Prolonged diplopia following a mandibular block injection.

A case is presented in which a 14-yr-old girl developed diplopia after injection of the local anesthetic Xylotox E 80 A (2% lidocaine with 1:80,000 epinephrine). Since the complication had a relatively slow onset and lasted for 24 hr, the commonly suggested explanations based on vascular, lymphatic, and neural route theories do not adequately fit the observations. No treatment, other than reassurance, was necessary, and the patient recovered fully.     

Application of a mandibular nerve block using an indwelling catheter for intractable cancer pain

We report a case in which a mandibular nerve block using an indwelling catheter was employed for pain management in a terminal case of orofacial cancer. The patient was a 74-year-old female weighing 27 kg. She had a 27-month history of mouth floor and tongue cancer. The cancer recurred and spread to bilateral face and neck. The severest pain mainly originated from the right mandibular region. Two steps of pain relief were performed for the patient. First, pain control using 1% lidocaine or 0.25% bupivacaine administered intermittently or continuously through an indwelling catheter in the mandibular nerve was performed for 1 week to estimate the amount of pain relief thereby obtained. Second, a neurolytic block was applied to the mandibular nerve through the catheter. After the neurolytic block, the total dosage of morphine and diclofenac remained unchanged for 2 months. We conclude from the present case that this technique is an excellent means of obtaining long-term pain control in patients with intractable orofacial cancer pain.     

Evaluation of craniospinal system condition using standardized volume-pressure loadings

Summary Standardized volume-pressure craniospinal system loadings based on physiological loadings were developed in order to study the CSF outflow route efficiency and to evaluate the intracranial volume-pressure relations. The study was carried out on 10 cats.Standardized abdominal compression was applied in order to produce a central venous pressure increased and subsequently ICP increase to the level of 20 and 30 mmHg for 2 minutes. The abdominal compression test seems to be useful in the CSF outflow route evaluation.The orthostatic changes were studied in control animals and in cats with an epidural balloon. The animal body was evaluated to an angle of 50° and 80° with the head directed upwards and downwards. This test was found suitable for the intracranial volume reserve estimation.Similar application, especially in experimental conditions can be found in the hypercapnia test. PaCO₂ concentration was increased by means of respiration with a gas mixture containing 5% CO₂. A steady increase of ICP of 9 ± 1 mmHg was obtained. Vascular dilatation resulted in an intracranial volume loading. The ICP response in subjects with normal CO₂ response can be related to the intracranial volume reserve.The studies performed show the usefulness of the standardized volume-pressure loadings. The loadings applied are more physiological than lumbar infusion tests used so far.     

Development of a standardized peripheral nerve block procedure note form

OBJECTIVES: Despite the tremendous growth of peripheral nerve blocks, no standard format exists to document their performance. Our objective was to create a peripheral nerve block form based on key elements of literature evidence and on our own group consensus. RESULTS: We describe the process and results of our multi-institutional effort to construct a standardized peripheral nerve block procedure form. CONCLUSION: A form was developed to help meet the medical, legal, and billing requirements of documentation consistent with the performance of peripheral nerve block.     

Evaluation of enterogastric reflux using a modified scintigraphy method

The aim of the study is evaluation of the clinical validity of the chosen and modified own model of the nuclear medicine method for the detection and quantification of enterogastric reflux (EGR), as well as evaluation of its clinical validity. The study was performed in 172 patients: with gastric and duodenal ulcer, after Billroth I and Billroth II gastrectomy, with gastroesophageal reflux, after cholecystectomy, with chronic cholecystitis and chronic duodenal disease. Acquisition was performed with gamma camera, during 90 minutes after intravenous application of 185 MBq 99m-Tc-Dietil IDA. Test meal was given in 30th minute, while gastric region was marked at the end of the study. On the basis of the radioactivity changes in the regions of the stomach and hepatobiliary system, presence of enterogastric reflux is determined and its index calculated. In all the groups of patients, values are significantly different from physiological. The most frequent occurrence and the largest quantity of reflux is present in patients after Billroth II gastrectomy with significantly different values from other groups of patients. The obtained results approve clinical value of the chosen and modified scintigraphy of EGR as a non-invasive and physiological method, which provides data about its presence and quantity.     

Detrusor thickness in healthy children assessed by a standardized ultrasound method.

PURPOSE: We determine the ultrasonographic detrusor thickness in healthy infants and children. MATERIALS AND METHODS: We studied 150 healthy children, 79 boys and 71 girls, from newborns to 13 years old. The detrusor of the ventral and dorsal wall was measured with a previously established ultrasonographic technique, and the variation with age and bladder fullness was assessed. RESULTS: Detrusor thickness varied significantly with the degree of bladder fullness (thinner at higher volumes). It also increased slightly with age. At bladder fullness of 10% or greater of expected bladder capacity (EBC), calculated using the formula EBC (ml.) = age (years) x 30 + 30, a practical upper limit for the detrusor thickness of the ventral wall at all ages was 2.0 mm. at a bladder fullness up to 50% of expected bladder capacity or 1.5 mm. at a higher degree of fullness. The detrusor of the ventral wall was slightly thicker in boys than in girls and also somewhat thicker than the detrusor of the dorsal wall. CONCLUSIONS: The results indicate that ultrasonographic measurements of detrusor thickness in children may serve as a diagnostic tool and its usefulness in clinical as well as research work should be explored.     

Real-time orthognathic surgical simulation using a mandibular motion tracking system.

