PURPOSE: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly if the injury is associated with severe additional truncal lesions. The timing of repair is controversial when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair. This study's objective was to evaluate the appropriate method and the timing for treatment in cases of truncal abdominal injury associated with other abdominal lesions. Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital or were not associated with abdominal organ injury, were excluded. All patients involved were managed by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment method of repair, the overall complications, and the survival rate were collected and analyzed. RESULTS: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9 patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal on admission. Several weeks later, they were diagnosed as having a truncal arterial injury. CONCLUSION: In stable rupture of the truncal artery, initial conservative management is safe and allows management of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative to surgical repair, especially in patients considered to be a high risk for a conventional horacotomy.
Abdominal Injuries ; Academic Medical Centers ; Arteries ; Diaphragm ; Heart ; Hemorrhage ; Humans ; Kidney ; Liver ; Lung ; Medical Records ; Multiple Organ Failure ; Pancreas ; Pelvic Bones ; Rupture ; Spine ; Spleen ; Stents ; Survival Rate ; Transplants

Transurethral resection of the prostate (TURP) is a common procedure for managing benign prostatic hyperplasia (BPH), and this procedure is associated with low complication rates. Bladder perforation is an unusual complication of TURP, and it may create an air leak into the retroperitoneal space. Here we describe a case of pneumomediastinum, pneumoretroperitoneum and subcutaneous emphysema that were all due to a bladder perforation that occurred during performing TURP in a 74-year-old male patient with BPH.
Aged ; Humans ; Male ; Mediastinal Emphysema ; Prostate ; Prostatic Hyperplasia ; Retroperitoneal Space ; Retropneumoperitoneum ; Subcutaneous Emphysema ; Transurethral Resection of Prostate ; Urinary Bladder

OBJECTIVE: To investigate the rates and mean duration of symptom recurrence after repeated radiofrequency thermocoagulations of the lumbar medial branch nerves for facet joint syndrome. METHOD: Medical records of 284 patients who had consecutive radiofrequency thermocoagulations for facet joint syndrome were reviewed. Responses of repeated radiofrequency thermocoagulations were compared with the initial radiofrequency thermocoagulation for mean duration of symptom recurrence and visual analogue scale (VAS). RESULTS: Forty-one (14.4%) among the patients who had radiofrequency thermocoagulation for facet joint syndrome were treated with additional radiofrequency thermocoagulation because of symptom recurrence. Thirty-seven patients were treated twice and four patients were treated three times. The mean duration of symptom recurrence of these patients was 7.3 months (2.3~12.3 months). Reduction of the VAS pain scores were significantly lower after repeated radiofrequency thermocoagulations compared with initial radiofrequency thermocoagulation (p<0.05). CONCLUSION: With well-defined diagnostic criteria for facet joint syndrome and a meticulous technique of radiofrequency thermocoagulation, radiofrequency thermocoagulation would be a useful treatment modality for patients with facet joint syndrome.
Electrocoagulation ; Humans ; Medical Records ; Recurrence ; Zygapophyseal Joint

PURPOSE: Although growth hormone treatment is now widely used to treat some group of children with short stature, it is still expensive and many parents are seeking alternative therapies. We report the current status of alternative therapies for children visiting the 'growth clinic' in a single tertiary center. METHODS: Questionnaire about the usage of alternative therapy was used. Parents were asked whether they used alternative therapies and where they achieved the information. Also, they were asked whether the treatment was effective, and whether they would continue to use the alternative therapy. RESULTS: Two hundred and twenty nine children (127 boys, 102 girls) visiting the growth clinic in Dongsan Medical Center from February 2005 to January 2006 were analyzed. Their ages were between 6.1 years to 15.4 years (mean 10.4 years). Height Standard Deviation Score (SDS) were between -3.2 to 1.0 (mean -1.1). Twelve boys (9.4%) and 7 girls (6.9%) were more than zero in height SDS value. Among 145 children (63.3%) who used the alternative therapy, supplemental foods and oriental herbs were most widely used (43.3% each) followed by over-the-counter drugs. They attained the information most frequently from their neighbors followed by television, newspaper, and internet. More than half (57.9%) of the parents answered that the alternative therapies were not effective. However, 46.9% of the parents answered they would continuously use the therapy though it is ineffective. CONCLUSION: Many patients visiting the 'growth clinic' for short stature had experiences on the alternative therapies. Although these therapies seemed not quite effective, many parents answered that they would continue alternative therapy.
Child ; Complementary Therapies ; Growth Hormone ; Humans ; Internet ; Periodicals ; Nonprescription Drugs ; Parents ; Surveys and Questionnaires ; Television

