ABSTRACT
We report here on a case of right side spasmodic torticollis (ST) that was refractory to botulinum toxin type A injection and medication.The patient finally underwent a selective ramisectomy with ipsilateral sternocleidomastoid muscle (SCM) resection, but the remaining symptoms slowly aggravated, and a contralateral left side SCM spasm began.As conservative therapy for reducing the spasmodic symptoms, accessory nerve block, upper cervical plexus block and stellate ganglion block were performed twice in a week.After 6 months, the spasmodic symptoms significantly decreased. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) decreased by more than 70%.After one year of serial intermittent local anesthetic blockade therapy, the patient became almost free from the original ST symptoms (TWSTRS = 1).Serial local anesthetic interventions for the ST patient may have a beneficial role on the pathological peripherocentral neural activity of the ST patient and can modulate motor-sensory integration in the patient.
Subject(s)
Humans , Accessory Nerve , Botulinum Toxins, Type A , Cervical Plexus , Nerve Block , Spasm , Stellate Ganglion , TorticollisABSTRACT
Placement of the endotracheal tube is a potent airway irritant that may trigger bronchospasm in asthmatic patients. But bronchospasm has been reported in association with regional anesthesia, but no clear understanding of the mechanism involved. This case describes acute bronchospasm during spinal anesthesia in lower limb surgery. In this case, bronchospasm was relieved by intravenous injection of glycopyrrolate, not by beta-agonist inhaler. We experienced repeated bronchospasm which was also very effectively treated by intravenous injection of glycopyrrolate.
Subject(s)
Humans , Anesthesia, Conduction , Anesthesia, Spinal , Asthma , Bronchial Spasm , Cholinergic Antagonists , Glycopyrrolate , Injections, Intravenous , Lower Extremity , Nebulizers and VaporizersABSTRACT
Upper thoracic back pain can be musculoskeletal in origin or it could be visceral referred pain, which may be indicative of a serious medical condition. We experienced a case of a 55-years-old female patient who complained of upper thoracic back pain for 1 month, which started 10 days after a traffic accident. She described the pain as being a dull, constant nagging sensation with an intensity of 4/10 on the visual analogue scale. Her pain did not subside after trigger point injection of the rhomboid and trapezius muscles. She reported intermittent palpitation, which indicated that the cardiovascular or pulmonary systems were involved. She was diagnosed with pulmonary thromboembolism by the imaging studies. Refractory upper thoracic back pain should be investigated to rule out this treatable, but potentially fatal condition.
Subject(s)
Female , Humans , Accidents, Traffic , Back Pain , Pain, Referred , Pulmonary Embolism , Sensation , Superficial Back Muscles , Trigger PointsABSTRACT
Upper thoracic back pain can be musculoskeletal in origin or it could be visceral referred pain, which may be indicative of a serious medical condition. We experienced a case of a 55-years-old female patient who complained of upper thoracic back pain for 1 month, which started 10 days after a traffic accident. She described the pain as being a dull, constant nagging sensation with an intensity of 4/10 on the visual analogue scale. Her pain did not subside after trigger point injection of the rhomboid and trapezius muscles. She reported intermittent palpitation, which indicated that the cardiovascular or pulmonary systems were involved. She was diagnosed with pulmonary thromboembolism by the imaging studies. Refractory upper thoracic back pain should be investigated to rule out this treatable, but potentially fatal condition.
Subject(s)
Female , Humans , Accidents, Traffic , Back Pain , Pain, Referred , Pulmonary Embolism , Sensation , Superficial Back Muscles , Trigger PointsABSTRACT
Laparoscopic procedures are accompanied by an increased intra-abdominal pressure and diaphragmatic elevation, which may interfere with adequate ventilation in obese patients. Re-expansion of a collapsed lung could be followed by pulmonary edema. Here, we describe a case of re-expansion pulmonary edema after laparoscopic bariatric surgery. A 23-year-old-female with morbid obesity received general anesthesia for laparoscopic adjustable gastric banding surgery. Unintentional one lung ventilation occurred for a short period during the operation and was promptly corrected. At the end of the operation, as spontaneous respiration recovered, profuse pinkish frothy sputum emerged from the endotracheal tube. Diffuse patchy increased opacity on the left lung field was observed by chest X-ray. With aspiration of bronchial secretion and oxygen supplementation, the patient was recovered uneventfully. We presume that inadequate lung expansion during pneumoperitoneum and unintentional right endobronchial intubation caused atelectasis of the left lung, and induced re-expansion pulmonary edema at the end of the operation. This case emphasizes the importance of constant vigilance with respect to endotracheal tube position and ventilation during laparoscopic surgery in obese patients.
