It has been known that more than 5% of cancer patients experience severe pain refractory to medical treatments. So it is necessary to use epidural or intrathecal analgesia with opioids and local anesthetics when systemic trial has failed. Although intrathecal catheter placement and drug infusion has some risks, it shows better pain control with least amount of analgesics. The authors managed a patient who had suffered from intractable cancer pain due to metastatic pancreatic cancer. His pain was spreading to his upper body area including chest wall and interscapular region as well as original abdomen and back pain. Pain severity became extreme reaching VAS (visual analogue scale) score to above 9. Cervical epidural catheterization and continuous drug infusion was not effective in this case. So the authors chose to give analgesics intrathecally, and placed the intrathecal catheter on 5th cervical vertebral level and connected it to subcutaneous port so that drugs could be infused continuously. The effect was dramatic by 5 mg/day morphine and 20 mg/day lidocaine, VAS score decreased to below 3 without any possible complications.
Abdomen ; Analgesia ; Analgesics ; Analgesics, Opioid ; Anesthetics, Local ; Back Pain ; Catheterization ; Catheters ; Humans ; Lidocaine ; Morphine ; Pain Management ; Pancreatic Neoplasms ; Thoracic Wall

PURPOSE: Doxylamine is commonly used for relief of insomnia; in addition, it is also a drug that is freguently used for intoxication in Korea. This drug is relatively safe; however, it is known to occasionally induce rhabdomyolysis. We have seen many cases of alcohol ingestion in doxylamine intoxications; however, few previous studies have documented the effects of alcohol on rhabdomyolysis. Therefore, the purpose of this study is to determine the effect of alcohol on rhabdomyolysis in doxylamine intoxicated patients. METHODS: This study was conducted on 91 patients admitted to an emergency department after doxylamine intoxication during the period from January 2001 to March 2012. Using the protocol developed beforehand, the amount of drug ingestion, past history, laboratory results, and whether or not alcohol was ingested were recorded. Rhabdomyolysis was defined as serum creatine kinase (CK) over 1,000 U/L. The SPSS package with logistic regression, t-test, and Fisher's test was used for analysis of data. RESULTS: Alcohol ingestion was detected in 52% of the study patients. The presence of hematuria and alcohol ingestion showed a significant association with development of rhabdomyolysis. CONCLUSION: Doxylamine intoxicated patients with alcohol ingestion may have a high rate of incidence of rhabdomyolysis. Therefore, doxylamine intoxicated patients who drink alcohol at the same time should be aware of rhabdomyolysis.
Creatine Kinase ; Doxylamine ; Eating ; Emergencies ; Hematuria ; Humans ; Incidence ; Korea ; Logistic Models ; Rhabdomyolysis

The purpose of this studs is to evaluate the Scientific soundness. reliability and harmfulness of medical information on world wide web in Korea. We focused this study just in "hepatitis" information, considering the high incidence of this disease in Korea. 689 web pages relating to hepatitis were collected by means of Lycos Korea search engine. and finally 182 web pages were selected. These 182 web paces were analyzed as category (western/oriental/folk medicine and as subject (prevention/diagnosis/treatment/others). Alter this analysis, these web paces were evaluated by investigators composed of two family physicians and one gastroenterologist. They analyzed the information on the criteria of "scientific soundness" "omission/ . exaggeration" and "harmfulness". The major results were as follows: 1. 133 web pages (73.3%) were scientifically sound. But the web pages relating to oriental and folk medicine revealed relatively low scientific soundness. compared with western medicine wet) pages. Also, the scientific soundness revealed low especially in the web pages that mainly described the treatment of hepatitis. 2. The web pages that had the omission of essential information was 9,3% . and those of the exaggeration" was 26% These results were related to the scientific soundness. The rate of the omission was relating high in the web pages related to the folk medicine (34.6% ), and the rate of exaggeration was remarkably high in die web pages related to the oriental medicine (89.5%), Both rates of the omission (20.9%) and exaggeration (67.2%) revealed especially high in the web pages that mainly described treatment of hepatitis. 3. The web pages that had the harmful information was also had the scientific unsoundness. The rate was high in the web pages related to the folk medicine, and the rate of web pages that had direct persuasion of harmful acting was as remarkably high in the oriental medicine. Also these rates were high in the web pages that mainly describe the treatment of hepatitis. This investigation showed that the large part of internet health information about `hepatitis in korea had the scientific soundness, but also revealed there were mails information that could give unhealthy influence to internet navigators it Korea. The most powerful element that could give unhealthy influence to internet navigators was lack of the scientific soundness, and this unhealthy information mainly revealed in the oriental or folk medicine web pages. especially in the treatment information.
Hepatitis* ; Humans ; Incidence ; Internet ; Korea* ; Medicine, East Asian Traditional ; Medicine, Traditional ; Persuasive Communication ; Physicians, Family ; Postal Service ; Research Personnel ; Search Engine

