Fibrous Mass Complicating Epidural Steroid and Local Anesthetic Injection : A Case Report

The use of epidural injection of local anesthetics with steroid for the treatment of back pain and sciatica is a widely used procedure. There have been several reports about spinal cord compression by granuloma or fibrous mass related to intrathecal or epidural morphine injection. There have been also some reports about arachnoiditis after epidural injection of steroid. However, there have been no reports regarding dural sac or nerve root compression by fibrous mass after epidural steroid injections. We would report a case of dural sac and nerve root compression secondary to the formation of fibrous mass in the lumbar epidural space after epidural steroid and local anesthetic injections. In this case, the characteristic radiologic findings before and after epidural injection therapy and clinical progress were documented.ope

A Study on the Development of the Overhead Hoist Transport Control and Management for 3mm Wafer Transfer Based on the Optimal Flow Path Algorithm

This paper explain Overhead Hoist Transport, Overhead Hoist Transport Control System and OPC(One-board Programmable Controller). Overhead Hoist Transport is the device that transfer wafer though rail installed on the ceiling. OHT Control System is the system that integrate and control to the best optimal and manage the many OHT. It is used in the factory that produced semiconductor wafer. OHT is operated from an upper group by the transport order to be ordered. Consequently, this paper is designed the module that consist is command entity and operate entity. And Wireless LAN communication and protocol is designed. It is ensured against risks which the minimize could communication error and fail. The experiment observe SEMI Standsed scenario made the OHT for research and was the low to the experiment method to be produced. Therefore, OPC that is made by the design verified the adequacy of a system design. In this paper, All final result developed so that the contentment could order various driving condition and characteristic that contain a semicoductor standard.제 1장 서론 1 1.1 연구배경 1 1.2 연구개요 2 제 2장 300mm 대구경 웨이퍼(wafer) 제조공정과 OHT 3 2.1 웨이퍼(wafer) 제조공정 3 2.2 OCS 개요 4 2.2.1 MCS 인터페이스 모듈 6 2.2.2 GUI 모듈 6 2.2.3 스케쥴링 엔진 모듈 6 2.2.4 OHT 인터페이스 모듈 7 2.3 OHT 개요 7 제 3장 알고리즘 구축 및 구현 10 3.1 최적 이송경로 선정 알고리즘 10 3.1.1 Floyd-Warshall 알고리즘 10 3.2 OHT 주행 레일(rail) 기본구조 12 3.3 알고리즘 구현 13 3.3.1 충돌방지 로직(Logic) 14 3.3.2 충돌방지 해법 16 3.3.2.1 충돌방지 해법에 의한 명령전송(From_OCS To_OHT) 16 3.4 OCS 시뮬레이터 구현 21 제 4장 시스템 구성 및 구현 34 4.1 전체 시스템 구성 34 4.1.1 OCS 시스템 36 4.1.2 OHT의 시스템 37 4.1.3 무선통신 시스템 39 4.2 시스템 구현 상세 구조설계 41 4.2.1 통신 소프트웨어 42 4.2.2 통신 소프트웨어 모듈 동기화 43 4.2.2.1 정규 동기화 43 4.2.2.2 비정규 동기화 47 4.2.2.3 명령 실행 사이클 동기화 48 4.2.3 통신구조 설계 49 4.2.3.1 OCS 및 OHT 시스템 50 4.2.3.2 핸드-터미널(hand-terminal) 시스템 및 OHT 시스템 51 4.2.3.3 프로그램 메니져(program manager) 시스템 및 OHT 시스템 52 4.2.4 프로토콜(Protocol) 설계 53 4.2.4.1 OCS 및 OHT 시스템 56 4.2.4.2 핸드-터미널(hand-terminal) 시스템 및 OHT 시스템 62 4.2.4.3 프로그램 메니져(program manager) 시스템 및 OHT 시스템 66 4.2.5 통신 구현 69 4.2.6 OHT 구동방식 상세설계 78 4.2.6.1 구동개념 설계 79 4.2.6.2 시스템 오류 처리기법 설계 81 4.2.6.3 주행부 구동방식 설계 82 4.2.6.4 승강부 구동방식 설계 86 4.2.6.5 횡행부 구동방식 설계 90 4.2.6.6 선회부 구동방식 설계 92 4.2.6.7 기타 구동부의 구동방식 설계 93 4.2.7 OHT 구동 구현 95 제 5장 실험 및 고찰 101 5.1 실험장치 101 5.2 시뮬레이션 실험 103 5.3 OHT 구동 실험 106 제 6장 결론 115 참고문헌 11

