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Sample records for epidural blood patches

  1. Epidural blood patch and acute varicella.

    PubMed

    Martin, David P; Bergman, Bradley D; Berger, Ines H

    2004-12-01

    We present the case of a 38-yr-old woman who required an epidural blood patch in the context of acute varicella (chickenpox). The unique risks in this case include the possible triggering of central nervous system complications after the introduction of viremic blood into the epidural or intrathecal space. However, the risk was believed to be acceptable because the patient was receiving antiviral coverage. She enjoyed complete relief of her headache but experienced transient back and leg pain. Leptomeningeal irritation caused by acute varicella infection may put patients at increased risk for pain after epidural blood patch.

  2. Chronic adhesive arachnoiditis after repeat epidural blood patch.

    PubMed

    Carlswärd, C; Darvish, B; Tunelli, J; Irestedt, L

    2015-08-01

    Epidural blood patching is an effective treatment for postdural puncture headache but has potential risks. Arachnoiditis is a very rare disabling condition and few cases have been described following an epidural blood patch. We present a case of chronic adhesive arachnoiditis in a parturient treated with a repeat epidural blood patch. A healthy 29-year-old woman had an accidental dural puncture following epidural insertion during labour. Initial treatment of postdural puncture headache with an epidural blood patch was ineffective and was therefore repeated. She gradually developed severe neurological symptoms consistent with arachnoiditis confirmed with magnetic resonance imaging. Despite intensive multimodal treatment with analgesics and physiotherapy, her neurological condition remains unresolved two years later. This serious but rare complication should encourage caution when treating parturients with postdural puncture headache with a repeat epidural blood patch.

  3. Observational study of changes in epidural pressure and elastance during epidural blood patch in obstetric patients.

    PubMed

    Pratt, S D; Kaczka, D W; Hess, P E

    2014-05-01

    During an epidural blood patch, we inject blood until the patient describes mild back pressure, often leading to injection of more than 20 mL of blood. We undertook this study to measure the epidural pressures generated during an epidural blood patch and to identify the impact of volume on epidural elastance in obstetric patients. This study was performed in postpartum patients who presented for an epidural blood patch with symptoms consistent with a postdural puncture headache. After identification of the epidural space using loss of resistance to air or saline, we measured static epidural pressure after each 5-mL injection of blood. Models were then fitted to the data and the epidural elastance and compliance calculated. Eighteen blood patches were performed on 17 patients. The mean final volume injected was 18.9±7.8 mL [range 6-38 mL]. The mean final pressure generated was 13.1±13.4 mmHg [range 2-56 mmHg]. A curvilinear relationship existed between volume injected and pressure, which was described by two models: (1) pressure=0.0254×(mL injected)(2)+0.0297 mL, or (2) pressure=0.0679×mL(1.742). The value for r2 was approximately 0.57 for both models. We found no correlation between the final pressure generated and the success of the epidural blood patch. We found a curvilinear relationship between the volume of blood injected during an epidural blood patch and the pressure generated in the epidural space. However, there was a large variation in both the volume of blood and the epidural pressure generated. The clinical importance of this finding is not known. A larger study would be required to demonstrate whether pressure is a predictor of success. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Observational study of changes in epidural pressure and elastance during epidural blood patch in obstetric patients

    PubMed Central

    Pratt, S.D.; Kaczka, D.W.; Hess, PE

    2014-01-01

    Background During an epidural blood patch, we inject blood until the patient describes mild back pressure, often leading to injection of more than 20 mL of blood. We undertook this study to measure the epidural pressures generated during an epidural blood patch and to identify the impact of volume on epidural elastance in obstetric patients. Methods This study was performed in postpartum patients who presented for an epidural blood patch with symptoms consistent with a postdural puncture headache. After identification of the epidural space using loss of resistance to air or saline, we measured static epidural pressure after each 5-mL injection of blood. Models were then fitted to the data and the epidural elastance and compliance calculated. Results Eighteen blood patches were performed on 17 patients. The mean final volume injected was 18.9 ± 7.8 mL [range 6 to 38 mL]. The mean final pressure generated was 13.1 ± 13.4 mmHg [range 2 to 56 mmHg]. A curvilinear relationship existed between volume injected and pressure, which was described by two models: (1) pressure = 0.0254 × (mL injected)2 + 0.0297 × mL, or (2) pressure = 0.0679 × mL1.742. The value for r2 was approximately 0.57 for both models. We found no correlation between the final pressure generated and the success of the EBP. Conclusions We found a curvilinear relationship between the volume of blood injected during an epidural blood patch and the pressure generated in the epidural space. However, there was a large variation in both the volume of blood and the epidural pressure generated. The clinical importance of this finding is not known. A larger study would be required to demonstrate whether pressure is a predictor of success. PMID:24631062

  5. Rebound intracranial hypertension: a complication of epidural blood patching for intracranial hypotension.

    PubMed

    Kranz, P G; Amrhein, T J; Gray, L

    2014-06-01

    Rebound intracranial hypertension is a complication of epidural blood patching for treatment of intracranial hypotension characterized by increased intracranial pressure, resulting in potentially severe headache, nausea, and vomiting. Because the symptoms of rebound intracranial hypertension may bear some similarity to those of intracranial hypotension and literature reports of rebound intracranial hypertension are limited, it may be mistaken for refractory intracranial hypotension, leading to inappropriate management. This clinical report of 9 patients with confirmed rebound intracranial hypertension reviews the clinical characteristics of patients with this condition, emphasizing factors that can be helpful in discriminating rebound intracranial hypertension from refractory spontaneous intracranial hypotension, and discusses treatment.

  6. Relief of postural post dural puncture headache by an epidural blood patch 12 months after dural puncture.

    PubMed

    Klepstad, P

    1999-10-01

    A 20-year-old previously healthy male presented at the pain clinic with chronic headache of about one year duration. Clinical examination revealed no pathological manifestations. During the consultation the patient was drinking Coca-Cola. On direct questioning he told that drinking Coca-Cola gave partial relief from the headache, and that the headache started after he had received two spinal anaesthetics for treatment of a lower leg fracture. Postural post dural puncture headache was now suspected and an epidural blood patch performed. Despite an interval of nearly 12 months since the dural punctures, a single epidural blood patch completely relieved the headache. This case history demonstrates that an epidural blood patch should be tried if a chronic post dural puncture headache is suspected.

  7. Spontaneous Intracranial Hypotension Treated with a Targeted CT-Guided Epidural Blood Patch

    PubMed Central

    Correia, Inês; Marques, Inês Brás; Ferreira, Rogério; Cordeiro, Miguel; Sousa, Lívia

    2016-01-01

    Spontaneous intracranial hypotension (SIH) is an important cause of new daily persistent headache. It is thought to be due to spontaneous spinal cerebrospinal fluid (CSF) leaks, which probably have a multifactorial etiology. The classic manifestation of SIH is an orthostatic headache, but other neurological symptoms may be present. An epidural blood patch is thought to be the most effective treatment, but a blind infusion may be ineffective. We describe the case of a young man who developed an acute severe headache, with pain worsening when assuming an upright posture and relief gained with recumbency. No history of previous headache, recent cranial or cervical trauma, or invasive procedures was reported. Magnetic resonance imaging showed pachymeningeal enhancement and other features consistent with SIH and pointed towards a cervical CSF leak site. After failure of conservative treatment, a targeted computer tomography-guided EBP was performed, with complete recovery. PMID:26981128

  8. [Management of transient radicular pain after receiving an epidural blood patch for headaches due to spontaneous intracranial hypotension].

    PubMed

    Melo, M C; Revuelta, M E; Santeularia, T; Genové, M; Català, E

    2015-11-01

    Spontaneous intracranial hypotension headache is an uncommon disease that resolves spontaneously in most of the cases and in a short period of time. The initial treatment should be symptomatic. In some patients the symptomatology is extremely disabling, and in these cases both the diagnosis and treatment may be performed by an epidural blood patch. A 49-year-old Caucasian woman, with no previous record of epidural or intrathecal puncture, consulted in the Emergency Department complaining of a 9-day history of frontal headache and diplopia, along with nausea and vomiting. The patient was diagnosed with spontaneous intracranial hypotension headache. Considering the symptomatology and the uncontrolled pain, the Pain Unit of our hospital performed an epidural blood patch. In the first 24h the patient reported a remarkable relief of both headache and diplopia but developed a left lumbar radiculopathy that was treated successfully with supportive measures. Transient lumbar radiculopathy is a common and acceptable event secondary to the use of epidural blood patch as a treatment for spontaneous intracranial hypotension headache. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Facial nerve paralysis and partial brachial plexopathy after epidural blood patch: a case report and review of the literature

    PubMed Central

    Shahien, Radi; Bowirrat, Abdalla

    2011-01-01

    We report a complication related to epidural analgesia for delivery in a 24- year-old woman who was admitted with mild pre-eclampsia and for induction of labor. At the first postpartum day she developed a postdural puncture headache, which was unresponsive to conservative measures. On the fifth day an epidural blood patch was done, and her headache subsided. Sixteen hours later she developed paralysis of the right facial nerve, which was treated with prednisone. Seven days later she complained of pain in the left arm and the posterior region of the shoulder. She was later admitted and diagnosed with partial brachial plexopathy. PMID:21386953

  10. Epidural Blood Patch Performed for Severe Intracranial Hypotension Following Lumbar Cerebrospinal Fluid Drainage for Intracranial Aneurysm Surgery. Retrospective Series and Literature Review

    PubMed Central

    Tanweer, Omar; Kalhorn, Stephen P.; Snell, Jamaal T.; Lieber, Bryan A.; Agarwal, Nitin; Huang, Paul P.; Sutin, Kenneth M.

    2015-01-01

    Intracranial hypotension (IH) can occur following lumbar drainage for clipping of an intracranial aneurysm. We observed 3 cases of IH, which were all successfully treated by epidural blood patch (EBP). Herein, the authors report our cases. PMID:27065093

  11. Cervical CT scan-guided epidural blood patches for spontaneous intracranial hypotension.

    PubMed

    Maingard, Julian; Giles, Lauren; Marriott, Mark; Phal, Pramit M

    2015-12-01

    We describe two patients with spontaneous intracranial hypotension (SIH), presenting with postural headache due to C1-C2 cerebrospinal fluid (CSF) leak. Both patients were refractory to lumbar epidural blood patching (EBP), and subsequently underwent successful CT scan-guided cervical EBP. SIH affects approximately 1 in 50,000 patients, with females more frequently affected. Its associated features are variable, and as such, misdiagnosis is common. Therefore, imaging plays an important role in the diagnostic workup of SIH and can include MRI of the brain and spine, CT myelogram, and radionuclide cisternography. In patients with an established diagnosis and confirmed CSF leak, symptoms will usually resolve with conservative management. However, in a select subgroup of patients, the symptoms are refractory to medical management and require more invasive therapies. In patients with cervical leaks, EBP in the cervical region is an effective management approach, either in close proximity to, or directly targeting a dural defect. CT scan-guided cervical EBP is an effective treatment approach in refractory SIH, and should be considered in those patients who are refractory to conservative management.

  12. Predictors of the Treatment Response of Spontaneous Intracranial Hypotension to an Epidural Blood Patch.

    PubMed

    Karm, Myong-Hwan; Choi, Jae-Hyung; Kim, Doohwan; Park, Jun Young; Yun, Hye Joo; Suh, Jeong Hun

    2016-05-01

    Spontaneous intracranial hypotension (SIH) is characterized by postural headache because of low cerebrospinal fluid (CSF) pressure. Brain magnetic resonance imaging (MRI) and radioisotope (RI) cisternography can be used to identify the site of a CSF leakage. Although autologous epidural blood patch (EBP) is a very effective treatment modality, some patients require a repeat autologous EBP. We investigated whether autologous EBP responses correlate with surrogate markers of quantitative findings.All cases of autologous EBP for SIH from January 2006 to December 2014 were enrolled. The demographic variables, number of EBPs, pain scores, RI cisternography (early visualization of bladder activity), and MRI findings (subdural fluid collections, pachymeningeal enhancement, engorgement of venous structures, pituitary hyperemia, and sagging of the brain) were reviewed.Patients with early bladder activity on RI cisternography had a tendency to need a higher number of autologous EBPs. Only sagging of the brain and no other variables showed a statistically significant negative correlation with the number of autologous EBPs.The response to autologous EBP may be related to the radiologic findings of early bladder activity on RI cisternography and sagging of the brain on MRI.

  13. Predictors of the Treatment Response of Spontaneous Intracranial Hypotension to an Epidural Blood Patch

    PubMed Central

    Karm, Myong-Hwan; Choi, Jae-Hyung; Kim, Doohwan; Park, Jun Young; Yun, Hye Joo; Suh, Jeong Hun

    2016-01-01

    Abstract Spontaneous intracranial hypotension (SIH) is characterized by postural headache because of low cerebrospinal fluid (CSF) pressure. Brain magnetic resonance imaging (MRI) and radioisotope (RI) cisternography can be used to identify the site of a CSF leakage. Although autologous epidural blood patch (EBP) is a very effective treatment modality, some patients require a repeat autologous EBP. We investigated whether autologous EBP responses correlate with surrogate markers of quantitative findings. All cases of autologous EBP for SIH from January 2006 to December 2014 were enrolled. The demographic variables, number of EBPs, pain scores, RI cisternography (early visualization of bladder activity), and MRI findings (subdural fluid collections, pachymeningeal enhancement, engorgement of venous structures, pituitary hyperemia, and sagging of the brain) were reviewed. Patients with early bladder activity on RI cisternography had a tendency to need a higher number of autologous EBPs. Only sagging of the brain and no other variables showed a statistically significant negative correlation with the number of autologous EBPs. The response to autologous EBP may be related to the radiologic findings of early bladder activity on RI cisternography and sagging of the brain on MRI. PMID:27149484

  14. Sub-dural hematoma following spinal anesthesia treated with epidural blood patch and burr-hole evacuation: a case report.

    PubMed

    K, Krishnakumar; Chatterjee, Nilay; Shrivastava, Adesh; Davis, Josemine; N, Suresh Nair

    2013-02-01

    The appearance of a subdural hematoma (SDH) following spinal anesthesia is a serious and rare complication which mandates prompt diagnosis, although the treatment modalities are not well codified. Patients with post-dural puncture headache (PDPH) non-responsive to conservative measures and/or those patients with a change of the character of the headache should be considered seriously. In symptomatic patients, evacuation of SDH is essential but epidural blood patch should be strongly considered as it can prevent reappearance of SDH by sealing the dural defect.

  15. Reversal of Progressive Conscious Disturbance with Epidural Blood Patch for Cerebrospinal Fluid Leakage at C2 Level.

    PubMed

    Lai, Yi-Chen; Chia, Yuan-Yi; Lien, Wei-Hung

    2017-03-01

    Intracranial hypotension syndrome (IHS) is generally caused by cerebrospinal fluid (CSF) leakage. Complications include bilateral subdural hygroma or haematoma and herniation of the cerebellar tonsils. Epidural blood patch (EBP) therapy is indicated if conservative treatment is ineffective. We reported the case of a 46-year-old man with a history of postural headache and dizziness. The patient was treated with bed rest and daily hydration with 2000 mL of fluid for 2 weeks. However, dizziness and headache did not resolve, and he became drowsy and disoriented with incomprehensible speech. Magnetic resonance imaging demonstrated diffuse dural enhancement on the postcontrast study, sagging of the midbrain, and CSF leakage over right lateral posterior thecal sac at C2 level. We performed EBP at the level of T10-T11. We injected 14 mL of autologous blood slowly in the Trendelenburg position. Within 30 minutes, he became alert and oriented to people, place, and time. We chose thoracic EBP as first line treatment in consideration of the risk of cervical EBP such as spinal cord and nerve root compression or puncture, chemical meningitis. Also we put our patient in Trendelenburg position to make blood travel towards the site of the leak. Untreated IHS may delay the course of resolution and affect the patient's consciousness. Delivery of EBP via an epidural catheter inserted from the thoracic spine is familiar with most of anesthesiologists. It can be a safe and effective treatment for patients with IHS caused by CSF leak even at C2.Key words: Anaesthetic techniques, regional, thoracic; cerebrospinal fluid leakage; epidural blood patch; heavily T2-weighted magnetic resonance myelography; intracranial hypotension syndrome; Trendelenburg position.

  16. The effect of serial in vitro haemodilution with maternal cerebrospinal fluid and crystalloid on thromboelastographic (TEG(®) ) blood coagulation parameters, and the implications for epidural blood patching.

    PubMed

    Armstrong, S; Fernando, R; Tamilselvan, P; Stewart, A; Columb, M

    2015-02-01

    Epidural blood patches may be used to treat post-dural puncture headache following accidental dural puncture in parturients. Their mode of action and the optimum volume of blood for injection remain controversial, with the interaction between injected blood and cerebrospinal fluid unknown. We aimed to establish the effects of serial haemodilution of whole blood with cerebrospinal fluid from 34 pregnant patients compared with serial haemodilution with Hartmann's solution, using the thromboelastogram. Haemodilution with either cerebrospinal fluid or Hartmann's solution had significant procoagulant and clot destabilising effects, enhanced with progressive haemodilution up to 30%. The effect of cerebrospinal fluid was greater compared with Hartmann's solution (p < 0.001). Cerebrospinal fluid led to a mean (95% CI) decrease in r-time by 2.4 (1.6-3.2) min, a decrease in k-time by 0.6 (0.4-0.8) min, an increase in alpha angle by 7.3 (5.5-9.0)°, and a decrease in maximum amplitude by 2.0 (0.6-3.4) mm. This may have implications for epidural blood patch, as success may be reduced near the time of dural puncture when cerebrospinal fluid leak is at its greatest, and large volumes of blood may be required to reduce haemodilution and clot destabilisation by cerebrospinal fluid. In addition, blood patching should be performed at the level of the dural puncture in order to ensure that the maximum volume of blood comes into contact with the cerebrospinal fluid. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

  17. Epidural blood patch for spontaneous intracranial hypotension with chronic subdural haematoma: A case report and literature review.

    PubMed

    Zhang, Jian; Jin, Dan; Pan, Kong-Han

    2016-08-01

    Spinal leakage of cerebrospinal fluid (CSF) is considered to be the primary cause of spontaneous intracranial hypotension (SIH). Subdural haematoma (SDH) is a serious complication of SIH. This current report presents a case of bilateral SDH with SIH that was treated with epidural blood patching (EBP). A 43-year-old male complained of experiencing orthostatic headaches for 2 months without neurological signs. The patient worsened in a local hospital and was transferred to the Sir Run Run Hospital. Brain computed tomography showed bilateral SDH with a midline shift. The patient underwent emergency trephination in the left frontal temporal region. Postoperative magnetic resonance myelography showed a CSF leak originating at the T11-L2 level. As a consequence of clinical deterioration of the patient, EBP was subsequently performed at the T12-L1 level. The headache was rapidly relieved and later the SDH was completely absorbed. This case report and literature review aims to remind clinicians that SIH can cause SDH and that EBP is a viable treatment option. © The Author(s) 2016.

  18. Epidural blood patch for spontaneous intracranial hypotension with chronic subdural haematoma: A case report and literature review

    PubMed Central

    Zhang, Jian; Jin, Dan

    2016-01-01

    Spinal leakage of cerebrospinal fluid (CSF) is considered to be the primary cause of spontaneous intracranial hypotension (SIH). Subdural haematoma (SDH) is a serious complication of SIH. This current report presents a case of bilateral SDH with SIH that was treated with epidural blood patching (EBP). A 43-year-old male complained of experiencing orthostatic headaches for 2 months without neurological signs. The patient worsened in a local hospital and was transferred to the Sir Run Run Hospital. Brain computed tomography showed bilateral SDH with a midline shift. The patient underwent emergency trephination in the left frontal temporal region. Postoperative magnetic resonance myelography showed a CSF leak originating at the T11–L2 level. As a consequence of clinical deterioration of the patient, EBP was subsequently performed at the T12–L1 level. The headache was rapidly relieved and later the SDH was completely absorbed. This case report and literature review aims to remind clinicians that SIH can cause SDH and that EBP is a viable treatment option. PMID:27225863

  19. Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: A randomised, observer-blind, controlled clinical trial [ISRCTN 71598245

    PubMed Central

    Oedit, R; van Kooten, F; Bakker, SLM; Dippel, DWJ

    2005-01-01

    Background Post dural punction headache (PDPH) occurs in 10% to 40% of the patients who had a lumbar puncture. Its symptoms can be severe and incapacitating. The epidural blood patch is widely accepted as the treatment of choice for postdural puncture headache. Uncontrolled studies report rapid recovery after patching in 90% to 100% of treated patients. However, sufficient evidence from randomised, controlled clinical trials is lacking. Methods BLOPP (blood patch for post dural puncture headache) is a randomised, single centre, observer-blind clinical trial. Patients with PDPH for at least 24 hours and at most 7 days after lumbar puncture will be randomised to treatment with an epidural blood patch (EDBP) or to conventional treatment, i.e. 24 hours bed rest and ample fluid intake. PDPH 24 hours after treatment, classified on a 4-point scale (no, mild, moderate, severe) is the primary outcome. The secondary outcome is the presence of PDPH 7 days after treatment. We estimated that a sample size of 2 × 20 patients would provide us with a power of 80% to detect a relative reduction in number of patients with persisting PDPH after 24 hours of 50% at the usual significance level α = 5%, taking into account that in approximately 10% of the patients the PDPH will have resolved spontaneously after one day. Discussion The EDBP is accepted as the treatment of choice for PDPH although randomised, controlled data is scarce. Our randomised, observer-blind clinical trial enables us to compare the efficacy of two clinically practiced methods of PDPH treatment; EDBP versus conventional treatment, as they are applied in clinical practise. PMID:15998467

  20. Treatment of Refractory Postdural Puncture Headache after Intrathecal Drug Delivery System Implantation with Epidural Blood Patch Procedures: A 20-Year Experience

    PubMed Central

    Moeschler, Susan M.; Qu, Wenchun; Hanley, Eugerie; Neuman, Stephanie A.; Eldrige, Jason S.; Hoelzer, Bryan C.

    2016-01-01

    A recent publication reported the incidence of postdural puncture headache (PDPH) in conjunction with intrathecal drug delivery system (IDDS) implantation to be nearly 23 percent. Many patients responded to conservative measures but a percentage needed invasive treatment with an epidural blood patch (EBP). There is limited data to describe the technical details, success rates, and complications associated with EBP in this population. This study aims to provide a retrospective report of EBP for patients suffering from PDPH related to IDDS implantation. A chart review established a cohort of patients that required EBP in relation to a PDPH after IDDS implantation. This cohort was evaluated for demographic data as well as details of the EBP including technical procedural data, success rates, and complications. All patients received a trial of conservative therapy. Standard sterile technique and skin preparation were utilized with no infectious complications. The EBP was placed below the level of the IDDS catheter in 94% of procedures. Fluoroscopy was utilized in each case. The mean EBP volume was 18.6 cc and median time of EBP was day 7 after implant. There were no complications associated with EBP. EBP appears to be an effective intervention in this subset of PDPH patients. PMID:27597897

  1. Value of Targeted Epidural Blood Patch and Management of Subdural Hematoma in Spontaneous Intracranial Hypotension: Case Report and Review of the Literature.

    PubMed

    Rettenmaier, Leigh A; Park, Brian J; Holland, Marshall T; Hamade, Youssef J; Garg, Shuchita; Rastogi, Rahul; Reddy, Chandan G

    2017-01-01

    Spontaneous intracranial hypotension (SIH) is a more common than previously noted condition (1-2.5 per 50,000 persons) typically caused by cerebrospinal fluid (CSF) leakage. Initial treatment involves conservative therapies, but the mainstay of treatment for patients who fail conservative management is the epidural blood patch (EBP). Subdural hematoma (SDH) is a common complication occurring with SIH, but its management remains controversial. In this report, we discuss a 62-year-old woman who presented with a 5-week history of orthostatic headaches associated with nausea, emesis, and neck pain. Despite initial imaging being negative, the patient later developed classic imaging evidence characteristic of SIH. Magnetic resonance imaging was unrevealing for the source of the CSF leak. Radionuclide cisternography showed possible CSF leak at the right-sided C7-T1 nerve root exit site. After failing a blind lumbar EBP, subsequent targeted EBP at C7-T1 improved the patient's symptoms. Two days later she developed a new headache with imaging evidence of worsening SDH with midline shift requiring burr hole drainage. This yielded sustained symptomatic relief and resolution of previously abnormal imaging findings at 2-month follow-up. A literature review revealed 174 cases of SIH complicated by SDH. This revealed conflicting opinions concerning the management of this condition. Although blind lumbar EBP is often successful, targeted EBP has a lower rate of patients requiring a second EBP or other further treatment. On the other hand, targeted EBP has a larger risk profile. Depending on the clinic situation, treatment of the SDH via surgical evacuation may be necessary. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Lumbar blood patching for proximal CSF leaks: where does the blood go?

    PubMed

    Nesbitt, Cassie; Amukotuwa, Shalini; Chapman, Caron; Batchelor, Peter

    2015-02-26

    Epidural blood patching (EBP) is an important therapeutic approach in managing spontaneous cerebrospinal fluid leaks. The mechanism of action of blood patching is likely to be twofold; fluid replacement having an immediate tamponade effect and the proximal flow of blood products having a 'plug' effect. The negative pressure gradient within the epidural space may be important to the rostral flow of injected blood and is possibly increased in intracranial hypotension.

  3. Lumbar blood patching for proximal CSF leaks: where does the blood go?

    PubMed Central

    Nesbitt, Cassie; Amukotuwa, Shalini; Chapman, Caron; Batchelor, Peter

    2015-01-01

    Epidural blood patching (EBP) is an important therapeutic approach in managing spontaneous cerebrospinal fluid leaks. The mechanism of action of blood patching is likely to be twofold; fluid replacement having an immediate tamponade effect and the proximal flow of blood products having a ‘plug’ effect. The negative pressure gradient within the epidural space may be important to the rostral flow of injected blood and is possibly increased in intracranial hypotension. PMID:25721827

  4. The post-operative analgesic effects of epidurally administered morphine and transdermal fentanyl patch after ovariohysterectomy in dogs.

    PubMed

    Pekcan, Zeynep; Koc, Bahattin

    2010-11-01

    To investigate the analgesic and side effects of epidural morphine or a fentanyl patch after ovariohysterectomy in dogs. Prospective, randomized clinical study. Twenty female mongrel dogs undergoing ovariohysterectomy. The dogs were allocated to one of two groups: epidural morphine or transdermal fentanyl patch. Anaesthesia was induced with propofol and maintained with isoflurane. Morphine (0.1 mg kg(-1)) was administered epidurally in the epidural morphine group and a transdermal fentanyl patch was applied 24 hours before the operation in the fentanyl patch group. The heart rate, respiratory rate, body temperature, plasma cortisol concentration, and sedation and analgesia scores were recorded during the 24 hour post-operative period. Adverse effects such as vomiting, anorexia, skin reactions, urinary retention, and time to start licking the surgical site were also recorded. p<0.05 was considered significant. Statistical analyses utilized anova for repeated measures, Friedman tests, Mann-Whitney U-tests and independent sample t-tests as relevant. Pain scores were lower in the epidural group than in the fentanyl group at all post-operative times. The dogs in the epidural morphine group were calm and relaxed, whereas discomfort and vocalization were recorded in the fentanyl patch group. The sedation scores were higher in the fentanyl patch group throughout the 12 hour period. Salivation and anorexia lasted longer in the fentanyl patch group than in the epidural morphine group. Plasma cortisol concentrations were high in the early post-operative period in both groups. The fentanyl patch group had higher cortisol concentrations than the epidural morphine group. Slight erythema was recorded in two dogs when the patches were removed. Epidurally administered morphine provided better analgesia and caused fewer adverse effects than the fentanyl patch after ovariohysterectomy in dogs. © 2010 The Authors. Veterinary Anaesthesia and Analgesia © 2010 Association of Veterinary

  5. Effects of epidural and spinal anesthesia on blood rheology.

    PubMed

    Odoom, J A; Bovill, J G; Hardeman, M R; Oosting, J; Zuurmond, W W

    1992-06-01

    This study was designed to compare the influence of epidural and spinal anesthesia on blood viscosity. We studied 22 patients, ASA classification I, who underwent elective knee or ankle arthroscopy and received epidural (n = 11) or spinal (n = 11) anesthesia with plain bupivacaine, and 10 control volunteers, who did not undergo surgery or receive anesthesia. There were significant decreases in hematocrit, plasma viscosity, and whole-blood viscosity at high (70 s-1), medium (0.5 s-1), and low (0.05 s-1) shear rates. The magnitude of changes was similar in all groups but occurred earlier in the control group (between 10 and 30 min) and after spinal administration (between 10 and 30 min) rather than after epidural administration (between 30 and 60 min) of bupivacaine. Only spinal anesthesia was associated with a decrease in erythrocyte deformability. The observed rheologic changes are attributed to hemodilution from the intravenous administration of fluids and the redistribution of fluid in the intravascular and extravascular compartments after sympathetic blockade and to postural changes rather than the effect of bupivacaine on blood elements.

  6. Computed tomography-guided epidural patching of postoperative cerebrospinal fluid leaks.

    PubMed

    Mihlon, Frank; Kranz, Peter G; Gafton, Andreia Roxana; Gray, Linda

    2014-11-01

    Cerebrospinal fluid leaks due to unrecognized durotomy during spinal surgery are often managed with a second surgery for dural closure. CT-guided percutaneous patching targeted to the dural defect offers an alternative to surgery since it can be performed in a minimally invasive fashion without the need for general anesthesia. This case series describes the authors' experience using targeted CT-guided percutaneous patching to repair incidental durotomies incurred during spinal surgery. This investigation is a retrospective case series involving patients who underwent CT-guided percutaneous patching of surgical incidental durotomies and were referred between January 2007 and June 2013. Their presenting clinical history, myelographic findings, and clinical outcomes, including the need for eventual surgical duraplasty, were reviewed. Nine cases were identified, including 7 durotomies incurred during lumbar discectomy, one due to a medial transpedicular screw breach, and one incurred during vertebrectomy for spinal osteosarcoma. All patients who had favorable outcomes with percutaneous intervention alone had 2 common features: dural defect of 4 mm or smaller and absence of a pseudomeningocele. Patients with CSF leaks complicated by pseudomeningocele and those with a dural defect of 6 mm or more all required eventual surgical management. The authors' results suggest that findings on CT myelography may help predict which patients with postsurgical durotomy can be treated with percutaneous intervention. In particular, CT-guided patching may be more likely to be successful in those patients with dural defects of less than 5 mm and without pseudomeningocele. In patients with larger dural defects or pseudomeningoceles, percutaneous blood patching alone is unlikely to be successful.

  7. Increased apoptosis of peripheral blood mononuclear cells (PBMC) during general and epidural anaesthesia in dogs.

    PubMed

    Simeonova, Galina P; Slavov, Emil; Usunov, Roustislav; Halacheva, Krasimira; Dinev, Dinco N

    2008-12-01

    The objective of the study was to investigate the hypothesis that perioperative lymphocytopenia was due to apoptosis of these cells induced by either halothane or epidural anaesthesia in dogs. The relationship between apoptosis induction and plasma concentrations of the stress hormone cortisol and the cytokines TNF-alpha and IL-10 was examined as well. The study was performed on 22 healthy mongrel dogs, equal numbers from both genders, weighing 18.3 +/- 2.9 kg, and aged between 3-5 years. Dogs were divided in three groups. Eight of the animals were anaesthetized with halothane, another eight received epidural anaesthesia using lidocaine, and six served as controls. Venous blood samples were obtained immediately before (0 minute) anaesthesia, during deep anaesthesia (120 minute), and on the next day (24 hour) in order to determine the following parameters: the total lymphocyte counts, the percentage of apoptotic peripheral blood mononuclear cells (PBMC) by flow cytometry, plasma concentrations of the cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) by enzyme-linked immunosorbent assay (ELISA), and plasma cortisol levels by radioimmune assay. Both halothane and epidural anaesthesia in dogs induces apoptosis of PBMC with slight decrease in total lymphocyte counts. These immunomodulatory effects were transient and faded till the 24th hour. Concerning the mechanism of inducing lymphocyte apoptosis by general or epidural anaesthesia, it seemed that neither cortisol, nor the tested cytokines TNF-alpha and IL-10 were implicated in this process. Further investigations are necessary to confirm this assumption.

  8. In vivo images of the epidural space with two- and three-dimensional optical coherence tomography in a porcine model

    PubMed Central

    Tsou, Mei-Yung

    2017-01-01

    Background No reports exist concerning in vivo optical coherence tomography visualization of the epidural space and the blood patch process in the epidural space. In this study, we produced real-time two-dimensional and reconstructed three-dimensional images of the epidural space by using optical coherence tomography in a porcine model. We also aimed to produce three-dimensional optical coherence tomography images of the dura puncture and blood patch process. Methods Two-dimensional and three-dimensional optical coherence tomography images were obtained using a swept source optical coherence tomography (SSOCT) system. Four laboratory pigs were intubated and ventilated after the induction of general anesthesia. An 18-gauge Tuohy needle was used as a tunnel for the optical coherence tomography probe to the epidural space. Two-dimensional and three-dimensional reconstruction optical coherence tomography images of the epidural space were acquired in four stages. Results In stage 1, real-time two-dimensional and reconstructed three-dimensional optical coherence tomography of the lumbar and thoracic epidural space were successfully acquired. In stage 2, the epidural catheter in the epidural space was successfully traced in the 3D optical coherence tomography images. In stage 3, water injection and lumbar puncture were successfully monitored in all study animals. In stage 4, 10 mL of fresh blood was injected into the epidural space and two-dimensional and three-dimensional optical coherence tomography images were successfully acquired. Conclusions These animal experiments suggest the potential capability of using an optical coherence tomography-based imaging needle in the directed two-dimensional and three-dimensional visualization of the epidural space. More investigations involving humans are required before optical coherence tomography can be recommended for routine use. However, three-dimensional optical coherence tomography may provide a novel, minimally invasive

  9. In vivo images of the epidural space with two- and three-dimensional optical coherence tomography in a porcine model.

    PubMed

    Kuo, Wen-Chuan; Kao, Meng-Chun; Tsou, Mei-Yung; Ting, Chien-Kun

    2017-01-01

    No reports exist concerning in vivo optical coherence tomography visualization of the epidural space and the blood patch process in the epidural space. In this study, we produced real-time two-dimensional and reconstructed three-dimensional images of the epidural space by using optical coherence tomography in a porcine model. We also aimed to produce three-dimensional optical coherence tomography images of the dura puncture and blood patch process. Two-dimensional and three-dimensional optical coherence tomography images were obtained using a swept source optical coherence tomography (SSOCT) system. Four laboratory pigs were intubated and ventilated after the induction of general anesthesia. An 18-gauge Tuohy needle was used as a tunnel for the optical coherence tomography probe to the epidural space. Two-dimensional and three-dimensional reconstruction optical coherence tomography images of the epidural space were acquired in four stages. In stage 1, real-time two-dimensional and reconstructed three-dimensional optical coherence tomography of the lumbar and thoracic epidural space were successfully acquired. In stage 2, the epidural catheter in the epidural space was successfully traced in the 3D optical coherence tomography images. In stage 3, water injection and lumbar puncture were successfully monitored in all study animals. In stage 4, 10 mL of fresh blood was injected into the epidural space and two-dimensional and three-dimensional optical coherence tomography images were successfully acquired. These animal experiments suggest the potential capability of using an optical coherence tomography-based imaging needle in the directed two-dimensional and three-dimensional visualization of the epidural space. More investigations involving humans are required before optical coherence tomography can be recommended for routine use. However, three-dimensional optical coherence tomography may provide a novel, minimally invasive, and safe way to observe the spinal

  10. Persistent post-dural-puncture headache treated with epidural infusion of dextran.

    PubMed

    Aldrete, J A

    1994-05-01

    A retrospective review was done on medical records of 13 patients with persistent post-dural-puncture headaches after one or more epidural blood patches. Headache occurred in nine patients with post-laminectomy syndrome after "wet taps" while performing epidural blocks. In two patients post-dural-puncture headache appeared after long term implanted intrathecal catheters were removed. In two other cases headache developed after spinal anesthesia. Treatment included bed rest, intravenous hydration and at least one epidural blood patch; three patients were given 60 milliliters of epidural saline, without success. Eight epidural catheters were inserted through the lumbar access and five through the caudal approach. Initially, a bolus of 20 milliliters of dextran-40 was given followed by an infusion of 3 mL/hr, until 12 hours after the head pain and any other related symptoms subsided. In all patients the headache disappeared within 20 hours after initiating therapy (9.55 mean hours, SD +/- 0.79). In five patients headache ceased in less than five hours. Nausea and photo-phobia subsided earlier. Patients with post-dural-puncture headache resistant to other treatments, including at least one epidural blood patch, were successfully treated by a bolus followed by continuous epidural infusion of dextran-40.

  11. Distribution in cerebrospinal fluid, blood, and lymph of epidurally injected morphine and inulin in dogs

    SciTech Connect

    Durant, P.A.; Yaksh, T.L.

    1986-06-01

    We describe procedures for catheterizing the epidural space, the azygos vein, and the thoracic lymph duct of dogs without using fluoroscopy. The success rates of the procedures were 100, 80, and 50%, respectively (n = 10). To assess the validity of the model, /sup 3/H-morphine and unlabeled morphine (2 mg) were injected epidurally in ten dogs. Lumbar cerebrospinal fluid (CSF), azygos venous blood, arterial blood, and lymph were sampled before and 5, 20, 60, 120, 180, 240, 300 and 360 min after injection. During the first 20 min, morphine levels in the azygos vein were about three and ten times greater than arterial and lymphatic levels, respectively (n = 3; P less than 0.01). Morphine levels were significantly greater in the azygos vein (n = 8) and the femoral artery (n = 10) during the first 20 and 60 min than they were later, respectively (P less than 0.05). In the lymph (n = 5), the levels of morphine at 60 min were statistically greater (P less than 0.05) than levels at 4, 5, and 6 hr. At no time were the concurrent arterial and lymph levels different from each other. In the lumbar CSF, the morphine peak concentration was reached 5-60 min after epidural injection and ranged between 5 and 93 micrograms/ml. In the CSF, the levels of morphine were significantly greater during the first 20 min than later (n = 7; P less than 0.05). The washout of the lumbar CSF curve for morphine appeared to be fitted by a two-compartment open model. The t1/2-alpha and t1/2-beta values were 14.7 +/- 7.2 min and 106 +/- 45 min, respectively (mean +/- SD). Cumulative percentages of the epidural dose of morphine passed into the azygos system within the first 5, 20, 60, and 120 min after injection were calculated to be 4.0 +/- 2.1, 23.5 +/- 14.6, 49.2 +/- 34.2, and 55.9 +/- 35.3, respectively (mean +/- SD; n = 8).

  12. Venoconstrictor agents mobilize blood from different sources and increase intrathoracic filling during epidural anesthesia in supine humans

    SciTech Connect

    Stanton-Hicks, M.; Hoeck, A.S.; Stuehmeier, K.D.A.; Arndt, J.O.

    1987-03-01

    The authors studied the effects of dihydroergotamine (DHE) and etilefrine hydrochloride (E) on the regional distribution of /sup 99m/Tc-marked erythrocytes during epidural anesthesia in eight supine men to determine if vasoactive agents with venoconstrictor action would enhance cardiac filling during epidural anesthesia. Radioactivity was recorded with a gamma camera, and its distribution determined in the thorax, abdomen, and limbs. Arterial and central venous pressure, heart rate, and calf volume by plethysmography were measured. During epidural anesthesia with a sensory block up to T4/5, DHE (7.5 micrograms/kg) reduced the radioactivity, i.e., blood volume, in both the innervated (-5.9 +/- 3.5%) and denervated muscle/skin (-16.9 +/- 7%) regions, and increased it in both the intrathoracic (+7.0 +/- 2.3%), and splanchnic vasculature (+4.2 +/- 3.2). In contrast, E (6 micrograms X kg-1 X min-1) decreased the blood volume most markedly in the splanchnic region (-5.4 +/- 0.7%) and increased it in the thorax (+2 +/- 0.6%). All these changes were statistically significant. The combined effects were estimated to be equivalent to a transfusion of nearly 1.01 of blood. Both drugs reversed the hypotensive action of epidural anesthesia. During epidural anesthesia, DHE preferentially constricted the capacitance vessels in skeletal muscle and skin irrespective of the state of innervation, whereas E preferentially constricted the splanchnic vasculature. In the doses used, the two agents replenished in an additive fashion the central circulation during epidural anesthesia.

  13. Trajectory of platelets in pregnancy - do low-risk women need an intrapartum full blood count prior to epidural?

    PubMed

    Duong, Christine; Kidson-Gerber, Giselle; Peters, Nancy; Listijono, Dave R; Henry, Amanda

    2015-10-01

    This study aimed to investigate whether pregnant women with a normal 28-week gestation platelet count and no high-risk conditions for thrombocytopenia require a pre-epidural platelet count. All 1844 included women (platelet count > 150 × 10(9) /L at 28 weeks' gestation, term singleton birth, no thrombocytopenia risk conditions) had a platelet count > 100 × 10(9) /L prebirth, suggesting low-risk pregnant women do not require pre-epidural full blood count solely to check platelet count.

  14. Effects of two different doses of epidural steroid on blood glucose levels and pain control in patients with diabetes mellitus.

    PubMed

    Kim, Won Ho; Sim, Woo Seog; Shin, Byung Seop; Lee, Chul Joong; Jin, Hyun Seung; Lee, Jin Young; Roe, Hee Jin; Kim, Chung Su; Lee, Sagmin M

    2013-01-01

    A high incidence of diabetes mellitus has been reported among patients diagnosed with lumbar degenerative spinal diseases. Although epidural steroid injections are known to increase the postprocedure blood glucose level, it has not been investigated whether a lower steroid dose can reduce blood glucose excursions and still be effective in controlling patients' subjective pain. We compared the effects of 2 common doses of triamcinolone administered via epidural steroid injections on blood glucose levels and pain control in patients with diabetes mellitus to determine an adequate epidural steroid dose. A prospective observational study. One hundred patients with diabetes mellitus were enrolled. They received lumbar transforaminal, lumbar interlaminar, or caudal epidural triamcinolone for radiculopathy, spinal stenosis, or failed back surgery syndrome. After the type of procedure was clinically determined, the doses of triamcinolone given were randomly chosen, either 40 mg (Group 40) or 20 mg (Group 20). The patients were asked to measure their finger stick blood glucose level twice daily (fasting and postprandial) for 3 days before the injection, on the day of the injection, for 7 days after the injection, and at 14 days after the injection. They also kept a blood glucose diary. Employment status and clinical outcome were evaluated at 8 weeks after the procedure. There were significant increases in fasting blood glucose (FBG) level on postprocedure day (PPD) #1 to PPD #3 in Group 40, but on PPD #1 in Group 20. Moreover, there was a significant difference in FBG between groups on PPD #1 and PPD #2 (FBG on PPD #1: 179 [51]) mg/dL in Group 40 versus 146 [50] mg/dL in Group 20, P < 0.001]. Postprandial blood glucose (PBG) level was significantly elevated in both groups from PPD #0 to PPD #3. Notably, the increase in PBG was significantly greater in Group 40 than Group 20 on PPD #0 and #1 (PBG on PPD #0: 288 [57] mg/dL versus 242 [94] mg/dL in Groups 40 and 20

  15. Combined spinal-epidural versus epidural analgesia in labour.

    PubMed

    Simmons, Scott W; Taghizadeh, Neda; Dennis, Alicia T; Hughes, Damien; Cyna, Allan M

    2012-10-17

    , 1015 women). Traditional epidural was more favourable in relation to umbilical venous pH (MD -0.03; 95% CI -0.06 to -0.00; one trial, 55 women). There were no data on maternal satisfaction, blood patch for post dural puncture headache, respiratory depression, umbilical cord pH, rare neurological complications, analgesia for caesarean section after analgesic intervention or any economic/use of resources outcomes for this comparison. No differences between CSE and traditional epidural were identified for mobilisation in labour, the need for labour augmentation, the rate of caesarean birth, incidence of post dural puncture headache, maternal hypotension, neonatal Apgar scores or umbilical arterial pH.For CSE versus low-dose epidurals, three outcomes were statistically significant. Two of these reflected a faster onset of effective analgesia from time of injection with CSE and the third was of more pruritus with CSE compared to low-dose epidural (average RR 1.80; 95% CI 1.22 to 2.65; 11 trials, 959 women; random-effects, T² = 0.26, I² = 84%). There was no significant difference in maternal satisfaction (average RR 1.01; 95% CI 0.98 to 1.05; seven trials, 520 women; random-effects, T² = 0.00, I² = 45%). There were no data on respiratory depression, maternal sedation or the need for labour augmentation. No differences between CSE and low-dose epidural were identified for need for rescue analgesia, mobilisation in labour, incidence of post dural puncture headache, known dural tap, blood patch for post dural headache, urinary retention, nausea/vomiting, hypotension, headache, the need for labour augmentation, mode of delivery, umbilical pH, Apgar score or admissions to the neonatal unit. There appears to be little basis for offering CSE over epidurals in labour, with no difference in overall maternal satisfaction despite a slightly faster onset with CSE and conversely less pruritus with low-dose epidurals. There was no difference in ability to mobilise, maternal

  16. Epidural analgesia complicated by dural ectasia in the Marfan syndrome

    PubMed Central

    Gray, Chelsea; Hofkamp, Michael P.; Noonan, Patrick T.; McAllister, Russell K.; Pilkinton, Kimberly A.; Diao, Zhiying

    2016-01-01

    Patients with the Marfan syndrome are considered to be high risk during pregnancy and warrant a complete multidisciplinary evaluation. One goal is to minimize hemodynamic fluctuations during labor since hypertensive episodes may result in aortic dissection or rupture. Although they may prevent these complications, neuraxial techniques may be complicated by dural ectasia. The case of a parturient with the Marfan syndrome and mild dural ectasia is presented. During attempted labor epidural placement, unintentional dural puncture occurred. A spinal catheter was used for adequate labor analgesia, and a resultant postdural puncture headache was alleviated by an epidural blood patch under fluoroscopic guidance. PMID:27695168

  17. Cardiovascular parameters and liver blood flow after infusion of a colloid solution and epidural administration of ropivacaine 0.75%: the influence of age and level of analgesia.

    PubMed

    Simon, Mischa J G; Reekers, Marije; Veering, Bernadette T; Boer, Fred; Burm, Anton G L; van Kleef, Jack W; Vuyk, Jaap

    2009-02-01

    Lumbar epidural anaesthesia induces cardiovascular changes and decreases liver blood flow (Qh). We studied the effects of age on haemodynamics, blood volumes and Qh before and after epidural anaesthesia. Thirty-six patients were enrolled as follows: group 1, 20-44 years; group 2, 45-70 years; group 3, >70 years. Using pulse dye densitometry, in addition to heart rate and arterial blood pressure (arterial BP), cardiac output, total blood volume, central blood volume and Qh were measured, before and after colloid infusion (500 ml hydroxyethyl starch, 6%) and after epidural administration of 15 ml of 0.75% ropivacaine. With age the level of analgesia [median (range)] increased from T7 (L2-T4) in group 1 to T4 (T10-C7) in group 3 (P = 0.04). After colloid infusion, heart rate (mean difference +/- SE; 2.1 +/- 0.7 beats min(-1)), systolic BP (4.1 +/- 2.2 mmHg) and Qh 162 ml min(-1) (ratio 0.90, 95% confidence interval 0.81-0.99) increased slightly but significantly, and were unaffected by age. Epidural anaesthesia induced a significant decrease in Qh (265 ml min(-1); ratio 1.20, 95% confidence interval 1.07-1.35) and arterial pressure (for systolic BP: P = 1 x 10(-7)). A significantly larger decrease in systolic BP occurred in the older, compared with the middle, age group (P = 0.04). Age did not affect epidural-induced changes in cardiac output, total and central blood volumes, and Qh. Age increases the level of analgesia after epidural ropivacaine and is associated with a more pronounced decrease in arterial pressure. A colloid preload mildly increases haemodynamics, but this insufficiently prevents younger and elderly patients from a decrease in Qh after lumbar epidural anaesthesia.

  18. A new approach using high volume blood patch for prevention of post-dural puncture headache following intrathecal catheter pump exchange

    PubMed Central

    Abdulla, Susanne; Vielhaber, Stefan; Heinze, Hans-Jochen; Abdulla, Walied

    2015-01-01

    Background: In an observational study, complications of intrathecal catheter pumps necessitating surgical exchange were analyzed. Also the use of a high-volume prophylactic epidural blood patch (EBP) during surgery for preventing post-dural puncture headache (PDPH) with a follow-up for 1 year is described. Materials and Methods: In 22 patients with refractory chronic pain of cancer/noncancer origin or severe spasticity, who were receiving intrathecal morphine including adjuvants or baclofen for symptom relief, catheter exchange with or without pump was performed. In patients with documented symptoms of PDPH following initial intrathecal catheter implantation, a prophylactic EBP with a high blood volume was used for PDPH prevention during surgery. Catheters were replaced using 40 mL EBP before entering dural space at a speed of 5mL/min into the epidural space. Patients were asked to quantify pain experience and functional ability. Results: From a sample of 72 patients admitted for catheter exchange with or without pump, 22 patients (33%) (12 male, 10 female) had a history of PDPH following initial implantation. Diagnostic and therapeutic measures occurring with malfunction of intrathecal catheter pump systems were described. Twenty-one patients were successfully treated with prophylactic EBP, while one patient could not be properly evaluated because of intracranial bleeding as the underlying disease. Conclusions: A new approach using a high-volume prophylactic EBP for preventing PDPH following catheter exchange is presented. The efficacy and safety of this technique for 1 year follow-up have been evaluated and was found to be safe and potentially effective. PMID:26157652

  19. Epidural abscess

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/001416.htm Epidural abscess To use the sharing features on this page, please enable JavaScript. An epidural abscess is a collection of pus (infected material) between ...

  20. Novel Wearable Device for Blood Leakage Detection during Hemodialysis Using an Array Sensing Patch.

    PubMed

    Du, Yi-Chun; Lim, Bee-Yen; Ciou, Wei-Siang; Wu, Ming-Jui

    2016-06-09

    Hemodialysis (HD) is a clinical treatment that requires the puncturing of the body surface. However, needle dislodgement can cause a high risk of blood leakage and can be fatal to patients. Previous studies proposed several devices for blood leakage detection using optical or electrical techniques. Nonetheless, these methods used single-point detection and the design was not suitable for multi-bed monitoring. This study proposed a novel wearable device for blood leakage monitoring during HD using an array sensing patch. The array sensing patch combined with a mapping circuit and a wireless module could measure and transmit risk levels. The different risk levels could improve the working process of healthcare workers, and enhance their work efficiency and reduce inconvenience due to false alarms. Experimental results showed that each point of the sensing array could detect up to 0.1 mL of blood leakage and the array sensing patch supports a risk level monitoring system up to 8 h to alert healthcare personnel of pertinent danger to the patients.

  1. Novel Wearable Device for Blood Leakage Detection during Hemodialysis Using an Array Sensing Patch

    PubMed Central

    Du, Yi-Chun; Lim, Bee-Yen; Ciou, Wei-Siang; Wu, Ming-Jui

    2016-01-01

    Hemodialysis (HD) is a clinical treatment that requires the puncturing of the body surface. However, needle dislodgement can cause a high risk of blood leakage and can be fatal to patients. Previous studies proposed several devices for blood leakage detection using optical or electrical techniques. Nonetheless, these methods used single-point detection and the design was not suitable for multi-bed monitoring. This study proposed a novel wearable device for blood leakage monitoring during HD using an array sensing patch. The array sensing patch combined with a mapping circuit and a wireless module could measure and transmit risk levels. The different risk levels could improve the working process of healthcare workers, and enhance their work efficiency and reduce inconvenience due to false alarms. Experimental results showed that each point of the sensing array could detect up to 0.1 mL of blood leakage and the array sensing patch supports a risk level monitoring system up to 8 h to alert healthcare personnel of pertinent danger to the patients. PMID:27294927

  2. Intrathecal Catheterization by Epidural Catheter: Management of Accidental Dural Puncture and Prophylaxis of PDPH.

    PubMed

    Jadon, Ashok; Chakraborty, Swastika; Sinha, Neelam; Agrawal, Rajiv

    2009-02-01

    Accidental or inadvertent dural puncture during epidural anaesthesia results in high incidence of post dural puncture headache (PDPH). Spinal or intrathecal catheter in such a situation, provides a conduit for administration of appropriate local anaesthetic for rapid onset of intraoperative surgical anaesthesia and postoperative pain relief. This procedure prevents PDPH if catheter left in situ for > 24 hrs and also avoids the associated risks with a repeat attempts at epidural analgesia. Primary aim of this study was to observe the effect of spinal catheter on incidence of PDPH, and to assess early and delayed complications of spinal catheterization by epidural catheter. In prospective clinical study 34 patients who had accidental dural puncture during epidural anaesthesia were included. The catheter meant for epidural use was inserted in spinal space and used for spinal anaesthesia and postoperative analgesia. Catheter was removed between 24-36hrs after surgery. The incidence of accidental dural puncture was 4%(34/846). Two patients 5.88% (2/34) had transient paresthesia during spinal catheter insertion. Post dural puncture headache occurred in 11.76% (4/34) patients. Two patients required epidural blood patch and two patients were managed with conservative treatment. No patient had any serious intraoperative or postoperative side effects. Epidural catheter can be used as spinal catheter to manage accidental dural puncture without serious complications, and it also prevents PDPH.

  3. Blood patch treatment of chylothorax following transthoracic oesophagogastrectomy: a novel technique to aid surgical management.

    PubMed

    Windhaber, R A J; Holbrook, A G; Krysztopik, R J

    2010-05-01

    Chylothorax is a well-recognised complication of oesophagectomy, occurring in around 3% of cases. If managed conservatively, the mortality rate can be over 50%. We describe our experience of managing a patient with a chylothorax following oesophagectomy, and the use of a blood patch (a novel technique) to overcome persistent leakage following re-operation. The authors feel that this technique has the potential for a wider application in the treatment of chyle leak, especially if combined with minimally invasive or radiological techniques.

  4. Fish scale-derived collagen patch promotes growth of blood and lymphatic vessels in vivo.

    PubMed

    Wang, Jun Kit; Yeo, Kim Pin; Chun, Yong Yao; Tan, Timothy Thatt Yang; Tan, Nguan Soon; Angeli, Véronique; Choong, Cleo

    2017-09-06

    In this study, Type I collagen was extracted from fish scales as a potential alternative source of collagen for tissue engineering applications. Since unmodified collagen typically has poor mechanical and degradation stability both in vitro and in vivo, additional methylation modification and 1,4-butanediol diglycidyl ether (BDE) crosslinking steps were used to improve the physicochemical properties of fish scale-derived collagen. Subsequently, in vivo studies using a murine model demonstrated the biocompatibility of the different fish scale-derived collagen patches. In general, favorable integration of the collagen patches to the surrounding tissues, with good infiltration of cells, blood vessels (BVs) and lymphatic vessels (LVs) were observed under growth factor-free conditions. Interestingly, significantly higher (p < 0.05) number of LVs was found to be more abundant around collagen patches with methylation modification and BDE crosslinking. Overall, we have demonstrated the potential application of fish scale-derived collagen as a promising scaffolding material for various biomedical applications. Currently the most common sources of collagen are of bovine and porcine origins, although the industrial use of collagen obtained from non-mammalian species is growing in importance, particularly since they have a lower risk of disease transmission and are not subjected to any cultural or religious constraints. However, unmodified collagen typically has poor mechanical and degradation stability both in vitro and in vivo. Hence, in this study, Type I collagen was successfully extracted from fish scales and chemically modified and crosslinked. In vitro studies showed overall improvement in the physicochemical properties of the material, whilst in vivo implantation studies showed improvements in the growth of blood and lymphatic host vessels in the vicinity of the implants. Copyright © 2017. Published by Elsevier Ltd.

  5. Massive Blood Transfusion during Revision Total Hip Arthroplasty under Combined Spinal Epidural Anaesthesia

    PubMed Central

    Kandemir, Tünay; Kandemir, Erbin; Aşkın, Tuğba; Dal, Tülay; Kılıç, Yeliz; Ünver, Süheyla

    2016-01-01

    Revision total hip arthroplasty (THA) is an orthopaedic surgery that is known to be associated with excessive bleeding. The rates of mortality and morbidity are high in patients with massive haemorrhage. The patient in this study was administered blood products with high fresh frozen plasma/red blood cell (RBC) suspension ratio and high platelet/RBC suspension ratio without waiting for haemostasis test results. This study suggests that this approach might prove beneficial in reducing the incidence of intra- and postoperative complications. this study presents our experience with a patient who underwent THA and required a transfusion that was three times her estimated total blood volume. The patient was successfully managed with close monitoring of haemorrhage and timely administration of blood and blood products before hypotension and loss of consciousness occurred. PMID:27366558

  6. A correlation found between gold concentration in blood and patch test reactions in patients with coronary stents.

    PubMed

    Ekqvist, Susanne; Svedman, Cecilia; Lundh, Thomas; Möller, Halvon; Björk, Jonas; Bruze, Magnus

    2008-09-01

    Patients with dental gold restorations are known to have a higher level of gold concentration in blood (B-Au). To further investigate, in a study on patients with intracoronary stents and contact allergy to metals, the gold and nickel release from stainless steel stent with (Au stent) and without (Ni stent) gold plating. A total of 460 patients treated with stenting underwent patch testing with metals, and information on gold and nickel exposure and blood samples were collected. About 200 blood samples were randomly selected and the analysis of B-Au and nickel concentration in blood (B-Ni) was made using inductively coupled plasma mass spectrometry. There was a correlation between the intensity of Au patch test reaction and B-Au (P < 0.001). This correlation could not be seen between Ni patch test reaction and B-Ni. A Au stent gave a fivefold higher B-Au than a Ni stent. Gold is released from the Au stent and patients with a Au stent have a fivefold higher B-Au than patients with an Ni stent. The patch test reactions for gold were correlated with B-Au.

  7. Effects of Thoracic Epidural Anesthesia on Liver Blood Flow and Indocyanine Green Clearance Test in Living-Donor Liver Transplantation: A Prospective, Randomized, Double-Blind Study.

    PubMed

    Sayan, H; Aydogan, M S; Bıcakcıoğlu, M; Toprak, H I; Isık, B; Yılmaz, S

    2015-06-01

    Donors are volunteers without any health problems. Therefore, the anesthetic management of donor safety is an important issue. Our aim in this study was to compare thoracic epidural anesthesia and general anesthesia effects on liver blood flow by means of liver function tests and indocyanine green and compared with living-donor liver transplantation. Subjects were divided into 2 equal groups: the control group (group I) and the epidural block group (group II, closed envelope method). In group II patients, the epidural catheter was inserted at the T6-8 level. In all patients, anesthesia was standardized with the use of lidocaine, fentanyl, and thiopental. Indocyanine green clearance test values before general anesthesia (T0), after induction of general anesthesia (T1), after transection (T2), and at postoperative 24 and 72 hours were recorded. Simultaneously, hemoglobin, hematocrit, platelet count, prothrombin time (PT), international normalized ratio (INR), total bilirubin, direct bilirubin, albumin, aspartate transaminase, and alanine transaminase values were analyzed. Plasma disappearance rate (PDR) and retention at 15 minutes (R15) of indocyanine green were not statistically significant difference between groups (P > .05). Intragroup comparison of PDR and R15 values at times T1, T2, T3, and T4 showed that the values at T0 were statistically significant (P < .05). PT and INR values were significantly different for all times within each group (P < .05). It was concluded that the use of thoracic epidural anesthesia has no effect on global liver function and liver-related liability tests in patients undergoing elective liver donor surgery. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Epidural Injections for Spinal Pain

    MedlinePlus

    ... Physician Resources Professions Site Index A-Z Epidural Injections An epidural injection provides temporary or prolonged relief ... limitations of Epidural Injection? What is an Epidural Injection? An epidural injection is an injection of medication ...

  9. Epidural electrical stimulation in severe limb ischemia. Pain relief, increased blood flow, and a possible limb-saving effect.

    PubMed Central

    Augustinsson, L E; Carlsson, C A; Holm, J; Jivegård, L

    1985-01-01

    Peripheral vascular disease of the extremities causes ischemic pain and, at times, skin ulcerations and gangrene. It has been suggested that epidural spinal electrical stimulation (ESES) could improve peripheral circulation. Since 1978 we have used ESES in 34 patients with severe limb ischemia; all had resting pain and most had ischemic ulcers. Arterial surgery was technically impossible. Twenty-six patients had arteriosclerotic disease, one had Buerger's disease, and seven had severe vasospastic disorders. Ninety-four per cent of the patients experienced pain relief. ESES healed ulcers in 50% of those with preoperative nonhealing skin ulcerations. Seventy per cent of the patients showed improved skin temperature recordings. Only 38% of the stimulated arteriosclerotic patients underwent amputations during a mean followup period of 16 months, as compared to 90% of a comparable group of unstimulated patients. ESES is very promising in severe limb ischemia where reconstructive surgery is impossible or has failed. PMID:3874610

  10. Epidural Steroid Injections

    MedlinePlus

    ... slipped vertebrae’, also known as spondylolisthesis). The epidural space is a fat filled ‘sleeve’ that surrounds the ... spinal cord. Steroids (‘cortisone’) placed into the epidural space have a very potent anti-inflammatory action that ...

  11. Effects of epidural anaesthesia on intestinal oxygenation in pigs.

    PubMed

    Vagts, D A; Iber, T; Szabo, B; Haberstroh, J; Reising, K; Puccini, M; Geiger, K; Nöldge-Schomburg, G F E

    2003-02-01

    Perioperative intestinal hypoperfusion is a major contributing factor leading to organ dysfunction. It can be caused by stress as a result of surgical manipulation or hypoxia. Additionally, anaesthesia can affect intestinal oxygenation. This animal study was designed to assess the effects of reduced regional sympathetic nervous activity induced by thoracic epidural anaesthesia on intestinal oxygenation. After ethical approval, 16 anaesthetized and acutely instrumented pigs were randomly assigned to two groups (epidural anaesthesia alone vs epidural anaesthesia plus volume loading). The epidural anaesthesia aimed for a T5-T12 block. Measurements were at baseline and after 1 and 2 h. Epidural anaesthesia was associated with a decrease in mean arterial blood pressure and pronounced mesenteric vasodilatation. Mesenteric blood flow did not change. Intestinal oxygen uptake, mucosal tissue oxygen partial pressure and tissue carbon dioxide partial pressure remained unchanged. Despite marked systemic hypotension, epidural anaesthesia did not affect intestinal oxygenation. There was no benefit obtained from volume loading.

  12. Cerebrospinal fluid cutaneous fistula following obstetric epidural analgaesia. Case report.

    PubMed

    Fedriani de Matos, J J; Quintero Salvago, A V; Gómez Cortés, M D

    2017-10-01

    Cutaneous fistula of cerebrospinal fluid is a rare complication of neuroaxial blockade. We report the case of a parturient in whom an epidural catheter was placed for labour analgesia and 12h after the catheter was removed, presented an abundant asymptomatic fluid leak from the puncture site, compatible in the cyto-chemical analysis with cerebrospinal fluid. She was treated with acetazolamide, compression of skin orifice of the fluid leakage, antibiotic prophylaxis, hydration and rest, and progressed satisfactorily without requiring blood patch. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Successful medical treatment of spinal epidural abscess.

    PubMed

    Xiao, Bo-Ren; Wang, Chih-Wei; Lin, Jung-Chung; Chang, Feng-Yee

    2008-04-01

    Spinal epidural abscess is a rare but potentially fatal disease. A 67-year-old female suffered fever and painful swelling of the right knee and lower leg for one week. Both synovial fluid and blood cultures yielded methicillin-sensitive Staphylococcus aureus. Low back pain developed and fever was sustained despite the administration of intravenous oxacillin. Magnetic resonance imaging (MRI) of the thoracolumbar spine revealed spinal epidural abscess from T12 to S1. Because of severe hypoalbuminemia and general anasarca and followed by exploratory laparotomy for massive duodenal bleeding, she did not receive surgical intervention for the spinal epidural abscess. After intravenous administration of oxacillin 2 g 4-hourly for 12 weeks, she recovered and follow-up MRI confirmed the efficacy of the medical treatment. She remained well at 1-year follow-up. In a patient with minimal neurological deficit or surgical contraindication, spinal epidural abscess can be successfully treated with a medical regimen.

  14. Large Increase in Blood Pressure After Extubation and High Body Mass Index Elevate the Risk of Spinal Epidural Hematoma After Spinal Surgery.

    PubMed

    Yamada, Kentaro; Abe, Yuichiro; Satoh, Shigenobu; Yanagibashi, Yasushi; Hyakumachi, Takahiko; Masuda, Takeshi

    2015-07-01

    Matched case-control study. To identify factors other than a multilevel procedure that increase the risk of symptomatic postoperative spinal epidural hematoma (SEH). Postoperative SEH is a potentially devastating complication of spinal surgery. Previous studies that reported risk factors for postoperative SEH all identified a multilevel procedure as a risk factor, but the other risk factors remain unclear. Patients who developed postoperative SEH requiring surgical evacuation were identified from database. Each patient was matched with 3 controls who underwent spinal decompression at the same number of levels in the same part of the spine by the same surgeon during the preceding or following year. Multiple logistic regression analysis was performed to identify the risk factors for postoperative SEH to obtain adjusted odds ratios with 95% confidence intervals. Clinical outcomes after evacuation were investigated separately divided with or without severe paralysis or time until the second surgery. Postoperative SEH evacuation was performed after 32 of 8250 (0.39%) spinal decompression procedures. The incidence was significantly higher after thoracic procedures (2.41%) than after cervical (0.21%) or lumbar (0.39%) procedures. Multivariate analysis identified a 50 mm Hg or greater increase in systolic blood pressure after extubation (adjusted odds ratio: 3.22, 95% confidence interval: 1.22-8.51) and higher body mass index (adjusted odds ratio 1.15, 95% confidence interval: 1.01-1.31) as risk factors. Among 14 patients with severe paralysis due to postoperative SEH, those who underwent evacuation within 24 hours of the onset had a significantly better improvement in clinical outcome and Frankel grade than did those after 24 hours. A 50 mm Hg or greater increase in systolic blood pressure after extubation and high body mass index were identified as risk factors for SEH. Appropriate blood pressure control especially at the end of surgery is important for the prevention of

  15. Influence of epidural dexamethasone on maternal temperature and serum cytokine concentration after labor epidural analgesia.

    PubMed

    Wang, Li-Zhong; Hu, Xiao-Xia; Liu, Xia; Qian, Ping; Ge, Jia-Mei; Tang, Bei-Lei

    2011-04-01

    To evaluate the effects of epidural dexamethasone on maternal temperature and serum cytokine levels after labor epidural analgesia. Sixty healthy term nulliparas in spontaneous labor were randomized to receive epidural analgesia alone using bupivacaine 0.125% and fentanyl 1 μg/mL (group I) or epidural analgesia combined with dexamethasone 0.2mg/mL (group II) (n=30 per group). Maternal tympanic temperature was measured before epidural analgesia and hourly thereafter until delivery. Maternal and cord venous blood were sampled for analysis of interleukin-6 (IL-6), tumor necrosis factor-α, and interleukin-10 levels. There was no difference in the incidence of intrapartum fever (38 °C or more) between the 2 groups (3/30 versus 1/30, P=0.612). The mean maternal temperature increased with time in group I, with the elevation reaching statistical significance at 4 hours post analgesia and at delivery compared with baseline (P=0.012 and P=0.043, respectively). A similar trend was observed with maternal serum IL-6 levels in group I. In group II, maternal temperature and IL-6 levels did not differ from baseline at any time point during labor. Epidural dexamethasone alleviates maternal temperature elevation after epidural analgesia. This effect can be attributed to the decrease in IL-6 levels. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  16. Horner's syndrome with epidural anaesthesia.

    PubMed

    Sharma, Rowena; Chatterjee, Jayanta; Edmonds, Keith

    2010-08-23

    A 29-year-old woman, primigravida, had labour induced for post-maturity following an uncomplicated antenatal course. She requested an epidural prior to commencement of syntocinon. This was administered in the sitting position without complication. The midwife noted drooping of the right eyelid of the patient 6.5 h following insertion of the epidural. Blood pressure and CTG remained reassuring. The obstetric anaesthetist reviewed the labouring woman and noted a right-sided ptosis as well as the right cheek being flushed and dry. There was no motor block and sensation in T1/T2/S3/S4 was intact. Horner's syndrome was diagnosed and anaesthetic review was recommended prior to further top-ups. The patient progressed well in the second stage of labour and did not require further top-ups and gave birth to a healthy male infant. Horner's syndrome resolved within 4 h following delivery and the postpartum period was uncomplicated.

  17. Controlled release ibuprofen-poloxamer gel for epidural use - A pharmacokinetic study using microdialysis in pigs.

    PubMed

    Paavola, Anne; Bernards, Christopher M; Rosenberg, Per H

    2016-11-01

    In order to avoid the risks of sideeffects of epidural local anesthetics and opioids, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) epidurally would be an interesting option of analgesic therapy. The fairly short duration of action of spinally administered NSAIDs, e.g., ibuprofen, may be prolonged by using controlled release poloxamer gel formulation. Using a microdialysis technique we studied the epidural and intrathecal pharmacokinetics of ibuprofen after its epidural administration as a poloxamer 407 formulation or a solution formulation. In addition, plasma ibuprofen concentrations were analyzed from central venous blood samples. Ibuprofen concentrations in the epidural space were significantly higher and longer lasting after the epidural gel injection compared with the epidural solution injection. The epidural AUC of ibuprofen was over threefold greater after epidural ibuprofen gel injection compared with the ibuprofen solution injection (p<0.001). The systemic absorption of ibuprofen from 25% poloxamer 407 gel was very low. The in situ forming poloxamer gel acted as a reservoir allowing targeted ibuprofen release at the epidural injection site and restricted ibuprofen molecules to a smaller spinal area. Ibuprofen diffusion from the epidural space to the intrathecal space was steady and prolonged. These results demonstrate that the use of epidurally injectable poloxamer gel can increase and prolong ibuprofen delivery from epidural space to the CSF enhancing thus ibuprofen entry into the central neuroaxis for spinal analgesia. Further toxicological and dose-finding studies are justified. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Postinfarction Functional Recovery Driven by a Three-Dimensional Engineered Fibrin Patch Composed of Human Umbilical Cord Blood-Derived Mesenchymal Stem Cells

    PubMed Central

    Roura, Santiago; Soler-Botija, Carolina; Bagó, Juli R.; Llucià-Valldeperas, Aida; Férnandez, Marco A.; Gálvez-Montón, Carolina; Prat-Vidal, Cristina; Perea-Gil, Isaac; Blanco, Jerónimo

    2015-01-01

    Considerable research has been dedicated to restoring myocardial cell slippage and limiting ventricular remodeling after myocardial infarction (MI). We examined the ability of a three-dimensional (3D) engineered fibrin patch filled with human umbilical cord blood-derived mesenchymal stem cells (UCBMSCs) to induce recovery of cardiac function after MI. The UCBMSCs were modified to coexpress luciferase and fluorescent protein reporters, mixed with fibrin, and applied as an adhesive, viable construct (fibrin-cell patch) over the infarcted myocardium in mice (MI-UCBMSC group). The patch adhered well to the heart. Noninvasive bioluminescence imaging demonstrated early proliferation and differentiation of UCBMSCs within the construct in the postinfarct mice in the MI-UCBMSC group. The implanted cells also participated in the formation of new, functional microvasculature that connected the fibrin-cell patch to both the subjacent myocardial tissue and the host circulatory system. As revealed by echocardiography, the left ventricular ejection fraction and fractional shortening at sacrifice were improved in MI-UCBMSC mice and were markedly reduced in mice treated with fibrin alone and untreated postinfarction controls. In conclusion, a 3D engineered fibrin patch composed of UCBMSCs attenuated infarct-derived cardiac dysfunction when transplanted locally over a myocardial wound. Significance Ischemic heart failure (HF) is the end stage of many cardiovascular diseases, including myocardial infarction. The only definitive treatment for HF is cardiac transplant, which is hampered by limited number of heart donors and graft rejection. In recent times, cellular cardiomyoplasty has been expected to repair infarcted myocardium by implantation of different sources of stem or progenitor cells. However, low cell survival and myocardial implantation rates have motivated the emergence of novel approaches with the objective of generating graftable cell-based implants. Here, the potential

  19. Spinal epidural abscess and meningitis following short-term epidural catheterisation for postoperative analgaesia.

    PubMed

    van Rappard, Juliaan R M; Tolenaar, Jip L; Smits, Anke B; Go, Peter M N Y H

    2015-08-20

    We present a case of a patient with a spinal epidural abscess (SEA) and meningitis following short-term epidural catheterisation for postoperative pain relief after a laparoscopic sigmoid resection. On the fifth postoperative day, 2 days after removal of the epidural catheter, the patient developed high fever, leucocytosis and elevated C reactive protein. Blood cultures showed a methicillin-sensitive Staphylococcus aureus infection. A photon emission tomography scan revealed increased activity of the spinal canal, suggesting S. aureus meningitis. A gadolinium-enhanced MRI showed a SEA that was localised at the epidural catheter insertion site. Conservative management with intravenous flucloxacillin was initiated, as no neurological deficits were seen. At last follow-up, 8 weeks postoperatively, the patient showed complete recovery.