No abstract available.
Tendinopathy

A pulse oximeter is used widely on account of its convenience and very few complications. We experienced a case of accidental burning by a pulse oximeter sensor. An 83-year-old woman underwent total hip replacement surgery. A pulse oximeter (Oxisensor II N-25, Nellcor Puritan Bennett Inc., USA) was placed on the left index finger. The patient complained of pain on her index finger 5 minutes after the operation began. A localized skin burn was found underneath the sensor of the pulse oximeter. The skin burn healed without any sequelae.
Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Burns* ; Female ; Fingers ; Humans ; Skin*

Stellate ganglion block (SGB) is an effective method that is used by pain clinicians to treat patients who have pain in the head, neck and arm area. SGB acts mainly by increasing regional blood flow via peripheral vasodilation and decreasing pain sensation by reducing the afferent sensory signals of the sympathetic nervous system in the region. This patient had received more than 450 sessions of left SGB continually for the past 6 years to relieve her left-sided facial pain caused by facial trauma. Out of our curiosity, we tried to obtain some objective dermatological measurements like skin elasticity, water content, and hair follicle density on her scalp and we found that the values were different between the left side of her face and the right side of her face. Here, we report the results and we want pain clinicians to know that repeated SGBs may improve skin elasticity, water content in the skin, and increase the number of hair follicles on the scalp.
Arm ; Elasticity ; Exploratory Behavior ; Facial Pain ; Hair Follicle ; Head* ; Humans ; Methods ; Neck ; Regional Blood Flow ; Scalp ; Sensation ; Skin* ; Stellate Ganglion* ; Sympathetic Nervous System ; Vasodilation ; Water

Stellate ganglion block (SGB) is an effective method that is used by pain clinicians to treat patients who have pain in the head, neck and arm area. SGB acts mainly by increasing regional blood flow via peripheral vasodilation and decreasing pain sensation by reducing the afferent sensory signals of the sympathetic nervous system in the region. This patient had received more than 450 sessions of left SGB continually for the past 6 years to relieve her left-sided facial pain caused by facial trauma. Out of our curiosity, we tried to obtain some objective dermatological measurements like skin elasticity, water content, and hair follicle density on her scalp and we found that the values were different between the left side of her face and the right side of her face. Here, we report the results and we want pain clinicians to know that repeated SGBs may improve skin elasticity, water content in the skin, and increase the number of hair follicles on the scalp.
Arm ; Elasticity ; Exploratory Behavior ; Facial Pain ; Hair Follicle ; Head* ; Humans ; Methods ; Neck ; Regional Blood Flow ; Scalp ; Sensation ; Skin* ; Stellate Ganglion* ; Sympathetic Nervous System ; Vasodilation ; Water

BACKGROUND/AIMS: Gastric variceal bleeding is a severe complication of cirrhosis, and it has a high mortality rate. This study was conducted to evaluate the efficacy of n-butyl-2-cyanoacrylate injection therapy for patients suffering with gastric variceal bleeding. METHODS: A total of 86 patients diagnosed with gastric variceal bleeding underwent endoscopic n-butyl-2-cyanoacrylate (Histoacryl(R)) injection therapy at our department between April, 2002 and July, 2005, with a mean follow-up period of 44 weeks (range: 2 to 136 weeks). The initial hemostasis rate and the rebleeding rate of endoscopic sclerotherapy were analyzed. Also, the cumulative survival rate was analyzed according to the status of hepatocellular carcinoma and hyponatremia, the MELD score, the Child-Pugh score and the amount of injected Histoacryl(R). RESULTS: The initial hemostasis rate of Histoacryl(R) injection therapy was 93% and the 1 month rebleeding rate was 16.1%. The total number of session for treating the initial hemostasis was 1.2+/-0.4 and the total volume of Histoacryl(R) was 2.7+/-1.2 mL. The cumulative rebleeding-free rates for the patients treated by the Histoacryl(R) injection method at 1 month, 12 months and 34 months period were 95.1%, 83.2% and 74%, respectively. The cumulative survival rates were 78.3% at 1 month, 61.9% at 12 months and 54.6% at 34 months, respectively. No thromboembolic phenomenon occurred. According to the Cox's proportional hazards analysis, only the MELD score (<15) was an independent predicting factor for survival of the patients with gastric variceal bleeding. CONCLUSIONS: Endoscopic sclerotherapy using n-butyl-2-cyanoacrylate was a safe and effective hemostatic method for patients with gastric variceal bleeding. Also, the MELD score (<15) contributed to predicting survival of the patients with gastric variceal bleeding.
Adult ; Aged ; Aged, 80 and over ; Enbucrilate/*analogs & derivatives/therapeutic use ; Esophageal and Gastric Varices/*therapy ; Female ; Gastrointestinal Hemorrhage/mortality/*therapy ; Hemostasis, Endoscopic ; Humans ; Male ; Middle Aged ; *Sclerotherapy ; Survival Rate ; Treatment Outcome

