[Diagnosis and treatment of 18 cases of Chiari malformation with hoarseness].

Objective: To investigate the diagnosis and treatment of Chiari malformation patients with hoarseness and other otorhinolaryngological symptoms. Methods: The clinical data of 18 patients of Chiari malformation with hoarseness were retrospectively collected, which was composed of 5 men and 13 women, aged 3-71 with median age of 52. All the patients were admitted to the Affiliated Hospital of Qingdao University from January 1989 to January 2020. All patients underwent brain MRI and laryngoscopy. The patient's symptoms and first diagnosis department, diagnosis time, total course of disease, hoarseness course, diagnosis and treatment, and postoperative recovery time were summarized. Follow-up time was 3-16 years, with median follow-up time of 6.5 years. Descriptive methods were used for analysis. Results: The first visit departments of 18 patients included neurology (9 cases), otorhinolaryngology head and neck surgery (5 cases), pediatrics (2 cases), orthopedics (1 case) and respiratory department (1 case). Except for the 7 cases in neurology department, the other 11 patients were not diagnosed in time. The disease duration of 18 patients with Chiari malformation ranged from 2 months to 5 years, and hoarseness was present from 20 days to 5 years. After diagnosis, 9 patients underwent posterior fossa decompression surgery, and 1 of them underwent syrinx drainage at the same time. The symptoms of 8 cases improved significantly after operation, with the improvement time from 1 to 30 days. In addition, 9 patients chose conservative treatment, among whom 8 had no improvement in symptoms and 6 progressed. Conclusions: Posterior fossa decompression is an effective treatment for Chiari malformation, and the prognosis is good. Timely diagnosis and treatment can improve the prognosis of patients.

Clonal Expansion of Stem/Progenitor Cells in Cancer, Fibrotic Diseases, and Atherosclerosis, and CD47 Protection of Pathogenic Cells.

We proposed and demonstrated that myelogenous leukemia has a preleukemic phase. In the premalignant phase, normal hematopoietic stem cells (HSCs) gradually accumulate mutations leading to HSC clonal expansion, resulting in the emergence of leukemic stem cells (LSCs). Here, we show that preleukemic HSCs are the basis of clonal hematopoiesis, as well as late-onset blood diseases (chronic-phase chronic myeloid leukemia, myeloproliferative neoplasms, and myelodysplastic disease). The clones at some point each trigger surface expression of "eat me" signals for macrophages, and in the clones and their LSC progeny, this is countered by upregulation of "don't eat me" signals for macrophages such as CD47,opening the possibility of CD47-based therapies. We include evidence that similar processes result in fibroblast expansion in a variety of fibrotic diseases, and arterial smooth muscle clonal expansion is a basis of atherosclerosis, including upregulation of both "eat me" and "don't eat me" molecules on the pathogenic cells.

LncRNA SNHG17 promotes proliferation and invasion of ovarian cancer cells through up-regulating FOXA1.

OBJECTIVE: This study was designed to investigate the specific mechanism through which long non-coding RNA (lncRNA) SNHG17 promotes the proliferative capacity and invasiveness of ovarian tumor cells. PATIENTS AND METHODS: Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) detected the expressions of SNHG17 and FOXA1 in 30 pairs of ovarian cancer tissue specimens and corresponding adjacent ones. Meanwhile, in ovarian cancer cell lines (A2780, OVCAR3, SKOV3, CAOV3) and normal ovarian epithelial cell line (IOSE80), SNHG17 and FOXA1 mRNA levels were also examined. In in vitro experiment, si-SNHG17, si-FOXA1, and their corresponding negative controls were transfected into ovarian cancer cell lines, respectively. After that, Cell Counting Kit-8 (CCK-8) and plate cloning experiments were carried out to examine cell proliferation ability, while transwell assay was performed for cell invasiveness detection. Lastly, the interplay between SNHG17 and FOXA1 was further assessed via qRT-PCR and Western blot. RESULTS: qRT-PCR results indicated that SNHG17 expression was remarkably enhanced in ovarian cancer tissue samples compared with that in adjacent ones. In addition, ovarian cancer cells also contained higher expression of SNHG17 than the normal ovarian epithelial cells. However, down-regulating SNHG17 attenuated the cell proliferation and invasive ability. At the same time, compared with that in adjacent tissue samples, FOXA1 also showed a higher expression in ovarian cancer tissues, which was positively correlated with SNHG17. Silencing SNHG17 markedly downregulated FOXA1 expression at both mRNA and protein levels. Furthermore, downregulation of FOXA1 expression was found to be able to inhibit cell proliferation and invasion as well. CONCLUSIONS: LncRNA SNHG17 can promote ovarian tumor cell proliferative ability and invasiveness by upregulating FOXA1, and serve as a potential therapeutic target for ovarian cancer.

