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Medicine May 2024Paraneoplastic neurological syndrome with anti-Hu antibody (Hu-PNS) is a neurological disorder that occur in patients with malignancy. The syndrome has a wide range of... (Review)
Review
RATIONALE
Paraneoplastic neurological syndrome with anti-Hu antibody (Hu-PNS) is a neurological disorder that occur in patients with malignancy. The syndrome has a wide range of presentations and can present before diagnosis of primary malignancy. Familiarity with these paraneoplastic neurological syndromes can help early recognition and take appropriate regimens.
PATIENTS CONCERNS
Diagnosis and treatment of Hu-PNS.
DIAGNOSES
This is retrospective study that analyzed the clinical data of this case. Through retrospective analysis and targeted antibody screening, serum anti-Hu antibody was detected. Subsequent spinal imaging revealed a mass in the paraspinal region, which was confirmed as ganglioneuroblastoma by pathologic examination.
INTERVENTIONS
The child was treated with a course of intravenous immunoglobulin and radical surgical operation without chemotherapy.
OUTCOMES
The neurological symptoms were gradually improved and no signs indicate disease progression or tumor recurrence.
LESSONS
Hu-PNS has rarely been reported in children with ganglioneuroblastomas. They can mimic non-neoplastic processes, making detection and diagnosis difficult. Serum and/or cerebrospinal fluid onconeural antibody can strongly indicate occult cancers. Early detection of paraneoplastic neurological syndromes can help take appropriate regimens and improve prognosis.
Topics: Humans; Ganglioneuroblastoma; Paraneoplastic Syndromes, Nervous System; Male; ELAV Proteins; Autoantibodies; Child, Preschool; Retrospective Studies
PubMed: 38728479
DOI: 10.1097/MD.0000000000038148 -
The American Journal of Emergency... Jun 2024Erector spinae plane blocks (ESPB) have shown to provide meaningful chest wall anesthesia and reduce opioid consumption after thoracic surgery. Emergency physicians...
Erector spinae plane blocks (ESPB) have shown to provide meaningful chest wall anesthesia and reduce opioid consumption after thoracic surgery. Emergency physicians often use erector spinae plane blocks in the emergency department (ED) for rib fractures when acetaminophen, non-steroidal anti-inflammatory (NSAID), and opioids fail to control pain. They have also demonstrated successful pain management for conditions like herpes zoster, renal colic, burns, and acute pancreatitis for ED patients. With low reported rates of complication and relatively easy landmarks to identify, erector spinae plane blocks are an appealing regional anesthetic technique for emergency physicians to utilize for uncontrolled pain. We present the case of a 58-year-old male presenting to the ED with chest pain from pneumonia which remained unmanageable after acetaminophen, NSAID, and opioid administration. An ultrasound-guided erector spinae plane block was performed in the ED and the patient had a significant reduction in his chest pain.
Topics: Humans; Male; Middle Aged; Nerve Block; Emergency Service, Hospital; Chest Pain; Ultrasonography, Interventional; Pneumonia; Paraspinal Muscles
PubMed: 38693022
DOI: 10.1016/j.ajem.2024.04.026 -
Annals of Plastic Surgery May 2024Resection of sacral neoplasms such as chordoma and chondrosarcoma with subsequent reconstruction of large soft tissue defects is a complex multidisciplinary process....
PURPOSE
Resection of sacral neoplasms such as chordoma and chondrosarcoma with subsequent reconstruction of large soft tissue defects is a complex multidisciplinary process. Radiotherapy and prior abdominal surgery play a role in reconstructive planning; however, there is no consensus on how to maximize outcomes. In this study, we present our institution's experience with the reconstructive surgical management of this unique patient population.
METHODS
We conducted a retrospective review of patients who underwent reconstruction after resection of primary or recurrent pelvic chordoma or chondrosarcoma between 2002 and 2019. Surgical details, hospital stay, and postoperative outcomes were assessed. Patients were divided into 3 groups for comparison based on reconstruction technique: gluteal-based flaps, vertical rectus abdominus myocutaneous (VRAM) flaps, and locoregional fasciocutaneous flaps.
