Unilateral Internuclear Ophthalmoplegia Following Minor Head Injury / 대한신경손상학회지

A lesion in the medial longitudinal fasciculus (MLF) causes internuclear ophthalmoplegia (INO). Many intracranial lesions, such as multiple sclerosis or vascular disorders may be associated with INO; however, INO is a rare complication of minor head injury. The mechanism underlying injury to the MLF may be shear force on the brain stem during head trauma. The shear force can tear or stretch the fibers of the MLF and can also lead to compromise or rupture of the perforating branches of the basilar artery. We present an unusual case of unilateral INO after minor head injury in a patient with a small site of hemorrhage in the midline of the pontomesencephalic junction, confirmed by brain magnetic resonance imaging using susceptibility-weighted imaging.

Studies on Pre-Modern Medical History in Korea, 2010-2019: Increased Study Areas and Diversified Approaches / 의사학

The goal of this article is to summarize the current status of medical history research conducted from 2010 to 2019, following Shin Dongwon's research covering 2000-2010 regarding the current status of Korean pre-modern medical history. The list of references is organized according to several principles. The representative subjects of the Korean Society for the History of Medicine and the Korean Society of Medical history are Korean Journal of Medical History and The Journal of Korean Medical History, and Yonsei Journal of Medical History of the Yonsei University Medical History Institute. Subsequently, “Reviews and Prospects” of the History Journal and “Korean History Research Report” of the National History Compilation Committee are also summarized, and “Medical History Company Research,” which was recently published by the Medical History Research Society, is also included.Unlike previous periods, many studies have been conducted on the topic, and the characteristics of the system are largely classified. Most notably, the medical data related to carriers that were concentrated in the early 2010s. It is also worth noting that the research on the agenda, including Lee Soo-gi's newly discovered agenda, is also increasing. In addition, studies that combine the history of medicine with women's history and intellectual history as interdisciplinary studies have been increasing. As such, this is an opportunity for future medical history research to expand the horizon.

The effects of adjuvant intrathecal fentanyl on postoperative pain and rebound pain for anorectal surgery under saddle anesthesia / 대한마취과학회지

BACKGROUND: Intrathecal opioid has been known to enhance the quality and prolong the duration of spinal anesthesia, as well as to reduce postoperative pain. The purpose of this study was to evaluate postoperative analgesic characteristics of intrathecal fentanyl for the first 48 hours after anorectal surgery under saddle anesthesia. METHODS: Eighty patients were recruited in our study. Forty patients were randomly allocated to group B that received 0.5% bupivacaine 5 mg with 0.3 ml normal saline. The other 40 patients were assigned to group BF which was given 0.5% bupivacaine 5 mg with fentanyl 15 μg. The primary outcome variable was a numeric rating scale (NRS) at six hours postoperatively. Secondary outcomes included changes in the NRS score between one and 48 hours postoperatively, consumption of rescue analgesics, and the frequency of rebound pain. RESULTS: Group BF exhibited a lower mean NRS score at postoperative six hours compared to group B (P < 0.001). However, the mean NRS score was not different after postoperative six hours between the two groups. The median consumption of rescue analgesics in group BF was less than that of group B (P = 0.028) and the frequency of rebound pain decreased in group BF when compared to group B (P = 0.021). The levels of sensory block were S1 dermatome and motor block scores were 0 for both groups. There was no significant difference in adverse effects between the groups. CONCLUSIONS: Intrathecal fentanyl 15 μg for anorectal surgery under saddle anesthesia led to an improved pain score for the first six hours after surgery and decreased postoperative analgesic use. Rebound pain diminished with intrathecal fentanyl and adverse effects did not increase.

From Woohwang Cheongsimwon (牛黃淸心元) to Ginseng (人蔘): The History of Medicine Use in the Joseon Era / 의사학

