Effectiveness of percutaneous epidural neuroplasty using a balloon catheter in patients with chronic spinal stenosis accompanying mild spondylolisthesis: a longitudinal cohort study

Background@#Degenerative lumbar spondylolisthesis (DLS) is frequently associated with lumbar spinal stenosis (LSS) and conservative treatments such as epidural steroid injection do not have long-term benefits in LSS patients with DLS. This study evaluated the effectiveness of percutaneous epidural neuroplasty using a balloon catheter in patients with LSS and DLS. @*Methods@#Patients’ sex, age, body mass index, diabetes, hypertension, stenosis grading, pain duration, location, pain intensity, and medications were retrieved from electronic medical records. At 1, 3, and 6 months following the procedure, data on pain severity, medication usage, and physical functional status were analyzed. A generalized estimating equations model was used at the six-month follow-up. Patients were divided into those with DLS (the spondylolisthesis group) and those without DLS (the no spondylolisthesis group) to evaluate whether the effects of percutaneous epidural neuroplasty using a balloon catheter were different. @*Results@#A total of 826 patients were included (spondylolisthesis: 433 patients, 52.4%; no spondylolisthesis: 393 patients, 47.6%). Age, body mass index, hypertension, pain location, and stenosis grading were statistically different between the two groups. The generalized estimating equations analyses with unadjusted and adjusted estimation revealed a significant improvement in the estimated mean numerical rating scale of pain intensities compared to that at baseline in both groups (P < 0.001). Any adverse events that occurred were minor and temporary. @*Conclusions@#Percutaneous epidural neuroplasty using a balloon catheter may be an alternative treatment option for patients with chronic LSS, regardless of accompanying DLS, who have had failed conservative management.

Factors associated with successful response to neurolytic celiac plexus block in patients with upper abdominal cancer-related pain: a retrospective study

Background@#Prior studies have reported that 40%-90% of the patients with celiac plexus-mediated visceral pain benefit from the neurolytic celiac plexus block (NCPB), but the predictive factors of response to NCPB have not been evaluated extensively. This study aimed to identify the factors associated with the immediate analgesic effectiveness of NCPB in patients with intractable upper abdominal cancer-related pain. @*Methods@#A retrospective review was performed of 513 patients who underwent NCPB for upper abdominal cancer-related pain. Response to the procedure was defined as (1) a decrease of ≥ 50% or ≥ 4 points on the numerical rating scale (NRS) in pain intensity from the baseline without an increase in opioid requirement, or (2) a decrease of ≥ 30% or ≥ 2 points on the NRS from the baseline with simultaneously reduced opioid consumption after NCPB. Logistic regression analysis was performed to determine the factors associated with successful responses to NCPB. @*Results@#Among the 513 patients included in the analysis, 255 (49.8%) and 258 (50.2%) patients were in the non-responder and responder group after NCPB, respectively. Multivariable logistic regression analysis showed that diabetes (odds ratio [OR] = 0.644, P = 0.035), history of upper abdominal surgery (OR = 0.691, P = 0.040), and celiac metastasis (OR = 1.496, P = 0.039) were the independent factors associated with response to NCPB. @*Conclusions@#Celiac plexus metastases, absence of diabetes, and absence of prior upper abdominal surgery may be independently associated with better response to NCPB for upper abdominal cancer-related pain.

Real-time ultrasound guided thoracic epidural catheterization: a technical review

Thoracic epidural analgesia is known to have superior perioperative pain control over intravenous opioid analgesia in open abdominal surgery and is an essential enhanced recovery after surgery component in major abdominal surgeries. Recently, the ultrasound-guided thoracic epidural catheter placement (TECP) technique has drawn attention as an alternative for the traditional landmark palpation-based TECP or fluoroscopic-guided TECP technique due to the equipment’s improvement and increased popularity. However, only a small number of studies have introduced the advantages and usefulness of ultrasound-guided TECP. Moreover, a certain level of ultrasound-guided in-plane technique is required to perform this technique. Thus, to apply ultrasound-guided TECP correctly and reduce the likelihood of side effects and complications, the practitioner must have a thorough understanding of the anatomical region, optimal block positioning, device selection, and management. In this technical review, the authors have compared the advantages and disadvantages of ultrasound-guided TECP to traditional techniques and described its technical aspects from patient positioning, ultrasound probe selection and scanning, needle insertion under ultrasound guidance, and successful thoracic epidural catheter insertion confirmation through ultrasound imaging. Additionally, the recommended epidural catheter tip placement level with the extent of its injectate epidural spread is further described in this review in reference to a recent prospective study published by the authors.

