BACKGROUND: Over the years, disc surgery has progressively evolved in the direction of decreasing trauma and its invasiveness. Conventional open surgery has many complications, such as scarring, instability, bleeding and a relative high mortality rate. Minimally invasive spinal surgery is now an alternative to a traditional discectomy. Herein, we present an operative technique, and the early results, for a percutaneous endoscopic lumbar discectomy in herniated lumbar disc disease. METHODS: 43 patients, including 27 men and 16 women, with ages ranging from 18 to 66 years, were enrolled in this study. All the patients showed a protruded or extruded soft disc herniation at the lumbar level on magnetic resonance imaging and computed tomography. A percutaneous endoscopic lumbar discectomy was applied to the patients, and clinical responses evaluated using MacNab's criteria. RESULTS: 40 patients were regarded as showing successful responses (93.1%), and there were no severe complications, such as a hematoma, nerve injury, postoperative dysesthesia or death. One patient underwent fusion surgery for remnant back pain six month later. CONCLUSIONS: We conclude that, in properly selected patients, a percutaneous endoscopic lumbar discectomy is a safe, noninvasive and effective treatment modality for herniated lumbar intervertebral disc disease.
Back Pain ; Cicatrix ; Diskectomy* ; Endoscopy ; Female ; Hematoma ; Hemorrhage ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging ; Male ; Mortality ; Paresthesia

Benign tumors of the esophagus occur rarely as compared with the incidence of carcinomas. Among the benign tumors of the esophagus such as leiomyoma, lipoma, hemangioma, papilioma. polyp, cystetc. leiomyoma is the most common, although less than 10 percents of leiomyomas of the gastrointestinal tract are found in the esophagus. Most of leiomyomas of the esophagus present as solitary lesions but multiple tumors occur in about 4 percents of cases. Leiomyomas of the esophagus are diagnosed by thorough clinical evaluation, esophagogram and upper gastrofiberscopic examination but histological confirmation requires surgical or necropsy specimens. Occasionally gastrofiberscopic polypectomized specimens are used. We report one case of multiple leiomyomas of the esophagus located in between 25 cm and 40 cm distance from the incisor in a 38-year-old man who complained of vague substernal discomfort for about 10 years. Gastrofiberscopic polypectomized specimen was used for preoperative histological confirmation. The pathologic examination of the specimen showed leiomyoma of the esophagus.
Adult ; Esophagus* ; Gastrointestinal Tract ; Hemangioma ; Humans ; Incidence ; Incisor ; Leiomyoma* ; Lipoma ; Polyps

BACKGROUND: Perioperative noxious stimuli and inflammation may induce peripheral and central sensitization. Together, these changes contribute to the state of postinjury pain hypersensitivity found postoperatively. Preemptive analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurones and may therefore, reduce postoperative pain. We studied whether or not intravenous meperidine infusion before induction could affect postoperative pain and analgesic consumption when compared with intravenous meperidine infusion at peritoneum closure. METHODS: Female patients scheduled for cesarean section were randomly assigned to one of two groups for prospective study. Group I (n=10) received intravenous meperidine (0.5 mg/kg) 5 minutes before induction of anesthesia and group II (n=10) received the same treatment at peritoneal closure. Both groups had a continuous infusion of meperidine (5 mg/hr) immediately after intravenous bolus meperidine. Postoperative pain relief was provided with intravenous meperidine from a PCA system (Walkmed , Medex, USA). Postoperative visual analogue pain scores (VAS), meperidine consumption and side effects were examined and compared between the groups for two postoperative days. RESULTS: At two hours post surgery VAS at rest were below 3 in both groups and were not statistically significant. VAS on motion were slightly higher than VAS at rest in both groups and were not statistically significant. There was no significant difference in meperidine consumption. There were minor side effects such as nausea, somnolence, dizziness and pruritus, but no patients needed any treatment and all of them were satisfied. CONCLUSION: Preemptive or postincisional intravenous PCA with meperidine was equally effective for postoperative analgesia after cesarean section, with minor side effects. These results suggested that there was no reason for applying preemptive analgesia for cesarean section patients. Further studies will be needed to evaluate preemptive effects of intravenous meperidine or other analgesics in cesarean section patients.
Analgesia* ; Analgesics ; Anesthesia ; Central Nervous System Sensitization ; Cesarean Section* ; Dizziness ; Female ; Humans ; Hypersensitivity ; Inflammation ; Meperidine* ; Nausea ; Neurons ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Peritoneum ; Pregnancy ; Prospective Studies ; Pruritus

