Recently, intravenous lidocaine has been reported to relieve chronic pain and to suppress the spontaneous abnormal ectopic discharge in injured nerve. Interest in the use of these modalities has been stimulated by animal researches of neuropathic pain syndromes. We performed this study to evaluate the analgesic responses and the side effects of intravenous(IV) irifusion of lidocaine used in chronic pain patients. Patients received 5 mg/kg of lidocaine, mixed in 150 mL over 40 minutes. The analgesic efficacy was evaluated in 20, 40, 60 minutes after the start of the initial IV lidocaine infusion, by a numeric rating scales (NRS) scores. The responders were received the repeated infusions at one week interval. The results were as follows; 1. Mean NRS scores was 6.7+/-1.9 before the infusion, and changed to 4.2, 2.7, 2.6, in 20,40,60 minutes after the start of the initial IV lidocaine infusion. 2. Eight of ten patients were responders during initial IV lidocaine infusion, and two patients were nonresponders. During the series of repeated lidocaine infusions to eight responders, six were partial relief, and two were complete relief of their pain without any medication. The diagnoses in responders were diabetic neuropathy, ischemic neuropathy, traumatic neuropathy, causalgia, reflex sympathetic dystrophy, erythromelalgia, and spinal stenosis. 3. The side effects, including sedation, dizziness, slurred speech, circumoral numbness, and lightheadedness, were not serious during the period of infusion. The conclusion is that repeated intravenous lidocaine infusions would be effective in the management of chronic pain states. But it needs more studies on the method of infusion and the safety of these modalities.
Analgesia ; Animal Experimentation ; Causalgia ; Chronic Pain* ; Diabetic Neuropathies ; Diagnosis ; Dizziness ; Erythromelalgia ; Humans ; Hypesthesia ; Infusions, Intravenous* ; Lidocaine* ; Neuralgia ; Reflex Sympathetic Dystrophy ; Spinal Stenosis ; Weights and Measures

PURPOSE: The mortality and morbidity rate after pancreaticoduodenectomy (PD) is still high, although the operative techniques and skills and the perioperative care has been improved. The incidence of PD for benign disease is 5~20%. The aim of this study is to determine the factors that differentiate between the benign group and the malignant group by comparing the clinical manifestations, and we studied the safety of performing PD for benign diseases by observing the early and late postoperative complications. METHODS: We retrospectively studied 124 patients who had been diagnosed with benign or malignant pancreatic diseases and who underwent PD between April 1995 and December 2005. We divided the patients into two groups, i.e., the benign group (20) and the malignant group (104), to compare their clinical characteristics and postoperative outcomes. Result: Chronic pancreatitis was the most common disease (35%) in the benign group and distal CBD cancer was the most common disease (40.4%) in the malignant group. Jaundice, weight loss, and elevation of CA 19-9 were more frequent in the malignant group than in the benign group (p<0.05). There were no statistical differences in the mortality rate (10.0% vs 6.7%), reoperation rate (5.0% vs 4.8%), hospital stays (27.1 days vs 24.0 days), early complications (30.0% vs 44.6%) and late complications (22.2% vs 26.4%) between the two groups. There were no mortality and newly developed malignancy during 33.4 months of follow-up period in benign group. CONCLUSION: On the preoperative evaluation, jaundice, weight loss, and elevation of CA 19-9 were more frequent in the malignant group. The postoperative early and late complications showed no difference between the two groups and complication rate was generally favorable. Thus, PD can be performed safely for benign diseases that cannot be treated in a conservative fashion and also for other clinically suspicious malignant diseases.
Follow-Up Studies ; Humans ; Incidence ; Jaundice ; Length of Stay ; Mortality ; Pancreatic Diseases ; Pancreaticoduodenectomy* ; Pancreatitis, Chronic ; Perioperative Care ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Weight Loss

Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized clinically by headache, seizure, altered mental status and visual impairment. Neuroimaging shows reversible white matter edema predominantly in the parietal and occipital lobes. RPLS has been associated with a variety of conditions, including hypertensive encephalopathy, renal failure, immunosupressive therapy, and autoimmune diseases such as systemic lupus erythematosus (SLE). We report a young woman of SLE presented with headache, generalized tonic-clonic seizure and altered mental status, after taking azathioprine and cyclosporine. The brain magnetic resonance images showed bilateral hyperintensitiy in the posterior parietal, occipital, temporal lobes and cerebellum on T2-weighted images and fluid attenuated inversion recovery images, whereas diffusion-weighted images showed isointensity in the same distribution. The patient was improved clinically and radiologically one week after the control of hypertension and discontinuation of cyclosporine.
Autoimmune Diseases ; Azathioprine ; Brain ; Cerebellum ; Cyclosporine* ; Edema ; Female ; Headache ; Humans ; Hypertension ; Hypertensive Encephalopathy ; Lupus Erythematosus, Systemic ; Neuroimaging ; Occipital Lobe ; Posterior Leukoencephalopathy Syndrome* ; Rabeprazole ; Renal Insufficiency ; Seizures ; Temporal Lobe ; Vision Disorders