In Korean traditional medicine, though herbal decoction, acupuncture, and moxibustion are all used to treat diseases, restorative medicines are the most widely preferred treatment method. This paper explores the historical background of restorative herbal medicines and ginseng among the Korean public and Korean traditional medicine practice. It also seeks to clarify how social and cultural perspectives on drug use have changed since restorative medicine became mainstream during the Joseon era. Drug use tendencies were affected by the medical system of the Joseon Dynasty, patients' desires for reliable treatment, and perceptions of the human body and the causes of disease. In the late Joseon Dynasty, medicine, an industry originally monopolized by the government, began to be manufactured and traded on the free market, and medical personnel began to participate in medical activities on a large scale. As the healthpreserving theory became more popular and medical personnel became more accessible, medicinal preferences also changed. Specifically, whereas preference was first given to common medicines, such as Cheongsimwon, which are effective for various symptoms, restorative medicines, such as ginseng, gradually became more popular. These restorative medicines were faithful to the basic tenet of East Asian traditional medicine: to avoid disease by making the body healthy before the onset of illness. Patients' desires for safe treatment and growing competition among commercial doctors who wanted stable profits further increased the popularity of milder medicines. Ultimately, as ginseng cultivation was realized, its use expanded even further in a wave of commercialization.

Cerebrospinal fluid infection after lumbar nerve root steroid injection: a case report / 대한마취과학회지

A 45-year-old woman was admitted due to severe headache and neck stiffness. She had visited a local clinic for back pain and received a lumbar nerve root steroid injection 10 days before admission. Computed tomography and magnetic resonance imaging showed psoas abscess, pneumocephalus, and subdural hygroma. She was diagnosed with psoas abscess and meningitis. The abscess and external ventricle were drained, and antibiotics were administered. Unfortunately, the patient died on hospital day 19 due to diffuse leptomeningitis. Lumbar nerve root steroid injections are commonly used to control back pain. Vigilance to "red flag signs" and a rapid diagnosis can prevent lethal outcomes produced by rare and unexpected complications related to infection. Here, we report a case of fatal meningitis after infection of the cerebrospinal fluid following a lumbar nerve root steroid injection.

Living-donor Sequential ABO-incompatible Kidney Transplantation after Liver Transplantation in a Patient with Alcoholic Liver Cirrhosis and End-stage Renal Disease / 대한이식학회지

A 47-year-old man developed chronic alcoholic liver cirrhosis and end-stage renal disease. He underwent blood-type-compatible liver transplantation with a graft from his daughter. After 8 months, sequential ABO-incompatible (ABOi) kidney transplantation was performed, with his brother as the donor (A to O). The patient had anti-A antibody titers (1:256). We performed pretransplant desensitization, including administration of rituximab, mycophenolate mofetil, tacrolimus, and prednisolone 2 weeks before the scheduled transplantation, and plasmaphresis (PP) and administered an intravenous immunoglobulin injection. The patient underwent PP before kidney transplantation until the anti-A antibody titer was <1:8. The patient achieved normal renal function within 4 posttransplantation days. Postoperative bleeding (diffuse hemorrhage) requiring additional blood transfusions and radiological intervention (drainage procedure) occurred 9 days after transplantation. The patient was discharged on day 20 of hospitalization. Nine months after the kidney transplantation, the recipient's and donor's liver and kidney functions were normal. ABOi renal transplantation after liver transplantation can be successfully performed in patients with high baseline anti-ABO antibody titers after preconditioning with rituximab and PP, and quadruple immunosuppressive therapy. However, caution is required regarding an increased risk of bleeding complications.

Difficult intubation using intubating laryngeal mask airway in conjunction with a fiber optic bronchoscope

When anesthesiologists encounter conditions in which intubation is not possible using a conventional direct laryngoscope, they can consider using other available techniques and devices such as fiber optic bronchoscope (FOB)-guided intubation, a laryngeal mask airway (LMA), intubating LMA (ILMA), a light wand, and the Combitube. FOB-guided intubation is frequently utilized in predicted difficult airway cases and is generally performed when the patient is awake to enable easier access to the trachea. An LMA can be introduced to ventilate the patient with relative ease, while an ILMA can be used for definite endotracheal intubation. However, occasionally, an endotracheal tube (ETT) cannot pass through the larynx, despite successful introduction of a FOB into the trachea and placement of an ILMA by the anesthesiologist. Therefore, we initially introduced an ILMA for emergent ventilation, followed by successful insertion of an ETT under FOB guidance. In this report, we describe three cases of difficult intubation using a FOB and ILMA combination approach.

