Ultrasound-guided auriculotemporal nerve block for post-herpetic auriculotemporal neuropathy: A case report

Auriculotemporal neuropathy is a rare aetiology of orofacial pain. A 66-year old female patientpresented with severe, throbbing pain around the right ear after herpes zoster. The pain was consistentwith post-herpetic neuropathy and was not relieved by oral medications. To alleviate neuropathicpain, ultrasound-guided auriculotemporal nerve block was done. The pain was relieved completelyand the patient remained symptom-free until the last follow up at eight months after treatment. Withunderstanding of the anatomy and related symptoms of auriculotemporal nerve, auriculotemporalneuropathy can be controlled by ultrasound-guided auriculotemporal nerve block.

Gross Motor Function Outcome After Intensive Rehabilitation in Children With Bilateral Spastic Cerebral Palsy

OBJECTIVE: To compare gross motor function outcomes in children with moderate to severe degrees of bilateral spastic cerebral palsy (CP) who received either intensive inpatient rehabilitation or intermittent rehabilitation on an outpatient basis. METHODS: A non-biased retrospective chart review was done for patients diagnosed with bilateral spastic CP who received rehabilitation therapy. The intensive rehabilitation group (inpatient group) agreed to be hospitalized to receive 22 sessions of physical and occupational therapy per week for 1 month. The intermittent rehabilitation group (outpatient group) received four sessions of physical and occupational therapy per week for 3 months in an outpatient setting. Changes in the total score on the Gross Motor Function Measure (GMFM) between baseline and the follow-up period were analyzed. RESULTS: Both groups showed significant improvements in total GMFM scores at the follow-up assessment compared to that at baseline (p=0.000 for inpatient group, p=0.001 for outpatient group). The increase in mean total GMFM score after 1 month was significantly greater in the inpatient group than that in the outpatient group (p=0.020). Higher increase in GMFM score was observed in younger subjects as revealed by the negative correlation between age and the increase in GMFM score after 1 month (p=0.002, r=-0.460). CONCLUSION: Intensive inpatient rehabilitation therapy for patients with bilateral spastic CP of moderate to severe degree was more effective for improving gross motor function than intermittent rehabilitation therapy on an outpatient basis.

MEF2C-Related 5q14.3 Microdeletion Syndrome Detected by Array CGH: A Case Report

Genetic screening is being widely applied to trace the origin of global developmental delay or intellectual disability. The 5q14.3 microdeletion has recently been uncovered as a clinical syndrome presenting with severe intellectual disability, limited walking ability, febrile convulsions, absence of speech, and minor brain malformations. MEF2C was suggested as a gene mainly responsible for the 5q14.3 microdeletion syndrome. We present the case of a 6-year-old girl, who is the first patient in Korea with de novo interstitial microdeletions involving 5q14.3, showing the typical clinical features of 5q14.3 microdeletion syndrome with a smaller size of chromosomal involvement compared to the previous reports. The microdeletion was not detected by subtelomeric multiplex ligation-dependent probe amplification, but by array comparative genomic hybridization, which is advisable for the detection of a small-sized genetic abnormality.

Facilitating Effects of Fast and Slope Walking on Paraspinal Muscles

OBJECTIVE: To quantify the activation of the paraspinalis muscles (multifidus and erector spinae) at different walking velocities and slope with surface electromyography. METHODS: This study was a prospective experimental study involving ten healthy male participants. Surface electrodes were placed over the multifidus and erector spinae muscles at the L5 and L3 level. After the electrode was placed at the lumbar paraspinalis muscles, electromyography signals were recorded over 20 seconds. Data were collected three times during the walking exercise at a 0degrees gradient with the speed from 3 to 6 km/hr. At 7degrees gradient and 15degrees gradient, data were also collected three times but a walking speed of 4 km/hr. The area under the curve was calculated for quantitative measurement of muscle activation. RESULTS: While the muscle activation was increased at higher walking velocities at the L5 and L3 levels of the multifidus, the erector spinae muscle activation did not show any change at higher walking velocities. At L3 level of the multifidus and erector spine muscles, the muscle activation was significantly increased in 15degrees gradient compared to those seen in at 0degrees gradient. At L5 level, the multifidus and erector spinae muscle activation in 0degrees gradient was not significantly different from that those seen in 7degrees or 15degrees gradient. CONCLUSION: Fast walking exercise activates lumbar multifidus muscles more than the slow walking exercise. Also, the mid lumbar muscles are comparatively more activated than low lumbar muscles when the walking slope increases.

