BACKGROUND: Phantom limb sensation is an unusual position sense of the extremity during nerve block that the position of extremity is misinterpreted as being flexed, or elevated, when actually they are in neutral position. Whether it is from the fixation of proprioceptive input at the time of motor blockade or from unmasking of the pattern which has been already present in the CNS is still controversial. We perfomed this study under the assumption that phantom limb sensation can still be reproduced without the influence of position at the time of nerve blockade. METHODS: Thirty-six patients scheduled for elective orthopedic surgery were randomly assigned. For 26 patients, spinal anesthesia was performed with hyperbaric 0.5% tetracaine or bupivacaine at lateral decubitus position and the position was changed to supine immediately. Existence of phantom limb sensation and the level of anesthesia was recorded at 10 and 20 minutes after injection of local anesthetics. For 10 patients, same local anesthetics were injected after patient's legs were straightened in lateral decubitus position. RESULTS: Forteen out of 26 patients whose position were changed to supine immediately after the injection of local anesthetics experienced phantom limb sensations. Five out of 10 patients whose legs were kept straight before the injection of local anesthetics experienced phantom limb sensations. Previous history of trauma was positively related to the expression of phantom limb sensation. CONCLUSION: Our data showed that the expression of phantom limb sensation is reproducible. And this was not related to the position at the time of spinal anesthesia. Trauma seems to be an important factor related to the expression of phantom limb sensation.
Anesthesia ; Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine ; Extremities ; Humans ; Leg ; Nerve Block ; Orthopedics ; Phantom Limb* ; Proprioception ; Sensation* ; Tetracaine

PURPOSE: Despite the clinical and socio-economic impact of acute poisoned patients, many of the treatments are not standardized in Korea. Moreover, no formal training that is specifically focused on clinical toxicology exists. Rather, training and education are conducted case by case in various institutions. This study was conducted to develop a standardized simulation-based clinical toxicology training curriculum for healthcare providers. This program will focus on specific assessment and treatment of critical toxicology patients, specifically those who have been poisoned with organophosphate. METHODS: The study was performed using a pre- and post-design to determine the effects of implementation of this program. The study was conducted at eight different urban teaching hospitals in a simulated room in the clinical area. The study was targeted to 19 groups composed of emergency residents and nurses. Simulation-based learning was conducted for each group. RESULTS: All 19 groups achieved the minimum passing score of 75%. Implementation of the program led to improved performance rates for overall management and cooperative moods competency (p<0.01). Inter-rater agreement between the two evaluators was excellent. In general, the participants thought the program was realistic and were able to recognize and improve the competencies needed to care for organophosphate poisoned patients. CONCLUSION: Simulation-based learning is an effective educational strategy that can be applied to improving and understanding proper care for rare but critical patients. This program was effective at improving team performance and cooperative moods when managing an organophosphate poisoned patient in the Emergency Department.
Critical Illness* ; Curriculum ; Education ; Emergencies ; Emergency Service, Hospital ; Health Personnel ; Hospitals, Teaching ; Humans ; Korea ; Learning* ; Organophosphate Poisoning ; Practice Guidelines as Topic* ; Simulation Training ; Toxicology

We present a case of paraplegia, compatible with spinal cord ischemia, following percutaneous nephrolithotomy in a 58-year-old male under the diagnosis of left renal stone. After retroperitoneal operative procedures in the prone position, sensory loss below the level of T4, paraplegia and transient loss of visual acuity were developed. These clinical findings reflect ischemia of the anterior spinal cord with complete motor paralysis and sensory loss to T4 dermatomal level resulting from an anterior spinal artery syndrome. The initial treatment was started with intravenous heparin and corticosteroid. At present, sensory loss is almost recovered and motor deficit is remarkably improved to a level of ambulation with cane. The patient is still treated with oral coumadine and neuromotor rehabilitation. The cause of spinal cord ischemia is unknown, but we speculate ischemia of the spinal cord was associated with embolism and spasm or trauma of feeding artery (ies) of Adamkiewicz.
Anesthesia, General* ; Anterior Spinal Artery Syndrome ; Arteries ; Canes ; Diagnosis ; Embolism ; Heparin ; Humans ; Ischemia ; Male ; Middle Aged ; Nephrostomy, Percutaneous* ; Paralysis ; Paraplegia* ; Prone Position ; Rehabilitation ; Spasm ; Spinal Cord ; Spinal Cord Ischemia ; Surgical Procedures, Operative ; Visual Acuity ; Walking ; Warfarin

Complications of tracheal intubation are well documented. However, iatrogenic aspiration of a broken metallic stylet following tracheal intubation has been infrequently reported. A 60-year-old woman, 10 days after shoulder arthroscopic surgery under endotracheal general anesthesia, was admitted to our hospital because of right chest pain. Chest radiographs showed a 8 cm length of metallic foreign body in the lower lobe of the right lung. Attempts at retrieval, including thoracoscopy, were unsuccessful. Open thoracostomy was performed. The removed foreign body was a part of metallic stylet. We report a case of iatrogenic aspiration of a broken metallic stylet.
Anesthesia, General ; Arthroscopy ; Chest Pain ; Female ; Foreign Bodies ; Humans ; Intubation ; Lung ; Middle Aged ; Radiography, Thoracic ; Shoulder ; Thoracoscopy ; Thoracostomy

