Effectiveness of direct needle puncture for complete hepaticojejunostomy anastomotic stricture after pancreaticoduodenectomy (with video).

A 79-year-old Japanese woman, who had undergone pancreaticoduodenectomy 6 months prior to presentation owing to pancreatic cancer, complained of jaundice with high fever. Computed tomography revealed proximal bile duct dilatation with complete hepaticojejunostomy anastomotic stricture (HJAS). We performed a single-balloon endoscopy for biliary drainage. The presence of a scar-like feature surrounding the anastomosis was identified as the HJAS. White-light imaging during single-balloon endoscopy revealed that the HJAS contained a milky whitish area (MWA), suggesting that a membranous and fibrosis layer affected continuous inflammation around the center of the anastomosis (within a scar-like feature). Endoscopic dilatation was performed using an endoscopic injection needle, with the MWA used as an indicator. A 23-gauge endoscopic injection needle was used to penetrate the center of the blind lumen within the MWA, and a pinhole was created in the stricture. After confirming the position of the proximal bile duct using a contrast medium with the needle, an endoscopic guidewire with a cannula was inserted into the pinhole. A through-the-scope sequential balloon dilator was used to dilate the stricture, and a plastic stent was inserted into the proximal bile duct. This endoscopic intervention led to positive outcomes. In cases of complete HJAS occlusion, an endoscopic approach to the bile duct is difficult because the anastomotic opening of the HJAS is not visible. Thus, puncturing within the MWA, which can be used as a scar-like landmark within a complete membranous HJAS, is considered a useful endoscopic strategy.

Trabecular Meshwork Regeneration for Glaucoma Treatment Using Stem Cell-Derived Trophic Factors.

Glaucoma is one of the leading causes of irreversible blindness. Stem cell therapy has shown promise in the treatment of primary open-angle glaucoma in animal models. Stem cell-free therapy using stem cell-derived trophic factors might be in demand in patients with high-risk conditions or religious restrictions. In this chapter, we describe methods for trabecular meshwork stem cell (TMSC) cultivation, secretome harvesting, and protein isolation, as well as assays to ensure the health of TMSC post-secretome harvesting and for secretome periocular injection into mice for therapeutic purposes.

How Much Time Do Focal Treatments for Retinoblastoma Add to Anesthetic Exposure?

Introduction: Children with retinoblastoma have anesthesia for exams and treatment, but there is little information about how long treatment interventions (laser, cryotherapy, and intravitreal injections) add to routine exams under anesthesia (EUA). This information would be useful for planning operating room schedules, staff schedules, family expectations, and billing. Methods: A retrospective, single-center, Institutional Review Board (IRB) approved review of anesthesia duration for retinoblastoma children undergoing EUA with laser, cryotherapy, or intravitreal injections performed at MSK between January 2019 and November 2023. Results: Three hundred eight patients had 2,399 EUAs. The average EUA lasted 24.3 min (range 7-77 min) when no interventions were done. Laser photocoagulation added an average of 18.9 min (range 19-77 min), cryotherapy 26.1 min (range 27-75 min), and intravitreal injection 23.5 min (range 10-71 min) to the basic EUA time. Bilateral laser treatments took 8 min longer than unilateral treatments. Conclusion: EUAs for children with retinoblastoma can be performed relatively quickly. Interventions such as laser, cryotherapy, or intravitreal injections roughly double the time under anesthesia but in some cases can take much longer (>1 h).

Small Intestine Ectopic Varices as a Cause of Obscure Gastrointestinal Bleeding in a Cirrhotic Patient.

Portal hypertension is a major complication of liver cirrhosis, leading to various life-threatening conditions. The most common of these is the formation and bleeding of varices at the portosystemic anastomosis. Varices are most commonly esophageal or gastric and less commonly ectopic. Although ectopic varices are rare, they should be considered as a cause of obscure gastrointestinal bleeding in cirrhotic patients. We present a case of ruptured ectopic varices in the small intestine of a known cirrhotic patient who presented with anemia and melena, alternated with hematochezia. The case was managed with Histoacryl® injection using push enteroscopy, resulting in adequate hemostasis.

Liposomal Ozonated Oil Ensures a Further Reduction in the Microbial Load Before Intravitreal Injection: the "OPERA" Study.

