Epidural nerve block is the most widely practiced procedure in the pain clinic. Accidental dural puncture during epidural nerve block also has been associated with postdural puncture headache and total spinal anesthesia. Especially, total spinal anesthesia is the most serious complication of epidural nerve block and can lead to a life threatening conditions. We have experienced two cases in whom total spinal anesthesia occurred during epidural nerve block for neck and lower back pain control. Immediately after epidural nerve block, the patients became unresponsive and apneic with loss of muscle tone in all extremity. We performed resuscitations and about 3 hours later the patients recovered completely without any complication.
Anesthesia, Spinal* ; Extremities ; Humans ; Low Back Pain ; Neck ; Nerve Block* ; Pain Clinics ; Post-Dural Puncture Headache ; Punctures ; Resuscitation

No abstract available.
Trichomonas*

No abstract available.
Trichomonas*

BACKGROUND: The nerve conduction study (NCS) is one of the most important diagnostic tools used to evaluate the function of large myelinated nerve fibers. However, the NCS in patients with diabetic polyneuropathy, who have senso-ry and motor abnormalities on neurological examination, are frequently found to be within normal limits. Somatosensory Evoked Potentials (SEP), F-waves, and NCS were performed to determine their usefulness in detecting electrophysiologic abnormalities in the early stages of patients with diabetic polyneuropathy. METHODS: Posterior tibial SEP (PTSEP) studies were performed in thirty patients with clinically suspected diabetic polyneuropathy who had with-in normal values of NCS involving the upper and lower extremities. PTSEP, F-wave, and NCS were also performed in age and height matched eighteen normal participants. RESULTS: The mean latencies of spinal evoked potentials (T12) and cortical evoked potentials (P1) were significantly prolonged in the diabetic patients compared to the control group (p < 0.05). The mean central conduction times and F wave latencies had no significant differences between the patients and control groups (p > 0.05). CONCLUSIONS: We found the SEP study to be a useful diagnostic test for detecting diabetic polyneuropathy.
Diabetic Neuropathies* ; Diagnostic Tests, Routine ; Evoked Potentials ; Evoked Potentials, Somatosensory* ; Humans ; Lower Extremity ; Nerve Fibers, Myelinated ; Neural Conduction* ; Neurologic Examination ; Reference Values

PURPOSE: Although most peritrochanteric fractures in old age necessitates surgical treatment, daily life functions are still impaired after discharge. We assessed the types of peritrochanteric fracture, risk factors, and functional recovery in elderly patients who were over 65 years old. We also tried to determine factors for recovery to daily life. MATERIALS AND METHODS: From January 2006 to December 2007, among 61 patients who were over 65 years old with the possibility of 1 year follow-up, 50 patients were selected through interviews. After verifying age, sex, mode, types of fracture, and method, we analyzed daily living activities with a functional recovery index and estimated recovery of daily life functions after surgery, assuming a score increase if functional recovery was good. RESULTS: The mean age was 75.8 years, and females (31 patients, 62%) exceeded males. Slipping (27 patients, 54%) was the most common cause of fracture, and the intertrochanteric femur fracture was the most common fracture type (34, 68%). The average functional recovery index decreased 16.24% compared with the pre-operation value, having a tendency to decrease more in old age and female patients. Subtrochanteric femur fracture showed a 17.6% decrease in functional recovery index among the fracture types. CONCLUSION: In elderly patients over 65 years, the functional recovery index after peritrochanteric fracture decreased 16.24% on average compared with the preoperation state. The largest decrease was in basic life ability. The functional recovery index decreased more in old age, females, and subtrochanteric femur fracture, which indicates these factors influence functional recovery.
Activities of Daily Living ; Aged ; Female ; Femur ; Follow-Up Studies ; Humans ; Life ; Male ; Risk Factors

