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ABSTRACT: Cervical facet joint (CFJ) syndrome is a common disorder observed in chronic pain of the cervical region, especially in long-standing myofascial pain syndrome (MPS). This study aimed to investigate the effects of therapeutic CFJ injections on patients with long-standing cervical MPS with referral pain patterns of CFJ syndrome.
Four hundred patients presented with long-standing cervical MPS with referral pain patterns of CFJ syndrome over a period of 6 months. A randomized clinical trial was performed wherein 200 patients (group 1) received therapeutic CFJ injections at bilateral C5/C6 and C6/C7 after diagnostic, controlled double-blind blocks. The same cointerventions, such as medication and a home exercise program, were simultaneously applied to patients in group 1 and the noninjection group (group N). Cervical range of motion (CROM), mean reduction of numeric rate scale (NRS) for pain, and comorbid tension-type headache were compared between groups during the 1-year follow-up period. Treatment duration and symptom-free periods were compared according to age group.
Group 1 showed increased CROM, increased mean NRS pain reduction, and decreased incidence of combined tension-type headache compared with group N during the follow-up. Younger patients in group 1 required a shorter treatment cycle and experienced a longer symptom-free period.
Addition of therapeutic CFJ injections to a multimodal treatment program is a useful therapeutic modality for patients, especially young patients, suffering from long-standing MPS with referral pain of CFJ syndrome.
Journal of Anesthesia 05/2012; 26(5):738-45. · 0.83 Impact Factor
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ABSTRACT: A spinal cord stimulation (SCS) trial was attempted to alleviate left knee pain in a patient with spinal fusion from T12 to L4. Good paresthesia coverage for the knee pain was attained with SCS. However, while removing the needle used for electrode placement, the needle became fixed in the bony supplementary tissue. Moreover, while attempting to remove the needle using Kelly forceps, the hub of the needle became blocked. Without the hub, we had no choice but to use a pneumatic drill for removing the needle. Accordingly, the supplementary bone tissue was drilled under real-time imaging, using a pneumatic drill with a 3.2-mm drill bit, and another epidural needle was inserted through the hole. We consider that, in patients with spinal fusion, making a borehole with a pneumatic drill for introducing the epidural needle for percutaneous SCS electrode placement may be advisable in order to avoid the above-mentioned difficulties.
Journal of Anesthesia 01/2012; 26(2):286-8. · 0.83 Impact Factor
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ABSTRACT: We present a case of combined general anesthesia with muscle relaxant and epidural analgesia for hemicolectomy in a 56-year-old woman with Pompe disease. Progressive pulmonary function loss predisposes Pompe disease patients to an increased risk of aspiration pneumonia, atelectasis, and all pulmonary infections. Given the impaired cough resulting from abdominal muscle weakness, patients with Pompe disease who undergo abdominal major surgery are prone to great risks of postoperative pulmonary complications. In our case, to optimize the patient's pulmonary toilet during the postoperative period, epidural block was provided as well as general anesthesia. Although she had a severe scoliotic spine and a worst pulmonary function test, the attempt of epidural block provided excellent pain control and pulmonary toilet care.
Journal of Anesthesia 10/2010; 24(5):768-73. · 0.83 Impact Factor
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ABSTRACT: We report the case of a 46-year-old woman presenting with postoperative bilateral cerebral visual loss that was initially misinterpreted as an irreversible ischemic event. Magnetic resonance imaging of the brain showed high signal intensity on T2-weighted and fluid-attenuated inversion recovery images and normal signal intensity on diffusion-weighted images of the posterior lobe, which mostly disappeared with the improvement of clinical symptoms. Subsequent diagnosis revealed posterior reversible encephalopathy syndrome (PRES). Recognition of PRES as the correct diagnosis led to the appropriate management strategy and the recovery of normal vision. Differentiation from acute cerebral ischemia is important in order to prevent permanent vision loss due to delay in initiating prompt and vigorous treatment of exacerbating factors, such as intermittent hypertension. We believe that it is important for anesthesiologists and critical care physicians to accurately diagnose PRES in view of the key differences in the management of similarly presenting conditions.
Journal of Anesthesia 10/2010; 24(5):783-5. · 0.83 Impact Factor
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ABSTRACT: We used warming fluid for maintenance of body temperature in operating room or intensive care unit. This study was aimed to investigate the effect of infusion rate and catheter length on the temperature of warming fluid.
Normal saline was used for testing infusion and temperature of infusion was maintained by a warmer as 40. The temperatures of solution in infusion line were measured at 0, 25, 50, 75, and 100 cm apart from warmer at six different flow rates (100, 200, 300, 700, 1,400, and 2,100 ml/h). We also measured the temperature changes at room temperature (RT) and 5, 10, and 15 above RT.
The time to maintain solution temperature as 40 was 165, 122, 37, 37, 21, and 19 s at flow rate 100, 200, 300, 700, 1,400, and 2,100 ml/h. The peak temperature was 43.58 +/- 0.58, 44.43 +/- 1.18, 44.37 +/- 0.70, 43.79 +/- 0.61, 42.82 +/- 0.97, and 42.11 +/- 0.92 according to increasing flow rate. The temperature at 100 cm apart from warmer was 23.96 +/- 1.53, 25.46 +/- 2.76, 29.32 +/- 3.47, 31.40 +/- 5.38, 31.39 +/- 6.75, and 38.14 +/- 0.96 according to increasing flow rate.
These results suggested that the decreasing rate of temperature was related inversely to the flow rate and directly to the catheter length. There may be needed a rapid infusion pump with adequate heating system at a high flow rate and to locate the warmer close to patient for reserving a heating effect.
Korean journal of anesthesiology 01/2010; 58(1):31-7.
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ABSTRACT: Inositol phosphates are recognized as having diverse and critical roles in biological systems. In this report, kinetic studies and TLC analysis indicate that beta-propeller phytase is a special class of inositol phosphatase that preferentially recognizes a bidentate (P-Ca(2+)-P) formed between Ca(2+) and two adjacent phosphate groups of its natural substrate phytate (InsP(6)). The specific recognition of a bidentate chelation enables the enzyme to sequentially hydrolyze one of the phosphate groups in a bidentate of Ca(2+)-InsP(6) to yield a myo-inositol trisphosphate (InsP(3)) and three phosphates as the final products. A comparative analysis of (1)H- and (13)C NMR spectroscopy with the aid of 2D NMR confirms that the chemical structure of the final product is myo-Ins(2,4,6)P(3). The catalytic properties of the enzyme suggest a potential model for how the enzyme specifically recognizes its substrate Ca(2+)-InsP(6) and produces myo-Ins(2,4,6)P(3) from Ca(2+)-InsP(6). These findings potentially provide evidence for a selective Ca(2+)-InsPs chelation between Ca(2+) and two adjacent phosphate groups of inositol phosphates.
Biochemistry 09/2006; 45(31):9531-9. · 3.42 Impact Factor
