1.Radiofrequency Treatment for Chronic Refractory Pain.
Jung Yul PARK ; Dong Hyuk PARK
Journal of the Korean Geriatrics Society 2001;5(4):285-301
Radiofrequcy(RF) treatment has a long history, more than hundred years, for the management of chronic intractable pain of various causes. With better understanding of pain mechanism and advancement of technology, along with previous valuable experience, a simpler and safer method of delivering RF thermo coagulation to ideal sites are now available that can be expected to provide more beneficial effects to these patients with chronic disabling pain. This type of treatment will be especially helpful in aged in whom surgery is often contraindicated or highly risky due to medical problems. Here, using up-to-dated, evidence based knowledge and personal experience, authors have tried to introduce briefly the history and basic mechanism of RF technique and various clinical situations where this type of therapy is currently known to be indicated or effective in providing substantial pain relief. In summary, the RF thermocoagulation is proven to be effective way of providing significant pain relief in many chronic refractory pain states with numerous advantages such as minimal invasive, quantitative lesioning with temperature-controlled, well-circumscription of lesions, simplicity and feasibility of procedure, and most of all safety and cost-effectiveness. When it is selected based on careful investigation on type and cause of pain it can be expected to provide relatively long duration of pain relief and also to help to recover functional disabilities from such pain. However, judicious use is warranted because some painful conditions are known to be ineffective or contraindicated from this type of therapy and because there are possible serious complications, although very few. Use of latest technique of pulsed, high-frequency, low-temperatured thermocoagulation will possibly bring hope and new insights in the management of chronic intractable pain of neuropathic in nature. Further research and experience will be required before justifying this type of therapy in appling broader and more challenging situations.
Electrocoagulation
;
Hope
;
Humans
;
Neuralgia
;
Pain, Intractable*
2.Congenital Bronchobiliary Fistula: A case report.
Hyuk Myun KWUN ; Tae Eun JUNG ; Dong Hyup LEE ; Sung Sae HAN ; Jung Cheul LEE
The Korean Journal of Thoracic and Cardiovascular Surgery 2000;33(8):684-687
Congenital bronchobiliary fistual is a rare disease with unclear etiology. An abnormal tract communicates the tracheobronchial junction to a hepatic segment, usually the left lobe. Billous sputum, a positive HIDA(o-Dimethyliminodiacetic acid) scan, and a trification at the level of the carina lead to the diagnosis, which can be confirmed by bronchoscopic contrast injection. We experienced a case of congenital bronchobiliary fistual in a 27-day-old girl. Our case is reported with literature reviews.
Diagnosis
;
Female
;
Fistula*
;
Humans
;
Rare Diseases
;
Sputum
3.Clinical Significances of Hyperamylasemia Following Cardiopulmonary Bypass.
Hyuk Myun KWUN ; Tae Eun JUNG ; Jung Cheul LEE ; Dong Hyup LEE ; Sung Sae HAN
The Korean Journal of Thoracic and Cardiovascular Surgery 2000;33(8):655-661
BACKGROUND: This study was performed to evaluate the incidences, the risk factors, and the clinical course of the hyperamylasemia in patients who underwent open heart surgery under cardiopulmonary bypass. MATERIAL AND METHOD: Thirty seven patients who underwent cardiopulmonary bypass were studied at Department of Thoracic & Cardiovascular Surgery, Yeungnam University Hospital, from July 1997 to June 1998. The thirty seven patients were divided into two groups, 13 patients in group I had normal serum amylase levels and 24 patients in group II had hyperamylasemia. Mean serum amylase(IU/l) levels and 24 patients in group II had hyperamylasemia. Mean serum amylase(IU/l) levels of gorup II showed 54.3+/-4.6, 78.0+/-9.2, 372.0+/-103.4, 460.5+/-80.4, 280.4+/-46.6, and 131.0+/-15.6, preoperative, immediate postoperative, at postoperative 1, 2, 3, and 7 days, respectively. In group II, serum amylase level of the postoperative day 2 was the highest and was significantly higher than that of the preoperative day (p<0.001). Serum amylase level started to decreased at postoperative day 3 and returned to the normal level at postoperative day 7. Significant clinical symtoms of overt pancreatitis were not shown in patients in group II. The following perioperative variable such as diagnosis, cardiopulmonary bypass time, aortic cross clamping time, mean systemic pressure during bypass, and administration of steroid were compared between groups. There were no significant differences between groups. In all patients, Serum amylase level of postoperative day 2 and aortic cross clamping time were correlated significantly (p=0.047). CONCLUSION: Serum amylase level after cardiopulmonary bypass could be elevated postoperatively and serum amylase level of POD 2 was considered to have significant correlation with aortic cross clamping time. Shortening of aortic cross clamping time will help in reducing the hyperamylsemia. In this study, although significant clinical symptoms and overt pancreatitis were not seen from hyperamylsemic patients, careful clinical observation of hyperamylasemia would be necessary.
