No abstract available.
Spinal Cord Compression* ; Spinal Cord* ; Thymoma*

No abstract available.
Dacryocystorhinostomy*

Obturator nerve block has been commonly used for pain management to prevent involuntary reflex of the adductor thigh muscles. One of several options for this block is chemical neurolysis. Neurolysis is done with chemical agents. Chemical agents used in the neurolysis of the obturator nerve have been alcohol, phenol, and botulinum toxin. In the current case, a patient with spasticity of the adductor thigh muscle due to cervical cord injury had obturator nerve neurolysis done with botulinum toxin type B (BoNT-B). Most of the previous studies have used BoNT-A with only a few reports that have used BoNT-B. BoNT-B has several advantages and disadvantages over BoNT-A. Thus, we report herein a patient who successfully received obturator nerve neurolysis using BoNT-B to treat adductor thigh muscle spasm.
Botulinum Toxins ; Botulinum Toxins, Type A ; Humans ; Muscle Spasticity ; Muscles ; Nerve Block ; Obturator Nerve ; Pain Management ; Phenol ; Reflex ; Spasm ; Thigh

No abstract available.
Atrophy ; Pityriasis* ; Tinea Versicolor*

A patient with a large bronchopleural fistula presents several intraoperative challenges for the anesthesiologist, particularly if bullae coexist bilaterally. Ideally, a double lumen tube is inserted while the patient is conscious or breathing spontaneously under general anesthesia to prevent possible tension pneumothorax in the contralateral lung due to positive-pressure ventilation and the possibility of inadequate ventilation due to an air leak from the fistula. However, we inserted a single lumen tube instead of a double lumen tube, because this patient had multiple giant bullae bilaterally and the contralateral lung tissue was almost completely compressed and destroyed. We report the use of a single lumen tube under volatile general anesthesia with synchronized intermittent mandatory ventilation with small tidal volume. In addition, we used permissive hypercapnia to further minimize barotraumas. Due to permissive hypercapnia, there were no cardiovascular consequences.
Anesthesia, General ; Barotrauma ; Bronchial Fistula ; Fistula* ; Humans ; Hypercapnia ; Lung ; Pneumothorax ; Positive-Pressure Respiration ; Respiration ; Rupture* ; Tidal Volume ; Ventilation

Prirnary sclerosing cholangitis, a chronic progressive cholestatic hepatobiliary disorder of unknown etiology, is characterized by inflammation, scarring and obliteration of bile duct leading to biliary cirrhosis and liver failure. Because histologic finding has only a limited role in the diagnosis, the gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricutre or beading. The natural history is extremely variable. We report two cases of primary sclerosing cholangitis diagnosed by repeated endoscopic retrograde cholangiographies. They were followed up for 7 and 2 years, respectively.
Bile Ducts ; Cholangiography ; Cholangitis, Sclerosing* ; Cicatrix ; Diagnosis ; Inflammation ; Liver Cirrhosis, Biliary ; Liver Failure ; Natural History

Biliary complications after orthotopic liver transplants are a continuing cause of morbidity and mortality. Biliary stones and sludge are less well known complications of hepatic transplantation, although they have long been recognized. Recently we experienced two cases of biliary stones developed after liver transplantation. One 32-year-old male, who frequently admitted due to recurrent cholangitis, was treated with percutaneous transhepatic biliary drainage and choledochojejunostomy with cholecystectomy. The other 58-year-old male, who had stones in commone bile duct, was treated by endoscopic manipulation. They are in good condition without recurrent bile duct stones or its accompanying complications. Although stones and sludge are relatively infrequent after liver transplantation, surgical or interventional radiologic treatments are usually performed for treatment.
Adult ; Case Report ; Common Bile Duct Calculi/ultrasonography ; Common Bile Duct Calculi/radiography ; Common Bile Duct Calculi/etiology* ; Human ; Liver Transplantation/adverse effects* ; Male ; Middle Age ; Tomography, X-Ray Computed/methods

