• Clinical and Experimental Pediatrics
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• 제51권5호
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• pp.542-545
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• 2008

가와사끼병은 대부분 급성 전신성 질환으로 나타나지만 드물게 편도 주위 농양, 인두 주위 농양, 인두 후부 농양 등 두경부 응급 질환의 양상으로 발현될 수 있다. 이러한 비전형적 임상 양상으로 나타날 경우 인두 주변부 농양에 대한 수술적 조치를 결정하기 전에 가와사끼병을 정확하게 진단하는 것은 매우 중요하다. 저자들은 인두 후부 농양으로 발현된 가와사끼병 1례를 경험하였기에 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.757-766
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• 2020

Objective : Spinal epidural abscess (SEA) is a severe and life-threatening disease. Although commonly performed, the effect of timing in surgical treatment on patient outcome is still unclear. With this study, we aim to provide evidence for early surgical treatment in patients with SEA. Methods : Patients treated for SEA in the authors' department between 2007 and 2016 were included for analysis and retrospectively analyzed for basic clinical parameters and outcome. Pre- and postoperative neurological status were assessed using the American Spinal Injury Association Impairment Scale (AIS). The self-reported quality of life (QOL) based on the Short-Form Health Survey 36 (SF-36) was assessed prospectively. Surgery was defined as "early", when performed within 12 hours after admission and "late" when performed thereafter. Conservative therapy was preferred and recommend in patients without neurological deficits and in patients denying surgical intervention. Results : One hundred and twenty-three patients were included in this study. Forty-nine patients (39.8%) underwent early, 47 patients (38.2%) delayed surgery and 27 (21.9%) conservative therapy. No significant differences were observed regarding mean age, sex, diabetes, prior history of spinal infection, and bony destruction. Patients undergoing early surgery revealed a significant better clinical outcome before discharge than patients undergoing late surgery (p=0.001) and conservative therapy. QOL based on SF-36 were significantly better in the early surgery cohort in two of four physical items (physical functioning and bodily pain) and in one of four psychological items (role limitation) after a mean follow-up period of 58 months. Readmission to the hospital and failure of conservative therapy were observed more often in patients undergoing conservative therapy. Conclusion : Our data on both clinical outcome and QOL provide evidence for early surgery within 12 hours after admission in patients with SEA.

• Journal of Korean Neurosurgical Society
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• 제40권4호
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• pp.289-292
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• 2006

Thoracic spinal actinomycosis causing epidural abscess and significant spinal cord compression is very rare. A case is presented of a 56-year-old woman with rapid progressive upper back pain and weakness in both legs without evidence of systemic infection. Magnetic resonance imaging revealed a thoracic epidural enhancing lesion at the T1-T5 level. After decompression by laminectomy, precise diagnosis was accomplished using specific histopathological studies of the surgical specimens. A histopathologic findings showing typical Actinomyces sulfur granules surrounded by acute inflammatory cells. The clinical radiological findings of spinal actinomycosis closely resemble metastatic tumors and other infectious processes. Delay in diagnosis and treatment can significantly worsen the condition of patient.

• The Korean Journal of Pain
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• 제14권2호
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• pp.253-256
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• 2001

One of the most serious complications of regional anesthesia is a neurological deficit. Although such a problem is very rare, obstetric patients may develop paresthesia and motor dysfuntion during the postoperative period in association with number of other factors, including direct nerve trauma, equipment problems, adhesive arachnoiditis, anterior spinal artery syndrome, epidural hematoma or abscess and adverse drug effect. We experienced a case of unilateral paraparesis following epidural anesthesia with 20 ml of 0.75% ropivacaine and $25{\mu}g$ of fentanyl in an obstetric patient.

• The Korean Journal of Pain
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• 제11권1호
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• pp.143-145
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• 1998

There are reports on cervical epidural anesthesia for surgery of neck, chest and upper limb. However, there are limited published data on the specific problems with this procedure, including dural puncture, epidural abscess, and vasovagal syncopes. We experienced two cases of vasovagal syncope during cervical epidural anesthesia in the sitting position. These syncopes consisted of sudden hypotention and bradycardia, associated with nausea, dizzness and sweating. The patients were resuscitated successfully and recovered without any adverse effects. Current literature is being reviewed and the possible mechanisms of cardiac arrest under cervical epidural anesthesia in the sitting position are being discussed.

