Effect of Cervical Interlaminar Epidural Steroid Injection: Analysis According to the Neck Pain Patterns and MRI Findings

BACKGROUND: It is widely accepted that cervical interlaminar steroid injection (CIESI) is more effective in treating radicular pain than axial neck pain, but without direct comparison. And the differences of effect after CIESI according to MRI findings are inconsistent. In this retrospective study, we evaluated the therapeutic response of CIESI according to pain sites, durations, MRI findings, and other predictive factors altogether, unlike previous studies, which evaluated them separately. METHODS: The medical records of 128 patients who received fluoroscopy guided CIESI were analyzed. We evaluated the therapeutic response (more than a 50% reduction on the visual analog scale [VAS] by their second visit) after CIESI by (1) pain site; neck pain without radicular pain/radicular pain with or without neck pain, (2) pain duration; acute/chronic (more than 6 month), and (3) findings of MRI; herniated intervertebral disc (HIVD)/spinal stenosis, respectively and altogether. RESULTS: Eighty-eight patients (68%) responded to CIESI, and there were no significant differences in demographic data, initial VAS score, or laboratory findings. And there were no significant differences in the response rate relating to pain site, pain duration, or MRI findings, respectively. In additional analysis, acute radicular pain with HIVD patients showed significantly better response than chronic neck pain with spinal stenosis (P = 0.04). CONCLUSIONS: We cannot find any sole predictive factor of therapeutic response to the CIESI. But the patients having acute radicular pain with HIVD showed the best response, and those having other chronic neck pain showed the worst response to CIESI.

Correction of target-controlled infusion following wrong selection of emulsion concentrations of propofol / 대한마취과학회지

BACKGROUND: We investigated the correction methods following wrong-settings of emulsion concentrations of propofol as a countermeasure against erroneous target-controlled infusions (TCI). METHODS: TCIs were started with targeting 4.0 microg/ml of effect-site concentration (C(eff)) of propofol, and the emulsion concentrations were selected for 2.0% instead of 1.0% (FALSE(1-2), n = 24), or 1.0% instead of 2.0% (FALSE(2-1), n = 24). These wrong TCIs were corrected at 3 min after infusion start. During FALSE(1-2), the deficit was filled up while injecting after equilibrium (n = 12), or while overriding (n = 12). During FALSE(2-1), the overdose was evacuated while targeting C(eff) (n = 12) or targeting plasma concentration (C(p)) (n = 12). The gravimetrical measurements of TCI reproduced the C(p) and C(eff) using simulations. The reproduced C(eff) at 3 min (C(eff-3min)) and the time to be normalized within +/- 5% of target C(eff) (T(+/-5%)), were compared between the correction methods. RESULTS: During the wrong TCI, C(eff-3min) was 1.98 +/- 0.01 microg/ml in FALSE(1-2), and 7.99 +/- 0.05 microg/ml in FALSE(2-1). In FALSE(1-2), T(+/-5%) was significantly shorter when corrected while overriding (3.9 +/- 0.25 min), than corrected after equilibrium (6.9 +/- 0.05 min) (P < 0.001). In FALSE(2-1), T(+/-5%) was significantly shorter during targeting C(p) (3.6 +/- 0.04 min) than targeting C(eff) (6.7 +/- 0.15 min) (P < 0.001). CONCLUSIONS: The correction methods, based on the pharmacokinetic and pharmacodynamic characteristics, could effectively and rapidly normalize the wrong TCI following erroneously selections of the emulsion concentration of propofol.

Administration of four different doses of gabapentin reduces awakening from breakthrough pain and adverse effects in outpatients with neuropathic pain during the initial titration / 대한마취과학회지

BACKGROUND: Gabapentin is a safe and well-tolerated anticonvulsant with a wide therapeutic index, and it is used for neuropathic pain. The aim of this study was to compare previous dosing methods with the administration of four different doses of gabapentin while maintaining the same maximum daily dose for the safe administration of high doses of the medication. METHODS: The subjects were outpatients with various neuropathic pain syndromes, with at least two of the following symptoms: allodynia, burning pain, shooting pain, or hyperalgesia. The TID group received equal doses of gabapentin 3 times per day, while the QID group received 4 different doses of gabapentin per day. The pain score, frequency of breakthrough pain (BTP), severity and the duration of pain, sleep disturbance due to nocturnal pain, and adverse effects were recorded each day. RESULTS: The average daily pain score and sleep disturbance were significantly reduced in the QID group between days 3 and 10 of the experiment. The adverse effects of the medication were also reduced in the QID group. However, the frequency of BTP and severity and duration of pain were not significantly different between two groups. CONCLUSIONS: Administration of 4 different doses of gabapentin during the initial titration in outpatients with neuropathic pain resulted in a significant reduction in awakening from breakthrough pain and a reduction in the adverse effects of the medication.

Compression of the left subclavian artery caused by a transesophageal echocardiography probe in an infant with a right-sided aortic arch: A case report

Intraoperative transesophageal echocardiography (TEE) has become an important monitoring device for patients undergoing cardiac or noncardiac surgery. Complications associated with TEE are unusual, but the potential for TEE probe compression of the posterior vascular structures has been reported in baby patients. We present here a case of compression of the left subclavian artery in an infant with a right-sided aortic arch after insertion of a TEE probe.