BACKGROUND: It is difficult to manage intractable pain from advanced carcinoma of the upper abdomen. One method used to control pain associated with these malignancies is to block the splanchnic nerve. We investigated that VAS (visual analogue scale) difference before and after splanchnic nerve block (SNB) and pain relief day. Also we studied relationship between VAS before SNB and pain relief day. METHODS: A rewiew of 70 patients who took splanchnic nerve block (SNB) from September 1994 to February 1998 was carried out to assess age, sex, primary diseases, pain sites, VAS before and after SNB, date of diagnosis, date of SNB, date of death and pain relief day, etc. RESULTS: Of 70 patients, 44 were males and the remaining 26 were females. The causes of pain were stomach cancer 28 (40%), pancreatic cancer 18 (25%), gall bladder cancer 7 (10%), hepatoma 6 (8.6%) respcectively. Average day from diagnosis to SNB was 272 and average day from diagnosis to death was 341. So, patients died on the average 69 days after they took the splanchnic nerve block in pain clinic. VAS average before SNB was 8.01 and VAS average after SNB was 3.64. Patients felt pain relief during 35 days after SNB. Pain relief day of patients who had lower VAS before SNB was longer than that of patients who had higher VAS before SNB. CONCLUSION: Early application of splanchnic nerve block will make the patients endure the cancer pain more easily.
Abdomen ; Carcinoma, Hepatocellular ; Diagnosis ; Female ; Gallbladder Neoplasms ; Humans ; Male ; Pain Clinics ; Pain, Intractable ; Pancreatic Neoplasms ; Splanchnic Nerves* ; Stomach Neoplasms

Trichobezoars are gastric concretions that are composed of hair or fibers. They are more common in children and adolescents and are usually associated with a pica, emotional disturbance, or mental retardation. Trichobezoar is quite rare in Korea. In most cases, trichobezoars tend to form a cast of the stomach. However, in rare cases, portions of the trichobezoar may separate from the gastric mass, migrate distally, and obstruct the small bowel. We report a case of small bowel obstruction due to multiple trichobezoars in a 14 year-old-girl who had a habit of swallowing hairs until 12 years of age. The patient was treated successfully surgically.
Adolescent ; Affective Symptoms ; Bezoars* ; Child ; Deglutition ; Hair ; Humans ; Intellectual Disability ; Korea ; Pica ; Stomach

OBJECTIVE: To analyze the clinical outcomes of computed tomography (CT) fluoroscopy-guided selective nerve root block (SNRB) for severe arm pain caused by acute cervical disc herniation. METHODS: The authors analyzed the data obtained from 25 consecutive patients who underwent CT fluoroscopy-guided SNRB for severe arm pain, i.e., a visual analogue scale (VAS) score of 8 points or more, caused by acute soft cervical disc herniation. Patients with chronic arm pain, motor weakness, and/or hard disc herniation were excluded. RESULTS: The series comprised 19 men and 6 women whose mean age was 48.1 years (range 35-72 years). The mean symptom duration was 17.5 days (range 4-56 days) and the treated level was at C5-6 in 13 patients, C6-7 in 9, and both C5-6 and C6-7 in 3. Twenty-three patients underwent SNRB in 1 session and 2 underwent the procedure in 2 sessions. No complications related to the procedures occurred. At a mean follow-up duration of 11.5 months (range 6-22 months), the mean VAS score and NDI significantly improved from 9 and 58.2 to 3.4 and 28.1, respectively. Eighteen out of 25 patients (72%) showed successful clinical results. Seven patients (28%) did not improve after the procedure, and 5 of these 7 underwent subsequent anterior cervical discectomy and fusion. CONCLUSION: CT fluoroscopy-guided SNRB may play a role as a primary conservative treatment for severe arm pain caused by acute cervical disc herniation.
Arm ; Cervical Vertebrae ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Male ; Nerve Block

