The Use of Radiofrequency Lesion Generation on the Ganglion Impar for the Treatment of Chronic Coccygodynia: A case report / 대한마취과학회지

Coccygodynia is a common problem that is characterized by pain in the tailbone that radiates to the lower sacral and perineal areas. Coccygodynia may occur after a fall in the sitting position or damage to the sacrococcygeal ligament during a difficult vaginal delivery.Currently, the therapeutic options for coccygodynia are unclear, however, a number of treatment approaches have been proposed.In this case a favorable outcome was obtained by using a radiofrequency lesion generator to create a lesion on the ganglion impar in a patient with chronic coccygodynia.

Remifentanil Prevents Withdrawal Movements Caused by Intravenous Injection of Rocuronium

PURPOSE: The incidence of pain induced withdrawal movement following intravenous injection of rocuronium is high. This randomized, double-blind, placebo-controlled study was designed to evaluate the effect of pretreatment of remifentanil on the withdrawal movements due to intravenous injection of rocuronium during anesthetic induction. MATERIALS AND METHODS: Ninety adult female patients undergoing thyroidectomy were randomly allocated to three groups. Each patient intravenously received one of three solutions of equal volume (4 mL): normal saline (Group I, n=30), 0.5 microgram/kg remifentanil (Group II, n=30) or 1 microgram/kg remifentanil (Group III, n=30). Thirty seconds after remifentanil administration, anesthesia was induced with 5 mg/kg IV thiopental. Twenty seconds after thiopental injection, 0.6 mg/kg IV rocuronium was administered (injection rate of 0.5 mL/sec) and patients' withdrawal movements were assessed. Mean arterial pressure (MAP) and heart rate were assessed on arrival in the operation room, before the tracheal intubation and immediately, 1 and 2 min after the tracheal intubation. RESULTS: The incidence of withdrawal movements was significantly lower in both of the remifentanil groups (3 and 0% in Group II and III, respectively) than in the saline group (70%). Remifentanil attenuated the increase of heart rate and MAP immediately and 1 min after the tracheal intubation. CONCLUSION: The pretreatment with 0.5 and 1.0 microgram/kg remifentanil of bolus doses prevented the withdrawal movements caused by rocuronium injection, and effectively blunted cardiovascular activation following tracheal intubation.

Effect of Alfentanil on the Intraoperative Localization of an Epileptogenic Focus in Pediatric Patients with Intractable Seizure Disorder / 대한마취과학회지

BACKGROUND: Intraoperative alfentanil is known to increase the epileptic discharge in the adult seizure patients. This study hypothesized that alfentanil might localize an epileptogenic focus in pediatric seizure patients. METHODS: This study was performed in the pediatric seizure patients who undergo second-staged operation. Thirteen pediatric patients were enrolled and their epileptic foci were already suspected from first operation. After anesthetic induction, sevoflurane was maintained at 0.6% end-tidal concentration for study period. Electrocorticography (ECoG) was recorded for 5 minutes before and 5 minutes after alfentanil 20microgram/kg IV. During the ECoG recordings, the mean arterial pressure (MAP) and heart rate (HR) were continuously monitored. After the surgery, a pediatric neurologist analyzed the changes of spike frequencies of suspected ictal zone. The spike frequencies of suspected non-ictal zone were also calculated in five patients. The suspected ictal zone was defined as the most abundant spontaneous spiking area observed after first staged grid insertion. RESULTS: Alfentanil induced a significant increase in spike activity of suspected ictal zone in 12 out of 13 patients (median of 20 [ranged 10 to 100] vs 38 [ranged 20 to 100], P< 0.05). Alfentanil-induced increase of spike activity was prominent in the suspected ictal zone rather than non-ictal zone. There were no significant changes in the MAP and HR after administration of alfentanil. CONCLUSIONS: Alfentanil activates epileptiform activity of suspected ictal zone in pediatric patients with seizure disorder and can be used to assist in the localization of the epileptogenic focus during seizure surgery.

The Prognostic Factors of Selective Transforaminal Epidural Block in Patients with Low Back Pain / 대한통증학회지