INTRODUCTION: This was a prospective study to investigate the antimicrobial efficacy of a novel ophthalmic solution comprising ozonated sunflower oil in liposomes plus hypromellose in conjunction with liposomal foam (BlefOX), in patients undergoing intravitreal injection, in comparison to povidone iodine 5%. METHODS: The study employed a paired-eye design with n = 195 patients and a total of n = 390 eyes divided into two groups. Conjunctival swabs were collected from both eyes of each patient at baseline (T0-3 days before the injection). The study group underwent home therapy, which included instilling two drops of an isotonic ophthalmic solution containing 0.5% ozonated sunflower oil in liposomes plus hypromellose (Ozodrop) four times daily and applying liposomal foam twice daily to the eye undergoing intravitreal injections. In contrast, the control group (contralateral eyes) received treatment with povidone iodine 5%. This treatment regimen was maintained for 3 days. At T1 (10 min before injection), all patients instilled one drop of a topical solution of povidone iodine 5% into the conjunctival sac of both eyes. After 30 seconds had elapsed, a conjunctival swab was obtained for each eye in both study groups. RESULTS: The results, derived from conjunctival swabs, exhibited a significant reduction in the microbial load of the study group on both chocolate agar and blood agar (p ≤ 0.007). The study demonstrated that the combination of povidone iodine 5% + Ozodrop + BlefOX provides a greater reduction in microbial load than povidone iodine 5% alone on both chocolate agar (141 [72.31%] vs. 98 [50.26%], p < 0.0001) and blood agar (130 [66.67%] vs. 97 [49.74%], p = 0.0007). The combination of povidone iodine 5% + Ozodrop + BlefOX resulted in the killing of approximately 41% to 49% of bacteria compared to povidone iodine 5% alone on the chocolate agar and blood agar, respectively. CONCLUSIONS: Liposomal ozonated oil treatment, coupled with liposomal foam, in patients undergoing intravitreal injection led to a substantial reduction in conjunctival microbial load compared to eyes treated solely with povidone iodine 5%.

Image-Guided Foot and Ankle Injections.

Ultrasound is a high-resolution, real-time imaging modality that is frequently used for image-guided procedures. Due to the highly complex anatomy of the foot and ankle, ultrasound should be considered a first-line imaging modality for injections and procedures in this region.

Quantitative classification evaluation model for tight sandstone reservoirs based on machine learning.

Tight sandstone reservoirs are a primary focus of research on the geological exploration of petroleum. However, many reservoir classification criteria are of limited applicability due to the inherent strong heterogeneity and complex micropore structure of tight sandstone reservoirs. This investigation focused on the Chang 8 tight reservoir situated in the Jiyuan region of the Ordos Basin. High-pressure mercury intrusion experiments, casting thin sections, and scanning electron microscopy experiments were conducted. Image recognition technology was used to extract the pore shape parameters of each sample. Based on the above, through grey relational analysis (GRA), analytic hierarchy process (AHP), entropy weight method (EWM) and comprehensive weight method, the relationship index Q1 between initial productivity and high pressure mercury injection parameters and the relationship index Q2 between initial productivity and pore shape parameters are obtained by fitting. Then a dual-coupled comprehensive quantitative classification prediction model for tight sandstone reservoirs was developed based on pore structure and shape parameters. A quantitative classification study was conducted on the target reservoir, analyzing the correlation between reservoir quality and pore structure and shape parameters, leading to the proposal of favourable exploration areas. The research results showed that when Q1 ≥ 0.5 and Q2 ≥ 0.5, the reservoir was classified as type I. When Q1 > 0.7 and Q2 > 0.57, it was classified as type I1, indicating a high-yield reservoir. When 0.32 < Q1 < 0.47 and 0.44 < Q2 < 0.56, was classified as type II. When 0.1 < Q1 < 0.32 and 0.3 < Q2 < 0.44, it was classified as type III. Type I reservoirs exhibit a zigzag pattern in the northwest part of the study area. Thus, the northwest should be prioritized in actual exploration and development. Additionally, the initial productivity of tight sandstone reservoirs showed a positive correlation with the porosity, permeability, sorting coefficient, coefficient of variation, and median radius. Conversely, it demonstrated a negative correlation with the median pressure and displacement pressure. The perimeters of pores, their circularity, and the length of the major axis showed a positive correlation with the porosity, permeability, sorting coefficient, coefficient of variation, and median radius. On the other hand, they exhibited a negative correlation with the median pressure and displacement pressure. This study quantitatively constructed a new classification and evaluation system for tight sandstone reservoirs from the perspective of microscopic pore structure, achieving an overall model accuracy of 93.3%. This model effectively predicts and evaluates tight sandstone reservoirs. It provides new guidance for identifying favorable areas in the study region and other tight sandstone reservoirs.

