Flexor Pollicis Longus Tendon Rupture as a Complication of a Closed Distal Radius Fracture: A Case Report

There are few reported cases of flexor pollicis longus tendon (FPL) rupture complicating a closed distal radius fracture. We report a case of FPL tendon rupture complicating a closed distal radius fracture. A 24-year-old male presented with a severe right wrist pain. He had a closed distal radius fracture that was treated by closed manual reduction. Three days later, he complained forearm pain and limitation of thumb motion. The physical examination revealed loss of active interphalangeal joint flexion of thumb. He was taken to the operating room. Intraoperatively, the FPL was found to be discontinuous at the level of the radius fracture site. The FPL was repaired by a modified Kessler technique, and the fracture was repaired with a volar plate. Clinicians must be cautious in possibility of tendon injury complicating a closed distal radius fracture and assessing patients with distal radius fracture following closed reduction.

Obturator Internus Pyomyositis: A Case Report

Pyomyositis is a primary bacterial infection of skeletal muscle and this is on the increase worldwide among children as well as young adults. We report herein on a case of a 29-year-old male with pyomyositis of the obturator internus. The fact that pyomyositis predominantly affects the muscles of the lower limb and it is confined to the obturator internus muscle has been poorly recognized. CT with an enhancement was an accurate imaging modality to image the obturator internus muscle and to ascertain the diagnosis for this case. The patient was managed with antibiotics and surgical intervention was not necessary. Pyomyositis of the obturator internus muscle needs to be differentiated from septic arthritis of the hip. The present study reports the clinical signs and treatments of pyomyostis and we review the relevant literature.

The Tribological and Lubrication Responses of a Cobalt-Chromium Femoral Head in Total Hip Arthroplasty

PURPOSE: This study aimed at investigating the role of albumin as a boundary lubricant in the lubrication of the Co-Cr femoral head of artificial hip implants by measuring the tribological parameters of the Co-Cr femoral head with Atomic Force Microscope (AFM) techniques. MATERIALS AND METHODS: Samples were prepared from the main wear region of a Co-Cr femoral head from revision hip surgery. Two types of solutions were prepared as lubricants: PBS (Phosphate Buffered Saline) as a control solution and BSA (Bovine Serum Albumin) as a lubricant at concentrations of 10, 20, 30 and 40 mg/ml in PBS solution. RESULTS: There were statistically significant differences in the frictional coefficients (micron) of a Co-Cr head between the PBS control and all the concentrations of BSA (10, 20, 30, 40 mg/ml) (P<0.001). Similarly, there were statistically significant differences for the micron between the BSA concentrations of 10, 20, 30 and 40 mg/m for all the cases except between the BSA of 30 and 40 mg/ml (P<0.01). CONCLUSION: There exists a maximum protein concentration of BSA to play a role as an effective boundary lubricant through adsorption on the surface of Co-Cr femoral head.

Cervical and Thoracic Spinal Cord Stimulation in a Patient with Pediatric Complex Regional Pain Syndrome: A case report / 대한통증학회지

Complex Regional Pain Syndromes (CRPS) type I and type II are neuropathic pain conditions that are being increasingly recognized in children and adolescents. The special distinctive features of pediatric CRPS are the milder course, the better response to treatment and the higher recurrence rate than that of adults and the lower extremity is commonly affected. We report here on a case of pediatric CRPS that was derived from ankle trauma and long term splint application at the left ankle. The final diagnoses were CRPS type I in the right upper limb, CRPS type II in the left lower limb and unclassified neuropathy in the head, neck and precordium. The results of various treatments such as medication, physical therapy and nerve blocks, including lumbar sympathetic ganglion blocks, were not effective, so implantation of a spinal cord stimulator was performed. In order to control the pain in his left lower limb, one electrode tip was located at the 7th thoracic vertebral level and two electrode tips were located at the 7th and 2nd cervical vertebral levels for pain control in right upper limb, head, neck and right precordium. After the permanent insertion of the stimulator, the patient's pain was significantly resolved and his disabilities were restored without recurrence. The patient's pain worsened irregularly, which might have been caused by psychological stress. But the patient has been treated with medicine at our pain clinic and he is being followed up by a psychiatrist.

What is the Optimal Angle of Needle Insertion in Korean Young Adult Male during Paramedian Spinal Puncture? A Radiological Study / 대한마취과학회지

BACKGROUND: The object of this study is to offer the optimal angle of needle insertion during L3-L4 paramedian approach using simple X-ray. METHODS: Twenty-five male patients were enrolled for this study. After placing a radio-opaque material (RO) on the point 1cm lateral and 1cm caudad to inferior edge of L3 spinous process in the sitting-flexion position, simple AP X-ray films in erect position and lateral films in sitting-flexion position were taken. The distance from RO (I) to the midline of vertebral column was measured on the AP film. On the lateral film, the optimal target point (T) was determined. When the real RO (I) appeared on lateral film, the point was named I'. The line perpendicular to the line tangential to skin on I' was drawn to the vertebral body. When another line perpendicular to that line was drawn from the target point (T), the two lines meet perpendicularly at the point C. Two triangles can be formed three-dimensionally with T, I', C and T, I, C. Medial insertion angle (alpha, angle I-C-I') and cephalad insertion angle (beta, angle T-I-C) were calculated. RESULTS: The mean angle of alpha was 10.7 +/- 2.3degrees and beta was 13.9 +/- 5.0degrees. The insertion based on the calculated angles was successfully achieved at the first trial in 24 patients and at the second in 1 patient. CONCLUSIONS: Spinal anesthesia with L3-L4 paramedian approach can be successfully performed using calculated angles measured by simple X-rays.

