[Prevention and treatment of the complications of peridurography]

In lumbar peridurography conducted in 117 patients with discogenic radiculitis complications occurred both in the stage of peridural anesthesia and after introduction of the radiocontrast medium. During anesthesia the dura mater was punctured in 4 patients, in another 2 patients dicaine penetrated into the subarachnoid space and caused spinal anesthesia with a high upper level. Peridural anesthesia with paralysis of the respiratory musculature developed in 1 patient. After the injection of the radiocontrast medium, spasm in the lower extremities and trunk of the type of spinal epilepsy developed in 4 patients. The clinical picture, prevention, and treatment of these complications are discussed.

[Reccurrent lingual hemiatrophy]

The author reported a 45-year-old woman with numerous developmental anomalies in whom lingual hemiatrophy preceded by strong occipital headaches followed tonsillectomy. After treatment considerable regeneration of tongue nuscle took place. The course of the disease was recurrent. In the differential diagnosis the author considered inflammatory processes, neoplastic diseases, developmental anomalies and toxic effect of procaine used in tonsillectomy as well as the possibility of deeply situated adhaesions in the vicinity of the hypoglossal nerve.

[Complications of a paranephric novocaine block for renal colic]

Under observation were 12 patients, in whom following paranephral novocain blockade subcapsular and paranephral hematomas, purulent paranephritis, abscesses and carbuncles of the kidneys developed. All patients were subjected to surgery. In such cases to eliminate renal colic it would be more safe to perform other kinds of theapeutic procedures (the injection of spasmolytic, the blockade after M. Ju. Lorin-Epshtein method, etc) which are not at all inferior in their effect to paranephral novocain blockade.

Hypersensitivity reactions to Gerovital

Procaine chloride, which was a common cause of allergic reactions in earlier years, has lost importance as a contact allergen because its use for local anesthesia has ceased. Recently, we have seen hypersensitivity reactions in three patients after the use of Gerovital, which is known to contain procaine chloride. A word of warning is warranted against indiscriminate use of Gerovital, particularly of its topical preparations.

[Nerve-root damage from local injections (author's transl)]

Paravertebral injections of local anaesthetics (procaine hydrochloride, frequencly in combination with other substances) may damage cervical or lumbosacral nerve roots, depending on the site of injection. Five such iatrogenic lesions are described. Paravertebral injections of local anaesthetics also carry the risk of irreversible paraplegia and such treatment should therefore not be given in the cervical and lumbar segments.

Oculomotor palsy following dental anesthesia

Paralysis of the right third and fourth cranial nerves, lasting for about six weeks, occurred in a patient following the injection of procaine hydrochloride in the area of the right superior alveolar artery. Ocular complications of dental anesthesia are rare and are probably caused by intra-arterial injection of anesthetic that reaches the orbit via an anastomosis between the middle meningeal and ophthalmic arteries. Such complications include transient oculomotor palsies and permanent or transient loss of vision.

Fatal consequences of local anesthesia: report of five cases and a review of the literature

The possible hazards of local anesthetic agents in either moderate or large doses are not always fully appreciated. The toxic side effects following rapid systemic absorption may be the unsuspected cause of death following the clinical use of these substances. Data on 15 deaths after the administration of local anesthetic substances are summarized. Five case histories involving lidocaine (lignocaine, Xylocaine) and cocaine are presented in detail, including the results of toxicologic analysis. The literature relevant to similar fatalities is reviewed but contains little information relating to blood and tissue concentrations in fatal cases. It is hoped that this paper may assist in clarifying the cause of death in some previously problematic situations.

Adverse reactions to topical ocular anesthetics

The purpose of this article is to clarify some of the misunderstanding about adverse reactions to topical ocular anesthetics. Discussion will include: types of adverse reactions that are theoretically and practically possible; advice on handling the reactions that can occur; and precautions for minimizing their occurrence.

[Local anaesthesia--modern outlook, faults and complications (author's transl)]

Development of general anaesthesia has reduced the amount of operations performed by local anaesthesia considerably. Inevitably this will cause than junior traines in large hospitals will be less informed and instructed in local anaesthesia than his demand will be after he has left the hospital. New results of mechanism of action of local anaesthesia are given and compared with other similar drugs. Tetracain is less efficient than the drugs of the amidtype as far as surface anaesthesia activity is concerned and Procain is surpassed by amidtype anaesthesia drugs for infiltration and conductive anaesthesia use.

