Asymptomatic Penetration of the Median Nerve by a Peripherally Inserted Central Catheter: A Case Report.

We report a rare case in which a peripherally inserted central catheter (PICC) asymptomatically penetrated the median nerve. The patient was a 71-year-old man who displayed no neurological symptoms until 4 days after PICC placement. An ultrasound scan revealed that the PICC had penetrated the median nerve. He underwent surgery to remove the catheter and had no sequelae. When placing a PICC, selecting the brachial vein as a puncture site is associated with a high risk of nerve injury. Furthermore, circumspect observation is needed until withdrawal as neurological symptoms may be absent even when the catheter has punctured a nerve.

Anterior quadratus lumborum block for postoperative recovery after total hip arthroplasty: a study protocol for a single-center, double-blind, randomized controlled trial.

BACKGROUND: Appropriate pain management is essential to improve the postoperative recovery after total hip arthroplasty (THA). Various case reports have indicated that anterior quadratus lumborum block (QLB) provides effective postoperative analgesia in lower limb surgeries. However, few randomized controlled trials have confirmed the efficacy of anterior QLB for lower limb surgeries. The aim of this single-center, double-blind, randomized controlled trial is to confirm the efficacy of anterior QLB for postoperative recovery after THA. METHODS: The participants will be randomly assigned to either the anterior QLB or placebo groups, using a set of random numbers for the allocation sequence. Only pharmacists will be aware of the allocations; other investigators will be blinded until study completion. After induction of general anesthesia, anterior QLB will be performed by using 0.25% levobupivacaine or normal saline. Fentanyl will be administered according to blood pressure change during the surgery. The primary outcome will be the quality of recovery 40 score (QoR-40). Secondary outcomes will include the visual analog scale score of pain intensity at rest and movement, intraoperative and postoperative doses of fentanyl, and incidence of postoperative nausea and vomiting. Statistical analysis will be performed by using the Student's t test, Mann-Whitney U test, and Fisher's exact test as appropriate. A P value of less than 0.05 will be considered statistically significant. DISCUSSION: The results of our study will reveal whether anterior QLB is effective for postoperative recovery after THA. TRIAL REGISTRATION: UMIN Clinical Trials Registry, UMIN000032255. Registered on 15 April 2018.

[Difference in the Spread of Injectate between Ultrasound Guided Pectoral Nerve Block I and II. A Cadaver Study].

BACKGROUND: Pectoral nerve block (PECS block) is first reported by Blanco et al, and mainly used for analgesia for breast surgery in Japan. However, the spread of PECS block is unclear. METHODS: Ultrasound guided PECS I and II blocks were performed in a cadaver, and the cadaver was dissected for evaluation of the spread of coloring matter. RESULTS: The coloring matter by PECS I block was spread to the axillary region between the major and minor pectoral muscles, while PECS II block remained over the fascia of the serratus muscle from mid-clavicular line to middle axillary line. Two possible routes to the axillary region by PECS I include: dorsal to the pectoral minor muscle through the clavipectoral fascia, and over the pectoral minor muscle to the axillary sheath. CONCLUSIONS: Our cadaveric evaluation suggests that PECS I block produces more analgesia of the axillary region than PECS II. Further evaluation is needed in more cadavers.

Photodecomposition of humic acid and natural organic matter in swamp water using a TiO(2)-coated ceramic foam filter: potential for the formation of disinfection byproducts.

This paper reports on the photodecomposition of aqueous humic acid (HA) by a TiO(2)-coated ceramic foam filter (TCF) reactor and on the potential for the formation of disinfection byproducts (DBPs) upon chlorination of the photocatalytically treated solutions. This photocatalytic reactor can also be applied to the removal of natural organic matter (NOM) in swamp waters. The proposed photocatalytic reaction system was operated as per standardized methodologies. First, the ability of the TCF to decompose HA (a representative compound of NOM) was evaluated from the changes in the total organic carbon (TOC) and UV(254) with the reaction time. Remarkably, TOC removal and UV(254) values ranging from 44% to 61% and from 60% to 83%, respectively, were achieved. The potential for the formation of DBPs (total trihalomethane and total haloacetic acid) by chlorination of the phototreated solution was strongly dependent on the TOC removal and UV(254) values in the solution. The degree of photodecomposition of NOMs in the swamp water samples and the DBP formation potential showed similar trends as in the case of the standard solutions containing HA. The method used in this study could be effectively used to evaluate the efficiency of TCF for reducing HA and NOM, while suppressing the formation of DBP products.