Acupuncture is a popular technique used worldwide, particularly for clinical pain management. Diverse methods of acupuncture with several types of needle have recently been introduced; however, medical evidence of the treatment and safety of many of these techniques has not been established. In addition, severe, life-threatening acupuncture-related complications have been reported even though the treatment is considered to be safe. We report a case of a post-dural puncture headache that occurred following acupuncture for the treatment of lower back pain, with a literature review. Pain physicians should consider that acupuncture can cause far more serious side effects than those previously known.
Acupuncture ; Low Back Pain ; Needles ; Pain Management ; Post-Dural Puncture Headache* ; Postoperative Complications

Most elective cesarean sections are conducted under spinal anesthesia. Regional anesthesia has become the preferred technique, because general anesthesia is associated with a greater risk of maternal morbidity and mortality. In patients without absolute contraindication, spinal anesthesia is avoided, when procedural difficulty is increased by severe spinal deformity. A 41-year-old female patient was 33 weeks into pregnancy. Her height and weight were 145 cm and 45 kg. The patient was planned for emergency cesarean section, due to cephalopelvic disproportion. Spinal anesthesia was planned since she was suffering from Duchenne's muscular dystrophy, and had risks of respiratory failure and prolonged mechanical ventilation after general anesthesia. However, the patient also had severe kyphoscoliosis, maybe due to Duchenne's muscular dystrophy. We are reporting a successful spinal anesthesia using real-time ultrasound guidance, for cesarean section in this obstetric patient with severe kyphoscoliosis.
Adult ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Cephalopelvic Disproportion ; Cesarean Section* ; Congenital Abnormalities ; Emergencies ; Female ; Humans ; Mortality ; Muscular Dystrophies* ; Pregnancy ; Respiration, Artificial ; Respiratory Insufficiency ; Scoliosis ; Ultrasonography

Purpose: This study analyzed the results of limb salvage surgery of classical internal bone transport using an Ilizarov apparatus for cases of infected nonunion of the lower extremity long bones, including the complications. Materials and Methods: The data of the patients with infected nonunion of the femur or tibia treated with bone internal transport method using Ilizarov apparatus from December 2006 to December 2011 were reviewed retrospectively. Results: Of the thirteen cases, eleven patients had a lesion of the tibia, one on the knee joint, and the last on the femur shaft. The average length of internal transport was 89.5 (42–191) mm with the external fixation period of 362.8 (175–601) days, resulting in the external fixator index of 1.43 (0.91–2.08) month/cm. The major complications were four cases of delayed union or nonunion, two cases of regenerate failure, two cases of limb length discrepancy of more than 2.5 cm, two cases of remnant angular deformity, one case of refracture, two cases of equinus deformity and ankle joint stiffness, and one case of intended knee joint fusion. In all thirteen cases, bone union was achieved without infection recurrence. Conclusion Limb salvage surgery using Ilizarov apparatus for classical internal bone transport could be a way to avoid amputation in patients with infected nonunion. The outcomes of classical internal bone transport with a higher bone union rate and lower infection recurrence were acceptable. On the other hand, all possible complications, the treatment course, and other options, such as bone transport with internal fixation or induced membrane technique, should be shared with the patient before surgery to enhance overall satisfaction.Furthermore, for difficulties in regenerate formation in the bone with osteomyelitis and massive bone defect, the patient should be informed of a potential longer fixation period or additional surgeries for regenerate failure, including bone graft or fibular transport, to facilitate the patient’s compliance to treatment.

Purpose: : The purpose of this study is to explore changes in the conceptual perception structure of medical students’ empathy according to the educational experience provided at the beginning of the basic medical education. Methods: : The subjects of this study were 116 students in the 2nd year of the pre-medical department of the College of Medicine. Results: : Before and after the basic medical interview class and after the end of the dissection practice, words included in the concept of empathy such as ‘the other person’, ‘emotion’, ‘understanding’, ‘position’, ‘situation’, and ‘thought’ appeared in common. However, these common words appeared mixed before and after the basic medical interview class, but after the end of the dissection practice, they changed to a structure that recognizes the concept of empathy by integrating the core concepts of ‘the other’, ‘understanding’, and ‘emotion’. In particular, after the end of the dissection practice, the word ‘patient’ appeared, expressing the specific object of empathy as a doctor for the first time. Conclusion : Curriculum related to medical interview within the basic medical education curriculum should be systematically developed so that students can continuously experience practical medical interview situations along with theoretical education.

