Journal of Yeungnam Medical Science

Focused Review article

Management and rehabilitation of moderate-to-severe diabetic foot infection: a narrative review: Chi Young An, Seung Lim Baek, Dong-Il Chun; J Yeungnam Med Sci. 2023;40(4):343-351. Published online September 19, 2023; DOI: https://doi.org/10.12701/jyms.2023.00717

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Diabetic foot is one of the most devastating consequences of diabetes, resulting in amputation and possibly death. Therefore, early detection and vigorous treatment of infections in patients with diabetic foot are critical. This review seeks to provide guidelines for the therapy and rehabilitation of patients with moderate-to-severe diabetic foot. If a diabetic foot infection is suspected, bacterial cultures should be initially obtained. Numerous imaging studies can be used to identify diabetic foot, and recent research has shown that white blood cell single-photon emission computed tomography/computed tomography has comparable diagnostic specificity and sensitivity to magnetic resonance imaging. Surgery is performed when a diabetic foot ulcer is deep and is accompanied by bone and soft tissue infections. Patients should be taught preoperative rehabilitation before undergoing stressful surgery. During surgical procedures, it is critical to remove all necrotic tissue and drain the inflammatory area. It is critical to treat wounds with suitable dressings after surgery. Wet dressings promote the formation of granulation tissues and new blood vessels. Walking should begin as soon as the patient’s general condition allows it, regardless of the wound status or prior walking capacity. Adequate treatment of comorbidities, including hypertension and dyslipidemia, and smoking cessation are necessary. Additionally, broad-spectrum antibiotics are required to treat diabetic foot infections.

Citations

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Unveiling the challenges of diabetic foot infections: diagnosis, pathogenesis, treatment, and rehabilitation
Chul Hyun Park
Journal of Yeungnam Medical Science.2023; 40(4): 319. CrossRef

Communication

The art of diabetes care: guidelines for a holistic approach to human and social factors: Muhammad Jawad Hashim; J Yeungnam Med Sci. 2023;40(2):218-222. Published online November 11, 2022; DOI: https://doi.org/10.12701/jyms.2022.00577

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Abstract PDF: A holistic approach to diabetes considers patient preferences, emotional health, living conditions, and other contextual factors, in addition to medication selection. Human and social factors influence treatment adherence and clinical outcomes. Social issues, cost of care, out-of-pocket expenses, pill burden (number and frequency), and injectable drugs such as insulin, can affect adherence. Clinicians can ask about these contextual factors when discussing treatment options with patients. Patients’ emotional health can also affect diabetes self-care. Social stressors such as family issues may impair self-care behaviors. Diabetes can also lead to emotional stress. Diabetes distress correlates with worse glycemic control and lower overall well-being. Patient-centered communication can build the foundation of a trusting relationship with the clinician. Respect for patient preferences and fears can build trust. Relevant communication skills include asking open-ended questions, expressing empathy, active listening, and exploring the patient’s perspective. Glycemic goals must be personalized based on frailty, the risk of hypoglycemia, and healthy life expectancy. Lifestyle counseling requires a nonjudgmental approach and tactfulness. The art of diabetes care rests on clinicians perceiving a patient’s emotional state. Tailoring the level of advice and diabetes targets based on a patient’s personal and contextual factors requires mindfulness by clinicians.

Review articles

Long-term management of Graves disease: a narrative review: Hyo-Jeong Kim; J Yeungnam Med Sci. 2023;40(1):12-22. Published online November 4, 2022; DOI: https://doi.org/10.12701/jyms.2022.00444

