BACKGROUND: Rocuronium can cause pain on injection in awake patients. We compared the effect of ketamine at three different small doses (0.1 mg/kg, 0.2 mg/kg, 0.3 mg/kg) and saline (placebo) for reducing pain on injection in awake patients. METHODS: 80 patients (aged 19-63 yr) scheduled for elective surgery were randomized to four groups in double-blind manner. Patients received the study drug intravenously, with venous occlusion for 20 seconds, followed by rocuronium 0.6 mg/kg into the dorsal vein over 10 seconds. Patient's response torocuronium injection was graded by four-point verbal rating scale. RESULTS: The incidence of pain was significantly less in patients receiving ketamine 0.3 mg/kg (55%) than in patients receiving saline (85%)(P < 0.05). But, No difference was found between ketamine 0.1 mg/kg, 0.2 mg/kg and saline groups. The pain score was significantly less in patients receiving ketamine 0.2 mg/kg and 0.3 mg/kg than in patients receving saline (P < 0.05). CONCLUSIONS: We concluded that pretreatment of ketamine 0.3 mg/kg with venous occlu-sion for 20 seconds, effectively decreases the incidence of pain caused by rocuronium injection.
Humans ; Incidence ; Ketamine* ; Veins

The methanolic extract of fruiting body of Paecilomyces tenuipes DGUM 32001 showed significant cytotoxicity against human cancer cells: HepG2 and MCF-7. The methanolic extract was further fractionated with organic solvents such as chloroform and ethyl acetate in that order. Among the fractions tested, the ethyl acetate fraction showed the highest cytotoxicity against the carcinoma tested. The IC50 values of ethyl acetate fraction against HepG and MCF-7 were 40 and 9.6 microg/ml, respectively.
Chloroform ; Fruit ; Hep G2 Cells* ; Humans* ; Inhibitory Concentration 50 ; Methanol ; Paecilomyces* ; Solvents

No abstract available.
Ilizarov Technique*

PURPOSE: Phyllodes tumors (PTs) of the breast have been classified as benign, borderline, or malignant based on their histopathologic features. However, predicting clinical behavior based on these features has proven to be difficult given that local recurrence occurs in both benign and malignant PTs. Recurrence has been shown to mirror the histologic pattern of the primary tumor or to show dedifferentiation. The aim of this study was to assess the value of the histopathologic parameters, expression or mutation of c-Kit and platelet derived growth factor receptor alpha (PDGFRA) in predicting tumor recurrence. METHODS: Representative areas from 39 benign, 16 borderline, and 12 malignant PTs were selected for construction of tissue microarrays. Immunohistochemical analyses for p53, Ki-67, c-Kit, and PDGFRA were performed and SSCP-PCR analysis was carried out to identify mutations in exons 9, 11, 13, and 17 of the c-Kit gene and exons 12 and 18 of the PDGFRA gene. Clinicopathologic features, including tumor recurrence and margin status, were also evaluated. RESULTS: Of the 67 PTs, 11 cases (16.4%) recurred from 3 to 92 months following initial diagnosis (4 benign, 2 borderline, and 5 malignant). One benign PT case recurred as a borderline tumor and two borderline PT cases recurred as malignancies. Three patients died of malignant PT. No mutations of the c-Kit or PDGFRA genes were found and there was no statistically significant association of either p53 or p16 immunostaining with recurrent disease (p>0.05). However, histologic grade (p=0.033), margin status (p<0.001), Ki-67 (p=0.012), c-Kit (p=0.002), and PDGFRA (p=0.007) stromal immunopositivity were significantly correlated with recurrence. CONCLUSION: Even though positive or close margins were significantly associated with tumor recurrence, stromal c-Kit, PDGFRA positivity, and the Ki-67 index were useful for predicting recurrent PTs. Despite this, no c-Kit or PDGFRA mutations were found.
Breast ; Exons ; Humans ; Phyllodes Tumor ; Proto-Oncogene Proteins c-kit ; Receptors, Platelet-Derived Growth Factor ; Recurrence

