No abstract available.
Female ; Humans ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy*

No abstract available.
Humans ; Male*

BACKGROUND: The aim of the present study was to examine whether gabapentin, a new anti-epileptic agent with relatively low toxicities and side effects, could reduce postoperative pain. METHODS: Thirty-two patients scheduled for an elective total hysterectomy were investigated in this randomized, double blind, placebo-controlled study. The patients were randomized to receive either oral gabapentin 400 mg (gabapentin group, n = 16) or a matching placebo capsule (control group, n = 16) the night before and again 30 min before surgery as an adjunct to morphine patient-controlled analgesia (PCA). The visual analogue scale (VAS) for pain at rest and on movement, morphine consumption, overall satisfactions and postoperative side effects including sedation were recorded for 24 h after surgery. RESULTS: Total morphine consumption for 24 h after surgery was not significantly different between the two groups, but mean hourly morphine consumption during the period of 2 6 h after surgery was significantly greater in the control group. Movement VAS of gabapentin group measured at 6 h and 12 h after surgery was significantly lower than those of control group. There were no significant differences between the two groups with respect to the sedation score, patient's satisfaction and the frequencies of side effects. CONCLUSIONS: We observed that preoperatively administered oral gabapentin 800 mg reduced postoperative morphine consumption and incidental pain without increasing side effects. The addition of gabapentin to a morphine regimen may lower morphine consumption and provide better pain relief without increasing side effects.
Analgesia, Patient-Controlled ; Humans ; Hysterectomy ; Morphine ; Pain, Postoperative

PURPOSE: To evaluate the usefulness of the coaxial technique in US-guided breast core biopsy. Materials andMethods : Using the coaxial technique, US-guided breast core biopsy was performed in 49 breast lesions (40patients). Under US-guidance the 17-gauge, 13 cm long introducer needle was positioned proximal to the lesion.Once the needle was in place, the central trocar was removed and was replaced with the core biopsy needle. We usedan 18-gauge, 16-cm-long core biopsy needle with a 17 mm specimen notch. Four to eight tissue specimens wereobtained from each lesion, and the quality and quantity of specimens, procedure time, and complications and theirrate were evaluated. RESULTS: For 48 of 49 lesions, specimens were adequate for histopathologic diagnosis, andthe findings were as follows : six cases of invasive ductal carcinoma, one of ductal carcinoma in situ, 29 offibrocystic disease, eight of fibroadenoma, two of chronic inflammation, and two of sclerosing lesion. In 12lesions agreement between the pathologic results of needle core biopsy and surgical results was 100%. Theprocedure time was about 15 minutes and no significant complications were noted. CONCLUSION: In breast corebiopsy, the coaxial technique is simple and time-saving, and compared with stan-dard breast core biopsy, may alsobe less traumatic and decrease the potential risk of seeding the biopsy tract with malignant cells.
Biopsy* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis ; Fibroadenoma ; Inflammation ; Needles ; Surgical Instruments

Purpose: Previous studies have suggested that serum phosphate concentration is a prognostic factor in critically ill patients. However, the association between changes in serum phosphate levels and prognosis of patients with trauma remains unclear. Materials and Methods: This study included patients with severe trauma who were treated at the emergency department. Delta phosphate (Δ phosphate) was defined as the difference between serum phosphate concentrations measured at baseline and after 24 hours from the initial measurement. Patients were divided into five groups according to their Δ phosphate levels: group I (Δ phosphate <-2 mg/dL), group II (Δ phosphate -2 to -0.5 mg/dL), group III (Δ phosphate -0.5 to 0.5 mg/dL), group IV (Δ phosphate 0.5 to 2 mg/dL), and group V (Δ phosphate ≥2 mg/dL). Results: Overall, 1905 patients with severe trauma were included in the analysis. The 30-day mortality was the lowest in group III and tended to increase in groups with a larger Δ phosphate in both the positive and negative directions (group I: 13.7%, group II:6.8%, group III: 4.6%, group IV: 6.6%, and group V: 26.8%). In multivariable analysis with group III as the reference group, the odds ratios (ORs) of mortality were statistically significant in group IV [OR, 1.92; 95% confidence interval (CI), 1.05–3.56] and group V (OR, 5.28; 95% CI, 2.47–11.24). Conclusion An increase in serum phosphate concentrations 24 hours after the initial measurement could be considered as an independent prognostic factor in patients with severe trauma.

