ABSTRACT
Cement-augmented fenestrated pedicle screw fixation is becoming more popular for osteoporotic patients. Although several reports have been published on leakage-related problems with bone cement, no cases of cardiac perforation after cement-augmented pedicle screw fixation have been reported. We present a case of cardiac perforation after cement-augmented fenestrated pedicle screw fixation. A 67-year-old female was admitted to our hospital with complaints of dyspnea and chest pain after lumbar surgery. She had been treated with L4–5 lumbar interbody fusion and percutaneous pedicle screw fixation with bone cement augmentation seven days earlier for degenerative spondylolisthesis. The right chest pain was observed a day after the surgery; she was treated conservatively but it did not improve for 7 days after surgery. Chest computed tomography (CT) revealed a hemothorax and a large sharp bone cement fragment that perforated the right atrium. Bone cement can be removed with thoracotomy surgery. We have to be aware of cement leakage through the normal venous drain system around the vertebral body. We also have to consider a detailed cardiac workup, which may include chest CT or echocardiography, if a patient complains of chest pain or dyspnea after cement augmentation.
ABSTRACT
A 72-year-old woman was diagnosed with Kümmell's disease of the T12 and L3 vertebrae. During bone cement injection under continuous fluoroscopic guidance, bone cement spread beyond the posterior border of the T12 vertebral body. We halted the injection immediately. A few minutes later, the patient complained of increasing right lower quadrant abdominal pain. This was diagnosed as a preceding sign of neurological complication due to thermal injury. Consequently, we administered an epidural steroid injection, followed by cooled normal saline irrigation through an epidural catheter to minimize and treat the thermal injury. The pain gradually decreased after saline irrigation and completely disappeared after approximately 10 minutes. After completing the percutaneous vertebroplasty, the patient's lower back pain improved without neurological complications. In conclusion, immediate epidural steroid injection followed by cooled normal saline irrigation through epidural catheterization can be used to treat thermal injury due to bone cement leakage.
Subject(s)
Aged , Female , Humans , Abdominal Pain , Catheterization , Catheters , Low Back Pain , Polymethyl Methacrylate , Spine , VertebroplastyABSTRACT
PURPOSE: Hydrogen sulfide (H2S) is an endogenous gaseous molecule with important physiological roles. It is synthesized from cysteine by cystathionine γ-lyase (CGL) and cystathionine β-synthase (CBS). The present study examined the benefits of exogenous H2S on renal ischemia reperfusion (IR) injury, as well as the effects of CGL or CBS inhibition. Furthermore, we elucidated the mechanism underlying the action of H2S in the kidneys. MATERIALS AND METHODS: Thirty male Sprague-Dawley rats were randomly assigned to five groups: a sham, renal IR control, sodium hydrosulfide (NaHS) treatment, H2S donor, and CGL or CBS inhibitor administration group. Levels of blood urea nitrogen (BUN), serum creatinine (Cr), renal tissue malondialdehyde (MDA), and superoxide dismutase (SOD) were estimated. Histological changes, apoptosis, and expression of mitogen-activated protein kinase (MAPK) family members (extracellular signal-regulated kinase, c-Jun N-terminal kinase, and p38) were also evaluated. RESULTS: NaHS attenuated serum BUN and Cr levels, as well as histological damage caused by renal IR injury. Administration of NaHS also reduced oxidative stress as evident from decreased MDA, preserved SOD, and reduced apoptotic cells. Additionally, NaHS prevented renal IR-induced MAPK phosphorylation. The CGL or CBS group showed increased MAPK family activity; however, there was no significant difference in the IR control group. CONCLUSION: Exogenous H2S can mitigate IR injury-led renal damage. The proposed beneficial effect of H2S is, in part, because of the anti-oxidative stress associated with modulation of the MAPK signaling pathways.
Subject(s)
Animals , Humans , Male , Rats , Apoptosis , Blood Urea Nitrogen , Creatinine , Cystathionine , Cysteine , Hydrogen Sulfide , Hydrogen , Ischemia , JNK Mitogen-Activated Protein Kinases , Kidney , Malondialdehyde , Oxidative Stress , Phosphorylation , Phosphotransferases , Protein Kinases , Rats, Sprague-Dawley , Reperfusion , Reperfusion Injury , Sodium , Superoxide Dismutase , Tissue DonorsABSTRACT
Adjuvant radiation therapy (RT) after colorectal cancer surgery can prevent local recurrence, but has several side effects. Precise injection of drugs into the affected areas is complicated by radiation-induced fibrosis of soft or connective tissue. A 48-year-old woman experienced severe intractable perineal pain, dysuria, urinary urgency, and frequent urination after rectal cancer surgery and adjuvant RT, and was diagnosed with radiation-induced cystitis and vulvodynia. Her symptoms persisted despite two fluoroscopy-guided ganglion impar blocks. Fluoroscopy revealed atypical needle tip positioning and radiolucent dye distribution, presumably due to radiation-induced fibrosis in the target region. We performed two computed tomography (CT)-guided ganglion impar blocks by using a lateral approach, which allowed more accurate po-sitioning of the needle tip. Her pain visual analog score decreased from 9 to 3, and she recently resumed sexual intimacy. CT guidance is a viable alternative to fluoroscopy guidance when performing ganglion impar blocks in fibrotic areas.
