Myokymia is one of involuntary movement, which is characterized by undulatory muscle spasm, similar to the worm's crawl. Sometimes muscle pain, itchy sensation, dysautonomia and other symptoms are associated with it. Derangement of the peripheral or central nervous system after nerve or tissue damage is suspected as the source of impulse generators causing this symptom. We encountered a patient with neuropathic pain and myokymia after thoracotomy. Although several medications and nerve blocks have been applied, all have failed to provide symptom relief. We experienced improvement of the pain and involuntary movement with a thoracic sympathetic ganglion block and gabapentin.
Central Nervous System ; Dyskinesias ; Ganglia, Sympathetic* ; Humans ; Myalgia ; Myokymia* ; Nerve Block ; Neuralgia* ; Primary Dysautonomias ; Sensation ; Spasm ; Thoracotomy*

Aspergilloma and Allergic Bronchopulmonary Aspergillosis (ABPA) are different types of spectrum of pulmonary aspergillosis. ABPA results from hypersensitivity reaction to Aspergillus species and is known to be usually associated with bronchial asthma and cystic fibrosis. Aspergilloma results from simple colonization of this fungus within cavitary lung lesion or bronchiectasis. But rarely some patients can present together with ABPA and aspergilloma. We experienced a case of ABPA associated with aspergilloma in a 38 year-old male. The diagnosis was confirmed by asthma, immediate cutaneous reactivity to A. fumigatus, IgG antibody to A. fumigatus, elevated total and specific IgE antibodies to A. fumigatus, central bronchiectasis and peripheral eosinophilia coincident with radiographic infiltrates. During follow-up management with steroid, left pneumonectomy was done because of spontaneous pneumothorax with persistent air-leak and multidrug resistance pulmonary tuberculosis in association with aspergilloma. His respiratory symptoms and ABPA activity was much more improved after removal of aspergilloma. These findings suggest that surgical resection of aspergilloma can be considered to reduce antigenic source of colonized fungi in ABPA patients when associated with aspergilloma.
Adult ; Antibodies ; Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus ; Asthma ; Bronchiectasis ; Colon ; Cystic Fibrosis ; Diagnosis ; Drug Resistance, Multiple ; Eosinophilia ; Follow-Up Studies ; Fungi ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulin G ; Lung ; Male ; Pneumonectomy ; Pneumothorax ; Pulmonary Aspergillosis ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: Anesthetic procedures are major potent stimulus for the neuroendocrine hormonal axis, which results in release of the stress hormone. It is important to know the influence of specific anesthetic procedures on those host responses. We compared endocrine stress response and anesthesia characteristics for TIVA (total intravenous anesthesia) and VIMA (volatile induction and maintenance of anesthesia). METHODS: Forty patients scheduled for elective total abdominal hysterectomy were randomly assigned to TIVA or VIMA group. The patients in TIVA group (n = 20) received target controlled infusion (TCI) of propofol and fentanyl TCI with Stelpump software, and the patients in VIMA group (n = 20) received sevoflurane-nitrous oxide for induction (6%) and maintenance (1.5%) of anesthesia. Blood sampling was done 5 minutes before induction (baseline blood sample, BBS), just after intubation (intubation blood sample, IBS), just after extubation (extubation blood sample, EBS), and at arrival in recovery room (recovery room blood sample, RBS). Plasma concentration of glucose, cortisol, epinephrine, norepinephrine were measured. Bispectal Index (BIS) and systolic, diastolic blood pressure, heart rate, induction and recovery profiles were also measured. RESULTS: In both groups, there was significant increase of the blood cortisol and glucose level in EBS and RBS. But only in VIMA group, there was significant increase of the blood cortisol level in IBS. There was no change of the blood epinephrine and norepinephrine in both groups at EBS and RBS, but only in VIMA group, there was significant increase of epinephrine and norepinephrine at IBS. Blood pressure and heart rate increased significantly at IBS in VIMA group, compared with TIVA group. CONCLUSIONS: In VIMA group, there was significant increase of stress response and hemodynamic change only during induction of anesthesia. However, in TIVA group, there was no significant increase of stress response and hemodynamic change during induction, maintenance and recovery of anesthesia.
Anesthesia* ; Axis, Cervical Vertebra ; Blood Pressure ; Epinephrine ; Fentanyl ; Glucose ; Heart Rate ; Hemodynamics ; Humans ; Hydrocortisone ; Hysterectomy ; Intubation ; Norepinephrine ; Plasma ; Propofol ; Recovery Room

