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.

Varicella-Zoster Virus Reactivation During the Incubation Period for Scrub Typhus: A Case Report.

BACKGROUND Herpes zoster caused by the reactivation of latent varicella-zoster virus is thought to result from the waning of specific cell-mediated immunity. Scrub typhus, an acute infectious disease caused by Orientia tsutsugamushi, affects multiple organs and is characterized by microangiopathies that result in significant vascular leakage and subsequent end-organ injury. Very few cases of reactivation of the varicella-zoster virus following scrub typhus occurrence have been reported. Furthermore, no previous studies have directly investigated whether Orientia tsutsugamushi infection is a potential risk factor for herpes zoster. CASE REPORT We present the case of a 64-year-old woman without a previous illness who simultaneously developed herpes zoster of the thoracic dermatome and scrub typhus. Clinical symptoms of scrub typhus appeared during the treatment course for herpes zoster symptoms. Based on positive virus antibody test results, the patient was diagnosed with scrub typhus. This is a unique case of reactivation of the varicella-zoster virus that occurred during a silent incubation period for scrub typhus. CONCLUSIONS This report indicates the possibility of reactivation of latent varicella-zoster virus following Orientia tsutsugamushi infection, although the relationship between the 2 remains undetermined. Physicians should be aware that scrub typhus might be a potential determinant of varicella-zoster virus reactivation.

Factors Affecting the Practice of Corona Virus Disease-19 Prevention Activities in Patients With Heart Diseases in Korea.

This study was conducted in a cross-sectional correlation design to identify factors affecting the practice of COVID-19 prevention activities in patients with heart diseases. A convenience sample of 195 patients with heart diseases from one tertiary teaching hospital completed questionnaires with items from the characteristics of these participants, their knowledge, attitude, and practice related to COVID-19 prevention activities. Participants' knowledge, attitude, and practice for COVID-19 prevention were relatively high but there was a significant difference in the degree of practice of COVID-19 prevention activities according to the characteristics of the participants. The higher the level of their knowledge and the more positive their attitude, the higher their practice. Attitude and information check about COVID-19 prevention were factors that influenced the practice of COVID-19 prevention activities, with an explanatory power of 32%. This study can help motivate and actively encourage COVID-19 prevention practices.

Thenar Compartment Syndrome Related to Tightened Radial Arterial Line During Robotic Laparoscopic Surgery: A Case Report.

We present a 54-year-old man who developed an unexpected thenar space compartment syndrome after robotic laparoscopic surgery, which was caused when the radial arterial pressure tubing was pulled too tightly around the base of the thumb while changing the surgical position. A conventional method of securing the tubing by looping it around the thumb appeared to be the primary cause. This complication went unnoticed during the surgery because the arm was tucked out of sight; there were no remarkable findings on monitoring. This case highlights the risks of looping tubing around the thumb, especially if continual inspection is not possible.

Sudden hemodynamic collapse after prone positioning on a Jackson spinal table for spinal surgery.

BACKGROUND: The prone position is used for a variety of procedures and surgeries, and hypotension is a commonly encountered complication. CASE: A 75-year-old obese woman with lumbar spinal stenosis underwent posterior lumbar spinal fusion and posterolateral interbody fusion under general anesthesia. Before the surgery, when she was positioned on a Jackson spinal table in the prone position, sudden severe hypotension and hemodynamic collapse developed. The circulatory collapse was refractory to intravascular volume expansion and administration of inotropes and vasopressors. However, the application of external abdominal support immediately restored hemodynamic stability. The patient successfully underwent the surgery using an external abdominal support, and no post-operative complication was noted, including abdominal compartment syndrome. CONCLUSIONS: The Jackson spinal table allowed the abdomen to hang freely, providing abdominal decompression while resulting in a severely sagged abdomen. We suspected that the sagging abdomen had pulled the abdominal contents downwards, kinking the inferior vena cava or causing a venous pool in the abdomen, resulting in the obstruction of venous return to the heart.

A Case of Solitary Brain Metastasis from Uterine Mullerian Adenosarcoma with Sarcomatous Overgrowth.