Difficult intubation using intubating laryngeal mask airway in conjunction with a fiber optic bronchoscope

When anesthesiologists encounter conditions in which intubation is not possible using a conventional direct laryngoscope, they can consider using other available techniques and devices such as fiber optic bronchoscope (FOB)-guided intubation, a laryngeal mask airway (LMA), intubating LMA (ILMA), a light wand, and the Combitube. FOB-guided intubation is frequently utilized in predicted difficult airway cases and is generally performed when the patient is awake to enable easier access to the trachea. An LMA can be introduced to ventilate the patient with relative ease, while an ILMA can be used for definite endotracheal intubation. However, occasionally, an endotracheal tube (ETT) cannot pass through the larynx, despite successful introduction of a FOB into the trachea and placement of an ILMA by the anesthesiologist. Therefore, we initially introduced an ILMA for emergent ventilation, followed by successful insertion of an ETT under FOB guidance. In this report, we describe three cases of difficult intubation using a FOB and ILMA combination approach.

Effect of YJ-7 (a calcium channel blocker) on blood pressure regulation in spontaneous hypertensive rat model

BACKGROUND: Farnesylacetone compounds that dilate blood vessels by blocking calcium channels in sargassum siliquastrum have been reported. And this study was done to demonstrate the effect of YJ-7, a synthetic material derived from these compounds, on vessel dilation and blood pressure control. METHODS: We used vasoconstricted basilar and carotid artery of rabbits. Changes in blood pressure were measured in vivo at 15, 30, 45, and 60 minutes after intravenous injection of YJ-7 3 microM, EC50 value from in vitro experiment, and nimodipine 10 microM through the tail vein of 20 rats. Spontaneous hypertensive rat (SHR) has its blood pressure higher than 190 mmHg. Measurements of blood pressure were done 6 times and the mean values were used for data analysis. RESULTS: Systolic and diastolic blood pressure before the injection of YJ-7 were 194.2 +/- 6.1 mmHg and 140.2 +/- 6.4 mmHg. Blood pressure were decreased with time, 157.2 +/- 2.6 / 120.8 +/- 4.2 mmHg at 15 minutes, 161.8 +/- 18.3 / 123.2 +/- 13.9 mmHg at 30 minutes, and 156.0 +/- 4.1 / 112.4 +/- 1.7 mmHg at 45 minutes. The blood pressure lowering effect lasted until 45 minutes. However, the blood pressure increased to 182.2 +/- 16.4 / 149.0 +/- 20.4 mmHg at 60 minutes reaching similar levels of before the injection (P < 0.05). CONCLUSIONS: We could see YJ-7 has vasorelaxation effect and would be helpful to control blood pressure with short recovery period than nimodipine.

The reaction of a patient with suspicious retroverted epiglottis to an anesthetic / 대한마취과학회지

No abstract available.

Development of Anatomy in the Edo Period: On the Publication of the Zoshi / 의사학

Chinese medicine that saw rapid development since the writing of Yellow Emperor's Canon of Internal Medicine (Hunagti Neiching) greatly influenced Korea and then Japan, firmly establishing its dominant position in the East Asian world. However, as sciences of the west were gradually imparted to East Asia, medical topography was changing little by little as well. It was Japan that actively accommodated Western medicine. During Edo Japan, many interpretation officers played an active part for exchanges with influential merchants from the Netherlands and the resultant compilation of Kaitai Shinsho in 1774 made anatomy of the West introduced to the nation in earnest. Thereafter, starting with anatomy, westernization of Japanese medicine rapidly unfolded in the nation. Accommodation of Western anatomy was enabled by the development of empirical medicine and resulting practice of dissection. Two decades before the compilation of Kaitai Shinsho, the first dissection was made in Japan and five years later, Zoshi was published by Yamawaki Toyo, triggering great controversy over dissection in the nation's medical world. It was very meaningful in that it raised a question about positivity of traditional medicine, namely, the Theory of Visceras and Bowels, and made a verification of it. Dissection of the human body that started with Yamawaki Toyo's book was faced with criticisms from Sano Yassada and through his publication of Hi Zoshi and others on one hand but it led to practice of dissection itself on the other hand. Sixteen years later a second dissection was performed by Kawaguchi Shinnin and Kaishihen was complied by him. Thereafter, western medicine was rapidly accommodated by the nation through successive dissections, publications of anatomy books, and translations of western anatomy books, and through the Meiji Restoration the medical world was reorganized into one centered on western medicine. Modern anatomy of the West was widely introduced to East Asia and at the same time Japan led a cultural attitude to massively accept Western sciences through translations. Such academic climate, which was literally called Dutch learning(Ran Gaku), made Japan reflect itself from Western perspectives and transformed East Asia's medieval world view, knowledge system, and medical thoughts.

