BACKGROUND: Epidural morphine has side effects, especially pruritus, nausea, and vomiting. Butorphanol has been added in studies to reduce these side effects in post cesarean patients. The purpose of this study was to evaluate the side effects and analgesic efficacy when a combination of epidural morphine and butorphanol was administered in patients having combined local anesthetic and opioid epidural infusion. METHODS: Sixty patients having epidural anesthesia for cesarean section were randomly divided into two groups. Group M (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and saline 0.75 ml, whereas group B (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and butorphanol 1.5 mg (0.75 ml). Continuous epidural infusion was done by Two-day Infusor containing either 0.25% bupivacaine 75 ml, morphine 5 mg, and saline 20 ml in group M or 0.25% bupivacaine 75 ml, morphine 5 mg, butorphanol 4 mg (2 ml), and saline 18 ml in group B. We compared the side effect and analgesic effect of group M to those of group B for 2 days. RESULTS: The incidence of pruritus and vomiting were reduced significantly in group B (p<0.05). There were no significant differences between both groups in the incidence of nausea or other side effects as well as no differences in analgesic effect. CONCLUSIONS: We conclude that the addition of butorphanol to morphine in combined local anesthetic and opioid epidural infusion for postoperative analgesia decreases the occurrence of pruritus and vomiting without significant increase of other side effects and adverse effect on analgesia.
Analgesia ; Anesthesia, Epidural ; Bupivacaine ; Butorphanol* ; Cesarean Section* ; Female ; Humans ; Incidence ; Infusion Pumps ; Morphine* ; Nausea ; Pregnancy ; Pruritus ; Vomiting

The brachial plexus block by interscalene approach is useful for any procedure on upper extremity, including the shoulder. Complications such as phrenic nerve block, Horner's syndrome, permanent neurologic damage, high epidural block, total spinal anesthesia, pneumothorax and cardiac arrest etc. were reported. We experienced a case of 56-year old male patient with ankylosing spondylitis who developed cervical spinal cord injury following the turning of head for brachial plexus block by interscalene approach. The patient developed quadriplegia and finally died after 28 days.
Anesthesia, Spinal ; Brachial Plexus* ; Head ; Heart Arrest ; Horner Syndrome ; Humans ; Male ; Middle Aged ; Phrenic Nerve ; Pneumothorax ; Quadriplegia ; Shoulder ; Spinal Cord Injuries* ; Spinal Cord* ; Spondylitis, Ankylosing ; Upper Extremity

Single spore isolates of Plasmodiophora brassicae e4 and e9 obtained from diseased Chinese cabbage were identified as race 4 and race 9, respectively, by the Williams' differential variety set. To confirm the possibility of variation in same generation and progeny of a single spore isolate of P. brassicae, random amplified polymorphic DNA (RAPD) analysis was conducted using the URP 3, 6 and OPA 7 primers. There was no difference in band type at each part of the gall of Chinese cabbage obtained by inoculation of e4 and e9 and amplification using the URP 3 and 6 primers when the same generation was analyzed. In addition, the progeny analysis, which was expanded to the third generation and conducted using the URP 3 and OPA 7 primers, revealed no differences in the band type of the e4 isolate. Based on these results, the single spore isolate of P. brassicae was genetically stable.
Asian Continental Ancestry Group ; Brassica ; Continental Population Groups ; DNA ; Genetic Variation ; Humans ; Plasmodiophorida ; Spores

PURPOSE: Transcatheter closure of the patent ductus arteriosus (PDA) is a well established alternative to surgical treatment. The aim of this study was to analyze safety, efficacy and follow up results of percutaneous closure of a moderate-to-large sized PDA. METHODS: Between November 1999 and October 2004, eighty-two patients underwent attempted transcatheter closure of a moderate to-large sized PDA. Age at intervention ranged from 9 months to 68 years (18.4+/-18.3 years). Body weight ranged from 7.8 kg to 74 kg (34.0+/-21.3 kg). RESULTS: The mean PDA diameter was 4.5+/-1.3 mm. The type of PDA was conical (72 patients), tubular (9 patients), other (1 patient, dumbbell shape). The devices used were Amplatzer Ductal Occluder (ADO(R), 64 cases), Detachable Coil (14 cases), and Duct Occlud (3 cases). Total complete closure rate was 93%. Complete closure was achieved in 58 patients (78%) at the end of procedure, 8 patients (11%) at 1week, 4 patients (5%) at 1 month, and 4 patients (5%) at 1 year, respectively. A residual shunt was present in three patients (4%). Complications occurred in eight patients: stenosis of left pulmonary artery (4 patients), hemolytic anemia (2 patients), infective endocarditis (1 patient), and device embolization (1 patient). CONCLUSION: Transcatheter closure of a moderate to-large sized PDA using the device is a safe and effective treatment with a favorable short and mid-term results. For optimal results, appropriate devices should be selected in relevance to PDA morphology and diameter, age, body weight, and +++economical factor.
Anemia, Hemolytic ; Body Weight ; Constriction, Pathologic ; Ductus Arteriosus, Patent* ; Endocarditis ; Follow-Up Studies ; Humans ; Pulmonary Artery

