Phenol Injection Research Articles

A Limited Renal Injury May Cause a Permanent Form of Neurogenic Hypertension

Previously, we have shown that an acute injury to the kidney produced by an intrarenal injection of phenol causes an immediate increase in blood pressure and in norepinephrine (NE) secretion from the posterior hypothalamus. The studies suggest that in this model afferent impulses from the kidney to central integrative structures in the brain may be responsible for the increase in blood pressure. To further evaluate whether a renal injury caused by the intrarenal injection of phenol leads to a permanent elevation of blood pressure and whether this is mediated by increased sympathetic nervous system activity, we examined the chronic effects (4 weeks) of an intrarenal injection of 50 μL of 10% phenol on blood pressure and NE secretion from the posterior hypothalamus. Systolic blood pressure increased from 128 ± 2.1 to 176 ± 1.5 mm Hg ( P < .01) 4 weeks after receiving the intrarenal injection of phenol, but it did not change in rats that received the vehicle (128 ± 2.4 and 135 ± 1.7 mm Hg) and in rats that were subjected to renal denervation (127 ± 3.4 and 124 ± 1.0 mm Hg). The secretion of NE from the posterior hypothalamic nuclei was greater ( P < .01) in rats that received phenol (253 ± 9.6 pg/mL) than in controls (158 ± 8.6 pg/mL) and denervated rats (170 ± 2.1 pg/mL). These studies have shown that a limited injury to one kidney may cause a permanent elevation of blood pressure and this is associated with increased sympathetic nervous system activity.

Surgery for the treatment of overactive bladder

Objectives. To describe surgical options that may be indicated when conservative management of overactive bladder is unsuccessful. Methods. The literature on current endoscopic and open surgical procedures is reviewed. Results. The endoscopic approach of hydrodistention under anesthesia may be therapeutic, but normally offers only temporary relief of symptoms. Among open surgical procedures, cystolysis has not withstood the test of time and is no longer used. Partial rhizotomy can reduce reflex bladder contractility while preserving other important urogenital functions. Peripheral denervation via a vaginal approach appears effective in as many as 70% of patients with motor instability, but is not effective in interstitial cystitis or other sensory bladder disorders. Transvesical phenol injection is most effective for detrusor instability (DI) caused by multiple sclerosis. Enterocystoplasty is more helpful in intractable DI than in interstitial cystitis. Detrusor myomectomy has yielded excellent results in patients with neurogenic causes of DI. Urinary diversion is rarely required in DI, but may be preferable to enterocystoplasty when severe pelvic pain is present. Conclusions. When appropriately chosen, surgical procedures can substantially improve the quality of life of some individuals with overactive bladder.

Trigeminal Nerve Peripheral Branch Phenol Injections for Tic Douloureaux

Trigeminal Nerve Peripheral Branch Phenol Injections for Tic Douloureaux

Trigeminal Nerve Peripheral Branch Phenol Injections for Tic Douloureaux

Trigeminal Nerve Peripheral Branch Phenol Injections for Tic Douloureaux

3 Gait initiation in a cerebral palsy spastic diplegic population

Hypertonia is the abnormal increase in muscle tone as a result of upper motor neuron lesions. There are three following clinical types: spasticity, dystonia, and rigidity. Management of hypertonia is individualized and should be directed by the patient and/or family׳s goals of care as well as the underlying cause of the hypertonia. Treatment options include stretching, strengthening, positioning, oral medications, botulinum toxin injections, phenol injections, as well as surgical procedures. Without effective management, hypertonia can result in muscle imbalance, abnormal movement patterns, pain, joint contracture, joint deformity, and ultimately negatively impact a patient׳s function. This discussion serves as an overview of hypertonia, focusing on spasticity and dystonia, in the pediatric population by examining the causes and epidemiology, elucidating its symptoms, discussing available treatment and management options, and clarifying why this all matters.

