No abstract available.
Neuralgia ; Spinal Cord Compression ; Spinal Cord Diseases

After developing sudden severe chest pain, an 11-year-old boy presented to the emergency room with chest pain and palpitations and was unable to stand up. The sudden onset of chest pain was first reported while swimming at school about 30 minutes prior to presentation. Arterial blood pressure (BP) was 150/90 mmHg, heart rate was 120/minute, and the chest pain was combined with shortness of breath and diaphoresis. During the evaluation in the emergency room, the chest pain worsened and abdominal pain developed. An aortic dissection was suspected and a chest and abdomen CT was obtained. The diagnosis of aortic dissection type B was established by CT imaging. The patient went to surgery immediately with BP control. He died prior to surgery due to aortic rupture. Here we present this rare case of aortic dissection type B with rupture, reported in an 11-year-old Korean child.
Abdomen ; Abdominal Pain ; Aorta ; Aortic Rupture ; Arterial Pressure ; Chest Pain ; Child ; Dyspnea ; Emergencies ; Heart Rate ; Humans ; Rupture ; Swimming ; Thorax

No abstract available.

Occipital nerve blockade is a widely used procedure in the treatment of primary and secondary headache disorders. The procedure is generally well tolerated, although local side effects such as cutaneous atrophy, hyperpigmentation, and alopecia can occur. The present study describes a case of alopecia following occipital nerve blockade with triamcinolone. This complication can be avoided by precautions such as local injection and the use of alternative steroid preparations.
Alopecia ; Atrophy ; Headache Disorders, Secondary ; Hyperpigmentation ; Nerve Block ; Triamcinolone

Occipital nerve blockade is a widely used procedure in the treatment of primary and secondary headache disorders. The procedure is generally well tolerated, although local side effects such as cutaneous atrophy, hyperpigmentation, and alopecia can occur. The present study describes a case of alopecia following occipital nerve blockade with triamcinolone. This complication can be avoided by precautions such as local injection and the use of alternative steroid preparations.
Alopecia ; Atrophy ; Headache Disorders, Secondary ; Hyperpigmentation ; Nerve Block ; Triamcinolone

BACKGROUND: The effects of dexmedetomidine on the propofol-sparing effect and intraoperative hemodynamics during remifentanil-based propofol-supplemented anesthesia have not been well investigated. METHODS: Twenty patients undergoing breast surgery were randomly allocated to receive dexmedetomidine (group DEX) or placebo (group C). In the DEX group, dexmedetomidine was loaded (1 microg/kg) before anesthesia induction and was infused (0.6 microg/kg/h) during surgery. Anesthesia was induced with a target-controlled infusion (TCI) of propofol (effect site concentration, Ce; 3 microg/ml) and remifentanil (plasma concentration, Cp, 10 ng/ml). The Ce of TCI-propofol was adjusted to a bispectral index of 45-55, and Cp of TCI-remifentanil was fixed at 10 ng/ml in both groups. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded at baseline (T-control), after the loading of study drugs (T-loading), 3 min after anesthesia induction (T-induction), tracheal intubation (T-trachea), incision (T-incision), 30 min after incision (T-incision30), and at tracheal extubation (T-extubation). MAP% and HR% (MAP and HR vs. T-control) were determined and the propofol infusion rate was calculated. RESULTS: The propofol infusion rate was significantly lower in the DEX group than in group C (63.9 +/- 16.2 vs. 96.4 +/- 10.0 microg/kg/min, respectively; P < 0.001). The changes in MAP% at T-induction, T-trachea and T-incision in group DEX (-10.0 +/- 3.9%, -9.4 +/- 4.6% and -11.2 +/- 6.3%, respectively) were significantly less than those in group C (-27.6 +/- 13.9%, -21.7 +/- 17.1%, and -25.1 +/- 14.1%; P < 0.05, respectively). CONCLUSIONS: Dexmedetomidine reduced the propofol requirement for remifentanil-based anesthesia while producing more stable intraoperative hemodynamics.
Airway Extubation ; Anesthesia ; Arterial Pressure ; Breast ; Dexmedetomidine ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Piperidines ; Propofol

Cancer stem cells have stem cell-like features, such as the ability for self-renewal and differentiation but show unlimited growth because they have the lost normal regulation of cell growth. Cancer stem cells and normal stem cells have similar features. They show high motility, diversity of progeny, robust proliferative potential, association with blood vessels, immature expression profiles, nestin expression, epidermal growth factor (EGF)-receptor expression, phosphatase and tensin homolog (PTEN) expression, hedgehog pathway activity, telomerase activity, and Wnt pathway activity. On the other hand, with cancer cells, some of these signaling pathways are abnormally modified. In 1875, Cohnheim suggested the concept of cancer stem cells. Recently, evidence for the existence of cancer stem cells was identified. In 1994, the cancer stem cells'specific cell surface marker for leukemia was identified. Since then, other specific cell surface markers for cancer stem cells in solid tumors (e.g. breast and colon cancer) have been identified. In oral cancer, studies on cancer stem cells have been performed mainly with squamous cell carcinomas. Oral cancer specific cell surface markers, which are genes strongly expressed in oral cancer and cancer stem cell specific side populations, have been identified. Cancer stem cells are resistant to radiotherapy and chemotherapy. Therefore, to eliminate malignant tumors efficiently and reduce the recurrence rate, therapy targeting cancer stem cells needs to be performed. Currently, studies targeting the cancer stem cells'specific signaling pathways, telomerase and tumor vasculatures are being done.
Antigens, Surface ; Blood Vessels ; Breast ; Carcinoma, Squamous Cell ; Colon ; Epidermal Growth Factor ; Hand ; Hedgehogs ; Intermediate Filament Proteins ; Leukemia ; Microfilament Proteins ; Mouth Neoplasms ; Neoplastic Stem Cells ; Nerve Tissue Proteins ; Recurrence ; Signal Transduction ; Stem Cells ; Telomerase ; Wnt Signaling Pathway

