BACKGROUND & AIMS: :Using a combined general anesthesia/epidural technique, two cases of intraoperative malfunctioning epidural catheters in obese patients are presented. After the epidural was found to be malfunctioning, the anesthesiologist placed the palm of both hands underneath the patients' lumbar and thoracic area. The epidural catheter with tape and subcutaneous tissue was pulled in both cases towards the head. In each case, this simple maneuver made the catheter function again. In conclusion, this simple corrective maneuver should be attempted prior to discarding the epidural anesthetic technique.

背景与目标： ：介绍了使用全身麻醉/硬膜外联合技术，在肥胖患者中出现两例术中出现硬膜外导管故障的病例。在发现硬膜外出现故障后，麻醉医师将双手的手掌放在患者的腰椎和胸廓区域下方。在两种情况下，将带有胶带和皮下组织的硬膜外导管拉向头部。在每种情况下，这种简单的操作都使导管再次起作用。总之，应该在放弃硬膜外麻醉技术之前尝试进行这种简单的矫正操作。

BACKGROUND & AIMS: A case of complete uterine rupture during a trial of labour in which epidural analgesia was used is described. The pain of uterine rupture was not masked by the addition of fentanyl 25 micrograms to bupivacaine 0.25% 6 ml but was relieved by bupivacaine 0.375% 6 ml.

背景与目标： 描述了在使用硬膜外镇痛的分娩试验中子宫完全破裂的病例。在25％的布比卡因中添加25毫克的芬太尼并不能掩盖子宫破裂的疼痛，但是布比卡因0.375％的6 ml可以缓解子宫破裂的疼痛。

BACKGROUND & AIMS: :Candida spondylodiscitis associatd with epidural abscess is rarely seen. We present a patient with Hodgkin lymphoma who received chemotherapy and developed systemic Candida infection, which was complicated by Candida spondylodiscitis and epidural abscess.

背景与目标： ：与硬膜外脓肿相关的念珠菌脊椎盘炎很少见。我们介绍了一名患有霍奇金淋巴瘤的患者，该患者接受了化疗并发展为全身性念珠菌感染，并发念珠菌脊椎盘炎和硬膜外脓肿。

BACKGROUND & AIMS: :Epidural blood patch (EBP) is an effective procedure for the treatment of spontaneous intracranial hypotension (SIH). Neurological compromise following EBP, although rare, is recognized as a serious potential complication. We describe a 33-year-old female patient in whom long-term bladder and bowel dysfunction developed following a small volume (10 mL) EBP to treat SIH. We also discuss the possible pathophysiological mechanisms related to this complication in the postprocedure setting.

背景与目标： ：硬膜外补血（EBP）是治疗自发性颅内低血压（SIH）的有效方法。 EBP后的神经功能损害虽然很少见，但被认为是严重的潜在并发症。我们描述了一名33岁的女性患者，在该患者中，小剂量（10 mL）EBP治疗SIH后会出现长期的膀胱和肠功能障碍。我们还将讨论与术后并发症相关的可能的病理生理机制。

BACKGROUND & AIMS: :The feasibility of using a subcutaneously implanted portal system attached to a conventional 16-gauge epidural catheter has been evaluated in 50 patients with sever pain associated with cancer. This technique allowed for the percutaneous epidural administration of morphine at 8-12-hourly intervals for pain control. The mean duration of implantation was 12 weeks and the longest period a portal remained in situ was 36 weeks. Five portals had to be removed for various reasons. The injection system has blocked on eight occasions due to catheter blockage (six times) and portal blockage (two occasions). These patients have continued to obtain excellent analgesia when either catheter or portal were replaced. In a cadaver, 300 injections were simulated using either 22-gauge Huber point needles or disposable needles (25 gauge) and the injectate examined by both light and scanning electron microscopy. Both needle types resulted in particulate contamination which was greater with the recommended Huber point needles.

