The effect of Gunn's intramuscular stimulation for postherpetic neuralgia: A report of 4 cases / 대한마취과학회지

Herpes zoster is the consequence of reactivation of latent varicella zoster virus from dorsal root ganglia. Postherpetic neuralgia (PHN) may be diagnosed when pain persists in a dermatomal pattern long after the vesicular erruption has healed. PHN is a kind of neuropathic pain. The pathophysiology of PHN is uncertain, but neuropathic pain due to denervation supersensitivity may be important to understand the pathophysiology of PHN. Numerous treatment have been introduced for the management of PHN, but no methods that results in complete remission. Gunn's intramuscular stimulation (IMS) is one of the best treatment of chronic pain, especially neuropathic pain. We tried Gunn's IMS for treatment of PHN patients affecting thoracic dermatomes. As a result, the visual analogue scale (VAS) was decreased from 7-8 to 2-3 and the result were satisfactory. The purpose of this case report is to introduce the Gunn's IMS and review our experience for the treatment of PHN.

A Case of Penetration of Mesh after Rectopexy and This Was Found by Colonoscopy / 대한소화기내시경학회지

Rectal prolapse is a protrusion of the rectum beyond the anal canal. Since rectal prolapse is a surgical disease, it is mostly diagnosed and treated at the surgical department. However, when surgical complications occur or they are suspected after an operation for colorectal disease, colonoscopy may now have a role in diagnosing the actual status of the problem. We present here the case of penetration of mesh at the distal rectum that was incidentally diagnosed by colonoscopy and the patient had previously undergone presacral rectopexy for rectal prolapse. Only one such case has been reported abroad and there has been no such case report in Korea. We report here on a case for which colonoscopy had a crucial role in diagnosing an occult complication after a colorectal operation that used a prosthesis.

Delayed recovery of neuromuscular blockade by rocuronium in a hypothermic patient during a laparoscopic procedure: A case report / 대한마취과학회지

Perioperative hypothermia can occur frequently and lead to various complications. Laparoscopic procedures do not require a large incision or exposure of the viscera, but a prolonged and high pressure procedure can lead to unexpected hypothermia. Hypothermia prolongs the time-course of non-depolarizing neuromuscular blocking agents by reducing the plasma clearance significantly. Rocuronium, a new aminosteroidal neuromuscular blocking agent, can be influenced by reductions in plasma clearance and prolong the duration of action. Therefore, patients must receive ventilator care in the ICU. Aggressive measures were taken for hypothermia, and the patient was discharged without any complications. We report a case of delayed of neuromuscular blockade by rocuronium in a hypothermic patient during a laparoscopic procedure with a brief review of literatures.

The therapeutic effect of interventional microadhesiolysis and nerve stimulation (IMNS) under ultrasonographic guide in frozen shoulder patient: A case report / 대한마취과학회지

Frozen shoulder is characterized by pain in the shoulder and limitation of glenohumeral movement. The underlying pathologic changes in frozen shoulder are synovial inflammation with subsequent reactive capsular fibrosis. Capsular fibrosis is the ultimate course of frozen shoulder suffering from various causes irrespectively. Therefore, adhesions that are affecting the joint movement must be released. Most important diagnostic method is thoughtful history taking and physical examination, and ultrasonography is very valuable device of diagnosis and treatment. Interventional microadhesiolysis and nerve stimulation (IMNS) is effective to manage frozen shoulder patients. IMNS for frozen shoulder is composed of three release approaches. These are (1) subacromial, (2) posterior inferior capsular, and (3) subdeltoidal & subcoracoidal release and round needle can be used for each release. We report this experiences and recommand this technique for the treatment of frozen shoulder patients.

Two Cases of Percutaneous Transhepatic Choledochoscopy Treatment of Intrahepatic Duct Stones that Occurred after Living Donor Liver Transplantation / 대한소화기내시경학회지

Percutaneous transhepatic cholangioscopy (PTCS) is the primary treatment option for general cases of intrahepatic duct stones. However, there are no reports on the use of PTCS for intrahepatic duct stones in patients who had undergone living donor liver transplantation (LDLT). We experienced two cases of successful intrahepatic stone removal by the use of PTCS in LDLT patients. With these cases, we have confirmed that PTCS management can be safely performed not only for a general bile duct stone, but also for a bile duct stone that develops in a patient that had previously undergone liver transplantation.

