Paraplegia after transforaminal epidural steroid injection in a patient with severe lumbar disc herniation - A case report -

Background@#Transforaminal epidural steroid injection (TFESI) is a conservative treatment for patients with lumbar disc herniation (LDH). However, there are reports of various complications that can occur after TFESI; among these, paraplegia is a serious complication. Case: A 70-year-old woman who was unable to lie supine due to low back pain exacerbation during back extension underwent TFESI. After injection, there was pain relief and the patient was able to lie supine; however, paraplegia developed immediately. Magnetic resonance imaging confirmed cauda equina syndrome (CES) due to nerve compression from L1–2 LDH. We determined that the patient's LDH was already severe enough to be considered CES and that the TFESI procedure performed without an accurate understanding of the patient's condition aggravated the disease. @*Conclusions@#It is important to accurately determine the cause of pain and disease state of a patient to establish a correct treatment plan before TFESI is performed.

The efficacy of vitamin C on postlaparoscopic shoulder pain: a double-blind randomized controlled trial

BACKGROUND: This study evaluated the effect of vitamin C on post-laparoscopic shoulder pain (PLSP) in patients undergoing benign gynecological surgery during the first 72 h. METHODS: Sixty patients (aged 20 to 60 years, with American Society of Anesthesiologists physical status classification I or II) scheduled for elective laparoscopic hysterectomy were enrolled in this study. The vitamin C group (Group C) received 500 mg of vitamin C in 50 ml of isotonic saline infusion intravenously twice a day from the day of surgery to the third day after surgery. Patients in the saline group (Group S) received the same volume of isotonic saline over the same period. Post-operative analgesic consumption, pain scores of the incision site and the shoulder, and the incidence of PLSP were all evaluated at 1, 6, 24, 48, and 72 h following surgery. RESULTS: Cumulative post-operative fentanyl consumption was significantly less in Group C at 24 and 48 h after surgery (P = 0.002, P = 0.012, respectively). The pain intensity of PLSP was also significantly lower in Group C 24 h after the operation (P = 0.002). Additionally, the incidence of PLSP was significantly lower in Group C 24 and 48 h after the operation (P = 0.002, P = 0.035, respectively). CONCLUSIONS: Perioperative intravenous administration of vitamin C (500 mg, twice a day) reduced post-operative analgesic consumption and significantly lowered the pain intensity and incidence of PLSP.

Subarachnoid hematoma after spinal anesthesia: A case report

Spinal subarachnoid hematoma is a very rare complication of spinal anesthesia. This complication can, and is, often overlooked and dismissed as a fatal neurological consequence of (what amounts to) delayed diagnosis. In this case, a 59-year-old female patient with no specific medical history underwent right knee arthroscopy under spinal anesthesia. The arthroscopic surgery concluded without complications but, on the first postoperative day, the patient complained of lower back pain, headache, nausea, vomiting. On the fifth postoperative day, magnetic resonance imaging was taken and it revealed evidence of a subarachnoid hematoma involving the L3 and L4 vertebral levels. Hematoma evacuation was performed, and the patient recovered without sequelae. Here, we report this case that lumbar spinal subarachnoid hematoma was found five days after spinal anesthesia which was done in a patient without coagulopathy.

Heating of infusion fluids through heated breathing circuits

BACKGROUND: Hypothermia is a common physiological condition that occurs during surgical operations. The goal of this experiment is to measure the temperature of the fluids flowing through heated breathing circuits with respect to changes in infusion speed. METHODS: The infusion pump was connected to the intravenous inlet of a heated breathing circuit with two 50 cm extension lines connected to the outlet. Fluids were injected through the heated breathing circuit at 100, 200, 300, 400, 500, 600, and 700 ml/h, with measurement of the fluid temperature immediately after transit (OP 20), 70 cm after transit (OP 70), and 120 cm after transit (OP 120). RESULTS: The mean fluid temperatures at OP 20, OP 70, and OP 120 were 40.7 ± 4.8℃, 35.1 ± 3.22℃, and 31.7 ± 2.5℃, respectively. CONCLUSIONS: The heated breathing circuit was effective to heat the fluid. After passing out the heated breathing circuit, the temperature of the fluid continuously reduced. A length of 70 cm can be used to efficiently supply heated fluid to the patient. From this experiment, it is expected that supplying heated fluid to a patient using the heated breathing circuit will help maintain the patient's body temperature.

