OBJECTIVE: To compare the visibility and procedural parameters between a standard spinal needle and a new laser-etched needle (LEN) in real-time ultrasonography guided lumbar medial branch access in a phantom of the lumbosacral spine. METHODS: We conducted a prospective single-blinded observational study at a rehabilitation medicine center. A new model of LEN was manufactured with a standard 22-gauge spinal needle and a laser etching machine. Thirty-two inexperienced polyclinic medical students performed ultrasonography-guided lumbar medial branch access using both a standard spinal needle and a LEN with scanning protocol. The outcomes included needle visibility score, needle elapsed time, first-pass success rate, and number of needle sticks. RESULTS: The LEN received significantly better visibility scores and shorter needle elapsed time compared to the standard spinal needle. First-pass success rate and the number of needle sticks were not significantly different between needles. CONCLUSION: A new LEN is expected to offer better visibility and enable inexperienced users to perform an ultrasonography-guided lumbar medial branch block more quickly. However, further study of variables may be necessary for clinical application.
Humans ; Needles* ; Needlestick Injuries ; Observational Study ; Phantoms, Imaging ; Prospective Studies ; Rehabilitation ; Spine ; Students, Medical ; Ultrasonography ; Zygapophyseal Joint

Acute pulmonary edema during anesthesia and operation is not common. We have recently experienced a case of acute pulmonary edema in a 13 year old girl which developed during anesthesia and operation for her fractured radial head. No specific cause could be found. She didn't have any known cardiopulmonary disease, and responded well to vigorous therapy, but hypoxic brain damage resulted. Her semicomatose state lasted about 40days, and she then recovered slowly and completely in several months.
Adolescent ; Anesthesia* ; Female ; Head ; Humans ; Hypoxia, Brain ; Pulmonary Edema*

Kawasaki disease (KD) is an immune-mediated disease which is a leading cause of acquired cardiovascular disease in developed country. Recently, tumor necrosis factor-alpha (TNF-alpha) blocker, infliximab has been considered a promising option for patients with refractory KD. Although chronic use of a TNF-alpha blocker could increase risk of opportunistic infections, a few studies have documented that use of infliximab was safe without serious adverse effects in patients with KD. We observed serious bacterial infection after infliximab treatment in an infant with refractory KD. Our patient was a 5-month-old male infant diagnosed with KD who did not respond to repeated doses of intravenous immunoglobulin. We effectively treated him with a single infusion of infliximab (5 mg/kg), but gram-negative (Acinetobacter lwoffii) septicemia developed after infliximab infusion. Therefore, we report a case of serious septicemia after treatment with infliximab, and suggest considering the risk of severe infection when deciding whether to prescribe infliximab to an infant with refractory KD.
Bacterial Infections ; Cardiovascular Diseases ; Developed Countries ; Humans ; Immunoglobulins ; Infant* ; Male ; Mucocutaneous Lymph Node Syndrome* ; Opportunistic Infections ; Sepsis* ; Tumor Necrosis Factor-alpha ; Infliximab

PURPOSE: The effect of female sex hormones in urinary stone formation has not been known. Sexual difference in the incidence and crystaline composition of urinary stones in human are well known, especially calcium oxalate stone occurs more frequently in men than women. These findings imply that sex hormone may be related to the pathogenesis of urolithiasis. The present study was conducted to investigate the effects of estrogen on stone formation by using an ethylene glycol (EG) and ammonium chloride-induced urolithiasis model in rat. MATERIALS AND METHODS: Adult Sprague-Dawley female rats were divided into 3 groups, containing 8 rats each. Group I were fed with normal diet for 7 days. Group II were fed with the 0.8% EG and 1.0% ammonium chloride for 7 days. Group III were oophorectomized and 7 days later were fed with the 0.8% EG and 1.0% ammonium chloride for 7 days more. Right kidneys were used for examining the crystal deposits by polarizing microscope and left kidneys were used for tissue calcium content. RESULTS: The concentration of estradiol in group III is lower than that of group I and II (p<0.05). There was a significant difference between control (179.03+/-45.46microgram/g) and lithogenic diet groups in tissue calcium contents (p<0.05). Also, there was a significant difference of tissue calcium contents between group II (318.68+/-46.86microgram/g) and group III (703.05+/-121.51microgram/g) (p<0.05). CONCLUSIONS: These data suggest that estrogen can inhibit calcium oxalate stone formation in EG and ammonium chloride diet rats.
Adult ; Ammonium Chloride ; Ammonium Compounds ; Animals ; Calcium Oxalate* ; Calcium* ; Diet ; Estradiol ; Estrogens* ; Ethylene Glycol ; Female ; Gonadal Steroid Hormones ; Humans ; Incidence ; Kidney* ; Male ; Rats* ; Rats, Sprague-Dawley ; Urinary Calculi ; Urolithiasis

