The abnormality of the number of ribs misleading incorrect vertebral segment identification during lumbar intervention: Two cases report

BACKGROUND: For patients who have back pain or radiating pain, lumbar intervention should be performed at the correct lumbar segment that triggers pain. It is quite common for pain physicians to identify lumbar segments based upon the 12th pair of ribs to do an interventional procedure. CASE: We experienced two cases of rib number abnormality (absent 12th rib pair) that made the injection ineffective. In both cases, we had misidentified the lumbar segmentation due to rib abnormality. Although the procedure was performed properly, the clinical symptoms of the patient were not well correlated with the dermatome, and the diagnosis was delayed. CONCLUSIONS: These cases suggest that rib counting is necessary for more accurate lumbar segmentation. If the expected effect has not appeared after intervention, rib numbers should be checked.

Effects of intraoperative single bolus fentanyl administration and remifentanil infusion on postoperative nausea and vomiting / 대한마취과학회지

BACKGROUND: Although the use of postoperative opioids is a well-known risk factor for postoperative nausea and vomiting (PONV), few studies have been performed on the effects of intraoperative opioids on PONV. We examined the effects of a single bolus administration of fentanyl during anesthesia induction and the intraoperative infusion of remifentanil on PONV. METHODS: Two hundred and fifty women, aged 20 to 65 years and scheduled for thyroidectomy, were allocated to a control group (Group C), a single bolus administration of fentanyl 2 microg/kg during anesthesia induction (Group F), or 2 ng/ ml of effect-site concentration-controlled intraoperative infusion of remifentanil (Group R) groups. Anesthesia was maintained with sevoflurane and 50% N2O. The incidence and severity of PONV and use of rescue antiemetics were recorded at 2, 6, and 24 h postoperatively. RESULTS: Group F showed higher incidences of nausea (60/82, 73% vs. 38/77, 49%; P = 0.008), vomiting (40/82, 49% vs. 23/77 30%; P = 0.041) and the use of rescue antiemetics (47/82, 57% vs. 29/77, 38%; P = 0.044) compared with Group C at postoperative 24 h. However, there were no significant differences in the incidence of PONV between Groups C and R. The overall incidences of PONV for postoperative 24 h were 49%, 73%, and 59% in Groups C, F, and R, respectively (P = 0.008). CONCLUSIONS: A single bolus administration of fentanyl 2 microg/kg during anesthesia induction increases the incidence of PONV, but intraoperative remifentanil infusion with 2 ng/ml effect-site concentration did not affect the incidence of PONV.

Recurrent Malignant Fibrous Histiocytoma in Psoas Muscle: A Case Report

Malignant fibrous histiocytoma is one of the most common sarcomas that occur in soft tissue, it usually develops in old age individuals and the incidence is similar between the genders. We report here on a case with invasive local recurrence after surgical resection of a malignant fibrous histiocytoma that occurred in the left psoas muscle of a 69-year-old male patient. The patient was first admitted to our hospital with a primary lesion in the left lower abdomen, as seen on magnetic resonance imaging. We report here on a rare case of a malignant fibrous histicytoma in the psoas muscle.

Relationship between the Synovialization and the Clinical Results after Anterior Cruciate Ligament Reconstruction Using Tibialis Tendon Allograft / 대한스포츠의학회지

The purpose of this study was to evaluate the relationship between the second-look arthroscopic findings of synovialization and the clinical results after the arthroscopic anterior cruciate ligament (ACL) reconstruction with the fresh-frozen tibialis tendon allograft. Fifty-seven patients could be examined with the second-look arthroscopy after the ACL reconstruction with tibialis tendon allograft. The average duration from reconstruction to second-look arthroscopy was 18.4 months (range, 4-48 months). The patients were classified, according to the extent of synovialization, into 3 groups; 37 cases (64.9%) in group A (good), 15 cases (26.3%) in group B (partial), and 5 cases (8.8%) in group C (poor). The clinical results were compared in each group. The 2000 International Knee Documentation Committee (IKDC) subjective knee score was 80 or more in 31 cases (83.8%) in group A, 9 (60%) in group B, and 1 (20%) in group C respectively. All thirty seven cases (100%) in group A had negative or 1+firm end-point Lachman test and negative pivot shift test, however, only 2 cases (40%) in group C. KT-1000 arthrometer measurement was less than 5 mm in 37 (100%) in group A, 14 (93.3%) in group B, and 2 (40%) in group C. According to the 2000 IKDC knee examination form, 37 (100%) in group A, 14 (93.3%) in group B, and 2 (40%) in group C respectively were normal or nearly normal. The synovialization of the graft had positive correlation with the clinical results after the ACL reconstruction with fresh-frozen allograft.