Fresh Fibroblast Allograft as a Treatment for Diabetic Foot Ulcers

PURPOSE: In order to overcome the limitations of the conventional cryopreserved fibroblast or keratinocyte allograft method used in the treatment of diabetic foot ulcers, we reported a pilot study in 2004 demonstrating promising results of a fresh fibroblast allograft method in eight patients. However, the number of cases was insufficient for full evaluation and the follow-up duration was not long enough to determine the efficacy and safety of the method. This encouraged us to conduct this follow-up study to fully evaluate the use of noncryopreserved fresh human fibroblast allografts in treating diabetic foot ulcers. METHODS: Thirty-seven patients with diabetic foot ulcers were treated using fresh fibroblast allografts. Human dermal fibroblasts from healthy teenagers were cultured in DMEM/F-12 medium supplemented with 10% serum. The cultured cells were applied on the wounds immediately following debridement, with fibrin being used as a cell carrier. In eight weeks, percentages of complete healing, mean healing time, and patient satisfactions were assessed, with follow-up time ranging from 6 to 40 months. RESULTS: Our study showed that 83.8% of the treated patients were complete healed. The time required for complete healing was 30.9+/-10.1 days. Patient satisfaction scores for the experimental treatment were higher than those for the conventional method(mean scores of 8.1+/-1.1 and 4.8+/-1.4, respectively). No adverse events related to the study treatment occurred. CONCLUSION: The use of fresh human fibroblast allografts was found to be a safe and effective treatment for diabetic foot ulcers.

Correction of Crow's Feet by the Expansion of Orbicularis Oculi Muscle Flap

As people grow older, many aging phenomena occur in the facial skin and soft tissues, including crow's feet, glabellar frown lines, jowls, depression of malar fat pads, brow ptosis, Marionette lines, and more. Among these results, the authors focused on crow's feet(Lateral. periorbital wrinkles), which are one of the major causes of facial rejuvenation in the periorbital area. Upper & lower blepharoplasty do not always improve crow's feet to one's satisfaction, and above that, surgery sometimes accentuates rather than improves these wrinkles. Consequently, the authors proposed a new operative method for lateral. periorbital wrinkle correction, which could be summarized as dissection of the orbicularis oculi muscle, below the subcutaneous tissue above the temporal fascia, elevation of the muscle flap, advancement of the flap to the upper-lateral direction, and excision of redundant skin. After laying the patient down on the operation table and exposing both ears, the whole face was cleansed with an antiseptic solution. Incision lines were designed as temporal W-shaped. After dissecting through the subcutaneous fat layer and elevating the flap from the temporal fascia, the orbicularis oculi muscle was incised at the lateral margin of orbicularis muscle. The orbicularis oculi muscle flap was then elevated, and pulled into the upper- lateral direction with smooth forceps to find the point which would make the patient's eyes look the most natural. The lateral margin of orbicularis muscle was fixed to the deep temporal fascia of temporal hairline. with 4-0 Nylon suture. Redundant skin was excised and wound was closed with 6-0 Black silk by W- plasty technique. Between 2001 and 2006, 63 patients were operated on using the technique mentioned above, with favorable aesthetic and functional results. Several patients complained about the W-plasty scar but those were aesthetically accepted. Crow's feet are not always corrected with satisfactory results, and sometimes are accentuated, by upper & lower blepharoplasty. In order to solve these problems, an operative technique was conceived that dissects the orbicularis oculi muscle, elevates and advances the muscle flap, and then excises the redundant skin. This technique showed favorable patient satisfaction scores in both functional and aesthetic aspects, with satisfactory results even in long-term follow up, and also had the effect of a central- facial face lift.

Slot Correction by the Frechet Flaps in Hair Restoration Surgery

PURPOSE: A common side effect of the scalp reduction is a creation of a 'slot' with the hair growing in the opposite directions away from the scar. Overcoming the unnatural appearance of the slot has been a vexing problem in the scalp reduction surgery. None of the conventional corrective surgical techniques provides a complete and satisfactory aesthetic result. The Frechet flap is a triple transposition flap used for the correction of the slot defect secondary to scalp reduction surgery, seldom needing further scar revision. The Frechet technique provides a solution to the problem of the central slot concealment that is unattainable by other means, such as; Z-plasty and mini-graft. METHODS: Authors applied the Frechet technique to Asian patients who had undergone scalp reduction and operated on 4 patients from March, 2000 to January, 2001. Average follow-up period was 13 months. Patients with long scars passing through the temporoparietoccipital zone were excluded. All the undermining was performed in the subgaleal plane, reaching the upper auricular sulcus and stopping just above the nuchal ridge. RESULTS: None of the patients experienced infection, hematoma, nor any permanent hair loss. Transient telogen effluvium at the distal end of flap 2 and 3 was noticeable in one case. CONCLUSION: In conclusion, the results are aesthetically satisfactory without any significant complications.