背景与目标： ：已对50例与癌症相关的严重疼痛的患者评估了使用皮下植入的门禁系统连接传统的16号硬膜外导管的可行性。该技术允许以8-12小时的间隔经皮硬膜外给予吗啡以控制疼痛。平均植入时间为12周，而门户留在原位的最长时间为36周。由于各种原因，必须删除五个门户。由于导管阻塞（六次）和门静脉阻塞（两次），注射系统已发生八次阻塞。当更换导管或门静脉时，这些患者继续获得出色的镇痛效果。在尸体中，使用22号Huber点针或一次性针头（25号针头）模拟了300次注射，并通过光学和扫描电子显微镜对注射进行了检查。两种类型的针都导致微粒污染，建议的Huber点式针污染更大。

BACKGROUND & AIMS: :The purpose of this study is to compare the effects of spinal and epidural anesthesia on a rat transverse rectus abdominus myocutaneous flap ischemia-reperfusion injury model.Forty Sprague-Dawley rats were divided into 4 experimental groups: group I (n = 10), sham group; group II (n = 10), control group; group III (n = 10), epidural group; and group IV (n = 10), spinal group. After the elevation of the transverse rectus abdominus myocutaneous flaps, all groups except for the sham group were subjected to normothermic no-flow ischemia for 4 hours, followed by a reperfusion period of 2 hours. At the end of the reperfusion period, biochemical and histopathological evaluations were performed on tissue samples.Although there was no significant difference concerning the malonyldialdehyde, nitric oxide, and paraoxonase levels in the spinal and epidural groups, the total antioxidant state levels were significantly increased, and the total oxidative stress levels were significantly decreased in the epidural group in comparison to the spinal group. The pathological evaluation showed that findings related to inflammation, nuclear change rates and hyalinization were significantly higher in the spinal group compared with the epidural group.Epidural anesthesia can be considered as a more suitable method that enables a decrease in ischemia-reperfusion injuries in the muscle flaps.

背景与目标： ：本研究的目的是比较脊髓麻醉和硬膜外麻醉对大鼠横直肌腹肌皮瓣缺血再灌注损伤模型的影响。40只Sprague-Dawley大鼠分为4个实验组：I组（n = 10），假小组组II（n = 10），对照组；第三组（n = 10），硬膜外组；第四组（n = 10），脊柱组。腹直肌横肌皮瓣抬高后，除假手术组外，其余各组均进行常温无血流缺血4小时，然后再灌注2小时。在再灌注期结束时，对组织样本进行了生化和组织病理学评估。尽管在脊髓和硬膜外组中丙二酰二醛，一氧化氮和对氧磷酶水平没有显着差异，但总抗氧化剂状态水平却明显升高，与硬膜外组相比，硬膜外组的总氧化应激水平显着降低。病理评估显示，与硬膜外组相比，脊柱组与炎症，核变化率和透明质化相关的发现显着更高。襟翼。

BACKGROUND & AIMS: :Growth hormone (GH) is a major regulator of growth, somatic development and body composition. Sex steroids can act centrally by regulating GH secretion and peripherally modulating GH responsiveness. This review addresses data of potential clinical relevance on how sex steroids modulate GH secretion and action, aiming to increase the understanding of sex steroid/GH interactions and leading to improved management of patients. Sex steroids regulate GH secretion directly as well as indirectly through IGF-I modulation. Testosterone stimulates GH secretion centrally, an effect dependent on prior aromatization to oestrogen. Oestrogen stimulates GH secretion indirectly by reducing IGF-I feedback inhibition. Whether oestrogen stimulates GH secretion centrally in females is unresolved. Gonadal steroids modify the metabolic effects of GH. Testosterone amplifies GH stimulation of IGF-I, sodium retention, substrate metabolism and protein anabolism while exhibiting similar but independent actions of its own. Oestrogen attenuates GH action by inhibiting GH-regulated endocrine function of the liver. This is a concentration-dependent phenomenon that arises invariably from oral administration of therapeutic doses of oestrogen, an effect that can be avoided by using a parenteral route. This strong modulatory effect of gonadal steroids on GH responsiveness provides insights into the biological basis of sexual dimorphism in growth, development and body composition and practical information for the clinical endocrinologist. It calls for an appraisal of the diagnostic criteria for GH deficiency of GH stimulation tests, which currently are based on arbitrary cut-offs that do not take into account the shifting baseline from the changing gonadal steroid milieu. In the management of GH deficiency in the hypopituitary female, oestrogen should be administered by a nonoral route. In hypopituitary men, androgens should be replaced concurrently to maximize the benefits of GH. In the general population, the metabolic consequences of long-term treatment of women with oral oestrogen compounds, including selective oestrogen receptor modulators, are largely unknown and warrant study.

