OBJECTIVES: We compared the characteristics of the pain threshold and pain experience between demented group and non-demented group. METHODS: This study was part of Gangwon projects for early detection of dementia in 2010. We recruited 8302 local resident ages over 65 years old. Of theses, 1259 people who scored low MMSE were selected and 365 of them completed CERAD-K(Consortium to Establish a Registry for Alzheimer's disease). Finally, 90 in non-demented group and 57 in demented group(mild to moderate Alzheimer's disease) were analyzed. Pain threshold was experimentally measured by pressure algometer and we investigated the pain experience, by Brief pain inventory (BPI), a self-report test. RESULTS: In the demographic characteristics, there are more female, higher ages, lower education in the demented group. There was no significant difference between the two groups in the pain threshold. On the BPI results, 'shoulder pain', 'the number of pain' and 'interference of working' were significantly more prevalent in non-demented group. However, there are no significant differences between the groups in the 'pain severity', 'prevalence of pain' and 'pain treatment'. CONCLUSIONS: Demented group report less pain experience but, still perceived pain. It support previous studies that patient with dementia have increased pain tolerance but preserved pain threshold. Thus, active pain assessment and treatment for patients with dementia is needed.
Aged* ; Dementia* ; Education ; Female ; Gangwon-do ; Humans ; Pain Measurement ; Pain Threshold*

The effect of the Nd:YAG laser on the rabbit retina was evaluated with fundus photography, light microscopy and transmission electron microscopy(TEM), and compared with the effect of the Argon laser. Fundus photography was performed at 2 days, 4 days, 7 days, 14 days, 29 days and 49 days after treatment. The enucleated retina was examined by light microscopy and TEM. In YAG treated eye, laser reaction was not found at 0.5mJ level but laser reaction(G2-3) was found at 1.5mJ level. Laser reaction(G3-4) with expulsive bleeding was found at 2.5 and 3.5mJ level. Bleeding was seemed to be originated from the choroidal layer. 2 days after treatment, hemorrhage was sustained but bleeding was not continued. 7 days after treatment, hemorrhage was completely absorbed. In Argon treated eye, photocoagulation burns was well formed without and bleeding. In pathologic examination of YAG treated eye, full thickness disruption of the retina amd Bruch's membrane and replacement of these layers with fibrous scar tissue were revealed at 2.5 and 3.5mJ level. In 1.5mJ energy level of the YAG laser and Argon laser irradiation, the outer half of the retina, RPE and Bruch's membrane appeared to be pridominantely affected than the inner half of the retina. The extent and character of his to pathology in Argon treated lesion was not so different from that of the YAG laser 1.5mJ lesion.
Argon ; Bruch Membrane ; Burns ; Choroid ; Cicatrix ; Hemorrhage ; Lasers, Solid-State ; Light Coagulation ; Microscopy ; Pathology ; Photography ; Retina*

Extramedullary plasmacytoma involves organs outside the bone marrow, but involvement of the pancreas is very rare. We present the imaging findings of extramedullary plasmacytoma of the pancreas in a patient with multiple myeloma. Mixed echogenecity was noted at US, and marked enhancement at CT and MR.
Bone Marrow ; Humans ; Multiple Myeloma ; Pancreas* ; Plasmacytoma*

We report a case of gastric inflammatory myofibroblastic tumor in a 25-month-old boy. The condition is very rare and is of unknown pathogenesis. Because it is large and invades adjacent organs, imaging procedure do not provide easy differentiation between an inflammatory myofibroblastic tumor and malignacy, and it should thus be included in the differential diagnosis of an infiltrative upper abdominal mass occurring in children.
Child ; Child, Preschool ; Diagnosis, Differential ; Granuloma, Plasma Cell ; Humans ; Male ; Myofibroblasts*

Arachnoid cysts are usually classified as developmental anomaly, inflammatory and traumatic in origin. Arachnoid cyst in posterior fossa occur frequently in the midline posterior to the cerebellum. These cyst usually present symptoms and signs due to increased intracranial pressure and may be confused with cerebellar or fourth ventricular tumor. Recently we had experienced a case of multiple retrocerebellar arachnoid cysts coexisted with pathologically confirmed desmoplastic medulloblastoma in eight months lod infant and reviewed the literatures.
Arachnoid Cysts* ; Arachnoid* ; Cerebellum ; Humans ; Infant ; Intracranial Pressure ; Medulloblastoma*

