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PubMed1999

Vasculitis in the Palmerston North mouse model of lupus: phenotype and cytokine production profile of infiltrating cells.

OBJECTIVE: To define the phenotype of cells in the perivascular and vascular infiltrates of Palmerston North (PN) mice and the cytokines that those cells produce. METHODS: Immunohistologic analysis, flow cytometric analysis, and reverse transcriptase-polymerase chain reaction (RT-PCR) studies were performed on tissues and cells from female PN mice and age-matched and sex-matched DBA/2 mice. RESULTS: With aging, PN mice developed a female-predominant, lupus-like disease, with a severe systemic mononuclear cell perivasculitis and vasculitis. The perivasculitis involved arteries and veins in kidney, liver, brain, and lung; the vasculitis predominantly involved veins and venules. The perivascular and vascular infiltrates in female PN mice were composed mainly of an unusual cell type that expressed phenotypic markers characteristic of both T cells (Thy1+, CD3+, CD4+, T cell receptor + [TCR+]) and B cells (B220+). In addition, the infiltrates contained a smaller number of conventional CD4+,B220- T cells and macrophages. Very few CD8+ T cells or surface Ig+ B cells were seen. Unlike the Thy1+,B220+ T cells present in MRL/lpr mice, most of which were CD4-,CD8- and TCRalpha/beta+, the majority of the Thy1+,B220+ T cells in the perivascular/vascular infiltrates of PN mice were CD4+ and expressed either TCRalpha/beta or TCRgamma/delta. By immunohistologic staining, the cells in the perivascular and vascular infiltrates in the kidneys of older PN mice were shown to produce interleukin-4 (IL-4), IL-6, and IL-10, but not IL-2, interferon-gamma, transforming growth factor beta, tumor necrosis factor alpha, or IL-1beta. By RT-PCR, the kidneys of older PN mice were found to express high levels of IL-4, IL-6, and IL-10 messenger RNA. CONCLUSION: The vascular and perivascular infiltrates in PN mice are composed predominantly of an unusual subpopulation of T cells that are Thy1+,B220+,CD4+,CD8-, express either TCRalpha/beta or TCRgamma/delta, and produce mainly type 2 cytokines. The exact role of these cells in the immunopathogenesis of lupus-like disease in PN mice remains to be elucidated.

Animals↗

PubMed2004

Lymphocyte activation and hepatic cellular infiltration in immunocompetent mice infected by dengue virus.

Activation and expansion of dengue virus-specific T cells and abnormal liver functions in dengue patients have been documented. However, it remains to be determined whether T cells are involved in the pathogenic mechanism of dengue virus infection. In this study, immunocompetent C57BL/6 mice were employed to study dengue virus-induced T cell activation. Mice were inoculated with 10(8) PFU dengue virus serotype 2 strain 16681 by the intravenous route. Dengue viral core RNA was detected by RT-PCR in mouse serum, liver, spleen, and brain at different time points after infection. Splenic T cells were activated as evidenced by their expression of CD69 and O-glycosylated CD43 at as early as day 3 after infection. Splenic T cell expression of O-glycosylated CD43 and IFN-gamma production coordinately peaked at day 5. Coincided with the peak of splenic T cell activation was hepatic lymphocyte infiltration and elevation of liver enzymes. Flow cytometric analysis revealed the infiltrating CD8(+) T cell to CD4(+) T cell ratio was 5/3. After a second inoculation of dengue virus, hepatic T cell infiltration and liver enzyme levels increased sharply. The infiltrating hepatic CD8(+) T cell to CD4(+) T cell ratio increased to 5.8/1. A strong correlation was found between T cell activation and hepatic cellular infiltration in immunocompetent mice infected with dengue virus. The kinetics of liver enzyme elevation also correlated with that of T cell activation. These data suggest a relationship between T cell infiltration and elevation of liver enzymes.

Alanine Transaminase↗

PubMed1993

Prognostic significance of tumor-host interaction in clinical gastric cancer: relationship between DNA ploidy and dendritic cell infiltration.

