Effectiveness of stellate ganglion block for the treatment of patulous eustachian tube: A case report.

A 56-year-old woman presented with a 2 months history of patulous eustachian tube. She had sudden weight loss after developing a cold, after which she had been experiencing disabling autophony and a sensation of blockage in the ear. She underwent stellate ganglion block in 8 months; her symptoms resolved subsequently.

[Effect of the sacroiliac ligament block on intractable low back pain in elderly patients].

BACKGROUND: Lumbar spine disease in the elderly people is complicated by a variety of pathophysiology in the spine and the cause of the pain is unclear. Diagnosis of pain may be difficult in patients with pain in the thigh and groin area. Sacroiliac joint is supporting the trunk and movable joint. We examined the effect of the sacroiliac joint block for intractable low back pain. METHODS: Retrospectively we examined the duration of disease in patients with hip and leg pain visiting the hospital for eight months, and we questioned the site of pain awareness. Newton test, Gaenslen test, Patrick test and Fadire test were carried out for sacroiliac joint pain in patients with at least one positive finding. When performing sacroiliac ligaments block local anesthetics was injected to check the position of the dorsal sacroiliac ligaments under ultrasonic echo whenever possible. The block is performed with the patients prone at a point one finger from the posterior superior iliac spine level at an angle of 30-45 degrees downward toward the outside. Injecting the drugs penetrating the ligament continued to give a feel slightly outward to avoid the iliac Cattelan 23 G needle. We confirmed pain assessment NRS at 11 (0-10), and the improvement of pain was assessed with the change of the NRS on the next return. RESULTS: NRS showed a significant decrease at all points in time before block, their pain decreased gradually. The patients showed NRS improvement of more than 50% of the first block in 15 of 24 patients. CONCLUSIONS: Block at the posterior sacroiliac ligament region significantly reduced pain for chronic intractable low back pain. The block was shown to be effective as a treatment and for diagnosis.

[Suspected case of peripartum cardiomyopathy developed during elective cesarean section].

A 35-year-old primigravida with twin gestation was admitted for elective cesarean section. She had no preoperative systemic diseases including heart disease. At 37 weeks of gestation, elective cesarean section was performed under combined spinal-epidural anesthesia. Anesthetic course was uneventful until the delivery when the patient started to cough and complained of dyspnea. At the same time, Spo2 started to decline to reach 95% despite the oxygen supplement. Pleural effusion was observed on the chest X-ray on postoperative day 2. An echocardiography showed diffuse hypokinesis of the left ventricle with ejection fraction (EF) of 36%. Peripartum cardiomyopathy was strongly suspected. Symptoms of heart failure were alleviated by water restriction and furosemide by the 9th POD. The EF increased to 50% on the 15th POD.

[Perioperative heart rate control with landiolol for a patient with rapid atrial fibrillation complicated with low cardiac function].

A 62-year-old man complicated with old antero-septal wall myocardial infarction and atrial fibrillation suffered from lung and pancreas cancer. He underwent gastro-duodenum bypass surgery under epidural combined with general anesthesia. His ECG and echocardiogram revealed atrial fibrillation and his left ventricular ejection fraction was 35%. After the start of surgery under general anesthesia, EHR was stable between 80-100 beats x min(-1) but rapid atrial fibrillation developed with a rate of over 140 beats x min(-1) after epidural injection of 0.375% ropivacaine 3 ml. Treatment including continuous intravenous diltiazem and several bolus intravenous injections of verapamil failed to decrease the heart rate. Therefore we used landiolol, a short-acting beta blocker, to control heart rate. HR decreased without decreasing his blood pressure. Continuous landiolol infusion was maintained for 3 hours and 30 minutes in the ICU. After finishing infusion, his heart rhythm never became rapid atrial fibrillation. We conclude that landiolol is useful for heart rate control of rapid atrial fibrillation.