"Advancements in minimally invasive treatment for lumbar disc herniation: insights into condoliase and chondroitin sulfate ABC endolyase".

This study examines the efficacy and safety of condoliase chemonucleolysis (CC) in treating lumbar disc herniation (LDH) and highlights emerging alternatives like chondroitin sulfate ABC endolyase. Research indicates that condoliase, an enzyme used to degrade glycosaminoglycans in the nucleus pulposus, provides effective and prompt relief of leg pain, with significant reductions observed within a day of treatment. Studies reveal that a lower pretreatment straight leg raising (SLR) angle may predict early symptom relief, and condoliase is generally effective at doses up to 1.25 U, balancing efficacy and safety. Despite promising results, concerns about long-term safety, including disc height reduction and imaging changes, persist. Additionally, chondroitin sulfate ABC endolyase shows potential as a safer and more effective alternative, though further research is needed to optimize treatment protocols and assess long-term outcomes. Future investigations should address current limitations, such as small sample sizes and short follow-up periods, to better understand the long-term benefits and risks of these treatments.

Brainstem Anesthesia During Retrobulbar Block: An Eye-Opener Clinical Case.

The use of a retrobulbar anesthetic block for surgery of the posterior chamber is a common, effective, and safe practice, although not without risks. This clinical case aims to describe one of the most feared complications of this ophthalmic block, which demands a high degree of suspicion and agility for proper diagnosis and management. A 91-year-old female patient, physical status ASA III, presents for vitrectomy via pars plana of the left eye due to retinal detachment. Light sedoanalgesia was performed, as well as a left retrobulbar block with 5 mL of local anesthetic. Approximately two minutes after the injection of the local anesthetic, she developed a sudden clinical decline of consciousness, accompanied by bilateral photoplegic mydriasis, sinus tachycardia, and hypertension, followed by central apnea. Orotracheal intubation and connection to a ventilatory prosthesis were performed, maintaining adequate oxygenation, ventilation, and hemodynamic stability. No abnormal findings were found in complementary diagnostic methods. The condition progressively reversed, with a gradual return to the initial state of consciousness, and it was possible to successfully extubate the patient after four hours. The patient remained stable, under surveillance, and was discharged home after 48 hours with no neurological impairment or ophthalmological complications. The clinical findings are compatible with brainstem anesthesia, explained by the dispersion of the local anesthetic into the subarachnoid space, through an inadvertent puncture of the ophthalmic artery or the meninges that involve the optic nerve. Although this event is a rare complication, a low threshold of suspicion should be maintained, given the potential severity of the clinical condition. Early recognition should be followed by a systematic A-B-C-D-E approach, and the outcomes are often favorable. Careful surveillance and monitoring should accompany the performance of ophthalmic surgical procedures, and the presence of an anesthesiologist is essential for the quality of the services provided and patient safety.

Acute renal infarction mimicking renal colic: A case report and review of the literature.

Renal infarction is a rare pathology, which can be life-threatening for the kidney. Its low incidence and non-specific clinical manifestations make it difficult to diagnose, often resulting in delayed or misdiagnosis. Contrast-enhanced CT has a role to play in early positive diagnosis, enabling rapid and effective management. We report the case of a right renal infarction simulating renal colic, with a review of the literature.

The effectiveness of cervical transforaminal epidural steroid injections for the treatment of cervical radicular pain: A prospective cohort study reporting 12-month outcomes.

