BACKGROUND: We prospectively evaluated the incidence and possible factors causing intramuscular injection during lumbar sympathetic ganglion block and compared the multiple needle technique to the single technique to obtain a profound and complete block effect. METHODS: Among 83 patients, 58 patients (group A, n = 27, multiple needle technique and group B, n = 31, single needle technique) were reevaluated for the changes of skin temperature (Ts) and mean segment of longitudinal contrast spread. After injecting the contrast agent, the incidence of psoas muscle injection and the change of Ts was compared between two groups. RESULTS: The incidence of psoas muscle injection was 21.3% (46/216) and it was associated with the level of injection (L2) significantly (chi-square = 14.773, P = 0.001). DT(post) (postblock temperature difference between ipsilateral and contralateral great toe, 4.6 +/- 2.8degrees C, 1.8 +/- 1.6degrees C, P < 0.001 for group A and B) and DT(net) (DT(post) - DT(pre), 3.9 +/- 2.7degrees C, 1.5 +/- 1.5degrees C, P < 0.001 for group A and B) was significantly higher in group A. The mean segment of longitudinal contrast spread was 8.1 +/- 0.9 for group A and 3.2 +/- 1.6 for group B (P < 0.001). CONCLUSIONS: The LSGB at the L2 level showed the lowest incidence of psoas muscle injection of contrast. Multiple needle approach showed more significant increase of DT(net) and DT(post).
Ganglia, Sympathetic ; Humans ; Incidence ; Injections, Intramuscular ; Needles ; Prospective Studies ; Psoas Muscles ; Skin Temperature ; Toes

No abstract available.
Hydronephrosis*

No abstract available.
Mucocutaneous Lymph Node Syndrome

No abstract available.
Adrenocortical Carcinoma*

Recurrent or refractory small bowel obstruction in postsurgical patients with advanced malignancies poses therapeutic dilemmas. Although some promising results have been achieved as small bowel endoscopic techniques advanced, palliative stent placement is both challenging and complex. Endoscopic ultrasound (EUS)-guided anastomosis using a lumen-apposing metal stent has been recently used during gastroenterostomy to treat benign or malignant gastric outlet obstruction. Data on the outcomes of EUS-guided enterostomy in patients with recurrent small bowel obstruction are lacking, although the technique is applicable throughout the entire gastrointestinal tract. We recently encountered recurrent or refractory small bowel obstruction in two poor surgical candidates. For the first case, we performed EUS-guided enterostomy to treat a recurrent obstruction after conventional stent insertion. The second case underwent EUS-guided transenteric stent placement to treat refractory small bowel obstruction associated with diffuse peritoneal carcinomatosis after failure of a conventional “push” endoscopic procedure.

Invasive infection of the Streptococcus bovis group in a neonate is rare. In cases reported to date, the pathogen of neonatal S. bovis infections is usually Streptococcus gallolyticus subsp. pasteurianus (S. bovis biotype II/2). Streptococcus lutetiensis (S. bovis biotype II/1) was identified using 16S rRNA and tuf gene sequence analysis of the isolates from blood and cerebrospinal fluid (CSF) of a fever-presenting 28-day-old male. Blood culture analysis was performed using automatic equipment (VITEK 2) and identified Streptococcus infantarius supsp. infantarius, yet we were unable to get accurate results from the CSF culture. The fever subsided on the second day of hospitalization, and the patient was discharged without neurologic complication after 14 days of antibiotic therapy. In this case, we were able to accurately identify the pathogen using molecular genetic methods. To our knowledge, this is the first case of late onset neonatal bacteremia and meningitis caused by S. lutetiensis.
Bacteremia* ; Cerebrospinal Fluid ; Fever ; Hospitalization ; Humans ; Infant, Newborn ; Male ; Meningitis* ; Molecular Biology ; Sequence Analysis ; Streptococcus bovis ; Streptococcus*

Epstein's syndrome is a rare disease whish is characterized by the association of thrombocytopenia, macrothrombocytopathia, nephritis and deafness. We experienced a case of Epstein's syndrome in a 12 years old male patient who was presented with a life long history of bleeding, usually as epistaxis, bilateral sensorineural deafness and hematuria with proteinuria starting in late childhood. Hematologic studies showed thrombocytopenia with giant platelets and anemia. A bone marrow aspirate revealed the megakaryocytes to be adequate in number and many giant size platelets. Platelet do not respond to addition of A and epinephrine; collagen and ristocetin induced agglutination response is decreased. It is difficult to be certain the association of thrombocytopenia with giant platelets, nephritis and deafness constitutes a new hereditary disease with a distinct pathogenesis or if it is an expansion of the well recognized Alport's syndrome of hereditary nephritis deafness. We report a case of Epstein's syndrome syndrome with brief review of related literatures.
Agglutination ; Anemia ; Blood Platelets ; Bone Marrow ; Child ; Collagen ; Deafness ; Epinephrine ; Epistaxis ; Genetic Diseases, Inborn ; Hematuria ; Hemorrhage ; Humans ; Male ; Megakaryocytes ; Nephritis ; Nephritis, Hereditary ; Proteinuria ; Rare Diseases ; Ristocetin ; Thrombocytopenia

No abstract available.
Child* ; Humans ; Infant* ; Urinary Tract Infections* ; Urinary Tract*

No abstract available.
Adrenoleukodystrophy*

No abstract available.