Renal afferent impulses, the posterior hypothalamus, and hypertension in rats with chronic renal failure

Hypertension in 5/6 nephrectomized (CRF) rats is partly related to increased activity of the sympathetic nervous system. We have previously shown a greater norepinephrine turnover rate in the posterior hypothalamic nuclei and locus coeruleus of CRF than control rats. Dorsal rhizotomy prevented the rise in blood pressure and the increase in NE turnover rate in the posterior hypothalamus and the locus coeruleus. The studies suggest that afferent impulses from the kidney to central integrative structures in the brain may be responsible for hypertension in CRF rats. To further evaluate the role of renal afferent nerves in the regulation of blood pressure, and whether renal afferent pathways integrate with the posterior hypothalamus, we studied the effects of an intrarenal injection of 50 microliters of 10% phenol on blood pressure and NE secretion from the posterior hypothalamus of Sprague-Dawley rats. Mean arterial pressure increased from 89 +/- 4.0 to 114 +/- 4.3 mm Hg in rats which received intrarenal injection of phenol, but it did not change in rats that received vehicle (95 +/- 4.3 and 89 +/- 3.6 mm Hg, respectively). Renal denervation totally prevented the increase in blood pressure caused by intrarenal injection of phenol. The secretion of NE from the posterior hypothalamus increased from 139 +/- 4.8 to 250 +/- 9.9 pg/ml (P < 0.01) in rats that received intrarenal phenol, but it did not change in rats which received vehicle or in those with renal denervation. In CRF rats NE secretion from the posterior hypothalamus was greater than in control and CRF rats subjected to dorsal rhizotomy. These studies show that afferent impulses from an injured kidney increase NE secretion from the posterior hypothalamus and raise blood pressure. NE secretion is higher in the posterior hypothalamus of CRF than control rats. The posterior hypothalamus appears to be an important integrative structure of the sympathetic regulation of blood pressure.

Interventional radiologic procedures with CT guidance in cancer pain management.

Reduction of pain without systematic side effects can be achieved in advanced stages of cancer with precise percutaneous techniques guided with computed tomography (CT). CT guidance allows exact needle positioning, reducing complications and improving the results. Regional analgesia with neurolytic block (neurolysis) is achieved by injection of alcohol or phenol and involves intentional destruction of a nerve or nerves to interrupt nociceptive pathways for weeks or months. Percutaneous alcoholization of bone metastasis is indicated in patients with painful, severe, osteolytic bone metastasis if conventional anticancer therapy is ineffective and high doses of opiates are necessary to control pain and when rapid pain relief is necessary. Bone packing with acrylic glue (methyl methacrylate) is used to prevent pathologic fractures and pain in patients with vertebral body tumors and acetabular metastasis. With these techniques, the radiologist is able to play an active role in pain management and in improving the quality of life of patients with malignancies.

Assessment of sympathetic nerve activity in the practice of lumbar sympatholysis: interest of sympathetic skin responses

The place of lumbar sympathectomy in the treatment of occlusive arterial disease of the lower limbs remains controversial. An adequate assessment of sympathetic nerve function in the practice of sympathectomy may reduce unsatisfactory results of this procedure. We report a series of 25 lumbar sympatholyses indicated for claudication, rest pain or distal arterial ulcer, and attempted by means of phenol injection in sympathetic ganglia under tomographic guidance. Sympathetic skin response (SSR) recording, an electrophysiological test of sympathetic activity, was performed before and after phenol injection, and its results were compared to the clinical outcome. SSR was abolished in the treated limb after phenol injection in only 64% of the cases. The post-injection abolition of SSR was correlated with the clinical improvement rate: 11% when SSR was still present, but 75% when SSR was abolished. In this latter case, the pre-injection values of SSR amplitudes could predict the clinical benefit of sympatholysis. It is necessary to assess the sympathetic activity in a limb before and after doing sympatholysis. Preoperatively, this activity may be diminished or already abolished in patients suffering from neuropathy involving the autonomic nervous system, limiting the indication of sympathectomy. Postoperatively, if sympathetic activity is still present in the treated limb, it implies that the sympathectomy is not completed, and it supports the indication of a new sympatholysis attempt. These observations show the usefulness of SSR recording in the practice of phenol sympatholysis, this test being simple and specific of sympathetic nerve function.