Evidence-based of nonoperative treatment in adolescent idiopathic scoliosis

Until now because there are many published journals with a variety of opinions so I will stratify these articles by giving weighted value on grade evaluation which depend on each institution (written author and co-authors) and external evaluate status (SCI, SCIE, impact factor) rather than the outcomes provided by each article. Consequently, before evaluating publicized papers, study quality assessment of each interesting paper should be performed by mean of gauging the quality of evidence. Reviewing these articles, a grade of medical literature was divided into the following 5 levels as level I (randomized controlled study), level II (non-randomized controlled study), level III (case-control study), level IV (case series), and level V (expert opinions). However, in present article I concluded only involved medical literatures with weighted value of level I and II evidence.ope

Thoracic Fracture-Dislocations Without Spinal Cord Injury: Two Cases Reports

Thoracic fracture-dislocations reportedly lead to an 80% incidence of complete paraplegia. Thus, thoracic fracture-dislocations without cord injury are uncommon. There are a few cases of thoracic fracture-dislocations in which the neural sparing status was associated with separation of the posterior spinal structures, such as the pedicles and laminae. The authors experienced two cases of thoracic fracture-dislocations without spinal cord injury: one was a 50-year-old man who fell from the fourth floor of a building and sustained a T6-7 fracture-dislocation; and the other was a 43-year-old man who was involved in motorcycle accident and sustained a T12 fracture-dislocation. Segmental spinal instrumentation and fusion without open reduction was performed in each of the two cases and there has not been any abnormality detected on neurological examination at a minimum follow-up period of 2 years.ope

Hibernoma in Psoas Muscle: A Case Report

Hibernoma is a rare benign tumor of a brown fat origin with hypervascularity. Although the magnetic resonance imaging features resemble a liposarcoma, its malignant potential is unknown. A complete local excision with meticulous hemostasis is the treatment of choice. We present a case of hibernoma in the psoas muscle with a review of the relevant literature.ope

Immediate ipsilateral fibular transfer in a large tibial defect using a ring fixator. A case report

Massive segmental bony defects in open tibial fractures are generally treated with conventional bone grafting, a free vascularised fibular graft or the ring fixator technique. A vascularised fibular graft may be superior to a conventional bone graft, but it is technically difficult and occasionally impossible. In such circumstances, fibular transfer in conjunction with a ring fixator is an alternative method. This procedure can be accomplished by transferring the osteotomised part of the fibula to the tibia by means of olive wires. The authors have treated a 20-year-old male who presented with a Gustilo type IIIB open tibial fracture. The soft tissue defect was severe, only the tibialis posterior artery was patent and the peroneal artery was partially damaged. A latissimus dorsi flap was performed to cover the soft tissue defect. Since the patent tibialis posterior artery had already been used for the flap, it was difficult to perform a vascularised fibular graft. Moreover, it was technically difficult to accomplish a gradual transport using a ring fixator because the distal tibia was lost. For this reason, the fibular transfer was performed immediately after the ring fixator was applied. Good bony union and fibular hypertrophy were obtained even though these two procedures were undertaken simultaneously.ope

Efficacy and Safety of Transdermal Buprenorphine versus Oral Tramadol/Acetaminophen in Patients with Persistent Postoperative Pain after Spinal Surgery

PURPOSE: Control of persistent pain following spinal surgery is an unmet clinical need. This study compared the efficacy and safety of buprenorphine transdermal system (BTDS) to oral tramadol/acetaminophen (TA) in Korean patients with persistent, moderate pain following spinal surgery. METHODS: Open-label, interventional, randomized multicenter study. Adults with persistent postoperative pain (Numeric Rating Scale [NRS] ≥ 4 at 14-90 days postsurgery) were enrolled. Patients received once-weekly BTDS (n = 47; 5 μg/h titrated to 20 μg/h) or twice-daily TA (n = 40; tramadol 37.5 mg/acetaminophen 325 mg, one tablet titrated to 4 tablets) for 6 weeks. The study compared pain reduction with BTDS versus TA at week 6. Quality of life (QoL), treatment satisfaction, medication compliance, and adverse events (AEs) were assessed. FINDINGS: At week 6, both groups reported significant pain reduction (mean NRS change: BTDS -2.02; TA -2.76, both P < 0.0001) and improved QoL (mean EQ-5D index change: BTDS 0.10; TA 0.19, both P < 0.05). The BTDS group achieved better medication compliance (97.8% versus 91.0%). Incidence of AEs (26.1% versus 20.0%) and adverse drug reactions (20.3% versus 16.9%) were comparable between groups. IMPLICATIONS: For patients with persistent pain following spinal surgery, BTDS is an alternative to TA for reducing pain and supports medication compliance. This trial is registered with Clinicaltrials.gov: NCT01983111.ope

