Nefopam, a centrally acting analgesic, has been used to control postoperative pain. Reported adverse effects are anticholinergic, cardiovascular or neuropsychiatric. Neurologic adverse reactions to nefopam are confusion, hallucinations, delirium and convulsions. There are several reports about fatal convulsive seizures, presumably related to nefopam. A 71-year-old man was admitted for surgery for a lumbar spinal stenosis. He was administered intravenous analgesics : ketorolac, tramadol, orphenadrine citrate and nefopam HCl. His back pain was so severe that he hardly slept for several days; he even needed morphine and pethidine. At 4 days of administration of intravenous analgesics, the patient suddenly started generalized tonic-clonic seizures for 15 seconds, and subsequently, status epilepticus; these were not responsive to phenytoin and midazolam. After 3 days of barbiturate coma therapy the seizures were controlled. Convulsive seizures related to nefopam appear as focal, generalized, myoclonic types, or status epilepticus, and are not dose-related manifestations. In our case, the possibility of convulsions caused by other drugs or the misuse of drugs was considered. However, we first identified the introduced drugs and excluded the possibility of an accidental misuse of other drugs. Physicians should be aware of the possible occurrence of unpredictable and serious convulsions when using nefopam.
Aged ; Analgesics ; Back Pain ; Coma ; Delirium ; Drug-Related Side Effects and Adverse Reactions ; Hallucinations ; Humans ; Ketorolac ; Meperidine ; Midazolam ; Morphine ; Nefopam* ; Orphenadrine ; Pain, Postoperative ; Phenytoin ; Seizures ; Spinal Stenosis ; Status Epilepticus* ; Tramadol

OBJECTIVE: Several types of interspinous process(ISP) devices have the common goal of limiting lumbar extension. In this study, we selected patients aged older than 60 years with lumbar spinal stenosis and assessed whether ISP devices are more beneficial in elderly patients with lumbar spinal stenosis than simple decompression. METHODS: Eighteen patients were treated with the Interspinous U device, and 17 patients were treated with decompre- ssion alone during the same period. Clinical results were assessed using the pre- and postoperative visual analogue scale(VAS) and activities of daily living(ADL). Radiologic results were assessed according to pre-and postoperative anterior disc height, posterior disc height, foraminal height, spondylolisthesis, segmental coronal angle and lordotic angle at the treated level. RESULTS: The mean age of the patients in the interspinous device group was 66.9 years(range 60-78 years), and the mean age of the patients in the decompression group was 70.6 years(range 60-80 years). The mean pre- and postoperative VAS scores were 8.5 and 3.8, respectively, in interspinous devices group and 7.7 and 2.5 in the decompression group. Both groups of patients showed significant improvement in their VAS and ADL scores in comparison with their preoperative scores. Radiologically, there were no significant differences in anterior and posterior disc height or foraminal height in the interspinous devices group. Coronal and lordotic angles were reduced postoperatively in the device group but not in the decompression group. Listhesis at the treated level was significantly aggravated in both groups. CONCLUSIONS: The ISP device was helpful in alleviating pain and improving ADL performance in elderly patients with lumbar spinal stenosis. It corrected segmental scoliosis and restricted extension. However Interspinous U may induce spondy- lolisthesis and do not prevent further displacement of preexisting spondylolisthesis. There should be careful selection to apply of this device in elderly patients.
Activities of Daily Living ; Aged ; Decompression ; Displacement (Psychology) ; Humans ; Scoliosis ; Spinal Stenosis ; Spondylolisthesis

