Prediction of the Cervical Epidural Space Depth from the Skin Using Cervical X-Ray, During Cervical Epidural Block with Paramedian Approach.

Objective: The purpose of this study is to compare the actual needle depth measured during cervical epidural block (CEB) with the predicted needle depth measured through a cervical flexion x-ray image at the paramedian approach. Methods: The study was conducted based on the medical records of patients who underwent CEB at the pain clinic of Haeundae Paik Hospital. The actual needle distance (AD) was recorded after each successful CEB. The distance from the spinolaminar line to the skin, predicted median depth (PMD), was measured using lateral x-ray images. The medial to lateral distance (MLD), which is the distance from the midline of the spine to the needle insertion point, was measured using anteroposterior (AP) x-rays. The predicted paramedian depth (PPD) was calculated using the Pythagorean formula. The PMD represents the expected depth of the median approach, while the PPD represents the expected depth of the paramedian approach. The PMD, PPD, and AD were compared with each other. Results: Concordance correlation coefficient (CCC) and Bland-Altman analysis were obtained for PMD and PPD. The CCC value of PMD was measured as 0.829, and the CCC value of PPD was measured as 0.830. In the Bland-Altman analysis, PPD was measured at -0.13 ± 8.37 mm, and PMD was measured at 1.29 ± 8.38 mm. Conclusion: When performing CEB through the paramedian approach, the depth can be predicted using a cervical flexion x-ray. At this time, the PMD can also be used to predict the depth during the paramedian approach.

Vocal cord paralysis following general anesthesia with endotracheal intubation: a clinical review on 43 cases.

BACKGROUND: Vocal cord paralysis (VCP) is one of the most stressful experiences for patients undergoing general anesthesia. Moreover, it is a risk factor for aspiration pneumonia and may increase morbidity and mortality. We examined several clinical features of the condition by reviewing the medical records of patients who experienced VCP following general anesthesia. METHODS: We reviewed the medical records of 321 patients who consulted an otolaryngologist owing to hoarseness, sore throat, throat discomfort, or dysphagia after general anesthesia. Among these, we included in the present study 43 patients who were diagnosed with VCP by laryngoscopy, who did not have symptoms of suspected VCP before surgery, who had no past history of VCP, and for whom endotracheal intubation was not continued after surgery. RESULTS: The mean age of patients with VCP was 51.3 years. With respect to surgical site, the most common was upper limb surgery, performed in 12 cases (9 cases were performed in sitting posture. With respect to surgical duration, only 11 cases lasted less than 3 h, whereas 32 cases required a surgical duration longer than 3 h. The most common symptom of VCP was hoarseness. Nine of the patients with VCP recovered spontaneously, but VCP persisted in 13 cases until the final follow-up examination. CONCLUSIONS: We hope that this study might call attention to the occurrence of VCP following general anesthesia. Moreover, it is necessary to further evaluate the reasons for the higher incidence of VCP in upper limb surgery performed in sitting posture.

Prevalence of Clostridium perfringens toxin in patients suspected of having antibiotic-associated diarrhea.

BACKGROUND: Although Clostridium perfringens has been reported as a cause of antibiotic-associated diarrhea (AAD), it is uncommon to detect this pathogen in clinical microbiology laboratories in Korea. The aim of this study was to investigate the prevalence of C. perfringens toxin in patients suspected of having AAD. METHODS: A total of 135 stool specimens submitted to a clinical microbiology laboratory for C. difficile toxin assay were tested. We tried to detect both C. difficile and C. perfringens toxins using the Seeplex Diarrhea ACE Detection kit (Seegene, Seoul, Korea). We evaluated the prevalence of 10 bacteria and 5 viruses. RESULTS: A total of 40 Clostridium spp. were detected in 34 specimens (29.6%). The C. perfringens toxin was detected in 14 of 135 specimens (10.4%), while C. difficile toxin was detected in 26 specimens (19.3%). Other bacteria and viruses, including 8 Aeromonas spp., were detected in 15 specimens. All tests were negative in 92 of the 135 specimens (68.1%). CONCLUSION: Clostridium perfringens toxin is relatively common, and we should consider the possibility of its presence in patients suspected of having AAD, especially if C. difficile tests are negative.

Neuroprotective and anti-inflammatory effects of mollugin via up-regulation of heme oxygenase-1 in mouse hippocampal and microglial cells.

Mollugin, a bioactive phytochemical isolated from Rubia cordifolia L. (Rubiaceae), exhibits antimutagenic activity, antitumor activity, antiviral activity, and inhibitory activity in arachidonic acid- and collagen-induced platelet aggregation. In this study, we investigated the effects of mollugin as a neuroprotective agent in glutamate-induced neurotoxicity in the mouse hippocampal HT22 cell line and as an anti-inflammatory agent in lipopolysaccharide-induced microglial activation in BV2 cells. Mollugin showed potent neuroprotective effects against glutamate-induced neurotoxicity and reactive oxygen species generation in mouse hippocampal HT22 cells. In addition, the anti-inflammatory effects of mollugin were demonstrated by the suppression of pro-inflammatory mediators, including pro-inflammatory enzymes (inducible nitric oxide synthase and cyclooxygenase-2) and cytokines (tumor necrosis factor-α and interleukin-6). Furthermore, we found that the neuroprotective and anti-inflammatory effects of mollugin were linked to the up-regulation of the expression of heme oxygenase (HO)-1 and the activity of HO in HT22 and BV2 cells. In addition, the effects of mollugin resulted in the nuclear accumulation of nuclear factor-E2-related factor 2 (Nrf2) in HT22 and BV2 cells. Furthermore, mollugin also activated the p38 mitogen-activated protein kinase (MAPK) pathway both in HT22 and BV2 cells. These results suggest that mollugin may be a promising candidate for the treatment of neurodegenerative diseases related to neuroinflammation.

Torilin from Torilis japonica inhibits melanin production in alpha-melanocyte stimulating hormone-activated B16 melanoma cells.

Epidermal melanocytes synthesize melanin pigments and transfer them to keratinocytes, which is responsible for skin pigmentation. However, abnormal accumulation of melanin pigments causes hyperpigmentation disorders, which are substantially improved with treatment of tyrosinase inhibitor. In our ongoing study, Torilis japonica DC. (Umbelliferae) was found to inhibit melanin production. A goal of this study is to elucidate the hypopigmenting principle of T. japonica. A sesquiterpene structure of torilin was isolated from the plant extracts via bioassay-guided phytochemical analysis. Torilin dose-dependently inhibited melanin production, with an IC(50) value of 25 microM, in alpha-melanocyte stimulating hormone (alpha-MSH)-activated B16 melanoma cells. Arbutin, a positive control of skin whitener, also inhibited alpha-MSH-induced melanin production with an IC(50) value of 170 microM. As to the mode of action, torilin downregulated alpha-MSH-induced protein levels of tyrosinase without directly inhibiting catalytic activity of the enzyme. Taken together, this study shows that torilin contributes to the hypopigmenting principle of T. japonica, and suggests its pharmacological potential in melanin-associated hyperpigmentation disorders.