Pneumocephalus following fluoroscopy-guided lumbar epidural injection in elderly patients: two cases report and a review of Korean literatures - Two cases report -

Background@#Pneumocephalus can originate from accidental dural puncture while performing epidural block using the loss-of-resistance (LOR) technique with an air-filled syringe. Case: We present two cases of pneumocephalus after lumbar epidural block under fluoroscopy for pain control in elderly patients. @*Conclusions@#Lumbar epidural block should be performed under fluoroscopic guidance in elderly patients with severe lesions. The physician should be aware of the increased possibility of a dural puncture occurring due to anatomical changes in older patients. The use of saline is recommended for the LOR technique. A contrast injection should be used together with the LOR technique to locate the epidural space. If a dural puncture occur, the patient should be carefully monitored to determine whether pneumocephalus has developed.

Systemic hemodynamic effects of norepinephrine versus phenylephrine in intermittent bolus doses during spinal anesthesia for cesarean delivery

Background@#Norepinephrine, a potent α-adrenergic agonist with β-adrenergic effects, has recently emerged as a potential alternative to phenylephrine that does not lower cardiac output (CO) and heart rate (HR) during cesarean deliveries. We examined the systemic hemodynamic effects of both agents in this setting, using intermittent bolus doses to treat spinal anesthesia-induced hypotension. @*Methods@#A total of 56 parturients consenting to spinal anesthesia for elective cesarean delivery were randomly assigned to phenylephrine (100 μg/ml) or norepinephrine (5 μg/ ml) intermittent bolus dosing. The primary study outcome was maternal normalized CO, examining and other hemodynamic variables, maternal side effects, and fetal outcomes secondarily. @*Results@#In terms of systolic blood pressure and HR, there were significant within-group differences over time (P < 0.001 and P < 0.001, respectively). Normalized CO and stroke volume (SV) also showed significant differences between groups (P < 0.001 and P = 0.002, respectively). In the phenylephrine group, normalized CO and SV declined (relative to baseline values) by as much as 13% and 9%, respectively; whereas in the norepinephrine group, normalized CO did not differ significantly from baseline, and SV increased up to 5% (relative to baseline). Normalized total peripheral resistance likewise displayed significant within-group differences over time (P < 0.001). @*Conclusions@#During elective cesarean delivery, intermittent bolus doses of norepinephrine proved effective for treating spinal anesthesia-induced hypotension, while maintaining CO and SV. No maternal complications or fetal effects were evident.

Comparison of the immediate hemodynamic changes induced by unilateral and bilateral spinal anesthesia in hypertensive elderly patients

BACKGROUND: The objective of this study was to compare the frequency of hypotension and immediate hemodynamic changes induced by unilateral and bilateral spinal anesthesia in hypertensive elderly patients. METHODS: Forty hypertensive elderly patients undergoing lower leg surgery were randomly allocated into unilateral (group US) and bilateral spinal anesthesia (group BS). After intrathecal bupivacaine injection, patients in group US were kept in the lateral position for 10 min while patients in group BS were immediately placed in the supine position. Hemodynamic parameters were measured for 20 min by non-invasive cardiac output monitor based on bioreactance. RESULTS: In both groups, mean arterial pressure was significantly decreased after spinal anesthesia compared to the baseline value. However, frequency of hypotension requiring vasoactive drug was significantly lower in group US (5%) than in group BS (35%) (P = 0.044). The dermatom of sensory block on the operated limb was significantly lower in group US [T10 (10–10)] than in group BS [T8 (7.5–10)] (P = 0.013). In comparison within the group, changes of cardiac index were similar as the baseline value in both groups, although total peripheral resistance index was constant in group US but significantly decreased in group BS. CONCLUSIONS: Unilateral spinal anesthesia effectively reduced the frequency of hypotension requiring vasoactive drug and affected hemodynamic performance less than bilateral spinal anesthesia.

Discussion: An alternative treatment option for a bony defect from large odontoma using recycled demineralization at chairside

No abstract available.