Treatment of osteonecrosis of the femoral head by botulinum toxin type A injection to the psoas muscle: A case report

Osteonecrosis of the femoral head (ONFH) can cause femoral head depression and cortical discontinuity. Treatment for ONFH remains challenging. We performed botulinum toxin type A injection to psoas major muscle in five patients with radiological femoral head collapse (Association Research Circulation Osseus classification stage III) who were non-responsive after two years of conservative treatment (tramadol 200 mg/day, mefenamic acid 1,000 mg/day). At two weeks after the procedure, their mean hip pain was decreased from 88 ± 0.4/100 mm to 22 ± 0.4/100 mm based on visual analogue scale (VAS). The pain was maintained at a minimum of 20/100 mm and a maximum of 30/100 mm in VAS for at least six weeks after the procedure. These values were mean ± SD. These patients were followed-up for 6 months. There was no exacerbation of pain from repeated (three times) botulinum toxin type A injection to the psoas major muscle.

Prevalence and Antimicrobial Susceptibility of Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum in Individuals With or Without Symptoms of Genitourinary Infections

BACKGROUND: The aim of this study was to determine the prevalence and antimicrobial susceptibility of Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum among patients displaying symptoms of genitourinary infections and asymptomatic volunteers. METHODS: Genitourinary samples were collected from 897 participants (365 symptomatic patients and 532 asymptomatic volunteers). The samples were analyzed using multiplex real-time PCR (Anyplex™ II, Seegene, Korea), multiplex PCR (Seeplex®, Seegene), and Mycoplasma IST 2 Kit (bioMerieux, France). RESULTS: The prevalence of M. hominis, U. urealyticum, and U. parvum in the genitourinary samples of symptomatic patients compared with asymptomatic volunteers was 9.9% vs. 5.5%, 12.3% vs. 9.0%, and 36.4% vs. 30.8%, respectively. After eliminating cases of co-infections with other pathogens, there was a significant difference in the prevalence of M. hominis between symptomatic patients and asymptomatic volunteers (9.1% vs. 5.2%, P<0.05), but not in the prevalence of U. urealyticum and U. parvum organisms. When tested for antimicrobial susceptibility, more than 95.5% of each species were susceptible to tetracycline, doxycycline, josamycin, and pristamycin. More than 78.9% of Ureaplasma spp. were susceptible to azithromycin, erythromycin, and clarithromycin; however less than 4.2% of M. hominis were susceptible to these antibiotics. When tested with ofloxacin and ciprofloxacin, 40.9-58.9% and 9.1-25.0% of the three species were susceptible to these drugs, respectively. CONCLUSIONS: M. hominis is the leading causative pathogen for genitourinary infection; however the involvement of Ureaplasma spp. is debatable. For optimal antimicrobial therapy, the accurate detection of these organisms and determination of antimicrobial susceptibility is crucial considering their diverse antimicrobial susceptibility patterns.

The Changes of Voiding Pattern After Midurethral Sling Between Pure Stress Urinary Incontinence and Stress Urinary Incontinence With Overactive Bladder Group

PURPOSE: The purpose of this study is to compare changes in voiding pattern after midurethral sling surgery (MUS) between the stress urinary incontinence (SUI) group and the overactive bladder (OAB)+SUI group. MATERIALS AND METHODS: From January 2008 to February 2011, a retrospective survey was conducted of 225 female patients who had been diagnosed with SUI and undergone MUS. The subjects were divided into the SUI group and the OAB+SUI group. Changes in the overactive bladder symptom score (OABSS) and American Urological Association-Symptom Index (AUA-SI) before and three months after the MUS were compared. RESULTS: Of the 225 patients, 165 patients (73.3%) were classified as SUI group, and 60 patients (26.7%) were classified as OAB+SUI group. The mean age of the subjects was 54.7 years (range, 31-80 years), and the mean age of patients was 53.9 years (range, 34-80 years), and 56.8 years (range, 31-78 years) in the SUI group and OAB+SUI group. In SUI group, voiding symptom and storage symptom among the AUA-SI were significantly increased (p<0.05). OABSS were slight increased, but was statistically insignificant (p=0.847). In OAB+SUI group, voiding symptom score and OABSS showed a significant increase (p<0.05), but storage symptom score showed an insignificant increase (p=0.790). CONCLUSIONS: OAB may occur in approximately 18% of SUI patients who undergo MUS surgery, and voiding dysfunctions with deteriorated voiding symptom and storage symptom may also occur. The deteriorated OAB was shown in 45% of SUI patients with OAB after the surgery.