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Abstract PDF

Graves disease (GD) is the most common cause of hyperthyroidism, accounting for more than 90% of cases in Korea. Patients with GD are treated with any of the following: antithyroid drugs (ATDs), radioactive iodine (RAI) therapy, or thyroidectomy. Most patients begin treatment with ATDs, and clinical guidelines suggest that the appropriate treatment period is 12 to 18 months. While RAI treatment and surgery manage thyrotoxicosis by destroying or removing thyroid tissue, ATDs control thyrotoxicosis by inhibiting thyroid hormone synthesis and preserving the thyroid gland. Although ATDs efficiently control thyrotoxicosis symptoms, they do not correct the main etiology of GD; therefore, frequent relapses can follow. Recently, a large amount of data has been collected on long-term ATDs for GD, and low-dose methimazole (MMZ) is expected to be a good option for remission. For the long-term management of recurrent GD, it is important to induce remission by evaluating the patient’s drug response, stopping ATDs at an appropriate time, and actively switching to surgery or RAI therapy, if indicated. Continuing drug treatment for an extended time is now encouraged in patients with a high possibility of remission with low-dose MMZ. It is also important to pay attention to the quality of life of the patients. This review aimed to summarize the appropriate treatment methods and timing of treatment transition in patients who relapsed several times while receiving treatment for GD.

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Commentary: Azathioprine as an adjuvant therapy in severe Graves’ disease: a randomized controlled open-label clinical trial
Madhukar Mittal, Azher Rizvi
Frontiers in Endocrinology.2024;[Epub] CrossRef
Total Thyroidectomy – A Cost-effective Alternative to Anti-Thyroid Drugs in the Management of Grave's Disease
Erivelto Volpi, Leonardo M. Volpi
Clinical Thyroidology.2023; 35(5): 183. CrossRef
Evaluation of the Abbott Alinity i Thyroid-Stimulating Hormone Receptor Antibody (TRAb) Chemiluminescent Microparticle Immunoassay (CMIA)
Deborah J. W. Lee, Soon Kieng Phua, Yali Liang, Claire Chen, Tar-Choon Aw
Diagnostics.2023; 13(16): 2707. CrossRef
Mechanisms and Treatment Options for Hyperthyroid-Induced Osteoporosis: A Narrative Review
Robert M Branstetter, Rahib K Islam, Collin A Toups, Amanda N Parra, Zachary Lee, Shahab Ahmadzadeh, Giustino Varrassi, Sahar Shekoohi, Alan D Kaye
Cureus.2023;[Epub] CrossRef

The use of platelet-rich plasma in management of musculoskeletal pain: a narrative review: Aung Chan Thu; J Yeungnam Med Sci. 2022;39(3):206-215. Published online June 8, 2022; DOI: https://doi.org/10.12701/jyms.2022.00290

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Abstract PDF

Musculoskeletal pain is the most common pain reported by patients. Platelet-rich plasma (PRP) is widely used to treat musculoskeletal pain. However, the efficacy of PRP to treat this pain remains controversial. This review highlights the application of PRP in the treatment of musculoskeletal pain. PRP treatment appears to reduce pain and improve function in patients with musculoskeletal pain. However, there are limitations to the currently published studies. These limitations include the PRP preparation methods, type of activators, types of pathology to be treated, methods and times of administration, and association of PRP with other treatments.