BACKGROUND: Shiitake dermatitis has been reported mostly from Japan and characterized by distinctive pattern of itchy skin eruption after the ingestion of raw shiitake mushrooms. OBJECTIVE: The purpose of this study is to investigate clinical, laboratory and histopathologic profiles about shiitake dermatitis occurring in Korea. METHODS: From 1997 to 2001, we had observed 58 patients with shiitake dermatitis and investigated clinical, laboratory and histopathologic aspects. RESULT: Most patients with shiitake dermatitis presented with a very strong itching sensation, which was accompanied with linearly grouped or disseminated small erythematous papules. 53 patients(91%) had noticed their skin eruption within 3 days after eating shiitake mushrooms. The involved sites were trunk, extremities, neck and face in decreasing order of frequency. Laboratory and histopathologic findings were nonspecific. In 33 patients(57%), the eruption occurred after eating boiled or panbroiled shiitake mushrooms. CONCLUSION: In this study, clinical, laboratory and histopathologic findings of shiitake dermatitis were almost consistent with the previous reports. But, contrary to the previous reports in Japan, many cases with shiitake dermatitis occurred on eating sufficiently boiled or cooked shiitake mushrooms. This may imply another eiologic factor different from thermolabile toxin.
Dermatitis* ; Eating ; Extremities ; Humans ; Japan ; Korea* ; Neck ; Pruritus ; Sensation ; Shiitake Mushrooms ; Skin

BACKGROUND: Paradoxical embolism through the patent foramen ovale (PFO) is a well-recognized mechanism for otherwise unexplained ischemic stroke. Although transthoracic contrast echocardiography (TCE) has been used frequently for noninvasive diagnosis of right to left shunt through PFO, its diagnostic accuracy appears limited, especially in patients with poor acoustic window. Since harmonic imaging (HI) can enhance the definition of contrast microbubbles, theoretical advantages of HI in the detection of right to left shunt through PFO using microbubbles can be considered. However, there are few data regarding the diagnostic efficacy of HI in the detection of right to left shunt through PFO. The purpose of this study was to compare the diagnostic value of transthoracic HI in the detection of right to left shunt through PFO in patients with stroke with that of fundamental imaging (FI). Methods: One hundred thirty-six consecutive patients with stroke (82 male, mean age:9) underwent TCE in both HI and FI and transesophageal echocardiography (TEE) during rest and Valsalva maneuver with intravenous administration of agitated saline. PFO was judged to be present if microbubbles appeared in the left atrium within 3 cardiac cycles of their appearance in the right atrium. TEE was regarded as the gold standard for assessing the diagnostic accuracy of TCE. Results: Right to left shunt through PFO was detected in 40 of 136 patients by TEE (29.4%). FI of TCE detected shunt through PFO in only 9 of 136 patients (6.6%). In contrast, HI detected shunt through PFO in 25 of 136 patients (18.4%). The overall sensitivity and specificity of FI and HI for detection of right to left shunt through PFO were 22.5%, 62.5% (p<0.05) and 100%, 100%, respectively. Valsalva maneuver during HI significantly increased the detection rate of shunt through PFO (during rest in 9 and during Valsalva maneuver in 25, p<0.05). CONCLUSION: HI with contrast microbubble injection significantly enhanced the detection of right to left shunt through PFO in patients with ischemic stroke compared with FI by transthoracic approach.
Acoustics ; Administration, Intravenous ; Diagnosis ; Dihydroergotamine ; Echocardiography* ; Echocardiography, Transesophageal ; Embolism, Paradoxical ; Foramen Ovale, Patent* ; Heart Atria ; Humans ; Male ; Microbubbles ; Sensitivity and Specificity ; Stroke ; Valsalva Maneuver

BACKGROUND: Lumbar transforaminal epidural steroid injections (TFESIs) are performed to provide symptom relief in patients with radicular pain. Recent articles suggested that injected volume itself have analgesic effects and higher volumes are associated with better outcomes. To date, few studies have been conducted to investigate the effects of volume. Therefore, well-designed controlled studies were necessary to confirm the effect of volume itself on pain relief. The purpose of this study was to examine the effectiveness of a forceful saline injection on lumbar TFESI using non-particulate steroids. METHODS: Fifty consecutive patients with lumbar radicular pain were enrolled. The participants were allocated into one of two groups: dexamethasone with volume (Group DV) and dexamethasone alone (Group DO). The volume was delivered by a forceful injection of 5ml of normal saline. The primary end-point for this study was a VAS pain score and modified MacNab score indicating the rate of effectiveness at the four-week follow-up. RESULTS: There were no significant post-procedural VAS differences between two groups (P = .252). The effectiveness rate among the patients was 47.8% in DV group, 34.8% in DO group, measured by modified MacNab score. The difference was not statistically significant (P = .117). CONCLUSIONS: A forceful saline injection did not have a significant effect during the treatment of radicular pain. Further studies with greater volumes and with additional techniques would offer a more conclusive perspective.
Dexamethasone ; Follow-Up Studies ; Humans ; Radiculopathy ; Steroids