Epidural abscess has been rarely reported as a complication of stellate ganglion block (SGB). We treated a case of epidural abscess, brain abscess and meningitis probably caused by SGB. A 63-year-old ...male who had an accidental finger injury suffered from CRPS type II. He visited this city hospital and received treatment for SGB several times a week. After treatment for six years, he complained of cervical back pain and progressive stump pain, and developed fever. He then visited our pain clinic and received MRI examination. It showed cervical and lumbar epidural masses and cerebrospinal fluid was xanthochromic. He was diagnosed as having epidural abscess and meningitis. Antibiotic therapy was initiated immediately and he was followed with MRI examination during this treatment. Finally, antibiotic therapy successfully reduced his abscess and surgical decompression was not required. He recovered without significant neurological deficitis. We should be aware of relatively rare complications of epidural abscess and meningitis associated with SGB even if a patient does not have a risk factor of infection.
Until now, replacing existing equipment with new without interruption has been technically possible because the power supply has been DC, and we have only had to control voltage. Increasingly ...customers are using AC power supply, and their need for uninterrupted power to their equipment is also increasing. However in the case of AC power supply, replacing equipment without interruption is difficult because we have to control voltage, phase, phase rotation, and phase difference. This paper presents a portable-transfer switch that we developed to enable UPS replacement for AC equipment without such interruption. It allows electrical workers to replace an existing UPS to a new one safely without interrupting the supply of power.
This study compared the use of general versus local anesthesia in patients who underwent surgical operation for femoral neck fracture between 1992 and 1998 at Showa University Fujigaoka ...Rehabilitation Hospital. The patients were divided into a general anesthesia with oral intubation group and local anesthesia group (epidural anesthesia or spinal anesthesia) . Complications during the perioperative period and the effects of anesthesia were compared between these groups. The results suggested that, in the selection of anesthetic methods, general anesthesia and local anesthesia have both advantages and disadvatages, and either of these methods can be selected. However, care must be taken to give optimal dosage of anesthetic agents and other drugs in anesthetic management because individual differences among elderly patients, who may have coexisting chronic disease, may influence the outcome.
We report a case of atypical facial pain, which was initially diagnosed as trigeminal neuralgia at another outpatient department. A 69-year-old woman complained of pain on her right infraorbital ...area. The pain in the face of which the patient complained did not seem to be consistent with symptons of trigeminal neuralgia, therefore, we diagnosed her facial pain as atypical facial pain based on her history and physical examination. The patient was treated with stellate ganglion block once a day for 20 days and infraorbital nerve block once on her 1st hospital day. On her 2nd hospital day, her pain did not progress and on her 20th hospital day, her facial pain was relieved. We confirmed that stellate ganglion block and infraorbital nerve block were effective for treatment of atypical facial neuralgia.
The 26 patients who were diagnosed with sleep apnea syndrome (SAS) at Fujigaoka Hospital of Showa Univ., department of snore outpatients were treated with a template, a type of oral appliance for ...temporomandibular joint dysfunction (TMD) . Evaluation of the template therapy was carried out by apnomonitor inspection such as apnea index (AI), desaturation index (DI), AI + DI, lowest saturation pulse O2 (lowest SpO2) and average saturation pulse O2 (mean SpO2) . The overjet and the overbite were measured as the dental occlusal condition. Whole indexes from the apnomonitor were improved by wearing the template. The mean overbite was 2.7 mm and the mean overjet was 3.9 mm (normal length : 2.4 mm) . A wider overjet results in a backward intrusion of the lower jaw making the oral cavity narrower. The template widers the oral cavity the same as a UPPP operation. From these clinical findings it is thought that the template is effective for SAS patients.
In patients undergoing radical mastectomy, we utilized isoflurane-induced hypotensive anesthesia in 8 patients, and isoflurane-induced normotensive anesthesia in 8 patients. We measured the blood ...glucose level, plasma insulin concentration, lactic acid, pyruvic acid and nonesterified fatty acid in each group. All patients were premedicated with 0.5mg atropine sulfate, and 50mg hydroxyzine. Anesthesia was induced with thiamylal and the trachea was intubated after vecuronium or succinylcholine administration. Isoflurane was administered until systolic blood pressure decreased to 80-90mmHg in the hypotensive group. In the normotensive group (control group), a concentration of 1-2% isoflurane was administered. Hemodynamic data (blood pressure, heart rate) and blood samples for the measurement of the blood glucose level (BG), plasma insulin concentration, pyruvic acid, lactic acid, and non-esterified fatty acid were collected : 1) before induction (S-1), 2) 30min after (S-2), 3) 60min after (S-3), and 4) 90min after the start of operation (S-4) . Decreases in mean blood pressure below the baseline were significantly greater in the hypotensive group than in the control group. Heart rate did not change in the control group, but in the hypotensive group, it increased significantly. Blood glucose level (S-2, S-3, S-4) in the hypotensive group was significantly greater than in the control group. Insulin concentration did not changed significantly in the hypotensive group, but it (S-3) was significantly below the baseline (S-1) in the control group. Lactic acid (S-2, S-3, S-4) was significanty above the baseline (S-1) in both groups. Lactic acid (S-2, S-3, S-4) in the hypotensive group was significantly greater than in the control group. Pyruvic acid was not changed significantlly in either group. L/P (S-2, S-3, S-4) was significantly greater in the hypotensive group than in the control group. NEFA (S-2, S-3, S-4) was significantly greater in the hyptensive group than in the control group. The result suggests that isoflurane induced hypotension did not markedly affect the carbohydrate metabolism. We speculate that isoflurane causes almost the same effects as other hypotensive agents on carbohydorate metabolism. We conclude that isoflurane can be employed safely and effectively as a hypotensive agent.
During the past 2 years, we have experienced 14 cases of postoperative neurological paralysis of lower extremities. All cases recieved lower laparotomy in the lithotomy position. Paralysis of 9 cases ...recovered within a week (3 cases had undergone simple abdominal hysterectomy under spinal anesthesia, and 6 cases had undergone amputation of the rectum or resection of the sigmoid colon under general anesthesia combined with epidural anesthesia). Paralysis of 5 cases was severe, and lasted from one to two-and-a-half months. These 5 cases had undergone amputation of the rectum (1 case) or resection of the sigmoid colon (4 cases) under general anesthesia combined with epidural anesthesia. Neurological nerve injuries after opration are considered to be associated with spinal or epidural anesthesia, and unphysiological position of the patient during the surgery. In these cases, however, it was found to be caused by continuous compression of the femoral nerves by the abdominal retractor. To avoid postoperative nerve injuries, it is important to pay attention to the abdomi-nal retractor, positioning and surgical procedure as well as regional block.