Acute cholecystitis developed immediately after thoracic kyphoplasty: A case report / 대한마취과학회지

Postoperative acute cholecystitis is a rare complication of orthopaedic surgery and is unrelated to the biliary tract. In particular, in the case of immediate postoperative state after surgery such as kyphoplasty at the thoracic vertebra, symptoms related to inflammation mimic those of abdominal origin, so the diagnosis and the treatment of acute cholecystitis can be delayed leading to a fatal outcome. It is important that physicians should be aware of the postoperative patient's condition in order to make an early diagnosis and determine treatment.

LPS-Induced Migration of Peritoneal B-1 Cells is Associated with Upregulation of CXCR4 and Increased Migratory Sensitivity to CXCL12

B-1 cells, which constitute a predominant lymphocyte subset in serosal cavities and produce most of natural antibodies, are subdivided into the CD5+ B-1a and CD5- B-1b cell subpopulations, but the differential roles of B-1a and B-1b cells are not well understood. We report that B-1a cells preferentially migrate out of the peritoneal cavity and upregulate the expression of CXCR4 with heightened sensitivity to CXCL12 and CXCL13 upon LPS treatment compared to B-1b and B-2 cells. Whereas B-1a cells were slightly more abundant than B-1b and B-2 cells in the homeostatic condition, the number of B-1a cells preferentially decreased 48 hr after LPS treatment. The decrease in the peritoneal B-1a cell number was accompanied with increased migration of B-1a cells toward CXCL-12 and CXCL-13 in in vitro transmigration assay using peritoneal B cells from LPS treated mice. The expression level of CXCR4, but not of CXCR5, was also more prominently increased in B-1a cells upon LPS stimulation. LPS-stimulated B-1a cells did not accumulate in omental milky spots in contrast to B-2 cells. These results suggest that B-1a cells actively migrate out of the peritoneal cavity through the regulation of the migratory responsiveness to chemokines and actively participate in systemic immune responses.

Psoas Compartment Blockade in a Laterally Herniated Disc Compressing the Psoas Muscle: A Case Report

A psoas compartment block has been used to provide anesthesia for orthopedic surgical procedures and analgesia for post-operative pain. Currently, this block is advocated for relieving pain in the lower extremity and pelvic area resulting from various origins. We report a case of a 69-year-old male patient who had gait abnormality with posterior pelvic and hip pain, which were both aggravated by hip extension. From the magnetic resonance image, the patient was found to have a laterally herniated intervertebral disc at the L2/3 level, which compressed the right psoas muscle. This was thought to be the origin of the pain, so a psoas compartment block was performed using 0.25% chirocaine with triamcinolone 5mg, and the pain in both the pelvis and hip were relieved.

Effects of Low and High Molecular Weight Hyaluronic Acids on Peridural Fibrosis and Inflammation in Lumbar Laminectomized Rats

BACKGROUND: Postlaminectomy peridural fibrosis is inevitable. Some studies have compared and identified the effects of high molecular weight hyaluronic acids (HMWHA) and low molecular weight hyaluronic acids (LMWHA) on peridural fibrosis in postlaminectomy animal models. However, no studies have been found that compare pain behaviors between hyaluronic acids or among hyaluronic acids and other solid materials. The purpose of this study was to examine the correlation between pain-related behaviors and histopathologic changes in laminectomized rats using various peridurally administered materials. METHODS: Forty male Sprague-Dawley rats, laminectomized at the L5 and L6 levels, were divided into four groups: group C, laminectomy only; group L, laminectomy and LMWHA application; group H, laminectomy and HMWHA application; group F, laminectomy and fat interposition. Pain behaviors were checked before, 3 days, 1 week, and 3 weeks after surgery. Histopathological changes were checked at the L5 level 3 weeks after the surgery. RESULTS: The 50% withdrawal thresholds in groups L and H were higher than that in groups C and F three days after laminectomy (P < 0.05). The paw withdrawal time did not change among the groups and in each group during the study period. Peridural fibrosis in group F was significantly lower than in the other groups (P < 0.05). CONCLUSIONS: Hyaluronic acids significantly reduced mechanical allodynia but not thermal hyperalgesia. Peridural fibrosis did not show any correlation with pain behaviors. There have been limited studies on the correlation between peridural fibrosis and pain behavioral change, which should be verified by further studies.