Factors associated with successful response to neurolytic celiac plexus block in patients with upper abdominal cancer-related pain: a retrospective study

Background@#Prior studies have reported that 40%-90% of the patients with celiac plexus-mediated visceral pain benefit from the neurolytic celiac plexus block (NCPB), but the predictive factors of response to NCPB have not been evaluated extensively. This study aimed to identify the factors associated with the immediate analgesic effectiveness of NCPB in patients with intractable upper abdominal cancer-related pain. @*Methods@#A retrospective review was performed of 513 patients who underwent NCPB for upper abdominal cancer-related pain. Response to the procedure was defined as (1) a decrease of ≥ 50% or ≥ 4 points on the numerical rating scale (NRS) in pain intensity from the baseline without an increase in opioid requirement, or (2) a decrease of ≥ 30% or ≥ 2 points on the NRS from the baseline with simultaneously reduced opioid consumption after NCPB. Logistic regression analysis was performed to determine the factors associated with successful responses to NCPB. @*Results@#Among the 513 patients included in the analysis, 255 (49.8%) and 258 (50.2%) patients were in the non-responder and responder group after NCPB, respectively. Multivariable logistic regression analysis showed that diabetes (odds ratio [OR] = 0.644, P = 0.035), history of upper abdominal surgery (OR = 0.691, P = 0.040), and celiac metastasis (OR = 1.496, P = 0.039) were the independent factors associated with response to NCPB. @*Conclusions@#Celiac plexus metastases, absence of diabetes, and absence of prior upper abdominal surgery may be independently associated with better response to NCPB for upper abdominal cancer-related pain.

Successful Extracorporeal Membrane Oxygenation Support for Acute Pulmonary Thromboembolism during Adult Liver Transplantation / 대한구급학회지

No abstract available.

Successful Extracorporeal Membrane Oxygenation Support for Acute Pulmonary Thromboembolism during Adult Liver Transplantation / 대한중환자의학회지

No abstract available.

Spinal cord stimulator malfunction caused by radiofrequency neuroablation: A case report / 대한마취과학회지

The implantation of spinal cord stimulators (SCSs) to treat chronic intractable pain is steadily increasing. And there is an increased likelihood of instances where other therapies or procedures are found to interfere with SCS function, which in turn may result in pain. Since SCS utilize electric impulses as well as magnets, special considerations need for patients with a SCS in situ who require these procedures. The present report describes a case where radiofrequency (RF) ablation of the third occipital nerve resulted in spontaneous activation of a cervical SCS device.

The effects of sevoflurane with propofol and remifentanil on tracheal intubation conditions without neuromuscular blocking agents / 대한마취과학회지

BACKGROUND: Propofol and remifentanil are used for tracheal intubation in the absence of neuromuscular blocking agents. We hypothesized that the addition of sevoflurane to propofol and remifentanil would improve intubation conditions and provide hemodynamic stability. METHODS: Seventy-six patients scheduled for elective surgery were randomly allocated to be ventilated with either 4% (group I) or 7% sevoflurane (group II) after propofol injection (2 mg/kg). All patients received remifentanil (1 microgram/kg) 30 seconds after administration of propofol. Ninety seconds after remifentanil was given, laryngoscopy and tracheal intubation were performed. Intubation conditions and hemodynamic changes were evaluated. RESULTS: The overall incidence of clinically acceptable intubation conditions was significantly higher in group II (92%) than group I (58%) (P = 0.001). Scores for vocal cord position, coughing, and limb movement were significantly better in group II (P < 0.05). Mean blood pressure remained significantly lower than the pre-induction level throughout the investigation in both groups (P < 0.001), but there was no incidence of bradycardia or hypotension requiring treatment. CONCLUSIONS: Tracheal intubation without neuromuscular blocking agents can be achieved safely and reliably by adding 7% sevoflurane to propofol (2 mg/kg) and remifentanil (1 microgram/kg).