背景与目标： ：生长激素（GH）是生长，体细胞发育和身体成分的主要调节剂。性类固醇可以通过调节GH分泌并在外围调节GH反应性来发挥中心作用。这篇综述探讨了有关性类固醇如何调节GH分泌和作用的潜在临床相关性数据，旨在增进对性类固醇/ GH相互作用的了解并改善患者的管理。性类固醇直接或通过IGF-I调节间接调节GH的分泌。睾丸激素可集中刺激GH分泌，其作用取决于先前对雌激素的芳香化作用。雌激素通过减少IGF-1反馈抑制作用间接刺激GH分泌。雌激素是否能集中刺激女性的GH分泌尚无定论。性腺类固醇会改变GH的代谢作用。睾丸激素可放大IGF-1的GH刺激，钠保留，底物代谢和蛋白质合成代谢，同时表现出类似但独立的作用。雌激素通过抑制GH调节的肝脏内分泌功能来减弱GH的作用。这是一种浓度依赖性现象，总是由口服治疗剂量的雌激素引起，这种现象可以通过肠胃外途径避免。性腺类固醇对GH反应性的这种强大调节作用为临床内分泌学家提供了有关生长，发育和身体组成方面性二态性的生物学基础的见解，并为临床内分泌学家提供了实用信息。它要求评估GH刺激试验中GH缺乏的诊断标准，该诊断标准目前基于任意临界值，该临界值未考虑来自不断变化的性腺类固醇环境的基线变化。在垂体下垂体GH缺乏症的治疗中，应通过非口服途径给予雌激素。在垂体下垂的男性中，应同时更换雄激素以最大程度地增加GH的益处。在一般人群中，口服雌激素化合物（包括选择性雌激素受体调节剂）对妇女进行长期治疗的代谢后果在很大程度上尚不清楚，值得研究。

BACKGROUND & AIMS: :Implanted cortical stimulation is foreseen to facilitate functional poststroke recovery. Until now, no study has concluded on its pathophysiological mechanism. We report a case of a 58-year-old patient for whom cortical stimulation triggered a drastic enhancement of speech performances. The effects remain reversible after 6 years of stimulation, reflecting intra/inter-hemispheric modulation.

背景与目标： ：预计将植入皮质刺激以促进功能性卒中后恢复。迄今为止，尚未对其病理生理机制进行任何研究。我们报道了一例58岁的病人，其皮质刺激刺激了言语能力的急剧增强。刺激6年后，效果仍可逆，反映了半球内/半球之间的调制。

BACKGROUND & AIMS: BACKGROUND:The present study was designed to assess the effect of sex steroids (testosterone and 17beta-estradiol) on insulin receptor expression, insulin binding and glucose oxidation in human liver cell line. METHODS:Non-malignant Chang liver cells were treated with different concentrations of testosterone and 17beta-estradiol dissolved in serum free medium for 24 h to identify the effective dose of both steroids for further studies. Cells with 70-80% confluency were challenged with testosterone (0.1 micromol/l), 17beta-estradiol (0.1 micromol/l) and their combination along with insulin as a positive control for 24 h. After the treatment period, insulin receptor mRNA expression, cell surface insulin binding and (14)C-glucose oxidation were assessed. RESULTS:Both testosterone and 17beta-estradiol significantly increased the insulin receptor mRNA expression, cell surface insulin binding and (14)C-glucose oxidation compared to basal, but the increase was not at par with the effect of insulin. Compared to individual effects of testosterone and 17beta-estradiol, their combination significantly increased the glucose oxidation similar to that of insulin. CONCLUSION:It is concluded from the present study that testosterone and 17beta-estradiol can directly enhance insulin receptor mRNA expression, insulin binding and glucose oxidation in Chang liver cells and thereby glucose metabolism.

