Treatment Experience of Pulsed Radiofrequency Under Ultrasound Guided to the Trapezius Muscle at Myofascial Pain Syndrome: A Case Report

Trigger point injection treatment is an effective and widely applied treatment for myofascial pain syndrome. The trapezius muscle frequently causes myofascial pain in neck area. We herein report a case in which direct pulsed radiofrequency (RF) treatment was applied to the trapezius muscle. We observed that the RF treatment produced continuous pain relief when the effective duration of trigger point injection was temporary in myofascial pain.

Necrotizing Fasciitis of the Low Extremity: A Case Report / 대한정형외과학회잡지

Necrotizing fasciitis is a rare soft tissue infection with very high rate of mortality unless promptly recognized and agressively treated. Early recognition and prompt medical and surgical treatment are mandatory to acheive a successful outcome. We report upon a case of neco-tizing fasciitis, which developed in a 53-year-old female and was treated successfully with early antibiotic teatment, hyperbaric oxygen therapy and fasciotomy.

Epidemiologic and Clinical Survey of Behcet's Disease in Korea: the First Multicenter Study

The prevalence of Behcet's disease is the highest in the East Asian and the Medi-terranean countries. Behcet's disease is also distributed in the Asian countries, but the nationwide survey has not been performed in Korea yet. The Korean Study Group for Behcet's Disease, founded in 1999, conducted a multicenter, retrospective survey on epidemiologic and clinical features of the patients with Behcet's disease from 20 hospitals around the nation from 1997 to 1999. Of 3,497 patients, 1,527 were classified into complete or incomplete type of Behcet's disease according to the revised Shimizu's classification. The sex ratio was 1:1.75 with the female predominance. Geographical distribution showed the highest frequency in Seoul (38.5%). Clinically, 98.8% had oral ulcers, 83.2% had genital ulcers, 84.3% had skin lesions and 50.9% had ocular lesions. As for the minor clinical manifestations, articular symptoms were the most frequent. The pathergy test showed positive in 15.4% of patients and revealed a higher positive rate in males (20.2%) than in females (12.7%). In conclusion, we performed the first multicenter study on Behcet's disease in Korea and revealed the female predominance, higher frequency of ocular lesions, and lower positivity of pathergy test in the patients.

Gabapentin for the Management of Various Neuropathic Pain Syndromes / 대한마취과학회지

BACKGROUND: Anticonvulsant agents have been used and found to be effective for the treatment of neuropathic pain. Even though it is rare, they can have very serious side effects and therefore the search for more selective drugs with fewer side effects is justified. This study was conducted to evaluate the newly introduced anticonvulsants, gabapentin, for various neuropathic pain syndromes in the Korean population. METHODS: According to individual diagnostic group as diabetic neuropathy, postherpetic neuralgia, chronic back pain with radiating pain, there were 20 patients per group. Patients have been stabilized in their analgesic regimen at least four weeks prior to enrollment in the study. An anticonvulsant, if taken, was discontinued for four weeks for wash-out. Pretreatment baseline pain scores (visual analog scale and a pain intensity score) were obtained. Oral administration of gabapentin 300 mg was initiated in all groups and doses were given from 300 mg per day with gradual titration over two weeks 1) to the maximum of 2400 mg per day, 2) to the onset of intolerable side effects, and 3) to the onset of analgesic effect. At two weeks follow-up visit, visual analog scale, pain intensity scores, pain improvement scores judged by family, drug efficacy, tolerability and overall evaluation were assessed. The incidence of side effects, cell blood count and chemistry were also obtained. RESULTS: After two weeks of treatment, the visual analog scale and pain intensity scores improved in all study groups and no patients experienced aggravation. These findings were objectively reflected in pain improvement scores observed by family members. In drug efficacy, tolerability and overall evaluation, the majority of patients scored as good or excellent. There were no reports of serious side effects. Minor side effects were spontaneously subsided even with continuation. CONCLUSIONS: Gabapentin, a newer anticonvulsant, appears to be effective as an adjunctive analgesic for the management of various neuropathic pain syndromes with minimal side effects.

Negative Association between Schizophrenia and Rheumatoid Arthritis : Epidemiology and Prolactin and Estrogen as Protective Factors

The purposes of this study were to test the negative association between schizophrenia and rheumatoid arthritis(RA) and to clarify the role of prolactin and estrogen as protective factors in this association. The author compared the prevalence rate of RA between 561 patients with schizophrenia and 222 patients with mood disorder. For investigating the role of estrogen and prolactin, the author checked the plasma prolactin and estradiol level in 80 patients with paranoid schizophrenia and 77 patients with RA. The results were as follows. 1) Epidemiological data The prevalence rate of RA in the schizophrenic group was 0/561 and that of RA in the mood disorder group was 2/222. To compare these results between two groups, the author applied the Binomial test using the average prevalence rate of RA(0.8%) in the general population as a reference rate. The prevalence rate of RA in the schizophrenic group was significantly lower than that of RA in the general population. However, the prevalence rate of RA in the mood disorder group was not significantly different to that of RA in the general population. 2) Comparison of plasma prolactin and estradiol level between two groups. The plasma level of prolactin in the schizophrenic group was significantly higher than that of prolactin in th RA group(p=0.000). However, the plasma level of estradiol in the schizophrenic group was significantly lower than that of estradiol in the RA group(p=0.017). These results were not consistent across gender. To contrast with the results in the female group, which were consistent with the results in the total subjects, for the male group, the plasma levels of prolactin and estradiol in the schizophrenic group were significantly higher than those of prolactin and estradiol in th RA group. These results support the results of previous studies which confirm the negative association between schizophrenia and RA. These results also suggest that the elevation of plasma prolactin level in the patient with schizophrenia has a antirheumatic effect while the elevation of plasma estradiol level in the patients with RA has a anti-schizophrenic effect, and that these effects act as a possible mechanism in the negative association between two disorders. However, these results suggest that this association is specific to female patients.

