scholarly journals Fluoroscopy-Guided Blockade of the Greater Occipital Nerve in Cadavers: A Comparison of Spread and Nerve Involvement for Different Injectate Volumes

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Zhanfeng Song ◽  
Shuming Zhao ◽  
Jianqing Ma ◽  
Zhanyong Wu ◽  
Sidong Yang
Keyword(s):  
Methylene Blue ◽  
Cadaveric Study ◽  
Tissue Composition ◽  
Occipital Nerve ◽  
The Third ◽  
Nerve Involvement ◽  
Greater Occipital Nerve ◽  
Cervicogenic Headaches ◽  
To Receive ◽  
Formalin Fixed

Background. Fluoroscopy-guided blockade of the greater occipital nerve (GON) is an accepted method for treating the symptoms of cervicogenic headaches (CGHs). However, the spread patterns among different injectate volumes of fluoroscopy-guided GON blocks are not well defined. Objective. A cadaveric study was established to determine the spread patterns of different volumes of dye injectate within a fluoroscopic GON block. Study Design. Cadaveric study. Setting. Xingtai Institute of Orthopaedics; Orthopaedic Hospital of Xingtai. Methods. 15 formalin-fixed cadavers with intact cervical spines were randomized in a 1 : 1 : 1 ratio to receive a fluoroscopy-guided GON injection of a 2, 3.5, or 5 ml volume of methylene blue. The suboccipital regions were dissected to investigate nerve involvement. Results. The suboccipital triangle regions, including the suboccipital nerves and GONs, were deeply stained in all cadavers. The third occipital nerve (TON) was stained in 7 of 10 administered 2 ml injections and in all the 3.5 ml and 5 ml injections. Compared to the 3 ml injectate group, the 5 mL cohort consistently saw injectate spreading to both superficial and distant muscles. Limitations. Given that cadavers were used in this study, cadaveric soft tissue composition and architecture can potentially become distorted and consequently affect injectate diffusion. Conclusions. A 3.5 or 5 mL fluoroscopy-guided GON injection of methylene blue successfully stains the GON, TON, and suboccipital nerves. This suggests that such an injection would generate blockade of all three nerve groups, which may contribute to the efficacy of the block for CGH. A volume of 3.5 ml may be enough for the performance of a fluoroscopy-guided GON block for therapeutic purposes.

scholarly journals Currently Recommended TON Injectate Volumes Concomitantly Block the GON: Clinical Implications for Managing Cervicogenic Headache

2016 ◽  
Vol 7;19 (7;9) ◽  
pp. E1079-E1086 ◽  
Author(s):  
Sayed Emal Wahezi
Keyword(s):  
Methylene Blue ◽  
Radiofrequency Ablation ◽  
Treatment Options ◽  
Academic Medical Center ◽  
Cervicogenic Headache ◽  
Small Sample ◽  
Medial Branch ◽  
Occipital Nerve ◽  
Number Of Patients ◽  
Greater Occipital Nerve

Background: Headache (HA) is a significant cause of morbidity globally. Despite many available treatment options, HAs that are refractory to conservative management can be challenging to treat. Third occipital nerve (TON) and greater occipital nerve (GON) irritation are potential etiologic agents of primary and cervicogenic HAs that can be targeted using minimally invasive treatment options such as nerve blocks or radiofrequency ablation. However, a substantial number of patients that undergo radiofrequency ablation do not experience pain relief despite a positive diagnostic medial branch block (MBB). Objective: In this study, we investigate the underlying cause for the high rate of false positives associated with MBBs by evaluating injectate spread in cadaveric subjects. Study Design: Cadaveric study. Setting: Academic medical center. Methods: After obtaining exemption status from our Institutional Review Board, TON injections were performed on 5 preserved cadavers, a total of 10 TONs, using anatomic landmarks, partial dissection, and palpation to guide needle placement. Cadaveric dissections were performed to evaluate the location, vertical spread, and grossly observed injectate coating of the TON and GON for each quantity of methylene blue injectate, 0.3 mL and 0.5 mL, administered. Results: The average distance between the TON and GON at their respective foraminal exit points was 1.81 cm. The average vertical spread for 0.3 mL and 0.5 mL of methylene blue injectate was 2.02 + 0.35 cm and 3.26 + 0.48 cm when performing a TON block. When using 0.3 mL injectate, both the TON and GON were simultaneously coated 60% of the time. After increasing the injectate volume to 0.5 mL, both the TON and GON were simultaneously coated 100% of the time. Limitations: The cadaveric design of this study presents limitations when translating cadaveric findings to the clinical setting. Also, the small sample size limits its power and generalizability. Lastly, the potential for researcher bias exists as the investigators were not blinded. Conclusions: This study demonstrates that currently recommended injectate volumes for TON blocks may result in concomitant coating of the GON. Conventional radiofrequency ablation (RFA) of these nerves may not lesion both the TON and GON given its restrictive circumferential lesioning diameter of 5 – 7 mm. As such, interventionalists should consider performing radiofrequency ablation to both the TON and GON after a positive TON block. Key Words: Chronic pain, cervicogenic headache, third occipital nerve, greater occipital nerve, injectate spread, radiofrequency ablation

BALBIR MADHOPURI. KORE KĀĠAZ KĪ GAHRĪ LIKHAT / INSCRIPTIONS ON A TENDER MIND (A CHAPTER FROM CHĀNGIĀ RUKH / AGAINST THE NIGHT)

2020 ◽  
pp. 249-264
Author(s):  
A. V. Bochkovskaya ◽  
Keyword(s):  
Everyday Life ◽  
Social Activist ◽  
Good Education ◽  
Social Oppression ◽  
The Third ◽  
Home Village ◽  
To Receive