Discussion: Effects of fresh mineralized dentin and cementum on socket healing: a preliminary study in dogs

No abstract available.

Autogenous tooth bone graft block for sinus augmentation with simultaneous implant installation: a technical note

In cases of severe alveolar bone atrophy in the posterior maxillary area, which has only a thin sinus floor, the autogenous tooth bone graft block (ABTB) was used to wrap the implant to enhance its primary stability and osseointegration in the sinus. These cases with four years of clinical follow-up demonstrate the applicability of the ABTB in maxillary sinus membrane elevation to improve the outcomes of implant placement.

Fluid extravasation caused by bladder perforation during bipolar transurethral resection using saline solution: a case report / 대한마취과학회지

Transurethral resection of the prostate is the gold standard in the operative management of benign prostatic hyperplasia. Bipolar transurethral resection of the prostate using saline solution is a safe technique and reduces the risk of transurethral resection syndrome. This report discusses a rare complication of bipolar transurethral resection of the prostate: the extravasation of 0.9% saline solution into intraperitoneal and retroperitoneal cavities due to bladder perforation, resulting in respiratory difficulties.

Endometriosis and ovarian cyst misconceived as a failed back surgery syndrome: A case report

A 26-year old woman visited our pain clinic with sudden severe low back pain. She was treated for back pain by laminectomy and discectomy 8 years ago. Despite managements by analgesics and nerve block series, her symptoms were improved only shortly every time. She referred to a gynecologist due to vaginal bleeding, and endometriosis and ovarian cyst was found. Her symptoms were relieved by laparoscopic oophorectomy. Endometriosis and ovarian cyst are common gynecological diseases associated with low back pain. The incidence and prevalence of endometriosis are also highest in the same age range as that of people with nonspecific low back pain. We present a case of endometriosis and ovarian cyst manifested as nonspecific low back pain in the patient with a history of back surgery.

A case of back pain caused by Salmonella spondylitis: A case report / 대한마취과학회지

Salmonella spondylitis is a rare illness, and it generally occurs in patients who have already had sickle cell anemia, and it is even rarer in patients who are without sickle cell anemia. A 61-year-old male patient was hospitalized for the evaluation of his renal function and then treatment was started for his back pain. His back pain had developed about 2 months previously without any specific trauma. Only a bulging disc was detected on the initial lumbar MRI. Regarding his fever, it was diagnosed as possible atypical pneumonia, scrub typhus, etc., and multiple antibiotic therapy was administered. At the time of transfer, the leucocytes and hs-CRP were normal and the ESR was elevated. A diagnostic epidural block was performed for his back pain, but his symptoms were not improved. Lumbar MRI was performed again and it showed findings of infective spondylitis. Salmonella D was identified on the abscess culture and so he was diagnosed as suffering from Salmonella spondylitis. After antibiotic treatment, his back pain was improved and the patient was able to walk.

Surgical Correction of Fixed Kyphosis

STUDY DESIGN: A retrospective review was carried out on 23 patients with rigid fixed kyphosis who underwent surgical correction for their deformity. PURPOSE: To report the results of surgical correction of fixed kyphosis according to the surgical approaches or methods. OVERVIEW OF LITERATURE: Surgical correction of fixed kyphosis is more dangerous than the correction of any other spinal deformity because of the high incidence of paraplegia. METHODS: There were 12 cases of acute angular kyphosis (6 congenital, 6 healed tuberculosis) and 11 cases of round kyphosis (10 ankylosing spondylitis, 1 Scheuermann's kyphosis). Patients were excluded if their kyphosis was due to active tuberculosis, fractures, or degenerative lumbar changes. Operative procedures consisted of anterior, posterior and combined approaches with or without total vertebrectomy. Anterior procedure only was performed in 2 cases, while posterior procedure only was performed in 8 cases. Combined procedures were used in 13 cases, including 4 total vertebrectomies. RESULTS: The average kyphotic angle was 71.8degrees preoperatively, 31.0degrees postoperatively, and the average final angle was 39.2degrees. Thus, the correction rate was 57% and the correction loss rate was 12%. In acute angular kyphosis, correction rate of an anterior procedure only was 71%, correction rate of the combined procedures without total vertebrectomy was 49% and correction rate of the combined procedures with total vertebrectomy was 60%. In round kyphosis, correction rate of posterior procedure only was 65% and correction rate of combined procedures was 59%. The clinical results according to the Kirkaldy-Willis scale demonstrated 17 excellent outcomes, 5 good outcomes and one poor outcome. CONCLUSIONS: Our data indicates that the combined approach and especially the total vertebrectomy showed the safety and the greatest correction rate if acute angular kyphosis was greater than 60 degrees.

