BACKGROUND: Epidural morphine has side effects, especially pruritus, nausea, and vomiting. Butorphanol has been added in studies to reduce these side effects in post cesarean patients. The purpose of this study was to evaluate the side effects and analgesic efficacy when a combination of epidural morphine and butorphanol was administered in patients having combined local anesthetic and opioid epidural infusion. METHODS: Sixty patients having epidural anesthesia for cesarean section were randomly divided into two groups. Group M (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and saline 0.75 ml, whereas group B (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and butorphanol 1.5 mg (0.75 ml). Continuous epidural infusion was done by Two-day Infusor containing either 0.25% bupivacaine 75 ml, morphine 5 mg, and saline 20 ml in group M or 0.25% bupivacaine 75 ml, morphine 5 mg, butorphanol 4 mg (2 ml), and saline 18 ml in group B. We compared the side effect and analgesic effect of group M to those of group B for 2 days. RESULTS: The incidence of pruritus and vomiting were reduced significantly in group B (p<0.05). There were no significant differences between both groups in the incidence of nausea or other side effects as well as no differences in analgesic effect. CONCLUSIONS: We conclude that the addition of butorphanol to morphine in combined local anesthetic and opioid epidural infusion for postoperative analgesia decreases the occurrence of pruritus and vomiting without significant increase of other side effects and adverse effect on analgesia.
Analgesia ; Anesthesia, Epidural ; Bupivacaine ; Butorphanol* ; Cesarean Section* ; Female ; Humans ; Incidence ; Infusion Pumps ; Morphine* ; Nausea ; Pregnancy ; Pruritus ; Vomiting

The brachial plexus block by interscalene approach is useful for any procedure on upper extremity, including the shoulder. Complications such as phrenic nerve block, Horner's syndrome, permanent neurologic damage, high epidural block, total spinal anesthesia, pneumothorax and cardiac arrest etc. were reported. We experienced a case of 56-year old male patient with ankylosing spondylitis who developed cervical spinal cord injury following the turning of head for brachial plexus block by interscalene approach. The patient developed quadriplegia and finally died after 28 days.
Anesthesia, Spinal ; Brachial Plexus* ; Head ; Heart Arrest ; Horner Syndrome ; Humans ; Male ; Middle Aged ; Phrenic Nerve ; Pneumothorax ; Quadriplegia ; Shoulder ; Spinal Cord Injuries* ; Spinal Cord* ; Spondylitis, Ankylosing ; Upper Extremity

BACKGROUND: Propafenone is a new class Ic antiarrhythmic compound.This study was performed to evaluate the clinical efficacy and safety of propafenone by double-blind, placebo-controlled, randomized cross-over comparison of propafenone and disopyramide in patients with stable ventricular ectopy. METHODS: All patients were included in the study if they had an average of at least 30 PVC/hr on a 24-hour Holter recordings. During the 1st 7 days, two placebo tablets(identical in apperance to the propafenone and the disopyramide tablets) were administrated in a double-blind manner(run-in period). Then 1st treatment period lasting 1 week with one verum and the other placebo, wish-out period of 3 day,2nd treatment period lasting 1 week with cross-over drugs were followed. RESULTS: Twenty patients were enrolled. During the run-in period, VPCs were reduced to 18%, compared to the baseline data before the administration of placebo.During the treatment period,propafenone 600mg/day reduced VPCs by 43% and disopyramide 400mg/day reduced VPCs by -10% Propafenone was effective(80% or greater reduction of VPCs) in 7 of 20 patients. Disopyramide was not effective in all patients. Propafenone and disopyramide produced no significant change of paired VPCs and VT events. Propafenone had no effect on heart rate. It increased the PR interval(7.9%;p<0.01) and QRS interval(5.2%;p<0.01). The drug did not change QTc interval(-1.1%) significantly. There were no cardiovascular side effects. Propafenone produced nausea in one patient. Disopyramide produced dysuria in 2 patients. CONCLUSIONS: Propafenone was more effective in controlling VPC than disopyramide, and there was no major limiting side effects.
Cross-Over Studies* ; Disopyramide* ; Dysuria ; Heart Rate ; Humans ; Nausea ; Propafenone* ; Ventricular Premature Complexes*

