Survey on the Status of Breastfeeding in Korean Medical Institution Workers

Background@#Human breast milk is essential and provides irreplaceable nutrients for early humans. However, breastfeeding is not easy for various reasons in medical institution environments. Therefore, in order to improve the breastfeeding environment, we investigated the difficult reality of breastfeeding through questionnaire responses from medical institution workers. @*Methods@#A survey was conducted among 179 medical institution workers with experience in childbirth within the last five years. The survey results of 175 people were analyzed, with incoherent answers excluded. @*Results@#Of the 175 people surveyed, a total of 108 people (61.7%) worked during the day, and 33 people (18.9%) worked in three shifts. Among 133 mothers who stayed with their babies in the same nursing room, 111 (93.3%) kept breastfeeding for more than a month, but among those who stayed apart, only 10 (71.4%) continued breastfeeding for more than a month (P = 0.024). Ninety-five (88.0%) of daytime workers, 32 (94.1%) two-shift workers, and 33 (100%) three-shift workers continued breastfeeding for more than a month (P = 0.026). Workers in general hospitals tended to breastfeed for significantly longer than those that worked in tertiary hospitals (P = 0.003). A difference was also noted between occupation categories (P = 0.019), but a more significant difference was found in the comparison between nurses and doctors (P = 0.012). Longer breastfeeding periods were noted when mothers worked three shifts (P = 0.037). Depending on the period planned for breastfeeding prior to childbirth, the actual breastfeeding maintenance period after birth showed a significant difference (P = 0.002). Of 112 mothers who responded to the question regarding difficulties in breastfeeding after returning to work, 87 (77.7%) mentioned a lack of time caused by being busy at work, 82 (73.2%) mentioned the need for places and appropriate circumstances. @*Conclusion@#In medical institutions, it is recommended that environmental improvements in medical institutions, the implementation of supporting policies, and the provision of specialized education on breastfeeding are necessary to promote breastfeeding.

Computed Tomography-Based Morphologic Analysis of Osteoarthritis of the Distal Radioulnar Joint Associated with Extensor Tendon Ruptures

Background@#Although the scallop sign is considered the most important risk factor for extensor tendon ruptures (ETRs) in patients with osteoarthritis of the distal radioulnar joint (DRUJ), previous reports provide a limited understanding of the changes at DRUJ, as risk factors were examined in plain radiographs of the wrist. The aim of this study was to assess the changes of DRUJ using axial images of computed tomography (CT) in patients with DRUJ osteoarthritis and associated ETRs and to evaluate the relationship between the changes of DRUJ and ETRs. @*Methods@#Twelve patients with ETRs due to osteoarthritis of the DRUJ were enrolled. The changes of DRUJ were examined on axial images of CT and the following 8 parameters were measured: width of radius, anteroposterior (AP) length of radius, width of sigmoid notch (SN), AP length of SN, AP length of ulnar head, subluxation length of ulnar head, dorsal inclination of SN, and distance from Lister’s tubercle to SN. Radiological parameters of the DRUJ were measured in 60 control wrists without trauma or osteoarthritis, and the patient and control groups were statistically compared. @*Results@#Statistically significant differences were observed between the patient and control groups in all the radiological parameters except for the AP length of SN and AP length of ulnar head. The width of radius, AP length of radius, width of SN, subluxation length of ulnar head, and dorsal inclination of SN were greater and the distance from Lister’s tubercle to SN was smaller in the patient group than in the control group. The width of SN, dorsal inclination of SN, and distance from Lister’s tubercle to SN were statistically significant risk factors among the 8 parameters. @*Conclusions@#ETRs due to osteoarthritis of the DRUJ was related to the changes of DRUJ, especially the changes around SN of the distal radius. In addition to the existing risk factors, a decreased distance from Lister’s tubercle to SN and increased dorsal inclination of SN were identified as new risk factors. Axial images of CT were effective to evaluate degenerative changes at the DRUJ.

Social Distancing in COVID-19: What Are the Implications for Musculoskeletal Problems and the Quality of Life?

