PURPOSE: The evaluation of pain in neonates is difficult due to their limited means of communication. The aim of this study was to determine whether the behavioral reactions of facial action and cry provoked by an invasive pain-induced procedure could be discriminated from the reactions to a noninvasive pain-induced procedure in normal full-term neonates. METHODS: Thirty-six healthy full-term neonates received three pain-induced procedures in counterbalanced order:intramuscular injection, tactile stimulus, and rubbing thigh with alcohol. The facial actions to the pain-induced procedures were measured and analysed by Neonatal Facial Action Coding System (NFACS) and the cry measures were analysed by the speech analysis after recording. RESULTS: 1) A cluster of facial actions comprised of brow bulging, eye squeezing, deepening of nasolabial furrow and open mouth was associated most frequently with the invasive procedure and the total facial action was the highest score in intramuscular injection. 2) Acoustic analysis of cry showed the shortest latency to the first cry and the lonegst duration of the first cry in intramuscular injection. 3) Two variables, total facial action and duration of the first cry, were most statistically significant in discriminating the invasive pain-induced procedure from the noninvasve pain-induced procedure. CONCLUSION: The facial actions and cry responses to the invasive pain-induced procedure were significantly different from the responses to the noninvasive pain-induced procedure in healthy full-term neonates.
Acoustics ; Clinical Coding ; Humans ; Infant, Newborn ; Injections, Intramuscular ; Mouth ; Thigh

No abstract available.
Adult* ; Humans ; Neck*

Harlequin baby may represent the extreme form of lamellar ichthyosis or may be a distinct entity. It is inherited as an autosomal recessive trait, but it's cause is unknown, although the abnormalities of keratinization and epidermal lipid metabolism have been suggested. We recently experienced a case of harlequin baby in a male neonate who showed the typical skin appearance at birth. His skin was markedly thickened and cracked, and large horny plates were formed over the entire body. His face was disfigured, and the nose and ear were flattened by the thickened skin. The chemosis and severe ectropion obscured the orbits, and his lips were everted and gaping. The inelastic skin resulted in flexion of all joints, and hands and feet appeared fixed and ischemic. The pathologic findings of skin biopsy were compatible to the lamellar ichthyosis and his family history was nonspecific. We managed the patient with supportive care for his special skin lesion, along with the trial of retinoic acid. However, the treatment was withheld and the baby was discharged against medical advice as the parents wised, and the baby died 5 days after discharge.
Biopsy ; Ear ; Ectropion ; Foot ; Hand ; Humans ; Ichthyosis, Lamellar ; Infant, Newborn ; Joints ; Lip ; Lipid Metabolism ; Male ; Nose ; Orbit ; Parents ; Parturition ; Skin ; Tretinoin

Murine norovirus (MNV) is a non-enveloped virus with a positive-sense RNA genome and causes lethal infection in mice. MNV has been used as a model virus for human norovirus (NV) whose in vitro cell culture system has not been available to date since MNV and NV are genetically related. In this study, the genome replication of MNV was investigated using strand-specific RT-PCR in RAW264.7 cells. Reverse transcription (RT) using a sense primer followed by PCR showed that negative-sense RNAs were first detected in RAW264.7 cells between 6 and 9 [3 and 6] hours post infection (h.p.i.). However, these negative-sense RNAs were not detected when cells were treated with a translation inhibitor cycloheximide. Then, RT with an antisense primer followed by PCR was performed to detect positive-sense RNAs. RT-PCR results revealed that the amount of positive-sense RNAs began to increase from 9 [6] h.p.i., indicating the accumulation of the newly synthesized (+)RNA genome. Furthermore, cycloheximide abrogated the increase of newly made RNAs during MNV infection. In conclusion, strand-specific RT-PCR using a sense or antisense primer, in combination with cycloheximide treatment, enabled us to detect positive-sense and negative-sense RNAs selectively and provided a useful tool to understand the replication cycle of MNV.
Animals ; Cell Culture Techniques ; Cycloheximide ; Genome ; Humans ; Mice ; Norovirus ; Polymerase Chain Reaction ; Reverse Transcription ; RNA ; Viruses

