Nerve injury in an undiagnosed adult tethered cord syndrome patients following spinal anesthesia: A case report

Spinal anesthesia is a safe and widely used procedure. Spinal cord injury is a rare but serious complication from spinal anesthesia occurs, unexpectedly. Risks of direct neural injury from spinal anesthesia increase in tethered cord syndrome that the spinal cord is tethered by the inelastic structure and is, also, extended to the lower lumbar vertebra. A 52-years-old female patient undergoing anti-incontinence surgery developed neurologic symptoms following spinal anesthesia. The low-lying conus (L5 body level) and tethered cord were found during the assessment of neurological symptoms.

Successful treatment of pediatric intervertebral disc calcification using ultrasound-guided cervical root block / 대한마취과학회지

No abstract available.

Successful treatment of pediatric intervertebral disc calcification using ultrasound-guided cervical root block / 대한마취과학회지

No abstract available.

Satisfaction in patients with chronic renal failure during the surgical creation of an arteriovenous fistula under monitored anesthesia care using remifentanil

BACKGROUND: Remifentanil is a rapid and short-acting drug that can be used for analgesia and sedation during monitored anesthesia care. This study was designed to evaluate the effect of remifentanil on pain and satisfaction of patients during creation of an arterio-venous fistula (AVF). METHODS: Forty chronic renal failure (CRF) patients, undergoing creation of an AVF, were assigned to receive remifentanil (0.05 microg/kg/min) (group R) or saline infusion (group S). Systolic blood pressure, diastolic blood pressure, heart rate, SpO2, Observer's Assessment Alertness/Sedation scale score, respiratory depression, dizziness, nausea and vomiting, pain intensity and frequency, satisfaction score, and operating time were measured. RESULTS: Pain frequency in group R was lower than group S (P < 0.01). The median (interquartile ranges) of pain frequency was 0 (0, 1) in group R and 1 (0.5, 4.0) in group S. In group R, 6 patients experienced respiratory depression, but responded readily to calling of the name in normal tone and recovered well. Satisfaction scores in group R were higher than that of group S (P < 0.05). The median (interquartile ranges) satisfaction score was 4.5 (4, 5) in group R and 4 (3.0, 4.5) in group S. There were no differences in others between the two groups. CONCLUSIONS: Remifentanil infusion at the rate of 0.05 microg/kg/min effectively reduces pain and increases satisfaction of CRF patients during the creation of an AVF.

Comparison of palonosetron with ondansetron in prevention of postoperative nausea and vomiting in patients receiving intravenous patient-controlled analgesia after gynecological laparoscopic surgery / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) are common complications after anesthesia and surgery. This study was designed to compare the effects of palonosetron and ondansetron in preventing PONV in high-risk patients receiving intravenous opioid-based patient-controlled analgesia (IV-PCA) after gynecological laparoscopic surgery. METHODS: One hundred non-smoking female patients scheduled for gynecological laparoscopic surgery were randomly assigned into the palonosetron group (n = 50) or the ondansetron group (n = 50). Palonosetron 0.075 mg was injected as a bolus in the palonosetron group. Ondansetron 8 mg was injected as a bolus and 16 mg was added to the IV-PCA in the ondansetron group. The incidences of nausea, vomiting and side effects was recorded at 2 h, 24 h, 48 h and 72 h, postoperatively. RESULTS: There were no significant differences between the groups in the incidence of PONV during 72 h after operation. However, the incidence of vomiting was lower in the palonosetron group than in the ondansetron group (18% vs. 4%, P = 0.025). No differences were observed in use of antiemetics and the side effects between the groups. CONCLUSIONS: The effects of palonosetron and ondansetron in preventing PONV were similar in high-risk patients undergoing gynecological laparoscopic surgery and receiving opioid-based IV-PCA.

