BACKGROUND: Anticonvulsants and antidepressants are adjuvant analgesic drugs that are used widely for treating chronic neuropathic pain syndromes. The combined analgesic effect of gabapentin and milnacipran was investigated with a rat neuropathic pain model. METHODS: The rat neuropathic pain model was made by ligating the spinal nerves (L5 and L6). An intrathecal catheter was inserted into the subarachnoid space. Tactile allodynia was tested with the up-down method using von Frey hair. We determined the antiallodynic effect of intraperitoneal (I.P.) and intrathecal (I.T.) gabapentin. The combined effect of I.P. gabapentin (50 mg/kg) and milnacipran (0, 10 and 30 mg/kg) was investigated. RESULTS: Intraperitoneal and intrathecal administration of gabapentin increased the threshold for tactile allodynia (the ED50 was 60.6 mg/kg and 45.5microng, respectively). Co-administration of I.P. milnacipran increased the antiallodynic effect of I.P. gabapentin in a dose-dependent fashion. CONCLUSION: The combined administration of milnacipran and gabapentin may increase the total analgesic effect during treatment of neuropathic pain.
Analgesia ; Analgesics ; Animals ; Anticonvulsants ; Antidepressive Agents ; Catheters ; Hair ; Hyperalgesia ; Neuralgia* ; Rats* ; Spinal Nerves ; Subarachnoid Space

Intracranial epidermoid cysts usually show homogeneous hypodensity on CT scans, hypointensity on T1-weighted MR images and hyperintensity on T2-weighted MR images. Most of them arise in the cerebellopontine angle and parasellar areas. We report a case of middle cranial fossa epidermoid tumor with unusual image findings. The entire tumor mass showed inhomogeneous low density, without any enhancing solid portion on the CT scans. The lateral portion of the tumor showed homogeneous T1 low signal intensity and T2 high signal intensity. The medial portion of the tumor showed heterogeneous T1 and T2 intermediate to high signal intensity. On the gadolinium enhanced MR images, enhancement of the thickened dura was observed behind the tumor. Surgery and pathologic examination revealed the presence of an extradural epidermoid cyst.
Cerebellopontine Angle ; Cranial Fossa, Middle* ; Epidermal Cyst* ; Gadolinium ; Tomography, X-Ray Computed

OBJECTIVE: The National Early Warning Score (NEWS) is used widely to detect deteriorating patients in a range of clinical situations. This study examined the ability of the NEWS to predict poor outcomes in trauma patients. METHODS: This was a retrospective observational study using a dataset collected prospectively from trauma patients who visited the emergency department of a tertiary referral center in the southern area of the Republic of Korea. The area under the receiver operating curves (AUC) of the Revised Trauma Score (RTS) and NEWS were compared. The primary outcome was in-hospital mortality. RESULTS: Among 17,661 patients finally enrolled, 66.3% were male, and the median age was 49 (34-64). The AUC of the NEWS and RTS were 0.878 (95% confidence interval [CI], 0.873–0.883) and 0.827 (95% CI, 0.821–0.833) (AUC difference, 0.051; 95% CI, 0.025–0.077; P<0.01), respectively. The sensitivity and specificity of the NEWS were 74.0% and 91.2%, respectively, at a cutoff of four, and those of the RTS were 67.7% and 96.1%, respectively, at 7.55. CONCLUSION The NEWS showed better performance in predicting the in-hospital mortality of patients with trauma compared to the RTS.

Purpose: The association of the initial serum ammonia level with in-hospital mortality in patients with acute glufosinate-ammonium herbicide poisoning was studied. Methods: This retrospective cohort study was conducted between March 2012 and August 2019 in the emergency department after glufosinate-ammonium herbicide poisoning. Survivors and non-survivors were analyzed using a Mann-Whitney U test and Fisher’s exact test. Multivariate logistic regression analysis was performed to determine the independent risk factors for mortality. Results: One hundred and six patients were enrolled; 11 died, yielding a mortality of 10.4%. The serum bicarbonate level was significantly lower in the non-survival group than the survival group. Age, serum ammonia, blood urea nitrogen, creatinine levels, SOFA score, and APACHE II score were significantly higher in the non-survival group than the survival group. Age, serum ammonia, and creatinine level were independent risk factors for mortality in multivariate logistic regression analysis. Conclusion The initial serum ammonia level is associated with mortality in patients with acute glufosinate herbicide poisoning.