  20. Peut-on réaliser une analgésie péridurale après un blood patch récent?

    PubMed Central

    Chkoura, Khalid; Kechna, Hicham; Loutid, Jaouad; Ouzad, Omar; Hachimi, Moulay Ahmed; Hannafi, Sidi Mohamed

    2015-01-01

    Le blood patch constitue le traitement de référence du syndrome post ponction lombaire. Son efficacité a été démontrée par plusieurs essais randomisés comparant le BPE aux mesures conservatrices et au placebo. Il consiste en l'injection d'une quantité de sang autologue dans l'espace péridurale afin d'obturer la brèche dure-mérienne. La réalisation d'une analgésie péridurale après antécédent de blood patch est possible, malgré la persistance de questions sur les délais de retour à la normal de l'espace péridurale. Nous rapportons un cas où une analgésie péridurale a été réalisée avec succès trois semaines après un blood patch. PMID:26600909

  1. Simultaneous appearance of cerebral venous thrombosis and subdural hematomas as rare cause of headache in puerperium following epidural analgesia: a case report

    PubMed Central

    Župan, Željko; Sotošek Tokmadžić, Vlatka; Matanić-Manestar, Marinka; Šustić, Alan; Antončić, Igor; Dunatov, Siniša; Pavlović, Ivan; Antulov, Ronald

    2012-01-01

    The aim of this study is to report the first case of simultaneous appearance of cerebral venous thrombosis (CVT) and bilateral subdural hematomas (SDHs) following epidural analgesia for labor and delivery and to point out the difficulty of establishing such a diagnosis in the presence of postpartum headache. A 26-year old primigravida with a history of epilepsy received epidural analgesia for delivery. Three days after the uneventful spontaneous vaginal delivery she complained about the headache. Patient responded very well to the pain medication and oral hydration, and the headache was relieved. Ten days after the delivery, the headache reoccurred, and an epidural blood patch was performed that successfully relieved her symptom. Stronger progressive headache with nausea reappeared two days later and the parturient was readmitted to hospital. Urgent neuroimaging examinations detected CVT of right the transverse sinus, ipsilateral cortical veins, and partially occluded superior sagittal sinus, as well as bilateral subacute/chronic SDHs. The treatment of the patient with low molecular weight heparin and antiaggregation therapy was effective. In this case, the diagnosis was delayed because of atypical clinical presentation and potentially confounding events (epidural analgesia and assumption that it was a case of PDPH). It is important to carefully observe patients in such conditions and promptly conduct suitable diagnostic tests. Otherwise, unrecognized intracranial complications and delay of appropriate therapy could be life-threatening. PMID:22911532

  2. Accidental catheterization of epidural venous plexus: tomographic analysis.

    PubMed

    Souza, Mariano Paiva; Magalhães, Edno; de Farias Cascudo, Elialba; Jogaib, Marco Antonio Dias; da Silva, Marcelo Carneiro

    2016-01-01

    Inadvertent venous catheterizations occur in approximately 9% of lumbar epidural anesthetic procedures with catheter placement and, if not promptly recognized, can result in fatal consequences. The objective of this report is to describe a case of accidental catheterization of epidural venous plexus and its recording by computed tomography with contrast injection through the catheter. A female patient in her sixties, physical status II (ASA), underwent conventional cholecystectomy under balanced general anesthesia and an epidural with catheter for postoperative analgesia. During surgery, there was clinical suspicion of accidental catheterization of epidural venous plexus because of blood backflow through the catheter, confirmed by the administration of a test dose through the catheter. After the surgery, a CT scan was obtained after contrast injection through the catheter. Contrast was observed all the way from the skin to the azygos vein, passing through anterior and posterior epidural venous plexuses and intervertebral vein. It is possible to identify the actual placement of the epidural catheter, as well as to register an accidental catheterization of the epidural venous plexus, using computed tomography with contrast injection through the epidural catheter. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  3. [Accidental catheterization of epidural venous plexus: tomographic analysis].

    PubMed

    Souza, Mariano Paiva; Magalhães, Edno; Cascudo, Elialba de Farias; Jogaib, Marco Antonio Dias; Silva, Marcelo Carneiro da

    2016-01-01

    Inadvertent venous catheterizations occur in approximately 9% of lumbar epidural anesthetic procedures with catheter placement and, if not promptly recognized, can result in fatal consequences. The objective of this report is to describe a case of accidental catheterization of epidural venous plexus and its recording by computed tomography with contrast injection through the catheter. A female patient in her sixties, physical status II (ASA), underwent conventional cholecystectomy under balanced general anesthesia and an epidural with catheter for postoperative analgesia. During surgery, there was clinical suspicion of accidental catheterization of epidural venous plexus because of blood backflow through the catheter, confirmed by the administration of a test dose through the catheter. After the surgery, a CT scan was obtained after contrast injection through the catheter. Contrast was observed all the way from the skin to the azygos vein, passing through anterior and posterior epidural venous plexuses and intervertebral vein. It is possible to identify the actual placement of the epidural catheter, as well as to register an accidental catheterization of the epidural venous plexus, using computed tomography with contrast injection through the epidural catheter. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  4. Effect of ThermaCare HeatWraps and Icy Hot Cream/Patches on Skin and Quadriceps Muscle Temperature and Blood Flow

    PubMed Central

    Petrofsky, Jerrold Scott; Laymon, Michael; Berk, Lee; Bains, Gurinder

    2016-01-01

    Objectives The purpose of this study was to compare the effects of over-the-counter treatments—ThermaCare HeatWraps (chemical reaction to produce heat above the skin), Icy Hot Patch, and Icy Hot Cream (topically applied menthol)—on skin and deep tissue temperature. Methods This was a longitudinal crossover study. On each of 3 days, a ThermaCare HeatWrap, Icy Hot Cream, or Icy Hot Patch was applied randomly over the quadriceps muscle in 15 healthy volunteers with normal body mass. Skin and muscle temperature and blood flow were measured by laser flowmetry every 15 minutes for 2 hours. Results After 2 hours, mean temperature decreased by 2.1°C (7.0%; P = .02) in skin and 1.0°C (2.9%; P = .01) in muscle with Icy Hot Cream. Icy Hot Patch decreased skin and muscle temperature by 1.7°C (5.4%; P = .03) and 1.3°C (3.8%; P = .01), respectively. In contrast, ThermaCare raised skin and muscle temperature by 7.8°C (25.8%; P = .001) and 2.7°C (7.7%; P = .002), respectively; both were significantly warmer with ThermaCare vs either Icy Hot product (all P < .007). Icy Hot products produced a net decrease in skin blood flow (Cream: 56.7 flux [39.3%; P = .003]; Patch: 19.1 flux [16.7%; P = .045]). Muscle blood flow decreased with the Patch (6.7 flux [7.0%; P = .02]). After a period of fluctuations, Icy Hot Cream produced a net increase vs baseline of 7.0 flux (16.9%; P = .02). ThermaCare more than doubled blood flow in skin (83.3 flux [109.7%; P = .0003]) and muscle (25.1 flux [148.5%; P = .004]). Conclusions In this group of 15 healthy volunteers, ThermaCare HeatWraps provided the greatest degree of tissue warming and increase in tissue blood flow. PMID:27069427

  5. Effect of ThermaCare HeatWraps and Icy Hot Cream/Patches on Skin and Quadriceps Muscle Temperature and Blood Flow.

    PubMed

    Petrofsky, Jerrold Scott; Laymon, Michael; Berk, Lee; Bains, Gurinder

    2016-03-01

    The purpose of this study was to compare the effects of over-the-counter treatments-ThermaCare HeatWraps (chemical reaction to produce heat above the skin), Icy Hot Patch, and Icy Hot Cream (topically applied menthol)-on skin and deep tissue temperature. This was a longitudinal crossover study. On each of 3 days, a ThermaCare HeatWrap, Icy Hot Cream, or Icy Hot Patch was applied randomly over the quadriceps muscle in 15 healthy volunteers with normal body mass. Skin and muscle temperature and blood flow were measured by laser flowmetry every 15 minutes for 2 hours. After 2 hours, mean temperature decreased by 2.1°C (7.0%; P = .02) in skin and 1.0°C (2.9%; P = .01) in muscle with Icy Hot Cream. Icy Hot Patch decreased skin and muscle temperature by 1.7°C (5.4%; P = .03) and 1.3°C (3.8%; P = .01), respectively. In contrast, ThermaCare raised skin and muscle temperature by 7.8°C (25.8%; P = .001) and 2.7°C (7.7%; P = .002), respectively; both were significantly warmer with ThermaCare vs either Icy Hot product (all P < .007). Icy Hot products produced a net decrease in skin blood flow (Cream: 56.7 flux [39.3%; P = .003]; Patch: 19.1 flux [16.7%; P = .045]). Muscle blood flow decreased with the Patch (6.7 flux [7.0%; P = .02]). After a period of fluctuations, Icy Hot Cream produced a net increase vs baseline of 7.0 flux (16.9%; P = .02). ThermaCare more than doubled blood flow in skin (83.3 flux [109.7%; P = .0003]) and muscle (25.1 flux [148.5%; P = .004]). In this group of 15 healthy volunteers, ThermaCare HeatWraps provided the greatest degree of tissue warming and increase in tissue blood flow.

  6. Spontaneous spinal epidural abscess.

    PubMed

    Ellanti, P; Morris, S

    2011-10-01

    Spinal epidural abscess is an uncommon entity, the frequency of which is increasing. They occur spontaneously or as a complication of intervention. The classical triad of fever, back pain and neurological symptoms are not always present. High index of suspicion is key to diagnosis. Any delay in diagnosis and treatment can have significant neurological consequences. We present the case of a previously well man with a one month history of back pain resulting from an epidural abscess.

  7. Anaphylactic Shock Following Nonionic Contrast Medium during Caudal Epidural Injection.

    PubMed

    Lee, Sang Hyun; Park, Jae Woo; Hwang, Byeong Mun

    2015-10-01

    Caudal epidural injection is a common intervention in patients with low back pain and sciatica. Even though the complications of fluoroscopically directed epidural injections are less frequent than in blind epidural injections, complications due to contrast media can occur. We report a case of anaphylactic shock immediately after injection of an intravenous nonionic contrast medium (iohexol) during the caudal epidural injection for low back pain and sciatica in a patient without a previous allergic history to ionic contrast media (ioxitalamate). Five minutes after the dye was injected, the patient began to experience dizziness, and the systolic blood pressure dropped to 60 mmHg. Subsequently, the patient exhibited a mild drowsy mental state. About 30 minutes after the subcutaneous injection of 0.2 mg epinephrine, the systolic blood pressure increased to 90 mmHg. The patient recovered without any sequela. Life-threatening complications after injection of intravenous contrast medium require immediate treatment.

  8. Patch tests.

    PubMed

    Lazzarini, Rosana; Duarte, Ida; Ferreira, Alessandra Lindmayer

    2013-01-01

    Patch tests were introduced as a diagnostic tool in the late nineteenth century. Since then, they have improved considerably becoming what they are today. Patch tests are used in the diagnostic investigation of contact dermatitis worldwide. Batteries or series previously studied and standardized should be used in patch testing. The methodology is simple, but it requires adequate training for the results to be correctly interpreted and used. Despite having been used for over a century, it needs improvement like all other diagnostic techniques in the medical field.

  9. Patch tests*

    PubMed Central

    Lazzarini, Rosana; Duarte, Ida; Ferreira, Alessandra Lindmayer

    2013-01-01

    Patch tests were introduced as a diagnostic tool in the late nineteenth century. Since then, they have improved considerably becoming what they are today. Patch tests are used in the diagnostic investigation of contact dermatitis worldwide. Batteries or series previously studied and standardized should be used in patch testing. The methodology is simple, but it requires adequate training for the results to be correctly interpreted and used. Despite having been used for over a century, it needs improvement like all other diagnostic techniques in the medical field. PMID:24474094

  10. Spinal epidural abscess.

    PubMed

    Miftode, E; Luca, V; Mihalache, D; Leca, D; Stefanidis, E; Anuţa, C; Sabadis, L

    2001-01-01

    In a retrospective study, 68 patients with Spinal Epidural Abscess (SEA) were reviewed. Of these, 66% had different predisposing factors such as staphylococcal skin infections, surgical procedures, rachicentesis, trauma, spondilodiscitis. Abscess had a lumbar region location in 53% of cases. Staphylococcus aureus was the most frequent etiological agent (81%). The overall rate of mortality in SEA patients was 13.2%.

  11. [Vertebral osteomyelitis associated with epidural block].

    PubMed

    Carrillo Esper, R; Cruz-Bautista, I

    2001-01-01

    Infectious complications after epidural anesthesia are infrequent and the most common are epidural and subdural abscess. We report one rare case of vertebral osteomyelitus associated with an epidural catheter and review the literature.

  12. Epidural and opioid analgesia following the Nuss procedure

    PubMed Central

    Walaszczyk, Malgorzata; Knapik, Piotr; Misiolek, Hanna; Korlacki, Wojciech

    2011-01-01

    Summary Background Parents have the right to decide on behalf of their children and deny consent to regional anaesthesia. The investigators decided to investigate quality of postoperative analgesia in adolescents undergoing epidural and opioid analgesia following the Nuss procedure. Material/Methods The study subjects were 61 adolescents aged 11–18 years who underwent pectus excavatum repair with the Nuss procedure. Patients were divided into epidural (n=41) and opioid (n=20) groups, depending on their parents’ consent to epidural catheter insertion. Intraoperatively, 0.5% epidural ropivacaine with fentanyl or intermittent intravenous injections of fentanyl were used. Postoperative analgesia was achieved with either epidural infusion of 0.1% ropivacaine with fentanyl, or subcutaneous morphine via an intraoperatively inserted “butterfly” cannula. Additionally, both groups received metamizol and paracetamol. Primary outcome variables were postoperative pain scores (Numeric Rating Scale and Prince Henry Hospital Pain Score). Secondary outcome variables included hemodynamic parameters, additional analgesia and side effects. Results Heart rate and blood pressure values in the postoperative period were significantly higher in the opioid group. Pain scores requiring intervention were noted almost exclusively in the opioid group. Conclusions Denial of parental consent to epidural analgesia following the Nuss procedure results in significantly worse control of postoperative pain. Our data may be useful when discussing with parents the available anaesthetic techniques for exceptionally painful procedures. PMID:22037752

  13. Myelopathy with syringomyelia following thoracic epidural anaesthesia.

    PubMed

    Aldrete, J A; Ferrari, H

    2004-02-01

    Under general anaesthesia and muscle relaxation, a thoracic epidural catheter was inserted at the T8-T9 level in a 7-year-old boy scheduled to have a Nissen fundoplication to provide postoperative analgesia. After 4 ml of lignocaine 1.5% was injected through the catheter, hypotension resulted. Fifty-five minutes later 5 ml of bupivacaine 0.25% produced the same effect. In the recovery room a similar injection resulted in lower blood pressure and temporary apnoea. Sensory and motor deficits were noted the next day and four days later magnetic resonance imaging demonstrated spinal cord syringomyelia extending from T5 to T10. Four years later, dysaesthesia from T6 to T10 weakness of the left lower extremity and bladder and bowel dysfunction persist. The risks of inserting thoracic epidural catheters in patients under general anaesthesia and muscle relaxation are discussed, emphasising the possibility of spinal cord injury with disastrous consequences.

  14. Epidural Hematoma in Lacrosse.

    PubMed

    Rimel, R W; Nelson, W E; Persing, J A; Jane, J A

    1983-03-01

    In brief: Several hours after being hit by a lacrosse stick in the left temporoparietal area slightly anterior to the ear, a lacrosse player was found unresponsive and wrapped in a blanket in his dormitory room. He had not lost consciousness during the game, sat out only five minutes, and completed the game. His Glasgow Coma Scale score was 12 of a possible 15. A CT scan showed an epidural hematoma and a skull fracture. He underwent an immediate left temporoparietal craniotomy and evacuation of the epidural hematoma. He recovered fully and requested permission to return to play six months after the injury. The authors think that an improved lacrosse helmet design would help prevent this type of injury.

  15. Aspergillus spinal epidural abscess

    SciTech Connect

    Byrd, B.F. III; Weiner, M.H.; McGee, Z.A.

    1982-12-17

    A spinal epidural abscess developed in a renal transplant recipient; results of a serum radioimmunoassay for Aspergillus antigen were positive. Laminectomy disclosed an abscess of the L4-5 interspace and L-5 vertebral body that contained hyphal forms and from which Aspergillus species was cultured. Serum Aspergillus antigen radioimmunoassay may be a valuable, specific early diagnostic test when systemic aspergillosis is a consideration in an immunosuppressed host.

  16. Medicolegal cases for spinal epidural hematoma and spinal epidural abscess.

    PubMed

    French, Keisha L; Daniels, Eldra W; Ahn, Uri M; Ahn, Nicholas U

    2013-01-01

    Spinal epidural hematoma and spinal epidural abscess are rare surgical emergencies resulting in significant neurologic deficits. Making the diagnosis for spinal epidural hematoma and spinal epidural abscess can be challenging; however, a delay in recognition and treatment can be devastating. The objective of this retrospective analysis study was to identify risk factors for an adverse outcome for the provider. The LexisNexis Academic legal search database was used to identify a total of 19 cases of spinal epidural hematoma and spinal epidural abscess filed against medical providers. Outcome data on trial verdicts, age, sex, initial site of injury, time to consultation, time to appropriate imaging studies, time to surgery, and whether a rectal examination was performed or not were recorded. The results demonstrated a significant association between time to surgery more than 48 hours and an unfavorable verdict for the provider. The degree of permanent neurologic impairment did not appear to affect the verdicts. Fifty-eight percent of the cases did not present with an initial deficit, including loss of bowel or bladder control. All medical professionals must maintain a high level of suspicion and act quickly. Physicians who are able to identify early clinical features, appropriately image, and treat within a 48 hour time frame have demonstrated a more favorable medicolegal outcome compared with their counterparts in filed lawsuits for spinal epidural hematoma and spinal epidural abscess cases.

  17. Peripheral blood lymphocyte typing as a useful tool to objectify the oral mucosa patch test in the diagnosis of allergic contact mucositis to nickel.

    PubMed

    Di Tola, Marco; Amodeo, Rachele; Marino, Mariacatia; Tabacco, Fabio; Casale, Rossella; Bove, Maurizio; Rossi, Alfredo; Cardelli, Patrizia; Picarelli, Antonio

    2014-06-01

    Nickel (Ni) exposure through the intestinal mucosa may cause a hypersensitivity reaction recently defined as allergic contact mucositis (ACM). This condition is identifiable by the oral mucosa patch test (omPT), a qualitative and subjective examination that requires clinical expertise. Our aim was to evaluate if a peripheral blood lymphocyte typing performed before and after the omPT for Ni may be able to objectify this examination for diagnostic purposes. Thirty patients with symptoms referable to the ingestion of Ni-rich foods were subjected to omPT for Ni. Before and after the omPT, each patient underwent blood sampling for the typing of total lymphocytes and their subsets (T, T helper or Th, T cytotoxic or Tc, B, natural killer or NK). Statistical analysis was performed by Student t test and receiver operating characteristic (ROC) curve analysis. According to the omPT outcomes, 18 patients were defined as Ni-sensitive and the remaining 12 as controls. In Ni-sensitive patients, the number of total, T, Th, Tc, and B lymphocytes/μL whole blood increased after the omPT (p<0.0001 for the first three, p=0.0004 and p=0.0001 for the last two lymphocyte types). No omPT-dependent lymphocyte increase was observed in controls. The post/pre omPT cell ratio, especially if calculated for Th lymphocytes, appears to be an effective index for diagnostic purposes (sensitivity=100%, specificity=83.3%, Youden index=0.833, area under curve (AUC)=0.926, p<0.0001). In conclusion, the peripheral blood lymphocyte typing with calculation of post/pre omPT cell ratio has the potential to support the omPT in diagnosing ACM, with the advantage of providing quantitative and objective data.

  18. Evaluation of cerebral perfusion pressure changes in laboring women: effects of epidural anesthesia.

    PubMed

    Williams, K P; Wilson, S

    1999-12-01

    To compare the effect of epidural anesthesia on cerebral perfusion pressure in laboring women. Maternal cerebral blood flow velocity was assessed in seven laboring patients with continuous epidural anesthesia and 15 without, using transcranial Doppler. Maternal cerebral blood flow velocity was assessed during the first stage at the trough of a contraction, at the peak of a contraction and at the second stage during pushing over the course of four contractions. Calculated estimated cerebral perfusion pressure: eCPP = Vmean/(Vmean - Vdiastolic) x (mean BP - diastolic BP), where V is velocity and BP is blood pressure; modified from Aaslid and colleagues. An index of cerebrovascular resistance, the resistance area product, was calculated: RAP = mean BP/mean velocity. We calculated an index of cerebral blood flow (cerebral blood flow index): CBF index = eCPP/RAP. In non-epidural patients, the eCPP fell significantly at the peak of a contraction and during pushing. Cerebrovascular resistance, RAP, rose significantly during the peak of a contraction, although cerebral blood flow did not change. In patients undergoing epidural anesthesia, the stages of labor had no significant effect on eCPP or RAP; however, these values were lower than those in patients without epidural anesthesia. The epidural group had a lower eCPP and RAP and cerebral blood flow index compared to the non-epidural group. In the non-epidural group, the mean arterial pressure was higher in all stages of labor with a trend towards an increase in eCPP and cerebral blood flow index.

  19. Spinal epidural abscess.

    PubMed

    Johnson, Katherine G

    2013-09-01

    Spinal epidural abscess is a rare bacterial infection located within the spinal canal. Early diagnosis and rapid treatment are important because of its potential to cause rapidly progressive spinal cord compression and irreversible paralysis. A staphylococcus bacterial infection is the cause in most cases. Treatment includes antibiotics and possible surgical drainage of the abscess. A favorable neurologic outcome correlates with the severity and duration of neurologic deficits before surgery and the timeliness of the chosen intervention. It is important for the critical care nurse to monitor the patient's neurologic status and provide appropriate interventions.

  20. Ethamsylate in vaginal surgery under lumbar epidural anaesthesia.

    PubMed Central

    Smith, G. B.; Eltringham, R. J.; Nightingale, J. J.

    1983-01-01

    Sixty patients scheduled for vaginal surgery under lumbar epidural block were randomly allocated into two groups, one of which received ethamsylate intravenously prior to induction of anaesthesia. Ethamsylate did not reduce the blood loss at operation in these patients. The possible factors underlying this observation are discussed. PMID:6338800

  1. Paraplegia following cervical epidural catheterization using loss of resistance technique with air: a case report.

    PubMed

    Chae, Yun Jeong; Han, Kyung Ream; Park, Hyung Bae; Kim, Chan; Nam, Si Gweon

    2016-02-01

    We report a case of paraplegia without neurologic deficit of upper extremities following cervical epidural catheterization using air during the loss of resistance technique. A 41-year-old woman diagnosed with complex regional pain syndrome had upper and lower extremity pain. A thoracic epidural lead was inserted for a trial spinal cord stimulation for treating lower extremity pain and cervical epidural catheterization was performed for treating upper extremity pain. Rapidly progressive paraplegia developed six hours after cervical epidural catheterization. Spine CT revealed air entrapment in multiple thoracic intervertebral foraminal spaces and surrounding epidural space without obvious spinal cord compression before the decompressive operation, which disappeared one day after the decompressive operation. Her paraplegia symptoms were normalized immediately after the operation. The presumed cause of paraplegia was transient interruption of blood supply to the spinal cord through the segmental radiculomedullary arteries feeding the spinal cord at the thoracic level of the intervertebral foramen caused by the air.

  2. EPIDURAL ANALGESIA IN LABOR - CONTROVERSIES.

    PubMed

    Bilić, Nada; Djaković, Ivka; Kličan-Jaić, Katarina; Rudman, Senka Sabolović; Ivanec, Željko

    2015-09-01

    Labor pain is one of the most severe pains. Labor is a complex and individual process with varying maternal requesting analgesia. Labor analgesia must be safe and accompanied by minimal amount of unwanted consequences for both the mother and the child, as well as for the delivery procedure. Epidural analgesia is the treatment that best meets these demands. According to the American Congress of Obstetrics and Gynecology and American Society of Anesthesiologists, mother's demand is a reason enough for the introduction of epidural analgesia in labor, providing that no contraindications exist. The application of analgesics should not cease at the end of the second stage of labor, but it is recommended that lower concentration analgesics be then applied. Based on the latest studies, it can be claimed that epidural analgesia can be applied during the major part of the first and second stage of labor. According to previous investigations, there is no definitive conclusion about the incidence of instrumental delivery, duration of second stage of labor, time of epidural analgesia initiation, and long term outcomes for the newborn. Cooperation of obstetric and anesthesiology personnel, as well as appropriate technical equipment significantly decrease the need of instrumental completion of a delivery, as well as other complications encountered in the application of epidural analgesia. Our hospital offers 24/7 epidural analgesia service. The majority of pregnant women in our hospital were aware of the advantages of epidural analgesia for labor, however, only a small proportion of them used it, mainly because of inadequate level of information.

  3. [Inadvertent epidural infusion of paracetamol].

    PubMed

    Charco Roca, L M; Ortiz Sánchez, V E; del Pino Moreno, A L

    2014-10-01

    A 45-year-old woman was accidentally administered an epidural infusion of paracetamol instead of levobupivacaine for postoperative pain therapy during the postoperative period of abdominal hysterectomy under general anesthesia combined with epidural analgesia. The patient had no neurological symptoms at any time, although a slight tendency to arterial hypotension that did not require treatment was observed. No rescue analgesia was necessary until 8h after the start of epidural infusion. The incidence of these types of errors is probably underestimated, although there are several cases reported with various drugs.

  4. [Epidural emphysema complicating bronchial asthma].

    PubMed

    Rouetbi, N; Ben Saad, A; Joobeur, S; Skhiri, N; Cheikh Mhamed, S; Mribah, H; El Kamel, A

    2012-12-01

    Epidural emphysema is an exceptional complication of bronchial asthma, revealed by an incidental finding in chest tomography. We report a case of a 21-year-old man admitted with asthma attack complicated by subcutaneous and mediastinal emphysema. Chest tomography confirmed the mediastinal emphysema and also revealed the epidural emphysema within the vertebral canal. Neurological examination was negative. The patient showed complete recovery 10days after the onset of symptoms. The epidural emphysema is a rare complication during asthma attacks. The benignity of this complication should not require a systematic chest tomography.

  5. Severe hypotension related to high negative pressure suction drainage on a thoracic epidural drain during multilevel spinal fixation.

    PubMed

    Brahmbhatt, Anjalee; Hall, Nicholas D P; Bradley, William Pierre Litherland

    2013-11-15

    Hypotension or bradycardia or both related to intracranial hypotension after craniotomy has been reported in the literature. However, such reports are uncommon with thoracic epidural drains. We describe a case in which application of high negative pressure suction to a thoracic epidural drain caused a sudden decrease in arterial blood pressure.

  6. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections.

    PubMed

    Furman, Michael B; Giovanniello, Michael T; O'Brien, Erin M

    2003-01-01

    STUDY DESIGN A prospective, observational, human, study was conducted. OBJECTIVES To evaluate the incidence of vascular penetration during fluoroscopically guided, contrast-enhanced transforaminal cervical epidural steroid injections, and to determine whether the observation of blood in the needle hub can be used to predict a vascular injection. SUMMARY OF BACKGROUND DATA Incorrectly placed intravascular cervical spinal injections result in medication flow systemically and not to the desired target. A recently published study demonstrates a high incidence of intravascular injections in transforaminal lumbosacral epidural injections. No studies so far have evaluated the incidence of vascular injections in transforaminal cervical epidural steroid injections, nor have they calculated the ability of observed blood in the needle hub to predict a vascular injection in the cervical spine.METHODS The incidence of fluoroscopically confirmed intravascular uptake of contrast was prospectively observed in 337 patients treated with cervical transforaminal epidural steroid injections. The ability of observed blood in the needle hub to predict intravascular injection was also investigated. For each subject, the injection level was chosen on the basis of the clinical scenario including history, physical examination, and review of imaging studies. Some patients had multilevel injections. Using fluoroscopic guidance, the authors placed a 25-gauge needle into the epidural space using a transforaminal approach according to accepted standard technique. Needle tip location was confirmed with biplanar imaging. The presence or absence of blood in the needle hub spontaneously ("flash") and after attempted aspiration by pulling back on the syringe's plunger was documented. Contrast then was injected under real-time fluoroscopy to determine whether the location of the needle tip was intravascular. The results were recorded in a prospective manner indicating the presence or absence of blood

  7. [Chronic epidural haematoma mimicking meningioma].

    PubMed

    Beculić, Hakija; Skomorac, Rasim; Jusić, Aldin; Mekić-Abazović, Alma; Bajtarević, Alma

    2011-02-01

    The study presents a rare case of organised chronic epidural haematoma that imitated a meningioma. A patient was admitted to the Department of Neurology of the Cantonal Hospital Zenica due to loss of consciousness and right hemiparesis. Non-contrast Computed Tomography (CT) scan had shown an expansive intracranial process in the left parietal region which was radiologically diagnosed as a meningioma. During the operation a linear skull fracture and organised chronic epidural haematoma were found.

  8. Antibacterial activity of epidural infusions.

    PubMed

    Coghlan, M W; Davies, M J; Hoyt, C; Joyce, L; Kilner, R; Waters, M J

    2009-01-01

    The incidence of epidural abscess following epidural catheterisation appears to be increasing, being recently reported as one in 1000 among surgical patients. This study was designed to investigate the antibacterial activity of various local anaesthetics and additives, used in epidural infusions, against a range of micro-organisms associated with epidural abscess. The aim was to determine which, if any, epidural infusion solution has the greatest antibacterial activity. Bupivacaine, ropivacaine and levobupivacaine crystals were dissolved and added to Mueller-Hinton Agar in concentrations of 0.06%, 0.125%, 0.2%, 0.25%, 0.5% and 1%. Fentanyl, adrenaline and clonidine were also mixed with agar in isolation and in combination with the local anaesthetics. Using a reference agar dilution method, the minimum inhibitory concentrations were determined for a range of bacteria. Bupivacaine showed antibacterial activity against Staphylococcus aureus, Enterococcus faecalis and Escherichia coli with minimum inhibitory concentrations between 0.125% and 0.25%. It did not inhibit the growth of Pseudomonas aeruginosa at any of the concentrations tested. Levobupivacaine and ropivacaine showed no activity against Staphylococcus aureus, Enterococcus faecalis and Pseudomonas aeruginosa, even at the highest concentrations tested, and minimal activity against Escherichia coli (minimum inhibitory concentrations 0.5% and 1% respectively). The presence of fentanyl, adrenaline and clonidine had no additional effect on the antibacterial activity of any of the local anaesthetic agents. The low concentrations of local anaesthetic usually used in epidural infusions have minimal antibacterial activity. While the clinical implications of this in vitro study are not known, consideration should be given to increasing the concentration of bupivacaine in an epidural infusion or to administering a daily bolus of 0.25% bupivacaine to reduce the risk of epidural bacterial growth.

  9. Myocardial Microvascular Responsiveness During Acute Cardiac Sympathectomy Induced by Thoracic Epidural Anesthesia.

    PubMed

    Bulte, Carolien S E; Boer, Christa; Hartemink, Koen J; Kamp, Otto; Heymans, Martijn W; Loer, Stephen A; de Marchi, Stefano F; Vogel, Rolf; Bouwman, R Arthur

    2017-02-01

    To evaluate the effect of acute cardiac sympathectomy by thoracic epidural anesthesia on myocardial blood flow and microvascular function. A prospective observational study. The study was conducted in a tertiary teaching hospital. Ten patients with a mean age of 48 years (range 22-63 years) scheduled for thoracic surgery. Myocardial contrast echocardiography was used to study myocardial blood flow and microvascular responsiveness at rest, during adenosine-induced hyperemia, and after sympathetic stimulation by the cold pressor test. Repeated measurements were performed without and with thoracic epidural anesthesia. An increased myocardial blood volume was observed with thoracic epidural anesthesia compared to baseline (from 0.08±0.02 to 0.10±0.03 mL/mL; p = 0.02). No difference existed in resting myocardial blood flow between baseline conditions and epidural anesthesia (0.85±0.24 v 1.03±0.27 mL/min/g, respectively). Hyperemia during thoracic epidural anesthesia increased myocardial blood flow to 4.31±1.07 mL/min/g (p = 0.0008 v baseline) and blood volume to 0.17±0.04 mL/mL (p = 0.005 baseline). After sympathetic stimulation, no difference in myocardial blood flow parameters was observed CONCLUSIONS: Acute cardiac sympathectomy by thoracic epidural anesthesia increased the blood volume in the myocardial capillary system. Also, thoracic epidural anesthesia increased hyperemic myocardial blood flow, indicating augmented endothelial-independent vasodilator capacity of the myocardium. Copyright © 2017. Published by Elsevier Inc.

  10. Spinal epidural abscess.

    PubMed

    Krishnamohan, Prashanth; Berger, Joseph R

    2014-11-01

    Spinal epidural abscess (SEA) remains a relatively infrequent diagnosis. Staphylococcus aureus is the most common organism identified, and the infectious source in SEA emanates from skin and soft tissue infections in about 20 % of instances. The thoracic spine is most often involved followed by the lumbar spine. The classic triad of fever, spinal pain, and neurological deficit is present in but a minority of patients. The appearance of neurological deficits with SEA has a significant impact on the prognosis; therefore, early diagnosis is imperative. Magnetic resonance imaging has permitted earlier diagnosis, although significant delays in diagnosis are common due to the nonspecific symptoms that frequently attend the disorder. Due to the rarity of this condition, there have been few randomized controlled trials to evaluate new treatment strategies, and most recommendations regarding treatment are based on case series studies often derived from the experiences at a single center.

  11. Surgical "Fat Patch" improves secondary intracranial hypotension orthostatic headache associated with lumbosacral dural ectasia. Case report.

    PubMed

    Elena, Beretta; Andrea, Franzini; Roberto, Cordella; Vittoria, Nazzi; Grazia, Valentini Laura; Angelo, Franzini

    2017-08-30

    Secondary intracranial hypotension is a clinical syndrome associated with the reduction of the cerebrospinal fluid volume and dural continuity violation. The main symptoms are orthostatic headache associated with nausea, vomiting, diplopia, dizziness and tinnitus. The treatment is usually non-specific. The authors describe the case of a 37-years-old woman who developed secondary intracranial hypotension caused by lumbosacral iatrogenic dural ectasia following de-tethering surgery. An orthostatic headache was the mainstay of her clinical picture and it was confirmed by intracranial pressure monitoring. Conservative treatment including spinal blood patch improved symptoms for a limited amount of time (less than 1 month). Altered compliance of the dural spinal sac was suspected. Therefore thecal sac remodeling by placing autologous fat at the level of the dural ectasia was performed improving the symptoms for 2 years. Volumetric reduction of the epidural space may be considered as a valuable therapeutic option in case of intracranial hypotension that is unresponsive to medical treatments and spinal blood patch, and when an altered compliance of the dural sac is hypothesized. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Granisetron Transdermal Patch

    MedlinePlus

    ... patch. Each patch is stuck onto a thin plastic liner and a separate rigid plastic film. Do not open the pouch in advance, ... cut the patch into pieces. Peel the thin plastic liner off of the printed side of the ...

  13. Methylphenidate Transdermal Patch

    MedlinePlus

    ... still remove the patch at your regular patch removal time. Do not apply extra patches to make ... room temperature and away from excess heat and moisture (not in the bathroom). Do not refrigerate or ...

  14. Cabbage Patch

    NASA Technical Reports Server (NTRS)

    1997-01-01

    This Sojourner rover image of the Cabbage Patch shows small rounded objects on the surface that are about 3-4 cm across. Some of these are within excavations, which are about 0.5 cm wide. Several questions arise about the pebbles: Why are they rounded? Where did they come from? What do they mean?

    Geologists use MULTIPLE WORKING HYPOTHESES when attempting to explain observations. Some hypotheses that could account for the pebbles are: They were rounded during transport by waters of catastrophic floods and deposited on the Ares Vallis floodplain They were rounded by wave action on an ancient Martian beach They were rounded during glacial transport They are glasses that were produced by melting during impact cratering. The glass was first ejected from the crater, then molded into spherical shapes or drops as it traveled through the atmosphere, and finally was deposited at the sites They are spatter from lava flows They are nodules brought up from the deep Martian interior by lava flows or pyroclastic eruptions. They are concretions formed in sedimentary rocks They came from ancient conglomerate rocks. The pebbles were rounded by water action and subsequently lithified into conglomerate rocks. Later, the waters of catastrophic floods transported the conglomerates and deposited them on the Ares floodplain. The pebbles were then freed from the rocks by weathering. A combination of the above

    Mars Pathfinder is the second in NASA's Discovery program of low-cost spacecraft with highly focused science goals. The Jet Propulsion Laboratory, Pasadena, CA, developed and manages the Mars Pathfinder mission for NASA's Office of Space Science, Washington, D.C. JPL is a division of the California Institute of Technology (Caltech).

  15. Positive atopy patch test reaction to Malassezia furfur in atopic dermatitis correlates with a T helper 2-like peripheral blood mononuclear cells response.

    PubMed

    Johansson, Catharina; Eshaghi, Hojjat; Linder, Maria Tengvall; Jakobson, Eva; Scheynius, Annika

    2002-06-01

    The yeast Malassezia furfur belongs to the normal cutaneous flora, but is also a triggering allergen that can contribute to atopic dermatitis. To illuminate the effect of circulating allergen-specific T cells in atopic dermatitis, the peripheral mononuclear cell response was correlated with the in vivo skin prick test and atopy patch test reactivity to M. furfur. None of 16 healthy controls showed any positive in vivo reaction. The 40 atopic dermatitis patients, of whom 18 had serum IgE reactivity to M. furfur, were subdivided according to their in vivo reaction to M. furfur extract into three groups: skin prick test positive/atopy patch test positive (n = 12), skin prick test positive/atopy patch test negative (n = 12), and skin prick test negative/atopy patch test negative (n = 16). The skin prick test positive/atopy patch test positive and the skin prick test positive/atopy patch test negative groups had a significantly higher peripheral mononuclear cell stimulation index than the healthy controls. Interestingly, the stimulation index values in the skin prick test positive/atopy patch test positive group were significantly higher than in the skin prick test positive/atopy patch test negative group. In the M. furfur skin prick test positive atopic dermatitis patients (n = 24) a correlation was found between stimulation index and the M. furfur atopy patch test reactions, but not between stimulation index and M. furfur-specific serum IgE levels. Skin prick test positive and/or atopy patch test positive reactions to the recombinant M. furfur allergens rMal f 1, rMal f 5, and rMal f 6 were observed in 7, 14, and 16 of the 40 atopic dermatitis patients, respectively. Further, there was a correlation between production of the T helper 2-related cytokines interleukins 4, 5, and 13 and stimulation index to M. furfur extract, but not between the T helper 1-related interferon-gamma and stimulation index to M. furfur extract. Our data strongly suggest a relationship between

  16. Primary spinal epidural B-lymphoblastic lymphoma

    PubMed Central

    Nambiar, Rakul K.; Prabhakaran, Pranab K.; Mathew, Sherin P.

    2017-01-01

    Extranodal lymphomas constitute 20% to 30% of all non-Hodgkin's lymphomas. The common sites involved are skin, stomach, brain, and small intestine. Epidural localization is a rare site for lymphomas, accounting for 10% of spinal epidural tumors. Lymphomas occurring primarily in the epidural space without other previously detected lymphomatous foci (i.e., primary spinal epidural lymphomas) represent an even rarer entity. We report a case of primary spinal epidural B-lymphoblastic lymphoma. The patient presented with paraparesis, and a spinal epidural lesion was diagnosed. Considering the rapidity of symptom onset, the possibility of epidural abscess was considered, and he underwent partial laminectomy with decompression of the lesion. Histopathology and immunohistochemistry were diagnostic of B-lymphoblastic lymphoma. The present case is the first report in the literature of B-lymphoblastic lymphoma presenting as a spinal epidural lesion. PMID:28127138

  17. Spinal epidural abscess following glossectomy and neck dissection: A case report

    PubMed Central

    Cheng, Esther; Thorpe, Eric; Borrowdale, Richard

    2016-01-01

    Introduction Spinal epidural abscess is an uncommon but potentially life threatening entity that rarely occurs after otolaryngology procedures. Presentation of case We report a case of a diabetic patient who presented with a lumbar spinal epidural abscess eight days after head and neck oncologic surgery. Magnetic resonance imaging revealed an L4 spinal epidural abscess. Cultures from the spinal epidural abscess, blood, urine, and the previous neck incision grew Klebsiella pneumoniae. The patient recovered neurologic function after surgical decompression and drainage, long-term intravenous antibiotics, and physical therapy. Discussion The development of postoperative spinal epidural abscess is rare after otolaryngology procedures but has been reported in the cervical epidural space. To our knowledge, lumbar spinal epidural abscess has not yet been reported after head and neck oncologic surgery. Even more unique is the presence of the pathogen K. pneumoniae. Conclusion A high index of suspicion of this potential outcome is paramount as early recognition and intervention are keys to recovery of neurologic function. PMID:26799413

  18. Informed consent for epidural analgesia in labour: a survey of Irish practice.

    PubMed

    Hegarty, A; Omer, W; Harmon, D

    2014-06-01

    Currently, we do not have a national standard regarding epidural consent in Ireland. The aim of this survey was to assess practice in obstetric units in Ireland with regard to obtaining informed consent prior to epidural insertion, and whether the risks discussed with women are being documented. A postal survey of anaesthetists in Irish obstetric units was performed in January 2012 to assess practice regarding obtaining informed consent prior to epidural insertion, and documentation of the risks discussed. The response rate was 16/18 (88%). There was major variation both in which risks are discussed with women in labour and what risks are quoted. The most frequently quoted risks were headache--15/16 (93.8% of the respondents), partially/not working epidural--15/16 (93.8%), drop in blood pressure--14/16 (87.5%) and temporary backache/local tenderness--12/16 (75%). The more serious risks were not discussed as frequently: permanent nerve damage--8/16 (50%), paralysis--8/16 (50%), epidural abscess/haematoma--6/16 (37.5%), meningitis--3/16 (18.7%). The vast majority of respondents supported introduction of a national standardised information leaflet, detailing all the benefits and risks of epidural analgesia, to be shown to all women before consenting to epidural insertion.

  19. Effects of epidural morphine and transdermal fentanyl analgesia on physiology and behaviour after abdominal surgery in pigs.

    PubMed

    Malavasi, L M; Nyman, G; Augustsson, H; Jacobson, M; Jensen-Waern, M

    2006-01-01

    The objective of this work was to evaluate the physiological and behavioural effects of opioid analgesic treatment in pigs subjected to abdominal surgery. Ten Swedish Landrace x Yorkshire pigs (20 +/- 4 kg b.w.) were submitted for intestinal cannulation. The pigs were allocated into two groups during one preoperative, one surgical and two postoperative days. All pigs were anaesthetized with medetomidine, tiletamine and zolazepam. One group was treated with epidural morphine (0.1 mg/kg) preoperatively, and transdermal fentanyl patches (50 microg/kg/h) were applied behind the ear immediately after surgery. The other group received epidural saline (equivalent volume) and placebo patches. All pigs were regularly weighed and clinically examined and repeated blood samples were analysed for serum concentrations of cortisol, beta-endorphin and fentanyl. Pre- and postoperative behaviours were evaluated by a swine specialist blinded to the treatment, three times a day, and were also videotape recorded for a total of 84 h per pig. No differences in behaviour were noted by the observer. During the first postoperative 12 h, treated pigs did not differ in activity compared with preoperative recordings, while untreated pigs were found to be less active. The treated group started to show interest in eating immediately after anaesthesia recovery, whereas the placebo group did not. During the 12-60 h postoperative period, the treated group had lower activity levels compared with the preoperative levels, which were similar to those in the placebo group. Treated pigs gained 0.5 +/- 0.2 kg during the subsequent two postoperative days, whereas the untreated pigs lost weight throughout the experiment. Cortisol concentration differed immediately after the surgery: Group P had 325 +/- 120 nmol/L and Group M 159 +/- 49 nmol/L. beta-endorphin concentration did not differ between groups. The highest serum fentanyl concentration (0.37 +/- 0.3 ng/mL) was measured 24 h postoperatively

  20. Recent Advances in Epidural Analgesia

    PubMed Central

    Bauer, Maria; George, John E.; Seif, John; Farag, Ehab

    2012-01-01

    Neuraxial anesthesia is a term that denotes all forms of central blocks, involving the spinal, epidural, and caudal spaces. Epidural anesthesia is a versatile technique widely used in anesthetic practice. Its potential to decrease postoperative morbidity and mortality has been demonstrated by numerous studies. To maximize its perioperative benefits while minimizing potential adverse outcomes, the knowledge of factors affecting successful block placement is essential. This paper will provide an overview of the pertinent anatomical, pharmacological, immunological, and technical aspects of epidural anesthesia in both adult and pediatric populations and will discuss the recent advances, the related rare but potentially devastating complications, and the current recommendations for the use of anticoagulants in the setting of neuraxial block placement. PMID:22174708

  1. MRI of spinal epidural lymphoma.

    PubMed

    Mascalchi, M; Torselli, P; Falaschi, F; Dal Pozzo, G

    1995-05-01

    We reviewed the MRI features in eight patients with spinal epidural lymphoma (clinically primary in 4 patients); one patient had multiple lesions. The cervical spine was involved in one patient, the thoracolumbar spine in 5 and the sacrum in two. Mean longitudinal extension of the epidural lesion was 2.6 vertebral segments. The tumours were homogeneously isointense with the spinal cord on T1-weighted images and isointense or hyperintense on proton-density and T2-weighted images. The spinal cord was compressed in four patients but showed signal changes in only one. In five patients the lesions communicated through the intervertebral foramina with paravertebral soft tissue masses. In all but one of the patients diffuse signal changes in the vertebral body marrow consistent with osteolytic or osteoblastic changes were identified adjacent to or at distance from the epidural lesion. Vertebral collapse was observed in two patients.

  2. Vertical Small-Needle Caudal Epidural Injection Technique

    PubMed Central

    Maniquis Smigel, Liza; Dean Reeves, Kenneth; Jeffrey Rosen, Howard; Patrick Rabago, David

    2016-01-01

    Background Anecdotal evidence suggests that a vertical small-needle injection method enters the caudal epidural space with comparable efficacy to cephalad-directed methods, with less intravascular injection. Objectives Assess the success rate of vertical caudal epidural injection using epidurography and the frequency of intravascular injection using a vertical small-needle approach. Patients and Methods Participants had chronic generalized non-surgical low back pain and either gluteal and/or leg pain and were enrolled in a simultaneous clinical trial assessing the analgesic effect of 5% dextrose epidural injection. A 25 gauge 3.7 cm hypodermic needle was placed at the sacral hiatus using a fingertip-guided vertical technique without imaging assistance, followed by fluoroscopic epidurography. Minimal needle redirection was allowed up to 10 degrees from the vertical plane if the initial epidurogram showed an extradural pattern, followed by repeat epidurography. Results First needle placement without imaging resulted in blood return in 1/199 participants and positive epidurography in 179/199 (90%). Minimal needle repositioning resulted in a positive epidurogram in the remaining 19 attempts. No intravascular injection patterns were observed. Conclusions This compares favorably to published success rates of fluoroscopically-guided technique and was well tolerated. Vertical caudal epidural injection may be suitable for combination with ultrasound-guided methods with Doppler flow monitoring. PMID:27826539

  3. In vitro adhesion of K88ac+ Escherichia coli to Peyer's patch and peripheral blood lymphocytes, buccal and rectal epithelial cells or intestinal epithelial brush borders of weaned pigs.

    PubMed

    Valpotić, I; Runnels, P L; Moon, H W

    1989-08-01

    Escherichia coli adhesion assays were conducted using isolated porcine peripheral blood lymphocytes, Peyer's patch lymphocytes, rectal epithelial cells or brush borders, buccal epithelial cells and brush borders from small intestinal epithelial cells. The cells and brush borders were tested for their ability to bind K88-piliated enterotoxigenic E. coli Strain M1823B (K88ac) and E. coli Strain 1476 (K-12, K88ac). Comparison of adhesive phenotypes of 37 weaned pigs as determined by the adhesion assay with small intestinal brush borders and the adherence of K88ac+ enterotoxigenic E. coli to peripheral blood lymphocytes, Peyer's patch lymphocytes and rectal epithelial cells or brush borders, revealed no correlation. In vitro adhesion of K88ac-bearing E. coli was always negative with buccal epithelial cells. K88ac strains varied in their ability to adhere to lymphocytes and rectal epithelial cells or brush borders, indicating that the mechanism of adherence is unrelated to K88-mediated adhesion observed in animals that had the receptors on small-intestinal epithelial-cell brush borders. The non-piliated control E. coli Strain 123 adhered to fresh peripheral blood lymphocytes, and less intensively to frozen-thawed peripheral blood lymphocytes or Peyer's patch lymphocytes. It was concluded that none of the cell types or brush borders, except small-intestinal epithelial-cell brush borders, could be used as targets for phenotyping pigs for the presence of the K88 receptors that have been associated with adhesion and colonization of K88+ enterotoxigenic E. coli in the porcine small intestine.

  4. Continuous positive pressure ventilation during epidural blockade--effects on cardiac output distribution.

    PubMed

    Elowsson, P; Norlén, K; Jakobson, S

    2001-01-01

    It has been shown that when cardiac output (CO) decreases during continuous positive pressure ventilation (CPPV), its regional distribution adapts with a favouring of vital organs. Does epidural blockade modify this adaptation? Regional blood flows were assessed by the microsphere technique (15 microm) in 17 anaesthetised pigs during spontaneous breathing and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after epidural blockade. The block was induced at either the Th6-7 (Thep) or the L6-S1 (Lep) level with 1 ml of lidocaine 40 mg x ml(-1). When Lep was combined with CPPV8, mean arterial pressure and CO decreased significantly, and they decreased even more when combined with Thep. In contrast, the relative perfusion of the central nervous system, heart and kidneys remained stable during the four conditions studied. The adrenal perfusion during CPPV8 was obviated by epidural blockade. The absolute and relative perfusion of the skeletal muscle decreased during epidural blockade. The administered doses of epidural lidocaine did not affect blood flow in the spinal cord. The locally mediated nutritive vasoregulation of vital organs outweighed the sympathetic blockade induced by epidural blockade. During Thep blockade the animals were less capable of responding to the haemodynamic changes induced by CPPV8, probably due to the blockade of the cardiac part of the sympathetic nervous system.

  5. [Case of spinal epidural abscess after continuous epidural block to manage the pain of herpes zoster].

    PubMed

    Miyamoto, Tatsuhito; Nakatani, Toshihiko; Narai, Yasuhiro; Sakakibara, Manabu; Hashimoto, Tatsuya; Saito, Youji

    2014-03-01

    A woman in her 90's received continuous epidural block for the pain of herpes zoster. Four days after epidural catheterization, she was found with cellutitis. Fourteen days after epidural catheterization, spinal epidural abscess was pointed out on MRI. Since there were no neurological symptoms, we performed conservative medical management with antibiotics. She recovered without sequela When the symptoms of cellutitis appeared after epidural block (even if there are neither neurological symptoms nor infectious signs), there is a possibility of progressing into spinal epidural abscess.

  6. [Hyperthermia after obstetrical epidural anesthesia].

    PubMed

    Mercier, F J; Benhamou, D

    1994-01-01

    Unlike epidural anaesthesia for general surgery or caesarean section, épidural analgesia for labour leads to maternal hyperthermia. Its recent demonstration is probably related to the multiple influencing factors: site of measurement, ambient temperature, previous labour duration and dilatation at the time of epidural puncture, and occurrence of shivering. During the first 2 to 5 hours of epidural analgesia, there is a weak--if any--thermic increase. Then, when labour is prolonged (mostly primiparae) a linear increase occurs with time, at a mean rate of 1 degree C per 7 hours. The pathophysiology remains hypothetical: heat loss (sweating and hyperventilation) would be reduced during epidural analgesia and therefore surpassed by the important labour-induced heat production. This hyperthermia has been correlated with foetal tachycardia but never with any infectious process. A potential deleterious effect is still debated and may lead to propose an active cooling for the mother. This hyperthermia must also be recognized to avoid an inadequate obstetrical attitude (antibiotics, extractions).

  7. Maternal and foetal outcome after epidural labour analgesia in high-risk pregnancies

    PubMed Central

    Samanta, Sukhen; Jain, Kajal; Bhardwaj, Neerja; Jain, Vanita; Samanta, Sujay; Saha, Rini

    2016-01-01

    Background and Aims: Low concentration local anaesthetic improves uteroplacental blood flow in antenatal period and during labour in preeclampsia. We compared neonatal outcome after epidural ropivacaine plus fentanyl with intramuscular tramadol analgesia during labour in high-risk parturients with intrauterine growth restriction of mixed aetiology. Methods: Forty-eight parturients with sonographic evidence of foetal weight <1.5 kg were enrolled in this non-randomized, double-blinded prospective study. The epidural (E) group received 0.15% ropivacaine 10 ml with 30 μg fentanyl incremental bolus followed by 7–15 ml 0.1% ropivacaine with 2 μg/ml fentanyl in continuous infusion titrated until visual analogue scale was three. Tramadol (T) group received intramuscular tramadol 1 mg/kg as bolus as well as maintenance 4–6 hourly. Neonatal outcomes were measured with cord blood base deficit, pH, ionised calcium, sugar and Apgar score after delivery. Maternal satisfaction was also assessed by four point subjective score. Results: Baseline maternal demographics and neonatal birth weight were comparable. Neonatal cord blood pH, base deficit, sugar, and ionised calcium levels were significantly improved in the epidural group in comparison to the tramadol group. Maternal satisfaction (P = 0.0001) regarding labour analgesia in epidural group was expressed as excellent by 48%, good by 52% whereas it was fair in 75% and poor in 25% in the tramadol group. Better haemodynamic and pain scores were reported in the epidural group. Conclusion: Epidural labour analgesia with low concentration local anaesthetic is associated with less neonatal cord blood acidaemia, better sugar and ionised calcium levels. The analgesic efficacy and maternal satisfaction are also better with epidural labour analgesia. PMID:27013750

  8. SafePatch

    SciTech Connect

    Kelley, M.; Elko, S.

    2000-10-01

    Authenticating and upgrading system software plays a critical role in information security, yet practical tools for assessing and installing software are lacking in today's marketplace. The SafePatch tool provides the mechanism of performing automated analysis, notification, distribution, and installation of security patches and related software to network-based computer systems in a vendor-independent fashion. SafePatch assists in the authentication of software by comparing the system's objects with the patch's objects. SafePatch will monitor vendor's sites to determine when new patches are released and will upgrade system software on target systems automatically. This paper describes the design of SafePatch, motivations behind the project and the advantages of SafePatch over existing tools.

  9. Estradiol Transdermal Patch

    MedlinePlus

    Most brands of estradiol transdermal patches are used to treat hot flushes (hot flashes; sudden strong feelings of heat ... different medication that does not contain estrogen. Most brands of estradiol transdermal patches are also sometimes used ...

  10. Metal Patch Antenna

    NASA Technical Reports Server (NTRS)

    Chamberlain, Neil F. (Inventor); Hodges, Richard E. (Inventor); Zawadzki, Mark S. (Inventor)

    2012-01-01

    Disclosed herein is a patch antenna comprises a planar conductive patch attached to a ground plane by a support member, and a probe connector in electrical communication with the conductive patch arranged to conduct electromagnetic energy to or from the conductive patch, wherein the conductive patch is disposed essentially parallel to the ground plane and is separated from the ground plane by a spacing distance; wherein the support member comprises a plurality of sides disposed about a central axis oriented perpendicular to the conductive patch and the ground plane; wherein the conductive patch is solely supported above the ground plane by the support member; and wherein the support member provides electrical communication between the planer conductive patch and the ground plane.

  11. Collection of analytes from microneedle patches.

    PubMed

    Romanyuk, Andrey V; Zvezdin, Vasiliy N; Samant, Pradnya; Grenader, Mark I; Zemlyanova, Marina; Prausnitz, Mark R

    2014-11-04

    Clinical medicine and public health would benefit from simplified acquisition of biological samples from patients that can be easily obtained at point of care, in the field, and by patients themselves. Microneedle patches are designed to serve this need by collecting dermal interstitial fluid containing biomarkers without the dangers, pain, or expertise needed to collect blood. This study presents novel methods to collect biomarker analytes from microneedle patches for analysis by integration into conventional analytical laboratory microtubes and microplates. Microneedle patches were made out of cross-linked hydrogel composed of poly(methyl vinyl ether-alt-maleic acid) and poly(ethylene glycol) prepared by micromolding. Microneedle patches were shown to swell with water up to 50-fold in volume, depending on degree of polymer cross-linking, and to collect interstitial fluid from the skin of rats. To collect analytes from microneedle patches, the patches were mounted within the cap of microcentrifuge tubes or formed the top of V-bottom multiwell microplates, and fluid was collected in the bottom of the tubes under gentle centrifugation. In another method, microneedle patches were attached to form the bottom of multiwell microplates, thereby enabling in situ analysis. The simplicity of biological sample acquisition using microneedle patches coupled with the simplicity of analyte collection from microneedles patches integrated into conventional analytical equipment could broaden the reach of future screening, diagnosis, and monitoring of biomarkers in healthcare and environmental/workplace settings.

  12. Collection of Analytes from Microneedle Patches

    PubMed Central

    2015-01-01

    Clinical medicine and public health would benefit from simplified acquisition of biological samples from patients that can be easily obtained at point of care, in the field, and by patients themselves. Microneedle patches are designed to serve this need by collecting dermal interstitial fluid containing biomarkers without the dangers, pain, or expertise needed to collect blood. This study presents novel methods to collect biomarker analytes from microneedle patches for analysis by integration into conventional analytical laboratory microtubes and microplates. Microneedle patches were made out of cross-linked hydrogel composed of poly(methyl vinyl ether-alt-maleic acid) and poly(ethylene glycol) prepared by micromolding. Microneedle patches were shown to swell with water up to 50-fold in volume, depending on degree of polymer cross-linking, and to collect interstitial fluid from the skin of rats. To collect analytes from microneedle patches, the patches were mounted within the cap of microcentrifuge tubes or formed the top of V-bottom multiwell microplates, and fluid was collected in the bottom of the tubes under gentle centrifugation. In another method, microneedle patches were attached to form the bottom of multiwell microplates, thereby enabling in situ analysis. The simplicity of biological sample acquisition using microneedle patches coupled with the simplicity of analyte collection from microneedles patches integrated into conventional analytical equipment could broaden the reach of future screening, diagnosis, and monitoring of biomarkers in healthcare and environmental/workplace settings. PMID:25367229

  13. Birth Control Patch

    MedlinePlus

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Birth Control Patch KidsHealth > For Teens > Birth Control Patch Print A A A What's in this ... Much Does It Cost? What Is It? The birth control patch is a thin, beige, 1¾-inch (4½- ...

  14. Birth Control Patch

    MedlinePlus

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Birth Control Patch KidsHealth > For Teens > Birth Control Patch A A A What's in this article? ... Much Does It Cost? What Is It? The birth control patch is a thin, beige, 1¾-inch (4½- ...

  15. Catheter failure rates and time course with epidural versus combined spinal-epidural analgesia in labor.

    PubMed

    Groden, J; Gonzalez-Fiol, A; Aaronson, J; Sachs, A; Smiley, R

    2016-05-01

    The combined spinal-epidural technique for labor analgesia has several advantages over the traditional epidural technique, including faster onset, greater maternal satisfaction, and decreased need for physician boluses. Proponents of the epidural technique criticize the combined spinal-epidural technique, arguing that the epidural catheter remains untested and thus may not be reliable if needed for surgical intervention. We compared failure rates and time of failure between techniques in our tertiary-care academic practice. Data regarding failed catheters were collected from October 2012 to September 2014 as part of our Quality Assurance program. Failed catheters were defined as any catheter replaced after it was considered to be properly placed and then determined to be intravascular, one sided or resulting in poor maternal analgesia or anesthesia. A total of 5487 analgesics were performed (3980 combined spinal-epidural; 1507 epidural). Eighty-five combined spinal-epidural catheters (2.1%) and 59 epidural catheters (3.9%) were replaced during labor (P<0.001). Mean time to replacement was 512±422min and 354±300min for the combined spinal-epidural (n=80) and epidural (n=57) groups, respectively (P=0.02). Median time to replacement was 398 [IQR 131-578] min and 281 [IQR 186-767] min for combined spinal-epidural and epidural groups, respectively (P<0.0001). We were able to demonstrate that catheters placed using a combined spinal-epidural technique were less likely to fail during labor and that the time to detection of a failed catheter was significantly longer in the combined spinal-epidural group. Our findings validate the combined spinal-epidural technique as reliable for labor analgesia and tend to refute the theory of the untested catheter. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Uterine artery, umbilical, and fetal cerebral Doppler velocities after epidural analgesia during labor.

    PubMed

    Valentin, Morgane; Ducarme, Guillaume; Ceccaldi, Pierre-François; Bougeois, Bernard; Luton, Dominique

    2012-08-01

    To evaluate the effects of epidural analgesia on uterine artery, umbilical, and fetal cerebral Doppler velocities during labor. In a prospective study at Beaujon Hospital, Paris, France, between September and December 2010, uterine artery, umbilical, and fetal cerebral Doppler flow velocities were measured in 12 pregnant women during spontaneous labor with epidural analgesia. The data were registered in a period of uterine relaxation before, and 20 and 60 minutes after the first administration of epidural analgesic drugs. The changes in Doppler velocimetry values and fetal heart rate after epidural analgesia were analyzed. Uterine artery velocities, but neither umbilical nor fetal cerebral Doppler velocities, were decreased significantly at 20 minutes and 1 hour after epidural analgesia (P<0.005). Women with the greatest decrease in uterine artery Doppler flow velocities delivered neonates with the lowest values of umbilical artery blood pH. The data suggest that the Doppler flow velocity of uterine arteries is affected by epidural analgesia during labor. Numerous Doppler flow studies of the effect of neuraxial blockade during labor on umbilical and uterine arteries have been published with incredibly variable and inconsistent results. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  17. Paraplegia After Thoracic Epidural Steroid Injection.

    PubMed

    Loomba, Vivek; Kaveeshvar, Hirsh; Dwivedi, Samvid

    2016-09-01

    Epidural steroid injections are a common procedure performed by pain physicians. The American Society of Regional Anesthesia along with several other groups recently provided guidelines for performing epidural injections in the setting of anticoagulants. We present a case of a patient who developed an epidural hematoma and subsequent paraplegia despite strict adherence to these guidelines. Although new guidelines serve to direct practice, risks of devastating neurologic complications remain as evidenced by our case.

  18. Postoperative analgesia with intravenous fentanyl PCA vs epidural block after thoracoscopic pectus excavatum repair in children.

    PubMed

    Butkovic, D; Kralik, S; Matolic, M; Kralik, M; Toljan, S; Radesic, L

    2007-05-01

    The aim of this prospective, randomized trial was to compare analgesia, sedation, and cardiorespiratory function in children after thoracoscopic surgery for pectus excavatum repair, using two types of analgesia--epidural block with bupivacaine plus fentanyl vs patient-controlled analgesia (PCA) with fentanyl. Twenty-eight patients scheduled for thoracoscopic pectus excavatum surgery were randomly assigned to receive either thoracic epidural block or i.v. PCA for postoperative analgesia. Pain was assessed using a visual-analogue scale (VAS). The Ramsay sedation score, arterial pressure, ventilatory frequency, and heart rate were also measured, and blood gas analysis was performed regularly during the first 48 h after surgery. A significant decrease in the VAS pain score, Ramsay sedation score, heart rate ventilatory frequency, systolic and diastolic blood pressure, and PaCO2, and a significant increase in PaO2 and oxygen saturation were found over time. Patients in the PCA group had significantly higher PaCO2 values. In addition, a significantly slower decline of systolic blood pressure and heart rate, and faster recovery of PaCO2 were found in PCA patients than in patients with epidural block. I.V. fentanyl PCA is as effective as thoracic epidural for postoperative analgesia in children after thoracoscopic pectus excavatum repair. Bearing in mind the possible complications of epidural catheterization in children, the use of fentanyl PCA is recommended.

  19. Spinal epidural abscess: a rare complication of olecranon bursitis

    PubMed Central

    Evans, Rhys D.R.; Thaya, Moe; Chew, Ne Siang; Gibbons, Charles E.R.

    2009-01-01

    Spinal epidural abscess is a rare but potentially fatal condition if left untreated. We report the case of a 67-year old man who presented to the Accident and Emergency department complaining of acute onset of inter-scapular back pain, left leg weakness and loss of sensation in the left foot. On examination he was found to be pyrexial with long tract signs in the left lower leg. In addition he had a left sided olecranon bursitis of three weeks duration. Blood tests revealed raised inflammatory markers and a staphylococcal bacteremia. Magnetic resonance imaging (MRI) confirmed the diagnosis of spinal epidural abscess and he subsequently underwent a three level laminectomy with good resolution of his back pain and neurological symptoms. He has made a complete recovery with a prolonged course of intravenous antibiotics. PMID:21808663

  20. Spinal epidural abscess: a rare complication of olecranon bursitis.

    PubMed

    Evans, Rhys D R; Thaya, Moe; Chew, Ne Siang; Gibbons, Charles E R

    2009-06-30

    Spinal epidural abscess is a rare but potentially fatal condition if left untreated. We report the case of a 67-year old man who presented to the Accident and Emergency department complaining of acute onset of inter-scapular back pain, left leg weakness and loss of sensation in the left foot. On examination he was found to be pyrexial with long tract signs in the left lower leg. In addition he had a left sided olecranon bursitis of three weeks duration. Blood tests revealed raised inflammatory markers and a staphylococcal bacteremia. Magnetic resonance imaging (MRI) confirmed the diagnosis of spinal epidural abscess and he subsequently underwent a three level laminectomy with good resolution of his back pain and neurological symptoms. He has made a complete recovery with a prolonged course of intravenous antibiotics.

  1. A case of Horner's syndrome with epidural anaesthesia

    PubMed Central

    Sharma, Rowena; Chatterjee, Jayanta; Edmonds, Keith

    2010-01-01

    A 29-year-old woman, primigravida, had labour induced for post-maturity following an uncomplicated antenatal course. She requested an epidural prior to commencement of syntocinon. This was administered in the sitting position without complication. The midwife noted drooping of the right eyelid of the patient 6.5 h following insertion of the epidural. Blood pressure and CTG remained reassuring. The obstetric anaesthetist reviewed the labouring woman and noted a right-sided ptosis as well as the right cheek being flushed and dry. There was no motor block and sensation in T1/T2/S3/S4 was intact. Horner's syndrome was diagnosed and anaesthetic review was recommended prior to further top-ups. The patient progressed well in the second stage of labour and did not require further top-ups and gave birth to a healthy male infant. Horner's syndrome resolved within 4 h following delivery and the postpartum period was uncomplicated. PMID:22767365

  2. [Maintaining epidural anesthesia by the midwife].

    PubMed

    Dörfling, C; Nolte, A G

    1990-12-01

    Epidural anaesthesia as a method of pain relief during labour has lately become very popular. Statistics show that in some labour units up to 70 per cent of all patients undergo epidural anaesthesia. The popularity of this method can be attributed to its effectiveness in relieving pain during labour. The anaesthetist commences an epidural block by introducing an epidural catheter into the epidural space. The anaesthetist administers the test dose and the first therapeutic dose. Within a short duration of time (10 to 20 minutes) the patient can already experience the numbing effect of the anaesthetic. This anaesthetic loses its numbing effect within two to three hours and effective pain relief can only be achieved by administering a further dose of local anaesthetic via the epidural catheter. This procedure can be repeated between three to six times during the average duration of labour. Alternatively, a continuous epidural infusion procedure can be used. The last method, however, sometimes requires the administration of additional epidural "top-ups". There are some risks in administering additional "top-up" dosages. The possibility exists of the anaesthetic causing a spinal block as a result of being administered into the spinal fluid. The "top-up" can also cause convulsions if administered intravenously. In some units it is expected of the midwife to maintain epidural anaesthesia on prescription by the doctor. These side-effects can, however, also occur when the patient is being treated by medical personnel with ample experience and knowledge. It is expected of some midwives to maintain an epidural block on prescription by the anaesthetist. If the midwife lacks the necessary knowledge of epidural anaesthetic and its maintenance, she might unintentionally administer the local anaesthetic into the spinal fluid or intravascularly. This might cause a threat to the mother's and baby's lives. This research covers the maintenance of epidural anaesthesia as carried out by

  3. Incidence of delayed hair re-growth, pruritus, and urinary retention after epidural anaesthesia in dogs.

    PubMed

    Kalchofner Guerrero, K S; Guerrero, T G; Schweizer-Kölliker, M; Ringer, S K; Hässig, M; Bettschart-Wolfensberger, R

    2014-04-16

    Delayed hair re-growth, pruritus and urinary retention are known complications after epidural anaesthesia in dogs. The aim of this study was to prospectively evaluate the effect of epidurally administered drugs on the occurrence of these complications in dogs. Ninety dogs were included in this study. Eighty client-owned dogs undergoing surgery were randomly assigned to one of three epidural treatment groups: either morphine and bupivacaine (MB), bupivacaine (B), or saline solution 0.9% (S) was administered epidurally to these patients. Ten dogs were only clipped in the lumbosacral area (C). Follow-up started 4 weeks after clipping and was performed every 4-5 weeks in cases of delayed hair re-growth or pruritus. Hair re-growth in the lumbosacral area was observed and compared to hair re-growth in the surgical field and the fentanyl patch area. Cytological analysis and a trichogram were performed if hair re-growth was delayed after 6 months. Time interval to first urination postoperatively was recorded (n = 80). Hair re-growth was delayed in 11 dogs (12.2%; B: n = 7, S: n = 2, MB: n = 1, C: n = 1) with no differences between groups. Pruritus was evident in two dogs (2.2%; MB: n = 1, S: n = 1). After 6 months, hair had started to re-grow in all but one dog (B). After 10 months the coat of this dog had re-grown. Time to first urination did not differ between groups. No direct correlation between the particular drugs injected epidurally and delayed hair re-growth, pruritus and urinary retention could be shown. Dog owners should be informed that hair re-growth after epidural anaesthesia could be markedly delayed.

