Endoscopic Cyanoacrylate Injection Treatment for Refractory High-risk Peptic Ulcer Bleeding by Conventional Endoscopic Therapy

Bleeding is a major and potentially life-threatening complication of peptic ulcer. Despite endoscopic hemostatic therapy advance, conventional endoscopic hemostatic modalities remain refractory for peptic ulcer bleeding with big size, fibrous base or in difficult-to-access anatomical locations. In this study, we attempted to evaluate the efficacy and safety of endoscopic cyanoacrylate injection treatment (ECIT) for refractory high-risk peptic ulcer bleeding by conventional endoscopic therapy. The patients with refractory high-risk peptic ulcer bleeding by conventional endoscopic therapy were carried out ECIT. The data were retrospectively collected. A total of 119 patients accepted ECIT. 74 patients (62.18%) obtained successful intravascular injection and perivascular injection was performed in 45 patients (37.82%). Immediate hemostatic rate for active bleeding achieved 90.91%. Rebleeding rate within 30 days was 12.07%. Overall successful hemostasis rate achieved 87.93%. Immediate hemostatic rate and overall successful hemostasis rate in intravascular injection patients were markedly superior over perivascular injection. Rebleeding rate in intravascular injection patients was markedly lower than that in perivascular injection patients. 11 patients complicated abdominal pain and no other complication occurred. In conclusion, ECIT, especial intravascular injection, was effective and safe, with high successful hemostasis rate for refractory high-risk peptic ulcer bleeding by conventional endoscopic therapy.

Histopathology and Renal Function in Wistar Rats after Intravascular Injection of Iodinated Contrast Media Iohexol and Iopamidol

This research aimed to analyze the histopathology (tubular necrosis and proteinaceous casts) and renal function (SCr and BUN) differences of male Wistar strain white rats (Rattus norvegicus) after intravascular injection of iodinated contrast media Iohexol and Iopamidol. This research is an experimental laboratory with a post-test only control group design. Male Wistar rats that fit the criteria were divided into three groups by random sampling technique: Control (K), Treatment 1 (P1, Iohexol 350 mg iodine/mL), and Treatment 2 (P2, Iopamidol 370 mg iodine/mL). Iohexol and Iopamidol were injected at a dose of 1600 mg iodine/kg BW. The histopathology differences were observed under a light microscope with a magnification of 400x, which were analyzed semi-quantitatively through slides formed by the paraffin method and H&E staining. SCr and BUN levels were checked using an automatic analysis machine with blood samples taken through the cardiac ventricle. Kruskal-Wallis test (α= 0.05) on renal histopathology scores, both tubular necrosis and protein casts showed Asymp. Sig. value > 0.05, which means there is no significant difference between the groups (K, P1, and P2). Kruskal-Wallis test (α= 0.05) on SCr levels also showed the Asymp. Sig. value > 0.05 and One-Way ANOVA Comparative Test on BUN levels showed the Sig. value > 0.05 which means there is no significant difference in renal function between the groups. This study proved no difference in histopathology and renal function in Wistar rats after injection of iodinated contrast media Iohexol and Iopamidol.

A comparative study between Bupivacaine volumes on diaphragmatic mobility in Ultrasound guided Supraclavicular Block

Background Brachial plexus is a complex network of nerves supplying the whole upper limb, with both motor and sensory supply. It arises from the neck and passes through the axilla to the upper limb. It is composed of 5 roots, 3 trunks, 6 divisions, 3 cords, and terminal branches. Objective To compare the effect of two different volumes of bupivacaine (20 ml and 25 ml) on diaphragmatic mobility within 15 and 30 minutes from ultrasound guided supraclavicular brachial plexus block in upper limb orthopedic surgeries. Patients and Methods In our study, 40 patients were randomly divided into 2 equal groups. Group A received 20 ml of bupivacaine (0.5%) and group B in which patients received 25 ml of bupivacaibe (0.5%). Diaphragmatic excursion measured in both groups after 15 and 30 mins sequentially. Results Our study showed that the use of low volume of bupivacine has much lower incidence of phrenic nerve affection, and in turn affection of mobility of the diaphragm measured by diaphragmatic excursion. Conclusion Assessment of diaphragmatic excursion is the best indication of phernic nerve injury after supraclavicular block. The use of the ultrasonography is the fastes, easiest and safest method for this assessment. The use of ultrasonography in performing the supraclavicular nerve block decreased significantly the incidence of complications such as pneumothorax or intravascular injection and hence, lowered the incidence of systemic toxicity of local anesthetics.

