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

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

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.

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

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by non-infectious ulceration of the skin. It is associated with various systemic diseases, including Takayasu arteritis (TA), rheumatoid arthritis, and inflammatory bowel disease. Notably, the co-occurrence of PG and TA is more frequent among Asians. Here, we present a rare case of TA associated with PG. A 42-year-old woman presented with recurrent ulcers affecting her legs, trunk, arms, and face, which had been refractory to various treatments for 7 years. Recently, the patient had experienced weakness in her left leg, dizziness, and a fever that had persisted for more than a month. Computed tomography angiography revealed thickening and irregularities in the common carotid arteries, right subclavian artery, and aortic arch. TA was diagnosed, following which treatment was initiated with systemic corticosteroids. It is important to consider TA in patients with PG, particularly in young women.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by non-infectious ulceration of the skin. It is associated with various systemic diseases, including Takayasu arteritis (TA), rheumatoid arthritis, and inflammatory bowel disease. Notably, the co-occurrence of PG and TA is more frequent among Asians. Here, we present a rare case of TA associated with PG. A 42-year-old woman presented with recurrent ulcers affecting her legs, trunk, arms, and face, which had been refractory to various treatments for 7 years. Recently, the patient had experienced weakness in her left leg, dizziness, and a fever that had persisted for more than a month. Computed tomography angiography revealed thickening and irregularities in the common carotid arteries, right subclavian artery, and aortic arch. TA was diagnosed, following which treatment was initiated with systemic corticosteroids. It is important to consider TA in patients with PG, particularly in young women.