LncRNA LUCAT1 promotes proliferation of ovarian cancer cells by regulating miR-199a-5p expression.

OBJECTIVE: To investigate the biological effect of long non-coding ribonucleic acid (lncRNA) lung cancer-associated transcript 1 (LUCAT1) in the development of ovarian cancer. MATERIALS AND METHODS: Real-time quantitative polymerase chain reaction (RT-qPCR) was utilized to detect the expression levels of lncRNA LUCAT1 in three human ovarian cancer cell lines (CaoV-3, SK-OV-3 and HO-8910) and the normal human ovarian surface epithelial cell line (IOSE80). Small interfering RNAs against lncRNA LUCAT1 (si-LUCAT1) were transfected into SK-OV-3 cells. Transfection efficiency of si-LUCAT1 was verified via RT-qPCR. Cell Counting Kit-8 (CCK-8) and colony formation assays were performed to test the effect of silencing lncRNA LUCAT1 on SK-OV-3 cell proliferation. The apoptosis was measured by flow cytometry. The miRcode database was searched to predict potential microRNAs (miRNAs) binding lncRNA LUCAT1. It was found that lncRNA LUCAT1 contained a highly conserved binding site of miR-199a-5p in the 3'-untranslated region (3'-UTR). Subsequently, the targeting relationship between them was determined through Dual-Luciferase reporter gene assay and RT-qPCR analysis. RESULTS: LncRNA LUCAT1 was highly expressed in three human ovarian cancer cell lines compared to that in normal ovarian surface epithelial cell line (p<0.05). The cell proliferation rate in SK-OV-3 cells with lncRNA LUCAT1 knockdown was remarkably lower in comparison to that in control group. Moreover, colony formation assay also revealed that the number of cell clones decreased significantly after knockdown of lncRNA LUCAT1 compared to that in control group (p<0.05). In addition, the apoptosis rate was distinctly elevated in the lncRNA LUCAT1 silencing group (p<0.05). Furthermore, a highly conserved binding site of miR-199a-5p was found in the 3'-UTR of lncRNA LUCAT1. Dual-Luciferase reporter gene assay exhibited that the Luciferase activity of LUCAT1-wt was significantly reduced after overexpression of miR-199a-5p (p<0.05), while that of LUCAT1-mut was unchangeable. Further analysis via RT-qPCR suggested that miR-199a-5p overexpression significantly decreased the expression level of lncRNA LUCAT1 (p<0.05). CONCLUSIONS: LncRNA LUCAT1 is overexpressed in ovarian cancer cells, which may target miR-199a-5p to exert its effects on driving the malignant development of ovarian cancer.

Modifiable risk factors in the first 1000 days for subsequent risk of childhood overweight in an Asian cohort: significance of parental overweight status.