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Restraint stress-associated gastrointestinal injury and implications from the Evans blue-fed restraint stress mouse model
Der-Shan Sun, Te-Sheng Lien, Hsin-Hou Chang
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Adarsh Jayasoorya , Nitin Samal, Gajanan Pisulkar, Kaustav Datta, Kevin Kawde
Cureus.2024;[Epub] CrossRef
Platelet-Rich Plasma in the Management of Temporomandibular Joint Pain in Young Adults With Temporomandibular Disorder
Santosh Kumar Mathpati, Gourav Jain, Vijay Mishra, Atul K Singh, Rahul Mishra, Bipin K Yadav
Cureus.2024;[Epub] CrossRef
Potentials and impact of platelet-rich plasma (PRP) on the regenerative properties of muscle tissue
V. H. Dzhyvak, I. M. Klishch, O. I. Khlibovska, S. S. Levenets
Biopolymers and Cell.2024; 40(1): 3. CrossRef
Injectable Lyophilized Chitosan-Thrombin-Platelet-Rich Plasma (CS-FIIa-PRP) Implant to Promote Tissue Regeneration: In Vitro and Ex Vivo Solidification Properties
Fiona Milano, Anik Chevrier, Gregory De Crescenzo, Marc Lavertu
Polymers.2023; 15(13): 2919. CrossRef
Systematic Review of Platelet-Rich Plasma for Low Back Pain
Edilson Silva Machado, Fabiano Pasqualotto Soares, Ernani Vianna de Abreu, Taís Amara da Costa de Souza, Robert Meves, Hans Grohs, Mary A. Ambach, Annu Navani, Renato Bevillaqua de Castro, Daniel Humberto Pozza, José Manuel Peixoto Caldas
Biomedicines.2023; 11(9): 2404. CrossRef
Potential Mechanism of Platelet-rich Plasma Treatment on Testicular Problems Related to Diabetes Mellitus
Rista Dwi Hermilasari, Dicky Moch Rizal, Yohanes Widodo Wirohadidjojo
Prague Medical Report.2023; 124(4): 344. CrossRef
The blind spot and challenges in pain management
Min Cheol Chang
Journal of Yeungnam Medical Science.2022; 39(3): 179. CrossRef

The mechanism of action of pulsed radiofrequency in reducing pain: a narrative review: Donghwi Park, Min Cheol Chang; J Yeungnam Med Sci. 2022;39(3):200-205. Published online April 7, 2022; DOI: https://doi.org/10.12701/jyms.2022.00101

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Abstract PDF

Pain from nervous or musculoskeletal disorders is one of the most common complaints in clinical practice. Corticosteroids have a high pain-reducing effect, and their injection is generally used to control various types of pain. However, they have various adverse effects including flushing, hyperglycemia, allergic reactions, menstrual changes, immunosuppression, and adrenal suppression. Pulsed radiofrequency (PRF) is known to have a pain-reducing effect similar to that of corticosteroid injection, with nearly no major side effects. Therefore, it has been widely used to treat various types of pain, such as neuropathic, joint, discogenic, and muscle pain. In the current review, we outlined the pain-reducing mechanisms of PRF by reviewing previous studies. When PRF was first introduced, it was supposed to reduce pain by long-term depression of pain signaling from the peripheral nerve to the central nervous system. In addition, deactivation of microglia at the level of the spinal dorsal horn, reduction of proinflammatory cytokines, increased endogenous opioid precursor messenger ribonucleic acid, enhancement of noradrenergic and serotonergic descending pain inhibitory pathways, suppression of excitation of C-afferent fibers, and microscopic damage of nociceptive C- and A-delta fibers have been found to contribute to pain reduction after PRF application. However, the pain-reducing mechanism of PRF has not been clearly and definitely elucidated. Further studies are warranted to clarify the pain-reducing mechanism of PRF.