Comparison of Touhy and Quincke needles on intravascular injection rate in lumbar transforaminal epidural block: a randomized prospective trial

BackgroundTransforaminal epidural steroid injection is widely used in clinical practice to effectively deliver injectate into the ventral epidural space. Complications associated with intravascular injection such as spinal cord infarction and paraplegia can occur during transforaminal epidural steroid injection. To improve the safety of the procedure, avoidance of intravascular injection is crucial, for which appropriate needle selection is important. The primary aim of this study was to compare intravascular injection rates during transforaminal epidural steroid injection between commonly used Quincke and Tuohy needles.MethodTwo hundred and four transforaminal epidural steroid injection cases were randomly assigned to one of two needle groups (22-gage Quincke needle or 22-gage Tuohy needle). Intravascular injection was evaluated using digital subtraction angiography. Spread of contrast medium to the ventral and medial epidural spaces was evaluated. Procedure time was compared between the two needle types.ResultsThe overall incidence of intravascular injection was 7.8%. The rate of intravascular injection was significantly lower in the Tuohy needle group than the Quincke needle group (2.9% vs 12.7%, p=0.009). The ventral and medial epidural spread rates of the Tuohy needle group were 92.2% and 95.1%, respectively, significantly higher than those of the Quincke needle group. The procedure time was shorter in the Tuohy needle group than in the Quincke needle group (97.4 (19.3) seconds vs 117.8 (31.9) s; mean difference −20.40 (95% CI −34.35 to −6.45), p=0.005).ConclusionsIn conclusion, Tuohy needles had a lower intravascular injection rate and higher medial and ventral epidural spreading rates than Quincke needles.Trial registration numberKCT0002095.

The Influence of Ultrasound-Guided Technique Using a Catheter-Over-Needle on the Incidence of Accidental Intravascular Injection during Caudal Block-A Retrospective Case Series Study

Background and Objectives: This study was conducted to investigate the influence of an ultrasound-guided technique using a catheter-over-needle when an intravascular injection occurs in patients undergoing a caudal block. Material and Methods: We retrospectively investigated 41 cases of an ultrasound-guided technique using an angiocatheter for caudal block. These had been performed between November 2019 through August 2020 to manage pain of lumbosacral origin. Under ultrasound guidance, after advancing the introducer needle through the sacrococcygeal ligament and then slowly withdrawing it, the outer catheter was continuously advanced into the sacral hiatus. We confirmed proper needle placement under fluoroscopic imaging, using 5 mL of contrast media. We assessed the contrast spread pattern with fluoroscopic imaging and checked it for the presence of intravascular injection. Results: In all recruited cases, the catheter-over-needle was guided successfully to the sacral hiatus and into the caudal epidural space. There was 100% accuracy under ultrasound guidance, without intravascular uptake, as confirmed by contrast media fluoroscopy. The incidence of ventral spread was 84.2% above the S1 with 5 mL of contrast. Conclusions: The technique of using a catheter-over-needle under ultrasound induced successful block without intravascular injection. Thus, this technique is a reliable option for conventional caudal block.

Aspiration Before Tissue Filler – An Exercise in Futility and Unsafe Practice

Background Aesthetic physicians rely upon certain anecdotal beliefs regarding the safe practice of filler injections. These include a presumed safety advantage of bolus injection after a negative aspiration. Objectives The article aims to review and summarize the published literature on inadvertent intravascular injection of hyaluronic acid and to investigate whether the technique of aspiration confers any safety to the practitioner and the patient. Methods Pertinent literature was analyzed and our understanding of the safety of negative and positive aspiration outlined. Results The available studies demonstrate that aspiration cannot be relied upon and should not be used as a safety measure. It is safer to adopt injection techniques that will avoid injecting an intravascular volume with embolic potential than use an unreliable test to permit a risky injection. Conclusions To prevent intravascular injection, understanding “injection anatomy” and injection plane and techniques such as slow, low-pressure injection are important safety measures. Assurance of safety when delivering a bolus after negative aspiration, does not appear to be borne out by the available literature. If there is any doubt about the sensitivity or reliability of a negative aspiration, then there is no role for its use. Achieving a positive aspiration would just defer the risk to the next injection location where a negative aspiration would then be relied upon.