Cement leakage into subcutaneous tissue after kyphoplasty: A case report

We describe a case of cement leakage from the pedicle of vertebrae to the subcutaneous tissue after kyphoplasty.We attempted to remove all cement leakage, but residual cement remained in the paraspinal tissue without any neurological complications.This case illustrates the importance of the right timing of cement injection and when to detach the bone-filler device from the cement.

Effect of the Preoperative Intercostal Nerve Block in a Rat Model of Postthoracotomy Pain / 대한통증학회지

BACKGROUND: Chronic pain after thoracotomy has been recently reproduced in a rat model that allows investigating the effect of potentially beneficial drugs that might reduce the incidence of allodynia or alleviate pain. Local anesthetics produce antinociception in normal animals and alleviate mechanical allodynia in animals with nerve injury although their mechanisms of action may differ in these situations. Our purpose of this study was to test whether the preoperative intercostal nerve block of bupivacaine could prevent the development of allodynia in a rat model of chronic postthoracotomy pain. METHODS: All male Sprague-Dawley rats were anesthetized and the right 4th and 5th ribs were exposed surgically. The pleura were opened between the ribs to which a retractor was placed and was opened 10 mm in width. Retraction was maintained for one hour. Total 1 mg of 0.5% bupivacaine was injected at the intercostal nerves before (n = 17) or after (n = 16) surgery. A control group (n = 25) that underwent rib retraction did not receive any drug. Rats were tested for mechanical allodynia using calibrated von Frey filaments applied around the incision site during the three weeks following surgery. RESULTS: The incidence of development of mechanical allodynia in the group that received intercostal injection with bupivacaine before surgery was significantly lower than that in the control group (P < 0.05). CONCLUSIONS: Preoperative intercostal nerves block around the surgical incision before thoracotomy may decrease the incidence of postthoracotomy pain syndrome.

A Case of Paraplegia Associated with Epidural Anesthesia: A case report / 대한통증학회지

Paraplegia is a relatively rare complication of epidural anesthesia. Several possible factors may contribute to the development of paraplegia including arachnoiditis, trauma and ischemia. We experienced a case where paraplegia had developed after epidural anesthesia for cesarean section. So we present the case and consider the possible etiologies. A 30-year-old previously healthy woman was referred to our hospital for postpartum motor weakness of the lower limbs. Six days prior, the patient was admitted at a local obstetric clinic for delivery at 39 weeks gestation. The patient underwent a Cesarean section under epidural anesthesia induced with 20 ml 2% lidocaine and 5 ml 0.5% bupivacaine. In the early morning of the day following the Cesarean section, a motor and sensory deficit in both lower extremities was noted. A lumbar MRI showed diffuse enhancement along the cauda equina and spinal cord surface in the lower lumbar spine, suggesting diffuse arachnoiditis.

5% Imiquimod Cream in the Treatment of Bowen's Disease / 대한피부과학회지

BACKGROUND: Bowen's disease is a challenging condition to treat because lesions often affect the elderly who are usually intolerable to invasive treatment modalities and lesions are often located at sites that heal poorly. OBJECTIVE: The aim of this study was to evaluate the effectiveness and the safety of 5% imiquimod cream for the treatment of Bowen's disease. METHODS: Eleven patients with biopsy-proven Bowen's disease were treated with once-daily or twice-daily self- application of 5% imiquimod cream for a maximum of 16 weeks. RESULTS: Nine of ten (90%) patients who completed the treatment schedule showed complete clinicopathologic regression. One (11%) patient showed recurrence of Bowen's disease on the treated site. 5% imiquimod cream was generally well-tolerated and no serious side effects were observed. CONCLUSION: 5% imiquimod cream appears to be an effective modality for treatment of Bowen's disease and might represent a valuable alternative to surgery or other invasive treatment methods.

