BACKGROUND: The initiation of treatment seems to be important in provoking preemptive analgesia and to provide excellent postoperative pain control. To verify the effectiveness of postoperative analgesia and preemptive effects, pre-incisional and post-incisional epidural infusion of morphine and bupivacaine mixture were compared. METHODS: Patients scheduled for elective upper abdominal surgery were divided into 2 groups. Each group received 2 mg of morphine in 10 ml of 0.25% bupivacaine as a bolus followed by 0.1 mg/ml/hr of morphine infusion in 0.125% bupivacaine epidurally. In post-incisional group, the epidural injection of mixture was started 15 minutes after skin incision and in pre-incisional group, the epidural infusion of mixture was started 15 minutes before skin incision. Each groups were evaluated in visual analogue scales (VAS) for pain, pain scores in movement, and total administered doses in postoperative 1, 2, 4, 8, 24, 48, and 72 hours and compared with each others. RESULTS: There were no differences between pre-incisional and post-incisional start of continuous epidural mixture infusion of morphine and bupivacaine in VAS for pain, pain scores at movement, and total amount of infused doses for 72 hours postoperatively. Also, there were no differences in the incidence of complications and satisfactions of patients between two groups. CONCLUSIONS: The continuous epidural mixture infusion of morphine 0.1 mg/ml/hr in 0.125% bupivacaine following a bolus dose of 2 mg morphine in 0.25% 10 ml bupivacaine has no difference in postoperative analgesic effect whether it starts after or before surgical incision.
Analgesia ; Bupivacaine ; Humans ; Incidence ; Injections, Epidural ; Morphine* ; Pain, Postoperative ; Skin ; Weights and Measures

OBJECTIVE: We wanted to valuate the mid-term therapeutic results of percutaneous transhepatic balloon angioplasty for portal vein stenosis after liver transplantation. MATERIALS AND METHODS: From May 1996 to Feb 2005, 420 patients underwent liver transplantation. Percutaneous transhepatic angioplasty of the portal vein was attempted in six patients. The patients presented with the clinical signs and symptoms of portal venous hypertension or they were identified by surveillance doppler ultrasonography. The preangioplasty and postangioplasty pressure gradients were recorded. The therapeutic results were monitored by the follow up of the clinical symptoms, the laboratory values, CT and ultrasonography. RESULTS: The overall technical success rate was 100%. The clinical success rate was 83% (5/6). A total of eight sessions of balloon angioplasty were performed in six patients. The mean pressure gradient decreased from 14.5 mmHg to 2.8 mmHg before and after treatment, respectively. The follow up periods ranged from three months to 64 months (mean period; 32 months). Portal venous patency was maintained in all six patients until the final follow up. Combined hepatic venous stenosis was seen in one patient who was treated with stent placement. One patient showed puncture tract bleeding, and this patient was treated with coil embolization of the right portal puncture tract via the left transhepatic portal venous approach. CONCLUSION: Percutaneous transhepatic balloon angioplasty is an effective treatment for the portal vein stenosis that occurs after liver transplantation, and our results showed good mid-term patency with using this technique.
Vascular Patency ; Ultrasonography, Doppler ; Treatment Outcome ; Tomography, X-Ray Computed ; Postoperative Complications ; Portal Vein/*pathology/ultrasonography ; Middle Aged ; Male ; *Liver Transplantation ; Infant ; Humans ; Follow-Up Studies ; Female ; Constriction, Pathologic ; Child ; *Angioplasty, Balloon ; Adult

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology. Non-steroidal anti-inflammatory drugs (NSAIDs), steroids, disease modifying anti-rheumatic drugs (DMARDs), immunosuppressives and intravenous immunoglobulin (IVIG) have been used to control the disease. It was suggested that several pro-inflammatory cytokines, such as interleukin (IL)-6, IL-8, IL-18, and tumor necrosis factor (TNF)-alpha, play an important role in its pathogenesis. Recent reports showed the clinical effectiveness of TNF-alpha blockers (infliximab and etanercept) in refractory AOSD. We report a case successfully treated with etanercept in the early AOSD refractory to the combination therapy of high-dose prednisolone and cyclosporine (CSA).
Antirheumatic Agents ; Cyclosporine ; Cytokines ; Etanercept ; Humans ; Immunoglobulins ; Interleukin-18 ; Interleukin-8 ; Interleukins ; Prednisolone ; Steroids ; Still's Disease, Adult-Onset* ; Tumor Necrosis Factor-alpha

