Radiation Safety and Education in the Applicants of the Final Test for the Expert of Pain Medicine

BACKGROUND: The C-arm fluoroscope is known as the most important equipment in pain interventions. This study was conducted to investigate the completion rate of education on radiation safety, the knowledge of radiation exposure, the use of radiation protection, and so on. METHODS: Unsigned questionnaires were collected from the 27 pain physicians who applied for the final test to become an expert in pain medicine in 2011. The survey was composed of 12 questions about the position of the hospital, the kind of hospital, the use of C-arm fluoroscopy, radiation safety education, knowledge of annual permissible radiation dose, use of radiation protection, and efforts to reduce radiation exposure. RESULTS: In this study, although most respondents (93%) had used C-arm fluoroscopy, only 33% of the physicians completed radiation safety education. Even though nine (33%) had received education on radiation safety, none of the physicians knew the annual permissible radiation dose. In comparing the radiation safety education group and the no-education group, the rate of wearing radiation-protective glasses or goggles and the use of radiation badges or dosimeters were significantly higher in the education group. However, in the use of other protective equipment, knowledge of radiation safety, and efforts to reduce radiation exposure, there were no statistical differences between the two groups. CONCLUSIONS: The respondents knew very little about radiation safety and had low interest in their radiation exposure. To make the use of fluoroscopy safer, additional education, as well as attention to and knowledge of practices of radiation safety are required for pain physicians.

Development of complex regional pain syndrome at independent arm associated with lateral decubitus position: A case report

A 27-year-old man underwent excision of a mediastinal mass using video-assisted thoracoscopic surgery (VATS) performed in the right lateral position. Postoperatively, he complained of pain in the left upper arm and chest wall, limitation of the left shoulder joint, allodynia, hyperalgesia, spontaneous pain in left finger, edema, hypohidrosis, and change of skin color of the left hand. We diagnosed the patient with complex regional pain syndrome (CRPS) by using the proposed modified International Association of the Study of Pain (IASP) research diagnostic criteria, and initiated treatment through medication and interventional management. After 3 months of treatment, the pain intensity reduced to below 2 cm on the VAS. In this study, we describe a case of postoperative CRPS, which is believed to have been caused by excessive stretching of the brachial plexus. Careful positioning of patients on the operating table with proper padding will reduce injuries to the peripheral nerves.

A Study to Compare the Radiation Absorbed Dose of the C-arm Fluoroscopic Modes

BACKGROUND: Although many clinicians know about the reducing effects of the pulsed and low-dose modes for fluoroscopic radiation when performing interventional procedures, few studies have quantified the reduction of radiation-absorbed doses (RADs). The aim of this study is to compare how much the RADs from a fluoroscopy are reduced according to the C-arm fluoroscopic modes used. METHODS: We measured the RADs in the C-arm fluoroscopic modes including 'conventional mode', 'pulsed mode', 'low-dose mode', and 'pulsed + low-dose mode'. Clinical imaging conditions were simulated using a lead apron instead of a patient. According to each mode, one experimenter radiographed the lead apron, which was on the table, consecutively 5 times on the AP views. We regarded this as one set and a total of 10 sets were done according to each mode. Cumulative exposure time, RADs, peak X-ray energy, and current, which were viewed on the monitor, were recorded. RESULTS: Pulsed, low-dose, and pulsed + low-dose modes showed significantly decreased RADs by 32%, 57%, and 83% compared to the conventional mode. The mean cumulative exposure time was significantly lower in the pulsed and pulsed + low-dose modes than in the conventional mode. All modes had pretty much the same peak X-ray energy. The mean current was significantly lower in the low-dose and pulsed + low-dose modes than in the conventional mode. CONCLUSIONS: The use of the pulsed and low-dose modes together significantly reduced the RADs compared to the conventional mode. Therefore, the proper use of the fluoroscopy and its C-arm modes will reduce the radiation exposure of patients and clinicians.

Anesthetic Management of Premature Infant with Severe Respiratory Distress Syndrome Who Underwent Surgical Closure of Patent Ductus Arteriosus: A case report / 대한마취과학회지

Premature infants with respiratory distress syndrome may have clinically significant shunting through a patent ductus arteriosus (PDA). Left-to-right shunting through the PDA may lead to left ventricular volume overload and pulmonary edema. We present a case of perioperative management for severe respiratory distress syndrome in a premature infant who underwent surgical closure of PDA. Under general anesthesia, the infant was successfully managed by inhaled nitric oxide, high frequency oscillation ventilation with intermittent mandatory ventilation despite intermittent hypoxia. The operation was performed safely in the neonatal intensive care unit.

