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

BACKGROUND: The optimal management of pain using magnetic irradiation modalities continues to attract considerable debate. Therefore, we conducted a randomized, double-blind, placebo-controlled clinical trial to determine the effectiveness of pulsed electromagnetic therapy for the treatment of chronic lower back pain. METHODS: Fifteen-minute sessions of active (n = 20) or placebo (n = 20) electromagnetic therapy were repeated 3 times a week for 3 weeks. Patients were assessed using the 11-point numerical rating scale and the revised Oswestry disability scores for up to 4 weeks after therapy. RESULTS: The active magnetic group showed significantly more pain reduction than the placebo group immediately after therapy and one and four weeks after therapy (P < 0.05). At 4 weeks after therapy percentage changes in NRS from baseline were 22 +/- 24% and 38 +/- 11% in the placebo and magnetic groups, respectively. The revised Oswestry disability percentage in the active magnetic group was also significantly improved (P < 0.05). CONCLUSIONS: Pulsed electromagnetic therapy provided pain relief and ameliorated disability in patients with chronic lower back pain. According to our results, pulsed electromagnetic therapy should be considered an important potential therapeutic tool for the conservative therapy of chronic lower back pain.
Humans ; Low Back Pain* ; Magnets*

BACKGROUND: A strategy of mechanical ventilation that limits tidal volume while permitting hypercapnia has been recommended for patients with the acute respiratory distress syndrome. We attempted to evaluate the effects of protective-ventilatory strategy on the outcome of the acute respiratory distress syndrome. METHODS: The study was performed on 31 patients over 16 years old who were under the mechanical ventilation with the diagnosis of acute lung injury (ALI)/ARDS in the Surgical ICU. Pulmonary artery catheter was inserted after start of ventilation. A tidal volume (VT) of 10 to 12 ml per kg and positive end expiratory pressure (PEEP) 10 cmH2O or less was used in conventional group (n = 15), and VT of 6 to 8 ml/kg and PEEP 15 cmH2O or less was used in protective group (n = 16). Arterial blood gas analysis, hemodynamic parameters and metabolic parameters were recorded 1, 3, 5 and 7 day interval. RESULTS: 1) VT, PEEP and respiratory rate showed statistical differences between groups (10.5 +/- 1.2 vs. 6.7 +/- 0.8 ml/kg, 7.7 +/- 3.3 vs. 13.3 +/- 3.1 cmH2O, 15.0 +/- 3.7 vs. 20.3 +/- 4.1 rate/min), but minute volume didn't showed significant difference in between groups. 2) Mortality was 46% in the conventional group and 25% in protective group (P < 0.001). 3) Significant difference was identified in PaO2/FiO2 (176.9 +/- 81.7 vs. 274.7 +/- 83.5), wedge pressure (11.1 +/- 3.7 vs. 16.2 +/- 3.9 mmHg) and mean pulmonary artery pressure (23.0 +/- 4.5 vs. 30.2 +/- 6.5 mmHg) during study periods. 4) The incidence of barotrauma and dialysis for renal failure were similar in the both groups. CONCLUSIONS: Protective ventilatory strategy with low VT and high PEEP shows low mortality in ALI/ARDS patients, it is recommended method for the ALI/ARDS patients.
Acute Lung Injury ; Adolescent ; Barotrauma ; Blood Gas Analysis ; Catheters ; Diagnosis ; Dialysis ; Hemodynamics ; Humans ; Hypercapnia ; Incidence ; Mortality ; Positive-Pressure Respiration ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Renal Insufficiency ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Respiratory Rate ; Tidal Volume ; Ventilation