The Effects of Phenol Nerve and Muscle Blocks in Treating Spasticity: Review of the Literature

Objective: a critical review of the literature on the clinical effects of phenol nerve and muscle blocks and the duration of effects for the treatment of local spasticity. Mapping out the advantages and disadvantages of phenol sets the stage for newly developed methods like radiofrequency thermocoagulation and botulinum toxin. Study selection: a computer search was carried out (MEDLINE) for the period 1966 to 1994 using the key words: spasticity, nerve block, motor point block, neurolysis, peripheral denervation, and phenol. In addition, references given in any relevant publications were examined and recent volume numbers of relevant, nonindexed journals were screened. Articles in English, French, German, or Dutch were included. Randomized and nonrandomized clinical trials as well as case series were selected if: (1) patients were treated for spasticity of the extremities, and (2) the treatment consisted of peripheral nerve or muscle blocks by phenol. Data synthesis: Forty-five studies were reviewed. For each study a success percentage could be calculated. Case studies reported the highest success percentages (71%), followed by the uncontrolled (61%), and nonrandomized controlled studies (45%). Percutaneous nerve blocks seem somewhat more effective than muscle blocks, with a success percentage of 66% when compared with 61%. So called 'open nerve' blocks seem less effective (54%). In nine studies the effects of 110 phenol blocks in the upper extremity were reported, whereas 8 studies with 260 patients/blocks presented the results of phenol injections into the lower extremity. Treatment of spasticity of the lower extremity seems more effective than treating the upper extremity, with an overall success rate of 89% vs. 59%. For the duration of phenol block response, a median was calculated, based on the longest duration of effects reported in the 45 studies. The effects of nerve blocks (13 studies) are reported to last longer than muscle blocks (6 studies): a median of 22 months vs. 11.5 months. The effects in the lower extremity studies (6) reportedly last longer that those in the tipper extremity studies (6): a median of 14.5 and 9.5 months, respectively. Neither for the nerve blocks nor for the muscle blocks could a dose-response relation be demonstrated. Moreover, no relation was found between dose and duration of effects. The most severe complication of percutaneous nerve blocks is painful paraesthesia, occurring in 11% of the patients. The main complications of muscle blocks were transient tenderness and swelling at the multiple injection sites, whereas surgical or open nerve blocks are complicated by wound infections. Conclusions: There are some indications that phenol injections might reduce spasticity, although the duration of effects is limited. However, this conclusion is based on subjective, clinical impressions of treatment effects. Blinded, unprejudiced, and objective assessments of the effects of phenol are still lacking. Furthermore, distortion of the presented results by placebo effects could not be excluded. Although phenol blocks are already widely used in clinical practice, placebo controlled efficacy studies, assessed according to present research rules, are needed to prove the real value of phenol. Well-designed randomized clinical trials might also clarify the effectiveness of peripheral nerve and muscle blocks by phenol when compared with other recently developed treatments.

Dynamic and static pelvic tilt of patients with cerebral palsy spastic deplegia

Hypertonia is the abnormal increase in muscle tone as a result of upper motor neuron lesions. There are three following clinical types: spasticity, dystonia, and rigidity. Management of hypertonia is individualized and should be directed by the patient and/or family׳s goals of care as well as the underlying cause of the hypertonia. Treatment options include stretching, strengthening, positioning, oral medications, botulinum toxin injections, phenol injections, as well as surgical procedures. Without effective management, hypertonia can result in muscle imbalance, abnormal movement patterns, pain, joint contracture, joint deformity, and ultimately negatively impact a patient׳s function. This discussion serves as an overview of hypertonia, focusing on spasticity and dystonia, in the pediatric population by examining the causes and epidemiology, elucidating its symptoms, discussing available treatment and management options, and clarifying why this all matters.

Histopathologic changes in primate spinal cord after single and repeated epidural phenol administration.

Epidural phenol for control of pain and spasticity has been advocated for clinical use. This study determined the histopathologic changes that follow single and repeated epidural administration of phenol in saline in nonhuman primates. Nine primates received 0.5 mL of either 3% phenol in saline (n = 4) or 6% phenol in saline (n = 5) via lumbar epidural injection. Two additional primates received three consecutive daily epidural doses of 0.5 mL of 3% phenol in saline. Finally, 5 unoperated primates and 5 primates that received only 2 mL of radiographic contrast material served as control subjects. Two weeks after the epidural injection, spinal cords were removed and processed for histopathologic study by a neuropathologist blinded to the solution administered. None of the control animals demonstrated histopathologic changes. One animal that received 6% phenol died 3 days after injection. All phenol-treated animals demonstrated predominantly posterior root damage. Spinal cord damage was seen in all animals receiving 6% phenol, in 2 animals receiving 3% phenol single doses, and in neither animal receiving 3% phenol multiple doses. Anterior root damage occurred in all phenol-treated animals except the 4 that received single 3% phenol injections. Animals that received 6% phenol demonstrated greater lower extremity motor weakness than those in the other groups, but no clear correlation existed between extent of histopathologic changes and motor weakness. Motor weakness, anterior root damage, and direct cord injury were noted in primates following epidural administration of phenol in concentrations below what has been reported for clinical use in humans. Since it is more difficult to control the spread of epidural versus subarachnoid phenol, the risks of epidural phenol may outweigh the benefits relative to subarachnoid administration.