BACKGROUND: To evaluate the safety and the efficacy of amlodipine, a dihydropyridine calcium antagonist, monotherapy in the treatment of moderate essential hypertension. METHOD: Amlodipine 5mg once a day was administered as a starting dose in 30 patients with essential hypertension in the morning and a one step upward titration was performed (amlodipine 10 mg once a day) was done at the end of 4weeks treatment. Final evaluation was done at 12weeks with laboratory test and echocardiogram. RESULT: Within 4weeks treatment with dose of 5mg amlodipine once a day, the systolic blood pressure (SBP) was decreased(184.5+/-23.3/150.5+/-16.0mmHg,p<0.000), and the diastolic blood pressure(DBP) was also decreased significantly (109.9+/-04.6/92.3+/-11.5mmHg, P<0.001). After 12 weeks of treatment with a mean dosage of 6.6mg once a day, SBP and DBP was maintained comparing with basal level (147.0+/-15.8/88.1+/-0.9mmHg, respectively). The efficacy of amlodipine treatment was noted an excellent in 16 patients(53.3%), good in 4 patient(13.3%), fair in 4 patients(13.3%), and failed in 2 patients(6.7%). There was no significant change in heart rate before and after amlodipine treatment. (80.0+/-2.3/80.9+/-10.4 beats/minute n.s). Amlodipine had not significant effects on laboratory findings such as serum creatinine, BUN, ALT/AST, hemoglobin, leukocyte count,platelet and lipid profiles. There was facial flushing 2 patients, but no need to discontinue administration of amlodipine and all patients completed for 12weeks therapy. CONCLUSION: It is concluded that amlodipine is an effective antihypertensive agent, as monotherapy once a day in patients with moderate essential hypertension.
Amlodipine ; Blood Pressure ; Calcium ; Creatinine ; Flushing ; Heart Rate ; Humans ; Hypertension* ; Leukocytes

"The Supporting Program for Obstetric Care Underserved Areas (SPOU)" provides financial aids to rural community (or district) hospitals to reopen prenatal care and delivery services for regions without obstetrics and gynecology clinics or hospitals. The purpose of this study was to evaluate the early stage effect of the SPOU program. The proportion of the number of birth through SPOU was calculated by each region. Also survey was conducted to investigate the extent of overall satisfaction, elements of dissatisfaction, and suggestions for improvement of the program; 209 subjects participated from 7 to 12 December, 2012. Overall, 20% of pregnant women in Youngdong (71 cases) and Gangjin (106 cases) used their community (or district) hospitals through the SPOU whereas Yecheon (23 cases) was 8%; their satisfaction rates were high. Short distance and easy accessibility was the main reason among women choosing community (or district) hospital whereas the reasons of not selecting the community (or district) hospital were favor of the outside hospital's facility, system, and trust in the medical staffs. The SPOU seems to be currently effective at an early stage. However, to successfully implement this program, the government should make continuous efforts to recruit highly qualified medical staffs and improve medical facility and equipment.
Adult ; Delivery, Obstetric/economics/*utilization ; Female ; Hospitals ; Humans ; Pregnancy ; Prenatal Care/economics ; *Program Evaluation ; Republic of Korea ; Rural Population

OBJECTIVE: We investigated the neuroprotective effect of anthocyanin, oxygen radical scavenger extracted from raspberries, after traumatic spinal cord injury (SCI) in rats. METHODS: The animals were divided into two groups : the vehicle-treated group (control group, n=20) received an oral administration of normal saline via stomach intubation immediately after SCI, and the anthocyanin-treated group (AT group, n=20) received 400 mg/kg of cyanidin 3-O-beta-glucoside (C3G) in the same way. We compared the neurological functions, superoxide expressions and lesion volumes in two groups. RESULTS: At 14 days after SCI, the AT group showed significant improvement of the BBB score by 16.7+/-3.4%, platform hang by 40.0+/-9.1% and hind foot bar grab by 30.8+/-8.4% (p<0.05 in all outcomes). The degree of superoxide expression, represented by the ratio of red fluorescence intensity, was significantly lower in the AT group (0.98+/-0.38) than the control group (1.34+/-0.24) (p<0.05). The lesion volume in lesion periphery was 32.1+/-2.4 microL in the control and 24.5+/-2.3 microL in the AT group, respectively (p<0.05), and the motor neuron cell number of the anterior horn in lesion periphery was 8.3+/-5.1 cells/HPF in the control and 13.4+/-6.3 cells/HPF in the AT group, respectively (p<0.05). CONCLUSION: Anthocyanin seemed to reduce lesion volume and neuronal loss by its antioxidant effect and these resulted in improved functional recovery.
Administration, Oral ; Animals ; Anthocyanins ; Antioxidants ; Cell Count ; Fluorescence ; Foot ; Horns ; Intubation ; Motor Neurons ; Neurons ; Neuroprotective Agents ; Oxygen ; Spinal Cord ; Spinal Cord Injuries ; Stomach ; Superoxides