RESULTS
Twenty-eight patients (17 males, 11 females), with mean age of 62 years (range, 34-86 years), were reviewed. Twenty-two patients (78.6%) received gluteal-based flaps, 3 patients (10.7%) received VRAM flaps, and 3 patients (10.7%) were reconstructed with locoregional fasciocutaneous flaps. Patients in the VRAM group were significantly more likely to have undergone total sacrectomy (P < 0.01) in a 2-stage operation (P < 0.01) compared with patients in the other 2 groups. Patients in the VRAM group also had a significantly greater average number of reoperations (2 ± 3.5, P = 0.04) and length of stay (29.7 ± 20.4 days, P = 0.01) compared with the 2 other groups. The overall minor and major wound complication rates were 17.9% and 42.9%, respectively, with 17.9% of patients experiencing at least 1 infection or seroma. There was no association between prior abdominal surgery, surgical stages, or radiation therapy and an increased risk of wound complications.
CONCLUSIONS
Vertical rectus abdominus myocutaneous flaps are a more suitable option for patients with larger defects after total sacrectomy via 2-staged anteroposterior resections, whereas gluteal myocutaneous flaps are effective options for posterior-only resections. For patients with small- to moderate-sized defects, local fasciocutaneous flaps are a less invasive and effective option. Paraspinous flaps may be used in combination with other techniques to provide additional bulk and coverage for especially long postresection wounds. Furthermore, mesh is a useful adjunct for any reconstruction aimed at protecting against intra-abdominal complications.
Topics: Humans; Male; Female; Middle Aged; Retrospective Studies; Plastic Surgery Procedures; Aged; Adult; Aged, 80 and over; Chordoma; Sacrum; Chondrosarcoma; Surgical Flaps; San Francisco; Spinal Neoplasms
PubMed: 38689413
DOI: 10.1097/SAP.0000000000003803 -
Scientific Reports Apr 2024Few non-surgical, longitudinal studies have evaluated the relations between spinal degeneration, lumbar multifidus muscle (LMM) quality, and clinical outcomes. None have...
Few non-surgical, longitudinal studies have evaluated the relations between spinal degeneration, lumbar multifidus muscle (LMM) quality, and clinical outcomes. None have assessed the potential mediating role of the LMM between degenerative pathology and 12-month clinical outcomes. This prospective cohort study used baseline and 12-month follow-up data from 569 patients conservatively managed for low back or back-related leg pain to estimate the effects of aggregate degenerative lumbar MRI findings and LMM quality on 12-month low back and leg pain intensity (0-10) and disability (0-23) outcomes, and explored the mediating role of LMM quality between degenerative findings and 12-month clinical outcomes. Adjusted mixed effects generalized linear models separately estimated the effect of aggregate spinal pathology and LMM quality. Mediation models estimated the direct and indirect effects of pathology on leg pain, and pathology and LMM quality on leg pain, respectively. Multivariable analysis identified a leg pain rating change of 0.99 [0.14; 1.84] (unstandardized beta coefficients [95% CI]) in the presence of ≥ 4 pathologies, and a disability rating change of - 0.65 [- 0.14; - 1.16] for each 10% increase in muscle quality, but no effect on back pain intensity. Muscle quality had a non-significant mediating role (13.4%) between pathology and leg pain intensity. The number of different pathologies present demonstrated a small effect on 12-month leg pain intensity outcomes, while higher LMM quality had a direct effect on 12-month disability ratings but no mediating effect between pathology and leg pain. The relations between degenerative pathology, LMM quality, and pain-related outcomes appear complex and may include independent pathways.