DNA ploidy of tumor cells and the degree of infiltration of dendritic cells were determined in 93 gastric cancer tissue specimens, and the mechanisms of tumor-host interaction on the prognosis were investigated. DNA ploidy patterns were grouped into low and high ploidy, and the degree of infiltration of dendritic cells (DC) was graded into marked and slight infiltration. In the low ploidy group, the 5-year survival rates in patients with marked and slight DC infiltration were 80.7% and 61.5%, respectively (P < 0.05). In the high ploidy group, however, there were no significant differences. In cases of low ploidy, the incidence of lymph node metastasis was significantly lower in the marked DC infiltration group compared with findings in the slight DC group. Thus, markedly infiltrating dendritic cells in gastric cancer tissue may lead to prolongation of survival time for patients with a carcinoma of the low ploidy profile, by preventing widespread nodal involvement.

Dendrites↗

PubMed1978

Eosinophilic infiltrates in carcinoma of the urinary bladder unassociated with schistosomiasis.

Two hundred and twenty-four biopsies from 151 patients with urinary bladder neoplasms have been studied in order to investigate the incidence of and possible causes for the infiltration of eosinophils. Cases of schistosomiasis were excluded from this study. Of these biopsies, 16 showed a heavy infiltrate 26 a moderate, 61 minimal and 121 no eosinophilic infiltrate. No correlation could be found between the degree of infiltrate and age, sex or tumour type. There was some statistically significant correlation between the eosinophilic infiltrate and stromal invasion and/or tumour necrosis. There was a strong statistical correlation between this infiltrate and previous trauma (biopsy) which was supported by the study of bladder biopsies from patients without neoplasms.

Adult↗

PubMed1999

Chagas' disease encephalitis: intense CD8+ lymphocytic infiltrate is restricted to the acute phase, but is not related to the presence of Trypanosoma cruzi antigens.

Central nervous system (CNS) damage can occur during Chagas' disease, especially in children and immunosuppressed patients. During the acute phase, amastigotes are rarely found, but inflammatory infiltrates are scattered throughout the CNS. Moreover, peripheral lymphocytes and antibodies recognizing neural components were described, suggesting the participation of the immune system in the genesis of neural lesions. Herein, we performed a histopathological study of Colombian-infected C3H/He mice, comparing the distribution of CNS-inflammatory infiltrates versus Trypanosoma cruzi antigens. Inflammatory infiltrates were observed during the acute phase, but did not correlate with the presence of detectable T. cruzi antigens. Infiltrates consisted mainly of CD8+ lymphocytes, although macrophages and a few CD4+ cells were observed. In the chronic stage of infection, although neuropathies were a common finding, only mild inflammatory infiltrates could be detected. Our results suggest that the presence of CNS inflammatory infiltrates is not directly related to the presence of parasite antigens and indicate that, different from chronic myocarditis, encephalitis resolves during the acute phase of Chagas' disease.

Acute Disease↗

PubMed1984

Relationship of tumor leucocytic infiltration to host defense mechanisms and prognosis.

The interface between the tumor and the host is often the site of leucocytic infiltration. We will examine the idea that the infiltrating leucocytes of human and experimental tumors are components of the host immunological defense against the tumor, and that the presence of the infiltrate is a marker of favorable prognosis. Leucocytes could infiltrate tumors because of an active immune response, either nonspecific or specifically directed to tumor-associated antigens. Leucocyte influx may also occur because of chemotactic factors secreted by the tumor cells. Some tumors release factors which enhance vascular permeability and permit improved access by leucocytes to the tumor focus. The consequences of leucocytic infiltration include tumor cell cytolysis, cytostasis, or stimulation of proliferation. The present state of our knowledge of the interactions between tumor cells and infiltrating leucocytes precludes broad generalization of mechanisms. Further study will probably reveal that the mechanisms are diverse, and that there are some systems in which immune interactions occur at this interface and others in which they do not.

Animals↗

PubMed1989

Characterization of T-lymphocyte subpopulations infiltrating primary breast cancer.

