This report describes a case of spinal nerve root compression due to an acute inflammatory granuloma after lumbar surgery. A 39 year-old man with a history of increasing back pain with a 3-week duration was diagnosed with a herniated intervertebral disc (HIVD). The diagnosis of a HIVD was confirmed by magnetic resonance imaging (MRI) with indications for surgery. A discectomy and a partial laminectomy was performed and the symptoms were alleviated immediately after surgery for a five-day period. However, a slowly progressing pain was subsequently noted along a different dermatome. There was no pain relief despite the patient being given pharmacological treatments, combined with an epidural steroid injection. The follow up MRI images showed severe compression of the nerve roots by a epidural lesion. Another procedure was performed 17 days after the initial operation. The lesion responsible for the compression of the nerve roots was found to be an acute inflammatory granuloma. The pain was relieved after the second procedure and there were no other symptoms or neurological problems. This case is remarkable in that a granuloma formed relatively quickly and grew to such a size that it was able to severely compress the surrounding nerve roots.
서 론 수술 후 오심, 구토(postoperative nausea and vomiting: PONV)는 수술 후 통증자가조절(patient-controlled analgesia: PCA)을 받는 환자의 40-75%에서 발생되며, 1-3) 유발요인으 로 수술의 종류에 따라 복강경수술, 4) 담낭수술, 5) 중이수술, 6) 유방수술, 7) 갑상선 절제수술 8) 등에서 발생이 높으며, 마취 와 연관된 요소로는 수술 중 desflurane, isoflurane, 9) enflurane, N2O, sufentanil, fentanyl, 10) glycopyrrolate, neostigmine 사용 11) 등이 있고, 환자에 따른 요인으로는 여자환 자, 12) 평소 멀미증상이 있던 환자, 수술 후 통증이 있는 환 자 10) 등이 있으며, 월경주기와도 연관이 있다.13) 본 연구는 수술 중 fentanyl 100μg 이상이 경막외로 투여 되어 PONV 가능성이 높은 산모를 대상으로, 분만직후 ondansetron 2 mg, 4 mg 또는 8 mg을 정주한 후 수술 후 butorphanol과 ropivacaine을 이용한 경막외 통증자가조절(patient-controlled epidural analgesia: PCEA)를 실시하여 PONV 발생률을 가장 효과적으로 감소시킬 수 있는 ondansetron의 투여용량과 그에 따른 부작용 발생 정도를 알아보기 위하 여 실시하였다.경막외
Background: Intrathecal sufentanil has been found to provide profound analgesia during labor. The analgesic effect of intrathecal sufentanil, morphine and hyperbaric bupivacaine were compared with that of epidural fentanyl and bupivacaine for labor pain. Methods: Thirty women received either 2 ml of 10 intrathecal sufentanil with 0.2 mg morphine and 3.5 mg bupivacaine (intrathecal group; n = 15) or 10 ml of 0.125% bupivacaine mixed with fentanyl 5 /ml (epidural group; n = 15) during active labor. When pain occurred, 50 mg meperidine was injected intravenously in the intrathecal group, or a patient-controlled epidural analgesia (PCEA) pump, using 0.0625% bupivacaine with fentanyl 2 /ml, was programmed to deliver a 4 ml/h basal infusion and a 4 ml on-demand bolus, with 10-min lockout intervals, was activated in the epidural group. Results: The quality of analgesia, side effects, duration of labor, overall satisfaction and Apgar scores did not differ between the two groups. Motor weakness and urinary retention were significantly lower in the intrathecal group (P
