpeg" style="border: none; box-sizing: border-box; font-family: Tahoma, 'Times New Roman', Times, serif; font-size: 14px; height: auto; line-height: 18px; margin: 0px; max-width: 100%; padding: 0px; vertical-align: middle;" title="Angologia" /></h1>
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<b>L'algologo non è il terapista del dolore e il suo compito primario non è quelllo di eseguire la terapia del dolore ma <em style="box-sizing: border-box; margin: 0px; padding: 0px;">porne la diagnosi patogenetica e sceglierne la cura</em>.</b></div>
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E' auspicabile che in avvenire gli algologi nascano tali e si sentano tali e non più anestesisti, neurologi o neurochirurghi dediti all'algologia; è su questi concetti che si deliniea il profilo dell'algologo, <em style="box-sizing: border-box; margin: 0px; padding: 0px;">ovvero lo specialista che sulla base della conoscenza della fisiopatologia e della semeiotica del dolore è in grado di porre la diagnosi patogenetica del dolore e di decidere il trattamento adeguato </em>che può essere di competenza sua come di altri specialisti.</div>
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Posto che <em style="box-sizing: border-box; margin: 0px; padding: 0px;">quel che definisce l'algologo è la competenza diagnostica</em>, sul piano terapeutico ogni algologo deve dedicarsi ad un settore (farmacologico, comportamentale o chirurgico) a seconda della personale attitudine e specifica preparazione in paritetico scambio di competenze con altri per eseguire le terapie che esulano dalla sua routine. Va superata la tendenza del medico ad "attaccarsi tenacemente al suo paziente e sperimentare tutti i metodi terapeutici con i quali ha familirità, anche quando le probabilità di successo sono inadeguate".</div>
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Purtroppo finchè gli algologi eseguiranno l'algologia come attività collaterale di una discplina che prevede altri compiti totalmente differenti, la maggior parte della pratica clinica algologica rimarrà compito di ogni medico che nell'ambito della propria specialità incontra pazienti con dolore. In queste condizioni, i pazienti continueranno ad essere senza diagnosi algologica. L'importanza sociale ed umanitaria del gran numero di pazienti con dolore persistente o cronico mertita l'attenzione della classe medica specializzata affinchè i malati non siano considerati incurabili o inadeguatamente trattati da improvvisati terapisti del dolore o da specialisti che, pur preparati nella loro disciplina, non sono algologi.</div>
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"La chirurgia percutane del dolore<br />
G. Orlandini<br />
Antonio Delfino Editore<br />
2011</div>
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J.J. Bonica [1990] affermò che il dolore cronico è "uno dei problemi sanitari e sociali più grave e pressante perchè affligge annualmente milioni di individui ed il sollievo è insufficiente per molti pazieni". Egli calcolò che per questa causa negli USA nel 1986 furono persi oltre 400.000.000 di giornate lavorative con un costo comprensivo dell'assistenza sanitaria, degli indennizzi e dei compensi legali di 79.000.000.000 di dollari.</div>
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The Managemente of Pain<br />
J.J. Bonica<br />
1990</div>
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<a href="http://www.terapiadeldolorepalermo.it/polopoly_fs/1.613602.1427187311!/httpFile/file.pdf" target="_blank">Scarica pdf</a></div>
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<a href="http://www.terapiadeldolorepalermo.it/polopoly_fs/1.613602.1427187311!/httpFile/file.pdf" target="_blank">Scarica pdf legge n. 38/2010</a></div>
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Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-347369032096439162015-09-13T01:04:00.000+02:002016-09-18T17:49:46.576+02:00La SACROILEITE e quel CHIODO alla natica quando CI SI ALZA IN PIEDI ...<div class="separator" style="clear: both; text-align: center;">
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<b>INFIAMMAZIONE ARTICOLAZIONE SACROILIACA</b></div>
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<b>SACROILEITE</b></div>
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<a href="https://files.acrobat.com/a/preview/1a6819fd-d216-4fa6-9724-f6f5e39d2b0e">Info - Prenotazioni - Dove </a></div>