BACKGROUND: Abnormal platelet activation has been identified in several disorders characterizedby vascular patholo-gy including coronary artery disease, Alzheimer disease, myeloproliferative disorders, diabetes, preeclampsia, inflam-matory bowel disease and glomerular disease. Antiplatelet therapy has been valuable in the management of some of these conditions. The aim of this study is to verify usefulness of mean platelet component (MPC) concentration as a marker of thrombotic process in patients with cerebral infarction. Our hypothesis is that MPC as measured by the ADVIA(R) 120 hematology system is used to detect and monitor platelet activation associated with thrombotic process of ischemic stroke. METHODS: To study the existence of platelet activation at the onset of cerebral infarction, mean platelet concentration of platelets were measured daily during post-stroke 10 days. Thirty-four acute thrombotic cerebral infarction and seventeen age-matched healthy persons were selected for this study. To investigate the time course of the platelet MPC changes observed in stroke patients, the blood samplings for MPC measuring were done and analyzed on the ADVIA 120(R) system. RESULTS: There was a statistically significant decrease in MPC concentration of the platelets at post-stroke 3rd to 7th day compared to the control group ( p < 0.05). CONCLUSIONS: We conclude that a reduction of MPC as measured by the ADVIA 120(R) hematology system may be used to detect and monitor thrombotic process associated with platelet activation in ischemic stroke.
Alzheimer Disease ; Blood Platelets* ; Cerebral Infarction ; Coronary Artery Disease ; Hematology ; Humans ; Myeloproliferative Disorders ; Platelet Activation* ; Pre-Eclampsia ; Stroke*

BACKGROUND: There were several studies for the incidence of gastroesophageal reflux associated with the laryngeal mask airway (LMA), but the results of those studies were much different from one another. This conflicting results may be due to the time of the removal of LMA, which has been usually after the arousal (when the patient can open the mouth on command). So, the authors investigated the incidence of the gastroesophageal reflux and the regurgitation of gastric contents above the upper esophageal sphincter associated with the difference of the time of the removal of LMA. METHODS: Sixty three patients scheduled for elective orthopedic surgery with a standardized general anesthetic technique were allocated randomly to Group A (n=34, LMA was removed when the rejection signs such as struggle, restlessness, swallowing and cough came out.) or Group B (n=29, LMA was removed after arousal). For the detection of reflux and regurgitation episodes during anesthesia, a pH monitoring probe was positioned in the lower esophagus and a methylene blue (50 mg) gelatine capsule was swallowed just before induction. At the end of anesthesia, the episodes of reflux and regurgitation of gastric contents were analyzed according to the pharyngeal blue staining or pH< or = 4. RESULTS: The incidence of reflux (pH< or = 4) from the time of the rejection signs to the removal of LMA and the total incidence of reflux in Group B were significantly higher than that of Group A. No patient in both group showed pharyngeal staining of methylene blue. There was no clinical evidence of aspiration of gastric contents in either group. CONCLUSION: Maintenance of LMA until the patient can open the mouth on command seems to increase the incidence of the gastroesophageal reflux.
Anesthesia ; Arousal ; Cough ; Deglutition ; Esophageal Sphincter, Upper ; Esophagus ; Gastroesophageal Reflux ; Gelatin ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Laryngeal Masks* ; Methylene Blue ; Mouth ; Orthopedics ; Psychomotor Agitation

BACKGROUND: Coronary artery bypass graft (CABG) surgery has been a main treatment modality of ischemic heart disease since Sabiston reported the first CABG operation using a saphenous vein graft in 1963. However, graft stenosis that happens after CABG surgery is one of the main limitations of the procedure. We investigated risk factors that are related to graft stenosis and occlusion in patients that needed a coronary angiogram after CABG surgery. METHODS: From May 1995 to April 2004, we performed 348 CABG surgeries. Among them, we performed follow up coronary angiogram for 45 patients because of clinical indications, corresponding to 146 graft vessels. According to the angiography findings, patients with 27 graft vessels that showed stenosis or occlusion were defined as group S and patients with 119 graft vessels that showed no stenosis or occlusion were defined as group P. RESULTS: The mean patient age of group S is 59.44 (+/-8.549) years and the mean patient age of group P is 57.99 (+/-8.676) years. Group P patients had more stenotic native coronary arteries than group S patients, which is statistically significant (80.0+/-7.2% vs. 68.0+/-11.9%, p=0.005). Group S patients had a statistically significant lower postoperative HDL level than the level of the group P patients (40.4+/-15.9 mg/dL vs. 50.5+/-4.4 mg/dL, p=0.002). CONCLUSIONS: When performing CABG surgery and postoperative patient management, the severity of native coronary artery stenosis and the postoperative HDL level should be considered for better patient outcome.
Angiography ; Cholesterol, HDL ; Constriction, Pathologic* ; Coronary Artery Bypass* ; Coronary Stenosis ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Myocardial Ischemia ; Risk Factors* ; Saphenous Vein ; Transplants*

