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epidural local

Alain Cunqueiro, Meir H Scheinfeld
Intracranial gas is commonly detected on neuroimaging. The recognition of this finding can at first blush be unsettling. Being able to localize this gas to a specific compartment: intraarterial, intravenous, intraparenchymal, subdural, epidural, subarachnoid and intraventricular, is the first step in determining the importance of the gas. Determination of the route of entry: through the skull, extension from a paranasal sinus or the mastoid air cells, via the spine, or trans-vascular, is the other important factor in determining potential consequences...
March 15, 2018: Emergency Radiology
Pini Koplovitch, Marshall Devor
Ectopic impulse discharge (ectopia) generated in the soma of afferent neurons in dorsal root ganglia (DRGs) following nerve injury is thought to be a major contributor to neuropathic pain. The DRG is thus a prime interventional target. The process of electrogenesis (impulse generation) in the DRG is far more sensitive to systemically administered Na channel blockers than the process of impulse propagation along sensory axons. It should therefore be possible to selectively suppress DRG ectopia with local application of membrane stabilizing agents without blocking normal impulse traffic...
March 12, 2018: Pain
Ilhan Yilmaz, Uzay Erdogan, Osman Tanriverdi, Omur Gunaldi, Utku Adilay, Muhammed Omeroglu, Canan Tanik, Bekir Tugcu
AIM: The etiology and mechanism underlying epidural fibrosis (EF), one of the most frequent causes of failed back surgery after laminectomy, remain unclear. Despite numerous potential modalities evaluated for EF prevention, treatment approaches are limited. This study aimed to evaluate bevacizumab for EF treatment in an experimental rat model using histopathology as well as immunohistochemical staining for CD105 and osteopontin (OPN). MATERIAL AND METHODS: Wistar Albino rats underwent either laminectomy alone to induce EF (group I, control) or laminectomy plus local bevacizumab treatment (group II)...
February 21, 2018: Turkish Neurosurgery
N Rooban, J Bell, E M Debenham
No abstract text is available yet for this article.
March 2018: Anaesthesia and Intensive Care
Xin Wang, António Pinto-Duarte, M Margarita Behrens, Xianjin Zhou, Terrence J Sejnowski
Reduced expression of Sp4, the murine homolog of human SP4, a risk gene of multiple psychiatric disorders, led to N-methyl-D-aspartate (NMDA) hypofunction in mice, producing behavioral phenotypes reminiscent of schizophrenia, including hypersensitivity to ketamine. As accumulating evidence on molecular mechanisms and behavioral phenotypes established Sp4 hypomorphism as a promising animal model, systems-level neural circuit mechanisms of Sp4 hypomorphism, especially network dynamics underlying cognitive functions, remain poorly understood...
2018: PloS One
Cosmas Mwikirize, John L Nosher, Ilker Hacihaliloglu
PURPOSE: We propose a framework for automatic and accurate detection of steeply inserted needles in 2D ultrasound data using convolution neural networks. We demonstrate its application in needle trajectory estimation and tip localization. METHODS: Our approach consists of a unified network, comprising a fully convolutional network (FCN) and a fast region-based convolutional neural network (R-CNN). The FCN proposes candidate regions, which are then fed to a fast R-CNN for finer needle detection...
March 6, 2018: International Journal of Computer Assisted Radiology and Surgery
Erin Sweet, Christine S Shusterman, Marina S Nedeljkovic, Jean C Solodiuk
Pain is a complex physical and emotional experience. Therefore, assessment of acute pain requires self-report when possible, observations of emotional and behavioral responses and changes in vital signs. Peripheral nerve and epidural catheters often provide postoperative analgesia in children. Administration of chloroprocaine (a short acting local anesthetic) via a peripheral nerve or epidural catheter allows for a comparison of pain scores, observations of emotional and behavioral responses and changes in vital signs to determine catheter function...
March 1, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Gen-Long Jiao, Yong-Bao Fan, De-Jun Deng, Jian-Li Shao, Guo-Dong Sun, Zhi-Zhong Li
OBJECTIVE: To analyze the clinical effect of spinal cord decompression and lavage therapy on chronic cervical spinal cord injury and explore the possible mechanism. METHODS: Fifty-seven patients with chronic cervical spinal cord injury treated in our hospital from January, 2008 to January, 2015 were enrolled, including 17 with multilevel cervical disc herniation, 25 with long segmental ossification of the posterior longitudinal ligament, 13 with hypertrophy or calcification of neck ligamentum flavum, and 2 with old cervical fractures...