Objectives: To evaluate the effectiveness of cervical transforaminal epidural steroid injection (CTFESI) for the treatment of unilateral cervical radicular pain. Design: Single-group prospective cohort study. Methods: Outcomes included ≥50% reductions in Numeric Rating Scale (NRS) for arm pain, ≥30% Neck Disability Index (NDI-5) improvement, health-related quality of life (EQ-5D), global improvement (PGIC), personal goal achievement (COMBI), Chronic Pain Sleep Index (CPSI), and healthcare utilization at one, three, six, and 12 months. Data analysis included descriptive statistics with the calculations of 95% confidence intervals (CIs), contingency table analysis, and multilevel logistic regression (LR) analysis, including a worst-case (WC) sensitivity analysis in which missing data were treated as treatment failure. Participants who were treated surgically were considered failures in the categorical analyses. Results: 33 consecutively enrolled participants (63.6% females, 51.2 ± 12.2 years of age, BMI 28.3 ± 4.5 kg/m2) were analyzed. Success rates for ≥50% reduction in NRS for arm pain at one, three, six and 12 months were 57.6% (95% CI 40.8-72.8%), 71.9% (95% CI 54.6-84.4%), 64.5% (95% CI 46.9-78.9%), and 64.5% (95% CI 46.9-78.9%). Success rates for ≥30% improvement in NDI-5 were 60.6% (95% CI 43.7-75.3%), 68.8% (95% CI 51.4-82.0%), 61.3% (95% CI 43.8-76.3%), and 71.0% (95% CI 53.4-83.9%). In WC analysis, success rates for ≥50% arm NRS and NDI-5 were 0-4.3% lower between 1 and 12 months. PGIC scores were at least "much improved" or "very much improved," in 48.4-65.6% of participants between 1 and 12 months. 6.1%, 6.1%, and 3.0% had one, two, or three repeat injections, respectively. 18.2% of participants underwent surgery by 12 months. Participants showed significant improvements in arm NRS and NDI-5 after treatment (p < 0.05), multilevel logistic regression models showed no significant decline in improvements across the follow-up time points (p > 0.05). Conclusion: Statistically significant and clinically meaningful improvements in pain and disability were observed after CTFESI for up to 12 months in individuals with unilateral cervical radicular pain.

Enhancing security in digitized healthcare system using blockchain technology.

BACKGROUND: In the modern medical industry, sensors and other medical electronic equipment such as ECG, thermometers, etc. that measure vitals like blood pressure, body temperature, heartbeat, and blood cells are used to record patient data. The information gathered helps to create a patient profile, which in turn helps doctors treat patients appropriately and helps users gain insights into their health. But, the information collected is regionally specific and not worldwide. Thus, this may create problems in transparency, integrity, and much more. The medical details of patients collected are stored in a simple database which appears to be a centralized application that is prone to be modified or hacked by intruders and also suffers from fault tolerance. OBJECTIVE: This paper aims to solve this problem using Blockchain and Data Possession methodologies. METHODS: Blockchain helps to store multiple copies of data in a decentralized fashion. Thus, a secured model could be implemented using blockchain in which the patient's data can be securely sent to any medical professional, thus promoting transparency, security, and integrity. RESULTS: Provable Data Possession helps the users to verify that their information is intact and has not been tampered. It can be achieved using cryptography which encrypts the information of the patients stored. CONCLUSION: This paper will be beneficial for the medical department and the public such that it will be beneficial in terms of transparency, scalability, and security.

Midazolam-Induced Seizure-Like Activity in Five Neonates: A case series.

An intravenous (IV) administration of midazolam may result in seizure-like activity or movement. This report describes 5 neonates who developed seizure-like movements after IV midazolam injection. The patients presented between 2019 and 2022 and were admitted to a neonatal intensive care unit located within an academic centre in Muscat, Oman. The abnormal movements occurred shortly after IV bolus administration of midazolam. None of the patients experienced seizure-like movements after receiving midazolam infusions. The seizure-like movements were aborted either spontaneously or by antiseizure medications. In addition, seizure recurrence was not observed in any of the infants during the later stages of their treatment. Since this adverse effect might be related to the speed of the bolus administration, IV midazolam must be given as a slow bolus over 2-3 minutes followed by a slow flush of normal saline. To prevent midazolam's potential adverse effect on newborns, neonatal caregivers must be aware of it.

Bioequivalence of Meloxicam Nanocrystal Injection in Healthy Chinese Volunteers.

This single-center, randomized, open, two-preparation, single-dose, two-period, self-crossover trial aimed to assess the bioequivalence and safety of the test (T) preparation compared to the reference (R) preparation following intravenous injection in healthy subjects under fasting conditions. Twenty-four healthy subjects were enrolled in the study and subjects were randomly divided into two groups at a 1:1 ratio and were administered once per period, with an 8-day washout period. During each period, serum drug concentrations were detected for pharmacokinetic analysis and adverse events were recorded for safety analysis. The 90% confidence intervals for the geometric mean ratios (T:R) of maximum serum concentration, area under the serum concentration-time curve from time zero to the last measurable concentration, and area under the serum concentration-time curve from time zero to infinite time fell within the predefined bioequivalence range of 80%-125%, indicating bioequivalence between the T and R preparation under fasting conditions. Additionally, four subjects (16.7%) experienced five instances of adverse events in the T group, while five subjects (21.7%) experienced five instances of adverse events in the R group. This trial indicated the potential bioequivalence between the T and R products under fasting conditions, based on pharmacokinetic and safety profile.