  4. Epidural optogenetics for controlled analgesia

    PubMed Central

    Bonin, Robert P; Wang, Feng; Desrochers-Couture, Mireille; Ga¸secka, Alicja; Boulanger, Marie-Eve; Côté, Daniel C

    2016-01-01

    Background Optogenetic tools enable cell selective and temporally precise control of neuronal activity; yet, difficulties in delivering sufficient light to the spinal cord of freely behaving animals have hampered the use of spinal optogenetic approaches to produce analgesia. We describe an epidural optic fiber designed for chronic spinal optogenetics that enables the precise delivery of light at multiple wavelengths to the spinal cord dorsal horn and sensory afferents. Results The epidural delivery of light enabled the optogenetic modulation of nociceptive processes at the spinal level. The acute and repeated activation of channelrhodopsin-2 expressing nociceptive afferents produced robust nocifensive behavior and mechanical sensitization in freely behaving mice, respectively. The optogenetic inhibition of GABAergic interneurons in the spinal cord dorsal horn through the activation of archaerhodopsin also produced a transient, but selective induction of mechanical hypersensitivity. Finally, we demonstrate the capacity of optogenetics to produce analgesia in freely behaving mice through the inhibition of nociceptive afferents via archaerhodopsin. Conclusion Epidural optogenetics provides a robust and powerful solution for activation of both excitatory and inhibitory opsins in sensory processing pathways. Our results demonstrate the potential of spinal optogenetics to modulate sensory behavior and produce analgesia in freely behaving animals. PMID:27030718

  5. Expectant fathers and labor epidurals.

    PubMed

    Chapman, L L

    2000-01-01

    A qualitative research study was conducted to describe and explain expectant father's experiences during labor when their partners receive labor epidurals. Grounded theory. Seventeen couples were interviewed using a semi-structured interview format. Two major concepts were identified: "Losing Her" and "She's Back." The men reported that these were the two critical points at which the epidural affected their experience. The theory, "Cruising through Labor," explained the fathers' experiences. Childbirth preparation classes that describe and explain women's responses to the increasing pain of labor contractions, the exhaustion of labor, and the effect of epidural analgesia could possibly assist men in preparing for the changes they will witness in their partners during the labor experience. Knowing that these changes are normal responses to the effects of labor might reduce men's levels of anxiety, frustration, and sense of helplessness. The labor nurse is a major support to the expectant fathers. Labor nurses who remain in the room during this phase, explain what is happening, and include the expectant father in their nursing care provide the best support.

  6. Epidural optogenetics for controlled analgesia.

    PubMed

    Bonin, Robert P; Wang, Feng; Desrochers-Couture, Mireille; Ga Secka, Alicja; Boulanger, Marie-Eve; Côté, Daniel C; De Koninck, Yves

    2016-01-01

    Optogenetic tools enable cell selective and temporally precise control of neuronal activity; yet, difficulties in delivering sufficient light to the spinal cord of freely behaving animals have hampered the use of spinal optogenetic approaches to produce analgesia. We describe an epidural optic fiber designed for chronic spinal optogenetics that enables the precise delivery of light at multiple wavelengths to the spinal cord dorsal horn and sensory afferents. The epidural delivery of light enabled the optogenetic modulation of nociceptive processes at the spinal level. The acute and repeated activation of channelrhodopsin-2 expressing nociceptive afferents produced robust nocifensive behavior and mechanical sensitization in freely behaving mice, respectively. The optogenetic inhibition of GABAergic interneurons in the spinal cord dorsal horn through the activation of archaerhodopsin also produced a transient, but selective induction of mechanical hypersensitivity. Finally, we demonstrate the capacity of optogenetics to produce analgesia in freely behaving mice through the inhibition of nociceptive afferents via archaerhodopsin. Epidural optogenetics provides a robust and powerful solution for activation of both excitatory and inhibitory opsins in sensory processing pathways. Our results demonstrate the potential of spinal optogenetics to modulate sensory behavior and produce analgesia in freely behaving animals. © The Author(s) 2016.

  7. Cervical epidural hematoma after chiropractic spinal manipulation.

    PubMed

    Heiner, Jason D

    2009-10-01

    Spinal epidural hematoma is a rare but potentially devastating complication of spinal manipulation therapy. This is a case report of a healthy pregnant female who presented to the emergency department with a cervical epidural hematoma resulting from chiropractic spinal manipulation therapy that responded to conservative treatment rather than the more common route of surgical management.

  8. Effect of epidural tramadol and lignocaine on physiological and behavioural changes in goats subjected to castration with a high tension band.

    PubMed

    Ajadi, R A; Owanikin, A O; Martins, M M; Gazal, O S

    2012-11-01

    To compare the effect of a single epidural injection of either lignocaine or tramadol on behavioural changes, anaesthetic indices, leucocyte parameters, erythrocyte sedimentation rates and concentration of cortisol in plasma in goats subjected to castration by high tension band. Ten male goats weighing 14.4 (SD 0.7) kg were randomly allocated to anaesthesia with epidural injections of tramadol (3 mg/kg), or lignocaine (4 mg/kg). Following anaesthesia, a rubber ring was applied and tensioned to the scrotal neck of each goat. Behavioural changes were noted as they occurred, and the onset of drug action (time between epidural injection and loss of pedal reflex) and duration of antinociception (time interval between disappearance and reappearance of pedal withdrawal reflex) were determined. Hearts rates, respiratory rates and rectal temperatures were determined every 15 minutes for a 90-minute period, while blood was obtained for determination of white cell counts, erythrocyte sedimentation rates and concentrations of cortisol. Anaesthetic indices were compared using Student's t-test, while physiological parameters were compared using an ANOVA for repeated measurements. Goats treated with epidural tramadol were not recumbent and continued rumination while goats treated with epidural lignocaine were recumbent and did not continue rumination. The onset of analgesia was longer (p=0.01) in goats treated with epidural tramadol (5.0 minutes; SD 1.2) than goats treated with epidural lignocaine (3.0 minutes; SD 1.1), while duration of analgesia was shorter (p=0.003) in goats treated with epidural tramadol (47.2 minutes; SD 13.1) than goats treated with epidural lignocaine (89.8 minutes; SD 23.1). There was no significant difference in heart rates, respiratory rates and erythrocyte sedimentation rates, while the concentration of cortisol in plasma differed (p<0.05) between goats treated with epidural tramadol and lignocaine. Epidural lignocaine injection produced longer

  9. Chronic epidural hematoma with rapid ossification.

    PubMed

    Chang, Jong Hee; Choi, Jae Young; Chang, Jin Woo; Park, Yong Gou; Kim, Tai Seung; Chung, Sang Sup

    2002-12-01

    The authors present a rare case of ossified chronic epidural hematoma. A 13-year-old female patient presented with an ossified chronic epidural hematoma. She had sustained a head injury about 10 weeks previously and had received conservative care for a delayed-onset epidural hematoma at a local hospital. Ossification was identified about 4 weeks after the head injury and then progressed rapidly. A chronic epidural hematoma with a thick collagenous capsule and newly formed bone was removed 73 days after the head injury. An epidural hematoma with mild symptoms can be treated conservatively. When, however, the hematoma is observed not to be naturally absorbed during serial follow-up examinations, surgical removal must be considered, even if the patient's condition is good, because this entity carries the risk of bone calcification and ossification.

  10. Postlumbar puncture arachnoiditis mimicking epidural abscess

    PubMed Central

    Gürbüz, Mehmet Sabri; Erdoğan, Barıs; Yüksel, Mehmet Onur; Somay, Hakan

    2013-01-01

    Lumbar spinal arachnoiditis occurring after diagnostic lumbar puncture is a very rare condition. Arachnoiditis may also present with fever and elevated infection markers and may mimic epidural abscess, which is one of the well known infectious complications of lumbar puncture. We report the case of a 56-year-old man with lumbar spinal arachnoiditis occurring after diagnostic lumbar puncture who was operated on under a misdiagnosis of epidural abscess. In the intraoperative and postoperative microbiological and histopathological examination, no epidural abscess was detected. To our knowledge, this is the first case of a patient with postlumbar puncture arachnoiditis operated on under a misdiagnosis of epidural abscess reported in the literature. The authors suggest that arachnoiditis may mimic epidural abscess due to its clinical and radiological features and should be considered in the differential diagnosis of complications of lumbar puncture. PMID:24197809

  11. Epidural Analgesia for Labor: Continuous Infusion Versus Programmed Intermittent Bolus.

    PubMed

    Onuoha, Onyi C

    2017-03-01

    Despite the traditional practice to maintain labor analgesia with a combination of continuous epidural infusion and patient-controlled epidural analgesia using an automated epidural pump; compelling data now shows that bolus injection through the epidural catheter may result in better distribution of anesthetic solution in the epidural space. The programmed intermittent epidural bolus technique is proposed as a better maintenance mode and may represent a more effective mode of maintaining epidural analgesia for labor, especially prolonged labor. Additional prospective and adequately powered studies are needed to confirm findings and determine the optimal combination of volume, rate, time, and drug concentration. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Large, spontaneous spinal subdural–epidural hematoma after epidural anesthesia for caesarean section: Conservative management with excellent outcome

    PubMed Central

    Siasios, Ioannis D.; Vakharia, Kunal; Gibbons, Kevin J.; Dimopoulos, Vassilios G.

    2016-01-01

    Background: Iatrogenic or spontaneous spinal hematomas are rarely seen and present with multiple symptoms that can be difficult to localize. Most spontaneous spinal hematomas are multifactorial, and the pathophysiology is varied. Here, we present a case of a scattered, multicomponent, combined subdural and epidural spinal hematoma that was managed conservatively. Case Description: A 38-year-old woman came to the emergency department (ED) complaining of severe neck and back pain. She had undergone a caesarean section under epidural anesthesia 4 days prior to her arrival in the ED. She was placed on heparin and then warfarin to treat a pulmonary embolism that was diagnosed immediately postpartum. Her neurological examination at presentation demonstrated solely the existence of clonus in the lower extremities and localized cervical and low thoracic pain. In the ED, the patient's international normalized ratio was only mildly elevated. Spinal magnetic resonance imaging revealed a large thoracolumbar subdural hematoma with some epidural components in the upper thoracic spine levels. Spinal cord edema was also noted at the T6-T7 vertebral level. The patient was admitted to the neurosurgical intensive care unit for close surveillance and reversal of her coagulopathy. She was treated conservatively with pain medication, fresh frozen plasma, and vitamin K. She was discharged off of warfarin without any neurological deficit. Conclusions: Conservative management of spinal hematomas secondary to induced coagulopathies can be effective. This case suggests that, in the face of neuroimaging findings of significant edema and epidural blood, the clinical examination should dictate the management, especially in such complicated patients. PMID:27843682

  13. Study Protocol- Lumbar Epidural Steroid Injections for Spinal Stenosis (LESS): a double-blind randomized controlled trial of epidural steroid injections for lumbar spinal stenosis among older adults

    PubMed Central

    2012-01-01

    Background Lumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, treatment of spinal stenosis symptoms remains controversial. Epidural steroid injections are used with increasing frequency as a less invasive, potentially safer, and more cost-effective treatment than surgery. However, there is a lack of data to judge the effectiveness and safety of epidural steroid injections for spinal stenosis. We describe our prospective, double-blind, randomized controlled trial that tests the hypothesis that epidural injections with steroids plus local anesthetic are more effective than epidural injections of local anesthetic alone in improving pain and function among older adults with lumbar spinal stenosis. Methods We will recruit up to 400 patients with lumbar central canal spinal stenosis from at least 9 clinical sites over 2 years. Patients with spinal instability who require surgical fusion, a history of prior lumbar surgery, or prior epidural steroid injection within the past 6 months are excluded. Participants are randomly assigned to receive either ESI with local anesthetic or the control intervention (epidural injections with local anesthetic alone). Subjects receive up to 2 injections prior to the primary endpoint at 6 weeks, at which time they may choose to crossover to the other intervention. Participants complete validated, standardized measures of pain, functional disability, and health-related quality of life at baseline and at 3 weeks, 6 weeks, and 3, 6, and 12 months after randomization. The primary outcomes are Roland-Morris Disability Questionnaire and a numerical rating scale measure of pain intensity at 6 weeks. In order to better understand their safety, we also measure cortisol, HbA1c, fasting blood glucose, weight, and blood pressure at baseline, and at 3 and 6 weeks post-injection. We also obtain data on resource utilization and costs to assess cost

  14. Long-Term Evaluation of Continuous Epidural Anesthesia in an Improved Canine Model

    PubMed Central

    Sasauchi, Kyoko; Sunada, Katsuhisa; Nakamura, Tatsuo

    2016-01-01

    Background Continuous epidural analgesia with catheterization is a useful technique, because it has a wide adaptation range and provides prolonged analgesia. Problems that may arise from long-term epidural analgesia are changes in the analgesic area, duration of analgesia and catheter-related problems. Few articles have evaluated gradual changes of long-term epidural analgesia. In the animal models used in those studies, the catheter was inserted by an invasive surgical procedure. In the present study, we evaluated changes in a canine model in which the catheter was inserted by a minimally invasive procedure. Objectives To evaluate long-term changes in the efficacy of epidural analgesia in an improved canine model in which the epidural catheter was inserted and fixed for 5 weeks using a minimally invasive procedure. Materials and Methods Six beagles underwent epidural catheterization under general anaesthesia. The catheter tip was located in the sixth lumbar region; the catheter peripheral end was passed subcutaneously through the neck. Physiological saline was continuously infused (1.0 mL/h) via the catheter throughout the study. The efficacy of epidural analgesia was assessed weekly with 2% lidocaine once a week in 5 weeks. Peripheral blood analysis including interleukin-6 (IL-6) level in the cerebrospinal fluid (CSF), histological evaluations and epidurography were performed to evaluate the mechanisms underlying the changes. Results No dog died and the catheters were kept in place. The efficacy of analgesia was well maintained until 4 weeks; at 5th week, the efficacy decreased by half. The spread of injected medium was not observed in the cranial direction at 5th week and the tip of catheter was capped with granulation tissue. Throughout the study period, white blood cell counts and C-reactive protein levels were slightly high for catheterization and the IL-6 level in CSF was below detectable limits. Conclusions This was the longest study period with continuous

  15. Skull infarction and epidural hematomas in a patient with sickle cell anemia.

    PubMed

    Resar, L M; Oliva, M M; Casella, J F

    1996-11-01

    Epidural hematomas are unusual manifestations of sickling disorders. We report a patient with sickle cell anemia and multiple skull infarctions associated with epidural hematomas. The association of skull infarctions and epidural hematomas in sickling hemoglobinopathies is reviewed. A 14-year-old boy with hemoglobin SS presented with lower back pain, left hip pain, headache, and fever. A bone scan was used to evaluate the patient for possible osteomyelitis. Head computed tomography (CT) and magnetic resonance imaging (MRI) were employed to delineate intracranial pathology. The bone scan showed multiple areas of decreased uptake in the skull consistent with acute infarction before abnormalities were present on physical examination. CT scan showed a bony contour deformity of the right frontal bone, suggestive of infarction. A right frontal extra-axial collection of blood was also observed below the bony abnormality. MRI further delineated bilateral frontal and left parietal collections adjacent to the bony abnormalities consistent with subacute epidural hematomas. This case emphasizes the need to recognize skull infarctions and epidural hematomas as rare but potential complications of sickle cell disease. The diagnosis was facilitated by MRI, which has not been used in previous cases of skull infarctions. Moreover, our patient was successfully managed without surgical intervention.

  16. Patching for corneal abrasion.

    PubMed

    Lim, Chris H L; Turner, Angus; Lim, Blanche X

    2016-07-26

    Published audits have demonstrated that corneal abrasions are a common presenting eye complaint. Eye patches are often recommended for treating corneal abrasions despite the lack of evidence for their use. This systematic review was conducted to determine the effects of the eye patch when used to treat corneal abrasions. The objective of this review was to assess the effects of patching for corneal abrasion on healing and pain relief. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to May 2016), EMBASE (January 1980 to May 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2016), System for Information on Grey Literature in Europe (OpenGrey) (January 1995 to May 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 9 May 2016. We also searched the reference lists of included studies, unpublished 'grey' literature and conference proceedings and contacted pharmaceutical companies for details of unpublished trials. We included randomised and quasi-randomised controlled trials that compared patching the eye with no patching to treat simple corneal abrasions. Two authors independently assessed the risk of bias and extracted data. Investigators were contacted for further information regarding the quality of trials. The primary outcome was healing at 24, 48 and 72 hours while secondary outcomes included measures of pain, quality of life and adverse effects. We graded the certainty of the evidence using GRADE. We included 12 trials which

  17. Spontaneous spinal epidural hematoma after abrupt sneezing with prompt recovery of severe paraparesis.

    PubMed

    Štětkářová, Ivana; Jelínková, Lenka; Janík, Vaclav; Peisker, Tomas

    2014-12-01

    Spontaneous spinal epidural hematoma (SSEH) is a rare neurologic condition with threatening consequences when spinal cord compression is present. The diagnosis must be performed quickly using magnetic resonance imaging (MRI), which shows collection of blood in the epidural space. With spinal cord compression, there is an indication for urgent surgical decompression. Here, we present a 64-year-old woman who developed sudden thoracic and lower back pain accompanied by severe paraparesis and urinary retention after sneezing abruptly. An MRI revealed a posterior thoracic epidural hematoma extending from the T6 to T11 vertebral level with spinal cord compression. Decompression was recommended, but the patient refused surgery, while neurologically improving with time. Complete neurologic recovery was observed within 24 hours after SSEH onset. A conservative therapeutic approach with careful observation may therefore be considered as a treatment of choice in some cases where surgery is refused, (due to high risk or other reasons) and neurologic recovery is early and sustained.

  18. Dorsal spinal epidural cavernous hemangioma.

    PubMed

    Sanghvi, Darshana; Munshi, Mihir; Kulkarni, Bijal; Kumar, Abhaya

    2010-07-01

    A 61-year-old female patient presented with diffuse pain in the dorsal region of the back of 3 months duration. The magnetic resonance imaging showed an extramedullary, extradural space occupative lesion on the right side of the spinal canal from D5 to D7 vertebral levels. The mass was well marginated and there was no bone involvement. Compression of the adjacent thecal sac was observed, with displacement to the left side. Radiological differential diagnosis included nerve sheath tumor and meningioma. The patient underwent D6 hemilaminectomy under general anesthesia. Intraoperatively, the tumor was purely extradural in location with mild extension into the right foramina. No attachment to the nerves or dura was found. Total excision of the extradural compressing mass was possible as there were preserved planes all around. Histopathology revealed cavernous hemangioma. As illustrated in our case, purely epidural hemangiomas, although uncommon, ought to be considered in the differential diagnosis of spinal epidural soft tissue masses. Findings that may help to differentiate this lesion from the ubiquitous disk prolapse, more common meningiomas and nerve sheath tumors are its ovoid shape, uniform T2 hyperintense signal and lack of anatomic connection with the neighboring intervertebral disk or the exiting nerve root. Entirely extradural lesions with no bone involvement are rare and represent about 12% of all intraspinal hemangiomas.

  19. Dorsal spinal epidural cavernous hemangioma

    PubMed Central

    Sanghvi, Darshana; Munshi, Mihir; Kulkarni, Bijal; Kumar, Abhaya

    2010-01-01

    A 61-year-old female patient presented with diffuse pain in the dorsal region of the back of 3 months duration. The magnetic resonance imaging showed an extramedullary, extradural space occupative lesion on the right side of the spinal canal from D5 to D7 vertebral levels. The mass was well marginated and there was no bone involvement. Compression of the adjacent thecal sac was observed, with displacement to the left side. Radiological differential diagnosis included nerve sheath tumor and meningioma. The patient underwent D6 hemilaminectomy under general anesthesia. Intraoperatively, the tumor was purely extradural in location with mild extension into the right foramina. No attachment to the nerves or dura was found. Total excision of the extradural compressing mass was possible as there were preserved planes all around. Histopathology revealed cavernous hemangioma. As illustrated in our case, purely epidural hemangiomas, although uncommon, ought to be considered in the differential diagnosis of spinal epidural soft tissue masses. Findings that may help to differentiate this lesion from the ubiquitous disk prolapse, more common meningiomas and nerve sheath tumors are its ovoid shape, uniform T2 hyperintense signal and lack of anatomic connection with the neighboring intervertebral disk or the exiting nerve root. Entirely extradural lesions with no bone involvement are rare and represent about 12% of all intraspinal hemangiomas. PMID:21572634

  20. [Epidural stimulation in arteritic patients].

    PubMed

    Herreros, J

    1989-10-01

    We are presenting the results of a multicenter retrospective study including 203 patients with arterial disease of the lower extremities, treated with epidural stimulation. The indications were: stage III or IV ischemia of the Leriche-Fontaine classification, arteriosclerosis or diabetic arteriopathy and untractable pain, or presence of necrosis as in Buerger's disease, Raynaud's phenomenon, frost-bite, Sudeck's disease and ergotamin poisoning. 47 p. cent of the patients had undergone a sympathectomy. The evolution was excellent in 47 p. cent of arteriosclerosis and/or diabetes cases, 100 p. cent of cases of Buerger's disease, 78 p. cent of cases of Raynaud's disease, and good in 33 p. cent of patients with arteriosclerosis and 12 p. cent of cases of Raynaud's disease. The plethysmography curves were improved and there was a statistically significant increase of the transcutaneous PO2 as well as of the isotopic results of muscular and cutaneous perfusion with 201TL and 125I antipyrin. These results demonstrate the capabilities of epidural stimulation in the treatment of arterial diseases of the extremities.

  1. Epidural analgesia improves postoperative nitrogen balance.

    PubMed Central

    Brandt, M R; Fernades, A; Mordhorst, R; Kehlet, H

    1978-01-01

    Postoperative nitrogen balance was monitored in twelve patients undergoing hysterectomy under either epidural analgesia or general anaesthesia. The mean cumulative five-day nitrogen losses were significantly lower after epidural analgesia than after general anaesthesia. Nitrogen sparing presumably results from inhibiting the stress-induced release of catabolic hormones, since epidural analgesia abolished postoperative hyperglycaemia and increase in plasma cortisol concentrations. No adverse effects of inhibiting the stress response were observed. Neurogenic stimuli thus play a crucial part in the catabolic response to surgery. Inhibiting the endocrine metabolic response to trauma by neurogenic blockade may reduce the morbidity precipitated in high-risk patients by the catabolic response to surgery. PMID:638618

  2. Bright Patches on Ariel

    NASA Image and Video Library

    1998-12-05

    Distinct bright patches are visible on Ariel, the brightest of Uranus five largest satellites. NASA Voyager 2 obtained this image Jan. 22, 1986, from a distance of 2.52 million kilometers 1.56 million miles.

  3. Gemini 6 patch

    NASA Image and Video Library

    1965-01-01

    The Gemini 6 patch is hexagonal in shape, reflecting the mission number; and the spacecraft trajectory also traces out the number "6". The Gemini 6 spacecraft is shown superimposed on the "twin stars" Castor and Pollux, for "Gemini".

  4. Lidocaine Transdermal Patch

    MedlinePlus

    Lidocaine patches are used to relieve the pain of post-herpetic neuralgia (PHN; the burning, stabbing pains, ... for months or years after a shingles infection). Lidocaine is in a class of medications called local ...

  5. Rotigotine Transdermal Patch

    MedlinePlus

    ... that causes difficulties with movement, muscle control, and balance) including shaking of parts of the body, stiffness, slowed movements, and problems with balance. Rotigotine transdermal patches are also used to treat ...

  6. FNAL system patching design

    SciTech Connect

    Schmidt, Jack; Lilianstrom, Al; Romero, Andy; Dawson, Troy; Sieh, Connie; /Fermilab

    2004-01-01

    FNAL has over 5000 PCs running either Linux or Windows software. Protecting these systems efficiently against the latest vulnerabilities that arise has prompted FNAL to take a more central approach to patching systems. Due to different levels of existing support infrastructures, the patching solution for linux systems differs from that of windows systems. In either case, systems are checked for vulnerabilities by Computer Security using the Nessus tool.

  7. Cervical Meningomyelitis After Lumbar Epidural Steroid Injection

    PubMed Central

    Kim, Joon-Sung; Kim, Ji Yeon

    2015-01-01

    Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement. PMID:26161360

  8. Incidence of epidural catheter-associated infections after continuous epidural analgesia in children.

    PubMed

    Sethna, Navil F; Clendenin, David; Athiraman, Umeshkumar; Solodiuk, Jean; Rodriguez, Diana P; Zurakowski, David

    2010-07-01

    Clinical observation suggests that the number of serious epidural catheter-associated infections have increased recently in children. This increase is likely attributed to an increase in reporting and in frequency of epidural analgesia usage. Estimates of infection rates are difficult to determine primarily because of insufficient study of large pediatric populations. In this retrospective study, the authors investigated the incidence of epidural catheter-associated soft tissue and epidural infections after use of continuous epidural analgesia spanning 17 yr. A total of 10,653 epidural catheters were used in 7,792 children. The majority of catheters, 10,437 (98%), were placed for the management of postoperative pain, and 216 (2%) were placed for the management of chronic pain. The authors identified 13 cases of infections (nine cellulitis, two paravertebral musculature infections, one epidural inflammation, and one epidural abscess) between 3 and 11 days after catheter insertion. The incidence of infection was significantly higher in patients treated for chronic pain (7 of 216 = 3.2%) compared with postoperative pain (6 of 10,437 = 0.06%; P < 0.0001). Surgical drainage of subcutaneous pus was performed in three patients, and medical therapy was administered in the remainder of patients; all patients recovered without sequelae. Although rare, epidural catheter-associated infections remain a serious concern in high-risk children who may benefit the most from epidural analgesia. The findings of the authors support the low rate of epidural infection previously reported despite growing concerns of serious infections in children. These findings highlight the importance of vigilance to early diagnostic indicators of infection and provide practitioners and families with incidence data to guide informed medical decision-making.

  9. Epidural Analgesia in the Postoperative Period

    DTIC Science & Technology

    2001-10-01

    an unwanted side effect of surgery, and is associated with many postoperative complications. This descriptive study was conducted to determine which...surgical patients experienced the most analgesia with the fewest side effects when receiving epidural analgesia in the postoperative period. A...hospital. A description of the patients age, gender, type of surgery, type of epidural medication, side effects , incidence of breakthrough pain, and

  10. Epidural steroid warning controversy still dogging FDA.

    PubMed

    Manchikanti, Laxmaiah; Candido, Kenneth D; Singh, Vijay; Gharibo, Christopher G; Boswell, Mark V; Benyamin, Ramsin M; Falco, Frank J E; Grider, Jay S; Diwan, Sudhir; Hirsch, Joshua A

    2014-01-01

    On April 23, 2014, the Food and Drug Administration (FDA) issued a letter of warning that injection of corticosteroids into the epidural space of the spine may result in rare, but serious adverse events, including "loss of vision, stroke, paralysis, and death." The advisory also advocated that patients should discuss the benefits and risks of epidural corticosteroid injections with their health care professionals, along with the benefits and risks associated with other possible treatments. In addition, the FDA stated that the effectiveness and safety of the corticosteroids for epidural use have not been established, and the FDA has not approved corticosteroids for such use. To raise awareness of the risks of epidural corticosteroid injections in the medical community, the FDA's Safe Use Initiative convened a panel of experts including pain management experts to help define the techniques for such injections with the aim of reducing preventable harm. The panel was unable to reach an agreement on 20 proposed items related to technical aspects of performing epidural injections. Subsequently, the FDA issued the above referenced warning and a notice that a panel will be convened in November 2014. This review assesses the inaccuracies of the warning and critically analyzes the available literature. The literature has been assessed in reference to alternate techniques and an understanding of the risk factors when performing transforaminal epidural injections in the cervical, thoracic, and lumbar regions, ultimately resulting in improved safety. The results of this review show the efficacy of epidural injections, with or without steroids, in a multitude of spinal ailments utilizing caudal, cervical, thoracic, and lumbar interlaminar approaches as well as lumbar transforaminal epidural injections . The evidence also shows the superiority of steroids in managing lumbar disc herniation utilizing caudal and lumbar interlaminar approaches without any significant difference as

  11. Spinal epidural abscess in brucellosis.

    PubMed

    Boyaci, Ahmet; Boyaci, Nurefsan; Tutoglu, Ahmet; Dokumaci, Dilek Sen

    2013-09-26

    Involvement of the skeletal system is a common complication of brucellosis. However, muscle involvement or paraspinal abscess formation are rare complications. Paraspinal abscess usually develops secondary to spondylitis. A case is reported here of a 33-year-old woman with symptoms of night sweats, fever and low back pain. Rose-Bengal test for brucellosis was positive and Brucella standard tube agglutination test was positive at a titre of 1/160. The diagnosis was made on MRI. The patient was treated with doxycycline and rifampin daily for 16 weeks. On day 14 of treatment, decline was observed in the patient's symptoms. In the presence of inflammatory lower back pain and fever, brucellosis should be considered particularly in the endemic areas. Furthermore, tuberculosis should be remembered in the differential diagnosis when a spinal epidural abscess is determined.

  12. Evaluation of a new training device to simulate the epidural and subarachnoid spaces for neuraxial anesthesia techniques.

    PubMed

    Capogna, G; Stirparo, S; Caniggia, S

    2013-04-01

    We are introducing a new epidural/spinal simulation unit to be used either as a part-task trainer to teach and learn regional anesthesia techniques or to be inserted in the manikin's back to allow reliable advanced simulation scenarios. The aim of this study was to determine if it may be a useful tool for training novice anesthesiologists in these procedures according to the evaluation performed by experienced anesthetists. Experienced anesthetists performed an epidural followed by a lumbar puncture procedure on the simulator model. Various aspects of both epidural and lumbar puncture insertions were scored for likeness to a real patient using a Likert scale. Experienced anesthetists found the simulator to be life-like for almost all the aspects of epidural or spinal insertion and that the overall impression was that the simulator could provide a useful tool for training of epidural and spinal techniques. Almost all the examiners appreciated that this device contained layers representing the anatomical boundaries of each compartment, and the module can be added blood or sponge to the epidural compartment or water to the spinal compartment to challenge the trainee with more difficult procedure such as inadvertent dural or vascular puncture or difficult catheter insertion. This device to be inserted in a full scale manikin may be a promising tool for training of neuraxial procedures. It could be also an essential component of more complex high fidelity scenarios when neuraxial anesthesia is one of the major learning goals.

  13. Extensive spinal epidural abscess treated with "apical laminectomies" and irrigation of the epidural space: report of 2 cases.

    PubMed

    Abd-El-Barr, Muhammad M; Bi, Wenya Linda; Bahluyen, Biji; Rodriguez, Samuel T; Groff, Michael W; Chi, John H

    2015-03-01

    Spinal epidural abscess (SEA) is a rare but often devastating infection of the epidural space around the spinal cord. When an SEA is widespread, extensive decompression with laminectomy is often impossible, as it may subject the patient to very long operative times, extensive blood loss, and mechanical instability. A technique called "skip laminectomy" has been described in the literature, in which laminectomies are performed at the rostral and caudal ends of an abscess that spans 3-5 levels and a Fogarty catheter is used to mechanically drain the abscess, much like in an embolectomy. In this report of 2 patients, the authors present a modification of this technique, which they call "apical laminectomies" to allow for irrigation and drainage of an extensive SEA spanning the entire length of the vertebral column (C1-2 to L5-S1). Two patients presented with cervico-thoraco-lumbar SEA. Laminectomies were performed at the natural apices of the spine, namely, at the midcervical, midthoracic, and midlumbar spine levels. Next, a pediatric feeding tube was inserted in the epidural space from the thoracic laminectomies up toward the cervical laminectomy site and down toward the lumbar laminectomy site, and saline antibiotics were used to irrigate the SEA. Both patients underwent this procedure with no adverse effects. Their SEAs resolved both clinically and radiologically. Neither patient suffered from mechanical instability at 1 year after treatment. For patients who present with extensive SEAs, apical laminectomies seem to allow for surgical cure of the infectious burden and do not subject the patient to extended operating room time, an increased risk of blood loss, and the risk of mechanical instability.

  14. Intermittent epidural TOP-UPS vs. patient control epidural analgesia during labor.

    PubMed

    Marijic, Vlatka; Bukovic, Damir; Mihaljevic, Slobodan; Oreskovic, Slavko; Persec, Jasminka; Zupic, Tomislav; Juras, Josip; Milinovic, Darko

    2013-12-01

    Pain during labor and delivery is often very unpleasant and stressful for the parturients. Patient controlled epidural analgesia (PCEA) has been found to be both safe and effective, providing optimal pain relief and allowing women to participate in their own analgesia). Compared to other epidural techniques, intermittent epidural top-ups and continuous epidural analgesia (CEA), PCEA uses diluted local anesthetic solutions with less motor block and less unscheduled clinician interventions. The purpose of our study was to compare intermittent bolus epidural top-ups and PCEA in labor. Sixty ASA I patients who requested epidural analgesia for labor and had written consent were included in the study. 30 patients in the first group received intermittent bolus epidural top-ups, while patients in the second group received PCEA. We evaluated duration of labor, maternal sense of pain using VAS scale and maternal satisfaction during fetal descent in both groups. We found that the duration of labor was significantly shorter and maternal sense of pain was lower in the PCEA group than in the group receiving epidural bolus top-ups. There were no differences between groups in maternal satisfaction during fetal descent.

  15. Blood

    MedlinePlus

    ... The liquid part, called plasma, is made of water, salts, and protein. Over half of your blood is plasma. The solid part of your blood contains red blood cells, white blood cells, and platelets. Red ...

  16. Symptomatic Spinal Epidural Lipomatosis After a Single Local Epidural Steroid Injection

    SciTech Connect

    Tok, Chung Hong Kaur, Shaleen; Gangi, Afshin

    2011-02-15

    Spinal epidural lipomatosis is a rare disorder that can manifest with progressive neurological deficits. It is characterized by abnormal accumulation of unencapsulated epidural fat commonly associated with the administration of exogenous steroids associated with a variety of systemic diseases, endocrinopathies, and Cushing syndrome (Fogel et al. Spine J 5:202-211, 2005). Occasionally, spinal epidural lipomatosis may occur in patients not exposed to steroids or in patients with endocrinopathies, primarily in obese individuals (Fogel et al. Spine J 5:202-211, 2005). However, spinal lumbar epidural lipomatosis resulting from local steroid injection has rarely been reported. We report the case of a 45-year-old diabetic man with claudication that was probably due to symptomatic lumbar spinal lipomatosis resulting from a single local epidural steroid injection.

  17. Sperm Patch-Clamp

    PubMed Central

    Lishko, Polina; Clapham, David E.; Navarro, Betsy; Kirichok, Yuriy

    2014-01-01

    Sperm intracellular pH and calcium concentration ([Ca2+]i) are two central factors that control sperm activity within the female reproductive tract. As such, the ion channels of the sperm plasma membrane that alter intracellular sperm [Ca2+] and pH play important roles in sperm physiology and the process of fertilization. Indeed, sperm ion channels regulate sperm motility, control sperm chemotaxis toward the egg in some species, and may trigger the acrosome reaction. Until recently, our understanding of these important molecules was rudimentary due to the inability to patch-clamp spermatozoa and directly record the activity of these ion channels under voltage clamp. Recently, we overcame this technical barrier and developed a method for reproducible application of the patch-clamp technique to mouse and human spermatozoa. This chapter covers important aspects of application of the patch-clamp technique to spermatozoa, such as selection of the electrophysiological equipment, isolation of spermatozoa for patch-clamp experiments, formation of the gigaohm seal with spermatozoa, and transition into the whole-cell mode of recording. We also discuss potential pitfalls in application of the patch-clamp technique to flagellar ion channels. PMID:23522465

  18. Pressure wall patch

    NASA Technical Reports Server (NTRS)

    Williamsen, Joel E. (Inventor); Weddendorf, Bruce C. (Inventor)

    1994-01-01

    A rigid patch body for placing over a damaged portion (hole) of an external wall of a pressurized vessel, such as a space vehicle or a habitat, is discussed. The rigid patch body allows an astronaut to make temporary repairs to the pressurized vessel from the exterior of the vessel, which enables more permanent repairs to be made from the interior of the vessel. The pressure wall patch of the present invention includes a floor surrounded by four side members. Each side member includes a threaded screw for anchoring the patch body to the external wall of the pressurized vessel and a recess in its lower surface for supporting an inflatable bladder for surrounding the damaged portion (hole) of the external wall to seal the area surrounding the damaged portion. This allows the vessel to be repressurized. The floor of the rigid patch body supports a source of gas that is connected to the gas supply valve and a gas supply gauge in communication with the gas supply valve and the inflatable bladder.

  19. Thoracic epidural analgesia reduces gastric microcirculation in the pig.

    PubMed

    Ambrus, Rikard; Strandby, Rune B; Secher, Niels H; Rünitz, Kim; Svendsen, Morten B S; Petersen, Lonnie G; Achiam, Michael P; Svendsen, Lars B

    2016-10-06

    Thoracic epidural analgesia (TEA) is used for pain relief during and after abdominal surgery, but the effect of TEA on the splanchnic microcirculation remains debated. We evaluated whether TEA affects splanchnic microcirculation in the pig. Splanchnic microcirculation was assessed in nine pigs prior to and 15 and 30 min after induction of TEA. Regional blood flow was assessed by neutron activated microspheres and changes in microcirculation by laser speckle contrast imaging (LSCI). As assessed by LSCI 15 min following TEA, gastric arteriolar flow decreased by 22 % at the antrum (p = 0.020) and by 19 % at the corpus (p = 0.029) of the stomach. In parallel, the microcirculation decreased by 19 % at the antrum (p = 0.015) and by 20 % at the corpus (p = 0.028). Reduced arteriolar flow and microcirculation at the antrum was confirmed by a reduction in microsphere assessed regional blood flow 30 min following induction of TEA (p = 0.048). These manifestations took place along with a drop in systolic blood pressure (p = 0.030), but with no significant change in mean arterial pressure, cardiac output, or heart rate. The results indicate that TEA may have an adverse effect on gastric arteriolar blood flow and microcirculation. LSCI is a non-touch technique and displays changes in blood flow in real-time and may be important for further evaluation of the concern regarding the effect of thoracic epidural anesthesia on gastric microcirculation in humans. Not applicable, non-human study.

  20. Incidence of intravascular penetration in transforaminal lumbosacral epidural steroid injections.

    PubMed

    Furman, M B; O'Brien, E M; Zgleszewski, T M

    2000-10-15

    A prospective, observational, human, in vivo study. To evaluate the incidence of vascular penetration during fluoroscopically guided, contrast-enhanced, transforaminal lumbar epidural steroid injections (ESIs) and determine whether a "flash" (blood in the needle hub) or aspiration of blood can be used to predict a vascular injection. Incorrectly placed, intravascular lumbosacral spinal injections result in systemic medication flow that misses the desired target. No previous studies evaluate the incidence of vascular injections in transforaminal ESIs, nor the ability of flash to predict a vascular injection. The incidence of flash or positive blood aspiration and the incidence of fluoroscopically confirmed vascular spread were prospectively observed in 670 patients treated with lumbosacral fluoroscopically guided transforaminal ESIs. Presence of a flash or positive aspiration was documented. Contrast was injected to determine whether the needle tip was intravascular. Seven hundred sixty-one transforaminal ESIs were included. The overall rate of intravascular injections was 11.2%. There was a statistically significant higher rate of intravascular injections (21.3%) noted with transforaminal ESIs performed at S1 (n = 178), compared with those at the lumbar levels (8.1%, n = 583). Using flash or positive blood aspirate to predict intravascular injections was 97.9% specific, but only 44.7% sensitive. There is a high incidence of intravascular injections in transforaminal ESIs that is significantly increased at S1. Using a flash or blood aspiration to predict an intravascular injection is not sensitive, and therefore a negative flash or aspiration is not reliable. Fluoroscopically guided procedures without contrast confirmation are instilling medications intravascularly and therefore not into the desired epidural location. This finding confirms the need for not only fluoroscopic guidance but also contrast injection instillation in lumbosacral transforaminal ESIs.

  1. Effect of early versus conventional epidural analgesia during labor on cytokine production.

    PubMed

    Orbach-Zinger, Sharon; Bessler, Hanna; Arnovetzky, Rosana; Levin, Yivgenia; Sulkes, Jaqueline; Bardin, Ron; Peleg, Dan; Eidelman, Leonid

    2012-03-01

    To compare the effect of early epidural analgesia (EEA) vs. conventional epidural analgesia (CEA) on cytokine production in mother and neonate. Healthy parturients with uncomplicated term pregnancies were randomized into two groups: EEA - parturients who would receive epidural analgesia before onset of pain and the control group, CEA - parturients who would receive epidural analgesia after onset of pain. Cytokines were measured in maternal blood at randomization Visual Analog Scale (VAS) < 30], 24 h postpartum, and in cord blood. Forty-one women were studied. Epidural was performed in EEA when VAS was 23 ± 10 and in CEA when VAS was77 ± 10 (p < 0.0001). Background data were similar except for ruptured membranes at admission (EEA 15%, CEA 46.6%; p = 0.03), transient hypotension (EEA 20%, CEA 0%; p = 0.03), and meconium (EEA 25%, CEA 0%; p = 0.01). No significant differences were found in cytokine levels between groups at any time. Interleukin (IL)-6 levels changed significantly only in the control group (p = 0.046). There was significant correlation between baseline maternal IL-6 level and cord blood level in CEA (r = 0.59, p = 0.005), while no significant correlation existed in EEA (r = 0.33, p = 0.16). Although there was no significant difference in cytokine levels between the groups, EEA prevented the significant increase in IL-6 during labor and interrupted IL-6 fetal-maternal dependency.

  2. Results of patch tests

    SciTech Connect

    Pontius, D.H.

    1994-10-01

    The objectives of this work were to construct, install, and operate a patch testing unit on a hot gas stream at a coal-fired fluidized-bed boiler. A 2,000-hour patch test was conducted on ceramic disks of materials used in the fabrication of ceramic candles and ceramic cross-flow filters. The primary issues addressed in these tests were the long-term physical, thermal, and chemical stability of the ceramic materials; long-term pressure drop and filtration characteristics of the ceramic filters; potential for irreversible blinding of filter elements; and long-term performance and reliability of auxiliary hardware, such as the tube sheet and pulse-cleaning systems. Results on three samples, or patches, 10 cm in diameter are given.

  3. Idiopathic Spinal Epidural Lipomatosis in the Lumbar Spine.

    PubMed

    Al-Omari, Ali A; Phukan, Rishabh D; Leonard, Dana A; Herzog, Tyler L; Wood, Kirkham B; Bono, Christopher M

    2016-05-01

    Overgrowth of epidural fat, known as spinal epidural lipomatosis (SEL), can cause symptomatic compression of the spinal cord, conus medullaris, or cauda equina. Suggested predisposing factors such as obesity, steroid use, and diabetes mellitus have been based on a few reported cases, many of which were not surgically confirmed. There is a paucity of epidemiological data in surgically confirmed cases for this disorder. The purpose of this independently reviewed, retrospective, matched cohort analysis was to compare the demographics and incidence of comorbidities of patients who underwent lumbar decompression for SEL vs degenerative stenosis without SEL. Two surgeons' databases were reviewed to identify patients older than 18 years who underwent decompression surgery for magnetic resonance imaging-verified, symptomatic lumbar SEL. A matched control group comprised an equal number of patients with degenerative stenosis (n=14). Demographic data, body mass index, symptom type/duration, comorbidities, complications, treatment history, and associated pathology were collected from medical records. Previously suggested risk factors, such as obesity, endocrinopathy, and epidural steroid injections, were not significantly different between the SEL and control groups. Furthermore, there were no differences in operative times, complications, or blood loss. The only noted difference between the 2 groups was the preoperative duration of symptoms, on average double in patients with SEL. This series represents the largest of its kind reported to date. Because symptom duration was the only difference noted, it is postulated to be the result of lack of awareness of SEL. Future prospective study in a larger group of patients is warranted. [Orthopedics. 2016; 39(3):163-168.].

  4. Comparison of the effects of lidocaine and fentanyl in epidural anesthesia in dogs.

    PubMed

    Saritas, Z K; Saritas, T B; Pamuk, K; Korkmaz, M; Demirkan, I; Yaprakci, M V; Sivaci, R G

    2014-01-01

    The study included 12 clinically healthy, adult male dogs of various breeds, admitted to our clinic for castration. After general anesthesia with sevoflurane, we administered epidural fentanyl (1 mcg/kg) to fentanyl group, while lidocaine group was given Lidocaine (3 mg/kg) through epidural administration. When hemodynamic parameters were stabilized, first measurements were recorded at minutes 0, 15, 30, 60 in both groups, which included Heart Rate (HR), body temperature, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), sodium (Na+), potassium (K+), glucose (GLC), and hemoglobin (HB) measurements. In addition, serum samples were obtained from arterial blood at the same measurement times, and pH, pO₂, pCO₂, HCO₃, %O₂ Saturation, BE levels were measured. For hematological analysis, WBC, RBC, HCT, THR counts were performed. For serum biochemical analysis, venous blood samples were collected at minutes 0 and 60 and CK, TP, UREA, ALT, AST, ALB, GGT, CRE, CK-MB parameters were assessed using auto-analyzer. Moreover, cortisol levels were measured in the samples collected at minutes 0, 30, and 60.Mean arterial blood pressure values measured at minutes 15, 30 and 60 were found significantly lower in the fentanyl group (p<0.01). In conclusion, we suggest that epidural anesthesia with lidocaine and fentanyl can provide an effective and safe option in high-risk groups (Tab. 5, Fig. 1, Ref. 24).

  5. Pneumococcal Vertebral Osteomyelitis after Epidural Injection: A Rare Event

    PubMed Central

    Johnson, Tamara M; Chitturi, Chandrika; Lange, Michael; Suh, Jin S; Slim, Jihad

    2016-01-01

    Streptococcus pneumoniae vertebral infections have rarely been reported. Herein, we report a case of pneumococcal vertebral osteomyelitis with paraspinal and epidural abscesses as well as concomitant bacteremia following epidural injection. This will be the second case in the literature reporting pneumococcal vertebral osteomyelitis related to epidural manipulation. PMID:27621563

  6. Difficulty in the removal of epidural catheter for labor analgesia.

    PubMed

    Hajnour, Mohamed S; Khokhar, Rashid Saeed; Ejaz, Abdul Aziz Ahmed; Al Zahrani, Tariq; Kanchi, Naveed Uddin

    2017-01-01

    For labor pain management epidural analgesia is a popular and an effective method. Difficult removal of epidural catheters occasionally occurs, and several maneuvers have been recommended. The purpose of this article is to raise awareness of the problem of retained epidural catheter fragments and identify the potential impact of complications.

  7. Difficulty in the removal of epidural catheter for labor analgesia

    PubMed Central

    Hajnour, Mohamed S.; Khokhar, Rashid Saeed; Ejaz, Abdul Aziz Ahmed; Al Zahrani, Tariq; Kanchi, Naveed Uddin

    2017-01-01

    For labor pain management epidural analgesia is a popular and an effective method. Difficult removal of epidural catheters occasionally occurs, and several maneuvers have been recommended. The purpose of this article is to raise awareness of the problem of retained epidural catheter fragments and identify the potential impact of complications. PMID:28217071

  8. Epidural cortical stimulation and aphasia therapy

    PubMed Central

    Cherney, Leora R.; Harvey, Richard L.; Babbitt, Edna M.; Hurwitz, Rosalind; Kaye, Rosalind C.; Lee, Jaime B.; Small, Steven. L.

    2013-01-01

    Background There are several methods of delivering cortical brain stimulation to modulate cortical excitability and interest in their application as an adjuvant strategy in aphasia rehabilitation after stroke is growing. Epidural cortical stimulation, although more invasive than other methods, permits high frequency stimulation of high spatial specificity to targeted neuronal populations. Aims First, we review evidence supporting the use of epidural cortical stimulation for upper limb recovery after focal cortical injury in both animal models and human stroke survivors. These data provide the empirical and theoretical platform underlying the use of epidural cortical stimulation in aphasia. Second, we summarize evidence for the application of epidural cortical stimulation in aphasia. We describe the procedures and primary outcomes of a safety and feasibility study (Cherney, Erickson & Small, 2010), and provide previously unpublished data regarding secondary behavioral outcomes from that study. Main Contribution In a controlled study comparing epidural cortical stimulation plus language treatment (CS/LT) to language treatment alone (LT), eight stroke survivors with nonfluent aphasia received intensive language therapy for 6 weeks. Four of these participants also underwent surgical implantation of an epidural stimulation device which was activated only during therapy sessions. Behavioral data were collected before treatment, immediately after treatment, and at 6 and 12 weeks following the end of treatment. The effect size for the primary outcome measure, the Western Aphasia Battery Aphasia Quotient, was benchmarked as moderate from baseline to immediately post-treatment, and large from baseline to the 12-week follow-up. Similarly, effect sizes obtained at the 12-week follow-up for the Boston Naming Test, the Communicative Effectiveness Index, and for correct information units on a picture description task were greater than those obtained immediately post treatment

  9. Foetal heart rate deceleration with combined spinal-epidural analgesia during labour: a maternal haemodynamic cardiac study.

    PubMed

    Valensise, Herbert; Lo Presti, Damiano; Tiralongo, Grazia Maria; Pisani, Ilaria; Gagliardi, Giulia; Vasapollo, Barbara; Frigo, Maria Grazia

    2016-01-01

    To understand the mechanisms those are involved in the appearance of foetal heart rate decelerations (FHR) after the combined epidural analgesia in labour. Observational study done at University Hospital for 86-term singleton pregnant women with spontaneous labour. Serial bedside measurement of the main cardiac maternal parameters with USCOM technique; stroke volume (SV), heart rate (HR), cardiac output (CO) and total vascular resistances (TVR) inputting systolic and diastolic blood pressure before combined epidural analgesia and after 5', 10', 15' and 20 min. FHR was continuously recorded though cardiotocography before and after the procedure. Correlation between the appearance of foetal heart rate decelerations and the modification of maternal haemodynamic parameters. Fourteen out of 86 foetuses showed decelerations after the combined spino epidural procedure. No decelerations occurred in the women with low TVR (<1000 dyne/s/cm(-5)) at the basal evaluation. FHR abnormalities were concentrated in 39 women who presented elevated TVR values at the basal evaluation (>1200 dyne/s/cm(-5)). Soon after the epidural procedure, the absence of increase in SV and CO was observed in these women. No variations in systolic and diastolic blood pressure values were found. The level of TVR before combined epidural analgesia in labour may indicate the risk of FHR abnormalities after the procedure. Low TVR (<1000 dyne/s/cm(-5)) showed a reduced risk of FHR abnormalities. FHR decelerations seem to occur in women without the ability to upregulate SV and CO in response to the initial effects of analgesia.

  10. Image inpainting by patch propagation using patch sparsity.

    PubMed

    Xu, Zongben; Sun, Jian

    2010-05-01

    This paper introduces a novel examplar-based inpainting algorithm through investigating the sparsity of natural image patches. Two novel concepts of sparsity at the patch level are proposed for modeling the patch priority and patch representation, which are two crucial steps for patch propagation in the examplar-based inpainting approach. First, patch structure sparsity is designed to measure the confidence of a patch located at the image structure (e.g., the edge or corner) by the sparseness of its nonzero similarities to the neighboring patches. The patch with larger structure sparsity will be assigned higher priority for further inpainting. Second, it is assumed that the patch to be filled can be represented by the sparse linear combination of candidate patches under the local patch consistency constraint in a framework of sparse representation. Compared with the traditional examplar-based inpainting approach, structure sparsity enables better discrimination of structure and texture, and the patch sparse representation forces the newly inpainted regions to be sharp and consistent with the surrounding textures. Experiments on synthetic and natural images show the advantages of the proposed approach.

  11. Unusual Spinal Epidural Lipomatosis and Lumbosacral Instability

    PubMed Central

    Ruiz Picazo, David; Ramírez Villaescusa, José

    2016-01-01

    Introduction. Epidural lipomatosis is most frequently observed in patients on chronic steroid treatment. Only a few idiopathic epidural lipomatosis cases have been described. Material and Methods. 64-year-old male patient presented with low back pain and left leg pain. Later, the patient experienced neurogenic claudication and radicular pain in the left leg without urinary dysfunction. Plain radiography and magnetic resonance imaging demonstrated an abnormal fat tissue overgrowth in the epidural space with compression of the dural sac, degenerative disc disease at L4-L5 level, and instability at L5-S1. Endocrinopathic diseases and chronic steroid therapy were excluded. If conservative treatment failed, surgical treatment can be indicated. Results. After surgery, there was a gradual improvement in symptoms and signs, and six months later the patient returned to daily activities and was neurologically normal. Conclusion. In the absence of common causes of neurogenic claudication, epidural lipomatosis should be considered. The standard test for the diagnosis of epidural lipomatosis is magnetic resonance (MR). At first, conservative treatment must be considered; weight loss and the suspension of prior corticosteroid therapy are indicated. In the presence of neurological impairment, the operative treatment of wide surgical decompression must be performed soon after diagnosis. PMID:27069704

  12. Selegiline Transdermal Patch

    MedlinePlus

    ... you can use baby oil or a medical adhesive removal pad to remove residue that will not come off with soap and water. Do not use alcohol, nail polish remover, or other solvents. Apply a new patch to a different area immediately by following steps 1 to 6.

  13. Oxybutynin Transdermal Patch

    MedlinePlus

    ... you can use baby oil or a medical adhesive removal pad to remove residue that will not come off with soap and water. Do not use alcohol, nail polish remover, or other solvents. Apply a new patch to a different area immediately by following steps 1–5.

  14. Nitroglycerin Transdermal Patch

    MedlinePlus

    ... press down on its center to lift the edges away from the skin. Hold the edge gently and slowly peel the patch away from ... your medications or monitor you carefully for side effects.tell your doctor if you think you may ...

  15. Measles vaccination using a microneedle patch.

    PubMed

    Edens, Chris; Collins, Marcus L; Ayers, Jessica; Rota, Paul A; Prausnitz, Mark R

    2013-07-25

    Measles vaccination programs would benefit from delivery methods that decrease cost, simplify logistics, and increase safety. Conventional subcutaneous injection is limited by the need for skilled healthcare professionals to reconstitute and administer injections, and by the need for safe needle handling and disposal to reduce the risk of disease transmission through needle re-use and needlestick injury. Microneedles are micron-scale, solid needles coated with a dry formulation of vaccine that dissolves in the skin within minutes after patch application. By avoiding the use of hypodermic needles, vaccination using a microneedle patch could be carried out by minimally trained personnel with reduced risk of blood-borne disease transmission. The goal of this study was to evaluate measles vaccination using a microneedle patch to address some of the limitations of subcutaneous injection. Viability of vaccine virus dried onto a microneedle patch was stabilized by incorporation of the sugar, trehalose, and loss of viral titer was less than 1 log10(TCID50) after storage for at least 30 days at room temperature. Microneedle patches were then used to immunize cotton rats with the Edmonston-Zagreb measles vaccine strain. Vaccination using microneedles at doses equaling the standard human dose or one-fifth the human dose generated neutralizing antibody levels equivalent to those of a subcutaneous immunization at the same dose. These results show that measles vaccine can be stabilized on microneedles and that vaccine efficiently reconstitutes in vivo to generate a neutralizing antibody response equivalent to that generated by subcutaneous injection.

  16. Blood

    MedlinePlus

    ... that die or are lost from the body. White Blood Cells White blood cells (WBCs, and also ... of severe pain. previous continue Diseases of the White Blood Cells Neutropenia (pronounced: new-truh-PEE-nee- ...

  17. Patch choice under predation hazard.

    PubMed

    Krivan, V; Vrkoc, I

    2000-12-01

    In this paper we study optimal animal movement in heterogeneous environments consisting of several food patches in which animals trade-off energy gain versus predation risk. We derive a myopic optimization rule describing optimal animal movements by fitness maximization assuming an animal state is described by a single quantity (such as weight, size, or energy reserves). This rule predicts a critical state at which an animal should switch from a more dangerous and more profitable patch to a less dangerous and less profitable patch. Qualitatively, there are two types of behavior: either the animal switches from one patch to another and stays in the new patch for some time before it switches again, or the animal switches between two patches instantaneously. The former case happens if animal state growth is positive in all patches, while the latter case happens if animal state growth is negative in one patch. In particular, this happens if one patch is a refuge. We consider in detail two special cases. The first one assumes a linear animal state growth while the second assumes a saturating animal state growth described by the von Bertalanffy curve. For the first model the proportion of time spent in the more profitable and more risky patch increases with profitability of this patch when state growth is positive in both patches. On contrary, if state growth is negative in the less profitable and safer patch, animals spend proportionally less time in the more profitable and more risky patch as its profitability increases. As a function of the predation risk in the more profitable patch the time spent there proportionally decreases. When animal state growth is described by the saturating curve, time spent in the more risky patch is a hump-shaped curve if state growth is positive in both patches. Our results extend the mu/f rule, which predicts that animals should behave in such a way as to minimize mortality risk to resource intake ratio.

  18. Lumbar Epidural Varix Mimicking Disc Herniation

    PubMed Central

    Bursalı, Adem; Guvenal, Ahmet Burak; Yaman, Onur

    2016-01-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4–5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  19. Sciatica caused by lumbar epidural gas.

    PubMed

    Belfquih, Hatim; El Mostarchid, Brahim; Akhaddar, Ali; gazzaz, Miloudi; Boucetta, Mohammed

    2014-01-01

    Gas production as a part of disc degeneration can occur but rarely causes nerve compression syndromes. The clinical features are similar to those of common sciatica. CT is very useful in the detection of epidural gas accumulation and nerve root compression. We report a case of symptomatic epidural gas accumulation originating from vacuum phenomenon in the intervertebral disc, causing lumbo-sacral radiculopathy. A 45-year-old woman suffered from sciatica for 9 months. The condition worsened in recent days. Computed tomography (CT) demonstrated intradiscal vacuum phenomenon, and accumulation of gas in the lumbar epidural space compressing the dural sac and S1 nerve root. After evacuation of the gas, her pain resolved without recurrence.

  20. Experience with symptomatic spinal epidural cysts.

    PubMed

    Freidberg, S R; Fellows, T; Thomas, C B; Mancall, A C

    1994-06-01

    Epidural cysts, either synovial or ganglion, are an unusual cause of epidural compressive syndromes. We report a series of 26 patients with cysts, including 1 cervical, 2 thoracic, and 23 lumbar. Complaints at the time of admission and findings were similar to those associated with other epidural lesions at the same locations. The surgical technique is similar to that for other spinal lesions, with a wide exposure to enable a clear view of the cyst and surrounding structures, and is governed by imaging studies. Patients with cervical and thoracic lumbar cysts were free of symptoms and signs postoperatively. Of the 23 patients with lumbar cysts, 15 were free of symptoms after an operation, 7 had symptomatic improvement but had some pain and neurological findings, and 1 patient had no improvement. Computed tomography and magnetic resonance imaging permit accurate preoperative evaluation.

  1. Spontaneous epidural hematoma due to cervico-thoracic angiolipoma.

    PubMed

    Eap, C; Bannwarth, M; Jazeron, J-F; Kleber, J-C; Theret, É; Duntze, J; Litre, C-F

    2015-12-01

    Epidural angiolipomas are uncommon benign tumors of the spine. Their clinical presentation is usually a progressive spinal cord compression. We report the case of a 22-year-old patient who presented with an acute paraparesis and a spontaneous epidural hematoma, which revealed a epidural angiolipoma which extended from C7 to T3. The patient underwent a C7-T3 laminectomy, in emergency, with evacuation of the hematoma and extradural complete resection of a fibrous epidural tumor bleeding. The postoperative course was favorable with regression of neurological symptoms. Epidural angiolipomas can be revealed by spontaneous intratumoral hemorrhage without traumatism. The standard treatment is total removal by surgery.

  2. [Effect of epidural analgesia on the duration of labor stages and delivery outcome].

    PubMed

    Zhang, Guanglan; Feng, Yan

    2012-08-01

    To assess the effect of epidural analgesia on the duration of labor stages and the delivery outcome. This prospective study was conducted in 328 nulliparous term parturients presenting for delivery in December 1 to 31, 2011. The parturients were assigned into epidural analgesia group (n=162) and control group (n=166) according to their request when no contraindications were present. The stage I, stage II, and total duration of labor, volume blood loss, oxytocin use, delivery mode, and neonatal outcomes were compared between the two groups. In epidural analgesia group, the duration of stage I and stage II labor and the total duration of labor was 497.9∓168.4 min, 54.3∓43.8 min, and 522.1∓178.9 min, respectively, significantly longer than those in the control group (404.2∓156.0 min, 31.5∓19.8 min, and 435.8∓159.2 min, respectively, P≤0.05). No significant difference was found between the two groups in the rates of oxytocin use, emergency cesarean section, instrumental delivery, meconium-stained amniotic fluid, and low Apgar scores (P≥0.05). Epidural analgesia prolongs the labor duration, especially the second stage of labor, but it does not increase the incidences of emergency cesarean section or instrumental delivery or cause adverse effect on the neonatal outcome, and is therefore safe for pain relief in labor.

  3. Pharmacokinetics of lidocaine delivered from a transmucosal patch in children.

    PubMed Central

    Leopold, Andrea; Wilson, Stephen; Weaver, Joel S.; Moursi, Amr M.

    2002-01-01

    The DentiPatch lidocaine transoral delivery system (Noven Pharmaceuticals) is indicated for mild topical anesthesia of mucosal membranes in the mouth. The DentiPatch is a mucoadhesive patch containing 46.1 mg of lidocaine (20% concentration). Current studies in adults report that DentiPatch application produces very low plasma concentrations of lidocaine. However, it is not known what plasma levels are obtained when the same dosage is used in children. The purpose of this study was to determine whether the plasma lidocaine concentrations generated by the DentiPatch are within a safe range for children. The sample in this study was 11 children aged 2-7 years requiring general anesthesia for comprehensive dental care. A lidocaine DentiPatch was placed on the buccal mucosa above the maxillary incisors for 5 minutes. Blood samples were drawn before placing the DentiPatch and at various time intervals after removing it. Blood samples were analyzed by fluorescence polarization immunoassay to determine the plasma concentrations of lidocaine and its major metabolite, monoethylglycinexylidide. The lidocaine and monoethylglycinexylidide absorbed from the DentiPatch did not reach toxic plasma levels in children. However, plasma concentrations were much higher than in adults and were high enough to require inclusion in the calculation of total lidocaine administered to a pediatric patient. Images Figure 1 PMID:15384296

  4. Rapidly Progressive Spontaneous Spinal Epidural Abscess.

    PubMed

    Aycan, Abdurrahman; Aktas, Ozgür Yusuf; Guzey, Feyza Karagoz; Tufan, Azmi; Isler, Cihan; Aycan, Nur; Gulsen, İsmail; Arslan, Harun

    2016-01-01

    Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

  5. Rapidly Progressive Spontaneous Spinal Epidural Abscess

    PubMed Central

    Aktas, Ozgür Yusuf; Guzey, Feyza Karagoz; Tufan, Azmi; Isler, Cihan; Aycan, Nur; Gulsen, İsmail

    2016-01-01

    Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation. PMID:27688918

  6. Epidural analgesia for labor: Current techniques

    PubMed Central

    Silva, Marcos; Halpern, Stephen H

    2010-01-01

    Epidural analgesia is an extremely effective and popular treatment for labor pain. In this review, we trace the history of the use of epidural analgesia and its refinements. We then outline the goals of treatment and methods used to attain those goals. The use of low concentrations of local anesthetics, combined with lipid-soluble opioids, does not impede the progress of labor or depress the newborn. The incidence of side effects is low. Maintenance of analgesia that allows patient control enhances patient satisfaction. PMID:23144567

  7. Obstetric epidurals and chronic adhesive arachnoiditis.

    PubMed

    Rice, I; Wee, M Y K; Thomson, K

    2004-01-01

    It has been suggested that obstetric epidurals lead to chronic adhesive arachnoiditis (CAA). CAA is a nebulous disease entity with much confusion over its symptomatology. This review outlines the pathological, clinical, and radiological features of the disease. The proposed diagnostic criteria for CAA are: back pain that increases on exertion, with or without leg pain; neurological abnormality on examination; and characteristic MRI findings. Using these criteria, there is evidence to show that epidural or subarachnoid placement of some contrast media, preservatives and possibly vasoconstrictors, may lead to CAA. No evidence was found that the preservative-free, low concentration bupivacaine with opioid mixtures or plain bupivacaine currently used in labour lead to CAA.

  8. [Characteristics and distribution of normal human epidural fat].

    PubMed

    Reina, M A; Pulido, P; Castedo, J; Villanueva, M C; López, A; Sola, R G

    2006-01-01

    Epidural fat provides sufficient cushion for the pulsatile movements of the dural sac, protects nerve structures, facilitates the movement of the dural sac over the periosteum of the spinal column during flexion and extension, and forms a pharmacologic reservoir of lipophilic substances. We review epidural fat and related structures, including their development during the fetal period when the epidural space is filled by undifferentiated loose, areolar mesenchymal tissue that surrounds the dural sac. In the adult, epidural fat has a continuous distribution and follows a certain metameric pattern. It is located mainly on the dorsal side of the epidural space, where it is organized in triangular capsules joined to the midline of the ligamentum flavum by a vascular pedicle. We consider the distribution of epidural fat in the axial and sagittal planes; its presence in the anterior, lateral and posterior epidural space; its presence in the cervical, thoracic and lumbar portions of the spinal column; and its characteristics and variations according to differing body habits and sex. Finally, we speculate on the possible anesthetic implications of epidural fat in terms of the pharmacokinetics of drugs injected into the epidural space and the tasks of locating the epidural space and inserting an epidural catheter during anesthetic procedures.

  9. Solitary spinal epidural cavernous haemangiomas as a rare cause of myelopathy.

    PubMed

    Meng, Ying; Shamji, Mohammed F

    2015-09-25

    Cavernous haemangiomas rarely occur in the spinal epidural space. We report the case of a 27-year-old man who presented with myelopathy secondary to spinal cord compression from a purely epidural lesion. The imaging characteristics of cavernous haemangiomas are unique, reflecting a highly vascular lesion. Key differentiating features from intracranial or intramedullary lesions include the lack of a surrounding hemosiderin ring and popcorn appearance. An urgent referral to a neurosurgeon is recommended given the possibility of acute neurological deterioration from intralesional haemorrhage, and good recovery from early surgical resection. Preoperative planning with thorough patient counselling and availability of matched blood is important, and an en bloc resection approach should be taken to minimise blood loss. In this case, the patient experienced complete recovery after surgical resection. No recurrence after complete resection has been reported in the literature. This suggests a good long-term outcome for the patient and that no early adjuvant therapy is necessary.

  10. Prediction by computerised tomography of distance from skin to epidural space during thoracic epidural insertion.

    PubMed

    Carnie, J; Boden, J; Gao Smith, F

    2002-07-01

    In this single group observational study on 29 patients, we describe a technique that predicts the depth of the epidural space, calculated from the routine pre-operative chest computerised tomography (CT) scan using Pythagorean triangle trigonometry. We also compared the CT-derived depth of the epidural space with the actual depth of needle insertion. The CT-derived and the actual depths of the epidural space were highly correlated (r = 0.88, R2 = 0.78, p < 0.0001). The mean (95% CI) difference between CT-derived and actual depths was 0.26 (0.03-0.49) cm. Thus, the CT-derived depth tends to be greater than the actual depth by between 0.03 and 0.49 cm. There were no associations between either the CT-derived or the actual depth of the epidural space and age, weight, height or body mass index.

  11. Spin Glass Patch Planting

    NASA Technical Reports Server (NTRS)

    Wang, Wenlong; Mandra, Salvatore; Katzgraber, Helmut G.

    2016-01-01

    In this paper, we propose a patch planting method for creating arbitrarily large spin glass instances with known ground states. The scaling of the computational complexity of these instances with various block numbers and sizes is investigated and compared with random instances using population annealing Monte Carlo and the quantum annealing DW2X machine. The method can be useful for benchmarking tests for future generation quantum annealing machines, classical and quantum mechanical optimization algorithms.

  12. Polymer concrete patching manual

    NASA Astrophysics Data System (ADS)

    Fontana, J. J.; Bartholomew, J.

    1982-06-01

    The practicality of using polymer concrete to repair deteriorated portland cement concrete bridge decks and pavements was demonstrated. This manual outlines the procedures for using polymer concrete as a rapid patching material to repair deteriorated concrete. The process technology, materials, equipment, and safety provisions used in manufacturing and placing polymer concrete are discussed. Potential users are informed of the various steps necessary to insure successful field applications of the material.

  13. exp 19 patch-1

    NASA Image and Video Library

    2008-12-03

    ISS019-S-001 (December 2008) --- Expedition 19 marks the final planned period of three person occupancy, prior to increasing the crew size to 6, and occurs in the final stages of International Space Station assembly. The patch emphasizes the earth, one of the major focuses of attention and study from the orbital research outpost. The design is stylized to highlight the beauty of the home planet and the station orbiting it, next to the sun now the unquestioned

  14. exp 19 patch-1

    NASA Image and Video Library

    2009-12-29

    ISS019-S-001A (December 2008) --- Expedition 19 marks the final planned period of three person occupancy, prior to increasing the crew size to 6, and occurs in the final stages of International Space Station assembly. The patch emphasizes the earth, one of the major focuses of attention and study from the orbital research outpost. The design is stylized to highlight the beauty of the home planet and the station orbiting it, next to the sun now the unquestioned

  15. Research and analysis of patch shape on microstrip patch antenna

    NASA Astrophysics Data System (ADS)

    Ji, Ai-guo; Wang, Peng

    2017-01-01

    The shape of the radiating patch in the microstrip patch antenna is one of the many factors that affect the performance of the microstrip antenna.In this paper, on the premise of center frequency of 2.45 GHz, rectangular, circular and triangular microstrip patch antennas are designed and simulated respectively.The simulation results of the three microstrip patch antenna are analyzed, such as feed point position, return loss and radiation patterns.The influence of the shape of the radiation patch on the impedance bandwidth, gain and directivity of microstrip antennas is discussed.The simulation results show that the comprehensive performance of rectangular microstrip patch antenna is better than the other two, the comprehensive performance of triangular microstrip patch antenna is poor.