Bilateral vocal cord palsy after removal of falx meningioma in the hyperflexion of the neck: A case report

We experienced a case of bilateral vocal cord palsy following general anesthesia for craniotomy. The patient was a 43-year-old woman undergoing tumor resection for falx meningioma on frontal lobe. She had no laryngeal symptoms prior to operation. Spontaneous ventilation resumed after reversal of neuromuscular blockade. Following extubation, she showed signs of airway obstruction and dyspnea. Reintubation was done and symptoms improved. Three days after operation, we confirmed bilateral vocal cord palsy by fiberoptic laryngoscopy. We suggested that possible causes of bilateral vocal cord paralysis were hyperflexion of neck and long operating time.

Use of premolded armored tube for a patient with tracheal stenosis: A case report

It is essential to predict possibility of difficulties beforehand in ventilating or intubating the patient for the safe airway management and anesthetic maintenance. Even if there is no internal invasion, external compression of an enlarged neck mass can cause tracheal stenosis. The patient with nontoxic goitor had symptoms of dysphagia, exertional dyspnea and wheezing. There was difficulty in endotracheal passage of small bronchoscope through the compressed portion of the trachea during preoperative bronchoscopic examination. We premolded an armored endotracheal tube to fit the patient's trachea based on chest radiography, computed tomography and brochoscopic findings. Endotracheal intubation and thyroidectomy was successful and the patient discharged without any complication. We report a new method of intubation in patient with nontoxic goiter that obstructs the trachea by compression.

An anesthetic experience with cesarean section in a patient with vasovagal syncope: A case report / 대한마취과학회지

Epidural anesthesia was performed for a cesarean section in a patient with vasovagal syncope. A 26-year-old woman at 41 weeks of gestation and with a known history of vasovagal syncope was scheduled to undergo an emergency cesarean section. She received epidural anesthesia for the cesarean delivery and showed signs and symptoms of vasovagal syncope, which were treated successfully with fluids and the administration of a vasoconstrictor. This case highlights the need for anesthesiologists to understand vasovagal syncope precisely because severe hypotension in a patient under anesthesia for a cesarean section is dangerous to both the mother and baby.

The effect of pneumoperitoneum and Trendelenburg position on respiratory mechanics during pelviscopic surgery / 대한마취과학회지

BACKGROUND: Conventional pelviscopic surgery requires pneumoperitoneum with CO2 gas insufflation and lithotomy-Trendelenburg position. Pneumoperitoneum and Trendelenburg position may influence intraoperative respiratory mechanics in anesthetic management. This study was conducted to investigate the influence of pneumoperitoneum and Trendelenburg position on respiratory compliance and ventilation pressure. METHODS: Twenty-five patients scheduled for elective gynecologic laparoscopy were evaluated. The patients had no preexisting lung or heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, lidocaine, rocuronium, and sevoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO2 were measured before and after creation of pneumoperitoneum with an intraabdominal pressure of 12 mmHg, then after 10 minutes and 30 minutes in the 20degrees Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was then calculated. RESULTS: Following creation of pneumoperitoneum, there was a significant increase in peak inspiratory pressure (6 cmH2O), plateau pressure (7 cmH2O), and end-tidal CO2 (5 mmHg), while dynamic lung compliance decreased by 12 ml/cmH2O. Overall, the Trendelenburg position induced no significant hemodynamic or pulmonary changes. CONCLUSIONS: The effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters.

Combined epidural anesthesia and ultrasound guided peripheral nerve block for wound revision in a patient with peripartum cardiomyopathy: A case report / 대한마취과학회지

Peripartum cardiomyopathy (PPCM) is a rare complication that occurs between the late stage of pregnancy and six months after delivery. PPCM presents as symptoms of left ventricular dysfunction and it can be fatal unless treated promptly. Furthermore, anesthesia and surgery in such patients is a large challenge to anesthesiologists. First and foremost, the maintenance of stable hemodynamics is a major concern. We report a case of combined lumbar epidural anesthesia and both ilioinguinal and iliohypogastric nerve block under ultrasound guided for a wound revision in a 37-year-old woman diagnosed with PPCM after an emergency cesarean section.

