Neurilemmomas of the trachea are extremely rare. The most common site of them is the distal third of the trachea and the age of the patients at presentation varied from 6 to 78 years old. They usually have a freqeuntly very long natural history, causing symptoms only after they have attained a considerable size. We experienced a case of near-total obstruction of the trachea by an intraluminal sessile neurilemmoma. The patient was a 66-year-old man with 2-year history of progressive exertional dyspnea and had several episodes of pneumonitis associated with productive cough. Grossly, the tumor was a well-circumscribed mass. Microscopically, typical cellular Antoni A and myxoid Antoni B areas were revealed.
Aged ; Cough ; Dyspnea ; Humans ; Natural History ; Neurilemmoma* ; Pneumonia ; Trachea

BACKGROUND: Remifentanil is useful during general anesthesia because of its rapid onset and short acting time. However, some studies report that due to opioid-induced hyperalgesia (OIH) and tolerance, remifentanil also increases early postoperative pain. The occurrence of OIH and opioid-induced tolerance is mainly thought to be due to central sensitization by the activation of NMDA receptors. Therefore, we investigated the effects of continuous infusion of ketamine, an NMDA receptor antagonist, on postoperative pain and the quantity of opioids used. METHODS: 40 patients scheduled to undergo laparoscopic gynecologic surgery were randomly allocated into two groups. Anesthesia was equally maintained with sevoflurane and 4 ng/ml of remifentanil in all patients. Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 microl/kg/min in the ketamine group (n = 20) while the control group was injected and infused with an equal amount of normal saline. We compared postoperative VAS up to 7 hours and morphine demand through PCA. RESULTS: Postoperative VAS and morphine demand was significantly lower in the ketamine group 2 and 3 hours after surgery, respectively. CONCLUSIONS: When general anesthesia is maintained with sevoflurane and remifentanil in patients undergoing laparoscopic gynecologic surgery, continuous infusion of low dose ketamine decreased early postoperative pain and the quantity of opioids used.
Analgesics, Opioid ; Anesthesia ; Anesthesia, General ; Central Nervous System Sensitization ; Female ; Gynecologic Surgical Procedures ; Humans ; Hyperalgesia ; Ketamine ; Methyl Ethers ; Morphine ; N-Methylaspartate ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Piperidines ; Receptors, N-Methyl-D-Aspartate

BACKGROUND: Although the use of intravenous patient controlled analgesia (IVPCA) has been compared to the use of patient conrolled epidural analgesia (PCEA), there is no optimal administration route of alfentanil for the treatment of postoperative pain. This randomized double-blind study compared the efficacy of the use of IVPCA and PCEA for postoperative pain and the side effects after a total abdominal hysterectomy (TAH). METHODS: Sixty patients undergoing a TAH were randomly assigned to receive either IVPCA (Group I) or PCEA (Group E) for the infusion of alfentanil for postoperative pain control. In both groups, a loading dose of 750 microgram alfentanil was administered. All patients received the same continuous infusion rate (0.3 mg/h), bolus dose (0.15 mg), and lockout time (15 min). The incidence of side effects, the VAS (visual analog scale) of pain, blood pressure, and heart rate were checked for 20 hours after the loading dose injection. RESULTS: The VAS of pain was not significantly different between the two groups of patients. The onset of the analgesic effect was significantly more rapid in the Group I patients than in the Group E patients. There was no difference in side effects for either group. CONCLUSIONS: When considering multiple factors such as the onset of analgesia, technical difficulties or infection after the procedure, IVPCA using alfentanil is more useful than PCEA for postoperative pain control after a TAH.
Alfentanil* ; Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled* ; Blood Pressure ; Double-Blind Method ; Heart Rate ; Humans ; Hysterectomy* ; Incidence ; Pain, Postoperative

Multiple primary cancer for the colon and rectum was reported in numorous literature. Therefore, complete preoperative evaluation of patients presenting with colorectal cancer seems to be essential. In addition, it is fundamental that patients who have been treated for colorectal cancer require careful follow up evaluation. When symptoms and signs of tumor develop in a patient who has been treated for an initial colorectal cancer, the possibility of a localized and curable second, third primary cancer should be considered and evaluated. We report 2 cases of metchronous triple primary cancer with a review of literature.
Colon ; Colorectal Neoplasms ; Humans ; Rectum

