Ultrasound-guided internal jugular venous cannulation: an introduction for non-radiologists to a technique that is here to stay.

The availability of relatively low-cost, portable ultrasound units has increased interest among non-radiologists in performing image-guided central venous cannulation, especially in high-risk patients. The essential elements of this relatively simple method of increasing the success and safety of internal jugular cannulation are presented.

Treatment of the cutaneous pain of acute herpes zoster with 9% lidocaine (base) in petrolatum/paraffin ointment.

BACKGROUND: Treatment of the pain of acute herpes zoster by local anesthetic injections has drawbacks. Topical percutaneous local anesthesia (TPLA) may offer another strategy of providing regional analgesia in affected patients. OBJECTIVE: We evaluate the analgesic efficacy and safety of 9% (wt/vol) lidocaine (base) in petrolatum/paraffin ointment in patients with acute herpes zoster. METHODS: Ointment was applied to the affected skin of 22 patients. Pain, tenderness, sensitivity to pinprick and cold, and blood lidocaine concentration were measured repeatedly during a 20-hour interval and intermittently thereafter. RESULTS: Mean pain, tenderness, and cutaneous sensation scores were reduced at measurements taken from 4 to 20 hours after ointment application (p < 0.05), but not every patient obtained relief. No patient had local skin irritation or systemic toxic effects related to the local anesthetic. CONCLUSIONS: TPLA is a promising therapy for control of cutaneous pain of acute herpes zoster. Controlled studies should be performed to prove efficacy, determine optimal TPLA formulation, and define dosage limits.

Outpatient spinal opiate analgesia: a case report.

Outpatient spinal opiate analgesia for relief of cancer pain has been well-described in the literature. We report a case of a patient with metastatic disease who received epidural morphine using a subcutaneous epidural catheter via home injections. The patient and his family administered the medications. There are several options to choose from when using epidural morphine, and each patient's needs must be evaluated for the appropriate system.

Fatal cardiac perforation caused by the dilator of a central venous catheterization kit.

We report a case of cardiac perforation and tamponade caused by the dilator of a central venous catheterization kit. Standards for dilator manufacture and guidelines for safe use of these instruments are suggested.

Elective transtracheal jet ventilation for bronchoscopic removal of tracheal foreign body.

We have shown that transtracheal jet ventilation can be used safely and effectively when removing a foreign body from the airway. In some cases, it may be wise to choose this method of ventilation initially, thus avoiding the difficulties associated with more conventional modes of controlled ventilation. This is especially true when the potential for loss of the airway during the procedure is significant. This technique also allows the bronchoscopist the benefit of unimpeded access to the airway and adequate uninterrupted time for his operative procedure.

Chronic neuralgia incidence following local anesthetic therapy for herpes zoster.

We treated 72 patients, referred to a pain clinic for acute herpes zoster neuralgia, with local anesthetics administered by nerve block and infiltration. Only those patients with severe pain initially proved to be at risk for the development of chronic postherpetic neuralgia (defined as pain in the involved dermatomes lasting at least six months). Although local anesthetic injections effectively relieved the acute pain of active herpes zoster, they did not prevent the development of chronic postherpetic neuralgia.

Renal carcinomas and erythrocytosis in rats following intrarenal injection of nickel subsulfide.

In rats, an intrarenal injection of nickel subsulfide (Ni3S2) regularly caused, within 2 months, an erythrocytosis and eventually a renal carcinoma in 40 per cent of the animals. Despite their great pleomorphism, the neoplastic renal cells appeared to be of the same lineage but showed a pronounced tendency to evolve toward an anaplastic, spindle-cell variant. By electron microscopy, they exhibited varying degrees of differentiation with surface specialization, suggesting an epithelial origin. There was no indication that the erythrogenic and carcinogenic responses to Ni3S2 were interrelated as the high hemoglobin and erythrocyte values tended to retrocede with the development of the renal carcinoma. Other nickel salts and a variety of divalent metallic preparations failed to produce similar changes when administered under identical conditions. The possible mechanism of NI3S2 at the cellular level is briefly discussed.

Hemangiomatosis of the liver in infants.

Seven patients with hemangiomatosis of the liver are presented together with 100 cases reported in the literature. Six of seven patients survived; four with supportive treatment only. Follow-up is from 2 to 11 yr. Hepatomegaly, heart failure, and cutaneous angiomas constitute the classical clinical triad. Arteriography is the best method for diagnosis; biopsy should be avoided. Clinical features and histologic examination of these benign vascular tumors seem to confirm the theory that hemangioendothelioma and hemangioma represent only different developmental stages of one disease. These lesions can regress spontaneously if left alone. Despite contrary prevailing opinion, the authors recommend nonoperative treatment as the first choice of the clinician.