Purpose@#This study examined the effects of social distancing in COVID-19 on musculoskeletal problems and the quality of life. @*Methods@#One hundred and thirty-five subjects participated in this study and responded to an online survey on stress from the social distancing in COVID-19, computer and smartphone usages, musculoskeletal pain, and quality of life. The stress from social distancing was assessed by a Visual Analogue Scale (VAS). The Neck Disability Index (NDI), Oswestry Disability Index (ODI), and Boston Carpal Tunnel Questionnaire (BCTQ) were provided to assess the musculoskeletal pain, and Short Form-36 (SF-36) was provided to assess the quality of life. Frequency analysis, descriptive statistics, Pearson’s correlation coefficient, and independent t-test were used for data analysis. @*Results@#Statistically significant, but low positive correlation stress from the social distancing (VAS) and NDI (r=0.19, p<0.05) and ODI (r=0.18, p<0.05), and negative correlation between stress from the social distancing (VAS) and SF-36 (r=-0.17, p<0.05). The NDI score was significantly greater in the group with high stress than in the group with low stress from social distancing (p<0.05). @*Conclusion@#This study is meaningful in that it evaluated, through the physical therapy approaches, the potential side-effects on physical and mental health in various social changes caused by COVID-19. The results of this study may be used as basic data in future studies related to COVID-19.

Social Distancing in COVID-19: What Are the Implications for Musculoskeletal Problems and the Quality of Life?

Purpose@#This study examined the effects of social distancing in COVID-19 on musculoskeletal problems and the quality of life. @*Methods@#One hundred and thirty-five subjects participated in this study and responded to an online survey on stress from the social distancing in COVID-19, computer and smartphone usages, musculoskeletal pain, and quality of life. The stress from social distancing was assessed by a Visual Analogue Scale (VAS). The Neck Disability Index (NDI), Oswestry Disability Index (ODI), and Boston Carpal Tunnel Questionnaire (BCTQ) were provided to assess the musculoskeletal pain, and Short Form-36 (SF-36) was provided to assess the quality of life. Frequency analysis, descriptive statistics, Pearson’s correlation coefficient, and independent t-test were used for data analysis. @*Results@#Statistically significant, but low positive correlation stress from the social distancing (VAS) and NDI (r=0.19, p<0.05) and ODI (r=0.18, p<0.05), and negative correlation between stress from the social distancing (VAS) and SF-36 (r=-0.17, p<0.05). The NDI score was significantly greater in the group with high stress than in the group with low stress from social distancing (p<0.05). @*Conclusion@#This study is meaningful in that it evaluated, through the physical therapy approaches, the potential side-effects on physical and mental health in various social changes caused by COVID-19. The results of this study may be used as basic data in future studies related to COVID-19.

Comparison of the presentation of atopic dermatitis induced by trinitrochlorobenzene and house dust mite in NC/Nga mice

Background@#Atopic dermatitis (AD) is a common chronic inflammatory skin disease. To understand AD, there have been many trials establishing AD animal models. Although various trials to establish AD animal models have been existed, even the mechanisms of AD in animal models are not enough clarified. @*Objectives@#This study assessed AD characteristics induced in Nishiki-nezumi Cinnamon/Nagoya (Nc/Nga) mice following trinitrochlorobenzene (TNCB) treatment for different periods and house dust mite (HDM) treatment to compare each model's immunological patterns, especially with cytokine antibody array tool. @*Methods@#In this study, we exposed Nc/Nga mice to TNCB or HDM extract to induce AD. Nc/Nga mice were divided into 4 groups: control, TNCB 2 weeks-treated, TNCB 8 weeks-treated, and HDM-treated groups. After AD induction, all mice were evaluated by serum immunoglobulin E (IgE) concentration and serum cytokine antibody assays, scoring of skin lesions, scoring of scratching frequency, and histological analysis. @*Results@#The results showed significant differences between groups in serum IgE concentration, skin lesion scores, and scratching frequency. The analysis results for serum cytokine antibody arrays showed that in the TNCB 8 weeks- and HDM-treated groups, but not in the TNCB 2 weeks-treated group, expressions of genes related to the immune response were enriched. Among the histological results, the skin lesions in the HDM-treated group were most similar to those of AD. @*Conclusions@#We confirmed that immunological pattern of AD mice was markedly different between HDM and TNCB treated groups. In addition, the immunological pattern was quietly different dependent on TNCB treated duration.

