Incidence of intravascular injection and the spread of contrast media during S1 transforaminal epidural steroid injection by two approaches: anteroposterior vs oblique.

The aim of this randomised study was to compare the incidence of intravascular injections during S1 transforaminal epidural steroid injection performed in the anteroposterior and oblique views. We also compared epidural spread patterns of contrast media, which included 201 injections at the S1 level. The overall incidence of intravascular injection during S1 transforaminal epidural steroid injection in the anteroposterior view was 29% (29/99), significantly higher than in the oblique view (11%, 11/102, p = 0.001). There were no significant differences between the two groups for epidural spread of contrast media in cases where intravascular injections did not occur (p = 0.77). Performing S1 transforaminal epidural steroid injection in the oblique view rather than the anteroposterior view reduces the risk of intravascular injections.

Evaluation of anatomic landmarks for axillary nerve block in the quadrilateral space.

BACKGROUND: Axillary nerve block (ANB) was recently introduced along with suprascapular nerve block as an alternative to inter-scalene brachial plexus block for post-operative pain control. However, the methods for performing ANB are variable. We studied the relationship between surface anatomy and the location of the axillary nerve in the quadrilateral space to ensure a technically safe and simple ANB. METHODS: Eighty-eight shoulders were included. All measurements were performed with the subjects seated and the shoulders in a neutral position. We located the posterior circumflex humeral artery (PCHA) using a vascular Doppler system and named this point 'AN'. We used this point to locate the axillary nerve, since this nerve is generally present with the PCHA in the quadrilateral space. We then examined the relationship between surface anatomic landmarks and AN. The depth of the medial side of the humerus at the AN (AN depth), which is at the lateral border of the quadrilateral space, was measured using ultrasonography. RESULTS: AN was located on the line between the posterolateral corner of the acromion (Ac) and the axillary fold (Axf) (Ac-Axf) in 77% of shoulders. The ratio of the distance from Ac to AN (Ac-AN) to Ac-Axf in all shoulders was 0.6 [standard deviation (SD), 0.1]. AN depth was 4.0 (SD, 0.5) cm in men and 3.6 (SD, 0.4) cm in women. CONCLUSION: Knowledge of the relationship between surface anatomy and AN, as well as estimated AN depth may aid in locating the axillary nerve in the quadrilateral space.

Biodegradable composite scaffolds incorporating an intramedullary rod and delivering bone morphogenetic protein-2 for stabilization and bone regeneration in segmental long bone defects.

In this study, a two-part bone tissue engineering scaffold was investigated. The scaffold consists of a solid poly(propylene fumarate) (PPF) intramedullary rod for mechanical support surrounded by a porous PPF sleeve for osseointegration and delivery of poly(dl-lactic-co-glycolic acid) (PLGA) microspheres with adsorbed recombinant human bone morphogenetic protein-2 (rhBMP-2). Scaffolds were implanted into critical size rat segmental femoral defects with internal fixation for 12 weeks. Bone formation was assessed throughout the study via radiography, and following euthanasia, via microcomputed tomography and histology. Mechanical stabilization was evaluated further via torsional testing. Experimental implant groups included the PPF rod alone and the rod with a porous PPF sleeve containing PLGA microspheres with 0, 2 or 8 µg of rhBMP-2 adsorbed onto their surface. Results showed that presence of the scaffold increased mechanical stabilization of the defect, as evidenced by the increased torsional stiffness of the femurs by the presence of a rod compared to the empty defect. Although the presence of a rod decreased bone formation, the presence of a sleeve combined with a low or high dose of rhBMP-2 increased the torsional stiffness to 2.06 ± 0.63 and 1.68 ± 0.56 N·mm, respectively, from 0.56 ± 0.24 N·mm for the rod alone. The results indicate that, while scaffolds may provide structural support to regenerating tissues and increase their mechanical properties, the presence of scaffolds within defects may hinder overall bone formation if they interfere with cellular processes.

Suction-curettage with combination of two different cannulae in the treatment of axillary osmidrosis and hyperhidrosis.

OBJECTIVE: To investigate the efficacy and safety of suction-curettage with a combination of two different cannulae for treatment of axillary osmidrosis and hyperhidrosis. DESIGN: Retrospective analysis of patients who underwent surgery from September 2004 to September 2006. SETTING: Outpatient clinic for hyperhidrosis at a university-affiliated hospital. SUBJECTS: Sixty-five patients who were treated for axillary malodor and hyperhidrosis. INTERVENTIONS: Patients were sequentially treated with Fatemi and Cassio cannulae. MAIN OUTCOME MEASURES: Demographic data, severity data (assessment of malodor), degree of satisfaction, sweating, hair growth, scarring, recurrence and complications. RESULTS: Sixty of the 65 patients (96.9%) had excellent to fair results, and only 2 patients (3.1%) had poor results. Complications occurred in 4 patients (6.2%). Recurrence occurred in 3 patients (4.6%). CONCLUSIONS: This simplified and inexpensive method resulted in a high success rate with low complications and high satisfaction with minimal scarring and rapid recovery.

Topical glycopyrrolate for patients with facial hyperhidrosis.