BACKGROUND: There were several studies for the incidence of gastroesophageal reflux associated with the laryngeal mask airway(LMA), but the results of those studies were much different much different from one another. The aim of this study was to compare the incidence of gastroesophageal reflux and regurgitation of gastric contents between the LMA and the endotracheal tube(ETT). METHOD: Ninety patients scheduled for elective orthopedic surgery with a standardized general anesthetic technique were randomly allocated to receive either a LMA(n-49) or a ETT(n=41) for airway management. The esophageal manometry was carried out for the exclusion of esophageal motility disorders and the 24-hour ambulatory pH metry was done from one day before the operation. A methylene blue(50mg) capsule was swallowed just before the induction and the simultaneous recordings of pH were maintained during anesthesia. At the end of anesthesia, the episodes of regurgitation of gastric contents above hypopharynx were analyzed by the pharyngeal blue staining and the pH metric data were analyzed for the detection of gastroesophageal relux episodes during anesthesia. RESULTS: There was no significant difference in the incidence of gastroesophageal relux(pH< or =4) between two groups; only two patients in LMA and three patients in ETT had reflux episodes during the removal or arousal phase. There was no episode of the pharyngeal blue staining in both group. All of the gastroesophageal reflux patients in both group developed a cough or straining during those phases. There was no clinical evidence of aspiration of gastric contents in both group. CONCLUSION: In comparison with ETT, use of LMA does not appear to increase the incidence of gastroesophageal reflux and regurgitation above hypophryngeal level in positive pressure ventilating patients during long surgical procedures. Therefore, the risk of aspiration in LMA will not be much more than ETT.
Airway Management ; Anesthesia ; Arousal ; Cough ; Esophageal Motility Disorders ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Hypopharynx ; Incidence ; Laryngeal Masks* ; Manometry ; Masks* ; Orthopedics

OBJECTIVES: Vitamin D deficiency, which causes secondary hyperparathyroidism, is considered to be a major contributor to osteoporosis. Because the serum 25-hydroxyvitamin D (25-OHD) level depend on sun exposure and, varies by season, the level of serum 25-OHD in each season at which vitamin D status can lead to changes in bone mineral density (BMD) is not known. METHODS: A total of 2,878 women who underwent periodic health examinations at Ajou University Hospital were included in this study. We measured the serum 25-OHD concentrations using radioimmunoassay and BMDs using dual energy x-ray absorptiometry (DXA). The differences in serum 25-OHD levels among groups as a function of age, season, and BMD were tested by one-way ANOVA. RESULTS: The serum 25-OHD level was not different based on age, but by season, with higher levels in the summer and autumn than in the winter and spring. However, the 25-OHD level did not have a significant relationship with BMD in any season. CONCLUSION: The serum 25-OHD level represents vitamin D status at the time of testing, which is not associated with long-term changes in BMD. When the 25-OHD levels are used to make clinical decisions related to the treatment of osteoporosis, careful interpretation is required.
Absorptiometry, Photon ; Bone Density ; Female ; Humans ; Hyperparathyroidism, Secondary ; Osteoporosis ; Radioimmunoassay ; Seasons ; Solar System ; Vitamin D ; Vitamin D Deficiency ; Vitamins