Postoperative Analgesia with Meperidine in Cesarean Section Patients / 대한마취과학회지

BACKGROUND: Perioperative noxious stimuli and inflammation may induce peripheral and central sensitization. Together, these changes contribute to the state of postinjury pain hypersensitivity found postoperatively. Preemptive analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurones and may therefore, reduce postoperative pain. We studied whether or not intravenous meperidine infusion before induction could affect postoperative pain and analgesic consumption when compared with intravenous meperidine infusion at peritoneum closure. METHODS: Female patients scheduled for cesarean section were randomly assigned to one of two groups for prospective study. Group I (n=10) received intravenous meperidine (0.5 mg/kg) 5 minutes before induction of anesthesia and group II (n=10) received the same treatment at peritoneal closure. Both groups had a continuous infusion of meperidine (5 mg/hr) immediately after intravenous bolus meperidine. Postoperative pain relief was provided with intravenous meperidine from a PCA system (Walkmed , Medex, USA). Postoperative visual analogue pain scores (VAS), meperidine consumption and side effects were examined and compared between the groups for two postoperative days. RESULTS: At two hours post surgery VAS at rest were below 3 in both groups and were not statistically significant. VAS on motion were slightly higher than VAS at rest in both groups and were not statistically significant. There was no significant difference in meperidine consumption. There were minor side effects such as nausea, somnolence, dizziness and pruritus, but no patients needed any treatment and all of them were satisfied. CONCLUSION: Preemptive or postincisional intravenous PCA with meperidine was equally effective for postoperative analgesia after cesarean section, with minor side effects. These results suggested that there was no reason for applying preemptive analgesia for cesarean section patients. Further studies will be needed to evaluate preemptive effects of intravenous meperidine or other analgesics in cesarean section patients.

A Case of Chondrosarcoma of the Hyoid Bone / 대한이비인후과학회지

Chondrosarcoma is a rare malignant tumor arising in bony or cartilagenous system. Chondrosarcoma of the hyoid bone is extremely rare, with approximately 10 cases having been reported in the english literature. Chondrosarcoma is a slow-growing, locally aggressive tumor which frequently recurs. Wide surgical excision is generally regarded as the treatment of choice for chondrosarcoma. The prognosis is best judged by three factors:tumor site, tumor grade and tumor resectability. Authors experienced a case of chondrosarcoma that originated from the greater cornu of the hyoid bone. The patient underwent wide excision of the tumor with total hyoidectomy and postoperative radiotherapy was performed.

The Effects of Premedication on Postoperative Pain in Nasal Surgery / 대한이비인후과학회지

BACKGROUND: In spite of frequent nasal surgery, the importance of preoperative medication has not been examined carefully(CAREFULLY). OBJECTIVE: To identify the effect of premedication, we investigated the effect of premedication on postoperative pain in nasal surgery under local anesthesia. MATERIALS AND METHOD: We studied 120 cases, composed of 60 cases of unilateral sinus surgery and 60 cases of septoplasty. The patients were divided into four groups. We analysed 4 groups each consisted of 30 patients(N=120). The first group consisted of patients who received atropine preoperatively. The second group received atropine and ketolorac tromethamine. The third group received atopine and diazepam. The fourth group received atropine, ketorolac trimethamine and atropine. To evaluate the postoperative pain, we made the protocol listed according to Verbal Rating Pain Scores(VRP), Visual Analogue Pain Scores(VAS), -2, 4, 6, 12, 24 and 48 hours- and a global postoperative pain using the VAS. RESULTS: In septoplasty group, pain-relief effects showed postoperative pain of ketorolac tromethamine during postoperative 6-hours in the second & fourth groups. In sinus surgery group, Ketorolac tromethamine was effective on postoperative pain at postoperative 2-hour. CONCLUSION: We concluded that preoperative ketorolac tromethamine was effctive on septoplasty group than sinus surgery group.

Sonographic Findings in Gouty Nephropathy

PURPOSE: Ultrasound(US) findings of hyperechoic renal medulla in gouty nephropathy were compared with clinical features such as serum uric acid level to evaluate its usefulness in determination of the treatment and prognosis. MATERIALS AND METHODS: A retrospective review of US of 36 cases of gouty arthritis was classified into four groups according to the medullary echogenicity (O:normal, grade 1 :renal medulla as isoechoic as renal cortex, grade 2'heterogeneous increased echogenicity of renal medulla than that of renal cortex, grade 3 :the echogenicity of all renal medulla higher than that of renal cortex with renal contour deformity) which were compared with the serum urate level and associated conditions. Nephrocalcinosis and nephrolithiasis were analyzed through the KUB and the RGP. RESULTS: The degree of hyperechoic renal medulla was related to the level of serum uric acid, and in group IV, six cases of obstructive uropathy (nephrocalcinosis and nephrolithiasis) showed deformed renal contour. Associated conditions such as hypertension, alcoholism, diabetes mellitus and drug abuse were distributed in relation to the degree of hyperechoic renal medullas. CONCLUSION: US findings of hyperechoic renal medulla was related with uric acid level in gouty nephropathy and thus could be valuable for treatment decision and prediction of prognosis.