Characteristics and Risk Factors of Seizure-related Injuries in Patients Presenting with Seizures to the Emergency Room

Background@#The goal of this study was to investigate the incidence and type of seizurerelated injuries (SRIs) in patients presenting with seizures to the emergency department (ED) and to determine the risk factors of SRIs. @*Methods@#In this retrospective cross-sectional study, we surveyed all seizure patients aged 18 years and older who visited the ED of Yeungnam University Hospital between October 2017 and September 2019. We excluded patients who developed seizures secondary to cardiac arrest or acute head trauma. @*Results@#A total of 165 patients were enrolled and SRIs occurred in 33 patients (20.0%). The most common SRI was head injury (35.3%), followed by soft tissue injury (29.4%) and orolingual injury (17.6%). Most injuries were single, minor injury and required little or no treatment. Death occurred in one patient (3.0%) with SRIs due to intracranial hemorrhage. On univariate analysis, young age (p<0.001), history of alcohol use disorder (p=0.005), hypertension (p=0.022) and stroke (p=0.032), falling during seizure (p<0.001), seizure cluster (p=0.001), convulsive status epilepticus (p=0.034), generalized tonic-clonic seizure (p=0.010), initial blood ammonia level (p=0.007), and alcohol-related seizure (p=0.032) predicted the occurrence of SRIs. All patients with SRIs were independent in daily activities. On multiple logistic regression analysis, five variables remained significant: young age (p=0.037), history of alcohol use disorder (p=0.040), falling during seizure (p<0.001), seizure cluster (p=0.013), and convulsive status epilepticus (p=0.032). @*Conclusions@#Young age, history of alcohol use disorder, falling during seizure, seizure cluster, and convulsive status epilepticus predicted SRIs in people presenting with seizure.

Subacute Combined Degeneration Caused by Chronic Atrophic Gastritis with Spurious Elevation of Vitamin B12 Level

We report a patient who was diagnosed as subacute combined degeneration (SCD) with elevated homocysteine and methylmalonic acid levels in the situation of a spurious elevation of the vitamin B12 concentration. A false-positive elevation of the vitamin B12 level could lead to a delayed diagnosis and cause irreversible changes in the nervous systems. We therefore suggest that the homocysteine and methylmalonic acid levels should be checked in patients with a normal or elevated vitamin B12 level for whom there is a high clinical suspicion for vitamin B12 deficiency, as a further evaluation for SCD.

Optic Neuritis in a Patient with Bickerstaff's Brainstem Encephalitis

No abstract available.

Reduction of Disease Activity in Patient with Relapsing-Remitting Multiple Sclerosis after Switching to Teriflunomide from Interferon Beta

No abstract available.

Reduction of Disease Activity in Patient with Relapsing-Remitting Multiple Sclerosis after Switching to Teriflunomide from Interferon Beta

No abstract available.

The Effect of a Stellate Ganglion Block on Acne Vulgaris: A case report / 대한마취과학회지

A stellate ganglion block is frequently used in the pain clinic. It has been known that a stellate ganglion block maintains the homeostasis of hormones by improvement of blood supply to the brain. Therefore it has a systemic effect as well as a regional effect. Androgen, the sebaceous gland, hair follicle and bacteria are involved in pathogenesis of acne. The background for the treatment of acne with a stellate ganglion block can be related to the increase of blood supply to the face and the effect on the pineal gland. We administered a stellate ganglion block for the treatment of acne and had good results. From our experience, we consider a stellate ganglion block as the one of the effective treatment of acne.

The Local Anesthetic Effect of 10% Lidocaine Spray on the Larynx / 대한마취과학회지

BACKGROUND: Although topically applied laryngeal lidocaine is known to be effective in preventing the cardiovascular events associated with endotracheal intubation, it is still debated whether the mechanism of action of topically applied laryngeal lidocaine is via increased plasma concentration of lidocaine or via topically induced superficial anesthesia. The purpose of the present study is to observe vocal cord responses to stimulation and to find out whether topically induced superficial anesthesia with 10% lidocaine spray is effective under propofol anesthesia. METHODS: Twenty-four patients scheduled for operation on the upper or lower extremities were randomly allocated to two groups: (1) twelve patients who did not receive 10% lidocaine spray before the insertion of a laryngeal mask airway (LMA), (2) twelve patients who received 10% lidocaine spray before the insertion of LMA. The vocal cords of each patient were stimulated by the spraying of 0.2 ml distilled water or directly by bronchoscope tip, and the evoked responses were assessed by analyzing the hemodynamic and respiratory variables and vocal cord movement. The vocal cord movements elicited by the laryngeal stimulation were classified into four grades. RESULTS: There was a significant difference between the groups regarding vocal cord movement (P < 0.05). There were no differences between the groups regarding hemodynamic and respiratory variables. CONCLUSIONS: The result indicates that there is a topical anesthetic effect on the vocal cords by 10% lidocaine spray on the larynx.

