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ARC (ARACHNOIDITIS) NEWSL=
ETTER
Volume7, No.1,=
Winter
of 2008
Published by the
Arachnoiditis Foundation, Inc.
A Non-Profit Organization created for the Study of the Causes, the Diagnosis and the Treatment of ARACHNOIDITIS.
FROM
THE EDITOR’S DESK
Dear patients and friends o= f the ARACHNOIDITIS FOUNDATION, as we approach the end of this 2008 year we can definitely say that it has been a year of achievement in the Foundation.
I am proud to inform all th= ose included in the Arachnoiditis Community that with the intention of advancing the knowledge and understanding of ARACHNOIDITIS as a disease, the second edition of the first publication is undergoing the final Editorial review a= nd there are plans to have it “in print” by the end of January 2009.
List of cha=
pters of “ARACHNOIDITIS: THE EVIDENCE REVEALED”
SECTION I. GENESIS OF
KNOWLEDGE ABOUT ARACHNOIDITIS
Chapter 1 &= nbsp; History and Evolution
SECTION II. BASIC CON=
CEPTS
ABOUT ARACHNOIDITIS
Chapter 2 &n= bsp; = ; Anatomical features in the spine related to Arachnoiditis
Chapter 3 = Ultramicroscopic Anatomy
Chapter 4 = = Physiopathology of Pain
Chapter 5 = = Inflammation and the Immune Response
SECTION III. ARACHNOI=
DITIS
CAUSED BY NON-INVASIVE PROCEDURES
Chapter 6 = = Genetics and Arachnoiditis
Chapter 7 &= nbsp; Cy= sts around the Dural Sac
Chapter 8 &= nbsp; In= fections
Chapter 9 = = Ischemia
Chapter 10 &= nbsp; Trauma
Chapter 11 &= nbsp; Cerebral Arachnoiditis
Chapter 12 &= nbsp; Tumors, Radiation and Chemotherapy
Chapter 13 &= nbsp; Spinal Stenosis
SECTION IV. ARACHNOID=
ITIS
RELATED TO OPERATIVE PROCEDURES
Chapter 14 &= nbsp; Failed Back Surgery Syndrome
Chapter 15 &= nbsp; Herniated Nucleus Pulposus
Chapter 16 &= nbsp; Dural Sac Deformities
Chapter 17 &= nbsp; Syringomyelia<= /p>
Chapter 18 &= nbsp; Foreign Body Reaction
Chapter 19 &= nbsp; Cauda Equina Syndrome
Chapter 20 &= nbsp; Blood in the Subarachnoid Space
Chapter 21 &= nbsp; Indurated Arachnoiditis
SECTION V. ARACHNOIDI=
TIS
RELATED TO ANESTHESIA
Chapter 22 &= nbsp; Spinal Anesthesia
Chapter 23 &= nbsp; Epidural Anesthesia
Chapter 24 &= nbsp; Combined Spinal-Epidural Anesthesia
Chapter 25 &= nbsp; Toxicity of Local anesthetics
Chapter 26 &= nbsp; Obstetric Anesthesia
Chapter 27 &= nbsp; Dural Punctures and Epidural Blood Patches
SECTION VI.
ARACHNOIDITIS FROM INTERVENSIONISM
Chapter 28 &= nbsp; Interventions for Pain Relief
Chapter 29 &= nbsp; Epidural Corticosteroids
Chapter 30 &= nbsp; Neurolytics
Chapter 31 &= nbsp; Infections from Interventionism
Chapter 32 &= nbsp; Granulomas
Chapter 33 &= nbsp; Myelography
SECTION VII. THE DIAG=
NOSIS
Chapter 34 &= nbsp; Clinical Diagnosis
Chapter 35 &= nbsp; A Cohort of patients with Arachnoiditis
Chapter 36 &= nbsp; Other Diagnostic Approaches
Chapter 37 &= nbsp; Radiological Diagnosis
Chapter 38 &= nbsp; Prognosis
SECTION VIII. TREATME=
NTS
Chapter 39 &= nbsp; Opiates
Chapter 40 &= nbsp; Conventional Medications
Chapter 41 &= nbsp; Non-Conventional Therapies
Chapter 42 &= nbsp; Epidural infusions an intrathecal infusions
SECTION IX. WELL BEIN=
G
Chapter 43 &= nbsp; Surgery indicated in Arachnoiditis
Chapter 44 = Spinal Cord Stimulation
Chapter 45 &= nbsp; Physical fitness
Chapter 46 = ; Nutrition in chronic inflammatory disease
Chapter 47 &= nbsp; Vitamin D’s role in autoimmunity
Chapter 48 &= nbsp; The Pain Diet
SECTION X. INTERACTIO=
N WITH
PATIENTS
Chapter 49 &= nbsp; Arachnoiditis and the Internet
Chapter 50 &= nbsp; Patients Opinions, Poems and Experienc= es
SECTION XI. DO WE HAV=
E THE
CURE?