BACKGROUND/OBJECTIVE: Many studies have identified early-life risk factors for subsequent childhood overweight/obesity, but few have evaluated how they combine to influence risk of childhood overweight/obesity. We examined associations, individually and in combination, of potentially modifiable risk factors in the first 1000 days after conception with childhood adiposity and risk of overweight/obesity in an Asian cohort. METHODS: Six risk factors were examined: maternal pre-pregnancy overweight/obesity (body mass index (BMI) ⩾25 kg m-2), paternal overweight/obesity at 24 months post delivery, maternal excessive gestational weight gain, raised maternal fasting glucose during pregnancy (⩾5.1 mmol l-1), breastfeeding duration <4 months and early introduction of solid foods (<4 months). Associations between number of risk factors and adiposity measures (BMI, waist-to-height ratio (WHtR), sum of skinfolds (SSFs), fat mass index (FMI) and overweight/obesity) at 48 months were assessed using multivariable regression models. RESULTS: Of 858 children followed up at 48 months, 172 (19%) had none, 274 (32%) had 1, 244 (29%) had 2, 126 (15%) had 3 and 42 (5%) had ⩾4 risk factors. Adjusting for confounders, significant graded positive associations were observed between number of risk factors and adiposity outcomes at 48 months. Compared with children with no risk factors, those with four or more risk factors had s.d. unit increases of 0.78 (95% confidence interval 0.41-1.15) for BMI, 0.79 (0.41-1.16) for WHtR, 0.46 (0.06-0.83) for SSF and 0.67 (0.07-1.27) for FMI. The adjusted relative risk of overweight/obesity in children with four or more risk factors was 11.1(2.5-49.1) compared with children with no risk factors. Children exposed to maternal pre-pregnancy (11.8(9.8-13.8)%) or paternal overweight status (10.6(9.6-11.6)%) had the largest individual predicted probability of child overweight/obesity. CONCLUSIONS: Early-life risk factors added cumulatively to increase childhood adiposity and risk of overweight/obesity. Early-life and preconception intervention programmes may be more effective in preventing overweight/obesity if they concurrently address these multiple modifiable risk factors.

Combining hand techniques with electric pumping increases the caloric content of milk in mothers of preterm infants.

OBJECTIVE: We previously reported that preterm mothers' milk production can exceed levels of term mothers by using early hand expression and hands-on pumping (HOP) with the highest production (955 ml per day) in frequent users of hand expression. In this study, we compared milk composition between mothers stratified by early hand expression frequency. STUDY DESIGN: A total of 67 mothers of infants <31 weeks gestation were instructed on hand expression and HOP. Subjects submitted expression records and 1-ml samples from each pumping session over 24 h once weekly for 8 weeks. RESULT: 78% (52/67) of mothers completed the study. But for Week 1, no compositional differences (despite production differences) were noted between the three groups. Protein and lactose tracked reported norms, but fat and energy of mature milk (Weeks 2-8) exceeded norms, 62.5 g l(-1) per fat and 892.7 cal l(-1) (26.4 cal oz(-1)), respectively. CONCLUSION: Mothers combining manual techniques with pumping express high levels of fat-rich, calorie-dense milk, unrelated to production differences.

Best practice guidelines for the operation of a donor human milk bank in an Australian NICU.

Until the establishment of the PREM Bank (Perron Rotary Express Milk Bank) donor human milk banking had not occurred in Australia for the past 20 years. In re-establishing donor human milk banking in Australia, the focus of the PREM Bank has been to develop a formal and consistent approach to safety and quality in processing during the operation of the human milk bank. There is currently no existing legislation in Australia that specifically regulates the operation of donor human milk banks. For this reason the PREM Bank has utilised existing and internationally recognised management practices for managing hazards during food production. These tools (specifically HACCP) have been used to guide the development of Standard Operating Procedures and Good Manufacturing Practice for the screening of donors and processing of donor human milk. Donor screening procedures are consistent with those recommended by other human milk banks operating internationally, and also consistent with the requirements for blood and tissue donation in Australia. Controlled documentation and record keep requirements have also been developed that allow complete traceability from individual donation to individual feed dispensed to recipient and maintain a record of all processing and storage conditions. These operational requirements have been developed to reduce any risk associated with feeding pasteurised donor human milk to hospitalised preterm or ill infants to acceptable levels.