  16. Global Patch Matching

    NASA Astrophysics Data System (ADS)

    Huang, X.; Hu, K.; Ling, X.; Zhang, Y.; Lu, Z.; Zhou, G.

    2017-09-01

    This paper introduces a novel global patch matching method that focuses on how to remove fronto-parallel bias and obtain continuous smooth surfaces with assuming that the scenes covered by stereos are piecewise continuous. Firstly, simple linear iterative cluster method (SLIC) is used to segment the base image into a series of patches. Then, a global energy function, which consists of a data term and a smoothness term, is built on the patches. The data term is the second-order Taylor expansion of correlation coefficients, and the smoothness term is built by combing connectivity constraints and the coplanarity constraints are combined to construct the smoothness term. Finally, the global energy function can be built by combining the data term and the smoothness term. We rewrite the global energy function in a quadratic matrix function, and use least square methods to obtain the optimal solution. Experiments on Adirondack stereo and Motorcycle stereo of Middlebury benchmark show that the proposed method can remove fronto-parallel bias effectively, and produce continuous smooth surfaces.

  17. Biocide patch tests.

    PubMed

    Andersen, K E; Veien, N K

    1985-02-01

    Routine patch testing with a series of 6 industrial biocides containing methylene-bis-thiocyanate (Cytox 3522), benzisothiazolin-3-one (BIT), chlorocresol (Preventol CMK), 2-n-octyl-4-isothiazolin-3-one (Kathon 893), polyhydroxymethylene monobenzylether (Preventol D2) or 1,3,5-tris (hydroxy-ethyl) hexahydrotriazine (Grotan BK) was carried out in 6 Danish out-patient clinics to evaluate guinea pig allergy test results with the same compounds. A total of 1652 consecutive patients with dermatitis were tested. The usefulness of this patch test battery was limited. There were a few positive reactions to Cytox 3522, BIT and the 2 formaldehyde releasers, Preventol D2 and Grotan BK. These reactions could not, however, be explained. The MOAHL-index (% of Male patients, Occupational cases, Atopic patients, Hand eczemas, and Leg ulcers/stasis dermatitis) for patients from the 6 clinics showed equal frequencies of male patients and atopics, but significant differences in the frequencies of occupational cases, hand eczemas, and leg ulcers/stasis dermatitis, indicating possible variations in referral patterns, use of patch tests, and/or environmental factors.

  18. Exp 36 Patch Final

    NASA Image and Video Library

    2012-08-10

    ISS036-S-001 (January 2012) --- The dynamic design of the Expedition 36 patch portrays the International Space Station?s (ISS) iconic solar arrays. The slanted angles denote a kinetic energy leading from the Earth in the lower right to the upper left tip of the triangular shape of the patch, representing the infinite scientific research, education, and long-duration spaceflight capabilities the ISS provides with each mission, as well as our goal for future exploration beyond the Space Station. The numbers 3 and 6 harmoniously intertwine to form expedition number 36 and its gray coloration signifies the unity and neutrality among all of the international partners of the ISS. The blue and gold color scheme of the patch represents the subtle way the central gold orbit wraps around the number 36 to form a trident at its lower right tip. The trident also symbolizes the sea, air, and land, all of which make up the Earth from where the trident originates in the design. The NASA insignia design for shuttle and space station flights is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the form of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, it will be publicly announced. Photo credit: NASA

  19. Con-Patch: When a Patch Meets Its Context.

    PubMed

    Romano, Yaniv; Elad, Michael

    2016-09-01

    Measuring the similarity between the patches in images is a fundamental building block in various tasks. Naturally, the patch size has a major impact on the matching quality and on the consequent application performance. Under the assumption that our patch database is sufficiently sampled, using large patches (e.g., 21 × 21 ) should be preferred over small ones (e.g., 7 × 7 ). However, this dense-sampling assumption is rarely true; in most cases, large patches cannot find relevant nearby examples. This phenomenon is a consequence of the curse of dimensionality, stating that the database size should grow exponentially with the patch size to ensure proper matches. This explains the favored choice of small patch size in most applications. Is there a way to keep the simplicity and work with small patches while getting some of the benefits that large patches provide? In this paper, we offer such an approach. We propose to concatenate the regular content of a conventional (small) patch with a compact representation of its (large) surroundings-its context. Therefore, with a minor increase of the dimensions (e.g., with additional ten values to the patch representation), we implicitly/softly describe the information of a large patch. The additional descriptors are computed based on a self-similarity behavior of the patch surrounding. We show that this approach achieves better matches, compared with the use of conventional-size patches, without the need to increase the database-size. Also, the effectiveness of the proposed method is tested on three distinct problems: 1) external natural image denoising; 2) depth image super-resolution; and 3) motion-compensated frame-rate up conversion.

  20. Epidural volume extension in combined spinal epidural anaesthesia for elective caesarean section: a randomised controlled trial.

    PubMed

    Loubert, C; O'Brien, P J; Fernando, R; Walton, N; Philip, S; Addei, T; Columb, M O; Hallworth, S

    2011-05-01

    We investigated the effect of epidural volume extension on spinal blockade in pregnant women undergoing elective caesarean section with a combined spinal-epidural technique. We randomly allocated 90 healthy subjects to three groups to receive spinal hyperbaric bupivacaine 7.5 mg (group B7.5), spinal hyperbaric bupivacaine 7.5 mg immediately followed by epidural volume extension with saline 5 ml (group B7.5-EVE) or spinal hyperbaric bupivacaine 10 mg without epidural volume extension (group B10). We evaluated the height of the block every 5 min for 15 min following the spinal injection. The overall sensory block level increased with time (p < 0.001), regardless of the group studied, and there were significantly fewer failures of block in the group B10 compared with both B7.5 and B7.5-EVE groups (p = 0.001). In conclusion, we could not demonstrate a benefit in using epidural volume extension with 5 ml saline as part of a combined spinal epidural technique in term parturients undergoing elective caesarean section. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

  1. Patch Test Negative Generalized Dermatitis.

    PubMed

    Spiker, Alison; Mowad, Christen

    2016-01-01

    Allergic contact dermatitis is a common condition in dermatology. Patch testing is the criterion standard for diagnosis. However, dermatitis is not always caused by an allergen, and patch testing does not identify a culprit in every patient. Generalized dermatitis, defined as eczematous dermatitis affecting greater than 3 body sites, is often encountered in dermatology practice, especially patch test referral centers. Management for patients with generalized dermatitis who are patch test negative is challenging. The purpose of this article is to outline an approach to this challenging scenario and summarize the paucity of existing literature on patch test negative generalized dermatitis.

  2. [Maternal postures and epidural analgesia during labour].

    PubMed

    Ducloy-Bouthors, A-S; De Gasquet, B; Davette, M; Cuisse, M

    2006-06-01

    The evolution of birth is of interest for obstetricians and midwives. Postures with asymmetric stretching and balance, kneeling, or sitting have been claimed to be able to help foetal head rotation. Although walking during labour have no influence on the outcome of labour, hip-flexed postures enlarging the pelvic diameter are yet evaluated to improve the obstetric course of labour. In a prospective randomised study including 93 parturients, we compared the supine 30 degrees lateral tilt (control group) to three hip-flexed postures: sitting (S), right hip-flexed left lateral position (L) and left hip-flexed right lateral position (R). Epidural analgesia with 12 ml ropivacaine 0.1% and sufentanil 0.5 microg/ml was administered over a period of six minutes. The total epidural spread was 15+/-0.3 dermatomes and the upper level of thermo-analgesic blockade reached T7-T8 (T5 to T10) in each group. There were no differences between groups for the left and right total spread and upper level of epidural blockade, for the time to maximal block and pain relief. There was no motor block and no maternal or foetal side effects. We conclude that, for the three hip-flexed postures tested, position does not influence local anesthetic spread or symmetry of analgesia after induction of obstetric epidural anaesthesia.

  3. Pneumocephalus and seizures following epidural steroid injection.

    PubMed

    Sorber, Joseph; Levy, David; Schwartz, Adam

    2017-09-18

    We describe a patient with pneumocephalus following an epidural steroid injection (ESI) who presented with altered mental status, headache, focal neurologic findings and seizures. Pneumocephalus has rarely been described following ESI. A 34-year-old female presented with an altered level of consciousness worsening over approximately 18h following an ESI for lumbar back pain. She had associated headache, right-sided facial twitching and right upper extremity weakness. A brain CT scan revealed pneumocephalus in the right lateral ventricle and quadrigeminal plate cistern. While in the emergency department she experienced a self-limited generalized seizure. She was admitted and her symptoms persisted. Seven days following admission she was discharged to a rehabilitation facility, but her arm weakness persisted for greater than a month before resolving. Epidural anesthesia relies on the localization of the epidural space. The manual loss of resistance technique is widely used to identify the epidural space. The incidence of adverse effects is unknown. Case reports noting complications associated with this technique have been reported; rarely including pneumocephalus. Complications from the pneumocephalus are even less commonly reported. Though rare following an ESI and generally self-limited without complication, pneumocephalus should be considered in the differential diagnosis when evaluating a patient with neurologic deficits after instrumentation. Copyright © 2017. Published by Elsevier Inc.

  4. Epidural Analgesia in the Postoperative Period

    DTIC Science & Technology

    2001-10-01

    violations. VI ABSTRACT Postoperative pain is an unwanted side effect of surgery, and is associated with many postoperative complications...This descriptive study was conducted to determine which surgical patients experienced the most analgesia with the fewest side effects when...epidural medication, side effects , incidence of breakthrough pain, and treatments were recorded and cross-tabulated. The following surgical categories

  5. Epidural Labor Analgesia-Fentanyl Dose and Breastfeeding Success: A Randomized Clinical Trial.

    PubMed

    Lee, Amy I; McCarthy, Robert J; Toledo, Paloma; Jones, Mary Jane; White, Nancy; Wong, Cynthia A

    2017-10-01

    Breastfeeding is an important public health concern. High cumulative doses of epidural fentanyl administered for labor analgesia have been reported to be associated with early termination of breastfeeding. We tested the hypothesis that breastfeeding success is adversely influenced by the cumulative epidural fentanyl dose administered for labor analgesia. The study was a randomized, double-blind, controlled trial of parous women at greater than 38 weeks gestation who planned to breastfeed, had successfully breastfed a prior infant, and who received neuraxial labor analgesia. Participants were randomized to receive one of three epidural maintenance solutions for labor analgesia (bupivacaine 1 mg/ml, bupivacaine 0.8 mg/ml with fentanyl 1 μg/ml, or bupivacaine 0.625 mg/ml with fentanyl 2 μg/ml). The primary outcome was the proportion of women breastfeeding at 6 weeks postpartum. Maternal and umbilical venous blood fentanyl and bupivacaine concentration at delivery were measured. A total of 345 women were randomized and 305 had complete data for analysis. The frequency of breastfeeding at 6 weeks was 97, 98, and 94% in the groups receiving epidural fentanyl 0, 1, and 2 μg/ml, respectively (P = 0.34). The cumulative fentanyl dose (difference: 37 μg [95% CI of the difference, -58 to 79 μg], P = 0.28) and maternal and umbilical cord venous fentanyl and bupivacaine concentrations did not differ between women who discontinued breastfeeding and those who were still breastfeeding at 6 weeks postpartum. Labor epidural solutions containing fentanyl concentrations as high as 2 μg/ml do not appear to influence breastfeeding rates at 6 weeks postpartum.

  6. Combination of epidural anesthesia and general anesthesia attenuates stress response to renal transplantation surgery.

    PubMed

    Hadimioglu, N; Ulugol, H; Akbas, H; Coskunfirat, N; Ertug, Z; Dinckan, A

    2012-12-01

    Choice of the anesthestic technique can reduce or even eliminate stress responses to surgery and decrease the incidence of complications. Our aim was to compare a combination of epidural anesthesia+general anesthesia with general anesthesia alone as regards perioperative insulin resistance and inflammatory activation among renal transplant recipients. Forty-six nondiabetic patients undergoing renal transplantation were prospectively randomized to the epidural anesthesia + general anesthesia group (n = 21), or general anesthesia alone group (n = 25). Plasma levels of glucose, insulin, interleukin (IL)-6, tumour necrosis factor (TNF)-α, resistin, and adiponectin were measured at baseline (T1), end of surgery (T2), postoperative first hour (T3), postoperative second hour (T4) and postoperative 24th hour (T5). Homeostasis model assessment-estimated insulin resistance (HOMA-IR) scores were calculated at every time point that the blood samples were collected. Glucose levels (P < .001) and insulin levels at the end of surgery (P = .048) and at postoperative first hour (P = .005) and HOMA-IR levels at the end of surgery (P = .012) and at postoperative first hour (P = .010) showed significantly higher values among the general anesthesia alone group when compared with the epidural+general anesthesia group. TNF-α levels at postoperative 2nd and at 24th hour (P = .005 and P = .004, respectively) and IL-6 levels at postoperative 1st and 2nd hours (P = .002 and P = .045, respectively) were significantly higher in the general anesthesia alone group when compared with the epidural+general anesthesia group. The TNF-α levels were significantly less at all time points when compared with baseline only in the epidural+general anesthesia group (T1, 33.36 vs 37.25; T2, 18.45 vs 76.52; T3, 15.18 vs 78.27; T4, 10.75 vs 66.64; T5, 2.98 vs 36.32) Hospital stays were significantly shorter among the epidural+general anesthesia group (P = .022). We showed partly attenuated surgical stress

  7. Thoracic Epidural Anesthesia Reduces Right Ventricular Systolic Function With Maintained Ventricular-Pulmonary Coupling.

    PubMed

    Wink, Jeroen; de Wilde, Rob B P; Wouters, Patrick F; van Dorp, Eveline L A; Veering, Bernadette Th; Versteegh, Michel I M; Aarts, Leon P H J; Steendijk, Paul

    2016-10-18

    Blockade of cardiac sympathetic fibers by thoracic epidural anesthesia may affect right ventricular function and interfere with the coupling between right ventricular function and right ventricular afterload. Our main objectives were to study the effects of thoracic epidural anesthesia on right ventricular function and ventricular-pulmonary coupling. In 10 patients scheduled for lung resection, right ventricular function and its response to increased afterload, induced by temporary, unilateral clamping of the pulmonary artery, was tested before and after induction of thoracic epidural anesthesia using combined pressure-conductance catheters. Thoracic epidural anesthesia resulted in a significant decrease in right ventricular contractility (ΔESV25: +25.5 mL, P=0.0003; ΔEes: -0.025 mm Hg/mL, P=0.04). Stroke work, dP/dtMAX, and ejection fraction showed a similar decrease in systolic function (all P<0.05). A concomitant decrease in effective arterial elastance (ΔEa: -0.094 mm Hg/mL, P=0.004) yielded unchanged ventricular-pulmonary coupling. Cardiac output, systemic vascular resistance, and mean arterial blood pressure were unchanged. Clamping of the pulmonary artery significantly increased afterload (ΔEa: +0.226 mm Hg/mL, P<0.001). In response, right ventricular contractility increased (ΔESV25: -26.6 mL, P=0.0002; ΔEes: +0.034 mm Hg/mL, P=0.008), but ventricular-pulmonary coupling decreased (Δ(Ees/Ea) = -0.153, P<0.0001). None of the measured indices showed significant interactive effects, indicating that the effects of increased afterload were the same before and after thoracic epidural anesthesia. Thoracic epidural anesthesia impairs right ventricular contractility but does not inhibit the native positive inotropic response of the right ventricle to increased afterload. Right ventricular-pulmonary arterial coupling was decreased with increased afterload but not affected by the induction of thoracic epidural anesthesia. URL: http

  8. Clonidine Transdermal Patch

    MedlinePlus

    ... agonist hypotensive agents. It works by decreasing your heart rate and relaxing the blood vessels so that blood ... doctor may ask you to check your pulse (heart rate) daily and will tell you how rapid it ...

  9. The Influence of Oral Carbohydrate Solution Intake on Stress Response before Total Hip Replacement Surgery during Epidural and General Anaesthesia.

    PubMed

    Çeliksular, M Cem; Saraçoğlu, Ayten; Yentür, Ercüment

    2016-06-01

    The effects of oral carbohydrate solutions, ingested 2 h prior to operation, on stress response were studied in patients undergoing general or epidural anaesthesia. The study was performed on 80 ASA I-II adult patients undergoing elective total hip replacement, which were randomized to four groups (n=20). Group G patients undergoing general anaesthesia fasted for 8 h preoperatively; Group GN patients undergoing general anaesthesia drank oral carbohydrate solutions preoperatively; Group E patients undergoing epidural anaesthesia fasted for 8 h and Group EN patients undergoing epidural anaesthesia drank oral carbohydrate solutions preoperatively. Groups GN and EN drank 800 mL of 12.5% oral carbohydrate solution at 24:00 preoperatively and 400 mL 2 h before the operation. Blood samples were taken for measurements of glucose, insulin, cortisol and IL-6 levels. The effect of preoperative oral carbohydrate ingestion on blood glucose levels was not significant. Insulin levels 24 h prior to surgery were similar; however, insulin levels measured just before surgery were 2-3 times higher in groups GN and EN than in groups G and E. Insulin levels at the 24(th) postoperative hour in epidural groups were increased compared to those at basal levels, although general anaesthesia groups showed a decrease. From these measurements, only the change in Group EN was statistically significant (p<0.05). Plasma cortisol levels at the 2(nd) peroperative hour were higher in epidural groups than in general anaesthesia groups. Both anaesthesia techniques did not have an effect on IL-6 levels. We concluded that epidural anaesthesia suppressed stress response, although preoperative oral carbohydrate nutrition did not reveal a significant effect on surgical stress response.

  10. A comprehensive analysis of continuous epidural analgesia's effect on labor and neonates in maternal hypertensive disorder patients.

    PubMed

    Han, Bin; Xu, Mingjun

    2017-01-01

    Maternal hypertensive disorder is one of the most common and severe medical complications during pregnancy. Epidural analgesia administration is widely used during labor process. To evaluate the potential advantage or disadvantage of continuous epidural analgesia's on labor and neonates for maternal hypertensive disorder patients comprehensively. We have retrospectively analyzed 232 patients who diagnosed as maternal hypertensive disorder in our hospital since 2015. Among which, 126 patients including 28 cases of severe preeclampsia were administrated with continuous epidural analgesia (Analgesia group), the other 106 patients were untreated (Control group). We have compared the maternal age, body weight, gestational weeks, period for the first and second labor stage; the incidence of eclampsia, natural labor, cesarean section, forceps delivery and postpartum hemorrhage between these two groups respectively; furthermore, we recorded patients who received oxytocin and antihypertensive treatment during the delivery progress as well as evaluated the neonate body weight, Apgar score and performed umbilical cord blood gas analysis. Continuous epidural analgesia does not affect the first and second labor stage period (p=0.36), However, there is a significantly higher demand for oxytocin treatment (36.5% Vs 19.8%, p<0.01) and a significantly lower requirement for antihypertensive treatment (22.2% Vs 81.1%, p<0.001) in analgesia group compared to control group. We also notice that the natural delivery ratio in analgesia group is higher than control group and most importantly, continuous epidural analgesia can increase 1min Apgar score and has no other effect on neonates' body weight, umbilical cord blood gas parameters, 5min and 10min Apgar score. Our result based on a large cohort comprehensive analysis indicates that continuous epidural analgesia can benefit both maternal hypertensive disorder patients and neonates without any side effect. Copyright © 2016 International

  11. [Clinical use of spinal or epidural steroids].

    PubMed

    Marinangeli, F; Ciccozzi, A; Donatelli, F; Paladini, A; Varrassi, G

    2002-01-01

    Steroids, drugs with potent antiinflammatory properties on the damaged nervous roots, have been especially used as adjuvants of local anesthetics, by spinal route, in the treatments of low-back pain. Spinal route was chosen to obtain a higher local concentration of drug, with few systemic side effects and to improve drug's action mechanism. Steroids seem to interact with GABA receptors and thus control neural excitability through a stabilising effect on membranes, modification of nervous conduction and membrane hyperpolarization, in supraspinal and spinal site. Epidural steroids are especially used in the treatment of low back pain due to irritation of nervous roots. They have been administered alone or in association with local anesthetics and/or saline solution. Slow release formulations have been generally used (methylprednisolone acetate, and triamcinolone diacetate). Other indications of epidural steroids are: postoperative hemilaminectomy pain, prevention of post herpetic neuralgia, degenerative ostheoartrithis. Intra-thecal steroids have been frequently used in the treatment of lumbar radiculopathy due to discopathy, as an alternative treatment when epidural administration is ineffective. Positive results have been obtained with methylprednisolone acetate, alone or in association with local anesthetics. Complications related to intraspinal steroids injections are due to execution of the block and side effects of drugs. Complications associated with intrathecal steroids are more frequent and severe than epidural injections and include: adhesive arachnoiditis, aseptic meningitis, cauda equina syndrome. Steroidal toxicity seems to be related to the polyethylenic glycole vehicle. Anyway, slow release formulations contain less concentrated polyethylenic glycole. The epidural administration, a correct dilution of steroid with local anesthetics solution and/or saline solution, and a limited number of injections (no more than three) allows a significant reduction of

  12. Uterine tocolysis at cesarean breech delivery with epidural anesthesia.

    PubMed

    Ezra, Yossef; Wade, Carol; Rolbin, Stephen H; Farine, Dan

    2002-07-01

    To assess the safety and efficacy of ritodrine and nitroglycerin for uterine relaxation during cesarean section with a breech-presenting fetus, performed under nongeneral anesthesia. A retrospective review of all breech singletons delivered by cesarean section under epidural anaesthesia in a two-year period. The study groups consisted of those who received ritodrine and those who received nitroglycerin. A group who received no relaxant served as a comparison group. The interval from uterine incision to delivery was recorded, and comparisons for potential complications of the medications included maternal changes in pulse and blood pressure, blood loss, and changes in hemoglobin and hematocrit. Fetal outcomes that were evaluated included five-minute Apgar score, cord pH and any recorded birth trauma. Statistical significance was set at P = .05. The Student t test, Yates's correlation for chi 2, Fisher's exact test and ANOVA were used as appropriate. The three groups had similar demographic characteristics. There was no significant difference in the uterine incision to delivery interval between the groups. In three cases the uterine incision to delivery interval was prolonged (> 5 minutes) in the nitroglycerin group, six cases in the ritodrine group and three in the comparison group (P = .002). There was no case of serious maternal morbidity or mortality, and no patient required a blood transfusion. The three groups had similar estimated blood loss, changes in maternal heart rate and systolic blood pressure intraoperatively and fall in hemoglobin and hematocrit 24 hours postoperatively. Neonatal outcome was similar among the three groups, and there was no case of neonatal birth trauma or intrapartum death. Cord blood analysis was similar in the three groups. One of the seven infants weighing < 1,500 g died within one hour of birth. Ritodrine and nitroglycerine are safe agents for use at cesarean breech delivery with epidural anesthesia and may be considered for

  13. Patch antenna terahertz photodetectors

    SciTech Connect

    Palaferri, D.; Todorov, Y. Chen, Y. N.; Madeo, J.; Vasanelli, A.; Sirtori, C.; Li, L. H.; Davies, A. G.; Linfield, E. H.

    2015-04-20

    We report on the implementation of 5 THz quantum well photodetector exploiting a patch antenna cavity array. The benefit of our plasmonic architecture on the detector performance is assessed by comparing it with detectors made using the same quantum well absorbing region, but processed into a standard 45° polished facet mesa. Our results demonstrate a clear improvement in responsivity, polarization insensitivity, and background limited performance. Peak detectivities in excess of 5 × 10{sup 12} cmHz{sup 1/2}/W have been obtained, a value comparable with that of the best cryogenic cooled bolometers.

  14. Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia

    PubMed Central

    Estcourt, Lise J; Ingram, Callum; Doree, Carolyn; Trivella, Marialena; Stanworth, Simon J

    2016-01-01

    Background People with a low platelet count (thrombocytopenia) often require lumbar punctures or an epidural anaesthetic. Lumbar punctures can be diagnostic (haematological malignancies, epidural haematoma, meningitis) or therapeutic (spinal anaesthetic, administration of chemotherapy). Epidural catheters are placed for administration of epidural anaesthetic. Current practice in many countries is to correct thrombocytopenia with platelet transfusions prior to lumbar punctures and epidural anaesthesia, in order to mitigate the risk of serious procedure-related bleeding. However, the platelet count threshold recommended prior to these procedures varies significantly from country to country. This indicates significant uncertainty among clinicians of the correct management of these patients. The risk of bleeding appears to be low but if bleeding occurs it can be very serious (spinal haematoma). Therefore, people may be exposed to the risks of a platelet transfusion without any obvious clinical benefit. Objectives To assess the effects of different platelet transfusion thresholds prior to a lumbar puncture or epidural anaesthesia in people with thrombocytopenia (low platelet count). Search methods We searched for randomised controlled trials (RCTs) in CENTRAL (The Cochrane Library 2016, Issue 3), MEDLINE (from 1946), EMBASE (from 1974), the Transfusion Evidence Library (from 1950) and ongoing trial databases to 3 March 2016. Selection criteria We included RCTs involving transfusions of platelet concentrates, prepared either from individual units of whole blood or by apheresis, and given to prevent bleeding in people of any age with thrombocytopenia requiring insertion of a lumbar puncture needle or epidural catheter. We only included RCTs published in English. Data collection and analysis We used standard methodological procedures expected by Cochrane. Main results We identified no completed or ongoing RCTs in English. We did not exclude any completed or ongoing RCTs

  15. Combined spinal-epidural analgesia for labor pain: best timing of epidural infusion following spinal dose.

    PubMed

    Okutomi, Toshiyuki; Saito, Miwako; Mochizuki, Junko; Kuczkowski, Krzysztof M

    2009-03-01

    The combined spinal-epidural analgesia (CSEA) technique for labor pain has attained wide spread popularity in obstetric anesthesia. The onset of analgesia is rapid and reliable, and maternal satisfaction is very high. However, the best timing of an epidural infusion following the spinal dose and its effect on the total local anesthetics consumption has not been well determined. A total of 144 consenting healthy nulliparous parturients whose labor was induced and who labored under regional analgesia were enrolled in this study. Following induction of the CSEA with intrathecal injection of bupivacaine, 2.5 mg and fentanyl, 25 microg, the patients were randomized into one of four groups to receive a subsequent continuous epidural infusion [E (3), E (30), E (60) and E (90)], depending on the timing of the initiation of epidural infusion of 0.1% ropivacaine, 0.0002% fentanyl and 1:500,000 epinephrine at the rate of 10 ml/h. In study Groups E (3), E (30), E (60) and E (90), epidural infusion was initiated 3, 30, 60 and 90 min, respectively following spinal induction dose. Patients requesting additional labor analgesia were given an epidural bolus (8 ml) of ropivacaine, 0.2%. The number of parturients requesting additional boluses of ropivacaine and the total dose of ropivacaine required for labor analgesia were registered. The numbers of patients who required additional boluses of ropivacaine in Group E (3) and Group E (30) were significantly less than those in Group E (60) and Group E (90). The total dose of ropivacaine required for labor pain in Group E (3) and Group E (30) was insignificantly smaller than the total dose required in Group E (60) and Group E (90). Our results suggest that the best timing of epidural infusion following spinal dose was within 30 min of spinal induction dose.

  16. [The efficacy and safety of continuous epidural analgesia versus intradural-epidural analgesia during labor].

    PubMed

    Gómez, P; Echevarría, M; Calderón, J; Caba, F; Martínez, A; Rodríguez, R

    2001-05-01

    To determine the efficacy and safety of intradural-epidural analgesia in comparison with continuous epidural analgesia during labor and childbirth. Forty-two women whose labor began spontaneously were enrolled and distributed randomly in two groups. The intradural-epidural analgesia group (IEA, n = 21) received 25 microgram of intradural fentanyl with 2.5 mg of isobaric bupivacaine with adrenalin, after which analgesia was maintained with epidural administration of one 8 mL bolus of 0.125% bupivacaine, followed by perfusion of a balanced concentration at a rate of 8 ml/h. Patients in the continuous epidural analgesia group (CEA, n = 21) were given 8 ml of 0.25% bupivacaine with adrenalin; the epidural perfusion of 0.125% bupivacaine and 1 microgram/ml of fentanyl was started at the same rate as in the IEA group. We recorded pain as assessed on a visual analog scale, extension of sensory and motor block, maternal hemodynamic constants, number of boluses of bupivacaine used, total doses of bupivacaine and oxytocin, instruments needed for childbirth, and side effects (pruritus, nausea and vomiting). Analgesic efficacy during the first 30 minutes was greater in the IEA group. The total dose of bupivacaine, required top-up boluses, and the extension of sensory block at 30 minutes, one hour and two hours were also significantly less in the IEA group. The incidence of pruritus was higher in the IEA group. No significant differences were observed for other variables. Intradural-epidural analgesia provides effective analgesia for labor, with rapid onset, reduced extension of sensory block, lower total doses of local anesthetics and few side effects.

  17. Epidural Injections for Spinal Pain

    MedlinePlus

    ... back or leg pain after spinal surgery) Other injuries to spinal nerves, vertebrae and surrounding tissues Bone ... Bleeding if a blood vessel is inadvertently damaged. Injury to the nerves at the injection site. Temporary ...

  18. Expedition 17 Patch

    NASA Image and Video Library

    2007-08-01

    ISS017-S-001B (Oct. 2007) --- The Expedition 17 patch is meant to celebrate current human achievements in space as well as symbolize the future potential for continuing exploration. The Earth, represented at the bottom of the patch, is the base from which all space exploration activities initiate. The International Space Station (ISS), shown in low Earth orbit, illustrates the current level of space operations. The arrow and star point outwards, away from the Earth, towards the wider universe indicating the direction of future activities as human beings build on what has already been accomplished. The flags, representing the home countries of the crew members, Russia and the United States, are touching, highlighting the cooperative nature of the space program and symbolizing the merger of science and technical knowledge of these two experienced space-faring nations. The NASA insignia design for space station flights is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the form of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, it will be publicly announced.

  19. Expedition 17 Patch

    NASA Image and Video Library

    2007-10-01

    ISS017-S-001D (Oct. 2007) --- The Expedition 17 patch is meant to celebrate current human achievements in space as well as symbolize the future potential for continuing exploration. The Earth, represented at the bottom of the patch, is the base from which all space exploration activities initiate. The International Space Station (ISS), shown in low Earth orbit, illustrates the current level of space operations. The arrow and star point outwards, away from the Earth, towards the wider universe indicating the direction of future activities as human beings build on what has already been accomplished. The flags, representing the home countries of the crew members, Russia and the United States, are touching, highlighting the cooperative nature of the space program and symbolizing the merger of science and technical knowledge of these two experienced space-faring nations. The NASA insignia design for space station flights is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the form of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, it will be publicly announced.

  20. Expedition 17 Patch

    NASA Image and Video Library

    2007-10-01

    ISS017-S-001C (Oct. 2007) --- The Expedition 17 patch is meant to celebrate current human achievements in space as well as symbolize the future potential for continuing exploration. The Earth, represented at the bottom of the patch, is the base from which all space exploration activities initiate. The International Space Station (ISS), shown in low Earth orbit, illustrates the current level of space operations. The arrow and star point outwards, away from the Earth, towards the wider universe indicating the direction of future activities as human beings build on what has already been accomplished. The flags, representing the home countries of the crew members, Russia and the United States, are touching, highlighting the cooperative nature of the space program and symbolizing the merger of science and technical knowledge of these two experienced space-faring nations. The NASA insignia design for space station flights is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the form of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, it will be publicly announced.

  1. Patched Conic Trajectory Code

    NASA Technical Reports Server (NTRS)

    Park, Brooke Anderson; Wright, Henry

    2012-01-01

    PatCon code was developed to help mission designers run trade studies on launch and arrival times for any given planet. Initially developed in Fortran, the required inputs included launch date, arrival date, and other orbital parameters of the launch planet and arrival planets at the given dates. These parameters include the position of the planets, the eccentricity, semi-major axes, argument of periapsis, ascending node, and inclination of the planets. With these inputs, a patched conic approximation is used to determine the trajectory. The patched conic approximation divides the planetary mission into three parts: (1) the departure phase, in which the two relevant bodies are Earth and the spacecraft, and where the trajectory is a departure hyperbola with Earth at the focus; (2) the cruise phase, in which the two bodies are the Sun and the spacecraft, and where the trajectory is a transfer ellipse with the Sun at the focus; and (3) the arrival phase, in which the two bodies are the target planet and the spacecraft, where the trajectory is an arrival hyperbola with the planet as the focus.

  2. STS-62 crew patch

    NASA Image and Video Library

    1993-10-01

    STS062-S-001 (October 1993) --- The crew patch depicts the world's first reusable spacecraft on its sixteenth flight. The space shuttle Columbia is in its entry-interface attitude as it prepares to return to Earth. The primary mission objectives of STS-62 include the United States Microgravity Payload (USMP-2) and the NASA Office of Aeronautics and Space Technology (OAST-2) payloads. These payloads represent a multifaceted array of space science and engineering experiments. The varied hues of the rainbow on the horizon connote the varied, but complementary, nature of all the payloads united on this mission. The upward-pointing vector shape of the patch is symbolic of America's reach for excellence in its in its unswerving pursuit to explore the frontiers of space. The brilliant sunrise just beyond Columbia suggests the promise that research in space holds for the hopes and dreams of future generations. The STS-62 insignia was designed by Mark Pestana. The NASA insignia design for space shuttle flights is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the forms of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, the change will be publicly announced. Photo credit: NASA

  3. Tiling motion patches.

    PubMed

    Hyun, Kyunglyul; Kim, Manmyung; Hwang, Youngseok; Lee, Jehee

    2013-11-01

    Simulating multiple character interaction is challenging because character actions must be carefully coordinated to align their spatial locations and synchronized with each other. We present an algorithm to create a dense crowd of virtual characters interacting with each other. The interaction may involve physical contacts, such as hand shaking, hugging, and carrying a heavy object collaboratively. We address the problem by collecting deformable motion patches, each of which describes an episode of multiple interacting characters, and tiling them spatially and temporally. The tiling of motion patches generates a seamless simulation of virtual characters interacting with each other in a nontrivial manner. Our tiling algorithm uses a combination of stochastic sampling and deterministic search to address the discrete and continuous aspects of the tiling problem. Our tiling algorithm made it possible to automatically generate highly complex animation of multiple interacting characters. We achieve the level of interaction complexity far beyond the current state of the art that animation techniques could generate, in terms of the diversity of human behaviors and the spatial/temporal density of interpersonal interactions.

  4. Tiling Motion Patches.

    PubMed

    Hyun, Kyunglyul; Kim, Manmyung; Hwang, Youngseok; Lee, Jehee

    2013-05-08

    Simulating multiple character interaction is challenging because character actions must be carefully coordinated to align their spatial locations and synchronized with each other. We present an algorithm to create a dense crowd of virtual characters interacting with each other. The interaction may involve physical contacts, such as hand shaking, hugging, and carrying a heavy object collaboratively. We address the problem by collecting deformable motion patches, each of which describes an episode of multiple interacting characters, and tiling them spatially and temporally. The tiling of motion patches generates a seamless simulation of virtual characters interacting with each other in a non-trivial manner. Our tiling algorithm uses a combination of stochastic sampling and deterministic search to address the discrete and continuous aspects of the tiling problem. Our tiling algorithm made it possible to automatically generate highly-complex animation of multiple interacting characters. We achieved the level of complexity far beyond the current state-of-the-art animation techniques could generate, in terms of the diversity of human behaviors and the spatial/temporal density of interpersonal interactions.

  5. Expedition 13 crew patch

    NASA Image and Video Library

    2006-01-01

    ISS013-S-001 (January 2006) --- This patch commemorates the thirteenth expeditionary mission to the International Space Station (ISS) which continues the permanent human presence in space. The ISS is depicted in its configuration at the start of the six-month expedition with trailing elements from the country flags representing both of the crew members--cosmonaut Pavel V. Vinogradov and astronaut Jeffrey N. Williams. The crew members made the following statement about their patch: "The dynamic trajectory of the space station against the background of the Earth, Mars, and the Moon symbolizes the vision for human space exploration beyond Earth orbit and the critical role that the ISS plays in the fulfillment of that vision." The NASA insignia design for shuttle flights and station increments is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the forms of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, the change will be publicly announced.

  6. STS-128 patch Pathd

    NASA Image and Video Library

    2009-04-14

    STS128-S-001 (April 2009) --- The STS-128 patch symbolizes the 17A mission and represents the hardware, people and partner nations that contribute to the flight. The Space shuttle Discovery is shown in the orbit configuration with the Multi-Purpose Logistics Module (MPLM) Leonardo in the payload bay. Earth and the International Space Station wrap around the Astronaut Office symbol reminding us of the continuous human presence in space. The names of the STS-128 crew members border the patch in an unfurled manner. Included in the names is the expedition crew member who will launch on STS-128 and remain on board ISS, replacing another Expedition crew member who will return home with STS-128. The banner also completes the Astronaut Office symbol and contains the U.S. and Swedish flags representing the countries of the STS-128 crew. The NASA insignia design for space shuttle flights is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the forms of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, the change will be publicly announced. Photo credit: NASA

  7. Statistics for Patch Observations

    NASA Astrophysics Data System (ADS)

    Hingee, K. L.

    2016-06-01

    In the application of remote sensing it is common to investigate processes that generate patches of material. This is especially true when using categorical land cover or land use maps. Here we view some existing tools, landscape pattern indices (LPI), as non-parametric estimators of random closed sets (RACS). This RACS framework enables LPIs to be studied rigorously. A RACS is any random process that generates a closed set, which encompasses any processes that result in binary (two-class) land cover maps. RACS theory, and methods in the underlying field of stochastic geometry, are particularly well suited to high-resolution remote sensing where objects extend across tens of pixels, and the shapes and orientations of patches are symptomatic of underlying processes. For some LPI this field already contains variance information and border correction techniques. After introducing RACS theory we discuss the core area LPI in detail. It is closely related to the spherical contact distribution leading to conditional variants, a new version of contagion, variance information and multiple border-corrected estimators. We demonstrate some of these findings on high resolution tree canopy data.

  8. Decrease in pulmonary artery pressure after administration of thoracic epidural anesthesia in a patient with Marfan syndrome awaiting aortic valve replacement procedure.

    PubMed

    Chakravarthy, Murali; Jawali, Vivek; Patil, Timmannagowda; Krishnamoorthy, Jayaprakash

    2011-08-01

    Thoracic epidural anesthesia is an adjunct to general anesthesia in cardiac surgery. Decrease in heart rate and blood pressure are frequently seen beneficial effects. There are several other hemodynamic effects of thoracic epidural anesthesia such as decrease in systemic vascular resistance, cardiac index, left ventricular stroke work index among others. However, the effect of thoracic epidural anesthesia on pulmonary artery pressure (PAP) has not been studied extensively in humans. Thoracic epidural anes-thesia decreased pulmonary artery pressure in experimen-tally induced pulmonary hypertension in animals. The mechanisms involved in such reduction are ill understood. We describe in this report, a significant reduction in PAP in a patient with Marfan's syndrome scheduled to under-go aortic valve replacement. The possible mechanisms of decrease in pulmonary artery pressure in the described case are, decrease in the venous return to the heart, decrease in the systemic vascular resistance, decrease in the right ventric-ular function and finally, improvement in myocardial contraction secondary to all the above. The possibility of Marfan's syndrome contributing to the decrease in PAP appears remote. The authors present this case to generate discussion about the possible mechanisms involved in thoracic epidural anesthesia producing beneficial effects in patients with secondary pulmonary hypertension. Thoracic epidural anesthesia appears to decrease pulmonary artery pressure by a combination of several mechanisms, some unknown to us. This occurrence, if studied and understood well could be put to clinical use in pulmonary hypertensives.

  9. Management and visualization of a kinked epidural catheter

    PubMed Central

    Aslanidis, T; Fileli, A; Pyrgos, P

    2010-01-01

    A lumbar epidural catheter inserted in a 29-year-old woman for labor analgesia. The catheter failed to provide adequate analgesia. Moreover, after labor, it proved difficult to be removed. After computer tomography (CT) and magnetic resonance impedance (MRI) examination the course of the catheter was visible, the entrapped catheter was dislodged intact, revealing a kinking near its distal tip. Kinking of an epidural catheter leading to entrapment is an unusual complication of epidural catheterization. PMID:21311644

  10. [Spinal cord compression by tumor with onset following epidural catheterization].

    PubMed

    Ruiz Garés, T; Mateo, J M; Longás Valién, J; Aisa Hernández, G; Cía Blasco, P; Cuartero Lobera, J

    2008-02-01

    We report the case of a 16-year-old boy with a pelvic tumor who developed signs of spinal cord compression following placement of a lumbar epidural catheter to obtain a percutaneous biopsy. The fact that a catheter had been inserted led us to suspect epidural hematoma as a complication, but surgery revealed that the pelvic tumor had spread to the lumbar epidural space and was causing motor blockade of both legs.

  11. Effect of combined spinal-epidural analgesia versus epidural analgesia on labor and delivery duration.

    PubMed

    Pascual-Ramirez, Javier; Haya, Javier; Pérez-López, Faustino R; Gil-Trujillo, Silvia; Garrido-Esteban, Rosa A; Bernal, Ginés

    2011-09-01

    To determine whether combined spinal-epidural analgesia (CSEA) can decrease the known epidural effect of lengthening delivery. Between April and May 2010, 144 women undergoing childbirth in hospital with epidural pain relief were randomized to receive either low-dose epidural analgesia (LEA) or CSEA. The spinal component included 2.5mg of bupivacaine, 25 μg of fentanyl, and 200 μg of morphine. The epidural component of the CSEA procedure was started once pain returned. The primary outcome was total labor duration measured from the time of initiation of labor analgesia to delivery. The difference in duration between LEA (n=72) and CSEA (n=72) was 5 minutes for labor (P=0.82), 2 minutes for delivery (P=0.60), and 7 minutes for total labor duration (P=0.75). The combined group used less levobupivacaine (P<0.001) and had lower sensory blockade at the dermatomal level (P=0.037). Women in the CSEA group had a higher incidence of pruritus (P=0.002) and lightheadedness (P=0.02) during labor; and a higher incidence of pruritus (P=0.002), nausea-vomiting (P=0.026), and drowsiness (P=0.003) in the postpartum period. As compared with LEA, CSEA did not shorten the duration of labor length; however, it did reduce levobupivacaine consumption and motor weakness. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  12. Improved Gain Microstrip Patch Antenna

    DTIC Science & Technology

    2015-08-06

    08-2015 Publication Improved Gain Microstrip Patch Antenna David A. Tonn Naval Under Warfare Center Division, Newport 1176 Howell St., Code 00L...Distribution A An antenna for mounting on a ground plane includes a dielectric substrate for mounting on the ground plane. A conductive patch...GAIN MICROSTRIP PATCH ANTENNA STATEMENT OF GOVERNMENT INTEREST [0001] The invention described herein may be manufactured and used by or for the

  13. Lab in a needle for epidural space identification

    NASA Astrophysics Data System (ADS)

    Carotenuto, B.; Micco, A.; Ricciardi, A.; Amorizzo, E.; Mercieri, M.; Cutolo, A.; Cusano, A.

    2016-05-01

    This work relies on the development of a sensorized medical needle with an all-optical guidance (Lab in a Needle) system for epidural space identification. The device is based on the judicious integration of a Fiber Bragg grating sensor inside the lumen of an epidural needle to discriminate between different types of tissue and thus providing continuous and real time measurements of the pressure experienced by the needle tip during its advancement. Experiments carried out on an epidural training phantom demonstrate the validity of our approach for the correct and effective identification of the epidural space.

  14. Serratia marcescens spinal epidural abscess formation following acupuncture.

    PubMed

    Yang, Chih-Wei; Hsu, Shun-Neng; Liu, Jhih-Syuan; Hueng, Dueng-Yuan

    2014-01-01

    The formation of spinal epidural abscess following acupuncture is very rare. We herein report the case of a 54-year-old woman who presented with progressive low back pain and fever with a root sign. She underwent surgical decompression, with an immediate improvement of the low back pain. A culture of the epidural abscess grew Serratia marcescens. One year postoperatively, magnetic resonance imaging revealed the almost complete eradication of the abscess. This case is the first case of Serratia marcescens-associated spinal epidural abscess formation secondary to acupuncture. The characteristics of spinal epidural abscess that develop after acupuncture and how to prevent such complications are also discussed.

  15. Imaging in spinal posterior epidural space lesions: A pictorial essay

    PubMed Central

    Gala, Foram B; Aswani, Yashant

    2016-01-01

    Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication. PMID:27857455

  16. Imaging in spinal posterior epidural space lesions: A pictorial essay.

    PubMed

    Gala, Foram B; Aswani, Yashant

    2016-01-01

    Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication.

  17. STS-102 Crew Patch

    NASA Image and Video Library

    2001-04-24

    STS102-S-001 (January 2001) --- The central image on the STS-102 crew patch depicts the International Space Station (ISS) in the build configuration that it will have at the time of the arrival and docking of Discovery during the STS-102 mission, the first crew exchange flight to the space station. The station is shown along the direction of the flight as will be seen by the shuttle crew during their final approach and docking, the so-called V-bar approach. The names of the shuttle crew members are depicted in gold around the top of the patch, and surnames of the Expedition crew members being exchanged are shown in the lower banner. The three ribbons swirling up to and around the station signify the rotation of these ISS crew members. The number two is for the Expedition Two crew who fly up to the station, and the number one is for the Expedition One crew who then return down to Earth. In conjunction with the face of the Lab module of the station, these Expedition numbers create the shuttle mission number 102. Shown mated below the ISS is the Italian-built Multi-Purpose Logistics Module, Leonardo, that will fly for the first time on this flight, and which will be attached to the station by the shuttle crew during the docked phase of the mission. The flags of the countries that are the major contributors to this effort, the United States, Russia, and Italy are also shown in the lower part of the patch. The build-sequence number of this flight in the overall station assembly sequence, 5A.1, is captured by the constellations in the background. The NASA insignia design for space shuttle flights is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the forms of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, the change will be publicly announced. Photo credit: NASA

  18. Expedition Seven patch

    NASA Image and Video Library

    2003-03-01

    ISS007-S-001 (March 2003) --- The International Space Station (ISS) Expedition Seven patch consists of two elliptical orbits which evoke the histories of the two space programs from which the crew is drawn. The Russian and American flags are intersecting, representing the peaceful cooperation of the many countries contributing to the ISS. Two stars indicate the station's goals of contributing to life on Earth through science and commerce. The NASA insignia design for station space flights is reserved for use by the crew members and other official use as the NASA Administrator may authorize. Public availability has been approved only in the form of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, such will be publicly announced.

  19. Expedition 10 patch

    NASA Image and Video Library

    2004-05-01

    ISS010-S-001 (May 2004) --- The Expedition 10 patch uses simple symbolism to describe the mission. The large Roman numeral "X," formed by the American and Russian flags, symbolizes the joint nature of this mission, as well as the fact that this flight is the 10th mission to stay on the International Space Station (ISS). The current configuration of the ISS is next to the name of the ISS Commander, while the Soyuz vehicle is placed next to the name of the Soyuz Commander. The single star and the black background signify this is a space mission. The NASA insignia design for shuttle flights and station increments is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the forms of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, the change will be publicly announced.

  20. sts-135patch only

    NASA Image and Video Library

    2011-01-25

    STS135-S-001 (27 Jan. 2011) --- The STS-135 patch represents the space shuttle Atlantis embarking on its mission to resupply the International Space Station. Atlantis is centered over elements of the NASA emblem depicting how the space shuttle has been at the heart of NASA for the last 30 years. It also pays tribute to the entire NASA and contractor team that made possible all the incredible accomplishments of the space shuttle. Omega, the last letter in the Greek alphabet, recognizes this mission as the last flight of the Space Shuttle Program. The NASA insignia design for space shuttle flights is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the forms of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, the change will be publicly announced. Photo credit: NASA

  1. Salmonella Typhi Vertebral Osteomyelitis and Epidural Abscess

    PubMed Central

    Chua, Ying Ying; Chen, John L. T.

    2016-01-01

    Salmonella vertebral osteomyelitis is an uncommon complication of Salmonella infection. We report a case of a 57-year-old transgender male who presented with lower back pain for a period of one month following a fall. Physical examination only revealed tenderness over the lower back with no neurological deficits. MRI of the thoracic and lumbar spine revealed a spondylodiscitis at T10-T11 and T12-L1 and right posterior epidural collection at the T9-T10 level. He underwent decompression laminectomy with segmental instrumentation and fusion of T8 to L3 vertebrae. Intraoperatively, he was found to have acute-on-chronic osteomyelitis in T10 and T11, epidural abscess, and discitis in T12-L1. Tissue and wound culture grew Salmonella Typhi and with antibiotics susceptibility guidance he was treated with intravenous ceftriaxone for a period of six weeks. He recovered well with no neurological deficits. PMID:27034871

  2. Hepatocellular carcinoma metastases to the epidural space.

    PubMed

    Somerset, Hilary; Witt, J Peter; Kleinschmidt-Demasters, Bette K

    2009-12-01

    Hepatocellular carcinoma (HCC) is relatively uncommon in the United States, although hepatitis C, one of the known risk factors for disease, is currently showing burgeoning growth in the country. Hence, it is possible that the incidence of HCC also will increase. Clinicians and pathologists in the United States are relatively unfamiliar with the patterns of metastatic spread for HCC. We report 2 US-native patients with cirrhosis and HCC who developed epidural space metastasis, a pattern of disease spread seen infrequently, even in endemic areas. Diagnostic testing was delayed in both patients because of the lowered suspicion for metastasis and the fact that neither patient had recognized metastatic spread to more common sites, such as lung or lymph nodes. New-onset neck or back pain-especially with symptoms of paresthesia, radiculopathy, or cord compression-in the setting of HCC warrants prompt investigation for metastases to the spine and epidural space.

  3. Epidural Abscess Masquerading as Lateral Sinus Thrombosis

    PubMed Central

    Brodner, David C.; Cutler, Jeff; Gianoli, Gerard J.; Amedee, Ronald G.

    2000-01-01

    Controversy regarding the use of anticoagulants, the evacuation of the sinus, or the use of medical treatment alone surrounds the treatment of lateral sinus thrombosis. Treatment of an epidural abscess associated with coalescent mastoiditis is much less controversial-drainage is usually recommended. The differing treatments of these complications mandate accurate diagnosis. The advent of more sophisticated radiological studies has facilitated diagnosis of these complications; however, tests are not infallible. We present three cases in which preoperative imaging demonstrates an epidural abscess mimicking lateral sinus thrombosis by compression of the vessel. A false-positive computed tomography (CT) or magnetic resonance imaging (MRI) study may lead to the wrong diagnosis and, consequently, improper treatment. In light of this possibility, we recommend surgical exploration in all such cases. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:17171148

  4. Epidural analgesia and anticoagulant therapy. Experience with one thousand cases of continuous epidurals.

    PubMed

    Odoom, J A; Sih, I L

    1983-03-01

    One thousand lumbar epidural blocks in 950 patients undergoing vascular surgery are reported. All patients were receiving oral anticoagulants pre-operatively. Mean thrombotest (TT) was 19.3% (normal range 70-130%). During surgery intravascular heparin was administered. At the end of surgery, the kaolin cephalin clotting time (KCCT) was 68 (+/- 0.8) seconds (normal range 35-60 seconds), and partial thromboplastin time (PTT) was 536 (77.9%, normal control of 100%). Despite the anticoagulant therapy, no side effects were observed in any patient which could be related to haemorrhage or haematoma formation in the epidural space. It is concluded that, provided adequate precautions are taken, epidural analgesia can be safely used in patients receiving anticoagulant therapy.

  5. Thromboprophylaxis and major oncologic surgery performed with epidural analgesia.

    PubMed

    Shouhed, Daniel; Amersi, Farin; Sibert, Thomas; Sibert, Karen; Hemaya, Emad; Silberman, Allan W

    2013-01-01

    To evaluate clinical outcomes in patients with cancer undergoing major abdominal surgery who received preoperative indwelling epidural catheters (ECs) and no postoperative thromboprophylaxis. Retrospective analysis of a prospective database. Tertiary referral medical center. PATIENTS Between January 1, 2009, and July 31, 2011, 119 patients, with a mean age of 64.5 years (range, 34-95 years), underwent major abdominal oncologic surgery with an indwelling EC. Records of all patients were reviewed for age, duration of surgery, hospital length of stay, and clinical outcomes. All patients underwent lower extremity venous duplex ultrasonography prior to hospital discharge. The average operative time was 338 minutes. Mean (SD) intensive care unit stay was 2.8 (1.4) days (range, 1-7 days). Patients ambulated by postoperative day 1 or 2. Most ECs were removed on postoperative day 4. There were no major complications from the EC. Fifty-two patients (44%) were treated with deep venous thrombosis prophylaxis on postoperative day 4 after removal of the EC. Lower extremity duplex studies showed 8 patients (6.7%) had an acute thrombus. One patient (0.8%) developed an asymptomatic proximal deep venous thrombosis and 7 patients (5.9%) developed distal superficial thrombi. No patient developed a pulmonary embolus. CONCLUSIONS Thromboembolic complications following major abdominal surgery for cancer may be reduced with the use of ECs. Epidural catheters may directly prevent deep venous thrombosis through sympathetic blockade, resulting in increased blood flow to the lower extremities. This effect may also be attributable to earlier ambulation. These results suggest that patients who have an EC and do not receive concurrent postoperative thromboprophylaxis do not have an increased risk for thromboembolic events.

  6. A rare case of paraplegia complicating a lumbar epidural infiltration.

    PubMed

    Thefenne, L; Dubecq, C; Zing, E; Rogez, D; Soula, M; Escobar, E; Defuentes, G; Lapeyre, E; Berets, O

    2010-11-01

    We report the case of a patient who developed paraplegia following a low lumbar epidural steroid injection. Alternative approaches to (or alternative means of) performing transforaminal injections should be considered, in order to avoid devastating neurological complications. A 54-year-old man (who had undergone surgery 14 years earlier to cure an L5-S1 slipped disc with right S1 radiculopathy) presented with low back pain (which had begun 6 weeks previously) and left S1 radiculopathy. During a second infiltration of prednisolone acetate, the patient reported feeling a heat sensation in his legs and concomitantly developed facial flushing. Immediately after the injection, the patient developed complete, flaccid T7 ASIA A motor and sensory paraplegia. Three days later, T2 magnetic resonance imaging (MRI) of the spine revealed a spontaneous hypersignal in the conus medullaris and from T6 to T9, suggesting medullary ischemia. Recovery has been slow; after 4 months of treatment in a physical and rehabilitation medicine department, urinary and sensory disorders are still present (T7 ASIA D paraplegia). The patient can walk 200 m unaided. Three months later, the MRI data had not changed. This is a rare case report of paraplegia following low lumbar epidural infiltration via an interlaminar route. The mechanism is not clear. Most of authors suggest that the pathophysiological basis of this type of complication is ischemia caused by accidental interruption of the medullary blood supply. Direct damage to a medullary artery, arterial spasm or corticosteroid-induced occlusion due to undetected intra-arterial injection could result in medullary infarction. This serious incident should prompt us to consider how to avoid further problems in the future. It also raises the issue of providing patients with information on the risks inherent in this type of procedure. Despite the rarity of this complication, patients should be made aware of its potential occurrence. In the case

  7. Labor epidural analgesia is independent risk factor for neonatal pyrexia.

    PubMed

    Agakidis, Charalampos; Agakidou, Eleni; Philip Thomas, Sumesh; Murthy, Prashanth; John Lloyd, David

    2011-09-01

    To explore whether epidural analgesia (EA) in labor is independent risk factor for neonatal pyrexia after controlling for intrapartum pyrexia. Retrospective observational study of 480 consecutive term singleton infants born to mothers who received EA in labor (EA group) and 480 term infants delivered to mothers who did not receive EA (NEA group). Mothers in the EA group had significantly higher incidence of intrapartum pyrexia [54/480 (11%) vs. 4/480 (0.8%), OR = 15.1, p < 0.0001] and neonatal pyrexia [68/480 (14.2%) vs. 15/480 (3.1%), OR = 5.1, p < 0.0001]. Neonates in the EA group had a median duration of pyrexia of 1 h (maximum 5 h) with a peak temperature within 1 h. Stepwise logistic regression analysis showed that maternal EA was independent risk factor for neonatal pyrexia (>37.5°C) after controlling for intrapartum pyrexia (>37.9°C) and other confounders (OR = 3.44, CI = 1.9-6.3, p < 0.0001). Sepsis work-up was performed significantly more frequently in infants in the EA group [11.7% vs. 2.5%, OR= 5.2, CI = 2.7-9.7, p < 0.0001] with negative blood cultures. EA in labor is an independent risk factor for pyrexia in term neonates. It is unnecessary to investigate febrile offspring of mothers who have had epidurals unless pyrexia persists for longer than 5 h or other signs or risk factors for neonatal sepsis are present.

  8. [Spinal epidural angiolipoma: a case report].

    PubMed

    Dufrenot, Leïla; Pelé, Eric; Cursolle, Jean-Christophe; Coindre, Jean-Michel; Lepreux, Sébastien

    2010-02-01

    Spinal epidural angiolipoma is a rare tumor revealed by a slowly progressive paraplegia. We reported a case of a 44-year-old female and point out the peculiar pattern of this lesion characterized by the prominence of the vascular component over the lipomatous component. Recognition of this entity is important because this is a benign and curable cause of paraplegia. Copyright (c) 2009 Elsevier Masson SAS. All rights reserved.

  9. Comparison of continuous epidural infusion and programmed intermittent epidural bolus in labor analgesia

    PubMed Central

    Lin, Yunan; Li, Qiang; Liu, Jinlu; Yang, Ruimin; Liu, Jingchen

    2016-01-01

    Background This study aims to investigate differences between continuous epidural infusion (CEI) and programmed intermittent epidural bolus (IEB) analgesia for the Chinese parturients undergoing spontaneous delivery and to approach their safety to parturients and neonates. Methods Two hundred healthy American Society of Anesthesiologists class I or II, term (≥37 weeks’ gestation), nulliparous women who requested analgesia for labor were recruited. Epidural analgesia was initiated with a solution of 0.15% ropivacaine 10 mL and maintained with 0.1% ropivacaine mixed with sufentanil 0.3 μg/mL by CEI at a rate of 5 mL/h combined with a patient-controlled epidural analgesia (PCEA) bolus of 5 mL of ropivacaine sufentanil mixture or IEB of 5 mL of ropivacaine sufentanil mixture combined with a PCEA bolus of 5 mL of ropivacaine sufentanil mixture. The lockout interval was 20 minutes in each arm between the CEI and the IEB group. After 20 minutes of first dosage, visual analog scale (VAS) score was obtained every 60 minutes. The maternal and fetal outcome and total consumption of analgesic solution were compared. Results There was no difference in demographic characteristics, duration of first and second stages, delivery methods, sensory block, fetal Apgar scores, and the maternal outcomes between the CEI and IEB groups. There was a significant difference in VAS scores and epidural ropivacaine total consumption between the two groups (IEB vs CEI: 51.27±9.61 vs 70.44±12.78 mg, P<0.01). Conclusion The use of programmed IEB mixed with PCEA improved labor analgesia compared to CEI mixed with PCEA, which could act as maintenance mode for epidural labor analgesia. PMID:27471390

  10. Epidural analgesia in cattle, buffalo, and camels.

    PubMed

    Ismail, Zuhair Bani

    2016-12-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed.

  11. [Epidemiology of complications of obstetrical epidural analgesia].

    PubMed

    Palot, M; Visseaux, H; Botmans, C; Pire, J C

    1994-01-01

    Epidural analgesia (EA) is the best technique to obtain pain relief during labour. But the needle, the catheter and the local anaesthetics (LA) are 3 reasons to cause maternal complications. In France we do not know the exact number of EA performed every year and it is very difficult to appreciate the incidence of maternal complications. Therefore, it is necessary to know it and try to reduce the incidence of some of them. Maternal complications after EA are classically: 1. caused by catheter or needle: massive subarachnoid injection, toxic intravenous injection with convulsions and/or cardiac arrest; 2. secondary to infectious problems: meningitis or epidural abscess; 3. due to LA with the very rare anaphylactoid reactions; 4. due to prolonged neurologic complications with epidural and subdural haematomas, subarachnoid cysts or arachnoiditis. These complications are rare: 1/4,700 in the largest series of literature, involving more than 500,000 EA. In France, we tried to quantify maternal complications among nearly 300,000 EA performed over a period of 5 years. The overall incidence of serious complications was 1/4,005 EA. The most frequent are accidental dural puncture (1/156), massive subarachnoid injections (1/8,010) and convulsions (1/9,011). The incidence of these 3 complications must be reduced by better training, material or attention during bolus injection of LA.

  12. Epidural labour analgesia using Bupivacaine and Clonidine

    PubMed Central

    Syal, K; Dogra, RK; Ohri, A; Chauhan, G; Goel, A

    2011-01-01

    Background: To compare the effects of addition of Clonidine (60 μg) to Epidural Bupivacaine (0.125%) for labour analgesia, with regard to duration of analgesia, duration of labour, ambulation, incidence of instrumentation and caesarean section, foetal outcome, patient satisfaction and side effects. Patients & Methods: On demand, epidural labour analgesia was given to 50 nulliparous healthy term parturients (cephalic presentation), divided in two groups randomly. Group I received bupivacaine (0.125%) alone, whereas Group II received bupivacaine (0.125%) along with Clonidine (60 μg). 10 ml of 0.125% bupivacaine was injected as first dose and further doses titrated with patient relief (Numerical Rating Scale <3). Top ups were given whenever Numerical Rating Scale went above 5. Results: There was statistically significant prolongation of duration of analgesia in Group II, with no difference in duration of labour, ambulation, incidence of instrumentation and caesarean section or foetal outcome. Also clonidine gave dose sparing effect to bupivacaine and there was better patient satisfaction without any significant side effects in Group II. Conclusion: Clonidine is a useful adjunct to bupivacaine for epidural labour analgesia and can be considered as alternative to opioids. PMID:21804714

  13. Epidural analgesia in cattle, buffalo, and camels

    PubMed Central

    Ismail, Zuhair Bani

    2016-01-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed. PMID:28096620

  14. Blood

    MedlinePlus

    ... spans vary from a few days to months. New cells are constantly being formed in the bone marrow. ... the bloodstream and are constantly being replaced by new cells. Blood also contains important proteins called clotting factors , ...

  15. EFFECT OF EPIDURAL ANALGESIA ON LABOR AND ITS OUTCOMES.

    PubMed

    Anwar, Sadia; Anwar, Muhannad Waseem; Ahmad, Sajjad

    2015-01-01

    Epidural analgesia is an effective and popular way to relieve labour pain but it may interfere with normal mechanism of labour. The objective of this study was to evaluate the outcome of labour in women with effective epidural analgesia in terms of duration of labour, mode of delivery and neonatal outcome. This was a quasi-experimental study conducted in the Department of Obstetrics and Gynaecology, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore. One hundred pregnant women were selected by non-probability convenient sampling method. Subjects were divided into two groups of. 50 each as per convenience. Patients of any gravidity at term from 37-41 weeks were included in the sample. Epidural analgesia was applied to group B and distilled water to group A at the lumber region and the progress of labour, mode of delivery and effects on Apgar scores of neonates were evaluated. Out of hundred patients, 77 had normal duration of second stage while 23 had prolonged second stage. Among them, 18 patients (36%) were in epidural group and 5 patients (10%) in non-epidural group, while 4 patients (8%) in epidural group developed intra-partum complications; whereas among non-epidural group had such complications. 65 patients had spontaneous vaginal delivery while 35 patients had instrumental delivery. Among them 29 patients (58%) were in epidural group while only 6 patients (12%) were in non-epidural group. Babies born had Apgar score 5/10 (21.8%), 6/10 (59.4%) and 7/10 (17.8%) at 1 minute and 8/10 (74.3%) and 9/10 (24.8%) at 5 minutes in both groups and none of them needed bag and mask resuscitation. Epidural analgesia does prolong the duration of second stage of labour and increases the instrumental delivery rate. Neonatal outcome is satisfactory while only a few intra-partum complications are found with epidural analgesia.

  16. An evaluation of epidural analgesia following circumferential belt lipectomy.

    PubMed

    Michaud, André-Paul; Rosenquist, Richard W; Cram, Albert E; Aly, Al S

    2007-08-01

    Belt lipectomy combines traditional abdominoplasty with a circumferential excision of skin and fat, with resultant buttock and lateral thigh lifts. Because of the extensive nature of the procedure, postoperative pain management can be difficult. Epidural analgesia has been shown to be efficacious in treating postoperative pain. This study compares the postoperative use of epidural analgesia with more traditional pain management regimens in a large series of belt lipectomy patients. Charts of 62 belt lipectomy patients were examined retrospectively. Postoperative pain control regimen, pain scores, total amount of opioids administered, and side effects encountered were recorded. Twenty-seven patients had traditional pain control regimens, opioids on demand, and pain control pumps. Thirty-five patients received epidural analgesia as their primary mode of postoperative pain control. Pain scores and total nonepidural opioids used were lower in the epidural analgesia group on postoperative days 0 and 1 compared with the nonepidural group. The two groups converged on postoperative days 2 through 5, sharing similar pain scores and opioid use after discontinuation of epidural analgesia. The incidence of side effects was similar in the two groups, with the exception of pruritus, which was much more prominent in the epidural group. Eight of the 35 epidural patients (23 percent) experienced transient and minor complications associated with epidural therapy; several resolved spontaneously, whereas the balance resolved with cessation or modification of the epidural infusion. Epidural analgesia is more effective than traditional pain control methods in reducing immediate postoperative pain in belt lipectomy patients. On the basis of these findings, epidural analgesia should also be considered for postoperative pain management in other truncal procedures.

  17. Mapped Plot Patch Size Estimates

    Treesearch

    Paul C. Van Deusen

    2005-01-01

    This paper demonstrates that the mapped plot design is relatively easy to analyze and describes existing formulas for mean and variance estimators. New methods are developed for using mapped plots to estimate average patch size of condition classes. The patch size estimators require assumptions about the shape of the condition class, limiting their utility. They may...

  18. [Desflurane--general anesthesia for cesarean section compared with isoflurane and epidural anesthesia].

    PubMed

    Navarro, E M

    2000-04-01

    Desflurane 2.5% was compared to Isoflurane 0.5% in a randomized study in terms of maternal and newborn effect on both groups with epidural anesthesia. Fifty patients under general anesthesia were randomly designated to receive either desflurane 2.5% or isoflurane 0.5% maintained in a 50-50% nitrous oxide and oxygen mixture. Twenty-five patients were assigned to receive epidural anesthesia using 15 ml ropivacaine 7.5 mg/ml with fentanyl 100 micrograms. Intraoperative hemodynamic changes, blood loss and maternal awareness were recorded. Apgar scores at 1 and 5 min., neurologic adaptive capacity scores (NACS) at 2 and 24 hours and umbilical vein blood gas analysis were done to assess the neonatal outcome. Intraoperatively, heart rate and blood pressure changes were similar in both desflurane and Isoflurane group at 0.4% MAC (minimal alveolar concentration). Blood loss and arterial blood gas analysis were not problematic and did not differ significantly between the three groups. In the desflurane group, the patients were more easily awake and cooperative compared to the isoflurane group. The patients were interviewed about intraoperative awareness 24 and 48 h after the operation. None of them reported awareness during the operation. Similarly, the level of postoperative comfort was the same in both groups. Comparing the general and epidural anesthetic groups, no differences could be detected in neonatal outcomes. Conclusion is that there is one significant difference between desflurane 2.5% and isoflurane 0.5% anesthesia for cesarean section and it is the rapid recovery characteristic with desflurane which makes it an attractive alternative to TIVA (total intravenous anesthesia) and to other inhalational anesthetics available to obstetric anesthesiologists.

  19. Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

    PubMed Central

    Xu, Zhendong; Su, Jing; Liu, Zhiqiang

    2014-01-01

    Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA) compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0∼180 min) (P<0.0001), and pain scores in the remifentanil group showed an increasing trend one hour later. The remifentanil group had a lower SpO2 (P<0.0001) and a higher sedation score (P<0.0001) within 30 min after treatment. The epidural group had a higher overall satisfaction score (3.8±0.4 vs. 3.7±0.6, P = 0.007) and pain relief score (2.9±0.3 vs. 2.8±0.4, P<0.0001) compared with the remifentanil group. There was no significant difference on side effects between the two groups, except that a higher rate of dizziness (1% vs. 21.8%, P<0.0001) was observed during remifentanil analgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative option for labor analgesia

  20. Topical lidocaine patch 5% for acute postoperative pain control.

    PubMed

    Gilhooly, D; McGarvey, B; O'Mahony, H; O'Connor, T C

    2011-02-08

    A 39-year-old para 3 woman presented for elective caesarean section (lower segment caesarean section (LSCS)) for breech presentation. The patient had a strong history of atopy and anaphylaxis to paracetamol, codeine, penicillin and latex. The patient was asthmatic, triggered by aspirin. Epidural anaesthesia was unsuccessful and LSCS was carried out under spinal anaesthesia. Postoperatively the patient was unwilling to take analgesic medication due to fear of an allergic reaction. Three 5% lidocaine patches were applied to the wound for postoperative analgesia. This reduced the patient's visual analogue scale pain score from 10/10 to 5/10 at rest and 10/10 to 7/10 with movement. Transcutaneous electrical nerve stimulation was added and this improved associated back pain, reducing the pain further to 2/10. This is the first description of lignocaine patch 5% for postoperative LSCS pain. It is suggested that this method of delivery of local anaesthetic, which is easy to apply and has minimal side effects, should be considered not as a sole agent but as part of a multimodal technique to address postoperative LSCS pain.

  1. Minimally invasive treatment of multilevel spinal epidural abscess.

    PubMed

    Safavi-Abbasi, Sam; Maurer, Adrian J; Rabb, Craig H

    2013-01-01

    The use of minimally invasive tubular retractor microsurgery for treatment of multilevel spinal epidural abscess is described. This technique was used in 3 cases, and excellent results were achieved. The authors conclude that multilevel spinal epidural abscesses can be safely and effectively managed using microsurgery via a minimally invasive tubular retractor system.

  2. Extensive spinal epidural abscess as a complication of Crohn's disease.

    PubMed

    Smith, Chez; Kavar, Bhadrakant

    2010-01-01

    A spinal epidural abscess is a neurosurgical emergency. Successful treatment frequently requires decompression of the spinal canal in combination with intravenous antibiotics. We report a patient with Crohn's disease who developed an extensive spinal epidural abscess communicating with an intra-abdominal collection.

  3. Roseomonas spinal epidural abscess complicating instrumented posterior lumbar interbody fusion.

    PubMed

    Maraki, Sofia; Bantouna, Vasiliki; Lianoudakis, Efstratios; Stavrakakis, Ioannis; Scoulica, Efstathia

    2013-07-01

    The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts.