The impact of intracytoplasmic sperm injection versus conventional in vitro fertilization on the reproductive outcomes of couples with non-male factor infertility and frozen-thawed embryo transfer cycles.

This study was aimed to investigate the impact of intracytoplasmic sperm injection (ICSI) on reproductive outcomes in couples with non-male factor infertility and frozen-thawed embryo transfer (FET) treatment. This retrospective cohort study involved a total of 10,143 cycles from 6206 couples who underwent FET at the Third Affiliated Hospital of Zhengzhou University between January 2016 and September 2022. Patients were categorized into two groups based on the insemination methods of transferred embryos. Clinical and neonatal outcomes were compared between ICSI and conventional in vitro fertilization (cIVF) groups. The results showed that ICSI was not associated with improved clinical outcomes compared to cIVF. However, ICSI was associated with lower birthweight when twins were born. In conclusion, although subgroup analysis showed that ICSI was associated with slightly improved live birth rate for infertile couples with non-male factor infertility compared to cIVF, the regression analysis showed that ICSI did not demonstrate any improvement of the reproductive outcomes. The infertile women with twin pregnancies should be further informed of the lower birthweight and lower birth length when their oocytes were inseminated with ICSI. The findings of this study provide valuable insights for clinicians when discussing the benefits and risks of ICSI in patients with non-male factor infertility.

Comparison of the efficacy and adverse effects of oral ferrous succinate tablets and intravenous iron sucrose: a retrospective study.

OBJECTIVE: To analyse the clinical efficacy and adverse drug reactions (ADRs) of iron preparations. METHODS: A total of 374 patients with iron deficiency anaemia admitted to our hospital between 1 January and 31 December 2020 were included in this study. They were divided into 2 groups based on their medication regimens: Group A (n = 187) took oral ferrous succinate tablets, and Group B (n = 187) received intravenous iron sucrose. The remission of major symptoms, laboratory test results, ADRs and other related data were collected after 4 weeks of treatment. RESULTS: Compared with the pre-treatment baseline, haemoglobin (Hb), serum iron (SI), serum ferritin (SF) and the mean corpuscular volume (MCV) increased in both groups at 4 weeks of treatment (P < 0.05). After treatment, Group A had lower levels of Hb (108.41 ± 8.39 vs. 122.31 ± 6.04 g/L, t = 6.293, P < 0.001), SI (9.72 ± 4.24 vs. 15.62 ± 5.41 µmol/L, t = 5.482, P < 0.001) and SF (27.1 ± 10.82 vs. 39.82 ± 10.44 ug/L, t = 6.793, P < 0.001) compared with Group B. In contrast, there was no significant difference in the post-treatment level of MCV (P > 0.05). The overall response rate significantly differed between the 2 groups (78.61% vs. 90.91%, χ2 = 10.949, P < 0.001). The incidence of ADRs of both groups were similar, and the difference was not statistically significant (χ2 = 0.035, P = 0.851). CONCLUSION: Iron sucrose demonstrates favourable efficacy and safety in treating iron deficiency anaemia.

Visceral Fat Associated with Worsening of Recurrent Esophageal Varices in Alcoholic/Nonalcoholic Steatohepatitis-Related Liver Cirrhosis.

BACKGROUND: Alcoholic steatohepatitis and nonalcoholic steatohepatitis-related liver cirrhosis (ASH/NASH-LC) are major causes of esophageal varices (EVs). However, the association between high visceral fat and exacerbation of EVs remains unclear. The aim of this study was to clarify the association of visceral fat and recurrence rate of EVs in ASH/NASH-LC and to identify independent predictors associated with recurrence. METHODS: We retrospectively evaluated data from 94 patients who underwent endoscopic injection sclerotherapy for EVs with ASH/NASH-LC. Using the receiver operating characteristic curve for the cut-off value of visceral fat index (VFI; 46.4 cm2/m2), we classified patients as having a high VFI (n = 53) or low VFI (n = 41). Propensity score matching was used to align for background factors, and the recurrence rate of EVs was compared between the two groups. Predictors associated with esophageal variceal recurrence were identified by multivariate analysis. The recurrence rate in patients with viral LC was also investigated. RESULTS: In the overall analysis, the recurrence rate was significantly higher in the high VFI group than in the low VFI group (P = 0.023). The recurrence rate was also higher in the high VFI group than in the low VFI group after propensity score matching, in which 19 patients were matched in each group (P = 0.048). VFI and Child-Pugh score were independently associated with recurrence. Recurrence rates were comparable between the two groups in viral LC patients. CONCLUSIONS: Worsening of variceal recurrence was observed in high visceral fat patients in ASH/NASH-LC but not in viral LC. Furthermore, high visceral fat was an independent predictor associated with variceal recurrence.