Tuberous sclerosis is a rare disease, which occurs sporadically or hereditarily and is recognized by its neurological and dermatological manifestations and may be accompanied with renal anomalies. The classical triad is composed of seizure, mental retardation and adenoma sebaceum on face. We experienced two cases of tuberous sclerosis in sporadic forms by mutation without any familial history which suggests the diseases were occurred by mutation rather than by autosomal dominant inheritance. In the first case, a 24-year-female patient with hypertension and abnormal renal function tests which were noted on the routine prenatal check at 32 weeks of gestation delivered normally at 37 weeks. The daughter of patient had seizure when she was 6 years old and was diagnosed as polycystic kidney disease by abdominal computed tomography. This case developed sporadic form of disease without familial history but, the daughter of patient might inherited by autosomal dominant form. The patient's clinical feature was characterized by history of epilepsy, painless abdominal mass due to polycystic kidney disease, abnormal renal function, skin abnormalites including angiofibroma and shagreen patch. Abdominal computed tomography demonstrated numerous variable sized cysts throughout both kidney. In second case, the patient was a 32-year-female patient complaining of 5kg weight gain, abdominal distension due to palpable masses. Her clinical feature was characterized by bilateral huge renal angiomyolipoma with normal renal function and skin abnormality such as erythematous papule on the face. Abd CT and MRI revealed huge angiomyolipoma of about 15cm X 18.5cm X 30cm and 14.5cm X 18cm X 30cm respectively. We presented the two cases with brief review of the literatures.
Angiofibroma ; Angiomyolipoma ; Child ; Epilepsy ; Humans ; Hypertension ; Intellectual Disability ; Kidney ; Magnetic Resonance Imaging ; Nuclear Family ; Polycystic Kidney Diseases ; Pregnancy ; Rare Diseases ; Seizures ; Skin ; Skin Abnormalities ; Tuberous Sclerosis* ; Weight Gain ; Wills

PURPOSE: To know biomechanical differences in methods of limb lengthening between using monolateral external fixator and using external fixator over an intramedullary nail. MATERIALS AND METHODS: In acryl rods, saw-bone, and cadeveric bone, we created two lengthening models of using monolateral external fixator and using external fixator over an intramedullary nail. The axial compression test was done on the site of osteotomy for lengthening. To fix the models, half pins of 5 mm in diameter and nails of 9 mm in diameter were used. Using MTS (Material Test System) machine, we evaluated the differences of axial stiffness according to the presence of an intramedullary nail or the numbers of half-pins which were fixed at each side of osteotomy. RESULTS: Lengthening over an intramedullary nail, comparing to monolateral external fixator only, increased the axial stiffness by 1.1~1.2 times in acryl rods, 1.2~1.6 times in saw bones, and 15.6~15.9 times in cadeveric bones when the same numbers of half-pins were used. In saw bone and cadaveric bone, the group of two half pins in lengthening over an intramedullary nail was stiffer than the group of three pins in lengthening with monolateral external fixator. CONCLUSION: In the distraction of the limb, the addition of an intramedullary nail may increase the axial stiffness of the frame of monolateral external fixator. In lengthening over an intramedullary nail, it is enough to distract the bone with fixing two half pins at each sides of osteotomy.
Cadaver ; External Fixators* ; Extremities ; Osteotomy

PURPOSE: The results and complications of femoral lengthening over an intramedullary nail with a external fixator in patients with limb length discrepancy were retrospectively reviewed. MATERIALS AND METHODS: After lengthening 22 femoral segments, all patients were followed-up for a mean of 3.2 years (range, 2 to 5.2 years). They ranged in age from 13 to 35 years (average age, 22.2 years) at the time of the index procedure. The mean lengthening was 5 cm (2.7 to 8.1 cm), and the external fixator was removed after a median 135.9 days (range, 59 to 210 days). The mean external fixation index was 23.8 days/cm of lengthening (range, 11.1 to 34.7 days/cm of lengthening). RESULTS: Nineteen patients achieved the length of their pre-operative goal. However, there were 3 failures with osteomyelitis and the removal of the nail, which had a past history of infection or open trauma. There were 4 knee joint complications when the lengthening was over 20%. These included three cases of a patella subluxation and one case of a posterior knee subluxation. In the other complications, there was one case of a collapse in the lengthened segment with a breakage of the locking screws. CONCLUSION: Although lengthening over a nail can reduce the duration of external fixation, caution is needed in order to prevent complications.
External Fixators* ; Extremities ; Humans ; Knee ; Knee Joint ; Osteomyelitis ; Patella ; Retrospective Studies

