Pectoral nerve block (Pecs block) with sedation for breast conserving surgery without general anesthesia

Most regional anesthesia in breast surgeries is performed as postoperative pain management under general anesthesia, and not as the primary anesthesia. Regional anesthesia has very few cardiovascular or pulmonary side-effects, as compared with general anesthesia. Pectoral nerve block is a relatively new technique, with fewer complications than other regional anesthesia. We performed Pecs I and Pec II block simultaneously as primary anesthesia under moderate sedation with dexmedetomidine for breast conserving surgery in a 49-year-old female patient with invasive ductal carcinoma. Block was uneventful and showed no complications. Thus, Pecs block with sedation could be an alternative to general anesthesia for breast surgeries.

Organized Hematoma of the Maxillary Sinus: Rapid Progression and Complications / 대한이비인후과학회지

An organized hematoma of the maxillary sinus (OHMS) is a rare, benign lesion with locally destructive behavior. Although various clinical manifestations of OHMS have been reported previously, their associated complications and rapid progression have not yet been described. Herein, we report a case of OHMS that was further complicated by facial and orbital abscesses. Intensive treatment was necessary to prevent complications and progression of the condition.

Magnetic Resonance Findings of Acute Severe Lower Back Pain

OBJECTIVE: To determine abnormal MRI findings in adults hospitalized with acute severe axial LBP. METHOD: Sixty patients with back pain were divided into 3 groups consisting of 1) 23 adults with acute axial severe LBP who could not sit up or stand up for several days, but had not experienced previous back-related diseases or trauma (group A), 2) 19 adults who had been involved in a minor traffic accident, and had mild symptoms but not limited mobility (group B), and 3) 18 adults with LBP with radicular pain (group C)., Various MRI findings were assessed among the above 3 groups and compared as follows: disc herniation (protrusion, extrusion), lumbar disc degeneration (LDD), annular tear, high intensity zone (HIZ), and endplate changes. RESULTS: The MRI findings of A group were as follows: disc herniation (87%), LDD (100%), annular tear (100%), HIZ (61%), and end plate changes (4.4%). The findings of disc herniation, annular tear, HIZ, and LDD were more prevalent in A group than in B group (p<0.01). HIZ findings were more prevalent in A group than in group B or group C (p<0.05). CONCLUSION: Patients with acute severe axial LBP were more likely to have disc herniation, LDD, annular tear, HIZ. Among LBP groups, there was a significant association of HIZ on MRI with acute severe axial LBP.

Motor Evoked Potentials and Somatosensory Evoked Potentials of Upper and Lower Extremities for Prediction of Functional Recovery in Stroke

OBJECTIVE: The aim of this study was to evaluate the relationship between motor evoked potentials (MEPs) or somatosensory evoked potentials (SSEPs) and the recovery of function in acute or subacute stroke patients. METHOD: Twenty one hemiplegic stroke patients were examined with MEPs of extensor carpi radialis, abductor pollicis brevis, tibialis anterior and abductor hallucis and SSEPs of median and tibial nerves. A separate score was defined for upper and lower extremities within the Fugl-Meyer assessment and Korean-modified Barthel index. Motor performances were evaluated simultaneously with the evoked potential assessments and at 2 weeks after the first examination. RESULTS: The second motor function of upper extremity was significantly higher in patients with the presence of MEP or SSEP (p0.05). MEP in tibialis anterior or tibial SSEP were correlated with the mobility. CONCLUSION: MEP in tibialis anterior is useful in predicting in mobility after stroke. SSEP is predictive for activities in daily living after stroke.

Hypoxia-Ischemia Induced Nigrostriatal System Damages and Motor Behavioral Changes in Neonatal Rat Brain

OBJECTIVE: To investigate hypoxia-ischemia induced nigrostriatal system damages and motor behavioral changes in the immature developing rat brain. METHOD: For establishment of hypoxia-ischemia (HI) injury, bilateral common carotid artery occlusion was performed permanently with bipolar electrocoagulation in the postnatal day 5 rats. And then rat pups were immediately subjected to hypoxic exposure (8% oxygen) at 37degrees C for 1 hour. The control group underwent sham operation and normoxic exposure. Brain injury including striatonigral system was examined. Motor behavioral changes were investigated at 2-, 4-, 6- and 8-week after HI injury using the Rota-rod test and the d-amphetamine-induced locomotor activity. RESULTS: HI-induced motor behavioral deficits showed from 2-week to 8-week after HI injury. In the Rota-rod test, HI group exhibited significantly shorter mean fall latencies as compared to the control group. The d-amphetamine-induced locomotor activity test at the same time point showed reduced locomotor activity in HI group. HI injury resulted in brain structural damages in hippocampus, dorsolateral region of striatum and substantia nigra, and decreases in tyrosine hydroxylase-positive dopaminergic neurons in the substantia nigra. There was no evidence of spontaneous recovery in the substantia nigra at the 8-week after injury. CONCLUSION: HI induced brain injury at neonatal period could result in persistent motor behavioral deficits in juvenile rats. Those deficits might be linked with structural damages including nigrostriatal dopaminergic system.