Characterization of T-lymphocyte subpopulations adjacent to and infiltrating the primary tumor of breast cancer was carried out using a direct immunofluorescence procedure with the antibodies anti-(Leu-2a) for suppressor/cytotoxic (CD8+) and anti-(Leu-3a) for helper/inducer (CD4+) T-lymphocytes. Fifty-six primary malignant tumors with lymphoid infiltration were studied. The majority (58.9%) were infiltrating duct carcinoma. There were metastases to axillary lymph nodes in 6.67% of the patients. Massive lymphoid infiltration (greater than 40 lymphocytes per x 400 microscopic field) was found in 19.6% of the tumors and moderate infiltration (20-40 lymphocytes per field) in 51.8%. In all the tumors studied there was a reversed CD4+/CD8+ ratio as compared to that found in normal peripheral blood. In 66.1% the CD4+/CD8+ ratio (helper/suppressor) was less than 1.0. The reversed ratio was due to a significant decrease in the number of helper cells (P less than 0.0005). The most significant drop was in the stroma area (P less than 0.0001) as well as in the tumor tissue (P = 0.001). Of particular interest was the significant positive correlation between the age of the patients and an increased number of CD4+lymphocytes in the stroma (P = 0.02). Significant negative correlations were found between a reduced number of CD4+ lymphocytes or CD4+/CD8+ ratio and several histological parameters: tumor diameter, pleomorphism, nucleus/cytoplasm ratio. There was also a significant positive correlation between the total number of CD8+ lymphocytes infiltrating the tumor tissue and the number of axillary lymph nodes with metastatic disease (P = 0.03). It is suggested that the reversed ratio of CD4+/CD8+ lymphocytes may significantly affect the host/tumor immune surveillance.

Adult↗

PubMed1986

Lymphoreticular infiltrates in invasive ductal breast cancer. A histological and immunohistological study.

Fifty-two invasive ductal breast cancers were investigated histologically and immunohistologically to assess localization and composition of the lymphoreticular infiltrates. The tumour-infiltrating cells were mainly located in the intervening stroma, whereas tumour foci often exhibited lower numbers of lymphoreticular cells. Macrophages (Mono 1+ and KiM 6+) and helper/inducer cells bearing the T4 surface antigen (Leu-3a+) regularly constituted the majority of the tumour-infiltrating lymphoreticular cells. In more than 80% of cases large numbers of macrophages were found, and many T4 cells occurred in about 60%. Next in frequency were the T lymphocytes (Leu-1+) which were mostly observed in high (46%), or in moderate (39%) numbers. In about 2/3 of the cases moderate numbers of T8 (suppressor/cytotoxic) lymphocytes (Leu-2a+) were detected. B lymphocytes (T0 15+) and natural killer cells (Leu-7+) were generally encountered in very low numbers, while eosinophilic granulocytes were virtually absent from the lymphoreticular infiltrates. Tissue mast cells and plasma cells were present in very low numbers in about one half of the tumours but cases with low, moderate or - rarely - even high numbers of infiltrating cells also occurred. It must be emphasized that an in situ histomorphological analysis of the cellular part of the stromal reaction of invasive ductal breast cancers allows only limited conclusions concerning the functional properties of the tumour-infiltrating lymphoreticular cells. From the present study, macrophages and T4 cells but also T8 lymphocytes might be of significance in immunooncological reactions "against" clinically detectable stages of invasive breast cancer.

Antibodies, Monoclonal↗

PubMed1987

Immunohistochemical study of epidermal Langerhans cells and dermal dendritic cells in benign and malignant skin lesions characterized by a dermal lymphoid infiltrate consisting either of B-cells or T-cells.