Cervical Myelopathy Secondary to Atlas Hypoplasia: Reports of 3 Adult Cases

There have been paucity of reports on atlas hypoplasia, and as a result this condition is not clearly defined, nor well understood. The authors reported three cases of atlas hypoplasia that were found in adults who presented with myelopathic symptoms. On radiographic examination, it was found that the anterior-posterior diameter of the atlas was remarkably narrower in all three cases in comparison with normal persons. The MRI in all three cases also revealed intramedullary high signal lesions at the levels where severe spinal cord compression was present. This led to our diagnosis of atlas hypoplasia causing myelopathy.

Dens Fracture-Nonunion in Ankylosing Spondylitis: A Case Report / 대한척추외과학회지

Patients with ankylosing spondylitis are susceptible to fractures, which usually occur in the cervical spine. However, upper spinal fractures, particularly dens fracture-nonunion complicating ankylosing spondylitis, are quite rare. We encountered one such case. The patient was treated with posterior fusion followed by a halovest, which resulted in good conditions.

Changes in Quality of Life after Adenotonsillectomy in Children with Sleep Disordered Breathing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep disordered breathing (SDB) comprises a spectrum of airway disorders that range from simple snoring to obstructive sleep apnea (OSA). In children, SDB can have an effect on the quality of life such as behavior, school performance, emotional distress and daytime function. We aim to verify changes in disease specific health related quality of life before and after adenotonsillectomy in children with SDB. SUBJECTS AND METHOD: Children aged 4 through 15 years old, a total of 50 (M:36, F:14) with symptoms of snoring, mouth breathing, sleep apnea and physical examination results demonstrating tonsil size of 3+ or greater, were included. To evaluate the quality of life in children, two standard questionnaires KOSA-18 (Korean Obstructive Sleep Apnea-18 Survey) and KOSA-6 (Korean Obstructive Sleep Apnea-6 Survey) were given to the parents of children to complete, preoperatively and postoperatively. RESULTS: There was significant improvement after adenotonsillectomy in the total score of KOSA-18 and KOSA-6. In KOSA-18 and KOSA-6, all domain scores showed improvement after surgery. CONCLUSION: Children with SDB who undergo adenotonsillectomy show significant improvement in the quality of life. Therefore, we suggest that surgical intervention could be recommended to improve the quality of life in children with adenotonsillar hypertrophy.

A Diffuse Idiopathic Skeletal Hyperostosis Patient Associated with Ossification of Thoracic Ligamentum Flavum: A Case Report / 대한정형외과학회잡지

Diffuse idiopathic skeletal hyperostosis (DISH), which is also known as Forestier's disease, is an idiopathic rheumatological abnormality in which extensive ossification occurs along the ligaments throughout the body, most notably in the anterior longitudinal ligament of the spine, and frequently in the posterior longitudinal ligament or ligamentum flavum. Ossification of the ligamentum flavum (OLF) causes narrowing of the spinal canal and cord compression. Radiculopathy, myelopathy or combined neurological alterations can be elicited as a result of ossification. We performed a long-term follow-up of a case progressive myelopathy caused by nodular ossification of the ligamentum flavum in a patient with DISH, who was treated with a posterior decompressive laminectomy and the removal of the ossified ligamentum flavum.