PURPOSE: The purpose of this study was to evaluate the effectiveness of thoracic paravertebral block (TPVB) for management of pain during and after percutaneous radiofrequency ablation (RFA) of hepatic tumor. MATERIALS AND METHODS: All patients were divided into non-TPVB (4 patients, 4 sessions of RFA for 4 tumors) and TPVB group (5 patients, 7 sessions of RFAs for 7 tumors). Ultrasound (US)-guided TPVB was performed at T7 level. The 15 mL of 0.375% ropivacaine was injected into right paravertebral space before RFA. If patients complained pain and asked analgesics or experienced pain with verbal numerical rating scale (VNRS) of more than 4, fentanyl 25 µg (up to 100 µg), pethidine 25 mg, and midazolam 0.05 mg/kg (up to 5 mg) were sequentially given intravenously during RFA. RESULTS: Total intravenous morphine equivalence of analgesics before, during, and after RFA was 129.1 mg and 0.0 mg in non-TPVB and TPVB group, respectively. CONCLUSION US-guided TPVB may be an effective and safe anesthetic method for decreasing or eliminating pain during and after RFA for hepatic tumor and helpful in decreasing the usage of opioids.

BACKGROUND: The intramural coronary artery has been known as a risk factor for early death after an arterial switch operation (ASO). We reviewed the morphological characteristics and evaluated the early and mid-term results of ASO for patients with an intramural coronary artery. MATERIALS AND METHODS: From March 1994 to September 15th 2010, 158 patients underwent ASO at Dong-A and Pusan National University Hospitals for repair of transposition of the great arteries and double outlet right ventricle. Among these patients, 14 patients (8.9%) had an intramural coronary artery. Mean age at operation was 13.4+/-10.2 days (4 to 39 days) and mean body weight was 3.48+/-0.33 kg (2.88 to 3.88 kg). All patients except one were male. Eight patients had TGA/IVS and 4 patients had an aortic arch anomaly. Two patients (14.3%) had side-by-side great artery relation, of whom one had an intramural right coronary artery and the other had an intramural left anterior descending coronary artery. Twelve patients had anterior-posterior relation, all of whom had an intramural left coronary artery (LCA). The aortocoronary flap technique was used in coronary transfer in 8 patients, of whom one patient required a switch to the individual coronary button technique 2 days after operation because of myocardial ischemia. An individual coronary button implantation technique was adopted in 6, of whom 2 patients required left subclavian artery free graft to LCA during the same operation due to LCA injury during coronary button mobilization and LCA torsion. RESULTS: There was 1 operative death (7.1%), which occurred in the first patient in our series. This patient underwent an aortocoronary flap procedure for coronary transfer combining aortic arch repair. Overall operative mortality for 144 patients without an intramural coronary artery was 13.2% (19/144). There was no statistical difference in operative mortality between the patients with and without an intramural coronary artery (p>0.1). There was no late death. The mean follow-up duration was 52.1+/-43.0 months (0.5 to 132 months). One patient who had a subclavian artery free graft required LCA stenting 6.5 years after surgery for LCA anastomotic site stenosis. No other surviving patient needed any intervention for coronary problems. All patients had normal ventricular function at latest echocardiography and were in NYHA class 1. CONCLUSION: The arterial switch operation in Transposition of Great Arteries or Double Outlet Right Ventricle patients with intramural coronary can be performed with low mortality; however, there is a high incidence of intraoperative or postoperative coronary problems, which can be managed with conversion to the individual coronary button technique and a bypass procedure using a left subclavian free graft. Both aortocoronary flap and individual coronary button implantation techniques for coronary transfer have excellent mid-term results.
Aorta, Thoracic ; Arteries ; Body Weight ; Constriction, Pathologic ; Coronary Vessels ; Double Outlet Right Ventricle ; Echocardiography ; Follow-Up Studies ; Hospitals, University ; Humans ; Incidence ; Male ; Myocardial Ischemia ; Risk Factors ; Stents ; Subclavian Artery ; Transplants ; Transposition of Great Vessels ; Ventricular Function

