Postdural puncture headache (PDPH) is probably the most common complication of spinal anesthesia. The incidence of spinal headache is believed to be related to age, sex, pregnancy, size of the dural puncture needle, direction of the needle bevel, and the angle at which the needle penetrates the dura. This study were done to see the relation of sex, age, needle size (23 gauge, 25 gauge & 27 gauge needle) & bevel direction (parallel, perpendicular insertion to the longutudinal dural fiber) on the incidence, duration, severity, and location. The following results were observed: 1) The overall incidence of headache was 7.9% (49 cases). 2) The size of the needle was statistically significant assouation of PDPH. 3) Headache occured in highest frequency in patients in the second and third decades. 4) The frequency of PDPH was inversely associated with age. 5) The onset of headache was 1-2 days (68%) and duration of headache was 4-5 days (82%) in postanesthetic day. 6) The severity of headache was mild and moderate in 90% cases.
Anesthesia, Spinal ; Headache ; Humans ; Incidence ; Needles* ; Post-Dural Puncture Headache* ; Pregnancy ; Punctures

Purpose: This study aimed to systematically evaluate literature related to the effects of exercise intervention programs on physical or psychological variables of post-operative breast cancer patients in Korea, and identify the effectiveness of exercise intervention through meta-analysis. Methods: The review question was defined according to PICO-SD (Participants, Intervention, Comparisons, Outcomes, Study Design) to achieve a systematic literature review: “How does exercise intervention affect the physical or psychological outcome in post-operative breast cancer patients compared to the control group?” The subjects were randomized clinical trials (RCTs) studies released in Korea between 2010 and December 2020. Literature searches were conducted using four electronic databases, including Korean Studies Information Service System (KISS), Research Information Sharing Service (RISS), National Assembly Library, and DBpia. The search terms were ‘breast neoplasms’ or ‘breast cancer’ with ‘exercise’ or ‘exercise intervention’ or ‘exercise program.’ A total of 13 RCTs were finally selected. Results: The outcome variables were in the upper extremity range of motion (ROM), shoulder disability, pain and edema. The effect size of exercise intervention on ROM was 0.95(95% CI:0.58, 1.33)( p<.001); shoulder disability was -1.16(95% CI:-1.77, -0.55)(p<.001); pain was -1.24(95% CI:-1.58, -0.89) (p<.001); and edema was -0.03(95% CI:-0.39, 0.33)(p=.858). Conclusion This result suggests that oncology nurses may apply exercise intervention to improve ROM, shoulder disability, and to alleviate pain in post-op breast cancer patients.

Purpose: This study aimed to systematically evaluate literature related to the effects of exercise intervention programs on physical or psychological variables of post-operative breast cancer patients in Korea, and identify the effectiveness of exercise intervention through meta-analysis. Methods: The review question was defined according to PICO-SD (Participants, Intervention, Comparisons, Outcomes, Study Design) to achieve a systematic literature review: “How does exercise intervention affect the physical or psychological outcome in post-operative breast cancer patients compared to the control group?” The subjects were randomized clinical trials (RCTs) studies released in Korea between 2010 and December 2020. Literature searches were conducted using four electronic databases, including Korean Studies Information Service System (KISS), Research Information Sharing Service (RISS), National Assembly Library, and DBpia. The search terms were ‘breast neoplasms’ or ‘breast cancer’ with ‘exercise’ or ‘exercise intervention’ or ‘exercise program.’ A total of 13 RCTs were finally selected. Results: The outcome variables were in the upper extremity range of motion (ROM), shoulder disability, pain and edema. The effect size of exercise intervention on ROM was 0.95(95% CI:0.58, 1.33)( p<.001); shoulder disability was -1.16(95% CI:-1.77, -0.55)(p<.001); pain was -1.24(95% CI:-1.58, -0.89) (p<.001); and edema was -0.03(95% CI:-0.39, 0.33)(p=.858). Conclusion This result suggests that oncology nurses may apply exercise intervention to improve ROM, shoulder disability, and to alleviate pain in post-op breast cancer patients.