  4. Use of epidural analgesia in post-operative pain management.

    PubMed

    Weetman, Carole; Allison, Wendy

    This article provides an overview of the use of epidural infusion analgesia in the management of patients with post-operative pain. Epidural analgesia is an effective method for relieving pain and has minimal side effects. However, life-threatening complications can occur and nurses need to be able to identify these and provide safe care for patients.

  5. Epidural technique for postoperative pain: gold standard no more?

    PubMed

    Rawal, Narinder

    2012-01-01

    Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in postoperative pain management. However, newer, evidence-based outcome data show that the benefits of epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic epidural analgesia with local anaesthetic drugs only. There is increasing evidence that less invasive regional analgesic techniques are as effective as epidural analgesia. These include paravertebral block for thoracotomy, femoral block for total hip and knee arthroplasty, wound catheter infusions for cesarean delivery, and local infiltration analgesia techniques for lower limb joint arthroplasty. Wound infiltration techniques and their modifications are simple and safe alternatives for a variety of other surgical procedures. Although pain relief associated with epidural analgesia can be outstanding, clinicians expect more from this invasive, high-cost, labour-intensive technique. The number of indications for the use of epidural analgesia seems to be decreasing for a variety of reasons. The decision about whether to continue using epidural techniques should be guided by regular institutional audits and careful risk-benefit assessment rather than by tradition. For routine postoperative analgesia, epidural analgesia may no longer be considered the gold standard.

  6. Subdural Hematoma Associated With Labor Epidural Analgesia: A Case Series.

    PubMed

    Lim, Grace; Zorn, Jamie M; Dong, Yuanxu J; DeRenzo, Joseph S; Waters, Jonathan H

    2016-01-01

    This report aimed to describe the characteristics and impact of subdural hematoma (SDH) after labor epidural analgesia. Eleven obstetric patients had SDHs associated with the use of labor epidural analgesia over 7 years at a tertiary care hospital. Ten of 11 patients had signs consistent with postdural puncture headache before the diagnosis of SDH. Five patients (45%) had a recognized unintentional dural puncture, 1 (9%) had a combined spinal-epidural with a 24-gauge needle, and 5 (45%) had no recognized dural puncture. For 10 of the 11 cases, SDH was diagnosed at a mean of 4.1 days (range, 1-7 days) after performance of labor epidural analgesia; one case was diagnosed at 25 days. Ten (91%) of 11 cases had a second hospital stay for a mean of 2.8 days (range, 2-4 days) for observation, without further requirement for neurosurgical intervention. One case (9%) had decompressive hemicraniectomy after becoming unresponsive. The observed rate of labor epidural analgesia-associated SDH was 0.026% (11 in 42,969, approximately 1:3900), and the rate of SDH was 1.1% (5 in 437, approximately 1:87) if a recognized dural puncture occurred during epidural catheter placement. Subdural hematoma after labor epidural anesthesia is rare but potentially more common than historically estimated. Cases of postdural puncture headache after labor epidural anesthesia should be monitored closely for severe neurologic signs and symptoms that could herald SDH.

  7. Practical tips for modified dorsolumbar epidural anesthesia in cattle

    PubMed Central

    Yamagishi, Norio; Oboshi, Kenji; Sasaki, Naoki; Yamada, Haruo

    2006-01-01

    Segmental dorsolumbar epidural anesthesia has been considered difficult to perform. The purpose of this study was to determine whether or not it is difficult for beginners to learn how to do modified dorsolumbar epidural anesthesia of cattle. Thirty cattle were divided into two groups, young (n = 8) and adult (n = 22), according to their age and body weight, and 0.12% new methylene blue (NMB) was injected into the first interlumbar (L1-L2) epidural space by four fifth-year veterinary school students who had never performed this method. After a 1 hour lecture on the modified dorsolumbar epidural anesthesia procedure which included basic anatomy and skills, each student successfully performed the procedure. In the young group, the NMB solution was distributed between the periosteum and the epidural fat (BPF) in one half and between the epidural fat and the dura mater (BFD) in the other half of the cattle. In about 60% (13/22) of the adult group, the NMB solution distributed as BFD type. This study showed that the modified dorsolumbar epidural anesthesia procedure is easy for beginners to perform if they overcome their fear about the deeper insertion of the epidural needle with basic anatomical knowledge and a little experience. PMID:16434853

  8. Caudal Epidural Block: An Updated Review of Anatomy and Techniques

    PubMed Central

    2017-01-01

    Caudal epidural block is a commonly used technique for surgical anesthesia in children and chronic pain management in adults. It is performed by inserting a needle through the sacral hiatus to gain entrance into the sacral epidural space. Using conventional blind technique, the failure rate of caudal epidural block in adults is high even in experienced hands. This high failure rate could be attributed to anatomic variations that make locating sacral hiatus difficult. With the advent of fluoroscopy and ultrasound in guiding needle placement, the success rate of caudal epidural block has been markedly improved. Although fluoroscopy is still considered the gold standard when performing caudal epidural injection, ultrasonography has been demonstrated to be highly effective in accurately guiding the needle entering the caudal epidural space and produce comparative treatment outcome as fluoroscopy. Except intravascular and intrathecal injection, ultrasonography could be as effective as fluoroscopy in preventing complications during caudal epidural injection. The relevant anatomy and techniques in performing the caudal epidural block will be briefly reviewed in this article. PMID:28337460

  9. Expedition 11 patch

    NASA Image and Video Library

    2005-01-01

    ISS011-S-001 (January 2005) --- The emblem of the eleventh expedition to the International Space Station (ISS) emphasizes the roles of the United States and the Russian Federation in the multinational ISS partnership. The two rocket plumes, in the style of the flags of these two nations, represent the Russian Soyuz vehicles and the American space shuttles. The ISS image shows the configuration of the orbiting station at the start of the expedition, with docked Soyuz and Progress vehicles and the huge American solar panels. The names of the two crew members are shown on the margin of the patch. ISS Commander Sergei Krikalev and John Phillips, NASA ISS science officer and flight engineer, are expected to launch on a Soyuz vehicle and to be in orbit during the return to flight of the space shuttle. The crew explains, “The beauty of our home planet and the vivid contrasts of the space environment are shown by the blue and green Earth with the space station orbiting overhead, and by the bright stars, dark sky, and dazzling sun.” The NASA insignia design for shuttle flights and station increments is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the forms of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, the change will be publicly announced.

  10. Exp 45 Patch - FINALai

    NASA Image and Video Library

    2014-02-05

    ISS045-S-001 (July 2014) --- The Expedition 45 crew will conduct its journey of exploration and discovery from a summit whose foundation was built by past generations of pioneers, scientists, engineers and explorers. This foundation is represented by the book of knowledge at the bottom of the patch. Curves radiate from the book representing the flow of knowledge - and the hard work, sacrifice and innovation that makes human spaceflight possible. The pages written during Expedition 45 will serve to benefit humanity on Earth and in space. The International Space Station is represented by a single bright star soaring over the Earth, illuminating a path to future, more distant destinations. Note: The NASA insignia design for shuttle and space station flights is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the form of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, it will be publicly announced.

  11. STS-121 Mission Patch

    NASA Image and Video Library

    2005-06-01

    STS121-S-001 (June 2005) --- The STS-121 patch depicts the space shuttle docked with the International Space Station (ISS) in the foreground, overlaying the astronaut symbol with three gold columns and a gold star. The ISS is shown in the configuration that it will be in during the STS-121 mission. The background shows the nighttime Earth with a dawn breaking over the horizon. STS-121, ISS mission ULF1.1, is the final Shuttle Return to Flight test mission. This utilization and logistics flight will bring a multipurpose logistics module (MPLM) to the ISS with several thousand pounds of new supplies and experiments. In addition, some new orbital replacement units (ORUs) will be delivered and stowed externally on ISS on a special pallet. These ORUs are spares for critical machinery located on the outside of the ISS. During this mission the crew will also carry out testing of shuttle inspection and repair hardware, as well as evaluate operational techniques and concepts for conducting on-orbit inspection and repair. The NASA insignia design for space shuttle flights is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the forms of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, the change will be publicly announced. Photo credit: NASA

  12. Expedition 12 patch

    NASA Image and Video Library

    2005-09-01

    ISS012-S-001 (September 2005) --- The Expedition 12 patch represents both mankind’s permanent presence in space and future dreams of exploration. The International Space Station (ISS), featured prominently in the center, will continue to grow in its capability as a world-class laboratory and test bed for exploration. The vision of exploration is depicted by the moon and Mars. The star symbolizes mankind's destiny in space and is a tribute to the space explorers who have been lost in its pursuit. The Roman numeral XII in the background signifies the 12th expeditionary mission to the ISS. The NASA insignia design for Shuttle flights and Space Station increments is reserved for use by the astronauts and cosmonauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the form of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, it will be publicly announced.

  13. Bilateral interpleural versus lumbar epidural bupivacaine-morphine analgesia for upper abdominal surgery.

    PubMed

    Demian, Atef D; Wahba, Ashraf M; Atia, Emad M; Hussein, Sami H

    2003-10-01

    This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated.

  14. The direction dependence of thermoregulatory vasoconstriction during isoflurane/epidural anesthesia in humans.

    PubMed

    Ozaki, M; Sessler, D I; McGuire, J; Blanchard, D; Schroeder, M; Moayeri, A

    1993-10-01

    We tested the hypothesis that once thermoregulatory vasoconstriction is triggered at a given core temperature during isoflurane anesthesia, redilation starts at a substantially higher core temperature. To avoid direct perception of cutaneous cooling and warming, we used epidural anesthesia and limited our thermal manipulations to the blocked area. Seven volunteers were anesthetized with isoflurane/epidural anesthesia (approximately T9 dermatomal level). Core hypothermia was induced by surface cooling restricted to the legs. Cooling was continued until fingertip blood flow suddenly decreased (vasoconstriction threshold). The core was then rewarmed by heating the legs until fingertip flow suddenly increased toward initial values (redilation threshold). The difference between the two thresholds defined the direction-dependent hysteresis. Vasoconstriction occurred at 35.2 +/- 0.6 degrees C and vasodilation at 36.2 +/- 0.5 degrees C (P < 0.01, paired t-test); consequently, the hysteresis was 1.0 +/- 0.6 degrees C. The observed hysteresis suggests that thermoregulatory responses during combined isoflurane/epidural anesthesia are not determined simply by instantaneous thermal input to central controllers, but may also depend on the direction of core temperature change.

  15. [Right sensory-motor syndrome as the presentation of a spontaneous cervico-thoracic epidural hematoma].

    PubMed

    Castro, M; Egido, J A; Saldaña, C; Andrés, M T

    1998-10-01

    A spontaneous cervical epidural hematoma is an infrequent cause of cord compression. The commonest clinical presentations are with paraparesia and tetraparesia. Transient hemiparesia is very rare and a sensory-motor syndrome is exceptional. A 38 year old man had sudden onset of spontaneous interscapular vertebral pain with bilateral root radiation. A few minutes later he started to have weakness and sensory loss in his right limbs. On clinical examination there was pain on pressure over the spinal apophyses of the T4 and T5 vertebrae, hemiparesia and hemi-hypoalgesia of the right limbs. After ten hours this had all returned to normal. MRI of the cord showed an epidural hematoma extending from C6 to T2. Coagulation studies and spinal arteriography were normal. The sensory motor syndrome is an unusual form of presentation of a spontaneous cervico-thoracic epidural hematoma. Root pain is a symptom of great value for orientation of a syndrome which would otherwise seem to be of central origin. The explanation for this clinical findings may be compression of both lateral cord pathways due to their particular blood distribution. Regarding therapeutic approach, this should be conservative, with close observation to see whether it will resolve spontaneously in a short period of time.

  16. Epidural anesthesia for cesarean section for pregnant women with rheumatic heart disease and mitral stenosis.

    PubMed

    Wu, Wei; Chen, Qiang; Zhang, Liangcheng; Chen, Wenhua

    2016-07-01

    Pregnancy increases stress on the circulation of parturient with mitral stenosis secondary to rheumatic heart disease and increases the risk of peripartum heart failure, especially during delivery. This study investigated the epidural anesthesia management for cesarean section in pregnant women with rheumatic heart disease and mitral stenosis. 48 parturients with rheumatic heart disease and mitral stenosis that had cesarean section deliveries with epidural anesthesia in the Union Hospital, Fujian Medical University (Fuzhou, China) from Jan 2002 to Dec 2012 were retrospectively analyzed. Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), central venous pressure (CVP), fluid intake volume and fluid output volume (blood loss + urine volume) were analyzed. Medication included digitalis drugs for heart failure or potential heart failure, digoxin and furosemide for chronic congestive heart failure and beta blockers for arrhythmia. Frequent premature ventricular contractions were treated with lidocaine and propafenone. Dexamethasone was administered when heart failure occurred during less than 37 weeks gestation. HR, SAP, DAP, MAP and CVP were significantly increased at the time of delivery. The fluid intake volume was more elevated in the NYHA III-IV group of parturients than the NYHA I-II group, while fluid output volume was less. All parturients survived. Epidural anesthesia was applied successfully for cesarean sections for parturients with rheumatic heart disease and mitral stenosis.

  17. Citrobocter kasori spinal epidural abscess: a rare occurrence.

    PubMed

    Kumar, Ashok; Jain, Pramod; Singh, Pritish; Divthane, Rupam; Badole, C M

    2013-01-01

    Pyogenic spinal epidural abscess Is an uncommon Infectious occurrence. Clinical prospects of pyogenic spinal epidural abscess are graver if not promptly diagnosed and treated appropriately. A case of spinal epidural abscess has been presented with sinus tract formation at L4-L5 level, of pyogenic aetiology that progressed to paraplegia over the course of the disease. MRI pointed towards an epidural abscess extending from T12 vertebral level to S1 vertebral level. Surgical decompression in the form of laminectomy and evacuation of pus was done and antibiotics were given according to culture and sensitivity. Histopathological analysis revealed the acute suppurative nature of the abscess. Citrobacter kasori was isolated on pus culture. Pyogenic epidural abscess with causative organism being Citrobacter kasori has least been documented.

  18. [Spontaneous epidural hematoma after open heart surgery: case report].

    PubMed

    Anegawa, S; Hayashi, T; Furukawa, Y; Nagashima, T; Kumate, M

    1999-11-01

    Acute epidural hematoma not associated with head injury is rarely encountered and is known as spontaneous epidural hematoma. To our knowledge, only five cases with epidural hematoma after open-heart surgery have been published. Pathogenesis and preventive measures have not yet been determined. We report a case of such spontaneous epidural hematoma and consider the possible pathogenesis. A 12-year-old female received a radical operation for severe subaortic stenosis. The intraoperative course was uneventful except for massive hemorrhage which was adequately controlled. Postoperatively, she was moved to the CCU still not having aroused from anesthesia. Eleven hours later, it was found that her pupils were fixed and dilated. CT scan demonstrated a huge bifrontal epidural hematoma with disappearance of the basal cistern. Even though immediate emergency evacuation was performed, the patient died of acute brain swelling four days after the operation.

  19. Effects of 4% Icodextrin on Experimental Spinal Epidural Fibrosis.

    PubMed

    Karanci, Turker; Kelten, Bilal; Karaoglan, Alper; Cinar, Nilgun; Midi, Ahmet; Antar, Veysel; Akdemir, Hidayet; Kara, Zeynep

    2017-01-01

    The aim of this experimental study was to investigate whether spinal epidural 4% glucose polymer solution is effective in the prevention of postoperative fibrosis. Twenty eight adult Wistar albino rats were randomly divided into two equal groups, including treatment and control. Both groups underwent L1 vertebral total laminectomy to expose the dura. Topical treatment group received 4% icodextrin. Four weeks later, epidural fibrosis was examined in both groups histologically, biochemically and macroscopically. Topical use of 4% icodextrin prevented significantly epidural fibrosis following the laminectomy operation. Topical 4% icodextrin application inhibits postoperative epidural fibrosis with various mechanisms and prevents adhesions by playing barrier role between tissue surfaces through flotation. Our study is first to present evidence of experimental epidural fibrosis prevention with 4% icodextrin.

  20. Acute onset headache complicating labor epidural caused by intrapartum pneumocephalus.

    PubMed

    Smarkusky, Loren; DeCarvalho, Helena; Bermudez, Ady; González-Quintero, Víctor Hugo

    2006-09-01

    Epidural placement for obstetric anesthesia is a common procedure. Pneumocephalus, the introduction of air into the cranial cavity after epidural placement, is a rare complication encountered when air is used for identification of the epidural space. A 42-year-old primipara undergoing epidural placement reported sudden onset of severe headache with associated neurologic symptoms and nuchal rigidity. Emergent CT scan revealed pneumocephalus. With conservative management, her symptoms resolved with interval resumption of the air collection evidenced on interval CT. Acute onset headache after epidural placement can present with impressive neurologic signs and symptoms. Prompt identification of the cause of this pathology is of vital importance to delineate pneumocephalus from potentially treatable or life-threatening disorders.

  1. Epidural catheter anchored in the posterior lateral epidural space: How to manage it.

    PubMed

    Costa, C; Fonseca, S; Guedes, L; Leão, A; Sousa, A

    2017-07-27

    We describe a case of an epidural catheter entrapment without knotting, kinking, shearing or breakage confirmed by CT scan and how to manage it. A patient was admitted for tibial fracture repair under general anesthesia with an epidural. At discharge day, multiple attempts to retrieve the catheter were made. Contrast CT scan showed the catheter anchored in the left posterior-lateral epidural space. Despite the absence of guidelines regarding epidural catheter entrapment, all the methods described in the literature were used. This is a rare complication and it may be associated with neurological and infectious complications. Radiologic imaging should be obtained to better characterize the catheters' position and plan removal. In this case, tension in the paraspinal muscles or in the supraspinous and intraspinous ligaments could explain the entrapment. General anesthesia with the non-depolarising muscle relaxant allowed muscles and ligaments to relax and we were able to retrieve the catheter intact. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Paraplegia after epidural-general anesthesia in a Morquio patient with moderate thoracic spinal stenosis

    PubMed Central

    Krane, Elliot J.; Tomatsu, Shunji; Theroux, Mary C.; Lee, Roland R.

    2014-01-01

    Purpose We describe an instance in which complete paraplegia was evident immediately postoperatively after apparently uneventful lumbar epidural-general anesthesia in a patient with Morquio Type A syndrome (Morquio A) with moderate thoracic spinal stenosis. Clinical features A 16-yr-old male with Morquio A received lumbar epidural-general anesthesia for bilateral distal femoral osteotomies. Preoperative imaging had revealed a stable cervical spine and moderate thoracic spinal stenosis with a mild degree of spinal cord compression. Systolic blood pressure (BP) was maintained within 20% of the pre-anesthetic baseline value. The patient sustained a severe thoracic spinal cord infarction. The epidural anesthetic contributed to considerable delay in the recognition of the diagnosis of paraplegia. Conclusion This experience leads us to suggest that, in patients with Morquio A, it may be prudent to avoid the use of epidural anesthesia without very firm indication, to support BP at or near baseline levels in the presence of even moderate spinal stenosis, and to avoid flexion or extension of the spinal column in intraoperative positioning. If the spinal cord/column status is unknown or if the patient is known to have any degree of spinal stenosis, we suggest that the same rigorous BP support practices that are typically applied in other patients with severe spinal stenosis, especially stenosis with myelomalacia, should apply to patients with Morquio A and that spinal cord neurophysiological monitoring should be employed. In the event that cord imaging is not available, e.g., emergency procedures, it would be prudent to assume the presence of spinal stenosis. PMID:25323122

  3. Decrease in serum potassium concentration during epidural anaesthesia.

    PubMed

    Hahn, R G

    1987-11-01

    A mean decrease in the arterial serum potassium concentration (S-K) of 0.40 mmol/l (range 0-1.0) was found in 45 elderly men who were studied before and after induction of epidural anaesthesia (using mepivacaine 2% with adrenaline). The decrease was similar in patients who received acetated Ringer solution or dextran 40 in normal saline as intravenous fluid supplementation. No difference in S-K change was found between patients with a normal (less than 115 mumol/l) or elevated serum creatinine concentration. The decrease in S-K prevailed at the end of surgery except in patients with an elevated serum creatinine. Corrections of S-K for changes in arterial blood pH and rectal temperature during induction of anaesthesia did not explain the decrease in S-K. Correlations of clinical parameters such as the extension of anaesthesia, amount of intravenous fluid given and blood pressure changes gave conflicting results. A smaller decrease or no change in S-K was usually seen in arterial (n = 7) and venous (n = 7) samples when no intravenous fluid was given, as well as in venous samples when acetated Ringer solution was given (n = 6).

  4. Spinal epidural abscess presenting as intra-abdominal pathology: a case report and literature review.

    PubMed

    Bremer, Andrew A; Darouiche, Rabih O

    2004-01-01

    Spinal epidural abscess is a rare infectious disease. However, if left unrecognized and untreated, the clinical outcome of spinal epidural abscess can be devastating. Correctly diagnosing a spinal epidural abscess in a timely fashion is often difficult, particularly if the clinician does not actively consider the diagnosis. The most common presenting symptoms of spinal epidural abscess include backache, radicular pain, weakness, and sensory deficits. However, early in its course, spinal epidural abscess can also present with vague and nondescript manifestations. In this report, we describe a case of spinal epidural abscess presenting as abdominal pain, and review the literature describing other cases of spinal epidural abscess presenting as intra-abdominal pathology.

  5. The experience of giving birth with epidural analgesia.

    PubMed

    Jepsen, Ingrid; Keller, Kurt Dauer

    2014-06-01

    There is a lack of literature about what constitutes good midwifery care for women who have epidural analgesia during labour. It is known that an increasing number of women receive epidural analgesia for labour pain. We also know that while women rate the painkilling effect of the epidural analgesia as high, in general, their satisfaction with labour is unchanged or even lower when epidural analgesia is used. How do women experience being in labour with epidural analgesia, and what kind of midwifery care do they, consequently, need? A field study and semi-structured interviews were conducted on a phenomenological basis. Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby. They were interviewed the day after the birth and again 2 months later. The involved midwives were interviewed 2-3h after the birth. Initiation of epidural analgesia can have considerable implications for women's experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence. Another important finding refers to the labouring woman's relationship with the midwife, which represents an essential influencing factor on the woman' experience of labour. Within this relationship, some rather unnoticed matters of communication and recognition appear to be of decisive significance. After initiation of epidural analgesia the requirements of midwifery care seem to go beyond how women verbalise and define their own needs. The midwife should be attentive to the labouring woman's type of emotional reaction to epidural analgesia and her possible intricate worries. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  6. Epidural analgesia during labor vs no analgesia: A comparative study

    PubMed Central

    Mousa, Wesam Farid; Al-Metwalli, Roshdi; Mostafa, Manal

    2012-01-01

    Background: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. Methods: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. Results: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Conclusion: Epidural analgesia by lidocaine (0.5%) and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration. PMID:22412775

  7. Formulation study of oxybutynin patches.

    PubMed

    Minghetti, Paola; Cilurzo, Francesco; Pagani, Stefania; Casiraghi, Antonella; Assandri, Riccardo; Montanari, Luisa

    2007-01-01

    The present feasibility study was designed to obtain a monolayer patch containing oxybutynin (OXY) avoiding chemical permeation enhancers. The highest flux was obtained with a polydimethylsiloxane matrix patch. Because OXY crystals were detected in the matrix within a week, two amino methylmethacrylate copolymers (Eudragit E or Eudragit RS) were used as OXY crystallization inhibitors. A preliminary in vivo study indicated that flux from the stabilized patches had to be increased about 30-40%. This goal was reached by occlusion with a polyethylene layer.

  8. Comparative evaluation of epidural bupivacaine – dexmedetomidine and bupivacaine –fentanyl on Doppler velocimetry of uterine and umbilical arteries during labor

    PubMed Central

    Selim, Mohamed Fouad; Elnabtity, Ali Mohamed Ali; Hasan, Ali Mohamed Ali

    2012-01-01

    Summary Objective uteroplacental blood flow is affected by myometrial contractions and hypotension. Epidural analgesia is frequently complicated by hypotension. The aim of the study was to compare the effect of bupivacaine-dexmedetomidine (BD) or bupivacaine – fentanyl (BF) on uterine artery pulsatitly index (UtA-PI) and umbilical artery pulsatitly index (UA-PI) during uterine contractions and relaxations. Methods this was a prospective controlled observational study performed in 130 healthy full term parturients divided into 3 groups [23 cases as control, 44 cases as (BD) epidural group and 43 cases as (BF) epidural group]. Over the study duration of 120 minutes; UtA-PI and UA-PI were measured at baseline, 30, 60, 120 minutes during uterine contractions and relaxations. Maternal hemodynamic, visual analogue scale (VAS), sedation score, side effects of epidural analgesia including nausea, vomiting, pruritis and respiratory depression were assessed. Results VAS significantly decreased after epidural compared with control group. BD group showed significant improvement in onset and duration of analgesia and sedation scores with lower incidence of nausea and pruritis compared with BF group. The BF and BD groups were associated with significant maternal hypotension and bradycadia that increase the UtA-PI during uterine contractions and relaxations compared with control group. UA-PI was increased with uterine contractions compared with during uterine relaxations in the three studied groups yet the effect of epidural and uterine contractions does significantly affect newborns apgar scores or umbilical cord pH. Conclusion bupivacaine-dexmedetomidine epidural analgesia showed better maternal satisfaction for labor pains control compared with bupivacaine – fentanyl without deleterious effect on utroplacental circulation and newborns outcome. PMID:23181173

  9. Creation of polar cap patches

    NASA Astrophysics Data System (ADS)

    Hosokawa, K.; Taguchi, S.; Ogawa, Y.

    2014-12-01

    Polar cap patches, which are islands of enhanced plasma density drifting anti-sunward, are one of the outstanding phenomena in the polar cap F region ionosphere. In the last decade, data from all-sky airglow imagers have been extensively used for better understanding the propagation of patches in the central polar cap region. But still, it has been rather difficult to capture the birth of patches in their generation region near the dayside cusp, because, in most places, the dayside part of the polar cap ionosphere is sunlit even in winter. In Longyearbyen (78.1N, 15.5E), Norway, however, optical observations are possible near the dayside cusp region in a limited period around the winter solstice. This enables us to directly image how polar cap patches are born in the cusp. In this paper, we present a few intervals of daytime optical observations, during which polar cap patches were generated within the field-of-view of an all-sky imager in Longyearbyen. During all the intervals studied here, we identified several signatures of poleward moving auroral forms (PMAF) in the equatorward half of the field-of-view, which are known as ionospheric manifestations of dayside reconnection. Interestingly, patches were directly produced from such poleward moving auroral signatures and propagated poleward along the anti-sunward convection near the cusp. In the literature, Lorentzen et al. (2012) first reported such a direct production of patches from PMAFs. During the current observations, however, we succeeded in tracking the propagation of patches until they reached the poleward edge of the field-of-view of the imager. This confirms that the faint airglow structures produced from PMAFs were actually transported for a long distance towards the central polar cap area; thus, polar cap patches were produced. From this set of observations, we suggest that polar cap patches during moderately disturbed conditions (i.e, non-storm time conditions) can be directly produced by the

  10. Formulation Optimization of Arecoline Patches

    PubMed Central

    Wu, Pao-Chu; Tsai, Pi-Ju; Lin, Shin-Chen; Huang, Yaw-Bin

    2014-01-01

    The response surface methodology (RSM) including polynomial equations has been used to design an optimal patch formulation with appropriate adhesion and flux. The patch formulations were composed of different polymers, including Eudragit RS 100 (ERS), Eudragit RL 100 (ERL) and polyvinylpyrrolidone K30 (PVP), plasticizers (PEG 400), and drug. In addition, using terpenes as enhancers could increase the flux of the drug. Menthol showed the highest enhancement effect on the flux of arecoline. PMID:24707220

  11. Formulation optimization of arecoline patches.

    PubMed

    Wu, Pao-Chu; Tsai, Pi-Ju; Lin, Shin-Chen; Huang, Yaw-Bin

    2014-01-01

    The response surface methodology (RSM) including polynomial equations has been used to design an optimal patch formulation with appropriate adhesion and flux. The patch formulations were composed of different polymers, including Eudragit RS 100 (ERS), Eudragit RL 100 (ERL) and polyvinylpyrrolidone K30 (PVP), plasticizers (PEG 400), and drug. In addition, using terpenes as enhancers could increase the flux of the drug. Menthol showed the highest enhancement effect on the flux of arecoline.

  12. Does epidural increase the incidence of cesarean delivery or instrumental labor in Saudi populations?

    PubMed

    Bakhamees, Hassan; Hegazy, Esmat

    2007-10-01

    This is a retrospective review of the medical records of 861 patients admitted for vaginal delivery. Patients were randomized to either epidural analgesia or other analgesic methods of pain relief for labor pains. The primary purpose of this study was to evaluate the effect of epidural analgesia on the rate of cesarean section delivery. 861 patients were admitted to Saad Specialist Hospital for vaginal delivery between May 1, to September 30, 2006. Patients were divided into Nulliparous (334 patients) and Multiparous (527 patients) populations. Each population was then divided into two groups, epidural and non-epidural group. Epidural analgesia was initiated by a bolus of bupivacaine 0.25% (6 to 10 ml) plus fentanyl (50 to 100 microg), followed by bupivacaine 0.125% plus fentanyl (1 to 2 microg/ml) at the rate of (6 to 12 ml/h). Non-epidural analgesia was initiated by one or mixture of I.M meperidine 50 to 100 mg I.M, promethazine hydrochloride 25 mg, or Ontonox inhalers. In the Nulliparous population a total of 57 patients requested epidural (the epidural gp), while 277 patients received other analgesic methods (the non-epidural gp). There was no difference in the rate of cesarean section deliveries between the two analgesia groups (12 patients of 57 in the epidural group (21.1%), versus 61 patients of 277 (22%) in the non-epidural gp). In the Multiparous population, a total of 49 patients requested epidural analgesia (epidural gp), while 478 patients received other analgesic methods (the non-epidural gp). There was no difference in the rate of cesarean section deliveries between the two analgesia groups (5 of 49 patients (10.2%) in the epidural group compared to 39 of 478 patients (8.2%) in the non-epidural gp). Significantly, more patients in the epidural group had forceps or vacuum assisted deliveries compared to the other analgesia group (the non-epidural gp). This was evident in both the Nulliparous population (7 of 57 patients in the epidural gp (12

  13. Sonographic evaluation of epidural and intrathecal injections in cats.

    PubMed

    Otero, Pablo E; Verdier, Natali; Zaccagnini, Andrea S; Fuensalida, Santiago E; Sclocco, Matias; Portela, Diego A; Waxman, Samanta

    2016-11-01

    To describe the ultrasonographic anatomy of the caudal lumbar spine in cats and to detect ultrasound (US) signs associated with epidural or intrathecal injection. Prospective, clinical study. Twenty-six client-owned cats. Transverse (position 1) and parasagittal (position 2) two-dimensional US scanning was performed over the caudal lumbar spine in all cats. Midline distances between the identified structures were measured. Cats assigned to epidural injection (group E, n = 16) were administered a bupivacaine-morphine combination confirmed by electrical stimulation. Cats assigned to intrathecal injection (group I, n = 10) were administered a morphine-iohexol combination injected at the lumbosacral level and confirmed by lateral radiography. The total volume injected (0.3 mL kg(-1) ) was divided into two equal aliquots that were injected without needle repositioning, with the US probe in positions 1 and 2, respectively. The presence or absence of a burst of color [color flow Doppler test (CFDT)], dural sac collapse and epidural space enlargement were registered during and after both injections. US scanning allowed measurement of the distances between the highly visible structures inside the spinal canal. CFDT was positive for all animals in group E. In group I, intrathecal injection was confirmed in only two animals, for which the CFDT was negative; seven cats inadvertently and simultaneously were administered an epidural injection and showed a positive CFDT during the second aliquot injection, and the remaining animal was administered epidural anesthesia and was excluded from the CFDT data analysis. Dural sac collapse and epidural space enlargement were present in all animals in which an epidural injection was confirmed. US examination allowed an anatomical description of the caudal lumbar spine and real-time confirmation of epidural injection by observation of a positive CFDT, dural sac collapse and epidural space enlargement. © 2016 Association of

  14. Cervical epidural steroid injections and spinal cord injuries.

    PubMed

    Schreiber, Adam L; McDonald, Brian P; Kia, Farid; Fried, Guy W

    2016-10-01

    Cervical interlaminar and transforaminal epidural steroid injections have been increasingly performed as a medical interventional treatment for pain. This study aimed to examine if there was increasing proportion of cervical spinal cord injured acute rehabilitation hospital admissions related to cervical epidural injections because of increased use of the procedure. Additionally, this study aimed to determine risk factors that may have made these patients known higher risk premorbidly. A retrospective chart review was carried out. The sample was from a 2001 to 2008 spinal cord-related injuries admitted to Magee Rehabilitation (2,770). A total of 1,343 patients were classified as having acute spinal cord injuries (SCIs). Of these patients, seven cases of SCI occurred after cervical epidural injections. Chart data regarding characteristics of patients and proportion of SCI admissions to cervical epidural injections injuries were the outcome measures. Parameters analyzed included age, sex, American Spinal Injury Association Impairment Scale on admission, mechanism of injury, presenting symptoms, time of onset, and risk factors. Proportion of SCI admissions to cervical epidural injections injuries was also analyzed. From the years 2001 to 2008, there were seven admissions for such injury with no change in the proportion of SCIs from cervical epidural injections relative to all SCIs. All were incomplete and mechanisms included anterior cord infarction (1), intraparenchymal injection (1), epidural abscess (2), contusion (1), epidural hematoma (1), and unknown (1). Presenting symptoms included hypotension, respiratory distress, chest pain, upper limb numbness, paresthesias, weakness, and fever. Symptom onset ranged from minutes to 72 hours after injection. Although there is an increased use of interventional spine procedures to treat pain, this did not increase the proportion of cervical epidural-related SCI admissions. Additional research is needed to advocate reporting

  15. Demonstration of an instrumented patch

    NASA Astrophysics Data System (ADS)

    Martinez, M.; Renaud, G.; Backman, D.; Genest, M.; Delannoy, M.

    2007-04-01

    The primary objective of this study was to demonstrate the effectiveness of various strain measurement techniques at detecting the disbonding of a composite repair patch and then using this information to validate a new capacitance based disbond detection technique. The instrumented repair patch was parametrically designed with the help of Finite Element Analysis (FEA) software to have a stress concentration at its tip. This stress concentration was designed to produce a disbond during fatigue testing, without the need for the introduction of any foreign material to create an artificial disbond condition. The aluminum substrate was grit blasted and the instrumented patch was bonded using FM ®73 adhesive, and was cured following the recommendations of the manufacturer. The geometric characteristics of the patch followed standard repair guidelines for such variables as material selection, taper angles and loading conditions, with the exception of the area designed for premature disbond. All test specimens were inspected using non-destructive testing technique (ultrasound pulse echo) to guarantee that no disbonding had occurred during curing of the specimen. The specimens were placed under fatigue loading to induce a disbond condition between the aluminum substrate and the patch. The specimens were cyclically loaded and strain gauges bonded to strategic locations on the aluminum and composite patch surface to be able to measure changes in surface strains as the disbond progressed. A Digital Image Correlation (DIC) system was also used to measure full field strains over the gauge length of the coupon. The DIC results were compared with the strain gauge data and were used to provide a qualitative measure of the load transfer in the bonded specimen, which clearly demonstrated the change in surface strain that occurred as the composite patch disbonded from the aluminum substrate. Thermoelastic Stress Analysis (TSA) was also used to measure surface strains on the

  16. Spinal epidural abscess successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy: case report and review of the literature.

    PubMed

    Lyu, Rong-Kuo; Chen, Chi-Jen; Tang, Lok-Ming; Chen, Sien-Tsong

    2002-08-01

    We describe a case of a posterior spinal epidural abscess that was successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy. A 48-year-old man experienced acute pain in the paralumbar region for 1 week, followed by gait disturbance and micturition difficulty. Laboratory studies demonstrated leukocytosis and hyperglycemia. Blood cultures yielded Staphylococcus aureus. Magnetic resonance imaging scans of the thoracolumbar spine revealed a posterior spinal epidural abscess located between L2 and the lower cervical spine. The patient's low back pain persisted despite 10 days of antibiotic therapy. Therefore, percutaneous, computed tomography-guided, needle aspiration was performed. The low back pain was relieved dramatically and immediately after the procedure. The spinal epidural abscess completely resolved after 6 weeks of antibiotic treatment. Surgical decompression and antibiotic therapy are the treatments of choice for patients with spinal epidural abscesses. Selected patients may be treated nonsurgically. Rarely, percutaneous drainage of the abscess has been reported to be helpful. Our case suggests that percutaneous, computed tomography-guided, needle aspiration might be a rational alternative to surgical decompression for treatment of spinal epidural abscesses.

  17. Congenital dilation of the cervical epidural venous plexus: neuroradiology and endovenous management.

    PubMed

    Rodiek, S O; Schmidhuber, H; Lumenta, C B

    1999-06-01

    We report a case of a 15-year-old girl suffering from cervicobrachialgia who was admitted to our service due to an enlarged neural foramen suspicious for a neurinoma. The cervical phlebography, however, revealed a space-occupying dilated epidural vein with increased blood supply from the suboccipital venous plexus. Lesions like this are absolutely rare, presumably of congenital origin and have not been described before. The lesion was treated by feeder occlusion applying platinum coils and enbucrilate via the internal jugular vein.

  18. How I do it: epidural anterior petrosectomy.

    PubMed

    Roche, Pierre-Hugues; Lubrano, Vincent F; Noudel, Rémy

    2011-06-01

    Among the potential approaches to access the petroclival area, epidural anterior petrosectomy (EAP) appears to be the most direct and conservative transpetrous route. In this article, we aim to detail the relevant surgical steps necessary to perform EAP in a reproducible and safe manner. The temporo-pterional bone flap is tailored to access the floor of the middle fossa and expose the foramen ovale and foramen spinosum. Elevation of the dura covering the upper surface of the petrous apex is conducted medially toward the level of the petrous ridge. Identification of the landmarks of the rhomboid fossa delineates the limits of the drilling zone (necessary for removal of the petrous apex)-beneath Meckel's cave and just anterior to the anterior margin of the internal auditory meatus. The tentorium is divided at its free edge and is followed by opening of the posterior fossa dura. Epidural anterior petrosectomy is a conservative trans-petrous approach that offers an excellent direct surgical corridor for exposure of disease processes involving Meckel's cave, the petroclival area and the ventrolateral pons.

  19. The efficacy and safety of epidural filter catheters when used for post-operative intra-articular anaesthesia.

    PubMed

    Reston, S C; Basanagoudar, P; McNair, A D; Deakin, A H; Kinninmonth, A W G

    2016-01-01

    There are concerns about the risk of iatrogenic infection when employing local anaesthetic techniques with post-operative intra-articular infusions in total knee arthroplasty. This study aimed to determine the efficacy of intact epidural filters in preventing transit of bacteria and to develop a technique of administration which would prevent membrane rupture. Filter efficacy was assessed using a standardised test suspension of Pseudomonas aeruginosa. Twenty millilitres of suspension was injected through isolated epidural filters (n=10) or filters with 40cm of catheter tubing attached (n=30). For each filter, injections were carried out at 0, 8 and 24h. Filtrates were collected, incubated, sub-cultured onto Columbia horse blood agar and examined for bacterial growth. Three delivery techniques were tested: manually controlled syringe with 5ml of water at 20ml/min, forced administration syringe with 5ml of water at >240ml/min and an automated syringe driver delivering 40ml of water at 6.7ml/min. For the two techniques using syringes, three syringe sizes, 5ml, 10ml and 20ml, were tested. Each test condition was carried out on 10 filters (total n=70). Filters were examined for rupture. Intact epidural filters prevented bacterial transit in all cases. Manual controlled and automated syringe driver administration generated no filter ruptures. Manual forced administration generated 93% filter rupture. Ruptures occurred at peak pressures of approximately 620kPa. Epidural filters can be used to prevent bacterial transit. These results suggest automated devices remove the risk of filter rupture. This study is relevant to all specialties that utilise these filters during infiltration such as epidurals or other regional anaesthetic techniques. This study identified that filters are prone to rupture with high infusion rates and that manual techniques are particularly vulnerable. From these results, it is recommended that pumps are used to minimise risk of filter rupture

  20. A randomized trial of dural puncture epidural technique compared with the standard epidural technique for labor analgesia.

    PubMed

    Cappiello, Eric; O'Rourke, Nollag; Segal, Scott; Tsen, Lawrence C

    2008-11-01

    We designed this prospective, double-blind, randomized study to examine whether a dural puncture without intrathecal drug administration immediately before epidural drug administration would improve labor analgesia when compared to a traditional epidural technique without prior dural puncture. Eighty nulliparous parturients with cervical dilation less than 5 cm were randomly assigned to receive a standardized epidural technique, with or without a single dural puncture with a 25-gauge (G) Whitacre spinal needle. After successful placement of the needle(s) and the epidural catheter, 12 mL of bupivacaine 2.5 mg/mL was administered through the epidural catheter and a patient-controlled epidural infusion of bupivacaine 1.25 mg/mL + fentanyl 2 mug/mL was initiated. The presence of sacral analgesia (S1) and pain scores were compared between groups. In demographically similar groups, parturients with prior dural puncture had more frequent blockade of the S1 dermatome (absolute risk difference [95% confidence interval] 22% [6-39]), more frequent visual analog scale scores <10/100 at 20 min (absolute risk difference 20% [1-38]), and reduced one-sided analgesia (absolute risk difference [95% CI] 17% [2-330]). The highest median sensory level (T10) was no different between groups. Dural puncture with a 25-G spinal needle immediately before the initiation of epidural analgesia improves the sacral spread, onset, and bilateral pain relief produced by analgesic concentrations of bupivacaine with fentanyl in laboring nulliparous patients.

  1. Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement

    PubMed Central

    Greene, Nathaniel H.; Cobb, Benjamin G.; Linnau, Ken F.; Kent, Christopher D.

    2015-01-01

    Background. Thoracic epidural catheters provide the best quality postoperative pain relief for major abdominal and thoracic surgical procedures, but placement is one of the most challenging procedures in the repertoire of an anesthesiologist. Most patients presenting for a procedure that would benefit from a thoracic epidural catheter have already had high resolution imaging that may be useful to assist placement of a catheter. Methods. This retrospective study used data from 168 patients to examine the association and predictive power of epidural-skin distance (ESD) on computed tomography (CT) to determine loss of resistance depth acquired during epidural placement. Additionally, the ability of anesthesiologists to measure this distance was compared to a radiologist, who specializes in spine imaging. Results. There was a strong association between CT measurement and loss of resistance depth (P < 0.0001); the presence of morbid obesity (BMI > 35) changed this relationship (P = 0.007). The ability of anesthesiologists to make CT measurements was similar to a gold standard radiologist (all individual ICCs > 0.9). Conclusions. Overall, this study supports the examination of a recent CT scan to aid in the placement of a thoracic epidural catheter. Making use of these scans may lead to faster epidural placements, fewer accidental dural punctures, and better epidural blockade. PMID:25628654

  2. Effect of different types of anesthesia on intraoperative blood glucose of diabetic patients

    PubMed Central

    Li, Xueqiong; Wang, Jinjing; Chen, Kang; Li, Yijun; Wang, Haibin; Mu, Yiming; Chen, Yaolong

    2017-01-01

    Abstract Background: Systematic review which analyzes the impact of different anesthesia on intraoperative blood glucose levels of diabetes patients. Methods: We searched Medline (via PubMed), Embase, Cochrane Library, Web of Science, Wangfang, CNKI, and CBM database through June 2016, included in randomized controlled trial (RCT), about different anesthesia on intraoperative blood glucose levels in patients with diabetes. Two researchers in 1 group independently screened literatures with eligibility criteria, extracted information, and used RevMan5.3 software to perform meta-analysis. Results: We included 11 trials and performed the meta-analysis with 10 trials. The meta-analysis results suggested that compared with general anesthesia, the combined general-epidural anesthesia has a better glycemic control in intraoperative blood glucose levels (WMD −1.26, 95% confidence interval [CI] −1.77 to 0.76), the epidural anesthesia had no significant effects compared with general anesthesia (WMD −0.74, 95% CI 4.41–2.92), and the combined spinal-epidural anesthesia had no significant effects compared with epidural anesthesia (WMD −0.28, 95% CI −1.02 to 0.46). One study suggested that compared with epidural anesthesia, the combined general-epidural anesthesia can lower blood glucose levels Conclusion: Existing evidence showed that compared with general anesthesia, the combined general-epidural anesthesia has a better glycemic control in intraoperative blood glucose levels. PMID:28353577

  3. Microneedle Patches as Drug and Vaccine Delivery Platform.

    PubMed

    Li, Junwei; Zeng, Mingtao; Shan, Hu; Tong, Chunyi

    2017-01-01

    Transcutaneous delivery is the ideal method for delivering therapeutic reagents or vaccines into skin. With their promise of self-administration, cost-effective and high efficiency, microneedle patches have been studied intensively as therapeutic and vaccination delivery platform that replaces injection by syringe. This review aims to summarize the recent advancements of microneedle patches in application for drugs and vaccine delivery. We reviewed the most of recently published papers on microneedle patches, summarized their evolution, classification, state-of the-art capabilities and discussed promising application in drugs and vaccine delivery. With the rapid development of nanotechnology, microneedle patches have been improved by switching from undissolving to dissolving microneedles, and their safety has also improved dramatically. As a drug delivery tool, microneedle patches can deliver bioactive molecular of different physical size. Additionally, microneedle patches can be coated or encapsulate with DNA vaccine, subunit antigen, inactivated or live virus vaccine. Combining clinical results with the results of patient interview, microneedle patches are found to be feasible and are predicated to soon be acceptable for the medical service. In this review, we summarized the evolution, current and future application of microneedle patches as delivery vehicle for drugs and vaccines. Compared with traditional delivery tools, microneedle patches have many advantages, such as providing pain-free, non-invasive, convenient route for reagent administration and delivery, with no cold chain required for storage and transportation as well as decreasing sharp medical waste, needle-caused injury and transmission of blood-borne infectious disease in rural area. However, even though there are dramatic progress in preclinical investigation of microneedle patches, further testing will be required for clinical application. Further research should be implemented in multiple fields

  4. Single dose pharmacokinetics of the novel transdermal donepezil patch in healthy volunteers

    PubMed Central

    Kim, Yo Han; Choi, Hee Youn; Lim, Hyeong-Seok; Lee, Shi Hyang; Jeon, Hae Sun; Hong, Donghyun; Kim, Seong Su; Choi, Young Kweon; Bae, Kyun-Seop

    2015-01-01

    Background Donepezil is an acetylcholinesterase inhibitor indicated for Alzheimer’s disease. The aim of this randomized, single-blind, placebo-controlled, single-dose, dose-escalation study was to investigate the safety, tolerability, and pharmacokinetics of the donepezil patch in healthy male subjects. Methods Each healthy male subject received a single transdermal donepezil patch (72 hours patch-on periods) of 43.75 mg/12.5 cm2, 87.5 mg/25 cm2, or 175 mg/50 cm2. Serial blood samples were collected up to 312 hours after patch application. The plasma concentrations of donepezil were determined by using a validated liquid chromatography–tandem mass spectrometry method. Pharmacokinetic parameters were obtained by noncompartmental analysis. Tolerability of the patches and performance of the patches (adhesion, skin irritation, residual donepezil content in the patch) were assessed throughout the study. Results The study was completed by 36 healthy subjects. After patch application, the maximal plasma donepezil concentration (Cmax) and the area under the curve (AUC) increased in a dose-proportional manner. Median time to Cmax was ~74–76 hours (~2–4 hours after patch removal), and mean t1/2β was ~63.77–93.07 hours. The average donepezil residue in the patch after 72 hours was ~73.9%–86.7% of the loading dose. There were neither serious adverse events nor adverse events that lead to discontinuation. Skin adhesion of the patch was good in 97.2% of the subjects. All skin irritations after patch removal were mild and were resolved during the study period. Conclusion The donepezil patch appeared to be generally well tolerated and adhesive. Pharmacokinetic analysis of the donepezil patch demonstrated linear kinetics. PMID:25792802

  5. Epidural Steroid Injection Complicated by Intrathecal Entry, Pneumocephalus, and Chemical Meningitis.

    PubMed

    Shah, Aakash Kaushik; Bilko, Andrey; Takayesu, James Kimo

    2016-09-01

    Epidural steroid injections are frequently used to treat back and extremity pain. The procedure is generally safe, with a low rate of adverse events, including intrathecal entry, pneumocephalus, and chemical meningitis. We report a case of a 45-year-old woman who presented to the emergency department (ED) with headache, nausea, vomiting, and photophobia after a lumbar epidural steroid injection. She was afebrile and had an elevated white blood cell count. A non-contrast computed tomography scan of the head revealed pneumocephalus within the subarachnoid space and lateral ventricles. The patient was admitted to the ED observation unit for pain control and subsequently developed a marked leukocytosis and worsening meningismus. A lumbar puncture was performed yielding cerebrospinal fluid (CSF) consistent with meningitis (1,000 total nucleated cells, 89% neutrophils, 85 mg/dL total protein, and no red blood cells). Gram stain revealed no bacteria. The patient was admitted on empiric vancomycin and ceftriaxone. Antibiotics were discontinued at 48 h when CSF cultures remained negative and the patient was clinically asymptomatic. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should consider intrathecal entry and pneumocephalus in patients who present with a headache after an epidural intervention. The management of pneumocephalus includes supportive therapies, appropriate positioning, and supplemental oxygen. These symptoms can be accompanied by fever, leukocytosis, and markedly inflammatory CSF findings consistent with bacterial or chemical meningitis. Empiric treatment with broad-spectrum antibiotics should be initiated until CSF culture results are available. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Considering symptomatic spinal epidural lipomatosis in the differential diagnosis.

    PubMed

    Alvarez, Adriana; Induru, Raghava; Lagman, Ruth

    2013-09-01

    Spinal epidural lipomatosis (SEL) is the abnormal accumulation of normal fat within the spinal canal. It is more frequent in those patients receiving chronic glucocorticoid therapy or in cases of endogenous hypercortisolism states. We report a case of SEL in a patient with metastatic prostate cancer with history of steroid treatment as part of his chemotherapy regimen, presenting with clinical manifestations of partial cord compression. Magnetic resonance imaging images of the lumbar spine revealed the presence of epidural tumor suspicious for metastatic disease. Operative findings were consistent with epidural lipomatosis. Spinal epidural lipomatosis is a rare condition that needs to be included in the differential diagnosis of patients with risk factors, presenting with symptomatic cord compression.

  7. Lower Back Tattoo: OK to Have an Epidural?

    MedlinePlus

    ... and delivery, postpartum care Could a lower back tattoo keep me from having an epidural during labor? ... Yvonne Butler Tobah, M.D. A lower back tattoo won't necessarily prevent you from having an ...

  8. The association between epidural labor analgesia and maternal fever.

    PubMed

    Arendt, Katherine W; Segal, B Scott

    2013-09-01

    The association between epidural labor analgesia and maternal fever is complex and controversial. Observational, retrospective, before-and-after, and randomized controlled trials all support the association, with the most current evidence supporting the mechanistic involvement of noninfectious inflammation. Considering the clinically significant neonatal consequences that have been previously demonstrated, and the possibility of more common subclinical fetal brain injury that animal models imply, the avoidance of maternal fever during labor is imperative. With the current popularity of epidural analgesia in labor, it is important that clinicians delineate how epidurals cause maternal fever and how to block the noninfectious inflammatory response that seems to warm a subset of women laboring with epidurals. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Symptomatic Epidural Gas-containing Cyst from Intervertebral Vacuum Phenomenon.

    PubMed

    Yun, Sung Min; Suh, Bumn Suk; Park, Jin Su

    2012-12-01

    Vacuum disc phenomenon is a collection of gas in the intervertebral disc space but rarely causes nerve compression. However, some rare type of vacuum phenomenon in the spinal canal may bring about posterior gas displacement within the epidural space. The authors describe two patients with symptomatic epidural gas-containing cyst that seem to be originating from vacuum phenomenon in the intervertebral disc, causing lumbosacral radiculopathy. Radiographic studies demonstrated intervertebral vacuum phenomenon and accumulation of gas in the lumbar epidural space compressing the dural sac and the nerve root. The nerve root in both patients was compressed by gas containing cyst that was surrounded by thin walled capsule separable from the gaseous degenerated disc space. The speculative mechanism of the nerve root compression is discussed. The possibility of gas containing cyst should be considered in case of the nerve root compression in which epidural gas is present.

  10. Epidural analgesia for labour: maternal knowledge, preferences and informed consent.

    PubMed

    Fröhlich, S; Tan, T; Walsh, A; Carey, M

    2011-01-01

    Epidural analgesia has become increasingly popular as a form of labour analgesia in Ireland. However obtaining true inform consent has always been difficult. Our study recruited 100 parturients who had undergone epidural analgesia for labour, aimed to determine the information they received prior to regional analgesia, and to ascertain their preferences regarding informed consent. Only 65 (65%) of patients planned to have an epidural. Knowledge of potential complications was variable and inaccurate, with less than 30 (30%) of women aware of the most common complications. Most women 79 (79%) believed that discomfort during labour affected their ability to provide informed consent, and believe consent should be taken prior to onset of labour (96, 96%). The results of this study helps define the standards of consent Irish patients expect for epidural analgesia during labour.

  11. Epidural analgesia during labour - maternal understanding and experience - informed consent.

    PubMed

    Mahomed, K; Chin, D; Drew, A

    2015-01-01

    Women obtain information on epidural analgesia from various sources. For epidural for pain relief in labour this is provided by the anaesthetist as part of the consenting process. There is much discussion about the inadequacy of this consenting process; we report on women's knowledge, experience and recall of this process at a regional hospital with a 24-h epidural service. Fifty-four women were interviewed within 72 h of a vaginal birth. 91% of the women had acquired information from friends, relatives and antenatal classes. Lack of recall of benefits of epidural analgesia accounted for 26 (38%) and 25 (26%) of the responses, respectively. Similarly in terms of amount of pain relief they could expect, 13 (21%) could not remember and 13 (21%) thought that it may not work. We suggest use of varying methods of disseminating information and wider utilisation of anaesthetists in the antenatal educational programmes.

  12. Micromachined patch-clamp apparatus

    SciTech Connect

    Okandan, Murat

    2012-12-04

    A micromachined patch-clamp apparatus is disclosed for holding one or more cells and providing electrical, chemical, or mechanical stimulation to the cells during analysis with the patch-clamp technique for studying ion channels in cell membranes. The apparatus formed on a silicon substrate utilizes a lower chamber formed from silicon nitride using surface micromachining and an upper chamber formed from a molded polymer material. An opening in a common wall between the chambers is used to trap and hold a cell for analysis using the patch-clamp technique with sensing electrodes on each side of the cell. Some embodiments of the present invention utilize one or more electrostatic actuators formed on the substrate to provide mechanical stimulation to the cell being analyzed, or to provide information about mechanical movement of the cell in response to electrical or chemical stimulation.

  13. Epidural resiniferatoxin induced prolonged regional analgesia to pain.

    PubMed

    Szabo, T; Olah, Z; Iadarola, M J; Blumberg, P M

    1999-09-04

    Adequate treatment of cancer pain remains a significant clinical problem. To reduce side effects of treatment, intrathecal and epidural routes of administration have been used where appropriate to reduce the total dose of agent administered while achieving regional control. Resiniferatoxin (RTX), an ultrapotent capsaicin analog, gives long-term desensitization of nociception via C-fiber sensory neurons. We evaluate here the analgesic effect on rats of epidurally administered RTX, using latency of response to a thermal stimulus in unrestrained animals. Results were compared with those for systemically administered RTX. Vehicle or graded doses of RTX were injected subcutaneously (s.c.) or through an indwelling lumbar (L4) epidural catheter as a single dose. Both routes of application of RTX produced profound thermal analgesia, reaching a plateau within 4-6 h and showing no restoration of pain sensitivity over 7 days. Vehicle was without effect. For the epidural route, the effect was selective as expected for the targeted spinal cord region, whereas the subcutaneous administration of RTX had a generalized analgesic effect. At doses yielding a tripling of back paw withdrawal latency, epidural treatment was 25-fold more effective than the subcutaneous route of application. Consistent with the regional selectivity of the lumbar epidural route, the front paws showed no more effect than by systemic RTX treatment. Binding experiments with [3H]RTX provided further evidence of the segmental desensitization induced by epidural RTX. We conclude that epidural administration of RTX at the lumbar spinal level produces profound, long-lasting, segmental analgesia to C-fiber mediated pain in the rat.

  14. Unilateral anhidrosis: A rare complication of thoracic epidural analgesia.

    PubMed

    Gulbahar, Gultekin; Gundogdu, Ahmet Gokhan; Alkan, Güzide; Baysalman, Hatice Baran; Kaplan, Tevfik

    2016-02-01

    Management of pain following thoracotomy is an important issue for the control of early morbidity. We herein present the case of a patient who was referred to our hospital after a fall from a height. Right-sided multiple rib fractures, hemopneumothorax, and diaphragmatic rupture were detected. Thoracic epidural catheterization was performed for pain management just before thoracotomy. The patient developed unilateral anhidrosis postoperatively. We discuss this rare complication of thoracic epidural analgesia with a review of relevant literature.

  15. Is epidural steroid injection effective for degenerative lumbar spinal stenosis?

    PubMed

    Flores, Sebastián; Molina, Marcelo

    2015-11-16

    There are several nonsurgical alternatives to treat radicular pain in degenerative lumbar spinal stenosis. Epidural steroid injections have been used for several decades, but the different studies have shown variable effects. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified nine systematic reviews including seven pertinent randomized controlled trials. We concluded epidural steroid injection probably leads to little or no effect on reducing radicular pain of spinal stenosis.

  16. Symptomatic epidural gas cyst associated with discal vacuum phenomenon.

    PubMed

    Kakitsubata, Yousuke; Theodorou, Stavroula J; Theodorou, Daphne J; Yuko, Miyata; Ito, Yasunori; Yuki, Yasuhiro; Wada, Shoichi; Maehara, Toyo

    2009-10-01

    Four cases of computed tomography and magnetic resonance imaging documented lumbar nerve root compression associated with a vacuum disc communicating with the epidural space are presented. To give an insight into the mechanism of nerve root compression associated with vacuum disc phenomenon. Few cases of lumbar radiculopathy resulting from epidural gas have been reported and illustrated using cross-sectional imaging studies. The medical records, imaging examinations, and surgical findings (when available) of 4 symptomatic patients with epidural and intradiscal gas collections were reviewed. Three patients underwent surgery with needle aspiration of the epidural gas, and 1 patient was treated conservatively. Clinical symptoms of epidural gas cyst were similar to those of other more common causes of nerve root compression. Computed tomography and magnetic resonance imaging findings showed intraspinal gas collection associated with a vacuum disc. One patient had an additional vertebral pneumatocyst. Although evacuation of intraspinal gas resulted in complete cure or major neurologic improvement in 3 patients, an initial period of observation is warranted because gas may disappear spontaneously as in 1 of our patients. All 4 patients recovered full motor and sensory functions of the lower extremities. One year later, patients were completely free of symptoms. Although the vacuum disc is considered a common imaging finding of no or not much pathologic significance, occasionally intradiscal gas may leak into the spinal canal. Detection of an epidural gaseous collection at the same level with a vacuum disc strongly suggests a communication between the intervertebral disc and the epidural space. Epidural gas collections can be implicated as a possible cause of radicular symptoms and should be considered in the differential diagnosis of lumbar radiculopathy.

  17. [Epidural analgesia during labour: maternal, fetal and neonatal aspects].

    PubMed

    Soncini, E; Grignaffini, A; Anfuso, S; Cavicchioni, O

    2003-06-01

    The most effective technique for eliminating labour and childbirth pain is continuous lumbar epidural analgesia. The preoccupation regarding the possible negative effects on the time taken for labour and on dystocias in general represents one of the greatest hindrances in the way of its wider use. The purpose of the present study is to monitor the effects of continuous lumbar epidural analgesia on delivery times, on the state of the fetus, on the incidence of dystocic deliveries and on neonatal outcome. Comparative prospective study. The data relating to the deliveries of 148 nulliparas and 51 pluriparas at term, submitted to epidural analgesia at the Obstetric Clinic of the University of Parma in 1999-2000 were compared with data from 144 nulliparas in labour and 60 pluriparas without epidural analgesia, selected in random fashion out of 4251 women who delivered children in the same period. The anesthetic procedure employed consisted in an injection of 20 mg/10 ml ropivacaine and 50 mg fentanyl in the epidural space at intervals of 1-2 h. The duration of the dilatation period was not influenced by administration of epidural analgesia while the expulsion period was longer in the course of epidural analgesia. There were no significant differences between delivery modalities in the 2 groups either as regards vaginal operative delivery or the number of cesarean sections for dystocia. The cardiotocographic profile was similar in the 2 groups. The neonatal outcome (Apgar index at 1' and 5' and transfer to the intensive care department) did not show significant differences, confirming the absence of noteworthy side-effects even from the neonatal standpoint. The use of low concentrations of ropivacaine (0.2%) associated with fentanyl in the epidural space proved to be a safe and effective technique for controlling labour and delivery pain.

  18. [MRI appearance of lumbar epidural abscesses: report of three cases].

    PubMed

    Semlali, S; Fikri, M; Nassar, I; El Quessar, A; El Hassani, Mr; Chakir, N; Jiddane, M

    2004-03-01

    The authors report three cases of non-tuberculous epidural abscess. Presenting symptoms included lumbar back pain, muscle spasms, soft tIssue swelling, and neurological deficits in all three cases. MR imaging was helpful for diagnosis and showed involvement of perivertebral soft tissues and an epidural abscess of variable size. There was no significant involvement of intervertebral disks or vertebrae. Diagnosis was confirmed by bacteriologic exam. Clinical outcome was favourable with antibiotic treatment.

  19. [Combined epidural and spinal anesthesia for cesarean section].

    PubMed

    Hody, J L

    1994-01-01

    Combined spinal epidural block has proven its efficacy in skilled hands. This technique allies advantages of spinal anaesthesia, regarding its speed of action and intensity of motor blockade and advantages of postoperative epidural analgesia. This block must be performed with great care and method to reach a success rate of almost 100%. Local anaesthetics and additives are reviewed and commented. The two main complications, hypotension and post dural puncture headache can be contained in very low limits.

  20. Spinal epidural arteriovenous hemangioma mimicking lumbar disc herniation.

    PubMed

    Kim, Kyung Hyun; Song, Sang Woo; Lee, Soo Eon; Lee, Sang Hyung

    2012-10-01

    A spinal epidural hemangioma is rare. In this case, a 51 year-old female patient had low back pain and right thigh numbness. She was initially misdiagnosed as having a ruptured disc with possible sequestration of granulation tissue formation due to the limited number of spinal epidural hemangiomas and little-known radiological findings. Because there are no effective diagnostic tools to verify the hemangioma, more effort should be put into preoperative imaging tests to avoid misdiagnosis and poor decisions).

  1. Epidural Anesthesia Complicated by Subdural Hygromas and a Subdural Hematoma

    PubMed Central

    Marovic, Paul; Ingram, Brendan

    2016-01-01

    Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause life-threatening subdural hematomas or cerebellar tonsillar herniation. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural hematoma following unintentional dural puncture during initiation of epidural anesthesia. PMID:27651956

  2. [Combined subarachnoid-epidural technique for obstetric analgesia].

    PubMed

    Fernández-Guisasola, J; García del Valle, S; Gómez-Arnau, J I

    2000-05-01

    Combined spinal-epidural blockade for labor pain has enjoyed increasing popularity in obstetric anesthesia. The usual procedure is to use a single space and a single needle for dural puncture, inserting a spinal needle through an epidural needle followed by insertion of a catheter. A small dose of one or several substances (usually a lipophilic opioid and a local anesthetic) is first injected in the intrathecal space to provide rapid, effective analgesia with minimal muscle blockade. The epidural catheter is used if labor lasts longer than the spinal block, if the spinal block is insufficient, or in case of cesarean section. Combined spinal-epidural blockade is a safe, valid alternative to conventional epidural analgesia and has become the main technique for providing obstetric analgesia in many hospitals. The most widely-recognized advantage of the technique is high maternal satisfaction with rapid and effective analgesia. Mobility of the lower extremities is preserved and the mother is often able to walk. Because opioids are injected into the intrathecal space and because the technique is more invasive than standard epidural analgesia, the potential risk to mother and fetus increases.

  3. Thoracic epidural anesthesia decreases endotoxin-induced endothelial injury

    PubMed Central

    2014-01-01

    Background The sympathetic nervous system is considered to modulate the endotoxin-induced activation of immune cells. Here we investigate whether thoracic epidural anesthesia with its regional symapathetic blocking effect alters endotoxin-induced leukocyte-endothelium activation and interaction with subsequent endothelial injury. Methods Sprague Dawley rats were anesthetized, cannulated and hemodynamically monitored. E. coli lipopolysaccharide (Serotype 0127:B8, 1.5 mg x kg-1 x h-1) or isotonic saline (controls) was infused for 300 minutes. An epidural catheter was inserted for continuous application of lidocaine or normal saline in endotoxemic animals and saline in controls. After 300 minutes we measured catecholamine and cytokine plasma concentrations, adhesion molecule expression, leukocyte adhesion, and intestinal tissue edema. Results In endotoxemic animals with epidural saline, LPS significantly increased the interleukin-1β plasma concentration (48%), the expression of endothelial adhesion molecules E-selectin (34%) and ICAM-1 (42%), and the number of adherent leukocytes (40%) with an increase in intestinal myeloperoxidase activity (26%) and tissue edema (75%) when compared to healthy controls. In endotoxemic animals with epidural infusion of lidocaine the values were similar to those in control animals, while epinephrine plasma concentration was 32% lower compared to endotoxemic animals with epidural saline. Conclusions Thoracic epidural anesthesia attenuated the endotoxin-induced increase of IL-1β concentration, adhesion molecule expression and leukocyte-adhesion with subsequent endothelial injury. A potential mechanism is the reduction in the plasma concentration of epinephrine. PMID:24708631

  4. Epidural fibrosis after permanent catheter insertion and infusion.

    PubMed

    Aldrete, J A

    1995-11-01

    Forty-six permanent epidural catheters and life-port units were implanted in 43 patients with severe, recurrent low back pain who had been considered not to be candidates for surgical intervention and in whom other therapeutic modalities had failed. Eight cases developed epidural fibrosis (EF). For analgesia, patients received either infusions with preservative-free solutions of fentanyl and bupivacaine or daily boluses of morphine and bupivacaine. Catheters remained from 75 days to 433 days. Signs of EF appeared from 21 days to 320 days after implantation. Pain at injection or resistance to injection were initial manifestations of EF, followed by poor, and eventually, nil analgesic effect. The epidural catheters were made of either polyamide, silicone, or polyurethane. Epidurograms revealed encapsulation, narrowing, and loculation of epidural space with gradually reduced spread of the contrast material. The occurrence of EF limits the permanency of implanted epidural catheters. The infusate does not cause this complication, which appears to be a foreign body reaction due to the presence of the catheter in the epidural space.

  5. Pneumocephalus during cervical transforaminal epidural steroid injections: a case report.

    PubMed

    Kim, Won-Joong; Park, Hae-Gyun; Park, Yong-Hee; Shin, Mee-Ran; Koo, Gill-Hoi; Shin, Hwa-Yong

    2015-01-01

    A cervical transforaminal epidural injection of anesthetic and corticosteroids (CTFESI) is a frequently used procedure for cervical radiculopathy. Most cases of pneumocephalus after an epidural block occur when using an interlaminar approach with the loss-of-resistance technique. The authors present the first case of pneumocephalus after cervical transforaminal epidural injection of anesthetic and corticosteroids. A 64-yr-old woman with left C7 radiculopathy was undergoing C6-7 transforaminal epidural injection of anesthetic and corticosteroids. The epidural spread of contrast was checked by fluoroscope, and 5 mg of dexamethasone in 4 ml of 0.1875% ropivacaine was injected. She lost consciousness 5 mins after the procedure and regained awareness after manual ventilation. She subsequently complained of nausea and headache, and a computed tomography brain scan revealed pneumocephalus. After carefully assessing the fluoroscopic images, the authors believe that the needle may have punctured the dura mater of the nerve root sleeve, allowing air to enter the subdural space. Thus, fluoroscopic images should be carefully examined to reduce dural puncture when performing cervical transforaminal epidural injection of anesthetic and corticosteroids, and air should be completely removed from the needle, extension tube, and syringe.

  6. [Inadvertent injection of succinylcholine as an epidural test dose].

    PubMed

    Pourzitaki, Chryssa; Tsaousi, Georgia; Logotheti, Helena; Amaniti, Ekaterini

    Epidural action of neuromuscular blocking agents could be explained under the light of their physicochemical characteristics and epidural space properties. In the literature there are few cases of accidental neuromuscular agent's epidural administration, manifesting mainly with neuromuscular blockade institution or fasciculations. We report a case of accidental succinylcholine administration as an epidural test dose, in a female patient undergoing scheduled laparotomy, under combined general and epidural anesthesia. Approximately 2min after the succinylcholine injection the patient complained for shortness of breath, while mild fasciculations appeared in her trunk and face, managed by immediate general anesthesia institution. With the exception of a relatively longer duration of neuromuscular blockade compared with intravenous administration, no neurological or cardiovascular sequelae or other symptoms of local or systemic toxicity were observed. Oral administration of diazepam seems to lessen the adverse effects from accidental epidural administration of succinylcholine. The meticulous and discriminative labeling of syringes, as well as keeping persistent cautions during all anesthesia procedures remains of crucial importance. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  7. Spinal epidural abscess treated with antibiotics alone.

    PubMed

    Pathak, Ashish; Singh, Poonam; Gehlot, Prateek; Dhaneria, Mamta

    2013-04-30

    Spinal epidural abscess (SEA) is a rare clinical condition among children. Most patients do not present with classical signs. A 13-year-old boy without any predisposing factors presented with paraparesis, bladder and bowel involvement. MRI spine demonstrated an SEA at the C7 and D1 levels on both sides of the midline with cord oedema at the C2-3 to C6 level with minimal marrow oedema in the C6 vertebral body. We treated the patient with antibiotics (ceftriaxone and vancomycin) alone. The patient showed excellent response with only minimal residual gait disturbance at the end of 6 weeks of antibiotic therapy. This is the first paediatric report of complete recovery of a patient at clinical stage 4 following antibiotic treatment alone from India. However, caution should be exercised to closely monitor the patient's recovery as any progression in the neurological state warrants surgery.

  8. Haematological and biochemical alterations caused by epidural and intramuscular administration of xylazine hydrochloride in dromedary camels (Camelus dromedarius).

