Although segmental or subsegmental atelectasis may occur during anesthesia, mucous plugging of a mainstem bronchus has been uncommonly reported in anesthetized patients with chronic respiratory disease. However, pulmonary atelectasis following mucous plugging may rarely result normal patients. We report this case of an allegedly healthy patient was developed a left main stem bronchus obstruction, resulting in subsegmental collapse of left lower lung after the induction of general anesthesia.
Anesthesia* ; Anesthesia, General ; Bronchi ; Humans ; Lung ; Pulmonary Atelectasis

BACKGROUND: Caudal block is useful when anesthesia for surgery or treatment for chronic pain is needed, but this procedure has a failure rate of up to 25% even when it performed byan experienced physician. This high failure rate is usually due to improper needle placement. METHODS: After gaining approval of the ethics committee, 46 patients received caudal blocks under ultrasound guidance; these were performed after the anatomical structures in the sacral hiatus had been measured with ultrasound. All these procedures were performed by the same anesthesiologist. The position and direction of the needle were identified using fluoroscopy by injecting a radio-opaque contrast through the needle. The time taken from thelidocaine injection to verification of the needle was measured and the planned nerve block was then carried out. RESULTS: All cases of needle insertion into the sacral canal under ultrasound guidance were successful. The average duration of the procedure and the trial count were 134.1 +/- 10.1 seconds and 1.2 +/- 0.1, respectively. In 12 of the 46 cases (26%), the needle deviated either left or right in the sacral canal, so the direction of the needle had to be adjusted. The distance between two cornua, the depth of the sacral hiatus and the thickness and length of the sacrococcygeal ligament were 17.1 +/- 0.4, 3.9 +/- 0.3, 2.3 +/- 0.1 and 24.9 +/- 0.9 mm, respectively. CONCLUSIONS: Ultrasound guidance can increase the success rate of inserting a needle into the sacral canal. However, even when ultrasound is used, the needle can deviate either left or right in the sacral canal.
Anesthesia ; Chronic Pain ; Ethics Committees ; Fluoroscopy ; Humans ; Ligaments ; Needles* ; Nerve Block ; Ultrasonography*

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Phrenic nerve palsy is a well-known complication following cardiac surgery in children. The incidence is approximately 1~2%. In infants and young children, it often causes a life-threatening respiratory distress. They must be treated with mechanical ventilation in the ICU. Many patients with phrenic nerve injury who is impossible to wean from a ventilator are candidates of diaphragmatic plication. Diaphragmatic plication is performed to restore the normal pulmonary parenchymal volume by replacing the diaphragm to its proper location. This is a case of 2-months-old infant who had phrenic nerve palsy after the removal of cavernous lymphangioma of the chest. He underwent 4 operations to remove the mass and to have pericardiotomy. We tried to wean him from the ventilator but failed several times in the ICU. After 4th operation, right diaphragmatic elevation was noted from the chest X ray. Phrenic nerve palsy was confirmed with fluoroscopy and he underwent diaphragmatic plication on 42 days after his 4th operation. Three days after the diaphragmatic plication, weaning was successfully carried out.
Child ; Diaphragm ; Fluoroscopy ; Humans ; Incidence ; Infant* ; Lymphangioma* ; Paralysis* ; Pericardiectomy ; Phrenic Nerve* ; Respiration, Artificial ; Thoracic Surgery ; Thorax ; Ventilators, Mechanical ; Weaning*

STUDY DESIGN: This is a retrospective clinical study. OBJECTIVES: To compare the efficacy of lidocaine and bupivacaine for the ultrasound-guided lumbar medial branch block in chronic low back pain. SUMMARY OF LITERATURE REVIEW: There is no study for comparison of the efficacy between lidocaine and bupivacaine for the medial branch block. MATERIALS AND METHODS: From August 2011 to May 2013, 186 patients were assigned 0.5% lidocaine(n=136) or 0.25% bupivacaine(n=45) for the ultrasound-guided lumbar medial branch block. All procedures have been performed by the same operator, and 23G, 10 cm needle was placed and drug was injected under ultrasound guide. To target medial branches from lumbar spinal nerve, the groove at the root of transverse process and the base of superior articular process has been identified on transverse scan. Patients were evaluated by pre- and post-interventional(1 hour) Visual Analog Scale and analyzed statistically. RESULTS: Reduction of VAS score in bupivacaine group is significantly greater than that in lidocaine group and post-interventional VAS score in bupivacaine group is significantly lower than that in lidocaine group through analysis of covariance test with adjusted pre-interventional VAS score. In multivariate analysis, while age, sex and treatment level were not significant factors, pre-interventional VAS score and the kind of drug were significant factors. Severe pain before treatment and bupivacaine was indicator of better result. Bupivacaine group reduced pain score in the VAS 2.285 more than lidocaine group with adjustment with other factors. CONCLUSIONS: Bupivacaine is more effective than lidocaine in the reduction of pain after ultrasound-guided lumbar medial branch blocks in posterior facet joint syndrome.
Bupivacaine* ; Humans ; Lidocaine* ; Low Back Pain ; Multivariate Analysis ; Needles ; Retrospective Studies ; Spinal Nerves ; Ultrasonography ; Visual Analog Scale ; Zygapophyseal Joint