Is total knee replacement more painful than total hip replacement?

BACKGROUND: During its use in pain management the patient-controlled analgesia (PCA) devices are capable of registering the course of treatment at patient request, the condition of drug delivery and total amount of drug being given. The patients could determine the need of medication to their own satisfaction while forced treatment by the bias of the health care personnel is avoided and the safety of patients is further warranted. In pain relief with this device, the number of requests for analgesia and the dose of analgesic used can be easily measured. Therefore, it is more objective to compare the pain intensity among different types of operation when PCA device is used. Using PCA morphine consumption as a parameter, we attempted to elucidate the difference of intensity of pain associated with total hip and total knee replacements by comparing their morphine requirement. METHODS: In this prospective cohort study, 50 patients who underwent either total hip replacement (THR, n = 24) or total knee replacement (TKR, n = 26) were enrolled. After recovery from general anesthesia when the patients first complained intense pain in the recovery room, morphine was given intravenously in titration with a calculated loading dose in 30 min to achieve an acceptable analgesia (VAS < or = 3) followed by morphine PCA at 1 mg bolus with a lockout interval of 6 min. The patients were then followed for 48 h. During and at the end of the course the data relevant to pain score, total dose, demand, delivery, and adverse effects were recorded for assessment. RESULTS: With the use of PCA, the pain scores were similar in both surgical groups in the 48 h observation. Total consumption of morphine in THR was 13.2 +/- 8.1 mg as against 19.7 +/- 5.7 mg in TKR in postoperative day 1 and 25.2 +/- 12.7 mg as against 34.1 +/- 13.9 mg in postoperative day 2 (P < 0.05, t-test). Demand/delivery ratio was not statistically significant between the 2 groups at 24 and 48 h (t-test). Minor adverse effects were seen in both groups but the differences were not significant. CONCLUSIONS: Using PCA morphine consumption as parameter, we can distinguish the magnitude of pain intensity between 2 major orthopedic surgeries. The deeper and more extensive operation would in total hip replacement does not mean that it is a more painful procedure than total knee replacement. Several speculations are proposed.

Intraoperative loading attenuates nausea and vomiting of tramadol patient-controlled analgesia.

PURPOSE: To evaluate the adverse effect profile of tramadol by patient-controlled analgesia (PCA) with administration of the loading dose either intraoperatively or postoperatively. METHODS: Sixty adult patients scheduled for elective abdominal surgery were enrolled into this prospective, randomized, double blind study. The patients were anesthetized in a similar manner. At the beginning of wound closure, the patients were randomly allocated to receive 5 mg x kg(-1) tramadol (Group 1) or normal saline (Group 2). In the post-anesthesia care unit (PACU), when patients in either group complained of pain, 30 mg x ml(-1) tramadol i.v. were given every three minutes until visual analogue scale (VAS) 3, followed by tramadol PCA with bolus dose of 30 mg and five minute lockout interval. Pain control and adverse effect assessments were done in the PACU and every six hours for 48 hr post drug by an independent observer. RESULTS: The loading dose was 290 +/- 45 mg in Group 1 and 315 +/- 148 mg in Group 2. In PACU, more nausea/vomiting both in terms of incidence (13/30, 43% vs 2/30, 6.6%, P < 0.05) and severity (nausea/vomiting score 2.5 +/- 2.0 vs 0.2 +/- 0.6, P < 0.05) was observed in patients with postoperative loading than in those with intraoperative loading of tramadol. CONCLUSION: Administering the loading dose of tramadol during surgery decreases the nausea/vomiting associated with high dose of tramadol and improves the quality of tramadol PCA in the relief of postoperative pain.

Acute jaundice in pregnancy: acute fatty liver or acute viral hepatitis?