Atypical femoral neck fracture after prolonged bisphosphonate therapy

Of the drugs developed to prevent and treat osteoporosis, bisphosphonate has played a very important role in preventing osteoporotic fractures. However, case reports describing atypical femoral fractures in patients using long-term bisphosphonates have emerged. The majority of atypical femur fractures occurs in the lateral aspect of the subtrochanteric or femur diaphysis, which is explained by accumulation of tensile stress in these areas. Although the superior cortex of the femur neck withstands maximum tensile stress, to our knowledge, there have been only two reports (three cases) of atypical femoral neck fracture. In addition, none of those case reports revealed detailed pathology related to suppressed bone turnover rate. We encountered an incomplete femoral neck fracture and diagnosed it as “atypical” on the basis of the patient’s lack of trauma and medication history and pathological findings. For patients with groin pain, minimal or no trauma, and a history of long-term bisphosphonate use, an atypical femoral neck fracture should be considered.

Changes of fat-mass and obesity-associated protein expression in the hippocampus in animal models of high-fat diet-induced obesity and D-galactose-induced aging / 한국실험동물학회지

Fat-mass and obesity-associated protein (Fto) is highly expressed in the brain including, the hippocampus, and its expression is significantly decreased in the brain of Alzheimer’s disease patients. In the present study, we measured Fto immunoreactivity and protein levels in the hippocampus of obese and aged mice, which were induced by high-fat diet for 12 weeks and D-galactose treatment for 10 weeks, respectively. The obesity and aging phenotypes were assessed by physiological parameters and Morris water maze test, respectively. High fat diet fed mice showed significant increases in body weight and blood glucose levels compared to that in the control or D-galactose-induced aged mice. In addition, treatment with D-galactose significantly decreased the spatial memory. Fto immunoreactivity in the control group was mainly detected in the pyramidal cells of the CA1 and CA3 regions and in the granule cells of the dentate gyrus. In the hippocampus of high-fat diet-fed mice, Fto immunoreactive structures were similarly found in the hippocampus compared to that in the control group, but Fto immunoreactivity in high-fat diet-fed mice was also found in the stratum oriens and radiatum of the CA1 and CA3 regions and the polymorphic layer of the dentate gyrus. In the hippocampus of D-galactose-induced aged mice, fewer Fto immunoreactive structures were detected in the granule cell layer of the dentate gyrus compared to the control group. Fto mRNA and protein levels based on quantitative real-time polymerase chain reaction and western blot assays were slightly increased in the hippocampus of high-fat diet-fed mice compared to that in control mice. In addition, Fto mRNA and protein levels were significantly decreased in the aged hippocampus compared to that in the control group. Fto protein levels are susceptible to the aging process, but not in the hippocampus of high-fat diet-induced obesity. The reduction of Fto in aged mice may be associated with reduced memory impairment in mice.

Analysis of factors affecting customer satisfaction of HACCP applied restaurant in highway service area / 한국영양학회지

PURPOSE: The purposes of this study were to investigate food consumption practices and analyze factors that influence customer satisfaction of an HACCP applied restaurant in a highway service area. METHODS: A total of 207 customer responses were used for data analysis. Statistical analyses were conducted using the SPSS program (ver. 22.0) for χ²-test, Pearson correlation analysis, and multiple regression analysis. RESULTS: Reasons for visiting the highway area were using the restroom (86.0%), purchasing of meals or snacks (70.1%), taking a rest (58.5%), and shopping (3.4%) and selection attributes of food sold in the highway service area were food taste (48.8%), food safety (33.3%), and waiting time for meal (10.7%). According to the results of the survey, udon (66.2%) was the most preferred meal, followed by instant noodles (56.0%), kimbap (50.7%), pork cutlet (38.2%), and bibimbap (29.0%). In addition, coffee (73.4%) was the most preferred among snacks and beverages, followed by beverages (58.9%), walnut cake (53.1%), mineral water (52.2%), and hotbar (52.2%). Satisfaction evaluation scores of foods sold in the highway service area were highest for appropriate portion size, followed by food safety, menu variety, food taste, and reasonable price. Overall customer satisfaction scores regarding the restaurant in the highway service area was 3.24 out of 5 points on average. According to the results of the multiple regressing analysis, food taste (p < 0.001) and reasonable price (p < 0.01) had significant positive effects on overall customer satisfaction. CONCLUSION: To enhance customer satisfaction, restaurant managers in the highway service area should implement HACCP, improve food taste, and set up a proper price for food sold at the restaurant in the highway service area.