The authors report a case of multiple spinal metastasis from a meningeal hemangiopericytoma. A 35-year-old man who had undergone radical resection of temporal hemangiopericytoma presented with a two-month history of worsening low back pain and severe radiating pain on the left leg. Radiologic examination demonstrated a tumor involving body, pedicle and facet joint on the left side of L4 compressing dural sac with large paraspinal extension. Also there was a small tumor on left side pedicle and posterior body of T10. Satisfactory results were obtained after gross total resection of tumors on both regions with posterior lumbar instrumented fusion. Unlike a well differentiated tumor on temporal lesion, the metastatic spinal lesions were anaplastic histologically. Multiple spinal metastasis should be considered after surgical treatment of cranial hemangiopericytoma.
Adult ; Hemangiopericytoma* ; Humans ; Leg ; Low Back Pain ; Neoplasm Metastasis* ; Zygapophyseal Joint

Postherpetic neuralgia (PHN) is a chronic pain syndrome associated with the reactivation of a primary varicella zoster virus infection and is one of the most serious complication of herpetic zoster. The clinical features of PHN are ongoing pain accompanied by allodynia, hyperalgesia, and paresthesia. Current treatment options aimed at relieving the symptoms of PHN include oral agents, such as, opioid, NSAIDs, antidepressants, anticonvulsants. And local anesthetics with steroids are used for subcutaneous infiltration, somatic nerve block, sympathetic nerve block and epidural nerve block. However, in some cases, the pain does not respond to this treatment. We report a case in which a patient suffering from PHN did not respond to conventional therapy, but in whom continuous intravenous infusion of magnesium and physiologic N-methyl-D-aspartate (NMDA) receptor antagonist, reduced severe pain.
Anesthetics, Local ; Anti-Inflammatory Agents, Non-Steroidal ; Anticonvulsants ; Antidepressive Agents ; Autonomic Nerve Block ; Chronic Pain ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Hyperalgesia ; Infusions, Intravenous* ; Magnesium* ; N-Methylaspartate ; Nerve Block ; Neuralgia, Postherpetic* ; Paresthesia ; Steroids

Spontaneous intracranial hypotension (SIH), a syndrome of low CSF pressure, occurs without preceeding events such as lumbar puncture, back trauma, an operative procedure, or medical illness. Postural headache, the most characteristic symptom, usually resolves spontaneously or with bed rest, hydration, and medication. Autologous epidural blood patch is an effective management of headache in SIH patients, and here we describe a one case successfully treated 5 times with an epidural blood patch. The patient had a cardinal feature of a postural headache, low CSF pressure, and showed CSF leakages on RI cisternography. The first three epidural blood patches improved the patient's headache markedly, but the headache recurred in one month. On her second RI cisternography, we found other CSF leakage sites. After a fifth epidural blood patch the patient became asymptomatic and remained so throughout 4 months of follow up. Epidural blood patches are considered the treatment of choice in SIH patients.
Bed Rest ; Blood Patch, Epidural* ; Follow-Up Studies ; Headache ; Humans ; Intracranial Hypotension* ; Spinal Puncture ; Surgical Procedures, Operative