Gnomic Instability of Microsatellite in Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: Genomic instability of microsatellite in patients with defects in the mismatch repair system of DNA resulting in replication error (RER) has a high risk of accumulating mutations in oncogene and tumor suppressor gene. In this study, we evaluated the incidence of microsatellite instability (MI) in renal cell carcinoma (RCC) by comparing polymerase chain reaction (PCR)-amplified sequences from frozen samples of normal and tumor tissue from affected patients. MATERIALS AND METHODS: Analysis of MI using the PCR based assay was performed in total 25 cases of RCC, including 21 clear cell types and 4 papillary types. MI of tumor DNA was observed as the occurrence of additional or absence of constitutional autoradiographic signals, or as at least a two to threefold increase or decrease of intensity of the autographic signals in comparison to the corresponding normal tissue DNA. Total 11 microsatellite loci were studied; 4 loci at 3p (D3S1274, D3S1296, D3S1300, D3S1313), 3 loci at 9p (IFNA, D9S1747, D9S171) and 4 loci at 17p (D17S513, D17S695, TP53, D17S261). RESULTS: Twenty-one of 25 RCC (84%) displayed MI in at least one informative locus. MI was found in 15 of 25 cases (60%) at 3p region and 7 of 25 cases (28%) at 9p region. All of them were clear cell type of RCC. MI was detected in 11 cases (44%) at 17p region, 7 of them were clear cell type. In all 4 cases of papillary type, MI was observed only at 17p region. CONCLUSIONS: These results suggest that alterations of 3p region might occur in the early stage of tumorigenesis in RCC. The DNA mismatch repair system may play an important role in tumorigenesis of RCC and MI analysis could be a useful method to detect early genetic alterations in RCC. Genetic alterations in tumorigenesis of RCC may have some differences according to the histologic characteristics.

A Case of Inflammatory Pseudotumor in the Retroperitoneum / 대한비뇨기과학회지

Inflammatory pseudotumor is a rare, benign lesion of various organ and tissue that usually occurs in children and young adults. We report on a 35-year-old male patient with retroperitoneal inflammatory pseudotumor who was completely cured by surgical resection and steroid therapy.

Value of the Voiding Cystourethrography Prior to Renal Transplantation / 대한비뇨기과학회지

PURPOSE: A retrospective review of the medical records of 168 patients who were evaluated for renal transplantation was undertaken to determine whether a voiding cystourethrography (VCUG) influenced the surgi cal care of the recipient. MATERIALS AND METHODS: Between June 1989 to May 1998, 168 patients received a transplantation at our center. These patients proceeded to transplantation, with all of them receiving a VCUG as part of their evaluation. We compared incidence of postoperative complications between normal VCUG group and abnormal group during follow up period (mean 31. 6 months). RESULTS: An urologic abnormality was identified by VCUG in 15 (8.9%) of 168 patients and all of them were vesicoureteral reflux (VUR). In 15 patients with VUR, grade of VUR were grade I in 2, grade II in 10, grade III in 2 and grade IV in 1. None of them with VUR required surgical intervention and had postoperative complications related to VUR. CONCLUSIONS: The VCUG is not essential for the preparation of potential recipients for renal transplantation and should be utilized selectively in individuals with a history of urologic disease or when urinary tract abnormalities are identified by physical examination or an abnormal urine analysis.

Osteitis Pubis after Laparoscopic Burch Colposuspension Using Tacker(R) / 대한비뇨기과학회지

Osteitis pubis is a noninfectious, painful, inflammmatory condition affecting the periosteum, cartilage, and ligaments of the symphysis pubis. It has been associated with urologic and gynecologic procedures, pregnancy and rheumatologic disorders. Despite seven decades of speculation, its pathogenesis, diagnostic criteria, natural history and optimal therapy for osteitis pubis remain controversial. We had experienced two cases of osteitis pubis after laparoscopic Burch colposuspension using prolene mesh and Tacker(R). All cases of osteitis pubis were treated with conservative managements.

The Use of Urokinase in Treatment of Epidural Hematoma

The treatment of epidural hematoma is operative or conservative and sometimes, the choice of the method is somewhat controversial. Traditional operative method is craniotomy or craniectomy. 34 patients treated surgically with burr hole trephination and urokinase irrigation at Taegu Fatima hospital between Jan 1989 and Mar 1991 are reviewed in point of clinical features, brain computerized tomography findings and outcomes. And we found several advantages in this method compared to conservative or traditional operative method. Advantages of this method were as follows: 1) It was simple. 2) It enabled us to operate under local anesthesia. 3) It was possible to reduce the rate of delayed intracranial hematoma and rebleeding. 4) It was possible to prevent air embolism. 5) Possible seizure focus was removed. But, there were disadvantages as follows: 1) There was difficulty in early ambulation. 2) Much effort to irrigate the hematoma was required.

A Case of Teratoma Arising within a Cervical Meningocele

The authors report a case of 21-year-old, neurologically normal female who presented with a teratoma contained in a cervical meningocele. The concurrence of a congenital neoplasm within the spine associated with spina bifida cystica seems to be a very rare event. The radiographic studies, histological examinations, treatment and follow up findings in this case are presented with a review of the literature.