ABSTRACT
Patients undergoing a panic attack (PA) or a hyperventilation attack (HVA) are sometimes admitted to emergency departments (EDs). Reduced serotonin level is known as one of the causes of PA and HVA. Serotonin is synthesized from tryptophan. For the synthesis of serotonin, vitamin B6 (Vit B6) and iron play important roles as cofactors. To clarify the pathophysiology of PA and HVA, we investigated the serum levels of vitamins B2, B6, and B12 and iron in patients with PA or HVA attending an ED. We measured each parameter in 21 PA or HVA patients and compared the values with those from 20 volunteers. We found that both Vit B6 and iron levels were significantly lower in the PA/HVA group than in the volunteer group. There was no significant difference in the serum levels of vitamins B2 or B12. These results suggest that low serum concentrations of Vit B6 and iron are involved in PA and HVA. Further studies are needed to clarify the mechanisms involved in such differences.
Subject(s)
Anemia, Iron-Deficiency/complications , Hyperventilation/etiology , Iron/blood , Panic Disorder/etiology , Vitamin B 6 Deficiency/complications , Vitamin B 6/blood , Adult , Anemia, Iron-Deficiency/blood , Female , Hemoglobins/metabolism , Humans , Hyperventilation/blood , Multivariate Analysis , Panic Disorder/blood , Riboflavin/blood , Serotonin/metabolism , Vitamin B 12/blood , Vitamin B 6 Deficiency/blood , Young AdultABSTRACT
A selective lumbosacral nerve root block is generally is performed under X-ray fluoroscopy, which has the disadvantage of radiation exposure and the need for fluoroscopy equipment. In this study, we assessed the effectiveness of ultrasound and nerve stimulation-guided S1 nerve root block on 37 patients with S1 radicular syndrome. With the patient in a prone position, an ultrasound scan was performed by placing the probe parallel to the body axis. The needle was pointed slightly medial from the lateral side of the probe and advanced toward a hyperechoic area in the sacral foramina with ultrasound guidance. Contrast medium was then injected and its dispersion confirmed by fluoroscopy. The acquired contrast images were classified into intraneural, perineural, and paraneural patterns. The significance of differences in the effect of the block among the contrast image patterns was analyzed. After nerve block, decreased sensation at the S1 innervated region and pain relief was achieved in all patients. No significant difference was noted in the effect of the block between perineural and paraneural patterns. In conclusion, this technique provided reliable S1 nerve root block in patients with S1 radicular syndrome and minimized radiation exposure.
Subject(s)
Low Back Pain/diagnostic imaging , Low Back Pain/therapy , Nerve Block/methods , Pain Management/methods , Radiculopathy/therapy , Adult , Aged , Contrast Media/administration & dosage , Electric Stimulation/methods , Female , Fluoroscopy/methods , Humans , Male , Middle Aged , Needles , Radiculopathy/diagnostic imaging , Sacrum/diagnostic imaging , Spinal Nerve Roots/diagnostic imaging , Ultrasonography , Young AdultABSTRACT
We describe the use of short-term epoprostenol in a 61-year-old man with primary pulmonary hypertension. The patient was on a ventilator because of respiratory distress. Continuous infusion of epoprostenol was started and it initially reduced the pulmonary artery pressure by 32%. Epoprostenol was tapered, and even after discontinuation, the pulmonary artery pressure was controlled. The ventilator was removed, and the patient remained well on home oxygen therapy 3 months after discharge.
