Severe Low Back Pain and Radiculopathy during Epiduroscopy / 대한마취과학회지

Epiduroscopy is a new method for managing chronic back pain. However there are potential complications such as hemorrhage, infection, neural damage, and increased pain due to increased epidural and intrathecal pressure. A 59-year-old male patient, suffering from lumbar radiculopathy after spine surgery was referred to the pain clinic. To ensure proper deposition of steroids and epidural lysis of adhesions, fibroptically directed epiduroscopy was planned. After positioning the epiduroscopy, 20 ml of normal saline was injected slowly. Immediately after injection, the patient complained of severe back pain and radiating pain to the lower extremities. When the pain was relieved, we restarted a saline injection. However, severe pain ocurred again and was sustained for more than an hour. There was no clinically significant findings on an emergency MRI. The symptoms improved slowly over a period of two hours.

Long-term Follow-Up Results of the Patients with Clinically Inapparent Pericardial Effusion

BACKGROUND: Pericardiocentesis is not routinely recommended in most patients with pericardial effusion (PE), except for patients with cardiac tamponade. However, the long-term follow-up results in patients with clinically not significant PE are few. METHODS: Sixty-five consecutive patients (mean age:57 yrs, 26 males) out of 87 patients with PE, who were clinically not serious, were studied prospectively once in every two month for mean 6 months (2-12 months) without any specific treatment. The amount of PE was measured at the enddiastole period of parasternal long axis view and apical four chamber view. RESULTS: The incidence of insignificant PE in our echocardiographic laboratory is 3.4% (n=87 from 2461). The maximal accumulation site of PE was posterior (n=51, 79%). The next is anterior (n=11, 17%) and right ventricular side (3, 5%). The amount of PE is less (0.37+/-0.17cm vs 0.64+/-0.54cm, p=0.018) in localized PE (n=24, 37%) than that of diffuse form (n=41, 63%), which spreads to more than 2 chambers. The presumptive etiologies of PE were unknown (n=41), heart failure (n=5), myocardial infarction (n=6), viral (n=3), and others (n=10). The amount of PE was decreased from 0.54+/-0.46 cm to 0.30+/-0.26 cm, 0.23+/-0.24 cm, and 0.21+/-0.23 cm 2, 4, and 6 months after intial evaluation, respectively, without any complication. CONCLUSION: The patients with PE, not combining >KERN=

Trial Stimulation of the Spinal Cord for Relief of Pain: A 6-year Experience / 대한마취과학회지

BACKGROUND: The results of 51 cases of trial spinal cord stimulation which had been carried out for relief of intractable pain were analyzed. METHODS: Most patients were referred due to failure of conventional pain treatment modalities. They consisted of 35 men and 16 women, ranging in age from 21 to 74 years. In 17 cases pain was associated with postherpetic neuralgia, 14 with failed back surgery syndrome, 3 with cauda equina syndrome, 3 with reflex sympathetic dystrophy, 3 with spinal cord injury, 2 with brachial plexus injury, 2 with torticollis, 2 with vertebral injury, 1 with phantom limb pain, 1 with myelitis, 1 with paraplegia, 1 with low back pain, and 1 with cancer metastasis to the vertebra. An electrode tip was positioned at varying sites from C1-2 to T11 dictated by the location of pain. T3, T6, and T8 were the most frequent sites. RESULTS: Pain due to postherpetic neuralgia, failed back surgery syndrome, cauda equina syndrome, reflex sympathetic dystrophy, and brachial plexus injury was well controlled. Noticeable complications included wound infection and electrode displacement. Following a trial period of stimulation, 10 patients had permanent stimulators implanted, while one patient died as a result of unrelated causes. CONCLUSIONS: We may suggest that spinal cord stimulation represents a useful technique in a well- selected group of patients with no other treatment options.

A Case of Complete Papillary Muscle Rupture after Blunt Chest Trauma Confirmed by Transesophageal Echocardiography

Acute mitral regurgitation associated with rupture of papillary muscle is a rare complication of blunt chest trauma. Echocardiographic information is very useful in the diagnosis of papillary muscle rupture, evaluation of left ventricular function and other abnoramlity of heart. The value of transthoracic echocardiography in blunt chest trauma is limited because patients with severe chest wall injury often have suboptimal echocardiographic fingings. But transesophageal echocardiography can provide high quality images when the transthoracic echocardiographic image quality is poor. We report 27 year-old female with papillary muscle rupture after blunt chest trauma in whom transthoracic echocardiography could not provide a prompt diangosis, but definitive evidence of papillary muscle rupture was demonstrated by transesophageal echocardiography.

Transesophageal Echocardiography in the Detection of Intracardiac Source of Cerebral Emboli

BACKGROUND: Intracardiac pathology resulting in embloic phenomena is a well-recognized cause of cerebral ischemia and infarction. Recently, the use of transesophageal echocardiography(TEE) has gained wide acceptance because of its superior resolution of basal structures such as the left atrium, left atrial appendage, mitral valvular apparatus, atrial septum, and aorta. The purposes of this study are to evaluate the effectiveness of TEE for detection of intracardiac source of cerebral emboli. METHOD: From 1991 to 1995, 215 patients were included in this study. All patients underwent both transthoracic and transesophageal imaging with saline contrast administration and Doppler color flow imaging. The study group consisted of 132 men and 83 women with a mean age of 51 years(range 15-74). We also reviewed TEE result of all patients according to two groups, which were divided by the presence of clinical cardiac abnormalities. RESULT: 1) TEE identified a potential cardiac source of embolism in 43.7%(94 to 215) of the overall study group compared with only 3.7%(8 to 215) by TTE. 2) Success rate of TEE was 93.5%(201 to 215). 3) Abnormalities noted by TEE included 23 patients with LA spontaneous echo contrast, 20 patients with patient foramen ovale, 16 patients with aortic atheroma, 16 patients with LA thrombi, 8 patients with atrial septal aneurysm, 5 patients with aortic valve prolapse, 4 patients with mitral valve prolapse, and 2 patients with LV thrombi. 4) In the 62 patients with cardiac disease, TEE identified 16 patients with LA spontaneous echo contrast, 12 patients with LA thrombi, 2 patients with patent foramen ovale, 1 patient with aortic atheroma, 1 patient with atrial septal aneurysm and 1 patients with aortic valve prolapse. In the 152 patients with no cardiac disease, TEE identified 18 patients with patent foramen ovale, 15 patients with aortic atheroma, 7 patients with artial septal aneurysm, 7 patients with spontaneous echo contrast, 4 patients with aortic valve prolapse, 1 patient with mitral valve prolapse and 1 patient LA thrombi. CONCLUSION: TEE was very useful method in investigating potential intracardiac source of cerebral emboli. Thus, the use TEE combined with TTE in patients with unexplained stroke should be recommended.

A Case of Huge Left Ventricular Thrombus Associated with Hypereosinophilic Syndrome

Cardiac manifestations of hypereosinophilic syndrome rarely include left ventricular thrombosis leading to peripheral emboli. And the cases of thrombectomy in patients with left ventricular thrombus and hypereosinophilic syndrome are extremely rare. Recently we experienced a 58-years-old woman with hypereosinophilic syndrome, the history of thalamic infarction and a huge thrombi in left ventricle. We report this case with literatures.