The incidence of anomalous aortic origin of the coronary arteries in the general papulation is unknown. In recent reports from various laboratories, the incidence was between 0.6-12% in patients referred for coronary arteriogtaphy. Anomalous origin of the right coronary artery from the left sinus of Valsalva is reported to constitute from 6% to 27% of all coronary anomalies, For many years pathologists classified it as a minor anomaly of no clinical importance. Recently, manifstations of myocardial ischemia have been described in patients with this anomaly in the absence of additional atherosclerotic or other disease processes. These manifestations have included acute myocardial infarction, angina pectoris, syncope, nonfatal ventricular fibrillation, and sudden death. We report a case of 56-year-old male with the anomalous origin of the right coronary artery from the left sinus of Valsalva, who had been admitted due to severe substernal chest pain and acute inferior wall myocardial infarction. The coronary angiography revealed that the right coronary artery originated from the left coronary sinus without significant atheroscleotic narrowing. The anomalous right coronary artery passed anteriorly between pulmonary artery and aortic root without significant coronary obstruction.
Angina Pectoris ; Chest Pain ; Coronary Angiography ; Coronary Sinus ; Coronary Vessels ; Death, Sudden ; Humans ; Incidence ; Inferior Wall Myocardial Infarction* ; Male ; Middle Aged ; Myocardial Infarction ; Myocardial Ischemia ; Pulmonary Artery ; Sinus of Valsalva ; Syncope ; Ventricular Fibrillation

Opioids are generally used to treat severe cancer pain. Usually, it is common to increase the dose of opioids to maintain analgesia. Opioid-induced hyperalgesia (OIH) is a paradoxical response to opioid resulting in increased perception of pain rather than antinociceptive effect. A 64-year-old female with pancreatic cancer was suffering from whole abdominal pain. She took massive opioid therapy, however, her pain had been worse and widen in the 3 months. Radiologic imaging was performed to exclude metastatic cancer. The result was negative. We suspected OIH, and reduced the amount of opioids, then, added to adjuvant analgesics. And also we performed celiac plexus neurolysis with the use of alcohol and continuous epidural catheter insertion. Her numeric rating pain scale (NRS) decreased from 9/10 to 3/10. This case suggests that adjuvant analgesics and interventional treatments can resolve a OIH patient with intractable cancer pain.
Abdominal Pain ; Analgesia ; Analgesics ; Analgesics, Opioid ; Catheters ; Celiac Plexus ; Female ; Humans ; Hyperalgesia ; Middle Aged ; Pain Management ; Pancreatic Neoplasms ; Stress, Psychological

PURPOSE: We investigated the operative outcome after bypass surgery in patients selected using viability criteria on F-18 FDG PET. MATERALS AND METHODS: Rest-24hr delay redistribution imaging of Tl-201 SPECT and F-18 FDG PET were performed in 11 patients. Seven of these 11 patients (6 men, 1 woman) were evaluated to have viable myocardium by F-18 FDG PET. Changes in symptoms and left ventricular ejection fraction (LVEF) after operation were evaluated. RESULTS: In seven of 11 patients, a significant amount of viable myocardium was found on F-18 FDG PET and Tl-201 SPECT. Severity of both chest pain and dyspnea improved markedly in all patients. Mean LVEF improved from 22% to 32%. CONCLUSION: F-18 FDG PET could be used to select the patients who will benefit from coronary artery bypass surgery.
Cardiomyopathies* ; Chest Pain ; Coronary Artery Bypass ; Dyspnea ; Humans ; Male ; Myocardium ; Positron-Emission Tomography ; Stroke Volume ; Tomography, Emission-Computed, Single-Photon