Occipital nerve stimulation in a patient with an intractable chronic headache: A case report / 대한마취과학회지

Occipital nerve stimulation (ONS) is a form of peripheral nerve stimulation used to treat refractory headaches. The trial of ONS was carried with the midline incision C1-2 level, inserted electrical lead subcutaneously to oblique and cephalad direction followed by trajectory of blunt dissection. We used 8 pole electrical lead to cover lesser occipital nerve, greater occipital nerve, third occipital nerve and great auricular nerve. We anchored the lead at the midline insertion site after confirming the stimulation of the patient. And then we looped and tightened the lead loosely, connected the lead and the extension under right supraspinatus muscle region. After 1 week trial period, we performed the permanent implantation of occipital nerve stimulator. We inserted internal pulse generator under a pocket located at right infraclavicular region. The VAS score dropped from 8/10 to 1-2/10. No serious complications were detected during 1 month follow-up.

A Clinical Study of Acquired Paralytic Strabismus in a Secondary Hospital

PURPOSE: To analyze the clinical course of acquired third, fourth, and sixth cranial nerve palsy at a secondary hospital. METHODS: We analyzed the medical records of 26 patients, 28 eyes who were diagnosed third, fourth, and sixth nerve palsy from March 2004 to September 2005. The clinical courses, affected cranial nerves, etiologic factors and recovery rates were examined retrospectively. RESULTS: The sixth cranial nerve was affected most frequently (12 eyes, 49.2%), followed by the third nerve (11 eyes, 17.9%). Vascular etiologic factors was most common (12 eyes, 42.9%). Only two cases were associated with neurosurgical diseases. Of the 28 eyes that were followed up for at least 3 months, 21 (75.0%) eyes showed a decrease in the angle of deviation. Of these, 14 (50%) eyes recovered completely. CONCLUSIONS: There are many vascular and undetermined etiologic causes of cranial nerve paralysis at 2nd grade hospital. So little cases are result from neurosurgical etiology. There are limitations in finding the affecting factors. Further evaluations for the factors associated with increasing recovery rates were needed.

Spinal Cord Stimulation in Management of Intractable Chronic Pain: A 5-Year Experience / 대한마취과학회지

BACKGROUND: We investigated the effect of spinal cord stimulation on intractable chronic pain retrospectively and report our 5-year experience. METHODS: 49 patients with the medical history of trial spinal cord stimulation have been retrospectively analyzed. They consist of 34 men and 15 women, ranging in age from 22 to 89 years. Causes of intractable chronic pain included postherpetic neuralgia, failed back surgery syndrome, complex regional pain syndrome, chronic back and leg pain, cauda equina syndrome, perineal pain, diabetic polyneuropathy, and spinal cord injury. RESULTS: The pain due to failed back surgery syndrome, complex regional pain syndrome, chronic low back and leg pain, and spinal cord injury was well controlled by using spinal cord stimulation system. After a trial period of stimulation, 20 patients had permanent stimulators implanted. Most of them reported satisfactory pain relief for maximum 60 months and minimum 9 months. Noticeable complications included electrode displacement and hemorrhage. CONCLUSIONS: We may suggest that spinal cord stimulation is an effective and safe therapy for chronic intractable pain.

A Case of Subhyaloid Hemorrhage due to Bungee Jumping

PURPOSE: To report a case of subhyaloid hemorrhage which resulted from bungee jumping and to describe the clinical course. METHODS: A 21-year-old man who presented with acute diminution in vision following bungee jumping from a height of approximately 64m visited our ophthalmologic department 3 days after the jump. RESULTS: Best uncorrected visual acuity (UCVA) was right eye 1.0 and left eye F.C 10cm initially. He demonstrated a periocular contusion of about 1cm in the left lateral eyebrow. A full examination of the anterior segment was normal but his left fundus showed a subhyaloid hemorrhage of about 7 disc-diameters in size. There were surrounding superficial retinal hemorrhages and peripheral retinal edema. At 54 days follow-up, subhyaloid hemorrhage of about 5 disc-diameters in size remained and visual acuity was not improved. Trans pars plana vitrectomy was performed in his left eye and improved his vision. One month after the operation, the vision was 1.0 unaided in the left eye. The visual acuity remained as 1.0 eight months after the operation. CONCLUSIONS: It is important that the public should be educated about the potential hazard of bungee jumping and we recommend the use of safety glasses during the bungee jump.