背景与目标： 背景：本研究旨在评估性类固醇（睾丸激素和17β-雌二醇）对人肝细胞系中胰岛素受体表达，胰岛素结合和葡萄糖氧化的影响。
方法：用不同浓度的睾丸激素和17β-雌二醇溶解于无血清培养基中的非恶性昌肝细胞24 h，以鉴定两种类固醇的有效剂量，以供进一步研究。将70-80％汇合的细胞用睾丸激素（0.1 micromol / l），17beta-雌二醇（0.1 micromol / l）及其组合以及胰岛素作为阳性对照攻击24小时。治疗期后，评估胰岛素受体mRNA表达，细胞表面胰岛素结合和（14）C-葡萄糖氧化。
结果：与基础相比，睾丸激素和17β-雌二醇均显着增加了胰岛素受体mRNA的表达，细胞表面胰岛素结合和（14）C-葡萄糖氧化，但与胰岛素的作用不相称。与睾丸激素和17β-雌二醇的个体作用相比，它们的组合显着增加了类似于胰岛素的葡萄糖氧化作用。
结论：本研究得出的结论是，睾丸激素和17β-雌二醇可以直接增强昌肝细胞中胰岛素受体mRNA的表达，胰岛素结合和葡萄糖氧化，从而促进葡萄糖代谢。

BACKGROUND & AIMS: PURPOSE OF REVIEW:Post dural puncture headache (PDPH) is a relatively common complication which may occur in the setting of inadvertent dural puncture (DP) during labor epidural analgesia and during intentional DP during spinal anesthetic placement or diagnostic lumbar puncture. Few publications have established the long-term safety of an epidural blood patch (EBP) for the treatment of a PDPH. RECENT FINDINGS:The aim of this pilot study was to examine the association of chronic low back pain (LBP) in patients who experienced a PDPH following labor analgesia and were treated with an EBP. A total of 146 patients were contacted and completed a survey questionnaire via telephone. The EBP group was found to be more likely to have chronic LBP (percentage difference 20% [95% CI 6-33%], RR 2.6 [95% CI 1.3-5.2]) and also LBP < 6 (percentage difference 24% [95% CI 9- 37%], RR 2.3 [95% CI 1.3-4.1]). There were no significant differences in the severity and descriptive qualities of pain between the EBP and non-EBP groups. Our findings suggest that PDPH treated with an EBP is associated with an increased prevalence of subsequent low back pain in parturients. The findings of this pilot study should spur further prospective research into identifying potential associations between DP, EBP, and chronic low back pain.

背景与目标： 审查目的：硬脑膜穿刺后头痛（PDPH）是一种相对常见的并发症，可能发生在分娩硬膜外镇痛期间的无意硬脑膜穿刺（DP）的情况下，以及在麻醉药放置或诊断性腰椎穿刺期间的故意DP发生期间。很少有出版物确定硬膜外补血片（EBP）用于治疗PDPH的长期安全性。
最近的调查结果：这项初步研究的目的是检查分娩镇痛后经历PDPH并接受EBP治疗的患者的慢性下背痛（LBP）的相关性。总共联系了146名患者，并通过电话填写了调查问卷。发现EBP组更有可能患有慢性LBP（百分比差异20％[95％CI 6-33％]，RR 2.6 [95％CI 1.3-5.2]）以及LBP <6（百分比差异24％[ 95％CI 9- 37％]，RR 2.3 [95％CI 1.3-4.1]。在EBP组和非EBP组之间，疼痛的严重程度和描述质量没有显着差异。我们的发现表明，用EBP治疗的PDPH与产妇随后发生的下背部疼痛的患病率增加有关。这项前瞻性研究的结果将刺激进一步的前瞻性研究，以发现DP，EBP和慢性下腰痛之间的潜在关联。

BACKGROUND & AIMS: STUDY DESIGN:A prospective review of patients undergoing epidural catheter placement after anterior spinal fusion and instrumentation for adolescent scoliosis was performed. Data were collected using visual analog pain scores reflecting the patients' perception of their pain control. OBJECTIVES:To present the authors' technique for epidural catheter placement and dosing protocol, and to demonstrate the results from postoperative pain control after anterior spinal instrumented fusion for 10 consecutive patients. SUMMARY OF BACKGROUND DATA:The literature regarding the benefits of epidural catheters after spinal surgery is contradictory, even with controlled studies comparing epidural catheters with intravenous morphine patient-controlled anesthesia. The authors believe that this lack of consensus stems from varied epidural dosing protocols and techniques in catheter placement, which they have witnessed anecdotally at their own institution. This prompted the authors to develop and refine a standardized dosing and catheter placement protocol for pain control after spinal surgery. METHODS:Epidural catheters were placed intraoperatively before wound closure, then removed on postoperative Day 5. Dosing consisted of fentanyl (1 microg/kg) and hydromorphone (5 microg/kg) diluted in preservative-free saline (0.2 mL/kg). After surgery, dosing consisted of 0.1% ropivacaine and hydromorphone (10 microg/ml) continuously infused at 0.2 mL/kg/hour. Postoperative pain control was assessed on each postoperative day using a visual analog pain scale with choices ranging from 0 to 10. RESULTS:The arithmetic mean of the median pain scores after surgery was 2.1. The mean of the maximum pain scores for the 5 days was 4.1. Three patients required an epidural bolus and a 20% increase in the epidural infusion rate. One patient was judged to be excessively sleepy, so the epidural infusion rate was decreased by 20%. Pruritus requiring diphenhydramine developed in three patients. No other adverse effects related to epidural analgesia were noted. No catheters were accidentally pulled out or disconnected. CONCLUSION:By following the dosing protocol described, epidural catheters can be used safely and effectively to control postoperative pain after anterior instrumentation and spinal fusion for adolescent scoliosis.