Topics: Humans; Female; Male; Paraspinal Muscles; Low Back Pain; Middle Aged; Prospective Studies; Leg; Aged; Lumbar Vertebrae; Treatment Outcome; Magnetic Resonance Imaging; Adult; Conservative Treatment; Pain Measurement; Intervertebral Disc Degeneration
PubMed: 38684854
DOI: 10.1038/s41598-024-60570-0 -
Life (Basel, Switzerland) Apr 2024The paraspinal muscles of the cervical, thoracic, and lumbar spine are important pain generators because muscle strains or myofascial pain syndrome caused by trigger... (Review)
Review
The paraspinal muscles of the cervical, thoracic, and lumbar spine are important pain generators because muscle strains or myofascial pain syndrome caused by trigger points are common during clinical practice. Ultrasonography is the most convenient imaging tool for evaluating these muscles due to its advantages, such as providing good delineation of soft tissues, easy accessibility, and zero radiation. Additionally, ultrasound can serve as a useful guiding tool for paraspinal muscle intervention to prevent inadvertent injuries to vital axial neurovascular structures. This pictorial essay presents ultrasound scanning protocols for the paraspinal and other associated muscles as well as a discussion of their clinical relevance. Axial magnetic resonance imaging has also been used to elucidate reciprocal anatomy. In conclusion, ultrasound imaging proves to be a valuable tool that facilitates the differentiation of individual paraspinal muscles. This capability significantly enhances the precision of interventions designed to address myofascial pain syndrome.
PubMed: 38672769
DOI: 10.3390/life14040499 -
Medicine Apr 2024To investigate the effects of capacitive and resistive monopolar radiofrequency (CRMF) on the shear elastic modulus of the multifidus and erector spinae muscles in... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate the effects of capacitive and resistive monopolar radiofrequency (CRMF) on the shear elastic modulus of the multifidus and erector spinae muscles in female athletes with low back pain (LBP) and a history of LBP.
DESIGN
Randomized crossover trial.
SETTING
Academic institution.
PARTICIPANTS
Twenty female university athletes with LBP or a history of LBP were included.
INTERVENTIONS
All participants received CRMF, hotpack, and sham (CRMF without power) in a random order on the right side of the lumbar region. More than 2 days were allocated between the experiments to eliminate any residual effects.
MAIN OUTCOME MEASURES
The shear elastic moduli of the right multifidus and erector spinae were evaluated in the prone (rest) position while sitting with 35° trunk flexion (stretched) using shear wave ultrasound imaging equipment. The moduli were measured before, immediately after, and 30 minutes after the intervention.
RESULTS
Repeated-measures 2-way analysis of variance and post hoc analysis showed that the moduli of the CRMF group were significantly lower than those of the sham group in the stretched position immediately after intervention (P = .045). This difference diminished 30 minutes after the intervention (P = .920).
CONCLUSIONS
CRMF can be used to reduce the shear elastic modulus of the multifidus muscle in the short term. Further studies are warranted to determine how to provide longer effects.
TRIAL REGISTRATION
None.
Topics: Humans; Female; Low Back Pain; Cross-Over Studies; Elastic Modulus; Young Adult; Athletes; Lumbosacral Region; Adult; Paraspinal Muscles; Hyperthermia, Induced
PubMed: 38669391
DOI: 10.1097/MD.0000000000038011 -
International Journal of Exercise... 2024Dry cupping is a therapeutic modality proposed to produce a negative pressure, stretching the skin and underlying tissue. This mechanism is said to promote regional...
Dry cupping is a therapeutic modality proposed to produce a negative pressure, stretching the skin and underlying tissue. This mechanism is said to promote regional blood flow of oxygenated blood and causing a physiological stretch in the tissue, allowing it to elongate and potentially changing skin temperature. The possible effects of the application to the lumbar spine paraspinal muscles, however, has not been thoroughly examined. The purpose of this pilot study was to explore the immediate effects of dry cupping the lumbar paraspinals on lumbar spine range of motion (ROM) and overlying skin temperature. 30 healthy individuals aged 18-30 years completed the study. The dry cupping was placed on the lumbar paraspinal muscles for 10-minutes. Two plastic cups were placed on the bilateral paraspinals muscles at L1 and L5. Lumbar spine flexion ROM and skin temperature were measured pre- and post-intervention. Descriptive statistics and paired sample -tests were used to analyze the data ( < .05). There was a statistically significant increase in lumbar spine flexion ROM measured with the Sit and Reach Test, (29) = 12.62 = 0.001; = 2.34, and inclinometry, (29) = 11.10, = 0.001; = 3.86, with a large effect size. There was also a statistically significant decrease in the skin temperature of the lumbar spine paraspinals, (29) = -2.23, 0.034; = 0.75, with a medium effect size, post-intervention. Dry cupping may be an effective strategy to increase lumbar spine ROM and decrease stiffness, promote recovery, and reduce functional limitations. Future research may examine the difference in effectiveness of static compared to dynamic cupping in a symptomatic population.
