Clinical Utility of an Automated Pupillometer in Patients with Acute Brain Lesion

OBJECTIVE: The purpose of this study was to evaluate the clinical utility and validity of using a pupillometer to assess patients with acute brain lesions. METHODS: Pupillary examinations using an automated pupillometer (NeurOptics(R)NPi(TM)-100 Pupillometer) were performed every 4 hours and were simultaneously assessed using the Glasgow Coma Scale (GCS) and for intracranial pressure (ICP), from admission to discharge or expire in neuro-intensive care unit (NICU). Manual pupillary examinations were also recorded for comparison. By comparing these data, we evaluated the validity of using automated pupillometers to predict clinical outcomes. RESULTS: The mean values of the Neurologic Pupillary index (NPi) were different in the groups examined manually. The GCS correlated well with NPi values, especially in severe brain injury patients (GCS below 9). However, the NPi values were weakly correlated with intracranial pressure (ICP) when the ICP was lower than 30 cm H2O. The NPi value was not affected by age or intensity of illumination. In patients with a "poor" prognosis who had a Glasgow Outcome Scale (GOS) of 1 or 2, the mean initial NPi score was 0.88+/-1.68, whereas the value was 3.89+/-0.97 in patients with a "favorable" prognosis who had a GOS greater than 2 (p<0.001). For predicting clinical outcomes, the initial NPi value of 3.4 had the highest sensitivity and specificity. CONCLUSION: An automated pupillometer can serve as a simple and useful tool for the accurate measurement of pupillary reactivity in patients with acute brain lesions.

Historical Changes of Extruded Lumbar Intervertebral Disc : A case report

We studied the historical changes of intervertebral disc displacement using magnetic resonance imaging. The phenomenon of the spontaneous regression of herniated discs is well known. The case of a 40-years-old male presenting with a large disc herniation at L5-S1, experiencing severe sciatic pain, and having the straight leg raising test positive at 25 degrees is presented. The extruded disc was documented by clinical examination. He was treated conservatively with epidural steroid injection (ESI), medication, physical therapy and self-exercise and reevaluated in 10 weeks later, 30 and 1 year. Large extruded disc can be treated successfully by physical therapy with ESI. However, the degeneration and the dehydration of disc result in decrease of disc height. Consequently, the regression of extruded disc might have been due to the resorption and the dehydration.

Effects of Decompression Therapy for the Treatment of a Herniated Lumbar Disc / 대한통증학회지

BACKGROUND: Traction has often been utilized to treat patients with a herniated lumbar disc. Currently, the most advanced type of traction therapy is non-surgical spinal decompression. Therefore, this study was conducted to evaluate the effectiveness of decompression therapy in patients with a herniated lumbar disc based on clinical findings and symptoms. METHODS: Sixty patients with herniated lumbar discs were included in this study. The patients were randomly divided into two groups, a decompression group (n = 30) and a traction group (n = 30). To evaluate the impact of decompression and traction therapy on the herniated disc, the clinical symptoms for each group were evaluated prior to and after treatment using the visual analogue scale (VAS), straight leg raising (SLR), the herniation index, and the disc height. RESULTS: The VAS score was significantly lower in the decompression group (2.0 +/- 0.2) than the traction group (3.9 +/- 0.2) following treatment. In addition, the SLR angle was significantly higher in the decompression group (79 +/- 1.5) than the traction group (63.3 +/- 1.9). The herniation index was significantly lower in the decompression group (217.6 +/- 19.1) than the traction group (259.5 +/- 16.4). Finally, the disc height was not significant differences between pre-treatment and follow-up in two groups. CONCLUSIONS: The results of this study suggest that decompression therapy for the treatment of patients suffering from a herniated lumbar disc has an effect on the pain, SLR, and herniation indices, not disc heights.

Bronchospasm After Intravenous Esomolol Injection with Rapid Sequence Induction for Preeclamptic Patient: Case report / 대한마취과학회지

Esmolol is rapid ultrashort-acting, cardioselective beta1-adrenergic blocker and that is used for attenuation of acute hypertension associated with rapid sequence induction of general anesthesia. A 35-year-old severe preeclamptic patient was scheduled for elective cesarean section. After preoxygenation, anesthesia induced with using penthotal sodium 250 mg, esmolol 25 mg, and succinylcholine 62.5 mg for endotrachial intubation. We detected to increase airway resistance during manual ventilation. Breathing sound was auscultated wheezing and ronchi. And then cyanosis was developed and oxygen saturation was decreased to below 75%. After 20 min, patient's color was returned to pink and patient's self-respiratory function was good. Bronchospasm occured because that beta-adrencergic blockade with esmolol, by leaving the parasympathetic and alpha-adrencrgic influence relatively unopposed. We report bronchospasm after esmolol 25 mg was injeected for attenuation of acute hypertensive response for cesarean section of preeclamptic patient with rapid sequence induction of general anesthesia.

Bronchospasm After Intravenous Esomolol Injection with Rapid Sequence Induction for Preeclamptic Patient: Case report / 대한마취과학회지

Esmolol is rapid ultrashort-acting, cardioselective beta1-adrenergic blocker and that is used for attenuation of acute hypertension associated with rapid sequence induction of general anesthesia. A 35-year-old severe preeclamptic patient was scheduled for elective cesarean section. After preoxygenation, anesthesia induced with using penthotal sodium 250 mg, esmolol 25 mg, and succinylcholine 62.5 mg for endotrachial intubation. We detected to increase airway resistance during manual ventilation. Breathing sound was auscultated wheezing and ronchi. And then cyanosis was developed and oxygen saturation was decreased to below 75%. After 20 min, patient's color was returned to pink and patient's self-respiratory function was good. Bronchospasm occured because that beta-adrencergic blockade with esmolol, by leaving the parasympathetic and alpha-adrencrgic influence relatively unopposed. We report bronchospasm after esmolol 25 mg was injeected for attenuation of acute hypertensive response for cesarean section of preeclamptic patient with rapid sequence induction of general anesthesia.