BACKGROUND: Rheumatoid arthritis(RA) is a systemic disease not infrequently involing the heart. It has been known that pericardial effusion, most commonly observed cardiac abnormality in patients with RA, and other cardiac manifestations such as conduction disturbances, valve thickenings, and enlargement of left atrium or aorta are associated with RA. We have determined the nature and extent of cardiac manifestations of RA in comparison with those of control group by echocardiographic examination. METHOD: 27 patients with RA(4 males and 23 females, mean age=47 +/-13 years) and 22 control subjects(3 males and 19 females, mean age+43 +/- 11 years) were randomly selected. Standard two-dimensional, M-mode and doppler echocardiographic examination were done on each group of subjects. RESULTS: 1) Pericardial effusions were more commonly detectd in patients with RA than control group(55.6% vs 22.7%, p<0.01). There were no significant differences in the amount of pericardial effusion according to the duration and the stage of RA. 2) Thickness of each cardiac valve was thicker in patients with RA than control group. But, there were no statistical significance between them. 3) The left ventricular mass index(LVMI) and the diameter of aorta showed a trend to increase in patients with RA(109.5 +/-28.0 g/m(2) vs 94.2 +/-24.6 g/m(2), p=0.054). 4) The diameter of left atrium was more lager in patients with RA(35.1 +/- 4.0mm vs 31.6 +/- 4.5mm, p=o.005). 5) The E/A ratio of mitral valve was statistically significantly lower in patients with RA(RA:control=1.2 +/- 0.5 : 1.7 +/- 0.4, p=0.01). CONCLUSION: The asymptomatic patients with RA more frequently show cardiac abnormalities such as pericardial effusion, valve thickening, decrease of E/A ratio than control group. So two-dimensional echocardiography is necessary for early, noninvasive and accurate evaluation of asymptomatic cardiac abnormalities in patients with RA.
Aorta ; Arthritis, Rheumatoid ; Echocardiography ; Female ; Heart ; Heart Atria ; Heart Valves ; Humans ; Male ; Mitral Valve ; Pericardial Effusion

PURPOSE: The purpose of this study was to investigate the relationship between suicide risk factors and psychiatric disorders, and between suicide risk factors and suicide attempts after discharge, and to analyze the necessity of a psychiatrist referral in patients who intentionally ingested drug but did not make a suicide attempt. METHODS: Between January 1, 2004 and December 31, 2008, we investigated cases of intentional drug ingestion in patients greater than 15 years of age who visited Kyung Hee University emergency medical center. We divided the patients into two groups - a suicide attempt group and a non-suicide attempt group. The difference between suicide risk factors of the two groups was investigated prospectively. Among the risk factors for suicide, we determined whether psychiatric diagnosis was highly associated with suicide and whether it was an influential factor in suicide attempts after discharge. SPSS version 13.0 was used for statistical analysis. Chi-square, paired sample t-test, and Fisher's exact test were performed, and a p<0.05 was considered to be statistically significant. RESULTS: There were no significant differences in suicide risk factors between the two groups (p>0.05). Patients who did not attempt suicide who had a psychiatric history associated with suicide attempts, who had previous suicide attempts, who had a family history of suicide, and who lived alone, may have psychiatric disorders associated with suicide or suicide attempt after discharge (p<0.05). CONCLUSION: All patients who intentionally ingested drugs should be given a psychiatrist referral, even if the patients did not attempt suicide. In particular, the psychiatric referral should be made when the patient has risk factors such as a psychiatric history associated with suicide attempts, previous suicide attempts, a family history of suicide, and living alone.
Eating ; Emergencies ; Humans ; Intention ; Mental Disorders ; Prospective Studies ; Psychiatry ; Referral and Consultation ; Risk Factors ; Suicide