Effects of Dosages of Remifentanil Calculated by Total Body Weight and Ideal Body Weight to Intubation Circumstances and Adverse Hemodynamic Responses

BACKGROUND: Remifentanil presents good intubation conditions and blunting adverse hemodynamic responses following intubation. So, we evaluated to determine optimal dosage of remifentanil for intubation which consider ideal body weight. METHODS: 160 ASA class 1-2 patients were selected and divided 4 groups, which were composed of 40 patients. Group 1 and 2 were administrated dosage calculated by TBW (total body weight). Each group was administrated intravenous continuous infusion dose of 1.0 ug/kg/min of remifentanil during 2 minutes followed by intravenous bolus dose of 2 mg/kg of propofol (Group 1) and 2.0 ug/kg/min of remifentanil followed by same dose of propofol (Group 2). Group 3 and 4 were administerated same dosage of Group 1 and 2 but administrated dosage calculated by IBW (ideal body weight). We didn't use any muscle relaxant. Intubation conditions and postintubation hemodynamic responses were assessed by 5 items based on GCRP (good clinical research practice), MAP (mean arterial pressure) and HR (heart rate). RESULTS: We have done intubation safely 60, 75, 55 and 98% of Group 1, 2, 3 and 4 respectively. Group 1, 3 have 'technically unacceptable' cases, but group 2, 4 have 'clinically unacceptable' cases. Hemodynamic responses of Group 4 were more stable than Group 2, especially obese patients. Obese patients present a problem for the appropriate dosing of remifentanil and profound hypotension and/or bradycardia developed more frequently when administerated agent calculated by total body weight. CONCLUSIONS: The optimal dosage which produce best intubation conditions and least side effects has to be determined according to IBW.

Endoscopic Papillary Large Balloon Dilatation for Large Biliary Stones in a Hemodialysis Patient: A Case Report / 대한소화기내시경학회지

In retrieving bile duct stones, full-endoscopic sphincterotomy (EST) with endoscopic mechanical lithotripsy (EML) is considered as a traditional method, and balloon dilation of the papillary sphincter has also been used. Recent studies have reported that mid-EST and endoscopic papillary large balloon dilatation (EPLBD) was as useful as full-EST with EML, without serious complications. In patients with coagulopathy, such as end-stage renal disease, even a small incision of the sphincter could cause profuse bleeding. In such patients, balloon dilation of the sphincter is a preferred technique over EST. A prior Billroth-II operation renders EST more difficult and increases the risk of a complication. In these patients, the use of EPBD is also preferred as well. We report a case of successfully retrieving large bile duct stones by EPLBD without EST, in a patient who had a prior Billroth-II operation, and is undergoing hemodialysis. The patient is free of complications, such as bleeding or acute pancreatitis.

Beneficial Effects of Thiazolidinediones on Diabetic Nephropathy in OLETF Rats

PURPOSE: Diabetic nephropathy is the most serious of complications in diabetes mellitus. Thiazolidinedione (TZD) is thought to ameliorate diabetic nephropathy; however, the mechanism underlying this effect has not been elucidated. We hypothesized that the vascular endothelial growth factor (VEGF) participates in the pathogenesis of diabetic nephropathy and that TZD may be beneficial for the treatment of diabetic nephropathy because of the effect it has on VEGF. MATERIALS AND METHODS: 23 Otsuka- Long-Evans-Tokushima-Fatty (OLETF) rats and eight control Long-Evans-Tokushima-Otsuka (LETO) rats were divided into the following four groups: LETO group, control OLETF group, pioglitazone treated group (10mg/kg/day), and rosiglitazone treated group (3mg/kg/day). RESULTS: A progressive increase in urinary protein excretion was observed in the diabetic rats. Glomerular VEGF expression in the control OLETF rats was significantly higher than in the control LETO rats. However, there was a significant reduction in both the glomerular VEGF expression and the VEGF mRNA levels after treatment with pioglitazone and rosiglitazone. The twenty-four hour urine protein levels were significantly decreased in both groups of the treated OLETF rats. CONCLUSION: These results suggest that TZD may have beneficial effects on diabetic nephropathy by reducing the VEGF expression.