背景与目标： 研究设计：对前路脊柱融合术和青春期脊柱侧弯器械置入硬膜外导管的患者进行了前瞻性评价。使用视觉模拟疼痛评分收集数据，以反映患者对疼痛控制的感知。
目的：介绍作者的硬膜外导管置入和给药方案技术，并演示连续10例患者经前路脊柱器械融合后术后疼痛控制的结果。
背景资料摘要：即使有比较硬膜外导管与静脉内吗啡患者自控麻醉的对照研究，有关脊柱外科手术后硬膜外导管益处的文献也相矛盾。作者认为，缺乏共识的原因在于导管置入过程中的各种硬膜外给药方案和技术，他们在自己的机构中轶事见证了这一点。这促使作者开发和完善用于脊柱手术后疼痛控制的标准化剂量和导管放置方案。
方法：在伤口闭合前术中放置硬膜外导管，然后在术后第5天取下。剂量由在无防腐剂盐水（0.2 mL / kg）中稀释的芬太尼（1 microg / kg）和氢吗啡酮（5 microg / kg）组成。手术后，剂量为0.1％罗哌卡因和氢吗啡酮（10微克/毫升），以0.2毫升/千克/小时的速度连续注入。在术后的每一天，使用视觉模拟疼痛量表（范围从0到10）评估术后疼痛的控制情况。
结果：手术后中位疼痛评分的算术平均值为2.1。 5天的最大疼痛评分平均值为4.1。三名患者需要硬膜外推注，硬膜外输注率增加20％。一名患者被判定为过度困倦，因此硬膜外输注率降低了20％。三名患者出现需要苯海拉明的瘙痒症。没有发现与硬膜外镇痛有关的其他不良反应。没有意外拔出或断开导管。
结论：按照所描述的给药方案，硬膜外导管可安全有效地控制青少年前路脊柱侧弯前路器械和脊柱融合术后的术后疼痛。

BACKGROUND & AIMS: BACKGROUND:Although thoracic epidural analgesia (TEA) is considered the gold standard for post-thoracotomy pain relief, thoracic paravertebral block (PVB) and intrathecal opioid (ITO) administration have also been shown to be efficacious. We hypothesized that the combination of PVB and ITO provides analgesia comparable with that of TEA. METHODS:After local ethics committee approval, 84 consecutive patients undergoing open thoracic procedures were randomized to the TEA (ropivacaine 0.2%+sufentanil) or the PVB (ropivacaine 0.5%)+ITO (sufentanil+morphine) group. The primary endpoints were pain intensities at rest and during coughing/movement at 1, 2, 4, 8, 12, 24, 48, and 72 h after operation assessed by visual analogue scale (VAS) score. Data were analysed by multivariate analysis (anova; P<0.05). RESULTS:Patient and surgical characteristics were comparable between the groups. The mean and maximal VAS scores were lower in the TEA (n=43) than in the PVB+ITO group (n=37) at several time points at rest (P<0.026) and during coughing/movement (P<0.021). However, in the PVB+ITO group, the mean VAS scores never exceeded 1.9 and 3.5 at rest and during coughing/movement, respectively; and the maximal differences between the groups (TEA vs PVB+ITO) in the maximal VAS scores were only 1.2 (3.4 vs 4.6) at rest, and 1.3 (4.4 vs 5.7) during coughing/movement. CONCLUSIONS:Although VAS scores were statistically lower in the TEA compared with the PVB+ITO group at some observation points, the differences were small and of questionable clinical relevance. Thus, combined PVB and ITO can be considered a satisfactory alternative to TEA for post-thoracotomy pain relief. ClinicalTrials.gov number. NCT00493909.