Skin biopsies from 43 patients with a rather dense dermal lymphoid infiltrate of either inflammatory or neoplastic nature have been investigated. We studied the number, distribution and immunophenotype of epidermal Langerhans cells and dermal dendritic cells. As previously reported, differences in epidermal Langerhans cell and dermal dendritic cell numbers between skin biopsies with a B-cell infiltrate and skin biopsies with a T-cell infiltrate were found, dendritic cells being more numerous in the latter. The main finding of this study was an uneven distribution of epidermal Langerhans cells and dermal dendritic cells in skin biopsies with a T-cell infiltrate: in skin lesions with an inflammatory lymphoid infiltrate, small clusters of epidermal and dermal dendritic cells admixed with T-lymphocytes (predominantly T-helper/inducer cells) and small blood vessels were present at areas of exocytosis. In skin lesions with a neoplastic lymphoid infiltrate larger, more loosely arranged aggregates of dendritic cells and T-cells were seen. These cell aggregations composed of activated (inflammatory or neoplastic) T-cells and dendritic cells may represent the cutaneous homologue of the secondary T-nodule in the lymph node. Both types of cell aggregates may correspond to the dendritic cell-T cell clusters observed in in vitro induced immune responses.

B-Lymphocytes↗

PubMed1995

Effect of tumor necrosis factor receptor binding protein on cell infiltration induced by lipopolysaccharide and Sephadex beads in guinea pig lung.

In the present study, the effect of a tumor necrosis factor receptor binding protein (TNFbp) on the cell infiltration induced by lipopolysaccharide (LPS) and Sephadex beads in guinea pig lung was examined. The intratracheal injection of LPS (2.5 micrograms) induced a six-fold increase in total cell number recovered in bronchoalveolar lavage (BAL) fluid at 24 hr. This increase in bronchopulmonary inflammation was mainly due to a neutrophil and macrophage infiltration, representing 60% and 35% of the total cells, respectively. The intravenous or intratracheal injection of Sephadex beads to guinea pigs induced a three-fold increase in total cell number recovered in BAL at 24 h and was characterized by a prominent eosinophil, macrophage, and neutrophil infiltration representing 36%, 42%, and 16% of the total cells, respectively. In addition, bronchial tissues isolated from Sephadex-treated guinea pigs showed an increased in vitro reactivity to both histamine and acetylcholine. TNFbp (1-50 micrograms) induced a dose-dependent inhibition of cell infiltration induced by LPS. In contrast TNFbp neither attenuated the bronchopulmonary cell infiltration observed 24 h following intravenous or intratracheal administration of Sephadex beads nor inhibited the increase in bronchial reactivity. These results show that TNF plays an important role in cell infiltration induced by LPS, but not that induced by Sephadex, in the guinea pig lung.

Animals↗

PubMed1996

Fat infiltration in liver of rats induced by different dietary plant oils: high oleic-, medium oleic- and high petroselinic acid-oils.

Beneficial effects on health parameters by ingestion of plant oils having high levels of monounsaturated fatty acids such as oleic (cis-9-octadecenoic) acid have been described in several studies. Recently, we have shown that feeding of coriander oil containing high proportions of a positional isomer of oleic acid, i.e. petroselinic (cis-6-octadecenoic) acid, led to significantly decreasing proportions of arachidonic (all cis-5,8,11,14-eicosatetraenoic) acid in the cellular lipids. Here, we report histopathological findings in male Wistar rats fed isocaloric diets containing 2% corn oil and 12% (w/w), each, of different plant oils (high-oleic and conventional sunflower oil, olive oil, rapeseed oil as well as coriander oil) containing varying levels of monounsaturated fatty acids, i.e. oleic or petroselinic acids. One group of animals was fed a standard diet containing 4% (w/w) of fat as control. Liver, heart, aorta, stomach, and spleen were anatomically and histologically examined. Livers of animals from all the groups that had received high-fat diets-except the coriander oil group-showed moderate non-degenerative fat infiltrations of the hepatocytes beginning in the periportal fields. Marked to severe fat infiltration was observed in hepatocytes of animals fed coriander oil. In this experimental group the livers were found to contain fatty cysts in addition to hepatocytes with mixed-size lipid vesicles. Moreover, enlarged nuclei were observed in numerous hepatocytes without fat infiltration. Fat infiltration was not observed in livers of animals fed a rat standard diet. In the cells of all other organs and tissues studied, in particular heart and aorta, neither non-degenerative fat infiltrations nor other degenerative changes were observed for any group. Our results show that feeding of fat-rich diets containing varying proportions of C18 cis-monoenoic fatty acids induced different histopathological alterations in the livers of rats, depending on position of the double bond. Plant oils containing varying proportions of oleic acid lead exclusively to moderate fat infiltration in the hepatocytes, whereas in the animals fed high-petroselinic coriander oil degenerative alterations (fatty cysts) as well as -in several cases-enlarged nuclei were found that are likely due to a non-specific stimulation of the hepatocytes resulting from the cell degeneration observed.