BACKGROUND: Anesthetic procedures are major potent stimulus for the neuroendocrine hormonal axis, which results in release of the stress hormone. It is important to know the influence of specific anesthetic procedures on those host responses. We compared endocrine stress response and anesthesia characteristics for TIVA (total intravenous anesthesia) and VIMA (volatile induction and maintenance of anesthesia). METHODS: Forty patients scheduled for elective total abdominal hysterectomy were randomly assigned to TIVA or VIMA group. The patients in TIVA group (n = 20) received target controlled infusion (TCI) of propofol and fentanyl TCI with Stelpump software, and the patients in VIMA group (n = 20) received sevoflurane-nitrous oxide for induction (6%) and maintenance (1.5%) of anesthesia. Blood sampling was done 5 minutes before induction (baseline blood sample, BBS), just after intubation (intubation blood sample, IBS), just after extubation (extubation blood sample, EBS), and at arrival in recovery room (recovery room blood sample, RBS). Plasma concentration of glucose, cortisol, epinephrine, norepinephrine were measured. Bispectal Index (BIS) and systolic, diastolic blood pressure, heart rate, induction and recovery profiles were also measured. RESULTS: In both groups, there was significant increase of the blood cortisol and glucose level in EBS and RBS. But only in VIMA group, there was significant increase of the blood cortisol level in IBS. There was no change of the blood epinephrine and norepinephrine in both groups at EBS and RBS, but only in VIMA group, there was significant increase of epinephrine and norepinephrine at IBS. Blood pressure and heart rate increased significantly at IBS in VIMA group, compared with TIVA group. CONCLUSIONS: In VIMA group, there was significant increase of stress response and hemodynamic change only during induction of anesthesia. However, in TIVA group, there was no significant increase of stress response and hemodynamic change during induction, maintenance and recovery of anesthesia.
Anesthesia* ; Axis, Cervical Vertebra ; Blood Pressure ; Epinephrine ; Fentanyl ; Glucose ; Heart Rate ; Hemodynamics ; Humans ; Hydrocortisone ; Hysterectomy ; Intubation ; Norepinephrine ; Plasma ; Propofol ; Recovery Room

OBJECTIVE: To determine the clinical utility of flexor carpi radialis (FCR) H-reflex with and without facilitation in the diagnosis of 7th cervical radiculopathy. METHOD: Thirty-four subjects (27 men, 7 women) participated in this study showed symptoms and signs suggesitive of cervical radiculopathy and every subject had single herniated cervical disc on MRI study. All participants underwent electrophysiologic study including routine nerve conduction study (NCS), electromyography (EMG), FCR H-reflexes with and without facilitation in both arms. Abnormal parameters for FCR H-reflex were 1) side to side latency difference more than 1.0 msec, 2) absence of FCR H-reflex in one side, 3) side to side amplitude ratio below 33% for without facilitation and 22% for facilitation. If the subjects had at least one of the three abnormal parameters, we concluded as having abnormal FCR H-reflex. RESULTS: In the FCR H-reflex without facilitation group, we were not able to elicit FCR H-reflex in both arms in 17 subjects. Among the 17 subjects with elicited FCR H-reflex, 7 had abnormal FCR H-reflex (C7 root; 4, other roots; 3). In the FCR H-reflex with facilitation group, FCR H-reflex was obtained in 32 subjects, 13 out of the 32 showed abnormal FCR H-reflex (C7 root; 6, other roots; 7). The sensitivity and specificity of FCR H-reflex without facilitation in the diagnosis of 7th cervical radiculopathy were 67%, 73%, with facilitation it were 50%, 65%. CONCLUSION: Even though FCR H-reflex without facilitation is superior in its sensitivity and specificity, low elicitabiliy is the factor that limits its clinical utility. FCR H-reflex with facilitation with its good elicitability, seems to be a useful adjunctive method to routine NCS and EMG examination in the diagnosis of 7th cervical radiculopathy.
Arm ; Diagnosis ; Electromyography ; H-Reflex* ; Humans ; Magnetic Resonance Imaging ; Male ; Neural Conduction ; Radiculopathy* ; Sensitivity and Specificity

OBJECTIVE: To verify the efficacy of 6cm segmental nerve conduction study in ulnar neuropathy at the elbow (UNE). METHOD: Ulnar nerve conduction studies were performed unilaterally in twenty five asymptomatic healthy adult volunteers and twenty five symptomatic patients with UNE. Twenty five symptomatic patients with UNE were diagnosed by standard ulnar nerve conduction studies, and needle EMG study. In the same healthy controls and patients groups, 6 cm and 10 cm segmental study were then performed at the elbow. The sensitivity and specificity of 6 cm segmental study were compared with those of 10 cm segmental study in these patients. RESULTS: The sensitivity and specificity came out to be 76% and 92% for the 6 cm segmental study and, 52% and 96% for the 10 cm segmental study. CONCLUSION: The sensitivity of 6 cm segmental NCS was much higher compared with 10 cm segmental NCS, whereas the specificity was similar in both tests. For screening of the UNE, 6 cm segmental NCS seems to be a more efficacious test.
Adult ; Elbow* ; Electromyography ; Humans ; Mass Screening ; Needles ; Neural Conduction ; Sensitivity and Specificity ; Ulnar Nerve ; Ulnar Neuropathies* ; United Nations ; Volunteers

OBJECTIVE: To determine the normal values of flexor carpi radialis (FCR) H-reflex without facilitation, with facilitation and with facilitation & averaging. And to compare the three methods. METHOD: The FCR H-reflex was tested in 60 healthy people. 1) H-reflexes was recorded in the FCR muscle without facilitation. 2) H-reflexes was recorded in the FCR muscle with facilitation and facilitation was carried out by contracting the FCR muscle with 1 kg of weight. 3) FCR H-reflex was tested by repetitive stimulation with facilitation and the multiple responses were averaged. RESULTS: Without facilitation, FCR H-reflexes were elicited only in 24 people out of 60 people and with facilitation, FCR H-reflexes were elicited in all 60 people. The mean latencies and amplitudes of the three methods were measured and normal limits of latency difference and amplitude ratio were calculated. In the FCR H-reflex without facilitation, with facilitation and with facilitation & averaging, the normal limits of latency difference were 1.0 msec, 1.0 msec, 1.1 msec and normal limits of amplitude ration were 0.37, 0.22, 0.57. CONCLUSION: FCR H-reflex with facilitation and with facilitation & averaging might be useful in the clinical diagnosis.
Diagnosis ; H-Reflex* ; Reference Values