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<a href="https://www.facebook.com/emanuelesbacchi.blogspot.it/reviews/">Vedi le recensioni </a></div>
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<span style="text-align: justify;">La </span><b style="text-align: justify;">Sacroileite</b><span style="text-align: justify;"> è un'infiammazione di una o di entrambe le </span><b style="text-align: justify;">articolazioni sacro-iliache</b><span style="text-align: justify;">, che collegano il </span><b style="text-align: justify;">sacro</b><span style="text-align: justify;"> alle ali iliache del </span><b style="text-align: justify;">bacino</b><span style="text-align: justify;">; sono fra le articolazioni maggiormente sottoposte a stress in quanto “scaricano” il peso della parte superiore del nostro corpo sugli arti inferiori collegando la colonna vertebrale e del bacino; colpisce prevalentemente le donne.</span></div>
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<span class="s1"><b>Sintomi:</b></span></div>
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<a href="https://4.bp.blogspot.com/-VmC5MJmEBTA/VzinR4xzcRI/AAAAAAAAFP4/ERqLcz2MAIEsJC9PV4U3f3EOuQigFfz3ACKgB/s1600/faccette-300x251.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://4.bp.blogspot.com/-VmC5MJmEBTA/VzinR4xzcRI/AAAAAAAAFP4/ERqLcz2MAIEsJC9PV4U3f3EOuQigFfz3ACKgB/s1600/faccette-300x251.jpg" /></a><span class="s1">E’ frequente che oltre al dolore nella zona corrispondente all’articolazione sacroiliaca siano presenti <b>zone di dolore riferito in sedi più o meno distanti</b> (dolore regione gluteo, inguine, lombare, coscia anteriore e posteriore, gamba) motivo per cui <b>spesso la diagnosi differenziale con altre patologie che causano dolore può risultare assai difficile </b>(sciatalgia, lombalgia da discopatia, sindrome delle faccette articolari, sindrome del muscolo piriforme, ecc)<b><i>.</i></b></span></div>
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<span class="s1">Il paziente riferisce <b>dolore nella regione glutea (mono o bilaterale)</b>, appena lateralmente la linea mediana, caratteristicamente riferisce <b>sensazione di “chiodo” nella regione,</b> spesso la sensazione di dolore riguarda una zona più vasta (per il fenomeno dell’amplificazione dei campi recettoriali e spinale) ovvero <b>coscia posteriore e lombare</b>.</span></div>
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<span class="s1">Il paziente riferisce lieve <b>miglioramento quando in scarico (disteso) </b>ma tipicamente il <b>dolore si presenta quando tenta di cambiare posizione a letto</b>, peggiora quando dalla <b>posizione seduta passa alla posizione in piede</b>; risulta difficile stare in piedi per lungo tempo, sostenere il peso corporeo più su una gamba rispetto all’altra, salire le scale.</span></div>
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<span class="s1">La gravidanza, a seguito dell’espansione dell’osso pelvico per prepararsi al parto può infiammare la zona intorno alle articolazioni sacro-iliache.</span></div>
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<span class="s1">La <b>diagnosi</b> si effettua con delle manovre di stress per evocare il dolore, esami radiologici ed eventuali test ematochimici in caso si sospetti artrite reumatoide o altra patologia sistemica:</span></div>
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<a name='more'></a><span class="s1">Poiché il mal di schiena può essere causato da tanti diversi tipi di problemi, il medico può suggerire di utilizzare <b>infiltrazioni di anestestico per formulare una diagnosi</b>. Per esempio, se una iniezione di anestetico nel regione sacroiliaca ferma il dolore, è probabile che il problema sia proprio in quella determinata zona; <b><i>è possibile aggiungere corticosteroidi/ozono localmente per ridurre l'infiammazione e il dolore, è spesso sufficiente ripetere 2 o 3 infiltrazioni per risolvere per lungo tempo la sintomatologia dolorosa.</i></b></span></div>
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<span class="s1">In caso di sollievo dal dolore di breve durata è possibile effettuare le <b>Denervazione a Radiofrequenze</b>, una tecnica infiltrativa che <b>non prevede l’utilizzo di farmac</b>i ma di calore in grado di interrompere la trasmissione nervosa delle vie che conducono il segnale dalla zona di infiammazione ai centri nervosi superiori; è una <b>valida soluzione anche in pazienti che per motivi vari non possono effettuare infiltrazioni di cortisone</b></span></div>
