Follow-up status of patients treated with nerve blocks for low-back pain.
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One hundred fifty-one (151) outpatients treated with epidural or subarachnoid blocks for low-back pain not due to malignancy were questioned by mail one to two years after treatment to assess their current functional status as compared with that at the time of treatment. The results emphasize the importance of bothe gender-associated differences in life functioning and the circumstances of pain onset, while supporting the proposition that nerve-block treatment of low-back pain is useful, particularly so since the majority were cases of chronic pain. The findings also emphasize the complexity of factors in the total treatment situation, the operation of psychologic, social and economic forces in determining the outcome of treatment, and the need for detailed criteria in studies evaluating treatment effects. (Key words: Pain, low-back; Anesthetic techniques, therapeutic; Anesthetic techniques, spinal; Anesthetics techniques, peridural.) (+info)
THE TREATMENT OF COCCIDIOIDAL MENINGITIS. THE USE OF AMPHOTERICIN B IN A GROUP OF 25 PATIENTS.
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In a study of 25 patients the usefulness of amphotericin B in the control of meningeal infection produced by Coccidioides immitis was established. Initial treatment must be intensive, consisting of intravenous and intraspinally administered amphotericin B. Serologic evaluation of coccidioidal disease provides the most important single criterion for determining the course of the meningeal infection and for estimating the response of the patient to amphotericin B therapy. Final control of coccidioidal meningitis rests upon the prevention of relapse after completion of initial intensive therapy. This requires continued suppressive fungistasis by regular intracisternal injections of amphotericin B at intervals of three to seven days after the patient returns home. Such suppressive cisternal therapy does not replace the initial intensive use of both intravenously and intraspinally administered amphotericin B. This "local" type of inhibition of C. immitis is without toxic effect upon the kidney, the red blood cells or the serum potassium values which may be associated with the intravenous administration of amphotericin B. Such intraspinal therapy, by lowering the total intravenous dosage required in the initial phase of treatment, results in a proportionate decrease in the degree of nephrotoxicity produced by amphotericin B. The total intravenous dosage given ordinarily should not exceed 5 grams. The long-term therapeutic plan as outlined permits the development of an adequate immune mechanism that appears essential to complete recovery from coccidioidal meningitis. The importance of such immunity in the recovery process has been previously indicated and confirmed by detailed study of a patient who required immunosuppression for successful homotransplantation of a kidney. (+info)
Effect of intrathecal tramadol administration on postoperative pain after transurethral resection of prostate.
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BACKGROUND: Tramadol administered epidurally has been demonstrated to decrease postoperative analgesic requirements. However, its effect on postoperative analgesia after intrathecal administration has not yet been studied. In this double-blind, placebo-controlled study, the effect of intrathecal tramadol administration on pain control after transurethral resection of the prostate (TURP) was studied. METHODS: Sixty-four patients undergoing TURP were randomized to receive bupivacaine 0.5% 3 ml intrathecally premixed with either tramadol 25 mg or saline 0.5 ml. After operation, morphine 5 mg i.m. every 3 h was administered as needed for analgesia. Postoperative morphine requirements, visual analogue scale for pain at rest (VAS) and sedation scores, times to first analgesic and hospital lengths of stay were recorded by a blinded observer. RESULTS: There were no differences between the groups with regard to postoperative morphine requirements (mean (SD): 10.6 (7.9) vs 9.1 (5.5) mg, P=0.38), VAS (1.6 (1.2) vs 1.2 (0.8), P=0.18) and sedation scores (1.2 (0.3) vs 1.2 (0.2), P=0.89). Times to first analgesic (6.3 (6.3) vs 7.6 (6.2) h, P=0.42) and length of hospital stay (4.7 (2.8) vs 4.4 (2.2) days, P=0.66) were similar in the two groups. CONCLUSION: Intrathecal tramadol was not different from saline in its effect on postoperative morphine requirements after TURP. (+info)
Ununsual manifestations of neurocysticercosis in MR imaging: analysis of 172 cases.
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PURPOSE: The typical manifestations of neurocysticercosis are described widely in the literature. The purpose of this study is to demonstrate the uncommon presentations of different forms of neurocysticercosis in MR imaging. METHOD: A retrospective analysis of 172 cases of neurocysticercosis in MR studies was carried out over a period of 13 years. One hundred and four males and 68 females with a mean age of 32 3.7 years were studied. The studies were performed on 1.5 T GE MR units and T1 was used before and after gadolinium injection, T2 and gradient-echo (T2*) sequences. RESULTS: The authors divided the unusual manifestations of neurocysticercosis into: intraventricular, subarachnoid, spinal, orbital, intraparenchymatous, and reactivation of previously calcified lesions. The results obtained were: intraparenchymatous 95 cases (55.23%); intraventricular 27 cases (15.69%); subarachnoid 20 cases (11.63%); spinal 6 cases (3.49%); orbital 1 case (0.58%); reactivated lesion 1 case (0.58%); association of intraventricular and intraparenchymatous 12 cases (6.98%); association of subarachnoid and intraparenchymatous 6 cases (3.49%); association of subarachnoid and intraventricular, 4 cases (2.32%). CONCLUSION: MR imaging is a sensitive and specific method in the analysis of different forms of unusual manifestations of neurocysticercosis, which should appear in the differential diagnosis of parenchymal, ventricular, spinal, cisternal, and orbital lesions. (+info)
Relationship between the concentration of supplemental oxygen and signal intensity of CSF depicted by fluid-attenuated inversion recovery imaging.