Chapter 51 &= nbsp; Treatment of the acute phase of Arachnoiditis
With the appropriate title = of “ARACHNOIDITIS: the evidence revealed”, <= span style=3D'mso-spacerun:yes'> it can be stated, without doubt, th= at this is a completely new volume, almost twice as large as the first edition, it = is indeed a complimentary continuation of the “ARACHNOIDITIS: the silent epidemic”. This time, a number of motivated, informed and inspired co-authors have con= tributed to make this a masterpiece of current information.
Searching for references in= the medical literature, it was amazing to find the enormous bulk of information= that has been either generated on arachnoiditis itself, as well as in some relat= ed conditions such as syringomyelia, intrathecal cysts, Chiari syndrome, increased pressu= re in the subarachnoid space, dural sac deformities, granulomas at the tip of catheters = and as I suspected before, all of them have an initiating process, INFLAMMATION of the arachnoid. Emphasis was give= n to the treatment of the acute phase of ARC. <= /p>
With nearly 100 histological microphotographs, over 250 radiological images, many drawings, tables and schematic representations the book has been illustrated so the concepts can= be better understood.
N=
ew
concepts about neuropathic pain, genetics, mechanisms of injury (pharmacolo=
gical
as well as traumatic), a treatment protocol for the acute phase of ARC has =
been
developed and is now in clinical trials and available to any physician who =
may
have a patient with neurological deficits or an early diagnosis of Arachnoiditis, prefer=
ably
before 90 days from the injurious event.
<= o:p>
S= till prevention is the best approach to avoid this disease. Invasive spinal procedures= , are not the only, but they are the main cause of cases of Arachnoiditis these d= ays, followed by epidural and or spinal procedures and injections.
Among many achievements, af=
ter
studying phenol and kaolin, we have develo=
ped
the experimental model of arachnoiditis by injecting methylene blue in rats,
intrathecally. So, we can now proceed to evaluate proposed treatments.
A protocol to treat Arachno= iditis in the first stage (inflammatory phase) has been developed and it has helpe= d in many instances, as long as it is administered in its entirety before 90 days from the injurious event. Clinical trials are in process. Caution: this approach is not advised in ca= ses of recurrent herniated discs, loose discs fragments in the vertebral canal, or when the diagnosis of expanding epidural hematoma has been reached. In any case, an early MRI is indica= ted. Currently, the treatment protocol has been suggested to the treating physic= ian who has the last word on it.
The feasibility to treat so= me patients that are in the chronic (proliferative phase) is still a chimera, various attempts are in progress but by all means, no more injury is to be caused by invading the dural sac, while attempting to separate the nerve ro= ots. The disease is by far more complex. Other treatments without the potential = of exacerbation of symptoms are in progress.
PUBLICAT=
IONS
AND PRESENTATIONS AT CONGRESSES.
In the p= rocess of informing the medical community, the following publications were partial= ly or totally sponsored by the ARACHNOIDITIS FOUNDATION, Inc.
PUBLISHED MANUSCRIPTS, ABSTRACTS AND CHAPTERS 2006-2008
Aldrete JA: Suspect= ing and diagnosing arachnoiditis: A review of the symptoms noted in a group of pati= ents with arachnoiditis presents an analysis of clinical observations of this disease. Practical Pain Management<= /i> 2006:6:1:72-83.
Guevara-Lópe= z U, Covarrubias-Gómez A, Gutierrez-Acar H, Aldrete JA, López-Múnoz FJ, Martínez-Benítez B: Chronic Subarachnoid administration of 1-(4chlorobenzoyl)-5methoxy-2methyl-1H-indol= e-3 Acetic Acid (indomethacin): An evaluation of its neurotoxic effects in an animal model. Anesth Analg 2006;103:1:99-102.
Aldrete JA: Publicando contribuciones científicas en españ=
;ol:
¿sueño efímero o posible realidad? Rev Arg Anest 2006:64:2:86-101.
Aldrete JA: Letter to the=
Editor.
The Posterior Epdiural Space Is Largest at the Level of the Disc. Anesth An=
alg
2006:103:3:781-3.
Aldrete JA, Romero-Figuer= oa MS, Ghaly RF: Potential hazards of vertebroplasty. Practical Pain Management 2006:6:5:20-27.