BACKGROUND: Facial hyperhidrosis may negatively impact the quality of life. Although various conservative modalities have been suggested, the condition is not often treated successfully. OBJECTIVES: To examine whether topical glycopyrrolate could be an effective and safe treatment for facial hyperhidrosis. METHODS: Twenty-five patients with facial hyperhidrosis were enrolled and treated with 2% topical glycopyrrolate on one half of the forehead while the other half of the forehead was treated with a placebo. RESULTS: The sweat production rate of the half of the forehead treated with topical glycopyrrolate was significantly reduced to 37.6+/-2.8 mg min(-1) (mean+/-SEM) compared with 102.2+/-5.5 mg min(-1) at the placebo-treated half of the forehead (P<0.001). Patients evaluated their degree of anhidrosis as excellent in six (24%) patients, good in 16 (64%), fair in two (8%) and poor in one (4%). Twenty-four patients (96%) were partially or fully satisfied with their fair to excellent anhidrosis; only one patient (who developed a transient headache after treatment) was dissatisfied with its therapeutic effect. Only seven patients (28%) experienced recurrence within 1 day while 17 patients (68%) had recurrence within 2 days. One patient (4%) remained stable for up to 4 days. CONCLUSIONS: Topical glycopyrrolate application appears to be effective and safe for the treatment of excessive facial sweating in primary craniofacial and secondary gustatory hyperhidrosis following sympathectomy.

Intrathecally administered NMDA receptor antagonists reduce the MAC of isoflurane in rats.

PURPOSE: We studied the effects of intrathecal administration of an N-methyl-D-aspartate (NMDA) receptor antagonist and an antagonist of the glycine site of the NMDA receptor on the minimum alveolar anaesthetic concentration (MAC) of isoflurane in rats, and on locomotor activity in conscious rats. METHODS: In Wistar rats fitted with indwelling intrathecal catheters, we determined the MAC of isoflurane after the administration of saline (control group); the competitive NMDA receptor antagonist 3-(2-carboxypiperazin-4-yl)propyl-1-phosponic acid(CPP) at 0.01, 0.1, and 1.0 nM; and the selective antagonist of the glycine site on the NMDA receptor complex 7-chlorokynurenic acid (7CKA) at 0.1, 1.0, and 10 nM. After measurement of MAC following administration of the antagonist, the equipotent reversal dose of NMDA or D-serine was administered. The rats were examined for the presence of locomotor dysfunction by intrathecal administration of NMDA receptor antagonists, NMDA and D-serine in conscious rats. All of the experiments were performed using randomization and masking of drugs. RESULTS: CPP at 0.1 and 1.0 nM decreased the MAC of isoflurane by 9.9-17.6% (P < 0.05). 7CKA at 1.0 and 10 nM reduced MAC from 10.5-15.5% (P < 0.05). Intrathecal administration of NMDA or D-serine reversed the decreases in MAC to control values. Locomotor activity was not changed. CONCLUSIONS: We believe that NMDA receptor plays an important role in determining the MAC of isoflurane in the spinal cord.

Intrathecal administration of N-methyl-D-aspartate receptor antagonist reduces the minimum alveolar anaesthetic concentration of isoflurane in rats.

We have studied the effect of intrathecal administration of N-methyl-D-aspartate (NMDA) receptor antagonists on the minimum alveolar anaesthetic concentration (MAC) of isoflurane in rats. In Wistar rats fitted with indwelling intrathecal catheters, we determined the MAC of isoflurane after administration of a competitive NMDA receptor antagonist, APV (0.01, 0.1, 1.0, 10, 30 micrograms), a non-competitive NMDA receptor antagonist, MK801 (0.1, 1.0, 10, 30 micrograms). NMDA (0.01, 0.1, 1.0, 10, 30 micrograms) and saline. APV at all doses except 0.01 micrograms decreased MAC by 17.1-32% (P < 0.001 and P < 0.0001). Although MK801 at 10 and 30 micrograms reduced MAC by 24.3-31.7% (P < 0.001 and P < 0.0001), lower doses did not affect MAC. Intrathecal administration of NMDA reversed these decreases in MAC, but not to control values with APV 10 and 30 micrograms and MK801 30 micrograms. We suspect that NMDA and NMDA receptor antagonists play important roles in the spinal cord in determining the MAC of isoflurane.

Therapy with antibody to tumor necrosis factor against endotoxin shock in rabbits.

The purpose of this study was to determine the efficacy of treatment with anti-tumor necrosis factor (TNF) antibody in preventing the deleterious effects of endotoxin. Polyclonal anti-TNF antibody was produced by immunizing rabbits. Experiments were carried out on 16 rabbits intravenously infused with the lethal dose of lipopolysaccharide (LPS). Pretreatment with anti-TNF antibody resulted in protection from the development of hypotension and metabolic acidosis. The serum TNF level was significantly depressed in the antibody-pretreated group. Eighty-eight percent in the anti-TNF antibody-pretreated rabbits survived more than 48 h, whereas none of the rabbits who were given LPS alone survived over 24 h (LPS group). Prominent histopathological changes in the liver and kidney were evident in the LPS group. In contrast, pathologic changes in the tissue from the anti-TNF antibody group were considerably less prominent. These results support the idea that TNF plays a central role in mediating the pathophysiologic changes during endotoxin shock.