Subject(s)
Female , Humans , Middle Aged , Colorectal Neoplasms , Connective Tissue , Cystitis , Dysuria , Fibrosis , Fluoroscopy , Ganglia, Sympathetic , Ganglion Cysts , Needles , Nerve Block , Radiotherapy , Rectal Neoplasms , Recurrence , Urination , VulvodyniaABSTRACT
The intrinsic structural failure of a Dacron graft resulting from the loss of structural integrity of the graft fabric can cause late graft complications. Late non-anastomotic rupture has traditionally been treated surgically via open thoracotomy. We report a case of the successful use of thoracic endovascular repair to treat a Dacron graft rupture in the descending aorta. The rupture occurred 20 years after the graft had been placed. Two stent grafts were placed at the proximal portion of the surgical graft, covering almost its entire length.
Subject(s)
Aorta, Thoracic , Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis , Endovascular Procedures , Polyethylene Terephthalates , Rupture , Stents , Thoracotomy , TransplantsABSTRACT
Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.
Subject(s)
Child, Preschool , Female , Humans , Cardiomyopathies , Catecholamines , Extracorporeal Membrane Oxygenation , Hypertension , Myocarditis , NeuroblastomaABSTRACT
Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.
Subject(s)
Child, Preschool , Female , Humans , Cardiomyopathies , Catecholamines , Extracorporeal Membrane Oxygenation , Hypertension , Myocarditis , NeuroblastomaABSTRACT
Anomalous aortic origin of the left subclavian artery (LSCA) from the left pulmonary artery (LPA) is a rare congenital cardiac malformation. We describe a case of LSCA from the LPA via ductus arteriosus in association with a double-outlet right ventricle, which never has been reported previously in Korea.
Subject(s)
Humans , Double Outlet Right Ventricle , Ductus Arteriosus , Embryology , Heart Defects, Congenital , Korea , Pulmonary Artery , Subclavian ArteryABSTRACT
A 10-year-old boy with arteriovenous malformation (AVM) of the right lower limb was scheduled for an amputation of the affected limb. Limb amputation was necessary because of the ineffectiveness of previous sclerotherapy and the rapid progression of AVM causing pain and heart failure. Right hip disarticulation was considered the best option to improve his quality of life. To prevent congestive heart failure and uncontrollable hemorrhage during surgery, the disarticulation was done under a partial cardiopulmonary bypass. The patient underwent surgery successfully without complications.
Subject(s)
Child , Humans , Male , Amputation, Surgical , Arteriovenous Malformations , Cardiopulmonary Bypass , Disarticulation , Extremities , Heart Failure , Hemorrhage , Hip , Lower Extremity , Quality of Life , SclerotherapyABSTRACT
BACKGROUND: Optiscope PM201 is a newly developed video stylet device. In comparison to the Macintosh laryngoscope, it offers a significantly improved laryngeal view and facilitates endotracheal intubation. The present study was performed to compare the general efficiency and the cardiovascular responses generated by Macintosh and Optiscope PM201 systems during endotracheal intubation. METHODS: This study included 66 patients with American Society of Anesthesiologists physical status class I or II requiring tracheal intubation for general anesthesia. All patients were randomly allocated into two groups: OptiScope PM201 (group O) and Macintosh (group M). Systolic, mean and diastolic blood pressure (SBP, MBP, DBP) and heart rate (HR) were recorded just prior to intubation (Tbase), 1 minute after intubation (T0), and over the following 10 minutes at 5 minute intervals 5, 10 minutes after intubation (T1, T2). Time for intubation and degree of sore throat were also recorded. RESULTS: There were no significant differences in SBP, MBP, DBP, HR, incidence of sore throat and time for intubation between both groups. The incidence of oral bleeding was none in patient in the Group O versus 1 in group M (P = 0.306). CONCLUSIONS: OptiScope PM201 video system in endotracheal intubation did not increase hemodynamic changes and postoperative airway complications comparing to the use of Macintosh laryngoscope.
Subject(s)
Humans , Anesthesia, General , Blood Pressure , Heart Rate , Hemodynamics , Hemorrhage , Incidence , Intubation , Intubation, Intratracheal , Laryngoscopes , PharyngitisABSTRACT
BACKGROUND: Optiscope PM201 is a newly developed video stylet device. In comparison to the Macintosh laryngoscope, it offers a significantly improved laryngeal view and facilitates endotracheal intubation. The present study was performed to compare the general efficiency and the cardiovascular responses generated by Macintosh and Optiscope PM201 systems during endotracheal intubation. METHODS: This study included 66 patients with American Society of Anesthesiologists physical status class I or II requiring tracheal intubation for general anesthesia. All patients were randomly allocated into two groups: OptiScope PM201 (group O) and Macintosh (group M). Systolic, mean and diastolic blood pressure (SBP, MBP, DBP) and heart rate (HR) were recorded just prior to intubation (Tbase), 1 minute after intubation (T0), and over the following 10 minutes at 5 minute intervals 5, 10 minutes after intubation (T1, T2). Time for intubation and degree of sore throat were also recorded. RESULTS: There were no significant differences in SBP, MBP, DBP, HR, incidence of sore throat and time for intubation between both groups. The incidence of oral bleeding was none in patient in the Group O versus 1 in group M (P = 0.306). CONCLUSIONS: OptiScope PM201 video system in endotracheal intubation did not increase hemodynamic changes and postoperative airway complications comparing to the use of Macintosh laryngoscope.
