Celiac plexus block: efficacy and safety of the anterior approach.

OBJECTIVE: A celiac plexus block performed via an anterior approach offers several potential advantages over a posterior approach, including shorter procedure time, less discomfort to the patient, and less risk of neurologic complications. We evaluated the use of an anterior approach to determine its efficacy and safety. MATERIALS AND METHODS: The procedure was performed in 17 consecutive patients referred for treatment of chronic abdominal pain thought clinically to be of celiac ganglion origin. A subjective evaluation of the degree of pain relief was obtained by retrospectively reviewing the notes of physicians and nurses. The degree of pain relief was graded from 1+ (no change) to 4+ (complete relief). An objective evaluation was also obtained by comparing average daily in-hospital analgesic usage before and after the procedure. RESULTS: Ethanol injection was performed successfully in 13 of 14 patients with pancreatic carcinoma and in two of three patients with other causes of pain. Eleven (79%) of the 14 patients with pancreatic carcinoma had some (2+ or greater) relief of pain, and eight of these patients had considerable or complete (3+ or 4+) relief of pain. Of the 10 patients with pancreatic carcinoma for whom complete data on the use of pain medication were available, the mean daily analgesic usage declined from 17% to 100% (mean, 58%) relative to preprocedure doses. Complications, all relatively mild, were encountered in only three of 17 patients, and no patient had neurologic symptoms or long-term sequelae. CONCLUSION: The anterior approach to a celiac plexus block is a safe and effective means of pain control in patients with pancreatic carcinoma. It offers several potential advantages to the posterior approach, and should be considered for all patients with pain caused by pancreatic carcinoma that is refractory to pain medication.

Comparison of initial injury features in cervical spine trauma of C3-C7: predictive outcome with halo-vest management.

The purpose of this retrospective study was to examine specific patient variables and fracture morphologies to further elucidate the predictors of successful halo-vest treatment for cervical spine fractures (C3-C7). Eighty-seven cases of acute cervical spine injuries treated with halo-vest management were reviewed to assess initial injury features and radiographic outcomes by measuring (a) subluxation and direction, (b) angulation, (c) facet abnormalities, and (d) vertebral body fracture patterns on plain radiographs and computed tomography scans. The cases were divided into three groups: facet subluxations with fractures, facet subluxation without fractures, and fractures with no subluxation. Patients with facet subluxation and advance-staged compression-flexion fractures (stages 4 or 5) were a distinct group when treated conservatively with a halo. Despite anatomic reduction, facet subluxations associated with advance-staged compression-flexion fractures (stages 4-5), might be best treated surgically. Risk factors for late halo failure should include subluxations with advance-staged compression-flexion fractures when treated conservatively.

Studies in vitro on the influence of ursodeoxycholate sodium salt (UDC) on hepatocyte proliferation.

In this study the influence of sodium ursodeoxycholate (UDC) on hepatocyte replicative activity was evaluated using quiescent or primed hepatocytes obtained from normal rats or from rats fed with a protein-free diet, respectively. At physiological concentrations UDC stimulated proliferation in quiescent or primed hepatocytes cultured in minimum essential medium plus insulin, and augmented the replicative activity in hepatocytes already stimulated by low concentration of epidermal growth factor and normal rat serum. However, UDC was not the only bile salt (BS) to show this stimulatory effect on hepatocyte proliferation. The stimulatory activity of BSs was not correlated with their degree of hydrophilia.

Modulation of rat hepatocyte proliferation by bile salts: in vitro and in vivo studies.

In this study, the stimulatory effect of bile salts (BS) was evaluated both in vitro, using hepatocyte primary cultures, and in vivo, in normal and 40% partially hepatectomized rats previously fed on BS-enriched diets for 4 weeks. In vitro results show that conjugated cholate (CA) and chenodeoxycholate (CDCA) augmented proliferative activity in rat hepatocytes cultured in absence of mitogens, whereas conjugated deoxycholate (DCA), and ursodeoxycholate (UDCA) did not have any significant effect. None of these BSs increased significantly the replicative response induced by submaximal concentrations of epidermal growth factor (EGF). In vivo, at the end of dietary treatment all animals fed on CA or DCA but not those fed on either CDCA, or UDCA, or tauroursodeoxycholate (TUDCA) developed cholestatic hepatitis and a burst of damage-induced hepatocyte proliferation. After 40% partial hepatectomy (PH), CA- and DCA-treated groups underwent a deterioration of cholestatic hepatitis. On the other hand, in CDCA-, and UDCA-, and TUDCA-treated groups liver histology, serum glutamic pyruvic transaminase (SGPT) and cholestasis indices did not change significantly compared with controls. As far as the proliferative activity, a significant increase was observed not only in CA and DCA but also in UDCA- and TUDCA-fed groups compared with controls, whereas a slight decrease was observed in CDCA-treated animals. In conclusion, our data indicate that conjugated BSs had only a modest stimulatory effect on hepatocyte proliferation in vitro. However, in vivo, in PH rats, UDCA or TUDCA treatment determined a further increase of hepatocellular proliferation not attributable to hepatotoxic effects. Our result suggest that modifications of bile acid pool could modulate hepatocellular proliferation.