BACKGROUND: The purpose of this study was to determine the possibility and safety of performing carotid endarterectomy under cervical plexus block. METHODS: Carotid endarterectomy was performed in 30 cases with deep and superficial cervical plexus block, to monitor the patient for cerebral ischemia in the awake state. The toy horn was placed in the contralateral hand in each case and was activated by the patient on command and patients had counted ten repeatedly during carotid clamping. Patients who had not been experienced in the change of mental status or motor response had been operated without a shunt. RESULTS: Cerebral ischemia requiring shunt was observed in one case (3.3%). There were no permanent neurologic deficit and major cardiovascular complication and mortality. CONCLUSIONS: Carotid endarterectomy under cervical plexus block allows direct and precise observation of the patient's central nervous system function during the operation.
Animals ; Brain Ischemia ; Central Nervous System ; Cervical Plexus* ; Constriction ; Endarterectomy, Carotid* ; Hand ; Horns ; Humans ; Mortality ; Neurologic Manifestations ; Play and Playthings

Multiple-system atrophy (MSA) is an adult-onset, sporadic, progressive neurodegenerative disease. Clinically, the cardinal features include autonomic failure, parkinsonism, cerebellar ataxia, and pyramidal signs in any combination, of which autonomic failure is an integral component in the diagnosis. Pathologically, MSA is characterized by alpha-synuclein-positive glial cytoplasmic inclusions and neuronal loss, predominantly in the basal ganglia, brainstem, cerebellum, and intermediolateral cell columns of the spinal cord. We report the first case of MSA confirmed by autopsy in Korea.
Atrophy ; Autopsy ; Basal Ganglia ; Brain Stem ; Cerebellar Ataxia ; Cerebellum ; Inclusion Bodies ; Korea ; Multiple System Atrophy ; Neurodegenerative Diseases ; Neurons ; Parkinsonian Disorders ; Spinal Cord

Clinicians often have difficulties diagnosing patients with subtle phenotypes of Noonan syndrome phenotypes. Facial recognition technology can help in the identification of several genetic syndromes with facial dysmorphic features, especially those with mild or atypical phenotypes. A patient visited our clinic at 5 years of age with short stature. She was administered growth hormone treatment for 6 years, but her growth curve was still below the 3rd percentile. She and her mother had wide-spaced eyes and short stature, but there were no other remarkable features of a genetic syndrome. We analyzed their photographs using a smartphone facial recognition application. The results suggested Noonan syndrome; therefore, we performed targeted next-generation sequencing of genes associated with short stature. The results showed that they had a mutation on the PTPN11 gene known as the pathogenic mutation of Noonan syndrome. Facial recognition technology can help in the diagnosis of Noonan syndrome and other genetic syndromes, especially in patients with mild phenotypes.

BACKGROUND: While gait disturbance is an important feature of idiopathic normal pressure hydrocephalus (NPH), there are only tentative theories explaining its pathophysiology. The mesencephalic locomotor region has been suggested as the anatomical substrate for the development of hypokinetic gait. We evaluated the correlation between gait disturbance and midbrain diameter to investigate the role of mesencephalic locomotor region in development of NPH gait. METHODS: We enrolled 21 patients with NPH and 20 age-matched control subjects. Maximal diameter of midbrain and pons and the width of lateral and third ventricle were measured at midsagittal T1-weighted MRI and axial T2-weighted MRI, respectively. Gait disturbance, cognitive dysfunction, and incontinence were semi quantified. RESULTS: Maximal midbrain diameter was significantly smaller in NPH group, as compared to the controls (14.8 +/- 0.9 vs. 17.1 +/- 0.7 mm, p<0.001). There was an inverse correlation between the midbrain diameter and the ventricular width (r=-0.562, p=0.008 in third ventricle and r=-0.510, p=0.018 in lateral ventricle). Severity of gait disturbance were negatively correlated with midbrain diameter (r=-0.598, p=0.004), but degree of cognitive dysfunction and incontinence showed no significant correlation with brainstem diameter nor ventricular width. CONCLUSIONS: This study suggests that midbrain atrophy is significantly associated with gait disturbance in NPH. Furthermore, this study implies the possible role of midbrain structures including mesencephalic locomotor region in the genesis of NPH gait.
Atrophy ; Brain Stem ; Gait* ; Humans ; Hydrocephalus, Normal Pressure* ; Magnetic Resonance Imaging ; Mesencephalon* ; Pons ; Third Ventricle

BACKGROUND AND OBJECTIVES: Psychogenic dizziness has not been studied extensively in Korea while it is seen frequently. We investigated the prevalence of psychiatric diagnosis and the results of vestibular function testings in patients with the diagnosis of psychogenic dizziness at a Korean tertiary university hospital. MATERIALS AND METHODS: The study was conducted on 38 patients with the diagnosis of psychogenic dizziness. They all received vestibular function testings (ENG, rotating chair test and posturography). Patients with central or vestibular organic disease were excluded from this study. RESULTS: Somatoform disorder was the most common psychiatric disorder causing psychogenic vertigo(47.4%) in this study. Anxiety disorder(21.1%) and depression(21.1%) were the next common causes. The vestibular function testings were abnormal in 19 patients(50.0%). The electronystagmography in 11, rotating chair test in 6, and posturography in 14 patients were abnormal. CONCLUSIONS: Somatoform disorder was the most common psychiatric disorder and vestibular function tests were abnormal in 50% of psychogenic dizziness patients. It implies that the patients with psychogenic dizziness have functional abnormalities in vestibular system.
Anxiety ; Diagnosis ; Dizziness* ; Electronystagmography ; Humans ; Korea ; Mental Disorders* ; Prevalence ; Somatoform Disorders ; Vestibular Function Tests*

No abstract available.
Hernia, Abdominal ; Herpes Zoster