Analysis of clinical characteristics and causes of chest pain in children and adolescents / 소아과

PURPOSE: Chest pain is common in children and adolescents and is a reason for referral to pediatric cardiologists. Although most cases of chest pain in these age groups are benign and do not require treatment, timely diagnosis is important not to miss life-threatening diseases requiring prompt treatment. We investigated certain clinical characteristics that may be useful in the diagnosis of such critical diseases. METHODS: Patient medical records between July 2006 and September 2013 were retrospectively examined. We included 517 patients who presented with chest pain to the Department of Pediatrics at Kyung Hee University Hospital in Gangdong. RESULTS: Most cases of chest pain were idiopathic in origin (73.6%), followed by cases with respiratory (9.3%), musculoskeletal (8.8%), cardiac (3.8%), gastrointestinal (2.9%), and psychiatric (1.4%) causes. In 6 patients (1.2%) with air-leak syndrome including pneumothorax or pneumomediastinum, the pain was abrupt, continuous, and lasted for a short period of 1-2 days after onset in the older adolescents. Of the patients with cardiac pain, 13 had cardiac arrhythmias (65.0%), 6 had congenital heart diseases (30%), and 1 had coronary aneurysms caused by Kawasaki disease (5.0%). One patient with atrial flutter had only symptoms of syncope and chest pain. CONCLUSION: The abrupt, continuous chest pain of a short duration in the older children was characteristic of air-leak syndrome. In patients with pneumomediastinum, radiological diagnosis was difficult without careful examination. Combined syncope should not be neglected and further cardiac workup is essential in such patients.

A Case of Subcutaneous Fat Necrosis of the Newborn with Hypoglycemia and Meconium Aspiration Syndrome / 대한주산의학회잡지

Subcutaneous fat necrosis of the newborn is a rare, benign disease usually found in full-term infants. It occurs usually in a few weeks after birth, as one or multiple indurated nodules or plaques on the fat pads-rich fraction of the body and disappeared after few weeks to months. Complications such as hypercalcemia, pain, lipid abnormalities (dyslipidemia), renal failure, and subcutaneous atrophy may occur. We report a case of subcutaneous fat necrosis associated with hypoglycemia and meconium aspiration syndrome in the term infant and review the associated literatures.

Morbidity of Low Birth Weight Infants in Korea (2012): A Comparison with Japan and the USA

PURPOSE: This study aimed to identify the morbidity in very low birth weight infants (VLBWI) and low birth weight infants (LBWI) in Korea and compare these data with similar data from Japan and the USA. METHODS: The analysis of morbidity in VLBWI in Korea was based on a 2012 survey of morbidity in LBWI in Korea. These findings were compared with the morbidity of VLBWI and LBWI in Japan and the USA. RESULTS: Morbidities in LBWI included jaundice (58.5%), respiratory distress syndrome (RDS; 37.0%), apnea (22.2%), patent ductus arteriosus (PDA; 22.0%), and small for gestational age (SGA; 19.2%). The research findings concerning LBWI morbidity found, high prevalence rates for neonatal jaundice, RDS, PDA, SGA, apnea, and sepsis. Compared with VLBWI morbidity of Japan and the USA, intraventricular hemorrhage, RDS, PDA, and sepsis were more prevalent in Korea, whereas bronchopulmonary dysplasia, necrotizing enterocolitis, and retinopathy of prematurity occurred at similar frequencies in all 3 countries. CONCLUSION: This study provides a recent nationwide summary of disease-specific morbidity in VLBWI and LBWI in Korea. Based on this study, future research and surveys are needed to identify the disease-specific mortality and survival rates in the field of neonatal intensive care.

Radiofrequency thermocoagulation of the thoracic splanchnic nerve in functional abdominal pain syndrome: A case report / 대한마취과학회지

The thoracic splanchnic nerve block has been used in managing abdominal pain, especially for pains arising from abdominal cancers. A 27-year-old male patient who had a constant abdominal pain was referred to our clinic for pain management but had no organic disease. The numeric rating scale (NRS) for pain scored 7/10. We applied a diagnostic thoracic splanchnic nerve block under the diagnosis of functional abdominal pain syndrome. Since the block reduced the pain, we applied a radiofrequency thermocoagulation at the T11 and T12 vertebral level. Thereafter, his symptoms improved markedly with pain decreasing to an NRS score of 2-3/10. Hereby, we report a successful management of functional abdominal pain via radiofrequency thermocoagulation of the thoracic splanchnic nerves.

