A Case of Intractable Hyperhidrosis in Spinal Cord Injury: Role of Stellate Ganglion Block

Objective: Autonomic dysreflexia (AD) in spinal cord injury (SCI) can present as hyperhidrosis due to sudomotor dysfunction. Hyperhidrosis can also occur without an identifiable etiology. There are no standard treatment guidelines for refractory hyperhidrosis in the setting of persistent noxious stimulation. Stellate ganglion blockade may prevent hyperhidrosis by inhibiting profound sympathetic surge and vasoconstriction. Case: 58-year-old female with C7 ASIA-A quadriplegia was admitted to the hospital for episodes of profuse sweating in the setting of autonomic dysreflexia secondary to underlying T7-8 discitis. Despite conservative treatment of discitis, patient continued experience 50-60 episodes of profuse sweating daily. Stellate ganglion block was performed under ultrasound guidance to reduce sympathetic surge. Patient underwent serial stellate ganglion blocks under ultrasound guidance with \u3e75% improvement in her hyperhidrosis episodes. Discussion: Stellate ganglion block is a safe interventional which can be considered for sympathetically mediated refractory hyperhidrosis. It may also be used as a treatment alternative in certain cases of refractory AD in SCI patients

Genomic Analysis Reveals Versatile Organisms for Quorum Quenching Enzymes: Acyl-Homoserine Lactone-Acylase and -Lactonase

Microbial virulence and their resistance to multiple drugs have obliged researchers to look for novel drug targets. Virulence of pathogenic microbes is regulated by signal molecules such as acylated homoserine lactone (AHL) produced during a cell density dependent phenomenon of quorum sensing (QS). In contrast, certain microbes produce AHL-lactonases and -acylases to degrade QS signals, also termed as quorum quenching. Mining sequenced genome databases has revealed organisms possessing conserved domains for AHL-lactonases and –acylases: i) Streptomyces (Actinobacteria), ii) Deinococcus (Deinococcus-Thermus), iii) Hyphomonas (α-Proteobacteria), iv) Ralstonia (β-Proteobacteria), v) Photorhabdus (γ-Proteobacteria), and certain marine gamma proteobacterium. Presence of genes for both the enzymes within an organism was observed in the following: i) Deinococcus radiodurans R1, ii) Hyphomonas neptunium ATCC 15444 and iii) Photorhabdus luminescens subsp. laumondii TTO1. These observations are supported by the presence motifs for lactonase and acylase in these strains. Phylogenetic analysis and multiple sequence alignment of the gene sequences for AHL-lactonases and –acylases have revealed consensus sequences which can be used to design primers for amplifying these genes even among mixed cultures and metagenomes. Quorum quenching can be exploited to prevent food spoilage, bacterial infections and bioremediation

Interventional Cancer Pain Management: Challenges and Conundrum

Interventional Cancer Pain Management: Challenges and Conundrum, Hemant Kalia, M.D., MPH, FACPM, Program Director, Interventional Spine and Pain Fellowship Program, The Spine Center at Ridgeway. Learning Objectives: Understand different presentation of cancer pain Understand the role and importance of interventional treatment options Role of diagnostic/therapeutic interventions in cancer pai

Inferior Cluneal Nerve

Chronic perineal neuropathic pain can be quite challenging to manage, primarily due to overlapping clinical presentation of multiple clinical entities, such as inferior pudendal neuritis, pudendal neuritis, pyriformis syndrome, and obturator neuritis. A thorough history, examination, and series of diagnostic blocks may be required to accurately diagnose the site of pain in patients suffering from chronic perineal, buttock, and/or pelvic pain. Chronic perineal pain secondary to inferior cluneal nerve involvement can often be misdiagnosed or remain undiagnosed, leading to significant morbidity affecting quality of life. Intractable perineal pain secondary to inferior cluneal neuritis can respond to advanced neuromodulation options such as peripheral nerve stimulation

Saphenous Nerve

Chronic intractable medial knee and/or foot/ankle pain recalcitrant to conservative treatment options may be considered for peripheral nerve stimulation of the saphenous nerve. The saphenous nerve can be targeted either above the knee within the adductor canal or below the knee in the anterior leg where the nerve is superficial. Ultrasound guidance allows safe deployment and implantation of the percutaneous electrode array lead within the adductor canal without injuring critical blood vessels

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