Tetsushi Fukushige

Successful treatment of epidural abscess with a percutaneously introduced 4-French catheter for drainage

W ith the recent improvements in antibiotics, conservative therapy for epidural abscess in the early stage has been reported to be effective (l-4). However, epidural abscesses are often difficult to treat, and surgery may be necessary. In the case described herein, we successfully treated an epidural abscess that developed in the course of continuous epidural block by continuous drainage through a percutaneously introduced 4-French catheter.

Connection between herniated nucleus pulposus and nerve roots in far lateral lumbar disc herniation

AbstractBackground: Far lateral lumbar disc herniation (FLLDH) compresses the nerve root or dorsal ganglion outside the spinal canal at the same level as the herniation, producing severe pain on the anterolateral thigh. The pain is so severe that many patients cannot even walk. The severity of pain is attributed not only to compression, but also some chemical inflammation. Objective: To report a case of FLLDH whose nerve root was depicted during discography.Case report: A 55-year-old-man presented with severe pain from the left buttock to the left anterolateral thigh and leg. Abnormal shadowing suggested left FLLDH at the L5/S1 level on magnetic resonance imaging. During discography, a shadow suggestive of the left fifth lumbar nerve sheath was depicted. Comparing the computed tomography (CT) after discography and CT after rootgraphy, the root sheath-like shadow on discography was confirmed as the nerve root sheath. After nerve root block, pain decreased and the patient was discharged. Conclusions: The co...

Neurological and histopathological effects of epidural phenol neurolysis in the rabbit

Abstract Objectives: Epidural phenol neurolysis for severe cancer pain has been linked to complications such as paraplegia and urinary incontinence. Given the ease of administration of epidural injections, proof of the safety and efficacy of epidural phenol injection would increase the popularity of this procedure for cancer pain relief. This study was conducted to evaluate the analgesic effects and histopathological changes in the spinal nervous system of rabbits after epidural administration of phenol. Materials and methods: Under pentobarbital anesthesia, percutaneous epidural catheterization at the level of the L6–L7 lumbar interspace was conducted in 16 rabbits. After epidurography using 0.3 ml of iopamidol, 0.3 ml of 7% phenol in saline was injected through the catheter into the epidural space of 15 rabbits, and 0.3 ml saline was epidurally injected in one rabbit serving as control. Motor function and analgesia were investigated on days 1 and 14. On day 14, the spinal cords were resected and process...

Bacterial contamination of epidural needles and catheters

Abstract Background: We estimated the possibility of bacterial contamination of the epidural space during catheterization. We prospectively investigated the incidence of bacterial contamination of the tips of epidural needles and indwelling epidural catheters, and also of disinfected skin at puncture sites. Methods: One hundred pain clinic patients received a total of 110 continuous epidural blocks. After local preparation with 0.5% chlorhexidine ethanol, the skin was swabbed with a small piece of saline-soaked cotton gauze for bacterial examination of the puncture site. The epidural space was punctured with an 18-G Tuohy needle, followed by placement of an epidural catheter. The tip of the needle was cut immediately after removal and incubated for bacterial examination. The tip of the indwelling catheter was also cut and incubated after removal. Bacteria in all samples were examined at the clinical laboratory in our institute. Results: The incidence of bacteriological contamination was as follows: 9 (8.2...

Clinical Usefulness of Fiberoptic D-C Coupling EKG Monitoring System

During the operation, it is difficult to continuously record the EKG, because the various noises present. Most important problem is a high frequency (HF) interference from the electrosurgical unit (ESU). There are three routes that the HF interference passes through a patient body as follows1); 1. Conduction through the alternating current (AC) power line 2. Radiation; HF interference is transmitted via electric and magnetic field coupling into the monitoring circuit cable 3. Conduction directly through a patient into the monitoring device