The heart in myasthenia gravis

The cardiac changes associated with myasthenia gravis have been reviewed and specific areas explored. There is no doubt concerning the involvement of the myocardium in this disease as indicated by clinical, ECG, vectorcardiographic, and autopsy data. The doubt lies in the precipitating factor for the pathology found. On the one hand the whole picture could be a direct result of the pathologic process of myasthenia gravis. On the other hand the patient with myasthenia gravis, during the natural history of the disease, encounters many iatrogenic and coincidental variables which could influence the nature of the clinical findings and autopsy data. One fact seems reasonably clear: The association of myocardial pathology with thymoma, especially malignant thymoma, is well established for the more severe form of the myocardial disease. Furthermore, the hypothesis that cardiac muscle antibodies give rise to such reactions is attractive, although not fully resolved. If such cases are excluded then there remain others where cardiac pathology could be due to other disease, primarily coronary heart disease, in the older group. In addition, the mode of death of some patients indicates that intercurrent respiratory problems could play a part. Most patients in this group do not seem to have cardiac abnormalities due to the pathologic process of myasthenia. There is in addition a small group where very striking cardiovascular findings suggestive of myocarditis are found. There is not necessarily a thymoma and no other specific etiologic factors can be found. These are rare cases and might still be related to disorders of immune mechanisms. In conclusion it can be stated that, although there is now a considerable body of evidence concerning the heart in myasthenia gravis, the implication of specific pathology for this neuromuscular disorder affecting the heart must be considered, in the traditional Scottish legal sense, as "not proven."

Effects of a procaine preparation (Gerovital H3) in hospitalized geriatric patients: a double-blind study

The effects of Gerovital H3 (a specially stabilized form of procaine hydrochloride) on geriatric psychiatric patients were assessed in a double-blind study at Bronx State Hospital. The mean age of the subjects was 73 years and the average rating for the severity of organic symptoms was "moderate." During the first six weeks of study, the patients were each given a 5-ml injection of either Gerovital or placebo (saline) intramuscularly three times a week. This dosage was doubled to 10 ml per injection during the second six weeks. Nine Gerovital and 10 control subjects completed the first six weeks; and 6 Gerovital and 7 control subjects completed the entire 12-week study. Objective rating scales were used to evaluate patients on measures of interpersonal functioning, cognitive ability, psychiatric symptoms, and urine and blood chemical findings. All subjects were assessed before treatment and at six weeks and twelve weeks of the study. Side effects were recorded at two-week intervals. On most measures the variability between subjects was quite large, whereas differences between average scores for the two groups usually were small The few significant differences showed no systematic pattern and would be expected to occur by chance alone when so many statistical comparisons are made. The overall results of this double-blind study strongly indicated that, among these hospitalized geriatric patients with organic symptoms, Gerovital H3 had no ameliorative effect on either psychologic or physiologic functioning.

Paracervical block with low doses of chloroprocaine. Fetal and maternal effects

Results of 261 paracervical blocks done with a dose of 12 ml of 1% chloroprocaine hydrochloride solution containing 1:200,000 epinephrine were recorded. The blocks were followed by abnormal heart rate patterns for 3 to 15 minutes in six of 104 (5.8%) of the fetuses. Excellent pain relief was obtained with 142 of 172 blocks or 83%. One fetus died owing to multiple congenital anomalies. Paracervical blocks performed as described are completely safe for the mother and do not affect Apgar scores. Potential fetal risks are acceptable when considered in light of the ease of administration and the amount of pain relief obtained.

Procaine HCl (Gerovital H3): a weak, reversible, fully competitive inhibitor of monoamine oxidase

A specially stabilized form of procaine hydrochloride (Gerovital H3) has been shown to be a more potent inhibitor of monoamine oxidase than procaine HCl itself and a weaker inhibitor of this enzyme than iproniazid. This preparation was studied to determine its mode of interaction with monoamine oxidase using purified rat brain mitochondrial monoamine oxidase as the enzyme source. Reaction velocities were determined spectrophotometrically by quantitating the rate of appearance of 4-hydroxyquinoline from kynuramine. Dilutional studies comparing the mechanism of inhibition of monoamine oxidase produced by Gerovital H3 and by ipronizid demonstrated that Gerovital H3 was a reversible inhibitor of monoamine oxidase. Analysis of studies using Lineweaver-Burk and Dixon plots revealed that Gerovital H3 was a fully competitive inhibitor of monoamine oxidase. That Gerovital H3 is a weak, reversible, competitive inhibitor of monoamine oxidase may explain the absence of adverse reactions associated with the clinical use of Gerovital H3 as compared to the severe adverse reactions that have been associated with the use of irreversible monoamine oxidase inhibitors.