BACKGROUND: The aim of this study was to compare the efficacy of ketorolac, paracetamol, and paracetamol plus morphine on pain relief after thyroidectomy. METHODS: Eighty patients were randomly allocated to one of the 4 groups: normal saline (group C), ketorolac 30 mg (group K), paracetamol 1 g (group P), and paracetamol 700 mg plus morphine 3 mg (group PM). Each regimen was administered intravenously (IV) 30 min. before the end of surgery. If pain was not relieved, patients received an IV bolus of pethidine hydrochloride 25 mg. Pain intensity using a visual analogue scale (VAS) was recorded at 0.5, 1, 2, 4, and 6 hr after the end of surgery. RESULTS: VAS at 0.5 and 1 hr after the end of surgery were significantly lower in group K, group P, and group PM than in group C (P < 0.05). The number of patients receiving pethidine hydrochloride at 0.5 and 1 hr after the end of surgery was significantly lower in group K, group P, and group PM than in group C (P < 0.05). There was no significant difference among the groups in the incidences of adverse events associated with study medications and patient satisfaction (P > 0.05). CONCLUSIONS: Paracetamol 1 g IV possesses a similar analgesic efficacy to ketorolac 30 mg IV after thyroidectomy. Paracetamol may represent an alternative to ketorolac for pain prevention after mildly to moderately painful surgery in situations where the use of NSAIDs is unsuitable.
Acetaminophen ; Analgesics ; Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Incidence ; Ketorolac ; Meperidine ; Morphine ; Patient Satisfaction ; Thyroidectomy

Invasive carcinoma of the cervix during the pregnancy is relatively uncommon , It must be considered fetal viability, tumor control as well. If the carcinoma is diagnosed in the first or second trimester, treatment should be undertaken immediately. At the third trimester, treatment should be undertaken until the fetus is viable.
Cervix Uteri ; Female ; Fetal Viability ; Fetus ; Humans ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnancy* ; Uterine Cervical Neoplasms

Bipotent progenitors for T and natural killer (NK) lymphocytes are thought to exist among early precursor thymocytes or liver lymphocytes. The identification of such a progenitor population or mature NK cells in such organs remains undefined. Here we report the identification of a novel receptor of NK cells, p58 (HLA class I-specific inhibitory receptors), in fetal thymocytes and fetal liver lymphocytes. Our finding suggests the NK cells mature in the developmental stage during feta1 ontogeny. Flow cytometric analysis revealed p58 positive cells in thymocytes or in fetal liver lymphocytes and reverse transcription PCR also showed amplification of p58 RNA. The result of single stranded conformational polymorphism (SSCP) showed it discriminates one or two base pair differences of the p58 gene. Although the question still remains as to whether the expression of p58 is due to the NK cells or natural T cells, it is clear the p58 is expressed in fetal thymocytes or liver lymphocytes. And SSCP analysis using appropriate sets of primers used in this study, is helpful to study the diversity of p58.
Base Pairing ; Killer Cells, Natural ; Liver* ; Lymphocytes* ; Polymerase Chain Reaction ; Polymorphism, Single-Stranded Conformational ; Reverse Transcription ; RNA ; T-Lymphocytes ; Thymocytes*