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<span class="s1">Fondamentale per il successo delle procedure infiltrative di terapie del dolore è la “precisione del sito di infiltrazione”; fra le prime cause di insuccesso vi è, infatti, la incapacità di iniettare il farmaco o l’ozono nel sito di infiammazione; nel caso delle <b>Articolazioni Sacroiliache</b> è possibile eseguire le </span><span class="s2"><b><i>infiltrazioni con guida ecografica</i></b></span><span class="s1"> con una buona accuratezza in modo avere la certezza di raggiungere il sito di infiammazione intrarticolare; per avere il 100% di certezza o in caso di pazienti obesi (unico grande limite della tecnica ecoguidata) è possibile eseguire la procedura con l’ausilio di <b><i>tac o raggi x</i></b>. E’ ormai certo che infiltrare le articolazioni sacroiliache senza alcun sistema di visione porta ad un numero di fallimenti elevato ed inaccettabile.</span></div>
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<a href="https://4.bp.blogspot.com/-C3evkmW6WEs/VzinU__-NDI/AAAAAAAAFP4/mfjyGznziMwyL-clCmW1F7fQtsIJFpokQCKgB/s1600/Screenshot%2B2016-05-15%2B17.36.51.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="280" src="https://4.bp.blogspot.com/-C3evkmW6WEs/VzinU__-NDI/AAAAAAAAFP4/mfjyGznziMwyL-clCmW1F7fQtsIJFpokQCKgB/s400/Screenshot%2B2016-05-15%2B17.36.51.png" width="400" /></a></div>
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<div class="p1">
<span class="s1">Rimane ovvio che, come qualunque altro intervento rivolto alla risoluzione del dolore osteoarticolare, <b>è fondamentale che il paziente intraprenda un percorso di ginnastica postulare e fisioterapia</b> che serva a migliore la dinamica del bacino e della colonna vertebrale e che qualunque intervento infiltrativo non può “durare per sempre”</span></div>
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<span class="s1"><b></b></span><br /></div>
<div class="p3" style="text-align: center;">
<span class="s1"><b></b></span><br /></div>
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<span class="s1"><b>insomma…</b></span></div>
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<span class="s1"></span><br /></div>
<div class="p4" style="text-align: center;">
<span class="s1"><b>tutto noi non possiamo fare</b></span><br />
<span class="s1"><b><br /></b></span></div>
<div class="p4" style="text-align: center;">
<span class="s1"><b>e</b></span><br />
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<div class="p4" style="text-align: center;">
<span class="s1"><b>la migliore terapia del dolore rimane l’attività fisica !!!</b></span></div>
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<a href="https://files.acrobat.com/a/preview/1a6819fd-d216-4fa6-9724-f6f5e39d2b0e">Info - Prenotazioni - Dove </a></div>
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<a href="https://www.facebook.com/emanuelesbacchi.blogspot.it/reviews/">Vedi le recensioni </a></div>
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Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0Via De Spuches Giuseppe, 22, 90141 Palermo, Italia38.1249949 13.35065180000003738.124604399999996 13.350021300000037 38.1253854 13.351282300000037tag:blogger.com,1999:blog-5119449392101510707.post-4414050289515303892015-08-18T13:05:00.001+02:002015-08-18T13:05:57.697+02:00AIFA: Nota Informativa Importante su Diclofenac<div class="p1">
<br /></div>
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<a href="https://questaitalia.files.wordpress.com/2013/07/diclofenac.jpg?w=637&h=381" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="191" src="https://questaitalia.files.wordpress.com/2013/07/diclofenac.jpg?w=637&h=381" width="320" /></a></div>
<div class="p2" style="text-align: justify;">
<span class="s1">L'Agenzia Italiana del Farmaco rende disponibili nuove e importanti informazioni sulle modalità di utilizzo dei medicinali contenenti diclofenac ad uso orale senza obbligo di ricetta.</span></div>
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<span class="s1"></span><br /></div>
<div class="p2" style="text-align: justify;">
<span class="s1">Tali importanti informazioni di sicurezza fanno seguito alle conclusioni della Commissione Europea del 25 Settembre 2013 sul rischio cardiovascolare associato alla somministrazione di diclofenac.</span></div>
<div class="p4" style="text-align: justify;">
<span class="s1"></span><br /></div>
<div class="p2" style="text-align: justify;">