True pancreaticoduodenal artery aneurysms are relatively rare, approximately 50% of which are associated with stenosis or occlusion of the celiac axis. It is imperative to treat the condition immediately after diagnosis, considering that its rupture has a mortality rate of approximately 50%. The current most commonly used method to treat pancreaticoduodenal artery aneurysms is transcatheter arterial embolization. Here, we report three cases of embolization of inferior pancreaticoduodenal artery aneurysm with celiac stenosis or occlusion along with a literature review.

Chronic postoperative inguinal pain (CPIP) is a major complication after inguinal herniorrhaphy. We report the treatment of CPIP using ultrasonography-combined with nerve stimulator for injection of the genitofemoral nerve (GFN). A 59-year-old man underwent laparoscopic herniorrhaphy and presented with numbness from the inguinal region to the scrotum after operation. In the pain clinic, ultrasonography-guided GFN block and pharmacological treatments had little effect. Six month after operation, patient was referred to the Department of Physical Medicine and Rehabilitation, and ultrasonography-combined with nerve stimulator for GFN injection underwent to enhance the accuracy of neural approach. The induction of scrotal contraction and paresthesia on the GFN distribution was monitored by nerve stimulator and local anesthetic was injected. After the block, pain relief lasted for 6 months without analgesic use. Ultrasonography-combined with nerve stimulator is an effective approach to treat CPIP as it enhances precise localization and injection of small peripheral nerve like GFN.
Herniorrhaphy ; Humans ; Hypesthesia ; Middle Aged ; Pain Clinics ; Paresthesia ; Peripheral Nerves ; Physical and Rehabilitation Medicine ; Scrotum

In order to study the range of flight and feeding activity of Anopheles sinensis, the dispersal experiment was conducted in Paju city, located in the northern part of Gyeonggi-do, Republic of Korea, during the period of 7th to 28th September 1998. Unfed females An. sinensis were collected in cowshed and released after being marked with fluorescent dye at 23:00 hours on the same day. Released female mosquitoes were recaptured everyday during 21 days using light traps, which were set at 10 sites in the cowsheds located 1, 3, 6, 9 and 12 km north-northwest and north-northeast and at 3 sites located 1, 6 and 9 km toward south-west from the release point. In addition, to study the longest flight distance in one night, we set the light traps at 16 and 20 km toward north-northeast from the release site. All the collected mosquitoes were placed on filter papers and observed on UV transilluminator after treatment with one drop of 100% ethanol. Out of 12,773 females of An. sinensis released, 194 marked females mosquitoes were recaptured, giving 1.52% recapture rate. Of 194, 72 mosquitoes (37.1%) were recaptured in light traps from three places set at 1 km from the release point, 57 mosquitoes (29.4%) from two places at 1-3 km, 41 mosquitoes (21.1%) from three places at 3-6 km, 20 mosquitoes (10.3%) from three places at 6-9 km, and 4 mosquitoes (2.1%) from two places at 9-12 km. Since 170 female mosquitoes (87.6%) out of 194 marked mosquitoes were captured within 6 km from the release point, this flight radius represents the main activity area. An sinensis was found to be able to fly at least 12 km during one night.
Animals ; Anopheles/*physiology ; Entomology/methods ; Feeding Behavior ; Female ; *Flight, Animal ; Fluorescent Dyes ; Korea ; Support, Non-U.S. Gov't ; Time Factors

Cutaneous Rosai-Dorfman disease (RDD) is a rare, benign condition mainly affecting the lymph nodes and sometimes involving the skin. RDD is notorious for its poor response to medication, and surgery is often the preferred treatment option for limited lesions. Herein, we present a case of cutaneous RDD in a 49-year-old woman with multiple facial nodules that showed minimal response to treatment with steroids, isotretinoin, and methotrexate.The diagnosis of cutaneous RDD was confirmed based on histopathological examination. The patient showed minimal response to medication; however, electrosurgery resulted in a relatively good cosmetic response. The present case demonstrates that electrosurgery can be an effective treatment option for cutaneous RDD, especially in case of patients with multiple lesions. The rarity of this disease and the limited reports on its management highlights the need for further research on the efficacy of different surgical modalities for cutaneous RDD.