Amylases
;
Cardiopulmonary Bypass*
;
Constriction
;
Diagnosis
;
Humans
;
Hyperamylasemia*
;
Incidence
;
Pancreatitis
;
Risk Factors
;
Thoracic Surgery
4.Cardiac Surgery Via Lower Partial Sternotomy Lower Partial Sternotomy.
Hyuk Myun KWUN ; Tae Eun JUNG ; Jung Cheul LEE ; Sung Sae HAN ; Dong Hyup LEE
The Korean Journal of Thoracic and Cardiovascular Surgery 2000;33(9):729-733
BACKGROUND: Recent trends suggest that minimally invasive cardiac surgery reduces postoperative morbidity and offers a cosmetic benefit. This study was performed to evaluate the CPB time, ACC time, OP time, ICU stay and postoperative hospital stay following a lower partial sternotomy and those of the median sternotomy. MATERIAL AND METHOD: A group of 26 adult patients who underwent cardiac surgery through lower partial sternotomy from August 1997 to July 1999 (A group) were compared to 45 adult patients who underwent cardiac surgery through median sternotomy from January 1996 to July 1997 (B group). The mean ages (46.4+/-14.6 years, A group and 46.8+/-13.2 years, B group) were similar. Operations were performed with central cannula and antegrade/retrograde blood cardioplegia. RESULT: There was no death in each group. No differences were found in CPB time, ACC time, OP time, ICU stay and postoperative hospital stay. Postoperative complications were sternal splitting in a patient in group A and a patient with bleeding that required reoperation and a patient with delayed wound closure in group B. CONCLUSION: The lower partial sternotomy offered a cosmetic benefit, but does not significantly reduced the length of operative time and hospital stay. Minimally invasive cardiac surgery will be applied increasing because of the suggested advantage and choosing a proper operative technique will be helpful.
Adult
;
Catheters
;
Heart Arrest, Induced
;
Hemorrhage
;
Humans
;
Length of Stay
;
Operative Time
;
Postoperative Complications
;
Reoperation
;
Sternotomy*
;
Thoracic Surgery*
;
Wounds and Injuries
5.Radionuclide Cisternographic Findings in Patients with Spontaneous Intracranial Hypotension.
Dae Hyuk MOON ; Hee Kyung LEE ; Jin Sook RYU ; Jung Woo SHIN ; Dong Jin JUNG ; Jae Seung KIM ; Joo Hyuk IM ; Myoung Chong LEE ; Sun Joo JUNG
Korean Journal of Nuclear Medicine 1998;32(6):482-489
PURPOSE: Radionuclide cisternography may be helpful in understanding pathophysiology of postural headache and low CSF pressure in patients with spontaneous intracranial hypotension. The purpose of this study was to characterize radionuclide cisternographic findings of spontaneous intracranial hypotension. MATERIALS AND METHODS: The study population consists of 15 patients with spontaneous intracranial hypotension. Diagnosis was based on their clinical symptoms and results of lumbar puncture. All patients underwent radionuclide cisternography following injection of 111 to 222 MBq of Tc-99m DTPA into the lumbar subarachnoid space. Sequential images were obtained between 1/2 hour and 24 hour after the injection of Tc-99m DTPA. Radioactivity of the bladder, soft tissue uptake, migration of radionuclide in the subarachnoid space, and extradural leakage of radionuclide were evaluated according to the scan time. RESULTS: Radionuclide cisternogram showed delayed migration of radionuclide into the cerebral convexity (14/15), increased soft tissue uptake (11/15), and early visualization of bladder activity at 30 min (6/10) and 2 hr (13/13). Cisternography also demonstrated leakage site of CSF in 4 cases and 2 of these were depicted at 30 min. Epidural blood patch was done in 11 patients and headache was improved in all cases. CONCLUSION: The characterstic findings of spontaneous intracranial hypotension were delayed migration of radionuclide and early visualization of the soft tissue and bladder activity. These scintigraphic findings suggest that CSF leakage rather than increased CSF absorption or decreased production may be the main pathophysiology of spontaneous intracranial hypotension. Early and multiple imaging including the bladder and soft tissue is required to observe the entire dynamics of radionuclide migration.