PURPOSE: Dexamethasone is a well-known treatment for preterm infants with bronchopulmonary dysplasia. However, serious side effects have been identified, including hypertension, and cardiac hypertrophy. This study was undertaken to examine whether dexamethasone induced cardiac hypertrophy in preterm infants with bronchopulmonary dysplasia. METHODS: We retrospectively reviewed 12 infants with bronchopulmonary dysplasia treated with dexamethasone at Korea University Hospital from August 1995 to February 1999. Serial two-dimensional and M-mode echocardiographic measurements were taken before treatment and at 1,2,3,4,5 weeks after the start of dexamethasone therapy. RESULTS: Patients receiving dexamethasone had a significantly increase in interventricular septal thickness and left ventricular posterior wall thickness. These effects were transient, reached their maximal degree by the third week of treatment, and approached pretreatment conditions by the fifth week of treatment. Heart rate was increased but statistically not significant. The fractional shortening, systolic and diastolic arterial pressure were transiently increased during dexamethasone therapy. CONCLUSION: We conclude that a transient myocardial hypertrophy is associated with dexamethasone therapy in infants with bronchopulmonary dysplasia. Follow up of careful echocardiac monitoring should be considered in infants with dexamethasone therapy.
Arterial Pressure ; Bronchopulmonary Dysplasia ; Cardiomegaly* ; Cardiomyopathy, Hypertrophic* ; Dexamethasone* ; Echocardiography ; Follow-Up Studies ; Heart Rate ; Humans ; Hypertension ; Hypertrophy* ; Infant ; Infant, Newborn ; Infant, Premature* ; Korea ; Retrospective Studies

PURPOSE : To evaluate MR image qualities we developed a new MRI phantom with the fixation structures necessary to position it into coil firmly. MATERIALS AND METHODS : We designed MRI phantom for eight evaluation items such as slice thickness accuracy, high contrast spatial resolution, low contrast object detectability, geometry accuracy, slice position accuracy, image intensity uniformity, percent signal ghosting and signal to noise ratio. For the positioning of phantom at coils, the fixation structures were set up on the surface of phantom. Six different MRI units were used for test the possibility for the clinical application and their image qualities were evaluated. RESULTS : We acquired appropriate MR image qualities enough for the evaluation on all used MR units and confirmed that their evaluations were within reliable values compared to real ones for some items. The positioning of our phantom into head coils with fixation structures worked well for proper imaging. CONCLUSION : We found that our prototype of MRI phantom had the possibility of clinical application for MR image quality assessment.
Head ; Magnetic Resonance Imaging* ; Quality Control ; Signal-To-Noise Ratio

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), also termed Bland-White-Garland syndrome, is a rare congenital cardiac anomaly characterized by myocardial ischemia which becomes symptomatic during early infancy leading to infarction, left heart failure or even death. More than 90% of patients can be dead within first year of life if untreated, so adult type ALCAPA without surgical correction is quitely rare. We present a case of a 20-year-old man with ALPACA syndrome whose diagnosis took several years to be made because he was mistaken to have organic mitral regurgitation.
Adult* ; Bland White Garland Syndrome ; Camelids, New World ; Coronary Vessels* ; Diagnosis ; Heart Failure ; Humans ; Infarction ; Mitral Valve Insufficiency ; Myocardial Ischemia ; Pulmonary Artery* ; Young Adult

