BACKGROUND: Techniques for identification of the epidural space have advantages and disadvantages. We made an electronic apparatus to ensure an epidural space by detecting the reduction of pressure. We investgated the instrument to see if this could be adequately used for identification of the epidural space. METHODS: Thirty adult patients scheduled to receive an epidural injection for surgery were selected for the investigation. We connected the apparatus with an epidural Tuohy needle of which the tip was in the ligamentum flavum. We injected air to increase the pressure inside the epidural needle to 50 mmHg or 100 mmHg, and then the epidural needle was advanced slowly until we heard the alarm from the epidural detector when pressure inside the epidural needle suddenly decreased under the set point, suggesting the epidural needle reached the epidural space. After ensuring the epidural space we injected the anesthetics to induce epidural anesthesia. RESULTS: In both groups, we obtained successful anesthesia results and there were no complications. The volume of air injected into the epidural space was 0.64 +/- 0.1 in 50 mmHg group and 0.95 +/- 0.2 in 100 mmHg group. CONCLUSIONS: The use of the epidural detector in 30 patients demonstrated that this instrument could be a safe and effective means of identifying the epidural space. It allows the reduction of air injected into the epidural space, reducing the chance of complications due to an overinjection of air.
Adult ; Anesthesia ; Anesthesia, Epidural ; Anesthetics ; Epidural Space* ; Humans ; Injections, Epidural ; Ligamentum Flavum ; Needles

BACKGROUND AND OBJECTIVES: The clinical utility of otoacoustic emissions (OAEs) has been well established in childhood hearing screenings. As middle ear negative pressure prevails in normal children, and since all OAEs must be transmitted through the middle ear before they can be measured in the ear canal, OAEs can be affected by middle ear negative pressure. The purpose of this study is to elucidate the effect of middle ear negative pressure on the detectability of OAEs. MATERIAL AND METHODS: TEOAEs were recorded for 36 ears using click before & after tonsillectomy and, or adenoidectomy (T and, or A) operations. Before & after T and or A operations, DPOAEs were generated at six geometric mean frequencies between 1-6 kHz for two different groups, Group I (40 ears) and Group II (36 ears). Group I: 3(f2/f1) ratios (1.21, 1.22 and 1.23) were used at the fixed stimulus level (70-70 dB SPL). Group II:3 stimulus levels were used (70-70 dB SPL, 60-70 dB SPL and 30-40 dB SPL). RESULTS: The negative middle ear pressure attenuated low frequency emission more than high frequency emission. CONCLUSION: Negative middle ear pressure may increase false alarm. So pneumatic otoscopy and aural immittance testing should be utilized to predict the feasibility of applying OAEs in childhood hearing screening test.
Adenoidectomy ; Child ; Ear ; Ear Canal ; Ear, Middle* ; Hearing ; Humans ; Mass Screening ; Otoscopy ; Tonsillectomy

In a study of the fungal diversity on Ulleung Island in Korea, three novel strains of Penicillium were isolated. Different sites on Ulleung Island were selected for collecting endophytic fungi, and three endophytic fungal strains showed unique morphological characteristics. DNA sequence of the internal transcribed spacer, β-tubulin, calmodulin, and RNA polymerase II second largest subunit regions of the strains were analyzed and they showed unique taxonomic position from the other species of Penicillium section Sclerotiora. The new strains were named Penicillium ulleungdoense sp. nov. As the novel endophytic Penicillium taxa were discovered in a unique environment, the data could be meaningful for understanding the geographical distribution of Ascomycetes on Ulleung Island.

An anastomotic pseudoaneurysm after the aortic replacement surgery is a rare complication which could be lethal when it ruptures. So it should be corrected whenever it is found after the aortic surgery. The authors performed three surgical corrections in 2 cases. The first case is type B chronic aortic dissection with abdominal aortic aneurysm. After an abdominal aortic replacement, the patient developed an anastomotic pseudoaneurysm. We treated him with a thoracoabdominal aortic replacement. The second case is ruputred throacoabdominal aortic aneurysm. After a thoracoabdominal aortic replacement, the patient developed an anastomotic pseudoaneurysm in the proximal anastomosis. We treated her with aortic arch replacement. But She developed another pseudoaneurysm in the aortic root anastomotic site. So we performed secondary operation to reinforce the anastomosis. They all recovered from the operations without any complication and are being followed up.
Aneurysm ; Aneurysm, False* ; Aorta, Thoracic ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Humans ; Rupture

OBJECTIVE: Protocols for posterior circulation ischemic stroke have not been established by randomized clinical trials. Mechanical endovascular thrombectomy (MET) devices are evolving, and many of these devices already developed or in development are suitable for posterior circulation MET. MATERIALS AND METHODS: We investigated the medical records of patients who underwent MET for posterior circulation ischemic stroke from January 2012 to August 2016. Fifteen patients were included. MET was performed in patients with or without injected intravenous tissue plasminogen activator. MET was considered in patients with a National Institute of Health Stroke Scale score of 4 or more, older than 18 years, with definite occlusion of the basilar artery or posterior cerebral artery (PCA), and who arrived at the hospital within 24 hours from onset. RESULTS: The direct catheter aspiration technique was used in five cases, and the stent retrieval technique was used in seven cases. The stent retrieval technique with the direct aspiration technique was used in three cases. Recanalization failed in two cases. Basilar occlusion without PCA involvement is the only effective factor of successful recanalization (p = 0.03). Successful recanalization (p = 0.005) and the presence of a posterior communicating artery (p = 0.005) affected the good outcome at discharge. CONCLUSION: An early diagnosis and active MET may improve the patient outcome. MET may help recanalization and good flow restoration and the potential for a good outcome.
Arteries ; Basilar Artery ; Catheters ; Early Diagnosis ; Humans ; Medical Records ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery* ; Stents ; Stroke ; Thrombectomy* ; Tissue Plasminogen Activator

OBJECTIVE: To find out how many causes constitute hemiplegic shoulder pain (HSP) and how they distribute in an individual patient. METHOD: Twenty-three consecutive patients with HSP which had newly developed within 3 months after stroke were enrolled from January 2008 till July, 2008. They all performed a passive range of motion test for adhesive capsulitis, modified Ashworth test for spasticity, simple x-ray for subluxation, ultrasonography for rotator cuff problems and three-phase bone scintigraphy for complex regional pain syndrome (CRPS). The causes of HSP were analyzed in number and distribution. RESULTS: Average 2.26 causes constituted with HSP in an individual patient. Most common causes were adhesive capsulitis and CRPS (respectively 14 patients). Two patients had 4 and eight patients had 3 types of shoulder pathology. CONCLUSION: More than two types of shoulder pathology existed in a patient with HSP. These findings shoulde be carefully considered when treating the patients with HSP.
Bursitis ; Humans ; Muscle Spasticity ; Range of Motion, Articular ; Rotator Cuff ; Shoulder ; Shoulder Pain ; Stroke