Ultrasound Guided Shoulder Joint Injection through Rotator Cuff Interval / 대한통증학회지

BACKGROUND: Shoulder joint injection is currently performed under fluoroscopic or computed tomography scan guidance. We performed this study to determine if an ultrasound guided shoulder joint injection through rotator cuff interval would have clinical usefulness. METHODS: A total of 17 volunteers [12 women, 5 men; mean age 28 yr (23-32 yr)] received shoulder joint injection under multilinear ultrasound (5-10 MHz). Volunteers were positioned supinely on a table with their arm in a neutral position. The anterior shoulder region of the patient was sterilized using povidone iodine. A 24 gauge needle was introduced and directly visualized in real time as it passed obliquely from the skin surface to the inferior space of the biceps tendon. If there was little or no resistance to the injection, a contrast media (omnipaque) was injected and checked fluoroscopically. RESULTS: Ultrasound guided shoulder joint injection through rotator cuff interval was successful in all cases. The average time taken for the procedure was 27.5 +/- 16.5 sec. The vertical distance from skin to the inferior space of the biceps tendon was 1.6 +/- 0.4 cm and the distance of needle from the skin to the inferior space of biceps tendon was 2.8 +/- 0.6 cm. The procedure was well tolerated by all volunteers. CONCLUSIONS: Ultrasound guided shoulder joint injection through rotator cuff interval is an effective, rapid, and easy-to-perform injection technique. Ultrasound guided injection enables exact needle placement and avoids the use of both ionizing radiation and iodinated contrast material.

Primary Pericardial Fibrosarcoma Presenting as Cardiac Tamponade: A case report / 대한흉부외과학회지

Primary malignant neoplasm of the pericardium is very rare. Neoplastic involvement of the pericardium may result in rapidly developing hemorrhagic effusion. A 30-year-old male who occasionally suffered from chest tightness was referred to our hospital under the diagnosis of unstable angina. He presented with acute chest pain and severe dyspnea that had developed one day previously. The diagnostic investigations such as echocardiography, chest CT and magnetic resonance image suggested cardiac tamponade that was caused by rupture of the pericardial teratoma. An operation to remove the tumor and effusion was performed. The pericardial mass was completely excised, and the result of the frozen biopsy favored malignancy. The final pathologic report was malignant fibrosarcoma of the pericardium and no malignant cells were found on the cytology of the pericardial effusion. The patient had a smooth postoperative course and was referred to another hospital for additional radiation therapy. We report here on this case of cardiac tamponade that was caused by primary pericardial fibrosarcoma, and this required urgent diagnosis and surgical management.

Dysfunction of the Prosthetic Aortic Valve in Idiopathic Hypereosinophilic Syndrome: A case report / 대한흉부외과학회지

Idiopathic hypereosinophilic syndrome is a rare systemic, leukoproliferative disorder characterized by eosinophil- mediated tissue injury causing multiple organ failure, including the heart. Cardiac involvement occurs in more than 75% of patients with hypereosinophilic syndrome. Cardiac manifestations include subendocardial fibrosis, thrombus leading to peripheral emboli, restrictive cardiomyopathy, and valvular dysfunction. It is more common in men than in women (9:1), and trends to present between the ages of 20 and 50 years. Presentation in childhood is unusual. We report for the first time a case of a 58-year-old man with idiopathic hypereosinophilic syndrome manifested by prosthetic aortic valve dysfunction that was successfully treated by steroid and hydroxyurea therapy after surgical valvular replacement.

A Study for Pressure-Flow Relationship and Oxygenation in the Denervated Canine Liver / 대한마취과학회지

BACKGROUND: Various pressor agents are used to raise systemic vascular resistance (SVR) during liver transplantation. The aim of this study was to investigate the effect of liver denervation on hepatic hemodynamic responses to vasopressors. METHODS: This study was conducted in eight anesthetized dogs randomly assigned in to 4 groups [epinephrine-Low dose (L): 0.05 microgram/kg/min, epinephrine-High dose (H): 0.5 microgram/kg/min, ephedrine (D): 0.2 mg/kg, phenylephrine (P): 80 microgram/min]. One hour after surgical denervation of the liver, cardiac output, blood gases and hepatic blood flow were measured before and after administration of vasopressors with an electromagnetic flow meter. Oxygen consumption rate (hepatic artery plus portal vein oxygen delivery-hepatic vein oxygen delivery) was calculated. The Wilcoxon signed rank test and Kruskal-Wallis test were used for statistical analysis; The level of significance was assumed at the P < 0.05 level. Results are expressed as mean +/- SE. RESULTS: The resulting hemodynamic values were not significantly different between groups except for hepatic vascular resistance in the P group. Hepatic blood flow decreased significantly in the P and H groups, whereas it increased significantly in the L group. Hepatic oxygen consumption and Base Excess in hepatic venous blood after vasopressors were not significantly different between groups. These results mean there were no significant differences in hepatic oxygenation between groups. CONCLUSIONS: Various pressor agents can be used to raise SVR without jeopardizing hepatic oxygenation. However, phenylephrine and high dose of epinephrine are not recommended after liver transplantation because decreased hepatic blood flow might affect the intracellular oxygen environment adversely.