The commented translation from Hindi of a chapter from the Chāṅgiā rukh (Against the Night) autobiography (2002) by Balbir Madhopuri, a renowned Indian writer, poet, translator, journalist and social activist, brings forward episodes from the life of low-caste inhabitants of a Punjab village in the 1960–1970s. Following the school of hard knocks of his childhood in the chamar quarter of Madhopur, a village in Jalandhar district, Balbir Madhopuri managed to receive a good education and take to literature. In 2014 he was awarded the Translation Prize from India’s Sahitya Academy for contribution to the development and promotion of Punjabi, his mother language. Narrating the story, Balbir Madhopuri shares memories, thoughts and emotions from early days that determined his motivations to struggle against poverty, deprivation and injustice. The chapter Kore kāġaz kī gahrī likhat (Inscriptions on a Tender Mind [Madhopuri, 2010]) tells readers about joys and sorrows, hopes and fears, delights and regrets that were part of his childhood in Madhopur. Scenes from everyday life in the home village, episodes highlighting complex relations between its inhabitants — predominantly Sikhs and Hindus — intertwine with Balbir Madhopuri’s reflections on social oppression and caste inequality that still remain in contemporary India’s society. This commented translation is the third in a series of four chapters from Balbir Madhopuri’s autobiography scheduled for publication in this journal in 2020.

scholarly journals Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study

Anaesthesia ◽  
2018 ◽  
Vol 73 (10) ◽  
pp. 1244-1250 ◽  
Author(s):  
H.‐M. Yang ◽  
Y. J. Choi ◽  
H.‐J. Kwon ◽  
J. O ◽  
T. H. Cho ◽  
...  
Keyword(s):  
Cadaveric Study ◽  
Erector Spinae ◽  
Thoracic Region ◽  
Nerve Involvement

Efficacy and safety of 121 injections of the greater occipital nerve in episodic and chronic cluster headache

Cephalalgia ◽  
2012 ◽  
Vol 32 (8) ◽  
pp. 630-634 ◽  
Author(s):  
Andreas R Gantenbein ◽  
Nina J Lutz ◽  
Franz Riederer ◽  
Peter S Sándor
Keyword(s):  
Cluster Headache ◽  
Chronic Cluster Headache ◽  
Efficacy And Safety ◽  
Occipital Nerve ◽  
Greater Occipital Nerve

scholarly journals Nitrate and nitrite poisoning in sheep and goats caused by ingestion of Portulaca oleracea

2018 ◽  
Vol 38 (8) ◽  
pp. 1549-1553
Author(s):  
João G. Simões ◽  
Rosane Maria T. Medeiros ◽  
Márcia A. Medeiros ◽  
Robério G. Olinda ◽  
Antônio Flávio M. Dantas ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Body Weight ◽  
Clinical Signs ◽  
Portulaca Oleracea ◽  
Sheep And Goats ◽  
Ruminal Ph ◽  
The Third ◽  
Mucous Membranes ◽  
Nitrate And Nitrite ◽  
Positive Results

ABSTRACT: Three outbreaks of poisoning by Portulaca oleracea were reported in sheep and goats in Northeast Brazil. In the first outbreak, 8 out of 20 sheep were affected and later died. In the second outbreak, three goats and one sheep died out of a flock of 30 animals that included both species. In the third outbreak, two out of 19 sheep were affected, and they recovered after a treatment of 2% methylene blue at a dose of 4 mg/kg body weight. In the first and second outbreaks, the animals ingested P. oleracea after it was cut and offered in feeders. In the third outbreak, the flock was grazing in an area that had been invaded by the plant. To determine the toxicity, P. oleracea was administered experimentally at a dose of 80g/kg of body weight to seven sheep, weighing 19-30 kg. One control sheep received green grass. One to four hours after P. oleracea ingestion, the animals showed clinical signs of poisoning characterized by cyanotic mucous membranes, bloat, ruminal pH of 8-9, pollakiuria, aerophagia, involuntary movements of the upper lip, apathy, tachypnea and tachycardia. Five animals recovered, including one that was treated with 1% methylene blue, and two animals died. During necropsy, the mucous membranes were brownish, and the blood was dark brown. Diphenylamine tests of the plant and of rumen contents were positive for nitrates. Positive results for nitrates were also found in 24 samples of P. oleracea that were collected in different places in the states of Pernambuco and Paraíba. We conclude that P. oleracea accumulates nitrates at toxic levels and may cause poisoning in sheep and goats.

Dacryostenosis in Newborns: Probing, or Syringing, or Both?

2000 ◽  
Vol 10 (2) ◽  
pp. 128-131 ◽  
Author(s):  
A.A. Tahat
Keyword(s):  
Methylene Blue ◽  
High Pressure ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
The Third ◽  
Lacrimal System ◽  
Age Range ◽  
Nasolacrimal Ducts

Purpose This prospective study was designed to establish whether it is more effective to treat symptomatic congenital nasolacrimal duct obstruction by probing, or high-pressure irrigation, or both. Methods During the period February 1991 to January 1999, 228 infants (300 nasolacrimal ducts) were examined (132 males, 96 females, age range 12–13 months). These patients were divided into three groups of 100 ducts each. The first group was probed only; in the second group the nasolacrimal ducts were irrigated under high pressure using methylene blue-stained saline, and the third group was probed and irrigated in the same setting. The procedures were done under light general anesthesia. Results Ninety-one ducts in the first group improved after probing. In the second group 64 ducts improved after irrigation. In the third group 96 ducts improved after both probing and irrigation. Conclusions To treat symptomatic congenital nasolacrimal duct obstruction, it is more effective to combine high-pressure irrigation and probing. This gives a better success rate, first in treatment and secondarily, permitting intraoperative verification of the patency of the excretory lacrimal system.

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