Ultrasound-guided Distance Measurements of Vertebral Structures for Lumbar Medial Branch Block / 대한통증학회지

BACKGROUND: Selective diagnostic blocks of the medial branches of the dorsal primary ramus are usually performed under the guidance of fluoroscopic or computed tomography. Recently, however, ultrasound guidance has been suggested as an alternative method. In this study, the distances between the vertebral structures were measured and compared with the values measured using magnetic resonance imaging (MRI) to assess the clinical feasibility of using ultrasound-guided block in Korean patients. METHODS: Five male and 15 female patients were enrolled in this study. The target point of the medial branch block in our study was the groove at the base of the superior articular process. We measured the depth from the skin to the target point at the transverse process (d-TP) and to the most superficial point of the superior articular process (d-AP). RESULTS: The d-TP and d-AP values measured under ultrasound guidance were concordant with the values measured using MRI. CONCLUSIONS: The images of the bony landmarks obtained under ultrasound examination could be useful for ultrasound-guided lumbar medial branch block.

Hemifacial Pain Accompanied with Delayed Ipsilateral Abducens Nerve Palsy: Tolosa-Hunt Syndrome / 대한통증학회지

Tolosa-Hunt syndrome is a rare self-limiting disease that's characterized by painful ophthalmoplegia. It has a relapsing and remitting course, and the pain responds promptly to systemic corticosteroid therapy. Yet it is diagnosed by the exclusion of other major causes involving the superior orbital fissure or cavernous sinus, including trauma, neoplasm, aneurysm and inflammation. Further, the associated ophthalmoplegia may follow days to weeks after the onset of orbital or hemifacial pain. Hence, this condition is often misdiagnosed as atypical facial pain, and so improper management could result in unnecessary suffering of the patient. The following case describes a patient suffering with hemifacial pain associated with ipsilateral abducens nerve palsy, which was evident 2 weeks after the onset of pain, and this was misdiagnosed as trigeminal neuralgia and atypical facial pain.

The Effect of Stellate Ganglion Block on the Treatment of Idiopathic Sudden Sensorineural Hearing Loss / 대한마취과학회지

BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSNHL) is defined as a sensorineural hearing loss which develops abruptly without definitive causes. Stellate ganglion block (SGB) has been used as one of the treatment modalities in ISSNHL. However, published data establishing the effect of SGB has been slim. We conducted this study to evaluate the effect of SGB according to the factors that may influence the prognosis of the disease. METHODS: We reviewed the records of 343 patients. The control group was managed with medications, and the SGB group was managed with SGB and the same medications. SGB was performed with 5 ml of 1.0% mepivacaine. The pure-tone audiogram was performed after the therapy and Siegel's criteria was used to define the recovery of hearing. RESULTS: The recovery rate of the SGB group was higher than that of the control group (58.1% vs. 42.1%, P < 0.05). The SGB group had a higher recovery rate than the control group in patients treated within 7 days from the onset of symptoms (66.9% vs. 44.1%, P < 0.05), without diabetes mellitus (58.5% vs. 44.9%, P < 0.05), without dizziness (61.6% vs. 44.6%, P < 0.05), or whose initial hearing loss was between 71 and 90 dB (69.4% vs. 38.9%, P < 0.05). CONCLUSIONS: SGB is thought to be a useful therapy for ISSNHL, especially in the patients treated within 7 days, without diabetes mellitus, dizziness, or whose initial hearing loss was severe.

A Treatment of Facial Blushing with Beta Blockade and Antianxiety Drug: A report of two cases / 대한통증학회지

Facial blushing is a personally disabling condition, which can result in emotional disturbance and be an impediment to social life. Although numerous treatment options exist, including beta blocker, cognitive behavioral therapy and sympathetic neurolysis, no generally accepted form of treatment has been established. Herein, we report two cases of successful reduction of facial blushing following the administration of beta blocker and a minor tranquillizing antianxiety drug.

The Effects of Desflurane on Ca2+ Release from the Myocardial Sarcoplasmic Reticulum in Vitro / 대한마취과학회지

BACKGROUND: The purpose of this study is to examine the effect of Desflurane on myocardial contractility and cellular electrophysiologic behabior in isolated guinea pig and rat right ventricular papillary muscle. METHODS: The isometric force of a guinea pig ventricular papillary muscle was studied in normal and 26 mM Tyrode's solution at various stimulation rates. Experiments using rat papillary muscles under normal Tyrode's solution at resting-state (RS) and using guinea pig papillary muscles under low Na Tyrode's solution (25 mM) were performed to evaluate the effect on Ca2+ release from the sarcoplasmic reticulum (SR). Normal and slow action potentials (APs) were evaluated by using a conventional microelectrode technique. Effects of desflurane on SR function in situ were examined by its effect on rapid colling contractures (RCCs). 1 MAC (end-tidal concentration: 6%) and 2 MAC desflurane were applied. RESULTS: Desflurane equivalent to 6% and 12% depressed guinea pig myocardial contractions in the control to -70% and -40% from RS to 3 Hz stimulation rates. Contractile force after rest in rat and guinea pig myocardium under low Na Tyrode's solution showed modest depression. In the partially depolarized, beta-adrenergically stimulated myocardium, 6% and 12% desflurane caused marked depression of late force (6%: -60%, 12%: -80%) with moderate changes of early peak force (6%: -20%, 12%: -40%). RCCs were abolished at 6% concentration. CONCLUSIONS: The direct myocardial depressant effects of desflurane is slightly greater to those seen with isoflurane. The rapid initial release of Ca2+ from the SR by depolarization seems to be modestly depressed, although certain release pathways induced by rapid colling appear to be markedly depressed.