背景与目标： 背景：尽管胸膜硬膜外镇痛（TEA）被认为是开胸术后疼痛缓解的金标准，但是胸椎旁椎体阻滞（PVB）和鞘内阿片类药物（ITO）的给药也已被证明是有效的。我们假设PVB和ITO的组合可提供与TEA相当的镇痛效果。
方法：经当地伦理委员会批准，将84例接受开胸手术的患者随机分为TEA（罗哌卡因0.2％舒芬太尼）或PVB（罗哌卡因0.5％）ITO（舒芬太尼吗啡）组。主要目的是通过视觉模拟量表（VAS）评分评估术后1、2、4、8、12、24、48和72小时休息和咳嗽/运动过程中的疼痛强度。通过多变量分析对数据进行分析（方差分析； P <0.05）。
结果：两组患者的病情和手术特点均具有可比性。在休息（P <0.026）和咳嗽/运动（P <0.021）的几个时间点，TEA（n = 43）的平均和最大VAS评分低于PVB ITO组（n = 37）。然而，在PVB ITO组中，静息时和咳嗽/运动时，VAS的平均得分分别从未超过1.9和3.5。两组之间（TEA与PVB ITO）的最大VAS评分差异在静止时仅为1.2（3.4 vs 4.6），在咳嗽/运动时仅为1.3（4.4 vs 5.7）。
结论：尽管在某些观察点上，TEA的VAS评分在统计学上低于PVB ITO组，但差异很小且临床相关性值得怀疑。因此，开胸手术后疼痛缓解时，PVB和ITO的组合可被视为TEA的令人满意的替代品。 ClinicalTrials.gov号。 NCT00493909。

BACKGROUND & AIMS: BACKGROUND AND OBJECTIVES:This study examined the effect of lumbar flexion on the extent of the epidural block during lumbar epidural anesthesia. METHODS:The epidural catheter was introduced at the L3-4 interspace with the patient in the lateral decubitus position with the surgical side down. After administering a test drug (3 mL of 2% lidocaine and 15 mug of epinephrine), the patients were randomly allocated to 1 of 2 groups: Group F (n = 16, lumbar spine flexed) and Group N (n = 17, lumbar spine in the neutral position). In both groups, 2% lidocaine (16 mL) mixed with sodium bicarbonate (2 mL) was administered through the epidural catheter while the patient maintained the lateral decubitus position with the lumbar spine either flexed or in the neutral position. All the patients maintained their respective positions for 5 minutes and were subsequently turned to the supine position. The pinprick block level and the degree of motor blockade were assessed every 10 minutes for 60 minutes after administering the local anesthetics. A 2-dermatomal difference in uppermost block between groups was determined to be clinically significant. RESULTS:The median difference between groups in the uppermost pinprick block level was only 1.5 dermatomes and it did not satisfy our criteria for clinical significance. There were no significant differences between the 2 groups in the lowermost pinprick block level and the degree of motor block. CONCLUSIONS:Lumbar flexion has no clinically relevant effect on sensory spread during epidural anesthesia.

背景与目标： 背景与目的：本研究探讨了腰部硬膜外麻醉期间腰椎屈曲对硬膜外阻滞程度的影响。
方法：将硬膜外导管插入L3-4间隙，患者置于侧卧位，手术侧朝下。服用试验药物（3 mL 2％利多卡因和15杯肾上腺素）后，将患者随机分为2组中的1组：F组（n = 16，腰椎屈曲）和N组（n = 17，腰椎）脊柱在中立位置）。在两组中，通过硬膜外导管给予2％利多卡因（16 mL）和碳酸氢钠（2 mL）混合，同时患者保持侧卧位，腰椎弯曲或处于中立位置。所有患者保持各自姿势5分钟，随后转为仰卧姿势。局部麻醉后60分钟，每10分钟评估一次针刺阻滞水平和运动阻滞程度。两组之间最上层阻滞的2层皮肤差异被确定为具有临床意义。
结果：最高针刺阻滞水平组之间的中位数差异仅为1.5皮肤切开，不符合我们的临床意义标准。最低的针刺阻滞水平和运动阻滞程度在两组之间没有显着差异。
结论：腰椎屈曲对硬膜外麻醉过程中的感觉扩散没有临床相关影响。