Comparison of palonosetron with ondansetron in preventing postoperative nausea and vomiting after thyroidectomy during a 48-hour period

BACKGROUND: Postoperative nausea and vomiting (PONV) are common complications after general anesthesia. This study compared the effects of palonosetron and ondansetron in preventing PONV in patients undergoing thyroidectomy. METHODS: 100 non-smoking female subjects were randomly assigned to a palonosetron group (n = 50) or an ondansetron group (n = 50). The patients of each group received 0.075 mg of palonosetron or 8 mg of ondansetron through intravenous bolus injection before induction of general anesthesia. The incidence of nausea and vomiting were monitored at 2 h, 24 h and 48 h after operation. RESULTS: The incidence of PONV during 48 h after operation had no significant differences between the groups. However, the incidence of nausea was lower in the palonosetron group than in the ondansetron group (34% vs. 56%, P = 0.027). No differences were observed in incidences of vomiting, use of antiemetics and adverse events between the groups. CONCLUSIONS: Palonosetron was more effective than ondansetron in preventing nausea for patients undergoing thyroidectomy. However, the effect of palonosetron or ondansetron in preventing PONV was similar.

Asystole during manipulation with a curved-blade laryngoscope and tracheal intubation in patient with a history of syncope: A case report

Vagal reflex during manipulation with a curved-blade laryngoscope and tracheal intubation may result in severe bradycardia and even, asystole. Manipulation with laryngoscope and tracheal intubation leaded to bradycardia and asystole at a 47-year-old woman during induction of anesthesia with propofol, remifentanil and cisatracurium and sevoflurane inhalation. Withdrawal of laryngoscope and atropine 0.5 mg injection, her heart rate was recovered to normal sinus rhythm. Intubation at secondary trial was done with bradycardia and heart rate was returned to normal sinus rhythm soon. She had a history of syncope in interview after surgery and was examined tilt test to find of cause of syncope. Although the result of the test was negative, the bradycardia and asystole seemed to be caused by vagal reflex.

Pulsed radiofrequency lesioning of the median nerve in a patient with bilateral carpal tunnel syndrome: A case report

Carpal tunnel syndrome, compression of the median nerve in the carpal tunnel at the wrist, is the most common entrapment syndrome of peripheral nerve. It is characterized by sensory and motor symptoms and signs in the distribution of the median nerve. Radiofrequency thermocoagulation is a neuroablative treatment for various chronic pain disorders, but is associated with neural injury, neuritis, and occasional neuroma. Unlike RF, pulsed radiofrequency, the use of the high current intensity and electrical fields, has been proposed for the modulation of the excited nervous system pathway of pain without neuro-destruction and other potential complications. We report a case of bilateral carpal tunnel syndrome that was relieved after PRF lesioning of both median nerves.

Fragmentectomy versus Conventional Microdiscectomy in Single-Level Lumbar Disc Herniations : Comparison of Clinical Results and Recurrence Rates

OBJECTIVE: This retrospective study aimed to compare clinical outcomes in terms of pain relief and recurrence rate between fragmentectomies and conventional microdiscectomies in patients with lumbar disc herniation (LDH). METHODS: Between January 2008 and May 2011, a total of 175 patients met the inclusion criteria of this study. The visual analogue scale (VAS) scores of back and radicular pains were recorded before surgery, 2 and 6 weeks after surgery. Recurrence was defined when a patient had the same pattern of preoperative symptoms and was confirmed with magnetic resonance imaging. RESULTS: Seventy-four patients (42.3%) were suitable for fragmentectomy, and 101 patients underwent conventional microdiscectomy. There were no significant differences in VAS scores between the fragmentectomy and conventional microdiscectomy groups 2 and 6 weeks after surgery. During the follow-up period, 3 patients (4.05%) in the fragmentectomy group and 7 patients (6.93%) in the conventional microdiscectomy group relapsed. CONCLUSION: If patients are selected according to well-defined criteria, fragmentectomy can be a good surgical option for LDH, in the physiological aspect of preserving healthy intervertebral disc materials.

