Articles: cations.
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Complications of unintended intravascular penetration and subsequent injection of local anesthetics and/or other drugs occasionally are devastating. Multiple reports have related to unrecognized intravascular placement of the needle. The generally accepted technique during interventional techniques is intermittent fluoroscopy. ⋯ This case report involves description of digital subtraction to enhance visualization of contrast distribution during injection. Three series of images are included from atlanto-occipital joint, caudal epidural catheterization, and a cervical transforaminal injection. The case reports demonstrate that digital subtraction fluoroscopic imaging is superior to intermittent or live fluoroscopy in detecting intravascular injections with interventional techniques.
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The intervertebral disc is the focal point of pathology for most low back pain. Contained disc herniation is a common cause of low back pain and, when unresponsive to conservative measures, is often treatable by disc decompression. To evaluate the safety and efficacy of percutaneous disc decompression using Coblation (Nucleoplasty) in the treatment of back and/or leg pain associated with contained disc herniation, a prospective, nonrandomized cohort analysis was conducted in an interventional pain management practice. ⋯ Additionally, significant improvement was reported by 54%, 44%, and 49% of patients in sitting, standing and walking abilities, respectively, at 12 months. There were no instances of complications. These results indicate that disc decompression using Coblation (Nucleoplasty) is a safe and efficacious procedure for reducing discogenic low back pain with or without leg pain.
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(a) To determine if self-reported diabetes mellitus is independently associated with sleep-disordered breathing (SDB); (b) to determine if diabetes mellitus is specifically associated with central sleep apnea including periodic breathing (Cheyne-Stokes breathing pattern) during sleep. ⋯ The authors concluded that diabetes mellitus is associated with sleep apnea but that this association is largely explained by risk factors in common for both disorders, most notably obesity. After adjusting for confounding factors there was no difference between diabetic and non-diabetic participants with regard to obstructive events. However, even after adjusting for potential confounders, there was a greater prevalence of periodic breathing in diabetic subjects. Although not reaching statistical significance, there was a suggestion of an increased prevalence of central events in the diabetic population, particularly when the sample included participants with known CVD. The investigators believed it unlikely that the findings were attributable to underlying congestive heart failure in as much as the diabetic subjects without prevalent CVD exhibited increased prevalence of periodic breathing and possibly increased central events. The authors proposed that diabetes mellitus might be a cause of SDB, mediated through autonomic neuropathy that may alter ventilatory control mechanisms. In this context, the authors commented that autonomic neuropathy may cause perturbations in ventilatory control by altering chemoreceptor gain or altering cardiovascular function (although the authors discounted underlying congestive heart failure as an explanation for the higher prevalence of periodic breathing in diabetic participants). To reinforce their conclusions, the authors cited the literature indicating increased prevalence of sleep apnea in diabetic patients with autonomic dysfunction, as well as the association between Shy--Drager syndrome, in which autonomic insufficiency is a constitutive element, and central sleep apnea.
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There is growing evidence that in end-stage shock or during cardiac arrest, inappropriately low endogenous vasopressin plasma levels may be responsible for pathologic vasodilatation, inadequate organ perfusion, and poor outcome. The purpose of this article is to review recent publications featuring arginine vasopressin as a potent vasoconstrictor in various shock states such as systemic vasodilatation, severe hypovolemia, or cardiac arrest. ⋯ Vasopressin administration is emerging as a rational and promising therapy in the management of various shock states and cardiac arrest.
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Irritation of neural structures, specifically the brachial plexus outside of the cervical spine is capable of producing pain in the upper extremity. These pain patterns may be similar to pain originating from the cervical spine, presenting a diagnostic challenge. Brachial plexus block is performed at multiple levels, including interscalene, supraclavicular, infraclavicular, and axillary. ⋯ Relevant anatomy and proposed technique of brachial plexus block is described. The procedure is performed under fluoroscopy with contrast injection. It is concluded that the proposed technique of brachial plexus block is useful for brachial plexus blockade providing precision and specificity with minimal complications.