Subject(s)
Humans , Anesthesia, General , Bariatric Surgery , Intubation , Laparoscopy , Lung , Obesity, Morbid , One-Lung Ventilation , Oxygen , Pneumoperitoneum , Pulmonary Atelectasis , Pulmonary Edema , Respiration , Sputum , Thorax , VentilationABSTRACT
Subject(s)
Female , Humans , Alleles , Digestion , Electrophoresis , Gene Frequency , Genotype , Korea , Polymerase Chain Reaction , Prevalence , Romania , Transforming Growth Factor beta3ABSTRACT
Paraganglioma is an extraadrenal pheochromocytoma originating from chromaffin cells distributed in the sympathetic nervous systems. Functioning extraadrenal paragangliomas represent more than 10% of all pheochromocytomas, and seems to be highly malignant tumor in comparison to intraadrenal pheochromocytomas. Recently, we experienced a case of a paraganglioma in the posterior mediastinum. A 32-year-old woman was admitted to hospital due to dyspnea on exertion, and intractable hypertension. A chest X-ray showed a well-defined mass density on the right cardiac border, and biochemical studies showed characteristic findings of pheochromocytoma. A solitary pheochromocytoma was located in the posterior mediastinum using 131I-MIBG scintigraphy. The clinical manifestations, including hypertension and dyspnea were improved after operation.
Subject(s)
Adult , Female , Humans , Chromaffin Cells , Dyspnea , Hypertension , Mediastinum , Paraganglioma , Pheochromocytoma , Radionuclide Imaging , Sympathetic Nervous System , ThoraxABSTRACT
Calciphylaxis is a rare, but fatal, condition that is characterized by a rapidly progressive ischemic necrosis of the skin, underlying tissue and other organs, as well as rapid vascular calcification. It results in death due to sepsis, heart or respiratory failure. A 67-year old female was admitted to hospital with the chief complaint of constant pain to both lower legs of 1 week duration. She was treated with calcitonin-salmon due to a prior unexplained hypercalcemia of 2 weeks. On the third day post admission. pain and weakness in the lower legs were aggravated, became painful, with violaceous skin lesions developing on the thigh with findings similar to those of rhabdomyolysis. Because she was suspected of having dermatomyositis, she was treated with methylpredrisolone. However, the skin lesions and symptoms were aggravated, and she died of sepsis due to a skin infection. About 160 cases of calciphylaxis have been reported, with most of these cases being associated with secondary hyperparathyroidism due to end-stage renal disease, but cases of calciphylaxis without renal failure are very rare. We now report a case of calciphylaxis without renal failure, mimicking dermatomyositis, and present a brief review of the pathophysiology and treatments of calciphylaxis inform the relevant literature.
Subject(s)
Aged , Female , Humans , Calciphylaxis , Dermatomyositis , Heart , Hypercalcemia , Hyperparathyroidism, Secondary , Kidney Failure, Chronic , Leg , Necrosis , Renal Insufficiency , Respiratory Insufficiency , Rhabdomyolysis , Sepsis , Skin , Thigh , Vascular CalcificationABSTRACT
Autoimmune insulin syndrome is characterized by insulin autoantibody, hyperinsulinemia, and fasting hypoglycemia without previous insulin immunization. This syndrome shows discordant levels between immunoreactive insulin and C-peptide. Negative results of an anatomic study of the pancreas and an inability to reproduce hypoglycemia during a prolonged fast may be helpful in excluding insulinoma. Symptomatic hypoglycemia usually develops during an oral glucose tolerance test. This syndrome is a self-limited disorder. Recently, we experienced one case that developed symptomatic hypoglycemia during both the fasting & oral glucose tolerance test, and another that developed symptomatic hypoglycemia during the oral glucose tolerance test but not the fasting test. Hereby, we present these cases with a review of the literature.