Efficacy of Stellate Ganglion Block in Cholinergic Urticaria with Acquired Generalized Hypohidrosis

Cholinergic urticaria with acquired generalized hypohidrosis, and its pathophysiology is not well known. Autoimmunity to sweat glands or to acetylcholine receptors on sweat glands has been mentioned as one of the possible etiologies. Systemic steroid therapy, antihistamines, anticholinergics, and avoidance of the stimulatory situations are recommended for treatment. We experienced a case of cholinergic urticaria with acquired generalized hypohidrosis in a patient who had no other associated disease, and the symptoms eased after repeated bilateral stellate ganglion block. Stellate ganglion block normalized the elevated sympathetic tone and may relieve symptoms in patients with this condition.

Recurrent Extranodal Marginal Zone B-Cell Lymphoma Presenting as a Huge Cheek Mass after Radiotherapy on Ocular Adnexal Lymphoma / 대한이비인후과학회지

Extranodal marginal zone B-cell lymphoma of mucosa associated lymphoid tissue (MALT lymphoma) is a low-grade B-cell lymphoma that presents with an indolent clinicopathologic nature. Although this tumor can occur in various sites, including the gastrointestinal, skin, salivary gland and ocular adnexa, radiation therapy shows high local control in that disease. We report a case of recurrent MALT lymphoma presenting a huge cheek mass after radiotherapy on ocular adnexal lymphomas. An 65-year-old man had a history of treatments on MALT lymphomas of ocular adnexa came again with a huge cheek mass, not recurred and not originated from salivary gland, skin, other related mucosa tissues. He got excisional biopsy and was confirmed immunohistochemically as MALT lymphoma. After diagnosis, he was sent urgently to a radiotherapist for further treatment. He responded well to added radiotherapy with 36 Gy dose and has remained well at 6 months after his initial presentation.

Clinical Analysis of Inguinal Hernia in Adult Using Prolene Hernia System

PURPOSE: The aim of this study was to detail clinical experiences with a type of tension-free herniorrhaphy using the prolene hernia system (PHS) and analyze the system's usefulness. METHODS: We retrospectively reviewed the medical records of 122 patients who underwent an inguinal hernia repair using PHS between March 2004 and August 2008. RESULTS: There were 116 male and 6 female patients ages 14 to 99; 79 indirect, 33 direct, 10 pantaloon hernias. The right inguinal hernias were more frequent (64.7%). The mean operative time for inguinal hernia repair using PHS was 45.2+/-1.5 minutes and the mean postoperative hospital stay was 3.5+/-1.5 days (101+/-82.9 hours). The most frequent combined disease was hypertension. The most frequent complication of PHS repair was hematoma. The mean number of used analgesics was 3.1+/-3.3. There were no postoperative recurrences. CONCLUSION: Tension-free herniorrhaphy using PHS is thought to be a useful method of inguinal hernia repair in adults because it offers lower postoperative pain, shorter operation time and shorter postoperative hospital stay.

Otogenic Pneumocephalus Associated with a Ventriculoperitoneal Shunt

Otogenic pneumocephalus is a condition of intracranial air originating from the middle ear or mastoid air cells. This communication between the intracranial cavity and the pneumatic cavities is usually associated with trauma after cranial fractures or iatrogenic trauma. We present a rare case of otogenic pneumocephalus arising in the left posterior fossa from wellpneumatized mastoid air cells. The patient complained of roaring tinnitus that developed 29 months after ventriculoperitoneal shunt insertion due to brain tumor surgery. High resolution computed tomography scan of the temporal bones revealed a large pneumocephalus below the left tentorium, and a bony dehiscent route was clearly identified in a sagittal view. A left mastoidectomy with preservation of the posterior wall of the external auditory canal was performed, and the expected bony dehiscent site was identified in the posterior fossa dura plate, just posterior to the posterior semicircular canal, below the Donaldson's line. This communication was sealed with a temporalis muscle plug from the deep temporalis muscle fascia and bone dust. Pneumocephalus may be caused by negative intracranial pressure in a patient with very well-pneumatized mastoid bone, and it can be a possible cause of 'wind-like' sound in the ear.

Pneumatosis Cystoides Intestinalis with Intestinal Volvulus

Pneumatosis cystoides intestinalis is an uncommon condition characterized by the presence of multiple gas-filled cysts within the wall of the gastrointestinal tract. It is still a poorly understood phenomenon, considered to result from primary mucosal insult from varying causes. However, it is associated with various diseases, including gastroenteral obstructive and connective vascular diseases and even pulmonary or endocrine diseases. Authors report a case of pneumatosis cystoides intestinalis with volvulus in the small intestine that developed in a 44-year-old man without history of any special underlying diseases.

Suggestion of Safer and Easier Technique of Suprascapular Nerve Block based on Cadaver Study

OBJECTIVE: To suggest a safer and easier technique of suprascapular nerve block by assessing anatomical relationship of the suprascapular notch from a view point of surface anatomy. METHOD: Fourteen shoulders of seven cadavers were dissected in prone position. The scapular notch was exposed and the articular branch of suprascapular nerve was observed. The length and depth of spine, height and relative position of scapular notch were measured for all of the specimen. RESULTS: The length of the spine was 11.45+/-0.72 cm. The injection point was measured as relative position of scapular notch on the spine. The ratio between distance from medial border of the spine to injection point and from the injection point to posterior angle of acromion was 1.89+/-0.2: 1. The depth of the spine, which was defined as the shortest vertical distance from the injection point to the scapula was 2.69+/-0.43 cm, and the vertical distance from this contact point to the base of the scapular notch, e.g. the height of the scapular notch, was 1.18+/-0.1 cm. CONCLUSION: We expect we could perform suprascapular nerve block easily and safely with suggested surface landmarks and measured data in this study.