PURPOSE: Colorectal cancer (CRC) has a high risk for postoperative thromboembolic complications such as venous thromboembolism (VTE) compared to other surgical diseases, but the relationship between VTE and CRC in Asian patients remains poorly understood. The present study examined the incidence of symptomatic VTE in Korean patients who underwent surgery for CRC. We also identified risk factors, incidence and survival rate for VTE in these patients. MATERIALS AND METHODS: The patients were identified from the CRC database treated from January 2011 to December 2012 in a single institution. These patients were classified into VTE and non-VTE groups, their demographic features were compared, and the factors which had significant effects on VTE and mortality between the two groups were analyzed. RESULTS: We analyzed retrospectively a total of 840 patients and the incidence of VTE was 3.7% (31 patients) during the follow-up period (mean, 17.2 months). Histologic subtype (mucinous adenocarcinoma) and previous history of VTE affected the incidence of VTE on multivariate analysis. There was a statistically significant difference in survival rate between the VTE and non-VTE group, but VTE wasn't the factor affecting survival rate on multivariate analysis. Comparing differences in survival rate for each pathologic stage, there was only a significant difference in stage II patients. CONCLUSION: Among CRC patients after surgery, the incidence of VTE was approximately 3% within 1 year and development of VTE wasn't a significant risk factor for death in our study but these findings are not conclusive due to our small sample size.
Asian Continental Ancestry Group ; Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Prognosis* ; Retrospective Studies ; Risk Factors ; Sample Size ; Survival Rate ; Venous Thromboembolism*

In the last decade Computed Tomography(CT) has played a critical role in the diagnostic evaluation of the patients with focal brain injury. But it is apparent from pathologic studies that CT underestimates the severity of the many forms of cerebral injury such as primary brain stem injury, non-hemorrhagic cortical contusion and diffuse axonal injury(DAI). Magnetic Resonance Imaging(MRI), however, has been shown to be highly sensitive in detecting diffuse brain injury(DBI). Among the consecutive 13 cases of DBI patients in this series for 10 months, twelve patients were verified as MR evidence of injury in prospective studies. The anatomical distribution of the injuries were 11 cases of corpus callosal lesion, 6 cases of lobar white matter lesion, 1 case of primary brain stem lesion. The sensitivities of MR imaging in detecting the primary lesion were 76.9%(10/13) in T1WI and 92.3%(12/13) in T2WI. In DBI, patients with callosal injuries had higher incidence(8/12) than lobar white matter and primary brain stem lesion, the corpus callosal atrophy by midsaggital MR imaging and behavioral seguellae in survivous of severe head injury implicate the corpus callosal injury and degeneration. More accurate detection and delineation of traumatic lesions with MR should permit more accurate prediction of neurologic and cognitive recovery and assist in optimizing form of treatment.
Atrophy ; Axons ; Brain ; Brain Injuries* ; Brain Stem ; Craniocerebral Trauma ; Humans ; Magnetic Resonance Imaging* ; Prospective Studies

Background: To date, few studies have investigated the feasibility of the loop-mediated isothermal amplification (LAMP) assay for identifying pathogens in tissue samples. This study aimed to investigate the feasibility of LAMP for the rapid detection of methicillin-susceptible or methicillin-resistant Staphylococcus aureus (MSSA or MRSA) in tissue samples, using a bead-beating DNA extraction method. Methods: Twenty tissue samples infected with either MSSA (n = 10) or MRSA (n = 10) were obtained from patients who underwent orthopedic surgery for suspected musculoskeletal infection between December 2019 and September 2020. DNA was extracted from the infected tissue samples using the bead-beating method. A multiplex LAMP assay was conducted to identify MSSA and MRSA infections. To recognize the Staphylococcus genus, S. aureus, and methicillin resistance, 3 sets of 6 primers for the 16S ribosomal ribonucleic acid (rRNA) and the femA and mecA genes were used, respectively. The limit of detection and sensitivity (detection rate) of the LAMP assay for diagnosing MSSA and MRSA infection were analyzed. Results: The LAMP result was positive for samples containing 10 3 colony-forming unit (CFU)/mL for 16S rRNA, 10 4 CFU/mL for femA, and 10 5 CFU/mL formecA. The limits of detection for 16S rRNA and femA were not different between MSSA and MRSA. For the 10 MSSA-positive samples, the LAMP assay showed 100% positive reactions for 16S rRNA and femA and a 100% negative reaction for mecA. For the 10 MRSA-positive samples, the LAMP assay showed 100% positive reactions for 16S rRNA and mecA but only 90% positive reactions for femA. The sensitivity (detection rate) of the LAMP assay for identifying MSSA and MRSA in infected tissue samples was 100% and 90%, respectively. Conclusions The results of this study suggest that the LAMP assay performed with tissue DNA samples can be a useful diagnostic method for the rapid detection of musculoskeletal infections caused by MSSA and MRSA.