The Retrial of Percutaneous Vertebroplasty for the Treatment of Vertebral Compression Fracture

OBJECTIVE: For the treatment of osteoporotic vertebral compression fracture, percutaneous vertebroplasty (PVP) is currently widely used as an effective and relatively safe procedure. However, some patients do not experience pain relief after PVP. We performed several additional PVP procedures in those patients who did not have any improvement of pain after their initial PVP and we obtained good results. Our purpose is to demonstrate the effective results of an additional PVP procedure at the same previously treated level. METHODS: We reviewed the medical records and the radiologic data of the PVP procedures that were performed at our hospital from November 2005 to May 2008 to determine the patients who had undergone additional PVP. We identified ten patients and we measured the clinical outcomes according to the visual analogue scale (VAS) score and the radiologic parameters, including the anterior body height and the kyphotic angulation. RESULTS: The mean volume of polymethylmethacrylate injected into each vertebrae was 4.3 mL (range: 2-8 mL). The mean VAS score was reduced from 8 to 2.32. The anterior body height was increased from 1.7 cm to 2.32 cm. The kyphotic angulation was restored from 10.14 degrees to 2.32 degrees. There were no complications noted. CONCLUSION: The clinical and radiologic outcomes suggest that additional PVP is effective for relieving pain and restoring the vertebral body in patients who have unrelieved pain after their initial PVP. Our study demonstrates that additional PVP performed at the previously-treated vertebral levels could provide therapeutic benefit.

Percutaneous Vertebroplasty for Pregnancy-Associated Osteoporotic Vertebral Compression Fractures

Osteoporosis is a worldwide problem and it mainly affects postmenopausal women. Osteoporosis associated with pregnancy or lactation is a rare condition. The incidence and mechanism of this phenomenon has not been clarified, but it can cause one or more vertebral compression fractures with severe, prolonged back pain in the affected women. We experienced this uncommon case, treated it with percutaneous vertebroplasty. A 35-old-woman visited our hospital with complaints of severe back pain and flank pain 2 months after normal vaginal delivery. She was diagnosed with osteoporotic vertebral compression fractures on the T5, 8, 9 and 11 vertebral bodies and we performed percutaneous vertebroplasty on the T8, 9 and 11 vertebrae with a good result. We present here an unusual case of pregnancy-associated compression fractures treated by percutaneous vertebroplasty.

Extreme Multi-Level Percutaneous Vertebroplasty for Newly Developed Multiple Adjacent Compression Fractures

Osteoporotic patients who undergo percutaneous vertebroplasty (PVP) have the risk of a repeated collapse of their adjacent vertebral body due to alteration of load transfer into the adjacent vertebral body. The authors have experienced a rare case of repeated osteoporotic vertebral compression fractures (VCF) resulting in extreme multi-level PVP. A 74-year-old female developed severe back pain after slipping down one month ago. Her X-ray and MR images indicated a T11 VCF. She underwent successful PVP with polymethylmethacrylate (PMMA). Two weeks later, she returned to our hospital due to a similar back pain. Repeated X-ray and MR images showed an adjacent VCF on T12. A retrial of PVP was performed on T12, which provided immediate pain relief. Since then, repeated collapses of the vertebral body occurred 12 times in 13 levels within a 24-month period. Each time the woman was admitted to our hospital, she was diagnosed of newly developed VCFs and underwent repeated PVPs with PMMA, which finally eased back pain. Based on our experience with this patient, repeated multiple PVP is not dangerous because its few and minor complications. Therefore, repeated PVP can serve as an effective treatment modality for extreme-multi level VCFs.

Analysis of Results Using Percutaneous Vertebroplasty for the Treatment of Avascular Necrosis of the Vertebral Body

OBJECTIVE: Avascular necrosis (AVN) of the vertebral body is known as a relatively uncommon phenomenon in a vertebral compression fracture (VCF). The outstanding radiologic findings of AVN are intravertebral vacuum phenomenon with or without fluid collection. Several reports revealed that PVP or balloon kyphoplasty might be the effective treatment modalities for AVN. We also experienced excellent results when using PVP for the treatment of AVN of the vertebral body, and intend to describe the treatment's efficacy in this report. METHODS: Thirty-two patients diagnosed with AVN of the vertebral body were treated with PVP. We measured the pre- and post-operative anterior body height and kyphotic angulation. The visual analogue scale (VAS) was used to determine the relief of back pain. RESULTS: The anterior body height (pre-operative : 1.49 cm, post-operative : 2.22 cm) and kyphotic angulation (pre-operative : 14.47 degrees, post-operative : 6.57 degrees) were significantly restored (p<0.001). VAS was improved from 8.9 to 3.7. Pseudoarthrosis was corrected in all cases, which was confirmed by dynamic radiographs. Fluid collection was found in sixteen cases and was aspirated with serous nature. No organism and tumor cell were noted. CONCLUSION: PVP proved to be an effective procedure for the treatment of AVN of the vertebral body, which corrected dynamic instability and significantly restored the anterior body height and kyphotic angulation.