In this case, the difficulty in differential diagnosis between acute viral hepatitis and acute fatty liver of pregnancy was analyzed. These 2 conditions often raise controversal question regarding the decision making on emergency anesthesia for cesarean section to avert complications and optimize management. The dilemma in which an anesthesiologist is put is whether to promise the anesthesia straightaway in the face of a demonstrable acute jaundice in pregnancy to advise a postponement of surgery until a turn for the better. In this embarrassing situation, the authors suggest that a postpronement of surgery is rational to observe the development during which both the mother and the fetus should be closely monitored. Once the necessity of a cesarean section outweighs the benefit of transitional conservative treatment, it should be performed immediately.

Comparison of patient-controlled analgesia (PCA) with tramadol or morphine.

PURPOSE: To compared the clinical efficacy of tramadol and morphine using a patient-controlled analgesia (PCA) delivery system. METHODS: In a prospective, randomized, double blind study, we evaluated 80 adult patients scheduled for elective hip or knee arthroplasty with general inhalational anesthesia. When patients complained of pain in the recovery room, patients were randomized to receive either tramadol or morphine by titration in 30 min to achieve analgesia (VAS < or =4). Equivalent volumes containing either 30 mg x ml(-1) tramadol or 1 mg x ml(-1) morphine were used for PCA with a lockout interval of 10 min. The patients were followed six-hourly for 48 hr for VAS, satisfaction rate, analgesic dose, and side effects. RESULTS: Patients obtained adequate analgesia with either drug. More patients had very good satisfaction scores in the morphine group in the recovery room (43% vs. 23%, P<0.05) and at 24 hr (40% vs. 20%, P<0.05) than those in the tramadol group. More nausea was evident in the tramadol group (48% vs. 11% in recovery room and 28% vs. 12% in 24 hr, P<0.05) than in the morphine group. Vomiting was also more (28% vs. 5% in recovery room, 15% vs. 3% in 24 hr, P<0.05). Morphine produced more sleepiness (45% vs. 23% in recovery room, P<0.05 and 35% vs. 15% in 24 hr, P<0.05). CONCLUSION: Tramadol PCA can provide effective analgesia following major orthopedic surgery provided sufficiently high doses are given for loading and by patient demand. However, the incidence of nausea/vomiting is also higher causing decreased satisfaction.

Epidural catheter placement in the rabbit--a novel approach.

BACKGROUND: Using a pediatric epidural set and through caudal approach, we studied a relatively non-invasive technique for epidural percutaneous cannulation in rabbit for chronic laboratory investigations. METHODS: Ten rabbits weighing over 3 kg were chosen and anesthetized with intravenous pentothal. A #19 pediatric Touhy needle and 23-gauge catheter were used for cannulation. Via the caudal approach, the epidural space could be located either by a "give" or with a technique of loss of resistance. Under fluoroscopy the catheter was tested with the injection of contrast medium for the confirmation of the proper position. The catheter was then tunneled under the skin and secured. The rabbits were kept in standard care for 4 weeks and then sacrificed by intraperitoneal pentothal overdose. A pathologist blinded to the study carefully examined the whole spine by laminectomy from cervical to coccyx and the findings were recorded. RESULTS: With the injection of contrast medium, the final position of the catheter was validated by fluoroscopy in all rabbits. Two rabbits sustained immediate complications from the contrast medium and/or technique, of which one died shortly after the contrast medium injection and the other had weakness of the hind legs for a week. At sacrifice, all the catheters were found in good position. Two had hematoma associated with signs of trauma. One developed subcutaneous abscess. One had stitch infection of skin. CONCLUSIONS: Percutaneous cannulation of epidural catheter is possible in the rabbit. Complications could be ameliorated by prudent approach in a skillful hand. It can be a reasonable model for the study of centrally administered medicines and their neurotoxicity.

Selective lumbar spinal nerve block, a review.