BACKGROUND: To determine whether an internet-based mentoring program can improve glycemic control in subjects with type 1 diabetes mellitus (T1DM). METHODS: Subjects with T1DM on intensive insulin therapy and with hemoglobin A1c (HbA1c) > or =8.0% were randomized to mentored (glucometer transmission with feedback from mentors) or control (glucometer transmission without feedback) groups and were examined for 12 weeks. Five mentors were interviewed and selected, of which two were T1DM patients themselves and three were parents with at least one child diagnosed with T1DM since more than 5 years ago. RESULTS: A total of 57 T1DM adult subjects with a mean duration after being diagnosed with diabetes of 7.4 years were recruited from Samsung Medical Center. Unfortunately, the mentored group failed to show significant improvements in HbA1c levels or other outcomes, including the quality of life, after completion of the study. However, the mentored group monitored their blood glucose (1.41 vs. 0.30) and logged into our website (http://ubisens.co.kr/) more frequently (20.59 times vs. 5.07 times) than the control group. CONCLUSION: A 12-week internet-based mentoring program for T1DM patients with inadequate glycemic control did not prove to be superior to the usual follow-up. However, the noted increase in the subjects' frequency of blood glucose monitoring may lead to clinical benefits.
Adult ; Blood Glucose ; Child ; Diabetes Mellitus, Type 1 ; Humans ; Insulin ; Internet ; Mentors* ; Parents ; Quality of Life

The purpose of this study was to determine if mild hypoxia alters the responsiveness to vasoactive agents in the renal and the femoral arteries in the fetal sheep. Ten pregnant sheep were operated under halothane anesthesia at 116 to 124 days' gestation. A maternal tracheal catheter was placed for infusing compressed air (control group, n=5) or nitrogen (hypoxia group, n=5) starting on post operative day 6 and maintained for 5 days. Femoral and renal arteries were harvested from the fetus to study the constriction response to phenylephrine (PE 10(-9) to 10(-5) mol/L). To determine the involvement of nitric oxide as a modulator of vessel constriction, N-nitro-Larginine methyl ester (L-NAME) was used at a concentration of 10(-4) mol/L in parallel chambers. In the hypoxia group, maternal Pao2 significantly decreased from a base-line of 110.4 +/-1.4 to 80.5 +/-1.6 (mmHg, p <0.01), fetal Pao2 significantly decreased from a baseline of 20.9 +/-0.3 to 15.5 +/-0.1 (mmHg, p <0.01). Hypoxia was associated with a significant increase in PE maximal response in the absence (184.5 +/-6.6 vs. 146.2 +/-4.3) and presence (166.9 +/-6.3 vs. 145.0 +/-4.5) of L-NAME, and a decrease in EC50 in the absence (6.0 +/-1.1 vs. 27.0 +/-4.1) of L-NAME of femoral arteries. However, there were no significant differences in PE maximal response and EC50 in the absence and presence of L-NAME of renal arteries. We concluded that mild chronic hypoxia seems to increase the fetal femoral artery response to PE, but not in the fetal renal artery. This observation is consistent with a redistribution of cardiac output away from the carcass.
Animals ; *Anoxia ; Blood Glucose/metabolism ; Dose-Response Relationship, Drug ; Enzyme Inhibitors/pharmacology ; Femoral Artery/*embryology/*pathology ; Hematocrit ; Hydrogen-Ion Concentration ; Kidney/blood supply ; Lactates/blood/metabolism ; NG-Nitroarginine Methyl Ester/pharmacology ; Nitric Oxide/metabolism ; Nitric-Oxide Synthase/antagonists & inhibitors ; Phenylephrine/chemistry/metabolism/pharmacology ; Renal Artery/pathology ; Sheep/*embryology ; Time Factors ; Vasoconstrictor Agents/*pharmacology

