No abstract available.
Echocardiography* ; Heart*

OBJECTIVE: Ultrasound-guided injections are a common clinical treatment for lower lumbosacral pain that are usually performed before surgical treatment if conservative treatment fails. The aim of this article was to review ultrasound-guided injections in the lumbar and sacral spine.SUMMARY OF LITERATURE REVIEW: Ultrasound-guided injections, unlike conventional interventions using computed tomography or C-arm fluoroscopy, can be performed under simultaneous observation of muscles, ligaments, vessels, and nerves. Additionally, they have no radiation exposure and do not require a large space for the installation of equipment, so they are increasingly selected as an alternative method. MATERIALS AND METHODS: We searched for and reviewed studies related to the use of ultrasound-guided injections in the lumbar and sacral spine. RESULTS: In order to perform accurate ultrasound-guided injections, it is necessary to understand the patient's posture during the intervention, the relevant anatomy, and normal and abnormal ultrasonographic findings. Facet joint intra-articular injections, medial branch block, epidural block, selective nerve root block, and sacroiliac joint injections can be effectively performed under ultrasound guidance. CONCLUSIONS Ultrasound-guided injections in the lumbar and sacral spine are an efficient method for treating lumbosacral pain.

STUDY DESIGN: Literature review. OBJECTIVE: Ultrasound-guided injections are a common clinical treatment for lower lumbosacral pain that are usually performed before surgical treatment if conservative treatment fails. The aim of this article was to review ultrasound-guided injections in the lumbar and sacral spine. SUMMARY OF LITERATURE REVIEW: Ultrasound-guided injections, unlike conventional interventions using computed tomography or C-arm fluoroscopy, can be performed under simultaneous observation of muscles, ligaments, vessels, and nerves. Additionally, they have no radiation exposure and do not require a large space for the installation of equipment, so they are increasingly selected as an alternative method. MATERIALS AND METHODS: We searched for and reviewed studies related to the use of ultrasound-guided injections in the lumbar and sacral spine. RESULTS: In order to perform accurate ultrasound-guided injections, it is necessary to understand the patient's posture during the intervention, the relevant anatomy, and normal and abnormal ultrasonographic findings. Facet joint intra-articular injections, medial branch block, epidural block, selective nerve root block, and sacroiliac joint injections can be effectively performed under ultrasound guidance. CONCLUSIONS: Ultrasound-guided injections in the lumbar and sacral spine are an efficient method for treating lumbosacral pain.
Fluoroscopy ; Injections, Intra-Articular ; Ligaments ; Methods ; Muscles ; Posture ; Radiation Exposure ; Sacroiliac Joint ; Spine ; Ultrasonography ; Zygapophyseal Joint

One of the most common symptoms of multiple sclerosis is visual loss. But the most previous reported cases are unilaterai visual loss due to optic neuritis or retrobulbar optic neuritis or visual field defect due to chiasmal or optic tract lesion. We report a 34 year old female patient who had developed sudden onset of blindenss because of optic chiasm and optic tract lesion. She also complained of involuntary right hand movement and mild left hemiparesis. On T2-weighted image of MRI we found abnormal high sigmal intensities on the optic chiasm, bilateral optic tract, internal capsule and periventricular white matter. Her total blindness has not recovered until the last follow nine months after the initial event.
Adult ; Blindness ; Female ; Hand ; Humans ; Internal Capsule ; Magnetic Resonance Imaging ; Multiple Sclerosis* ; Optic Chiasm* ; Optic Neuritis ; Paresis ; Visual Fields ; Visual Pathways*