Ureteral Substitution Using Appendix for a Ureteral Defect Caused by a Retroperitoneal Rhabdomyosarcoma in a Child

A 7-year-old boy was diagnosed with a recurrent embryonal rhabdomyosarcoma in the retroperitoneum. After resection of the mass, direct end-to-end anastomosis of the ureter was not possible owing to the length of the resected segment. Accordingly, we performed ureteral substitution by using the appendix to repair the ureteral defect.

Perioperative consideration of general anesthesia for acromegalic patients / 대한마취과학회지

No abstract available.

Microbiological Characteristics of Acute Prostatitis After Transrectal Prostate Biopsy

PURPOSE: We aimed to identify microbiological characteristics in patients with acute prostatitis after transrectal prostate biopsy to provide guidance in the review of prevention and treatment protocols. MATERIALS AND METHODS: A retrospective analysis of medical records was performed in 1,814 cases who underwent prostate biopsy at Seoul St. Mary's Hospital and St. Vincent's Hospital over a 5 year period from 2006 to 2011. Cases in which acute prostatitis occurred within 7 days after the biopsy were investigated. Before starting treatment with antibiotics, sample collections were done for culture of urine and blood. Culture and drug susceptibility was identified by use of a method established by the Clinical and Laboratory Standards Institute. RESULTS: A total of 1,814 biopsy procedures were performed in 1,541 patients. For 1,246 patients, the procedure was the first biopsy, whereas for 295 patients it was a repeat biopsy. Twenty-one patients (1.36%) were identified as having acute bacterial prostatitis after the biopsy. Fifteen patients (1.2%) had acute prostatitis after the first biopsy, and 6 patients (2.03%) experienced acute prostatitis after a repeat biopsy. Even though the incidence of acute bacterial prostatitis was higher after repeat biopsy than that after the first biopsy, there was no statistically significant intergroup difference in terms of incidence (chi2=1.223, p=0.269). When the collected urine and blood samples were cultured, Escherichia coli was found in samples from 15 patients (71.4%), Klebsiella pneumoniae in 3 patients (14.3%), Enterobacter intermedius in 1 patient (4.8%), E. aerogenes in 1 patient (4.8%), and Pseudomonas aeruginosa in 1 patient (4.8%). A fluoroquinolone-resistant strain was confirmed in 5 cases (23.8%) in total. Three cases of E. coli and 1 case of Klebsiella had extended-spectrum beta-lactamase activity. CONCLUSIONS: Empirical treatment of acute prostatitis should be done with consideration of geographical prevalence and drug resistance. This study will provide meaningful information for the management of acute prostatitis after transrectal prostate biopsy.

The effectiveness of L2 nerve root block for the management of patients who are suffering from chronic low back and referred pain / 대한마취과학회지

No abstract available.

Fatal pulmonary thromboembolism during total hip replacement under spinal anesthesia / 대한마취과학회지

No abstract available.

Factors That Affect Nosocomial Catheter-Associated Urinary Tract Infection in Intensive Care Units: 2-Year Experience at a Single Center

PURPOSE: This study took a retrospective approach to investigate patients with catheter-associated urinary tract infection (CAUTI) over 2 years at a single hospital's intensive care unit (ICU) to identify meaningful risk factors and causative organisms. MATERIALS AND METHODS: A retrograde analysis was performed on patients with indwelling catheters between January 2009 and December 2010 in Yeouido St. Mary Hospital medical and surgical ICU. CAUTI was defined as isolated bacterial growth of 100,000 colony-forming units or more either 48 hours after transfer to the ICU if a urinary catheter was placed before the transfer or 48 hours after insertion if the catheter was inserted in the ICU. Only the patients whose culture results were negative before ICU admission were included. RESULTS: There were a total of 1,315 patients with indwelling urinary catheters in our hospital's medical and surgical ICU between January 2009 and December 2010. Of these patients, 241 had positive urine culture results, and 61 had CAUTI. Using multivariate logistic regression analysis, those with diabetes were 4.55 (p<0.001) times as likely to have occurrences of CAUTI than were those without and also had a 1.10-fold (p<0.01) longer duration of an indwelling catheter. Upon urine culture, among the 61 patients with CAUTI, Escherichia coli was the most common bacterium grown; it was identified in 24 patients (38.7%). CONCLUSIONS: The factors and causative organisms contributing to the development of CAUTI in the management of ICU patients must be considered to prevent the occurrence of UTIs in this setting.