Pneumothorax after Interventional Muscle and Soft Tissue Stimulation Therapy : A case report

Pneumothorax is the presence of gas in the pleural space. Traumatic pneumothorax results from penetrating or nonpenetrating chest injuries and iatrogenic pneumothorax occurs as a consequence of a diagnostic or therapeutic maneuver. When interventional muscle and soft tissue stimulation (IMNS) therapy is performed, iatrogenic pneumothorax is not common, but once it has occurred, it gives suffering and pain to both the patient and physician. We experienced three cases of iatrogenic pneumothorax after IMNS therapy. Commonly, the patients with peumothorax are treated with a tube thoracostomy on admission, but these patients can be simply treated with simple observation, oxygen inhalation and simple aspiration without admission and the results are satisfactory. Although iatogenic pneumothorax after IMNS therapy appears to be an rare, IMNS procedure still must be done with care.

Epidural Abscess after Interventional Muscle and Nerve Stimulation Therapy (IMNS): A Case Report

Advanced procedures for pain control have recently grown and became popular Although the incidence of epidural abscess is very low, but appears to have increased due to procedures being performed more frequently in the spine region, we should devote every effort to the prevention of abscess formation. Most cases of epidural abscess in the literature are related to epidural catheterization and neuroaxial anesthesia. MRI or CT scanning should be performed to confirm the diagnosis, and early neurosurgical consultation is advisable to avoid sequelae. A 63-year-old female patient with diabetes mellitus received interventional muscular and nerve stimulation (IMNS). After IMNS, the patient began to suffer severe low back pain and local tenderness MRI showed epidural and multifocal abscess in the lumbar region, and an emergency decompressive laminectomy with drainage was performed. We recommend an aseptic technique to prevent infection during IMNS for diabetic patients.

A Case of Autoimmune Hypoglycemia Complicated with Diabetic Ketoacidosis

Autoimmune hypoglycemia is characterized by hyperinsulinemia, fasting hypoglycemia, and the presence of insulin auto- antibodies without previous exposure to exogenous insulin. We experienced a case of autoimmune hypoglycemia without diabetes mellitus or any evidence of insulinoma. The insulin auto-antibody and insulin receptor auto-antibody were present. We diagnosed the patient as having autoimmune hypoglycemia and treated with glucocorticoid. After treatment, the hypoglycemic symptoms were resolved. However, four months later, the patient was readmitted with transient diabetic ketoacidosis. After recovery, he showed no signs of diabetes mellitus. We believe that insulin auto-antibodies may play a role in autoimmune hypoglycemia and diabetic ketoacidosis, but its role and mechanism are not precisely known. Further studies are needed to define the action mechanisms and the functions of insulin auto-antibodies: here we present case with a relevant literature.

The Effect of Bupivacaine on Blood Coagulation In Vitro under Thromboelastography / 대한마취과학회지

BACKGROUND: Deep vein thrombosis (DVT) is a common complication following major surgical procedure. In regional anesthesia with local anesthetics, deep vein thrombosis is less frequent than in general anesthesia. Several studies have advocated that local anesthetics alter the function of platelets, the stability of vascular endothelium, and the hemodynamics of the blood flow in the epidural anesthetic region. We investigate the effect of the local anesthetic bupivacaine on blood coagulation in vitro under thromboelastography (TEG). METHODS: 16 Healthy volunteers who had no history of coagulation defect and anticoagulant use were evaluated. The patients were divided into 4 groups and each group was treated with bupivacaine in the following concentrations; the lower clinical level (1 microgram/ml, B1 group), the higher clinical level (2 microgram/ml, B2 group), the systemic toxicity level (4 microgram/ml, B3 group), and a control group which was treated with normal saline. We compared the TEG parameters of each group, reaction time (R), coagulation time (K), alpha angle (alpha), maximal amplitude(MA) and fibrinolysis index (lysis 60), respectively. RESULTS: As compared with the control group, there were no significant differences in the other 3 groups, especially in maximal amplitude. CONCLUSIONS: In the clinical concentration, bupivacaine had no effect on blood coagulation under TEG. Thus in the clinical concentration of bupivacaine, DVT is more influenced by several physiologic changes which are induced by epidural anesthesia, include stability of vascular endothelium, increased blood flow, and decreased catecholamine release rather than by the effect of bupivacaine on blood per se.