OBJECTIVE: To evaluate the efficiency of carbon fiber composite frame and polyetheretherketone(PEEK) cages in the interbody fusion for surgical treatment of cervical disc diseases, we analyzed fusion time and subsidence rate. METHODS: From March 2004 to February 2007 fifty patients with cervical disc diseases underwent anterior discectomy and interbody fusion in 60 levels. The subjects were 26 men and 24 women with a mean age of 57.2 years ranging from 29 to 67. Among them 25 patients underwent operations using carbon fiber composite frame cages (Osta-Pek(R), Co-Ligne, Zurich, Switzerland) in 30 levels, and 25 patients using PEEK cages(Cornerstone(R), Medtronic, TN, USA) in 30 levels. The cages were packed with allograft bone or bone substitute(demineralised bone matrix). On lateral flexion-extension radiographs anterior disc height and posterior disc height were measured at preoperative time, postoperative 1, 3, 6 and 12 month respectively. Segmental stability(lordotic angle) was measured at postoperative 3, 6, and 12 months in all 60 levels for fusion time. RESULTS: The anterior disc height and posterior disc height were 4.87+/-1.36mm and 3.25+/-0.73mm at preoperative time, 7.32+/-1.41mm and 4.77+/-0.80mm at postoperative 1month, and 5.87+/-1.47mm and 3.22+/-0.93mm at posto- perative 12 months respectively in carbon fiber composite frame cage group(30 levels). The anterior disc height and posterior disc height were 4.88+/-1.18mm and 3.75+/-0.75mm at preoperative time, 7.26+/-1.17mm and 5.27+/-0.55mm at postoperative 1month, and 6.23+/-1.16mm and 3.96+/-0.69mm at postoperative 12months respectively in PEEK cage group(30 levels). The angular motion at the fused segment was measured in carbon fiber composite frame cage and PEEK group for segmental stability(two degrees or less flexion-extension range of motion at the fusion site). The carbon fiber composite frame cage group was stabilized between postoperative 3 months and 6 months, but PEEK cage group was stabilized between 6 months and 9 months. This result was statistically significant(p-value =0.003)(Fig. 2). Fusion rate of carbon composite frame cage group was 28%, 67% and 83% at 3, 6, 12 months after operation, and that of PEEK cage group was 24%, 48% and 86% at postoperative 3, 6 and 12 months respe- ctively. Complications included transient hoarseness, cage migration and subsidence. There was no persistent hoar- seness or Horner syndrome. We have observed severe subsidence(above 3mm) in two cases(6.7%) of carbon fiber composite frame cage group only. Anterior cage migration was shown in each one case(3.3%) of carbon fiber composite frame and PEEK cage group. CONCLUSION: The carbon fiber composite frame cage group showed a tendency of earlier fusion than PEEK cage group but both cages were same in the fusion rate at postoperative 1 year. But, restoration or maintenance of inter- vertebral height was much better in PEEK cage group than carbon fiber composite frame cage group. Subsidence rate was higher in carbon fiber cage group rather than PEEK cage group.
Carbon ; Diskectomy ; Female ; Hoarseness ; Horner Syndrome ; Humans ; Ketones ; Male ; Polyethylene Glycols ; Range of Motion, Articular ; Transplantation, Homologous

