Articles: cations.
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Postherpetic neuralgia (PHN) is by far the most common complication of herpes zoster (HZ) and one of the most intractable pain disorders. Since PHN is seen most often in the elderly, the number of patients with this disorder is expected to increase in our ageing society. PHN may last for months to years and has a high impact on the quality of life. The results of PHN treatment are rather disappointing. Epidural injection of local anaesthetics and steroids in the acute phase of HZ is a promising therapy for the prevention of PHN. Since randomised trials on the effectiveness of this intervention are lacking, the PINE (Prevention by epidural Injection of postherpetic Neuralgia in the Elderly) study was set up. The PINE study compares the effectiveness and cost-effectiveness of a single epidural injection of local anaesthetics and steroids during the acute phase of HZ with that of care-as-usual (i.e. antivirals and analgesics) in preventing PHN in elderly patients. METHODS / DESIGN: The PINE study is an open, multicenter clinical trial in which 550 elderly (age >/= 50 yr.) patients who consult their general practitioner in the acute phase of HZ (rash < 7 days) are randomised to one of the treatment groups. The primary clinical endpoint is the presence of HZ-related pain one month after the onset of the rash. Secondary endpoints include duration and severity of pain, re-interventions aiming to treat the existing pain, side effects, quality of life, and cost-effectiveness. ⋯ The PINE study is aimed to quantify the (cost-) effectiveness of a single epidural injection during the acute phase of HZ on the prevention of PHN.
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Knowledge of the relationship of the lumbar sympathetic chain to the vertebral bodies is needed to perform sympathetic block and sympatholysis. This information should be correlated with fluoroscopy to determine the best method to perform this technique clinically. Twenty cadavers were dissected to demonstrate the lumbar sympathetic chain. ⋯ Use of at least two needles is advisable (L2 and L3 vertebral body). Care should be taken to avoid the lumbar vessels. A transdiscal technique recently advocated may also avoid some of the complications with the paramedian technique, but chances of discitis, nerve root injury, accelerated disc degeneration, disc herniation and rupture of the anterior annulus have to be considered when using this technique.
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Comparative Study
Pre- and post-synaptic effects of manipulating surface charge with divalent cations at the photoreceptor synapse.
Persistence of horizontal cell (HC) light responses in extracellular solutions containing low Ca2+ plus divalent cations to block Ca2+ currents (ICa) has been attributed to Ca2+-independent neurotransmission. Using a retinal slice preparation to record both ICa and light responses, we demonstrate that persistence of HC responses in low [Ca2+]o can instead be explained by a paradoxical increase of Ca2+ influx into photoreceptor terminals arising from surface charge-mediated shifts in ICa activation. Consistent with this explanation, application of Zn2+ or Ni2+ caused a hyperpolarizing block of HC light responses that was relieved by lowering [Ca2+]o. ⋯ Nominally divalent-free media produced inversion of HC light responses even though rod light responses remained hyperpolarizing; HC response inversion can be explained by surface charge-mediated shifts in ICa. In summary, HC light responses modifications induced by low divalent cation solutions can be explained by effects on photoreceptor light responses and membrane surface charge without necessitating Ca2+-independent neurotransmission. Furthermore, these results suggest that surface charge effects accompanying physiological changing divalent cation levels in the synaptic cleft may provide a means for modulating synaptic output from photoreceptors.
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Bleeding risk in interventional pain practice: assessment, management, and review of the literature.
The rarity of published bleeding complications with respect to the practice of interventional pain medicine suggests two possibilities: techniques are being performed in a manner to minimize bleeding or the process of hemostasis is very forgiving. Hence, bleeding complications may increase if techniques are not performed with due skill or if the process of hemostasis is impaired. Interventional pain physicians may be well acquainted with the technical aspects of procedures, but the degree of their expertise in the field of coagulation is unclear. ⋯ This manuscript will present a tool to help stratify the risk of bleeding with specific techniques and specific hemostatic abnormalities. The Overall Risk of Significant Bleeding score may help interventional pain practitioners in their individualized assessment of bleeding risk. If used collectively, this tool may help improve patient safety and data collection, with respect to bleeding complications.
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The heart surgery forum · Jan 2004
Immediate Extubation after Aortic Valve Surgery Using High Thoracic Epidural Anesthesia.
Abstract Purpose: Fast-track anesthesia has gained widespread use in cardiac centers around the world. No study has focused on immediate extubation after aortic valve surgery. This study examines the feasibility and hemodynamic stability of immediate extubation after simple or combined aortic valve surgery using thoracic epidural anesthesia. ⋯ There were no complications related to TEA. Conclusions: Immediate extubation is feasible after aortic valve surgery with high thoracic epidural analgesia and maintenance of hemodynamic stability throughout surgery. Immediate extubation after aortic valve surgery is a promising new path in cardiac anesthesia.