    PubMed

    Azari, Omid; Molaei, Mohammad Mahdi; Emadi, Ladan; Sakhaee, Ehsanollah; Sharifi, Hamid; Mehdizadeh, Sara

    2012-01-01

    This study was conducted in 16 healthy immature dromedary camels weighing 120-150 kg to evaluate and compare the effects of epidural and intramuscular injections of xylazine administered at 0.1 mg/kg and 0.2 mg/kg. Haematological parameters included haemoglobin, packed cell volume, total erythrocyte count and total leukocyte count. Biochemical parameters included alkaline phosphates, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine and glucose. Parameters were measured at different intervals before (baseline) and after the administration of drugs. Our study showed that the effect of xylazine on haematological and biochemical parameters is dose-dependant and is also related to the route of administration. The low dose of xylazine administered using both intramuscular and epidural methods showed minimal effects, whereas high doses of the drug, especially when injected intramuscularly, caused greater changes in haematological and biochemical parameters.

  9. A case of paradoxical presentation of a postural postdural puncture headache after combined spinal-epidural anesthesia.

    PubMed

    Bordlee, John W; Beakley, Burton D; Mody, Rayomond; McConville, Anne P; Weed, Jonathan T; McClure, Brian P; Foldes, Peter J; Ma, Jonathan G; Kaye, Alan D; Eskander, Jonathan P

    2017-05-01

    We report a case of paradoxical presentation of a postural postdural puncture headache secondary to dural puncture with a 25-gauge Whitacre needle for combined spinal-epidural anesthesia. This 27-year-old female patient presented to the emergency department with elevated blood pressure and a global headache 9 days after administration of epidural anesthesia for a spontaneous vaginal delivery after an uncomplicated pregnancy. The patient reported that the headache was more intense when lying down and immediately improved when she sat or stood up from a recumbent position. The patient was discharged from emergency department after an improvement following treatment with labetalol, ondansetron, ketorolac, and fluid resuscitation. Copyright © 2016. Published by Elsevier Inc.

  10. Comparison of epidural oxycodone and epidural morphine for post-caesarean section analgesia: A randomised controlled trial.

    PubMed

    Sng, Ban Leong; Kwok, Sarah Carol; Mathur, Deepak; Ithnin, Farida; Newton-Dunn, Clare; Assam, Pryseley Nkouibert; Sultana, Rehena; Sia, Alex Tiong Heng

    2016-03-01

    Epidural morphine after caesarean section may cause moderate to severe pruritus in women. Epidural oxycodone has been shown in non-obstetric trials to reduce pruritus when compared to morphine. We hypothesised that epidural oxycodone may reduce pruritus after caesarean section. A randomised controlled trial was conducted in pregnant women at term who underwent caesarean section with combined spinal-epidural technique initiated with intrathecal fentanyl 15 μg. Women received either epidural morphine 3 mg or epidural oxycodone 3 mg via the epidural catheter after delivery. The primary outcome was the incidence of pruritus at 24 h after caesarean section. The secondary outcomes were the pruritus scores, treatment for post-operative nausea and vomiting (PONV), pain scores and maternal satisfaction. One hundred women were randomised (group oxycodone O = 50, morphine M = 50). There was no difference between Group O and M in the incidence of pruritus (n [%] 28 [56%] vs. 31 [62%], P = 0.68) and the worst pruritus scores (mean [standard deviation] 2.6 (2.8) vs. 3.3 [3.1], P = 0.23), respectively. Both groups had similar pain scores at rest (2.7 [2.3] vs. 2.0 [2.7], P = 0.16) and sitting up (5.0 [2.3] vs. 4.6 [2.4], P = 0.38) at 24 h. Pruritus scores were lower at 4-8, 8-12 and 12-24 h with oxycodone, but pain scores were higher. Both groups had a similar need for treatment of PONV and maternal satisfaction with analgesia. There was no difference in the incidence of pruritus at 24 h between epidural oxycodone and morphine. However, pruritus scores were lower with oxycodone between 4 and 24 h after surgery with higher pain scores in the same period.

  11. A prospective, randomized, blinded-endpoint, controlled study - continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia.

    PubMed

    Nunes, Joana; Nunes, Sara; Veiga, Mariano; Cortez, Mara; Seifert, Isabel

    2016-01-01

    There is evidence that administration of a programmed intermittent epidural bolus (PIEB) compared to continuous epidural infusion (CEI) leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10mL with Ropivacaine 0.16% plus Sufentanil 10μg, parturient were randomly assigned to one of three regimens: A - Ropivacaine 0.15% plus Sufentanil 0.2μg/mL solution as continuous epidural infusion (5mL/h, beginning immediately after the initial bolus); B - Ropivacaine 0.1% plus Sufentanil 0.2μg/mL as programmed intermittent epidural bolus and C - Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10mL/h starting 60min after the initial bolus. Rescue boluses of 5mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. We analyzed 130 pregnants (A=60; B=33; C=37). The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p=0.83). We found a higher caesarean delivery rate in group A (56.7%; p=0.02). No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satisfaction and no adverse outcomes. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  12. [A prospective, randomized, blinded-endpoint, controlled study - continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia].

    PubMed

    Nunes, Joana; Nunes, Sara; Veiga, Mariano; Cortez, Mara; Seifert, Isabel

    2016-01-01

    There is evidence that administration of a programmed intermittent epidural bolus (PIEB) compared to continuous epidural infusion (CEI) leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10mL with Ropivacaine 0.16% plus Sufentanil 10μg, parturient were randomly assigned to one of three regimens: A - Ropivacaine 0.15% plus Sufentanil 0.2μg/mL solution as continuous epidural infusion (5mL/h, beginning immediately after the initial bolus); B - Ropivacaine 0.1% plus Sufentanil 0.2μg/mL as programmed intermittent epidural bolus and C - Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10mL/h starting 60min after the initial bolus. Rescue boluses of 5mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. We analyzed 130 pregnants (A=60; B=33; C=37). The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p=0.83). We found a higher caesarean delivery rate in group A (56.7%; p=0.02). No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satisfaction and no adverse outcomes. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  13. Comparison of epidural oxycodone and epidural morphine for post-caesarean section analgesia: A randomised controlled trial

    PubMed Central

    Sng, Ban Leong; Kwok, Sarah Carol; Mathur, Deepak; Ithnin, Farida; Newton-Dunn, Clare; Assam, Pryseley Nkouibert; Sultana, Rehena; Sia, Alex Tiong Heng

    2016-01-01

    Background and Aims: Epidural morphine after caesarean section may cause moderate to severe pruritus in women. Epidural oxycodone has been shown in non-obstetric trials to reduce pruritus when compared to morphine. We hypothesised that epidural oxycodone may reduce pruritus after caesarean section. Methods: A randomised controlled trial was conducted in pregnant women at term who underwent caesarean section with combined spinal-epidural technique initiated with intrathecal fentanyl 15 μg. Women received either epidural morphine 3 mg or epidural oxycodone 3 mg via the epidural catheter after delivery. The primary outcome was the incidence of pruritus at 24 h after caesarean section. The secondary outcomes were the pruritus scores, treatment for post-operative nausea and vomiting (PONV), pain scores and maternal satisfaction. Results: One hundred women were randomised (group oxycodone O = 50, morphine M = 50). There was no difference between Group O and M in the incidence of pruritus (n [%] 28 [56%] vs. 31 [62%], P = 0.68) and the worst pruritus scores (mean [standard deviation] 2.6 (2.8) vs. 3.3 [3.1], P = 0.23), respectively. Both groups had similar pain scores at rest (2.7 [2.3] vs. 2.0 [2.7], P = 0.16) and sitting up (5.0 [2.3] vs. 4.6 [2.4], P = 0.38) at 24 h. Pruritus scores were lower at 4–8, 8–12 and 12–24 h with oxycodone, but pain scores were higher. Both groups had a similar need for treatment of PONV and maternal satisfaction with analgesia. Conclusion: There was no difference in the incidence of pruritus at 24 h between epidural oxycodone and morphine. However, pruritus scores were lower with oxycodone between 4 and 24 h after surgery with higher pain scores in the same period. PMID:27053782

  14. Smart patch piezoceramic actuator issues

    NASA Technical Reports Server (NTRS)

    Griffin, Steven F.; Denoyer, Keith K.; Yost, Brad

    1993-01-01

    The Phillips Laboratory is undertaking the challenge of finding new and innovative ways to integrate sensing, actuation, and the supporting control and power electronics into a compact self-contained unit to provide vibration suppression for a host structure. This self-contained unit is commonly referred to as a smart patch. The interfaces to the smart patch will be limited to standard spacecraft power and possibly a communications line. The effort to develop a smart patch involves both contractual and inhouse programs which are currently focused on miniaturization of the electronics associated with vibrational control using piezoceramic sensors and actuators. This paper is comprised of two distinct parts. The first part examines issues associated with bonding piezoceramic actuators to a host structure. Experimental data from several specimens with varying flexural stiffness are compared to predictions from two piezoelectric/substructure coupling models, the Blocked Force Model and the Uniform Strain Model with Perfect Bonding. The second part of the paper highlights a demonstration article smart patch created using the insights gained from inhouse efforts at the Phillips Laboratory. This demonstration article has self contained electronics on the same order of size as the actuator powered by a voltage differential of approximately 32 volts. This voltage is provided by four rechargeable 8 volt batteries.

  15. Microscopic epidural lesions in goats given repeated epidural injections of morphine: use of a modified autopsy procedure.

    PubMed

    Larsen, J J; Svendsen, O; Andersen, H B

    1986-01-01

    Epidural catheterization was performed in six goats. Five days later either saline or 20 mg (5 mg/ml) preservative free morphine was injected epidurally once daily for 8 days. The goats were sacrificed 4, 24 or 48 hours after the last injection. The lumbar part of columna was removed in toto for microscopic examination of the spinal cord and the entire epidural space after decalcification and transverse sectioning. After saline, minimal changes including a fibrous membrane surrounding the catheter, scattered fat cell necrosis, scattered small focal cell infiltrations and occasionally focal haemorrhages were seen. After morphine the changes were considerably more severe including diffuse cellular inflammatory reaction in the epidural space, fat cell necrosis, occasionally focal exudative inflammation and chronic inflammatory reaction in the vicinity of the fibrous membrane demarcating position of the catheter. It is concluded that the present modified autopsy procedure permits microscopic examination of the epidural space. It has been shown that repeated administration of morphine caused tissue damage in the epidural space of goats. The human predictability of the results obtained is unknown. However, the results are encouraging for investigations with similar procedure in humans.

  16. [Reversible cerebral vasoconstriction syndrome (RCVS) triggered by nicotine patches].

    PubMed

    Hijikata, Yasuhiro; Watanabe, Hirohisa; Ito, Mizuki; Yoneyama, Noritaka; Atsuta, Naoki; Sobue, Gen

    2013-01-01

    We present a case of a patient with reversible cerebral vasoconstriction syndrome (RCVS) triggered by nicotine patches. A-50-year-old woman had no medical history and no regular medication. She smoked 20 cigarettes a day for 30 years. Six days after using nicotine patches, she had recurrent severe headaches of sudden onset (thunderclap headaches). On examination, the blood pressure was 142/88 mmHg. Her neurological and general examination, laboratory serum investigations, and cerebrospinal fluid examination were normal. Magnetic resonance imaging (MRI) including magnetic resonance angiography (MRA) on admission, day 10 after the first episode showed severe multifocal segmental narrowing of the bilateral posterior cerebral artery (PCA). Cessation of nicotine patches and administration of calcium-channel antagonist amlodipine 5 mg daily ameliorated her headache. Follow-up MRA, 37 days after the first episode, showed improvement of PCA stenosis. We diagnosed her as reversible cerebral vasoconstriction syndrome (RCVS) due to nicotine patches. It is important to recognize nicotine patches as a trigger of RCVS.

  17. Severe Scapular Pain Following Unintentional Cervical Epidural Air Injection.

    PubMed

    Henthorn, Randall W; Murray, Kerra

    2016-03-01

    This a unique case of severe scapular pain following unintentional epidural space air injection during epidural steroid injection.A 70-year-old woman presented for a fluoroscopically guided C7-T1 interlaminar epidural steroid injection. Three injection attempts were made using the loss of resistance with air technique. On the first attempt the epidural space was entered, but contrast injection showed that the needle was intravenous. On the second attempt an equivocal loss of resistance with air was perceived and 5 mL of air was lost from the syringe. The needle was withdrawn and redirected, and upon the third needle passage the contrast injection showed appropriate epidural space filling up to the C4-5 level. Injection of betamethasone mixed in lidocaine was initially uneventful.However, 20 minutes post-injection the patient experienced sudden sharp and continuous pain along the medial edge of the scapula. After failing to respond to multiple intravascular analgesics, the patient was transferred to the emergency room. Her pain subsided completely following an intravenous diazepam injection. Cervical spine computerized tomography showed obvious air in the posterior epidural space from C4-5 to C6-7 as well as outside the spinal canal from (C4-T2). Having recovered fully, she was discharged the following morning. In reviewing the procedure, the equivocal loss of resistance on the second passage was actually a true loss of resistance to epidural space and air was unintentionally injected. Surprisingly, severe scapular pain resulted in a delayed manner after the steroid solution was injected. The authors theorize that unintentional prefilling of the epidural space with air prior to the injection of the subsequent steroid mixture added sufficient pressure to the epidural space to cause right-sided C4 nerve root stretching/entrapment and ensuing radicular pain to the right scapular border. The subsequent intravenous diazepam provided cervical muscle relaxation and

  18. Estimating the Incidence of Suspected Epidural Hematoma and the Hidden Imaging Cost of Epidural Catheterization: A Retrospective Review of 43,200 Cases

    PubMed Central

    Henneman, Justin P.; Sandberg, Warren S.

    2013-01-01

    Introduction Hematoma associated with epidural catheterization is rare, but the diagnosis might be suspected relatively frequently. We sought to estimate the incidence of suspected epidural hematoma after epidural catheterization, and to determine the associated cost of excluding or diagnosing an epidural hematoma through radiologic imaging. Methods We conducted an electronic retrospective chart review of 43,200 patient charts using 4 distinct search strategies and cost analysis, all from a single academic institution from 2001 through 2009. Charts were reviewed for use of radiological imaging studies to identify patients with suspected and confirmed epidural hematomas. Costs for imaging to exclude or confirm the diagnosis were related to the entire cohort. Results In our analysis, over a 9-year period that included 43,200 epidural catheterizations, 102 patients (1:430) underwent further imaging studies to exclude or confirm the presence of an epidural hematoma—revealing 6 confirmed cases and an overall incidence (per 10,000 epidural blocks) of epidural hematoma of 1.38 (95% CI 0, 0.002). Among our patients, 207 imaging studies, primarily lumbar spine MRI, were performed. Integrating Medicare cost expenditure data, the estimated additional cost over a 9-year period for imaging and hospital charges related to identifying epidural hematomas nets to approximately $232,000 or an additional $5.37 per epidural. Discussion About 1 in 430 epidural catheterization patients will be suspected to have an epidural hematoma. The cost of excluding the diagnosis, when suspected, is relatively low when allocated across all epidural catheterization patients. PMID:23924685

  19. Epidural Anesthesia for Cesarean Delivery in a Morbidly Obese Parturient With Spinal Meningioma

    PubMed Central

    Clark, Allison; DiGiovanni, Neil; Hart, Stuart; Russo, Melissa; Bui, Cuong

    2012-01-01

    We report our experience with epidural anesthesia for cesarean section in a morbidly obese parturient with progressive paraplegia from a spinal meningioma. Epidural anesthesia may represent a safe anesthetic choice in such clinical situations. PMID:22778679

  20. Epidural anesthesia for cesarean delivery in a morbidly obese parturient with spinal meningioma.

    PubMed

    Clark, Allison; Digiovanni, Neil; Hart, Stuart; Russo, Melissa; Bui, Cuong

    2012-01-01

    We report our experience with epidural anesthesia for cesarean section in a morbidly obese parturient with progressive paraplegia from a spinal meningioma. Epidural anesthesia may represent a safe anesthetic choice in such clinical situations.

  1. Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

    PubMed Central

    Ahn, Dong Ki; Kim, Jin Woo; Yi, Seong Min

    2016-01-01

    Background Postoperative spinal epidural hematoma (POSEH) is different from spontaneous or post-spinal procedure hematoma because of the application of suction drains. However, it appeared that suction drains were not effective for prevention of POSEH in previous studies. The purpose of this study was to test our hypothesis that POSEH can be caused by hypercoagulability. Methods This was an experimental study. One hundred fifty milliliters of blood was donated from each of the 12 consecutive patients who underwent spine surgery and infused into 3 saline bags of 50 mL each. One of the 3 bags in each set contained 5,000 units of thrombin. All of them were connected to 120 ± 30 mmHg vacuum suctions: drainage was started 8 minutes after connection to the vacuum system for 12 normal blood bags (BV8) and 12 thrombin-containing blood bags (TBV8) and 15 minutes after connection for the remaining 12 normal blood bags (BV15). The amount of initial and remaining hematoma at 20 minutes, 120 minutes, and 24 hours after vacuum application were measured by their weight (g). The primary endpoint was the difference between BV8 and TBV8. The secondary end point was the difference between BV8 and BV15. Results The remaining hematoma in TBV8 was significantly greater than that in BV8 at all measurement points: 46.3 ± 12.4 vs. 17.0 ± 1.3 (p = 0.000) at 20 minutes; 33.0 ± 8.2 vs. 16.3 ± 1.2 (p = 0.000) at 120 minutes; and 26.1 ± 4.0 vs. 15.8 ± 1.6 (p = 0.000) at 24 hours after vacuum application. The remaining hematoma of BV15 was significantly greater than that of BV8 at all measurement points: 30.0 ± 12.0 vs. 17.0 ± 1.3 (p = 0.002) at 20 minutes; 24.2 ± 7.6 vs. 16.3 ± 1.2 at 120 minutes (p = 0.002); and 22.2 ± 6.6 vs. 15.8 ± 1.6 (p = 0.004) at 24 hours after vacuum application. Conclusions With a suction drain in place, the amount of remaining hematoma could be affected by coagulability. Thrombin-containing local hemostatics and the length of time elapsed before the

  2. Labor Epidural Analgesia and Breastfeeding: A Systematic Review.

    PubMed

    French, Cynthia A; Cong, Xiaomei; Chung, Keun Sam

    2016-08-01

    Despite widespread use of epidural analgesia during labor, no consensus has been reached among obstetric and anesthesia providers regarding its effects on breastfeeding. The purpose of this review was to examine the relationship between labor epidural analgesia and breastfeeding in the immediate postpartum period. PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature were searched for articles published in 1990 or thereafter, using the search term breastfeeding combined with epidural, labor epidural analgesia, labor analgesia, or epidural analgesia Of 117 articles, 23 described empirical studies specific to labor epidural analgesia and measured a breastfeeding outcome. Results were conflicting: 12 studies showed negative associations between epidural analgesia and breastfeeding success, 10 studies showed no effect, and 1 study showed a positive association. Most studies were observational. Of 3 randomized controlled studies, randomization methods were inadequate in 2 and not evaluable in 1. Other limitations were related to small sample size or inadequate study power; variation and lack of information regarding type and dosage of analgesia or use of other intrapartum interventions; differences in timing, definition, and method of assessing breastfeeding success; or failure to consider factors such as mothers' intention to breastfeed, social support, siblings, or the mother's need to return to work or school. It is also unclear to what extent results are mediated through effects on infant neurobehavior, maternal fever, oxytocin release, duration of labor, and need for instrumental delivery. Clinician awareness of factors affecting breastfeeding can help identify women at risk for breastfeeding difficulties in order to target support and resources effectively.

  3. Finite Element Analysis of the Effect of Epidural Adhesions.

    PubMed

    Lee, Nam; Ji, Gyu Yeul; Yi, Seong; Yoon, Do Heum; Shin, Dong Ah; Kim, Keung Nyun; Ha, Yoon; Oh, Chang Hyun

    2016-07-01

    It is well documented that epidural adhesion is associated with spinal pain. However, the underlying mechanism of spinal pain generation by epidural adhesion has not yet been elucidated. To elucidate the underlying mechanism of spinal pain generation by epidural adhesion using a two-dimensional (2D) non-linear finite element (FE) analysis. A finite element analysis. A two-dimensional nonlinear FE model of the herniated lumbar disc on L4/5 with epidural adhesion. A two-dimensional nonlinear FE model of the lumbar spine was developed, consisting of intervertebral discs, dura, spinal nerve, and lamina. The annulus fibrosus and nucleus pulpous were modeled as hyperelastic using the Mooney-Rivlin equation. The FE mesh was generated and analyzed using Abaqus (ABAQUS 6.13.; Hibbitt, Karlsson & Sorenson, Inc., Providence, RI, USA). Epidural adhesion was simulated as rough contact, in which no slip occurred once two surfaces were in contact, between the dura mater and posterior annulus fibrosus. The FE model of adhesion showed significant stress concentration in the spinal nerves, especially on the dorsal root ganglion (DRG). The stress concentration was caused by the lack of adaptive displacement between the dura mater and posterior annulus fibrosus. The peak von Mises stress was higher in the epidural adhesion model (Adhesion, 0.67 vs. Control, 0.46). In the control model, adaptive displacement was observed with decreased stress in the spinal nerve and DRG (with adhesion, 2.59 vs. without adhesion, 3.58, P < 0.00). This study used a 2D non-linear FE model, which simplifies the 3D nature of the human intervertebral disc. In addition, this 2D non-linear FE model has not yet been validated. The current study clearly demonstrated that epidural adhesion causes significantly increased stress in the spinal nerves, especially at the DRG. We believe that the increased stress on the spinal nerve might elicit more pain under similar magnitudes of lumbar disc protrusion.

  4. Racial differences in the use of epidural analgesia for labor.

    PubMed

    Glance, Laurent G; Wissler, Richard; Glantz, Christopher; Osler, Turner M; Mukamel, Dana B; Dick, Andrew W

    2007-01-01

    There is strong evidence that pain is undertreated in black and Hispanic patients. The association between race and ethnicity and the use of epidural analgesia for labor is not well described. Using the New York State Perinatal Database, the authors examined whether race and ethnicity were associated with the likelihood of receiving epidural analgesia for labor after adjusting for clinical characteristics, demographics, insurance coverage, and provider effect. This retrospective cohort study was based on 81,883 women admitted for childbirth between 1998 and 2003. Overall, 38.3% of the patients received epidural analgesia for labor. After adjusting for clinical risk factors, socioeconomic status, and provider fixed effects, Hispanic and black patients were less likely than non-Hispanic white patients to receive epidural analgesia: The adjusted odds ratio was 0.85 (95% CI, 0.78-0.93) for white/Hispanic and 0.78 (0.74-0.83) for blacks compared with non-Hispanic whites. Compared with patients with private insurance, patients without insurance were least likely to receive epidural analgesia (adjusted odds ratio, 0.76; 95% CI, 0.64-0.89). Black patients with private insurance had similar rates of epidural use to white/non-Hispanic patients without insurance coverage: The adjusted odds ratio was 0.66 (95% CI, 0.53-0.82) for white/non-Hispanic patients without insurance versus 0.69 (0.57-0.85) for black patients with private insurance. Black and Hispanic women in labor are less likely than non-Hispanic white women to receive epidural analgesia. These differences remain after accounting for differences in insurance coverage, provider practice, and clinical characteristics.

  5. [Epidural obstetric analgesia, maternal fever and neonatal wellness parameters].

    PubMed

    Fernández-Guisasola, J; Delgado Arnáiz, C; Rodríguez Caravaca, G; Serrano Rodríguez, M L; García del Valle, S; Gómez-Arnau, J I

    2005-04-01

    To study the relation between epidural analgesia and the development of maternal fever during labor and childbirth, and to determine the possible relation between that association and neonatal welfare and in the performance of tests to rule out sepsis in newborns. Prospective study of all women who gave birth at Fundación Hospital Alcorcón over a period of 3 years. All the women were offered epidural analgesia based on infusion of 0.0625% bupivacaine and 2 microg x mL(-1). Data collected were age, nulliparity, epidural analgesia infusion, induction of labor, uterine stimulation with oxytocin, type of birth, fetal weight, duration of dilation and expulsion, Apgar score (at 1 and 5 minutes), umbilical artery pH, and maternal temperature. Data for 4364 women were analyzed. Fever developed during labor in 5.7%; 93.7% of the fevers occurred in women receiving epidural analgesia (P<0.05). Logistic regression analysis revealed that independent risk factors for the development of fever were epidural analgesia (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.05-3.04), nulliparity (OR, 2,929; 95% CI, 2.005-4.279), fetal weight (OR, 1.484; 95% CI, 1.102-2.001), and duration of labor (OR, 1.003; 95% CI, 1.003-1.004). No significant differences in Apgar score at 5 minutes or umbilical artery pH were found between the women with and without fever. Tests to rule out sepsis were ordered for 85.1% of the infants of mothers with fever after epidural analgesia. Epidural analgesia was associated with greater risk of developing fever in mothers giving birth, but that association had no repercussion on the neonatal wellness parameters studied.

  6. Labor Epidural Anesthesia, Obstetric Factors and Breastfeeding Cessation

    PubMed Central

    Dozier, Ann M.; Howard, Cynthia R.; Brownell, Elizabeth A.; Wissler, Richard N.; Glantz, J. Christopher; Ternullo, Sharon R.; Thevenet-Morrison, Kelly N.; Childs, Cynthia K.; Lawrence, Ruth A.

    2013-01-01

    Objective Breastfeeding benefits both infant and maternal health. Use of epidural anesthesia during labor is increasingly common and may interfere with breastfeeding. Studies analyzing epidural anesthesia’s association with breastfeeding outcomes show mixed results; many have methodological flaws. We analyzed potential associations between epidural anesthesia and overall breast-feeding cessation within 30 days postpartum while adjusting for standard and novel covariates and uniquely accounting for labor induction. Methods A pooled analysis using Kaplan-Meier curves and modified Cox Proportional Hazard models included 772 breastfeeding mothers from upstate New York who had vaginal term births of healthy singleton infants. Subjects were drawn from two cohort studies (recruited postpartum between 2005 and 2008) and included maternal self-report and maternal and infant medical record data. Results Analyses of potential associations between epidural anesthesia and overall breastfeeding cessation within one month included additional covariates and uniquely accounted for labor induction. After adjusting for standard demographics and intrapartum factors, epidural anesthesia significantly predicted breastfeeding cessation (hazard ratio 1.26 [95%confidence interval 1.10, 1.44], p<.01) as did hospital type, maternal age, income, education, planned breastfeeding goal, and breastfeeding confidence. In post hoc analyses stratified by Baby Friendly Hospital (BFH) status, epidural anesthesia significantly predicted breastfeeding cessation (BFH: 1.19 [1.01,1.41], p<.04; non-BFH: 1.65 [1.31, 2.08], p<.01). Conclusions A relationship between epidural anesthesia and breastfeeding was found but is complex and involves institutional, clinical, maternal and infant factors. These findings have implications for clinical care and hospital policies and point to the need for prospective studies. PMID:22696104

  7. Labor epidural anesthesia, obstetric factors and breastfeeding cessation.

    PubMed

    Dozier, Ann M; Howard, Cynthia R; Brownell, Elizabeth A; Wissler, Richard N; Glantz, J Christopher; Ternullo, Sharon R; Thevenet-Morrison, Kelly N; Childs, Cynthia K; Lawrence, Ruth A

    2013-05-01

    Breastfeeding benefits both infant and maternal health. Use of epidural anesthesia during labor is increasingly common and may interfere with breastfeeding. Studies analyzing epidural anesthesia's association with breastfeeding outcomes show mixed results; many have methodological flaws. We analyzed potential associations between epidural anesthesia and overall breast-feeding cessation within 30 days postpartum while adjusting for standard and novel covariates and uniquely accounting for labor induction. A pooled analysis using Kaplan-Meier curves and modified Cox Proportional Hazard models included 772 breastfeeding mothers from upstate New York who had vaginal term births of healthy singleton infants. Subjects were drawn from two cohort studies (recruited postpartum between 2005 and 2008) and included maternal self-report and maternal and infant medical record data. Analyses of potential associations between epidural anesthesia and overall breastfeeding cessation within 1 month included additional covariates and uniquely accounted for labor induction. After adjusting for standard demographics and intrapartum factors, epidural anesthesia significantly predicted breastfeeding cessation (hazard ratio 1.26 [95% confidence interval 1.10, 1.44], p < 0.01) as did hospital type, maternal age, income, education, planned breastfeeding goal, and breastfeeding confidence. In post hoc analyses stratified by Baby Friendly Hospital (BFH) status, epidural anesthesia significantly predicted breastfeeding cessation (BFH: 1.19 [1.01, 1.41], p < 0.04; non-BFH: 1.65 [1.31, 2.08], p < 0.01). A relationship between epidural anesthesia and breastfeeding was found but is complex and involves institutional, clinical, maternal and infant factors. These findings have implications for clinical care and hospital policies and point to the need for prospective studies.

  8. Epidural analgesia in labour and risk of caesarean delivery.

    PubMed

    Bannister-Tyrrell, Melanie; Ford, Jane B; Morris, Jonathan M; Roberts, Christine L

    2014-09-01

    A Cochrane Systematic Review of randomised controlled trials of epidural analgesia compared with other or no analgesia in labour reported no overall increased risk of caesarean delivery. However, many trials were affected by substantial non-compliance, and there are concerns about the external validity of some trials for contemporary maternity populations. We aimed to explore the association between epidural analgesia in labour and caesarean delivery in clinical practice and compare with findings from randomised controlled trials. Population-based cohort of pregnant women (n = 210 708) without major obstetrical complications who delivered a singleton live infant in hospitals in New South Wales, Australia, 2007-10. Data were obtained from linked, validated population-based data collections. Propensity score matching was used to examine the association between epidural analgesia in labour and caesarean delivery. Epidural analgesia in labour was used by a third (31.5%, n = 66 317) of the women, and 9.8% (n = 20 531) had a caesarean delivery. Epidural analgesia in labour was associated with increased risk of caesarean delivery {risk ratio [RR] 2.5, [95% confidence interval (CI) 2.5, 2.6]}. The association with epidural analgesia in labour was higher for caesarean delivery for failure to progress {RR 3.0, [95% CI 2.9, 3.0]} than for caesarean delivery for fetal distress {RR 1.9, [95% CI 1.8, 2.0]}. Epidural analgesia in labour is associated with caesarean delivery in a large maternity population. Population-based studies contribute important data about obstetrical care, when research settings and participants may not represent the clinical settings or broader population in which obstetrical interventions in labour are applied. © 2014 John Wiley & Sons Ltd.

  9. Circulatory collapse following epidural bolus for Caesarean section a profound vasovagal reaction? A case report

    PubMed Central

    Oddby, Eva; Hein, Anette; Jakobsson, Jan G.

    2016-01-01

    Introduction Reduced blood pressure is commonly seen associated to spinal anaesthesia for Caesarean section and efforts to reduce its occurrence and its magnitude is common practice. Cardiovascular collapse requiring cardio-pulmonary resuscitation after putting the spinal/epidural block for Caesarean section is however a rare but most dramatic event. Presentation of case We describe a case with sudden short loss of circulation, circulatory collapse, short after start of emergency Caesarean section in top up epidural anaesthesia (3 + 12 ml ropivaciane 7.5 mg/ml), requiring CPR. The neonate was delivered during CPR with Apgar 1, 10, 10 at 1, 5 and 10 min. Circulation was restored following 60–90 s of CPR and administration of 0.5 mg adrenaline. No cardioversion was administered sinus rhythm was regained spontaneously. The mother and child had a further uncomplicated course. No signs of cardiac damage/anomaly, emboli, septicaemia, pereclampisa or local anaesthetic toxicity was found. The patient had prior to the decision about Caesarean section had fever and was subsequently relatively dehydrated. Discussion The patient had a fast return of sinus rhythm following birth of the child, without cardioversion. None of common causes for cardiac arrest was found and the patient an uncomplicated post Caesarean section course. The combination of epidural induced sympathetic block and reduced preload possibly triggered a Bezold-Jarisch reflex with a profound vasovagal reaction. Concluiosn A structured plan for the handling of cardiovascular crisis must be available wherever Caesarean section are performed. Adequate volume loading, left tilt and vigilant control of circulation following regional block performance is of outmost importance. PMID:27100952

  10. Feasibility of radical cystectomy in exclusive spinal and/or epidural anaesthesia.

    PubMed

    Karl, A; Schneevoigt, B; Weninger, E; Grimm, T; Stief, C

    2013-10-01

    Muscle invasive bladder cancer can be found predominantly in elderly people with a high likelihood of suffering from concomitant diseases; especially in these patients, the risks associated with general anaesthesia during radical cystectomy can be the limiting factor of performing an otherwise indicated radical operation. To overcome this limitation, we analysed the feasibility of performing radical cystectomy in exclusive spinal and/or epidural anaesthesia. Between March and June 2010, nine patients underwent radical cystectomy in exclusive spinal and/or epidural anaesthesia. These patients were either not willing or unfit to undergo radical cystectomy in general anaesthesia. A continent urinary diversion (ileum neobladder) and an ileum-conduit were performed in five patients and four patients, respectively. The feasibility of radical cystectomy in regional anaesthesia was tested using a variety of parameters. All nine procedures could be performed under strict regional anaesthesia. Mean operation time was 206 min (range 146-265 min), mean intraoperative blood loss was 622 ml (range 200-1,500 ml), mean postoperative time at intermediate care was 1 day (range 0-3 days) and mean length of hospital stay was 21.8 days (range 17-26 days). Analgesics of the WHO class I, II and III were applied for 5.7, 1.2 and 2.8 days mean, respectively. Performance of radical cystectomy in exclusive spinal and/or epidural anaesthesia is feasible and can be considered particularly in those patients who would be otherwise unfit to undergo radical cystectomy in general anaesthesia. This new operative and anaesthesiological concept could also play an important role in new fast track regimens.

  11. Epidural Volume Extension During Combined Spinal-Epidural Labor Analgesia Does Not Increase Sensory Block.

    PubMed

    Zaphiratos, Valerie; George, Ronald B; Macaulay, Bruce; Bolleddula, Prasad; McKeen, Dolores M

    2016-09-01

    Combined spinal-epidural (CSE) analgesia is widely used for delivering labor analgesia. Epidural volume extension (EVE) involves the injection of fluid into the epidural space compressing the dural sac, causing cephalad shift of the cerebral spinal fluid. Our hypothesis was that EVE with 10 mL normal saline during CSE would increase the sensory block height at 15 minutes after intrathecal injection. We expected EVE to decrease pain scores, decrease analgesia onset time, and decrease motor block compared with performing CSE without EVE (NEVE). We randomly assigned 60 healthy term laboring nulliparous parturients with cervical dilation <5 cm to receive CSE either with EVE of 10 mL normal saline through the Tuohy needle before catheter insertion or CSE NEVE. Intrathecal analgesia consisted of 2 mg plain bupivacaine and 10 μg fentanyl (1 mL total). A blinded researcher assessed sensory dermatome level, analgesia, and motor blockade at regular intervals for 30 minutes. The primary outcome measure was the median peak sensory dermatome level at 15 minutes. Fifty-four parturients were analyzed. There was no significant difference in peak sensory dermatome levels at 15 minutes (median difference, 1 dermatome level; 95% confidence interval of median difference, 0 to 2; P = 0.22) and 30 minutes (median difference, 0 dermatome level; 95% confidence interval, -2 to 2; P = 0.76). There was no difference in the time to peak dermatome, minimum pain score, or the time to minimum pain score between groups. We found no significant difference between groups with regard to sensory dermatome level or pain scores when using EVE compared with NEVE. Our study demonstrates that addition of EVE does not offer superior analgesia when using a CSE technique for parturients requesting labor analgesia.

  12. Bye-Bye Flu Shot, Hello Patch?

    MedlinePlus

    ... medlineplus.gov/news/fullstory_166897.html Bye-Bye Flu Shot, Hello Patch? Early results look promising for ... TUESDAY, June 27, 2017 (HealthDay News) -- An experimental flu vaccine patch with dissolving microneedles appears safe and ...

  13. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy.

    PubMed

    Yeung, Joyce H Y; Gates, Simon; Naidu, Babu V; Wilson, Matthew J A; Gao Smith, Fang

    2016-02-21

    Operations on structures in the chest (usually the lungs) involve cutting between the ribs (thoracotomy). Severe post-thoracotomy pain can result from pleural (lung lining) and muscular damage, costovertebral joint (ribcage) disruption and intercostal nerve (nerves that run along the ribs) damage during surgery. Poor pain relief after surgery can impede recovery and increase the risks of developing complications such as lung collapse, chest infections and blood clots due to ineffective breathing and clearing of secretions. Effective management of acute pain following thoracotomy may prevent these complications and reduce the likelihood of developing chronic pain. A multi-modal approach to analgesia is widely employed by thoracic anaesthetists using a combination of regional anaesthetic blockade and systemic analgesia, with both non-opioid and opioid medications and local anaesthesia blockade.There is some evidence that blocking the nerves as they emerge from the spinal column (paravertebral block, PVB) may be associated with a lower risk of major complications in thoracic surgery but the majority of thoracic anaesthetists still prefer to use a thoracic epidural blockade (TEB) as analgesia for their patients undergoing thoracotomy. In order to bring about a change in practice, anaesthetists need a review that evaluates the risk of all major complications associated with thoracic epidural and paravertebral block in thoracotomy. To compare the two regional techniques of TEB and PVB in adults undergoing elective thoracotomy with respect to:1. analgesic efficacy;2. the incidence of major complications (including mortality);3. the incidence of minor complications;4. length of hospital stay;5. cost effectiveness. We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 9); MEDLINE via Ovid (1966 to 16 October 2013); EMBASE via Ovid (1980 to 16 October 2013); CINAHL via EBSCO host (1982 to 16 October 2013); and reference lists of

  14. Failure to Extend Epidural Labor Analgesia for Cesarean Delivery Anesthesia: A Focused Review.

    PubMed

    Mankowitz, Suzanne K W; Gonzalez Fiol, Antonio; Smiley, Richard

    2016-11-01

    Extension of epidural labor analgesia for cesarean delivery anesthesia may fail. There are a number of factors associated with labor epidural catheter failure. This focused review discusses these associations and anesthetic options when faced with inadequate surgical epidural anesthesia for cesarean delivery.

  15. Visible Evidence of Lumbar Epidural Catheter Misplacement–A Critical Incident Case Report

    PubMed Central

    Butala, Beena; Parikh, Geeta; Pargi, Rajesh

    2017-01-01

    One of the causes of failed epidurals is catheter misplacement. Though various techniques of epidural space identification have been developed, none of them is 100% successful. Here, we present a case of lumbar epidural catheter misplacement in a patient scheduled to undergo right sided open nephrectomy. Catheter was found in the surgical field coming out of psoas major muscle. PMID:28274024

  16. Visible Evidence of Lumbar Epidural Catheter Misplacement-A Critical Incident Case Report.

    PubMed

    Shah, Rajkiran; Butala, Beena; Parikh, Geeta; Pargi, Rajesh

    2017-01-01

    One of the causes of failed epidurals is catheter misplacement. Though various techniques of epidural space identification have been developed, none of them is 100% successful. Here, we present a case of lumbar epidural catheter misplacement in a patient scheduled to undergo right sided open nephrectomy. Catheter was found in the surgical field coming out of psoas major muscle.

  17. Cervical epidural steroid injections for the treatment of cervical spinal (neck) pain.

    PubMed

    Candido, Kenneth D; Knezevic, Nebojsa 'nick'

    2013-02-01

    Cervical epidural steroid injections (CESI) are an accepted treatment for neck pain with a radicular component, and may be accomplished by using either transforaminal (CTFESI) or interlaminar (CILESI) approaches. CESIs are routinely performed using real-time fluoroscopic-guidance in conjunction with the injection of water soluble, iodine-based contrast media to enhance visualization of intravascular injections. Digital subtraction angiography (DSA) imaging is an adjuvant to fluoroscopic methods for visualizing blood vessels while performing spinal injections. However, as with any neuraxial procedure, various complications associated with CESIs have been reported. Complications are directly associated with the technical procedures of CESIs. Particulate steroids may have a prolonged duration of action but non-particulate steroids are safer for CESIs. Blunt-beveled needles are less likely than sharp-beveled needles to penetrate blood vessels to cause bleeding complications during CTFESI procedures. Small doses of local anesthetics appear to be safe and assist in identifying intravascular injections previously overlooked by conventional techniques.

  18. Wireless link design using a patch antenna

    SciTech Connect

    Hall, E

    2000-08-11

    A wireless link was designed using a patch antenna. In the process, several different models were tested. Testing proved a patch antenna was a viable solution for building a wireless link within the design specifications. Also, this experimentation provided a basis for future patch antenna design.

  19. Epidural Bovine Pericardium Facilitates Dissection During Cranioplasty: A Technical Note.

    PubMed

    Griessenauer, Christoph J; He, Lucy; Salem, Mohamed; Chua, Michelle; Ogilvy, Christopher S; Thomas, Ajith J

    2015-12-01

    Adhesions and scarring of the subcutaneous tissue to the dura mater or dural substitute often complicate cranioplasty. We present our experience with epidural bovine pericardium as a barrier membrane to minimize adhesions and facilitate separation of tissue layers. A cohort of patients who underwent decompressive craniectomy and subsequent cranioplasty at a major academic institution in the United States from August 2007 to October 2013 and had epidural bovine pericardium placed as a barrier membrane was retrospectively reviewed. Medical records and imaging studies were reviewed for a number of variables including presence of adhesions, infection, contusions, and operative complications. Twenty-nine patients (male-to-female = 1:1.1; mean age 45 ± 14.7 years) who underwent decompressive craniectomy with placement of epidural bovine pericardium with subsequent cranioplasty were identified. The median interval between craniectomy and cranioplasty was 64 days, and autologous bone was used for cranioplasty in 86.2% of cases. The average size of cranial defect was 71.2 ± 28.5 cm(2). At the time of cranioplasty, no or minimal adhesions were found between the subcutaneous tissue and the epidural bovine pericardium. There were 2 (6.9%) infections, 2 (6.9%) patients had contusion after the cranioplasty, and no patient had a complication after cranioplasty that required reoperation. Epidural bovine pericardium at the time of decompressive craniectomy facilitates dissection at the time of cranioplasty and is not associated with any additional risks. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Pentoxifylline Inhibits Epidural Fibrosis in Post-Laminectomy Rats

    PubMed Central

    Kelten, Bilal; Erdogan, Hakan; Antar, Veysel; Sanel, Selim; Tuncdemir, Matem; Kutnu, Muge; Karaoglan, Alper; Orki, Tulay

    2016-01-01

    Background The aim of this experimental study was to investigate the effectiveness of intramuscular pentoxifylline in the prevention of postoperative fibrosis. Material/Methods We divided 16 adult Wistar albino rats into 2 equal groups: treatment and control. Both groups underwent L1 vertebral total laminectomy to expose the dura. The intramuscular treatment group received pentoxifylline. Four weeks later, epidural fibrosis was studied in both groups using electron microscopy, light microscopy, histology, biochemistry, and macroscopy. Results The evaluation of epidural fibrosis in the 2 groups according to macroscopic (p<0.01) assessment and light microscopy revealed that epidural scar tissue formation was lower in the treatment group compared to the control group (p<0.001) and the number of fibroblasts was also decreased significantly in the pentoxifylline-treated group (p<0.05). More immature fibers were demonstrated in the treatment group by electron microscopy in comparison with the control group. In biochemical analysis, a statistically significant decrease was detected in hydroxyproline, which indicates fibrosis and myeloperoxidase activity, and shows an inflammatory response (P<0.001). Conclusions Systemic pentoxifylline application prevents postoperative epidural fibrosis and adhesions with various mechanisms. Our study is the first to present evidence of experimental epidural fibrosis prevention with pentoxifylline. PMID:26974057

  1. Morphine and hydromorphone epidural analgesia. A prospective, randomized comparison.

    PubMed

    Chaplan, S R; Duncan, S R; Brodsky, J B; Brose, W G

    1992-12-01

    Because evidence from uncontrolled, unblinded studies suggested fewer side effects from epidural hydromorphone than from epidural morphine, we employed a randomized, blinded study design to compare the side effects of lumbar epidural morphine and hydromorphone in 55 adult, non-obstetric patients undergoing major surgical procedures. A bolus dose of epidural study drug was given at least 1 h prior to the conclusion of surgery, followed by a continuous infusion of the same drug for two postoperative days. Infusions were titrated to patient comfort. Visual analog scale (VAS) pain scores, VAS sedation scores, and subjective ratings of nausea and pruritus were assessed twice daily. The two treatments provided equivalent analgesia. Sedation scores and prevalence of nausea did not differ significantly between groups. Prevalence of pruritus, however, differed significantly on postoperative day 1, with moderate to severe pruritus reported by 44.4% of patients in the morphine group versus 11.5% in the hydromorphone group (P < .01). On post-operative day 2, reports of pruritus by patients receiving morphine remained higher than those among the hydromorphone-treated subjects, although this difference was no longer statistically significant (32% vs. 16.7%, P = .18). We conclude that lumbar epidural morphine and hydromorphone afford comparable analgesia, but the occurrence of moderate to severe pruritus on the first postoperative day is reduced by the use of hydromorphone.

  2. Polar cap hot patches: Enhanced density structures different from the classical patches in the ionosphere

    NASA Astrophysics Data System (ADS)

    Zhang, Q.-H.; Ma, Y.-Z.; Jayachandran, P. T.; Moen, J.; Lockwood, M.; Zhang, Y.-L.; Foster, J. C.; Zhang, S.-R.; Wang, Y.; Themens, D. R.; Zhang, B.-C.; Xing, Z. Y.

    2017-08-01

    Based on in situ and ground-based observations, a new type of "polar cap hot patch" has been identified that is different from the classical polar cap enhanced density structure (cold patches). Comparing with the classical polar cap patches, which are transported from the dayside sunlit region with dense and cold plasma, the polar cap hot patches are associated with particle precipitations (therefore field-aligned currents), ion upflows, and flow shears. The hot patches may have the same order of density enhancement as classical patches in the topside ionosphere, suggesting that the hot patches may be produced by transported photoionization plasma into flow channels. Within the flow channels, the hot patches have low-energy particle precipitation and/or ion upflows associated with field-aligned currents and flow shears. Corresponding Global Navigation Satellite System (GNSS) signal scintillation measurements indicate that hot patches may produce slightly stronger radio signal scintillation in the polar cap region than classical patches. A new type of polar cap patches, "polar cap hot patches," is identified to differentiate enhanced density structures from classical patches. Hot patches are associated with particle precipitations, ion upflows, field-aligned currents, and shear flows in the polar cap. Hot patches may lead to slightly stronger ionospheric scintillations of GNSS signals in the polar cap region than classical patches.

  3. Diabetic foot complicated by vertebral osteomyelitis and epidural abscess

    PubMed Central

    Trombetta, Maddalena; Imbriaco, Chiara; Rigolon, Riccardo; Mingolla, Lucia; Zamboni, Federica; Dal Molin, Francesca; Cioccoloni, Dario; Sanga, Viola; Bruti, Massimiliano; Brocco, Enrico; Conti, Michela; Ravenna, Giorgio; Perrone, Fabrizia; Stoico, Vincenzo; Bonora, Enzo

    2016-01-01

    Summary Vertebral osteomyelitis (or spondylodiscitis) is steadily increasing in Western countries and often results from hematogenous seeding, direct inoculation during spinal surgery, or contiguous spread from an infection in the adjacent soft tissue. We present the case of a 67-year-old white patient with type 2 diabetes who went to Hospital for high fever, back pain, and worsening of known infected ulcers in the left foot. Despite intravenous antibiotic treatment and surgical debridement of the foot infection, high fever and lower back pain continued. Bone biopsy and two consecutive blood cultures were positive for Staphylococcus aureus. A spinal magnetic resonance imaging (MRI) was performed, revealing serious osteomyelitis in L4 and L5 complicated by an epidural abscess. Contiguous or other distant focuses of infection were not identified. In this case, diabetic foot could be considered as a primary distant focus for vertebral osteomyelitis. Clinicians should consider vertebral osteomyelitis as a ‘possible’ diagnosis in patients with type 2 diabetes complicated by foot infection that is associated with fever and lower back pain. Learning points Vertebral osteomyelitis is increasing in Western countries, especially in patients with type 2 diabetes. The primary focus of infection is the genitourinary tract followed by skin, soft tissue, endocarditis, bursitis, septic arthritis, and intravascular access. Diabetic foot could be a rare primary focus of infection for vertebral osteomyelitis, and, however, vertebral osteomyelitis could be a serious, albeit rare, complication of diabetic foot. Clinicians should keep in mind the many potential complications of diabetic foot ulcerations and consider vertebral osteomyelitis as a “possible” diagnosis in patients with type 2 diabetes and foot ulcers associated with nonspecific symptoms such as lower back pain. Early diagnosis and correct management of vertebral osteomyelitis are crucial to improve clinical outcomes

  4. Pathophysiology of intracranial epidural haematoma following birth.

    PubMed

    Hamlat, Abderrahmane; Heckly, Anne; Adn, Mahmoudreza; Poulain, Patrice

    2006-01-01

    Epidural haematoma in newborn infants is rare, and few specific obstetrical data related to its formation are available in the literature. The aim of this study is to discuss the pathophysiology of this condition. EDH is always a post traumatic lesion and it is only possible if the insult has produced a cleavage of the dura mater from bone. Therefore, EDH results from the mechanical forces exerted on the foetal head during birth, with or with no instrumental interference. Although it is still unclear whether the injury (and dura mater cleavage) was directly caused by the forceps or had already been inflicted by natural forces, or a combination of both however, in some patients (with neither dystocia nor skull fracture), there is no basis for explaining EDH formation, apart from propulsion of the fore coming head through the birth canal. Excessive moulding, whether or not associated with iatrogenic trauma, has been incriminated in most cases of EDH. As dystocia cannot always be anticipated, EDH will remain an ever-present cause of morbidity in the neonatal population, albeit a rare occurrence.

  5. Evaluation and management of spinal epidural abscess.

    PubMed

    DeFroda, Steven F; DePasse, J Mason; Eltorai, Adam E M; Daniels, Alan H; Palumbo, Mark A

    2016-02-01

    Spinal epidural abscess (SEA) is an uncommon and potentially catastrophic condition. SEA often presents a diagnostic challenge, as the "classic triad" of fever, spinal pain, and neurological deficit is evident in only a minority of patients. When diagnosis is delayed, irreversible neurological damage may ensue. To minimize morbidity, an appropriate level of suspicion and an understanding of the diagnostic evaluation are essential. Infection should be suspected in patients presenting with axial pain, fever, or elevated inflammatory markers. Although patients with no known risk factors can develop SEA, clinical concern should be heightened in the presence of diabetes, intravenous drug use, chronic renal failure, immunosuppressant therapy, or a recent invasive spine procedure. When the clinical profile is consistent with the diagnosis of SEA, gadolinium-enhanced magnetic resonance imaging of the spinal column should be obtained on an emergent basis to delineate the location and neural compressive effect of the abscess. Rapid diagnosis allows for efficient treatment, which optimizes the potential for a positive outcome.

  6. Epidural infection: Is it really an abscess?

    PubMed Central

    Avilucea, Frank R.; Patel, Alpesh A.

    2012-01-01

    Background: We reviewed the literature regarding the pathogenesis, clinical presentation, diagnosis, and management of spinal epidural abscess (SEA). Methods: Utilizing PubMed, we performed a comprehensive review of the literature on SEAs. Results: SEA remains a difficult infectious process to diagnose. This is particularly true in the early stages, when patients remain neurologically intact, and before the classic triad of fever, back pain, and neurologic deficit develop. However, knowledge of risk factors, obtaining serologic markers, and employing magnetic resonance scans facilitate obtaining a prompt and accurate diagnosis. In patients without neurologic deficits, lone medical therapy may prove effective. Conclusions: More prevalent over the previous three decades, SEA remains a rare but deleterious infectious process requiring prompt identification and treatment. Historically, identification of SEA is often elusive, diagnosis is delayed, and clinicians contend that surgical debridement is the cornerstone of treatment. Early surgery leads to more favorable outcomes and preserves neurologic function, particularly in the early stages of disease when minimal or no neurologic deficits are present. The advent of improved imaging modalities, diagnostic techniques, and multidrug antimicrobial agents has enabled medical/spinal surgical consultants to more rapidly diagnose SEA and institute more effective early medical treatment (e.g., data suggest that lone medical therapy may prove effective in the early management of SEA). PMID:23248757

  7. Computational modeling of epidural cortical stimulation

    NASA Astrophysics Data System (ADS)

    Wongsarnpigoon, Amorn; Grill, Warren M.

    2008-12-01

    Epidural cortical stimulation (ECS) is a developing therapy to treat neurological disorders. However, it is not clear how the cortical anatomy or the polarity and position of the electrode affects current flow and neural activation in the cortex. We developed a 3D computational model simulating ECS over the precentral gyrus. With the electrode placed directly above the gyrus, about half of the stimulus current flowed through the crown of the gyrus while current density was low along the banks deep in the sulci. Beneath the electrode, neurons oriented perpendicular to the cortical surface were depolarized by anodic stimulation, and neurons oriented parallel to the boundary were depolarized by cathodic stimulation. Activation was localized to the crown of the gyrus, and neurons on the banks deep in the sulci were not polarized. During regulated voltage stimulation, the magnitude of the activating function was inversely proportional to the thickness of the CSF and dura. During regulated current stimulation, the activating function was not sensitive to the thickness of the dura but was slightly more sensitive than during regulated voltage stimulation to the thickness of the CSF. Varying the width of the gyrus and the position of the electrode altered the distribution of the activating function due to changes in the orientation of the neurons beneath the electrode. Bipolar stimulation, although often used in clinical practice, reduced spatial selectivity as well as selectivity for neuron orientation.

  8. Cervical Epidural Depth: Correlation Between Cervical MRI Measurements of the Skin-to-Cervical Epidural Space and the Actual Needle Depth During Interlaminar Cervical Epidural Injections.

    PubMed

    Algrain, Haitham; Liu, Alison; Singh, Sarabdeep; Vu, To-Nhu; Cohen, Steven P

    2017-05-08

    The purpose of this study was to assess the correlation between skin-to-epidural space depth, as measured on cervical magnetic resonance imaging (MRI), and actual needle depth, as measured by Tuohy needle markings during cervical epidural steroid injections. We conducted a retrospective review of cervical MRI images to determine estimated depth from skin to epidural space. Of the 121 reviewed patients who underwent cervical epidural steroid injections, 81 met inclusion criteria and were retained for data analysis. At the C6-C7 level, the estimated needle depth according to MRI images was 6.03 ± 1.15 cm (mean ± SD) and the actual needle depth was 5.62 ± 0.77 cm. At the C7-T1 level, the estimated needle depth based on MRI images was 5.90 ± 1.05 cm and the actual needle depth was 5.73 ± 0.98 cm. At both C6-C7 and C7-T1, MRI depth ( P  <   0.009, P  <   0.001) and body mass index ( P  <   0.001, P  <   0.002) were significantly associated with actual depth. Estimates of needle depth made with MRI were consistently slightly deeper than the actual loss-of-resistance needle depth, indicating that the provider should employ caution when using MRI predictive depths. Information garnered from preprocedure MRIs can be used to improve the safety of cervical epidural steroid injection procedures.

  9. Palmar herald patch in pityriasis rosea.

    PubMed

    Polat, Mualla; Yildirim, Yasemin; Makara, Anil

    2012-08-01

    Pityriasis rosea is an acute self-limited inflammatory disorder of the skin. The initial clinical features of typical cases are the appearance of a herald patch. The herald patch is commonly located on the thigh, upper arm, trunk or neck; rarely the patch may be on the face, scalp or penis. There are no reports of a palmar herald patch in pityriasis rosea. In this article we present a 14-year-old male patient who had a palmar herald patch with truncal lesions of pityriasis rosea. © 2012 The Authors. Australasian Journal of Dermatology © 2012 The Australasian College of Dermatologists.

  10. A Double-Blind Randomized Controlled Trial Comparing Epidural Clonidine vs Bupivacaine for Pain Control During and After Lower Abdominal Surgery

    PubMed Central

    Abd-Elsayed, Alaa A.; Guirguis, Maged; DeWood, Mark S.; Zaky, Sherif S.

    2015-01-01

    Background Alpha-2 adrenergic agonists produce safe and effective analgesia, but most investigations studying the analgesic effect of alpha-2 adrenoceptor agonists postoperatively included previous or concomitant administration of other analgesics. Because clonidine potentiates the effect of these drugs, its own intrinsic analgesic effect has been difficult to establish. This study was designed to compare the intraoperative and postoperative effects of epidural clonidine vs bupivacaine for patients undergoing lower abdominal surgery. Methods This randomized controlled trial included 40 patients aged 18-50 who were scheduled for elective lower abdominal surgery. Patients were randomly divided into 2 groups. Group I (n=20) received epidural clonidine; Group II (n=20) received epidural bupivacaine. Intraoperative and postoperative hemodynamics, pain scores, and complications were monitored. Results Mean pain scores were significantly lower in Group I compared to Group II (1.5 ± 0.5 compared to 3.4 ± 1.0, respectively) in the first 12 hours after surgery. Sedation was more prominent in Group I until 9 hours after surgery. Opioid requirements were significantly lower in Group I. Respiratory rate was similar in the 2 groups. Group I had larger decreases from baseline in systolic blood pressure and diastolic blood pressure than Group II. Heart rate in Group I was reduced from baseline, while it was increased in Group II. Less postoperative nausea and vomiting, urinary retention, pruritus, and shivering were observed in Group I. Conclusion Compared to bupivacaine, epidural clonidine provided effective intraoperative and postoperative analgesia in selected patients, resulting in a decreased intravenous pain medication requirement and prolonged duration of analgesia after epidural infusion was discontinued. PMID:26130975

  11. A Double-Blind Randomized Controlled Trial Comparing Epidural Clonidine vs Bupivacaine for Pain Control During and After Lower Abdominal Surgery.

    PubMed

    Abd-Elsayed, Alaa A; Guirguis, Maged; DeWood, Mark S; Zaky, Sherif S

    2015-01-01

    Alpha-2 adrenergic agonists produce safe and effective analgesia, but most investigations studying the analgesic effect of alpha-2 adrenoceptor agonists postoperatively included previous or concomitant administration of other analgesics. Because clonidine potentiates the effect of these drugs, its own intrinsic analgesic effect has been difficult to establish. This study was designed to compare the intraoperative and postoperative effects of epidural clonidine vs bupivacaine for patients undergoing lower abdominal surgery. This randomized controlled trial included 40 patients aged 18-50 who were scheduled for elective lower abdominal surgery. Patients were randomly divided into 2 groups. Group I (n=20) received epidural clonidine; Group II (n=20) received epidural bupivacaine. Intraoperative and postoperative hemodynamics, pain scores, and complications were monitored. Mean pain scores were significantly lower in Group I compared to Group II (1.5 ± 0.5 compared to 3.4 ± 1.0, respectively) in the first 12 hours after surgery. Sedation was more prominent in Group I until 9 hours after surgery. Opioid requirements were significantly lower in Group I. Respiratory rate was similar in the 2 groups. Group I had larger decreases from baseline in systolic blood pressure and diastolic blood pressure than Group II. Heart rate in Group I was reduced from baseline, while it was increased in Group II. Less postoperative nausea and vomiting, urinary retention, pruritus, and shivering were observed in Group I. Compared to bupivacaine, epidural clonidine provided effective intraoperative and postoperative analgesia in selected patients, resulting in a decreased intravenous pain medication requirement and prolonged duration of analgesia after epidural infusion was discontinued.

  12. Postoperative pain control in cats: clinical trials with pre-emptive lidocaine epidural co-administered with morphine or methadone.

    PubMed

    DeRossi, Rafael; Hermeto, Larissa Correa; Jardim, Paulo Henrique Affonseca; de Andrade Bicudo, Natalia; de Assis, Klebs Tavares

    2016-11-01

    Objectives The aim of the study was to evaluate the effectiveness of epidural lidocaine in combination with either methadone or morphine for postoperative analgesia in cats undergoing ovariohysterectomy. Methods Under general anesthesia, 24 cats that underwent ovariohysterectomy were randomly allocated into three treatment groups of eight each. Treatment 1 included 2% lidocaine (4.0 mg/kg); treatment 2 included lidocaine and methadone (4.0 mg/kg and 0.3 mg/kg, respectively); and treatment 3 included lidocaine and morphine (4.0 mg/kg and 0.1 mg/kg, respectively). All drugs were injected in a total volume of 0.25 ml/kg via the lumbosacral route in all cats. During the anesthetic and surgical periods, the physiologic variables (respiratory and heart rate, arterial blood pressure and rectal temperature) were measured at intervals of time zero, 10 mins, 20 mins, 30 mins, 60 mins and 120 mins. After cats had recovered from anesthesia, a multidimensional composite pain scale was used to assess postoperative analgesia 2, 4, 8, 12, 18 and 24 h after epidural. Results The time to first rescue analgesic was significantly ( P <0.05) prolonged in cats that received both lidocaine and methadone or lidocaine and morphine treatments compared with those that received lidocaine treatment alone. All cats that received lidocaine treatment alone required rescue analgesic within 2 h of epidural injections. All treatments produced significant cardiovascular and respiratory changes but they were within an acceptable range for healthy animals during the surgical period. Conclusions and relevance The two combinations administered via epidural allowed ovariohysterectomy with sufficient analgesia in cats, and both induced prolonged postoperative analgesia.

  13. A New Less Invasive Technique for Multiple-Level Spontaneous Spinal Epidural Hematomas: Wash-and-Go Technique.

    PubMed

    Tanriverdi, Osman; Gungor, Abuzer; Coban, Mustafa Kemal; Okay, Onder; Kamaci, Umit

    2017-03-01

    Aim Spinal epidural hematomas are rare entity in neurosurgery practice. Most of them are spontaneous due to anticoagulant therapy and called spontaneous spinal epidural hematomas (SSEHs). Laminectomy or hemilaminectomy for affected levels is still the first choice in the operative treatment of an SSEH. We describe a new less invasive surgical technique, performing single-level laminectomy and washing with 0.9% sodium chloride through a thin soft catheter for a 12-level thoracic-cervical SSEH in a patient under anticoagulant therapy. Patient and Operative Technique A 55-year-old woman was brought to the emergency department with a rapid onset of pain in her upper back and both legs with weakness of her lower extremities. An urgent magnetic resonance imaging (MRI) of the whole spine showed a SEH. During the operation, after T2 laminectomy, a thin soft catheter was epidurally placed under the T1 lamina and gently pushed forward rostrally. Then continuous saline irrigation was utilized and aspiration made via the catheter to wash out the hematoma. Drainage of blood was observed. The procedure was performed for 15 minutes. Then the catheter was epidurally placed under the T3 lamina, and the procedure for the hematoma in the lower segment was repeated. Decompression of spinal cord and nerve roots was observed. Result Postoperative early MRI of the thoracic-cervical spine showed gross total evacuation of the SEH. Accordingly, the patient's muscle strength improved. Conclusion Although multiple laminectomy or hemilaminectomy for affected levels to evacuate the hematoma and decompress the spinal cord is the main choice of surgical treatment, single-level laminectomy and irrigation plus aspiration via a thin soft catheter can be performed successfully with good results in SSEH.

  14. Effect of programmed intermittent epidural boluses and continuous epidural infusion on labor analgesia and obstetric outcomes: a randomized controlled trial.

    PubMed

    Ferrer, Leopoldo E; Romero, David J; Vásquez, Oscar I; Matute, Ednna C; Van de Velde, Marc

    2017-09-07

    Continuous epidural infusion and programmed intermittent epidural boluses are analgesic techniques routinely used for pain relief in laboring women. We aimed to assess both techniques and compare them with respect to labor analgesia and obstetric outcomes. After Institutional Review Board approval, 132 laboring women aged between 18 and 45 years were randomized to epidural analgesia of 10 mL of a mixture of 0.1% bupivacaine plus 2 µg/mL of fentanyl either by programmed intermittent boluses or continuous infusion (66 per group). Primary outcome was quality of analgesia. Secondary outcomes were duration of labor, total drug dose used, maternal satisfaction, sensory level, motor block level, presence of unilateral motor block, hemodynamics, side effects, mode of delivery, and newborn outcome. Patients in the programmed intermittent epidural boluses group received statistically less drug dose than those with continuous epidural infusion (24.9 vs 34.4 mL bupivacaine; P = 0.01). There was no difference between groups regarding pain control, characteristics of block, hemodynamics, side effects, and Apgar scores. Our study evidenced a lower anesthetic consumption in the programmed intermittent boluses group with similar labor analgesic control, and obstetric and newborn outcomes in both groups.

  15. Comparison of lidocaine and saline for epidural top-up during combined spinal-epidural anesthesia in volunteers.

    PubMed

    Trautman, W J; Liu, S S; Kopacz, D J

    1997-03-01

    This study was designed to determine the efficacy of saline as an epidural top-up to prolong spinal anesthesia during combined spinal-epidural anesthesia (CSEA). Eight volunteers received three separate CSEAs with intrathecal lidocaine (50 mg). After two-segment regression, each subject received either a saline (10 mL), lidocaine 1.5% (10 mL), or control sham (0.5 mL saline) epidural injection in a randomized, double-blind, triple cross-over fashion. Sensory block was assessed by pinprick and tolerance to transcutaneous electrical stimulation (TES) equivalent to surgical stimulation at the knee and ankle. Motor strength was assessed with iso-metric force dynamometry. Data were analyzed with a repeated measures analysis of variance and a paired t-test. Sensory block to pinprick was prolonged in the thoracolumbar dermatomes only by lidocaine (P < 0.05). Neither lidocaine nor saline prolonged the duration of tolerance to TES at the tested sites. Instead, saline decreased the duration of tolerance to TES by 20 and 24 min at the knee and ankle (P < 0.05). Recovery from motor block at the quadriceps was prolonged by an epidural injection of lidocaine (P < 0.05). We conclude that when 10 mL of epidural saline is administered after two-segment regression, it is an ineffective top-up and may decrease the duration of spinal anesthesia during CSEA.

  16. Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

    PubMed Central

    Baduni, Neha; Sanwal, Manoj Kumar; Vajifdar, Homay; Agarwala, Radhika

    2016-01-01

    Background and Aims: Caudal epidural block is the most commonly used neuraxial block in children. Morphine has been used as a caudal additive for more than three decades. The aim of our study was to evaluate the efficacy and duration of analgesia of three different doses of caudal epidural morphine (CEM), and to find out the incidence of side effects. Material and Methods: This study was conducted on 75 patients of American Society of Anesthesiologists grades I and II, aged 2-12 years, undergoing lower abdominal and urogenital surgeries. Patients were randomly allocated to one of the three groups according to the dose of morphine. Group I received 30 μg/kg, group II 50 μg/kg, and group III 70 μg/kg. Heart rate, blood pressure, oxygen saturation, electrocardiogram, pain score, sedation score, duration of analgesia, and side-effects were noted. Results: The mean duration of analgesia was 8.63 h in group I, 13.36 h in group II and 19.19 h in group III. Respiratory depression was noted in three patients in group III. One patient in group I had itching. One patient each in groups I, II, and III had nausea/vomiting. Conclusion: CEM significantly prolongs the duration of analgesia, though with a higher dose the risk of respiratory depression should always be kept in mind. PMID:27275053

  17. Knotting of a Cervical Epidural Catheter in the Patient with Post-Herpetic Neuralgia: A Rare Complication

    PubMed Central

    Park, Jong Taek; Cho, Dong Woo; Lee, Young Bok

    2017-01-01

    Epidural block is achieved either by single injection of local anesthetic through an epidural needle or as a continuous block by infusion pump through an epidural catheter. Complications associated with epidural catheters include breakage, entrapment, and knotting. Knotting of epidural catheters is very rare, but knotting in lumbar epidural catheters has been reported in a number of studies, and most of these cases involved removal difficulty. We report a case in which we inserted a cervical epidural catheter in a patient who was experiencing severe post-herpetic neuralgia and then removed the knotted catheter without complications. PMID:28261560

  18. Patching. Restitching business portfolios in dynamic markets.

    PubMed

    Eisenhardt, K M; Brown, S L

    1999-01-01

    In turbulent markets, businesses and opportunities are constantly falling out of alignment. New technologies and emerging markets create fresh opportunities. Converging markets produce more. And of course, some markets fade. In this landscape of continuous flux, it's more important to build corporate-level strategic processes that enable dynamic repositioning than it is to build any particular defensible position. That's why smart corporate strategists use patching, a process of mapping and remapping business units to create a shifting mix of highly focused, tightly aligned businesses that can respond to changing market opportunities. Patching is not just another name for reorganizing; patchers have a distinctive mindset. Traditional managers see structure as stable; patching managers believe structure is inherently temporary. Traditional managers set corporate strategy first, but patching managers keep the organization focused on the right set of business opportunities and let strategy emerge from individual businesses. Although the focus of patching is flexibility, the process itself follows a pattern. Patching changes are usually small in scale and made frequently. Patching should be done quickly; the emphasis is on getting the patch about right and fixing problems later. Patches should have a test drive before they're formalized but then be tightly scripted after they've been announced. And patching won't work without the right infrastructure: modular business units, fine-grained and complete unit-level metrics, and companywide compensation parity. The authors illustrate how patching works and point out some common stumbling blocks.

  19. "Patch"ing up our tumor signaling knowledge.

    PubMed

    Atwood, Scott X; Whitson, Ramon J; Oro, Anthony E

    2013-05-01

    The tumor suppressor Patched1 (Ptch1) possesses well-described roles in regulating sonic hedgehog (SHH) signaling in the skin and preventing the formation of basal cell carcinomas (BCCs). In this issue, Kang et al. extend their previous work to show that a naturally occurring allele of Ptch1 found in FVB mice promotes early squamous cell carcinoma (SCC) growth without aberrant activation of the SHH pathway. The study reveals new roles for Ptch1 that lie at the nexus between BCC and SCC formation.

  20. Techniques for the maintenance of epidural labor analgesia.

    PubMed

    Capogna, Giorgio; Stirparo, Silvia

    2013-06-01

    After initiating neuraxial labor analgesia, there are many techniques that can be used to maintain analgesia for the duration of labor. In this review, we have examined the new techniques of maintenance of epidural labor analgesia recently proposed to overcome the undesirable effects of continuous infusion and patient-controlled epidural analgesia (PCEA). As labor progresses, there is a greater need for analgesia. PCEA with basal infusion, automated intermittent mandatory boluses, programmed intermittent epidural boluses and computer-integrated PCEA have been introduced to combine the advantages of a manual bolus and continuous infusion, thus matching infusion rate and bolus modality to the patient's analgesic needs. Increased maternal satisfaction, reduced anesthetic consumption and decreased incidence of motor block are features of these new maintenance techniques. Technology has now provided us with more advanced drug delivery systems that may have the potential to fulfill the maternal requirements of a safe, natural, and painless childbirth, tailoring the analgesic regimen for each parturient's need.

  1. Epidural Gas Accumulation in Connection with Canine Degenerative Lumbosacral Disease.

    PubMed

    Skytte, Ditte; Schmökel, Hugo

    2017-01-01

    Three dogs were presented with lumbosacral hyperesthesia. Computerized tomography scans were performed in all the cases, and magnetic resonance imaging was also performed in cases 1 and 3. There was intervertebral disc (IVD) protrusion causing nerve root compression and epidural gas accumulation in all the three cases. The gas-filled cystic structures in cases 1 and 3 were within the spinal canal; in case 2, the gas was within the disc protrusion. The IVD vacuum phenomenon is relatively common in dogs, but the formation of an epidural gas accumulation in cases of a lumbar disc protrusion is rare. The clinical significance of these epidural gas accumulations is unknown. Two of the dogs were treated surgically, improved after surgery, and showed no signs of pain in the follow-up examinations.