We developed a new orthognathic surgical simulation system able to predict both occlusal correction and mandibular repositioning in three dimensions. This system uniquely integrates the real motion of the dental cast model with the virtual motion of the reconstructed cranio-facial model. The skeletal change of the mandibular osteotomy is simulated on the PC monitor while the occlusal change is confirmed by checking the cast model on the simulator. The simulation process is easily repeated and the operator can make several attempts to determine the final mandibular position. The occlusal relationship at the simulated mandibular posture is registered and the occlusal wafer splint, which ensures intermaxillary fixation, is fabricated on the simulator. This surgical simulation system appears to satisfy clinical demands well and is an important facilitator of communication between orthodontists and surgeons. Here, we outline the system and apply it to a demonstration case of orthognathic surgery.     

Evaluation of an oral mandibular advancement titration appliance.

OBJECTIVES: To determine whether a manually adjustable oral mandibular advancement titration appliance (EMA-T) predicts successful long-term treatment with an oral mandibular advancement appliance (MAA). STUDY DESIGN: At an academic medical center, 21 adults with obstructive sleep apnea (AHI > 10 events/hr) performed baseline, titration, and MAA (Klearway) polysomnograms. During the titration polysomnogram with EMA-T, the mandible was advanced until apneas and hypopneas were eliminated or maximum tolerable advancement was reached. Participants then used the MAA at home and, once the mandible was advanced to the amount determined during the titration polysomnogram, a polysomnogram with MAA was performed. RESULTS: Mean AHI at baseline was 33.5 +/- 18.3 (SD) events/hr. During the titration polysomnogram, 9 subjects achieved an AHI < 10 and at least a 50% reduction in AHI. None of the subjects met these criteria on the MAA polysomnogram. CONCLUSIONS: EMA-T lowered the AHI to efficacious levels in 43% of patients but this acute response did not predict the efficacy of long-term MAA treatment.     

Centralization: prevalence and effect on treatment outcomes using a standardized operational definition and measurement method

STUDY DESIGN: Retrospective, observational cohort design. OBJECTIVES: Purpose 1 was to determine the association between age, symptom chronicity, and prevalence of centralization in a sample of patients with nonserious cervical or lumbar spinal syndromes referred to a hospital-based outpatient rehabilitation clinic. Purpose 2 was to examine if classifying these patients at intake to centralization or noncentralization predicts functional status, pain intensity, and number of treatment visits at discharge from rehabilitation. Purpose 3 was to compare clinically meaningful changes in functional status and pain intensity between patients subgrouped by centralization and noncentralization. BACKGROUND: Variations in operational definitions and measurements used to identify centralization affect patient classification, contribute to variation in reported prevalence rates, and influence treatment strategy and outcome interpretation. Investigating a standardized operational definition and measurement method for centralization may reduce practice and outcomes variation. METHODS AND MEASURES: Adults (n=418) with cervical or low back syndromes (mean +/- SD age, 58 +/- 17 years; range, 19-91 years; 33% male; 76% lumbar symptoms; 53% chronic symptoms) were assessed. Therapists classified patients using a standardized operational definition and method for centralization during initial evaluation. Prevalence rates were calculated for centralization by age and acuity. Multivariate models were used to assess discharge functional status, pain intensity, and visits while controlling important variables. Percentage of patients subgrouped by centralization and noncentralization achieving minimal clinically important differences (MCID) in functional status and pain intensity was assessed. RESULTS: Overall prevalence rate for centralization was 17%, but increased for patients who were younger and reported acute symptoms regardless of body part. For patients with lumbar syndromes, noncentralization was associated with lower discharge functional status and more pain, but not associated with number of visits compared to patients classified as centralization. For patients with cervical syndromes, noncentralization was associated with more pain but not associated with functional status or number of visits compared to patients classified as centralization. Pain pattern classification affected percentage of patients with lumbar and cervical impairment achieving MCID. CONCLUSION: Results supported the clinical use of a standardized definition of centralization to facilitate patient classification and management and interpretation of outcomes.     

Statistical results of andrological research using a standardized questionnaire

In the present study the author presents extracts of more extensive statistics from the year 1978. It could be demonstrated that time-consuming statistics and documentation with some organizational modifications can be simplified. The advantage of punch cards for a standardized diagnostic questionnaire is evident, since all data from a special patient are present. For the clinical investigation this questionnaire guarantees consideration of all data. By this method in andrology new knowledge can be obtained. Furthermore, the statistical results also bring stimulation for scientific work also in the daily practice.     

Continuous mandibular nerve block for pain relief. A report of two cases

PURPOSE: Mandibular nerve block allows surgery to be performed on the mandible. However, pain in the postoperative period needs to be treated with opioids or non-steroidal anti-inflammatory agents which have undesirable side effects. We examine the feasibility of continuous mandibular nerve block with 0.25% bupivacaine top-ups using a catheter for intraoperative and postoperative pain relief in two patients with a fracture of the mandible. METHODS: Using the lateral extraoral approach, the mandibular nerve was approached with an 18-gauge indwelling iv cannula in two patients undergoing repair of a fractured mandible under general anesthesia. After removing the needle, an 18-gauge epidural catheter was inserted into the cannula which was then removed. The catheter was tunnelled subcutaneously to emerge at the lateral aspect of the forehead. Two to 4 mL bupivacaine 0.25% were injected on a 12-hr basis and the catheter was kept in place for seven days. RESULTS: Both patients had excellent pain relief and no parenteral or oral analgesics were required throughout the postoperative period. No side effects were noted. CONCLUSIONS: Continuous mandibular nerve block with 2-4 mL 0.25% bupivacaine top-ups injected twice a day through a catheter provides excellent pain relief in patients with a fracture of the mandible. This method may have implications for the management of pain of other etiology in the mandibular region.