Purpose: We investigated the association between social support, metabolic syndrome, and incident cardio-cerebrovascular disease (CCVD) in rural Koreans aged ≥50 years. Materials and Methods: We conducted a prospective study using the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population (KoGES-ARIRANG) dataset. From the baseline of 5169 adults, 1682 participants were finally included according to the exclusion criteria. For outcomes, myocardial infarction, angina, and stroke were included. For independent variables, the social support score and metabolic syndrome were used. Descriptive statistics and multivariate logistic regression were performed to investigate the association among the variables. Paired t-test was conducted to analyze the longitudinal variation of social support scores. Results: During the 6.37 years of median follow-up, 137 participants developed CCVD. The adjusted odds ratio (aOR) of metabolic syndrome with persistently high social support was 2.175 [95% confidence interval (CI): 1.479–3.119]. The aOR of metabolic syndrome with persistently low social support was 2.494 (95%CI: 1.141–5.452). The longitudinal variation of the social support score of persistently high social support group was increased significantly by 4.26±26.32. The score of the persistently low social support group was decreased by 1.34±16.87 with no statistical significance. Conclusion The presence of metabolic syndrome increases the likelihood of developing onset CCVD. Within the metabolic syndrome positive group, when social support was persistently low, the cohort developed more cardio-cerebrovascular disease compared to the persistently higher social support group. The social support score of the persistently low social support group could be improved through proper intervention. To prevent CCVD, metabolic syndrome components and low social support should be improved in the study participants.

BACKGROUND: Many epidemiologic studies have reported on the controversial concept of the obesity paradox. The presence of acute kidney injury (AKI) can accelerate energy-consuming processes, particularly in patients requiring continuous renal replacement therapy (CRRT). Thus, we aimed to investigate whether obesity can provide a survival benefit in this highly catabolic condition. METHODS: We conducted an observational study in 212 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014. The study end point was defined as death that occurred within 30 days after the initiation of CRRT. RESULTS: Patients were categorized into three groups according to tertiles of body mass index (BMI). During ≥30 days after the initiation of CRRT, 39 patients (57.4%) in the highest tertile died, as compared with 58 patients (78.4%) in the lowest tertile (P = 0.02). In a multivariable analysis adjusted for cofounding factors, the highest tertile of BMI was significantly associated with a decreased risk of death (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.37–0.87; P = 0.01). This significant association remained unaltered for 60-day (HR, 0.64; 95% CI, 0.43–0.94; P = 0.03) and 90-day mortality (HR, 0.66; 95% CI, 0.44–0.97; P = 0.03). CONCLUSION: This study showed that a higher BMI confer a survival benefit over a lower BMI in AKI patients undergoing CRRT.
Acute Kidney Injury* ; Body Mass Index* ; Epidemiologic Studies ; Humans ; Mortality* ; Obesity ; Observational Study ; Renal Replacement Therapy*

Barium sulfate is an inert material used as a radiographic contrast medium during upper gastrointestinal contrast studies for evaluation of patients with dysphagia. Oral barium aspiration is an uncommon but well-reported complication of this procedure. While barium aspiration of small amounts may not cause any symptoms, massive barium aspiration can be life-threatening, particularly in elderly patients with multiple comorbidities. In this case report, we describe an elderly patient with multiple comorbidities who presented with thyrotoxicosis and dysphagia, and then died after massive barium aspiration. Despite administration of intensive medical care with ventilator support and therapeutic bronchoalveolar lavage to remove the aspirated barium, the patient died of multiple organ failure 9 days after barium aspiration. Clinicians should pay attention to elderly patients with predisposing factors for aspiration in whom upper gastrointestinal barium contrast studies are indicated, and should consider other diagnostic tools for evaluation of dysphagia in this population.
Aged* ; Barium Sulfate* ; Barium* ; Bronchoalveolar Lavage ; Causality ; Comorbidity ; Deglutition Disorders* ; Humans ; Multiple Organ Failure ; Thyrotoxicosis ; Ventilators, Mechanical