  2. Continuous Cervical Epidural Analgesia in Metastatic Spinal Cord Compression

    PubMed Central

    Menon, Mahesh; Taha, Nafisa; Purohit, Navita; Kothari, Vatsal; Singh, Shweta

    2016-01-01

    Metastatic spinal cord compression is a devastating complication of cancer. Patients may often require high doses of opioids that may cause side effects, myoclonus being one such. A 63-year-old male suffering from malignant spinal cord compression was admitted to our institution. The primary team managed him conservatively with pharmacotherapy with no relief of pain, and he experienced myoclonus and sedation as adverse effects. A continuous cervical epidural catheter with local anesthetic infusion was inserted for 5 days to control his pain. This relieved his pain, which was sustained even after we removed the epidural catheter on day 5, for up to 64 days until the time of his death. Continuous cervical epidural local anesthetic infusions may help with refractory pain by deafferentation of noxious stimuli. Central neuraxial blocks may be a valuable rescue in selected patients. PMID:27803576

  3. Clinical evaluation of a new epidural pressure monitor.

    PubMed

    Czech, T; Korn, A; Reinprecht, A; Schramm, W; Kimla, T; Spiss, C K

    1993-01-01

    Comparative measuring of epidural pressure using the Spiegelberg probe 1 and ventricular fluid pressure was carried out in 15 neurosurgical intensive-care patients. Deviations in both directions were established, with a trend toward overestimating ventricular pressure in epidural pressure measuring (r = 0.77). Individual pulsations, spontaneous wave courses and therapy-induced pressure changes were reflected without delays. There were no complications observed with probe implantation periods for up to 6 days. The system has been shown to be mechanically stable and easy to implant. We believe the device to be fit for trend monitoring of intracranial pressure. As with other epidural pressure monitoring systems, false assessments of ventricular pressure may lead to wrong decisions as to required therapy.

  4. Acute lymphocytic leukemia recurring in the spinal epidural space.

    PubMed

    Higashida, Tetsuhiro; Kawasaki, Takashi; Sakata, Katsumi; Tanabe, Yutaka; Kanno, Hiroshi; Yamamoto, Isao

    2007-08-01

    A 27-year-old man presented with a very rare spinal epidural mass associated with recurrence of acute lymphocytic leukemia (ALL) manifesting as acute progressive neurological deficits. The patient presented with shoulder pain and ambulatory difficulties 3 years after remission of ALL treated by bone marrow transplantation. Magnetic resonance imaging revealed an epidural mass extending from C-7 to T-3, which compressed the cord and extended to the intervertebral foramen along the roots. After decompression surgery, the symptoms dramatically improved. Histological examination showed clusters of immature lymphocytes consistent with recurrence of leukemia, so chemotherapy and radiation therapy were carried out. At 1 year after the operation, no local mass expansion or systemic progression of leukemia had occurred. Leukemic mass must be considered in the differential diagnosis of spinal epidural mass, even in patients with ALL.

  5. Analysis of Stub Loaded Microstrip Patch Antennas

    NASA Technical Reports Server (NTRS)

    Bailey, M. C.; Deshpande, M. D.

    1997-01-01

    A microstrip patch antenna fed by a coaxial probe and reactively loaded by a open circuited microstrip line has been used previously to produce circular polarization[ l] and also as a building block for a series fed microstrip patch array [2]. Rectangular and circular patch antennas loaded with a microstrip stub were previously analyzed using the generalized Thevenin theorem [2,3]. In the Thevenin theorem approach, the mutual coupling between the patch current and the surface current on the stub was not taken into account. Also, the Thevenin theorem approach neglects continuity of current at the patch-stub junction. The approach in this present paper includes the coupling between the patch and stub currents as well as continuity at the patch-stub junction.

  6. The dynamics of epidural and opioid analgesia during labour.

    PubMed

    Zondag, Dirkje C; Gross, Mechthild M; Grylka-Baeschlin, Susanne; Poat, Angela; Petersen, Antje

    2016-11-01

    To investigate the association of analgesia, opioids or epidural, or the combination of both with labour duration and spontaneous birth in nulliparous women. A secondary data analysis of an existing cohort study was performed and included nulliparous women (n = 2074). Durations of total labour and first and second labour stage were calculated with Kaplan-Meier estimation for the four different study groups: no analgesia (n = 620), opioid analgesia (n = 743), epidural analgesia (n = 482), and combined application (n = 229). Labour duration was compared by Cox regression while adjusting for confounders and censoring for operative births. Logistic regression was used to investigate the association between the administration of different types of analgesia and mode of birth. Most women in the combined application group were first to receive opioid analgesia. Women with no analgesia had the shortest duration of labour (log rank p < 0.001) and highest chance of a spontaneous birth (p < 0.001). If analgesia was administered, women with opioids had a shorter first stage (p = 0.018), compared to women with epidural (p < 0.001) or women with combined application (p < 0.001). Women with opioids had an increased chance to reach full cervical dilatation (p = 0.006). Women with epidural analgesia (p < 0.001) and women with combined application (p < 0.001) had a prolonged second stage and decreased chance of spontaneous birth compared to women without analgesia. Women with opioids had a prolonged first stage, but increased chance to reach full cervical dilatation. Women with epidural analgesia and women with both opioid and epidural analgesia had a prolonged first and second stage and a decreased chance of a spontaneous birth.

  7. Is epidural analgesia during labor related to retained placenta?

    PubMed

    Sarit, Avraham; Sokolov, Amit; Many, Ariel

    2016-05-01

    To explore the influence of epidural analgesia on the course of the third stage of labor and on the incidence of the complete retained placenta as well as retained parts of the placenta. This is a population-based cohort study in a tertiary medical center. We collected data from all 4227 spontaneous singleton vaginal deliveries during 6 months and compared the incidence of retained placenta in deliveries with epidural analgesia with those without analgesia. Multivariable logistic regression was used to control for possible confounders. More than two-thirds of the women (69.25%) used epidural analgesia during their delivery. A need for intervention due to placental disorder during the third stage of labor was noted in 4.2% of all deliveries. Epidural analgesia appeared to be significantly (P=0.028) related to placental disorders compared with no analgesia: 4.8% vs. 3%, respectively. Deliveries with manual interventions during the third stage, for either complete retained placenta or suspected retained parts of the placenta, were associated with the use of epidural analgesia (P=0.008), oxytocin (P=0.002) and older age at delivery (P=0.000), but when including all factors in a multivariable analysis, using a stepwise logistic regression, the factors that were independently associated with interventions for placental disruption during the third stage of delivery were previous cesarean section, oxytocin use and, marginally, older age. Complete retained placenta and retained parts of the placenta share the same risk factors. Epidural analgesia does not directly influence the incidence of complete retained placenta or retained parts, though clinically linked through increased oxytocin use. The factors that were independently associated with interventions for placental disruption during the third stage of delivery were previous cesarean section, oxytocin use and older age.

  8. Epidural analgesia associated with better survival in colon cancer.

    PubMed

    Vogelaar, F J; Abegg, R; van der Linden, J C; Cornelisse, H G J M; van Dorsten, F R C; Lemmens, V E; Bosscha, K

    2015-08-01

    Surgery remains the mainstay of treatment for potentially curable colon cancer. Otherwise, the surgical stress response might increase the likelihood of cancer dissemination during and after cancer surgery. There is growing evidence that the type of anaesthesia during cancer surgery plays a role in the metastatic process. Therefore, we assessed if the method of anaesthesia is associated with long-term survival after colon cancer surgery. A retrospective single-centre study was conducted including 588 patients who underwent colorectal cancer surgery, TNM stage I-IV, in the Jeroen Bosch Hospital between 1995 and 2003. The Cox proportional hazard model was used for statistical analysis. Adjustments were made for age, sex, comorbidity, TNM stage, chemotherapy, emergency surgery status and year of incidence. Of the 588 primary colon cancer patients with a median age of 70 years, 399 (68 %) patients underwent colon surgery with epidural anaesthesia, whilst 189 (32 %) patients were operated without epidural anaesthesia. Five-year survival for patients not receiving epidural analgesia was 42 % versus 51 % for patients receiving epidural analgesia (p = 0.03). This effect remained after adjustment for relevant patient, tumour, and treatment characteristics (hazard ratio (HR) 1.30 (95 % confidence interval (CI) 1.05-1.59), p = 0.01). Subgroup analysis in patients of 80 years and older (n = 100) showed also a better overall survival after receiving epidural analgesia (HR 1.74 (95 % CI 1.11-2.72), p = 0.01). Epidural analgesia during colon cancer surgery was associated with a better overall survival. Prospective trials evaluating the effects of locoregional analgesia on colon cancer recurrence are warranted.

  9. Rapidly Progressive Gas-containing Lumbar Spinal Epidural Abscess

    PubMed Central

    Bang, Jin Hyuk

    2015-01-01

    Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus. PMID:26512268

  10. Rapidly Progressive Gas-containing Lumbar Spinal Epidural Abscess.

    PubMed

    Bang, Jin Hyuk; Cho, Keun-Tae

    2015-09-01

    Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus.

  11. Epidural Dexamethasone Influences Postoperative Analgesia after Major Abdominal Surgery.

    PubMed

    Hong, Jeong-Min; Kim, Kyung-Hoon; Lee, Hyeon Jeong; Kwon, Jae-Young; Kim, Hae-Kyu; Kim, Hyae-Jin; Cho, Ah-Reum; Do, Wang-Seok; Kim, Hyo Sung

    2017-05-01

    Epidurally administered dexamethasone might reduce postoperative pain. However, the effect of epidural administration of dexamethasone on postoperative epidural analgesia in major abdominal surgery has been doubtful. To investigate the effects and optimal dose of epidural dexamethasone on pain after major abdominal surgery. A prospective randomized, double-blind study. University hospital. One hundred twenty ASA physical status I and II men, scheduled for gastrectomy, were enrolled. Patients were randomly assigned to receive one of 3 treatment regimens (n = 40 in each group): dexamethasone 5 mg (1 mL) with normal saline (1 mL) (group D) or dexamethasone 10 mg (2 mL) (group E) or 2 mL of normal saline (group C) mixed with 8 mL of 0.375% ropivacaine as a loading dose. After the surgery, 0.2% ropivacaine - fentanyl 4 ?g/mL was epidurally administered for analgesia. The infusion was set to deliver 4 mL/hr of the PCEA solution, with a bolus of 2 mL per demand and 15 minutes lockout time. The infused volume of PCEA, intensity of postoperative pain using visual analogue scale (VAS) during rest and coughing, incidence of postoperative nausea and vomiting (PONV), usage of rescue analgesia and rescue antiemetic, and side effects such as respiratory depression, urinary retention, and pruritus were recorded at 2, 6, 12, 24, and 48 hours after the end of surgery. The resting and effort VAS was significantly lower in group E compared to group C at every time point through the study period. On the contrary, only the resting VAS in group D was lower at 2 hours and 6 hours after surgery. Total fentanyl consumption of group E was significantly lower compared to other groups. There was no difference in adverse effect such as hypotension, bradycardia, PONV, pruritis, and urinary retention among groups. Use of epidural PCA with basal rate might interrupt an accurate comparison of dexamethasone effect. Hyperglycemia and adrenal suppression were not evaluated. Epidural dexamethasone was

  12. Epidural catheter design: history, innovations, and clinical implications.

    PubMed

    Toledano, Roulhac D; Tsen, Lawrence C

    2014-07-01

    Epidural catheters have evolved during the past several decades, as clinicians and manufacturers have sought to influence the quality of analgesia and anesthesia and reduce the incidence of catheter-related complications. This evolution has allowed a transformation from single-shot to continuous-infusion techniques and resulted in easier passage into the epidural space, more extensive medication distribution, and ultimately, improved patient satisfaction. Particular catheter features, including the materials used, tip design, and orifice number and arrangement, have been associated with specific outcomes and provide direction for future development.

  13. Using clinical governance to standardise an epidural service.

    PubMed

    Trim, Jacquie; Fordyce, Fiona; Dua, Sharron

    Continual epidural infusions are an accepted intervention for the management of postoperative pain (McQuay and Moore 1998). Benchmarking nationally through an unpublished audit of Pain Society members identified variation in the concentrations prescribed and delivery systems used. These differences were reflected in local practice. As a result of the local disparity in the management and provision of epidural infusions, the acute pain service at Southampton University Hospitals NHS Trust worked in conjunction with the pharmacy department to standardise the service provided to patients and staff. This process was complicated by the difficulty in obtaining anaesthetist consensus for a standard solution that was commercially available and funding for the dedicated delivery system.

  14. Hyperventilation-induced tetany associated with epidural analgesia for labor.

    PubMed

    Ray, N; Camann, W

    2005-01-01

    We report a case of painful carpo-pedal spasm associated with the initiation of epidural analgesia for labor. The patient, an otherwise healthy primigravida in early labor at term, was experiencing severe hyperventilation as a result of inappropriate use of the Lamaze breathing technique. Bilateral carpo-pedal spasm occurred, and produced severe pain. Resolution of symptoms coincided with onset of effective epidural labor pain relief. A diagnostic challenge was presented to the anesthesiologist, as the symptoms could have been consistent with subdural block, local anesthetic toxicity, high sensory level of analgesia or eclamptic neuro-excitation activity.

  15. Advantages and guidelines for using epidural drugs for analgesia.

    PubMed

    Pascoe, P J

    1992-03-01

    The administration of drugs by the epidural route is a safe and effective method for providing analgesia before, during, and after a surgical procedure. Local anesthetics administered by this route block nociceptive input as well as providing excellent muscle relaxation for surgery. The use of local anesthetics may be associated with short-term motor dysfunction and hypotension as a result of sympathetic blockade. Morphine given by the epidural route also provides effective analgesia and has the advantages of giving more prolonged analgesia with no effect on either motor or sympathetic pathways.

  16. Patch testing for noncontact dermatitis: the atopy patch test for food and inhalants.

    PubMed

    Wollenberg, Andreas; Vogel, Sandra

    2013-10-01

    The atopy patch test (APT) is defined as a patch test procedure to assess delayed type hypersensitivity reactions against those protein allergens known to elicit IgE-mediated type I reactions in atopic patients. This patch test procedure uses intact protein allergens instead of haptens in an optimized test setting and with a special reading key. It may be clinically useful especially for atopic dermatitis, as the currently available test procedures either target the wrong reaction type (type I and not type IV) or use the wrong allergens (haptens and not protein allergen). A positive APT reaction correlates with a positive lymphocyte transformation test and allergen-specific Th2 cells in the peripheral blood. As even small changes in the test procedure influence the sensitivity, specificity, and reproducibility of the APT, the European Task Force on Atopic Dermatitis (ETFAD) has developed a standardized APT technique: Intact protein allergens, purified in petrolatum, are applied in 12-mm-diameter Finn chambers mounted on Scanpor tape for 48 h to non-irritated, non-abraded, or tape-stripped skin of the upper back for 48 h; the evaluation of the test reaction is done after 48 and 72 h using the ETFAD reading key, assessing erythema as well as number and distribution pattern of the papules. The APT may reveal type IV sensitization in patients who are negative for the respective type I tests. Limited availability of the expensive test substances and limited reimbursement is among the factors restricting the routine use of the APT.

  17. Transient Horner's syndrome following thoracic epidural anesthesia for mastectomy: a prospective observational study.

    PubMed

    Park, Sun Young; Chun, Hea Rim; Kim, Mun Gyu; Lee, Se Jin; Kim, Sang Ho; Ok, Si Young; Cho, Ana

    2015-03-01

    Transient Horner's syndrome is an uncommon complication of epidural anesthesia, though its exact incidence in thoracic epidural anesthesia is not clear. Therefore, this study prospectively evaluated the incidence of Horner's syndrome after thoracic epidural anesthesia for mastectomy. Patients scheduled for mastectomy, with or without breast reconstruction, were enrolled in this prospective observational study from September 2010 to December 2013. Intraoperative thoracic epidural anesthesia was established using 0.375% or 0.5% ropivacaine 15 mL with thoracic epidural analgesia continued postoperatively with a continuous infusion of 0.15% ropivacaine 2 mL·hr(-1) with fentanyl 8 μg·hr(-1). Signs of Horner's syndrome (miosis, ptosis, and hyperemia) were assessed at one and two hours as well as one, two, and three days postoperatively. Thoracic epidural anesthesia was successful in 439 patients, with six (1.4%) of these patients acquiring Horner's syndrome. All signs of Horner's syndrome resolved gradually within 180 min of discontinuing the epidural infusion. In one patient with Horner's syndrome, a radiographic contrast injection confirmed that the drug had spread to the cervical epidural level. The incidence of Horner's syndrome following thoracic epidural anesthesia and continuous thoracic epidural analgesia for mastectomy was 1.4%. The mechanism was consistent with cephalic spread of the epidural local anesthetic. This trial was registered at: Clinicaltrials.gov, number: NCT02130739.

  18. What's trending now? An analysis of trends in internet searches for labor epidurals.

    PubMed

    Sutton, C D; Carvalho, B

    2017-05-01

    The study aim was to investigate internet use for obtaining information about epidurals for labor and delivery. Google Trends for US data was queried from 2004 to 2015 to find the most common searches and determine temporal trends. The Google Trends query used the term [epidural] and evaluated changes in search trends over time. Search comparisons were made for each year from 2004 to 2015, and three equal time epochs during the study period (2004-07, 2008-11, 2012-15) were compared. We also compared searches for epidurals with commonly searched birth-related terms. Internet searches are increasing; there were 726000 searches for [epidural] in 2015. Search terms with the most significant growth in the past 4years (2012-15) were "birth with epidural," "pain after epidural," "labor without epidural," "epidural birth video," and "epidural vs natural". Searches for epidural side effects, risks, and pain on insertion were among the most common and were increasing most rapidly. Searches related to epidurals were more common than searches related to "natural births", "home births", and "labor pain", but were less common than searches for "midwives" or "doulas". The findings provide an insight into internet use by those seeking information about labor analgesic options. Identifying the most common and rapidly increasing online search queries may guide physician-parturient interactions and online content creation, to address labor analgesic topics that most interest users. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Unusual case of persistent Horner's syndrome following epidural anaesthesia and caesarean section

    PubMed Central

    Goel, Shubhra; Burkat, Cat Nguyen

    2011-01-01

    This is a rare case of persistent Horner's syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) of head, neck, and chest were unremarkable. Medline search using terms Horner’s, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles describing Horner's syndrome in obstetric epidural anesthesia, of which 11 were following Caesarean section. The increased incidence of Horner's syndrome in the setting of epidural anesthesia in pregnancy may be related to epidural venous engorgement and cephalic spread of the local anaesthetic, with disruption in the oculosympathetic pathway. It is important to include recent epidural anesthesia within the differential diagnosis of acute Horner's syndrome in a postpartum female. Rarely, the ptosis may be permanent and require surgical intervention. PMID:21836349

  20. Unusual case of persistent Horner's syndrome following epidural anaesthesia and caesarean section.

    PubMed

    Goel, Shubhra; Burkat, Cat Nguyen

    2011-01-01

    This is a rare case of persistent Horner's syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) of head, neck, and chest were unremarkable. Medline search using terms Horner's, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles describing Horner's syndrome in obstetric epidural anesthesia, of which 11 were following Caesarean section. The increased incidence of Horner's syndrome in the setting of epidural anesthesia in pregnancy may be related to epidural venous engorgement and cephalic spread of the local anaesthetic, with disruption in the oculosympathetic pathway. It is important to include recent epidural anesthesia within the differential diagnosis of acute Horner's syndrome in a postpartum female. Rarely, the ptosis may be permanent and require surgical intervention.

  1. Ectopic extramedullary hematopoiesis: evaluation and treatment of a rare and benign paraspinal/epidural tumor.

    PubMed

    Mattei, Tobias A; Higgins, Michael; Joseph, Flynn; Mendel, Ehud

    2013-03-01

    Ectopic extramedullary hematopoiesis (EMH), defined as the formation of blood cells outside the bone marrow, usually occurs in a scenario of chronic anemia when, even after conversion of the bony yellow marrow to red marrow, the body is still unable to meet the demand for red blood cells. Ectopic extramedullary hematopoiesis most commonly occurs in the liver and spleen but may, in fact, occur almost anywhere in the body. Although previous reports have documented EMH presenting as paraspinal masses, such lesions have almost always been associated with a predisposing hematological disorder such as hemolytic anemia, myelofibrosis or myelodysplastic syndromes, thalassemia, polycythemia vera, leukemia, or lymphoma. The authors of this report describe the first reported instance of EMH in a patient presenting with a symptomatic epidural and paraspinal cervical lesion arising from the posterior spinal elements and no known predisposing hematological disease. Initial radiographs revealed a bony lesion arising posteriorly from the C2-3 laminae and spinous processes. Subsequent imaging suggested the diagnosis, which was confirmed by CT-guided biopsy, peripheral blood smears, and bone marrow aspirate. Despite epidural compression and slight displacement of the cervical cord and thecal sac, the patient's symptoms were limited to pain and diminished cervical range of motion. Therefore, surgery was deferred in favor of nonsurgical therapy. Several alternative modalities for the treatment of EMH have been suggested in the literature, including cytotoxic agents and radiotherapy. The authors opted for an approach utilizing directed low-dose radiotherapy of a total of 25 Gy divided in 2.5-Gy fractions. At the 3-month follow-up, the patient continued to be asymptomatic, and MRI demonstrated a significant reduction in the dimensions of the lesion. Extramedullary hematopoiesis with spinal cord compression in the absence of a preexisting hematological disorder has not been described in

  2. Cervical epidural steroid injection for cervicobrachialgia.

    PubMed

    Stav, A; Ovadia, L; Sternberg, A; Kaadan, M; Weksler, N

    1993-08-01

    Fifty patients with chronic resistant cervicobrachialgia were randomly divided into two groups. Twenty-five patients (group A) were treated with cervical epidural steroid/lidocaine injections and 17 patients (group B) were treated with steroid/lidocaine injections into the posterior neck muscles. Another eight patients from group B were excluded from the study because they had started the process of litigation of insurance claims and their subjective analysis of pain relief might therefore not be trustworthy. One to three injections were administered at 2-week intervals according to the clinical response. All patients continued their various pre-study treatments: non-steroidal anti-inflammatory drugs, non-opioid analgesics and physiotherapy. Pain relief was evaluated by the visual analogue scale 1 week after the last injection and then 1 year later. One week after the last injection we rated pain relief as very good and good in 76% of the patients in group A, as compared to 35.5% of the patients in group B. One year after the treatment 68% of the group A patients still had very good and good pain relief, whereas only 11.8% of group B patients reported this degree of pain relief. These differences were statistically significant. We failed to achieve significant improvement of tendon reflexes or of sensory loss in both groups, but the increase in the range of motion, the fraction of patients who were able to decrease their daily dose of analgesics, and recovery of the capacity for work were significantly better in group A. We encountered no complications in either group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Multiple epidural steroid injections and body mass index linked with occurrence of epidural lipomatosis: a case series

    PubMed Central

    2014-01-01

    Background Epidural lipomatosis (EL) is an increase of adipose tissue, normally occurring in the epidural space, sufficient to distort the thecal sac and compress neural elements. There is a lack of knowledge of risk factors, impact on patient’s symptoms, and its possible association with epidural steroid injections. Methods History, physical examination, patient chart, and MRI were analyzed from 856 outpatients referred for epidural steroid injections. Seventy patients with signs of EL on MRI comprised the study group. Thirty-four randomly selected patients comprised the control group. The severity of EL was determined by the MRI assessment. The impact of EL was determined by the patient’s history and physical examination. Logistic regression was used to correlate the probability of developing EL with BMI and epidural steroid injections. Results EL was centered at L5 and S1 segments. The average BMI for patients with EL was significantly greater than that of control group (36.0 ± 0.9 vs. 29.2 ± 0.9, p <0.01). The probability of developing EL with increasing BMI was linear up to the BMI of 35 after which it plateaued. Triglycerides were significantly higher for the EL group as compared to controls (250 ± 30 vs. 186 ± 21 mg/dL p < 0.01). The odds of having EL were 60% after two epidural steroid injections, 90% after three epidural steroid injections and approached 100% with further injections, independent of BMI. Other risk factors considered included alcohol abuse, use of protease inhibitors, levels of stress, hypothyroidism and genetic predisposition. However there were insufficient quantities to determine statistical significance with a degree of confidence. The impact of EL on patient’s symptoms correlated with EL severity with Spearman correlation coefficient of 0.73 at p < 0.01 significance level. Conclusions The BMI and triglycerides levels were found to be significantly elevated for the EL group, pointing to an increased

  4. Exp 41 Patch - Final Approved

    NASA Image and Video Library

    2013-05-14

    ISS041-S-001 (July 2013) --- The Expedition 41 crew members have released their patch and have written some text to go along with it: ?Portraying the road of human exploration into our vastly unknown universe, all elements of the Expedition 41 patch build from the foundation, our Earth, to the stars beyond our solar system. The focus of our six-month expedition to the International Space Station (ISS) is Earth and its inhabitants as well as a scientific look out into our universe. The distinguishing ISS solar arrays reach onward and serve as the central element, with the icon of an atom underneath representing the multitude of research onboard that will bring new discoveries for the benefit of humanity. The sun is rising over Earth?s horizon, spreading its light along the road of human exploration. Equipped with the knowledge and inspiration gained from ISS, our successful multinational cooperation will lead human space exploration to the moon, Mars, and ultimately, the stars. We are Expedition 41. Join us for the adventure.? Photo credit: NASA Note: The NASA insignia design for shuttle and space station flights is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the form of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, it will be publicly announced.

  5. STS_134_patch_OL

    NASA Image and Video Library

    2010-03-09

    STS134-S-001 (March 2010) --- The design of the STS-134 crew patch highlights research on the International Space Station (ISS) focusing on the fundamental physics of the universe. On this mission, the crew of the space shuttle Endeavour will install the Alpha Magnetic Spectrometer (AMS) experiment - a cosmic particle detector. By studying subatomic particles in the background cosmic radiation and searching for antimatter, dark-matter, and dark energy, it will help scientists better understand the evolution and properties of our universe. The shape of the patch is inspired by the international atomic symbol, and represents the atom with orbiting electrons around the nucleus. The burst near the center refers to the origin of the universe. The space shuttle Endeavour and ISS fly together into the sunrise over the limb of the Earth, representing the dawn of a new age?understanding the nature of the universe. The NASA insignia design for space shuttle flights is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the forms of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, the change will be publicly announced. Photo credit: NASA

  6. Thoracic epidural catheter for postoperative pain control following an ineffective transversus abdominis plane block using liposome bupivacaine

    PubMed Central

    Terrien, Brian D; Espinoza, David; Stehman, Charles C; Rodriguez, Gabriel A; Connolly, Nicholas C

    2017-01-01

    A 24-year-old female with a history of ulcerative colitis underwent colectomy. The patient received an ineffective transversus abdominis plane (TAP) block with liposome bupivacaine (Exparel) intraoperatively and was started on a hydromorphone patient-controlled analgesia 5 hours after the TAP block, which did not relieve her pain. A continuous thoracic epidural (CTE) was then placed after blood levels of bupivacaine were drawn, and the patient immediately experienced significant pain relief. The combined use of liposome bupivacaine and bupivacaine CTE infusion in the postoperative management of this patient demonstrated no safety concerns, provided excellent analgesia and plasma concentrations of bupivacaine remained far below toxic levels. PMID:28144162

  7. Adaptation of prey and predators between patches.

    PubMed

    Wang, Wendi; Takeuchi, Yasuhiro

    2009-06-21

    Mathematical models are proposed to simulate migrations of prey and predators between patches. In the absence of predators, it is shown that the adaptation of prey leads to an ideal spatial distribution in the sense that the maximal capacity of each patch is achieved. With the introduction of co-adaptation of predators, it is proved that both prey and predators achieve ideal spatial distributions when the adaptations are weak. Further, it is shown that the adaptation of prey and predators increases the survival probability of predators from the extinction in both patches to the persistence in one patch. It is also demonstrated that there exists a pattern that prey and predators cooperate well through adaptations such that predators are permanent in every patch in the case that predators become extinct in each patch in the absence of adaptations. For strong adaptations, it is proved that the model admits periodic cycles and multiple stability transitions.

  8. Epidural morphine analgesia in Guillain Barré syndrome.

    PubMed Central

    Genis, D; Busquets, C; Manubens, E; Dávalos, A; Baró, J; Oterino, A

    1989-01-01

    Severe pain is a frequent symptom in the Guillain Barré syndrome and can be intense, long lasting and with no response to the usual analgesics, including parenteral opiates. Epidural analgesia using morphine chloride in low doses has satisfactorily relieved pain in this disease in nine patients. PMID:2795070

  9. [Iliopsoas abscess accompanied by epidural abscess--a case report].

    PubMed

    Fukushige, Tetsushi; Sano, Tomomi; Yamada, Sinichi; Ueda, Sawako; Kano, Tatsuhiko

    2003-09-01

    A 55-year-old man was admitted to a hospital with pain of the low back as well as the left leg, and fever. He was suspected of suffering from the lumbar disc herniation because of the presence of Lasegue's sign on the first physical examination. Abdominal computed tomography, however, revealed the swelling of the left iliopsoas muscle. Iliopsoas abscess accompanied epidural abscess was confirmed by subsequent magnetic resonance imaging (MRI). Antibiotic therapy was started for the successive 8 days. The fever resolved, but the pain persisted. The abscess extending from the iliopsoas muscle to the epidural space was still seen on the MRI 20 days after the completion of the antibiotic therapy, and he still complained of the pain of his low back and left leg. Therefore, we conducted epidural puncture under fluoroscopic guidance. Approximately 3 ml of pus was aspirated from the epidural space. Then, his complains decreased remarkably. Iliopsoas abscess should be taken into account in case of a patient with pain on the low back and leg and also inflammatory signs such as fever and leucocytosis.

  10. Spinal epidural abscess in a patient with piriformis pyomyositis

    PubMed Central

    Oh, Gerald S.; Abou-Al-Shaar, Hussam; Arnone, Gregory D.; Barks, Ashley L.; Hage, Ziad A.; Neckrysh, Sergey

    2016-01-01

    Background: Spinal epidural abscess resulting from piriformis pyomyositis is extremely rare. Such condition can result in serious morbidity and mortality if not addressed in a timely manner. Case Description: The authors describe the case of a 19-year-old male presenting with a 2-week history of fever, low back pain, and nuchal rigidity. When found to have radiographic evidence of a right piriformis pyomyositis, he was transferred to our institution for further evaluation. Because he demonstrated rapid deterioration, cervical, thoracic, and lumbar magnetic resonance imaging scans were emergently performed. They revealed an extensive posterior spinal epidural abscess causing symptomatic spinal cord compression extending from C2 to the sacrum. He underwent emergent decompression and abscess evacuation through a dorsal midline approach. Postoperatively, he markedly improved. Upon discharge, the patient regained 5/5 strength in both upper and lower extremities. Cultures from the epidural abscess grew methicillin-sensitive Staphylococcus aureus warranting a 6-week course of intravenous nafcillin. Conclusion: A 19-year-old male presented with a holospinal epidural abscess (C2 to sacrum) originating from piriformis pyomyositis. The multilevel cord abscess was emergently decompressed, leading to a marked restoration of neurological function. PMID:28028447

  11. Upper Cervical Epidural Abscess in a Patient With Parkinson Disease

    PubMed Central

    Al-Hourani, Khalid; Frost, Chelsea

    2015-01-01

    To our knowledge, there are no reports in the literature of patients with Parkinson disease (PD) developing upper cervical spine infections. Our objective is to present a case of upper cervical epidural abscess in a patient with PD and to review upper cervical spine infection. We present the patient’s presentation, physical examination, imaging findings, and management as well a review of the literature. A 66-year-old male with PD presented to the emergency department (ED) following referral by a neurologist for a presumed C2 fracture. The preceding history was 1 week of severe neck pain requiring a magnetic resonance imaging (MRI), which was initially interpreted as a C2 fracture. On admission from the ED, further review of the MRI appeared to show anterior prevertebral abscess and an epidural abscess. The patient’s neurological examination was at baseline. In the span of 2 days, the patient developed significant motor weakness. A repeat MRI demonstrated expansion of the epidural collection and spinal cord compression. Surgical management consisting of C1 and C2 laminectomy, irrigation, and debridement from anterior and posterior approaches was performed. Postoperatively, the patient did not recover any motor strength and elected to withdraw care and died. Spinal epidural abscess requires a high index of suspicion and needs prompt recognition to prevent neurological impairment. Upper cervical spine infections are rare but can lead to lethal consequences. PMID:26623170

  12. Upper Cervical Epidural Abscess in Clinical Practice: Diagnosis and Management

    PubMed Central

    Al-Hourani, Khalid; Al-Aref, Rami; Mesfin, Addisu

    2015-01-01

    Study Design Narrative review. Objective Upper cervical epidural abscess (UCEA) is a rare surgical emergency. Despite increasing incidence, uncertainty remains as to how it should initially be managed. Risk factors for UCEA include immunocompromised hosts, diabetes mellitus, and intravenous drug use. Our objective is to provide a comprehensive overview of the literature including the history, clinical manifestations, diagnosis, and management of UCEA. Methods Using PubMed, studies published prior to 2015 were analyzed. We used the keywords “Upper cervical epidural abscess,” “C1 osteomyelitis,” “C2 osteomyelitis,” “C1 epidural abscess,” “C2 epidural abscess.” We excluded cases with tuberculosis. Results The review addresses epidemiology, etiology, imaging, microbiology, and diagnosis of this condition. We also address the nonoperative and operative management options and the relative indications for each as reviewed in the literature. Conclusion A high index of suspicion is required to diagnose this rare condition with magnetic resonance imaging being the imaging modality of choice. There has been a shift toward surgical management of this condition in recent times, with favorable outcomes. PMID:27190742

  13. Disseminated blastomycosis presenting as mastoiditis and epidural abscess.

    PubMed

    Makary, Chadia A; Roberts, Thomas D; Wetmore, Stephen J

    2014-01-01

    Blastomycosis is a systemic fungal infection that affects primarily the lungs. Head and neck involvement has been reported most commonly in the larynx as well as oral and nasal mucosa. Temporal bone involvement is extremely rare. We report a case of disseminated blastomycosis presenting as mastoiditis and epidural abscess. We discuss the importance of early diagnosis and prompt initiation of treatment for optimal outcome.

  14. Spinal epidural angiolipomas: Clinical characteristics, management and outcomes

    PubMed Central

    Bouali, Sofiene; Maatar, Nidhal; Bouhoula, Asma; Abderrahmen, Khansa; Said, Imed Ben; Boubaker, Adnen; Kallel, Jalel; Jemel, Hafedh

    2016-01-01

    Purpose: The spinal epidural angiolipomas are rare expansive processes made of mature lipomatous and angiomatous elements. They often have a benign character. Their etiology, pathogenesis remains uncertain, and it is a cause of spinal cord compression. The magnetic resonance imaging is the most important neuroradiological examination. Histological examination is the only examination to confirm the diagnosis. Surgery is the treatment of choice. Methods: A retrospective study of all patients operated on for a spinal epidural angiolipoma at the Department of Neurosurgery at the National Institute of Neurology of Tunis between January 2000 and December 2014 (15 years) was performed. The aim of this study is to describe the clinical, radiological, histological characteristics and the treatment of this tumor. Results: A total of nine patients were operated from January 01, 2000 to November 30, 2014. The average age of our patients was 51 years with ages that ranged from 29 to 65 with a male predominance. The period between onset of symptoms and diagnosis ranged from 24 months with an average 12 months. Posterior localization of the tumor was seen in all patients. Surgical resection was performed for all cases. The postoperative course has been satisfactory, with a complete recovery of neurological functions in all patients. Conclusions: The spinal epidural angiolipomas is rare expansive process causing spinal cord compression. Treatment is exclusively surgical resection. The functional outcome of spinal epidural angiolipomas is particularly favorable with a complete neurological recovery is if the patient was quickly operated. PMID:27695535

  15. Update on epidural analgesia during labor and delivery.

    PubMed

    Lurie, S; Priscu, V

    1993-05-01

    Properly administered epidural analgesia provides adequate pain relief during labor and delivery, shortens the first stage of labor, avoids adverse effects of narcotics, hypnotics, or inhalation drugs and it could be used as anesthesia in case a cesarean section is required. Epidural analgesia should be provided to all patients who need and ask for it with an exception of contraindications such as coagulation disorders, suspected infection or gross anatomic abnormality. The technique must be carried out with care if serious life-threatening complications, such as intravenous or intrathecal injection of local anesthetic, are to be avoided. The aim of many recent investigations has been to reduce the total dose of local anesthetic used. Supplementation of an opioid (mainly fentanyl) and introduction of the patient controlled epidural pump may not only serve this goal, but also reduce the demands on the time of obstetric anesthetists. We conclude that properly and skillfully administered epidural is the best form of pain relief during labor and delivery and we hope that more mothers could enjoy its benefits.

  16. Hyaluronidase shortens levobupivacaine lumbosacral epidural anaesthesia in dogs.

    PubMed

    DeRossi, R; de Barros, A L C; Silva-Neto, A B; Pompermeyer, C T; Frazílio, F O

    2011-04-01

    The aim of this study was to evaluate the effects of hyaluronidase added to levobupivacaine in lumbosacral epidural blockade in dogs. Six adult mixed breed dogs (two males and four females) weighing 7 to 14 kg (10.5 ±1.5 kg) and aged two to five years were used. Each dog received both treatments in random order: levobupivacaine alone (LBA; n=6) or levobupivacaine plus hyaluronidase (LBH; n=6) administered in the lumbosacral epidural space. Systemic effects, spread and duration of anaesthesia and motor block were determined before treatment and at predetermined intervals. The duration of local anaesthesia was 90 ±10 minutes (P=0.001) for LBH treatment and 150 ±15 minutes for LBA treatment. In the LBH treatment, anaesthesia reached the T12 to T13 dermatome and in the LBA treatment it reached the T11 to T12 dermatome in all animals in 5 and 15 minutes, respectively. Complete motor blockade was 75 ±12 minutes (P=0.01) and 120 ±15 minutes for LBH and LBA treatments, respectively. Hyaluronidase added to levobupivacaine significantly shortens the duration of epidural anaesthesia with the same dermatome spread into the epidural space in dogs. © 2011 British Small Animal Veterinary Association.

  17. Compliance and patching and atropine amblyopia treatments.

    PubMed

    Wang, Jingyun

    2015-09-01

    In the past 20 years, there has been a great advancement in knowledge pertaining to compliance with amblyopia treatments. The occlusion dose monitor introduced quantitative monitoring methods in patching, which sparked our initial understanding of the dose-response relationship for patching amblyopia treatment. This review focuses on current compliance knowledge and the impact it has on patching and atropine amblyopia treatment. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Multi-Mode Broadband Patch Antenna

    NASA Technical Reports Server (NTRS)

    Romanofsky, Robert R. (Inventor)

    2001-01-01

    A multi-mode broad band patch antenna is provided that allows for the same aperture to be used at independent frequencies such as reception at 19 GHz and transmission at 29 GHz. Furthermore, the multi-mode broadband patch antenna provides a ferroelectric film that allows for tuning capability of the multi-mode broadband patch antenna over a relatively large tuning range. The alternative use of a semiconductor substrate permits reduced control voltages since the semiconductor functions as a counter electrode.

  19. Foil Patches Seal Small Vacuum Leaks

    NASA Technical Reports Server (NTRS)

    Spiegel, Kirk W.; Reed, David W.

    1995-01-01

    Report discloses technique to patch holes in nickel-alloy rocket-engine nozzle parts prior to vacuum brazing. Technique involves lightly spot-welding nickel foil 0.002 in. thick over hole patched, then spot-welding corrosion-resistant steel foil of same thickness over nickel foil. Once patches subject to pressure and temperature of vacuum brazing, nickel foil diffuses to bond with nickel-alloy nozzle, making vacuum-tight seal.

  20. Foil Patches Seal Small Vacuum Leaks

    NASA Technical Reports Server (NTRS)

    Spiegel, Kirk W.; Reed, David W.

    1995-01-01

    Report discloses technique to patch holes in nickel-alloy rocket-engine nozzle parts prior to vacuum brazing. Technique involves lightly spot-welding nickel foil 0.002 in. thick over hole patched, then spot-welding corrosion-resistant steel foil of same thickness over nickel foil. Once patches subject to pressure and temperature of vacuum brazing, nickel foil diffuses to bond with nickel-alloy nozzle, making vacuum-tight seal.

  1. Measurement and control of electrostatic patch potentials

    NASA Astrophysics Data System (ADS)

    Garrett, Joseph L.; Munday, Jeremy N.

    Electrostatic patch potentials hinder many precision measurements, particularly measurements of the Casimir force. Despite the improved force sensitivity achieved over the last decade, only recently have attempts been made to measure and quantify the effects of patch potentials. Here we present an analysis of patch potentials measured by Kelvin probe force microscopy (KPFM) and discuss methods to control these potentials (e.g. humidity, material choice, etc).

  2. RF MEMS reconfigurable triangular patch antenna.

    SciTech Connect

    Nordquist, Christopher Daniel; Christodoulou, Christos George; Feldner, Lucas Matthew

    2005-01-01

    A Ka-band RF MEMS enabled frequency reconfigurable triangular microstrip patch antenna has been designed for monolithic integration with RF MEMS phase shifters to demonstrate a low-cost monolithic passive electronically scanned array (PESA). This paper introduces our first prototype reconfigurable triangular patch antenna currently in fabrication. The aperture coupled patch antenna is fabricated on a dual-layer quartz/alumina substrate using surface micromachining techniques.

  3. RF MEMS reconfigurable triangular patch antenna.

    SciTech Connect

    Christodoulou, Christos George; Nordquist, Christopher Daniel; Feldner, Lucas Matthew

    2005-07-01

    A Ka-band RF MEMS enabled frequency reconfigurable triangular microstrip patch antenna has been designed for monolithic integration with RF MEMS phase shifters to demonstrate a low-cost monolithic passive electronically scanned array (PESA). This paper introduces our first prototype reconfigurable triangular patch antenna currently in fabrication. The aperture coupled patch antenna is fabricated on a dual-layer quartz/alumina substrate using surface micromachining techniques.

  4. Patch definition in metapopulation analysis: a graph theory approach to solve the mega-patch problem.

    PubMed

    Cavanaugh, Kyle C; Siegel, David A; Raimondi, Peter T; Alberto, Filipe

    2014-02-01

    The manner in which patches are delineated in spatially realistic metapopulation models will influence the size, connectivity, and extinction and recolonization dynamics of those patches. Most commonly used patch-definition methods focus on identifying discrete, contiguous patches of habitat from a single temporal observation of species occurrence or from a model of habitat suitability. However, these approaches are not suitable for many metapopulation systems where entire patches may not be fully colonized at a given time. For these metapopulation systems, a single large patch of habitat may actually support multiple, interacting subpopulations. The interactions among these subpopulations will be ignored if the patch is treated as a single unit, a situation we term the "mega-patch problem." Mega-patches are characterized by variable intra-patch synchrony, artificially low inter-patch connectivity, and low extinction rates. One way to detect this problem is by using time series data to calculate demographic synchrony within mega-patches. We present a framework for identifying subpopulations in mega-patches using a combination of spatial autocorrelation and graph theory analyses. We apply our approach to southern California giant kelp (Macrocystis pyrifera) forests using a new, long-term (27 years), satellite-based data set of giant kelp canopy biomass. We define metapopulation patches using our method as well as several other commonly used patch delineation methodologies and examine the colonization and extinction dynamics of the metapopulation under each approach. We find that the relationships between patch characteristics such as area and connectivity and the demographic processes of colonizations and extinctions vary among the different patch-definition methods. Our spatial-analysis/graph-theoretic framework produces results that match theoretical expectations better than the other methods. This approach can be used to identify subpopulations in metapopulations

  5. Klebsiella pneumoniae Spinal Epidural Abscess treated conservatively: case report and review.

    PubMed

    Araújo, Filipe; Ribeiro, Célia; Silva, Inês; Nero, Patrícia; Branco, Jaime C

    2012-01-01

    Spinal infections are rare but potentially life-threatening disorders. A high level of clinical suspicion is necessary for rapid diagnosis and treatment initiation. The treatment combines both antibiotics and surgical intervention in the vast majority of cases. The authors report the case of a 84-year old female patient with a three week history of persistent lumbar back pain radiating to both thighs following a lower respiratory tract infection. She had lumbar spine tenderness but no neurological compromise. Her inflammatory markers were elevated and lumbar spine magnetic resonance imaging revealed L4-L5 spondylodiscitis with spinal epidural abscess. Blood cultures isolated Klebsiella pneumoniae and, since she was neurologically stable, conservative treatment with two-week intravenous gentamicin and eight-week intravenous ceftriaxone was initiated with positive inpatient and outpatient evolution.

  6. Recurrent vitreous haemorrhage and epidural haematoma in a child with hypofibrinogenaemia

    PubMed Central

    Mansour, Ahmad M; Jaroudi, Mahmoud O

    2012-01-01

    A 14-month-old male infant was brought by parents for redness of the right eye of 18 days duration. Exam and B-scan ultrasonography revealed total hyphema, dense vitreous haemorrhage and lens subluxation in the right eye while CT disclosed right small epidural haematoma. The left eye had neither retinal haemorrhage nor disc oedema. There was no sign of shaken baby syndrome. Fibrinogen level in the blood was very low. The parents are first-degree cousins with two family members having hypofibrinogenaemia. Vitreous haemorrhage recurred after surgical intervention resulting in phthisis and loss of vision. Hypofibrinogenaemia needs to be included in the differential diagnosis of ocular haemorrhage and vision loss. PMID:22778479

  7. Comparative evaluation of general, epidural and spinal anaesthesia for extracorporeal shockwave lithotripsy.

    PubMed Central

    Rickford, J. K.; Speedy, H. M.; Tytler, J. A.; Lim, M.

    1988-01-01

    The results of a prospective randomised evaluation of general anaesthesia (GA), epidural anaesthesia (EA) and spinal anaesthesia (SA) for extracorporeal shockwave lithotripsy are presented. GA provided speed and reliability but resulted in a high incidence of postoperative nausea, vomiting and sore throat. Both regional techniques conferred the advantages of an awake, cooperative patient, but EA required a longer preparation time than SA and more supplementary treatment with fentanyl or midazolam. A major drawback associated with the use of SA was a 42% incidence of postspinal headache. All three techniques were associated with hypotension on placement in the hoisl; bath immersion resulted in significant rises in blood pressure in the EA and SA groups and a more variable (overall non-significant) response in the GA group. PMID:3044238

  8. Hierarchical patch dynamics and animal movement pattern.

    PubMed

    Fauchald, Per; Tveraa, Torkild

    2006-09-01

    In hierarchical patch systems, small-scale patches of high density are nested within large-scale patches of low density. The organization of multiple-scale hierarchical systems makes non-random strategies for dispersal and movement particularly important. Here, we apply a new method based on first-passage time on the pathway of a foraging seabird, the Antarctic petrel (Thalassoica antarctica), to quantify its foraging pattern and the spatial dynamics of its foraging areas. Our results suggest that Antarctic petrels used a nested search strategy to track a highly dynamic hierarchical patch system where small-scale patches were congregated within patches at larger scales. The birds searched for large-scale patches by traveling fast and over long distances. Once within a large-scale patch, the birds concentrated their search to find smaller scale patches. By comparing the pathway of different birds we were able to quantify the spatial scale and turnover of their foraging areas. On the largest scale we found foraging areas with a characteristic scale of about 400 km. Nested within these areas we found foraging areas with a characteristic scale of about 100 km. The large-scale areas disappeared or moved within a time frame of weeks while the nested small-scale areas disappeared or moved within days. Antarctic krill (Euphausia superba) is the dominant food item of Antarctic petrels and we suggest that our findings reflect the spatial dynamics of krill in the area.

  9. The "edge effect" with patch test materials.

    PubMed

    Fyad, A; Masmoudi, M L; Lachapelle, J M

    1987-03-01

    A positive "edge effect", i.e., the accumulation on the skin of a chemical solution (such as fluorescein 0.01% in a 50/50 water-ethanol solution) at the periphery of the patch test sites has been demonstrated. It occurs with different test materials (Finn Chamber; Silver Patch Test; Patch Test Chamber). Practical implications are discussed: this observation could be important when discussing results of laboratory investigations. In clinical practice, it could explain the occurrence of "ring-shaped" positive allergic patch test reactions to chemicals used in solution, i.e., Kathon CG or hydrocortisone.

  10. [Glossodynia--indication for patch testing?].

    PubMed

    Bäurle, G; Schönberger, A

    1986-08-15

    100 patients suffering from glossodynia without pathologic changes of the oral mucosa and 16 patients with suspected allergic contact stomatitis underwent patch testing using standard patch test and dental materials. The results were compared with those of patients in dental occupations suffering from hand eczema. As there is no clinical relevance of allergens in patients with glossodynia, patch testing seems to be unnecessary. On the other hand, patch test results of patients with stomatitis and dentures often suggest a causal allergy. In most of those cases, this was confirmed by complete healing after changing the denture bases, whereas in glossodynia such replacements never brought about a convincing improvement of the symptoms.

  11. Epidural dexamethasone for post-operative analgesia in patients undergoing abdominal hysterectomy: A dose ranging and safety evaluation study

    PubMed Central

    Hefni, Amira Fathy; Mahmoud, Mohamed Sidky; Al Alim, Azza Atef Abd

    2014-01-01

    Aim: Number of studies revealed that epidural bupivacaine-dexamethasone has the same analgesic potency as bupivacaine-fentanyl with opioid sparing and antiemetic effects. Different doses of dexamethasone were used in different studies. This study was designed to evaluate the optimum dose of epidural dexamethasone for post-operative analgesia. Materials and Methods: In this double-blinded randomized controlled study, we evaluated the efficiency and safety of different doses of epidural dexamethasone for post-operative analgesia in 160 patients aged 45-60 years scheduled for total abdominal hysterectomy. Patient were randomly allocated into four groups to receive a total volume of 10 ml epidural plain bupivacaine 0.25% in the control group (Group D0) with either 4 mg dexamethasone in (Group D4) or 6 mg dexamethasone in (Group D6) or 8 mg dexamethasone in (Group D8). Patients then received general anesthesia. Sedation, satisfaction and visual analog pain scores (VAS) at rest and with effort were measured post-operatively. Meperidine was administered when VAS > or = 4. Intra-operative fentanyl dose, post-operative meperidine consumption and the time to first analgesic requirement were recorded by a blinded observer. Blood glucose was measured pre-operatively and at 4 h and 8 h after study drug administration. Wound healing and infection were assessed after 1 week. Results: Intraoperative fentanyl requirements were comparable among groups. The time to first analgesic requirement was significantly prolonged 5.5 times in D8 Group but only 1.5 times in D6 and D4 Groups more than the analgesic duration in the control Group D0, with a P < 0.01. There was a significant reduction in post-operative meperidine consumption during the first 24 h in the D8 (75%) in comparison with D6 and D4 Groups (50%), respectively, (P < 0.01) and the control Group D0 (0%) (P < 0.01). VAS scores were significantly lower and patient satisfaction score was significantly higher in the D8 and

  12. Cardiovascular effects of epidural administration of methadone, ropivacaine 0.75% and their combination in isoflurane anaesthetized dogs.

    PubMed

    Bosmans, Tim; Schauvliege, Stijn; Gasthuys, Frank; Duchateau, Luc; Marcilla, Miguel Gozalo; Gadeyne, Caroline; Polis, Ingeborgh

    2011-03-01

    To compare the cardiovascular effects of four epidural treatments in isoflurane anaesthetised dogs. Prospective, randomized. experimental study. Six female, neutered Beagle dogs (13.3±1.0 kg), aged 3.6±0.1 years. Anaesthesia was induced with propofol (8.3±1.1 mg kg(-1)) and maintained with isoflurane in a mixture of oxygen and air [inspiratory fraction of oxygen (FiO(2))=40%], using intermittent positive pressure ventilation. Using a cross-over model, NaCl 0.9% (P); methadone 1% 0.1 mg kg(-1) (M); ropivacaine 0.75% 1.65 mg kg(-1) (R) or methadone 1% 0.1 mg kg(-1) + ropivacaine 0.75% 1.65 mg kg(-1) (RM) in equal volumes (0.23 mL kg(-1)) using NaCl 0.9%, was administered epidurally at the level of the lumbosacral space. Treatment P was administered to five dogs only. Cardiovascular and respiratory variables, blood gases, and oesophageal temperature were recorded at T-15 and for 60 minutes after epidural injection (T0). Mean overall heart rate (HR in beats minute(-1)) was significantly lower after treatment M (119±16) (p=0.0019), R (110±18) (p< 0.0001) and RM (109±13) (p<0.0001), compared to treatment P (135±21). Additionally, a significant difference in HR between treatments RM and M was found (p=0.04). After both ropivacaine treatments, systemic arterial pressures (sAP) were significantly lower compared to other treatments. No significant overall differences between treatments were present for central venous pressure, cardiac output, stroke volume, systemic vascular resistance, oxygen delivery and arterial oxygen content (CaO(2)). Heart rate and sAP significantly increased after treatment P and M compared to baseline (T-15). With all treatments significant reductions from baseline were observed in oesophageal temperature, packed cell volume and CaO(2) . A transient unilateral Horner's syndrome occurred in one dog after treatment R. Clinically important low sAPs were observed after the ropivacaine epidural treatments in isoflurane anaesthetised dogs. Systemic

  13. Nonintubated thoracoscopic lobectomy for lung cancer using epidural anesthesia and intercostal blockade: a retrospective cohort study of 238 cases.

    PubMed

    Hung, Ming-Hui; Chan, Kuang-Cheng; Liu, Ying-Ju; Hsu, Hsao-Hsun; Chen, Ke-Cheng; Cheng, Ya-Jung; Chen, Jin-Shing

    2015-04-01

    Intubated general anesthesia with single-lung ventilation has been considered mandatory for thoracoscopic lobectomy for nonsmall cell lung cancer. Few reports of thoracoscopic lobectomy without tracheal intubation are published, using either thoracic epidural anesthesia (TEA) or intercostal blockade. The comparisons of perioperative outcomes of nonintubated thoracoscopic lobectomy using epidural anesthesia and intercostal blockade are not reported previously. From September 2009 to August 2014, a total of 238 patients with lung cancer who underwent nonintubated thoracoscopic lobectomy were recruited from our prospectively maintained database of all patients undergoing nonintubated thoracoscopic surgery using TEA or intercostal blockade. A multiple regression analysis, adjusting for preoperative variables, was performed to compare the perioperative outcomes of the 2 anesthesia methods. Overall, 130 patients underwent nonintubated thoracoscopic lobectomy using epidural anesthesia whereas 108 had intercostal blockade. The 2 groups were similar in demographic data, except for sex, preoperative lung function, physical status classification, and history of smoking. After adjustment for the preoperative variables, nonintubated thoracoscopic lobectomy using intercostal blockade was associated with shorter durations of anesthetic induction and surgery (P < 0.001). Furthermore, hemodynamics were more stable with less use of vasoactive drugs (odds ratio: 0.53; 95% confidence interval [CI], 0.27 to 1.04; P = 0.064) and less blood loss (mean difference: -55.2 mL; 95% CI, -93 to -17.3; P = 0.004). Postoperatively, the 2 groups had comparable incidences of complications. Patients in the intercostal blockade group had a shorter average duration of chest tube drainage (P = 0.064) but a similar average length of hospital stay (P = 0.569). Conversion to tracheal intubation was required in 13 patients (5.5%), and no in-hospital mortality occurred in either group

  14. Does intrapartum epidural analgesia affect nulliparous labor and postpartum urinary incontinence?

    PubMed

    Liang, Ching-Chung; Wong, Shu-Yam; Chang, Yao-Lung; Tsay, Pei-Kwei; Chang, Shuenn-Dhy; Lo, Liang-Ming

    2007-01-01

    The effect of epidural analgesia on nulliparous labor and delivery remains controversial. In addition, pregnancy and delivery have long been considered risk factors in the genesis of stress urinary incontinence (SUI). We sought to determine the effect of epidural analgesia and timing of administration on labor course and postpartum SUI. Five hundred and eighty three nulliparous women were admitted for vaginal delivery at > or = 36 gestational weeks. We compared various obstetric parameters and SUI, at puerperium and 3 months postpartum, among patients who had epidural and non-epidural analgesia, and among those who had early (cervical dilatation < 3 cm) and late (cervical dilatation > or = 3 cm) epidural analgesia. When compared with the non-epidural analgesia group (n = 319), the group that received epidural analgesia (n = 264) had significant prolongation of the first and second stages of labor, and higher likelihood for instrumental and cesarean delivery but similar incidence of severe vaginal laceration and postpartum SUI. Except for the first stage of labor, early administration of epidural analgesia did not result in a significant influence on obstetric parameters or an increased incidence of postpartum SUI. Our findings showed that epidural analgesia is associated with an increased risk of prolonged labor, and instrumental and cesarean delivery but is not related to increased postpartum SUI. Regarding the impact of the timing of epidural analgesia given in the labor course, the first stage of labor appeared to last longer when analgesia was administered early rather than late.

  15. Spinal cord ischemia following thoracotomy without epidural anesthesia.

    PubMed

    Raz, Aeyal; Avramovich, Aharon; Saraf-Lavi, Efrat; Saute, Milton; Eidelman, Leonid A

    2006-06-01

    Paraplegia is an uncommon yet devastating complication following thoracotomy, usually caused by compression or ischemia of the spinal cord. Ischemia without compression may be a result of global ischemia, vascular injury and other causes. Epidural anesthesia has been implicated as a major cause. This report highlights the fact that perioperative cord ischemia and paraplegia may be unrelated to epidural intervention. A 71-yr-old woman was admitted for a left upper lobectomy for resection of a non-small cell carcinoma of the lung. The patient refused epidural catheter placement and underwent a left T5-6 thoracotomy under general anesthesia. During surgery, she was hemodynamically stable and good oxygen saturation was maintained. Several hours following surgery the patient complained of loss of sensation in her legs. Neurological examination disclosed a complete motor and sensory block at the T5-6 level. Magnetic resonance imaging (MRI) revealed spinal cord ischemia. The patient received iv steroid treatment, but remained paraplegic. Five months following the surgery there was only partial improvement in her motor symptoms. A follow-up MRI study was consistent with a diagnosis of spinal cord ischemia. In this case of paraplegia following thoracic surgery for lung resection, epidural anesthesia/analgesia was not used. The MRI demonstrated evidence of spinal cord ischemia, and no evidence of cord compression. This case highlights that etiologies other than epidural intervention, such as injury to the spinal segmental arteries during thoracotomy, should be considered as potential causes of cord ischemia and resultant paraplegia in this surgical population.

  16. [Comparison of ropivacaine and bupivacaine for epidural analgesia during labor].

    PubMed

    Sánchez-Conde, P; Nicolás, J; Rodríguez, J; García-Castaño, M; del Barrio, E; Muriel, C

    2001-05-01

    To compare the analgesic efficacy and level of motor block using two local anesthetics, ropivacaine and bupivacaine, during labor. Sixty nulliparous women were enrolled during labor after full-term pregnancies. They were randomly assigned to receive epidural analgesia with ropivacaine (group R) or bupivacaine (group B). Group R patients received 10 ml of 0.18% ropivacaine with 5 microgram/ml of fentanyl followed by continuous epidural infusion of 0.1% ropivacaine with 2 microgram/ml of fentanyl at a rate of 10 ml/h. Group B patients received 10 ml of 0.15% bupivacaine with 5 microgram/ml of fentanyl followed by continuous epidural perfusion of 0.0625% bupivacaine with 2 microgram/ml of fentanyl at the same rate. Pain intensity was assessed on a visual analog scale, motor blockade on a Bromage scale, and level of sensory block at different moments. We also recorded total doses of local anesthetic employed during continuous epidural infusion, manner of final delivery, Apgar score, degree of maternal satisfaction and side effects. The demographic and delivery characteristics were similar in both groups. We found no statistically significant differences between the two groups for level of motor blockade, which was nil for 29 patients (96.66%) in group R and 28 patients (93.33%) in group B. No differences in degree of pain or level of sensory block (T8-T10 in both groups) were observed. The total doses of local anesthetic used were similar at 23.7 +/- 11.6 mg in group R and 16.5 +/- 7.3 mg in group B (non-significant difference). Nor did we find differences in manner of delivery, neonatal Apgar scores, degree of maternal satisfaction or side effects. Ropivacaine and bupivacaine are equally effective for epidural analgesia during labor at the doses used and they do not cause a relevant level of motor blockade.

  17. Human skin flora as a potential source of epidural abscess.

    PubMed

    Sato, S; Sakuragi, T; Dan, K

    1996-12-01

    The mechanism of epidural infection associated with epidural block is not clearly understood. Resident organisms in skin specimens were studied after skin was prepared with disinfectants. Sixty-nine paired skin specimens were excised at incisional sites after skin disinfection with 10% povidone-iodine (10% PVP-I) or 0.5% chlorhexidine in 80% ethanol (0.5% CHE) from 60 patients having back surgery. One of the specimen pairs was placed in 10 ml brain-heart infusion broth and incubated in air at 37 degrees C for 96 h. The other specimen was sectioned at 3 microns and prepared with Gram's stain for examination with the microscope. Thirteen gram-positive staphylococcal species (Staphylococcus epidermidis, 69.2%; S. hyicus, 15.4%; and S. capitis, 15.4%) were isolated from cultures. The isolates were found in a significantly greater proportion of the skin specimens disinfected with 10% PVP-I than in those disinfected with 0.5% CHE (11 of 34 cultures [32.4%] vs. 2 of 35 cultures [5.7%]; P < 0.01). Many gram-positive cocci were observed with the microscope in 4 (11.8%) and 5 (14.3%) of 34 and 35 skin specimens disinfected with 10% PVP-I and 0.5% CHE, respectively. The cocci formed a dense colony in each follicle and in the stratum corneum. No organism was present in any of 17,584 sweat glands examined. In a large proportion of patients, isolation of viable organisms from excised skin specimens after disinfection with 10% PVP-I suggests that contamination of the epidural space by the skin flora may be a potential mechanism of epidural infection associated with epidural block.

  18. Patient-controlled epidural analgesia: interactions between nalbuphine and hydromorphone.

    PubMed

    Parker, R K; Holtmann, B; White, P F

    1997-04-01

    Epidural opioid analgesia can offer advantages over intravenous administration, however, opioid-related side effects are common after epidural administration. We studied the effect of adding nalbuphine (NB), an opioid agonist-antagonist, to hydromorphone (HM) for patient-controlled epidural analgesia (PCEA) in 78 healthy women after elective cesarean delivery. Patients were randomly assigned to one of four treatment groups. The control group received preservative-free HM (Dilaudid) alone, 0.075 mg/mL, while the three study groups received HM, 0.075 mg/mL, containing preservative-free NB (Nubain) 0.02, 0.04, or 0.08 mg/mL. Intraoperatively, all patients received epidural bupivacaine 0.5%. Postoperatively, a patient-controlled anesthesia (PCA) device was connected to the epidural catheter and programmed to deliver a 3-mL loading dose of the analgesic solution. Subsequently, patients could self-administer 2 mL bolus doses on demand with a 30-min lockout interval. Patients were encouraged to ambulate approximately 8 h after surgery, and PCEA therapy was discontinued when a clear liquid diet was tolerated. Visual analog scale scores were used to assess pain at 8-h intervals while using PCEA therapy. Although the overall incidences of nausea (19%-35%) and pruritus (32%-62%) were similar in all four groups, the addition of NB decreased the need for bladder catheterization. The highest NB concentration resulted in increased PCA demands during the 32-h study period. In conclusion, the combination of HM 0.075 mg/mL and NB 0.04 mg/mL resulted in lower nausea scores and a decreased incidence of urinary retention compared with HM alone, without increasing the opioid analgesic requirement.

  19. Pure spinal epidural cavernous hemangioma: A case series of seven cases

    PubMed Central

    Esene, Ignatius Ngene; Ashour, Ahmed M; Marvin, Eric; Nosseir, Mohamed; Fayed, Zeiad Y; Seoud, Khaled; El Bahy, Khaled

    2016-01-01

    Introduction: Pure spinal epidural cavernous hemangiomas (PSECHs) are rare vascular lesions with about 100 cases reported. Herein, we present a case series of 7 PSECHs discussing their clinical presentation, radiological characteristics, surgical technique and intraoperative findings, pathological features, and functional outcome. Materials and Methods: We retrieved from the retrolective databases of the senior authors, patients with pathologically confirmed PSECH operated between January 2002 and November 2015. From their medical records, the patients’ sociodemographic, clinical, radiological, surgical, and histopathological data were retrieved and analyzed. Results: The mean age of the seven cases was 50.3 years. Four were females. All the five cases (71.4%) in the thoracic spine had myelopathy and the 2 (28.6%) lumbar cases had sciatica. Local pain was present in all the cases. All the lesions were isointense on T1-weighted images, hyperintense on T2-weighted images, and in five cases there was strong homogeneous enhancement. In six cases (85.7%), classical laminectomy was done; lesions resected in one piece in five cases. Total excision was achieved in all the cases. Lesions were thin-walled dilated blood vessels, lined with endothelium, and engorged with blood and with scanty loose fibrous stroma. The median follow-up was 12 months (range: 1–144 months). All patients gradually improved neurologically and achieved a good outcome with no recurrence at the last follow-up. Conclusion: PSECH although rare is increasing reported and ought to be included in the differential diagnosis of spinal epidural lesions. Early surgical treatment with total resection is recommended as would result in a good prognosis. PMID:27630480

  20. Two Holes in 'Wooly Patch'

    NASA Technical Reports Server (NTRS)

    2004-01-01

    The rock abrasion tool on NASA's Mars Exploration Rover Spirit ground two holes in a relatively soft rock called 'Wooly Patch' near the base of the 'Columbia Hills' inside Gusev Crater on Mars. This approximately true-color image from the panoramic camera was taken on sol 200 (July 25, 2004) and generated using the camera's 600-, 530-, and 480-nanometer filters. It shows the natural red and reddish-brown color of the rock. Scientists speculate that this relatively soft rock (compared to others analyzed by Spirit) may have been modified by water. Small cracks in the surface outside the drill holes may be the result of interactions with water-rich fluids.

  1. Pretreatment of pericardial patches with antibiotics does not alter patch healing in vivo

    PubMed Central

    Bai, Hualong; Kuwahara, Go; Wang, Mo; Brownson, Kirstyn; Foster, Trenton; Yamamoto, Kota; Xing, Ying; Dardik, Alan

    2014-01-01

    Introduction: Pretreatment with antibiotics is commonly performed prior to surgical implantation of prosthetic materials. We have previously shown that pericardial patches are infiltrated by macrophages and arterial stem cells after implantation into an artery. We hypothesized that antibiotic pretreatment would diminish the number of cells infiltrating into the patch, potentially affecting early neointimal formation. Methods: Bovine pericardial patches were pretreated with saline, bacitracin (500 U/ml), or cephalexin (10 mg/ml) for 30 minutes prior to implantation into the Wistar rat infrarenal aorta. Patches were retrieved on day 7 or day 30, and analyzed for histology and cell infiltration; markers of proliferation, apoptosis, vascular cell identity, and M1 and M2 macrophage subtypes were examined using immunofluorescence and immunohistochemistry. Extracted proteins were analyzed by Western blot. Results: At day 7, pericardial patches pretreated with either bacitracin or cephalexin showed similar amounts of neointimal thickening (p=0.55) and cellular infiltration (p=0.42) compared to control patches. Patches pretreated with antibiotics showed similar proliferation (p=0.09) and apoptosis (p=0.84) as control patches. The cell composition of the neointima in pretreated patches was similar to control patches, with a thin endothelial layer overlying a thin layer of SMC (p=0.45), and containing similar numbers of CD34-positive (p=0.26) and VEGFR2-positive (p=0.31) cells. Interestingly, within the body of the patch, there were fewer macrophages (p=0.0003) and a trend towards fewer EPC (p=0.051). There were no M1 macrophages in or around any of the patches; M2 macrophages were present around the patches and there was no difference in numbers of M2 macrophages surrounding control patches and patches pretreated with antibiotics (p=0.24). There was no difference in neointimal thickness at day 30 between control patches and patches pretreated with antibiotics (p=0

  2. Cytokine expression in Peyer's patches following hemorrhage and resuscitation.

    PubMed

    Shenkar, R; Chang, Y H; Abraham, E

    1994-01-01

    Intestinal dysfunction commonly occurs following hemorrhage and injury and appears to contribute to the development of multiple organ system failure in this setting. In order to examine possible mechanisms leading to intestinal dysfunction following blood loss, we investigated mRNA levels for cytokines with proinflammatory and immunoregulatory properties (interleukin 1 beta (IL-1 beta), IL-6, IL-10, TNF-alpha, TGF-beta, IFN-gamma) as well as mRNA expression for inducible nitric oxide synthase (NOS) over the 3 days following hemorrhage and resuscitation. Significantly increased levels of mRNA for IL-1 beta, IL-10, and IFN-gamma were found among cells isolated from Peyer's patches 3 days following hemorrhage. Amounts of mRNA for inducible NOS were not significantly altered 24 or 72 h after blood loss. In addition to being increased 72 h following hemorrhage, levels of mRNA for IL-10 also were increased 1 and 4 h posthemorrhage. No alterations in cytokine or NOS expression were found 24 h following blood loss. These results demonstrate that significant increases in proinflammatory and immunoregulatory cytokine mRNA levels among cellular populations in Peyer's patches are present at late posthemorrhage time points. These alterations in cytokine expression may contribute to the morphologic, immunologic, and functional changes in the intestines which are present following blood loss and injury.

  3. Systemic photosensitivity due to a contraceptive patch.

    PubMed

    Gómez-Bernal, Silvia; Loureiro, Manuel; Rodríguez-Granados, María Teresa; Toribio, Jaime

    2010-08-01

    Hormonal contraceptives are a known but rarely reported cause of photosensitivity. A 35-year-old female developed several episodes of a prurigionous papulovesicular eruption located on sun-exposed areas that resolved without scarring in days. She had been using a transdermal contraceptive (EVRA: norelgestromin and ethinyloestradiol) for 3 years, and once it was stopped, the patient became asymptomatic. She had another episode after the use of oral contraceptives (YAZ: ethinyloestradiol and drospirenone). The biopsy of the lesions showed a spongiotic dermatitis. Minimal erythema dose was diminished when the patient was using EVRA and YAZ and became normal when they were withdrawn. Phototesting with UVA, photopatch testing and blood porphyrins were normal. Antinuclear antibodies were 1/80 initially and were 1/320 6 months later. Anti-deoxyribonucleic acid antibodies, extractable nuclear antigens, anti Ro and Anti La were negative and no systemic symptoms had developed. When all hormonal contraceptives were stopped, the patient became asymptomatic. We report a case of systemic photosensitivity induced by the contraceptive patch. To the best of our knowledge, no other cases induced by transdermal contraceptives have been reported previously.