Vertebral compression fractures result in vertebral height loss and alter sagittal spinal alignment, which in turn can lead to increased morbidity and mortality. Acute osteoporotic vertebral compression fractures are known to increase mobility and instability of the spine. There are limited published data correlating the degree of dynamic mobility and the efficacy of kyphoplasty on vertebral compression fractures. Here we report a 73-year-old female with a severe acute osteoporotic L2 compression fracture who obtained total vertebral height restoration following kyphoplasty, with resolution of back pain.
Aged ; Back Pain ; Female ; Fractures, Compression ; Humans ; Kyphoplasty ; Osteoporosis ; Spine

Congenital unilateral renal agenesis is a rare congenital anomaly. Furthermore, renal agenesis associated with neuroblastoma and cryptorchism is more rare in incidence. Recently we experieced a case of Rt. renal agenesis combined with cryptorchism and neuroblastoma. We diagnosed it with IVP and selective renal angiography and confirmed it with explolaparotomy and biopsy. We reviewed the literatures on renal agenesis, cryptorchism and neuroblastoma, and discussed possible embryological relationships between them and other combined congenital anomalies.
Angiography ; Biopsy ; Cryptorchidism* ; Embryology ; Incidence ; Male ; Neuroblastoma*

BACKGROUND: This study evaluated the effectiveness of a continuous interscalene block (CISB) by comparing it with that of a single interscalene block combined with a continuous intra-bursal infusion of ropivacaine (ISB-IB) after arthroscopic rotator cuff repair. METHODS: Patients who had undergone CISB (CISB group; n = 25) were compared with those who had undergone ISB-IB (ISB-IB group; n = 25) for more than 48 hours after surgery. The visual analog scale (VAS) for pain, motor and/or sensory deficit, supplementary analgesics and adverse effects were recorded. RESULTS: There were no significant differences between the postoperative VAS of the CISB and ISB-IB groups, except at 1 hour after surgery. Their supplementary analgesics of the two groups were similar. Transient motor weakness (52%) and sensory disturbance (40%) of the affected arm were observed in patients in the CISB group. The catheters came out accidentally in 22% of the CISB group but in only 4% of the ISB-IB group. CONCLUSIONS: ISB-IB provides similar analgesia to CISB. However, the ISB-IB group had a lower incidence of neurological deficits and better catheter retention.
Adult ; Aged ; Amides/*administration & dosage ; Analgesia/*methods ; Anesthetics, Local/*administration & dosage ; Arthroscopy ; Bursa, Synovial ; Case-Control Studies ; Female ; Humans ; Infusions, Intralesional ; Male ; Middle Aged ; *Nerve Block ; Pain Measurement ; Pain, Postoperative/*prevention & control ; Prospective Studies ; Rotator Cuff/*surgery ; Shoulder Joint/surgery

BACKGROUND: Pamidronate is a potent inhibitor of osteoclast-mediated bone resorption. Recently, the drug has been known to relieve bone pain. We hypothesized that direct epidural administration of pamidronate could have various advantages over oral administration with respect to dosage, side effects, and efficacy. Therefore, we evaluated the neuronal safety of epidurally-administered pamidronate. METHODS: Twenty-seven rats weighing 250-350 g were equally divided into 3 groups. Each group received an epidural administration with either 0.3 ml (3.75 mg) of pamidronate (group P), 0.3 ml of 40% alcohol (group A), or 0.3 ml of normal saline (group N). A Pinch-toe test, motor function evaluation, and histopathologic examination of the spinal cord to detect conditions such as chromatolysis, meningeal inflammation, and neuritis, were performed on the 2nd, 7th, and 21st day following administration of each drug. RESULTS: All rats in group A showed an abnormal response to the pinch-toe test and decreased motor function during the entire evaluation period. Abnormal histopathologic findings, including neuritis and meningeal inflammation were observed only in group A rats. Rats in group P, with the exception of 1, and group N showed no significant sensory/motor dysfunction over a 3-week observation period. No histopathologic changes were observed in groups P and N. CONCLUSIONS: Direct epidural injection of pamidronate (about 12.5 mg/kg) showed no neurotoxic evidence in terms of sensory/motor function evaluation and histopathologic examination.
Administration, Oral ; Animals ; Bone Resorption ; Diphosphonates ; Inflammation ; Injections, Epidural ; Neuritis ; Neurons ; Rats ; Spinal Cord

