BackgroundWe prospectively evaluated the incidence and possible factors causing intramuscular injection during lumbar sympathetic ganglion block and compared the multiple needle technique to the single technique to obtain a profound and complete block effect.MethodsAmong 83 patients, 58 patients (group A, n = 27, multiple needle technique and group B, n = 31, single needle technique) were reevaluated for the changes of skin temperature (Ts) and mean segment of longitudinal contrast spread. After injecting the contrast agent, the incidence of psoas muscle injection and the change of Ts was compared between two groups.ResultsThe incidence of psoas muscle injection was 21.3% (46/216) and it was associated with the level of injection (L2) significantly (χ2 = 14.773, P = 0.001). DTpost (postblock temperature difference between ipsilateral and contralateral great toe, 4.6 ± 2.8℃, 1.8 ± 1.6℃, P < 0.001 for group A and B) and DTnet (DTpost - DTpre, 3.9 ± 2.7℃, 1.5 ± 1.5℃, P < 0.001 for group A and B) was significantly higher in group A. The mean segment of longitudinal contrast spread was 8.1 ± 0.9 for group A and 3.2 ± 1.6 for group B (P < 0.001).ConclusionsThe LSGB at the L2 level showed the lowest incidence of psoas muscle injection of contrast. Multiple needle approach showed more significant increase of DTnet and DTpost.
Hydroxyethyl starch (HES) solutions are synthetic non-protein colloid solutions used to treat hypovolemia. However, their use is not free from the risk of allergic reactions. A 42-year-old male was scheduled to undergo aortic-iliac-femoral bypass surgery for the treatment of arteriosclerosis obliterans. He had no history of allergy. Two hours after the start of surgery, and within minutes after HES administration, facial erythema, hypotension and bronchospasm developed. HES infusion was discontinued under the estimation of anaphylaxis. The patient received phenylephrine, ephedrine, diphenhydramine and hydrocortisone with hydration. After restoration of vital signs, surgery was performed without complications.
LSGB at the L2 level showed the lowest incidence of psoas muscle injection of contrast in comparison with LSGB at L3 and L4. The aspiration test and static radiography frequently missed the intravascular injection of contrast during LSGBs.
We propose a universal surface reaction model without any ad-hoc assumptions for fluorocarbon (FC) plasma oxide etching. A self-consistent numerical algorithm was developed to predict the deposition and etch yields simultaneously from our model considering the passivation layer and mixed layer. The internal model variables such as surface coverages showed consistent results under a wide range of FC plasma conditions. This model predicts the transition conditions between deposition and etch yield and the FC passivation layer thickness during the etching process. Finally, quantitative verification of the proposed model was performed through comparison to various FC plasma experimental data.
Background:We hypothesized that if a fluoroscopic image of the lumbar sympathetic ganglion block (LSGB) showed the spread patterns of contrast at both the L2/3 and L4/5 disc areas, then this would demonstrate a more profound blockade effect because the spread patterns are close to sympathetic ganglia. In addition, we compared the effects of LSGB and transforaminal epidural steroid injection (TFESI) for the patients suffering with spinal stenosis.Methods: Eighty patients were divided into two groups (Group S: the patients treated with TFESI, Group L: the patients treated with LSGB). The patients of group L were classified into three groups (groups A, B and, C) according to their contrast spread pattern. The preblock and postblock temperature difference between the ipsilateral and contralateral great toe (DT
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