The Relationship between Clinical Symptoms and Urine Culture in Adult Patients with Acute Epididymitis

PURPOSE: We evaluated adult patients with acute epididymitis to identify the frequency of actual sexual contacts and the causative organism, and compared clinical examinations, degrees of manifested symptoms, and radiological test results. MATERIALS AND METHODS: We reviewed the medical records of 65 patients older than 18 years presenting with acute epididymitis who had been treated between 2002 and 2011. Scrotal ultrasonography, urinalysis, and urine culture were performed to diagnose the acute epididymitis. Patients were divided into negative (n=45) and positive (n=20) urine culture groups. Then the latter groups were subdivided into a sexually transmitted organism (STO) culture group (n=13) and a non-STO (n=7) culture group. Data on any history of sexual contact, scrotal pain and tenderness, symptoms of urethritis (discharge, dysuria, urethral burning, or irritation), and lower urinary tract symptoms (dysuria, frequency, and urgency of urination) were obtained from all of the subjects. RESULTS: Patients in the positive urine culture group were significantly younger than those in the other group (p=0.224) and were more likely to have a history of sexual contact at least two weeks prior to onset of epididymitis (p=0.012). They had also a significantly enlarged epididymal head and significantly more severe complaints of pain or tenderness than those of latter group (p=0.348, p=0.288). However, the difference in these measures between the STO and non-STO group was not significant, except in the case of age (p=0.044). CONCLUSIONS: Patients of the positive urine culture group with acute epididymitis were significantly younger and more sexually active than the others. They also had severe pain or tenderness and an enlarged epididymal head. There was a close association between clinical symptoms, a positive urine culture, and ultrasonographic findings.

The Prevalence and Characteristic Differences in Prostatic Calcification between Health Promotion Center and Urology Department Outpatients

PURPOSE: We evaluated the differences in calculi characteristics and their prevalence according to the presence of lower urinary tract symptoms between adult patients examined at the Urology Department and those examined at the Health Promotion Center (HPC). MATERIALS AND METHODS: The prevalence of prostatic calcification, characteristics of calculi (number, size, and location), and differences in lower urinary tract symptoms were compared and analyzed for 479 subjects who underwent transrectal ultrasonography at the HPC and the Urology Outpatients Department at our hospital from October 2009 to October 2010. RESULTS: Of 479 subjects, 268 patients were examined at the HPC, and 211 were examined at the Urology Outpatients Department. Between the two groups, age, prostate-specific antigen levels, prostate volume transrectal ultrasonography, International Prostate Symptom Score (total, voiding, and storage), quality of life, and the prostatic calcification rate were significantly higher in the patients who visited the Urology Outpatients Department. The prevalence of prostatic calcification was 41.5% (199/479), with 36.1% (97/268) from the HPC and 48.3% (102/211) from the Urology Outpatients Department. When the characteristics of prostatic calcification were compared, there were no significant differences in the appearance, size, or location of the calculi between the two groups. CONCLUSIONS: The prevalence of prostatic calcification was high in patients complaining of lower urinary tract symptoms; however, there were no significant differences in the characteristics of the calculi. This finding leads us to believe that prostatic calcification can aggravate lower urinary tract symptoms but does not result in differences according to the number, size, or appearance of the calculi.

The Anti-inflammatory and Antimicrobial Effects of Selenium-rich Hot Spring Water on a Chronic Bacterial Prostatitis Rat Model / 대한남성과학회지

PURPOSE: The conventional primary therapy for chronic bacterial prostatitis (CBP) is the use of antibiotics. However, the therapy has a low cure rate and long-term use of antibiotics can lead to adverse effects including bacterial resistance. For these reasons, a new therapy for CBP is strongly needed. MATERIALS AND METHODS: To evaluate the anti-inflammatory and antimicrobial effects of selenium-rich hot spring water on CBP, rats were divided into four groups and treatment was administered for four weeks as follows: (1) control (n=8), (2) ciprofloxacin (n=8), (3) selenium-rich hot spring water (n=8), and (4) selenium-rich hot spring water with ciprofloxacin (n=8). Drip infusion of bacterial suspension (E. coli Z17 O2:K1;H-) into Spargue-Dowley rats was then conducted to induce CBP. Four weeks later, the results of prostate tissue and urine culture and histological analysis on the prostate were analyzed in each group. RESULTS: The use of ciprofloxacin, and selenium-rich hot spring water with ciprofloxacin showed statistically significant decreases in bacterial growth and improvements in prostatic inflammation compared with the control group (p<0.05). The selenium-rich hot spring water with ciprofloxacin group showed a statistically significantly lower rate of bacterial growth and and greater improvements in prostatic inflammation than the ciprofloxacin group (p<0.05). CONCLUSIONS: These results suggest that spring water may be an effective material in the treatment of CBP. Notably, the combination treatment of selenium-rich hot spring water and ciprofloxacin has synergistic effects. Therefore, we can suggest that the combination of selenium-rich hot spring water and ciprofloxacin may be effective in the treatment of CBP, and with a higher success rate than ciprofloxacin alone.