BACKGROUND: The aim of this study was to clarify to what extent bacterial meningitis could be distinguished from aseptic or tuberculous meningitis through C-reactive protein (CRP) in adults. METHODS: We retrospectively analyzed the medical records of 91 patients aged 15~81 years who had been hospitalized for acute meningitis and underwent lumbar puncture due to suspected central nervous system infection. RESULTS: We included 50 patients with aseptic meningitis, 23 patients with acute bacterial meningitis, and 18 patients with tuberculous meningitis. Blood CRP was higher in bacterial meningitis. None of the patients with bacterial meningitis had a CRP value of under 20 mg/dl. The CRP values were under 20 mg/dl in 92% of the patients with aseptic meningitis and in 73% of those with tuberculous meningitis. Taking a CRP level of above 20 mg/dl as a positive discriminatory factor for bacterial meningitis, the sensitivity and specificity were 1.0, 0.88. To better predict whether a patient has bacterial or nonbacterial meningitis, we developed a canonical discriminant function equation using CRP and CSF parameter, and finally concluded that blood CRP was a good predictive indicator that differentiated bacterial meningitis from aseptic or tuberculous meningitis at admission. CONCLUSIONS: The CRP measurement, is easily performed and inexpensive. We believe it is worth analyzing CRP whenever meningitis is suspected, it can also limit the unnecessary use of antibiotics.
Adult* ; Anti-Bacterial Agents ; C-Reactive Protein* ; Central Nervous System Infections ; Cerebrospinal Fluid ; Diagnosis, Differential* ; Discriminant Analysis ; Humans ; Medical Records ; Meningitis* ; Meningitis, Aseptic ; Meningitis, Bacterial ; Retrospective Studies ; Sensitivity and Specificity ; Spinal Puncture ; Tuberculosis, Meningeal

BACKGROUND: Anticoagulant therapy can be required during pregnancy with prosthetic heart valves. Warfarin and heparin provide real protection against thromboembolic phenomena, but they also carry serious risks for the fetus and the mother. In an attempt to identify the best treatment for pregnant women with cardiac valve prostheses who are receiving anticoagulant, we studied 19 pregnancies, the warfarin was discontinued and heparin was administered every 12 hours by subcutaneous injection in doses adjusted to keep the midinterval aPTT in the therapeutic range(at least 2-2.5 control) from the conception to the 12th week of gestation and oral antiocagulant was then administered until the middle of the third trimester in the therapeutic range(at least 2 INR), and heparin therapy was restared until delivery. Also in order to avoid an anticoagulant effect during delivery, it has been our practice to instruct women to either discontinue their heparin injections with the onset of labur or to stop heparin injections 12 hours prior to the elective induction of labour. RESULT: The outcome of 19 pregnancies managed with above protocol was spontaneous abortion in 3 cases, voluntary termination in 2 cases, premature delivery at 35 weeks in 1 case and delivery at full-term in 14 cases. There was no maternal morbidity and moratality and fetopathy. CONCLUSIONS: We conclude that in the second and third trimester of pregnancy, warfarin provide effective protection against thromboembolism, Oral antiocagulant therapy should be avoided in 2 weeks before delivery because of the risk of serious perinatal bleeding caused by the trauma of delivery to the anticoagulated fetus. However, the substitution of heparin at first trimester and 2 weeks before delivery reduce the incidence of complications.
Abortion, Spontaneous ; Female ; Fertilization ; Fetus ; Heart Valve Prosthesis* ; Heart Valves* ; Hemorrhage ; Heparin ; Humans ; Incidence ; Injections, Subcutaneous ; Mothers ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Third ; Pregnant Women* ; Thromboembolism ; Warfarin

OBJECTIVES: This study aimed to evaluate preliminarily the clinical effects of cognitive-behavioral treatment in children with anxiety disorders. METHODS: Subjects were 11 children between 2nd and 6th grade with anxiety disorder. All subjects were diagnosed through Kiddie-Schedule for Affective Disorder and Schizophrenia Present and Lifetime Version (K-SADS-PL) interview. The CBT program consisted of sessions once a week (60min/session) for 14 weeks with parent education. RESULTS: Children and parents reported significantly improved social skills, social competence and decreased anxiety. However, there were no significant changes in children's negative thoughts and subjective depressive symptoms. CONCLUSION: Cognitive-behavioral treatment is expected to be effective in children with anxiety disorders such as generalized anxiety disorder, phobia, separation anxiety disorder, and obsessive-compulsive disorder.
Anxiety ; Anxiety Disorders ; Anxiety, Separation ; Child ; Humans ; Mental Competency ; Mood Disorders ; Parents ; Phobic Disorders ; Schizophrenia