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Himanshu Gupta, Colm Vance, Vishal Bansal, Ahilraj Siva
Pain Practice.2024; 24(2): 374. CrossRef
Pulsed Radiofrequency for Auriculotemporal Neuralgia: A Case Report
Yan Tereshko, Enrico Belgrado, Christian Lettieri, Simone Dal Bello, Giovanni Merlino, Gian Luigi Gigli, Mariarosaria Valente
Neurology International.2024; 16(2): 349. CrossRef
Transforaminal pulsed radiofrequency and epidural steroid injection on chronic lumbar radiculopathy: A prospective observational study from a tertiary care hospital in Vietnam
Viet-Thang Le, Phuoc Trong Do, Vu Duc Nguyen, Luan Trung Nguyen Dao, Ipek Saadet Edipoglu
PLOS ONE.2024; 19(4): e0292042. CrossRef
Comparison of two distinct needle tip positions in pulsed radiofrequency for herpes zoster‐related pain
Shao‐jun Li, Dan Feng
CNS Neuroscience & Therapeutics.2023; 29(7): 1881. CrossRef
Previous Lumbar Spine Surgery Decreases the Therapeutic Efficacy of Dorsal Root Ganglion Pulsed Radiofrequency in Patients with Chronic Lumbosacral Radicular Pain
Jiri Jandura, Milan Vajda, Roman Kostysyn, Jiri Vanasek, Eva Cermakova, Jan Zizka, Pavel Ryska
Journal of Personalized Medicine.2023; 13(7): 1054. CrossRef
Spinal Injections: A Narrative Review from a Surgeon’s Perspective
Dong Ah Shin, Yoo Jin Choo, Min Cheol Chang
Healthcare.2023; 11(16): 2355. CrossRef
Pulsed Radiofrequency 2 Hz Preserves the Dorsal Root Ganglion Neuron Physiological Ca2+ Influx, Cytosolic ATP Level, Δψm, and pERK Compared to 4 Hz: An Insight on the Safety of Pulsed Radiofrequency in Pain Management
Ristiawan Muji Laksono, Taufiq Agus Siswagama, Fa'urinda Riam Prabu Nery, Walter van der Weegen, Willy Halim
Journal of Pain Research.2023; Volume 16: 3643. CrossRef
Summary of the 48th KORSIS Symposium in 2023
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International journal of Pain.2023; 14(2): 96. CrossRef
The blind spot and challenges in pain management
Min Cheol Chang
Journal of Yeungnam Medical Science.2022; 39(3): 179. CrossRef
Use of QR Codes for Promoting a Home-Based Therapeutic Exercise in Patients with Lumbar Disc Herniation and Lumbar Spinal Stenosis: A Prospective Randomized Study
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Journal of Pain Research.2022; Volume 15: 4065. CrossRef

Drug-induced liver injury: Jeong Ill Suh; Yeungnam Univ J Med. 2020;37(1):2-12. Published online August 27, 2019; DOI: https://doi.org/10.12701/yujm.2019.00297

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Abstract PDF

Drug-induced liver injury (DILI), including herbal and dietary supplement hepatotoxicity, is often passed lightly; however, it can lead to the requirement of a liver transplant or may even cause death because of liver failure. Recently, the American College of Gastroenterology, Chinese Society of Hepatology and European Association for the Study of the Liver guidelines for the diagnosis and treatment of DILI have been established, and they will be helpful for guiding clinical treatment decisions. Roussel Uclaf Causality Assessment Method scoring is the most commonly used method to diagnose DILI; however, it has some limitations, such as poor validity and reproducibility. Recently, studies on new biomarkers have been actively carried out, which will help diagnose DILI and predict the prognosis of DILI. It is expected that the development of new therapies such as autophagy inducers and various other technologies of the fourth industrial revolution will be applicable to DILI research.