PubMed: 38665683
DOI: No ID Found -
Saudi Journal of Anaesthesia 2024The erector spinae plane (ESP) block is the most sought-after block since its inception. However, it is more of dorsal rami block with unpredictable ventral diffusion to...
BACKGROUND
The erector spinae plane (ESP) block is the most sought-after block since its inception. However, it is more of dorsal rami block with unpredictable ventral diffusion to the paravertebral area. We injected dye in ESP and other paraspinal spaces to study and compare the dye diffusion pattern along the neuroaxis and paraspinal region in human cadavers.
METHODS
In six soft-embalmed cadavers (12 specimens), 20 mL methylene blue dye (erector spinae plane and paravertebral space) or indocyanine green dye (inter-ligament space) was injected bilaterally using an in-plane ultrasound-guided technique at the level of the costotransverse junction of fourth thoracic vertebrae. Dye spread was evaluated bilaterally in the coronal plane in the paravertebral and intercostal spaces from the 1 and the 12 rib. Axial and sagittal sections were performed at the level of the 4 thoracic vertebrae. After cross sections, the extent of dye spread was investigated in ESP, inter-ligament, and paravertebral spaces. The staining of the ventral and dorsal rami and spread into the intercostal spaces was evaluated.
RESULTS
ESP injection was mainly restricted dorsal to the costotransverse foramen and did not spread anteriorly to the paravertebral space. The paravertebral injection involved the origin of the spinal nerve and spread laterally to the intercostal space. The inter-ligament space injection showed an extensive anterior and posterior dye spread involving the ventral and dorsal rami.
CONCLUSIONS
Following ESP injection, there was no spread of the dye anteriorly to the paravertebral space and it only involved the dorsal rami. Inter-ligamentous space injection appears to be the most promising block as dye spread both anteriorly to paravertebral space and posteriorly toward ESP.
PubMed: 38654869
DOI: 10.4103/sja.sja_582_23 -
BMC Anesthesiology Apr 2024There is a sizable niche for a minimally invasive analgesic technique that could facilitate ambulatory video-assisted thoracoscopic surgery (VATS). Our study aimed to... (Randomized Controlled Trial)
Randomized Controlled Trial
Erector spinae plane block did not improve postoperative pain-related outcomes and recovery after video-assisted thoracoscopic surgery : a randomised controlled double-blinded multi-center trial.
INTRODUCTION
There is a sizable niche for a minimally invasive analgesic technique that could facilitate ambulatory video-assisted thoracoscopic surgery (VATS). Our study aimed to determine the analgesic potential of a single-shot erector spinae plane (ESP) block for VATS. The primary objective was the total hydromorphone consumption with patient-controlled analgesia (PCA) 24 h after surgery.
METHODS
We conducted a randomized, controlled, double-blind study with patients scheduled for VATS in two major university-affiliated hospital centres. We randomized 52 patients into two groups: a single-shot ESP block using bupivacaine or an ESP block with normal saline (control). We administered a preoperative and postoperative (24 h) quality of recovery (QoR-15) questionnaire and assessed postoperative pain using a verbal numerical rating scale (VNRS) score. We evaluated the total standardized intraoperative fentanyl administration, total postoperative hydromorphone consumption (PCA; primary endpoint), and the incidence of adverse effects.