The role of brain acetylcholine in phenol-induced tremor in mice

The relation between phenol-induced tremor and brain acetylcholine levels, and the effects of cholinergic drugs on the tremor were investigated, using male ddY mice weighing 28–35 g. The magnitude of phenol-induced tremor was graded on a 4-point scale: 0, normal; 1, slight; 2, moderate; 3, severe, and acetylcholine levels were measured by high-performance liquid chromatography with electrochemical detection. The magnitude of tremor and the decrease in acetylcholine levels in the striatum and cerebral cortex induced by s.c. injection of phenol (50, 100, 200 mg/kg) were dose-dependent, and both showed parallel time courses. Intracerebroventricular (i.c.v.) injection of phenol (100 μg/mouse) caused a decrease in acetylcholine levels in the striatum but did not induce tremor. Intraperitoneal injection of pentobarbital (10 mg/kg), which inhibits the release of acetylcholine, weakened both the magnitude of the tremor and the decrease in acetylcholine levels induced by phenol (200 mg/kg), whereas i.c.v. injection of pentobarbital (120 μg/mouse) attenuated the decrease in acetylcholine levels induced by phenol, but did not affect the magnitude of the tremor. Intraperitoneal (20 mg/kg) or i.c.v. (60 μg/mouse) injection of mecamylamine further strengthened the tremor. Intraperitoneal (0.3 mg/kg) injection of physostigmine strengthened the tremor, while i.c.v. injection (1 μg/mouse) caused a reduction in its magnitude. These results suggest that the tremor is caused directly by the phenol-induced increase in acetylcholine release in the peripheral nervous system (motor nerve endings), that the decrease in brain acetylcholine levels may be due to phenol-induced increases in acetylcholine release within the central nervous system, and that the resultant reduction in brain acetylcholine levels indirectly suppresses the tremor.

Treatment of spasmodic torticollis with intramuscular phenol injection.

Treatment of spasmodic torticollis with intramuscular phenol injection.

Treatment of pilonidal sinuses by phenol injections.

Six female and 39 male outpatients, who suffered from acutely inflamed pilonidal sinus were treated by sclerotherapy between January 1985 and December 1988. Under local anaesthesia, 1-2 ml 80% phenol was injected into the sinus. The phenol, which was allowed to act for a minute, was washed out by irrigating the sinus with physiological common-salt solution. Of the questionnaire sent to all 45 patients, 37 proved suitable for evaluation. Complete healing occurred in 22 cases (59.8%). The healing time was 6.2 weeks on average. Besides a rather frequently observed transient reddening as a result of the local inflammation caused by the phenol, 5 patients developed an abcess which needed operative treatment. This study does not support the encouraging results of previous series.

Acute paraplegia following intrathecal phenol block in the presence of occult epidural malignancy

A 68-year-old woman with an invading adenocarcinoma of the lung underwent intrathecal phenol block for chest wall pain. Acute paraplegia resulted immediately following the procedure. Subsequent CT scan showed dural compression from an epidural metastasis five segments above the site of the phenol injection. This was confirmed at surgical decompression of the spinal cord and by histological findings. The cause of the paraplegia, which has not recovered, was probably spinal coning.