PURPOSE: The purpose of this study was to describe the MR imaging and CT findings of intracranial inflammatory pseudotumors. MATERIALS AND METHODS: We reviewed the MR imaging (n=8) and CT (n=4) studies of eight patients (M:F = 4:4, mean age: 41 years) with pathologically proven intracranial inflammatory pseudotumor. The findings were then evaluated with regard to location, shape, MR signal intensity, CT density and degree of contrast enhancement of the lesion, surrounding parenchymal edema, adjacent bone change and the location of accompanying extracranial lesion. RESULTS: In two patients, the parietal convexity was involved unilaterally, with no extracranial mass, and in the other six, the middle cranial fossa was involved unilaterally and extracranial mass was present. The lesion also involved the tentorium in four cases, the cavernous sinus in four, the anterior cranial fossa in one, and the posterior cranial fossa in one. The location of extracranial mass was the mastoid and middle ear cavity in two cases, the infratemporal fossa in two, both the infratemporal fossa and paranasal sinuses in one, and the orbit in one. MR images showed diffuse dural thickening in all eight cases, leptomeningeal thickening in four, and focal meningeal-based mass in two. As seen on T1-weighted images, the lesions were isointense to gray matter in eight cases, and on T2-weighted images were hypointense in seven cases and isointense in one. Marked homogeneous contrast enhancement was seen in all eight cases. The lesions seen on brain CT, performed in two cases, were isodense. Adjacent brain parenchymal edema and the destruction of adjacent bones were each seen in five cases. CONCLUSION: The characteristic MR findings of intracranial inflammatory pseudotumors are(1) diffuse dural thickening;(2) a focal meningeal-based mass which on T2-weighted images is seen as hypointense; and marked (3) contrast enhancement : these findings are, however, nonspecific. In order to differentiate these tumors, an awareness of these findings is, however, useful.
Brain ; Cavernous Sinus ; Cranial Fossa, Anterior ; Cranial Fossa, Middle ; Cranial Fossa, Posterior ; Ear, Middle ; Edema ; Granuloma, Plasma Cell* ; Humans ; Magnetic Resonance Imaging* ; Mastoid ; Orbit ; Paranasal Sinuses ; Rabeprazole

No abstract available.
Heart Transplantation*

An assessment of early graft function in canine single lung transplant recipients was made by analysing early postoperative radiographic progression, lung perfusion, bronchial patency and bronchial anastomotic wound healing and histopathology of the allografted lung. Eighteen mongrel dogs weighing 15kg on average were used. Donor lung bloc with a generous atrial cuff, the pulmonary artery and left bronchus were taken and flushed with Euro-Collins solution which implanted in the pneumonectomized recipient dog. Anastomosis was done with the atrium, pulmonary artery and bronchus in that order. To assess an early graft function, a protocol for a grading system was designed into the chest roentgenogram, lung perfusion scan, bronchial patency and histopathologic progression of the bronchial anastomosis and allografted lung (Table 1). The results were obtained as follows: Radiographically, clear to infiltrate was seen in 67% (8/12), 33% (5/15), 30% (3/10) and 33% (2/6) on postoperative day 0, 1, 2 and 3 respectively. Lobar to total opacification was 33% (4/12), 67% (10/15), 70% (7/10) and 67% (4/6) on days 0 to 3 (Table 2). Perfusion scan showed normal to mild defect in 43% (3/7) and moderate to severe defect in 57% (4/7) on day 0 and 100% (5/5) on day 2 (Table 3). The bronchial anastomotic site showed patent to mild stenosis in 100% (8/8) on day 0 and mild stenosis in 2/2 on day 9 bronchofiberscopically, and showed normal wound healing in 38% (3/8), cellular infiltration in 38% (3/8) and infarction in 25% (2/8) up to day 9 postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals ; Bronchoscopy ; Dogs ; Fiber Optic Technology ; Lung/pathology/physiology/*radiography ; *Lung Transplantation ; Perfusion ; Time Factors ; Transplantation, Homologous

PURPOSE: The evaluation of a lecture by students is one of the good way to improve a lecture. In one medical school, we started one-year-integrated-lecture curriculum for sophomore. And we evaluated lectures using formal lecture evaluation sheet after completion of each integrated lectures. The results were fed back to lecturers. But lecturers were indifferent to the results. So we performed this study to evaluate the current lecture evaluation method. METHODS: Answering patterns of evaluation sheets were reviewed. 50 students entitled to integrated lectures were given structured questions. 44 of them recovered. And randomly selected 10 students were interviewed. RESULTS: Analysis of evaluation sheets showed that some students checked the items just for fun. More than half of the students answered that they did not check the questions seriously. Reasons why the evaluation of lectures were not going well were; students were not trained to evaluate something; evaluation sheet was not designed to evaluate individual lecturer; listed items were too many in number and inappropriate; some students were suspicious about the impact of evaluation of lectures. In addition to this, it was revealed that students thought the timing of evaluation of lecture was important, too. CONCLUSION: Indifference of lecturers to the results is one form of resistance to the evaluation of lectures by students. To make evaluation of lectures effective, numbers and contents of evaluation items must be selected carefully, students need to be trained, and adequate evaluation timing should be determined with frequent feed backs.
Curriculum ; Humans ; Lectures ; Schools, Medical*

