John F. Hamer

Background: Elevated lipase is considered an important biomarker for pancreatitis. The aim of this study was to assess a potential correlation between elevated lipase and characteristic imaging findings, as per the well-established Modified CT Severity index (MCTSI). Materials and methods: This retrospective, single centre cohort study reviewed the radiologic findings and medical records of 200 consecutive patients with elevated lipase values. Subgroups were then created categorizing patients into low lipase elevation, medium lipase elevation, and high lipase elevation groups. CT exams evaluated by a single fellowship trained radiologist was used to establish MCTSI criteria. Results: Statistical significance was calculated by an independent statistician using a linear regression model which demonstrated a statistically significant correlation between the high lipase group, (>= 600 U/L) and MCTSI with p-value of < 0.05. No significant correlation existed between MCTSI and lipase values below 600 U/L. Conclusions: The previously held notion that lipase values do not correlate with severity of pancreatitis does not hold true for lipase values >= 600 U/L. This suggests a likelihood of higher morbidity and may justify earlier use of contrast enhanced CT imaging in patients with pancreatitis whose lipase values are > 600 U/L. This needs to be further validated with a multisite blinded prospective study.

Objective: This article investigates the degree and duration of pain relief from cervicogenic headaches or occipital neuralgia following treatment with radiofrequency ablation of the C 2 dorsal root ganglion and/or third occipital nerves. It also addresses the procedure's complication rate and patient's willingness to repeat the procedure if severe symptoms recur. Methods: This is a single‐center retrospective observational study of 40 patients with refractory cervicogenic headaches and or occipital neuralgia. Patients were all referred by a headache specialty clinic for evaluation for radiofrequency ablation of the C 2 dorsal root ganglion and/or third occipital nerves. After treatment, patients were followed for a minimum of 6 months to a year. Patient demographics and the results of radiofrequency ablation were recorded on the same day, after 3‐4 days, and at 6 months to 1 year following treatment. Results: Thirty‐five percent of patients reported 100% pain relief and 70% reported 80% or greater pain relief. The mean duration of improvement is 22.35 weeks. Complication rate was 12‐13%. 92.5% of patients reported they would undergo the procedure again if severe symptoms returned. Conclusions: Radiofrequency ablation of the C 2 dorsal root ganglion and/or third occipital nerve can provide many months of greater than 50% pain relief in the vast majority of recipients with an expected length of symptom improvement of 5‐6 months.