Intramuscular stimulation (IMS) therapy has been used widely ever since Gunn introduced the effect of IMS in his study in 1980. Usually IMS has been based on Cannon's radiculopathic model, known for its effectiveness in chronic pain relief. In this study we systematically review the effectiveness and safety of IMS. In order to accomplish a systematic review, we searched for IMS-related studies through 12 bibliographical databases and 19 studies were included (4 randomized controlled trials (RCTs), 2 non-RCTs and 13 case reports/studies). Study selection was conducted independently by two researchers based on title and abstract. As a result, most included studies of 16 showed significant improvement in range of motion, decrease of drug consumption as well as pain relief after IMS treatment; the other 3 studies reported adverse events. In terms of the effectiveness of IMS, the results of intervention were good, so we concluded that IMS therapy is a useful method of pain treatment; with respect of safety, few adverse events that could have been caused by IMS were observed. However, it is not certain that there was a causal relationship between IMS and the adverse events that were reported due to a lack of evidence. Therefore, clinicians who have sufficient knowledge and experience of IMS will have to perform the procedure after thorough clinical examinations to determine its appropriateness for target patients. This study provided meaningful data on the current state of IMS treatment. We expect that the result of this study will stimulate further more extensive research on IMS.
Chronic Pain ; Humans ; Range of Motion, Articular

Although spontaneous bacterial peritonitis is a frequent complication in the childhood nephrotic syndrome, it is very rare in adults with nephrotic syndrome. It frequently develops when the patients are either in relapse or receiving steroid therapy at the time peritonitis is diagnosed. We report an unusual case of a spontaneous bacterial peritonitis as the presenting feature in a 15-year-old male patient with nephrotic syndrome. He presented with diffuse abdominal pain and distension for 15 days. Abdominal paracentesis revealed the diagnostic laboratory findings of peritonitis, and the bacterial culture of the ascites showed a mixed growth of Escherichia coli and Pseudomonas aeruzinosa. His serum albu- min level was 1.6gldL and the amount of 24 hours proteinuria was 21.0g/day. Although he was treated with adequate antibiotics for 3 weeks, the peritonitis was more aggravated. We decided to insert a catheter into the peritoneal cavity for continuous drainage of the intractable ascites. Two weeks after drainage, the peritonitis improved as the peritonitis subsided, the proteinuria disappeared completely without a steroid therapy. Six months after spontaneous remission, the proteinuria have recurred, and the kidney biopsy then showed focal segmental glomerulorsclerosis.
Abdominal Pain ; Adolescent ; Adult ; Anti-Bacterial Agents ; Ascites ; Biopsy ; Catheters ; Drainage ; Escherichia coli ; Humans ; Kidney ; Male ; Nephrotic Syndrome* ; Paracentesis ; Peritoneal Cavity ; Peritonitis* ; Proteinuria ; Pseudomonas ; Recurrence ; Remission, Spontaneous

To identify the role of the myocardial beta-adrenergic pathway in congestive heart failure, we examined beta-adrenergic receptor density and C-AMP by receptor assay with mononuclrear cell and polymorphonuclear cell in 7 cases of normal control and 7 cases of congestive heart failure. The results were as follows: 1)The mean serum concerntrations of norepinephrine(566.00+/-48.12 pg/ml)and epinephrine(353.14+/-44.24 pg/ml) in congestive heart failure group were significantly higher than those(218.12+/-17.08 pg/ml, 187.23+/-24.62 pg/ml)in normal contral group(P<0.05 for each comparison). 2) In normal control group, the receptor concentration of mononuclear cell was 35.51+/-19.19 fmol/mg and that of polymorphonuclrear cell was 35.53+/-15.05 fmol/mg. The affinity constant of mononuclear cell was(2.47+/-0.42)x10(9)/m and that of polymorphonuclear cell was(2.24+/-0.58)x10(9)/m. 3) In congestive heart failure group, the receptor concentration of mononuclear cell(29.31+/-5.41 fmol/mg) was significantly lower than that in normal control group(p<0.05). And the affinity constant(3.57+/-1.02)x10(9)/m) was significantly higher than that in normal control group(p<0.05). 4) In congestive heart failue group, the receptor concentration of polymorphonuclear cell(33.15+/-10.46 fmol/mg) was not significantly different from that in normal control group. And the affinity constant(2.66+/-0.43)x109/m) was not significantly different from that in normal control group. 5) In congestive heart failure group, the C-AMP concentrations of mononuclear cell(basal 119.9+/-17.2 pmol/min/mg, isoproterenol stimulation 137.2+/-23.2 pmol/min/mg) were significantly lower than those(basal 205.2+/-21.1 pmol/min/mg, isoproterenol stimulation 267.5+/-34.3 pmol/min/mg) in normal control group(p<0.05 for each comparison). 6) In congestive heart failure group, the C-AMP concentrations of polymorphonuclear cell(basal 115.2+/-34.3 pmol/min/mg, isoproterenol stimulation 142.5+/-20.5 pmol/min/mg) were significantly lower thatn those(basal 186.3+/-24.2 pmol/min/mg, isoproterenol stimulation 233.4+/-32.2 pmol/min/mg) in normal control group(P<0.05 for each comparison). In conclusion, a decrease in beta-adrenergic density in congestive heart failure leads to subsensitivity of the beta-adrenergic pathway and decreased beta-agonist-stimulated contraction. However, other factors may be important in adenylate cyclase activation, and so further research is needed.
Adenylyl Cyclases ; Estrogens, Conjugated (USP)* ; Heart ; Heart Failure* ; Isoproterenol ; Plasma*

