Phenol Injection Research Articles

Role of inorganic anions in improving the oxidizing capacity of heat-activated peroxymonosulfate: Identification of primary degradative pathways

This study demonstrated a drastic improvement in the oxidizing capacity of heat-activated peroxymonosulfate (heat/PMS) upon the addition of bicarbonate (HCO3) and phosphate (PO4). Injecting the anions caused a 20- to 30-fold increase in the phenol degradation efficiency of heat/PMS at the temperature range of 40–50 ℃ that was insufficient to thermally activate peroxydisulfate (PDS). The heat/PMS-PO4 outperformed heat/PDS in degrading benzoic acid, whereas heat/PMS-HCO3 marginally decomposed it. The reactivity of heat/PMS-PO4 did not vary sensitively depending on substrate type, which resulted from the increased yield of sulfate radical due to facile thermal cleavage of the peroxide bond loosened in the PMS-PO4 complex, based on the electron paramagnetic spectral features and quenching effects of radical scavengers. Degradation of phenols and furfuryl alcohol by heat/PMS-anion was highly accelerated under alkaline conditions through heat-promoted direct PMS oxidation and singlet oxygenation. Along with the similarity between the heat/PMS-anion systems in intermediate distribution (distinguished from that of heat/PDS) and chronoamperometric current response of the heated PMS solution upon the subsequent injection of anion and phenol, the extent of PMS consumption in the heated PMS-anion or PMS-organic-anion mixtures, which depended on substrate type and temperature, implied the role of heat-activated PMS-anion complexes as the non-radical oxidants.

Effectiveness of Phenol Application in Pediatric Pilonidal Sinus

Purpose: Phenol application is an increasingly popular method in the treatment of pediatric pilonidal sinus because of its ease of use. However, there has been insufficient research on standards for phenol application in children. This study aimed to determine standards for evaluating phenol applications to identify parameters that can be used in treatment planning.
 Methods: Pediatric patients with pilonidal sinus who underwent surgical excision and/or phenol injection between January 2011 and January 2021 were evaluated retrospectively. Data related to the patients’ age, sex, treatment method (phenol, surgery), number of phenol applications, preoperative complications and antibiotic use, postoperative complications, and treatment duration were analyzed.
 Results: The study included 57 patients, 34 boys (59.6%) and 23 girls (40.3%), with a mean age of 15.15±1.62 years (range: 11-18). Number of phenol applications and postoperative complications were significantly higher in patients with prolonged preoperative antibiotic use (>2 weeks) and preoperative complications (p

Phenol vs. botulinum toxin A injection for managing lower limb spasticity in adult patients with upper motor lesions: A randomized clinical trial

Background: Phenol and botulinum toxin type A (BTX-A) injections are two options for treating spasticity with the ability to select a specific spastic muscle and determine the dosage based on spasticity degree. This study intends to compare the efficacy of BTX-A vs. phenol blockade in treating lower limb spasticity and to evaluate the performance improvement in gross motor functional outcomes among adult patients with upper motor neuron (UMN) lesions. Methods: This randomized, double-blind clinical trial of 28 spastic lower limb adult patients with UMN was diagnosed between March 1, 2017, to April 30, 2019. Patients were randomized in a 1:1 ratio to a “BTX-A injections” or a “Phenol injections” group. The outcomes were measured through assessment spasticity by the Modified Ashworth Scale (MAS), active range of motion (AROM) of lower limb joint by a goniometer, Verbal Rating Scale (VRS), Visual Analog Scale (VAS), and Penn Spasm Frequency Scale (PSFS) as a baseline and post-injection follow-up at 24 hours, 3 weeks, and 3 months. Results: All 28 randomized patients were analyzed. No significant difference between the two study arms, neither in demographic characteristics nor in MAS, AROM, VRS, VAS, and PSFS parameters prior to the procedures. AROM showed a significant decrease from baseline throughout the study in the phenol group. While in the BTX-A group, they improved significantly at 3 weeks; no more improvement was observed at 3 months, and the differences were statistically significant (p < 0.05). The reduction in MAS, VRS, VAS, and PSFS was statistically significant in each group at 24 hours, 3 weeks, and 3 months after the injection (p < 0.05). However, the differences were not significant between the phenol and BTX-A groups (p > 0.05), except for PSFS at the 3 months of follow-up in the Phenol group (p = 0.01). The need for re-injection at 6 months and 9 months was that 5 patients vs. 0 patients (p = 0.01) and 8 patients vs. 3 patients (p = 0.04) in the BTX-A and phenol groups, respectively, were statistically significant. Conclusion: Phenol injection showed superior treatment effects in AROM, decreased spasm degree based on PSFS at 3 months, and less-frequent re-injection rate compared to BTX-A injections in adult patients with UMN lesions. However, both phenol and BTX-A injections effectively reduce spasticity without significant differences in efficacy and adverse effects. Future studies must be conducted with a longer duration of follow-up, and larger sample sizes better to compare both drugs’ effectiveness and side effects. Trial registration: The study protocol was registered as a clinical trial under registration IRCT20170826035914N2 at the Iranian Registry of Clinical Trials (http://www.irct.ir).