A burnt-out prostate cancer tumor is a very rare clinical entity. The term 'burnt-out' refers to a primary tumor that has spontaneously and nearly completely regressed without treatment. Since metastasis of prostate cancer is usually encountered in the presence of advanced disease, distant metastasis with an undetectable primary tumor is very rare. We report herein a case of a burnt-out prostate cancer tumor that metastasized to the thoracic (T) spine and caused cord compression. A 66-year-old man visited the Emergency Department due to weakness of both legs for the past two days. His blood and urine tests were normal at the time. His spine magnetic resonance imaging (MRI) scans looked like bone metastasis that involved the T-7 vertebral body and a posterior element, and caused spinal cord compression. Other images, including from the brain MRI, neck/chest/abdomino-pelvic computed tomography (CT) scan and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and endoscopy, revealed no lesions that suggested malignancy. After total corpectomy T-7 and screw fixation/fusion at T5 to T10, the pathology report revealed a metastatic carcinoma that was strongly positive for prostate-specific antigen (PSA). The serum PSA value was 1.5 ng/mL. The transrectal 12-core prostate biopsy and ultrasonography showed no definitive hypoechoic lesion, but one specimen had slight (only 1%) adenocarcinoma with a Gleason score of 6 (3+3). The final diagnosis was burned-out prostate cancer with an initial normal PSA value. Although metastatic disease with an unknown primary origin was confirmed, a more aggressive approach in seeking the primary origin could provide a more specific treatment strategy and greater clinical benefit to patients.
Adenocarcinoma ; Aged ; Biopsy ; Brain ; Diagnosis ; Emergencies ; Endoscopy ; Humans ; Leg ; Magnetic Resonance Imaging ; Neoplasm Grading ; Neoplasm Metastasis ; Pathology ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Spinal Cord Compression ; Spine ; Ultrasonography

Mycobacterium avium intracellulare complex (MAC) usually causes an opportunistic pulmonary infection in immunocompromised hosts who have underlying structural lung disease. Central nervous system infection due to MAC is very rare even in an immunocompromised host. Most previous reports of central nervous system infection due to MAC have been meningoencephalitis in patients infected with human immunodeficiency virus (HIV). Only four cases of brain abscess due to MAC have been reported worldwide. We report a case of brain abscess due to MAC in a non-HIV patient. Although drugs used for treatment of MAC have limited central nervous penetration, an azithromycin-based anti-tuberculous therapy after surgical drainage of the abscess showed improvement. To the best of our knowledge, this is the first reported case of MAC brain abscess in the Korean literature.
Abscess ; Brain Abscess ; Central Nervous System Infections ; Drainage ; HIV ; Humans ; Immunocompromised Host ; Lung Diseases ; Meningoencephalitis ; Mycobacterium ; Mycobacterium avium

BACKGROUND: Isoflurane, a common anesthetic for cardiac surgery, reduced myocardial contractility in many experimental studies, few studies have determined isoflurane's direct impact on the left ventricular (LV) contractile function during cardiac surgery. We determined whether isoflurane dose-dependently reduces the peak systolic velocity of the lateral mitral annulus in tissue Doppler imaging (S′) in patients undergoing cardiac surgery. METHODS: During isoflurane-supplemented remifentanil-based anesthesia for patients undergoing cardiac surgery with preoperative LV ejection fraction greater than 50% (n = 20), we analyzed the changes of S′ at each isoflurane dose increment (1.0, 1.5, and 2.0 minimum alveolar concentration [MAC]: T1, T2, and T3, respectively) with a fixed remifentanil dosage (1.0 μg/min/kg) by using transesophageal echocardiography. RESULTS: Mean S′ values (95% confidence interval [CI]) at T1, T2, and T3 were 10.5 (8.8–12.2), 9.5 (8.3–10.8), and 8.4 (7.3–9.5) cm/s, respectively (P < 0.001 in multivariate analysis of variance test). Their mean differences at T1 vs. T2, T2 vs. T3, and T1 vs. T3 were −1.0 (−1.6, −0.3), −1.1 (−1.7, −0.6), and −2.1 (−3.1, −1.1) cm/s, respectively. Phenylephrine infusion rates were significantly increased (0.26, 0.22, and 0.47 μg/kg/min at T1, T2, and T3, respectively, P < 0.001). CONCLUSION: Isoflurane increments (1.0–2.0 MAC) dose-dependently reduced LV systolic long-axis performance during cardiac surgeries with a preserved preoperative systolic function.
Anesthesia ; Echocardiography ; Echocardiography, Transesophageal ; Heart Function Tests ; Heart Valves ; Humans ; Isoflurane ; Multivariate Analysis ; Phenylephrine ; Thoracic Surgery