<span class="s1">Nello specifico, sebbene i dati indichino un <b><i>effetto dose-dipendente sul rischio trombotico associato all’uso di diclofenac, in particolare a dosi elevate</i></b>, è difficile stabilire una chiara dose limite oltre la quale i rischi aumentano in modo significativo.</span></div>
<div class="p4" style="text-align: justify;">
<span class="s1"></span><br /></div>
<div class="p2" style="text-align: justify;">
<span class="s1">Alcuni studi riportano un’associazione anche a dosi più basse. Sulla base dei dati finora disponibili, il Comitato di Valutazione dei Rischi per la Farmacovigilanza (PRAC) dell’EMA ha concluso che <b><i>non è possibile escludere il rischio trombotico cardiovascolare, tra tutte le dosi di diclofenac, soprattutto nei pazienti con co-morbilità preesistenti</i></b>.</span></div>
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<span class="s1"></span><br /></div>
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<span class="s1">Gli Operatori sanitari sono invitati ad informare i pazienti sulle nuove limitazioni d’uso che devono essere immediatamente attuate per i medicinali contenenti diclofenac ad uso orale senza obbligo di ricetta al fine di minimizzarne il rischio.</span></div>
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<span class="s1"></span><br /></div>
<div class="p2" style="text-align: justify;">
<span class="s1"><b><i>Le indicazioni prevedono di</i></b></span></div>
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<span class="s1"><b><i>non utilizzare il farmaco per curare l’influenza e gli stati febbrili</i></b></span></div>
<div class="p2" style="text-align: justify;">
<span class="s1"><b><i>non usarlo nei bambini al di sotto dei 14 anni</i></b></span></div>
<div class="p2" style="text-align: justify;">
<span class="s1"><b><i>non superare la dose massima giornaliera di 75 mg</i></b></span></div>
<div class="p2" style="text-align: justify;">
<span class="s1"><b><i>non superare i 3 giorni di terapia.</i></b></span></div>
<div class="p4" style="text-align: justify;">
<span class="s1"></span><br /></div>
<div class="p2" style="text-align: justify;">
<span class="s1">Inoltre, i pazienti devono essere sensibilizzati sull’importanza dell’appropriatezza di utilizzo di tali medicinali e sugli eventuali rischi cardiovascolari e gastrointestinali ad essi associati.</span></div>
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<span class="s1"></span><br /></div>
<div class="p2" style="text-align: justify;">
<span class="s1">Per maggiori informazioni leggi la Nota informativa Importante</span></div>
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<span class="s1"></span><br /></div>
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<span class="s1"></span><a href="https://files.acrobat.com/a/preview/d2b0f369-3dce-497d-a2ad-d79830eeae44" target="_blank">Scarica pdf</a></div>
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<span class="s1"></span><br /></div>
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<span class="s1">fonte aifa http://www.agenziafarmaco.gov.it/it/content/aifa-nota-informativa-importante-su-diclofenac#.VdL__7nJk_w.facebook</span></div>
Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-17071587854377881452015-08-18T09:47:00.000+02:002015-08-18T10:15:01.904+02:00Pet Therapy: definite le linee guida<div class="p3" style="text-align: left;">
<span class="s1"><b><i><br /></i></b></span></div>
<div class="p3" style="text-align: left;">
<span class="s1"><b><i>cane è il miglior amico dell’uomo e forse anche il suo miglior terapeuta</i></b></span></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.popsci.it/wp-content/uploads/2015/08/scott.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://www.popsci.it/wp-content/uploads/2015/08/scott.jpg" height="240" width="320" /></a></div>
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<span class="s1">Insieme a lui a dare più che un aiuto nei percorsi di guarigione di adulti e bambini ci sono anche gatti, cavalli, asini e conigli. È la Pet Therapy ed è molto di più che un piccolo sostegno a quattro zampe, è un processo di cura vero e proprio. Per questo arrivano le Linee Guida nazionali sugli interventi assistiti con gli animali (Iaa), Pet Therapy, per standardizzarne i protocolli e stabilire norme a tutela di animali e operatori.</span></div>
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<span class="s1"></span><br /></div>