A Comparative Study of the Effective Infusion Method of Propofol for Patients That Prefer to be Sedated under Brachial Plexus Block / 대한마취과학회지

BACKGROUND: Patients who are scheduled for upper extremity surgery under brachial plexus block (BPB) prefer to have no memory of the surgical procedure and some form of sedation is therefore necessary. Because of this we have tried to find an adequate infusion method for propofol that would supply better sedation and less complications. METHODS: We divided 60 patients who were scheduled for upper extremity surgery under BPB into four groups according to loading dose and following continuous infusion rate of propofol (Group 1: 0.2 mg/kg, 8 microgram/kg/min, group 2: 0.4 mg/kg, 16 microgram/kg/min, group 3: 0.6 mg/kg, 33 microgram/kg/min, group 4: 0.8 mg/kg, 50 microgram/kg/min.). We evaluated the degree of sedation, amnesia, recovery, changes of blood pressure, heart rate, and respiratory effect of each group. RESULTS: According to the sedation score, groups 3 and 4 were sedated better than groups 1, 2 (P< 0.05). But the mean arterial pressure (MAP), heart rate and respiration were more depressed and recovery time prolonged in the higher dosage groups (P< 0.05). Three patients among group 4 developed severe respiratory depression, at which time infusion of propofol was stopped. CONCLUSIONS: The ideal infusion method of propofol for effective sedation was 0.4 0.8 mg/kg of loading dosage, followed by 16 50 microgram/kg/min of continuous infusion dosage. But the more dosages of propofol that were administered, the more complications appeared, so we must use care in administering propofol as a sedation adjuvant to BPB.

Two Cases of Postoperative Bleeding Monitored by Thromboelastography in Reoperation of Open Heart Surgery / 대한마취과학회지

The excessive postoperative hemorrhage increases the mortality and morbidity after surgery. The longer expracorporeal circulation time, the worse the patient's blood coagulation disorder. And it makes the possibility of bleeding tendency predictable. We have two clinical experiences of reoperation due to postoperative hemorrhage after open-heart surgery. As with the heparin independent thromboelastography(TEG) following Cardiopulmonary Bypass(CPB) and postbypass TEG, we could distinguish expectantly surgical bleeding from medical bleeding relating with open heart surgery.

Atretic Cephaloceles: Report of 3 Cases

Atretic cephalocele is a rare congenital cranial anomaly. We have experienced 3 cases of atretic cephalocele at the Department of Neurosurgery, Kyungpook University Hospital between 1990 and 1993. Clinical features, operative considerations, and outcome are discussed.

Heparin Independent Coagulation Monitoring during Open Heart Surgery / 대한마취과학회지

Thromboelastography(TEG) is a useful monitor for assessing coagulation function in patients undergoing open heart surgery. However, whole blood clotting patterns on TEG are not able to obtain during the cardiopulmonary bypass(CPB) with heparin anticoagulation. When pretreating TEG sample with heparin antidote, heparinase or protamine (heparinase-modified TEG or protamine modified TEG) can make possible assessing the changes of clotting on TEG during the CPB. In this study, data from heparinase(N=50) and protamine(N=26) modified TEG were obtained before, during and after CPB in 76 open cardiac patients, which are presented to describe their usefulness concerning about prediction for coagulation after weaning of CPB. Heparin neutralized TEG revealed that all of depressed values initially after starting bypass were returning back to the values of before starting bypass on weaning CPB. These results suggested that function of the fibrinogen and platelet were relatively well maintained during the bypass. The fibrinolysis during the bypass were commonly developed in 51.2% without affecting by time course of CPB. Even though initial dose of protamine reversal after bypass, there were obviously residual heparin effects on heparinase-modified TEG as simultaneously comparing with native TEG. Regarding correlation of TEG findings in cases excluding fibrinolysis between before and after bypass, R time and MA before bypass were significantly correlate with R time and MA on heparinase-modified TEG after bypass but not on native TEG. (R time: R 0.46, MA: R=0.54). The data gathered in this study suggested heparin independent TEG assay can be useful to assess the coagulation function during the bypass and to predict the values of TEG after bypass, but residual heparin effect must be initially excluded to avoid underestimating the coagulation status after protamine reversal.

Clinical study on urinary tract infections after renal transplantation / 대한신장학회잡지

No abstract available.

A Case of the Hepatoblastoma with Precocious Puberty

No abstract available.