• The Korean Journal of Pain
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• 제10권2호
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• pp.301-303
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• 1997

A 35-year-old female patient was referred to our hospital with neurologic symptoms after continuous epidural block performed 2 days earlier. She die not have any prior no previous lumbar surgery or experience trauma, intraspinal hemorrhage, infections or other known causative factors to associate with neurologic symptoms. Continuous epidural block is widely used for postoperative pain control. Complications can occur with this block including postduralpuncture headache, epidural abscess and rare cases of arachnoiditis etc. We experienced such a case of spinal arachnoiditis after continuous epidural block. Neurologic examination revealed painful bilateral hypoesthesia below $S_2$ level dermatomes, urinary and fecal incontinence and various degrees of leg weakness. The following day, the patient was noted to have bilateral sacral radiculopathies and lesion on proximal portion of both tibial nerve. CSF study reported: protein 264 mg/dl, sugar 64 mg/dl, WBC $7/mm^3$. L-spine MyeloCTscan results were unremarkable. She was discharged after a month of hospitalization and has regular checkups but her neurologic symptoms show no signs of improvement.

• The Korean Journal of Pain
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• 제8권2호
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• pp.383-385
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• 1995

Postpuncture headache is the most common complication of epidural block, others include abscission of the tip of catheter, epidural abscess and subarachnoid infection, etc. A 69-year-old female patient visited the Neuro-Pain Clinic of Seran General Hospital for treatment of lower back pain and both sciatica. She received continuous epidural block, psoas compartment block, lumbar facet joint block and lumbar facet thermocoagulation. During the epidural block procedure the dura was accidently punctured and auto-logous blood patch was performed. Three days later, she manifested fever, nausea, vomiting, mild neck stiffness and mental deterioration. Meningitis was suspected as the cause of these signs. The CSF study reported: protein 400 mg/dl, sugar 14 mg/dl, WBC $468/mm^3$. She was recovered from the meningitis after adequate antibiotic therapy.

• The Korean Journal of Pain
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• 제7권1호
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• pp.113-115
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• 1994

통증치료를 목적으로 통증치료실에서 경막외 카테타 거치술의 빈도가 증가하고 있으며 현재 지속적 경막외 차단은 통증치료실에서 가장 필수적인 치료수단으로 알려져 있다. 암성통증, 대상포진, 혈관폐쇄성질환, 요하지통 등 여러가지 질환에 따라 수일에서 수개월간 경막외 카테터를 거치하여 치료하고 있다. 합병증으로 장기간의 경막외 카테터 유치로 인한 경막외 감염의 가능성이 항상 존재하고 있고 경막외 농양 동의 경막외 감염중이 드물게 발생하며 세균성 뇌막염의 발생은 매우 희귀하다고 한다. 본원에서는 당뇨병환자로서 우하지의 당뇨병성 말초 신경염으로 인한 통증의 치료를 위해 시술한 지속적 경막외 차단 도중 발생한 세균성 뇌막염을 1예 경험하였으며 이와 같은 합병증을 예방하기 위하여 경막외 천자시, 경막외 카테터 거치후에 지속적인 카테터 관리와 약물주입시 무균조작의 중요성을 절감하여 문헌적 고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제76권2호
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• pp.80-83
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• 2014

Patients with acquired immunodeficiency syndrome (AIDS) are at higher risks of bacterial pneumonia than the general population, and the pathogen is the most commonly involved Streptococcus pneumoniae. We hereby report a case of pneumococcal pneumonia associated with leptomeningitis, osteomyelitis and epidural abscess in a patient with AIDS. He is being successfully treated with ampicillin/sulbactam and clindamycin. And because the pneumococcal infection is usually associated with morbidity and mortality rates in the setting of AIDS, we should consider for pneumococcal vaccinations among the AIDS populations.

• Archives of Plastic Surgery
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• 제40권6호
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• pp.735-741
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• 2013

Background The prosthetic dura is an essential element in the protection of the cranial parenchyma and prevention of cerebrospinal fluid leakage. Although prosthetic dura are widely used in neurosurgery, they occasionally provoke infection, which can be a major concern after neurosurgical treatment. However, removal of the prosthetic dura carries a risk of brain parenchyma injury and cerebrospinal fluid leakage. The salvage of infected prosthetic dural material has not been adequately addressed in the literature. In this study, we demonstrate the value of the combination of a meticulous surgical debridement of necrotic tissue and simultaneous muscle free flap for intractable postoperative epidural abscess without removal of the infected prosthetic dura. Methods Between 2010 and 2012, we reviewed the data of 11 patients with persistent infection on the prosthetic dura. The epidural infections each occurred after a neurosurgical procedure, and there was soft tissue necrosis with the disclosure of the underlying prosthetic dura and dead bone around the scalp wound. To salvage the infected prosthetic dura, meticulous debridement and a muscle free flap were performed. Results All 11 patients experienced complete recovery from the complicated wound problem without the need for further surgical intervention. No signs of prosthetic dural infection were observed during the mean follow-up period of 11 months. Conclusions The combination of a meticulous surgical debridement and coverage with a muscle free flap is an effective treatment for salvage of infected prosthetic dura.