Uterine adenosarcoma (AS) are rare tumors and have more favorable outcomes than the aggressive uterine carcinosarcomas. Uterine adenosarcoma with sarcomatous overgrowth (ASSO) is a variant form of AS and exhibits aggressive growth of tumor and the prognosis is relatively poor compared with typical AS. Usually patterns of metastasis have been known to behave like endometrial carcinoma and spread through the lymphatics. Brain metastasis from uterine AS is extremely rare. Herein, we report a case of successfully surgically removed solitary brain metastasis without any extracranial recurrence from uterine ASSO after 4 years of primary treatment.

Simultaneous multiplex PCR detection of seven cucurbit-infecting viruses.

Two multiplex polymerase chain reaction (PCR) systems using dual priming oligonucleotide (DPO) primers were developed for the simultaneous detection of seven cucurbit-infecting viruses. One system allows for the detection of papaya ringspot virus, watermelon mosaic virus, and zucchini yellow mosaic virus, whereas the other permits the detection of cucumber green mottle mosaic virus, cucumber fruit mottle mosaic virus, kyuri green mottle mosaic virus, and zucchini green mottle mosaic virus. Viral species-specific DPO primers developed in this study detected as little as 10 fg/µl of viral RNA under monoplex conditions and 10 pg/µl of viral RNA under multiplex conditions. Multiplex PCR using the DPO primer sets was capable of amplifying viral genes at annealing temperatures ranging from 53 °C to 63 °C. Whereas the use of conventional primers gave rise to non-specific bands, the DPO primers detected target viral genes in the absence of non-specific amplification. When these DPO multiplex primer sets were applied to virus-infected cucurbit samples obtained in the field, multiple infection as well as single infection was accurately identified. This novel approach could also detect multiple viruses in infected seeds. The reliability of multiplex PCR systems using DPO primers for plant virus detection is discussed.

Reverse Transcription Polymerase Chain Reaction-based System for Simultaneous Detection of Multiple Lily-infecting Viruses.

A detection system based on a multiplex reverse transcription (RT) polymerase chain reaction (PCR) was developed to simultaneously identify multiple viruses in the lily plant. The most common viruses infecting lily plants are the cucumber mosaic virus (CMV), lily mottle virus (LMoV), lily symptomless virus (LSV). Leaf samples were collected at lily-cultivation facilities located in the Kangwon province of Korea and used to evaluate the detection system. Simplex and multiplex RT-PCR were performed using virus-specific primers to detect single-or mixed viral infections in lily plants. Our results demonstrate the selective detection of 3 different viruses (CMV, LMoV and LSV) by using specific primers as well as the potential of simultaneously detecting 2 or 3 different viruses in lily plants with mixed infections. Three sets of primers for each target virus, and one set of internal control primers were used to evaluate the detection system for efficiency, reliability, and reproducibility.

Clinical outcome of gastric cancer patients with bone marrow metastases.

PURPOSE: The prognosis of gastric cancer patients with bone marrow metastases is extremely poor. The current study was conducted to evaluate the clinical outcomes of advanced gastric cancer patients with bone marrow metastases. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 26 advanced gastric cancer patients with bone marrow metastases who were treated at Soonchunhyang University Hospital between September 1986 and February 2009. RESULTS: The median age was 46 years (range, 24 to 61 years). All patients had poorly differentiated adenocarcinoma, including 17 signet ring cell carcinomas. The majority of the patients had thrombocytopenia, anemia, and elevated lactate dehydrogenase levels. Sixteen patients (61.5%) received palliative chemotherapy (median, 4 cycles; range, 1 to 13 cycles). The median overall survival after detection of bone marrow metastases for the cohort of patients was 37 days (95% confidence interval, 12.5 to 61.5 days). The median overall survival after detection of bone marrow involvement was 11 days in the best supportive care group (range, 2 to 34 days) and 121 days (range, 3 to 383 days) in the palliative chemotherapy group (p<0.001). The causes of death were tumor progression (11 patients, 45%), brain hemorrhage (6 patients, 25%), infection (5 patients, 21%), and disseminated intravascular coagulation (1 patient, 4%). There were no chemotherapy-related deaths. CONCLUSION: Palliative chemotherapy could be considered in advanced gastric cancer patients with bone marrow metastases as a treatment option.