Association between intra-articular hyaluronic acid injections in delaying total knee arthroplasty and safety evaluation in primary knee osteoarthritis: analysis based on Health Insurance Review and Assessment Service (HIRA) claim database in Republic of Korea.

BACKGROUND: The prevalence of knee osteoarthritis (KOA), a progressive degenerative disease, is gradually increasing, and it is a progressive degenerative disease. In patients with mild-to-moderate KOA, intra-articular hyaluronic acid (IA-HA) has been shown to be an effective non-operative treatment option that can provide significant pain relief and symptom improvement by increasing intra-articular viscoelasticity. This study aimed to evaluate the efficacy of IA-HA injections in delaying total knee arthroplasty (TKA) and the safety of IA-HA according to IA-HA type and combination with intra-articular corticosteroid (IA-CS) using a large health insurance claim database. METHODS: For this retrospective cohort study, the study population included patients aged ≥ 50 years with a first diagnosis of KOA between 2009 and 2014, who underwent TKA by 2020, using the Health Insurance Review and Assessment Service claim database in Republic of Korea. IA-HA injections were categorized as single or multiple injection regimen agents. Cox proportional hazard models estimated hazard ratios (HR) for TKA risk, adjusted for covariates. Logistic regression assessed the occurrence of adverse events after IA-HA administration. RESULTS: In all, 36,983 patients were included. Patients who received IA-HA injections had a significantly longer time to TKA compared to those who did not (mean delay of approximately 1 year). The IA-HA group had a significantly lower risk of TKA (HR: 0.61, 95% CI: 0.60-0.62) than non-IA-HA group after adjusting for covariates, which included age, sex, medical history, number of hospital beds, and CS injection. Single injection IA-HA regimen agents showed the longest time to TKA and lowest risk (HR: 0.56, 95% CI: 0.53-0.59). TKA risk decreased with the number of IA-HA cycles. Adverse events occurred in 6.7% of IA-HA cases without CS, with very low incidence of infection. Multiple injection regimen agents (multiple injection regimen 7.0% vs. single injection regimen 3.6%) and concurrent IA-CS use (concurrent IA-CS use 13.9% vs. IA-HA only 6.7%) were associated with higher infection risk. CONCLUSION: IA-HA injections were associated with a significant delay in TKA among patients with KOA. Single-injection regimen agents had the lowest TKA risk. Infection risk increased with multiple injections and concurrent IA-CS use. These findings could suggest the use of IA-HA as an effective non-operative intervention option for managing KOA and delaying TKA. Careful selection of IA-HA type and consideration of concurrent IA-CS use could play a role in delaying the time to TKA and reducing complications.

Causes, risk factors, and complications of accidental intra-arterial administration of medications in a children's hospital: a case series.

BACKGROUND: Accidental intra-arterial administration of a medication can lead to serious iatrogenic harm. Most studies have discussed single cases of accidental intra-arterial administration of a medication, but only a few have described multiple cases occurring in a single, pediatric hospital setting. METHODS: The subjects were pediatric patients with an accidental intra-arterial administration of a medication. After obtaining approval from the institutional review board, the relevant cases were extracted from incident reports submitted to the patient safety office of the study center between November 2016 and April 2023. RESULTS: A review of 18,204 incident reports yielded 10 cases (patient age: 27 days to 13 years) of accidental intra-arterial administration of a medication. The most common site of the cannulation was the dorsum of the foot followed by the dorsum of the hand. The medications administered were narcotics, sedatives, muscle relaxants, antibiotics, and crystalloids. No serious adverse events occurred after injection. In some cases, the accidental arterial cannulation was not discovered immediately (53 min to 26 days). Seven patients had difficult intravenous access; in two of these, ultrasound-guided peripheral venous cannulation was used. CONCLUSIONS: We experienced 10 cases of accidental intra-arterial administration of a medication. The dorsalis pedis artery and the radial artery around the anatomical tobacco socket were common sites of unintentional arterial cannulation. Difficult intravenous (IV) access may be associated with unintentional arterial cannulation. If IV access is difficult or the free IV drip is sluggish, strict vigilance and repeated confirmation are needed to prevent unintentional arterial cannulation.