A study of continuous postoperative regional analgesia by nerve sheath block for limb amputation is presented. The authors reviewed 65 patients with amputation at the level proximal to the wrist or ankle. 15 patients of which were managed with continuous postoperative regional analgesia (CPRA) by nerve sheath block. At the time of exposure of nerve trunk during amputation, a catheter was introduced directy into the transected nerve sheath through a seperated stab wound, then infuse 0.5% bupivacaine 5ml prior to wound closure and postoperatively at the rate of 2 ml/4~6 hours for 3~4 days. The results were as follows : 1) Effective amputation stump analgesia was obtained, significantly reducing the need for narcotic analgesics. 2) 46 (70%) patients experienced Phantom phenomena and 30 (46%) patients experienced Phantom pain, a less frequently in CPRA group. 3) Phantom pain was more commonly observed in patients with rnore severe preamputation pain. 4) There were no significant relationships between the occurence of Phantom pain and the age of amputee or the level of amputation. We concluded that continuous postoperative regional analgesia by nerve sheath block significantly reduced the narcotic requirements in patients with ampotation surgeries.
Amputation Stumps ; Amputation* ; Amputees ; Analgesia* ; Ankle ; Bupivacaine ; Catheters ; Extremities* ; Humans ; Narcotics ; Phantom Limb ; Wounds and Injuries ; Wounds, Stab ; Wrist

OBJECTIVE: The purpose of this study was to evaluate the efficacy of implant removal of percutaneous short segment fixation after vertebral fracture consolidation in terms of motion preservation. METHODS: Between May 2007 and January 2011, 44 patients underwent percutaneous short segment screw fixation due to a thoracolumbar burst fracture. Sixteen of these patients, who underwent implant removal 12 months after screw fixation, were enrolled in this study. Motor power was intact in all patients, despite significant vertebral height loss and canal compromise. The patients were divided into two groups by degree of osteoporosis : Group A (n=8), the non-osteoporotic group, and Group B (n=8), the osteoporotic group. Imaging and clinical findings including vertebral height loss, kyphotic angle, range of motion (ROM), and complications were analyzed. RESULTS: Significant pain relief was achieved in both groups at final follow-up versus preoperative values. In terms of vertebral height loss, both groups showed significant improvement at 12 months after screw fixation and restored vertebral height was maintained to final follow-up in spite of some correction loss. ROM (measured using Cobb's method) in flexion and extension in Group A was 10.5degrees (19.5/9.0degrees) at last follow-up, and in Group B was 10.2degrees (18.8/8.6degrees) at last follow-up. Both groups showed marked improvement in ROM as compared with the screw fixation state, which was considered motionless. CONCLUSION: Removal of percutaneous implants after vertebral fracture consolidation can be an effective treatment to preserve motion regardless of osteoporosis for thoracolumbar burst fractures.
Follow-Up Studies ; Humans ; Methods ; Osteoporosis ; Range of Motion, Articular

Intracranial calcifications are relatively common computed tomographic findings in the field of neurosurgery, and cysticercosis, tuberculosis, HIV, and cryptococcus are acquired intracranial infections typically associated with calcifications. However, intracranial calcification caused by a bacterial brain abscess is rare. Here, we present a rare case of intracranial calcification caused by a bacterial brain abscess, from which staphylococcus hominis was isolated. To the best of our knowledge, no previous report has been published on intracranial calcification caused by bacterial brain abscess after decompressive craniectomy for traumatic brain injury. In this article, the pathophysiological mechanism of this uncommon entity is discussed and relevant literature reviewed.
Brain ; Brain Abscess ; Brain Injuries ; Cryptococcus ; Cysticercosis ; Decompressive Craniectomy ; HIV ; Neurosurgery ; Staphylococcus hominis ; Tuberculosis

