Comparison between anteroposterior and oblique "Scotty dog" approach during S1 transforaminal epidural steroid injection: A randomized controlled trial.

BACKGROUND: Traditionally, S1 transforaminal epidural steroid injection (TFESI) has been performed using an anteroposterior (AP) fluoroscopic view. In 2007, the oblique "Scotty dog" (OS) approach was introduced as an alternative technique. We compared passage time of the needle into S1 foramen (Tf) between the anteroposterior (AP) and oblique "Scotty dog" (OS) approach during S1 TFESI. METHODS: In this prospective randomized controlled trial, seventy patients scheduled S1 TFESI were randomly allocated into AP or OS groups. In the AP group, a slight cephalad-caudad tilt was used. In the OS group, the C-arm was rotated ipsilateral oblique degrees to view the S1 Scotty dog. Both groups received injection of steroid mixed with local anesthetics. We measured the passage time of the needle into S1 foramen (Tf), primary outcome, and total procedure time (Tt) between the groups. We also recorded presence of intravascular injection, patients-assessed pain relief for one month and complications. RESULTS: The Tf and Tt were shorter in the OS than in the AP group (24.4 ±â€Š24.0 s vs 47. 8 ±â€Š53.2seconds; 93.3 ±â€Š35.0 seconds vs 160.0 ±â€Š98.7 seconds, P < .001, both). Incidence of intravascular injection (AP, 8 [22.8%]; OS, 4 [11.4%], P = .205), pain score, and complication rates were not statistically different between the two groups. In logistic regression analysis, the body mass index (BMI) was a risk factor for longer Tt (odds ratio [OR] = 1.27, 95% CI: 1.02-1.58, P = .030). CONCLUSION: The passage time of the needle into S1 foramen was shorter in OS approach and the OS approach reduced the procedure time compared with the AP approach during S1 TFESI. The practitioners should note that procedure time can be prolonged in obese patients.

Five-lead Electrocardiography During Living Donor Liver Transplantation: Incidence and Clinical Significance of ST Segment Abnormality.

OBJECTIVES: Five-lead electrocardiography (ECG) is commonly used during liver transplantation, while 3-lead ECG is used during most noncardiac operations. This study aimed to evaluate the incidence and clinical significance of ST segment abnormality during living donor liver transplantation (LDLT) with 5-lead ECG. METHODS: We retrospectively reviewed medical records of patients who received LDLT between May 2018 and May 2019. A total of 109 adult recipients underwent LDLT, and 108 recipients were divided into 2 groups according to whether or not significant ST segment abnormality had occurred at 8 predetermined time points during the operation. ST segment change by more than 1 mm was regarded as significant. RESULTS: Of the 108 recipients, 21 recipients (19.4%) had significant ST segment depression during the operation. No case of significant ST segment elevation was noted. The significant ST segment depression was detected mostly in lead II and V5, and with 2 in combination we could detect 95.2% of significant ST segment change. The significant ST segment depression was frequently observed 1 hour after anhepatic phase and 2 hours after reperfusion. Patient characteristics were not different between the 2 groups. Moreover, the cardiac enzyme (troponin I) measurements, measured immediately after the operation, were not different between the 2 groups. CONCLUSIONS: Although significant ST segment change was frequently observed during LDLT, more studies are required to determine the clinical significance of 5-lead ECG ST segment abnormality during LDLT.

Liver transplantation in Jehovah's Witnesses: two cases report.

Liver transplantation is especially challenging in patients who are Jehovah's Witnesses because their religious beliefs prohibit the receipt of blood products. We present two cases of living donor liver transplantation performed in adult Jehovah's Witnesses in South Korea without the use of blood products. In the first case, preoperative erythropoiesisstimulation therapy increased hemoglobin levels from 8.1 to 13.1 g/dl after 9 weeks. In the second case, hemoglobin levels increased from 7.4 to 10.8 g/dl after 6 months of erythropoiesis-stimulation therapy. With the combination of acute normovolemic hemodilution, intraoperative cell salvage, and use of transfusion alternatives, liver transplantation was successfully performed without transfusion of blood products.

Emergence and spread of carbapenem-resistant Acinetobacter baumannii sequence type 191 in a Korean hospital.

Emergence and spread of specific carbapenem-resistant Acinetobacter baumannii (CRAB) clones cause a serious therapeutic problem. This study was aimed to investigate the clonal diversity and genetic basis of antimicrobial resistance among the 69 CRAB isolates from 2009 to 2010 in a Korean hospital. All CRAB isolates were found to be sequence type (ST) 2 using the Institute Pasteur's multilocus sequence typing (MLST) scheme, but classified into two sequence groups and nine pulsotypes. Fifty-six CRAB isolates belonging to two main pulsotypes were found to be ST191 using the Bartual's MLST scheme. All CRAB isolates showed an extensively drug-resistant phenotype. The blaOXA-51/blaOXA-23, blaAmpC/blaPER-1 and armA genes were largely responsible for resistance to carbapenems, extended-spectrum ß-lactams and aminoglycosides, respectively. The first CRAB strains identified in 2005 in this hospital were found to be ST2 using the Institute Pasteur's MLST scheme, but showed ST353 using the Bartual's MLST scheme and different pulsotypes from the CRAB isolates from 2009 to 2010. In conclusion, this is the first report of emergence and spread of A. baumannii ST191 in Korea, as well of the genetic basis of its antimicrobial resistance.