Objective: : Trigeminal neuralgia (TN) is a severe neuropathic condition that affects several elderly patients. It is characterized by uncontrolled pain that significantly impacts the quality of life of patients. Therefore, the condition should be treated as an emergency. In the majority of patients, pain can be controlled with medication; however, other treatment modalities are being explored in those who become refractory to drug treatment. The use of the trigeminal nerve block with a local anesthetic serves as an excellent adjunct to drug treatment. This technique rapidly relieves the patient of pain while medications are being titrated to effective levels. We report the efficacy and safety of percutaneous trigeminal nerve block in elderly patients with TN at our outpatient clinic. Methods: : Twenty-one patients older than 65 years with TN received percutaneous nerve block at our outpatient clinic. We used bupivacaine (1 mL/injection site) to block the supraorbital, infraorbital, superior alveolar, mental, and inferior alveolar nerves according to pain sites of patients. Results: : All patients reported relief from pain, which decreased by approximately 78% after 2 weeks of nerve block. The effect lasted for more than 4 weeks in 12 patients and for 6 weeks in two patients. There were no complications. Conclusion : Percutaneous nerve block procedure performed at our outpatient clinic provided immediate relief from pain to elderly patients with TN. The procedure is simple, has no serious side effects, and is easy to apply.

BACKGROUND: In elderly asthmatics, underdiagnosis is one of the most important feature. The main reason of underdiagnosis is thought to be decreases in complaining of symptoms by reduction of intellectual faculties or physical activity. Among various symptoms, wheezing is the principal clue in diagnosing bronchial asthma, and decreases in wheezing complaints are also noted in elderly asthmatics. The objective of this study is to determine whether decreases in wheezing complaints in elderly asthmatic is due to decrease in the development of wheezing or decrease in the perception of wheezing. METHODS: Sixty one young(20-39 years old), 68 middle aged(40-59 years old), and 65 elderly(older than 60 years) stable asthmatic subjects were studied. During methacholine challenge test, lung auscultation and questionnaire survey about presence and perception of wheezing were conducted. RESULTS: One hundred sixty nine patients (87%) developed wheezing during the methacholine challenge test. Development of wheezing during methacholine challenge test was not different between groups. The methacholine concentration, % fall in FEV1, and FEV1% at first detection of wheezing were not different between groups. Among the patients who developed wheezing, 47 patients (90%), 42 patients (74%), and 26 patients (46%) felt wheezing in young, middle, and old age groups, respectively. CONCLUSION: In conclusion, the perception of wheezing are more decreased in elderly asthmatics compared to those in younger patients.
Aged* ; Asthma ; Auscultation ; Humans ; Lung ; Methacholine Chloride ; Motor Activity ; Respiratory Sounds* ; Surveys and Questionnaires

BACKGROUND: Intravascular ultrasound (IVUS) is one of the golden standards for the assessment of optimal angioplasty. Pressure-derived myocardial fractional flow reserve (FFRmyo) is a lesion-specific functional index of epicardial conduit and may be particularly useful for the assessment of optimal coronary angioplasty. The purpose of this study was to assess IVUS parameters and FFRmyo after successful angioplasty on coronary angiogram and compare them between balloon and stent group. METHODS: The study population consisted of 28 patients who underwent revascularization (14 cases of balloon angioplasty only, 14 cases of angioplasty with stent) from Jan. 1999 to Aug. 2000 at Inha University Hospital. After successful angioplasty on coronary angiogram, we measured minimal luminal diameter (MLD), minimal luminal area (MLA), lesion area stenosis (l-AST) and reference area stenosis (r-AST) with IVUS imaging. And we calculated FFRmyo from the ratio of mean coronary pressure distal to the stenosis (Pd) to the aortic mean pressure (Pa) during maximum coronary hyperemia (Pd/Pa). RESULTS: There was significant difference of MLD (2.2+/-0.4 vs 2.6+/-0.3), MLA (4.4+/-1.1 vs 6.4+/-1.7), r-AST (43.7+/-9.2 vs 29.8+/-9.4) and FFRmyo (0.89+/-0.07 vs 0.93+/-0.03) between balloon and stent group. All IVUS parameters (MLD, MLA, r-AST) are well correlated with FFRmyo after angioplasty (r=0.52, p<0.05, r=0.48, p<0.05 and r=-0.72, p<0.05 respectively). By multiple regression analysis, r-AST showed the best correlation with FFRmyo among IVUS parameters. CONCLUSION: Coronary angioplasty with stent showed more favorable MLD, MLA, r-AST and FFRmyo than balloon angioplasty. FFRmyo may be seemed to be alternative to IVUS for estimating the result of coronary angioplasty.
Angioplasty* ; Angioplasty, Balloon ; Constriction, Pathologic ; Fractional Flow Reserve, Myocardial ; Humans ; Hyperemia ; Phenobarbital ; Stents ; Ultrasonography*

BACKGROUND: In elderly asthmatics, underdiagnosis is one of the important features. The main reason for underdiagnosis is thought to be a low frequency in complaining of symptoms due to the reduction of intellectual recognition and physical activity. Among the various symptoms, wheezing is the principal clue in diagnosing bronchial asthma, and decreased complaints for wheezing are also noted in elderly asthmatics. The objective of this study is to determine if less complaints of wheezing in elderly asthmatic is due to a decrease in the development of wheezing. METHODS: 61 young (20-39 years old), 68 middle-aged (40-59 years old) and 65 elderly (older than 60 years old) stable asthmatic subjects were studied (each group shall be called, hereafter, Young Group, Middle-aged Group and Old Group, respectively). During the methacholine induced airway narrowing, lung auscultation and questionnaire survey about presence and perception of wheezing were conducted in 194 asthmatics. RESULTS: One hundred and sixty-nine patients (87%) developed wheezing during the methacholine induced airway obstruction. The frequency of wheezing during the methacholine challenge was found to be comparable among the groups. The methacholine concentration, % fall in FEV1, and FEV1 levels of the initial detection of wheezing were not different among the groups. Among the patients who developed wheezing, 47 patients (77%), 42 patients (61.8 %) and 26 patients (40%) complained of wheezing in Young, Middle and Old Group, respectively. CONCLUSION: In conclusion, the decreased perception of wheezing is a main factor for the low frequency of complaints of wheezing in elderly asthmatics.
Adult ; Age Factors ; Aged ; Analysis of Variance ; Asthma/*complications/diagnosis ; Chi-Square Distribution ; Comparative Study ; Female ; Human ; Male ; Middle Age ; Perception ; Respiratory Sounds/*etiology