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Amal Oweid Almutairi, Mahmoud Zaki El-Readi, Mohammad Althubiti, Yosra Zakariyya Alhindi, Nahla Ayoub, Abdullah R. Alzahrani, Saeed S. Al-Ghamdi, Safaa Yehia Eid
Tropical Medicine and Infectious Disease.2023; 8(2): 129. CrossRef
Hepatotoxic Components Effect of Chebulae Fructus and Associated Molecular Mechanism by Integrated Transcriptome and Molecular Docking
Liwen Ai, Fan Yang, Wanjun Hu, Liyang Guo, Weixue Liu, Xuexue Xue, Lulu Li, Zunlai Sheng
Molecules.2023; 28(8): 3427. CrossRef
Systematic Review of Safety of Selective Androgen Receptor Modulators in Healthy Adults: Implications for Recreational Users
Jonathan D. Vignali, Kevin C. Pak, Holly R. Beverley, Jesse P. DeLuca, John W. Downs, Adrian T. Kress, Brett W. Sadowski, Daniel J. Selig
Journal of Xenobiotics.2023; 13(2): 218. CrossRef
Antitubercular drugs induced liver injury: an updated insight into molecular mechanisms
Devaraj Ezhilarasan
Drug Metabolism Reviews.2023; 55(3): 239. CrossRef
Advances in Idiosyncratic Drug-Induced Liver Injury Issues: New Clinical and Mechanistic Analysis Due to Roussel Uclaf Causality Assessment Method Use
Rolf Teschke, Gaby Danan
International Journal of Molecular Sciences.2023; 24(13): 10855. CrossRef
Application of artificial intelligence and machine learning in early detection of adverse drug reactions (ADRs) and drug-induced toxicity
Siyun Yang, Supratik Kar
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Rifampicin-induced ER stress and excessive cytoplasmic vacuolization instigate hepatotoxicity via alternate programmed cell death paraptosis in vitro and in vivo
KM Kainat, Mohammad Imran Ansari, Nuzhat Bano, Pankaj Ramji Jagdale, Anjaneya Ayanur, Mahadeo Kumar, Pradeep Kumar Sharma
Life Sciences.2023; 333: 122164. CrossRef
Establishment of a Stable Acute Drug-Induced Liver Injury Mouse Model by Sodium Cyclamate
Quan Zhou, Zhongtian Peng, Xialing Huang
Journal of Inflammation Research.2022; Volume 15: 1599. CrossRef
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Shujuan Piao, Hongwei Lin, Xia Tao, Wansheng Chen
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Mahesh Botejue, Gurjot Walia, Omar Shahin, Jyotsna Sharma, Rasiq Zackria
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Hepatología.2021; : 273. CrossRef
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Sylwia Szeląg-Pieniek, Stefan Oswald, Mariola Post, Joanna Łapczuk-Romańska, Marek Droździk, Mateusz Kurzawski
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Frontiers in Pharmacology.2021;[Epub] CrossRef
Changes in Liver Function Test Results after Korean Medicine Treatment in Patients of a Korean Medicine Hospital: A Retrospective Chart Review
Min Young Yim, Han Byeol Park, Jae Soo Kim, Hyun Jong Lee, Sung Chul Lim, Yun Kyu Lee
Korean Journal of Acupuncture.2021; 38(4): 275. CrossRef
Herb-induced Liver Injury in Asia and Current Role of RUCAM for Causality Assessment in 11,160 Published Cases
Rolf Teschke, Yun Zhu, Jing Jing
Journal of Clinical and Translational Hepatology.2020; 8(2): 200. CrossRef
Embarazo y lesión hepática inducida por medicamentos. Reporte de un caso y revisión de la literatura
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Hepatología.2020; : 157. CrossRef

Original Article

Retrograde balloon dilation as a therapeutic option for post-gynecologic surgery ureteral stricture followed by ureteroureterostomy: a comparative study regarding stricture length: Geon Woo Lim, Young Dong Yu, Kyung Hwa Choi, Seung Ryeol Rhee, Dong Soo Park, Young Kwon Hong; Yeungnam Univ J Med. 2018;35(2):179-186. Published online December 31, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.2.179