페놀 중독 사망사례

Phenol (also called carbolic acid) is a white or colorless crystalline solid, and it dissolves well in water and exists in a liquid state. Phenol has been mainly used as precursors for plastics, drugs and pesticides. In addition, phenol has been used as a preservative and a local anesthetic. Phenol causes severe irritation and corrosion on skin and other tissue by protein degeneration, and it may cause harmful effects on central nervous system and heart resulting in dysrhythmia, seizure, and death. Fatal cases by ingestion or intravenous injection of phenol for suicide were described in literatures, and there are many cases of death from accidental inhalation or absorption through the skin in workplace. In this study, we present two cases of death from phenol poisoning. Analysis of phenol in blood and tissues was performed by head space-solid phase micro extraction-gas chromatography-mass spectrometry method (HS-SPME-GC/MS). In one case, the concentration of phenol in heart and peripheral blood were 205.2 mg/L and 19.1 mg/L, respectively. In both cases, the concentration of phenol in liver and kidney tissue were 15.1-259.6 mg/kg and 45.8-38.5 mg/kg, respectively.

Dual roles of ANGPTL4 in multiple inflammatory responses in stomatitis mice.

Stomatitis is inflammation of the oral mucosa. Angiopoietin-like protein 4 (ANGPTL4) has pleiotropic functions both anti-inflammatory and pro-inflammatory properties. In the present study, we tested whether there is a correlation between increased ANGPTL4 expression and inflammation in stomatitis mice and the mechanisms involved. In this study, the oral mucosa of mice was burned with 90% phenol and intraperitoneal injection of 5-fluorouracil to establish the model of stomatitis mice. The pathological changes of stomatitis mice were observed by H&E staining of paraffin section. The expressions of cytokines and ANGPTL4 were detected by fluorescence quantitative PCR, and the protein levels of ANGPTL4 were detected by western blot. Compared with control group, the oral mucosal structure of model mice was damaged. The expression of ANGPTL4 were significantly increased concomitantly with elevated production of anti-inflammatory cytokine (peroxisome proliferator-activated receptoralpha) and pro-inflammatory cytokines [nuclear transcription factor-kappaB, interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α] in mice with stomatitis. This study suggests that ANGPTL4 may be a double-edged sword in multiple inflammatory responses in stomatitis mice.

Comparison of treatment of pilonidal sinus using phenol injection versus wide excision with secondary healing.