Despite recent successful efforts to shorten the door-to-balloon time in patients with acute ST-segment elevation myocardial infarction (STEMI), prehospital delay remains unaffected. Nonetheless, the factors associated with prehospital delay have not been clearly identified in Korea. We retrospectively evaluated 423 patients with STEMI. The mean symptom onset-to-door time was 255 +/- 285 (median: 150) min. The patients were analyzed in two groups according to symptom onset-to-door time (short delay group: < or = 180 min vs long delay group: > 180 min). Inhospital mortality was significantly higher in long delay group (6.9% vs 2.8%; P = 0.048). Among sociodemographic and clinical variables, diabetes, low educational level, triage via other hospital, use of private transport and night time onset were more prevalent in long delay group (21% vs 30%; P = 0.038, 47% vs 59%; P = 0.013, 72% vs 82%; P = 0.027, 25% vs 41%; P < 0.001 and 33% vs 48%; P = 0.002, respectively). In multivariate analysis, low educational level (1.66 [1.08-2.56]; P = 0.021), symptom onset during night time (1.97 [1.27-3.04]; P = 0.002), triage via other hospital (1.83 [1.58-5.10]; P = 0.001) and private transport were significantly associated with prehospital delay (3.02 [1.81-5.06]; P < 0.001). In conclusion, prehospital delay is more frequent in patients with low educational level, symptom onset during night time, triage via other hospitals, and private transport, and is associated with higher inhospital mortality.
Acute Disease ; Aged ; Demography ; Electrocardiography ; Emergency Service, Hospital ; Female ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Myocardial Infarction/*mortality/physiopathology ; Retrospective Studies ; Socioeconomic Factors ; Time Factors ; Triage

PURPOSE: The aim of this study was to investigate changes in bronchial hyperresponsiveness, total IgE, blood total eosinophil counts and serum eosinophil cationic protein (ECP), after treatment with inhaled corticosteroids or leukotriene modifiers in children with asthma. METHODS: Methacholine bronchoprovocation tests were repeated at 12 months of follow-up in 37 children with atopic asthma and eight children with non-atopic asthma, who regularly attended the Allergy Clinic of Korea University Anam Hospital and Seoul National University Hospital over one year from their initial visit. A serum total IgE, peripheral blood eosinophil counts, and serum ECP levels were measured on their initial visits and at 12 months of follow-up. RESULTS: Following six to 12 months of inhaled corticosteroids or leukotriene modifiers treatment, the geometric mean (range of 1 SD) of methacholine PC20 was significantly changed in the atopic asthma group [2.20 mg/mL (0.41-11.82) vs. 6.69 mg/mL (1.25-35.87), P=0.000] but not in non-atopic asthma group [2.41 mg/mL (0.90-6.42) vs. 2.46 mg/mL (0.62-9.78), P=0.065]. Blood total eosinophil counts and serum ECP levels decreased significantly over one year in atopic asthma, while these changes were not observed in non-atopic asthma. Significantly higher FEV1 %predicted values (98.3+/-6.6%) were noted at 12 month follow-up compareed to the initial values (92.9+/-11.4%, P=0.023) in the non-atopic asthma group. CONCLUSION: Inhaled corticosteroids or leukotriene modifiers treatment resulted in a significantly decreased bronchial hyperresponsiveness in children with atopic asthma. This effect was reflected primarily by reduced blood eosinophilic inflammation. The persistence of bronchial hyperresponsiveness in children with non-atopic asthma might be related with genetic factors or airway remodeling other than eosinophilic inflammation.
Adrenal Cortex Hormones ; Airway Remodeling ; Asthma* ; Child* ; Eosinophil Cationic Protein ; Eosinophils ; Follow-Up Studies ; Humans ; Hypersensitivity ; Immunoglobulin E ; Inflammation ; Korea ; Methacholine Chloride ; Seoul

Recessive mutations of the SLC26A4 (PDS) gene on chromosome 7q31 can cause sensorineural deafness with goiter (Pendred syndrome, OMIM 274600) or NSRD with goiter (at the DFNB4 locus, OMIM 600791). H723R (2168A>G) is the most commonly reported SLC26A4 mutations in Korean and Japanese and known as founder mutation. We recently experienced one patient with enlarged vestibular aqueduct syndrome. The genetic study showed H723R homozygous in the proband and H723R heterozygous mutation in his family members. The identification of a disease-causing mutation can be used to establish a genotypic diagnosis and provide important information to both families and their physicians.
Asian Continental Ancestry Group ; Databases, Genetic ; Deafness ; Goiter ; Goiter, Nodular ; Hearing Loss, Sensorineural ; Humans ; Vestibular Aqueduct