PURPOSE: Venous stasis ulcer is the most severe form of chronic venous insufficiency and this commonly appears in the lower limb. Pharmacological therapy, reconstruction of the venous system, surgical management, cellular therapy and compression therapy are known as the treatments of venous stasis ulcer, but relapses are common, which make it a typical chronic wound. We report here on a case of recurrent venous stasis ulcer that healed with compression therapy without any other treatment. METHODS: A 35-year-old man with a 13 years history of venous stasis had developed an ulcer on the distal third portion of the lower left limb which was developed 12-year before enrollment in this study. He had been treated with vacuum assist closure, 2 times of cell therapy and 3 times of skin graft for 8 years, but the lesion recurred. From November, 2008 compression therapy was done with the 3M Coban(TM) 2 Layer Compression System(3M, St. Paul, USA). The ulcer at that time was oval shaped and 3x4cm in size. A comfort layer bandage was applied from the proximal phalanx of the great toe to the knee. A compression layer bandage was applied on the previous layer with it being overlapped one half the width of the comfort layer bandage. The dressing was changed every 4 days and the change was recorded with photography. RESULTS: A total of 12 Coban(TM) 2 Layer Compression Systems were used. The size of the ulcer decreased to 2.5x2.5cm in one month, to 2x2cm in 2 months, it was 1x1.8cm in size at 3 months and it completely healed in 4 months. CONCLUSION: The venous stasis ulcer was completely healed using the 3M Coban(TM) 2 Layer Compression System. This method was easy to apply, made the patient comfortable and it provided an excellent compression effect. As in the previous studies, this compression therapy has been proven to play an important role for the treatment and prevention of venous stasis ulcer.
Adult ; Bandages ; Extremities ; Humans ; Knee ; Lower Extremity ; Recurrence ; Skin ; Tissue Therapy ; Toes ; Transplants ; Ulcer ; Vacuum ; Varicose Ulcer ; Venous Insufficiency

BACKGROUND: Recently, ultrasound has been commonly used. Ultrasound-guided interscalene brachial plexus block (IBPB) by posterior approach is more commonly used because anterior approach has been reported to have the risk of phrenic nerve injury. However, posterior approach also has the risk of causing nerve injury because there are risks of encountering dorsal scapular nerve (DSN) and long thoracic nerve (LTN). Therefore, the aim of this study was to evaluate the risk of encountering DSN and LTN during ultrasound-guided IBPB by posterior approach. METHODS: A total of 70 patients who were scheduled for shoulder surgery were enrolled in this study. After deciding insertion site with ultrasound, awake ultrasound-guided IBPB with nerve stimulator by posterior approach was performed. Incidence of muscle twitches (rhomboids, levator scapulae, and serratus anterior muscles) and current intensity immediately before muscle twitches disappeared were recorded. RESULTS: Of the total 70 cases, DSN was encountered in 44 cases (62.8%) and LTN was encountered in 15 cases (21.4%). Both nerves were encountered in 10 cases (14.3%). Neither was encountered in 21 cases (30.4%). The average current measured immediately before the disappearance of muscle twitches was 0.44 mA and 0.50 mA at DSN and LTN, respectively. CONCLUSIONS: Physicians should be cautious on the risk of injury related to the anatomical structures of nerves, including DSN and LTN, during ultrasound-guided IBPB by posterior approach. Nerve stimulator could be another option for a safer intervention. Moreover, if there is a motor response, it is recommended to select another way to secure better safety.
Anesthesia, Conduction ; Brachial Plexus Block* ; Brachial Plexus* ; Humans ; Incidence ; Phrenic Nerve ; Shoulder ; Superficial Back Muscles ; Thoracic Nerves* ; Ultrasonography