BACKGROUND: Selective transforaminal epidural block (STEB) has showen effectiveness as a diagnostic and therapeutic option for the management of patients with low back pain or sciatica. This study was carried out in order to determine the short-term effects and prognostic factors associated with STEB in patients with low back pain or sciatica. METHODS: Ninety-seven patients were selectedfor participation in this study. Their diagnosis were based werewason the clinical symptoms and MRI findings. We performed STEB under fluoroscopic guidance and injected 3 ml of radio opaque dye in order to confirm the technical success of the procedure. We then injected 20 mg of triamcinolone mixed into 3 ml of 0.5% mepivacaine. One month later, we classified the patient outcomes as excellent, good, moderate or poor, according to the degree of reduction in VAS score from baseline. The independent variables assessed included symptom duration, block level, number of blocks, primary diagnosis, prior caudal block, anterior epidural space filling of dye, medication history, demographic data, radiating pain, back surgery and spondylolisthesis. RESULTS: At a mean follow-up period of 1 month after STEB, excellent results were noted in the patients diagnosed with herniated lumbar disc (70%), non-specific spondylosis (54%), spinal stenosis (44%), and failed back syndrome (28%). The patients with epidural adhesion and combined spondylolisthesis were associated with poorer outcomes. Combined caudal block, symptom duration and the extent of epidural spread of the drug were not related to the effectiveness of the treatment. CONCLUSIONS: Selective transforaminal epidural block is effective in treating patients with radiculopathy, such as herniated lumbar disc, but it isrelatively ineffective in treating patients with structural deformities, such as failed back syndrome and spondylolisthesis.

Short Term Outcomes and Prognostic Factors Based on Radiofrequency Thermocoagulation on Lumbar Medial Branches / 대한통증학회지

BACKGROUND: Lumbar zygapophysial joints are a common source of chronic lower back pain and radiofrequency thermocoagulation (RF) of the medial branches (MB) has been shown to be effective at providing substantial pain relief for chronic low back pain.Therefore, we carried out this study to determine the short term outcomes and prognostic factors of RF on the MB of patients with lumbar facet syndrome. METHODS: We performed RF in fourteen patients who showed greater than 80% pain relief up to three times after a diagnostic MB block was conducted using 0.3 ml of 0.5% bupivacaine.Using 10 cm curved electrodes with 10-mm active tip, a 60 second, 80 degrees C lesion was made after electrical stimulation at 50 Hz for sensory and 2 Hz for motor nerve testing.The degree of pain relief was then assessed after 2 weeks, and again after 3 months using a visual analog scale (VAS) and a four point Likert scale.The outcome was regarded as 'success' if at least a 50% reduction in the VAS was observed.Possible prognostic factors between the two groups were also evaluated. RESULTS: The success rate was 71.4% (10/14) after three months of follow-up. However, there were transient complications, such as neuritis like syndrome, in 4 patients. In addition, short symptom duration and low minimal voltage (< 0.4 V) for sensory stimulation were shown to be the relevant prognostic factors for a successful outcome. CONCLUSIONS: RF may be an alternative to repeated MB block or intraarticular injection for palliation of lumbar facet syndrome. For better outcomes, early diagnosis and strict patient selection should be coupled with efforts to avoid anatomically incorrect RF.

An Optimal Regimen of 0.2% Ropivacaine-Sufentanil as a Continuous Thoracic Epidural Infusion for Pain Control after Thoracotomy / 대한마취과학회지

BACKGROUND: Thoracotomy is considered one of the most painful surgical procedures. Thus optimal pain control is essential in the postoperative care of thoracotomy patients. In this randomized double-blinded study, we sought to determine an optimal dose-combination of sufentanil and ropivacaine 0.2% for postoperative epidural analgesia. METHODS: Forty-five of fifty-two patients that underwent thoracotomy were assigned to three groups to receive continuous high thoracic epidural analgesia with ropivacaine 0.2% + sufentanil 0.5microgram/ml (group I), ropivacaine 0.2% + sufentanil 0.75microgram/ml (group II), or ropivacaine 0.2% + sufentanil 1.0microgram/ml (group III). Upon completion of surgery, a thoracic epidural catheter was inserted at the T1-3 level, and moved downward by 5-7 cm. Epidural continuous infusion was administered at 5 ml/hr. Resting VAS (visual analogue scale), dynamic VAS, forced vital capacity, and side effects were recorded at three times: immediate after extubation; 12 hours after arrival at the ICU; and 24 hours after arrival at the ICU. RESULTS: Resting VAS was significantly lower in group III immediately after extubation (P < 0.05) and dynamic VAS was significantly lower in group III immediately after extubation, and 12 hours after arriving at the ICU (P < 0.05) than in the other two groups. The differences in ketorolac dosing number, sedation scores, respiratory depression, pruritus, nausea/vomiting, and motor block were not significant between the three groups. CONCLUSIONS: We conclude that the combination of ropivacaine 0.2% and sufentanil 1.0microgram/ml provides effective analgesia for post-thoracotomy pain with fewer side effects than the other two combinations tested.