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<span class="s1">Presentate all’Expo 2015 in occasione del convegno organizzato da Rete Italiana Iaa in collaborazione con il Ministero della Salute, Coldiretti e Codacons, nelle linee guida si definiscono le caratteristiche delle strutture dove la Pet Therapy può essere praticata, oltre ai requisiti sanitari e comportamentali degli animali, che devono essere sottoposti ad uno specifico percorso di addestramento che non deve ovviamente prevedere alcun metodo coercitivo, tutelando sempre il benessere degli animali stessi anche ”attraverso il rilievo di indicatori dello stress”.</span></div>
<div class="p6" style="text-align: justify;">
<span class="s1"></span><br /></div>
<div class="p5" style="text-align: justify;">
<span class="s1">Vengono poi indicati nel dettaglio i percorsi formativi per gli operatori, come veterinari e sanitari in equipe multidisciplinari: la formazione è erogata dal Centro di referenza nazionale per gli Iaa, dall’Istituto superiore di sanità (Iss) e dagli Enti accreditati. ”Con l’approvazione da parte della Conferenza Stato Regioni, lo scorso marzo, delle Linee Guida sugli interventi assistiti con gli animali – afferma il sottosegretario alla Salute Vito De Filippo – l’Italia pone una pietra miliare e si contraddistingue quale primo Paese al mondo ad avere stabilito una norma di riferimento nel contesto della mediazione uomo-animale”.</span></div>
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<span class="s1"></span><br /></div>
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<span class="s1">“Gli animali domestici – prosegue – possono svolgere un importante ruolo di mediatori nei processi terapeutico-riabilitativi ed educativi e il loro coinvolgimento, in ambito terapeutico, avrà sempre una maggiore diffusione uscendo dall’empirismo iniziale e seguendo sempre più un approccio scientifico”. Infatti, ”nonostante in Italia sia ancora esiguo il numero di pubblicazioni scientifiche sull’efficacia terapeutica degli interventi con gli animali, i risultati di vari progetti condotti con il Centro di referenza e con l’Iss ed i successi ottenuti in Centri di eccellenza, come l’Ospedale Meyer di Firenze e l’Ospedale Niguarda di Milano – conclude De Filippo – sono estremamente incoraggianti”.</span></div>
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<span class="s1"></span><br /></div>
<div class="p6" style="text-align: justify;">
<br /><span class="s1"></span></div>
<div class="p6" style="text-align: justify;">
<span class="s1"></span><a href="https://files.acrobat.com/a/preview/3933b211-f519-4866-878d-f5f90f0d66c8" target="_blank">Scarica pdf</a></div>
<div class="p7" style="text-align: justify;">
<span class="s1"></span><br /></div>
<br />
<div class="p8" style="text-align: justify;">
<span class="s1">fonte: http://www.popsci.it/pet-therapy-definite-le-linee-guida.html</span></div>
Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-8194040787079845042015-07-21T09:19:00.001+02:002015-07-21T09:19:17.429+02:00Cannabis: da droghe leggere danni pesanti<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.lastampa.it/rf/image_lowres/Pub/p3/2014/02/13/Italia/Foto/RitagliWeb/68c652117a992f456f2423c4dd36628a-kJoH-U10202578805091TpE-568x320@LaStampa.it.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://www.lastampa.it/rf/image_lowres/Pub/p3/2014/02/13/Italia/Foto/RitagliWeb/68c652117a992f456f2423c4dd36628a-kJoH-U10202578805091TpE-568x320@LaStampa.it.jpg" height="180" width="320" /></a></div>
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</w:wrap></v:imagedata></v:shape><span style="color: #323232; font-family: "Arial","sans-serif"; font-size: 13.0pt;">In realtà, “i danni provocati dalle cosiddette droghe leggere
sono molto pesanti”. A parlare è Umberto Tirelli, direttore del Dipartimento di
oncologia medica del Centro di ferimento oncologico di Aviano, bocciando senza
appello la proposta di legge bipartisan presentata da 218 parlamentari per
legalizzare la cannabis. Varie, spiega l’esperto, le ragioni a sostegno del ”no
alla legalizzazione”.<o:p></o:p></span></div>
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</w:wrap></o:lock></v:textpath></v:shadow></v:fill></v:shape><span style="color: #323232; font-family: "Arial","sans-serif"; font-size: 13.0pt;">Innanzitutto, chiarisce, ”la quantità di principio attivo della
cannabis è passata dal 5% degli anni ’70 al 50-80% di oggi. Non esistono
droghe leggere, e la cannabis superpotente, poiché modificata, è spacciata
