Musicians' Medicine: Musculoskeletal Problems in String Players

There is increasing attention to medical problems of musicians. Many studies find a high prevalence of work-related musculoskeletal disorders in musicians, ranging from 73.4% to 87.7%, and string players have the highest prevalence of musculoskeletal problems. This paper examines the various positions and movements of the upper extremities in string players: 1) basic postures for holding instruments, 2) movements of left upper extremity: fingering, forearm posture, high position and vibrato, 3) movements of right upper extremity: bowing, bow angles, pizzicato and other bowing techniques. These isotonic and isometric movements can lead to musculoskeletal problems in musicians. We reviewed orthopedic disorders that are specific to string players: overuse syndrome, muscle-tendon syndrome, focal dystonia, hypermobility syndrome, and compressive neuropathy. Symptoms, interrelationships with musical performances, diagnosis and treatment of these problems were then discussed.

Surgical Treatment of Chronic Flexor Carpi Ulnaris Tendinopathy

PURPOSE: The purpose of this study was to evaluate the results of surgical treatment in patients with chronic flexor carpi ulnaris tendinopathy. MATERIALS AND METHODS: Five patients with 7 wrists underwent surgical treatment for chronic flexor carpi ulnaris tendinopathy. The degenerative tissue inside the tendon over the pisiform was debrided and partial release of the tendon was performed. The clinical outcome was evaluated using pre and postoperative visual analogue scale (VAS) pain score and modified Mayo wrist score at the final follow-up. RESULTS: The mean VAS score was 7.3 preoperatively, which was significantly improved to 3.6 at postoperative 2 weeks, 1.9 at 6 weeks, 1.1 at 3 months, 0.7 at 6 months, and 0.7 at the final visit. Modified Mayo wrist score showed 3 excellent, 3 good, and one fair result. Biopsy showed degenerative tissue findings in all cases. CONCLUSION: Chronic flexor carpi ulnaris tendinopathy is a degenerative disease and surgical treatment of refractory cases can decrease clinical symptoms in the early postoperative period and enable patients to return to activities of daily-living.

Analysis of the rocuronium-vecuronium interaction on tetanic fade based on a generalized response surface model with varying relative potencies / 대한마취과학회지

BACKGROUND: Some studies have shown that rocuronium and vecuronium have additive, or synergistic effects on muscle relaxation based on the Loewe additivity. Therefore, we performed a fit of tetanic fade data to a generalized response surface model with varying relative potencies proposed by Kong and Lee (KLGRS) to evaluate the usefulness of KLGRS for capturing the interspersed drug interactions and to characterize the interaction between the two drugs. METHODS: Left phrenic nerve-hemidiaphragms (Male Sprague-Dawley rats, 150-250 g) were mounted in Krebs solution. Supramaximal electrical stimulation (0.2 ms, rectangular) of 50 Hz for 1.9 s to the phrenic nerve evoked tetanic contractions that were measured with a force transducer. Each preparation was exposed to one of 4 vecuronium concentrations (0.0, 1.5, 2.5, and 3.0 microM), or one of 4 rocuronium concentrations (0.0, 3.0, 4.5, and 5.5 microM). Subsequently the adequate amount of rocuronium was added to a vecuronium bath and that of vecuronium was added to a rocuronium until an 80-90% increase in tetanic fade was achieved. We then fitted the modified KLGRS models to the above data, after which we selected the best model, based on 5 methods for determining goodness of fit. Using this method, we obtained the response surface, as well as contour plots for the response surface (i.e. isoboles), the polynomial function and the interaction index. RESULTS: The model with the constant relative potency ratio and 8 parameters was found to best describe the results, and this model reflected well the characteristics of the raw data. In addition, the two drugs showed a synergistic interaction in almost every area and an antagonistic one in a very narrow area. CONCLUSIONS: KLGRS was found to be a useful method of analyzing data describing interspersed drug interactions. The interaction between rocuronium and vecuronium was found to be synergistic.

Analysis for Failure and Immediate Complications of Subclavian Venous Catheterization

BACKGROUND: This study was to investigate success rate, immediate complications, and risk factors of failure and immediate complications of subclavian venous catheterization (SVC). METHODS: All patients requiring SVC, older than 18 years of age and without past history of operation, scar, and radiation therapy at puncture site were included. After general or regional anesthesia was induced, SVC was done via infraclavicular approach. Patient's age, gender, weight, height, the rank of operator, anesthesia method, the side of venipuncture, the number of puncture attempts, arterial puncture, and success or failure were recorded. After the operation, a chest radiography was evaluated to check the occurrence of pneumothorax, hemothorax and the location of the catheter tip. RESULTS: SVC was performed in 1092 patients. Thirty-nine patients were excluded because a chest radiography was not checked. Successful catheterization without immediate complications was performed in 939 patients (89.2%). Failure occurred in 65 patients (6.2%). Arterial puncture, pneumothorax and misplacement of the catheter tip were reported in 26 (2.5%), 5 (0.5%), and 35 (3.3%) patients, respectively. Misplacement of the catheter tip were observed in 26 patients (2.5%) at ipsilateral internal jugular vein, and in 9 (0.8%) at contralateral subclavian vein. Failure and immediate complications of SVC were associated with the number of puncture attempts. The number of puncture attempts were associated with age, puncture side and anesthetic method. CONCLUSIONS: Failure and immediate complications of SVC occurred in 10.8% of cases and were associated with the number of puncture attempts.

The Effects of Prolonged Minimal-flow Sevoflurane Anesthesia on Postoperative Hepatic and Renal Function / 대한마취과학회지

BACKGROUND: Minimal-flow and low-flow anesthesia provide many advantages, including reduced costs and pollution, and conservation of body heat and airway humidity. However, low-flow sevoflurane anesthesia is associated with an increase in the circuit concentration of compound A, which causes nephrotoxicity in rats. Therefore, this study was conducted to assess the effects of prolonged minimal-flow sevoflurane anesthesia on hepatic and renal function. METHODS: Forty female patients who underwent free flap surgery lasting more than 8 hours randomly received either high-flow (5 L/min) or minimal-flow (0.5 L/min) sevoflurane anesthesia. Hepatic functions were then assessed by measuring the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin levels. In addition, renal functions were assessed by measuring the blood urea nitrogen (BUN) and serum creatinine levels and by spot urinalysis. Venous blood and spot urine samples were obtained prior to administration of the anesthesia, and then on the first, third and fifth days following administration of the anesthesia. RESULTS: The anesthetic time (9.9 +/- 1.7 vs. 9.6 +/- 2.0 h) and sevoflurane exposure (8.2 +/- 1.7 vs. 7.4 +/- 1.9 MAC-h) were not different between the high-flow and minimal-flow anesthesia group. The serum AST, ALT, ALP and total bilirubin levels were within the normal range throughout the study period in both groups. Additionally, the BUN and serum creatinine levels were within the normal range throughout the study period in both groups. Furthermore, there were no significant differences in any hepatic or renal biomarkers between the two groups. CONCLUSIONS: No significant differences in postoperative hepatic and renal function were observed between the minimal-flow and high-flow sevoflurane anesthesia groups.