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

For the pharmacokinetic analysis of isoniazid transfer into CSF, steady-state isoniazid concentrations of plasma and CSF were measured in eleven tuberculous meningitis patients confirmed with findings of CSF and neuroimazing. Peak plasma levels (4.17-21.5 micrograms/mL) were achieved at 0.25 to 3 hours after multiple isoniazid dose (600 mg/day). Terminal half-life, total clearance (CI/F) and volume of distribution (Vd/F) were 1.42 +/- 0.41 hr, 0.47 +/- 0.22 L/kg/hr and 0.93 +/- 0.48 L/kg, respectively. Isoniazid concentrations in CSF collected intermittently were highest at 3 hr (Mean, 4.18 micrograms/mL) and were 0.54 +/- 0.21 micrograms/mL at 12 hrs after the last dose of isoniazid 10 mg/kg/day. CSF/plasma partitioning of isoniazid and equilibration rate were estimated using modified pharmacokinetic/pharmacodynamic model. Disposition rate constant from CSF to plasma and CSF/plasma partitioning ratio of isoniazid were estimated to be 0.39 h-1 and 1.17, respectively.
Administration, Oral ; Humans ; Isoniazid/*cerebrospinal fluid ; Metabolic Clearance Rate ; Models, Biological ; Tuberculosis, Meningeal/*cerebrospinal fluid

BACKGROUND: The age distribution of patients with moyamoya disease (MMD) forms two characteristic peaks in children and adults. It is well known that hemorrhagic presentation is more frequent in adults, while hemorrhage is rare in children. There is controversy in the management of adult-onset MMD and its natural course is not well defined. We investigated the clinical features and outcomes of adult onset MMD to clarify its characteristics. METHODS: Fifty patients with MMD whose first manifestation appeared later than 15 years of age were studied retrospectively. The first manifestations were divided into ischemic and hemorrhagic categories. The types of reattack and their frequencies according to treatment type, as well as the differences between probable (unilateral) and definite (bilateral) MMD, and current clinical outcomes by the Modified Rankin Scale were investigated. RESULTS: The mean follow-up duration was 24.4+/-25.9 months. The female/male ratio was 1.5. The most frequent age of onset was in the 4th decade. Ischemia was more frequent (58%) than hemorrhage (40%) at the initial presentation. Reattack occurred in 20 (41%) patients and more frequently in the ischemic type (55%) than the hemorrhagic (20%). Patients with probable MMD had a later onset age (39 vs. 31.5 years old) and more frequent reattacks (50%) than patients with definite MMD (38%). Reattack occurred in 2 patients (9.5%) among 21 patients who received surgical revascularization during mean follow-up of 15.1+/-21.7 months. One patient had ischemic reattack and the other had hemorrhagic reattack after operation. Thirty five (71%) of 50 patients had good outcomes but 3 patients with hemorrhagic reattacks had poor outcomes (6%). CONCLUSIONS: Probable and definite MMD have some differences in clinical features such as onset age and reattack. Regardless of initial manifestations, most of the adult MMD patients had good outcomes. However, patients with recur-rent attacks had worse outcomes than those without reattacks, especially of the hemorrhagic type. Therefore, revention of rebleeding should receive more attention in the management of adult MMD.
Adult ; Age Distribution ; Age of Onset ; Child ; Follow-Up Studies ; Hemorrhage ; Humans ; Ischemia ; Moyamoya Disease* ; Prognosis* ; Retrospective Studies

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

The authors conducted a clinical observation of 55 cases of solitary pulmonary nodules at Yeungnam University Hospital from June 1986 to October 1990, and the following results were obtained: 1. The age distribution was ranged from 18 to 77 years, and the male-to female ratio was 1.8:1. 2. Among 55 cases of nodules, 28 cases were benign and 27 cases were malignant nodules, and of malignant nodules, the primary lung cancer was 23 cases and of benign nodules, 18 cases were tuberculoma. 3. 23 cases (41.8%) was asymptomatic and the other 32 cases were symptomatic; chest pain 12 cases, hemoptysis; 8 cases, cough; 8 cases and dyspnea; 4 cases. 4. The non-smoker-to-smoker ratio was 1:1.04, but among 23 smoker over 20 pack years, 14 cases were malignant nodules. 5. According to nodular size, there is no striking differences between benign and malignant nodules except 3-4 cm sized nodules. 6. The lobar distribution of nodules, 35 cases were in the right lung (upper lobe; 14 cases, middle lobe; 11 cases, and lower lobe; 10 cases) and 23 cases were in the left lung (upper lobe; 9 cases, lower lobe; 11 cases), and the malignant nodules were most commonly observed in the right upper lung.
Age Distribution ; Chest Pain ; Cough ; Dyspnea ; Female ; Hemoptysis ; Humans ; Lung ; Lung Neoplasms ; Solitary Pulmonary Nodule* ; Strikes, Employee ; Tuberculoma