PURPOSE: To evaluate injury patterns of facet joints and associated soft tissue injuries in patients withacute traumatic cervical facet joint injuries. MATERIALS AND METHODS: From among patients with cervical spinetrauma, 27 with facet joint injuries, as seen on CT and MRI, were chosen for this study. CT scans were analyzedwith regard to the location of facet joint injury, the presence or absence of facet dislocation or fracture, andother associated fractures. MR images were analyzed with regard to ligament injury, intervertebral disc injury,intervertebral disc herniation, and spinal cord injury. RESULTS: The most common location of facet joint injurywas C6-7 level(n=10), followed by C5-6(n=8). Among these 27 patients with facet joint injuries, 12(44%) hadbilateral injuries and 15(56%) unilateral injuries. Facet fractures were present in 17 cases(63%) and the fractureof inferior facet was more frequent than superi-or. Patterns of fracture were vertical, transverse, or comminuted,but vertical fracture was the most common. Various degrees of dislocation were observed in patients with facetfractures. Fractures other than facet includ-ed pillar(n=11), lamina(n=6), transverse process(n=14), body(n=13),and spinous process(n=3). On MR im-ages, anterior longitudinal ligament injury was found in 8 patients(30%),posterior longitudinal ligament injury in 4(15%), and interspinous ligament injury in 20(74%). Twelvepatients(44%) had spinal cord injuries includ-ing edema(n=8) and hemorrhage(n=4). Among patients with discabnormalities, 11(41%) had intervertebral disc injuries, and traumatic disc herniations were found in nine. CONCLUSION: Traumatic cervical facet joint injuries were manifested as various patterns and frequentlyassoci-ated with other fractures or soft tissue injuries. Analysis of CT and MR findings of these injury patternshelped formulate a therapeutic plan and determine of prognosis.
Dislocations ; Humans ; Intervertebral Disc ; Ligaments ; Longitudinal Ligaments ; Magnetic Resonance Imaging* ; Prognosis ; Soft Tissue Injuries ; Spinal Cord Injuries ; Spine* ; Tomography, X-Ray Computed ; Zygapophyseal Joint*

BACKGROUND: Haloperidol, a major tranquilizer similar to droperidol, has been found to have a potent antiemetic effect on postoperative nausea and vomiting (PONV), but the supporting evidence was incomplete, especially in Korea.Therefore we evaluated the prophylactic effect of haloperidol on opioid-based IV patient-controlled analgesia (PCA) related PONV in susceptible patients after gynecological laparoscopic surgery. METHODS: Ninety-six adult women scheduled gynecological laparoscopic surgery were enrolled in a randomized, double-blinded and placebo study.Patients received haloperidol 1 mg (Group H) or saline (Group C) 30 min before the end of surgery.Fentanyl-based IV PCA was administered after surgery.The incidences and severity of nausea, vomiting, rescue antiemetic administration, pain, and adverse effects (cardiac arrhythmias and extrapyramidal effects) were assessed for 24 h after surgery.The sedation score was recorded in the post-anesthesia care unit for 2 h. RESULTS: The incidences and severity of nausea and the number of antiemetic administration were significantly lower in Group H than Group C (P < 0.05). But the sedation and pain score were similar. There was no QTc prolongation or extrapyramidal symptom in both groups. CONCLUSIONS: Prophylactic haloperidol 1 mg is effective in preventing PONV related to fentanyl-based IV PCA, with less adverse effects, in patients undergoing gynecological laparoscopic surgery.
Adult ; Analgesia, Patient-Controlled ; Antiemetics ; Arrhythmias, Cardiac ; Droperidol ; Female ; Haloperidol ; Humans ; Incidence ; Laparoscopy ; Nausea ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Vomiting