PURPOSE: This study aimed to understand why mothers do not utilize the prenatal care and delivery services at their local hospital supported by the government program, the Supporting Program for Obstetric Care Underserved Area (SPOU). METHODS: We conducted a focus group interview by recruiting four mothers who delivered in the hospital in their community (a rural underserved obstetric care area) and another four mothers who delivered in the hospital outside of the community. RESULTS: From the finding, the mothers were not satisfied with the quality of services that the community hospital provided, in terms of professionalism of the obstetric care team, and the outdated medical device and facilities. Also, the mothers believed that the hospital in the metropolitan city is better for their health as well as that of their babies. The mothers who delivered in the outside community hospital considered geographical closeness less than they did the quality of obstetric care. The mothers who delivered in the community hospital gave the reason why they chose the hospital, which was convenience and emergency preparedness due to its geographical closeness. However, they were not satisfied with the quality of services provided by the community hospital like the other mothers who delivered in the hospital outside of the community. CONCLUSIONS: Therefore, in order to successfully deliver the SPOU program, the Korean government should make an effort in increasing the quality of maternity service provided in the community hospital and improving the physical factors of a community hospital such as outdated medical equipment and facilities.
Delivery, Obstetric/statistics & numerical data ; Emergency Treatment ; Female ; Focus Groups ; Health Knowledge, Attitudes, Practice ; Hospitals, Community/*utilization ; Humans ; *Medically Underserved Area ; Mothers/psychology ; Patient Acceptance of Health Care/*psychology/statistics & numerical data ; Patient Satisfaction ; Pregnant Women/psychology ; Prenatal Care/*utilization ; Qualitative Research ; Quality Improvement ; Quality of Health Care ; Republic of Korea ; Trust

Malignant peripheral nerve sheath tumors (MPNSTs) are very rare tumors. We experienced a case of MPNST in the cervical paraspinal space which was not associated with neurofibromatosis. The tumor located in left C6-7 foramen and compressed C7 root. The tumor was removed through the occipital triangle. We report a case of the primary cerivcal MPNST in a patient who did not have neurofibromatosis-1.
Humans ; Nerve Sheath Neoplasms ; Neurofibromatoses ; Peripheral Nerves

OBJECTIVE: To investigate risk factors for S1 screw loosening after lumbosacral fusion, including spinopelvic parameters and paraspinal muscles. METHODS: We studied with 156 patients with degenerative lumbar disease who underwent lumbosacral interbody fusion and pedicle screw fixation including the level of L5-S1 between 2005 and 2012. The patients were divided into loosening and non-loosening groups. Screw loosening was defined as a halo sign larger than 1 mm around a screw. We checked cross sectional area of paraspinal muscles, mean signal intensity of the muscles on T2 weight MRI as a degree of fatty degeneration, spinopelvic parameters, bone mineral density, number of fusion level, and the characteristic of S1 screw. RESULTS: Twenty seven patients showed S1 screw loosening, which is 24.4% of total. The mean duration for S1 screw loosening was 7.3+/-4.1 months after surgery. Statistically significant risk factors were increased age, poor BMD, 3 or more fusion levels (p<0.05). Among spinopelvic parameters, a high pelvic incidence (p<0.01), a greater difference between pelvic incidence and lumbar lordotic angle preoperatively (p<0.01) and postoperatively (p<0.05). Smaller cross-sectional area and high T2 signal intensity in both multifidus and erector spinae muscles were also significant muscular risk factors (p<0.05). Small converging angle (p<0.001) and short intraosseous length (p<0.05) of S1 screw were significant screw related risk factors (p<0.05). CONCLUSION: In addition to well known risk factors, spinopelvic parameters and the degeneration of paraspinal muscles also showed significant effects on the S1 screw loosening.
Bone Density ; Humans ; Incidence ; Lumbosacral Region ; Magnetic Resonance Imaging ; Muscles ; Paraspinal Muscles* ; Risk Factors ; Spinal Fusion