RESULTS
There was no difference in the primary objective, hydromorphone consumption at 24 h (7.6 (4.4) mg for the Bupivacaine group versus 8.1 (4.2) mg for the Control group). Secondary objectives and incidence of adverse events were not different between the two groups at any time during the first 24 h following surgery.
CONCLUSION
Our multi-centre randomized, controlled, double-blinded study found no advantage of an ESP block over placebo for VATS for opioid consumption, pain, or QoR-15 scores. Further studies are ongoing to establish the benefits of using a denser block (single-shot paravertebral with a continuous ESP block), which may provide a better quality of analgesia.
Topics: Humans; Double-Blind Method; Thoracic Surgery, Video-Assisted; Pain, Postoperative; Male; Nerve Block; Female; Middle Aged; Analgesia, Patient-Controlled; Analgesics, Opioid; Aged; Bupivacaine; Anesthetics, Local; Paraspinal Muscles; Hydromorphone; Adult
PubMed: 38654164
DOI: 10.1186/s12871-024-02544-3 -
BMC Anesthesiology Apr 2024Regional analgesia techniques are crucial for pain management after cervical spine surgeries. Anesthesiologists strive to select the most effective and least hazardous... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
Regional analgesia using ultrasound-guided intermediate cervical plexus block versus cervical erector spinae block for anterior cervical spine surgery: a randomized trial.
BACKGROUND
Regional analgesia techniques are crucial for pain management after cervical spine surgeries. Anesthesiologists strive to select the most effective and least hazardous regional analgesia technique for the cervical region. Our hypothesis is that an intermediate cervical plexus (IC) block can provide adequate postoperative analgesia compared to a cervical erector spinae (ES) block in patients undergoing anterior cervical spine surgery.
METHODS
In this double-blind prospective trial, 58 patients were randomly assigned into two equal groups prior to the administration of general anesthesia. Patients in the IC group (n = 29) underwent ultrasound-guided bilateral intermediate cervical plexus block with 15 ml of bupivacaine 0.25% administered to each side. The ES group (n = 29) underwent ultrasound-guided bilateral cervical erector spinae plane blocks with 15 ml of 0.25% bupivacaine administered to each side at the C6 level. The primary outcome was to record the time to the first call for rescue analgesia (nalbuphine), and the secondary outcomes were to measure the performance time, the onset of the sensory block, the intraoperative fentanyl consumption, postoperative pain intensity using VAS, the postoperative total nalbuphine consumption, and postoperative complications such as nausea, vomiting, hypotension, and bradycardia.
RESULTS
The performance and onset of sensory block times were significantly shorter in the IC group compared to the ES group. The time to first call for nalbuphine was significantly shorter in the IC group (7.31 ± 1.34 h) compared to the ES group (11.10 ± 1.82 h). The mean postoperative VAS scores were comparable between the two groups at the measured time points, except at 8 h, where it was significantly higher in the IC group, and at 12 h, where it was significantly higher in the ES group. The total nalbuphine consumption was significantly higher in the IC group (33.1 ± 10.13 mg) compared to the ES group (22.76 ± 8.62 mg).
CONCLUSIONS
For patients undergoing anterior cervical spine surgery, the intermediate cervical plexus block does not provide better postoperative regional analgesia compared to the cervical erector spinae block. Performance time and onset time were shorter in the IC group, whereas nalbuphine consumption was lower in the ES group.
TRIAL REGISTRATION
The trial was registered at clinicaltrials.gov. (NCT05577559, and the date of registration: 13-10-2022).
Topics: Humans; Female; Ultrasonography, Interventional; Double-Blind Method; Male; Pain, Postoperative; Middle Aged; Prospective Studies; Cervical Vertebrae; Cervical Plexus Block; Adult; Anesthetics, Local; Bupivacaine; Nerve Block; Paraspinal Muscles; Analgesics, Opioid; Nalbuphine; Aged
PubMed: 38649826
DOI: 10.1186/s12871-024-02533-6