soprattutto fra i giovani e giovanissimi che la usano senza sapere i rischi che
corrono”. Ed ancora ”a chi fuma marijuana, va detto che questa abitudine
danneggia gravemente i polmoni, aumenta il rischio di cancro, danneggia le
facoltà cognitive come l’attenzione e la memoria ed aumenta
conseguentemente il rischio di incidenti stradali”.<o:p></o:p></span></div>
<div style="background: white; line-height: 15.9pt; margin: 0cm 0cm 13.1pt; text-align: justify;">
<span style="color: #323232; font-family: "Arial","sans-serif"; font-size: 13.0pt;">Il punto, secondo Tirelli, è che ”nella nostra società si
è andata sempre più evidenziando una sorta di accettazione, quasi
ineluttabile, delle droghe in generale, basti pensare a quello che
è successo nello sport e all’uso degli anabolizzanti. Ma se esiste il fumo
di sigaretta e se esiste l’abuso dell’alcool, non e’ possibile accettare il
principio che per non fare delle differenze devono essere approvate anche la
marijuana e le altre droghe cosiddette leggere”.<o:p></o:p></span></div>
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</w:wrap></o:lock></v:textpath></v:shadow></v:fill></v:shape><span style="color: #323232; font-family: "Arial","sans-serif"; font-size: 13.0pt;">Inoltre, prosegue, ӏ ovvio che se il fumo di sigaretta provoca
ogni anno nel mondo un milione di tumori del polmone, il fumo delle droghe
leggere aggiunge solo altre vittime. Infatti, non è la nicotina che
provoca questi problemi, anche se è ovviamente alla base della dipendenza
che si crea fumando il tabacco, bensì i prodotti della combustione che
sono cancerogeni, ed è lo stesso processo che si verifica fumando
marijuana”. Il tutto con un’aggravante: ”la marijuana, a differenze del
tabacco, può provocare alterazioni cerebrali, senza escludere effetti a medio e
lungo termine sulla funzionalità del cervello stesso e sul sistema
immunitario”.<o:p></o:p></span></div>
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<span style="color: #323232; font-family: "Arial","sans-serif"; font-size: 13.0pt;">Insomma, conclude l’oncologo, ”bisogna combattere contro ogni
tipo di droga ed è senz’altro consigliabile che almeno i medici si
oppongano decisamente all’utilizzo delle droghe leggere da parte di chicchessia
e che i politici facciano in modo, con leggi adeguate, non di legalizzare le
droghe come vorrebbero fare oggi, ma di combattere il fenomeno senza fare
inutili distinzioni tra quello che viene considerato leggero o pesante. E’
soltanto dannoso”.<o:p></o:p></span></div>
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<span style="line-height: 115%; mso-bidi-font-size: 12.0pt;">Fonte:
http://www.popsci.it/cannabis-da-droghe-leggere-danni-pesanti.html</span><span style="line-height: 115%; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-53738187446556205272015-07-13T00:44:00.000+02:002015-07-15T10:44:31.613+02:00Dolore nei bambini? Lo misura l’algoritmo<h1 style="background: white; line-height: 22.5pt; margin: 0cm 0cm 0.0001pt; text-align: justify;">
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<a href="http://static.piusanipiubelli.it/articoliGallery/7878/480/img1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: justify;"><img border="0" src="http://static.piusanipiubelli.it/articoliGallery/7878/480/img1.jpg" height="212" width="320" /></a></div>
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<span style="color: #323232; font-family: "Arial","sans-serif"; line-height: 150%; mso-bidi-font-size: 10.5pt;">Il
dolore nei bambini è spesso difficile da quantificare, ma in aiuto
dei medici può essere usato l’algoritmo che permette ai computer di riconoscere
i volti opportunamente modificato. Lo ha dimostrato uno studio della San Diego
School of Medicine pubblicato dalla rivista<span class="apple-converted-space"> </span><em>Pediatrics</em>, secondo cui il
programma è in grado di dare una stima uguale a quella fatta dai genitori
e migliore di quella degli infermieri. Lo studio si basa su 50 bambini e
ragazzi tra i 5 e i 18 anni che si erano sottoposti ad appendicectomia in un
ospedale di San Diego.<o:p></o:p></span></div>
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<span style="color: #323232; font-family: "Arial","sans-serif"; line-height: 150%; mso-bidi-font-size: 10.5pt;">I ricercatori hanno filmato i
partecipanti in tre differenti visite post intervento, a 24 e 48 ore e a due
settimane, raccogliendo anche la stima del dolore provato dei pazienti, dei
genitori e di un infermiere. Il software, che si basa su 46 movimenti possibili