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BACKGROUND AND PURPOSE: Prior reports have described increased signal intensity (SI) of CSF on fluid-attenuated inversion recovery (FLAIR) images of anesthetized patients receiving 100% O(2). This appearance can simulate that of diseases. We evaluated the relationship between the concentration of inhaled O(2) and the development of increased SI of CSF on FLAIR images. METHODS: FLAIR was performed in 25 healthy volunteers breathing room air and 100% O(2) through a face mask for 5, 10, and 15 minutes. MR imaging, including FLAIR imaging, was performed in 52 patients with no potential meningeal abnormalities under general anesthesia: 21 received an equal mixture of N(2)O and O(2), and 31 received 100% O(2). The SI of CSF in volunteers and patients was graded in several locations by using a three-point scale. RESULTS: SI of CSF significantly increased (P <.05) in various locations, in both volunteers and patients breathing 100% O(2), when compared with SI in the same volunteers breathing room air. Hyperintensity of CSF was not significantly different in volunteers receiving 100% O(2) through a face mask compared with anesthetized patients receiving 100% O(2) through a laryngeal airway or an endotracheal tube. No significant increase in SI occurred in patients receiving 50% O(2), when compared with the SI of volunteers breathing room air. CONCLUSION: Supplemental oxygen at 100% is a main cause of artifactual CSF hyperintensity on FLAIR images, regardless of the anesthetic drug used. This artifact does not develop when 50% O(2) is administered. (+info)
Anaestethic problems in Sanfilippo syndrome. A rare case of adult patient.
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The authors report the case of a female patient (41 years old) affected by mucopolysaccharidosis type III or Sanfilippo syndrome submitted to a gynecologic surgical procedure and describe the main anesthesiologic problems. A sub-arachnoid anesthesia with hyperbaric Bupivacain 0.5% was used. This technique proved to be safe and convenient without peri- and postoperative complications. (+info)
Leptomeningeal dissemination of pilocytic astrocytoma at diagnosis in childhood: two cases report.
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Pilocytic astrocytoma (PA) is a benign tumor that rarely spread along the neuraxis. At the moment there are no more than five cases of leptomeningeal dissemination (LD) from PA at diagnosis described in the literature. Different patterns of presentation or recurrence may be noted: local recurrence, malignant transformation, multicentric disease or metastatic disease. LD and multicentric disease can be distinct pathological entities. We report two cases and analyse literature, emphasizing leptomeningeal spread at presentation. Hydrocephalus, biopsy and parcial ressection are likely to be favorable factors to the occurrence of LD. Otherwise, LD may be part of natural history of PA, as evidenced by its ocurrence in non-treated cases. (+info)
Intrathecal injection of HVJ-E containing HGF gene to cerebrospinal fluid can prevent and ameliorate hearing impairment in rats.
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Hearing impairment, which is the most prevalent sensory deficit of human beings, needs a breakthrough in therapeutic technologies. One technology is the usage of a vector system to reach the inner ear, and another is by a therapeutic molecule. Here we developed a novel gene therapy strategy by combining hepatocyte growth factor (HGF) with hemagglutinating virus of Japan envelope (HVJ-E) vector. When HVJ-E containing human HGF gene was injected intrathecally into the cerebrospinal fluid via cisterna magna of rats, the vector reached the inner ear region, and human HGF gene expression was detected in the spiral ganglion cells (SGCs) of the inner ear. Expression of endogenous rat HGF and its receptor, c-Met, was also induced in SGCs by human HGF. Kanamycin treatment results in hearing impairment by inducing degeneration of hair cells (HCs) and apoptosis of SGCs in rats. By HGF gene transfer before kanamycin treatment, both loss of HCs and apoptosis of SGCs were prevented. Furthermore, hearing function, evaluated by auditory brainstem response, was maintained at a normal level. When HGF gene transfer was performed 2 wk after kanamycin treatment, hearing impairment was significantly recovered. These results indicate a novel and effective therapeutic strategy against sensorineural hearing impairment. (+info)