The effect of multimodal approach with combination of antiemetics and total intravenous anesthesia on postoperative nausea and vomiting in very high-risk patients

BACKGROUND: Postoperative nausea and vomiting (PONV) is a long standing problem in both surgical patients and anesthesiologists, and the treatment of this problem is very important.The purpose of this study was to evaluate the effect of multimodal approach with combination of antiemetics and total intravenous anesthesia (TIVA) on PONV in very high risk patients identified by the Korean predictive model. METHODS: Between March 2008 and February 2009, we evaluated 96 patients who were considered to be at very high risk of PONV according to the Korean predictive model.Among the patients, those who received antiemetic combination of dexamethasone and ondansetron were allocated to treatment group (T) and, those who underwent operation without antiemetics were placed in control group (C).All patients were anesthetized using propofol and remifentanil.We evaluated the incidences of PONV in two groups during the first 24 hours after surgery. RESULTS: The overall incidence of PONV was 14 (29.17%) in C group and 4 (8.33%) in T group, respectively (P = 0.027). CONCLUSIONS: The overall incidence of PONV in T group was significantly lower than that of C group.This study shows that multimodal approach with combination of antiemetics and TIVA was effective in preventing PONV in patients with very high risk.

Determination of Adequate Entry Angle of Lumbar Sympathetic Ganglion Block in Korean

BACKGROUND: The target of lumbar sympathetic ganglion block is the anterolateral surface of the L2, 3 and 4 vertebral bodies, where the lumbar sympathetic ganglion usually lies. In most cases, a block-needle is inserted approximately 5-8 cm lateral to spinous process on the skin and directed to the anterolateral surface of vertebral body obliquely. The purpose of this study is to determine the safe entry angle and entry point in Korean by using the abdominal CT scan images. METHODS: The abdominal CT images of eighty five patients were recruited to this study. The minimal angle aimed at the lumbar sympathetic ganglion that can pass through the lateral aspect of body and maximal angle that avoids puncturing the kidney, ureter or retroperitoneal space were measured. The distance from midline to skin entry point was also measured. RESULTS: There was no significant difference in entry angle among L2, 3, and 4 level. The entry angle was similar in the right and left side, and in males and females. The entry angle of old age group was significantly smaller than that of young age group. The calculated safe entry angle was 30.5 +/- 0.4degrees and entry point was 7.7 +/- 0.2 cm and 6.7 +/- 0.1 cm lateral from midline in males and females respectively. CONCLUSION: These measurements can be used as a reference for lumbar sympathetic ganglion block and radiofrequency lesioning. Prior to performing the lumbar sympathetic ganglion block for cancer patients, the abdominal CT scan should be reviewed to prevent complications.

Two Cases of Bacteremia Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus / 감염과화학요법

Recent reports have described an increasing incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in patients who do not exhibit established risk factors for healthcare exposure. We report two cases of CA-MRSA bacteremia complicated by vertebral osteomyelitis. Both of CA-MRSA isolates were resistant to beta-lactam agents, but susceptible to clindamycin, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, and tetracycline. Both isolates carried staphylococcal cassette chromosome mec (SCCmec) type IVA, and were identified as sequence type (ST) 72 by mlultilocus sequence typing (MLST). However, the Panton-Valentine leukocidin (PVL) gene was not identified.

Two Cases of Bacteremia Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus / 감염과화학요법

Recent reports have described an increasing incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in patients who do not exhibit established risk factors for healthcare exposure. We report two cases of CA-MRSA bacteremia complicated by vertebral osteomyelitis. Both of CA-MRSA isolates were resistant to beta-lactam agents, but susceptible to clindamycin, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, and tetracycline. Both isolates carried staphylococcal cassette chromosome mec (SCCmec) type IVA, and were identified as sequence type (ST) 72 by mlultilocus sequence typing (MLST). However, the Panton-Valentine leukocidin (PVL) gene was not identified.

Is Intravenous Patient Controlled Analgesia Enough for Pain Control in Patients Who Underwent Thoracoscopy?

This prospective randomized study was conducted to evaluate the efficacy of two common analgesic techniques, thoracic epidural patient-controlled analgesia (Epidural PCA), and intravenous patient-controlled analgesia (IV PCA), in patients undergoing lobectomy by the video-assisted thoracic surgical (VATS) approach. Fifty-two patients scheduled for VATS lobectomy were randomly allocated into two groups: an Epidural PCA group receiving an epidural infusion of ropivacaine 0.2%+fentanyl 5 microg/mL combination at a rate of 4 mL/hr, and an IV PCA group receiving an intravenous infusion of ketorolac 0.2 mg/kg+fentanyl 15 microg/mL combination at a rate of 1 mL/hr. Pain scores were then recorded using the visual analogue scale at rest and during motion (VAS-R and VAS-M, 0-10) for five days following surgery. In addition, we measured the daily morphine consumption, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), satisfaction score, and the incidence of side effects. Thirty-seven patients out of 52 completed the study (18 in the Epidural PCA group, 19 in the IV PCA group). There were no differences in the pain scores, analgesic requirements, pulmonary function, satisfaction score, and the incidence of side effects between groups. This indicates that IV PCA and Epidural PCA are equally effective to control the postoperative pain after VATS lobectomy, which suggests that IV PCA may be used instead of Epidural PCA.