Absorption
;
Blood Patch, Epidural
;
Diagnosis
;
Headache
;
Humans
;
Intracranial Hypotension*
;
Pentetic Acid
;
Radioactivity
;
Spinal Puncture
;
Subarachnoid Space
;
Urinary Bladder
6.Amino Acid Substitution Caused by Mutated rpoB Gene of Rifampin - Resistant Mycobacterium tuberculosis.
Dong Taek CHO ; Yoo Chul LEE ; Sung Hyuk BANG ; Jung Min KIM
Journal of the Korean Society for Microbiology 1997;32(4):389-399
Mobility shifts in non-denatured gel electrophoresis of PCR-amplified Rif' region in each of fifteen different mutants of M. tuberculosis were discerned by single strand conformation polymorphism (SSCP) analysis. The findings of mobility differences between rifampin-resistant and susceptible strains showed an excellent agreement with data obtained by traditional susceptibility test. SSCP-PCR seemed to replace the cultivation method of susceptibility test that was known to be time-consuming, labor wasting, and skeptical in quality control. After screening of rpoB gene mutation by SSCP-PCR, detection of specific sequence changes in the region of rpoB gene was attempted through the procedures of PCR-amplification, cloning of PCR-products using pGEM-T vector and DNA thermocycling sequencing. Fifteen different types of mutations were identified among fifty strains of rifampin-resistant strains while five rifampin-susceptible control strains showed no sequence changes of rpoB gene as well as reference strain H37rv. Most mutation appeared to be a point mutation due to substitution or deletion except seven mutants showing somewhat complex mutation. Each of mut#ated loci inclined to clustering within a region of eighteen amino acids involving eight codons. The most common mutation of Ser425 shared among twenty-nine mutants and followed by eleven mutants of His420. Several mutants alleles identified in this study appeared to be dissimilar to those of previous reports.
Alleles
;
Amino Acid Substitution*
;
Amino Acids
;
Clone Cells
;
Cloning, Organism
;
Codon
;
DNA
;
Electrophoresis
;
Mass Screening
;
Mycobacterium tuberculosis*
;
Mycobacterium*
;
Point Mutation
;
Quality Control
;
Rifampin*
;
Tuberculosis
7.Factors Affecting On-Line Medical Information Retrieval by Patients at a General Hospital in Seoul.
Young KIM ; Sang Hyuk JUNG ; Hye Jean LEE
Journal of Korean Society of Medical Informatics 2003;9(4):457-468
This study was designed to identify the factors relating to the retrieval of medical information from the Internet by patients at a general hospital in Seoul. A questionnaire survey was carried out for 440 inpatients and outpatients who visited the general hospital by 20 educated nurses between 24 and 25 October, 2002. The collected data were analyzed to evaluate the relationship between socioeconomic characteristics and Internet use, and opinions about medical information on the Internet and Internet use, by t-tests or chi-square tests. A logistic regression analysis was applied to find models explaining the factors affecting Internet use and the search for medical on the Internet. According to our logistic regression analysis, the younger, better educated, higher income, and singles showed a higher Odds ratio for Internet use. Age, education period, income and confidence level of the Internet contents were statistically significant in the search for medical information on the Internet(p< 0.05). The results showed the customers characteristics, needs, and problems with using the Internet in medical area on the customer s views. These results would be useful for building marketing strategies using the Internet as a way of servicing and communicating with the patients.
Education
;
Hospitals, General*
;
Humans
;
Information Storage and Retrieval*
;
Inpatients
;
Internet
;
Logistic Models
;
Marketing
;
Odds Ratio
;
Outpatients
;
Surveys and Questionnaires
;
Seoul*
8.A Case of Complete Hydatidiform Mole in a triplet pregnancy following In Vitro Fertilization and Embryo Transfer.
Gwang Kook KIM ; Myung Chul KIM ; Jin Soo PARK ; Hyuk Dong HAN ; In Bae JUNG
Korean Journal of Obstetrics and Gynecology 2000;43(11):2062-2066
A complete hydatidiform mole coexisting with a fetus is a rare condition, particularly when diagnosed after IVF-ET. In spite of the wide spread use of assisted reproductive technology, there have been, to our knowledge, only few reported cases of molar pregnancy after IVF-ET. At present, there are limited data to guide the antenatal management of a complete hydatidiform mole coexisting with fetuses. A complete mole can coexist with a normal, healthy fetus who can be carried to term, with good outcome. But, patients who desire to continue the pregnancy after such a diagnosis must be cautioned about the potential for severe medical complications and developing persistent gestational trophoblastic tumor. We report here a case of complete hydatidiform mole in a triplet pregnancy coexistent with two live fetuses following in IVF-ET.