PURPOSE: This study was conducted to identify risk factors that influence the probability and severity of elder abuse in community-dwelling older adults. METHODS: This study was a cross-sectional descriptive study. Self-report questionnaires were used to collect data from community-dwelling Koreans, 65 and older (N=416). Logistic regression, negative binomial regression and zero-inflated negative binomial regression model for abuse count data were utilized to determine risk factors for elder abuse. RESULTS: The rate of older adults who experienced any one category of abuse was 32.5%. By zero-inflated negative binomial regression analysis, the experience of verbal-psychological abuse was associated with marital status and family support, while the experience of physical abuse was associated with self-esteem, perceived economic stress and family support. Family support was found to be a salient risk factor of probability of abuse in both verbal-psychological and physical abuse. Self-esteem was found to be a salient risk factor of probability and severity of abuse in physical abuse alone. CONCLUSION: The findings suggest that tailored prevention and intervention considering both types of elder abuse and target populations might be beneficial for preventative efficiency of elder abuse.
Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Depression/pathology ; Elder Abuse/prevention & control/*statistics & numerical data ; Female ; Health Status ; Humans ; Male ; Mental Health ; Motor Activity ; Odds Ratio ; Probability ; Questionnaires ; Regression Analysis ; Risk Factors ; Self Concept ; Self Report ; Social Support ; Suicidal Ideation

PURPOSE: Dipyridamole stress myocardial perfusion SPECT could predict prognosis, however, long-term follow-up showed change of hazard ratio in patients with suspected coronary artery disease. We investigated how long normal SPECT could predict the benign prognosis on the long-term follow-up. MATERIALS AND METHODS: We followed up 1169 patients and divided these patients into groups in whom coronary angiography were performed and were not. Total cardiac event rate and hard event rate were predicted using clinical, angiographic and SPECT findings. Predictive values of normal and abnormal SPECT were examined using survival analysis with Mantel-Haenszel method, multivariate Cox proportional hazard model analysis and newly developed statistical method to test time-invariance of hazard rate and changing point of this rate. RESULTS: Reversible perfusion decrease on myocardial perfusion SPECT predicted higher total cardiac event rate independently and further to angiographic findings. However, myocardial SPECT showed independent but not incremental prognostic values for hard event rate. Hazard ratio of normal perfusion SPECT was changed significantly (p<0.001) and the changing point of hazard rate was 4.4 years of follow up. However, the ratio of abnormal SPECT was not. CONCLUSION: Dipyridamole stress myocardial perfusion SPECT provided independent prognostic information in patients with known and suspected coronary artery disease. Normal perfusion SPECT predicted least event rate for 4.4 years.
Coronary Angiography ; Coronary Artery Disease ; Dipyridamole* ; Follow-Up Studies ; Humans ; Perfusion ; Prognosis ; Proportional Hazards Models ; Tomography, Emission-Computed, Single-Photon*

OBJECTIVE: This study was carried out to evaluate the clinicopathologic significance of hepatocyte growth factor (HGF) and c-met expression as well as tumor angiogenesis in endometrial hyperplasia and adenocarcinoma. METHOD: By means of immunohistochemical staining, HGF, c-met expression, and angiogenesis were investigated in total of 49 patients (19 endometrial hyperplasia, 30 endometrial adenocarcinoma). HGF and c-met were identified with specific corresponding antibodies. To evaluate angiogenesis, the microvessels were highlighted by staining their endothelial cells immunohistochemically for anti-CD31. Areas close to the deepest myometrial invasion or those with the highest grade of endometrial hyperplasia and the highest angiogenic intensity were selected. Three fields of 400 magnification were selected for each slide, and the mean microvessel count was obtained. RESULTS: Diffuse staining for HGF was demonstrated in normal, endometrial hyperplasia and endometrial adenocarcinoma tissue in 45.5, 52.6 and 63.3 percent, respectively, while that for c-met was demonstrated in 9.1, 36.8 and 60.0 percent, respectively. c-Met overexpression was significantly correlated with high surgical stage as well as poor cellular differentiation. There were significant differences in microvessel count among normal, complex endometrial hyperplasia and adenocarcinoma (median 5, 9 vs. 22) and was between simple and complex endometrial hyperplasia (median 6 vs. 9). The microvessel counts were also significantly correlated with high surgical stage, poor cellular differentiation, lymph node involvement and deep myometrial invasion. CONCLUSION: This results suggested that both c-met overexpression and angiogenesis measured by microvessel count could be significantly important prognostic indicators for the prognosis of endometrial adenocarcinoma.
Adenocarcinoma* ; Antibodies ; Endometrial Hyperplasia* ; Endothelial Cells ; Female ; Hepatocyte Growth Factor* ; Hepatocytes* ; Humans ; Lymph Nodes ; Microvessels ; Prognosis