• Journal of Trauma and Injury
• /
• v.22 no.1
• /
• pp.18-23
• /
• 2009

Purpose: In this study, we retrospectively investigated the medical records of patients with facial fractures and suspected cranial injuries in order to determine if there was any relationship between various facial fracture patterns and cranial injuries. Methods: Medical records were reviewed to identify patients diagnosed with facial fractures who underwent cranial computed tomography (CT) scans. Records were reviewed for gender, age, injury mechanism, facial fracture pattern, and presence or absence of cranial injuries. Facial fracture patterns were classified as isolated fractures (tripod, zygomatic arch, maxilla, orbit, and mandible), combined fractures, or total fractures. Cranial injuries included skull fractures, traumatic subarachnoid hemorrhages, subdural hemorrhages, epidural hemorrhages, and contusional hemorrhages. All cranial injuries were established by using cranial CT scans, and these kinds of cranial injuries were defined radiologically-proven cranial injuries (RPCIs). We evaluated the relationship between each pattern of facial fractures and the incidence of RPCIs. Results: Of 132 eligible patients with facial fractures who underwent cranial CT scans, a total of 27 (20.5%) patients had RPCIs associated with facial fractures. Falls and slips were the most common causes of the fractures (31.8%), followed by assaults and motor vehicle accidents (MVAs). One hundred one (76.5%) patients had isolated facial fractures, and 31 (23.5%) patients had combined facial fractures. Fractures were found most commonly in the orbital and maxillary bones. Patients with isolated maxillary fractures had a lower incidence of RPCIs than those with total mandibular fractures. RPCIs frequently accompanied combined facial fractures. Conclusion: Combined facial fractures had a significant positive correlation with RPCIs. This means that facial fractures caused by stronger or multidirectional external force are likely to be accompanied by cranial injuries.

• Journal of Trauma and Injury
• /
• v.23 no.2
• /
• pp.142-150
• /
• 2010

Purpose: In this study, patients in whom two computed tomography (CT) scans had been obtained within 24 hours of injury were analyzed to determine the incidence, risk factors and clinical significance of a progressive intracerebral hematoma (PIH). Methods: Participants were 182 patients with a traumatic intracerebral hematoma and contusion who underwent a repeat CT scan within 24 hours of injury. Univarite and multivariate statistics were used to define growth (volume increase) and to examine the relationship between the risk factors and hemorrhage expansion. Results: Fifty-four percent of the patients experienced progression in the size of the lesion in the initial 24 hours postinjury. A PIH was independently associated with worsened Glasgow coma scale (GCS) score (2.99, 1.04~8.60), the presence of subarachnoid hemorrhage (6.29, 2.48~16.00), the presence of a subdural hematoma (6.18, 2.13~17.98), the presence of an epidural hematoma (5.73, 1.18~27.76), and the presence of a basal cistern effacement (10.93, 1.19~99.57). Conclusion: For patients undergoing scanning within 2 hours of injury, the rate of PIH approaches 61%. Early repeated CT scanning is indicated in patients with a nonsurgically-treated hemorrhage revealed on the first CT scan. Worsened GCS score, significant hematoma growth and effacement of the basal cisterns on the initial CT scan are powerful predictors of which patients will require surgery. These findings should be important factors in understanding and managing of PIH.

• The Korean Journal of Nuclear Medicine
• /
• v.28 no.3
• /
• pp.301-306
• /
• 1994

The purpose of this study was to compare Tc-99m-HMPAO SPECT with MRI after acute and subacute closed-head injury. There were thirty two focal lesions in all cases of these. Fifteen lesions(47%) were seen on both MRI and SPECT. Fourteen lesions(44%) were seen only on MRI. Three lesions(9%) were seen only on SPECT. Of the 14 lesions seen only on MRI, one was epidural hematoma, two were subdural hematoma, three were subdural hygroma, one was intracerebral hematoma, four were contusion, and three were diffuse axonal injuries. SPECT detected 52% of the focal lesions found on MRI. For the detection of lesions, MRI was superior to SPECT in fourteen cases, while SPECT was superior to MRI in three cases. In conclusion, there was a tendency that detection rate of the traumatic lesions was higher on MRI, but the SPECT could delineate more wide extent of lesion.

• Korean Journal of Animal Reproduction
• /
• v.24 no.1
• /
• pp.77-82
• /
• 2000

This study was conducted to establish the methods of ultrasound-guided transvaginal retrieval of oocytes (ovum pick-up) in Korean native, Hanwoo Heifers. To obtain the basic data about Hanwoo, the size of ovaries in luteal and follicular phases were measured and the number of follicles in ovaries during the estrus cycle was counted by using ultrasound. And to determine the effective anesthetic to Hanwoo, various mixture of anesthetic compounds, Rompun(equation omitted), lidocaine, Monzal(equation omitted), and Domosedan(equation omitted), were treated. The size of Hanwoo ovaries were not significant differently between luteal and follicular phases. The number of medium and small follicles were peak on day 3 and 12 of the estrous cycle, and this result suggested that Hanwoo has 2 follicular growth waves per estrus cycle. The most effective anesthetic method was intramuscular injection of a.3m! Rompun(equation omitted), epidural injection of 5$m\ell$ lidocaine and sprayed cervix by 2$m\ell$ lidocaine.