Animals↗

PubMed2007

Macrophages and dendritic cells infiltrating islets with or without beta cells produce tumour necrosis factor-alpha in patients with recent-onset type 1 diabetes.

AIMS/HYPOTHESIS: Type 1A diabetes results from autoimmune destruction of pancreatic beta cells. We examined the involvement of TNF-alpha and IL-1beta, as well as of T cells, macrophages and dendritic cells, in the destruction of beta cells in patients with recent-onset type 1 diabetes. MATERIALS AND METHODS: We obtained pancreatic biopsy specimens from six patients with recent-onset type 1 diabetes and analysed these by immunohistochemistry. RESULTS: T cell infiltration was less common in islets without beta cells (12.5 [0-33.3]%) than in those with beta cells (46.0 [17.4-83.3]%), while macrophages and dendritic cells showed a similar extent of infiltration into islets both with or without beta cells. TNF-alpha was detected in 25.0 (4.3-46.9)% of macrophages and 11.8 (0-40.0)% of dendritic cells infiltrating the islets in samples from each patient, but not at all in T cells. IL-1beta was detected in 1.8 (0-11.3)% of T cells infiltrating the islets with beta cells, while it was found in 19.2 (0-35.3)% of macrophages or 10.7 (0-31.3)% of dendritic cells infiltrating the islets in samples from each patient (all values median [range]). CONCLUSIONS/INTERPRETATION: Macrophages and dendritic cells infiltrate the islets and produce inflammatory cytokines (TNF-alpha and IL-1beta) during the development of type 1A diabetes.

Adolescent↗

PubMedDate not supplied

Diagnosis of fatty infiltration of the liver on contrast enhanced CT: limitations of liver-minus-spleen attenuation difference measurements.

BACKGROUND: We investigated whether liver-minus-spleen (L-S) attenuation differences can accurately diagnose fatty infiltration of the liver on contrast-enhanced computed tomography (CT). METHODS: A group of 78 patients administered a fast injection (90-s duration) of 150 mL 60% ionic contrast was compared with 81 patients given a slow injection (152.5 s). The presence or absence of fatty infiltration of the liver was diagnosed by noncontrast CT. RESULTS: The L-S attenuation differences varied significantly, depending on both injection rate and timing of measurements. For the fast-injection group, the optimal L-S threshold for diagnosing fatty infiltration ranged from -43 to -33 Hounsfield units (HU) for early (79 s) and late measurements (106 s), respectively. For the slow-injection group, the optimal threshold ranged from -31 to -25 HU (80 and 112 s, respectively). In addition, sensitivity was not very high (range = 0.54-0.71) for either injection protocol at any measurement time because of significant overlap of L-S values between normal and fatty infiltration patients. Moderate and severe fatty infiltration were more reliably diagnosed than mild fatty infiltration by this method. CONCLUSIONS: Contrast injection rate and timing of measurements significantly influence the optimal L-S threshold for diagnosing fatty liver. This limits the clinical usefulness of such measurements.

Contrast Media↗

PubMed2004

NK cell activation and tumor infiltration are involved in the antitumor mechanism of Virulizin.

