There are many methods for treatment of solitary bone cyst. But the recurrence rate was relatively high and beside, serious complications may be followed. Recently, simple topical of steroid into cyst was contrived and the result was know as same or even better than surgical management. A patient of solitary bone cyst who had been failed two times by surgical intervention was treated with topical steroid injection for several times. Two years following up, the result was good. No evidence of recurrency was seen and was shown good healing process
Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated the influence of injection speed of local anesthetic to subarachnoid space on maternal hypotension and level of sensory block.
Bupivacaine (0.5%) 9 mg with fentanyl 10 µg was injected to subarachnoid space either quickly (during 20 seconds, 0.1 mL/sec, n=20) or slowly (during 100 seconds, 0.02 mL/sec, n=20) in parturients scheduled for elective cesarean section. The onset and level of sensory block was checked and heart rate and blood pressure was checked by 2.5 minutes during 20 minutes. Hypotension (systolic blood pressure <100 mmHg or <70% of baseline) was treated with ephedrine.
Hypotension occurred 70% of parturients with spinal anesthesia. Slow injection didn't influence on the onset and level of sensory block and didn't reduce the incidence of hypotension. But onset of hypotension was delayed.
Slow injection (during 100 seconds, 0.02 mL/sec) of local anesthetic delayed onset of hypotension and required less amount of ephedrine. Slow injection of local anesthetic was one of the effective methods for the cardiovascular stability during cesarean section under spinal anesthesia.
In the past decade, vocal fold injection (VFI) has re-emerged as a valuable treatment modality for a variety of laryngeal disorders. It offers many advantages for the treatment of glottal insufficiency. It can avoid surgical scar and is easily performed with local anesthesia. In this article, we describe the indication of injection laryngoplasty, variable injection materials and discuss about vocal fold injection approaches.
Citations
With increase of endoscopy, physical trauma including endoscopic procedure can develop gastric submucosal hematoma. Symptoms are usually abdominal pain, vomiting, fever and bloody stool due to upper GI tract obstruction and complications like intestinal obstruction or peritonitis. Diagnosis is usually made by CT, trans-esophageal sonogram and patients with no intestinal obstruction or peritonitis complications and good general condition usually recover with only conservative treatment. Authors have experienced submucosal hematoma developed after submucosal epinephrine injection with intent to uplift distal lesion in gastric polypectomy and improved with conservative treatment.
The piriformis syndrome appears to be more common because it is often underdiagnosed and undertreated. This syndrome is caused by compression or irritation of the sciatic nerve by the piriformis muscle as it passes through the sciatic notch. This entrapment neuropathy presents as pain, numbness, paresthesias, and associated weakness in the distribution of the sciatic nerve. In this article. we present the clinical symptoms, anatomy of the piriformis muscle, and the technique and result of the injection therapy with local anesthetics and steroid.
A 72-year-old woman presented with 7 days history of severe pain in the right buttock, hip, numbness of the right thigh. Previous management had included non-steroidal anti-inflammatory drug and physical therapy in local orthopedic clinic. Her past medical history was unremarkable. Her right side buttock was tender and discomfort was increased by right hip flexion, adduction and internal rotation with pain radiating to the anterior thigh. The her leg lenghts were equal, the strenght of right hip abductors and abduction was normal. Also low back range of motion and neurological examination were normal. Radiographs of the lumbosacral spine, pelvis and the hip joint were unremarkable. The she didn't respond to conservative treatment including physcal theraphy combined with the use antiimflammatory drugs, analgesics and muscle relaxants.
One week later she received an injection of 0.5% mepibacaine HCI 8cc and methyl-predanisolone(Depomedrol) 40mg into the medal right piriformis muscle. She reported that the 3 days after the injection, her right buttock pain had resolved and 7 days after the injection the pain resolved completely and she resumed normal activities and continued pain free.
We reviewed the literature on piriformis syndrome and its signs, symptoms and treat-ments. In an isolated piriforms syndrome, the major finding include buttock tenderness from the sacrum to the greater trochanter, piriformis tenderness on rectal or vaginal examination. The patient with piriformis syndrome usually does not have neurologic deficits Through complete history, physical and neurologic examinations, the other causes of low back pain and sciatica should be eliminated. Patients who do not respond to conservative therapy are candidates for local anesthetics and steroid injection. We injected methyl prednisolone 40mg and 0.5% mepibacaine HCl 8cc into the medial right piriformis muscle. 3 days after injection, her pains of right buttock and trochanter had resolved and 7 days after the injection, she resumed normal activites and consumed free. In order to improve the reliability of proper needle placement and allow for definite and treatment, EMG-assisted or MRI guidance may utilize.