• The Korean Journal of Pain
• /
• v.10 no.2
• /
• pp.246-249
• /
• 1997

Hiccup is defined as an abrupt involuntary contraction of the diaphragm and intercostal muscles with sudden closure of the glottis 35 msec after onset. The term "intractable" is given to those hiccups with a duration ranging from 24 hours to more than 25 years. Short hiccup bouts are mostly associated with gastric distention or alcohol intake, resolved spontaneously or with simple remedies. In contrast, intractable hiccup is a rare but disabling condition which can induce depression, weight loss and sleep deprivation. Although the pathophysiologic mechanisms of hiccup are still poorly understood, wide variety of pathological conditions such as: brain tumor, abdominal tumor, myocardial infarction, renal failure, abdominal surgery etc., can cause intractable hiccup. A 58-year-old male who had suffered from hepatocellular cancer was consulted from medical department due to intractable hiccup. Initial treatment modalities with administrations of metoclopramide and chlorpromazine and nerve block including phrenic nerve block, cervical epidural block and glossopharyngeal nerve block were not effective. Administration of midazolam and baclofen however achieved desirable effect.

• The Korean Journal of Pain
• /
• v.1 no.1
• /
• pp.120-124
• /
• 1988

Phenol sympathetic block is valuable for the treatment of ischemic pain, gangrene, intermittent claudication, Paget's disease of the bone and pain associated with pancreatitis, pancreatic carcinoma, etc. The author has experienced a case of successful lumber sympathetic block using 7% phenol under fluoroscopy and given to a patient with Buerger's disease who had severe pain and ulceration of the right great toe for several years. After the sympathetic block, 2 epidural blocks with 2.5% bupivacaine were done in order to augment the effects of this sympathetic block. Subsidence of rest pain, increase in walking distance from under 100 M to over 500 M and circulatory improvement of the affected limb were observed, Improvement of circulation was confirmed by strain gauge plethysmography.

• Journal of Pharmacopuncture
• /
• v.6 no.3
• /
• pp.75-80
• /
• 2003

Lumbar spinal stenosis results from the progressive combined narrowing of the central spinal canal, the neurorecesses, and the neuroforaminal canals. In the absence of prior surgery, tumor, or infection, the spinal canal may become narrowed by bulging or protrusion of the intervertebral disc annulus, herniation of the nucleus pulposis posteriorly, thickening of the posterior longitudinal ligament, hypertrophy of the ligamentum flavum, epidural fat deposition, spondylosis of the intervertebral disc margins, or a combination of two or more of the above factors. Patients with spinal stenosis become symptomatic when pain, motor weakness, paresthesia, or other neurologic compromise causes distress. In one case, we administrated oriental medical treatment with acupuncture treatment and herb-medicine. Oriental medical treatment showed desirable effect on lumbar spinal stenosis.

• Journal of Korean Neurosurgical Society
• /
• v.49 no.5
• /
• pp.273-277
• /
• 2011

Objective : A single balloon extrapedicular kyphoplasty has been introduced as one of the unilateral approaches for thoracic compression fractures; however, the unilateral extrapedicular technique in the lumbar area needs a further understanding of structures in the lumbar area. The purpose of the present study is to describe methods and pitfalls of this procedure based on the anatomy of the lumbar area and to analyze clinical outcome and complications. Methods : Anatomical evaluation was performed with 2 human cadavers. A retrospective review of unilateral extrapedicular approaches yielded 74 vertebral levels in 55 patients that were treated with unilateral extrapedicular vertebroplasty and kyphoplasty. Radiographic assessment included the restoration rate of vertebral height and correction of kyphosis. Results : Anatomical evaluation indicates that the safe needle entry zone of bone for the extrapedicular approach was located in the supero-lateral aspect of the junction between the pedicle and vertebral body. The unilateral extrapedicular procedure achieved adequate pain relief with a mean decreases in pain severity of $7.25{\pm}1.5$ and $2.0{\pm}1.4$, respectively. Complications were 1 retroperitoneal hematoma, 6 unilateral fillings and 3 epidural leak of the polymethylmethacrylate. Conclusion : The method of a unilateral extrapedicular approach in kyphoplasty and vertebroplasty in the lumbar area might be similar to that in thoracic approach using a route via the extrapedicular space. However, different anatomical characteristics of the lumbar area should be considered.

• The Korean Journal of Pain
• /
• v.24 no.4
• /
• pp.205-215
• /
• 2011

Background: Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues. Methods: A cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital. Result: The maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis. Conclusion: All procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties.

• Tuberculosis and Respiratory Diseases
• /
• v.62 no.2
• /
• pp.140-143
• /
• 2007

A 60-year-old man was diagnosed with locally advanced non-small cell lung cancer. He refused treatment with a curative aim and was treated conservatively. Pain had developed on his shoulder and chest wall, which became worse as the cancer progressed. Although his pain initially appeared to be relieved with weak opioids and analgesics, it became more severe Strong opioids (transdermal fentanly patch and oxycodone), antidepressant or epidural block were introduced, However, the background pain became more intense and reached up to 8~9/10 on the visual analog scale (VAS). The dose of the transdermal fentanl patch was gradually increased to $600{\mu}g/hr$, which resulted in a dramatic improvement in his pain (9/10 of VAS) to 3/10 for most of the time. We described the successful experience with a high dose transdermal fentanyl patch for cancer pain relief, which might be an alternative option for cancer patients suffering from severe pain.