BACKGROUND: Various hemodynamic changes occur during left ventriculography, such as myocardial depression, hypotension, peripheral circulatory changes, ECG changes(such as arrhythmias and conduction abnormalities) and anaphylactic reaction etc. These effects are somewhat caused by osmolality, ionic concentration of Na+, viscosity and molecular weight of contrast dye and underlying various heart disease itself during left ventriculography. We compared the hemodynamic differences between ionic(ioxaglate) and non-ionic(iopromide) low osmolar contrast agents during routine ventriculography. METHODS: In a prospective, randomized, double blind study of 124 patients underwent left ventriculography, we examined the various hemodynamic effects of the two contrast agents on left ventricle. All subjects were divided into 2 groups : ioxaglate and iopromide groups. Also, each agent was used in randomized double blind fashion in both groups ; normal control subjects(14 in ioxaglate group : 12 in iopromide group) and subjects whose ejection fraction less than 50%(12 in ioxaglate group : 16 in iopromide group). Left ventricular systolic pressure(LVSP), left ventricular end-diastolic pressure(LVEDP), maximum dP/dt, (dP/dt)/P ratio, peak - dP/dt and Tau were obtained immediately before and left ventriculography. RESULTS: 1) In total(normal+angina+MI) subjects of both groups, LVEDP(p<0.001) and maximum dP/dt(p<0.001) were increased and T(au) was reduced significantly(p<0.05). But LVSP(p<0.001) and peak - dP/dt(p<0.005) were increased significantly only in ioxaglate group. 2)In normal(control) subjects, there were no significant differences in both groups, except LVEDP that was increased by equal magnitude(p<0.001). 3) In subjects with ejection fraction less than 50%, there were no significant hemodynamic differences in both contrast agent groups bur LVEDP increased significantly in both groups(p<0.001). CONCLUSIONS: This present study showed that both ionic(ioxaglate) and non-ionic(iopromide) low osmolar contrast agents were very safe without any significant side effects except two agents caused an increase in LVEDP and did not show major differences between ioxaglate and iopromide contrast agents from a hemodynamic point of view. Two contrast agents tend to improve contractilities and diastolic properties of left ventricle since both caused an increase in maximum dP/dt and a reduce in Tau, in total subjects. This effect may be caused by cardiac compensation, probably because of osmolality, volume loading by contrast agents and secondary activation of sympathetic system immediately after injection of contrast agents. Thus, it is concluded that two ioxaglate and iopromide contrast agents amy be used safely in left ventriculography in patients with and without left ventricular dysfunction, with paying attention to an increase in LVEDP.
Anaphylaxis ; Arrhythmias, Cardiac ; Compensation and Redress ; Contrast Media* ; Depression ; Double-Blind Method ; Electrocardiography ; Heart Diseases ; Heart Ventricles ; Hemodynamics* ; Humans ; Hypotension ; Ioxaglic Acid ; Molecular Weight ; Osmolar Concentration ; Prospective Studies ; Ventricular Dysfunction, Left ; Viscosity

OBJECTIVE: This study was designed to evaluate the correlation of periventricular leukomalacia (PVL) on brain MRI and Denver II and Capute developmental test. METHOD: Thirty children with PVL on brain MRI showing delayed development were included. The severity of PVL was graded as localized/generalized lesion in three fields; periventricular hyperintensity in T2 weighted image (PVHI in T2WI), reduced volume of cerebral white matter (RV of CWM), ventriculomegaly with periventricular wall irregula rity (VM with PVWI). Development quotients were obtained by Denver II and Capute test, and assessed according to the severity of PVL. RESULTS: Although language, fine motor-adaptive, personal- social scale of Denver II and cognitive-adaptive and clinical linguistic and auditory milestone of Capute test had little correlation with severity of PVL, gross motor developmental scale assessed by Denver II had a certain degree of correlation with severity of PVL which was not significant statistically. The gross motor developmental scale of the nineteen preterm births had a significant correlation with VM with PVWI, but the other developmental scales still had no significant correlation with PVL. CONCLUSION: As for the children with delayed development the degree of motor development was a significant predictor of the PVL on brain MRI, but those of language and cognitive development were not.
Brain* ; Child ; Humans ; Infant, Newborn ; Leukomalacia, Periventricular* ; Linguistics ; Magnetic Resonance Imaging* ; Premature Birth ; Weights and Measures

Dupuytren's contracture is characterized by progressive fibroplasia and contracture of palmar fascia with resultant deformity of hands and fingers. Recently it has been shown that the cellular element, called myofibroblast, contributes significantly in the process of contracture. Among the 6 patients we have seen during the last few years, there was a total of 9 hands with Dupuytren's contracture. Seven of these were treated by a partial fasciectomy or by a dermofascietomy with a full thickness skin graft and the results of these two procedures were compared. Electron microsconic studies were done in 3 of the 6 patients and myofibroblasts were found in 2 of them.
Biopsy ; Clinical Study ; Congenital Abnormalities ; Contracture ; Dupuytren Contracture ; Fascia ; Fingers ; Hand ; Humans ; Myofibroblasts ; Skin ; Transplants

