Clinical usefulness of ultrasound as an early diagnostic tool for neuroleukemiosis -a case report- / 대한마취과학회지

Background@#Neuroleukemiosis is a rare complication of leukemia. The diagnosis may be delayed owing to non-specific symptoms and the need for special diagnostic modalities. Case: A 70-year-old man in his sixth year of remission from acute myeloid leukemia was referred to the pain clinic for shooting and radiating pain in the left posterior leg. A lumbar spine magnetic resonance imaging showed mild disc bulging of the L2-3, which was insufficient to explain the patient’s symptoms. With insufficient pain response to lumbar epidural block and piriformis injection, we examined both sciatic nerves using an ultrasound and identified an enlarged hypoechoic mass on the left sciatic nerve at mid-thigh level. After that, we biopsied the mass under general anesthesia, and histology confirmed it to be neuroleukemiosis. @*Conclusions@#Ultrasound is an inexpensive, non-invasive, simple, and quick diagnostic modality that can be used as a screening tool in the diagnosis of neuroleukemiosis.

Anaphylaxis induced by sugammadex and sugammadex-rocuronium complex -a case report- / 대한마취과학회지

Background@# In sugammadex-induced anaphylaxis, sugammadex and/or sugammadex-rocuronium complex have possible allergenic epitope. Case: We report a case of sugammadex-induced anaphylaxis during general anesthesia in a 60-year-old male undergoing orthopedic hand surgery, manifesting as profound hypotension and urticaria. The timing of onset was closely associated with sugammadex administration. The patient recovered after extensive therapy including fluid, epinephrine, other vasopressors, steroid, and antihistamine administration. By intradermal skin test which was done at four weeks after anaphylaxis, we confirmed positive reactions to both sugammadex and sugammadex-rocuronium complex. @*Conclusions@# This is a rare case of sugammadex-induced anaphylaxis that both sugammadex and sugammadex-rocuronium complex were confirmed as allergenic epitopes.

Lead fracture of peripheral nerve stimulator for brachial plexopathy: a case report / 대한마취과학회지

Peripheral nerve stimulation (PNS) is a useful treatment for chronic pain, but it can cause damage depending on its application site. Here, we describe the case of a 54-year-old man who underwent PNS for brachial plexopathy in 2015. One lead was implanted on the left medial cord to stimulate the medial antebrachial cutaneous nerve, and the other was implanted on the radial nerve to stimulate the posterior antebrachial cutaneous nerve. Both leads were inserted near the shoulder joint but did not cross it. Before PNS, the patient did not move his shoulder and elbow because of severe pain, but the treatment greatly alleviated this pain. Twenty months after the operation, both leads were fractured, and the severe pain returned. Repetitive motion near the joint was closely related to the lead fractures. In conclusion, large joints as the insertion sites of PNS leads should be avoided to prevent lead fractures.

Implantable drug delivery systems with morphine in fibromyalgia: A case report

The fibromyalgia syndrome (FMS) could be approached by various treatments modalities including education, aerobic exercise, cognitive behavioral therapy, tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, pregabalin, and so on. If other treatments fail, opioids including morphine should be considered. In this case report, we describe the case of a 44-year-old woman who was diagnosed with FMS three years ago, and suffered from severe intractable pain, side effects from other drugs, and opioid tolerance. Administration of morphine via an implantable drug delivery system resulted in significant improvement in the patient's pain intensity, fibromyalgia impact questionnaire score, and sleep disturbance. Our case demonstrates that an implantable drug delivery system with morphine can be a potential treatment option for refractory fibromyalgia patients.

Microsurgical Foraminotomy via Wiltse Paraspinal Approach for Foraminal or Extraforaminal Stenosis at L5-S1 Level : Risk Factor Analysis for Poor Outcome

OBJECTIVE: The purpose of this study was to present the outcome of the microsurgical foraminotomy via Wiltse paraspinal approach for foraminal or extraforaminal (FEF) stenosis at L5–S1 level. We investigated risk factors associated with poor outcome of microsurgical foraminotomy at L5–S1 level. METHODS: We analyzed 21 patients who underwent the microsurgical foraminotomy for FEF stenosis at L5–S1 level. To investigate risk factors associated with poor outcome, patients were classified into two groups (success and failure in foraminotomy). Clinical outcomes were assessed by the visual analogue scale (VAS) scores of back and leg pain and Oswestry disability index (ODI). Radiographic parameters including existence of spondylolisthesis, existence and degree of coronal wedging, disc height, foramen height, segmental lordotic angle (SLA) on neutral and dynamic view, segmental range of motion, and global lumbar lordotic angle were investigated. RESULTS: Postoperative VAS score and ODI improved after foraminotomy. However, there were 7 patients (33%) who had persistent or recurrent leg pain. SLA on neutral and extension radiographic films were significantly associated with the failure in foraminotomy (p17.3°) and extension radiographic films (>24°).