Respiratory insufficiency in a patient with preeclamsia and hypothyroidism developed after general anesthesia for emergency cesarean section: A case report / 대한마취과학회지

Anesthesia and surgery in a patients with undiagnosed or untreated hypothyroidism can carries the risk of potential complications such as prolonged unconsciousness, respiratory insufficiency, hypotension, hyponatremia, congestive heart failure, and even coma. A 33-year-old gravida was admitted at 36 weeks gestation with hypertension, proteinuria, generalized edema, and intrauterine fetal growth retardation. She had thyroidectomy for thyroid mass six years ago. Because of doubt of uterine abruption, emergency cesarean section was performed without result of thyroid function test. Preeclamsia and mild hypothyroidism show similar symptoms and it can make difficult to diagnose hypothyroidism. We experienced delayed recovery and respiratory insufficiency in a patient with preeclamsia and undetected hypothyroidism during emergence from general anesthesia. She was fully recovered after ventilatory care in intensive care unit.

Re-evaluation of the Medical Practice and the Medicine in the Later Half of the Chosun Dynasty / 의사학

The state-running medical institutions which had been instituted in the earlier period of the Chosun dynasty substantially downsized during the reconstructing process after the major wars with Japan and Qing dynasty. The downsizing was mainly due to the malfunctioning public financial system; but it was also due to the growth of the private medical market. The growth of the private medical market reoriented the focus of the public health system of the Chosun dynasty from providing treatment for every minor disease to providing the more efficient policy against epidemic. Hwal-in Seo (a temporary local public health center established for epidemic) became a new core of the dynasty's health policy under the phrase of "Ae Rye (saving the rituals)." As the changes of the dynasty's public health policy, the growing private medical market had been admitted into the public domain. Chosun government once had declared Sa Yak Gye (a private mutual-aid group for medicine) illegal and prohibited the private groups to be organized. Instead, with the policy change mentioned above, the government tried to support the private mutual-aid group for medicine while forbidding sales of fake medicine, restraining rise of price of medicine. Especially the Do go merchants often caused the sudden rise of price of medicine by bulk purchasing. Medical practice was reassessed as the period when it was considered as one of the lowest professions had been over. Although the Yangban class still refused to be a professional medical practitioner themselves, they also well understood the value of medicine as a field of study to save human and dismissed negative perception on medicine. Medicine as a field of study and medical practice, which had been underestimated under the ruling system influenced by the Song Confucianism and the status system of the Chosun dynasty, faced a new era. The whole society guaranteed more free practices of the medical practitioners and they were recognized for their works. With the change of social environment, the government officials gradually realized needs to discuss how they could educate and recruit medical practitioners to provide advanced medical treatment and what provisions they had to legislate to ensure the stable supply of the medicine. It is certain that the transformation developed in the medical environment and the changes of the public health policy up to 18th century Chosun dynasty accompanied the emergence of the commercial society. However, the overall social urge was still not enough to induce the actual law-making process. The change of the public health policy and the growth of the private medical market were surely the evidence of the transforming Chosun society; at the same time, they also revealed the immaturity of the medical environment which was not able to lead new health policies.

Cardiopulmonary arrest due to sick sinus syndrome: A case report / 대한마취과학회지

Sick sinus syndrome (SSS) is an abnormality of sinus nodal impulse formation by intrinsic or extrinsic causes. Patients with SSS often are asymptomatic, or have mild or nonspecific symptoms, including dizziness, palpitations, fatigue, and confusion related to the decreased cardiac output. SSS can rarely cause conditions like syncope, congestive heart failure, thromboembolism, pulmonary edema, cardiac arrest, or sudden death. We report here on a severe bradycardia during general anesthesia for aneurysmal clipping and tachycardia-bradycardia syndrome followed by cardiac arrest postoperatively in the ICU, which was subsequently diagnosed as SSS with 24-hour Holter monitoring.

Anesthetic experience in a patient with Gorham's disease : A case report

Gorham's disease is a very rare non-familial disorder of uncertain etiology characterized by uncontrolled non-neoplastic proliferation of vascular or lymphatic channels within bone, leading to resorption and replacement of osseous matrix with angiomatous tissue. Spinal cord compression due to cervical spine osteolysis can lead to respiratory problems due to chylous pleural effusion or cardiac dysfunction due to chylous pericardial effusion, which can be life threatening and cause high morbidity and mortality. We present a 32-year-old female patient complicated by chylothorax who underwent general anesthesia for a bone biopsy.