OBJECTIVE: In order to elucidate the retrogressive degeneration of orofacial cleft, the fissured tissues of prenatal and postnatal cleft lip and palate were examined by histological and immunohistochemical methods. DESIGN: Totally 42 cases of prenatal (n=17) and postnatal (n=25) cleft lip and/or palate were examined in comparison with 10 cases of normal lip and oral mucosa using immunohistochemical stainings of MMP-3, MMP-9, MMP-10, cathepsin G, PCNA, E-cadherin, TGase 2, HSP-70, vWF, and VEGF. MAIN OUTCOME MEASURES: In the fissured tissue the sebaceous glands were strongly positive for PCNA and grew into the underlying fibromuscular tissue (24/42). Some hyperplastic sebaceous glands of prenatal cleft lip produced infundibular follicular cyst (9/17). The skin and mucosal epithelia from the postnatal cleft lip and palate (10/25) showed severe basal hyperplasia (11/25) and melanocyte infiltration (7/25). RESULTS: The immunostaining of MMP-3 and HSP-70 were strongly positive in the hyperplastic sebaceous glands and nearby atrophying muscle bundles of the fissured tissue, while MMP-9, MMP-10, and cathepsin G were almost negative. The immunoreactions of the other antibodies used in this study were similar between in the fissured tissues and in the normal controls. CONCLUSIONS: These data suggest that the over-expression of MMP-3 is closely related to the sebaceous gland hyperplasia, epithelial dysplasia, and the muscle degeneration, and that the over-expression of MMP-3 in the fissured tissue may continuously aggravate the cleft condition in the later life.
Adult ; Antibodies ; Cadherins ; Cathepsin G ; Cleft Lip* ; Follicular Cyst ; Humans ; Hyperplasia ; Lip ; Melanocytes ; Mouth Mucosa ; Outcome Assessment (Health Care) ; Palate* ; Proliferating Cell Nuclear Antigen ; Sebaceous Glands ; Skin ; Vascular Endothelial Growth Factor A

OBJECTIVE: Thrombotic thrombocytopenic purpura (TTP) is a disorder characterized by microangiopathic hemolytic anemia, thrombocytopenia, fluctuating neurological symptoms and a variable degree of impairment of renal function, which are thought to be due to endothelial cell injury, platelet activation and subsequent formation of thrombi in the microcirculaion. It usually occurs in adults but few reports are available on etiology, clinical manifestation, progression and the outcome of disease in Korea. METHODS: We investigated 10 adult patients who had admitted and were diagnosed as TTP in Department of Internal Medicine, Chungnam National University Hospital from Dec. 1994 to Jul. 2001. RESULTS: The male to female ratio was 1 : 4. The etiologic antecedants were infectious diarrhea in 3 patients, upper respiratory infection in 3 patients and pregnancy was related with TTP in 2 patents. The clinical manifestations were variable neurologic symptoms(100%), renal involvement(90%), hemorrhagic manifestations(80%), fever(60%), and diarrhea(40%). Acute renal failure was noted in 6 patients and hemodialysis was required in 5 patients. Plasma exchange was performed in 9 patients and corticosteroid was prescribed in 8 patients, simultaneously. Vincristine, azatioprine and cyclophosphamide were added in 2 patients. One patient died of hepatic failure. Seven patients showed complete recovery. One patient progressed to end-stage renal failure. The other patient showed multiple recurrences. CONCLUSION: It is thought that a considerable number of TTP patients show very serious acute renal failure and plasma exchange should be included in therapeutic modalities of TTP.
Acute Kidney Injury ; Adult* ; Anemia, Hemolytic ; Chungcheongnam-do ; Cyclophosphamide ; Diarrhea ; Endothelial Cells ; Female ; Humans ; Internal Medicine ; Kidney Failure, Chronic ; Korea ; Liver Failure ; Male ; Plasma Exchange ; Platelet Activation ; Pregnancy ; Purpura, Thrombotic Thrombocytopenic* ; Recurrence ; Renal Dialysis ; Thrombocytopenia ; Thrombotic Microangiopathies ; Vincristine