Fluoroscopy-guided pudendal nerve block and pulsed radiofrequency treatment : A case report / 대한마취과학회지

Pudendal nerve block (PNB) is performed for differential diagnosis and treatment of chronic pelvic and perineal pain. Several block methods, such as transvaginal, transperineal, computerized tomography-, ultrasound- and fluoroscopy-guided approach are currently under practice. Compared to others, a fluoroscopy-guided approach has several advantages, such as its relatively low cost, facility and ease of landmark recognition. We depicted a fluoroscopy-guided PNB technique to selectively block and elaborate a pulsed radiofrequency treatment in a 51-year-old man with chronic pelvic and perineal pain. The patient had undergone a ganglion of impar block with a limited pain relief. Thereafter, a PNB was performed and the pain was relieved significantly for 2 weeks. Further PNB with a pulsed radiofrequency treatment reduced the pain for more than 8 weeks. The pain relief sustained up to the time of this report. The fluoroscopy-guided PNB and pulsed radiofrequency treatment allowed simplicity in manipulation and precision in performing the procedures with a favorable outcome.

Intravascular injection in cervical medial branch block: an evaluation of 361 injections

BACKGROUND: The prevalence of persistent neck pain, secondary to involvement of cervical facet or zygapophysial joints, has been described in controlled studies as varying from 39% to 67%. Cervical medial branch block (MBB) represents a useful interventional pain management procedure indicated in patients with a chronic neck pain of facet joint origin. In the current study, we prospectively evaluated the incidence of, and the factors associated with, intravascular injection during block. In addition, we assessed the efficiencies of generally accepted safety measures, such as pre-injection aspiration and intermittent fluoroscopy to avoid intravascular injections. METHODS: We prospectively examined 361 cervical MBBs in 158 patients performed by 2 physicians. Aspiration test, spot radiography, and contrast injection under real-time fluoroscopic visualization were performed sequentially without repositioning the needle. Incidences of blood flash back and the presence of intravascular contrast spread on spot radiographic images and during real-time fluoroscopy were checked. The factors studied for intravascular injection included patient age and sex and block spinal level. RESULTS: No specific factors were found to affect the incidence of intravascular uptake during block. The overall incidence of intravascular uptake was 3.3% per nerve block (12/361), and 7 of these were predicted by pre-injection aspiration (sensitivity = 58.3%) and 8 by spot radiography (sensitivity = 66.7%). CONCLUSIONS: The aspiration test with or without spot radiography frequently missed the intravascular uptake of contrast during cervical MBBs. We strongly advocate the use of real-time fluoroscopy during contrast injection to increase diagnostic and therapeutic value and to avoid possible complications.

The Effective Steroid Dose of Caudal Epidural Injection with Unilateral Epidural Catheter Position in Patients with Symptomatic Herniated Nucleus Purposus / 대한마취과학회지

BACKGROUND: The epidural steroid injection is commonly used in the management of chronic low back pain and radiating pain. We compared the efficacy of 40, 60, and 80 mg of methylprednisolone acetate in patients with lumbar herniated disc disease treated with caudal epidural block. METHODS: Seventy-two patients with lumbar herniated nucleus purposes on magnetic resonance imaging were included.All patients received fluoroscopically guided caudal epidural injections, with the guidewire-reinforced epidural catheter introduced through a Tuohy needle.After confirming the catheter tip position at the affected nerve root, contrasts were injected until patients felt discomfort in their site of pain.24 patients in each group received 40 mg, 60 mg, 80 mg of methylprednisolone acetate, respectively.We evaluated the improvements by pain relief scale (0-100%) after 2 weeks. RESULTS: There are no significant differences in the pain improvement between three groups (P = 0.537 ). CONCLUSIONS: Sixty and 80 mg methylprednisolone acetate injection during caudal epidural block showed no further benefit compared to 40 mg injection.