Phlegmonous gastritis is a rare disease of acute suppurative inflammation in the stomach wall. It is rapidly progressive and potentially fatal. Its mortality rate remains very high because the clinical diagnosis is often delayed. Many patients with phlegmonous gastritis undergo surgery. We present the case of 63-year-old woman with epigastric pain, fever, nausea and vomiting. The presumed diagnosis of acute phlegmonous gastritis was made by esophagogastroduodenoscopy, abdominal computed tomography, endoscopic ultrasonography and deep submucosal biopsy assisted with hook knife. Acinetobacter baumannii was cultured in the aspiration from the stomach. We treated the patient with antibiotics alone. Early recognition of phlegmonous gastritis by endoscopic biopsies and bacteriological study may improve the prognosis of these patient.
Acinetobacter baumannii ; Anti-Bacterial Agents ; Biopsy ; Biopsy, Needle ; Cellulitis ; Endoscopy, Digestive System ; Endosonography ; Female ; Fever ; Gastritis ; Humans ; Inflammation ; Middle Aged ; Nausea ; Prognosis ; Rare Diseases ; Stomach ; Vomiting

Autoimmune pancreatitis (AIP) is a rare and unique type of chronic pancreatitis. The prognosis of AIP, particularly when associated with pancreatic cancer or a related malignancy, is not known. Only a few cases, where metachronous pancreas-related cancer developed during follow-up, have been reported. Most of these patients either underwent surgery or steroid therapy. This paper reports a case of a 66-year-old woman with untreated type I AIP who developed peritoneal carcinomatosis more than 2 years later. Initially, the patient had a markedly elevated serum IgG4 level and a diffuse, infiltrative mass-like lesion in the pancreatic head, in which the biopsy results were consistent with type I AIP. The patient was not treated with steroids because of a cerebellar infarction. Twenty-eight months after the diagnosis of AIP, peritoneal carcinomatosis developed without noticeable changes in the pancreas from the initial findings.

Some cases of polypoid lesions arisen from the gastric mucosa just below a lower esophageal erosion. This lesion can have various sizes and shapes. It is known as a hyperplastic lesion associated with esophagitis or an inflammatory lesion. Sometimes only a polyp is found without an erosion. This polypoid lesion is often called as sentinel polyp and is usually considered to be a benign lesion. Here we report a case of a pseudomalignant erosion in which an inflammatory polyp at the esophagogastric junction was successfully removed by endoscopic submucosal dissection even though the polyp was initially mistaken for a squamous cell carcinoma.
Carcinoma, Squamous Cell ; Esophagitis ; Esophagogastric Junction ; Gastric Mucosa ; Nitriles ; Polyps ; Pyrethrins

Xanthogranulomatous inflammation is a rare chronic inflammatory condition that is characterized by aggregation of lipid-laden foamy macrophages (xanthoma cells). Although the precise pathogenesis of xanthogranulomatous inflammation is not well understood, various mechanisms have been proposed, including chronic recurrent infection, the presence of gallstones, immunologic disorders and defective lipid transport. This disease entity is well recognized in the kidney and gallbladder, yet involvement of the gastrointestinal tract is extremely rare and the involvement of both the stomach and colon has never been reported on. A coexisting malignancy rarely has been reported in a patient with xanthogranulomatous inflammation. This might present as an inflammatory mass-like lesion with infiltration to the surrounding tissues, and so this often mimics advanced cancer. Therefore, a surgical operation together with careful pathological evaluation is required for making the precise diagnosis. We herein report on a case of xanthogranulomatous inflammation that presented as a submucosal mass in the stomach which was a huge irregular mass involving transverse colon.
Colon ; Colon, Transverse ; Gallbladder ; Gallstones ; Gastrointestinal Tract ; Humans ; Inflammation ; Kidney ; Macrophages ; Stomach