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Abstract PDF

Background
To evaluate the success rate of balloon dilation and the factors possibly influencing the outcomes of balloon dilation for the ureteric strictured portion of ureteroureterostomy (UUS) site in patients with post-gynecologic surgeries.
Methods
A single institution data base was screened for the patients who received balloon dilation for a treatment of ureteral stricture diagnosed after gynecologic surgery. Overall 114 patients underwent primary intra-operative UUS due to ureteral injury during gynecologic surgery. Among them, 102 patients received balloon dilation, and their medical records were retrospectively reviewed. Success of balloon dilation was defined as the condition that requires no further clinical interventions after 6 months from balloon dilation.
Results
The ureter injury rate of women treated with open radical abdominal hysterectomy was highest (32 cases, 31.4%). 60 patients (60.8%) showed successful outcomes regarding dilation. All patients underwent technically successful dilation with a full expansion of balloon during the procedure, but 40 patients (39.2%) were clinically unsuccessful as they showed a recurrence of ureteral stricture on the previous balloon dilation site after the first dilation procedure. Univariate logistic regression analyses showed that stricture length >2 cm was a significant predictor of successful dilation (odds ratio, 0.751; 95% confidence interval, 0.634-0.901; p-value, 0.030), but it failed to achieve independent predictor status in multivariate analysis.
Conclusion
Balloon dilation can an effective alternative treatment option for strictured portion of the primary UUS in post-gynecologic surgery patients when its length is <2 cm.

Citations

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Analysis of the Efficacy and Risk Factors for Failure of Balloon Dilation for Benign Ureteral Stricture
Bing Wang, Wenzhi Gao, Kunlin Yang, Honglei Liu, Yangjun Han, Mingxin Diao, Chao Zuo, Minghua Zhang, Yingzhi Diao, Zhihua Li, Xinfei Li, Gang Wang, Peng Zhang, Chunji Wang, Chunjuan Xiao, Chen Huang, Yaming Gu, Xuesong Li
Journal of Clinical Medicine.2023; 12(4): 1655. CrossRef
Mechanical characteristics of the ureter and clinical implications
Sorcha O’Meara, Eoghan M. Cunnane, Stefanie M. Croghan, Connor V. Cunnane, Michael T. Walsh, Fergal J. O’Brien, Niall F. Davis
Nature Reviews Urology.2023;[Epub] CrossRef
Left-sided flap transposition of the appendix for urethroplasty in oncourology
A. K. Nosov, D. I. Rumyantseva, E. M. Mamizhev, P. A. Lushina, N. A. Shchekuteev, M. V. Berkut
Cancer Urology.2022; 18(1): 127. CrossRef

Review article

Implementation of a care coordination system for chronic diseases: Jung Jeung Lee, Sang Geun Bae; Yeungnam Univ J Med. 2019;36(1):1-7. Published online December 20, 2018; DOI: https://doi.org/10.12701/yujm.2019.00073

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Abstract PDF

The number of people with chronic diseases has been increasing steadily but the indicators for the management of chronic diseases have not improved significantly. To improve the existing chronic disease management system, a new policy will be introduced, which includes the establishment of care plans for hypertension and diabetes patients by primary care physicians and the provision of care coordination services based on these plans. Care coordination refers to a series of activities to assist patients and their families and it has been known to be effective in reducing medical costs and avoiding the unnecessary use of the hospital system by individuals. To offer well-coordinated and high-quality care services, it is necessary to develop a service quality assurance plan, track and manage patients, provide patient support, agree on patient referral and transition, and develop an effective information system. Local governance should be established for chronic disease management, and long-term plans and continuous quality improvement are necessary.

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Personalized, interdisciplinary patient pathway for cross-sector care of multimorbid patients (eliPfad trial): study protocol for a randomized controlled trial
Christoph Heinrich Lindemann, Volker Burst, Linus Alexander Völker, Sebastian Brähler, Dusan Simic, Ingrid Becker, Martin Hellmich, Clarissa Kurscheid, Nadine Scholten, Ruben Krauspe, Kerstin Leibel, Stephanie Stock, Paul Thomas Brinkkoetter
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Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study
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Case Reports

Columnar variant of papillary carcinoma in the thyroglossal duct cyst with progression to lung metastasis.: Yujung Yun, Hye Jung Park, Young Ki Lee, Yongin Cho, Beoduel Kang, Hyun Ju Kim, Jung Hee Lee, Moo Nyun Jin, Dong Yeob Shin; Yeungnam Univ J Med. 2014;31(2):103-108. Published online December 31, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.2.103