OBJECTIVES AND OMPORTANCE: The present study investigated the levels of basic fibroblast growth factor(bFGF) in the CSF of patients with moyamoya disease and its clinical significance. METHODS: The levels of bFGF in CSF, taken from 26 hemispheres of 14 moyamoya patients and 20 patients without vascular anomaly(control group), were measured by an enzyme-linked immunosorbent assay. We analyzed the correlation between the level of bFGF and the clinical factors such as age, onset pattern, development of neovascularization, and cerebral circulation. RESULTS: The CSF of moyamoya patients contained a high concentration of bFGF to a significant extent. The bFGF level was apparently elevated in the patients in whom neovascularization from indirect revascularization, such as modified encephalo-duro-arterio-synangiosis(EDAS) was well developed. A linear correlation between the values of bFGF and clinical progression was noted. CONCLUSIONS: The elevation of bFGF in moyamoya disease seems to be specific. Clinically, the bFGF level may be considered a useful indicator to predict the efficacy of indirect revascularization.
Enzyme-Linked Immunosorbent Assay ; Fibroblast Growth Factor 2* ; Fibroblasts ; Humans ; Moyamoya Disease*

Injury to the vertebral artery during anterior cervical discectomy is rare but potentially fatal. We report a case of cerebellar infarction after endovascular embolization for iatrogenic vertebral artery injury at C5-C6 during an anterior cervical discectomy and fusion. A 61-year-old man had an intraoperative injury of the right vertebral artery that occurred during anterior cervical discectomy and fusion at C5-C6. Hemorrhage was not controlled successfully by packing with surgical hemostatic agents. While the patient was still intubated, an emergency angiogram was performed. The patient underwent endovascular occlusion of the right V2 segment with coils. After the procedure, his course was uneventful and he did not show any neurologic deficits. Brain computed tomographic scans taken 3 days after the operation revealed a right cerebellar infarction. Anti-coagulation medication was administered, and at 3-month follow-up examination, he had no neurologic sequelae in spite of the cerebellar infarction.
Brain ; Diskectomy ; Emergencies ; Follow-Up Studies ; Hemorrhage ; Humans ; Infarction ; Middle Aged ; Neurologic Manifestations ; Vertebral Artery

Primary malignant melanoma of tbe esophagus is extremely rare and its incidence is below 0.1%. The tumor is polypoid and tend to be large, which is covered with false membrane, friable, hemorrhagic, and necrotic. Hematogenous and lymphogenic metastasis are common. Resection of the tumor with an anastomotic procedure seems to be the treatment of choice, and postoperative irradiation may be useful. But, despite these measures, prognosis is poor, with a 5-year survival of 4.2%. We report a case of 58-year-old man with primary malig- nant melanoma of the epophagus, and review of the literature in presented related studies.
Esophagus* ; Humans ; Incidence ; Intestines* ; Melanoma* ; Membranes ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Stomach*

BACKGROUND: This study was conducted to evaluate belief and practice levels of family physicians concerning primary care is settled or not. METHODS: The target population were those family physicians having finished their three-year residency course in family medicine after 1989. Out of 2,075 people, the addresses 945were identified of This was a sample population. We exckyded 63persins who worked in medical school. The questionnaires were sent twice during July to September in 1998, and contents were constructed if general characteristics, items of belief and practice level of five areas of primary care(1977, IOM - Accessibility, Comprehensiveness, Continuity, Coordination, Accountability). RESULTS: Response rate was 32.1%(total : 270 : 1st respondents : 226 and 2nd : 44). Average belief level concerning principles of primary care was 4.45 point(5 point scale), and according to area rate continuity, coordination, comprehensiveness, accountability which was significant(p=0.00). Average practice level(5 point scale) concerning principles of primary care was 3/64 point. In order of strength of belief : accessibility, comprehensiveness, coordination, accountability, continuity, which was significant (p=0.00). The highest concordance between belief and practice was accessibility(p=0.00) and the highest gap was continuity(p=0.00). Compared with the unsatisfied group, the satisfied group had higher practice level(p=0.00). Significant variables that affect practice level were belief level, opening, satisfaction(r2=0.27, p=0.00). The opinion of whether primary care was settled was mostly negative(95.8%). CONCLUSION: Although, family physicians were revealed to have relatively high belief and practice level concerning primary care, their opinions about primary care setting werew negative. There is a lot of significant gap between individual level as family physician and societal level in primary care. More studies need to be conducted to determine the causes of such difference.
Surveys and Questionnaires ; Health Services Needs and Demand ; Humans ; Internship and Residency ; Physicians, Family* ; Primary Health Care* ; Schools, Medical ; Social Responsibility