The patient was a 45-year-female who presented with pain at right shoulder and right upper arm. The patient suffered from right shoulder and arm pain for 3 years and had pain management which was performed using medication and conservative management after she had been diagnosed with calcific tendinitis. However, substantial pain relief was not consistently achieved, and recurrence of pain was reported. Therefore, we performed right axillary nerve and suprascapular nerve block through pulsed radiofrequency. Two months after the procedure, the shoulder pain gradually subsided with the size reduction of the calcified nodule and she needed no more pain management.
Arm ; Calcinosis ; Humans ; Nerve Block ; Pain Management ; Recurrence ; Rotator Cuff ; Shoulder ; Shoulder Pain ; Tendinopathy

BACKGROUND: An independent medical examination (IME) is a critical process for awarding reparation for injury. However, conducting an IME in pain medicine is very difficult, not only because pain is a subjective symptom, but also because there are no proper objective methods to demonstrate it. This study was conducted to compare IME reports and the court decisions on the disability status of the patients. METHODS: We analyzed 79 IME reports and 25 corresponding court decisions on the disability status of patients. The diagnoses, causal relationships between the patients' status and the trauma, McBride's degree of disability, the American Medical Association's impairment ratings, the estimated annual cost for future treatment, and the necessity of care-giving were compared and analyzed. RESULTS: The diagnoses in the 79 cases were complex regional pain syndrome (CRPS) type I (58 cases), CRPS type II (7 cases), peripheral neuropathy (5 cases), myofascial pain syndrome (4 cases), herniated intervertebral disc (2 cases), and fibromyalgia (1 case). The types of accidents were road traffic accidents (50 cases), military injuries (14 cases), industrial accidents (11 cases), and others (4 cases). The IME reports and the court decisions stated considerably different McBride's degrees of disability (P = 0.014). However, there was no significant difference in the estimated cost for future treatment between the IME reports and the court decisions (P = 0.912). CONCLUSION: IME reports should be accurate, fair, and based on objective findings. Feedback on IMEs from the court decisions is helpful for reference use.
Accidents, Occupational ; Accidents, Traffic ; Awards and Prizes ; Causalgia ; Disability Evaluation ; Fibromyalgia ; Humans ; Intervertebral Disc ; Jurisprudence ; Military Personnel ; Myofascial Pain Syndromes ; Peripheral Nervous System Diseases

Hyaluronidase is an enzyme that has temporary and reversible enzymatic effects on the matrix of connective tissue. When added to local anesthetics in pain treatments, it enhances their infiltration and dispersal into tissues. It is widely used in anesthesia for ocular, dental, and plastic surgery. Reports of drug hypersensitivity to hyaluronidase are rare and are usually confined to peribulbar or retrobulbar anesthesia during ophthalmic surgery. However, few reports exist on adverse drug reaction after epidural injection. We have observed two patients experiencing anaphylactic shock caused by hyaluronidase following epidural injection. Most of the patients with a hypersensitivity to hyaluronidase had one previous uneventful injection containing hyaluronidase, implying that sensitization had taken place. However, hypersensitivity occurring at the first administration is possible. A positive skin test can help establish the diagnosis. Although rare, the possibility of an allergic reaction to hyaluronidase should be considered even in patients with no known previous exposure.
Anaphylaxis ; Anesthesia ; Anesthetics, Local ; Connective Tissue ; Drug Hypersensitivity ; Drug Toxicity ; Humans ; Hyaluronoglucosaminidase ; Hypersensitivity ; Hypogonadism ; Injections, Epidural ; Mitochondrial Diseases ; Ophthalmoplegia ; Skin Tests ; Surgery, Plastic