Mono-segment Cervical Spondylotic Myelopathy / 대한척추외과학회지

STUDY DESIGN: A retrospective follow-up study comparing soft disc cervical myelopathy (Group A) and spondylotic bar cervical myelopathy (Group B). OBJECTIVES: To analyze different factors by comparing preoperative radiological and clinical data of Group A with that of Group B. SUMMARY AND LITERATURE REVIEW: The different causes of cervcal myelopathy resulted in different symptoms and prognoses. MATERIALS AND METHOD: A clinical and radiological analysis of the data in 31 patients who underwent an anterior cervical decompression and fusion was performed to assess the different factors between two groups. The patients were classified into two groups; 20 in Group A and 11 in Group B. Comparisons between the two groups were made in regard to the physical findings, radiological and clinical evaluation. RESULTS: The duration of myelopathy was 3 months in Group A and 8.7months in Group B. Of all cases, 5 cases (25.0%) in group A and 4 cases (36.4%) in group B had myelopathy associated with radiculopathy. Of the 20 cases in group A with myelopathy, 7 cases had a median compression and 13 cases had a paramedian compression on MRI. Of the 11 cases in group B with meylopathy, 9 cases had a median compression and 2 cases had a paramedian compression on MRI. The follow-up MRI of the 14 cases (73.7%) in group A and 2 cases (20.0%) in group B showed spontaneous regression of the T2 WI high signal intensity. CONCLUSION: In degenerative disc disease, the different causes of cervcal myelopathy result in different symptoms and prognoses. However, the treatment of choice in both groups is a one level anterior decompression and fusion.

Effects of 3-aminobenzamide (3-AB) on the alterations in primary afferent and spinal neurons induced by spinal nerve injury in rats / 대한정형외과연구학회지

PURPOSE: The authors studied the effect of the 3-AB, an inhibitor of poly(ADP-ribose)polymerase (PARP), on the changes of primary afferents and spinal cord after spinal nerve injury. METHOD: The L5 and L6 spinal nerve of the rats were cut, and 3-AB (10 mg/Kg) was injected intraperitoneally once per day. The animals were sacrificed 3 days, 7 days, 14 days and 28 days after nerve injury. Binding of isolectin B4 (IB4) and immunohistochemistry (IHC) of CGRP for the changes in primary afferents, IHC of NK1 for sensory neurons, and of cleaved caspase 3 and NeuN for the apoptotic changes in spinal neurons were performed. RESULT: Decreased binding of IB4 and immunoreactivity (IR) for CGRP, increase of IR for NK1, and cleaved caspase 3 in both neurons and glia in ipsilateral dorsal horn were observed after spinal nerve injury. These changes were attenuated, especially at between 3 days and 14 days, by administration of 3-AB. CONCLUSION: It is suggested that inhibition of PARP by 3-AB may attenuate alterations of primary afferents and spinal neurons, at least in early stage, after spinal nerve injury.

Effects of 3-aminobenzamide (3-AB) on the alterations in primary afferent and spinal neurons induced by spinal nerve injury in rats / 대한정형외과연구학회지

PURPOSE: The authors studied the effect of the 3-AB, an inhibitor of poly(ADP-ribose)polymerase (PARP), on the changes of primary afferents and spinal cord after spinal nerve injury. METHOD: The L5 and L6 spinal nerve of the rats were cut, and 3-AB (10 mg/Kg) was injected intraperitoneally once per day. The animals were sacrificed 3 days, 7 days, 14 days and 28 days after nerve injury. Binding of isolectin B4 (IB4) and immunohistochemistry (IHC) of CGRP for the changes in primary afferents, IHC of NK1 for sensory neurons, and of cleaved caspase 3 and NeuN for the apoptotic changes in spinal neurons were performed. RESULT: Decreased binding of IB4 and immunoreactivity (IR) for CGRP, increase of IR for NK1, and cleaved caspase 3 in both neurons and glia in ipsilateral dorsal horn were observed after spinal nerve injury. These changes were attenuated, especially at between 3 days and 14 days, by administration of 3-AB. CONCLUSION: It is suggested that inhibition of PARP by 3-AB may attenuate alterations of primary afferents and spinal neurons, at least in early stage, after spinal nerve injury.