Diagnosis
;
Embryo Transfer*
;
Embryonic Structures*
;
Female
;
Fertilization in Vitro*
;
Fetus
;
Humans
;
Hydatidiform Mole*
;
Pregnancy
;
Pregnancy, Triplet*
;
Reproductive Techniques, Assisted
;
Triplets*
;
Trophoblastic Neoplasms
9.A Case of Congenital Intestinal Obstruction Diagnosed by Prenatal Ultrasound.
Dae Jung KIM ; Yong Gul KIM ; Dong Won KIM ; Kyung Chul RHU ; Hyuk JUNG ; Sang Joon CHOI
Korean Journal of Obstetrics and Gynecology 2000;43(10):1832-1836
No abstract available.
Intestinal Obstruction*
;
Ultrasonography*
10.Intestinal Ultrasonographic and Endoscopic Findings in Pediatric Patients with Henoch-Schonlein Purpura and Gastrointestinal Symptoms.
Yun Il NOH ; Min Hyuk RYU ; Chul Zoo JUNG ; Dong Jin LEE ; Jung Hyeok KWON
Korean Journal of Pediatric Gastroenterology and Nutrition 2001;4(2):181-191
PURPOSE: The aim of this study is to investigate the usefulness of intestinal ultrasonography (US) and upper gastrointestinal endoscopy in the early diagnosis of Henoch-Schonlein purpura (HSP) with the gastrointestinal (GI) symptoms preceding the emergence of the skin lesion. METHODS: The clinical, intestinal US and upper gastrointestinal endoscopic records of 85 patients (88 cases) with GI symptoms relating to HSP presenting between January 1999 and April 2001 were reviewed. RESULTS: 1) GI symptoms were observed in 52 cases (59%) and skin, joint, renal and scrotal manifestations were observed in 88 (100%), 64 (73%), 15 (17%), 3 cases (3%) respectively. 2) Out of 52 cases with GI symptoms, abdominal pain was observed in all cases (100%). Positive stool occult blood, nausea and vomiting, abdominal tenderness, melena or tarry stool, diarrhea, hematemesis, rebound tenderness and rigidity were observed in 28 (50%), 17 (33%), 17 (33%), 12 (23%), 6 (12%), 4 (8%), 1 (2%) and 1 case (2%) respectively in order of frequency. 3) Intestinal US examination was performed in 27 cases with HSP and GI symptoms (52 cases). Out of 27 sonographic examinations 22 showed abnormal findings. Thickening of the duodeno-jejunal wall was observed in 16 cases (73%). Free peritoneal fluid, enlarged mesenteric lymph node, ileus and abnormal gall bladder were seen in 8 (36%), 8 (36%), 4 (18%) and 1 case (5%) respectively. In three cases of HSP without GI symptoms, those changes were absent. 4) In all of five cases with HSP and GI symptoms, endoscopic study showed mucosal edema and multiple hemorrhagic erosions especially at the second portion of the duodenum. Biopsy specimens from the duodenum of 2 cases out of 5 endoscopic examinations showed acute inflammatory infiltrates in the mucosa with hemorrhage. 5) Both intestinal US and endoscopic studies were performed in 4 cases with HSP and GI symptoms simultaneously. Out of 4 those cases, 3 cases showed the thickened duodeno-jejunal wall on the intestinal US, which suggested erosive hemorrhagic duodenitis by endoscopic findings. CONCLUSION: The typical but nonpathognomonic intestinal US findings including the thickening of the duodeno-jejunal wall and upper gastrointestinal endoscopic findings including hemorrhagicerosive duodenitis, in children with GI symptoms, should be considered a manifestation of HSP, even in the absence of skin lesion.
Abdominal Pain
;
Ascitic Fluid
;
Biopsy
;
Child
;
Diarrhea
;
Duodenitis
;
Duodenum
;
Early Diagnosis
;
Edema
;
Endoscopy
;
Endoscopy, Gastrointestinal
;
Hematemesis
;
Hemorrhage
;
Humans
;
Ileus
;
Joints
;
Lymph Nodes
;
Melena
;
Mucous Membrane
;
Nausea
;
Occult Blood
;
Purpura, Schoenlein-Henoch*
;
Skin
;
Ultrasonography
;
Urinary Bladder
;
Vomiting