Objective: To compare mean early post-operative pain and frequency of wound healing of pilonidal sinus using application of crystallized phenol versus wide excision with open healing. Study Design: Randomized Controlled Trial. Setting: Department of Surgical, Allied Hospital Faisalabad. Period: 13-10-2018 to 12-04-2019. Material & Methods: A total of 60 patients were operated in our unit during the study period and were allocated into two groups randomly: Group A and Group B. The patients in Group A underwent treatment using crystallized phenol. Patients in Group B underwent wide local excision of the pilonidal sinus tract. All patients were given single dose of broad-spectrum antibiotic at time of procedure. Analgesia in post-operative period was maintained by using Diclofenac Sodium (Inj Artifen 75mg/3ml IM) as requested by the patient as long as the safe dose is not exceeded. First assessment of all patients was done at 24 hours after surgery. The analgesic requirement and visual analog scale score were documented for patients of both groups at this time. Follow up visit for patients in both groups was scheduled at 3 weeks after treatment. All the data was collected with the help of a specially designed Performa. Results: Mean pain score in Group-A was calculated as 1.36±0.55 and in Group-B it was 3.23±0.82, p value was 0.0001, comparison of wound healing in both groups shows that wound healing in Group-A was in 80%(n=24) and in Group-B, it was 30%(n=9), p value was 0.0001. Conclusion: We concluded that mean early post-operative pain and frequency of wound healing of pilonidal sinus using application of crystallized phenol is significantly lower when compared with wide excision with open healing.

Radiological, Clinical, and Histological Findings in the Treatment of Pilonidal Sinus with Phenol Injection.

Objective:Sacrococcygeal pilonidal disease is a chronic discharging wound that causes pain and loss of quality of life. Phenol application is an outpatient procedure with low complications and low recurrence rates. We evaluated the radiological, histological, and clinical results of phenol application.Methods:A total of 44 consecutive patients with sacrococcygeal pilonidal disease underwent phenol application in Kocaeli University Faculty of Medicine, General Surgery Clinic between December 2015 and March 2017. Demographics, complaints, symptom duration, and the number of sinuses were recorded. Patients were examined using ultrasonography (USG) before surgery and two months after surgery. Four patients who wanted rhomboid excision and Limberg flap procedure underwent preoperative local phenol application and were excluded from the study. The excised tissues were used for pathological evaluation.Results:Purulent discharge was the leading symptom. All of the patients had hair in the preoperative USG evaluation, whereas five patients had still hairs in the sinuses in the postoperative USG examination. Four of these cases had recurrences on a 2-month follow-up. After phenol application, a 10% volume decrease was observed. Pathological examination was performed in four cases with phenol application, and in pathological material, the sinuses looked sclerotic and fibrotic.Conclusions:Our study revealed that a single phenol application achieved 90% success. However, no significant difference was observed in the cavity volume after phenol injection.

Early Use of Phenol Neurolysis Likely Reduces the Total Amount of Botulinum Toxin in Management of Post-Stroke Spasticity.

The main objective was to examine practice patterns of phenol neurolysis for post-stroke spasticity management in the early stage. We performed a chart review of patients who were admitted for inpatient rehabilitation within 6 months after first-ever stroke and received phenol neurolysis within 15 months post-stroke. Out of 2,367 stroke admissions from January 2014 and December 2018, 68 patients met the criteria. 52.9% of these patients received phenol neurolysis within 12 weeks, i.e., early stage. The earliest phenol neurolysis procedure was at 19 days after stroke. On average, patients received first phenol injections at 16.3 weeks after stroke with an average dose of 7.3 ml. Most commonly injected nerves were tibial nerve motor branches (41/68), sciatic nerve motor branches (37/68), lateral pectoral nerve (16/68), medial pectoral nerve (15/68), obturator nerve (15/68) and musculocutaneous nerve (15/68). Among 68 patients, 24 received phenol only; 17 received phenol neurolysis first followed by botulinum toxin (BoNT) injections; 19 received BoNT injections first followed by phenol neurolysis; 8 received both phenol and BoNT injections at the same time. The interval from stroke to first procedure was similar between the Phenol-First group (13.3 weeks) and the BoNT-First group (12.6 weeks). The total amount of BoNT was significantly lower in the Phenol-First group (361.3 units) than in the BoNT-First group (515.8 units) (p = 0.005). The total amount of phenol was not statistically different between the Phenol-First group (5.9 ml) and the BoNT-First group (8.3 ml). The interval between the first procedure and its subsequent procedure was not statistically different between the Phenol-First group (18.3 weeks) and the BoNT-First group (10.7 weeks). These long intervals suggest that the subsequent injection (type and dose) was not planned during the first procedure. The general patterns of target areas were similar between BoNT injections and phenol neurolysis, except that phenol neurolysis rarely targeted the upper extremity distal muscles. No side effects after phenol or BoNT injections in the early stage after stroke were observed in the chart review. In summary, phenol neurolysis was started as early as 19 days after stroke. On average, patients received first phenol about 4 months after stroke with an average of 7.3 ml of phenol. Early use of phenol neurolysis likely decreases the total amount of BoNT for management of post-stroke spasticity without increased side effects.

