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      • SCOPUSKCI등재

        Correlation between Epidurographic Contrast Flow Patterns and Clinical Effectiveness in Chronic Lumbar Discogenic Radicular Pain Treated with Epidural Steroid Injections Via Different Approaches

        Gupta, Ruchi,Singh, Saru,Kaur, Sukhdeep,Singh, Kulvinder,Aujla, Kuljeet The Korean Pain Society 2014 The Korean Journal of Pain Vol.27 No.4

        Background: Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement. Methods: Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results: The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions: The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.

      • SCOPUSKCI등재

        Correlation between Epidurographic Contrast Flow Patterns and Clinical Effectiveness in Chronic Lumbar Discogenic Radicular Pain Treated with Epidural Steroid Injections Via Different Approaches

        ( Ruchi Gupta ),( Saru Singh ),( Sukhdeep Kaur ),( Kulvinder Singh ),( Kuljeet Aujla ) 대한통증학회 2014 The Korean Journal of Pain Vol.27 No.4

        Background: Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement.Methods: Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results: The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions: The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom. (Korean J Pain 2014; 27: 353-359)

      • KCI등재후보

        Cryptanalysis of an `Efficient-Strong Authentiction Protocol (E-SAP) for Healthcare Applications Using Wireless Medical Sensor Networks`

        ( Muhammad Khurram Khan ),( Saru Kumari ),( Pitam Singh ) 한국인터넷정보학회 2013 KSII Transactions on Internet and Information Syst Vol.7 No.5

        Now a day, Wireless Sensor Networks (WSNs) are being widely used in different areas one of which is healthcare services. A wireless medical sensor network senses patient`s vital physiological signs through medical sensor-nodes deployed on patient`s body area; and transmits these signals to devices of registered medical professionals. These sensor-nodes have low computational power and limited storage capacity. Moreover, the wireless nature of technology attracts malicious minds. Thus, proper user authentication is a prime concern before granting access to patient`s sensitive and private data. Recently, P. Kumar et al. claimed to propose a strong authentication protocol for healthcare using Wireless Medical Sensor Networks (WMSN). However, we find that P. Kumar et al.`s scheme is flawed with a number of security pitfalls. Information stored inside smart card, if extracted, is enough to deceive a valid user. Adversary can not only access patient`s physiological data on behalf of a valid user without knowing actual password, can also send fake/irrelevant information about patient by playing role of medical sensor-node. Besides, adversary can guess a user`s password and is able to compute the session key shared between user and medical sensor-nodes. Thus, the scheme looses message confidentiality. Additionally, the scheme fails to resist insider attack and lacks user anonymity.

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