Hepatic Parenchymal Changes After Percutaneous Injection of Holmium-166 in Rabbit

PURPOSE: To evaluate changes in rabbit liver parenchyma on MR images following percutaneous Holmium-166 injection, and to correlate those changes with histologic findings. MATERIALS AND METHODS: Holmium-166 (10-25 mCi) was percutaneously injected into the liver of rabbit (n=12) under sonographic guidance. MR images were obtained between one to two weeks (acute phase) after the injection in four rabbits, and between two to four weeks (subacute phase) after the injection in four rabbits. Tissue specimens of these eight rabbits were obtained immediately after MR imaging. Tissue specimens were obtained without MR imaging in four rabbits (between one to two weeks in one rabbit and between three to four weeks in three rabbits). RESULTS: Tissue specimens showed central liquefactive necrosis and peripheral coagulative necrosis containing deposition of small particles and hemorrhage. The peripheral margin of the lesions showed formation of the granulation tissue with fibrosis, which tended to be more prominent in subacute phase. The area of the necrosis tended to correlate with the dose of the radioactive Holmium-166. On MR images, the central portion of the necrosis showed hyperintensity on T2-weighted image, hypointensity on the precontrast T1-weighted images, and no enhancement on the dynamic MR images. The peripheral portion of the necrosis showed hypointensity on T2-weighted images, iso or mild hypointensity on the T1-weighted images, and mild peripheral enhancement on the delayed dynamic MR images. The peripheral margin of the lesion showed hypointensity on both T1- and T1-weighted images with increased enhancement on the delayed phase images of the dynamic MR images. CONCLUSION: After percutaneous Holmium-166 injection into rabbit liver parenchyma, the central portion showed liquefactive necrosis, the peripheral portion showed coagulative necrosis with granulation, fibrosis, hemorrhage and depostition of small granules. MR imaging may be helpful in evaluation of the histological change of the liver after percutaneous Holmium-166 treatment.

Evaluation of Conotruncal Anomalies by Electron Beam Tomography / 대한흉부외과학회지

BACKGROUND: To evaluate the diagnostic accuracy of EBT(Electron Beam Tomography) in the diagnosis of conotruncal anomaly and to determine whether it can be used as a substitute for cardiac angiography. MATERIAL AND METHOD: 20 patients(11M & 9F) with TOF(n=7, pulmonary atresia 2), DORV(n=7), complete TGV(n=4), & corrected TGV(n=2) were included. The age ranged from 7 days to 26 years(median 60 days). We analyzed the sequential chamber localization, the main surgical concenrn in each disease category (PA size, LVED volume and coronary artery pattern for TOF& pulmonary atresia, the LV mass, LVOT obstruction, coronary artery pattern for complete TGV, and type of VSD and TV-PV distance for DORV, etc) and other associated anomalies(e.g., VSD, arch anomalies, tracheal stenosis, etc). Those were compared with the results of echocardiography(n=19), angiography (n=9), and surgery(n=11). The interval between EBT and echocardiography/angiography was within 20/11 days, respectively except for an angiography in a patient with corrected TGV (48 days). RESULT: EBT correctly diagnosed the basic components of conotruncal anomalies in all subjects, compared to echocardiography, angiography or surgery. These included the presence, type and size of VSD(n=20), pulmonic/LV outflow tract stenosis(n=15/2), relation of great arteries and the pattern of the proximal epicardial coronary arteries(16 out of 20). EBT proved to be accurate in quantitation of the intrapericardial and hilar pulmonary arterial dimension and showed high correlation and no difference compared with echocardiography, angiography, or surgery(p>0.05) except for left pulmonary arterial & ascending arterial dimension by echocardiography. LVED volume in seven TOF(no difference: p>0.05 & high correlation: r=0.996 with echocardiography), and LV mass in 4 complete TGV were obtained. Additionally, EBT enabled the cdiagnosis of subjlottic tracheal stenosis and tracheal bronchus in 1 respectively. Some peripheral PA stenosis were not detected by echocardiography, while echocardiography appeared to be slightly more accurate than EBT in detecing ASD or PDA. CONCLUSIONS: EBT can be a non-invasive and accurate modality of for the evaluation of most anatomical alteration including peripheral PS or interruption in patients with conotruncal anomalies. Combined with echocardiography, EBT study provides sufficient information for the palliative or total repair of anomalies.

Primary Lymphoma of the Colon: Radiologic and Pathologic Findings

Compared with the stomach and small intestine, the colon and rectum are uncommon sites of lymphomatous involvement. Primary colorectal lymphoma is diagnosed when the lesion is confined to the colorectal area and regional lymph nodes, without involvement of other organs including the upper gastrointestinal tract, bone marrow, and distant lymph nodes. The radiologic appearance of primary lymphoma of the stomach and small bowel is well known, but in cases involving the colorectal area, this is not so. In this article, we categorize and illustrate the radiologic manifestations of primary colorectal lymphoma according to the findings of double-contrast barium enema and CT images, and describe the pathologic findings.