Aldrete JA, Guevara U, Arenoso JH, Ceraso OL: Eficacia y tolerabilidad =
de
esteroides epidurales vs. Dosis bajas de esteroides mas metamizol mas
D-propoxifeno administrados por vía paravertebral en pacientes con
síndrome post-laminectomía. Rev
Soc Esp Dolor 2006:7:454-461.
Aldrete JA, Vascell=
o LA,
Aldrete JA, Guevara=
U,
Ceraso OL, Arenoso HJ: “ESI vs Paravertebral Reduced Steroids, Dipiro=
na
and Propoxyphene for Postlaminectomy Syndrome.” ASA Annual Meeting,
Romero-Figueroa S, Aldret= e JA, Martínez-Cruz A, Orozco S, Castillo S, Castillo-Henkel C, Guízar-Sahagún G: Nerve root degeneration and regeneration by intra-thecal phenol in rats; a morphologic approach. J of the Peripheral Nervous System 2006:11:1-8.
Rios Girard JJ, Aldrete JA: Consideraciones sobre la palabra algologia.= Rev Iberoamericana del Dolor 2007:3:7-11.
Aldrete JA: Arachnoiditis= and Related Conditions. In: Pain Management. Ed. Steven D. Waldman. Elsevier, 2= 007, pp 791-9.
Aldrete JA: Failed Back S= urgery Syndrome. In: Pain Management. Ed. Steven D. Waldman. Elsevier, 2007, pp 817-30.
Aldrete JA: Letter to the Editor “Neurological deficit after thoracic epidural catheter
Insertion.”&nbs=
p;
Acta Anaesthesiol Scand 2008, accepted for publication.
Also the following presen= tations were totally or in part sponsored by the ARACHNOIDITIS FOUNDATION, Inc.
LECTURES AND PRESENTATIONS BY
DR. J. ANTONIO ALDRETE 2006-2008
Alteraciones
postquirugicas en el saco dural y dolor”. Curso de Postgrado para
especialistas (Algología), Instituto Nacional de Ciencias Medicas y
Nutricion Salvador Zubirán, México D.F., México, Janua=
ry
11, 2006.
“Can Anesthesiologists Identi=
fy
Lumbar Discopathy in MRI’s That Would Indicate ESI? ASA Annual Meeting,
“ESI vs Paravertebral Reduced Steroids,
Dipirona and Propoxyphene for Postlaminectomy Syndrome. ASA Annual Meeting,
“Failed Back Surgery Syndrome=
: The
New Challenge in Pain Management”
ASA Annual Meeting,
“Complicaciones Neuroaxiales =
de los
Anestésicos Locales”. El Colegio de Anestesiologos del Estado =
de
Chihuahua, A.C., Chihuahua, Mexico, May 25, 2007.
“Síndrome de cirugia fallida y abor=
daje
del Algólogo”. 9 Aniversario Jornadas Medicas Avances del Nuevo
Milenio. CIMA, Chihuahua,
Mexico, May 26, 2007.
Riesgo de déficit neurológico por
anestesia neuroaxial.” 36 Congreso Argentino de Anestesilogía,=
IV
Encuentro Latinoamericano de Anestesiología Pediátrica, Salta,
Argentina. September 27, 2007=
.
“Etiologia de los deficits neurologicos por
bupivacaina intrathecal: dosis o baricidad.”
XXIX Congreso Latinoamericano de Anestesiologia,=
XLI
Congreso Mexicano de Anestesiologia, IV Congreso Iberolatinoamericano,
Cancún, Quintana Roo, México, November 22, 2007.
“Complicaciones neurologicas epidemiologia=
de
la Aracnoiditis posterior a bloqueo espinal.” XXIX Congreso
Latinoamericano de Anestesiologia, XLI Congreso Mexicano de Anestesiologia,=
IV
Congreso Iberolatinoamericano, Cancún, Quintana Roo, México,
November 24, 2007.
“Complicaciones postcirugia de columna.=
221;
3er Simposio Internacional para Especialistas. Juriquilla, Querétaro,
México. July 11-13, 2008.
“Aracnoiditis.” 3er Simposio
Internacional para Especialistas. Juriquilla, Querétaro, Méxi=
co.
July 11-13, 2008.
“Déficit neuroló=
;gico
post anestesia subarcnoidea, con el uso de altas dosis soluciones
hiperbáricas." 37o Congreso Argentino de
Anestesología VIII Panamerican Symposium of Regional Anestesia ̵=
1;
LASRA, Buenos Aires, Argentina, August 16, 2008.