PURPOSE: To investigate the characteristics of the limbal epithelial cells auto-cultivated in vivo on amniotic membrane (LIVAMs) designed for the treatment of limbal stem cell deficiency. METHODS: We removed the epithelium of AM with a No.15 blade after it was blotted with 20% ethanol and made a 360 degrees stromal flap along the epithelial defect. We then mounted over-sized AM (1 mm larger in diameter than the defect) over the defect with the border of AM inserted under the flap, and performed interrupted suture with 10-0 nylon. A therapeutic contact lens was fitted over the AM and a temporary tarsorrhaphy was performed. To examine whether the limbal epithelial cells grew well onto AM, we observed the cornea after fluorescein dye staining using a slit lamp. To explore the characteristics of LIVAMs, we performed hematoxylin-eosin (H&E) staining, immunochemical staining with AK-2, AE-5, AM-3 monoclonal antibodies, and transmission electron microscopy. RESULTS: Three of four rabbits had successful epithelial growth on the amniotic membrane. The epithelial growth on the amniotic membrane was stained using immunohistochemical staining (AK-2, AE-5). Electron microscopy showed a structure similar to that of a normal corneal epithelium. CONCLUSIONS: The technique of auto-cultivation of limbal epithelial cells in vivo on amniotic membrane can be an efficient and convenient method and preserves the characteristics of limbal epithelial cells for the treatment of limbal stem cell deficiency.
Amnion* ; Antibodies, Monoclonal ; Cornea ; Epithelial Cells* ; Epithelium ; Epithelium, Corneal ; Ethanol ; Fluorescein ; Microscopy, Electron ; Microscopy, Electron, Transmission ; Nylons ; Rabbits* ; Stem Cells ; Sutures

Neurolysis of the celiac plexus has been performed to relieve intractable pain cauaed by carcinoma of the pancreas, liver, gall bladder or atomach. It is also occasionally effective in controlling the pain of chronic pancreatitis. In practice, hoarever celiac plexus 71oct ig not a simple procedure to the beginner. The results and 77mplications are variable, In order to correctly inject neurolytic agents into or near the celiac plexus and to reduce the time consumed to perform celiac plexus block, we used CT scanner for 7 cases of alcohol celiac plexus b1ock. The effects will be described. The purpose Of 7hia article is to improve the technical aspect of Celiac Plexus block to the beginner.
Celiac Plexus* ; Liver ; Pain, Intractable ; Pancreas ; Pancreatitis, Chronic ; Urinary Bladder

Hemiparkinsonism with hemiatrophy (HP-HA) syndrome is characterized by a predominant unilateral parkisonism associated with ipsilateral body and/or contralateral brain abnormality. We report three cases of Hemiparkinsonism- hemiatrophy, which is a rare form of secondary parkinsonism. One patient revealed motor complication in the involved limb suggesting that the degeneration of nigrostriatal pathway as the underlying mechanism in this disorder. The functional neuro-imaging can play an important role to verify the cortical abnormalities when structural changes are not evident in brain MRI.
Brain ; Extremities ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Parkinson Disease, Secondary ; Parkinsonian Disorders

There are many methods in reconstruction for skin defect in hand and forearm. Among them, reverse ulnar artery forearm flap has several advantages which are versatile, safe and convenient flap. We report 6 cases of our experiences.
Forearm Injuries ; Forearm ; Hand ; Skin ; Ulnar Artery

BACKGROUND: If patients have a better understanding about their problem and treatment, compliance and satisfaction with treatment will increase. For this purpose, simple repeated explanations regarding a patients' problem and treatment are essential. Critical pathway (CP) has a very wide range in medicine with the exception of the plastic surgery field. The authors developed a CP for facial bone fractures and implemented it clinically. The aim of this study was to evaluate the effectiveness of the CP on the degree of recognition of the problem along with patient satisfaction with the treatment process. METHODS: From May 2011 to October 2011, a total of 82 patients suffering from facial bone fractures were studied. The CP for facial bone fractures was developed by plastic surgeons, residents and nurses. Subsequently, the authors investigated the degree of recognition of the disease and patient satisfaction with the treatment through the use of a questionnaire. The authors compared the score of the questionnaires before and after implementation of the clinical pathway. RESULTS: The degree of the recognition of the problem changed from 3.1 to 4.2 (p<0.001). Further, the degree of satisfaction with the treatment process changed from 3.6 to 4.3 (p<0.05). Overall, there was a two point increase in improvement. CONCLUSION: Implementation of the CP for facial bone fractures was effective in improving the degree of recognition and satisfaction. The authors expect that hereafter, the CP for facial bone fractures will be implemented actively in the plastic surgery field.
Compliance ; Critical Pathways* ; Facial Bones* ; Humans ; Patient Satisfaction ; Surgery, Plastic ; Surveys and Questionnaires

Spontaneous gastric perforation of the newborn is a rare, serious and life-threatening problem. This is surgical emergency because of high mortality. Most historical reports have described gastric perforation in the neonate as spontaneous cause. But, recent reviews report the contributing factor including prematurity and mechanical ventilation. Usually clinician identifies the pneumoperitoneum in simple abdomen X-ray. The final diagnostic method is surgical finding and the treatment of gastric perforation is immediate surgical correction. Early diagnosis, hemodynamic monitoring and fluid therapy for hypovolemia improve outcome. Pseudocyst formation after gastric perforation is very rare in newborn. We report a rare case of pseudocyst formation after spontaneous gastric perforation in full term newborn.
Abdomen ; Early Diagnosis ; Emergencies ; Fluid Therapy ; Hemodynamics ; Humans ; Hypovolemia ; Infant, Newborn ; Mortality ; Pneumoperitoneum ; Respiration, Artificial