Dysphagia Following Anterior Approach Cervical Spinal Surgery in a Patient with Ankylosing Spondylitis / 대한연하장애학회지

The known causes of dysphagia following cervical spine surgery include pre-vertebral soft tissue swelling, decreased posterior pharyngeal movement, and impaired upper esophageal sphincter opening. Some studies have suggested that dysphagia is associated with movement of the cervical vertebrae during swallowing. In the present case, a 59-year-old man with a limited cervical range of motion due to ankylosing spondylitis slipped and fell, resulting in a C7 vertebral body fracture. He underwent anterior cervical discectomy as well as C5-T1 anterior fusion and C5-T2 level postero-lateral fusion. After surgery, he showed signs and symptoms of aspiration. A video-fluoroscopic swallowing study (VFSS) revealed incomplete laryngeal elevation, cricopharyngeal dysfunction, and vallecular remnant. Aspiration was observed in the semisolid-swallowing test. The patient's dysphagia could be attributed to two main causes. First, the esophagus might have been compressed by thickened pre-vertebral soft tissue after surgery. Second, the cervical range of motion, which was already limited by ankylosing spondylitis, might have been limited further by the anterior fusion of the cervical spine. In conclusion, a preoperative evaluation, including VFSS, should be considered before cervical spinal surgery, particularly in patients with ankylosing spondylitis presenting with a limited cervical range of motion.

Severe Ulnar Nerve Injury After Bee Venom Acupuncture at a Traditional Korean Medicine Clinic: A Case Report

This case report describes a severe nerve injury to the right ulnar nerve, caused by bee venom acupuncture. A 52-year-old right-handed man received bee venom acupuncture on the medial side of his right elbow and forearm, at a Traditional Korean Medicine (TKM) clinic. Immediately after acupuncture, the patient experienced pain and swelling on the right elbow. There was further development of weakness of the right little finger, and sensory changes on the ulnar dermatome of the right hand. The patient visited our clinic 7 days after acupuncture. Electrodiagnostic studies 2 weeks after the acupuncture showed ulnar nerve damage. The patient underwent steroid pulse and rehabilitation treatments. However, his condition did not improve completely, even 4 months after acupuncture.

Extracorporeal Shock Wave Therapy Versus Trigger Point Injection in the Treatment of Myofascial Pain Syndrome in the Quadratus Lumborum

OBJECTIVE: To compare the effectiveness of extracorporeal shock wave therapy (ESWT) and trigger point injection (TPI) for the treatment of myofascial pain syndrome in the quadratus lumborum. METHODS: In a retrospective study at our institute, 30 patients with myofascial pain syndrome in the quadratus lumborum were assigned to ESWT or TPI groups. We assessed ESWT and TPI treatment according to their affects on pain relief and disability improvement. The outcome measures for the pain assessment were a visual analogue scale score and pain pressure threshold. The outcome measures for the disability assessment were Oswestry Disability Index, Roles and Maudsley, and Quebec Back Pain Disability Scale scores. RESULTS: Both groups demonstrated statistically significant improvements in pain and disability measures after treatment. However, in comparing the treatments, we found ESWT to be more effective than TPI for pain relief. There were no statistically significant differences between the groups with respect to disability. CONCLUSION: Compared to TPI, ESWT showed superior results for pain relief. Thus, we consider ESWT as an effective treatment for myofascial pain syndrome in the quadratus lumborum.

Use of Magnetic Resonance Imaging to Identify Outcome Predictors of Caudal Epidural Steroid Injections for Lower Lumbar Radicular Pain Caused by a Herniated Disc

OBJECTIVE: We used lumbar magnetic resonance image (MRI) findings to determine possible outcome predictors of a caudal epidural steroid injection (CESI) for radicular pain caused by a herniated lumbar disc (HLD). METHODS: Ninety-one patients with radicular pain whose MRI indicated a HLD were enrolled between September 2010 and July 2013. The CESIs were performed using ultrasound (US). A responder was defined as having complete relief or at least a 50% reduction of pain as assessed by the visual analog scale (VAS) and functional status on the Roland Morris Disability Questionnaire (RMDQ); responder (VAS n=61, RMDQ n=51), and non-responder (VAS n=30, RMDQ n=40). MRI findings were analyzed and compared between the two groups with regard to HLD level, HLD type (protrusion or exclusion), HLD zone (central, subarticular, foraminal, and extraforaminal), HLD volume (mild, moderate, or severe), relationship between HLD and nerve root (no contact, contact, displaced, or compressed), disc height loss (none, less than half, or more than half ), and disc degeneration grade (homogeneous disc structure or inhomogeneous disc structure-clear nucleus and height of intervertebral disc). RESULTS: A centrally located herniated disc was more common in the responder group than that in the non-responder group. Treatment of centrally located herniated discs showed satisfactory results. (VAS p=0.025, RMDQ p=0.040). Other factors, such as HLD level, HLD type, HLD volume, relationship to nerve root, disc height loss, and disc degeneration grade, were not critical. CONCLUSION: The HLD zone was significant for pain reduction after CESI. A centrally located herniated disc was a predictor of a good clinical outcome.

