Epidural Blood Patch for the Treatment of Abducens Nerve Palsy due to Spontaneous Intracranial Hypotension -A Case Report-

Intracranial hypotension is characterized by a postural headache which is relieved in a supine position and worsened in a sitting or standing position. Although less commonly reported than postural headache, sixth nerve palsy has also been observed in intracranial hypotension. The epidural blood patch (EBP) has been performed for postdural puncture headache, but little is known about the proper timing of EBP in the treatment of sixth nerve palsy due to intracranial hypotension. This article reports a case of sixth nerve palsy due to spontaneous intracranial hypotension which was treated by EBP 10 days after the onset of palsy

Massive transfusion protocol: the reason it is necessary

Objective. The purpose of this study is to identify problems of emergency transfusion at the bedside and to determine need for massive transfusion protocol. Methods. We included patients who met the criteria for “trauma team activation” and were admitted to division of trauma. The amount of blood product transfused in each unit was investigated for balanced transfusion. We also investigated the compliance with assessment of blood consumption score. The correlation between the time elapsed from patient visit to first transfusion order and time elapsed from first transfusion order to transfusion start was analyzed. Finally, we investigated various factors which serve to influence the decision-making process regarding early transfusion order. Results. Ratio of packed Red blood cells (pRBC): Fresh frozen plasma (FFP) was well-balanced, but platelet transfusion done was much lower than pRBC and FFP in emergency room. The application of emergency blood release did not match the criteria of assessment of blood consumption (ABC) score. The time from the first transfusion order to the transfusion start was found to be constant irrespective of time from patient visit to first transfusion order. And, the time from the first transfusion order to transfusion start did not differ significantly among patients with early transfusion order and delayed transfusion order. Only systolic blood pressure of < 90 mmHg was identified as a major predictor for early transfusion order. Conclusion. Balanced transfusion is not easy and emergency transfusion could be delayed at the bedside. Integrated and systematic structures for massive transfusion protocol would be invaluable and indispensable

Institutional Change and Continuity in Koreas Central Agencies, 1948-2011

This article analyzes Koreas central agencies, which have been organized and reorganized to support presidential executive leadership since the foundation of the Republic. Each central agency has carried out the standardization of a core administrative function which is essential to the operation of administrative apparatuses, including policy planning and coordination, budgeting, organizing, staffing, legislation, public relations, central-local relations, control and performance evaluation, etc. The six decades of institutionalization can be characterized, based on the central agencies proportion of the total administrative apparatus, into three phases: high (more than 35 percent, 1948-1961), middle (around 20 percent, 1962-2007), and low (about 10 percent, 2008-present). Regardless of the changing size and organizational configuration of the central agencies, however, their roles and influence as core executive apparatuses have remained largely unchanged, especially since the early 1960s. More than 67 percent, on average, of the heads and deputy heads of CAs have been former public servants, less than 18 percent have been former politicians, and about 15percent have been former outside experts. This strong bureaucratic background has oriented Koreas core executive policy direction significantly toward longterm, consistent, and plan rationality rather than short-term, flexible, and democratic responsiveness

An Analysis of Location of Needle Entry Point and Palpated PSIS in S1 Nerve Root Block

BACKGROUND: The first sacral nerve root block (S1NRB) is a common procedure in pain clinic for patients complaining of low back pain with radiating pain. It can be performed in the office based setting without C-arm. The previously suggested method of locating the needle entry point begins with identifying the posterior superior iliac spine (PSIS). Then a line is drawn between two points, one of which is 1.5 cm medial to the PSIS, and the other of which is 1.5 cm lateral and cephalad to the ipsilateral cornu. After that, one point on the line, which is 1.5 cm cephalad to the level of the PSIS, is considered as the needle entry point. The purpose of this study was to analyze the location of needle entry point and palpated PSIS in S1NRB. METHODS: Fifty patients undergoing C-arm guided S1NRB in the prone position were examined. The surface anatomical relationships between the palpated PSIS and the needle entry point were assessed. RESULTS: The analysis revealed that the transverse and vertical distance between the needle entry point and PSIS were 28.7 ± 8.8 mm medially and 3.5 ± 14.0 mm caudally, respectively. The transverse distance was 27.8 ± 8.3 mm medially for male and 29.5 ± 9.3 mm medially for female. The vertical distance was 1.0 ± 14.1 mm cranially for male and 8.1 ± 12.7 mm caudally for female. CONCLUSIONS: The needle entry point in S1NRB is located on the same line or in the caudal direction from the PSIS in a considerable number of cases. Therefore previous recommended methods cannot be applied to many cases.ope

Pulsed Radiofrequency Treatment of Pain Relieving Point in a Soft Tissue

Pulsed radiofrequency (PRF) treatment of nervous tissue has been proposed as a less neurodestructive technique alternative to continuous RF heat lesioning. Recently, clinical reports using PRF have shown favorable effects in the treatment of a variety of focal pain areas, even in non-nervous tissues; however, the mechanism of effect underlying this treatment to non-nervous tissue remains unclear. We report the case of a 67-year-old male who presented with pain reliving point in the posterior neck. The patient had pain in the posterior neck for 3 years. The pain subsided with pressure applied to a point in the posterior neck. There were no specific abnormal findings on laboratory testing and radiologic examinations. After PRF treatment to the pain-relieving point, he had pain relief which lasted more than 5 months

Radiation Exposure to Physicians During Interventional Pain Procedures

BACKGROUND: Fluoroscopy has been an integral part of modern interventional pain management. Yet fluoroscopy can be associated with risks for the patients and clinicians unless it is managed with appropriate understanding, skill and vigilance. Therefore, this study was designed to determine the amount of radiation received by a primary operator and an assistant during interventional pain procedures that involve the use of fluoroscopy 0aMETHODS: In order to examine the amount of radiation, the physicians were monitored by having them wear three thermoluminescent badges during each single procedure, with one under a lead apron, one under the apron collar and one on the leg during each single procedure. The data obtained from each thermoluminescent badge was reviewed from September 2008 to November 2008 and the annual radiation exposure was subsequently calculated. 0aRESULTS: A total of 505 interventional procedures were performed with C-arm fluoroscopy during three months. The results of this study revealed that the annual radiation exposure was relatively low for both the operator and assistant. 0aCONCLUSION: With proper precautions, the use of fluoroscopy during interventional pain procedures is a safe practiceope

Allergic reactions to hyaluronidase in pain management -A report of three cases-

Hyaluronidase has been gaining interest because it reduces tissue edema and fibrosis. Although rare, hyaluronidase has been shown to cause allergic reactions. A few cases of allergic reactions following hyaluronidase administration have been reported. Most of the described patients presented allergic reactions after peribulbar anesthesia for eye surgery. In this report, we describe three patients who experienced with allergic reactions to hyaluronidase following pain management. Two of the patients had a history of uneventful injection with hyaluronidase. All patients were afebrile and blood tests results were normal. Intradermal skin tests were positive. These clinical findings were helpful in establishing the differential diagnosis of infection. Although allergic reaction to hyaluronidase is rare and mostly benign, this must be considered before treating patients