The Change of Blood Glucose and Cortisol Levels after Three Consecutive Epidural Steroid Injections

OBJECTIVE: To investigate the change of blood glucose and cortisol levels after three consecutive epidural steroid injections METHOD: Fifteen patients with low back pain and radiating pain were included. Three consecutive epidural injections were performed weekly. The serum glucose, insulin and cortisol levels were measured 30 minutes before the 1st injection and at 24 hours and l week after each injection. RESULTS: There were significant changes in the result of glucose and insulin levels at 24 hours after each injection (p<0.05), but no signigicant changes at 1 week compared with pre-injection level. The cortisol level significantly decreased at 24 hours after 1st injection and did not return to pre-injection level at 1 week after 1st injection (p<0.05). There were no further increases in the glucose and insulin levels and no further decrease in the cortisol level after each of the three consecutive injections. CONCLUSION: Three consecutive epidural injections at 1 week interval seems to be as safe procedure. But significant suppression of cortisol kept on for 1 week, so it should be taken into account when patients with previous epidural injection undergo major stress.

The Usefulness of Supine Position on Swallowing of Liquid Diet in Neurogenic Dysphagia: Comparison with Sitting Position

OBJECTIVE: The purpose of this study is to find the proper feeding posture for the safe liquid meal in the patients with neurogenic dysphagia. METHOD: Fifty patients of neurogenic dysphagia with tracheal aspiration diagnosed with the videofluoroscopic swallowing test (VFST) were evaluated. VFST using 5 cc of barium solution was done for each patient in the sitting and supine position. The results of VFST of supine position were analyzed and compared with those of sitting position for the tracheal aspiration, laryngeal penetration, premature leakage, and laryngeal spillage. RESULTS: The incidence of premature leakage, tracheal aspiration, and laryngeal penetration is significantly decreased in the supine position (56%, 14% and 46%) compared to the sitting position (96%, 100% and 100%) (p<0.001). The incidence of laryngeal penetration referable to the swallowing reflex is significantly decreased in the supine position (0%, 46%, 0%) compared to the sitting position (14%, 96%, 44%) (p<0.001). The incidence of nasal regurgitation is 2% in the sitting position and 30% in the supine position. CONCLUSION: The incidence of tracheal aspiration of liquid diet is significantly decreased in the supine position compared to the sitting position. The supine position would be safer than the sitting position in the feeding of liquid diet.