Keun Man Shin

Partial-Thickness Rotator Cuff Tears

Although the incidence of partial-thickness rotator cuff tears (PTRCTs) was reported to be from 13% to 32% in cadaveric studies, the actual incidence is not yet known. The causes of PTRCTs can be explained by either extrinsic or intrinsic theories. Studies suggest that intrinsic degeneration within the rotator cuff is the principal factor in the pathogenesis of rotator cuff tears. Extrinsic causes include subacromial impingement, acute traumatic events, and repetitive microtrauma. However, acromially initiated rotator cuff pathology does not occur and extrinsic impingement does not cause pathology on the articular side of the tendon. An arthroscopic classification system has been developed based on the location and depth of the tear. These include the articular, bursal, and intratendinous areas. Both ultrasound and magnetic resonance image are reported with a high accuracy of 87%. Conservative treatment, such as subacromial or intra-articular injections and suprascapular nerve block with or without block of the articular branches of the circumflex nerve, should be considered prior to operative treatment for PTRCTs.

A New Anterior Approach for Fluoroscopy-guided Suprascapular Nerve Block - A Preliminary Report -

Background The aim of the study was to investigate the feasibility of fluoroscopy-guided anterior approach for suprascapular nerve block (SSNB). Methods Twenty patients with chronic shoulder pain were included in the study. All of the nerve blocks were performed with patients in a supine position. Fluoroscopy was tilted medially to obtain the best view of the scapular notch (medial angle) and caudally to put the base of coracoid process and scapular spine on same line (caudal angle). SSNB was performed by introducing a 100-mm, 21-gauge needle to the scapular notch with tunnel view technique. Following negative aspiration, 1.0 ml of contrast was injected to confirm the scapular notch, and 1 % mepivacaine 2 ml was slowly injected. The success of SSNB was assessed by numerical rating scale (NRS) before and after the block. Results The average NRS was decreased from 4.8 ± 0.6 to 0.6 ± 0.5 after the procedure (P < 0.05). The best view of the scapular notch was obtained in a medial angle of 15.1 ± 2.2 (11-19°) and a caudal angle of 15.4 ± 1.7° (12-18°). The average distance from the skin to the scapular notch was 5.8 ± 0.6 cm. None of the complications such as pneumothorax, intravascular injection, and hematoma formation was found except one case of partial brachial plexus block. Conclusions SSNB by fluoroscopy-guided anterior approach is a feasible technique. The advantage of using a fluoroscopy resulted in an effective block with a small dose of local anesthetics by an accurate placement of a tip of needle in the scapular notch while avoiding pneumothorax.

Spontaneous Retropharyngeal Hematoma - A Case Report -

Spontaneous retropharyngeal hematoma is rare and difficult to diagnosis early. A 23-year-old male spontaneously developed acute onset of neck pain, limitation of neck motion, and mild dysphagia. Magnetic resonance imaging demonstrated blood products in prevertebral space from C2 to C4, suggesting a diagnosis of retropharyngeal hematoma. We report a rare case of spontaneous retropharyngeal hematoma causing neck pain.

The efficacy of pre-warming on reducing intraprocedural hypothermia in endovascular coiling of cerebral aneurysms

BackgroundThe anesthetic management of patients undergoing endovascular treatment of cerebral aneurysms in the interventional neuroradiology suite can be challenged by hypothermia because of low ambient temperature for operating and maintaining its equipments. We evaluated the efficacy of skin surface warming prior to induction of anesthesia to prevent the decrease in core temperature and reduce the incidence of hypothermia.MethodsSeventy-two patients were randomized to pre-warmed and control group. The patients in pre-warmed group were warmed 30xa0minutes before induction with a forced-air warming blanket set at 38°C. Pre-induction tympanic temperature (Tpre) was measured using an infrared tympanic thermometer and core temperature was measured at the esophagus immediately after intubation (T0) and recorded at 20xa0minutes intervals (T20, T40, T60, T80, T100, and T120). The number of patients who became hypothermic at each time was recorded.ResultsTpre in the control and pre-warmed group were 36.4u2009±u20090.4°C and 36.6u2009±u20090.3°C, whereas T0 were 36.5u2009±u20090.4°C and 36.6u2009±u20090.2°C. Core temperatures in the pre-warmed group were significantly higher than the control group at T20, T40, T60, T80, T100, and T120 (Pu2009<u20090.001). Compared to T0, core temperatures at each time were significantly lower in both two groups (Pu2009=u20090.007 at T20 in pre-warmed group, Pu2009<u20090.001 at the other times in both groups). The incidence of hypothermia was significantly lower in the pre-warmed group than the control group from T20 to T120 (Pu2009=u20090.002 at T20, Pu2009<u20090.001 at the other times).ConclusionPre-warming for 30xa0minutes at 38°C did not modify the trends of the temperature decrease seen in the INR suite. It just slightly elevated the beginning post intubation base temperature. The rate of decrease was similar from T20 to T120. However, pre-warming considerably reduced the risk of intraprocedural hypothermia.Trial registrationClinical Research Information Service (CRiS) Identifier: KCT0001320. Registered December 19th, 2014.