PURPOSE: The Korean society has moved rapidly toward becoming a multicultural society. This study aimed to estimate the seroprevalence of hepatitis viruses and investigate hepatitis B virus (HBV) genotypic diversity in female marriage immigrants. MATERIALS AND METHODS: Screening program was conducted at support centers for multicultural families in 21 administrative districts in Korea between July 2011 and January 2017. A total of 963 female marriage immigrants were included in this study. Blood samples were tested for hepatitis viral markers and HBV genotype. RESULTS: Subjects' median age was 33 years (20–40 years), and they originated from nine countries including Vietnam (n=422, 43.8%), China (n=311, 32.3%), the Philippines (n=85, 8.8%), Cambodia (n=58, 6.0%), and Japan (n=39, 4.0%). About 30% (n=288) of subjects required hepatitis A vaccination. HBsAg positive rate was 5.4% (n=52). Positive HBsAg results were the highest in subjects from Southeast Asia (6.6%, n=38). Anti-HBs positive rate was 60.4% (n=582). About 34% (n=329) of subjects who were negative for anti-HBs and HBsAg required HBV vaccinations. Genotypes B and C were found in 54.6% (n=12) and 45.4% (n=10) of the 22 subjects with HBV, in whom genotypes were tested. Eight (0.8%) subjects were positive for anti-HCV. Positive anti-HCV results were the highest in subjects from Central Asia (7.9%, n=3). CONCLUSION: Testing for hepatitis viral marker (hepatitis A virus IgG and HBsAg/anti-HBs) is needed for female marriage immigrants. Especially, HBV genotype B is different from genotype C of Koreans. Therefore, interest and attention to vaccination programs for female marriage immigrants are necessary for both clinicians and public health institutes.
Academies and Institutes ; Asia ; Asia, Southeastern ; Biomarkers ; Cambodia ; China ; Emigrants and Immigrants* ; Female* ; Genotype* ; Hepatitis A ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B* ; Hepatitis Viruses* ; Hepatitis* ; Humans ; Immunoglobulin G ; Japan ; Korea* ; Marriage* ; Mass Screening ; Philippines ; Prevalence ; Public Health ; Seroepidemiologic Studies ; Vaccination ; Vietnam

Metastatic spinal tumor may cause pain by direct tumor involvement of bone with activation of local nociceptors or compression of adjacent structures. As an adjunct to pharmacologic therapy, many patients benefit from the use of additional nerve blocks to treat cancer pain. However, they require repeated injections as nerve block under local anesthetic sometimes only give the patient temporary relief of pain. Recently, the advent of pulsed radiofrequency application has proved a successful treatment for refractory pain disorders. A 43 year-old man was presented with a constant, dull, aching pain in the posterior neck with radicular pain referred to right shoulder due to metastatic cervical spinal tumor. Right C5 and C6 medial branch nerve blocks, with local anesthetic-steroid injections were effective, but short pain relief for a couple of days. However, the pain relief lasted longer and was effective with pulsed radiofrequency application over 3 months.
Adult ; Humans ; Neck ; Neck Pain* ; Nerve Block ; Nociceptors ; Pain, Intractable ; Shoulder

Airway management is important during general anesthesia. Difficulties with a direct laryngoscopy can be managed successfully in a routine manner using a laryngeal mask airway. A 65-year-old woman was scheduled to undergo gynecologic surgery. After injecting the intravenous induction agents and muscle relaxants, intubation was attempted with a direct laryngoscope. However, the vocal cords could not be observed with only the epiglottis being slightly visible. Although intubation was re-attempted by another anesthesiologist, it failed. Intubation was successfully performed via an intubating laryngeal mask airway (ILMA) after additional 100% oxygen mask ventilation. We report a case of vocal cord palsy subsequent to tracheal extubation after endotracheal intubation via ILMA.
Aged ; Airway Extubation ; Airway Management ; Anesthesia, General ; Epiglottis ; Female ; Gynecologic Surgical Procedures ; Hoarseness ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks ; Laryngoscopes ; Laryngoscopy ; Masks ; Muscles ; Oxygen ; Ventilation ; Vocal Cord Paralysis ; Vocal Cords

Placenta accreta is a rare complication of pregnancy with high rates of maternal morbidity and mortality.It is usually discovered when removal of the placenta after delivery is difficult or there is substantial postpartum bleeding.Placenta accreta can be complicated by disseminated intravascular coagulation (DIC) and this increases maternal morbidity and mortality.DIC is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and midsize vessel.We report a 24-year-old woman with DIC, who developed severe pre- and intraoperative bleeding and massive transfusion during emergent cesarean section.
Dacarbazine ; Disseminated Intravascular Coagulation ; Female ; Fibrin ; Hemorrhage ; Humans ; Placenta ; Placenta Accreta ; Postpartum Period ; Pregnancy ; Young Adult