The Sphenopalatine Ganglion Radiofrequency Thermocoagulation on a Patient of CRPS with Facial Pain and Pruritus:A report of 2 cases / 대한통증학회지

Complex regional pain syndrome (CRPS) type 1 is characterized by the presence of pain, which is severe, diffuse and associated with allodynia, and is also associated with autonomic and trophic changes. The sensitization phenomena of CRPS also cause allodynia and itching, as well as pain. These symptoms are the issues associated with the treatment of CRPS. Under normal conditions, an antagonistic interaction exists between the pain and itching, but the patterns of peripheral and central sensitization phenomena for the pain and itching are very similar. The chronic pain and chronic itch have similar characteristics in their developmental and therapeutical principles. Herein, our experience of 2 cases of CRPS, which showed improvement of these facial symptoms after sphenopalatine ganglion radiofrequency thermocoagulation, but were not controlled by spinal cord stimulation or other conservative treatments, is reported.

Difficult Endotracheal Intubation Due to an Asymptomatic Epiglottic Cyst / 대한마취과학회지

Airway problems are easiest to manage when they are anticipated. Difficult intubation might, however, occur in patients with no obvious signs or symptoms suggesting airway obstruction. We describe a case of difficult intubation where the laryngeal inlet was obscured by a large epiglottic cyst that was discovered during rapid-sequence induction of general anesthesia. A 3-year-old male weighing 15 kg was admitted for an emergency appendectomy. After preoxygenation, a rapid-sequence induction was carried out. Direct laryngoscopy (Macintosh 1 blade) revealed a large 2-cm cyst arising from the lingual surface of the epiglottis. The cyst completely obstructed the view of the epiglottis and larynx, and several attempts at endotracheal intubation were unsuccessful. Fortunately, the patient was mask ventilated without difficulty and oxygen saturation was 98 99%. After a second 10 mg dose of succinylcholine, intubation was attempted using the same laryngoscope blade and a styletted 4.5 mm endotracheal tube by another anesthesiologist as cricoid pressure was maintained. By using the tube to push the cyst upward, intubation of the trachea was performed after a brief view of the arytenoid cartilages. Anesthesia and the operation then proceeded uneventfully. Following an appendectomy, an ENT surgeon removed the cyst.

Effects of Postoperative Patient-Controlled Ketorolac Analgesia on Recovery of Gastro-intestinal Motility after Gynecologic Surgery / 대한마취과학회지

BACKGROUND: Postoperative ileus remains a common condition that prolongs hospitalization and increases the cost of surgical therapy. Ketorolac, a potent nonsteriodal antiinflammatory drug, has been known to prevent small bowel ileus in a rodent model. Therefore, we compared the effect of intravenous patient-controlled analgesia (iv PCA) with or without ketorolac. METHODS: Fifty-four patients undergoing gynecologic surgery were assigned in a double-blind manner into one of three groups (n = 18). Pain control was achieved using meperidine 600 mg only (group M), meperidine 300 mg-ketorolac 150 mg (group MK) or butorphanol 10 mg-ketorolac 150 mg (group BK) during the 48 hours following surgery. It was designed as loading (30 mg), continuous infusion (9.6 mg/hr), PCA dose (9.6 mg) and lockout interval (15 min) for group M and as loading (30 mg of ketorolac), continuous infusion (2 ml/hr), PCA dose (2 ml), and lockout interval (15 min) for groups MK and BK. We measured the interval to the first flatus during the 72 hours following surgery and recorded the numerical rating score (NRS) of pain with side effects at 1, 6, 12, 24 and 48 hrs postoperatively. RESULTS: Ketorolac expedited the return of bowel function significantly (P < 0.05). Analgesic efficacy and side effect were not significantly different in all three groups. CONCLUSIONS: IV PCA with meperidine-ketorolac and butorphanol-ketorolac afforded equal analgesia compared to the meperidine only. It also allowed earlier recovery of bowel function in patients undergoing gynecologic surgery.

A Case of Leiomyoma in the Female Urethra / 대한비뇨기과학회지

Leiomyoma of the female urethra is a very rare entity. A case of leiomyoma of the female urethra arising from the anterior lip of the external urethral meatus in a forty-year-old female is presented. The presenting symptoms were awareness of a mass and recurrent urinary tract infection. The mass was resected surgically and confirmed as a leiomyoma histologically.

Correlation Between Histopathology and Prognosis in Wilms` Tumor: Result of a Retrospective Study of l0 Patients / 대한비뇨기과학회지

A histologic analysis of 10 cases of Wilms` tumor in the department of Urology, Chosun University Hospital during 11 years periods from January, l975 to December, l985 has been carried out. A classification based on the tumor differentiation and degree of tubular formation are described. A comparison of the histologic findings with the survival was undertaken and it was found that the histologic classification was significantly correlated with survivals. The results were as follows : I. Low grade tumors(grade I) with predominance of differentiated tubules were associated with a better cure rate than high grade tumors(grade IH) composed mainly of undifferentiated spindle elements : 2 year or more survival rate was lOOf6 for grade I but O% for grade III. 2. Cure rate was lower for the low degree of tubular formation than for the high degree of tubular formation : 2-year cure rates were O%, O%, 33.3%, lOO% for group O, +,++ and +++ respectively. 3. 6 patients with the focal or diffuse anaplasia and sarcomatous stroma had a bad prognosis. giving a survival rate of 0%.