Subject(s)
Humans , Anesthesia, General , Blood Pressure , Heart Rate , Hemodynamics , Hemorrhage , Incidence , Intubation , Intubation, Intratracheal , Laryngoscopes , PharyngitisABSTRACT
Hemothorax is a possible immediate complication of central venous catheterization. We experienced a patient who suffered from massive hemothorax 72 hours after right subclavian venous catheterization. A 29-year-old female patient with Marfan's syndrome underwent the Bentall's operation and aortic arch replacement with an artificial graft, which was performed uneventfully. She recovered favorably in the intensive care unit and was transferred to the general ward on postoperative day 3. Immediately after the removal of the catheter in the general ward, massive hemothorax developed and emergent thoracotomy should have been performed to control bleeding. We report this case to re-emphasize the careful monitoring even after removal of central venous catheter and the need for ultrasound guidance during insertion of central venous catheters.
Subject(s)
Female , Humans , Aorta, Thoracic , Catheterization , Catheterization, Central Venous , Catheters , Central Venous Catheters , Hemorrhage , Hemothorax , Intensive Care Units , Marfan Syndrome , Patient Safety , Patients' Rooms , Thoracotomy , TransplantsABSTRACT
BACKGROUND: Recent research has shown that reactive oxygen species (ROS) play a significant role in the development and persistence of neuropathic pain through central sensitization via N-methyl-D-aspartate (NMDA) receptor activation. In the present study, we examined whether the intraperitoneal administration of vitamins C and E alone or together could alleviate mechanical allodynia in a chronic post-ischemia pain (CPIP) rat model. METHODS: Vitamins C and E were administered intraperitoneally to 48 male Sprague Dawley rats once per day for 3 days before hindpaw ischemia-reperfusion (I/R) injury was induced. On the third day, the CPIP rat model was produced by inducing ischemia in the left hindpaw by applying an O-ring for 3 h, followed by reperfusion. Three days after reperfusion, hindpaw mechanical allodynia was assessed by measuring the withdrawal response to von Frey filament stimulation. The rats were sacrificed immediately after behavioral testing to determine the phosphorylated NMDA receptor subunit 1 (pNR1) and extracellular-signal-regulated kinases (pERK) levels in the spinal cord. RESULTS: When the antioxidant vitamins C and E were administered intraperitoneally to CPIP rats, I/R injury-induced mechanical allodynia was attenuated, and pNR1 and pERK levels were decreased in the rat spinal cord. Additionally, the co-administration of both vitamins had an increased antiallodynic effect. CONCLUSIONS: The reduced phosphorylated NR1 and ERK levels indicate that vitamins C and E inhibit the modulation of spinal cord neuropathic pain processing. Co-administration of vitamins C and E had a greater antiallodynic effect.
Subject(s)
Animals , Humans , Male , Rats , Antioxidants , Ascorbic Acid , Central Nervous System Sensitization , Complex Regional Pain Syndromes , Hyperalgesia , Inositol Phosphates , Ischemia , Mitogen-Activated Protein Kinases , Models, Animal , N-Methylaspartate , Neuralgia , Phosphotransferases , Prostaglandins E , Rats, Sprague-Dawley , Reactive Oxygen Species , Receptors, N-Methyl-D-Aspartate , Reperfusion , Reperfusion Injury , Spinal Cord , Vitamin E , VitaminsABSTRACT
A 56-year-old woman complained of radiating pain to the left arm. She was diagnosed with left-sided foraminal stenosis at the C5-6 level. The neurosurgeon requested a left C6 cervical selective transforaminal epidural block (CSTE). Cervical MRI showed a left-sided large tortuous vertebral artery (VA) at the C5-6 level. Before performing CSTE, a CT angiogram was carried out and showed bilateral tortuous VAs. To minimize adverse events, CSTE was performed with non-particulated steroids and under CT guidance. Following the procedure, the patient's symptoms were relieved completely. Although complication rates of CSTE are generally low, if it occurs, disastrous situation could be. Additionally, if the patient has anatomical variations, the possibility of a complication occurring is greatly increased. It is therefore important to determine whether the patient has any anatomical variations of the VA before performing procedures such as CSTE, and to ensure that needle placement is correct during the procedure and an appropriate drug, such as a non-particulated steroid, is selected.
Subject(s)
Female , Humans , Middle Aged , Arm , Constriction, Pathologic , Magnetic Resonance Imaging , Needles , Steroids , Vertebral ArteryABSTRACT
No abstract available.
ABSTRACT
No abstract available.