The influence of working conditions in the basic branches of animal husbandry on the nosological structure of occupational morbidity of workers

On the basis of updated data, the influence of working conditions on the nosological structure of professional morbidity of workers in the basic branches of animal husbandry of the Russian Federation is analyzed. In total, from 2011 to 2017, occupational diseases were detected in 823 livestock workers, who received 881 diagnoses, of which the share of cattle breeders, poultry breeders and pig breeders accounted for 95,0, 3,4 and 1,6 % of cases, respectively. Harmful labor factors that cause the formation of professional pathology in livestock breeders were: physical overload (64,6 %), industrial contact with cattle infected with Brucella abortus bovis (32,6 %) and the presence of dust in the work area containing toxic chemicals and aggressive biological mixes (2,3 %). A high etiopathogenetic relationship between the nosological form of the disease and working conditions in the profession was revealed. In livestock workers, occupational diseases were formed under the influence of physical overloads (64,6 %) and infection with the brucellosis pathogen (34,6 %); in pig farming, as a result of the severity of labor (84.5 %) and air pollution of the working area with dust, chemical toxicants and biologically active substances (7,7 %); in poultry farming, occupational health risk was associated with allergization of working with poultry products (50 %) and physical overloads (42,9 %). In the nosological spectrum of accumulated occupational diseases of livestock workers, the first rank places were occupied by residual brucellosis (32,6 %), radiculopathy of the cervical and lumbo-sacral levels (25,8 %), mono- and polyneuropathy (25,2 %), arthrosis and polyarthrosis (8,2 %), shoulder and shoulder periarthrosis (5,4 %). In poultry workers ¾ respiratory diseases: allergic bronchial asthma (39,3 %), allergic rhinopharyngitis (10,7 %) and cervical and lumbo-sacral radiculopathy (21,4 %). Pig workers were mainly diagnosed with cervical and lumbo-sacral radiculopathy (46,2 %), mono- and polyneuropathy (23,1 %), shoulder periarthrosis (15.4 %).

Pelvic Neuralgias by Neuro-Vascular Entrapment: Anatomical Findings in a Series of 97 Consecutive Patients Treated by Laparoscopic Nerve Decompression

Background: Some patients have pelvic, pudendal, or low lumbar pain radiating into the legs that is worse while sitting but differs from pudendal neuralgia. The purpose of this study was to present a new clinical entity of neuropathic pelvic pain by pelvic neuro-vascular entrapment. Objectives: To report about the locations of predilection for pelvic neurovascular entrapment. Study Design: Prospective cohort pre- and post-intervention. Setting: University referral unit specializing in advanced gynecological surgery and neuropelveology. Methods: Patients, Intervention: In a prospective study, 97 patients presenting with intractable pelvic neuropathic pain (pudendal pain, gluteal pain, vulvodynia, coccygodynia, and sciatic pain) underwent laparoscopic exploration with decompression of compressed pelvic somatic nerves. The population included 76 (78.3%) women and 21 men. Indication for laparoscopic exploration of pelvic nerves suspected to be involved in pain has been indicated after neuropelveological work up, pelvic neuromagnetic resonance imaging (MRI) and Doppler-sonography. Pain evolution was recorded over 2 years after the procedure. Measurements and Main Results: Three entities were isolated: pudendal neuralgie by compression at the less sciatic notch, sacral radiculopathy at S2-4 by compression at the infracardinal level of the sacral plexus, and sciatica L5-S1/2 by compression at the greater sciatic notch. Pain was worse sitting (98%), during menstrual bleeding in women, and during Valsalva maneuver, but the pain did not wake the patients up at night and was not accompanied by neurologic dysfunctions. A decrease in VAS scores (> 50%) at 2 years follow-up was observed in 86 patients (88.6%). Conclusions: Neuro-vascular entrapment is a pathophysiologic phenomenon implicated in several pelvic neuropathies. The most common are L5-S1 sciatica, pudendal neuralgia, and sacral radiculopathy. After intraoperative confirmation, laparoscopic exploration of the entire sacral plexus is essential to diagnose conflict. Laparoscopic decompression is a treatment of choice, based on the separation of the offending vessel from the nerves. Those procedures are safe, with a high success rate; the neuropelveological approach is essential in order to obtain good treatment results. The laparoscopic approach gives the possibility of reducing morbidity and improving results by providing wider insight into the operating field with smaller intraoperative injury. Key words: Vulvodynia, coccygodynia, chronic pelvic pain, pudendal pain, neuro-vascular conflict

Successful operative management of an upper lumbar spinal canal stenosis resulting in multilevel lower nerve root radiculopathy

ABSTRACTLumbar stenosis is a common disorder, usually characterized clinically by neurogenic claudication with or without lumbar/sacral radiculopathy corresponding to the level of stenosis. We present a case of lumbar stenosis manifesting as a multilevel radiculopathy inferior to the nerve roots at the level of the stenosis. A 55-year-old gentleman presented with bilateral lower extremity pain with neurogenic claudication in an L5/S1 distribution (posterior thigh, calf, into the foot) concomitant with dorsiflexion and plantarflexion weakness. Imaging revealed grade I spondylolisthesis of L3 on L4 with severe spinal canal stenosis at L3-L4, mild left L4-L5 disc herniation, no stenosis at L5-S1, and no instability. EMG revealed active and chronic L5 and S1 radiculopathy. The patient underwent bilateral L3-L4 hemilaminotomy with left L4-L5 microdiscectomy for treatment of his L3-L4 stenosis. Postoperatively, he exhibited significant improvement in dorsiflexion and plantarflexion. The L5-S1 level was not involved in the operative decompression. Patients with radiculopathy and normal imaging at the level corresponding to the radiculopathy should not be ruled out for operative intervention should they have imaging evidence of lumbar stenosis superior to the expected affected level.