Three Cases of Primary Spinal Malignant Schwannomas: Case Reports

Malignant peripheral nerve sheath spinal tumours are relatively rare. A primary spinal location at the first onset is rarely reported in the literature, thus the clinical features and therapeutic results of these spinal malignant tumours are not defined. We describle three patients with primary spinal malignant schwannomas and stress the surgical mananement of these cases.

Clinical Analysis of 178 Metastatic Brain Tumors

OBJECTIVE: A retrospective clinical analysis for metastatic brain tumors was undertaken to understand demographic feature, to determine the survival rate, prognostic factors and to decide the role of surgery. PATIENTS AND METHODS: From 1987 to 1994, 178 patients with brain metastases were treated at our hospital. Data regarding the primary disease and characteristics of brain metastases were retrospectively collected. We used Kaplan-Meier method to assess survival rate, and log-rank test to compare survival rates between subgroups. RESULTS: The most common age at the time of diagnosis was sixth and seventh decade(62%). The male to female ratio was 97:81. The supratentorial lesions were in 128(77%, n=67) and multiple lesions were in 84(55%, n=52). The most common primary cancer was lung cancer(80, 45%), and metastases of unknown origin(28, 16%), breast(27, 15%), head and neck(11, 6%), colorectal cancer(7, 4%), and stomach cancer(6, 3%). The time to metastasis was shortest in lung cancer(15 months), and longest in head and neck cancer(61 months). The overall 1 year survival rate(1YSR) was 25.4% and median survival time(MST) was 5.6 months. There was no statistically significant difference in MST and 1YSR between single and multiple metastases. The 1YSR of metastatic brain tumor from head and neck cancer was 62.5% and that from breast, lung, and GI tract was 37.7%, 25.7%, and 8.3% respectively. The overall 1YSR and MST of resected group in single metastasis(n=0, resection plus whole brain radiation therapy; WBRT) were 33.3% and 6.6 months, and those of non-resected group(n=5, WBRT) were 31.5% and 5.6 months. The 1YSR and MST of resected group in single metastasis from lung cancer(n=) were 37.5% and 8.4 months, and those of non-resected group(n=6) were 25% and 4.8 months. But there were no statistically significant differences. Karnofsky performance scale score was improved in 37% of resected group, compared with 24% of non-resected group. CONCLUSION: Surgical removal of metastatic brain tumor in selected patients results in increased survival time and better quality of life. For the statistical significance, multi-institutional well-designed prospective randomized study is needed.

Clinical Analysis on Open Thoracic Cordotomy of the Cancer Pain

Patients with pain syndromes resulting from recurrent or metastatic cancer should be evaluated carefully to determine the cause of their pain and the need for appropriate antitumor treatment. The most effective ablative pain control procedure at the current time is cordotomy, which is indicated in patients with unilateral pain. The authors results of 12 antero-lateral thoracic cordotomies performed for intractable cancer pain between 1996-1998. The follow-up of these patients was continued for at least 12 months or until death to determine the late success of this procedure. Excellent surgical results were obtained in 100% after one week and in 50% in 6 months after operation. The operation was considered to be successful for patients with malignant disease of short life expectancy.

Brain Stem Gliomas in Adult: Correlation between MRI, Clinical Findings and Outcome: Preliminary Report