Purpose: The association of the initial serum ammonia level with in-hospital mortality in patients with acute glufosinate-ammonium herbicide poisoning was studied. Methods: This retrospective cohort study was conducted between March 2012 and August 2019 in the emergency department after glufosinate-ammonium herbicide poisoning. Survivors and non-survivors were analyzed using a Mann-Whitney U test and Fisher’s exact test. Multivariate logistic regression analysis was performed to determine the independent risk factors for mortality. Results: One hundred and six patients were enrolled; 11 died, yielding a mortality of 10.4%. The serum bicarbonate level was significantly lower in the non-survival group than the survival group. Age, serum ammonia, blood urea nitrogen, creatinine levels, SOFA score, and APACHE II score were significantly higher in the non-survival group than the survival group. Age, serum ammonia, and creatinine level were independent risk factors for mortality in multivariate logistic regression analysis. Conclusion The initial serum ammonia level is associated with mortality in patients with acute glufosinate herbicide poisoning.

BACKGROUND: Cardiopulmonary bypass(CPB) induces the productions of several inflammatory mediators that may be implicated in postoperative organ dysfunction, a problem to which the pediatric population is particularly prone. The purpose of this study was to determine if gene expressions of proinflammatory cytokines and chemokines were activated in plasma subjected to pediatric patients who underwent CPB for congenital heart diseases. MATERIAL AND METHOD: Blood was taken from the radial artery of eighteen pediatric patients after induction of anesthesia(baseline), immediately after CPB(0 hour), 2 hours, 24 hours, and 48 hours after CPB. The mRNA expressions of interleukin-1alpha (IL-1alpha ), Interleukin-1beta(IL-1beta), Interleukin-6 (IL-6), Interleukin-8(IL-8), Tumor necrosis factor-alpha (TNF-alpha ), Interleukin-15(IL-15), and Interferon-gamma(INF-gamma) were evaluated with semiquantitative reverse transcription-polymerase chain reaction(RT-PCR). IL-6 protein levels were measured in six patients by using enzyme-linked immunosorbent assay(ELISA.) RESULT: Systemic IL-6 mRNA and protein increased from baseline to a peak at 0 hour(239.5 pg/ml; p=0.01 versus baseline) and sustained at 2 hours before declining at 24 hours(82.7 pg/ml; p<0.05 versus 0hour). In IL-8 mRNA, there was a similar pattern but the increase was smaller than that of IL-6. IL-1 and IL-1 mRNA expressions peaked later(2 hours) from baseline, and declined by 48 hours. TNF- levels peaked at 24 hours, and declined by 48hours. There were no significant differences between before and after bypass were seen in IL-15 mRNA production. IFN- levels gradually decreased during the course of time. CONCLUSION: Gene expressions of IL-6, IL-8, IL-1alpha , IL-beta and TNF-alpha were changed significantly in plasma of pediatric patients who underwent CPB for congenital heart disease. IL-15 showed a different proinflammatory. response, and reverse responses were shown in IFN-gamma mRNA expression. These may result in high concentrations of proinflammatory cytokines and chemokines in the blood after CPB, contributing to the tissue injury.
Cardiopulmonary Bypass ; Chemokines* ; Cytokines* ; Gene Expression* ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Interleukin-1 ; Interleukin-15 ; Interleukin-1alpha ; Interleukin-6 ; Interleukin-8 ; Plasma ; Radial Artery ; RNA, Messenger ; Tumor Necrosis Factor-alpha

Colorectal cancer is the third most common cancer in Korea; it is the second most common cancer in men and the third most common in women. The incidence rate in Korea has continuously increased since 1999 when the National Cancer Registry statistics began. Currently; there are several screening modalities; that have been recommended by expert societies, including fecal occult blood test, colonoscopy, computed tomographic colonography The annual fecal immunochemical test (FIT) has been used in adults aged 50 and older as part of the National Cancer Screening Program in Korea since 2004. Although several study results from regional or national colorectal cancer screening programs in other countries have been reported, the National Cancer Screening Program in Korea has not yet been evaluated with evidence-based methods. Herein report the consensus statements on the National Screening Guideline for colorectal cancer developed by a multi-society expert committee in Korea, as follows: 1) We recommend annual or biennial FIT for screening for colorectal cancer in asymptomatic adults, beginning at 45 years of age and continuing until 80 years (recommendation B). 2) There is no evidence for the risks or benefits of FIT in adults older than 80 years (recommendation I). 3) Selective use of colonoscopy for colorectal cancer screening is recommended, taking into consideration individual preference and the risk of colorectal cancer (recommendation C). 4) There is no evidence for the risks or benefits of double-contrast barium enema for colorectal cancer screening in asymptomatic adults (recommendation I). 5) There is no evidence for the risks or benefits of computed tomographic colonography for colorectal cancer screening in asymptomatic adults (recommendation I).
Adult ; Barium ; Colonography, Computed Tomographic ; Colonoscopy ; Colorectal Neoplasms* ; Consensus ; Early Detection of Cancer ; Enema ; Female ; Humans ; Incidence ; Korea ; Male ; Mass Screening* ; Occult Blood