BACKGROUND & AIMS: BACKGROUND:Transforaminal epidural steroid injection (TFESI) is a useful treatment modality for pain management. Most complications of TFESI are minor and transient. However, there is a risk of serious complications such as nerve injury, spinal cord infarct, or paraplegia. Some of the risks are related to direct injury to the vessel or intravascular injection of the particulate steroid. We prospectively tested the hypothesis that the intravascular injection rate of the Whitacre needle is lower than that of the Quincke needle during TFESI. METHODS:This study was a randomized trial of 1376 TFESIs at the S1 level. We collected data of age, gender, height, weight, laterality (right/left), history of lumbosacral spine operation, history of appropriate interval discontinuation of anticoagulation medicines, and underlying disease. During the S1 TFESI, intrasacral bone contact, a blood aspiration test, and real-time fluoroscopy of the intravascular injection using contrast media were investigated. RESULTS:There were no significant differences in the intravascular injection rate with respect to age, gender, height, weight, hypertension, diabetes mellitus, laterality, history of lumbosacral spine operation, or history of appropriate interval discontinuation of anticoagulation medicines. Intravascular injection was significantly associated with a blood aspiration test (P < 0.001), needle tip type (P = 0.002), intrasacral bone contact (P < 0.001), and physicians (some P < 0.05). The use of Quincke needles and intrasacral bone contact increased the rate of intravascular injection. CONCLUSIONS:To reduce the risk of intravascular injection, the use of Whitacre needles without intrasacral bone contact may be a safer and more effective approach.

背景与目标： 背景：经椎间孔硬膜外注射类固醇激素（TFESI）是一种有效的疼痛治疗方法。 TFESI的大多数并发症是次要的和短暂的。但是，存在严重并发症的风险，例如神经损伤，脊髓梗塞或截瘫。一些风险与直接伤害血管或类固醇的血管内注射有关。我们前瞻性地检验了在TFESI期间Whitacre针的血管内注射速率低于Quincke针的血管内注射速率的假设。
方法：这项研究是在S1级进行的1376个TFESI的随机试验。我们收集了年龄，性别，身高，体重，侧卧（左右），腰s部脊柱手术史，适当停用抗凝药物的间隔史以及潜在疾病的数据。在S1 TFESI期间，研究了contrast骨内接触，血液抽吸试验和使用造影剂对血管内注射进行实时荧光检查。
结果：在年龄，性别，身高，体重，高血压，糖尿病，侧卧，腰s部脊柱手术史或适当停用抗凝药物的历史方面，血管内注射率无显着差异。血管内注射与抽血试验（P <0.001），针尖类型（P = 0.002），s骨内接触（P <0.001）和医师（P ＜0.05）显着相关。使用Quincke针和s骨内接触可增加血管内注射的速度。
结论：为减少血管内注射的风险，使用不带intra骨内接触的Whitacre针可能是一种更安全，更有效的方法。

BACKGROUND & AIMS: :Malignant optic nerve glioma (MONG) is a rare but uniformly fatal disease that remains poorly understood. We describe a notable case of this rare disease occurring in the optic chiasm. Normal brain imaging and normal ophthalmic examination two years prior to diagnosis provide evidence for de novo genesis of MONG in our patient. Early response to steroids highlights the degree to which MONG can initially mimic inflammatory optic neuropathies and chiasmal syndromes. Our case also demonstrates a poor outcome with MONG even with current advanced therapy for glioblastoma including radiotherapy plus concomitant and adjuvant temozolomide (the EORTC/NCIC regimen) and bevacizumab.

背景与目标： ：恶性视神经胶质瘤（MONG）是一种罕见的但致命的疾病，至今知之甚少。我们描述了这种罕见疾病在视神经交叉症中发生的显着情况。诊断前两年的正常大脑成像和正常眼科检查为我们的患者重新发生MONG提供了证据。对类固醇的早期反应突显了MONG最初可模拟炎症性视神经病变和chiasmal综合征的程度。我们的病例还证明，即使采用目前针对胶质母细胞瘤的先进疗法（包括放疗，伴随和辅助的替莫唑胺（EORTC / NCIC方案）和贝伐单抗），MONG的预后也很差。