Safety and Efficacy of Bearxat(R)XL Tablet (alfuzosin 10 mg) in Patients with Benign Prostatic Hyperplasia: A Prospective Multicenter Study of Primary Care Clinics / 대한남성과학회지

PURPOSE: A prospective multi-center study was conducted to evaluate the safety and efficacy of alfuzosin (10 mg), for male lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in primary care clinics. MATERIALS AND METHODS: Three hundred twenty-four patients with complaints of LUTS associated with BPH were enrolled from 17 clinics. Patients received a 12-week course of 10 mg alfuzosin (Bearxat(R)XL Tablet) once daily, and underwent follow-up at 2~4 and 12 weeks post-treatment. The maximum flow rate (Qmax) and residual urine volume (RUV) were measured at each visit. The International Prostate Symptom Score (IPSS), Quality of Life (QoL), and International Index of Erectile Function (IIEF-5) were evaluated at baseline and post-treatment. During the study period, the presence of orthostatic hypotension was evaluated by blood pressure measurement before and after a postural change. Any adverse effects of alfuzosin including retrograde ejaculation were assessed. RESULTS: Of the 324 enrolled patients, 62 (19.1%) patients dropped out and a total of 262 patients were evaluated. Each value of Qmax, RUV, IPSS, QoL, and IIEF-5 was significantly improved from 14.19+/-8.85 ml/sec, 41.10+/-81.44 ml, 18.04+/-7.36, 3.81+/-0.86, and 11.75+/-6.91, respectively, at baseline, to 15.68+/-6.25 ml/sec, 24.29+/-29.46 ml, 12.19+/-5.59, 2.54+/-0.91, and 12.33+/-7.55, respectively, at end-point. Retrograde ejaculation was found in 2 patients (2/255, 0.78%) at 2~4 weeks and 1 patient (1/152, 0.66%) at 12 weeks. The frequency of orthostatic hypotension was 13.27% (30/226) at baseline, 13.11% (27/206, p=0.8658) at 2~4 weeks, and 14.29% (19/133, p=0.8348) at end-point. The number of patients with adverse events was 36 where the number of adverse events was 60. Among those 60 adverse events, 8 events were related to treatment, which consisted of headache (2), dizziness (2), palpitation (1), voiding difficulty (1), erectile dysfunction (1), and arthralgia (1). CONCLUSIONS: Treatment with alfuzosin (10 mg) once daily led to significant improvements in LUTS associated with BPH and QoL in primary care clinic patients. alfuzosin (10 mg) use resulted in few hypotensive events, no deleterious effect on sexual function, and no drug related SAEs during the study. The study findings suggest that alfuzosin (10 mg) can be safely prescribed in primary care clinics for male LUTS with efficacy.

Guillain-Barre syndrome after lumbar epidural block / 대한마취과학회지

No abstract available.

A survey on the clinical practice and the guidelines for sexually transmitted infections in Korea

Every year 150 million new cases of sexually transmitted infection are expected to occur around the world with high occurrence and morbidity rates in both males and females. To respond to dramatically changing social and cultural environments, clinical treatment guidelines for diagnosis, treatment, and prevention of sexually transmitted infections have been developed in many countries, and South Korea has also prepared treatment guidelines which can be used in medical institutions treating primarily these diseases. Against this background, this study conducted a 31-item questionnaire survey by mail and e-mail to investigate the actual clinical practices of physicians treating sexually transmitted infections. In total, 250 and 1,068 questionnaires were distributed through mail and e-mail, respectively, and 274 of them were completed and returned for a response rate of 20.8%. According to the results, physicians' actual clinical practices were found to be different from textbook guidelines to some degree. Therefore, treatment guidelines that take into account the current situation for sexually transmitted infections should be developed in Korea, and a foundation for national management of the diseases should be established through active advertisements.

Foraminal stenosis complicating retained broken epidural needle tip: A case report / 대한마취과학회지

Lumbar epidural anesthesia is useful in a variety of chronic benign pain syndromes, including lumbar radiculopathy, low back pain syndrome, spinal stenosis, and vertebral compression fractures. Given the increased number of epidural nerve blocks being performed, some have reported unexplained complications of a transient or permanent nature and with varying degrees of severity. However, no case has been reported of a broken epidural needle tip retained in the lumbar facet joint area. This represents the first reported case presentation of foraminal stenosis developing in a patient after a retained epidural needle tip.