C-arm fluoroscopy is useful equipment in interventional pain management because it helps to guide correct needle targeting for the accurate injection and drug delivery. However, due to increased use of C-arm fluoroscopy in various pain procedures, the risk of radiation exposure is a significant concern for pain physicians. The harmful biological effects of ionizing radiation on the human body are well known. It is therefore necessary to strive to reduce radiation exposure. Lead aprons with thyroid shields are the most fundamental radiation protective devices for interventional procedures, and are very effective. However, the operator's radiation safety cannot be guaranteed because pain physicians seem to lack sufficient interest, knowledge, and awareness about radiation safety. Also, inappropriate care and use of radiation protective devices may result in a higher risk of radiation exposure. The purpose of this article was to review the literature on radiation safety with a focus on lead aprons and thyroid shields and present recommendations related to those devices during C-arm fluoroscopic-guided interventions by pain physicians.
Fluoroscopy ; Human Body ; Needles ; Pain Management ; Protective Devices ; Radiation Exposure ; Radiation Protection ; Radiation, Ionizing ; Thyroid Gland

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BACKGROUND: Total oxygen consumption has been found to be reduced under deep neuromuscular blockade due to a lower rate of metabolism of skeletal muscles. However, the magnitude of this effect in individual muscles has not been investigated. Thus the aim of this study was to compare the oxygenation of paralyzed versus non-paralyzed forearm muscle under tourniquet-provoked ischemia. METHODS: After ethics approval and written informed consent, 30 patients scheduled for elective hand and wrist surgery were included. Ischemia was provoked by inflation of bilateral upper arm tourniquets and muscle relaxation was achieved via intravenous administration of rocuronium 0.9 mg/kg. Bilateral tourniquets were applied to both upper arms before induction of anesthesia and near infrared spectrometry (NIRS) electrodes applied on both forearms. Muscular ischemia in an isolated (= non-paralyzed, NP) as well as a paralyzed forearm (P) was created by sequential inflation of both tourniquets before and after intravenous administration of rocuronium. Muscle oxygen saturations (SmO2) of NIRS in both forearms and their changes were determined and compared. RESULTS: Data of 30 patients (15 male, 15 female; 41.8 +/- 14.7 years) were analyzed. The speed of SmO2 decrease (50% decrease of SmO2 from baseline (median [percentiles]: NP 210 s [180/480s] vs. P 180 [180/300]) as well as the maximum decrease in SmO2 (minimum SmO2 in % (median [percentiles]: NP 20 [19/24] vs. P 21 [19/28]) were not significantly affected by neuromuscular paralysis. CONCLUSIONS: No significant effect of muscle relaxation on NIRS-assessed muscle oxygenation under tourniquet-induced ischemia was found in human forearm muscles.
Administration, Intravenous ; Anesthesia ; Arm ; Electrodes ; Ethics ; Female ; Forearm* ; Hand ; Humans ; Inflation, Economic ; Informed Consent ; Ischemia ; Male ; Metabolism ; Muscle Relaxation* ; Muscle, Skeletal* ; Muscles ; Neuromuscular Blockade ; Oxygen Consumption ; Oxygen* ; Paralysis ; Prospective Studies* ; Spectroscopy, Near-Infrared ; Spectrum Analysis ; Tourniquets ; Wrist