Medical uses for phenol in the urinary tract: A possible forgotten treatment (Review).

Phenol is a chemical compound that was first used medically as an antiseptic. At low concentrations, phenol exerts local anesthetic effects achieved through denervation; at high concentrations, it exerts a potent protein-denaturing effect that induces apoptosis. Phenol injection therapy has a long history of use in urology. It is reportedly effective for hemorrhagic cystitis, benign prostate hyperplasia, overactive bladder, hydrocele, bladder tumors, interstitial cystitis and other benign urologic diseases, and it is also used as a tool to decrease bleeding during prostate surgery. The present review article summarizes the medical applications of phenol in urological field. The articles available on the medical uses of phenol are primarily older and retrospective, involving small numbers of patients. In the absence of comparative studies with other treatments, it is impossible to determine the relative benefit of phenol. However, the treatment outcomes of phenol injection are fairly well-established. Phenol therapy may be an option for patients who are poor candidates for invasive treatment. Further studies are required, however, as are improvements in the injection technique to reduce the rate of complications.

The Time Course of Onset and Peak Effects of Phenol Neurolysis.

The aim of this study was to explore the time course of onset and peak effects of phenol neurolysis. This is a retrospective chart review. Eleven patients with elbow flexor spasticity after brain injury were enrolled. The resting angle of the elbow joint was measured before and after the injection and up to 6 wks of follow-up. Phenol injection was performed to 13 musculocutaneous nerves under ultrasound and electrical stimulation guidance. The resting elbow angles were 84.4° ± 25.8° (before injection), 116.6° ± 20.9° (immediately after injection), 121.2° ± 21.4° (2 hrs after injection), 127.2° ± 19.7° (24 hrs after injection), 145.4° ± 11.8° (7 days after injection), 145.5° ± 10.4° (14 days after injection), and 150.3° ± 12.2° (6 wks after injection; N = 7). The mean resting angle was statistically different among the time points from preinjection to 14 days after (F2.625, 31.505 = 36.805, P < 0.01). Post hoc tests revealed that significant improvements existed immediately after and 7 days after the injection (P < 0.01 for both). The effects seemed to reach its peak in 7 days. The effect sizes immediately and 7 days after the injection were 1.37 and 3.04, respectively. The immediate effect accounted for approximately 60% of the maximal effect. Phenol neurolysis has an immediate effect on spasticity reduction and reaches its peak effect around 1 wk after injection.

Successful combination therapy with radiofrequency ablation and phenol injection in a young patient with refractory trigeminal neuralgia

Trigeminal neuralgia (TN) is defined as sudden, usually unilateral, severe, brief, stabbing, and recurrent pain in the distribution of one or more branches of the fifth cranial nerve. The pain is generally abrupt, severe, and can pose a significant impact on the quality of life. The etiology of TN is not always clear, and therefore, treatment can be challenging and multimodal. Pharmacotherapy is generally the first-line treatment though unsuccessful in over a third of patients requiring minimally invasive modality. We report the case of a young patient with refractory and debilitating TN with failed four sessions of radiofrequency ablation (RFA) in addition to the regular use of oral medications. Our treatment included simultaneous RFA and phenol injection with complete symptomatic resolution within fortnight after intervention. In conclusion, the treatment of TN poses a clinical challenge. Although RFA or phenol injections are recognized invasive treatment modalities, we have proven that simultaneous use of both therapies at the same time is safe and effective treatment option for refractory TN with failed previous multi-modal therapy.

Pilonidal Sinus Disease; What is the Best Treatment Option?

