International journal of clinical practice
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Pudendal nerve block (PNB) is an effective diagnostic and/or treatment method for perineal pain. Various approach techniques, such as transperineal, transvaginal, computerised tomography (CT)- or sono-guided approach, have been suggested for this block. However, they have some limitations, such as high cost, difficulty to perform in practice, inaccurate and unreliable results and inconvenience. ⋯ All of the 25 patients enrolled in this study were blocked successfully using this method. No side-effects or complications were observed in relation to the block. We concluded that the C-arm-guided approach for PNB is an effective alternative to the existing techniques, which can overcome their limitations.
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Int. J. Clin. Pract. · May 2006
Case ReportsTorsades de pointes in congenital long QT syndrome following low-dose orphenadrine.
We report the case of a woman, affected by congenital long QT syndrome (LQTS), who experienced three syncopal episodes shortly after the assumption of a low dose of orphenadrine. The ECG revealed a QT interval of 600 ms, and the corrected QT interval (QTc) was 537 ms. No structural cardiac disease was demonstrated by echocardiography. ⋯ During the ensuing 6 months, the patient remained asymptomatic, and the QTc did not change. Orphenadrine is an analogue of diphenhydramine, an antihistaminic drug that produces sodium channel blockade similar to that caused by quinidine and other Class Ia antiarrhythmic drugs. Our case rises the suspicion that orphenadrine could cause life-threatening arrhythmias in LQTS even at a low dose, and independently from concomitant assumption of potentially QT-prolonging drugs.
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Persistent hiccup can be a distressing disorder. I present a case of migraine-attack-associated sustained hiccup. ⋯ Vasopressin release probably underlies migraine-aborting action of metoclopramide while restoration of oesophageal smooth muscle function involves competitive dopaminergic antagonism and a prominent cholinergic agonist activity. Episodic prolonged hiccup associated with nausea is an unusual presenting feature of migraine.