An analysis of 13 patients with brain stem glioma in adult, treated between 1988 and 1995, was undertaken. The purpose of this study is to establish the correlations between the MRI appearance, clinical findings and the prognosis. Based on the MRI appearance of the tumor at the time of clinical diagnosis, tumors were divided into four types: intrinsic diffuse, intrinsic focal, intrinsic cervicomedullary and exophytic type. Five patients were diagnosed pathologically by means of stereotactic biopsy(2 patients) and open surgery(3 patients), the rest were diagnosed on the basis of MRI appearance. All patients had received radiation therapy, and 11 patients had received chemotherapy during or immediately after radiation therapy. The methods of radiation therapy were either conventional or hyperfractionated type. The histological features were not always correlated with the prognosis. MRI and clinical findings could suggest the prognosis and probably the histological nature of the tumors. Moreover, response to initial radiotherapy and chemotherapy was considered to be a good prognostic factor. Seven of the 13 patients had response to the initial radiotherapy and chemotherapy. The poor prognostic factors determined in our study were 1) diffuse type 2) rapid growing with rim enhancement in spite of initial radiotherapy and chemotherapy 3) malignant pathologic finding 4) intratumoral necrosis after radiotherapy 5) multiple site involvement. The good prognostic factors were 1) intrinsic focal type 2) intrinsic cervicomedullary type 3) no cranial nerve involvement 4) good response to initial radiotherapy and chemotherapy.

Vertebral Hemangioma Causing Cord Compression: A Case Report

We present a case of thoracic vertebral hemangioma causing spinal cord compression in a 57-year-old man. It is not common for vertebral hemangioma to cause neurologic deficits. The chief complaint of the patient was progressive paraparesis. Plain T-spine x-rays appeared normal. Axial and sagittal T1-weighted magnetic resonance(MR) imagings of T-spine showed multiple ring-like high signal lesion in vertebral body and decreased signal intensity at T7 with epidural mass causing spinal cord compression. Decompressive laminectomy and subtotal removal of the epidural mass were performed. The mass was reddish, friable and easily-coagulated. The postoperative computerized tomography(CT) scan of T-spine demonstrates characteristic thick vertical trabeculae and honeycomb pattern involving body and pedicles of T7 vertebrae. Bowel and urinary incontinence returned to normal two weeks following operation, and the patient was discharged with walking by sue of crutch three weeks later. Based on clinical features with this patient review of the literature, the authors recommend annual neurological and radiological examinations for patients harbouring hemangiomas with associated pain. Radiation therapy or embolization is an effective therapeutic alternative for patients with severe medically refractory pain. It is concluded that management of patients with a progressive neurological deficit should include prompt preoperative angiography and embolization, decompressive surgery with the approach determined by the degree of vertebral involvement and site of spinal cord compression, and postoperative radiation therapy in patients following subtotal tumor removal.

BCNU-CDDP Continuous Infusion Chemotherapy in Recurrent Oligodendroglioma

Eight patients with recurrent oligodendroglioma were treated with 1.3-bis(2-chloroethyl) nitrosourea(BCNU) and CDD continuous infusion chemotherapy. They were 5 with benign oligodendrogliomas and 3 with anaplastic oligodendrogliomas. All the recurrent tumors had been treated with surgery and radiotherapy. Four patients had already received chemotherapy with ACNU. Seven of them showed response to continuous infusion chemotherapy. The time from the response to progression was 15 to 67 weeks. No severe complication of the chemotherapy was found. In conclusion, BCNU-CDDP continuous infusion chemotherapy is an effective treatment modality in recurrent oligodendrogliomas.

Treatment of Recurrent Gliomas with PCV Chemotherapy : A Preliminary Report

Twelve patients with recurrent malignant glioma were treated with combination chemotherapy, consisting of procarbazine(60mg/m2, 8th-21th day), CCNU(110mg/m2, 1st day), and vincristine(1.4mg/m2, 8th and 29th day) every 6 weeks. Most patients had undergone initial resection of primary tumor, postoperative radiotherapy, and another form of chemotherapy. Response or progression was defined as improvement or deterioration in MRI scan. Assessment of response followed evaluation of MRI obtained after the completion of each two cycles of chemotherapy, if possible. Partial(more than 50% reduction of tumor mass) response at 15+ to 47+ weeks after chemotherapy was noted in three(60%) of the five patients with recurrent oligodendrogliomas. But in patients with recurrent anaplastic astrocytoma or gllioblastoma, partial response at 8+ weeks after chemotherapy was noted in one(14%) of the seven patients. It is suggested that PCV chemotherapy is more effective for patients with recurrent oligodendrogliomas than other recurre nt gliomas.