The increase in the prevalence of head injury amongst civilian population and the provision of adequate hospital services have become matters of world-wide concern. Many present-day accidents may result in the victims receiving multiple complex injuries beside head injuries and the prognosis may become unfavorable in these patients. Therefore, the neurosurgeon must be alert to the possibility that his patients have injuries to areas outside the brain and be capable of rendering necessary, often lifesaving, treatment during the initial phase of management. We analysed associated injuries in 1523 head injured patients admitted to Department of Neurosurgery, Kyung Hee University Hospital from October, 1971 till September, 1977. The results were as follows : 1) The incidence of associated injury was 23.6% of all 1523 head injured patients. 2) In all head injuries, male outnumbered female by almost 2 to 1 and the ratio was similar in associated injury group(2.4:1). 3) The age distribution of all head injuries was 3rd, 1st and 4th decases in order, but in associated injury group it was 4th, 3rd and 5th decades in order. 4) Common causes of head injuries were traffic accidents(76.6%) and fall(11.6%), but in associated injury group traffic accident was the most frequent cause(90.8%). 5) The incidence of associated injury was higher in relation to the severity of head injury. 6) The sites of associated injuries were distributed as limbs, chest and face in order and the most frequent nature of associated injuries was fracture. 7) Single associated injury was more frequent than multiple, associated injury, about 5 to 1. 8) Overall mortality rate of all head injuries was 9.3% in contrast that of associated injuries was 17.5%. 9) Surgical mortality rate was significantly higher in associated group(40.3%) than nonassociated group(26.1%). 10) In multiple associated injuries the mortality rate was higher(21.3%) than in single associated injury(16.4%). 11) Mortality rate according to associated injured sites was as follows ; 36% for visceral injuries and 34.1% for chest injuries. 12) The mortality rate was highest in serious chest injuries such as hemo and/or pneumothorax and in hypovolemic shock on admission(60%).
Accidents, Traffic ; Age Distribution ; Brain ; Craniocerebral Trauma ; Extremities ; Female ; Head* ; Humans ; Incidence ; Male ; Mortality ; Neurosurgery ; Pneumothorax ; Prevalence ; Prognosis ; Shock ; Thoracic Injuries ; Thorax

Influenza-associated encephalopathy is rare in adults and the role of influenza virus in the pathogenesis of influenza-associated encephalopathy is unclear. We report a case of an adult patient who presented with typical clinical manifestations and magnetic resonance imaging findings of herpes simplex virus (HSV) encephalitis confirmed by positive PCR test in cerebrospinal fluid (CSF), and who was also PCR-positive PCR for H1N1 A/influenza in CSF and a nasopharyngeal swab. The results strongly suggest co-infection of the central nervous system. Given the significant implications for therapeutic interventions and infection control, A/H1N1 influenza should be considered one of the possible etiologies of viral encephalitis when patients present with an influenza-like illness during an influenza epidemic, even in those with typical manifestation of HSV encephalitis.
Adult ; Central Nervous System ; Coinfection ; Encephalitis ; Encephalitis, Viral ; Herpes Simplex ; Humans ; Infection Control ; Influenza A virus ; Influenza, Human ; Magnetic Resonance Imaging ; Methylmethacrylates ; Orthomyxoviridae ; Polymerase Chain Reaction ; Polystyrenes ; Simplexvirus

Background: Teicoplanin is used to treat serious gram-positive infections. Optimal teicoplanin trough levels are considered to be ≥ 10 μg/mL. Despite its wide use in various clinical settings, data on teicoplanin trough level in pediatric patients are limited. Therefore, the aim of this study was to investigate the therapeutic drug level monitoring of teicoplanin in Korean pediatric patients, including those with impaired renal function. Methods: A retrospective study was performed in pediatric patients (age ≤ 18 years old) who received teicoplanin from September 2014 to April 2018. The regimen included a loading dose of 10 mg/kg/dose at 12 hours' interval three times in a row, and a maintenance dose of 10 mg/kg/dose commenced at 24 hours of interval after the loading dose, with a maximum of 400 mg/dose, respectively. The first therapeutic drug levels were measured. Distribution and characteristics of trough levels in patients with decreased renal function and those with bacteremia were also assessed. Results: A total of 187 trough levels were collected from 143 patients. Hematologic and oncologic diseases were the most common underlying diseases (83.2%, n = 119). One hundred eighty trough levels were first measured, and their median value was 16.2 μg/mL (range, 2.3–100 μg/mL) and the median interval between initial teicoplanin injection and 1st trough level was 96.5 hours (range 47.6–179.3 hours). Lower steady-state levels were observed in younger age group (median, 13.5 vs. 18.0 μg/mL, P = 0.038). Median trough levels were higher in patients with decreased renal functions (P < 0.001). In addition, among eight with gram-positive bacteremia, seven of them had a favorable outcome. Conclusion This study provides additive information on trough level monitoring of teicoplanin in children with impaired renal function and treatment effect in patients with gram-positive bacteremia. Careful monitoring for steady state trough levels of teicoplanin is warranted.