Minimum Effective Anesthetic Concentration of Hyperbaric Tetracaine 10 mg for Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Minimum effective anesthetic concentration (MEAC) of local anesthetics for spinal anesthesia, defined as the concentration at which a spinal anesthetic agent produces surgical anesthesia within 20 minutes of administration in 50% of patients. This concept is similar to the concept of minimum alveolar concentration (MAC) for inhalation anesthetic. Furthermore, as MEAC may vary with the administered dose, it will be determined using 10 mg of hyperbaric tetracaine. METHODS: 10 mg hyperbaric tetracaine containing dextrose 10 % was administered intrathecally to 12 patients (ASA I-II, age 20~40 yr), who were undergoing lower limb or urological procedures within 90 minutes, at concentrations ranging from 0.07~0.1%. The choice of tetracaine concentration was determined by Dixon's up-and-down method. Complete anesthesia was defined as: (1) pinprick anesthesia at or higher than T10 and (2) complete leg paralysis; all occurring in both lower extremities within 20 min. General anesthesia was initiated if spinal anesthesia was incomplete. RESULTS: MEAC of 10 mg hyperbaric tetracaine was 0.083 %. Mean anesthetic duration was 75.2 minutes (range: 40~100 min). The maximum sensory block level ranged from T3~T8. CONCLUSION: The aim of this study was to establish new concept of minimum effective anesthetic concentration of hyperbaric tetracaine for spinal anesthesia. We recognized that spinal anesthesia can be accomplished with very dilute solution. As fixed dose, no correlation was found between concentration of the spinal tetracaine solution with the highest sensory level, anesthetic duration and the degree of mean arterial pressure decreased.

Minimum Effective Anesthetic Concentration of Hyperbaric Tetracaine 10 mg for Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Minimum effective anesthetic concentration (MEAC) of local anesthetics for spinal anesthesia, defined as the concentration at which a spinal anesthetic agent produces surgical anesthesia within 20 minutes of administration in 50% of patients. This concept is similar to the concept of minimum alveolar concentration (MAC) for inhalation anesthetic. Furthermore, as MEAC may vary with the administered dose, it will be determined using 10 mg of hyperbaric tetracaine. METHODS: 10 mg hyperbaric tetracaine containing dextrose 10 % was administered intrathecally to 12 patients (ASA I-II, age 20~40 yr), who were undergoing lower limb or urological procedures within 90 minutes, at concentrations ranging from 0.07~0.1%. The choice of tetracaine concentration was determined by Dixon's up-and-down method. Complete anesthesia was defined as: (1) pinprick anesthesia at or higher than T10 and (2) complete leg paralysis; all occurring in both lower extremities within 20 min. General anesthesia was initiated if spinal anesthesia was incomplete. RESULTS: MEAC of 10 mg hyperbaric tetracaine was 0.083 %. Mean anesthetic duration was 75.2 minutes (range: 40~100 min). The maximum sensory block level ranged from T3~T8. CONCLUSION: The aim of this study was to establish new concept of minimum effective anesthetic concentration of hyperbaric tetracaine for spinal anesthesia. We recognized that spinal anesthesia can be accomplished with very dilute solution. As fixed dose, no correlation was found between concentration of the spinal tetracaine solution with the highest sensory level, anesthetic duration and the degree of mean arterial pressure decreased.

Comparative Effects of Laryngeal Mask Airway Insertion and Endotracheal Intubation on Intraocular Pressure during Induction with Propofol / 대한마취과학회지

BACKGROUND: It is important to control the intraocular pressure (IOP) during ophthalmic surgery. The precise control of IOP is an accepted advantage of general anesthesia. METHODS: The authors have compared IOP, blood pressure (BP) and heart rate (HR) with the insertion of laryngeal mask airway (LMA) or endotracheal tube (TI) during the induction of propofol. All data were recorded in the operating room upon arrival (Phase 1), just before the LMA or TI (Phase 2), immediately after (Phase 3), and 1 minute (Phase 4) and 3 minutes (Phase 5) after the LMA or TI. RESULTS: The IOP with the LMA was significantly lower at Phase 3 and Phase 4 than that with the TI. The changes of the IOP during Phases 2, 3, 4 and 5 was insignificant in LMA but significant in TI. The BP with LMA was significantly lower at Phases 3, 4 and 5 but the difference in HR was not significant between LMA and TI. CONCLUSION: The LMA offers advantages over TI for ophthalmic surgery in respect to the changes in IOP, BP and HR during the induction of propofol.