Margaret Aranda

Radiofrequency sacroiliac joint denervation for sacroiliac syndrome

Background and Objectives Radiofrequency (RF) denervation of the sacroiliac (SI) joint has been advocated for the treatment of sacroiliac syndrome, yet no clinical studies or case series support its use. Methods We report the results of a consecutive series of 50 SI joint RF denervations performed in 33 patients with sacroiliac syndrome. All patients underwent diagnostic SI joint injections with local anesthetic before denervation. Changes in visual analog pain scores (VAS), pain diagrams, physical examination (palpation tenderness over the joint, myofascial trigger points overlying the joint, SI joint pain provocation tests, and range of motion of the lumbar spine), and opioid use were assessed pre- and postdenervation. Results The criteria for successful RF denervation were at least a 50% decrease in VAS for a period of at least 6 months; 36.4% of patients (12 of 33) met these criteria. Failure of denervation correlated with the presence of disability determination and pain on lateral flexion to the affected side. The average duration of pain relief was 12.0 ± 1.2 months in responders versus 0.9 ± 0.2 months in nonresponders (P ≤ .0001). A positive response was associated with an atraumatic inciting event. Successful denervation was associated with a change in the pain diagram and a reduction in the pattern of referred pain, a normalization of SI joint pain provocation tests, and a reduction in the use of opioids. Conclusions This study suggests that RF denervation of the SI joint can significantly reduce pain in selected patients with sacroiliac syndrome for a protracted time period. Moreover, certain abnormal physical findings (i.e., SI joint pain provocation tests) revert to normal for the duration of the analgesia.

Detection and localization of pulmonary air leaks using laser-polarized 3He MRI

Pulmonary air leaks were created in the lungs of Yorkshire pigs. Dynamic, 3D MRI of laser‐polarized 3He gas was then performed using a gradient‐echo pulse sequence. Coronal magnitude images of the helium distribution were acquired during gas inhalation with a voxel resolution of approximately 1.2 × 2.5 × 8 mm, and a time resolution of 5 sec. In each animal, the ventilation images reveal focal high‐signal intensity within the pleural cavity at the site of the air leaks. In addition, a wedge‐shaped region of increased parenchymal signal intensity was observed adjacent to the site of the air leak in one animal. 3He MRI may prove helpful in the management of patients with pulmonary air leaks. Magn Reson Med 44:379–382, 2000.

Inhaled nitric oxide and pulmonary vasoreactivity.

Inhaled nitric oxide is a ubiquitous molecule which is produced endogenously and is also found in air pollution and in cigarette smoke. After describing the chemistry of NO, we review its history from the first description in 1980 to the current clinical indications. The biosynthesis of NO, its effects on pulmonary vasoreactivity, and the administration of inhaled NO will be described. The indications, uses, and side effects of inhaled NO are discussed with an emphasis on withdrawal of NO therapy, specifically the “rebound” phenomenon. Possible drug interactions are listed. Inhaled nitric oxide is here to stay, and future studies will provide more information on its therapeutic dose, duration and potential toxicity.

ANESTHETICS, SEDATIVES, AND PARALYTICS: Understanding Their Use in the Intensive Care Unit

This article reviews the use of inhalational, intravenous, and epidural agents used in the operating room and ICU. An emphasis is placed on the rationale for their selection. Additionally, the side effects and expected complications are discussed. By developing expertise with ones own repertoire of sedatives, narcotics, and neuromuscular blocking agents, one may decrease postoperative complications and lengths of stay.

Analytic Reviews : Impact of Intensivists and ICU Teams on Patient Outcomes

care practice exists, costs are substantial: there are about 55,000 ICU patients/day in the United States, and organizational structures vary substantially. ICU outcome studies can be divided into three groups: multi-institutional comparisons, before-and-after studies, and side-by-side comparisons. Multi-institutional comparisons have tended to show improved outcomes in well-organized ICUs, with strong medical direction and on-site intensivists. The change from an &dquo;open&dquo; to a &dquo;closed&dquo; format for ICU care is associated with