Subject(s)
C-Peptide , Fasting , Glucose Tolerance Test , Hyperinsulinism , Hypoglycemia , Immunization , Insulin , Insulinoma , PancreasABSTRACT
BACKGROUND: Congenital nephrogenic diabetes insipidus (NDI) is a rare inherited disorder, in which two different hereditary forms, X-linked and autosomal recessive traits, have been identified. The X-linked recessive form, mostly (>90%) congenital NDI, has been known to be caused by mutation of the arginine-vasopressin receptor 2 (AVPR2) gene. AVPR2 mutation sites are different in ethnic groups and recently 72 different mutation sites have been reported among AVPR2 gene. This study aimed to analyze AVPR2 gene in selected members in a Korean family with NDI and provided a report of the existence of a new mutation site in AVPR2 gene. METHODS: Three-generation maternal pedigree of the index patient (21-year old male, patient I) and his younger brother (19-year old male, patient II) with NDI was collected. Genomic DNA was obtained from patient I, II, III (index patient's male maternal cousin with NDI), index patient's mother, three maternal aunts, one female maternal cousin and, for control, one healthy male volunteer. Three coding exons of AVPR2 gene were amplified by PCR using 4 pairs of oligonucleotide primers. After direct sequencing of amplified PCR products, the sequence was compared with whole squence of normal AVPR2 gene and identification of a new site of mutation in this gene was done. RESULTS: 1) all three male patients had transversion of G to C at position 1033 of the AVPR2 gene, resulting in a subsequent change of amino acid from glycine to cysteine in codon 201. 2) Two small peaks of G and T, the result of direct sequencing in five female members in this family, would suggest that they are carriers of G to N transversion. CONCLUSION: These results can demonstrate the significant functional correlation of the mutation in AVPR2 gene sequence with clinical NDI, and suggest the clinical utility of direct mutation testing for congenital NDI in family.
Subject(s)
Female , Humans , Male , Clinical Coding , Codon , Cysteine , Diabetes Insipidus, Nephrogenic , DNA , DNA Primers , Ethnicity , Exons , Glycine , Mothers , Pedigree , Polymerase Chain Reaction , Receptors, Vasopressin , Siblings , Vasopressins , VolunteersABSTRACT
PURPOSE: Lower caliceal stones treated with ESWL do fail to pass more frequently than middle or upper caliceal stones. We analyzed the results of ESWL of renal caliceal stones according to the location of calix. MATERIALS AND METHODS: We reviewed the stone-free rate in 119 caliceal stone patients treated with 3rd generation lithotriptor, EDAP LT-02 according to the caliceal location of the stone. Location of the stones were upper calix in 30, middle calix in 30, and lower calix in 59 patients. RESULTS: Stone-free rate was 90.0%(27/30 patients) in middle caliceal stones, 74.6%(44/59 patients) in lower caliceal stones, and 66.7%(20/30 patients) in upper caliceal stones. CONCLUSIONS: Stone-free rate of lower caliceal stones is higher than upper caliceal stones.
Subject(s)
Humans , Lithotripsy , ShockABSTRACT
Pelvic lipomatosis is a rare disease of unknown etiology characterized by overgrowth of mature, nonmalignant fat cells in the pelvis, especially in the perivesical and perirenal space. An overgrowth of fat surrounding the bladder and rectosigmoid colon produces a radiologic picture characterized by 1) radiolucent pelvic densities, 2) elevation and vertical elongation of the bladder, 3) straightening and elevation of the rectosigmoid colon and 4) absence of malignant vessels on pelvic angiography. Cystoscopy has shown a high incidence of cystitic changes: chronic inflammation, cystitis glandularis and cystitis cystica. We report a case of pelvic lipomatosis associated with cystitis glandularis.