Enhanced Needle Visualization: advantages and indications of an ultrasound software package.

The ultrasound software package Enhanced Needle Visualization (ENV) has been reported to provide improved ultrasound imaging of needles even at steep insertion angles. ENV has three settings: shallow, medium and steep. However, the angles are unknown. We examined the advantages and indications of ENV in an in vitro study. A 22-gauge needle was inserted into pork meat using the in-plane technique. The needle was positioned at zero, 30, 45 and 60 degree angles, and 1, 2, 3 and 4 cm in-depth from the probe. The ultrasound visibility in each ENV setting was objectively evaluated and graded as 'not visible', 'poor', 'visible', 'good' and 'excellent' in ascending order. At zero degrees we found no advantage of ENV. At 30 degrees, the needle exhibited better visibility with 'good' or above grade in the shallow setting at all depths and in the medium setting at depths of 1, 2 and 3 cm than in the off position. At 45 degrees, needle visibility significantly increased from 'not visible' in the off position to 'visible' or above in the steep settings at depths of 1, 2 and 3 cm. At 60 degrees the objective visibility was 'not visible' in the off position and significantly increased to 'poor' in the steep setting. We recommend selecting the shallow setting for needles with an insertion angle of 30 degrees and the steep setting for 45 degrees within the advantageous area. This technique may allow safer ultrasound procedures for various unprecedented approaches.

Evaluation of the therapeutic results of epiduroscopic adhesiolysis for failed back surgery syndrome.

BACKGROUND: No data for patients with failed back surgery syndrome (FBSS) based on the location of adhesions separated by epiduroscopic adhesiolysis have been reported. METHODS: We performed epiduroscopic adhesiolysis on 28 FBSS patients to examine the impact of differences in the locations of the separated regions on the treatment results. We performed fluoroscopic imaging through the sacral hiatus to assess the condition of adhesions in the epidural space during the post-adhesiolysis observation period. RESULTS: In patients in whom only the epidural space was separated by adhesiolysis, there was a significant improvement in the Roland-Morris disability questionnaire (RDQ) score until 12 weeks after adhesiolysis, but the score gradually returned to the preoperative value thereafter. Among patients in whom the nerve root responsible for radicular pain was separated, there was a long-term improvement in the RDQ, Oswestry disability index 2.0 (ODI), and Japanese Orthopedic Association Assessment of Treatment (JOA) scores. Among patients in whom both the epidural space and the nerve root responsible for pain were separated, there was a 12 week improvement in the RDQ score and 24 week improvements in the ODI and JOA scores. CONCLUSIONS: Progressive epidural imaging after adhesiolysis suggested that pain was caused by re-adhesion around the nerve root. Since re-adhesion of the nerve root required some time, the effect of adhesiolysis was maintained for extended periods in these cases. We suggest that epiduroscopic adhesiolysis is an effective therapy for FBSS patients, and that adhesiolysis of the nerve root may exhibit the long-term (24 weeks) efficacy in patients with pain.

Effects of high peak airway pressure on the expression of heat shock protein 70 in rat lungs: a preliminary study.

BACKGROUND: Heat shock protein 70 (HSP70) is induced by a wide variety of stresses in addition to hyperthermia. Recent studies have clarified that mechanical stretching and pressure overload can induce HSP70 in some tissues and cells. However, it remains unclear whether HSP70 is induced in stretch-subjected lungs, such as those under mechanical ventilation. This study was designed to investigate the effects of high peak airway pressure (PAP) ventilation on HSP70 expression in intact rat lungs. METHODS: Male Sprague-Dawley rats were randomly allocated to one of three groups: non-ventilated (anesthesia alone) control group; PAP 15 cm H(2)O group (P15); and PAP 30 cm H(2)O group (P30). The rats in the PAP groups were subjected to pressure-controlled assisted ventilation at the appropriate PAP for 30 min. Rats were killed at 12, 24 and 48 h after ventilation or anesthesia alone, and the lungs were removed. The lung tissues were processed for immunohistochemical and Western blotting analyses of HSP70. RESULTS: Following 30 min of pressure-controlled assisted ventilation, HSP70 expression in the P30 group was significantly up-regulated in bronchiolar cells and subepithelial tissues at 12 h, and this up-regulation continued throughout the observation period. In contrast, there were no significant differences between the control and P15 groups, although the expression of HSP70 was higher in the P15 group than in the control group at all time points. CONCLUSIONS: HSP70 was induced by high PAP ventilation, but its specific role and induction mechanism remain unclear. Therefore, further investigations should be encouraged.