Postherpetic neuralgia is the most frequent complication of herpes zoster. Treatment of this neuropathic pain syndrome is difficult and often disappointing. Although postherpetic neuralgia is generally a self-limited condition, it can last indefinitely. Continuous epidural blockade for patients with acute zoster can shorten the duration of treatment. However, continuous epidural block has some complications such as infection, dural puncture, and total spinal and nerve damages. We report a case of myoclonus during continuous epidural block with ropivacaine, morphine, and ketamine in an acute zoster patient.
Amides ; Analgesia ; Herpes Zoster ; Humans ; Ketamine ; Morphine ; Myoclonus ; Neuralgia ; Neuralgia, Postherpetic ; Punctures

No abstract available.
Lymphangioma* ; Mediastinal Cyst*

OBJECTIVE: The purpose of this study was to evaluate the physicochemical properties and cytocompatibility of microporous, spherical biphasic calcium phosphate(BCP) ceramics with a 60/40 hydroxyapatite/beta-tricalcium phosphate weight ratio for application as a bone graft substitute. MATERIALS AND METHODS: Microporous, spherical BCP granules(MGSB) were prepared and their basic characteristics were compared with commercially available BCP(MBCP; Biomatlante, France) and deproteinized bovine bone mineral(Bio-Oss; Geistlich-Pharma, Switzerland, BBP; Oscotec, Korea). Their physicochemical properties were evaluated by scanning electron microscopy, X-ray diffractometry, Fourier-transform infrared spectroscopy, inductively coupled plasma atomic emission spectrometer, and Brunauer-Emmett-Teller method. Cell viability and proliferation of MC3T3-E1 cells on different graft materials were evaluated. RESULTS: MGSB granules showed a chemical composition and crystallinity similar with those in MBCP, they showed surface structure characteristic of three dimensionally, well-interconnected micropores. The results of MTT assay showed increases in cell viablity with increasing incubation times. At 4d of incubation, MGSB, MBCP and BBP showed similar values in optical density, but Bio-Oss exhibited significantly lower optical density compared to other bone substitutes(p < 0.05). MGSB showed significantly greater cell number compared to other bone substitutes at 3, 5, and 7d of incubation(p < 0.05), which were similar with those in polystyrene culture plates. CONCLUSION: These results indicated the suitable physicochemical properties of MGSB granules for application as an effective bone graft substitute, which provided compatible environment for osteoblast cell growth. However, further detailed studies are needed to confirm its biological effects on bone formation in vivo.
Bone Substitutes ; Calcium* ; Cell Count ; Cell Survival ; Ceramics* ; Crystallins ; Microscopy, Electron, Scanning ; Osteoblasts ; Osteogenesis ; Plasma ; Polystyrenes ; Spectrum Analysis ; Switzerland ; Transplants*

OBJECTIVE: To assess head posture using cervical spine X-rays to find out whether forward head posture is related to myofascial pain syndrome (MPS) in neck and shoulder. METHODS: Eighty-eight participants who were diagnosed with MPS in neck and shoulder were evaluated in this study. Four parameters (distance among head, cervical spines, and shoulder, and cervical angle) were measured from lateral view of cervical spine X-ray. The location and number of trigger points in the neck and shoulder and symptom duration were evaluated for each patient. RESULTS: Both horizontal distances between C1 vertebral body and C7 spinous process and between the earhole and C7 vertebral body were negatively correlated with cervical angle reflecting cervical lordosis (p<0.05). Younger patients had significantly (p<0.05) less cervical angle with more forward head posture. There was no relationship between MPS (presence, location, and number of trigger points) and radiologic assessments (distance parameters and the cervical angle). CONCLUSION: Forward head posture and reduced cervical lordosis were seen more in younger patients with spontaneous neck pain. However, these abnormalities did not correlate with the location or the number of MPS. Further studies are needed to delineate the mechanism of neck pain in patients with forward head posture.
Animals ; Cervical Vertebrae ; Female ; Head* ; Humans ; Lordosis ; Myofascial Pain Syndromes* ; Neck ; Neck Pain ; Posture* ; Shoulder ; Spine ; Trigger Points