Enhancement Pattern of Small Hepatic Hemangioma: Findings on Multiphase Spiral CT and Dynamic MRI

PURPOSE: To compare the enhancement characteristics of small hemangiomas seen on multiphase spiral CT anddynamic MR imaging MATERIALS AND METHODS: Thirteen patients with 20 hepatic hemangiomas less than 25mm indiameter underwent both multiphase spiral CT and dynamic MR imaging. All lesions were assigned to one of threeclassified into 3 categories according to the enhancement pattern seen on multiphase spiral CT : typical delayedpooling, atypical early enhancement, or continuous low attenuation. The enhancement patterns seen on spiral CT andon dynamic MRI were correlated. RESULTS: On CT scans, ten lesions (50%) showed delayed pooling. Six(30%) showedearly arterial enhancement and four(20%) showed continuous low attenuation. On delayed-phase MRI, all lesionsshowed delayed high signal intensity compared to adjacent liver parenchyma. Four of six lesions with earlyenhancement on CT showed peripheral globular enhancement on early arterial-phase MRI. CONCLUSION: On multiphasespiral CT scans, small hemangiomas can show variable atypical enhancement features. In this situation,contrast-enhanced dynamic MRI is helpful for the diagnosis of hemangiomas.

Clinical analysis of 1136 early gastric cancers / 대한암학회지

No abstract available.

Diverticular Diseases of the colon in Korea / 대한소화기내시경학회지

The purpose of this study is to review epidemiological and clinical characteristics of diverticular disease of the colan in Korea and to discuss the difference of the findings from those in other countries. Reviewing all thebarium enema films taken at the Seoul National University Hospital retrospectively for the last 8 years. that is, from January 1, 1980 to December 31, 1987, we observed the annual and overall incidence of the disease, the number and location of the diverticula, and the presenting symptoms of the cases. The results are summarized as follows: 1) Out of the patients examined, 237 cases had one or more diverticula in the colon, the overall incidence being 1.32%, 2) The annual incidence increased progressively for the last 8 years, from 0.25% in 1980 to 2.53% in 1987. 3) The mean age of the patients at the time of diagnosis was 51 years. The male to female ratio was 2.5. 4) The diverticula were located on the right side in 81.0% of the cases, on the left side in 10.6%, and on both sides in 8.4%. 5) In 82 cases (34.6%) single diverticulum was found, whereas 34 cases (14.3%) had more than 10 diverticula. 6) The most frequent symptoms for taking barium enema were abdominal discomfort and pain (34. 2%) and changes in bowel habits (33.8%}, whereas 45 casea (19.0%) had the examination just for a routine health check. In conclusiion, the diverticular disease of the colon is still uncommon in Korea as compared with in western countries, and the right colon type is far more freqtaent than the left colon type. However in recent years the incidence increases quite rapidly and the left colon type is getting more common.

Plain radiologic findings of primary lung cancer by histologic types

Plain chest films are the most useful modality in diagnosis of primary lung cancer, but it is difficult tointerpret the radiologic findings by histological types. Authors reviewed chest films of 324 cases ofhistologically confirmed primary lung cancer from Jan. 1974 to April 1982 at Seoul National University. The resulsare as follows; 1. Incidence was most common in the 6th decade as 34.4%. Male to female sex ratio was 3.8:1 andthere was no sex difference in Adenocarcinoma. 2. Distrubution of histologic types of primary lung cancer asfollows; Squamous cell Carcinoma 50.6%, Small Cell Carcinoma 22.5% lange Cell Carcinoma 9.3% Bronchegenic adenocaranoma 10.5% Bronchioloalveolar Cell Carcinoma 1.9%. Adenosquamos Carcinoma 0,6%, Carcinoid Tumor 0.3%, AdenoidCystic Carcinoma 0.3%. 3. Radiologic findings by histologic types as follows; a) Squamous cell carcinoma commonlypresent as collapse(51.8%) peripheral mass (40.8%), pneumonitis(37.2%), hilar involvement(34.8%), and in singleabnormality, peripheral mass (44.4%). b) Small cell carcinoma commonly present as hilar involvement(78.1%),mediastinal wideing or mass (53.4%) and in single abnormality, hilar involvement(58.3%). c) Large cell carciomacommonly present as hilar involvement(50%) pneumonia(46.7%), collapse (40%), peripheral mass(36.7%) and in singleabnormality, large peripheral mass (33.3%). d) Bronchogenic Adenocarcinoma commonly present as peripheralmass(44.1%), collapse (41.2%), pleural effusion (35.2%) and in single abnormality, peripheral mass(50%). e)Solitary peripheral mass commonly present as lobulation(48%) and spiculated margin (51%), but no specific findingsby histologic types. Cavitary formation was most common in Squamous cell carcinoma.