Prenatal Cytogenetic Diagnosis with Fetal Ascitic Fluid as a Rapid Chromosome Analysis / 대한산부인과학회잡지

OBJECTIVE: The goal of this study is to determine the efficacy of rapid karyotyping from fetal ascitic fluid. METHODS: In three cases of isolated fetal ascites diagnosed by prenatal ultrasonography, ultrasound guided fetal paracentesis and amniocentesis were performed and successfully obtained. Fetal karyotyping in each case at 29, 30 and 32 weeks gestation using modified lymphocyte culture method was conducted. RESULTS: The chromosomal analysis was successful within 72 hours and abnormalities were detected in two cases and revealed trisomy 21 in each case. Our study demonstrated that the majority distribution of white blood cells was lymphocytes which ranged from 2.1 * 10(6) cells/ml to 3.7 * 10(6) cells/ml and the cell density for culture was at least than 0.35 * 10(6) cells/ml. CONCLUSION: The use of ascitic fluid as a cell source to achieve rapid fetal karyotyping can be valuable when cordocenteis or amniocentesis would be technically more difficult, or when rapid result is required for planning of perinatal management at late second or third trimester gestational age.

The hypobaric spinal anesthesia for total hip-replacement arthroplasty / 대한정형외과학회잡지

No abstract available.

Clinical Evaluation of Hypobaric Spinal Anesthesia for Total Hip Replacement in Lateral Decubitus Position / 대한마취과학회지

Hypobaric spinal anesthesia for fifty patients(spinal group) undergoing total hip replacement were compared with general anesthesia(general group) in respect to intraoperative blood loss, changes of blood pressures, postoperative analgesics, etc. Furthermore, the technical aspects were evaluated for hypobaric spinal anesthesia in the lateral position when 1% tetracaine in distilled water (epinephrine 1: 200,000) was administered. The lowest blood pressure parameters were significantly lower in the spinal group(29%) than in the general group(22%). The amount of blood loss in the spinal group was less than that in the general group even though there was no difference in blood replacement between groups. The time period before analgesic use longer in the spinal group(4.1 hours)than the general group(2.7 hours). The most common complication in either group was urinary retention(50% in the spinal and 44% in the general) in which urinary catheterization was necessary. In the general group, thirty-six per cent of the patients had mild fever in the first or second postoperative day which were not consistently related to pulmonary complications. For spinal anesthesia, 5 or 6 mg of 1%-tetracaine in distilled water mixed to 1: 200,000 epinephrine was used. The spinal puncture was performed by a 22G needle on the L2-3 or L3-4 in- tervertebral space with lateral aproach in the position of the operation. Injection speed was controlled to 1 ml/sec in all patients. Sensory levels were reached to T7-8 and T9-10 in the non-dependent and dependent side, respectively. Motor funetion on knee and ankle was lost in the non-dependent side, but not in the dependent side. There were some intraoperative complaintments including positional discomfort on hip rest and shoulder bar. However, there was no remarkable problem in hypobaric spinal anesthesia intraoperatively. The results of our study indicate that hypobaric spinal anesthesia in lateral decubitus position is a recommendable anesthetic technique for total hip replacement surgery.

Clinical Experiences of Balanced Anesthesia with Nalbuphine or Fentanyl in Cesarean Section / 대한마취과학회지

The effect of fentanyl and nalbuphine used as analgesics in balanced anesthesia were evaluated in 60 full term parturients, ASA physical status class I or II, sheduled for elective cesarean section. They were injected intramusculary with 0.2 mg of glycopyrrolate 30 minutes to one hour prior to the induction of anesthesia. Four mg/kg of thiopental sodium and one mg/kg of succinylcholine were administered intravenously for the induction and endotracheal intubation. Anesthesia was maintained with 66% of nitrous oxide in oxygen until delivery. Following the intravenous injection of 4 mg-vecuronium, controlled ventilation was applied to maintain at PCO1 30 to 40 mmHg. Immediately after clamping of the umbilical cord, 3 ug/kg of fentanyl(F group) or 0.3 mg/kg of nalbuphine(N group) with 5 mg of droperidol were administered. In the F group, the systolic and diastolic blood pressures at three minutes after fentanyl were significantly lower than those during the preinduction period and during recovery room stay. The systolic BP in the preinduction period was significantly higher than those of three minutes after nalbuphine, and the diastolic BP at the preinduction period was also higher than those of three minutes after nalbuphine and during recovery room stay. Heart rates were significantly increased three minutes after nalbuphine than at recovery room. The blood presures and heart rates were not significantly different between the two groups. The time intervals from the end of the operation to the first analgesics were significantly longer in the N group(mean 11.3 hours) in contrast to the F group(mean 6.9 hours). There were a few complications such as nausea, headache, dizziness, somnolence and euphoria. The incidences of awareness was 13.3 and 6.7% in the F and N group, respectively. We concluded that the balanced anesthetic technique using nalbuphine with droperidol nuder the inhalation of 66%-nitrous oxide resulted in a satisfactory anesthesia for cesarean seetion with good postoperative analgesia.