Objective: To investigate the relationship between aircraft noise and the results of audiological evaluation on tinnitus and hearing loss among residents near United States military air-bases in Pyeongtaek city. METHODS: Residents (n=492) exposed to aircraft noise were selected from eight villages near U.S. military air-bases (K-55 and K-6) in Pyeongtaek city. Residents (n=200) from five villages located at least 10 km away from the air-base were selected for the control group. All participants completed a questionnaire on tinnitus and audiological evaluations included pure tone audiometry (PTA) and distortion product otoacoustic emissions (DPOAE). Statistical analyses involved a general linear model and multiple logistic regression stratified by gender and data was adjusted by age, educational level, stress response index and noise type (i.e. military, agricultural and occupational). RESULTS: The equivalent noise levels (Leq) in the vicinity of the air-field were 73.4~81.5 dB (A). Tinnitus prevalence was 47.3% and odds ratio (OR) was 2.06 (95% confidence interval (CI): 1.09~3.88) among noise-exposed males. Tinnitus prevalence was 50.8% and OR was 1.97(95% CI: 1.17~3.30) among noise-exposed females. Tinnitus handicap scores among exposed group were significantly higher in functional, emotional, and catastrophic subclasses (p<0.001). PTA revealed hearing thresholds among the exposed group of 0.5 and 1 kHz (male right ear), 0.5 and 1 kHz (female left ear) and 0.5, 1, 2, 3, 4 and 6 kHz on female right ear that were significantly higher than those of the unexposed group. No significant difference in DPOAE was observed among noise-exposed males. However, significant differences were evident for noise-exposed females at 3175 and 4007 Hz. ORs of right female ears 3175 and 4007 Hz were 1.73(95% CI: 1.01~2.99) and 1.78(95% CI: 1.01~3.15). ORs of left female ears at 3175 Hz and 4007 Hz were 1.92(95% CI: 1.10~3.36) and 2.71(95% CI: 1.49~4.91) CONCLUSIONS: Aircraft noise may adversely affect hearing function and tinnitus.
Aircraft ; Audiometry ; Ear ; Electrolytes ; Female ; Hearing ; Hearing Loss ; Humans ; Linear Models ; Logistic Models ; Male ; Military Personnel ; Noise ; Odds Ratio ; Prevalence ; Questionnaires ; Tinnitus ; United States

Objective: To investigate the relationship between aircraft noise and the results of audiological evaluation on tinnitus and hearing loss among residents near United States military air-bases in Pyeongtaek city. METHODS: Residents (n=492) exposed to aircraft noise were selected from eight villages near U.S. military air-bases (K-55 and K-6) in Pyeongtaek city. Residents (n=200) from five villages located at least 10 km away from the air-base were selected for the control group. All participants completed a questionnaire on tinnitus and audiological evaluations included pure tone audiometry (PTA) and distortion product otoacoustic emissions (DPOAE). Statistical analyses involved a general linear model and multiple logistic regression stratified by gender and data was adjusted by age, educational level, stress response index and noise type (i.e. military, agricultural and occupational). RESULTS: The equivalent noise levels (Leq) in the vicinity of the air-field were 73.4~81.5 dB (A). Tinnitus prevalence was 47.3% and odds ratio (OR) was 2.06 (95% confidence interval (CI): 1.09~3.88) among noise-exposed males. Tinnitus prevalence was 50.8% and OR was 1.97(95% CI: 1.17~3.30) among noise-exposed females. Tinnitus handicap scores among exposed group were significantly higher in functional, emotional, and catastrophic subclasses (p<0.001). PTA revealed hearing thresholds among the exposed group of 0.5 and 1 kHz (male right ear), 0.5 and 1 kHz (female left ear) and 0.5, 1, 2, 3, 4 and 6 kHz on female right ear that were significantly higher than those of the unexposed group. No significant difference in DPOAE was observed among noise-exposed males. However, significant differences were evident for noise-exposed females at 3175 and 4007 Hz. ORs of right female ears 3175 and 4007 Hz were 1.73(95% CI: 1.01~2.99) and 1.78(95% CI: 1.01~3.15). ORs of left female ears at 3175 Hz and 4007 Hz were 1.92(95% CI: 1.10~3.36) and 2.71(95% CI: 1.49~4.91) CONCLUSIONS: Aircraft noise may adversely affect hearing function and tinnitus.
Aircraft ; Audiometry ; Ear ; Electrolytes ; Female ; Hearing ; Hearing Loss ; Humans ; Linear Models ; Logistic Models ; Male ; Military Personnel ; Noise ; Odds Ratio ; Prevalence ; Questionnaires ; Tinnitus ; United States