Characterization of Monoclonal Antibody Specific for Hepatitis C Virus E2 Envelope Protein

Hepatitis C virus (HCV) E2 protein is known to be one of putative envelope proteins. To develop a sensitive detection method for HCV infected tissues and cells, monoclonal antibodys (MAbs) to the E2 protein of HCV were prepared from mice immunized with recombinant baculovirus-expressing E2 protein (Bac-E2). Several hybridoma clones secreting various levels of MAb were isolated and isotypes of these MAb were determined. One clone (L.2.3.3) was used for ascites production and the E2-MAb was purified and characterized. The L.2.3.3 reacted well with both Bac-E2 and E. coli expressed glutathione-5-transferase-E2 (GST-E2) fusion proteins. Using HCV patient sera, E2 envelope protein was found to be localized in the cell membrane boundary both in CHO cells and insect cells which express HCV E2 protein. Similar result was obtained when same cells were treated with the MAb L.2.3.3. These results demonstrated that Bac-E2 protein is capable of eliciting high titer antibody production in mice.

A Case of Bilateral Blindness Occurred During General Anesthesia for Anterior Cerebral Communicating Artery Aneurysm Surgery

The authors have experienced a case of bilateral blindness which occurred during general anesthesia for neurosurgical intervention. A 49-year-old female patient was received aneurysmal neck clipping of anterior cerebral communicating artery under N O general anesthesia in supine position on July, the 21th, 1986, and at regaining consciousness, she complained of loss of vision. At inital examination, visual acuity of right eye was light perception and left eye was hand movement. Pupils were mid-dilated and light reflexes were lost on both eyes. Anterior segments were normal with no limitation of ocular movements. The retinas were milky edematous with cherry red spot at the macula and VEPs showed flat curves on both eyes.

A Review of Color Deficiency Among the Industrial Workers

The authors surveyed on 154 color deficient workers among 6,023 industrial workers that had undergone a physical examination at Soon Chun Hyang Gumi Hospital but had good visual acuity and no retinal disease. They were examined with 3 kinds of test including AO pseudoisochromatic plate, Ishihara's plate and Han's color vision test. So, results were obtained as follow; 1. AO pseudoisochromatic plate was used only as distinguishable method of existence of color defect. 2. With the Ishihara plate, frequencies as to types of defect were protanopia 19(12.3%), deuteranopia 71(46.1%), protanomaly and deuteranomaly 15(9.7%), and unclassified 48(31.2%). The most frequent type of color defect was deuteranopia. 3. With the Hahn's color vision test, frequencies as to types of defect were protan 33(21.4%), deutan 72(46.7%), and unclassified 48(31.2%). Also in this test, deutan was the most frequent type. 4. Extent of color defect by the Hahn's test was mild(Grade I) 38.3%, medium(Grade II) 23.4%, and strong(Grade III) 38.3%.

Cataracts Induced by Dialysis Because of Chronic Renal Failure and It's Operation Results

There has been increased dialysis because of chronic renal failure, and also has been increased cataractous changes. We found 8 eyes(5 patients) who were under dialysis and also had cataractous changes. They received cataract operations. The results were obtained as follows: 1. Male to female ratio is 4:1 and the average age of cataract patients is 45 years old. 2. The cataractous changes after dialysis occurred within 1 year(except example 1). 3. We found that the cataracts developed from posterior subcapsule of lens(except example 1) and the corrected visual acuity at 2 months after surgery were over 0.5. 4. There were no serious problems after surgery(routine I.C.C.E.). 5. On blood chemistry, the average calcium level was 7.88mg% (hypocalcemic state), and we suggest that this condition may be related with cataractous changes.