Flumazenil, an imidazobenzodiazepine, is the first benzodiazepine antagonist and is being used to reverse the adverse pharmacological effects of benzodiazepine. There have been a few reports on the central nevous system side effects with its use. We report a patient with generalized ballism following administration of flumazenil. The mechanism through which flumazenil induced this symptom is unknown. It is conceivable that flumazenil may antagonize the GABA-benzodiazepine receptor complex and induce dopamine hypersensitivity, thus induce dyskinesic symptoms.
Diagnosis, Differential ; Dyskinesias/etiology* ; Female ; Flumazenil/adverse effects* ; GABA Modulators/adverse effects* ; Human ; Middle Aged

An endoscopic retrograde cholangiopancreatography (ERCP) is endoscopically complicated procedure which carries a higher risk of serious adverse events, and it is more challenging compared with general endoscopy. On a national basis, the accepted standards of practice in ERCP are needed to be outlined to ensure consistent clinical standards in patient management. Certificated system for general endoscopy has been implemented since 2006 in Korea. However, an established system for certification of ERCP does not exist, which requires longer training than general endoscopy. Recently, much has been reported about the need to measure and improve the quality of endoscopy services, but still the variability exists in standards used by hospitals for credentialing physicians to ERCP in Korea. There is an urgent need to settle the credentialing process to enhance practice and to protect patients, which suits our society. This article investigated the system of ERCP certification in overseas, and should be helpful to establish the standard certification system of ERCP in Korea.
Certification ; Cholangiopancreatography, Endoscopic Retrograde ; Credentialing ; Endoscopy ; Humans ; Korea

BACKGROUND/AIMS: Although balloon-occluded retrograde transvenous obliteration (BRTO) has been used as a new procedure for gastric variceal bleeding due to its feasibility and minimal invasiveness, reports regarding the results of BRTO are not well presented in Korea. Therefore, we analyzed the results of our experience in recent 39 months. METHODS: Twenty eight patients who received BRTO for primary hemostasis or secondary prevention of gastric variceal bleeding from December 2001 to March 2005 were analyzed retrospectively. RESULTS: Twenty three men and five women were involved, and the mean age was 53.7+/-9.6 years. Technical and clinical success rates were 89.3% and 85.7%, respectively. Follow-up duration was 17.5+/-12.5 months in 23 patients. Gastric varices disappeared in 78.3% and decreased in 21.7%. Relapses occurred in 4.3% of the patients. Preexisting hepatic encephalopathy improved in all 11 patients. Aggravation of ascites, esophageal varices, portal hypertensive gastropathy were observed in 45.8%, 30.4%, 56.5%, respectively. Increased Child-Pugh score (p<0.001) and decreased albumin concentration (p=0.002) were observed 3 days after BRTO, but resolved 7 days later. Increased albumin concentration and decreased Child-Pugh score maintained thereafter. Rebleeding occurred in 3 patients which were caused by esophageal varices. Two-year survival rate was 54.6%. Presence of hepatocellular carcinoma (HCC) (p=0.001) and Child-Pugh grade (p=0.033) affected the survival, but HCC was the only independent risk factor (p=0.010, OR=15.837) in multivariate analysis. CONCLUSIONS: BRTO is an effective therapeutic procedure for primary hemostasis, secondary prevention, and for improving survival in gastric variceal bleeding patients.
Adult ; Aged ; Aged, 80 and over ; *Balloon Occlusion ; Esophageal and Gastric Varices/*complications ; Female ; Gastrointestinal Hemorrhage/etiology/*therapy ; Humans ; Male ; Middle Aged ; Recurrence