BACKGROUND: Magnesium has been used for treatments and preventions of various situations, such as cardiovascular disease and pre-eclampsia. And it also used for decreasing demands of anesthetics and analgesics during anesthesia. Activity of autonomic nervous system has important roles for homeostasis of cardiovascular system, and its dysfunction affects mortality and morbidity. Because there are few reports about effects of magnesium infusion on autonomic nervous system, we investigated effects of magnesium infusion on hemodynamic and autonomic changes using variable autonomic function tests in healthy volunteers. METHODS: Hemodynamic parameters, heart rate variability, blood pressure variability, and baroreflex sensitivity were evaluated before and after magnesium infusion of 30 mg/kg during 20 min in twenty healthy volunteers. Cold face test, valsalva maneuver were also performed before and after magnesium infusion. RESULTS: Low-frequency components of blood pressure variability decreased after magnesium infusion (P = 0.026). There were no significant differences in blood pressure, heart rate, cardiac output, stroke volume, total peripheral resistance, heart rate variablility and baroreflex sensitivity between before and after magnesium infusion. Increases of diastolic blood pressure during cold face test decreased significantly after magnesium infusion (P = 0.022). In addition, no significant hemodynamic and autonomic changes were found during valsalva maneuver. CONCLUSIONS: Central sympathetic vasomotor tone decreased after magnesium infusion of 30 mg/kg during 20 min in healthy volunteers. However, it had no effects on parasympathetic system and baroreflex sensitivity.
Analgesics ; Anesthesia ; Anesthetics ; Autonomic Nervous System ; Baroreflex ; Blood Pressure ; Cardiac Output ; Cardiovascular Diseases ; Cardiovascular System ; Cold Temperature ; Heart Rate ; Hemodynamics ; Homeostasis ; Magnesium ; Pre-Eclampsia ; Stroke Volume ; Valsalva Maneuver ; Vascular Resistance

PURPOSE: Intravenous immunoglobulin (IVIG) is effective for the treatment of idiopathic thrombocytopenic purpura (ITP) in children. Recently, several reports have been published that show its impact on the absolute neutrophil count. The present study was performed to confirm these findings. METHODS: Data on 26 ITP patients were analyzed. Patients with febrile illness or increased C-reactive protein levels at presentation, which would influence the neutrophil counts, were excluded to determine the sole impact of IVIG. In addition, patients who received steroid treatment were also excluded. RESULTS: Sixteen boys and ten girls were analyzed. For patients who received an IVIG dose of 0.4 g/kg/day (n=17), the absolute neutrophil count (ANC) measured next day was significantly decreased. For patients who received an IVIG dose of 1 g/kg/day (n=9), the ANC measured the next day was also significantly decreased. However, the decrease was more profound in the high-dose group compared to the low-dose group. Among six cases with profoundly decreased ANC greater than 1,000/ mm3, four patients (67%) received IVIG at a dose of 1 g/kg/day. All four cases with increased ANC were treated with IVIG dose of 0.4 g/kg/day, and three cases (75%) among them had a febrile reaction during IVIG administration. None of the cases with decreased ANC had a febrile reaction. No cases had infectious complications reported. CONCLUSION: IVIG treatment for ITP patients appears to suppress the ANC. This decrease of ANC was more pronounced when a higher dose of IVIG was used. Some cases with increased ANC counts after IVIG use were found only in low-dose IVIG group, and was associated with febrile reactions during IVIG use.
C-Reactive Protein ; Child* ; Female ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Neutrophils* ; Purpura, Thrombocytopenic, Idiopathic*

BACKGROUND: Thalidomide has been reported to have antitumor activity for treating metastatic hepatocellular carcinoma (HCC). We evaluated the safety and efficacy of using thalidomide for treating selected patients with unresectable or metastatic HCC, and their disease was refractory to systemic chemotherapy. METHODS: Eight patients with measurable and metastatic HCC that had progressed with prior systemic chemotherapy and who desired further active therapy were enrolled in this study. Thalidomide was given orally at bedtime and it was started at 200 mg/day with no further dose escalation. The response was measured at 2-month intervals. RESULTS: The median age was 44 years (range: 34-52 years) and all the patients had received doxorubicin-based systemic chemotherapy prior to their enrollment. Each patient received thalidomide for a median of 152 days (range: 5-422 days). One partial response was observed (12.5%, 95% CI; 0-42%) along with 4 cases of stable diseases. The most commonly encountered toxicity was somnolence; grade 3 somnolence was noted for one patient, which led to treatment discontinuation. Skin rash was observed in one responding patient. CONCLUSIONS: The results indicate that thalidomide may feasibly offer disease stabilization to metastatic HCC patients. Further dose escalation of thalidomide, or its combination with other chemotherapeutic agents, may be of interest and this should be investigated for treating patients with metastatic HCC.
Treatment Outcome ; Thalidomide/*therapeutic use ; Retrospective Studies ; Pilot Projects ; Middle Aged ; Male ; Lymphatic Metastasis ; Lung Neoplasms/drug therapy/*secondary ; Liver Neoplasms/*drug therapy/pathology ; Immunosuppressive Agents/*therapeutic use ; Humans ; Follow-Up Studies ; Female ; Carcinoma, Hepatocellular/*drug therapy/secondary ; Bone Neoplasms/drug therapy/*secondary ; Adult