Sinus pilonidalis is a chronic infection of the hairy skin in the area of skin wrinkles, with the most common localization in the natal cleft. The disease often has a significant impact on the quality of life of the affected person; the treatment may be complex and needs to be adapted to the patient's needs. Below is an overview of the origin as well as the treatment alternatives and their peculiarities. The following aspects are presented: early post-operative results, wound healing disorder and long-term results. The pathomechanism of pilonidal sinus disease has still not been conclusively clarified; it must continue to be assumed that the hair in the natal cleft contributes significantly to the formation. However, recent findings indicate that the large tufts of hair that are repeatedly found in the wound cavity are most likely to come from the hairy scalp. Three essential treatment options can be distinguished: The standard treatment of excision and subsequent open wound treatment, has a low recurrence rate, but requires considerable effort in wound treatment and thus leads to protracted time off work. Relatively new treatments include locally destructive treatment that essentially preserves the skin. Important representatives are so-called pit picking, fistuloscopy and other forms of treatment, such as phenol injection and/or laser treatment. In these treatment options, the final evaluation of the results is still pending. The third treatment group is excision and plastic reconstruction. These procedures are technically demanding, often involve inpatient treatment but lead to relatively good results in the long term. Treatment of pilonidal disease requires patient-oriented therapy planning. The patient must be taught the different treatment options and a treatment recommendation must be given to the patient. Excision and open granulation continues to serve as a standard procedure with which other treatment options can be compared.

Cryopreserved amniotic membrane and umbilical cord particulate for managing pain caused by facet joint syndrome: A case series.

Treatment of back pain due to facet joint syndrome has been a challenge for physicians since its recognition ∼80 years ago. Intra-articular injections of steroids, local anesthetics, and phenol have been widely adopted despite their known shortcomings. Recently, intra-articular injection of amniotic membrane-umbilical cord (AMUC) has been utilized in various orthopedic indications, including those involving synovial joints, due to its reported anti-inflammatory properties. Herein, use of AMUC for facet joint syndrome was evaluated.A single-center case series was conducted on patients presenting with pain caused by facet joint syndrome, confirmed by single blocking anesthetic injection and treated using a single intra-articular injection of 50 mg particulate AMUC (CLARIX FLO) suspended in preservative-free saline. Patient reported back pain severity (numerical scale 0–10) and opioid use were compared between baseline and 6 months following treatment.A total of 9 patients (7 males, 2 females), average age 52.1 ± 15.9 years, were included. Five patients with cervical pain had a history of trauma, 1 patient had suffered lumbar facet injury and 3 had degenerative lumbar facet osteoarthritis. All patients had severe pain prior to injection (8.2 ± 0.8) and 4 (44%) were taking opioids (>100 morphine milligram equivalents). Six-month post-treatment, average pain had decreased to 0.4 ± 0.7 (P <.05). All patients had ceased use of prescription pain medications, including opioids. No adverse events, repeat procedures, or complications were reported.Intra-articular injection of AMUC appears to be promising for managing facet pain and mitigating opioid use. Further investigation with larger sample size is warranted.

Management of Spasticity with Intrathecal Phenol Injections

Introduction: Spasticity is increased, involuntary, velocity-dependent muscle tone that causes resistance to movement. Intrathecal injection of phenol is a form of treatment used in a very selective group of patients with spasticity. Aim: This study aims to highlight current evidence in the treatment of spasticity with intrathecal neurolytic phenol injections. Materials and Methods: A computer-based literature search was performed using MEDLINE, EMBASE, CINAHL, and the Cochrane Library using the following key words: intrathecal, phenol, spasticity, and pain. Results: The search identified 83 articles. Of 16 articles met the inclusion criteria of being specifically relating to the use of intrathecal phenol injections in spasticity. There was a lack of randomized controlled studies addressing intrathecal phenol injections in our search. Conclusions: Intrathecal phenol can be valuable for the treatment of spasticity when adapted for each individual, and used as part of an overall program that includes multidisciplinary team assessment and goal planning.