Meningiomas are primarily benign, mesenchymal tumors which in most cases can be surgically removed. Some tumors, however, are inoperable or invasive, and histology alone may be insufficient to characterize their biologic behavior. Thus, there is a need for a more effective means of differentiation between benign and atypical/malignant meningiomas. To determine whether abnormal gene expression correlates with the histologic grade of meningiomas, we immunohistochemically analyzed the expression of multiple oncogenes and p53 protein in 47 meningioma tissue specimens; six were malignant, 14 were atypical, and 27 we randomly sampled were benign. The specimens were on paraffin-embedded tissue sections and monoclonal antibody was used. The results are summarized as follows: 1) among multiple oncogene factors, erb B-2 and bFGF expression was associated with malignancy, 2) p53 protein expression did not correlate with histologic grade. We believe that not only for a better understanding of the mechanism of oncogenesis, but also to justify the prognostic significance of aggressiveness or potential for recurrence, further investigation of the molecular genetics of meningiomas is required.
Carcinogenesis ; Gene Expression ; Meningioma* ; Molecular Biology ; Oncogenes* ; Recurrence

Spasmodic dysphonia is defined as a focal laryngeal disorder characterized by dystonic spasms of the vocal cord during speech. We described a case of a 22-year-old male patient who presented complaining of idiopathic difficulty swallowing that suddenly developed 6 months ago. The patient also reported pharyngolaryngeal pain, throat discomfort, dyspnea, and voice change. Because laryngoscopy found no specific problems, an electrodiagnostic study and videofluoroscopic swallowing study (VFSS) were performed to find the cause of dysphagia. The VFSS revealed continuous twitch-like involuntary movement of the laryngeal muscle around the vocal folds. Then, he was diagnosed with spasmodic dysphonia by VFSS, auditory-perceptual voice analysis, and physical examination. So, we report the first case of spasmodic dysphonia accompanied with difficulty swallowing that was confirmed by VFSS.
Deglutition Disorders ; Deglutition* ; Diagnosis* ; Dyskinesias ; Dysphonia* ; Dyspnea ; Humans ; Laryngeal Muscles ; Laryngoscopy ; Male ; Pharynx ; Physical Examination ; Spasm ; Vocal Cords ; Voice ; Young Adult

Three hundred nine adult patients with the diagnosis of intestinal obstruction were treated at the Department of Surgery, Seoul National University Hospital during 5 years and three months from September 1989 to December 1994. A clinical analysis of those patients was done and the following results were obtained. The most prevalent age group was sixth decade in cases of 90(29%) and male to female ratio was 2.1:1. The etiologic factors included adhesions 206(66.7%), malignant disease 51(16.5%), hernia 10(3.2%), intussusception 9(2.9%), ischemic injury 7(2.3%), bezoar 6(1.9%), volvulus 6(1.9%), inflammatory disease 5(1.6%), intestinal tuberculosis 5(1.6%), and others 3(0.9%). Malignant obstructions increased and it may be caused by increased cases of cancer operation. The location of intestinal obstruction was small bowel in cases of 275(89%) and large bowel in the remained proportion. The frequency of strangulation was 14.2% and its causes were adhesion(56.8%), ischemic injury(15.9%), hernia(9.1%), malignant disease(6.8%), volvulus(6.8%), intestinal tuberculosis(2.3%), and intususception(2.3%). The main cardinal symptoms on admission were abdominal pain(93.9%), vomiting(79.3%), abdominal distension(72.8%), diarrhea(24.9%), obstipation(17.2%), bloody stool(11.7%) and the physical signs were abdominal tenderness(74.8%), abdominal distension(72.8%), altered bowel sound(55.0%), tachycardia(18.1%), fever(17.5%), rebound tenderness(8.4%) . Toxic signs such as fever, tachycardia, rebound tenderness with leukocytosis over 10,000/mm3 have the clinical significance in the strangulated obstruction. Operations were done in 196 cases and the types of operative procedures were resection (23.7%), bypass surgery (11.4%), adhesiolysis (11.1%), colostomy (8.4%), herniorrhaphy(1.8%), bezoar removal (1.8%), and others (0.6%). Operative complications occurred in 44 cases(22.4%) and among them, wound infection was the most common cause(7.7%).The overall mortality was 3.2% and sepsis was the most common cause(30%).
Adult* ; Bezoars ; Colostomy ; Diagnosis ; Female ; Fever ; Hernia ; Humans ; Intestinal Obstruction* ; Intestinal Volvulus ; Intussusception ; Leukocytosis ; Male ; Mortality ; Seoul ; Sepsis ; Surgical Procedures, Operative ; Tachycardia ; Tuberculosis ; Wound Infection