February 20, 2018: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
Mehdi Trifa, Dmitry Tumin, Joseph D Tobias
BACKGROUND: The aim of this review was to evaluate the current evidence regarding the use of dexmedetomidine as an adjuvant to local anaesthetic agents (LAA) for caudal blockade anaesthesia and analgesia in children. METHODS: A literature search was performed of the Medline, Embase, and CINAHL databases using the keywords "dexmedetomidine" and "caudal". We included all studies that used caudal dexmedetomidine as an adjuvant to a LAA in children, excluding case reports, reviews, expert opinions, and animal studies...
February 22, 2018: Minerva Anestesiologica
Kassam Mahomed, Kellie Wild, Christopher R Weekes
BACKGROUND: Pre-labour rupture of membranes (PROM) at term is a common event with early induction of labour reducing infectious morbidity without increasing the caesarean rate. Syntocinon is commonly used for induction but prostaglandins are also routinely used. Large studies have shown no difference in the maternal and neonatal outcomes with either method. AIM: To assess the safety and efficacy of vaginal prostaglandin (PG) compared to syntocinon for induction of labour in term-PROM...
February 22, 2018: Australian & New Zealand Journal of Obstetrics & Gynaecology
Stanley Sau Ching Wong, Qiu Qiu, Chi Wai Cheung
OBJECTIVE: Lumbar transforaminal epidural steroid injection is commonly used for treating lumbar radicular pain. We report a case of segmental spinal myoclonus that developed during lumbar transforaminal epidural injection with local anesthetic and steroid. CASE REPORT: A 58-year-old woman with failed back surgery syndrome presented with low back and right L3 and L4 radicular pain. As she had responded well previously to diagnostic selective nerve root injection with local anesthetic at the right L3 and L4 levels, lumbar transforaminal epidural steroid injection at the same levels was scheduled...
February 16, 2018: Regional Anesthesia and Pain Medicine
Tatsuya Kunigo, Takeshi Murouchi, Shuji Yamamoto, Michiaki Yamakage
Background: Serratus plane block is a thoracic truncal block that has been proposed as alternatives for analgesia such as epidural anesthesia and paravertebral block for the anterolateral chest wall. Previously, we performed the clinical study about optimal volume of the local anesthetic in serratus plane block. The primary aim of this study was to assess the pattern of distribution of dye into the serratus plane of cadavers after ultrasound-guided serratus plane injection. Findings: Ultrasound-guided serratus plane injection was performed at the level of the fourth rib on the mid-axillary line in nine adult Thiel-embalmed cadavers...
2018: JA Clin Rep
Marija Damjanovska, Tatjana Stopar Pintaric, Erika Cvetko, Kamen Vlassakov
Purpose: The ultrasound-guided retrolaminar block is one of the newer and simpler alternatives to the traditional, often technically challenging, paravertebral (PV) block. Its feasibility, safety, and efficacy have already been clinically demonstrated in patients with multiple rib fractures using higher volumes of local anesthetic, when compared with the traditional approach. The primary aim of this observational anatomical study was to assess the spread of local anesthetic from the retrolaminar injection point to the PV space and its volume dependence...
2018: Journal of Pain Research
Takashi Igarashi, Hideki Murakami, Satoru Demura, Satoshi Kato, Katsuhito Yoshioka, Noriaki Yokogawa, Hiroyuki Tsuchiya
BACKGROUND: The aim of this study was to evaluate local recurrence and survival outcomes after frozen autograft total en bloc spondylectomy for metastatic spinal tumors. METHODS: We retrospectively analyzed data from 91 patients with metastatic spinal tumors who underwent frozen autograft total en bloc spondylectomy at our institution between May 2010 and April 2015. We assessed the incidence, primary cancer type, and sites of local recurrence. Risk factors for local recurrence were also examined through the statistical analysis of 17 items, including clinico-pathological characteristics, treatment history, and preoperative or surgical complications...