Involvement of brain GABAAR-coupled Cl−/HCO3−-ATPase in phenol-induced the head-twitching and tremor responses in rats

Phenol-induced neurotoxicity manifests as twitching/tremor and convulsions, but its molecular mechanisms underlying the behavioral responses remain unclear. We assessed the role of the brain Cl−/HCO3−-ATPase in behavioral responses in rats following an in vivo intraperitoneal injection of phenol (20–160 mg/kg). Low concentrations of phenol (20–80 mg/kg) increased the ATPase activity as well as the head twitching responses in rat, whereas higher phenol concentrations (>60 mg/kg) increased the tremor but reduced the ATPase activity. At phenol concentrations >120 mg/kg, no ATPase activity was detected. Phenobarbital (10 mg/kg) and picrotoxin (1 mg/kg) as well as o-vanadate (2 mg/kg), significantly prevented (˜55–70%) the phenol-induced change in the behavioral responses and completely restored the enzyme activity. In vitro experiments confirmed that phenol stimulated the Cl−/HCO3−-ATPase activity at low concentrations, but had no stimulating effect on other transport ATPases. Low doses of phenol increased the formation of phosphoprotein and the rate of ATP-consuming Cl− transport by the reconstituted enzyme. The present findings provide evidence that phenol-induced neurotoxicity involves the Cl−/HCO3−-ATPase in the behavioral responses in mammals and indicate the potential benefit of this enzyme as a target for the treatment of head twitching and other types of tremor diseases.

The efficacy and safety of Phenol 5% neurolysis in patients with lower limb spasticity

The phenol use in spasticity is a recognized treatment but used by only a few group of colleagues. The phenol cost is accessible, but its use needs experience in order to avoid adverse effects like pain, local fibrosis, loss of sensitivity. This study is a retrospective cohort of medical record analysis of patients treated with Phenol 5% neurolysis to lower limbs spasticity from January 2014 to December 2016 in a Brazilian Public General Rehabilitation Center from all the patients that were submitted a Phenol 5% neurolysis to treat lower limbs spasticity from January 2014 to December 2015. The patients submitted to the phenol 5% injections were evaluated in relation to their spasticity by both, Asworth Modified Scale (AMS) and Range of Motion (ROM) from knee flexion/extension and hip extension/abduction. All patients were inquired about side effects (including pain, local reactions and any other comorbidities) thirty days after the injection. One hundred and twenty-eight patients were treated with phenol 5% neurolysis due to lower limbs spasticity. The average age was 27.8 years old, 47 were under 18, being the youngest 4 years old, and 23 were elderly. Seventy-three patients had a cerebral palsy, 38 had a spinal cord injury and 17 a stroke. The treated muscles and nerves were sciatic motor branch nerve ( n = 69), obturator nerve ( n = 74), femoral nerve ( n = 6) and psoas muscle ( n = 35), Seven patients reported moderate pain after the injection in the region of femoral cutaneal nerve (all of them after the obturator injection) with full resolution up to 7 days. Any other side effect was reported. The study concludes that phenol injections are safe and efficient in the lower limbs spasticity treatment.

What Is Good?

Professor Timofey Pnin, the lovably hapless, ‘ideally bald’, comic-heroic émigré protagonist of Nabokov’s novel, thinks the unthinkable: In order to exist rationally, Pnin had taught himself, during the last ten years, never to remember Mira Belochkin – not because, in itself, the evocation of a youthful love affair, banal and brief, threatened his peace of mind … but because, if one were quite sincere with oneself, no conscience, and hence no consciousness, could be expected to subsist in a world where such things as Mira’s death were possible. One had to forget – because one could not live with the thought that this graceful, fragile, tender young woman with those eyes, that smile, those gardens and snows in the background, had been brought in a cattle car to an extermination camp and killed by an injection of phenol into the heart, into the gentle heart one had heard beating under one’s lips in the dusk of the past.

Coloproctology procedure clinic: a novel service developed to reduce suffering of patients with bleeding per rectum.