There are different kinds of peripancratic diseases that we can hardly differdntiate from pancreatic tumors preoperatively. Seventeen cases of peripancreatic lesions, in which preoperative diagnosis was made as pancreatic tumor during the last six year period were reviewed retrospectively. They were neurogenic tumor(4 cases), tuberculosis of peripancreatic lymph node(2 cases), recurred gastric cancer (2 cases), Castlemann's disease(2 cases), gallbladder cancer(1 case), splenic hematoma(1 case), mesenteric lymphangioma(1 case), lyphoepithelial tumor(1 case), omental cyst(1 case), pheochromocytoma(1 case) and teratoma(1 case). All of them were operated and confirmed histologically. In conclusion, for correct preoperative diagnosis and proper therapy, the application of additional diagnostic measures such as CT or ultrasound guided aspiration cytology, diagnostic laparoscopy, and endoscopic ultrasound should be considered when the diagnosis is not conclusive. The disease entities we mentioned in this paper should be excluded preoperatively or intraoperatively.
Diagnosis ; Gallbladder ; Laparoscopy ; Retrospective Studies ; Stomach Neoplasms ; Tuberculosis ; Ultrasonography

No abstract available.
Apraxias ; Eyelids ; Lithium

PURPOSE: Insulinoma is a rare disease for which early diagnosis followed by proper surgical management provides a chance for cure. Analyses of clinicopathological features of patients can help optimize the surgical approach in the treatment of insulinoma. METHODS: The records of 13 patients (seven male, six female mean age 44.3 years; age range 17~62 years) who were diagnosed clinically and pathologically with insulinoma and who underwent surgery between March 1997 and April 2007 at the Department of Surgery, Seoul National University Hospital. Hospital in English please were retrospectively examined. RESULTS: All patients had findings compatible with Whipple's triad. Mean fasting blood sugar was 40.5 mg/dl, serum insulin level was 33.5µU/ml, and insulin-to-glucose ratio was 0.6. A prolonged starvation test was performed on six patients. Tumors were localized in 10 patients with a computed tomography (CT) scan and in three patients with CT angiography. Five tumors were located in the pancreas head and uncinate process, five in the body, and four at the body-tail border and tail. Patients underwent resection of tumorby enucleation, distal pancreatectomy, pylorus-preserving pancreaticoduodenectomy, laparoscopic distal pancreatectomy, and duodenum-preserving resection of pancreas head. Four immediate postoperative complications (fluid collection, pancreatic fistula, delayed gastric emptying) occurred. No symptoms or recurrences were apparent during the median 15 month follow-up. CONCLUSION: Insulinoma is difficult to diagnose correctly without a prolonged duration of symptoms. Localization of insulinoma can be aided by a CT scan and/or CT angiography. Less aggressive operative procedures such as simple enucleation might be a sufficient and feasible procedure for curative resection of benign insulinomas.
Adenoma, Islet Cell ; Angiography ; Blood Glucose ; Early Diagnosis ; Fasting ; Female ; Follow-Up Studies ; Head ; Humans ; Insulin ; Insulinoma* ; Male ; Pancreas ; Pancreatectomy ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Postoperative Complications ; Rare Diseases ; Recurrence ; Retrospective Studies ; Seoul ; Starvation ; Surgical Procedures, Operative ; Tail ; Tomography, X-Ray Computed