Comparison of the Result of Vertebroplasty and Conservative Treatment in Osteoporotic Vertebral Compression Fracture

PURPOSE: To evaluate the results of vertebroplasty and conservative treatment in osteoporotic vertebral compression fractures. MATERIALS AND METHODS: Patients were divided randomly into 2 groups; Group I (conservative treatment) and Group II (vertebroplasty). There are 14 cases in group I and 16 cases in group II. Radiologically, the progression of compression was observed. Clinical evaluation was done using Denis pain scale. In both groups, prolonged pain with nonunion or avascular necrosis that resulted in surgical intervention was evaluated as complication. In group II, the complication associated the procedures were evaluated. RESULTS: Group II was superior to conservative treatment in terms of maintaining vertebral height radiologically. The characteristics of symptom improvement were the same in two groups. There were cement leakage among group II but they did not influence to the results. In group I, 2 subjects needed surgery due to prolonged pain. In group II, 1 subject needed surgery due to prolonged pain and there were 3 cement leakage cases which were insignificant. CONCLUSION: In vertebroplasty group, complications associated the procedures were noted. In conservative treatment group, more patients needed operation. Therefore, we should be very prudent when we choose the treatment of the osteoporotic vertebral compression fracture.

Thyroid Hemiagenesis: Case Report / 대한이비인후과학회지

Thyroid hemiagenesis is a very rare abnormality, where one thyroid lobe fails to develop. Most patients diagnosed with the disease have associated thyroidal diseases. We report a 32-year-old female who presented with the left thyroid mass that had gradually increased in size over two years. Thyroid scan revealed the absence of right lobe and isthmus and a hypoactive nodule in the lower pole of left lobe. Ultrasonography confirmed the right lobe and the isthmus agenesis. The operative findings confirmed hemiagenesis of the right lobe and nodular hyperplasia in the left lobe. The purpose of this report is to present a case of nodular hyperplasia, where agenesis of the contralateral lobe was also observed.

Effect of Posterior Lumbar Interbody Fusion for Maintaining the Reduction in Isthmic Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study on the effect of posterior lumbar interbody fusion for maintaining the reduction in isthmic spondylolisthesis patients. OBJECTIVES: We evaluated the efficacy of performing posterior lumbar interbody fusion for maintaining the reduction in isthmic spondylolisthesis. SUMMARY OF THE LITERATURE REVIEW: There have been many reports regarding the surgical treatment of spondylolisthesis. Although there are many reports that the clinical results have nothing to do with the reduction, many surgeons have tried to maintain the reduction. However, the question about what kind of fusion modality is the most effective for maintaining the reduction is still controversial. MATERIAL AND METHOD: Between August 2002 and January 2004, 24 patients with isthmic spondylolisthesis were operated on. 14 underwent posterolateral fusion alone (group A) and 10 underwent additional posterior interbody fusion (group B). These two groups were compared in terms of the clinical results, the radiological changes and fusion rates. RESULTS: the reduction rate were 11.81% and 7.32% in the PLF and PLF+PLIF groups, respectively (p>0.05). The reduction losses were 0.19% and 0.35% in the PLF and PLF+PLIF groups, respectively (p>0.05). The changes after fusion were 0.11% and 0.10% in the PLF and PLF+PLIF groups, respectively (p>0.05). There was no case of nonunion. The satisfaction rates were 86% and 83% in the PLF and PLF+PLIF groups, respectively (p>0.05). CONCLUSIONS: In our study, the addition of posterior interbody fusion showed no benefit in maintaining correction. If solid fusion can be obtained, then posterolateral fusion seems to be sufficient enough to maintain correction in isthmic spondylolisthesis. The authors think that further studies are mandatory because of the small number subjects in our study.