Evaluation of the role and impact of introducing a dedicated coloproctology procedure clinic in tertiary referral colorectal unit. A retrospective analysis of 126 consecutive patients managed in the coloproctology clinic between March2015 and September 2016 was carried out. All patients were preselected for attendance based on symptom-based protocol. Based on the information available in GP referrals, 126 patients with bleeding per rectum with low risk of cancer were re-triaged from the general outpatient to dedicated coloproctology procedure clinic. Those patients accounted for 14% of waiting list. The average waiting time to attend clinic was 27months from referral to undergoing definitive procedure. A proctoscopy or/and rigid sigmoidoscopy was performed in patients. Seventy-nine (89.7%) patients were completely managed and discharged after attending their first visit. Sixty-seven (76%) patients had 2nd- or 3rd-degree haemorrhoids and were treated with rubber band ligation (RBL) or phenol injection in outpatient setting. Two patients had an anal fissure and were managed conservatively with medication. After clinic, follow-up was through telephone clinic. This avoids attendance physically in the hospital. Symptoms persisted in nine patients and were subsequently scheduled for colonoscopy, three had benign polyps. With the introduction of the procedure clinic, the waiting time from referral to treatment was reduced from 27 to 6months (p < 0.05). Establishing a dedicated "Coloproctology procedure clinic" is an effective strategy in reducing number of hospital visits per patient and hospital waiting list. This innovative clinic reduces utilisation of precious endoscopy unit resources. This ultimately will improve endoscopy efficiency.

Comparing Electrical Stimulation With and Without Ultrasound Guidance for Phenol Neurolysis to the Musculocutaneous Nerve

BackgroundUltrasound guidance is increasingly being used for neurolytic procedures that have traditionally been done with electrical stimulation (e-stim) guidance alone. Ultrasound visualization with e-stim−guided neurolysis can potentially allow adjustments in injection protocols that will reduce the volume of neurolytic agent needed to achieve clinical improvement. ObjectiveThis study compared e-stim only to e-stim with ultrasound guidance in phenol neurolysis of the musculocutaneous nerve (MCN) for elbow flexor spasticity. We also evaluated the ultrasound appearance of the MCN in this population. DesignRetrospective review. SettingUniversity hospital outpatient clinic. ParticipantsAdults (N = 167) receiving phenol neurolysis to the MCN for treatment of elbow flexor spasticity between 1997 and 2014 and adult control subjects. MethodsFor each phenol injection of the MCN, the method of guidance, volume of phenol injected, technical success, improved range of motion at the elbow postinjection, adverse effects, reason for termination of injections, and details of concomitant botulinum toxin injection were recorded. The ultrasound appearance of the MCN, including nerve cross-sectional area and shape, were recorded and compared between groups. Main Outcome MeasuresThe volume of phenol injected and MCN cross-sectional area and shape as demonstrated by ultrasound. ResultsThe addition of ultrasound to e-stim−guided phenol neurolysis was associated with lower doses of phenol when compared to e-stim guidance alone (2.31 mL versus 3.69 mL, P < .001). With subsequent injections, the dose of phenol increased with e-stim guidance (P < .001), but not with e-stim and ultrasound guidance (P = .95). Both methods of guidance had high technical success, improved ROM at elbow postinjection, and low rates of adverse events. In comparing the ultrasound appearance of the MCN in patients with spasticity to that of normal controls, there was no difference in the cross-sectional area of the nerve, but there was more variability in shape. ConclusionsCombined e-stim and ultrasound guidance during phenol neurolysis to the MCN allows a smaller volume of phenol to be used for equal effect, both at initial and repeat injection. The MCN shape was more variable in individuals with spasticity; this should be recognized so as to successfully locate the nerve to perform neurolysis. Level of EvidenceIV

Phenol injection for Morton's neuroma under elettroneurographic guidance

Effective management of chronic diseases involves sustained changes in health behavior, which often requires substantial effort and patient burden. As treatment burden is associated with reduced adherence across several chronic conditions, its assessment and treatment are important clinical priorities. The balance between patient demands and capacity (e.g. coping resources) may be indexed by patients’ subjective experience of treatment fatigue. We present a modified workload–capacity model that incorporates evidence that treatment fatigue may, firstly, be caused by increased workload due to treatment burden (e.g. intensity, complications) and secondly, undermine adherence. Emerging technology-based interventions may be well-suited to reduce treatment burden, prevent treatment fatigue, and increase treatment adherence.