The Therapeutic Effect of 5% Imiquimod Cream on Pyogenic Granuloma / 대한피부과학회지

BACKGROUND: Conventional interventions for pyogenic granuloma include excision, electrodessication and curettage, cryotherapy, and laser ablation, all of which can be associated with local tissue destruction, scarring, and recurrence in some cases. Although imiquimod is commonly regarded as an immune response modifier, it also induces antiangiogenic factors such as tissue inhibition of matrix metalloproteinase-1 (TIMP-1), IL-12 and increases apoptosis in vascular tumors. OBJECTIVE: To investigate the therapeutic efficacy of imiquimod on pyogenic granuloma. METHODS: Twelve patients with pyogenic granuloma were treated with 5% imiquimod cream every night for up to 8 weeks. Therapeutic efficacy, side effects and patient's satisfaction scale were evaluated. RESULTS: The onset time of effects ranged from 1 to 11 days (mean: 4.6 days). The clearance rate at 8 weeks after treatment was 83.3% and the mean time for clearance was 3.6 weeks. 3 of 12 (25%) patients experienced local pain, erosion and hemorraging as adverse events. However, there has been no recurrence, scarring, or hypopigmentation after more than 8 months of follow-up. CONCLUSION: Imiquimod may represent a safe, simple and effective alternative in the management of pyogenic granuloma. This therapeutic modality may be of particular benefit in children and patients whose lesions are on the face.

A Case of Semicircular Lipoatrophy Induced by Repeated Occupational Traumas / 대한피부과학회지

Semicircular lipoatrophy is a rare entity characterized by atrophic cutaneous indentation, typically involving the anterolateral thigh of young women. Although many previous reports have failed to reveal underlying trauma histories, repeated external microtraumas seem to be the most plausible causal factor at present. We report a case of semicircular lipoatrophy which occurred on both thighs of a 23-year-old woman after she started a new job as a waitress in fast-food restaurant.

A Case of Exacerbation of Porokeratosis with Myelodysplastic Syndrome / 대한피부과학회지

Immunosuppressive therapy has been reported to exacerbate or initiate the development of porokeratosis. We report a patient who noted a dramatic worsening of previously unrecognized lesions of porokeratosis accompanied by malaise and fatigue. He was subsequently found to have myelodysplastic syndrome. On the basis of this case, the sudden appearance or exacerbation of disseminated porokeratosis without immunosuppressive therapy may justify the search for underlying immunodepressive conditions.

A Case of Extramammary Paget's Disease Treated with 5% Imiquimod Cream / 대한피부과학회지

Extramammary Paget's disease (EMPD) is an uncommon malignancy involving the epidermis, which sometimes extends into the dermis. Current treatments for EMPD are surgical excision, Mohs micrographic surgery, or laser ablation. We report a case of a 50-year-old man who presented with EMPD. The patient refused to undergo surgery and, as an alternative, he applied 5% imiquimod cream, an immune response modifier, on a daily basis for 8 months. During the initial weeks of therapy, he experienced moderate erythema and flu-like symptoms. However, imiquimod treatment resulted in clinical and histological eradication of EMPD after 8 months with no recurrence during the 18 month follow-up period.

Effect of Dynamic Balance Training Using Visual Biofeedback of Center of Pressure in Patients with Stroke

OBJECTIVE: To investigate the effect of dynamic balance training with center of pressure (COP) games using visual biofeedback of COP movement in stroke patients. METHOD: Thirty-eight stroke patients were randomly as signed to the static or dynamic balance training group, or control group. Static group received weight-shift training with visual biofeedback of weight distribution bar. Dynamic group received dynamic balance training using COP games. Each training session lasted 30 minutes, 3 times in a week during 3 weeks. Control group received traditional rehabilitation only. The ability of balance control was assessed using posturography by total path distance, frequency of sway, and COP weight-spectrums during standing, and during presentation of virtual moving surround. Total patherror was also assessed during sine curve and dynamic circle trace test. RESULTS: In static group, there were significant improvement in the total path distance during comfortable standing and path error during sine curve tracing. In dynamic group, significant improvements were found in the path error during sine curve and dynamic circle tracing. CONCLUSION: Dynamic training group showed more improvement in dynamic balance ability, whereas static group showed more changes in the static balance ability. The visual biofeedback training is more specified for balance rehabilitation in stroke patients.