OBJECTIVE: The purpose of this retrospective study was to evaluate the incidence of deep vein thrombosis (DVT) in spinal cord injury (SCI). METHOD: We analyzed the incidence of DVT and factors that alter its risk in 263 SCI patients. The injury status of each SCI subject was categorized as either motor complete or motor incomplete and either quadriplegic or paraplegic. The cause of injury was categorized as either traumatic or nontraumatic. Duplex ultrasound was performed in the clinically DVT suspected patients. No patient had been started on anticoagulant prophylaxis prior to diagnosis of DVT. RESULTS: Fifteen patients (5.7%) had a diagnosed DVT and one patient (0.4%) had a diagnosed pulmonary embolism. Motor complete lesion and quadriplegic status were better predictors of DVT than motor incomplete lesion and paraplegic status. Cause of injury and existence of spasticity were not statistically correlated with the incidence of DVT. Accuracy of clinical diagnosis was 45.4%. All cases of the diagnosed DVT was located proximal veins (iliac and femoral veins). Ten of 15 DVTs (66.6%) were detected earlier than 2 months after SCI. CONCLUSION: Incidence of DVT in SCI patients were 5.7%. Motor complete lesion and quadriplegic status were suggested as significant predictors of DVT in SCI patients.
Diagnosis ; Humans ; Incidence* ; Muscle Spasticity ; Pulmonary Embolism ; Retrospective Studies ; Spinal Cord Injuries* ; Spinal Cord* ; Ultrasonography ; Veins ; Venous Thrombosis*

BACKGROUND: Although the efficacy of morphine in a neuropathic pain state is somewhat controversial, spinally administered morphine reversed the tactile allodynia in a previous animal study. Using a behaviorial test, we examined the involvement of serotonergic and adenosine receptors in the mechanism of the antiallodynic action of the intrathecal morphine by injection of serotonergic and adenosine antagonist in a rat model of neuropathic pain induced by a spinal nerve ligation. METHODS: Male Sprague-Dawley rats were prepared with a tight ligation of the left lumbar 5th and 6th spinal nerve and a chronic lumbar intrathecal catheter implantation. Morphine 1 microgram was administered intrathecally to attenuate the tactile allodynia. Methysergide 10 microgram and 30 microgram, theophylline 20 microgram was administered intrathecally before and after the injection of morphine in order to investigate the reversal of an increased allodynic threshold by morphine. The allodynic thresholds for the left hindpaw withdrawl to von Frey hairs were assessed and converted to %MPE. RESULTS: The tactile allodynic threshold was significantly increased by 1 microgram of intrathecal morphine (P < 0.05). Methysergide 10 microgram and 30 microgram, but not theophylline 20 microgram, reversed significantly the antiallodynic effect of intrathecal morphine in pre- and post-treatment (P < 0.05). CONCLUSIONS: The results suggested that the mechanism of tactile antiallodynia induced by intrathecal morphine appears to be mediated by serotonin receptor system at the spinal level in the rat model of spinal nerve ligation.
Adenosine ; Animals ; Catheters ; Hair ; Humans ; Hyperalgesia ; Ligation* ; Male ; Methysergide* ; Models, Animal ; Morphine* ; Neuralgia* ; Rats, Sprague-Dawley ; Receptors, Purinergic P1 ; Serotonin ; Spinal Nerves* ; Theophylline*

Aneurysm of the sinus of Valsalva on mostly congenital disease that develops more frequently in Orientals, is very low in incidence. In most cases, aneurysm of the sinus of Valsalva extends to intracardiac and results in ruptures into the right ventricle or atrium. The likelihood of extracardiac aneurysm of the sinus of Valsalva is very low. Cases of extracardiac aneurysm are usually accompanied by aortic regurgitation and can cause right ventricle outflow tract obstruction, myocardial ischemia, and myocardial infarction due to compression by aneurysm. Since the aneurysm can rupture in the intrapericardium and cause cardiogenic shock or sudden death, definite diagnosis and management are important. If confirmed, it is preferable operform a surgical correction. We report here, with a literature review, a case where myocardial ischemia and aortic egurgitation caused by aneurysm developed in the left coronary and noncoronary sinus, and were surgically corrected with satisfactory esults.
Aneurysm* ; Aortic Valve Insufficiency ; Death, Sudden ; Diagnosis ; Heart Ventricles ; Incidence ; Myocardial Infarction ; Myocardial Ischemia ; Rupture ; Shock, Cardiogenic ; Sinus of Valsalva*