del volto, ha eseguito una stima del dolore provato su una scala da 1 a 10, che
poi è stata confrontata con le altre. “Di solito i genitori sono più
accurati dei medici nello stimare il dolore dei propri bambini – spiegano gli
autori – ma non sono sempre presenti. Il programma si è dimostrato bravo
quanto i genitori nel dare un voto al dolore, e migliore rispetto al personale
sanitario”.<o:p></o:p></span></div>
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<span style="font-size: small;"><i><span style="font-family: TimesNewRomanPSMT; line-height: 150%;"> </span></i><i style="line-height: 150%;"><span style="font-family: TimesNewRomanPSMT; font-weight: normal; line-height: 150%;"> </span></i><a href="https://files.acrobat.com/a/preview/1306b015-d671-4834-80c7-9a4a6dcf8930" style="font-family: TimesNewRomanPSMT; font-weight: normal; line-height: 150%;" target="_blank">---------> scarica pdf</a><span style="font-family: TimesNewRomanPSMT; font-style: italic; font-weight: normal; line-height: 150%;"> </span></span></h1>
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<i><span style="font-family: TimesNewRomanPSMT; font-size: 10pt; font-weight: normal; line-height: 150%;"> </span></i><i><span style="font-family: TimesNewRomanPSMT; font-size: 10pt; font-weight: normal; line-height: 150%;">Fonte: http://www.popsci.it/canali-medicina/dolore/dolere-nei-bambini-lo-misura-lalgoritmo.html</span></i></h1>
Anonymoushttp://www.blogger.com/profile/10259422690916079582noreply@blogger.com0tag:blogger.com,1999:blog-5119449392101510707.post-23901311982825997492015-07-07T13:15:00.002+02:002015-07-07T13:15:33.531+02:00Emicrania: prescrizioni inappropriate di oppiacei e barbiturici<br />
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</o:lock></v:path></v:stroke></v:shapetype><span style="color: #323232; font-family: "Arial","sans-serif"; line-height: 150%; mso-bidi-font-size: 10.5pt;">La prescrizione inappropriata di oppiacei e
barbiturici per il trattamento dell’emicrania è un fenomeno comune: lo ha
stabilito un recente studio che ha esaminato per primo le recenti statistiche
riguardo il consumo di questi farmaci su 217 pazienti che si sono presentati
all’osservazione in un centro cefalee.<o:p></o:p></span></div>
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<span style="color: #323232; font-family: "Arial","sans-serif"; line-height: 150%; mso-bidi-font-size: 10.5pt;">Secondo
Mina Minen della<span class="apple-converted-space"> </span><em>New York University</em>,
autrice dello studio, questi risultati sono sorprendenti in quanto le attuali
linee guida indicano che questi farmaci non siano raccomandati come trattamento
di prima linea per le cefalee primarie, ma essi sono ancora usati da un
sostanziale numero di pazienti. Diverse società specialistiche hanno editato
raccomandazioni che sconsigliano l’uso indiscriminato di oppiacei o barbiturici
per il trattamento dell’emicrania, consigliando invece i triptani come
trattamento di prima linea per le emicranie moderate-gravi ed i FANS per
cefalee più lievi. Altrettanto sorprendente è stata la durata per cui molti
pazienti hanno ricevuto oppiacei o barbiturici, dato che un quarto di essi ha
riportato di averli assunti per più di 2 anni. Un documento edito dall’<em>American Academy of Neurology</em><span class="apple-converted-space"> </span>ha dichiarato che non sussistono
evidenze sostanziali a supporto dell’impiego a lungo termine degli oppiacei e
che esso comporta gravi rischi di overdose e dipendenza. Secondo alcuni
esperti, peraltro, oppiacei e barbiturici risultano inappropriati per questi
pazienti anche perché essi inducono cefalee ancora più frequenti se assunti in
eccesso. </span><span lang="EN-US" style="color: #323232; font-family: "Arial","sans-serif"; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 10.5pt;">(<em>American Headache Society (AHS) 57th
Annual Scientific Meeting</em>. Abstract PF01, presentato il 19/6/2015)<o:p></o:p></span></div>
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<a href="https://files.acrobat.com/a/preview/7c75ddec-f4ee-4353-b93a-740d3375d63a" target="_blank">Scarica pdf ----- ></a></div>
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<i><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Fonte: http://www.popsci.it/canali-medicina/dolore/emicrania-prescrizioni-inappropriate-di-oppiacei-e-barbiturici.html</span></span></i></div>
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