Predicting the Effect of Complex Physical Therapy: Utility of Manual Lymph Drainage Performed on Lymphoscintigraphy

OBJECTIVE: To evaluate the utility of manual lymph drainage (MLD) during lymphoscintigraphy (LS) in predicting the effect of complex physical therapy (CPT). METHOD: Forty seven patients were included in this study. MLD was done for 30 minutes after one hour LS image was obtained. 24 patients were followed up for 3~6 months. According to one hour LS image, patients were assigned to visible lymph node or lymphatic vessel group (Either group) and invisible lymph node and lymphatic vessel group (Neither group), and also according to LS changes after MLD, good and poor response group. The limb volume was checked before, and immediately after CPT, and at 1 month and 3~6 months after CPT. The treatment response was evaluated by percent volume reduction (PVR). RESULTS: There were no significant differences in volume reduction between Either group and Neither group. Otherwise, good response group showed significantly greater volume reduction after CPT than poor response group. Mean PVR in the good response group was 37.02% immediately after CPT, 41.2% at 1 month after CPT, and 47.4% at 3~6 months after CPT. Mean PVR in the poor response group was 19.22% immediately after CPT, 13.0% at 1 month after CPT, and 5.21% at 3~6 months after CPT. CONCLUSION: LS changes after MLD reflected the effects of CPT more accurately than one hour LS image.

The Diagnosis of Duchenne and Becker Muscular Dystrophy: Multiplex-PCR methods / 대한정형외과학회잡지

PURPOSE: The objective of this study is to evaluate the value of multiple-PCR as a diagnostic modality in detection of dystrophin gene deletion by observing its detection rate and concordance rate with clinical diagnosis. MATERIALS AND METHODS: Fifty-two male patients who were clinically diagnosed as DMD or BMD (Duchenne or Becker muscular dystrophy) and received multiple-PCR from 1994 to 1997 at our center were included in this study. The relationship between clinical phenotype and the location of gene deletion were studied using reading-frame rule. Dystrophin protein analysis by immunocyto-chemical technique was done in 7 cases with negative multiplex-PCR. RESULTS: Out of fifty-two patients, thirty-four were DMD and eighteen as BMD clinically. Multiplex-PCR revealed dystrophin gene deletion in 19 patients (36%) consisting of twelve DMD and seven BMD cases. The locations of the gene deletion coincide with the clinical phenotype in 17 cases (89%). Among the 7 cases that underwent dystrophin protein analysis, 3 DMD and 2 BMD were confirmed. CONCLUSIONS: Though no substantial gene deletion detection rate was observed in this study, multiple-PCR could be used as a first-line diagnostic tool in detecting dystrophin gene deletion in DMD/BMD patients based on its high concordance rate with phenotype and favorable patient compliance and convenience.

Spinal Dimensions and Shape Variation in Koreans: Radiographic Quantitative Morphometry / 대한정형외과학회잡지

Spinal dimensions (anterior, mid, and posterior height of the vertebral body) and shape variation (wedge compression, biconcave, and crush ratio) were obtained from plain radiographs of healthy Korean men and women. The purpose of this study was to define vertebral fracture from normal spinal morphometry of Korean men and women and to compare spinal dimension between men and women. Healthy 100 men and 100 women were included in this study. Plain lateral radiographs of thoracic and lumbar vertebrae were taken with standard method. Quantitative morphometry (anterior, mid, and posterior height of the vertebral body) was performed with plain radiographs. Spinal shape variations (wedge compression, biconcave, and crush ratio) were calculated from morphometric data. Spinal dimensions and shape variation of Korean men and women were presented, and morphometric cut-off vaiues for vertebral fracture were evaluated(mean-3xSD). Spinal dimensions of men were greater than women in all level (p<0.01). Wedge compression ratios (T6, 7, 8, 9, 12, L5 level) and biconcave ratios (T12, Ll, 4, 5 level) and crush ratios (Tll, L4, L5 level) were different between men and women (p<0.01). Spinal dimensions and shape variation from quantitative morphometry can be used in objective definition of vertebral fracture which can be used in medicolegal problem, workers compensation and medical insurance.