Growth hormone deficiency (GHD) is defined as a serum peak GH concentration <10 ng/mL with provocation as tested by a combination of at least two separate tests. The aim of this study was to compare two standard tests, insulin and levodopa (L-dopa), with a primary focus on specificity and accuracy. Clinical data were collected retrospectively from a review of 120 children who visited the pediatric endocrine clinic at Chonnam National University Hospital for the evaluation of short stature between January 2006 and April 2014. Subjects underwent GH provocation tests with insulin and L-dopa. Blood samples were obtained at 0, 15, 30, 45, 60, 90, and 120 min after administration, and GH levels were measured. In the insulin test, serial glucose levels were also checked, closely monitoring hypoglycemia. A total of 83 children (69.2%) were diagnosed with GHD and 37 children (30.8%) were diagnosed with idiopathic short stature (ISS). Peak GH levels were achieved an average of 45 min after the administration of insulin and L-dopa for both groups. The specificity and accuracy were 78.4% and 93.6% for the insulin test and 29.7% and 79.2% for L-dopa test, respectively. In the ISS group, the cumulative frequency of a GH cutoff value of >10 ng/mL at 120 min was 75.6% after insulin stimulation compared with 35.1% after L-dopa stimulation. Considering these results, we recommend performing the insulin test first to exclude ISS and then the L-dopa test for the diagnosis of GHD. This way, ISS patients are diagnosed after a single test, thus reducing hospital days and the burden of undergoing two serial tests.
Child ; Diagnosis ; Dwarfism ; Glucose ; Growth Hormone ; Humans ; Hypoglycemia ; Insulin ; Jeollanam-do ; Levodopa ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: We aimed to examine the effectiveness of the head-up tilt test (HUT) for the diagnosis of syncope or presyncope in children and adolescents. METHODS: HUT results and clinical features of 160 children and adolescents with syncope or presyncope were studied from May 2003 through March 2008 at the Chonbuk National University Hospital. The children and adolescents were subjected to 70degrees HUT for 45 minutes. The testees were divided into 2 groups: group I (children) comprising 39 children in the age range 7-12 years (mean, 10.59+/-1.60 years) and group II (adolescents) comprising 121 adolescents in the age range 13-20 years (mean, 15.93+/-2.28 years). Positive result rates of the HUT and types of hemodynamic response to the test in the 2 groups were compared. RESULTS: Of the 160 testees, 92 (57.5%) showed positive HUT results; they showed 3 patterns of response to tilting. Twelve patients showed a predominantly vasodepressor response; 10 patients showed a cardioinhibitory response; and 70 patients showed a mixed response. The positive result rates were 43.6% (17/39) and 62.0% (75/121) in groups I and II, respectively. Mixed response was the predominant positive hemodynamic response in both the groups. CONCLUSION: The HUT is a useful diagnostic tool for evaluating the condition of pediatric patients, including adolescents, with syncope. Further, it may be considered as the first step for evaluating the condition of such patients.
Adolescent ; Child ; Hemodynamics ; Humans ; Resin Cements ; Syncope

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: In chronic obstructive pulmonary disease (COPD) patients, the serum levels of C-reactive protein (CRP) are elevated and an increase of CRP is more exaggerated in the acute exacerbation form of COPD (AECOPD) than in stable COPD. Pulmonary arterial hypertension is a common complication of COPD. An increased level of CRP is known to be associated with the risk of systemic cardio-vascular disorders. However, few findings are available on the potential role of CRP in pulmonary arterial hypertension due to COPD. METHODS: This study was performed prospectively and the study population was composed of 72 patients that were hospitalized due to AECOPD. After receiving acute management for AECOPD, serum CRP levels were evaluated, arterial oxygen pressure (PaO2), was measured, and the existence of pulmonary arterial hypertension under room air inhalation was determined in the patients. RESULTS: The number of patients with pulmonary arterial hypertension was 47 (65.3%)., There was an increased prevalence of pulmonary arterial hypertension and an increase of serum CRP levels in patients with the higher stages of COPD (e.g., patients with stage 3 and stage 4 disease; P<0.05). The mean serum CRP levels of patients with pulmonary arterial hypertension and without pulmonary arterial hypertension were 37.6+/-7.4 mg/L and 19.9 +/-6.6 mg/L, respectively (P<0.05). However, there was no significant difference of the mean values of PaO2 between patients with pulmonary arterial hypertension and without pulmonary arterial hypertension statistically (77.8+/-3.6 mmHg versus 87.2+/-6.0 mmHg). CONCLUSION: We conclude that higher serum levels of CRP can be a sign for pulmonary arterial hypertension in AECOPD patients.
C-Reactive Protein ; Humans ; Hypertension ; Hypertension, Pulmonary ; Inhalation ; Oxygen ; Prevalence ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive

BACKGROUND: Levobupivacaine appears attractive as epidural analgesia because it is less cardio- and neurotoxic than its racemic mixture. This study evaluated the efficacy and safety of two different concentrations of levobupivacaine infused epidurally as analgesia for elderly patients undergoing abdominal surgery. METHODS: This prospective study evaluated the quality of postoperative analgesia, the six graded physical activity score, the time to the first passage of flatus, the time to the first oral intake of clear fluid, and the postoperative hospital stay in patients who received a continuous thoracic epidural infusion of levobupivacaine at two different concentrations over a 48 hour period: Group 0.2% (n = 15) or Group 0.25% (n = 15). The incidence of side effects, such as motor block, hypotension, and bradycardia, was also assessed. RESULTS: There were no differences with regard to the verbal numerical rating scale at rest and cough, the total consumption of rescue analgesia, the incidence of side effects, and the overall satisfaction. The physical activity scores at postoperative 24 and 48 hours were similar in both groups. However, the time to the first passage of flatus and time to the first oral intake of clear fluid was significantly faster in Group 0.25% than in Group 0.2% (P < 0.05). CONCLUSIONS: The continuous thoracic epidural infusion of levobupivacaine in elderly patients after abdominal surgery at both 0.2% and 0.25% provides a similar quality of analgesia without any significant motor block. However, increasing the concentration to 0.25% provides a more rapid return of the bowel function but does not shorten the postoperative hospital stay.
Aged* ; Analgesia* ; Analgesia, Epidural ; Bradycardia ; Cough ; Flatulence ; Humans ; Hypotension ; Incidence ; Length of Stay ; Motor Activity ; Prospective Studies

A pulmonary blastoma is a rare malignant tumor of the lung that is composed of epithelial and mesenchymal elements and resembles the structure of an embryonic lung. Pulmonary blastomas have a very poor prognosis and make up 0.25 to 0.5 percent of all primary malignant lung tumors. A pulmonary blastoma usually manifests as a solitary parenchymal mass or nodule and multiple subpleural mass with effusion on chest X-ray and computed tomography. We encountered a very rare case of pulmonary blastoma in a 52 years old male. He complained of abdominal pain, fullness, and dyspnea. The radiology examination revealed a huge lung mass invading the mediastinum, heart, diaphragm, and liver. The percutaneous needle biopsies were performed, and this tumor was diagnosed as a pulmonary blastoma. We report a biopsy confirmed case of a huge pulmonary blastoma invading multiple organs.
Abdominal Pain ; Biopsy ; Biopsy, Needle ; Diaphragm ; Dyspnea ; Heart ; Humans ; Liver ; Lung ; Lung Neoplasms ; Male ; Mediastinum ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Pulmonary Blastoma* ; Thorax

The clinical syndrome of hyperammonemic encephalopathy is often encountered in the context of decompensated liver disease. Although it is rare in patients without hepatic disease, non-hepatic causes cannot be excluded. Anesthesiologists should be careful in choosing the anesthetic agent and perioperative management for hyperammonemic patients in order to avoid acute hyperammonemia and encephalopathy. We report successful general anesthesia during GDC (Guglielmi detachable coil) embolization for a large unruptured aneurysm in the right distal internal carotid artery in a female patient with hyperammonemic encephalopathy that was caused by a portal-systemic shunt.
Anesthesia ; Anesthesia, General ; Aneurysm ; Carotid Artery, Internal ; Female ; Hepatic Encephalopathy* ; Humans ; Hyperammonemia ; Intracranial Aneurysm* ; Liver Diseases