OBJECTIVE: The name of whiplash Injury derives from the etiopathogenic description of the sudden sharp whipping movement of the head and neck, symptoms are varied, manifesting as neck pain, occipital pain, dysesthesia, and weakness of arm, and so on. But there is no objective diagnostic tool for the evaluation of its symptoms. The purpose of the study is to visualize the symptomatic region before and after treatment and comparing the images obtained by infrared study. METHODS: From march 2006 to June 2008, 20 patients diagnosed as whiplash injuries were examined by digital infrared thermographic imaging system (DITI, DOREX, USA). The male-to-female ratio was 14:6 and their ages were ranging in age from 20 to 67 years, with mean age of 38.5 years. We evaluated thermal change (deltaT) in lesion area(neck and shoulder) and also compared thermal difference (deltaT (2wk-I)) after pre- & post- treatment. RESULTS: Initial DITI was 34.28 +/- 2.90 on anterior neck, 34.29 +/- 2.98 on posterior neck, 33.42 +/- 2.93 on right shoulder shoulder (Lt), and 33.59 +/- 2.81 on left shoulder. DITI after 2weeks treatment was 33.60 +/- 2.88 on anterior neck, 33.78 +/- 2.99 on posterior neck, 32.79 +/- 2.78 on right shoulder, and 33.05 +/- 2.74 on left shoulder. The thermal difference of lesional area on the initial treatment and after treatment (deltaT (2wk-I)) was 0.68 +/- 0.45 on anterior neck, 0.51 +/- 0.36 on posterior neck, 0.63 +/- 0.32 on right shoulder, and 0.54 +/- 0.64 on left shoulder, and these result were statistically significant (p < 0.05). Thermal difference (deltaT) was neck 0.34 and shoulder 0.33 on initial injury, and 0.39, 0.31 after 2 weeks respectively. This finding was symmetrical and below deltaT 0.5 based on pathologic body temperature. Initial VAS (Visual Analogue Scale) of Neck was 7.9 +/- 0.78 and after 2 weeks was 3.6 +/- 1.21 the initial VAS of shoulder was 7.4 +/- 0.52 and after 2 weeks was 3.2 +/- 0.97. There was statistically significant (p=0.001). CONCLUSION: Therefore DITI was perceived as a reliable tool in the objective assessment of treatment effect after sustaining whiplash injuries, in clinical practice.
Arm ; Body Temperature ; Head ; Humans ; Neck ; Neck Pain ; Paresthesia ; Shoulder ; Whiplash Injuries

Objective: To evaluate the radiographic characteristics of the ampulla of Vater cancer. Subjects and Methods:The authors analyzed retrospectively the US(n=25) and CT(n=15) findings in 25 cases of ampulla of Vater cancer, with emphasis on the potential of CT & US in regand to the detectibility of the mass. ERCP(n=15) and hypotonic duodenography(n=5) were also evaluated for the configuration of obstructed duct. RESULTS: The tumor was detected on sonography in only 12 cases(48%) as a small, relatively well delinated mass with slighty low echogenicity to the pancreas. The tumor was shown by CT in 8 cases(53% ) as a well delinated mass protruding into the second portion of duodenal lumen with slightly low attenuation to the pancreas. CBD was dilated in 25 cases(100%), but pancreatic duct was dilated in 15 cases(60%). Obstructed end of CBD was nipple shaped in 7 cases(47%), clubbed in 3, flat in 3, and indistict in 2 by ERCP. Hypotonic duodenogram showed irregular filling defect in the medial wall of second portion of the duodenum in 5 cases (100%). CONCLUSION: Mas detection rate crsing US or CT were not high in ampulla of Vater cancer. Except for a CT finding of a small mass protruding into the regional duodenal lumen, other finclings were nonspecific. Therefore, additional studies or more afgressive approach should be attempted for a correct diagnosis.
Ampulla of Vater* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Duodenum ; Nipples ; Pancreas ; Pancreatic Ducts ; Retrospective Studies

OBJECTIVE: The aim of this study is to evaluate of the significance of intraoperative electrophysiologic monitoring and follow up electrophysiologic study at seven days after microvascular decompression(MVD) for hemifacial spasm(HFS). METHODS: Thirty nine patients with hemifacial spasm were included in this study and were treated with MVD of the facial nerve from Jun 1990 to May 2001. The patients were divided into a monitoring group and a non-monitoring group. We compared the surgical outcomes, operation related complications between two groups. The abnormal muscle response(AMR) of preoperative electromyographic recording appeared on the mentalis muscle during stimulation of the zygomatic branch of the facial nerve was compared with those of changed during operation, immediately after operation and at postoperative 7th day(POD 7). The relationship between degree of AMR disappearance and surgical outcome was analyzed. RESULTS: There was no difference in surgical outcomes but significant difference in the incidence of operation-related complications between two groups. The results of electrophysiologic study at POD 7 were significantly correlated with surgical outcome in the monitoring group. CONCLUSION: The electrophysiologic study is helpful for identifying the offenders, determining the adequacy of vascular decompression and decrease of operation-related complications. The clinical and electrophysiologic status of HFS after MVD has continuously changed, and therefore the results of eletrophysiologic study at POD 7 are useful for predicting the surgical outcome.
Criminals ; Decompression ; Electromyography* ; Facial Nerve ; Follow-Up Studies* ; Hemifacial Spasm* ; Humans ; Incidence ; Microvascular Decompression Surgery*

