Seung Zhoo Yoon

The carina as a useful radiographic landmark for positioning the intraaortic balloon pump.

BACKGROUND:The aortic knob is thought to be the most useful radiographic landmark for the proper positioning of the intraaortic balloon pump (IABP) tip. However, this has not been studied formally. In this study we assessed whether the aortic knob is a reliable landmark for positioning the IABP and compared it with another potential landmark, the carina. METHODS:We measured the distance from the top of the distal aortic arch (aortic knob) to the left subclavian artery (LSCA) on three-dimensional computed tomography angiography in 100 patients. The distance from the level of the LSCA origin to the level of the carina was also measured using three-dimensional computed tomography in 150 additional patients. RESULTS:In 16% of the aortic knob study population, the LSCA to aortic knob distance was <0 cm or 0 cm. The median distance from the LSCA to the carina was 42 mm (range: 30–63 mm). In the carina study population, the origin of the LSCA was 35–55 mm above the carina in 95.3% of patients. CONCLUSION:In 16% of patients, the IABP was too close to the LSCA origin when it was placed at the aortic knob, whereas positioning the IABP at 2 cm above the carina provided an adequate position for the IABP tip (1.5–3.5 cm distal to the origin of the LSCA) in 95.3% of patients. The carina may be a more reliable landmark for positioning the IABP than the aortic knob.

Management of CRPS type II unresponsive to sympathetic nerve block with trigger points injection

Abstract Objective: Complex regional pain syndromes (CRPS) type II (causalgia) is one of the causes of neuropathic pain. For the management of CRPS type II, various kinds of medications, nerve block, intravenous lidocaine and neurostimulation are used. We report good results by injection of trigger points around the left calf and lateral dorsum of the foot after unsuccessful different treatments in a patient with CRPS type II. Case Report: The authors describe a twenty-three year old female patient with CRPS type II after damage to the left sciatic and tibial nerves. The continuous epidural administration of opioids and local anesthetics, and oral medication with phenoxybenzamine did not sufficiently control the pain. Pain control was satisfactory with injections into the trigger points in the involved limb muscles. After six years, the patient complains of only slight tingling sensations around the left little toe.