Effects of Needle Size and Needle Bevel Direction on the Postspinal Headache / 대한마취과학회지

The incidence of postspinal headache is one of the well known complications of spinal anesthesia. Several factors such as needle size, bevel direction, multiple dural puncture and previous history of postspinal headache were thought to influence the incidence of postspinal headache. This studies were done to see the effect of needle size (22 and 25 gauge needle) and needle bevel direction (parallel, vertical, oblique insertion to the longitudinal dural fiber) on the incidence, duration, severity and location of spinal headache in the 548 patients underwent spinal anesthesia. The following results wre observed: 1) Neither needle size nor needle bevel direction had effect on the incidence of severity, duration and location of postspinal headache. 2) The ineidence of headache was 8.8% (48 cases), 3) The onset of headache was 1~2 day (67%) and duration of headache was 4~5 day (85%) in postanesthetic day. 4) The severity of headache was mild and moderate in 77% cases. 5) In the half cases, headache was relieved by means of bed rest alone.

Clinical Evaluation of Outpatient Anesthesia for Pediatric General Sugery / 대한마취과학회지

Anesthesia for thoracic surgery is most commonly performed with the patient in the lateral decubitus position, with nondependent hemithorax comprising the operation field. When one-lung ventilation is employed, the nondependent lung is nonventilated and collapsed, while the dependent lung is ventilated. Consequently one-lung ventilation creates an obligatory right to left transpulmonary shunt through the nondependent nonventilated lung. Therefore one-lung ventilation results in a much larger alveolar-arterial oxygen tension-difference P(A-a)O2 and lower PaO2 than does two-lung ventilation. The present study was to evaluate oxygenation effect of selective CPAP to nondependent lung in the 17 thoracic surgical patients. Arterial blood gases were analysed, systolic blood pressures and heart rates were measured at following stages. Stage I; lateral decubitus position before chest opening Stage II; 15 min after chest opening and one lung ventilation stage III; 15 min after application of selective CPAP 5 cmHO to the nondependent lung stage IV; 40 min after application of selective CPAP 5 cmHO to the nondependent lung The results were as follows: 1) In stage II, the value of PaO2 was significantly lower as compared to that in stage I(224.9+/-78.0 vs 418.2+/-63.1 mmHg, P<0.01). 2) In stage III and IV, the values of PaC4 were significantly higher.as compared to that in stage II(333.8+/-97.1, 364.5+/-88.6 vs 224,9+/-78.0 mmHg, P<0.01). 3) In stage III, the value of PaCO2 was significantly lower as compared to that in stage II(37.1+/-2.9 vs 38.2+/-2.7 mmHg, P<0.05). 4) In stage IV, the value of pH was significantly lower as compared to that in stage III(7.37+/-0.05 vs 7.38+/-0.05 P<0.05). 5) Systolic blood pressures and heart rates remained unchanged at all times. We concluded that application of 5 cmHO CPAP to the nondependent lung during one-lung ventilation is one of most efficacious maneuvers to increase PaO2, accompanying less surgical interference.

Effect of Extreme Leukocytosis on Arterial Oxygen Tension / 대한마취과학회지

Arterial blood gas analysis has become an integral part of the clinical evaluation of the patient with known or suspected pulmonary disease. However, when the results of the measurements show arterial hypoxemia which is out of proportion to the clinical and X-ray evidence of lung disease, we may consider potential errors in measurement involving the blood gas analyzer or methods of blood sample storage. We experienced spurious hypoxemia in a patient with extreme leukocytosis (220.0 X 10(3)/mm3) secondary to leukemia. The degree of PaO2 decay was blunted by placing the blood on ice.

A Computer Program for Cumulation and Analysis of Anesthetic Records by Month ( Year ) / 대한마취과학회지

We have developed computer software to store data on all anesthetics administered by our department. Our residents transcribe data from the anesthetic records into the computer file, which is then available for producing monthly reports of method, agent, age, and duration statistics. Also another back up floppy disk is made for yearly statistics. Capacity of a floppy disk is 3000 cases of records in a month and 30000 cases in a year. It imposes little additional workload on our clinical personnel, who use simple codes to cumulation and analyze anesthetic records monthly with emphasis on minimal cost, accuracy of data and economy of time.