BACKGROUND: Antihypertensive agents such as verapamil and esmolol are well known for their effects of hemodynamic stabilization on tracheal intubation. But hemodynamic discrepancies in these agents may result from different techniques of anesthetic induction. The aim of the present study was to compare and evaluate their efficacy in controlling hemodynamic responses to tracheal intubation under the different anesthetic induction agents. METHODS: Seventy-two patients, ASA physical status I or II, were randomly assigned to one of six groups (n = 12 each): a Thiopental-Saline (T-S) group and a Propofol-Saline (P-S) group in saline 10 ml; a Thiopental-Verapamil (T-V) group and a Propofol-Verapamil (P-V) group in verapamil 0.1 mg/kg; a Thiopental-Esmolol (T-E) group and a Propofol-Esmolol (P-E) group in esmolol 1 mg/kg according to the induction agents, thiopental or propofol. Anesthesia was induced with thiopental 5 mg/kg or propofol 2 mg/kg intravenous, respectively. Next, saline, verapamil and esmolol were administered as a bolus, and were immediately followed by succinylcholine 1.5 mg/kg. Tracheal intubation was carried out 60 s and 90 s after the intravenous injections of verapamil and esmolol, respectively. Systolic and diastolic blood pressure and heart rate were measured before induction and every minute for 5 minutes after tracheal intubation. RESULTS: There was a significant attenuation in systolic and diastolic arterial pressure after tracheal intubation in the verapamil groups compared to the esmolol groups. Heart rates were significantly lower in the esmolol groups than in the verapamil groups after tracheal intubation. CONCLUSIONS: Verapamil 0.1 mg/kg and esmolol 1 mg/kg attenuated increases in blood pressure and heart rate after tracheal intubation. The different anesthetic induction agents did not influence the hemodynamic effects of verapamil and esmolol on tracheal intubation.
Anesthesia ; Antihypertensive Agents ; Arterial Pressure ; Blood Pressure* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Injections, Intravenous ; Intubation* ; Propofol ; Succinylcholine ; Thiopental ; Verapamil*

BACKGROUND: Antihypertensive agents such as verapamil and esmolol are well known for their effects of hemodynamic stabilization on tracheal intubation. But hemodynamic discrepancies in these agents may result from different techniques of anesthetic induction. The aim of the present study was to compare and evaluate their efficacy in controlling hemodynamic responses to tracheal intubation under the different anesthetic induction agents. METHODS: Seventy-two patients, ASA physical status I or II, were randomly assigned to one of six groups (n = 12 each): a Thiopental-Saline (T-S) group and a Propofol-Saline (P-S) group in saline 10 ml; a Thiopental-Verapamil (T-V) group and a Propofol-Verapamil (P-V) group in verapamil 0.1 mg/kg; a Thiopental-Esmolol (T-E) group and a Propofol-Esmolol (P-E) group in esmolol 1 mg/kg according to the induction agents, thiopental or propofol. Anesthesia was induced with thiopental 5 mg/kg or propofol 2 mg/kg intravenous, respectively. Next, saline, verapamil and esmolol were administered as a bolus, and were immediately followed by succinylcholine 1.5 mg/kg. Tracheal intubation was carried out 60 s and 90 s after the intravenous injections of verapamil and esmolol, respectively. Systolic and diastolic blood pressure and heart rate were measured before induction and every minute for 5 minutes after tracheal intubation. RESULTS: There was a significant attenuation in systolic and diastolic arterial pressure after tracheal intubation in the verapamil groups compared to the esmolol groups. Heart rates were significantly lower in the esmolol groups than in the verapamil groups after tracheal intubation. CONCLUSIONS: Verapamil 0.1 mg/kg and esmolol 1 mg/kg attenuated increases in blood pressure and heart rate after tracheal intubation. The different anesthetic induction agents did not influence the hemodynamic effects of verapamil and esmolol on tracheal intubation.
Anesthesia ; Antihypertensive Agents ; Arterial Pressure ; Blood Pressure* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Injections, Intravenous ; Intubation* ; Propofol ; Succinylcholine ; Thiopental ; Verapamil*