Exercise enhances memory function by increasing neurogenesis in the hippocampus, and circadian rhythms modulate synaptic plasticity in the hippocampus. The circadian rhythm-dependent effects of treadmill exercise on memory function in relation with neurogenesis were investigated using mice.The step-down avoidance test was used to evaluate short-term memory, the 8-arm maze test was used to test spatial learning ability, and 5-bromo-2'-deoxyuridine immunofluorescence was used to assess neurogenesis. Western blotting was also performed to assess levels of synaptic plasticity-associated proteins, such as brain-derived neurotrophic factor, tyrosine kinase receptor B, phosphorylated cAMP response element-binding protein, early growth response protein 1, postsynaptic density protein 95, and growth-associated protein 43. The mice in the treadmill exercise at zeitgeber 1 group started exercising 1 hour after sunrise, the mice in the treadmill exercise at zeitgeber 6 group started exercising 6 hours after sunrise, and the mice in the treadmill exercise at zeitgeber 13 group started exercising 1 hour after sunset. The mice in the exercise groups were forced to run on a motorized treadmill for 30 minutes once a day for 7 weeks.Treadmill exercise improved short-term memory and spatial learning ability, and increased hippocampal neurogenesis and the expression of synaptic plasticity-associated proteins. These effects of treadmill exercise were stronger in mice that exercised during the day or in the evening than in mice that exercised at dawn.Treadmill exercise improved memory function by increasing neurogenesis and the expression of synaptic plasticity-associated proteins. These results suggest that the memory-enhancing effect of treadmill exercise may depend on circadian rhythm changes.
서 론 마취란 무의식, 망각, 유해감각에 대한 반응의 차단 등이 복합된 상태이며, 상기 앞 두가지는 최면제에 의하여, 세번 째 요소는 아편양제제에 의하여 조절된다. 1) 두 약제의 병용 투여 시 각 약물의 상승작용으로 각각의 요구량이 감소되 는데 의식소실보다는 유해감각차단에 대한 상승효과가 더 크다. 2) 따라서 심한 통증이 예상되는 수술에서 혈역학적 안 정성과 적절한 최면효과[bispectral index (BIS)로 측정], 빠른 회복을 얻기 위하여 propofol과 아편양제제의 병용투여가 이 루어진다.또한 적절한 혼합투여는 최소량과 최소의 부작용 으로 최고의 상승효과를 얻고, 3) 빠른 마취회복과 4) 최소의 비용을 얻는 목적이 있다.전정맥마취(total intravenous anesthesia, TIVA)란 흡입마취 제를 사용하지 않고 정맥마취제만을 사용하여 앞서 기술한 마취의 세가지 요소를 충족시키는 마취방법을 말하며 흡입 마취제를 사용한 전신마취에 비해 마취의 심도의 조절이 용이하고 고농도의 산소투여가 가능하고 심혈관계억제를 최소화하며 흡입마취제의 부작용을 피할 수 있고 수술실의 대기오염도 감소되는 이점이
This report describes a case of dizziness in a patient with trigeminal neuralgia that was caused by a vestibular schwannoma. A 60-year-old man with a history of pain on his left cheek, chin, molar and tongue for 5 months was diagnosed as suffering with trigeminal neuralgia of the left mandibular nerve, and this was caused by a left vestibular schwannoma. The diagnosis of the tumor was confirmed with magnetic resonance imaging (MRI), and so gamma knife surgery was performed 1 month later. At that time, the patient had been referred to the pain clinic due to allodynia on the tongue and gingival, and hypesthesia was also present on the left half of the face. Trigeminal nerve block with dehydrogenated alcohol and stellate ganglion block with 1% mepivacaine were performed and oral medication with diphenylhydantoin was started. The symptoms were alleviated after nerve block and oral medication. Dizziness, blurred vision and ataxia then developed from the 13th hospital day. We considered the symptoms as a side effect of diphenylhydantoin and we reduced the dose of diphenylhydantoin. However, the symptoms grew worse. Another brain MRI showed a slight increase of the tumor size and a mass effect with displacement of the adjacent organs, and hydrocephalus was also noted. This case shows the importance of considering the secondary symptoms that are due to brain tumor while treating trigeminal neuralgia. The changes of the brain tumors should also be considered along with the presence of new side effects.
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