Treatment of Refractory Lateral Epicondylitis with Platelet-Rich Plasma

PURPOSE: To evaluate clinical results of a single percutaneous injection of platelet-rich plasma in patients with refractory lateral epicondylitis. MATERIALS AND METHODS: Between Jan and Dec 2009, fifteen patients (5 male, 10 female) received a diagnosis of lateral epicondylitis of the elbow and were evaluated in this study. Their average age was 43.5 years. All patients were initially given a variety of non-surgical treatments for more than 1year. All patients were considering surgery. These patients were given a single percutaneous injection of 3cc of platelet-rich plasma. To assess pain, we used a visual analogue scale (VAS) at rest and during work & the Patient-Rated Tennis Elbow Evaluation (PRTEE) score. We compared the score before treatment with scores 4 and 12 weeks after treatment. RESULTS: Average VAS scores at rest improved from 4.6 before treatment to 2.5 at week 4, and 1.8 at week 12. The average VAS score while working also improved from 7.8 before treatment to 6.2 at week 4, and 4.25 at week 12. The average PRTEE score improved from 60.13 before treatment to 46.12 at week 4 and 24.6 at week 12. CONCLUSION: Treatment using a single percutaneous injection of platelet-rich plasma in patients with refractory lateral epicondylitis appears to be an effective treatment modality. Platelet-rich plasma should be considered before surgical intervention.

Pectoralis Major Tendon Transfer for Refractory Winged Scapula: A Case Report

PURPOSE: We wanted to evalulate the clinical results of pectoris major tendon transfer for a neglected winged scapula that was caused by paralysis of the serratus anterior due to injury to the long thoracic nerve. MATERIALS AND METHODS: A patient had neglected winged scapula that followed an arthroscopic operation for multi-directional instability of the shoulder joint, which was caused by traumatic dislocation. The patient was treated with pectoralis major tendon transfer using the modified Eden-Lange procedure. The range of a motion was improved from forward flexion 90degrees and external rotation 70degrees to 170degrees and 150degrees respectively. RESULTS AND CONCLUSION: There were no complications or recurrence and the patient's psychological satisfaction was also high. If the shoulder girdle muscles are intact, except for the serratus anterior, then pectoralis tendon transfer is a satisfactory method that can provide normal scapulo-thoracic motion.

Surgical Management of Dural Arteriovenous Fistula of the Anterior Cranial Fossa after Failure of Embolization Therapy: Case Report

Dural arteriovenous fistula (DAVF) of anterior cranial fossa is a rare entity. The authors report a 57 year-old man presented with retro-orbital headache caused by a large hematoma in the right frontal lobe. Angiography demonstrated a DAVF of anterior cranial fossa fed by branches of middle meningeal and anterior ethmoidal artery. Endovascular therapy using N-butyl cyanoacrylate was tried, however, was failed to occlude the fistula. After than, the lesion was successfully obliterated by surgical means. The therapeutic roles and pitfalls of endovascular treatment and surgical treatment for the anterior fossa DAVF are discussed.

A Case of the Pulsatile Tinnitus due to Post-traumatic Arteriovenous Fistula Involving Superficial Temporal Artery Treated with Percutaneous Embolization / 대한이비인후과학회지

Tinnitus is one of the most common complaints in the otolaryngology. It can be classified as either as subjective or objective; the former refering to that sensation heard only by the patient and the latter to that sensation heard also by the examiner. Arteriovenous fistula is the most common cause of objective tinnitus due to the trauma. Recently, the authors experienced one case of the pulsatile tinnitus caused by post-traurnatic arteriovenous fistula involving the superficial temporal artery. This was confirmed by selectcd angiography and was treated by percutaneous transarterial embolization which resulted in the disappearance of tinnitus.

A Case of Enterobacter sakazakii Epidural Abscess in Neonate

Enterobacter sakazakii previously known as a 'yellow-pigmented Enterobacter cloacae', was designated as a unique species in 1980. This reclassification was based on differences from E. cloacae in DNA relatedness, pigment production and biochemical reactions. In 1961, Urmenyi and Franklin reported the first two known cases of neonatal meningitis and septicemia caused by E. sakazakii, although at that time it was still considered as an E. cloacae strain. Since 1961, a number of cases of neonatal infection caused by E. sakazakii have been reported worldwide. Usually newborn with E. sakazakii meningitis have a poor prognosis, many of them dying within days of infection. The reported case-fatality rate vary from 40-80%. We diagnosed and experienced a case of epidural abscess caused by E. sakazakii in a 1 month old male patient, who was asymptomatic with brain mass detected on brain ultrasound examination. We presented this case with a brief review of literatures.