Selective spinal nerve block is a useful tool in today's multidisciplinary approach to the diagnosis and treatment of low back pain. The indications, sources of spinal pain, block technique, result interpretation, complications and clinical applications relevant to the subject are discussed. The value of a spinal nerve block relies on an understanding of the pain elements in the back, nerve innervations and careful patient selection. If the technique is performed properly and the results are interpreted cautiously, selective spinal nerve block may prove helpful, especially for patients from whom diagnostic information is inadequate. In some cases, therapeutic effect including that from surgical intervention can be achieved selectively at the symptomatic root. However, controversy remains and therefore well designed clinical studies are needed to provide more information about the validity of this diagnostic and therapeutic modality.

The peripheral analgesic effect of tramadol in reducing propofol injection pain: a comparison with lidocaine.

BACKGROUND AND OBJECTIVES: Tramadol and metoclopramide have a local anesthetic effect similar to lidocaine following intradermal injection. When metoclopramide was retained in the venous system for 1 minute, it was found to be as effective as lidocaine in reducing propofol injection pain. Using this metoclopramide model, the effects of tramadol in reducing pain on propofol injection was investigated. METHODS: One hundred five patients were randomly allocated to receive 50 mg tramadol (group T), 60 mg lidocaine (group L), or normal saline (group NS) as pretreatment to reduce pain on propofol injection. Following venous occlusion with a tourniquet (70 mm Hg), one of the drugs was intravenously administered. Venous retention of the drug was maintained for 1 minute. Immediately after the tourniquet release, intravenous injection of 100 mg propofol (10 mL) at a rate of 0.5 mL/s followed. Pain assessment was made after each injection. RESULTS: Transient minor injection pain and local skin reactions were significantly greater with tramadol than with lidocaine (P < .05). Both tramadol and lidocaine significantly reduced the incidence and intensity of propofol injection pain when compared with normal saline (P < .05). CONCLUSIONS: Using -minute retention in veins, both tramadol and lidocaine significantly reduced propofol injection pain. A local anesthetic activity is postulated.

Pain on injection of propofol: the mitigating influence of metoclopramide using different techniques.

BACKGROUND: Metoclopramide administered intravenously (i.v.) immediately before injection of propofol, after mixing with propofol, or after a rubber tourniquet for 1 min before propofol injection will reduce pain induced by propofol injection. In this study, these three different techniques in reducing propofol injection pain with metoclopramide were compared with lidocaine or saline to evaluate the most effective method in reducing propofol injection pain. METHODS: In a randomized, semi-double-blind treatment, 175 patients were included into this study. Patients in group A were pretreated with metoclopramide 10 mg i.v. before propofol (2 mg/kg) induction. Patients in group B were induced with a mixture of propofol and metoclopramide. Patients in group C were pretreated with metoclopramide i.v. with a rubber tourniquet on the arm for 1 min followed by propofol administration. Groups D and E were identical to group C except for the replacement of pretreatment with either lidocaine (40 mg) or saline, respectively. RESULTS: Groups A, C and D (with active pain prophylaxis) showed a significantly less incidence of pain than the saline control group (E) as propofol was injected. There was no significance difference between metoclopramide and lidocaine in reducing propofol injection pain using a tourniquet technique. The intensity of the propofol injection pain (verbal pain score) was stronger with saline as compared with the other groups. CONCLUSIONS: We conclude that i.v. retention of metoclopramide with tourniquet is as good as lidocaine and may be a useful alternative for reducing pain on propofol injection.

The effects of tramadol versus fentanyl in attenuating hemodynamic response following tracheal intubation.