Trichloroethylene concentration effects on pilot field-scale in-situ groundwater bioremediation by phenol-oxidizing microorganisms

A pilot study of in-situ aerobic cometabolic degradation of trichloroethylene (TCE) through the injection of phenol and oxygen into a confined aquifer was conducted at the Moffett Field test site together with a related laboratory study. With injected phenol and dissolved oxygen concentrations of 12.5 and 35 mg/L, respectively, first-order TCE removal of 88% was obtained over a concentration range of 62-500 [mu]g/L. With 1000 [mu]g/L TCE, removal was lower (77%), but increased to 90% when the phenol concentration was raised to 25 mg/L. The maximum field transformation yield of 0.062 g of TCE/g of phenol compared favorably with the highest measured resting-cell laboratory yield of 0.11 g of TCE/g of phenol. These results demonstrate high promise for in-situ aerobic cometabolic biodegradation of TCE with phenol-induced enzymes. 30 refs., 6 figs., 2 tabs.

Long-term results of large-dose, single-session phenol injection sclerotherapy for hemorrhoids.

The aim of our study was to assess the medium to long-term outcome following single session large dose injection sclerotherapy for symptomatic hemorrhoids. One hundred eighty-nine patients (male = 106, female = 83, median age, 51; range, 20-85 years) were assessed following single-session, large-dose (3 x 5 ml) phenol injection therapy. The most frequent complaint was bleeding (100 percent). At four-year follow-up, 53 patients (28.0 percent) were cured, 26 (13.7 percent) were improved, 35 (18.5 percent) remained unchanged, 59 (31.2 percent) deteriorated, and 16 (8.5 percent) required surgical intervention. Among the patients who were not cured, symptoms were minimal in 50 percent. Sclerotherapy was associated with a reduced incidence of bleeding (P < 0.05) but an increase in difficulty in perineal cleaning was observed (P < 0.05). Large-dose, single-session sclerotherapy provides only short-term benefits in the majority of patients with symptomatic hemorrhoids.

Microcosm and in situ field studies of enhanced biotransformation of trichloroethylene by phenol-utilizing microorganisms

The ability of different aerobic groundwater microorganisms to cometabolically degrade trichloroethylene (TCE), 1,2-cis-dichloroethylene (c-DCE), and 1,2-trans-dichloroethylene (t-DCE) was evaluated both in groundwater-fed microcosms and in situ in a shallow aquifer. Microcosms amended with phenol or toulene were equally effective in removing c-DCE (> 90%) followed by TCE (60 to 70%), while the microcosm fed methane was most effective in removing t-DCE (> 90%). The microcosm fed ammonia was the least effective. None of the microcosms effectively degraded 1,1,1-trichloroethane. At the Moffett Field groundwater test site, in situ removal of c-DCE and TCE coincided with biostimulation through phenol and oxygen injection and utilization, with c-DCE removed more rapidly than TCE. Greater TCE and c-DCE removal was observed when the phenol concentration was increased. Over 90% removal of c-DCE and TCE was observed in the 2-m biostimulated zone. This compares with 40 to 50% removal of c-DCE and 15 to 25% removal of TCE achieved by methane-grown microorganisms previously evaluated in an adjacent in situ test zone. The in situ removal with phenol-grown microorganisms agrees qualitatively with the microcosm studies, with the rates and extents of removal ranked as follows: c-DCE > TCE > t-DCE. These studies demonstrate the potential for in situ TCE bioremediation using microorganisms grown on phenol.

Peripheral nerve block with phenol to treat spasticity in spinal cord injured patients.

In this study an attempt was made to treat spinal cord injured patients with severe spasticity by peripheral nerve blocks. Thirty-six patients (5 female, 31 male) ranging in age from 20 to 71 years (mean: 29 +/- 8.2) were treated by phenol injections. A specially designed electrostimulation needle was used for the injections. The results showed that peripheral nerve blocks with phenol solution could be a remedy on a temporary basis, but are not as effective as has been described previously.

Subtrigonal phenol injections in the treatment of idiopathic detrusor instability in the female--a long-term urodynamic follow-up.

A total of 36 subtrigonal phenol injections were performed on 29 patients with detrusor instability. Long-term follow-up (mean 13.7 months) showed a subjective response rate of only 14%, and objectively there was no significant change in any urodynamic parameter in the group as a whole. There was, however, a significant improvement in cystometric capacity and volume at first contraction, in those under 55 years of age. One patient developed a vesicovaginal fistula following repeat injections. This suggests that subtrigonal phenol injections have little place in the treatment of detrusor instability, especially in the over 55s, and repeat injections should be abandoned because of the risk of major complications.