February 8, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Seyhmus Guler, Moritz Dannhauer, Biel Roig-Solvas, Alexis Gkogkidis, Rob Macleod, Tonio Ball, Jeffrey G Ojemann, Dana H Brooks
Direct stimulation of the cortical surface is used clinically for cortical mapping and modulation of local activity. Future applications of cortical modulation and brain-computer interfaces may also use cortical stimulation methods. One common method to deliver current is through electrocorticography (ECoG) stimulation in which a dense array of electrodes are placed subdurally or epidurally to stimulate the cortex. However, proximity to cortical tissue limits the amount of current that can be delivered safely...
February 7, 2018: NeuroImage
Dominik Kaczmarek, Elzbieta Jankowska
Direct current (DC) evokes long-lasting changes in neuronal networks both presynaptically and postsynaptically and different mechanisms were proposed to be involved in them. Different mechanisms were also suggested to account for the different dynamics of presynaptic DC actions on myelinated nerve fibres stimulated before they entered the spinal grey matter and on their terminal branches. The aim of the present study was to examine whether these different dynamics might be related to differences in the involvement of K+ channels...
February 5, 2018: Neuroscience
Sanjib Das Adhikary, Ashlee Pruett, Mauricio Forero, Venkatesan Thiruvenkatarajan
Post-operative pain after minimally invasive video-assisted thoracoscopic surgery (VATS) in adults is commonly managed with oral and parenteral opioids and invasive regional techniques such as thoracic epidural blockade. Emerging research has shown that the novel erector spinae plane (ESP) block, can be employed as a simple and safe alternative analgesic technique for acute post-surgical, post-traumatic and chronic neuropathic thoracic pain in adults. We illustrate this by presenting a paediatric case of VATS, in which an ESP block provided better analgesia, due to greater dermatomal coverage, as well as reduced side-effects when compared with a thoracic epidural that had previously been employed on the same patient for a similar procedure on the opposite side...
January 2018: Indian Journal of Anaesthesia
Katelynn Campbell, Asangi R Kumarapeli, Neriman Gokden, Roni Michele Cox, Laura Hutchins, Jerad M Gardner
Melanoma may undergo dedifferentiation and sarcomatous transformation with loss of melanocytic markers. Dedifferentiated melanoma rarely forms true rhabdomyoblasts with skeletal muscle immunophenotype (rhabdomyosarcomatous heterologous component). A 52 year-old woman was diagnosed with invasive melanoma (Breslow depth 0.83 mm) of the upper back in 2012, treated by wide local excision only. In 2013, an axillary mass was excised to show metastatic melanoma with two morphologies: an epithelioid morphology expressing S100 and MART-1 and a spindled morphology with loss of melanocytic markers but strong expression of desmin...
February 5, 2018: Journal of Cutaneous Pathology
Janna L Friedly, Bryan A Comstock, Patrick J Heagerty, Zoya Bauer, Micol S Rothman, Pradeep Suri, Ryan Hansen, Andrew L Avins, Srdjan S Nedeljkovic, David R Nerenz, Venu Akuthota, Jeffrey G Jarvik
This analysis of the Lumbar Epidural steroid injections for Spinal Stenosis (LESS) multi-center randomized controlled trial data identifies the degree of and risk factors for cortisol suppression following epidural steroid injections in older adults with spinal stenosis. 400 patients aged > 50 years with back or leg pain and central lumbar spinal stenosis completed baseline demographic and psychosocial measures. Morning serum cortisol levels were measured at baseline and 3 weeks after initial injection. Patients were randomized to receive epidural injections of either local anesthetic with corticosteroid (n = 200) or local anesthetic only (n = 200)...
January 30, 2018: Pain
Naoki Notani, Masashi Miyazaki, Toyomi Yoshiiwa, Toshinobu Ishihara, Shozo Kanezaki, Hiroshi Tsumura
RATIONALE: Acute neurological deficits following spinal surgery commonly result from epidural hematoma, surgical trauma, vascular compromise, and graft or hardware impingement, with the cause identified by magnetic resonance imaging (MRI). We present a rare case of dynamic paraspinal muscle impingement after C1 posterior arch laminectomy, which was diagnosed by myelography, with no significant findings on MRI. PATIENT CONCERNS: An 81-year-old, severely obese male, was referred to our department for the treatment of vertebral disease of the lumbar spine...
December 2017: Medicine (Baltimore)
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