BACKGROUND: Tramadol is a novel central acting analgesic. It has been used as a complement to general anesthesia and an effective agent for postoperative analgesia. However, the influence of tramadol on the hemodynamic response following laryngoscopy and tracheal intubation is less known. METHODS: Forty patients of both sexes, 16-50 year old, ASA physical status I or II, scheduled for elective surgery were randomly divided into equal groups in this prospective, double blind study. After obtaining the baseline data, the patient was given 3 micrograms/kg fentanyl (Group F) or 3 mg/kg tramadol (Group T). Then induction of anesthesia in a uniform and standardized manner was carried out by an anesthesiologist who was blind to the medication. The hemodynamic parameters were measured and recorded immediately after induction but prior to laryngoscopy, 3, 6, and 9 min after intubation, and before incision. We also observed any unusual effect in the postoperative care unit. Chi-square test, Student's t-test and paired t-test were used for statistical comparison. A P less than 0.05 was considered statistically significant. RESULTS: All patients had a successful induction and intubation. Differences in baseline values were not significant, nor were the differences in the values following induction. After laryngoscopy and intubation, heart rate increased significantly above the baseline level in both groups. The increase of heart rate was significantly more at 6 and 9 min (P < 0.05) and lasted longer in the tramadol group. After intubation, systolic, mean and diastolic arterial pressure (SAP, MAP, DAP) increased significantly above baseline in both groups too, except for DAP in fentanyl group. At 6 and 9 min, the MAP and DAP were significantly higher in tramadol than in fentanyl group (P < 0.05). Six patients in tramadol group had mild pain on injection of tramadol. CONCLUSIONS: When administered right before thiopental induction, 3 mg/kg tramadol did not display a better attenuation against the increase of hemodynamic profiles than did 3 micrograms/kg fentanyl following tracheal intubation.

Local anesthetic effect of tramadol, metoclopramide, and lidocaine following intradermal injection.

BACKGROUND AND OBJECTIVES: We observed clinically that tramadol and metoclopramide appear to have local anesthetic action. Tramadol is a central-acting analgesic. Metoclopramide is a commonly used antiemetic. The local anesthetic effect of tramadol in reducing propofol injection pain has never been mentioned, although it was speculated with metoclopramide. METHODS: We conducted a double-blind, placebo-controlled study by injecting tramadol or metoclopramide intradermally in 10 healthy volunteers (5 men, 5 women; age 25-56 years). Each subject received 0.5 mL of four solutions in random order on the volar side of the forearm. These solutions were 25 mg tramadol, 5 mg metoclopramide, 5 mg lidocaine, and 0.5 mL normal saline. Pain on injections and the degree of local anesthesia (tested by pinprick, light touch, and cold) at each site was reported on a 0-3 scale at designed time intervals. RESULTS: Like 1% lidocaine, tramadol and metoclopramide demonstrated loss of sensation for pinprick, light touch, and cold for 15 minutes after intradermal injection (P < .01 ). CONCLUSIONS: Intradermal tramadol or metoclopramide can produce local anesthetic effect.

Application of spinal pain mapping in the diagnosis of low back pain--analysis of 104 cases.

BACKGROUND: Low back pain is probably the most common pain problem seen in a general pain clinic and the cause of low back pain can be enigmatic at times. Often the pain sources are difficult to identify with the conventional diagnostic modalities. Spinal pain mapping is a sequence of well organized nerve block procedures. We undertook this study to evaluate the usefulness of this modality in diagnosing low back pain of uncertain etiology. METHODS: In this prospective study, 104 consecutive adult patients who underwent spinal pain mapping were examined and analyzed. All patients had intractable low back pain of undetermined etiology after medical history, physical examination and 4-view roentgenographic evaluation of the lumbar spine had been undertaken to locate it. In addition, 41 patients (39%) had one or more of the following tests done, which included CT, MRI, EMG/NC but all failed to delineate the causes of the pain. All patients failed to respond to the conservative therapies. RESULTS: With pain mapping the source of pain was found to be caused by sacro-iliac joint in 6%, lumbar nerve root in 20%, facet joint in 24%, combined lumbar nerve root and facet disease in 24%, internal disc disorder in 7%, combined facet and sacro-iliac joint in 4% and lumbar sympathetic dystrophy in 2% of patients. Pain mapping failed to demonstrate the causes of the pain in the remaining 13% of the patients. CONCLUSIONS: Considering the difficult nature of this group of patients, spinal pain mapping provided a useful functional approach to the diagnosis of low back pain with obscure etiology in 87% of patients in our series.