OBJECTIVE: The aim of this study is to determine the treatment strategies for spinal neurogenic tumor involving nerve root and to evaluate the outcome after resection of the root. METHODS: The retrospective review of 76 cases of spinal cord tumors, operated between 1992-2001, was done. We underwent surgery for 22 cases of spinal neurogenic tumors with somatosensoty evoked potential monitoring. Resection of the affected nerve root was necessary in 15 cases for complete removal of the tumor. In six patients of these the resected nerve root was relevant for upper or lower limb function and five patients underwent end to end anastomosis. RESULTS: There were 12 men and 10 women and the mean age was 43 years. The tumors were located most frequently in the lumbar area(7 cases, 31.8%). The most common initial symptoms were radiating pain(18 cases, 81.8%) and mean duration of presentation was 39.3 weeks. In all cases, tumor was removed totally except one case of schawannoma which is dumbbell-shaped and huge extradural extension to retroperitoneal cavity. The postoperative outcomes on discharge were improved in 16 cases(72.7%). Among 15 cases of tumor resection together with involving nerve root, 13 cases(86.7%) were improved. All the cases performed end to end neural anastomosis were inproved. CONCLUSION: The results indicate that resection of the involved nerve root usually do not produce neurological deficit and complete removal of tumor with the involved nerve root is one of the appropriate and safe procedure. Also, end to end anastomosis of resected nerve root contribute to the chance of regeneration and functional recovery.
Evoked Potentials ; Female ; Humans ; Lower Extremity ; Male ; Regeneration ; Retrospective Studies ; Spinal Cord Neoplasms

In Korea, physicians of the public health sector have significantly contributed to health services such as prevention and treatment of disease. However, advances in the field of public health have not provided sufficient institutional strategies and systems for reinforcement of administrative capabilities and health services. As a result, the satisfaction of physicians working in community health centers has been decreasing and their advances in the field of public health have also decreased. This study was conducted to examine the work status, working conditions, and overall job satisfaction physicians in order to strengthen of the role of physicians who work in community health centers. The subjects of the study included 191 individuals. The data were analyzed by frequency analysis and descriptive analysis using SAS. It was found that among physicians working in a community health center, the overall degree of job satisfaction was satisfactory, at 52.2% of respondents. However, it was found that employment stability (81.3%), salary increases (78.8%), the abolition of new recruitment of managing physicians on the basis of temporary (5-year term) employment (75.4%), and the provision and support for education (71.2%) should be improved to increase the job satisfaction of physicians in the community health center. Regarding this, the physicians responded that the most important conditions for them to work in the community health center were actualization of salary (63.3%) and the change of job status from temporary to full-time employment (17.0%). In conclusion, we must increase the job satisfaction of physicians working in community health centers to improve the quality of the public health care system in Korea and systematically improve the personnel system, salary, administration, and job status to increase job satisfaction.
Community Health Centers ; Employment ; Health Services ; Job Satisfaction ; Korea ; Phenothiazines ; Public Health ; Reinforcement (Psychology) ; Salaries and Fringe Benefits ; Surveys and Questionnaires

Object : This study was conducted to evaluate the surgical results of the active treatment of unruptured intracranial aneurysms (UIAs) and to suggest treatment indications. METHODS: Operations were performed on 49 patients with 52 UIAs between 1999 and 2005. Medical records and radiologic studies of the patients with UIAs were retrospectively reviewed. The clinical outcomes were evaluated in each patient by the modified Glasgow Outcome Scale (m-GOS) one month after operation. RESULTS: UIAs had a high frequency of a middle cerebral artery (MCA) and an internal carotid artery (ICA) aneurysm. Forty-four UIAs (84.6%) ranged between 5 mm to 15 mm in diameter. Fortysix UIAs were treated by clipping, 2 by wrapping, and coil embolization was used in 3 UIAs. In one patient, which had only one UIA, one procedure and one operation was performed. There was no surgical mortality. In most patients, surgical complications or neurological deteriorations were not found. In three patients, minor neurological deficits of ptosis (2 patients) and spinal subdural hematoma (1 patient) were newly developed after operation. However the patients completely recovered within 3 months after operation. Finally, the surgical mortality and morbidity rate was 0%. CONCLUSION: If the UIAs are larger than 5 mm in diameter and located in a susceptible area for rupture, surgical treatment should be considered for the UIAs. If operation is performed by an expert neurosurgeon, surgical clipping is one of the best treatment modalities with or without endovascular treatment.
Aneurysm ; Carotid Artery, Internal ; Embolization, Therapeutic ; Glasgow Outcome Scale ; Hematoma, Subdural, Spinal ; Humans ; Intracranial Aneurysm* ; Medical Records ; Middle Cerebral Artery ; Mortality ; Retrospective Studies ; Rupture ; Surgical Instruments