PURPOSE : To evaluate MR image qualities we developed a new MRI phantom with the fixation structures necessary to position it into coil firmly. MATERIALS AND METHODS : We designed MRI phantom for eight evaluation items such as slice thickness accuracy, high contrast spatial resolution, low contrast object detectability, geometry accuracy, slice position accuracy, image intensity uniformity, percent signal ghosting and signal to noise ratio. For the positioning of phantom at coils, the fixation structures were set up on the surface of phantom. Six different MRI units were used for test the possibility for the clinical application and their image qualities were evaluated. RESULTS : We acquired appropriate MR image qualities enough for the evaluation on all used MR units and confirmed that their evaluations were within reliable values compared to real ones for some items. The positioning of our phantom into head coils with fixation structures worked well for proper imaging. CONCLUSION : We found that our prototype of MRI phantom had the possibility of clinical application for MR image quality assessment.
Head ; Magnetic Resonance Imaging* ; Quality Control ; Signal-To-Noise Ratio

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), also termed Bland-White-Garland syndrome, is a rare congenital cardiac anomaly characterized by myocardial ischemia which becomes symptomatic during early infancy leading to infarction, left heart failure or even death. More than 90% of patients can be dead within first year of life if untreated, so adult type ALCAPA without surgical correction is quitely rare. We present a case of a 20-year-old man with ALPACA syndrome whose diagnosis took several years to be made because he was mistaken to have organic mitral regurgitation.
Adult* ; Bland White Garland Syndrome ; Camelids, New World ; Coronary Vessels* ; Diagnosis ; Heart Failure ; Humans ; Infarction ; Mitral Valve Insufficiency ; Myocardial Ischemia ; Pulmonary Artery* ; Young Adult

PURPOSE: Dexamethasone is a well-known treatment for preterm infants with bronchopulmonary dysplasia. However, serious side effects have been identified, including hypertension, and cardiac hypertrophy. This study was undertaken to examine whether dexamethasone induced cardiac hypertrophy in preterm infants with bronchopulmonary dysplasia. METHODS: We retrospectively reviewed 12 infants with bronchopulmonary dysplasia treated with dexamethasone at Korea University Hospital from August 1995 to February 1999. Serial two-dimensional and M-mode echocardiographic measurements were taken before treatment and at 1,2,3,4,5 weeks after the start of dexamethasone therapy. RESULTS: Patients receiving dexamethasone had a significantly increase in interventricular septal thickness and left ventricular posterior wall thickness. These effects were transient, reached their maximal degree by the third week of treatment, and approached pretreatment conditions by the fifth week of treatment. Heart rate was increased but statistically not significant. The fractional shortening, systolic and diastolic arterial pressure were transiently increased during dexamethasone therapy. CONCLUSION: We conclude that a transient myocardial hypertrophy is associated with dexamethasone therapy in infants with bronchopulmonary dysplasia. Follow up of careful echocardiac monitoring should be considered in infants with dexamethasone therapy.
Arterial Pressure ; Bronchopulmonary Dysplasia ; Cardiomegaly* ; Cardiomyopathy, Hypertrophic* ; Dexamethasone* ; Echocardiography ; Follow-Up Studies ; Heart Rate ; Humans ; Hypertension ; Hypertrophy* ; Infant ; Infant, Newborn ; Infant, Premature* ; Korea ; Retrospective Studies

Phakomatosis pigmentovascularis(PPV) was first described in 1947 as a distinctive association of vascular and pigmentary nevi by Ota et al. Hasegawa et al subclassified the disorder into eight types and type I a is characterized by the coexistence of nevus flammeus and nevus pigmentosus et verrucous, which is not associated with systemic organ involvement. PPV type I a is relatively rare and a case with multiple pyogenic granulomas developed in pregnancy, is not reported yet. We present a case of PPV type I a with multiple pyogenic granulomas developed in pregnancy within nevus flammeus in a 29-year-old female.
Adult ; Female ; Granuloma, Pyogenic* ; Humans ; Neurocutaneous Syndromes* ; Nevus ; Port-Wine Stain ; Pregnancy*