Previous studies have demonstrated antitumor efficacy of Virulizin in several human tumor xenograft models and a critical role for macrophages in the antitumor mechanism of Virulizin. Although there is growing support for an immune stimulatory mechanism of action for Virulizin, the details remain to be elucidated. The aim of this study was to determine whether infiltration of natural killer (NK) cells into xenografted tumors is altered by Virulizin treatment, and whether such alterations contribute to the antitumor activity of Virulizin. Immunohistochemical analysis demonstrated that xenografted tumors from Virulizin-treated mice had an increase in infiltration of F4/80(+) (macrophages) and NK1.1(+) (NK) cells. The increase in NK1.1(+) cell infiltration occurred at an early stage of Virulizin treatment, which correlated with an early sign of apoptosis. In addition, Virulizin resulted in an increase in the number of NK cells in the spleens, and NK cells isolated from the spleen exhibited increased cytotoxicity to tumor cells in vitro. In NK cell-deficient SCID-beige mice, the antitumor activity of Virulizin was compromised, providing additional support to the hypothesis that NK cells are necessary for inhibition of tumor growth by Virulizin. Finally, depletion of macrophages resulted in the loss of Virulizin-induced increase in NK1.1(+) cell infiltration into xenografted tumors, suggesting the involvement of macrophages in NK cell infiltration into tumors. Taken together, these results strongly support a mechanism in which Virulizin stimulates a sustained expansion and infiltration of NK cells and macrophages into tumors with subsequent activation of NK cells that is responsible for the observed antitumor activity.

Adjuvants, Immunologic↗

PubMedDate not supplied

Comparative analysis of bupivacaine and ropivacaine for infiltration analgesia for bilateral breast surgery.

Local anesthesia infiltration has been established as a preferred method of perioperative analgesia in many cosmetic operations. In an attempt to maximize the risk-benefit ratio of local anesthesia, a study was conducted to compare efficacy of two local anaesthetic agents. Bupivacaine was compared to ropivacaine in a bilaterally symmetrical breast surgery model. A local anaesthetic solution containing either bupivacaine or ropivacaine was infiltrated into each of the breasts of 15 patients undergoing either breast augmentation or breast reduction. Both surgeon and patient were blinded to the nature of local anaesthetic agent injected. Patients were requested to score their pain at 1, 2, 6, and 10 hours after surgery on a visual analog scale. The results were analyzed statistically using a cross-sectional time-series regression model employing the random effects option of the xtreg command from Strata Release 6 statistical software. We found that overall analgesia achieved with bupivacaine and ropivacaine infiltrations was not statistically different. The use of a higher dose of ropivacaine is likely to have removed the clinical advantage noted for the bupivacaine group. There was, however, a statistical and clinical difference in the efficacy of local anaesthetic infiltration of both agents in breast augmentation patients as compared to breast reduction patients, local anaesthetic being less effective in patients who had submuscular breast augmentation than in patients who had breast reduction. In view of these findings, it appears reasonable to recommend the use of ropivacaine in high-dose infiltration breast analgesia, as it is reported to be less cardiotoxic than bupivacaine. Serious attention needs also to be given to the adequacy of field infiltration of local anesthesia in submuscular breast augmentation.

Amides↗

PubMed2006

Usefulness of the MSG/IFICG/EORTC diagnostic criteria of invasive pulmonary aspergillosis in the clinical management of patients with acute leukaemia developing pulmonary infiltrates.

Invasive pulmonary aspergillosis (IPA) is a frequently fatal complication in patients with acute leukaemia. Because diagnosis is still difficult, non-invasive diagnostic criteria were recently proposed by MSG/IFICG/EORTC for study purposes. We have analysed their usefulness in the clinical management of acute leukaemic patients with pulmonary infiltrates. Twenty-seven infiltrates developed during 174 chemotherapy cycles given to 50 consecutive patients. According to diagnostic criteria, IPA was diagnosed in 42% of patients and 77.8% of pulmonary infiltrates. AML diagnosis and the first induction cycle were significant risk factors. "Proven" IPA was rare, occurring in one patient (2%). The diagnosis of "probable" IPA was made in seven patients (14%) and was strongly supported by the significant association of characteristic radiological lesions ("major" clinical criterion) with the positivity of one microbiological criterion (P = 0.026). Conversely, "possible" IPA was frequent (26%) because its pertinent diagnostic criteria were fulfilled in 48.1% of pulmonary infiltrates. However, in 84.6% of cases, the diagnosis of "possible IPA" aspecifically derived from the association of two conditions, a new pulmonary infiltrate with symptoms of lower respiratory tract infection ("minor clinical criterion"), together with the definition of "susceptible" host, which applied to 100% of our leukaemic patients. We conclude that, according to MSG/IFICG/EORTC criteria, a high number of pulmonary infiltrates would be diagnosed as IPA, but only a diagnosis of "proven/probable" IPA should be considered reliable in the clinical management of suspected IPA.

