Comparison of Radiation Exposure during Fluoroscopy-Guided Transforaminal Epidural Steroid Injections at Different Vertebral Levels

OBJECTIVE: To estimate and compare radiation exposure during transforaminal fluoroscopy-guided epidural steroid injection (TFESI) at different vertebral levels. MATERIALS AND METHODS: Fluoroscopy-guided TFESI was performed in 181 patients. The patients were categorized into three groups according to the injected lumbosacral nerve level of L2-4, L5, or S1. Fluoroscopy time (FT) and dose area product (DAP) were recorded for all patients; correlations between FT and DAP were determined at each level, and both FT and DAP were compared between the different vertebral levels. RESULTS: The numbers of patients who received ESI at L2-4, L5, and S1 were 29, 123, and 29. Mean FT was 44 seconds at L2-4, 33.5 seconds at L5, and 37.7 seconds at S1. Mean DAP was 138.6 microGy.m2 at L2-4, 100.6 microGy.m2 at L5, and 72.1 microGy.m2 at S1. FT and DAP were positively correlated in each group (p values < 0.001). FT was significantly shorter at L5 than that at L2-4 (p = 0.004) but was not significantly different between S1 and L2-4 or L5 (p values = 0.286 and 0.532, respectively). DAP was significantly smaller at L5 and S1 than that at L2-4, but L5 and S1 were not significantly different. After correcting for FT, DAP was significantly smaller at S1 than that at either L2-4 or L5 (p values = 0.001 and 0.010). CONCLUSION: The radiation dose was small during a single procedure of ESI and showed differences between different lumbosacral spine levels.

Candida Septic Arthritis with Rice Body Formation: A Case Report and Review of Literature

Rice body formation in a joint or bursa is a rare condition, and is usually associated with rheumatoid arthritis or tuberculous arthritis. Here we describe a case of multiple rice body formation in a shoulder joint and in adjacent bursae, which was confirmed to be due to septic arthritis by Candida species. To the best of our knowledge, rice body formation in Candida septic arthritis in an immune-competent patient has not been previously reported.

Posterior Circulation Aneurysms Treated with Circulatory Arrest, Hypothermia and Barbiturate:3 Cases

Direct approach of technically difficult or inoperable intracranial aneurysms many become possible using complete circulatory arrest with extracorporeal circulation and profound hypothermia and barbiturate cerebral protection. To avoid difficulties associated with closed chest method, open chest method was used by direct cannulation of the right atrium and aorta through the chest. 3 patients with posterior circulation aneurysms operated on with these techniques;1 large basilar bifurcation aneurysm and 1 irregular shaped vertebro-basilar junction aneurysm and 1 posterior cerebral artery aneurysm were operated on and all had excellent results. Careful attention was needed to the depth of hypothermia, duration of total circulatory arrest, and hemostasis which important factors in the success of these methods.

A Case of Miller Fisher Syndrome (Variant of Guillain Barr'e Syndrome-Ophthalmoplegia, Ataxia, Areflexia)

Miller Fisher syndrome is a syndrome of acute external ophthalmoplegia, ataxia and areflexia without significant motor or sensory deficit in the limbs and usually results in complete recovery without specific treatment. It's accurate anatomic lesion sites and pathogeneiss is still unknown. Recently we experienced a 57 year old man who had the sudden onset of ophthalmoplegia, ataxia, areflexia and albuminocytologic dissociation in CSF and completely recovered 2 1/2 months later.

A Case of Miller Fisher Syndrome (Variant of Guillain Barr'e Syndrome-Ophthalmoplegia, Ataxia, Areflexia)

Miller Fisher syndrome is a syndrome of acute external ophthalmoplegia, ataxia and areflexia without significant motor or sensory deficit in the limbs and usually results in complete recovery without specific treatment. It's accurate anatomic lesion sites and pathogeneiss is still unknown. Recently we experienced a 57 year old man who had the sudden onset of ophthalmoplegia, ataxia, areflexia and albuminocytologic dissociation in CSF and completely recovered 2 1/2 months later.