Percutaneous aspiration of lumbar zygapophyseal joint synovial cyst under fluoroscopic guidance -A case report-

A 51-year-old man with a 1-month history of lower back pain and radiating pain visited to our pain clinic. A magnetic resonance imaging (MRI) scan demonstrated a cyst like mass at the level of the L4-5 interspace and compression of the thecal sac and the nerve root on the right side. We performed percutaneous needle aspiration of the lumbar zygapophyseal joint synovial cyst under fluoroscopic guidance. The patient felt an immediate relief of symptoms after the aspiration, and had no signs or symptoms of recurrence at the follow-up 6 months later. No demonstrable lesion was found in the 6 months follow-up MRI.

Morphologic Analysis of Water-Cooled Bipolar Radiofrequency lesions on Egg White in Vitro

Background The aim of this study was to document the optimal spacing of two cannulae to form continuous strip lesions and maximal surface area by using water-cooled bipolar radiofrequency technology. Methods Two water-cooled needle probes (15 cm length, 18-gauge probe with 6 mm electrode tip) were placed in a parallel position 10, 20, 24, 26, and 28 mm apart and submerged in egg white. Temperatures of the probes were raised from 35℃ to 90℃ and the progress of lesion formation was photographed every 1 minute with the increase of the tip temperature. Approximately 30 photographs were taken. The resultant surface areas of the lesions were measured with the digital image program. Results Continuous strip lesions were formed when the cannulae were spaced 24 mm or less apart; monopolar lesions around each cannula resulted if they were spaced more than 26 mm apart. Maximal surface areas through the formation of continuous strip lesion were 221 mm2, 375 mm2, and 476 mm2 in 10, 20, and 24 mm, respectively. Summations of maximal surface area of each monopolar lesions were 394 mm2 and 103 mm2 in 26 and 28 mm, respectively. Conclusions Water-cooled bipolar Radiofrequency technology creates continuous strip lesions proportional in size to the distance between the probes till the distance between cannulae is 24 mm or less. Spacing the cannulae 24 mm apart and treating about 80℃ for 24 minutes maximizes the surface area of the lesion.

Percutaneous bipolar radiofrequency T3 sympathicotomy in Raynaud's disease -A case report-.

A 54-year-old female was suffering from cold-induced Raynauds attacks in her both hands with symptoms most severe in her left hand. As the patient did not respond to previous medical treatments and endoscopic thoracic sympathectomy, we performed percutaneous bipolar radiofrequency thoracic sympathicotomy at the left T3 vertebral level. After the procedure, the patient obtained a long duration of symptom relief over 3 years. Percutaneous bipolar radiofrequency T3 sympathicotomy is minimally invasive and effective technique by creating large continuous strip lesion.

Symptomatic epidural gas cyst treated with epidural block and percutaneous needle aspiration -A case report-.

A 68-year-old woman suffered from lower back and radiating pain on her right buttock and posterior calf. Axial magnetic resonance imaging showed a 7 × 7 mm nodular lesion (T1 and, T2 low signal intensity) at the epidural space between the L5-S1 level and computed tomography revealed it was an epidural gas cyst. The authors performed an epidural block and percutaneous needle aspiration of the epidural gas cyst. The patient showed almost complete resolution of symptoms one year later. The authors suggest that an epidural nerve block with needle aspiration of a gas cyst could be an alternative treatment option for patients with a symptomatic epidural gas cyst before surgery.

Left atrial appendage thrombus detected by intraoperative transesophageal echocardiography in a patient with acute small bowel infarction -A case report-

Acute mesenteric ischemia and infarction is an emergent situation associated with high mortality, commonly due to emboli or thrombosis of the mesenteric arteries. Embolism to the mesenteric arteries is most frequently due to a dislodged thrombus from the left atrium, left ventricle, or cardiac valves. We report a case of 70-year-old female patient with an acute small bowel infarction due to a mesenteric artery embolism dislodged from a left atrial appendage detected by intraoperative transesophageal echocardiography and followed by anticoagulation therapy.

A comparative study on the analgesic effect of continuous intraarticular infusion with ropivacaine, ropivacaine/fentanyl and ropivacaine/fentanyl/ketorolac after arthroscopic shoulder surgery

BACKGROUNDnArthroscopic shoulder surgery can result in severe postoperative pain. A variety of methods have been used to control pain in postoperative period and the results are variable. The purpose of this study was to compare the relative analgesic efficacies of the postoperative intraarticular infusion of ropivacaine, ropivacaine/fentanyl, and ropivacaine/fentanyl/ketorolac after arthroscopic shoulder surgery.nnnMETHODSnThirty patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to three groups. At the end of surgery, 0.5% ropivacaine 20 ml was infused into the articular space and a continuous infusion catheter was inserted into intraarticular operated site. After surgery, continuous infusion of 0.5% ropivacaine 100 ml (Group 1, n = 10), 0.5% ropivacaine 100 ml including fentanyl 10 microg/kg (Group 2, n = 10), or 0.5% ropivacaine 100 ml including fentanyl 10 microgram/kg and ketorolac 150 mg (Group 3, n = 10) was started through catheter at rate of 2 ml/hr with bolus dose of 0.5 ml with a lock out time of 15 minutes for 2 days. The level of pain was assessed using a visual analogue scale (VAS) postoperative 2, 6, 12, 24 and 48 hours and the amounts of supplemental analgesics were recorded.nnnRESULTSnThe VAS was significantly lower after 2, 6, 12 hours in Group 2 than in Group 1. In Group 3, the VAS was significantly lower all hours than in the other two groups.nnnCONCLUSIONSnThe combination of fentanyl and ketorolac with ropivacaine did provide better postoperative analgesia than the other groups after arthroscopic shoulder surgery.