Clinical Issues in Indication, Correction, and Outcomes of the Surgery for Neuromuscular Scoliosis: Narrative Review in Pedicle Screw Era

Surgical treatment for neuromuscular scoliosis has evolved with pedicle screw instrumentation and the improvement of perioperative management. We aimed to review recent papers related to posterior surgical correction with a pedicle screw system for neuromuscular scoliosis, particularly cerebral palsy and muscular dystrophy, in terms of indication, correction method, and outcomes. The most remarkable change was the posterior-only operation with all-pedicle screw fixations. With this change, operation time, blood loss, and postoperative complications decreased. Furthermore, spinal osteotomy could be performed with the pedicle screw system for severe scoliosis. S2-alar-iliac screws demonstrated favorable outcomes in terms of stability and complication, but a question remains about saving the mobile segment for sitting balance, interaction between the hip and spine, effect to the sagittal balance, and proximal junctional problem. The quality of life improvement was more definite in patients with cerebral palsy. The improvement of respiratory function in Duchenne muscular dystrophy was not certain, although an increase of spinal height, thoracic cavity size, and absolute forced vital capacity have been reported. Further prospective studies or randomized clinical trials are needed to evaluate the long-term outcomes of lumbosacral fixation, preservation of the lumbosacral joint, or functional improvement considering the different etiology.ope

Phospholipase A2 in herniated Lumbar Discs: Its Relevalence to Pain

Study Design A prospective study. Objective To determine whether phospholipase A2(PLA2) activity in herniated lumbar disc is correlated with clinical, radiographic and anatomic signs of the patients with herniated nucleus pulposus. Summary of Literature Review Several studies have suggested inflammation around nerve root as a mechanism of sciatica and PLA2 emerges as a key enzyme of the inflammation. However, consensus about association between PLA2 and sciatica has been lacking. In addition, there has been no report that investigated the relationship between cytosolic and membrane PLA2 in herniated disc and patient's symptoms. Materials and Methods Human intervertebral disc materials were obtained from 33 patients who underwent discectomy for HNP. The information was noted about smoking history, medication of NSAID, symptom duration, pain score on a visual analog scale(VAS), positive angle of straight leg raising test (SLR), neurologic deficits, Thompson grade of herniated disc, volume of herniation shown by the MRI and type of herniation based on the operative record. These data were matched to the PLA2 activity in herniated disc measured using Western blotting analysis. PLA2 activity was expressed as the relative percentage compared to that of a 33-year-old female disc obtained during an operation for spinal fracture. The analysis was carried out using Mann-Whitney test, Pearson correlation analysis, simple linear regression analysis. A value of p<0.05 was considered significant. Results Cytosolic and membrane PLA2 activity showed no statistical relationship to clinical, radiographic and anatomic characteristics of herniated disc. However, membrane PLA2(active form) activity was correlated with the pain score on VAS(p=0.013, r=0.481), while cytosolic PLA2(latent form) showed no statistically significant correlation with the pain score. Conclusion This study demonstrates that membrane PLA2 activity is correlated with the pain score. It also suggests that selective PLA2 inhibitors could be used for the alternative treatment modality of HNP.ope

Gradual neurologic deterioration post kyphoscoliosis correction surgery: a case report

A 13-year-9-month-old female child presented with congenital kyphoscoliosis along with progressive paraparesis. Radiographs confirmed kyphoscoliosis and magnetic resonance imaging revealed a stretched and flattened spinal cord over the kyphotic deformity and a T7 hemivertebra. She underwent a posterior correction of the curve along with posterior decompression and a posterior to anterior excision of T7 hemivertebra to relieve her of the deteriorating neurology. While carrying out the excision of T7 hemivertebra, her trans cranial electrical motor evoke potential dropped. Consequently, she was administered a mega dose steroid therapy. After a positive wake-up test, the excision was discontinued and surgery was concluded by in situ fixation of the deformity with short rods. Thereafter, a gradual deterioration in the neurologic status was observed and patient became paraplegic on the fourth post operative day. In this case report, we try to analyze various causes for gradual deterioration in neurologic statusope