Background and objectives The costoclavicular brachial plexus block is performed deep and posterior to the midpoint of the clavicle. There are limited data evaluating the spread of the costoclavicular brachial plexus block. We performed a cadaveric study to evaluate the spread of injectate after a costoclavicular brachial plexus block. Methods Five ultrasound-guided costoclavicular block injections were performed with 20 mL of 0.1% methylene blue. The brachial plexus and its branches were dissected from the level of C4 to the lower axilla. The extent of dye spread was recorded including spread to the phrenic nerve, suprascapular nerve, roots, trunks, divisions, cords and terminal branches of the brachial plexus. Results The dye extended cephalad to the level of the cricoid cartilage in two of the five injections; three injections had dye extending 0.75 cm, 1.5 cm and 2 cm caudad to the level of the cricoid cartilage, respectively. The C7, C8 and T1 nerve roots were stained in all injections. The dye did not extend cephalad to the C5 and C6 nerve roots. All trunks, cords and divisions of the brachial plexus were stained, as was the suprascapular nerve. There was no spread of dye to the phrenic nerve in any of the specimens. Conclusions This cadaveric study demonstrates that ultrasound-guided injection in the costoclavicular space spreads cephalad to the brachial plexus in the supraclavicular space, consistently reaching the suprascapular nerve and all trunks and cords of the brachial plexus, while sparing the phrenic nerve.
A rare case of Myxoma of right maxilla in a 25 year female, presenting as-bilateral nasal obstruction with destruction of the septum and maxillary antral bone is reported.
This study contrasts the acquired immunodeficiency syndrome mortality experience of residents of Puerto Rico with that of New York City residents identified as either Puerto Rico-born and non-Puerto Rico-born Hispanics. Portions of the mortality data examined in this investigation update and extend the data previously published describing selected groups in New York City through the end of 1987 but which did not consider residents of Puerto Rico. The nine-year cumulative, age-adjusted acquired immunodeficiency syndrome mortality rate for males was found to be 5x higher among Puerto Rico-born New York City residents compared with residents of Puerto Rico (702/100,000 v 141/100,000) and 1 1/2 x greater than that of other male Hispanic New York City residents (447/100,000). In New York City, Puerto Rico-born females had higher age-adjusted mortality rates (121/100,000) than female residents of Puerto Rico (25/100,000) and other female Hispanic residents of New York City (70/100,000). Within five of the six age categories considered, acquired immunodeficiency syndrome mortality rates for adult males and females are higher for Puerto-Rico-born, New York City residents. Limitations of acquired immunodeficiency syndrome incidence data, as they pertain to persons of Puerto Rican ancestry, are discussed.