Delayed Subsequent Refracture of a Thoracolumbar Vertebral Compression Fracture

Most patients experiencing an osteoporotic vertebral compression fracture remain asymptomatic or minimally symptomatic. However, a notable number of these patients do experience significant pain at some time resulting in disability and decreased quality of life. A 77-year-old man was admitted to a hospital with severe thoracolumbar pain and functional disabilities even though, 12 months ago, he had received inpatient treatment for 6 months in another hospital with the diagnosis of T12 vertebral compression fracture. Although initial outside spine MRI revealed a stable T12 com pression fracture with a 27.6% compression rate, delayed subsequent re-fracture of the same vertebrae was found on simple X-ray and thoracolumbar CT scan with an 86.5% compression rate and retropulsion to the central spinal canal. He continued to have severe spinal pain and functional disabilities in spite of undergoing a first anterolateral fusion one year ago and a subsequent posterior fusion. We emphasize a proper clinical and radiologic examination at one-year follow-up after successful conservative treatment of vertebral compression fractures.

Analysis of Electrophysiological Change in the Rat LC Nucleus after Salicylic Acid Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The precise mechanism of salicylic acid induced tinnitus has not been clearly identified as yet in spite of wide range of studies undertaken. We looked for the electrophysiologic evidence that salicylic acid has effect on the Locus Coeruleus (LC) neurons in vitro. MATERIALS AND METHOD: In LC, we measured the neuronal firing rate and cell membrane property according to the concentration of salicylic acid with extracellular single unit recording and whole cell current clamp recording. RESULTS: The basal firing activity was increased in 15 of the 20 LC nuclei, which were treated with 0.3 mM salicylic acid. Both 1mM and 2 mM salicylic acid increased the basal firing rate of all except for one LC neuron (n=20). These neurons also showed recovery after washing. However, 5 mM salicylic acid induced cell death after the bursting response in all of the LC neurons (n=10)(Fig. 2). There were no specific changes in the whole cell current-clamp recording of the LC neurons during the period of drug treatment (Fig. 3). CONCLUSION: The dose dependent response pattern observed in the extracellular single unit recording and the fact that there were no specific changes in the whole-cell current-clamp recording following the salicylic acid treatment suggest that the salicylic acid induced intracellular change in the LC neuron is caused not by the direct ligand-receptor reaction but by the indirect 2nd messenger system.

A Case of Osteoma of the Tongue / 대한이비인후과학회지

Lingual osseous lesion can be classified as one of three types: osteoma, chondroma and osteochondroma. Osteoma is a benign neoplasms consisting of mature normal osseous tissue. Osseous growths within the oral cavity, but it is especially rare to find it in the tongue. The majority of the lesions occur in the posterior third of the tongue at or in close proximity to the foramen cecum and the circumvallate papillae. Clinically, tongue osteomas are benign, slow- growing tumors made up of densely sclerotic, well-formed bone. Symptoms include foreign body sensation, dysphagia, nausea, and choking. However, most patients tend to be asymptomatic, and histologic studies can confirm the diagnosis. Treatment of the oral osteoma is by surgical excision, preferably by a transoral approach. This should give complete resolution and there were rare recurrences with good prognosis. Recently, we experienced a 25 year old woman with asymptomatic hard mass on the base of the tongue. A surgical resection was performed and pathologic analysis confirmed tongue osteoma for the patient. Now we report this case with a review of literature.

A Case Report of Leiomyoma of the Hard Palate / 대한이비인후과학회지

Leiomyoma is a benign smooth muscle tumor that can be classified into three types: solid, vascular and ephithelioid leiomyoma. This disease occurs most frequently in the uterus, gastrointestinal tract and skin. The oral cavity is an unusual site for a leiomyoma and occurrence in the hard palate is very rare because there is so little smooth muscle tissue present in this region. Clinically, oral leiomyomas usually grow slowly and are asymptomatic firm superficial nodule like lesions, although occasional tumors can be painful. The diagnosis and treatment of oral leiomyoma is possible with complete surgical excision and histological studies by special specific stains. Recently, we experienced a 60-year-old man with 6 month history of soft mass on the hard palate. He underwent surgical resection. Pathological analysis confirmed vascular leiomyoma. Here, we report this case with review of literature.

A Clinical study on the dental emergency patients of k-country hospital of medical college during recent 8 years

No abstract available.

Closure of the orocutaneous perforated wound due to the resection and radiation therapy of malignant tumor

No abstract available.

Active Bleeding Acre During Surgical Extraction of Mandibular Third Molar: Report of Two Cases

The experienced surgeon can be surprised & challenged by the hazards of active bleeding during oral & maxillofacial surgical procedure, because of alterations in the surgical anatomy, bleeding disorders and surgical intervention of infected tissues. This is a report of two cases of active bleeding during surgical extraction of mandibular third molar, that had the pericoronitis, osteitis and adjacent neurovascular bundle in its apex. When the abrupt active bleeding was occurred during surgical extraction of mandibular third molar, pressure packing by hemostatic agent(bone wax) & wet gauze biting were applied into the extraction socket during 30 minutes. After 30 minutes, the wound was explored about the bleeding and active bleeding was then continued. In spite of repeated bleeding control method of the pressure dressing, the marked hemorrhage was generated continuously. Therefore, the author decised the bleeding as immediately uncontrollable hemorrhage and the pressure dressing was again applied for the more longer duration without wound closure. After 3 days, the pressure dressing was removed and iodoform gauze drainge was then established without the bleeding. The drain was changed as the interval of 3~5 days for prevention of infection & secondary hemorrhage and relatively good wound healing was then resulted in 6 weeks.