No abstract available.
Amniotic Fluid* ; Female ; Meconium*

Free vascularized tissue transfer to preserve upper extremity amputation level is uncommon but very useful procedure. To cover the below-elbow amputee stump and restore the function of the elbow, we have used a free flap as a spare part concept from the contralateral hand which was so severely damaged that amputation was inevitable.
Amputation ; Amputees* ; Elbow* ; Forearm* ; Free Tissue Flaps ; Hand ; Humans ; Upper Extremity

No abstract available.
Polymerase Chain Reaction*

BACKGROUND: Methotrexate (MTX) is an antifolate antagonist that is widely used for treating various malignancies and non-malignant diseases. MTX levels should be monitored when used in high concentration to determine when to start leucovorin rescue. In this study, we evaluated the analytical performance of the EMIT Methotrexate Assay on a 200FR NEO Chemistry Analyzer (Toshiba Medical System Co., Japan) and compared it with Viva-E Drug Testing System (Siemens Healthcare, Germany). METHODS: According to the Clinical Laboratory and Standards Institute (CLSI) Evaluation Protocol (EP) 5-A2, three concentrations of the Liquichek Therapeutic Drug Monitoring Control (Bio-Rad Laboratories, USA) were analyzed twice a day for 20 days to monitor assay precision. The 200FR NEO and Viva-E instruments were compared using 40 patients' sera, according to CLSI EP9-A2. The linearity and carry-over rate were also evaluated. RESULTS: Between-run CVs for low-, medium-, and high-level controls were 4.9%, 0.9%, and 2.0%, respectively, whereas between-day CVs for low-, medium-, and high-level controls were 8.1%, 1.3%, and 3.5%, respectively. In the linearity test, the coefficient of determination (R2) was 0.98 (0.06-1.92 micromol/L). In the comparison study, R2 was 0.955, showing good correlation between the 200FR NEO and Viva-E instruments. The carry-over rate was 0.9%. CONCLUSIONS: The EMIT assay showed good precision, linearity, and carry-over rate on the Toshiba 200FR. An excellent correlation was observed when comparing results obtained using the Toshiba and Viva-E instruments. In conclusion, the Syva EMIT MTX assay can be readily used for MTX monitoring on the Toshiba 200FR NEO.
Chemistry ; Delivery of Health Care ; Drug Monitoring ; Leucovorin ; Methotrexate*

Chest pain is a symptom observed commonly in outpatients and emergency room patients, and its causes are variable. Because treatment and prognosis of chest pain are different depending on its cause, it is more important than anything else to accurately diagnose the cause of chest pain. Most of patients complaining of chest pain undergo basic tests at a private local clinic or at the Internal medicine or chest surgery department of a general hospital and, they are referred to the pain clinic, with a note stating no particular finding. However, if they have sustained severe neuropathic pain in spite of nerve block, accurate diagnosis for chest pain is essential. We experienced rapidly developing spine breakdown and cord compression caused by metastatic spinal tumor in an inpatient who was being treated for chest pain, and thus, we report here in the case with literature review.
Chest Pain ; Emergencies ; Hospitals, General ; Humans ; Inpatients ; Internal Medicine ; Nerve Block ; Neuralgia ; Outpatients ; Pain Clinics ; Prognosis ; Spine ; Thorax

PURPOSE: Chronic administration of anticonvulsants for children with epilepsy may cause multiple abnormalities in bone metabolism. The aim of this study was to evaluate the effects of anticonvulsants on bone mineral density(BMD) in children with epilepsy. METHODS: Seventy patients with epilepsy were enrolled in this study. All subjects had taken anticonvulsants for at least 1 year or more. Subjects were classified into three groups according to age(5-7 yrs, 8-11 yrs, >12 yrs). BMD was measured by Dual-energy X-ray Absorptiometry(DXA) on the lumbar spine and whole body. Statistical analysis for BMD of anticonvulsants-treated subjects were compared to results with the published data. RESULTS: BMD was significantly decreased in the anticonvulsants-treated group as compared with the control group of all age groups(P<0.05). But BMD among groups according to anticonvulsants was not significantly different(P>0.05). CONCLUSION: Because chronic administration of anticonvulsants for growing children leads to a decrease in BMD, early detection and management of abnormal BMD is important in monitoring of children with epilepsy.
Child ; Male ; Female ; Humans

This report describes the perioperative management of an adrenergic crisis and intraoperative pulmonary edema occurring during planned surgery for pheochromocytoma. We experienced the anesthetic management of a 45-year-old male patient with pheochromocytoma on the extra-adrenal retroperitoneum. The patient had been treated with prazosin for only 1 week before surgery. After inducing anesthesia with intravenous remifentanil, thiopental sodium, and rocuronium, anesthesia was maintained with nitrous oxide, oxygen, and isoflurane administration. The blood pressure was poorly controlled with sodium nitroprusside, esmolol, and remifentanil after manipulating the tumor. Pulmonary edema occurred intraoperatively but subsided with positive end expiratory pressure and the use of diuretics and morphine. After removing the tumor, the blood pressure was well controlled using a colloid solution, Hartman's solution, and dopamine administration. This complication occurred because of inadequate preoperative preparation. We reported this case of surgery for the removal of a pheochromocytoma with a review of the relevant literature.
Anesthesia ; Blood Pressure ; Colloids ; Diuretics ; Dopamine ; Humans ; Isoflurane ; Male ; Middle Aged ; Morphine ; Nitroprusside ; Nitrous Oxide ; Oxygen ; Pheochromocytoma* ; Positive-Pressure Respiration ; Prazosin ; Pulmonary Edema* ; Thiopental