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Abstract PDF: Thyroglossal duct cyst (TGDC) carcinoma generally shows a favorable prognosis. If metastasis is present latently, it may not threaten the patient's life immediately. It has been shown, however, that larger than 1 cm papillary carcinoma (PC), level VI metastasis to the lymph node (LN), which is the nearest to the thyroid, independently predicts a worse prognosis. In the case presented herein, a 61-year-old female patient was diagnosed with an about 3 cm PC in the TGDC, particularly the columnar variant subtype, one of the aggressive variants. She had occult papillary thyroid microcarcinoma, but no LN metastasis. Even though she underwent the Sistrunk procedure and total thyroidectomy with central compartment neck dissection followed by high-dose radioactive iodine remnant ablation, however, the cancer cells spread to level IV neck LN, and finally to the lung. Therefore, when a patient is diagnosed with an aggressive histologic variant of PC in the TGDC, even without LN metastasis, the invasive surgical approach and close postoperative surveillance are necessary, with consideration of the risk of disease progression. Therefore, if it is possible to stratify the risk for patients, higher-risk patients can be offered a more invasive therapeutic approach.

Anesthetic Management of a Patient with Kimura's Disease.: Eun Ji Choi, Sang Jin Park; Yeungnam Univ J Med. 2009;26(1):38-43. Published online June 30, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.1.38

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Abstract PDF: Kimura's disease is an idiopathic chronic condition, associated with a high-titer of IgE and peripheral eosinophilia. It frequently presents as a solitary or multiple lesions in the head and neck area. During the perioperative period, anesthesiologists should understand the anatomical structures of the patient who has Kimura's disease involvement of the head and neck, especially the airway. It is important to pay attention to the occurrence of signs and symptoms of acute allergic reactions related to a high-titer of IgE and eosinophilia. We report our experience with anesthetic management in an 18-year-old patient with multiple neck masses due to Kimura's disease.

Review Article

Ketamine : Refocused Role of Ketamine in Pain Management: Sun Ok Song; Yeungnam Univ J Med. 2007;24(2 Suppl):S108-117. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S108

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Abstract PDF: Ketamine has used as a dissociative anesthetics from 40 years ago. Its mechanism of action is an antagonism of the N-methyl-D-aspartate (NMDA) receptors, which has an important role into the central sensitization during pain states. The role of ketamine, in lower sub-anesthetic doses, has recently gained increasing interest in pain management. There are considerable numbers of trials to use ketamine in acute or chronic pain states. Recently, Hocking et al. summarized their recent reviews of the evidence concerning ketamine’s clinical use on PAIN: Clinical Updates. In this review, the author introduce their summery with personal experience. Based on their summary, the primary role of ketamine in such subanesthetic doses is as an ‘anti-hyperalgesic’, ‘anti-allodynic’ or ‘tolerance-protective’ agent rather than as a primarily ‘analgesic’. However, to support the evidence-based clinical guideline using a ketamine in pain management, there will be needed numerous high-quality studies that access both immediate and long-term outcomes.

Case Report

Nonsurgical Management of Parasagittal Epidural Hematoma Report of 4 Cases.: Dong Soo Nam, Seong Ho Kim, Bum Dae Kim, Jang Ho Bae, Eun Sig Doh, Oh Lyong Kim, Yong Chul Chi, Byung Yearn Choi, Soo Ho Cho, Jow Hyuk Ihm; Yeungnam Univ J Med. 1990;7(2):173-179. Published online December 31, 1990; DOI: https://doi.org/10.12701/yujm.1990.7.2.173

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Abstract PDF: Nonsurgical management of four cases of the parasagittal epidural hematoma were experienced. Patients were mildly symptomatic or minimal neurological disturbances on admission. Patients were treated conservatively because of stable neurologic sign. All patients had who diastatic fracture and / or suture have become a complete neurological recovery with satisfactory absorption of EDH over a period of 5 to 12 weeks.

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