  4. Lumbo-sacral epidural anaesthesia as a complement to dissociative anaesthesia during scrotal herniorrhaphy of livestock pigs in the field.

    PubMed

    Ekstrand, Carl; Sterning, Marie; Bohman, Love; Edner, Anna

    2015-06-24

    In Sweden, scrotal or inguinal herniorrhaphy of livestock pigs in the field has traditionally been an important part of the surgical skills training of veterinary students. Few substances meet the legal requirements for field anaesthesia of production animals in the European Union but a protocol based on azaperone-detomidine-butorphanol-ketamine does. Unfortunately the anaesthesia is characterised by unpredictable duration and depth and of abrupt awakenings which is not acceptable from an animal welfare perspective and impedes surgical training. Lumbo-sacral epidural analgesia is proven to provide sufficient analgesia to allow abdominal surgery, but there are few reports on the field use of this loco-regional technique. The study aim was to evaluate whether lumbo-sacral anaesthesia can be safely and successfully used in the field by a veterinary student and whether the combination of dissociative and lumbo-sacral epidural anaesthesia improves analgesia and anaesthesia to guarantee animal welfare during herniorrhaphy in livestock pigs, enabling surgical skills training. Pigs in the control-group (placebo) responded significantly stronger to surgery, with five out of 11 requiring additional doses of detomidine and ketamine. There were no significant differences between groups in respiratory rate, heart rate, blood pressure, SpO2 or blood gases. SpO2 levels <94 % were recorded in several pigs in both groups. No post-injection complications were reported at follow-up. The results from this study showed that lumbo-sacral epidural anaesthesia with lidocaine could successfully be administered during dissociative anaesthesia of livestock pigs by a veterinary student and without reported post-injection complications. It improved analgesia and anaesthesia during herniorrhaphy of sufficient duration to enable surgical skills training. The risks and consequences of hypoxaemia and hypoventilation should be considered.

  5. Fast exact nearest patch matching for patch-based image editing and processing.

    PubMed

    Xiao, Chunxia; Liu, Meng; Nie, Yongwei; Dong, Zhao

    2011-08-01

    This paper presents an efficient exact nearest patch matching algorithm which can accurately find the most similar patch-pairs between source and target image. Traditional match matching algorithms treat each pixel/patch as an independent sample and build a hierarchical data structure, such as kd-tree, to accelerate nearest patch finding. However, most of these approaches can only find approximate nearest patch and do not explore the sequential overlap between patches. Hence, they are neither accurate in quality nor optimal in speed. By eliminating redundant similarity computation of sequential overlap between patches, our method finds the exact nearest patch in brute-force style but reduces its running time complexity to be linear on the patch size. Furthermore, relying on recent multicore graphics hardware, our method can be further accelerated by at least an order of magnitude (≥10×). This greatly improves performance and ensures that our method can be efficiently applied in an interactive editing framework for moderate-sized image even video. To our knowledge, this approach is the fastest exact nearest patch matching method for high-dimensional patch and also its extra memory requirement is minimal. Comparisons with the popular nearest patch matching methods in the experimental results demonstrate the merits of our algorithm. © 2011 IEEE

  6. HotPatch Web Gateway: Statistical Analysis of Unusual Patches on Protein Surfaces

    DOE Data Explorer

    Pettit, Frank K.; Bowie, James U. [DOE-Molecular Biology Institute

    HotPatch finds unusual patches on the surface of proteins, and computes just how unusual they are (patch rareness), and how likely each patch is to be of functional importance (functional confidence (FC).) The statistical analysis is done by comparing your protein's surface against the surfaces of a large set of proteins whose functional sites are known. Optionally, HotPatch can also write a script that will display the patches on the structure, when the script is loaded into some common molecular visualization programs. HotPatch generates complete statistics (functional confidence and patch rareness) on the most significant patches on your protein. For each property you choose to analyze, you'll receive an email to which will be attached a PDB-format file in which atomic B-factors (temp. factors) are replaced by patch indices; and the PDB file's Header Remarks will give statistical scores and a PDB-format file in which atomic B-factors are replaced by the raw values of the property used for patch analysis (for example, hydrophobicity instead of hydrophobic patches). [Copied with edits from http://hotpatch.mbi.ucla.edu/

  7. Gravity Survey of the Rye Patch KGRA, Rye Patch, Nevada

    NASA Astrophysics Data System (ADS)

    Mcdonald, M. R.; Gosnold, W. D.

    2011-12-01

    The Rye Patch Known Geothermal Resource Area (KGRA) is located in Pershing County Nevada on the west side of the Humboldt Range and east of the Rye Patch Reservoir approximately 200 km northeast of Reno, Nevada. Previous studies include an earlier gravity survey, 3-D seismic reflection, vertical seismic profiling (VSP) on a single well, 3-D seismic imaging, and a report of the integrated seismic studies. Recently, Presco Energy conducted an aeromagnetic survey and is currently in the process of applying 2-D VSP methods to target exploration and production wells at the site. These studies have indicated that geothermal fluid flow primarily occurs along faults and fractures and that two potential aquifers include a sandstone/siltstone member of the Triassic Natchez Pass Formation and a karst zone that occurs at the interface between Mesozoic limestone and Tertiary volcanics. We hypothesized that addition of a high-resolution gravity survey would better define the locations, trends, lengths, and dip angles of faults and possible solution cavity features. The gravity survey encompassed an area of approximately 78 km2 (30 mi2) within the boundary of the KGRA along with portions of 8 sections directly to the west and 8 sections directly to the east. The survey included 203 stations that were spaced at 400 m intervals. The simple Bouguer anomaly patterns were coincident with elevation, and those patterns remained after terrain corrections were performed. To remove this signal, the data were further processed using wave-length (bandpass) filtering techniques. The results of the filtering and comparison with the recent aeromagnetic survey indicate that the location and trend of major fault systems can be identified using this technique. Dip angles can be inferred by the anomaly contour gradients. By further reductions in the bandpass window, other features such as possible karst solution channels may also be recognizable. Drilling or other geophysical methods such as a

  8. Efficacy of single dose epidural morphine versus intermittent low-dose epidural morphine along with bupivacaine for postcaesarean section analgesia

    PubMed Central

    Agarwal, Kiran; Agarwal, Navneet; Agrawal, V. K.; Agarwal, Ashok; Sharma, Mahender

    2012-01-01

    Background: Obstetric anesthesia presents a challenge to the anesthesiologist. The effective pain management allows the partu-rient adequate degree of comfort and promotes physical reco-very and a sense of well being. Materials and Methods: This randomized controlled study was designed to assess the analgesic efficacy and side effects of 1.20 mg single-dose epidural morphine (Group 1) versus intermittent 12 hourly epidural morphine (0.5 mg) with bupivacaine (Group2) for postoperative analgesia in lower segment caesarean section cases. Results: Each group consisted of 36 patients. Demographic characteristics of two groups were comparable and differences among them were not statistically significant. Mean duration of analgesia was significantly longer in group one patients (16.5±2.5h) in comparison to group two patients (11.5±1.5h). Mean highest visual analog scales (VAS scale) was significantly lower (3.2±0.9) in group one patients in comparison of group two (6.7±0.8) patients. Only 43% patient in group one required supplementary perenteral analgesic (Paracetamole/Diclofenac) and 71% required epidural morphine/bupivacaine in group two. Mean number of supplementary perenteral analgesic required in group one was 0.7 and it was 1.8 in group two. There was no significant difference in nausea, vomiting, itching, and pruritis in two groups of patients. Conclusion: Our study showed that the use of single dose epidural morphine is associated with lower pain scores at rest and movement when compared to intermittent epidural morphine with bupivacaine in postcaesarean section analgesia. PMID:25885497

  9. Immunoisolation Patch System for Cellular Transplantation

    NASA Technical Reports Server (NTRS)

    Wang, Taylor G. (Inventor)

    2014-01-01

    An immunoisolation patch system, and particularly a patch system comprising multiple immunoisolation microcapsules, each encapsulating biological material such as cells for transplantation, which can be used in the prophylactic and therapeutic treatment of disease in large animals and humans without the need for immunosuppression.

  10. Transdermal patches: history, development and pharmacology

    PubMed Central

    Pastore, Michael N; Kalia, Yogeshvar N; Horstmann, Michael; Roberts, Michael S

    2015-01-01

    Transdermal patches are now widely used as cosmetic, topical and transdermal delivery systems. These patches represent a key outcome from the growth in skin science, technology and expertise developed through trial and error, clinical observation and evidence-based studies that date back to the first existing human records. This review begins with the earliest topical therapies and traces topical delivery to the present-day transdermal patches, describing along the way the initial trials, devices and drug delivery systems that underpin current transdermal patches and their actives. This is followed by consideration of the evolution in the various patch designs and their limitations as well as requirements for actives to be used for transdermal delivery. The properties of and issues associated with the use of currently marketed products, such as variability, safety and regulatory aspects, are then described. The review concludes by examining future prospects for transdermal patches and drug delivery systems, such as the combination of active delivery systems with patches, minimally invasive microneedle patches and cutaneous solutions, including metered-dose systems. PMID:25560046

  11. Development of Forced Patches in Steep Channels

    NASA Astrophysics Data System (ADS)

    Monsalve Sepulveda, A.; Yager, E. M.

    2012-12-01

    Bed surface patchiness occurs in most gravel-bedded rivers. This spatial variability in grain size and sorting impacts bed load transport. Laboratory experiments have shown that patches can arise from a local sediment transport-supply imbalance, grain to grain interactions or size-selective cross-stream transport in the presence of topographically forced heterogeneous flow fields. It is still unknown if these mechanisms can explain the formation of patches in high gradient channels with large roughness elements, which create spatial and temporal variations in depth, velocity and shear stress and alter pressure gradients, centrifugal forces, boundary friction and along and cross-stream changes in fluid momentum. To understand how these forced patches (spatially persistent due to strong topographic controls) form, a set of flume experiments using staggered immobile boulders and steep slopes wasconducted through different stages of patch evolution, starting from a flat uniform bed until patch geometry was stable in time and sediment fluxes were in equilibrium. Areas, changes in elevation, stream and crosswise sediment fluxes, and grains size distributions for patches located upstream, downstream and between boulders were measured for five different discharges. Flow field properties were obtained using a quasi-three-dimensional model to explain the influence of different components of the momentum equations on patch formation and evolution. We present these flume measurements and numerical modeling results to determine how the formation of patches is influenced by immobile boulders and the relative submergence of these roughness elements.

  12. Transdermal patches: history, development and pharmacology.

    PubMed

    Pastore, Michael N; Kalia, Yogeshvar N; Horstmann, Michael; Roberts, Michael S

    2015-05-01

    Transdermal patches are now widely used as cosmetic, topical and transdermal delivery systems. These patches represent a key outcome from the growth in skin science, technology and expertise developed through trial and error, clinical observation and evidence-based studies that date back to the first existing human records. This review begins with the earliest topical therapies and traces topical delivery to the present-day transdermal patches, describing along the way the initial trials, devices and drug delivery systems that underpin current transdermal patches and their actives. This is followed by consideration of the evolution in the various patch designs and their limitations as well as requirements for actives to be used for transdermal delivery. The properties of and issues associated with the use of currently marketed products, such as variability, safety and regulatory aspects, are then described. The review concludes by examining future prospects for transdermal patches and drug delivery systems, such as the combination of active delivery systems with patches, minimally invasive microneedle patches and cutaneous solutions, including metered-dose systems. © 2015 The British Pharmacological Society.

  13. Formulation study of tea tree oil patches.

    PubMed

    Minghetti, Paola; Casiraghi, Antonella; Cilurzo, Francesco; Gambaro, Veniero; Montanari, Luisa

    2009-01-01

    The antimicrobial, antifungal and anti-inflammatory properties of tea tree oil (TTO), the essential oil of Melaleuca alternifolia are well documented. In order to optimize its therapeutic activity, TTO patches were designed. The aim of this work was the formulation of monolayer patches containing TTO. Moreover, the performance of oleic acid (OA) as a skin penetration enhancer in patches was evaluated. Terpinen-4-ol (T4OL), the main component of TTO, was the marker used to evaluate TTO skin permeability. The permeation study was performed through human epidermis by using Franz diffusion cells. Patches were prepared by using methacrylic copolymers, Eudragit E100 (EuE100) or Eudragit NE (EuNE), and a silicone resin, BioPSA7-4602 (Bio-PSA). TTO and OA contents were fixed at 10% w/w and 3% w/w, respectively. The patches were prepared by a casting method and characterised in terms of T4OL content and skin permeability. All the selected polymers were suitable as the main component of the patch matrix. Since the main critical issue in the use of TTO is related to its toxicity after absorption, the local administration of TTO can take advantage of the use of patches based on EuE100 because of the high retained amount and the low permeation of T4OL. In this matrix, OA slightly increased the T4OL retained amount, improving the efficacy and safety of TTO patches.

  14. Spontaneous Spinal Epidural Hematoma on the Ventral Portion of Whole Spinal Canal: A Case Report

    PubMed Central

    Lee, Hyun-Ho; Kim, Young; Ha, Young-Soo

    2015-01-01

    Spontaneous spinal epidural hematoma is an uncommon but disabling disease. This paper reports a case of spontaneous spinal epidural hematoma and treatment by surgical management. A 32-year-old male presented with a 30-minute history of sudden headache, back pain, chest pain, and progressive quadriplegia. Whole-spinal sagittal magnetic resonance imaging (MRI) revealed spinal epidural hematoma on the ventral portion of the spinal canal. Total laminectomy from T5 to T7 was performed, and hematoma located at the ventral portion of the spinal cord was evacuated. Epidural drainages were inserted in the upper and lower epidural spaces. The patient improved sufficiently to ambulate, and paresthesia was fully recovered. Spontaneous spinal epidural hematoma should be considered when patients present symptoms of spinal cord compression after sudden back pain or chest pain. To prevent permanent neurologic deficits, early and correct diagnosis with timely surgical management is necessary. PMID:26512277

  15. Modern approach to an old technique: Narrative revision of techniques used to locate the epidural space.

    PubMed

    Brogly, N; Guasch Arévalo, E; Kollmann Camaiora, A; Alsina Marcos, E; García García, C; Gilsanz Rodríguez, F

    2017-03-16

    Since the first description of the epidural technique during the 1920s, the continuous progress of knowledge of the anatomy and physiology of the epidural space has allowed the development of different techniques to locate this space while increasing both the safety and efficacy of the procedure. The most common techniques used today are based on the two main characteristics of the epidural space: the difference in distensibility between the ligamentum flavum and the epidural space, and the existence of negative pressure within the epidural space. However, over recent years, technological advances have allowed the development of new techniques to locate the epidural space based on other physical properties of tissues. Some are still in the experimental phase, but others, like ultrasound-location have reached a clinical phase and are being used increasingly in daily practice.

  16. Predicting early epidurals: association of maternal, labor, and neonatal characteristics with epidural analgesia initiation at a cervical dilation of 3 cm or less.

    PubMed

    Moore, Albert R; Shan, William Li Pi; Hatzakorzian, Roupen

    2013-01-01

    Retrospective studies have associated early epidural analgesia with cesarean delivery, but prospective studies do not demonstrate a causal relationship. This suggests that there are other variables associated with early epidural analgesia that increase the risk of cesarean delivery. This study was undertaken to determine the characteristics associated with early epidural analgesia initiation. Information about women delivering at 37 weeks or greater gestation with epidural analgesia, who were not scheduled for cesarean delivery, was extracted from the McGill Obstetric and Neonatal Database. Patients were grouped into those who received epidural analgesia at a cervical dilation of ≤3 cm and >3 cm. Univariable and multivariable logistic regression was used to determine the maternal, neonatal, and labor characteristics that increased the risk of inclusion in the early epidural group. Of the 13,119 patients analyzed, multivariable regression demonstrated odds ratios (OR) of 2.568, 5.915 and 10.410 for oxytocin augmentation, induction, and dinoprostone induction of labor (P < 0.001). Increasing parity decreased the odds of early epidural analgesia (OR 0.780, P < 0.001), while spontaneous rupture of membranes (OR 1.490) and rupture of membranes before labor commenced (OR 1.288) were also associated with early epidural analgesia (P < 0.001). Increasing maternal weight (OR 1.049, P = 0.002) and decreasing neonatal weight (OR 0.943, P < 0.001) were associated with increasing risk of early epidural analgesia. Labor augmentation and induction, nulliparity, rupture of membranes spontaneously and before labor starts, increasing maternal weight, and decreasing neonatal weight are associated with early epidural analgesia. Many of these variables are also associated with cesarean delivery.

  17. Epidural Neostigmine versus Fentanyl to Decrease Bupivacaine Use in Patient-controlled Epidural Analgesia during Labor: A Randomized, Double-blind, Controlled Study.

    PubMed

    Booth, Jessica L; Ross, Vernon H; Nelson, Kenneth E; Harris, Lynnette; Eisenach, James C; Pan, Peter H

    2017-07-01

    The addition of opioids to epidural local anesthetic reduces local anesthetic consumption by 20% but at the expense of side effects and time spent for regulatory compliance paperwork. Epidural neostigmine also reduces local anesthetic use. The authors hypothesized that epidural bupivacaine with neostigmine would decrease total hourly bupivacaine use compared with epidural bupivacaine with fentanyl for patient-controlled epidural analgesia. A total of 215 American Society of Anesthesiologists physical status II, laboring parturients requesting labor epidural analgesia consented to the study and were randomized to receive 0.125% bupivacaine with the addition of either fentanyl (2 μg/ml) or neostigmine (2, 4, or 8 μg/ml). The primary outcome was total hourly local anesthetic consumption, defined as total patient-controlled epidural analgesia use and top-ups (expressed as milliliters of 0.125% bupivacaine) divided by the infusion duration. A priori analysis determined a group size of 35 was needed to have 80% power at α = 0.05 to detect a 20% difference in the primary outcome. Of 215 subjects consented, 151 patients were evaluable. Demographics, maternal and fetal outcomes, and labor characteristics were similar among groups. Total hourly local anesthetic consumption did not differ among groups (P = 0.55). The total median hourly bupivacaine consumption in the fentanyl group was 16.0 ml/h compared with 15.3, 14.6, and 16.2 ml/h in the 2, 4, and 8 μg/ml neostigmine groups, respectively (P = 0.55). The data do not support any difference in bupivacaine requirements for labor patient-controlled epidural analgesia whether patients receive epidural bupivacaine with 2 to 8 μg/ml neostigmine or epidural bupivacaine with 2 μg/ml fentanyl.

  18. Safe patch version 0.9 user manual

    SciTech Connect

    Kelley, M

    1999-03-01

    The SafePatch version 0.9 provides automated analysis of network-based computer systems to determine the status of security patches and distributes needed patches. SafePatch determines what patches need to be installed and what patches are installed on a system. SafePatch will distribute needed patches to the remote system for later installation. For those patches that are installed, SafePatch checks the permissions and ownership of the files referenced in the patch and reports on the attributes that differ from those recommended by the patch. SafePatch also ensures that the system software is authentic (that is, belonging to either a release of an operating system or a patch). The process SafePatch uses to authenticate the software on a system is more reliable and secure than other vendor-specific tools. SafePatch compares the remote system's files with the files from the patches to determine what is actually installed and what needs to be installed. This approach ensures accurate reporting of a system's patch status. It also allows SafePatch to identify files that do not belong to either the original system distribution (for example, Solaris 2.5) or to any patch. These unidentified files may be customized or trojan. Either way these files should be investigated further to determine their exact origin.

  19. Methicillin-Resistant Staphylococcus aureus Vertebral Osteomyelitis Following Epidural Catheterization: A Case Report and Literature Review

    PubMed Central

    Krishnakumar, R.; Renjitkumar, J.

    2012-01-01

    Indwelling epidural catheters are frequently used to manage postoperative pain. This report describes a patient who developed methicillin-resistant Staphylococcus aureus (MRSA) vertebral osteomyelitis of the lumbar spine following epidural catheterization. To the best of our knowledge, this is the first reported case of MRSA vertebral osteomyelitis secondary to epidural catheter use in the English orthopedic literature. The patient and his family consented to publishing the data. PMID:24353973

  20. Patch scales in coastal ecosystems

    NASA Astrophysics Data System (ADS)

    Broitman, Bernardo R.

    Quantifying the spatial and temporal scales over which ecological processes are coupled to environmental variability is a major challenge for ecologists. Here, I assimilate patterns of oceanographic variability with ecological field studies in an attempt to quantify spatial and temporal scales of coupling. Using coastal time series of chlorophyll-a concentration from remote sensing, the first chapter examines the alongshore extent of coastal regions subject to similar temporal patterns of oceanographic variability in Western North America (WNA) and North-Central Chile (Chile). I found striking interhemispherical differences in the length of coastal sections under similar oceanographic regimes, with the Chile region showing longshore coherency over much smaller spatial scales (˜60 km) than on the coast of WNA (˜140 km). Through a spatial analysis of coastal orientation I suggest that the characteristic length scales may be traced to the geomorphologic character of the ocean margins. The second chapter examines spatial patterns of primary production through long-term means of coastal chlorophyll-a concentration and kelp (Macrocystis pyrifera) cover and explores their relationship with coastal geomorphology and sea surface temperature (SST). Spatial analyses showed a striking match in length scales around 180--250 km. Strong anticorrelations at small spatial lags and positive correlations at longer distances suggest little overlap between patches of kelp and coastal chlorophyll-a. In agreement with findings from the previous chapter, I found that coastal patches could be traced back to spatial patterns of coastal geomorphology. Through SST time series and long-term datasets of larval recruitment in Santa Cruz Island, California, the third chapter examines temporal patterns of oceanographic variability as determinants of ecological patterns. SST time series from sites experiencing low larval recruitment rates were dominated by strong temporal variability. These sites

  1. Image Quality Assessment Based on Inter-Patch and Intra-Patch Similarity

    PubMed Central

    Zhou, Fei; Lu, Zongqing; Wang, Can; Sun, Wen; Xia, Shu-Tao; Liao, Qingmin

    2015-01-01

    In this paper, we propose a full-reference (FR) image quality assessment (IQA) scheme, which evaluates image fidelity from two aspects: the inter-patch similarity and the intra-patch similarity. The scheme is performed in a patch-wise fashion so that a quality map can be obtained. On one hand, we investigate the disparity between one image patch and its adjacent ones. This disparity is visually described by an inter-patch feature, where the hybrid effect of luminance masking and contrast masking is taken into account. The inter-patch similarity is further measured by modifying the normalized correlation coefficient (NCC). On the other hand, we also attach importance to the impact of image contents within one patch on the IQA problem. For the intra-patch feature, we consider image curvature as an important complement of image gradient. According to local image contents, the intra-patch similarity is measured by adaptively comparing image curvature and gradient. Besides, a nonlinear integration of the inter-patch and intra-patch similarity is presented to obtain an overall score of image quality. The experiments conducted on six publicly available image databases show that our scheme achieves better performance in comparison with several state-of-the-art schemes. PMID:25793282

  2. Robustness of metacommunities with omnivory to habitat destruction: disentangling patch fragmentation from patch loss.

    PubMed

    Liao, Jinbao; Bearup, Daniel; Wang, Yeqiao; Nijs, Ivan; Bonte, Dries; Li, Yuanheng; Brose, Ulrich; Wang, Shaopeng; Blasius, Bernd

    2017-06-01

    Habitat destruction, characterized by patch loss and fragmentation, is a major driving force of species extinction, and understanding its mechanisms has become a central issue in biodiversity conservation. Numerous studies have explored the effect of patch loss on food web dynamics, but ignored the critical role of patch fragmentation. Here we develop an extended patch-dynamic model for a tri-trophic omnivory system with trophic-dependent dispersal in fragmented landscapes. We found that species display different vulnerabilities to both patch loss and fragmentation, depending on their dispersal range and trophic position. The resulting trophic structure varies depending on the degree of habitat loss and fragmentation, due to a tradeoff between bottom-up control on omnivores (dominated by patch loss) and dispersal limitation on intermediate consumers (dominated by patch fragmentation). Overall, we find that omnivory increases system robustness to habitat destruction relative to a simple food chain. © 2017 by the Ecological Society of America.

  3. Medical and surgical management of spinal epidural abscess: a systematic review.

    PubMed

    Arko, Leopold; Quach, Eric; Nguyen, Vincent; Chang, Daniel; Sukul, Vishad; Kim, Bong-Soo

    2014-08-01

    Spinal epidural abscess (SEA) is a rare condition that has previously been treated with urgent surgical decompression and antibiotics. Recent availability of MRI makes early diagnosis possible and allows for the nonoperative treatment of SEA in select patients. The first retrospective review of medically and surgically managed SEA was published in 1999, and since that time several other retrospective institutional reports have been published. This study reviews these published reports and compares pooled data with historical treatment data. A PubMed keyword and Boolean search using ("spinal epidural abscess" OR "spinal epidural abscesses" AND [management OR treatment]) returned 429 results. Filters for the English language and publications after 1999 were applied, as the first study comparing operative and nonoperative management was published that year. Articles comparing operative to nonoperative treatment strategies for SEA were identified, and the references were further reviewed for additional articles. Studies involving at least 10 adult patients (older than 18 years) were included. Case reports, studies reporting either medical or surgical management only, studies not reporting indications for conservative management, or studies examining SEA as a result of a specific pathogen were excluded. Twelve articles directly comparing surgical to nonsurgical management of SEA were obtained. These articles reported on a total of 1099 patients. The average age of treated patients was 57.24 years, and 62.5% of treated patients were male. The most common pathogens found in blood and wound cultures were Staphylococcus aureus (63.6%) and Streptococcus species (6.8%). The initial treatment was surgery in 59.7% of cases and medical therapy in 40.3%. This represented a significant increase in the proportion of medically managed patients in comparison with the historical control prior to 1999 (p < 0.05). Patients with no neurological deficits were significantly more likely to

  4. Can We Prevent a Postoperative Spinal Epidural Hematoma by Using Larger Diameter Suction Drains?

    PubMed

    Ahn, Dong Ki; Kim, Jin Hak; Chang, Byung Kwon; Lee, Jae Il

    2016-03-01

    Epidural hematoma is a rare but serious complication. According to previous studies, it is not prevented by suction drains. This study evaluated the following alternative hypothesis: the larger the diameter of a suction drain, the less the remaining epidural hematoma after spinal surgery. This was a randomized prospective study. Patients who underwent posterior lumbar decompression and instrumented fusion were divided into two groups: the large drain (LD, 2.8-mm-diameter tube) and small drain (SD, 1.6-mm-diameter tube) groups according to the diameter of the suction drains. All patients were consecutive and allocated alternately according to the date of operations. Suction drains were removed on day 3 and magnetic resonance imaging was performed on day 7 postoperatively. The size of remaining hematomas was measured by the degree of thecal sac compression in cross section using the following 4-point numeric scale: G1, less than one quarter; G2, between one quarter and half; G3, more than half; and G4, more than subtotal obstruction. There were 39 patients with LDs and 38 with SDs. They did not differ significantly in terms of sex, number of fusion segments, revision or not, antiplatelet medication, intraoperative injection of tranexamic acid. However, patient age differed significantly between the two groups (LD, 63.3 years and < SD, 68.6 years; p = 0.007). The two groups did not differ significantly in terms of prothrombin time, activated partial thromboplastin time, platelet number, blood loss, or operation duration. However, platelet function analysis exhibited a significant difference (LD, 164.7 seconds and < SD, 222.3 seconds; p = 0.002). The two blinded readers showed high consistency (Kappa value = 0.740; p = 0.000). The results of reader 1 were as follows: LD and SD had 21 and 21 cases of G1, 9 and 11 cases of G2, 6 and 6 cases of G3, and 3 and 0 cases of G4, respectively. The results of reader 2 were as follows: LD and SD had 22 and 23 cases of G1, 7 and 9

  5. [Utility of epidural catheterization by the caudal route in pediatric anesthesia].

    PubMed

    Blanco, D; Llamazares, J; Martínez-Mora, J; Vidal, F

    1994-01-01

    To compare analgesic effect of bupivacaine during and after surgery when delivered through a lumbar epidural catheter entering by the caudal route with either caudal or lumbar administration of anesthetic through the needle. One hundred forty ASA I patients under 110 months undergoing infraumbilical surgery were studied. The children were distributed randomly into 3 groups: group 1, caudal puncture and anesthesia with 2.5 mg/kg bupivacaine 1:200,000; group 2, lumbar puncture at L4-L5 and 1.25 mg/kg of the same local anesthetic; and group 3, epidural catheter in the caudal space up to L4-L5 and 1.25 mg/kg of the same local anesthetic administered through the catheter (Minipack: SYSTEM 2-Portex). The patients were anesthetized with endovenous or inhalational anesthetics. Variables recorded were analgesia during surgery (hemodynamic constants) and afterwards (CHEOPS scale), level of cutaneous sensory blockade immediately after the operation and its relationship to age, complementary analgesia used and complications. X-rays of the distal end of the catheter were taken in group 3. Analgesia during and after surgery was sufficient for all patients in group 1. Two patients, 1 from group 2 and 1 from group 3, were eliminated due to lack of analgesia during surgery. The level of cutaneous sensory blockade attained was significantly lower in group 3 than in group 1, and only in group 1 were we able to establish a linear correlation between level of sensory blockade and age (R = 0.51; p < 0.01). In group 3, 85.5% of the catheters reached L4-L5. Complementary analgesia was similar in the three groups. Complications included 5 cases of blood loss at the point of puncture in groups 1 and 2, and 1 case of catheter penetration of the juncture in group 3. Epidural anesthesia by way of a catheter entering by the caudal space allows us to achieve intra- and postoperative analgesia of comparable quality to that afforded by a lumbar approach or a single direct caudal puncture.

  6. Early versus late initiation of epidural analgesia for labour.

    PubMed

    Sng, Ban Leong; Leong, Wan Ling; Zeng, Yanzhi; Siddiqui, Fahad Javaid; Assam, Pryseley N; Lim, Yvonne; Chan, Edwin S Y; Sia, Alex T

    2014-10-09

    Pain during childbirth is arguably the most severe pain some women may experience in their lifetime. Epidural analgesia is an effective form of pain relief during labour. Many women have concerns regarding its safety. Furthermore, epidural services and anaesthetic support may not be available consistently across all centres. Observational data suggest that early initiation of epidural may be associated with an increased risk of caesarean section, but the same findings were not seen in recent randomised controlled trials. More recent guidelines suggest that in the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labour. The choice of analgesic technique, agent, and dosage is based on many factors, including patient preference, medical status, and contraindications. There is no systematically reviewed evidence on the maternal and foetal outcomes and safety of this practice. This systematic review aimed to summarise the effectiveness and safety of early initiation versus late initiation of epidural analgesia in women. We considered the obstetric and fetal outcomes relevant to women and side effects of the treatments, including risk of caesarean section, instrumental birth and time to birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (12 February 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE (January 1966 to February 2014), Embase (January 1980 to February 2014) and reference lists of retrieved studies. We included all randomised controlled trials involving women undergoing epidural labour analgesia that compared early initiation versus late initiation of epidural labour analgesia. Two review authors independently assessed trials for inclusion, extracted the data and assessed the trial quality. Data were checked for accuracy. We included nine studies with a total of 15,752 women.The overall risk of bias of

  7. Epidural analgesia during labor: continuous infusion or patient-controlled administration?

    PubMed

    Benhamou, D

    1995-05-01

    Patient-controlled epidural analgesia (PCEA) has several advantages over continuous epidural infusion of bupivacaine during labor: it produces a good analgesia with a limited sensory spread; generally, less bupivacaine is administered and maternal satisfaction with pain control is increased. However, the quality of analgesia is similar to that obtained with other forms of epidural administration. Moreover, PCEA is only a particular form of epidural and, as such, has the same safety requirements. PCEA does not appear to reduce the workload of the anesthetic team. The cost of the PCA pump will need to be included in future evaluation of the cost/benefit ratio.

  8. Effectiveness of premature epidural catheter termination as a quality indicator in a developing country.

    PubMed

    Hamid, Mohammad; Qamar ul hoda, Muhammad; Samad, Khalid

    2010-07-01

    Premature epidural catheter termination in the postoperative period is a common cause of epidural analgesia failure. The incidence varies from 5.7 to 13%. A higher incidence of unplanned epidural catheter termination was observed in our hospital. We took this as a quality improvement project, monitored the causes and applied remedial measures at the same time to reduce the incidence. An audit was conducted by the Acute Pain Service between January 2004 and December 2007 to find the incidence and different causes of accidental epidural catheter pullout. Different strategies were applied simultaneously to counter the identified causes. A predesigned pro forma was used for audit while remedial measures included change in practice, counselling of the person responsible, group teaching and reinforcement of epidural care policy. The overall incidence of premature epidural termination was 3.9% during a 4-year period with a higher incidence in 2004 (5.59%), which was reduced in later years. The main reason for premature epidural catheter removal was mishandling of the catheter and filter (64%). The most common site for catheter disconnection was found to be at the filter end of the catheter (54.7%), although 39 (61%) epidural catheters were removed by the Acute Pain Service following disconnection or breakage to avoid danger of infection. Identification of premature epidural catheter termination as a quality indicator and continuous quality improvement efforts later on proved to be a useful approach in reducing the incidence. The present audit also helped to quantify the improvement in the quality of care.

  9. Patient-controlled epidural analgesia in labor does not always improve maternal satisfaction.

    PubMed

    Nikkola, Eeva; Läärä, Arja; Hinkka, Susanna; Ekblad, Ulla; Kero, Pentti; Salonen, Markku

    2006-01-01

    We investigated whether patient-controlled epidural analgesia in labor with bupivacaine and fentanyl provides more satisfaction to mothers than intermittent bolus epidural analgesia or patient-controlled epidural analgesia with plain bupivacaine. Ninety mothers with term, uncomplicated pregnancies were randomized to receive intermittent bolus epidural analgesia (bupivacaine + fentanyl), patient-controlled epidural analgesia (bupivacaine + fentanyl), or patient-controlled epidural analgesia (bupivacaine). Pain during labor was evaluated with a visual analog scale. Obstetric and neonatal outcomes were recorded. After delivery, the mothers were given a questionnaire covering the following themes: experience of labor pain, feeling of control, fears and expectations associated with pregnancy/with delivery/with becoming a mother, as well as pain, physical condition and emotions after delivery. To elaborate on these answers, 30 mothers were further randomized to a semistructured interview, in which the same topics were discussed. The main outcome measure was maternal satisfaction. The intermittent bolus epidural analgesia group felt they could influence labor most (p = 0.03), and in the interview they expressed most satisfaction. In this group, the total drug utilization was smallest (bupivacaine: p <0.0001 comparing all groups, fentanyl: p = 0.03 comparing the two fentanyl-receiving groups). No differences in pain occurred. Vomiting (p = 0.04) and pruritus (p <0.0001) were more common or more severe in the groups receiving fentanyl. We found no advantages for patient-controlled epidural analgesia over intermittent bolus epidural analgesia in terms of maternal satisfaction.

  10. Incidence of intradiscal injection during lumbar fluoroscopically guided transforaminal and interlaminar epidural steroid injections.

    PubMed

    Candido, Kenneth D; Katz, Jeffrey A; Chinthagada, Mariadas; McCarthy, Robert A; Knezevic, Nebojsa Nick

    2010-05-01

    Intradiscal injections during transforaminal epidural steroid injections and interlaminar lumbar epidural steroid injections have been reported rarely. In that regard, this retrospective observational report is the first attempt to quantify the overall rate of this complication. A retrospective analysis of 3 years of accrued data (2004-2007) showed that 2412 transforaminal epidural steroid injections were performed at the 2 training institutions (Loyola University Medical Center and Northwestern University/Feinberg School of Medicine). There were 6 intradiscal (annular) injections of contrast, for a rate of 1:402. Over the same interval, 4723 lumbar epidural steroid injections were performed, with 1 intradiscal injection, for a rate of 1:4723.

  11. Histopathological Alterations after Single Epidural Injection of Ropivacaine, Methylprednizolone Acetate, or Contrast Material in Swine

    SciTech Connect

    Kitsou, Maria-Chrysanthi; Kostopanagiotou, Georgia; Kalimeris, Konstantinos; Vlachodimitropoulos, Demetrios; Soultanis, Konstantinos; Batistaki, Chrysanthi; Kelekis, Alexis

    2011-12-15

    Purpose: The consequences from the injection of different types of drugs in the epidural space remains unknown. Increasing evidence suggests that localized inflammation, fibrosis, and arachnoiditis can complicate sequential epidural blockades, or even epidural contrast injection. We investigate the in vivo effect of epidural injections in the epidural space in an animal model. Materials and Methods: A group of ten male adult pigs, five punctures to each at distinct vertebral interspaces under general anesthesia, were examined, testing different drugs, used regularly in the epidural space (iopamidol, methylprednisolone acetate, ropivacaine). Each site was marked with a percutaneous hook wire marker. Histological analysis of the epidural space, the meninges, and the underlying spinal cord of the punctured sites along with staining for caspase-3 followed 20 days later. Results: The epidural space did not manifest adhesions or any other pathology, and the outer surface of the dura was not impaired in any specimen. The group that had the contrast media injection showed a higher inflammation response compared to the other groups (P = 0.001). Positive staining for caspase-3 was limited to <5% of neurons with all substances used. Conclusion: No proof of arachnoiditis and/or fibrosis was noted in the epidural space with the use of the above-described drugs. A higher inflammation rate was noted with the use of contrast media.

  12. Epidural catheter misplaced into the thoracic cavity: Utilized to provide interpleural analgesia

    PubMed Central

    Sundary, M. Thiriloga

    2015-01-01

    Thoracic epidural analgesia is one of the most effective and time-tested modalities of providing postthoracotomy pain relief. It improves postoperative pulmonary outcome. Nevertheless, being a blind procedure several complications have been associated with the technique. Pleural puncture is one rare complication that might occur following thoracic epidural catheterization. We have discussed a patient who underwent a right thoracotomy for excision of emphysematous bulla of lung under general anesthesia with thoracic epidural. The epidural catheter was misplaced in the pleural cavity and was detected intraoperatively after thoracotomy. The catheter was left in situ and was successfully utilized to provide postoperative analgesia via the interpleural route. PMID:25886437

  13. Expedition 52 Crew Patch-042517

    NASA Image and Video Library

    2016-11-17

    ISS052-s-001 (01/27/2016) --- Orbiting the Earth continuously since 1998, the International Space Station (ISS) is one of our greatest engineering achievements. It is depicted in gold, symbolic of constancy and excellence. Flying directly toward a sunrise represents the ISS’s contributions to a bright future. That sunrise and the Earth beneath ituses blue, white, red, and green, the combined national colors of Italy, Russia, and the United States, symbolizing the crew’s cohesiveness. Crewmember names are in blue symbolizing devotion and loyalty. The white border represents sunlight unscattered by the Earth’s atmosphere. Symbolic of new Russian and U.S. spacecraft that will further human exploration, the patch is shaped as a capsule. The number 52 is drawn as a path eventually leading to Mars. Finally, the stars symbolize the values of leadership, trust, teamwork, and excellence lived by mission control teams throughout the history of human space programs, as well as their global vigilance in operating the ISS.

  14. STS-74 patch or insignia

    NASA Image and Video Library

    1996-09-13

    STS074-S-001 (July 1995) --- Designed by crew members, this STS-74 crew patch depicts the space shuttle Atlantis docked to Russia's Mir Space Station. The central focus is on the Russian-built Docking Module (DM), drawn with shading to accentuate its pivotal importance to both mission STS-74 and the NASA - Mir Program. The rainbow across the horizon represents Earth's atmosphere, the thin membrane protecting all nations, while the three flags across the bottom show those nations participating in STS-74 - Russia, Canada and the United States. The sunrise is symbolic of the dawn of a new era in NASA space flight - that of space station construction. The NASA insignia design for space shuttle flights is reserved for use by the astronauts and for other official use as the NASA Administrator may authorize. Public availability has been approved only in the forms of illustrations by the various news media. When and if there is any change in this policy, which is not anticipated, the change will be publicly announced. Photo credit: NASA

  15. [Clinical presentation of a dorsal epidural arachnoid cyst after an epidural anesthesia].

    PubMed

    Obil-Chavarría, Claudia Alejandra; García-Ramos, Carla Lisette; Castro-Quiñonez, Sergio Alberto; Huato-Reyes, Raúl; Santillán-Chapa, Concepción Guadalupe; Reyes-Sánchez, Alejandro Antonio

    Arachnoid cysts are dural diverticula with liquid content similar to cerebrospinal fluid, with 1% occurring in the spinal cord. They locate mainly in the dorsal region of the thoracic spine, and are unusual causes of spinal cord compression. The case is presented of a previously healthy 15-year-old boy, with a 20-month history of spastic paraparesis that started apparently after epidural block for ankle osteosynthesis. There was decreased sensitivity and strength of the pelvic limbs and gradually presented with anaesthesia from T12 to L4 dermatomes, L5 and S1 bilateral hypoaesthesia and 4+/5 bilateral strength, in the L2 root and 2+/5 in L3, L4, L5, S1, hyperreflexia, Babinski and clonus, but with no alteration in the sacral reflexes. In the magnetic resonance it was diagnosed as an extradural arachnoid cyst from T6 to T9. The patient underwent a T6 to T10 laminotomy, cyst resection, dural defect suture, and laminoplasty. One year after surgery, the patient had recovered sensitivity, improvement of muscle strength up to 4+/5 in L2 to S1, and normal reflexes. After the anaesthetic procedure, increased pressure and volume changes within the cyst could cause compression of the spinal cord, leading to symptoms. Despite being a long-term compression, the patient showed noticeable improvement. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  16. Use of transcutaneous electrical nerve stimulation as an adjunctive to epidural analgesia in the management of acute thoracotomy pain

    PubMed Central

    Chandra, Alka; Banavaliker, Jayant N; Das, Pradeep K; Hasti, Sheel

    2010-01-01

    The present randomized study was conducted in our institute of pulmonary medicine and tuberculosis over a period of 1 year. This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as an adjunctive to thoracic epidural analgesia for the treatment of postoperative pain in patients who underwent posterolateral thoracotomy for decortication of lung. Sixty patients in the age group 15–40 years scheduled to undergo elective posterolateral thoracotomy were divided into two groups of 30 each. Patients were alternatively assigned to one of the groups. In group I, only thoracic epidural analgesia with local anaesthetics was given at regular intervals; however, an identical apparatus which did not deliver an electric current was applied to the control (i.e. group I) patients. While in group II, TENS was started immediately in the recovery period in addition to the epidural analgesia. A 0–10 visual analog scale (VAS) was used to assess pain at regular intervals. The haemodynamics were also studied at regular intervals of 2 h for the first 10 h after the surgery. When the VAS score was more than three, intramuscular analgesia with diclofenac sodium was given. The VAS score and the systolic blood pressure were comparable in the immediate postoperative period (P = NS) but the VAS score was significantly less in group II at 2, 4, 6, 8 h (P < 0.01, P < 0.05, P < 0.05, P < 0.05, respectively), and at 10 h the P value was not significant. Similarly, the systolic blood pressure was significantly less in group II at 2, 4, 6 h after surgery, that is P < 0.02, P < 0.01, P < 0.01, respectively, but at 8 and 10 h the pressures were comparable in both the groups. Adding TENS to epidural analgesia led to a significant reduction in pain with no sequelae. The haemodynamics were significantly stable in group II compared to group I. TENS is a valuable strategy to alleviate postoperative pain following thoracic surgery with no side effects and with

  17. Oral vaccination through Peyer's Patches: update on particle uptake.

    PubMed

    Soares, Edna; Borges, Olga

    2017-08-25

    Oral immunization has numerous advantages over parenteral administrations. In addition to ease administration, more effective pathogen elimination on the mucosa before spreading into the blood circulation, constitutes the main benefit. This is particularly true for pathogens that enter the body through the oral route. On the other hand, it is the most challenging administration route for peptides, proteins and recombinant antigens due to gastrointestinal (GI) tract numerous barriers including the harsh environment and the inherent weak immunogenicity. In addition to the adjuvant properties, polymeric particles arise as the most promising strategy to overcome poor antigen bioavailability/stability upon oral administration. The Peyer's patches have been considered an important structure of the gut associate lymphoid tissue (GALT) for the initiation of the immune response towards particulate oral antigens. The transport mechanism of both, nano and microparticles across intestinal mucosa, particularly throughout Peyer's patches, is discussed in this review. We provide a short and concise update (last decade) focused on the importance of particle physicochemical properties, M-cell ligands and size-dependent transport and intracellular fate concerning Peyer's patches targeted oral vaccination. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  18. A retrospective comparison of programmed intermittent epidural bolus with continuous epidural infusion for maintenance of labor analgesia.

    PubMed

    Tien, Michael; Allen, Terrence K; Mauritz, Amy; Habib, Ashraf S

    2016-08-01

    To assess whether maintenance of labor epidural analgesia using programmed intermittent epidural bolus (PIEB) is associated with reduced local anesthetic (LA) consumption, patient-controlled epidural analgesia (PCEA) use, and rescue analgesia requirements compared to continuous epidural infusion (CEI). This is a retrospective study at an academic university medical center. Women receiving epidural labor analgesia from March to July of 2015 were identified and categorized into three groups: 1) CEI 5 mL/hr, 2) PIEB 5 mL/60 minutes, 3) PIEB 3 mL/30 minutes. The LA consisted of bupivacaine 0.125 mg/mL and fentanyl 2 μg/mL. All patients had similar PCEA settings. Data were collected on pattern of LA usage, obstetric outcomes and Bromage scores. The primary endpoint was total volume of LA consumed per hour. Secondary outcomes included need for clinician boluses, pattern of PCEA use, degree of motor blockade and delivery mode. We included 528 patients (262 had CEI, 162 had PIEB 5 mL/60 minutes, and 104 had PIEB 3 mL/30 minutes). Median LA consumed was 10.3, 9.5, and 9.7 mL/hr, respectively (p = 0.10). There were no differences in PCEA attempts or rescue clinician boluses, but PCEA volume (p = 0.03) and ratio of PCEA attempts/given (p < 0.01) were significantly different among the groups. Patients receiving PIEB 3 mL/30 minutes used lower PCEA volume than patients receiving CEI (p = 0.04). Patients with PIEB 5 mL/60 minutes and PIEB 3 mL/30 minutes had a higher ratio of PCEA attempts/given than CEI patients (p = 0.01 and p < 0.01, respectively). There were no differences in Bromage scores (p = 0.14) or delivery mode (p = 0.55) among the groups. The epidural maintenance regimen used (CEI vs. PIEB) was not associated with differences in LA consumption, motor blockade or delivery mode. Main limitations of the study include its single center retrospective design and the fact that patients were not randomized

  19. Oracle Applications Patch Administration Tool (PAT) Beta Version

    SciTech Connect

    2002-01-04

    PAT is a Patch Administration Tool that provides analysis, tracking, and management of Oracle Application patches. This includes capabilities as outlined below: Patch Analysis & Management Tool Outline of capabilities: Administration Patch Data Maintenance -- track Oracle Application patches applied to what database instance & machine Patch Analysis capture text files (readme.txt and driver files) form comparison detail report comparison detail PL/SQL package comparison detail SQL scripts detail JSP module comparison detail Parse and load the current applptch.txt (10.7) or load patch data from Oracle Application database patch tables (11i) Display Analysis -- Compare patch to be applied with current Oracle Application installed Appl_top code versions Patch Detail Module comparison detail Analyze and display one Oracle Application module patch. Patch Management -- automatic queue and execution of patches Administration Parameter maintenance -- setting for directory structure of Oracle Application appl_top Validation data maintenance -- machine names and instances to patch Operation Patch Data Maintenance Schedule a patch (queue for later execution) Run a patch (queue for immediate execution) Review the patch logs Patch Management Reports

  20. Patch shape, connectivity, and foraging by oldfield mice (Peromyscus polionotus).

    SciTech Connect

    Orrock, John, L.; Danielson, Brent J

    2005-06-01

    We examined how corridors and patch shape affect foraging by the oldfield mouse (Peromyscus polionotus) by deploying foraging trays and live traps in experimental landscapes with 3 different patch types: patches connected with a corridor, unconnected patches with projecting corridorlike portions (winged patches), and unconnected rectangular patches. Corridors did not lead to different levels of activity of P. polionotus among the 3 patch types. Rather, corridors influenced activity by changing patch shape: foraging in seed trays and total number of captures of P. polionotus tended to be greater at the patch center than at the patch edge, but only in connected and winged patches where corridors or wings increased the amount of patch edge relative to the amount of core habitat in the patch. P. polionotus avoided open microhabitats near the patch edge in winged and connected patches, but not open microhabitats near the patch interior, suggesting that predation risk caused shifts in foraging near edges in connected and winged patches. Foraging in corridors and wings was generally low, suggesting that both are high-risk habitats where predation risk is not ameliorated by proximity to vegetative cover. By changing patch shape, corridors caused changes in within-patch activity of P. polionotus, changing foraging patterns and potentially altering the dynamics of P. polionotus and the seeds they consume.

  1. A spinal epidural hematoma with symptoms mimicking cerebral stroke.

    PubMed

    Shima, Hiroshi; Yasuda, Muneyoshi; Nomura, Motohiro; Mori, Kentaro; Miyashita, Katsuyoshi; Tamase, Akira; Kitamura, Yoshihisa; Osuka, Koji; Takayasu, Masakazu

    2012-02-01

    A spontaneous cervical epidural hematoma (SCEH) is a rare condition, which usually requires urgent treatment. However, unusual manifestations, such as hemiparesis, may lead to a misdiagnosis. We herein report a case of SCEH that presented with pure motor hemiparesis to discuss the appropriate and prompt diagnosis and treatment of such cases. An 84-year-old female was brought to our emergency department complaining of nuchal pain, followed by right hemiparesis. A contrast-enhanced computed tomography (CT) scan of the neck demonstrated a spinal epidural hematoma right posterolateral to the spinal cord, extending from C2 to C3. She was managed conservatively and her symptoms improved significantly. The authors emphasize that cervical spinal lesions should be considered in the differential diagnosis for patients with acute onset of hemiparesis, when they are associated with neck pain. Even though magnetic resonance imaging is the gold standard, a CT scan is also useful for quick screening for SCEH.

  2. Lumbar spine osteomyelitis and epidural abscess formation secondary to acupuncture

    PubMed Central

    Godhania, Vinesh

    2016-01-01

    A 39-year-old male with no previous medical history presented with abdominal and low back pain. Based on clinical and radiological findings he was diagnosed with L1/L2 osteomyelitis and epidural abscess. Further history taking revealed recent use of acupuncture for treatment of mechanical back pain. The patient was treated conservatively with an extended course of antibiotics, monitored with repeat MRI scans and had a full recovery with no neurological deficit. This is the first reported case of epidural abscess formation and osteomyelitis after acupuncture in the UK. As acupuncture becomes more commonly used in western countries, it is important to be aware of this rare but serious complication. PMID:26976275

  3. Rosai-Dorfman Disease Isolated to the Thoracic Epidural Spine

    PubMed Central

    Kozak, Benjamin; Talbott, Jason; Uzelac, Alina; Rehani, Bhavya

    2015-01-01

    Rosai-Dorfman disease is a rare benign histiocytic disease that infrequently presents in the spine. We report a case of Rosai-Dorfman disease isolated to the epidural thoracic spine in a 26-year-old male. To our knowledge, this is the 15th reported case of isolated spinal disease and only the fourth case of isolated thoracic epidural disease. Given its rarity as well as non-specific symptoms and imaging findings, Rosai-Dorfman disease is often not considered and misdiagnosed on imaging studies. To help improve awareness of Rosai-Dorfman spinal disease, we review the literature and discuss the epidemiology, clinical presentation, imaging features, and treatment considerations for this condition. PMID:27252790

  4. Transient unilateral Horner's syndrome after epidural ropivacaine in a dog.

    PubMed

    Bosmans, Tim; Schauvliege, Stijn; Gasthuys, Frank; Marcilla, Miguel Gozalo; Polis, Ingeborgh

    2009-07-01

    A left sided Horner's syndrome (ptosis, prolapse of the nictitating membrane and miosis) was observed in a 4-year-old female, neutered Beagle dog after epidural injection of 0.22 mL kg(-1) ropivacaine (0.75%) in 0.01 mL kg(-1) of saline during isoflurane anaesthesia. Clinical signs disappeared gradually and resolved completely 4 hours and 10 minutes after injection. The epidural injection of 0.22 mL kg(-1) ropivacaine (0.75%) in 0.01 mL kg(-1) of saline during isoflurane anaesthesia caused unilateral (left) Horner's syndrome in a 4-year-old female, neutered Beagle dog.

  5. Spontaneous spinal epidural hemorrhage from intense piano playing.

    PubMed

    Chang, Hui-Ju; Su, Fang Jy; Huang, Ying C; Chen, Shih-Han

    2014-06-01

    Spontaneous spinal epidural hematoma (SSEH) is a rare but real neurosurgical emergency. It is caused by atraumatic rupture of the vertebral epidural vein that results in nerve root or spinal cord compression. Most cases of SSEH have a multifactorial etiology, including congenital and acquired coagulopathies; platelet dysfunction; vascular malformation; tumors; uncontrolled hypertension; pregnancy; and, very rarely, activities requiring Valsalva. Herein we reported the case of a young pianist who was attacked by SSEH during piano practice. Playing the piano is a joyful, relaxing entertainment; however, this musical activity can be a highly demanding physical and mental exercise for pianists. Emotional and expressive performance, especially in professional performing, has been reported to result in significant increase of sympathetic and decrease of parasympathetic activities and thus influence the cardiorespiratory variables. The increased biomechanical stress from fluctuating hemodynamics was thought to trigger the rupture of her spinal arteriovenous malformation.

  6. Mesenchymal stem cell-loaded cardiac patch promotes epicardial activation and repair of the infarcted myocardium.

    PubMed

    Wang, Qiang-Li; Wang, Hai-Jie; Li, Zhi-Hua; Wang, Yong-Li; Wu, Xue-Ping; Tan, Yu-Zhen

    2017-02-28

    Cardiac patch is considered a promising strategy for enhancing stem cell therapy of myocardial infarction (MI). However, the underlying mechanisms for cardiac patch repairing infarcted myocardium remain unclear. In this study, we investigated the mechanisms of PCL/gelatin patch loaded with MSCs on activating endogenous cardiac repair. PCL/gelatin patch was fabricated by electrospun. The patch enhanced the survival of the seeded MSCs and their HIF-1α, Tβ4, VEGF and SDF-1 expression and decreased CXCL14 expression in hypoxic and serum-deprived conditions. In murine MI models, the survival and distribution of the engrafted MSCs and the activation of the epicardium were examined, respectively. At 4 weeks after transplantation of the cell patch, the cardiac functions were significantly improved. The engrafted MSCs migrated across the epicardium and into the myocardium. Tendency of HIF-1α, Tβ4, VEGF, SDF-1 and CXCL14 expression in the infarcted myocardium was similar with expression in vitro. The epicardium was activated and epicardial-derived cells (EPDCs) migrated into deep tissue. The EPDCs differentiated into endothelial cells and smooth muscle cells, and some of EPDCs showed to have differentiated into cardiomyocytes. Density of blood and lymphatic capillaries increased significantly. More c-kit(+) cells were recruited into the infarcted myocardium after transplantation of the cell patch. The results suggest that epicardial transplantation of the cell patch promotes repair of the infarcted myocardium and improves cardiac functions by enhancing the survival of the transplanted cells, accelerating locality paracrine, and then activating the epicardium and recruiting endogenous c-kit(+) cells. Epicardial transplantation of the cell patch may be applied as a novel effective MI therapy.

  7. Effect of parecoxib combined with thoracic epidural analgesia on pain after thoracotomy

    PubMed Central

    Ling, Xiao-Min; Fang, Fang; Zhang, Xiao-Guang; Ding, Ming; Liu, Qiu-A-Xue

    2016-01-01

    Background Thoracotomy results in severe postoperative pain potentially leading to chronic pain. We investigated the potential benefits of intravenous parecoxib on postoperative analgesia combined with thoracic epidural analgesia (TEA). Methods Eighty-six patients undergoing thoracic surgery were randomized into two groups. Patient-controlled epidural analgesia (PCEA) was used until chest tubes were removed. Patients received parecoxib (group P) or placebo (group C) intravenously just 0.5 h before the operation and every 12 h after operation for 3 days. The intensity of pain was measured by using a visual analogue scale (VAS) and recorded at 2, 4, 8, 24, 48, 72 h after operation. The valid number of PCA, the side effects and the overall satisfaction to analgesic therapy in 72 h were recorded. Venous blood samples were taken before operation, the 1st and 3rd day after operation for plasma cortisol, adrenocorticotropic hormone (ACTH), interleukin-6 and tumor necrosis factor-α level. The occurrence of residual pain was recorded using telephone questionnaire 2 and 12 months after surgery. Results Postoperative pain scores at rest and on coughing were significantly lower with the less valid count of PCA and greater patient satisfaction in group P (P<0.01). Adverse effect and the days fit for discharge were comparable between two groups. The cortisol levels in placebo group were higher than parecoxib group at T2. The level of ACTH both decreased in two groups after operation but it was significantly lower in group P than that in group C. There were no changes in plasma IL-6 and TNF-α levels before and after analgesia at T1 and T2 (P>0.05). The occurrence of residual pain were 25% and 51.2% separately in group P and C 3 months postoperatively (P<0.05). Conclusions Intravenous parecoxib in multimodal analgesia improves postoperative analgesia provided by TEA, relieves stress response after thoracotomy, and may restrain the development of chronic pain. PMID:27162662

  8. Long-term survival in a dog with meningoencephalitis and epidural abscessation due to Actinomyces species.

    PubMed

    Song, Rachel B; Vitullo, Carina A; da Costa, Ronaldo C; Daniels, Joshua B

    2015-07-01

    A 2-year-old, female spayed Golden Retriever dog was presented to The Ohio State University Veterinary Medical Center for evaluation of ataxia, cervical pain, 1 episode of acute collapse, dull mentation, and inappetence. Physical examination revealed an elevated temperature of 39.7°C and severe cervical pain. Blood work revealed a mature neutrophilia. Cerebrospinal fluid (CSF) analysis revealed nondegenerative neutrophilic pleocytosis with no infectious agents. A presumptive diagnosis of steroid-responsive meningitis-arteritis was made, and corticosteroid therapy was started. The patient improved initially but experienced a vestibular episode characterized by falling and vertical nystagmus. A magnetic resonance imaging of the brain revealed an epidural abscess in the cervical vertebral canal and diffuse meningeal enhancement in the brain and cranial cervical spine. Abscess drainage revealed degenerate neutrophils and several filamentous, branching organisms. Culture of the initial CSF using an enrichment broth revealed growth of a Gram-positive organism 5 days after fluid collection. The isolate was identified by partial 16S ribosomal DNA sequencing as Actinomyces spp. The patient was successfully treated with long-term antibiotics. Our study reports the long-term survival after medical treatment of bacterial meningoencephalitis and epidural abscessation due to Actinomyces sp. infection in a dog. Bacterial meningoencephalitis should be included as a differential diagnosis in patients with cervical pain and fever, even when a nondegenerative neutrophilic pleocytosis is found on CSF analysis. Culture of the CSF with use of an enrichment broth should be considered in all cases of neutrophilic pleocytosis to rule out infections of the central nervous system. © 2015 The Author(s).

  9. Spontaneous spinal epidural hematoma management: a case series and literature review.

    PubMed

    Raasck, Kyle; Habis, Ahmed A; Aoude, Ahmed; Simões, Leonardo; Barros, Fernando; Reindl, Rudy; Jarzem, Peter

    2017-01-01

    Spontaneous spinal epidural hematoma (SSEH) manifests from blood accumulating in the epidural space, compressing the spinal cord and leading to acute neurological deficits. Standard therapy is decompressive laminectomy, although spontaneous recoveries have been reported. Sub-optimal therapeutic principles contribute to SSEH's 5.7% mortality-which patient will benefit from surgery remains unclear. This study aims to investigate parameters that affect SSEH's progression, outlining a best-practice therapeutic approach. Literature review yielded 65 cases from 12 studies. Furthermore, 6 cases were presented from our institution. All data were analyzed under American Spinal Injury Association (ASIA) score guidelines. Fifty percent of SSEH patients do not fully recover. In all, 30% of patients who presented with an ASIA score of A did not improve with surgery, although every SSEH patient who presented at C or D improved. Spontaneous recovery is rare-only 23% of patients were treated conservatively. Seventy-three percent of those made a full recovery, as opposed to the 48% improvement in patients managed surgically. Thirty-three percent of patients managed conservatively had an initial score of A or B, all improving to a score of D or E without surgery. Regardless, conservative management tends toward low-risk presentations. Patients managed conservatively were three times as likely to have an initial score of D than their surgically managed counterparts. The degree of pre-operative neural deficit is a major prognostic factor. Conservative management has proven effective, although feasible only if spontaneous recovery is manifested. Decompressive laminectomy should continue to remain readily available, given the inverse correlation between operative interval and recovery.

  10. Epidural steroid injection for lumbar disc herniation in NFL athletes.

    PubMed

    Krych, Aaron J; Richman, Daniel; Drakos, Mark; Weiss, Leigh; Barnes, Ronnie; Cammisa, Frank; Warren, Russell F

    2012-02-01

    To our knowledge, there is no published information on the efficacy of epidural steroid injections for the treatment of lumbar disc herniation in an athletic population. The purpose of this study was to evaluate the efficacy of epidural corticosteroid injection for treatment of lumbar disc herniation in a group of National Football League (NFL) players. We retrospectively reviewed the records of all NFL players who underwent an epidural steroid injection at our institution for incapacitating pain secondary to an acute lumbar disc herniation (confirmed on magnetic resonance imaging) from 2003 to 2010. Our primary outcome was success of the injection, defined as return to play. The secondary outcome of the study was to evaluate risk factors for failure of this treatment approach. Seventeen players had a total of 37 injections for 27 distinct lumbar disc herniation episodes from 2003 to 2010. The success rate of returning an athlete to play for a given episode of disc herniation was 89% (24 of 27 episodes) with an average loss of 2.8 practices (range = 0-12) and 0.6 games (range = 0-2) after the injection. Four players required a repeat injection for the same episode. Three of these four players ultimately failed conservative management and required surgical intervention. Risk factors for failing injection therapy included sequestration of the disc herniation on magnetic resonance imaging (P = 0.01) and weakness on physical examination (P = 0.002). There were no complications reported. In this highly selective group of professional athletes, our results suggest that epidural steroid injections are a safe and effective therapeutic option in the treatment of symptomatic lumbar disc herniation.

  11. [Epidural venography in the diagnosis of lumbar disease (author's transl)].

    PubMed

    Gasparini, D; Giammusso, V; Di Lelio, A; Vaccari, U; Bacarini, L

    1980-04-01

    80 patients with back pain and sciatalgia were studied by plain-film of lumbosacral spine, radiculography and epidural phlebography; 30 of them were surgically controlled. Radiculographic and phlebographic specimens were compared and phlebography showed more sensibility and specificity in the study of extradural pathology. The analysis of the phlebographic alterations suggested a semeiologic criterion we think that could be usefully used in the study of osteoligamentous lesions in lumbosacral spine.

  12. Diabetes mellitus and spinal epidural abscess: clinical or surgical treatment?

    PubMed

    Felício, João S; Martins, Carlliane Lins P; Liberman, Bernardo

    2011-12-01

    Spinal epidural abscess (SEA) is an uncommon condition and its most important predisposing factor is diabetes mellitus. Although the treatment of choice is prompt surgical abscess evacuation, followed by antibiotic therapy, successful conservative treatment of SEA has been reported in some cases. We describe a SEA case in a 23-year old white woman with diabetes for 14 years, who was successfully treated only with antibiotics, and achieved full recovery at the fourth month of follow-up.

  13. Care and management of intrathecal and epidural catheters.

    PubMed

    Du Pen, Anna

    2005-01-01

    Epidural and intrathecal catheters have increasingly become a part of acute and chronic pain management over the past 25 years. Externalized systems include temporary, permanent exteriorized, and permanent port systems for use over weeks to months of expected therapy. Implanted, completely internalized systems are available for conditions expected to require many months or years of therapy. Expert care includes routine management as well as advanced troubleshooting. Prevention of infection is a key priority for nurses managing these devices.

  14. Epidural Catheter Migration in a Patient with Severe Spinal Stenosis

    PubMed Central

    Anderson, Ryan

    2016-01-01

    Establishment of appropriate neuraxial catheter positioning is typically a straightforward procedural undertaking. It can, however, lead to deception of even the most experienced clinician and occur despite the most meticulous attention to detail. Written and verbal consent were obtained from the patient to prepare, discuss, and publish this case report; we describe the occurrence of what we believe was the intraoperative migration of an epidural catheter in the setting of significant tissue changes resulting from a previous spinal fusion. PMID:28097025

  15. Epidural injections of indomethacin for postlaminectomy syndrome: a preliminary report.

    PubMed

    Aldrete, J Antonio

    2003-02-01

    Since there have been side effects reported with the administration of corticosteroids epidurally, their application has been limited. Because some nonsteroidal antiinflammatory drugs have central and spinal antinociceptive actions, we have compared the effects of indomethacin (INM) given by the epidural route to methylprednisolone (MTP). This was a prospective, comparative study in an ambulatory pain care center. Two hundred six patients with recurrent low back pain (Visual Analog Scale >7) and radiculopathy after they had had 2 or more lumbar laminectomies with the diagnosis of "postlaminectomy syndrome" were randomly assigned to 1 of 3 groups. Group I (64 patients) was given 2 epidural injections of lyophilized INM 1 mg. Group II (60 patients) received 2 injections of 2 mg of INM at the same intervals. Group III (82 patients) was treated by 2 epidural injections of MTP 80 mg. In every case, the medication was diluted in 3 mL of 0.5% bupivacaine. Reductions of pain were assessed by changes in the Visual Analog Scale; physical activities, attitude, and medication intake were graded by the Pain Progress Score recorded before each treatment and 2 wk after the last. After each injection, all patients had pain relief to Visual Analog Scale <3. Increased analgesia (P < 0.05) was noted when a double dose of INM was used (Group II) or when 80 mg of MTP was given. The total average scores of the Pain Progress Score showed significant differences at the second injection in Groups II and III only. Physical activity, emotional attitudes, and medication intake were also improved but the changes were not statistically significant. In conclusion, in this group of patients, INM produced adequate analgesia in Groups I and II, with evidence suggesting that 2 mg of INM may produce a similar degree of pain relief as 80 mg of MTP after the second injection. Other nonsteroidal antiinflammatory drugs may be explored in the future for the same purpose.

  16. Hands-and-knees positioning during labor with epidural analgesia.

    PubMed

    Stremler, Robyn; Halpern, Stephen; Weston, Julie; Yee, Jennifer; Hodnett, Ellen

    2009-01-01

    Hands-and-knees position has shown promise as an intervention to improve labor and birth outcomes, but no reports exist that examine its use with women laboring with epidural analgesia. Concerns of safety, effects on analgesia, and acceptability of use may limit use of active positioning during labor with regional analgesia. This article presents a case study series of 13 women who used hands-and-knees position in the first stage of labor.

  17. Epidural anaesthesia for caesarean section in pituitary dwarfism.

    PubMed

    Li, Hongbo; Li, Ruihua; Lang, Bao

    2017-04-01

    We describe the anaesthetic management for caesarean section in a 32-year-old patient with pituitary dwarfism. In addition to supportive treatment, we offered a postoperative epidural analgesia pump. The patient recovered well without any complications. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  18. Does pregnancy increase the efficacy of lumbar epidural anesthesia?

    PubMed

    Arakawa, M

    2004-04-01

    Pregnancy has been reported to enhance the sensitivity of nerves to local anesthetics and to decrease anesthetic requirements during regional anesthesia. In this study, whether pregnancy increased the efficacy of lumbar epidural anesthesia was evaluated. Two populations (14 pregnant and 14 non-pregnant women) undergoing lumbar epidural anesthesia were studied and received 17 mL of 2% lidocaine-epinephrine (1: 200,000). The pain threshold response after repeated electrical stimulation was used to assess sensory blockade at the L2, S1 and S3 dermatomes. Motor blockade was evaluated using the Bromage score. Demographic data except for weight were comparable between the two groups. There was a significant difference in cephalad spread of anesthesia between the groups. No significant differences in pain threshold or onset of sensory blockade at the L2, S1 or S3 segments were found between the groups. The pain thresholds at the S1 and S3 dermatomes were significantly lower than that at L2 within each group. The mean onset times at the S1 and S3 dermatomes were significantly longer than that at L2 within each group. No differences in Bromage score were found between the groups. In pregnant women, cephalad spread of epidural anesthesia was facilitated but latency of blockade, density and motor blockade were not. It takes over 25 min to achieve satisfactory blockade at sacral segments. Those who perform lumbar epidural anesthesia alone for cesarean section should consider the use of additives (e.g. fentanyl, bicarbonate) to enhance the block, or a greater volume of local anesthetic.

  19. The Neurological Safety of Epidural Pamidronate in Rats

    PubMed Central

    Lee, Pyung Bok; Kim, Yong Chul; Lee, Chul Joong; Shin, Hye Young; Lee, Seung Yun; Park, Jong Cook; Choi, Yun Suk; Kim, Chong Soo

    2010-01-01

    Background Pamidronate is a potent inhibitor of osteoclast-mediated bone resorption. Recently, the drug has been known to relieve bone pain. We hypothesized that direct epidural administration of pamidronate could have various advantages over oral administration with respect to dosage, side effects, and efficacy. Therefore, we evaluated the neuronal safety of epidurally-administered pamidronate. Methods Twenty-seven rats weighing 250-350 g were equally divided into 3 groups. Each group received an epidural administration with either 0.3 ml (3.75 mg) of pamidronate (group P), 0.3 ml of 40% alcohol (group A), or 0.3 ml of normal saline (group N). A Pinch-toe test, motor function evaluation, and histopathologic examination of the spinal cord to detect conditions such as chromatolysis, meningeal inflammation, and neuritis, were performed on the 2nd, 7th, and 21st day following administration of each drug. Results All rats in group A showed an abnormal response to the pinch-toe test and decreased motor function during the entire evaluation period. Abnormal histopathologic findings, including neuritis and meningeal inflammation were observed only in group A rats. Rats in group P, with the exception of 1, and group N showed no significant sensory/motor dysfunction over a 3-week observation period. No histopathologic changes were observed in groups P and N. Conclusions Direct epidural injection of pamidronate (about 12.5 mg/kg) showed no neurotoxic evidence in terms of sensory/motor function evaluation and histopathologic examination. PMID:20556213

  20. Electrostatic patch potentials in Casimir force measurements

    NASA Astrophysics Data System (ADS)

    Garrett, Joseph; Somers, David; Munday, Jeremy

    2015-03-01

    Measurements of the Casimir force require the elimination of the electrostatic force between interacting surfaces. The force can be minimized by applying a potential to one of the two surfaces. However, electrostatic patch potentials remain and contribute an additional force which can obscure the Casimir force signal. We will discuss recent measurements of patch potentials made with Heterodyne Amplitude-Modulated Kelvin Probe Force Microscopy that suggest patches could be responsible for >1% of the signal in some Casimir force measurements, and thus make the distinction between different theoretical models of the Casimir force (e.g. a Drude-model or a plasma-model for the dielectric response) difficult to discern.