“Cloroprocaína al 3% neuroaxial
¿Solución o inconveniente?” 37o Congr=
eso
Argentino de Anestesología VIII Panamerican Symposium of Regional
Anestesia – LASRA, Buenos Aires, Argentina, August 16, 2008.
Cefalea postpunción dural.” XXI Curso Internacional de
Actualización en Anestesiología. Puebla, México, August
30, 2008.
“Déficits
neurológicos post-anestesia obstétrica.” XXI Curso Internacional de
Actualización en Anestesiología. Puebla, México, August
30, 2008.
“Aracnoiditis en Anestesia Obstétri=
ca.” XXI Curso Internacional de
Actualización en Anestesiología.
“Intrathecal injection of meytheylen blu=
e in
rats as experienmental model for arachnoiditis (ARC)”. ASA Annual Meeting,
=
“Timing
of early treatment of neurological deficits post intervention and operative
spinal procedures”. ASA Ann=
ual
Meeting,
CALL FOR DONATION=
S TO
THE FOUNDATION IN ORDER TO CONTINUE TO FUND RESEARCH AND INFORMATION ABOUT
ARACHNOIDITIS.
To be able to continue these investigative activities = which have shown to be promising The ARACHNOIDITIS FOUNDATION Inc. needs your hel= p. The Donations by patients, relatives and friends of patients, as well as sympathetic charities are used in their entirety to fund research, to promo= te knowledge and to advance the treatment of ARACHNOIDITIS.
Please SEND your DONATIONS to
ARACHNOIDITIS FOUNDATION, Inc.
All donations to the Arachnoiditis Foundation, Inc. ar=
e tax
deductible.
Best wishes for happy holidays and why not, a Merry Christmas from all of us in the FOUNDATION.
Bright stars Falling snow=
Warm hearts<=
o:p> May these si=
mple
joys be yours this holiday. wishing you =
a &n=
bsp;
New Year filled with =
new hope, new joy and =
new
beginnings.
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The hopes of many patients suffering from Arachnoiditi= s are perhaps better expressed in this pyramid of phrases that my patients have shared with me, a confidence that I have treasured for their meaning and sentiment:
*
I wish
I could
Get back my life.
Walk beyond the mailbox.
Not be depressed and lonely.
To have sex without pain. Not sweat all the time.
Be able to go back to work. Get out of bed feeling normal.
Get off from all these medicines. Play with my kids as I used =
to.
Hope for something good for a change. Be able to pick up and carry my
grandchildren.
Not to be embarrassed by my bladder malfunctioning.
Be able to walk through a shopping mall and enjoy it.=
Sleep a whole night and wake up wi=
thout
hurting.
We at the Foundation have continued to gradually elimi= nate this despair and hopelessness; we shall overcome for the sake of every pati= ent.
For more information visit our WEB SITE www.arachnoiditis.com , read the issues of our ARACHNOIDITIS NEWSLETTER, or contact me at my e-mail aldrete@arachnoiditis.com
Your tax deductible contribu=
tion to
the Arachnoiditis Foundation, Inc. will allow us to learn more about
arachnoiditis so we can eventually prevent it and treat it.
CALL FOR WRITTEN CONTRIBUTION=
S
As in the past, we invite contributions by physicians, patients, relatives of patients, therapists on subject related to ARACHNOIDITIS, specially their impressions, experiences = and sacrifices as they help or care for this patients.
CALL FOR LETTERS, ARTICLES, CONFESSIONS POEMS, DEBATES, e=
tc.
Readers are invited to write short, but meaningful, ar= ticles on any subject related to Arachnoiditis.&n= bsp; They may be submitted with the author’s name or anonymously, however, with the understanding that:
a. = The Editorial Board reserves the right to modify them or alter them to conform = with the style and the ”Objectives” of the ARC Newsletter.
b. The copyrights will be waived with the assurances that the Editorial Board will= not derive any profit from any of these publications.
c. = They are simple, constructive and civil.
Thank you.
The Editorial Board
DISCLAIMER
Personal information (e-mail, location, etc) on the au= thors of reports will be made available upon request, as long as the authors auth= orize it. The editors are entitled = to modify the material so it can comply with the objectives of the Newsletter.=
Neither the Arachnoiditis Foundation, Inc, nor the Edi= tors of the Newsletter are responsible for the opinions or concepts herein expressed. They represent the author’s point of view.
Arachnoiditis Foundation, Inc.
E-mail: a= ldrete@arachnoiditis.com
PLEASE GIVE YOUR DONATION WHICH WILL HELP=
TO
LEARN MORE ABOUT ARACHNOIDITIS.
“WITH GREATER HELP, WE CAN DO MORE&=
#8221;