Acute Disease↗

PubMed2002

MRI-guided periradicular nerve root infiltration therapy in low-field (0.23-T) MRI system using optical instrument tracking.

The purpose of this study was to evaluate the feasibility of the MRI-guided periradicular nerve root infiltration therapy. Sixty-seven nerve root infiltrations under MRI guidance were done for 61 patients suffering from lumbosacral radicular pain. Informed consent was acquired from all patients. A 0.23-T open-MRI scanner with interventional tools (Outlook Proview, Philips Medical Systems, MR Technologies, Finland) was used. A surface coil was used in all cases. Nerve root infiltration was performed with MRI-compatible 20-G needle (Chiba type MReye, Cook, Bloomington, Ind.; or Manan type, MD Tech, Florida). The evaluation of clinical outcome was achieved with 6 months of clinical follow-up and questionnaire. The effect of nerve root infiltration to the radicular pain was graded: 1=good to excellent, i.e., no pain or not disturbing pain allowing normal physical activity at 3 months from the procedure; 2=temporary, i.e., temporary relief of pain; 3=no relief of pain; and 4=worsening of pain. As an adjunct to MRI-guided positioning of the needle the correct needle localization by the nerve root was confirmed with saline injection to nerve root channel and single-shot fast spin echo (SSFSE) imaging. The MRI guidance allowed adequate needle positioning in all but 1 case (98.5%). This failure was caused by degeneration-induced changes in anatomy. Of patients, 51.5% had good to excellent effect with regard to radicular pain from the procedure, 22.7% had temporary relief, 21.2% had no effect, and in 4.5% the pain worsened. Our results show that MRI guidance is accurate and safe in performing nerve root infiltration at lumbosacral area. The results of radicular pain relief from nerve root infiltration are comparable to CT or fluoroscopy studies on the subject.

Adult↗

PubMed2005

Postoperative pain relief after laparoscopic cholecystectomy: a placebo-controlled double-blind randomized trial of preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25%.

BACKGROUND: The aim of this study was to test the use of preincisional and intraperitoneal levobupivacaine (L-B) 0.25% in laparoscopic cholecystectomies for postoperative analgesia. METHODS: A total of 108 patients under general anesthesia were randomly assigned to receive preincisional local infiltration of 20 ml solution and intraperitoneal instillation of another 20 ml solution. Group A received for local infiltration and intraperitoneal instillation normal saline (NS). Group B received for local infiltration L-B 0.25% and for intraperitoneal instillation NS. Group C received for local infiltration NS and for intraperitoneal instillation L-B 0.25%. Group D received both for local infiltration and intraperitoneal instillation L-B 0.25%. Abdominal and right shoulder pain were recorded for 24 h postoperatively. RESULTS: The pain scores were lower in group D than in the other groups during rest, cough, and movement (p < 0.05). Rescue analgesic treatment was significantly lower in patients of group D (35%) as compared with that of group A (84%) (p < 0.05). The incidence of right shoulder pain was significantly lower in groups C (22%) and D (18%) than in any of the other groups (p < 0.05). CONCLUSIONS: The combination of preincisional local infiltration and intraperitoneal instillation of L-B 0.25% shows an advantage for postoperative analgesia after laparoscopic cholecystectomy.

Adult↗