OBJECTIVE: The purpose of this study is to identify the relationship between asymptomatic urinary tract infection (aUTI) and postoperative spine infection. METHODS: A retrospective review was done in 355 women more than 65 years old who had undergone laminectomy and/or discectomy, and spinal fusion, between January 2004 and December 2008. Previously postulated risk factors (i.e., instrumentation, diabetes, prior corticosteroid therapy, previous spinal surgery, and smoking) were investigated. Furthermore, we added aUTI that was not previously considered. RESULTS: Among 355 patients, 42 met the criteria for aUTI (Bacteriuria > or = 10(5) CFU/mL and no associated symptoms). A postoperative spine infection was evident in 15 of 355 patients. Of the previously described risk factors, multi-levels (p < 0.05), instrumentation (p < 0.05) and diabetes (p < 0.05) were proven risk factors, whereas aUTI (p > 0.05) was not statistically significant. However, aUTI with Foley catheterization was statistically significant when Foley catheterization was added as a variable to the all existing risk factors. CONCLUSION: aUTI is not rare in elderly women admitted to the hospital for lumbar spine surgery. The results of this study suggest that aUTI with Foley catheterization may be considered a risk factor for postoperative spine infection in elderly women. Therefore, we would consider treating aUTI before operating on elderly women who will need Foley catheterization.
Aged ; Diskectomy ; Female ; Humans ; Laminectomy ; Retrospective Studies ; Risk Factors ; Spinal Fusion ; Spine ; Urinary Catheterization ; Urinary Tract ; Urinary Tract Infections

OBJECTIVE: We used an interspinous process device, the Wallis system, to treat patients with disc disease or lumbar spinal stenosis and retrospectively assessed the clinical and radiological outcomes. METHOD: The patients were divided into two groups, one with herniated disc disease(HDD) and the other with lumbar spinal stenosis(LSS). Nineteen patients and fourteen patients were enrolled in the HDD and the LSS group, respectively. Preoperative and postoperative pain and activities of daily living(ADL) were assessed in each group. The anterior, posterior disc height and height of the neural foramen were measured. The degree of flexion, extension and lateral flexion were measured. RESULTS: Both groups improved in pain and ADL after surgery. There were no significant changes in anterior, posterior disc height and height of the neural foramen after the operation in both groups. The change in coronal angle was statistically significant in the entire patient population. The kyphotic angle on the flexion lateral film was 6.1+/-4.1degrees preoperatively and 6.0+/-3.8degrees postoperatively in the entire patient population. Although it was not statistically significant, the kyphotic angle tended to decrease in the HDD group. The lordotic angle was 15.9+/-5.5degrees preoperatively and 13.5+/-6.3degrees postoperatively in overall patient population(from 15.5+/-3.9degrees to 14.0+/-2.7degrees in the HDD group and from 16.0+/-5.9degrees to 13.4+/-6.8degrees in the LSS group). The lordotic angle was significantly decreased in the LSS group. CONCLUSIONS: Interspinous process devices can induce favorable motion changes on lumbar motion such as decreasing tendency of flexion in the HDD group and decreasing tendency of extension in the LSS group. It suggests that interspinous devices may act as dynamic stabilizers in patients with degenerative disc disease and lumbar spinal stenosis.
Activities of Daily Living ; Humans ; Intervertebral Disc Displacement ; Pain, Postoperative ; Retrospective Studies ; Spinal Stenosis