PURPOSE: To analyze the clinical features of peripheral neuropathy in Korean children. METHODS: A total of 62 children with acute flaccid paralysis, longstanding weakness of extremities, or abnormal electrophysiological studies, suggestive of peripheral neuropathy, were evaluated retrospectively from the hospital records. The subjects were recruited at the pediatric neurology and endocrine clinic, Kyungpook National University Hospital from 2000 to 2002 and they all went through neurological examination and electrophysiological studies with or without nerve biopsy. RESULTS: Thirty nine children(Male 24:Female 15; Mean age 7.6+/-4.3 years) were found to have clinical peripheral neuropathy. Inflammatory neuropathy(5 children with Guillain Barre syndrome, 1 children with chronic inflammatory demyelinating polyneuropathy, 12 children with Bell's palsy; 46%) was the most common, followed by hereditary neuropathy(4 children, 10%), Chemotherapy induced neuropathy(3 children, 8%), metachromatic leukodystrophy(2 children, 5%), trauma(2 children, 5%), diabetic neuropathy(1 children, 3%) and so on. Thirty two children had motor neuropathy(82%), six children had combined motor and sensory neuropathy(15%), two had pure sensory(5%), but nobody had autonomic neuropathy. With respect to the type of involvement, polyneuropathies constitute 59%(23 children), mononeuropathy simplex accounted for 38%(15 children), mononeuropathy multiplex was found in 3%(1 child). Based on electrophysiological studies and biopsy results, demyelinating neuropathy was seen in 22 children(56%), axonal neuropathy in 12 children(31%), combined neuropathy in 5 children(13%). Eighteen children(46%) were completely or almost completely recovered from the illness. CONCLUSION: Inflammatory neuropathy was the most common among the acquired neuropathies and hereditary motor sensory neuropathy was the most common among the genetic neuropathies. Treatable neuropathies took up 46%. Potentially preventable neuropathies accounted for 36%. Early diagnosis and early intervention may have significant impacts on the prognosis of peripheral neuropathy in children.
Axons ; Bell Palsy ; Biopsy ; Child* ; Drug Therapy ; Early Diagnosis ; Early Intervention (Education) ; Extremities ; Guillain-Barre Syndrome ; Gyeongsangbuk-do ; Hospital Records ; Humans ; Mononeuropathies ; Neurologic Examination ; Neurology ; Paralysis ; Peripheral Nervous System Diseases* ; Polyneuropathies ; Prognosis ; Retrospective Studies

Spondylolysis, also known as stress injury of pars interarticularis, is a common cause of back pain in athletes, particularly children and young adults. Repeated minor traumas during flexion and extension of the spine are thought to result in bony failure due to excessive bone resorption. These lesions are common in the low back, with the majority found at the L5 vertebra. In the majority of cases of spondylolysis, non-operative treatments are recommended, such as NSAIDs, physiotherapy and bracing. Only if symptoms do not respond to conservative treatments should surgical intervention be considered. Recently, pars interarticularis injections for diagnostic and therapeutic purposes have been found to allow significant pain relief from spondylolysis for long periods. Here, the case of a 57-year-old man with spondylolysis, who suffered from back pain, which was not relieved by an epidural steroid injection, but in whom pars interarticularis injections of local anesthetic and steroid induced complete transient pain relief, following by moderate long-term relief, is presented.
Anti-Inflammatory Agents, Non-Steroidal ; Athletes ; Back Pain ; Bone Resorption ; Braces ; Child ; Humans ; Middle Aged ; Spine ; Spondylolysis* ; Young Adult

OBJECTIVE: Gamma knife radiosurgery (GKRS) is the least invasive surgical option for patients with trigeminal neuralgia (TN). However, the indications and long term outcomes of GKRS are still controversial. Additionally, a series with uniform long-term follow-up data for all patients has been lacking. In the present study, the authors analyzed long-term outcomes in a series of patients with TN who underwent a single GKRS treatment followed by a minimum follow-up of 60 months. METHODS: From 1994 to 2009, 40 consecutive patients with typical, intractable TN received GKRS. Among these, 22 patients were followed for >60 months. The mean maximum radiation dose was 77.1 Gy (65.2-83.6 Gy), and the 4 mm collimator was used to target the radiation to the root entry zone. RESULTS: The mean age was 61.5 years (25-84 years). The mean follow-up period was 92.2 months (60-144 months). According to the pain intensity scale in the last follow-up, 6 cases were grades I-II (pain-free with or without medication; 27.3%) and 7 cases were grade IV-V (<50% pain relief with medication or no pain relief; 31.8%). There was 1 case (facial dysesthesia) with post-operative complications (4.54%). CONCLUSION: The long-term results of GKRS for TN are not as satisfactory as those of microvascular decompression and other conventional modalities, but GKRS is a safe, effective and minimally invasive technique which might be considered a first-line therapy for a limited group of patients for whom a more invasive kind of treatment is unsuitable.
Follow-Up Studies ; Humans ; Microvascular Decompression Surgery ; Radiosurgery ; Trigeminal Neuralgia