BACKGROUND: Postherpetic neuralgia (PHN) is usually managed pharmacologically. It is not uncommon for patients with chronic kidney disease (CKD) to suffer from PHN. It is difficult to prescribe a sufficient dose of anticonvulsants for intractable pain because of the decreased glomerular filtration rate. If the neural blockade and pulsed radiofrequency ablation provide only short-term amelioration of pain, spinal cord stimulation (SCS) with a low level of evidence may be used only as a last resort. This study was done to evaluate the efficacy of spinal cord stimulation in the treatment of PHN in patients with CKD. METHODS: PHN patients with CKD who needed hemo-dialysis who received insufficient relief of pain over a VAS of 8 regardless of the neuropathic medications were eligible for SCS trial. The follow-up period was at least 2 years after permanent implantation. RESULTS: Eleven patients received percutaneous SCS test trial from Jan 2003 to Dec 2007. Four patients had successfully received a permanent SCS implant with their pain being tolerable at a VAS score of less than 3 along with small doses of neuropathic medications. CONCLUSIONS: SCS was helpful in managing tolerable pain levels in some PHN patients with CKD along with tolerable neuropathic medications for over 2 years.
Anticonvulsants ; Electric Stimulation Therapy ; Follow-Up Studies ; Glomerular Filtration Rate ; Health Resorts ; Humans ; Kidney ; Kidney Diseases ; Neuralgia, Postherpetic ; Pain, Intractable ; Renal Insufficiency, Chronic ; Spinal Cord ; Spinal Cord Stimulation

No abstract available.
Female ; Humans ; Myiasis

Interferon (IFN) alpha is commonly used for the treatment of chronic hepatits C with a combination of ribavirin. There are numerous dermatologic adverse events of IFN, such as xerosis, pruritus, alopecia, and injection site reaction. Panniculitis is one of the rare cutaneous side effects of IFN treatment, which may have a significant reduction on patient's quality of life and may lead to discontinuation of the treatment. Although there have been several reports of panniculitis induced by IFN-beta, IFN-alpha induced panniculitis are rarely reported in the literature. Herein, we report a case of panniculitis caused by pegylated IFN alpha2a injection in a patient with chronic hepatitis C.
Alopecia ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; Interferon-alpha ; Interferons ; Panniculitis ; Pruritus ; Quality of Life ; Ribavirin

An 82-year-old woman presented with a 5-year history of erythematous to brown patches and plaques on both legs, arms and trunk. Histopathological findings of biopsy specimens were consistent with mycosis fungoides, and the tumor cells were positive for CD3 and negative for CD20 in immunohistochemical stain. Imaging studies proposed the suspicion of ureter cancer, and the result of cystoscopic biopsy showed papillary urothelial carcinoma. Mycosis fungoides is the most common type of cutaneous T-cell lymphoma, characterized by variable cutaneous manifestations, including patches, plaques, tumors, and erythroderma. There were several studies concerning the evaluation of the second malignancy risk after cutaneous T-cell lymphoma, however the relationship between mycosis fungoides and ureter cancer is not revealed. This patient is considered a case of mycosis fungoides with coincidental ureter cancer.
Aged, 80 and over ; Arm ; Biopsy ; Dermatitis, Exfoliative ; Female ; Humans ; Leg ; Lymphoma, T-Cell, Cutaneous ; Mycosis Fungoides ; Neoplasms, Second Primary ; Ureter ; Ureteral Neoplasms

PURPOSE: Serum creatinine is a late marker of acute kidney injury (AKI). We assessed the diagnostic value of plasma neutrophil gelatinase-associated lipocalin (NGAL) for predicting acute kidney injury in emergency department patients with sepsis. METHODS: This was a prospective observational study of adult sepsis patients. Plasma NGAL levels were measured upon admission to the hospital, and clinical data and serum creatinine were collected daily during the hospital stay. The primary outcome measure was the occurrence of AKI based on criteria from the Acute Kidney Injury Network (AKIN). RESULTS: A total of 178 patients were included, with 13 patients (7.3%) that developed AKI during their hospital stay; 9 and 4 were classified as AKIN stage 1 and 2, respectively. Six patients out of the 13 with AKI died. Mean plasma NGAL levels were 277 ng/mL in patients without AKI and 852 ng/mL in patients with AKI. The area under the receiver operating characteristic curve was 0.883 (95% confidence interval 0.803 to 0.964), the sensitivity was 91.7%, and the specificity was 80.5% for the prediction of AKI (using a cut-off value of 353.5 ng/mL). CONCLUSION: Plasma NGAL is a useful early marker that predicts the development of AKI in adult sepsis patients.
Acute Kidney Injury ; Adult ; Biomarkers ; Creatinine ; Emergencies ; Humans ; Length of Stay ; Lipocalins ; Neutrophils ; Outcome Assessment (Health Care) ; Plasma ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Sepsis

Medication errors remain an unsolved problem in medicine. Some factors have been found to contribute to drug errors, and among them, the incorrect administration of drugs is a major factor. In this case report, 2 ml of dobutamine was inadvertently injected intrathecally instead of bupivacaine owing to ampoule confusion during spinal anesthesia, followed by the induction of general anesthesia with sodium thiopental-sevoflurane. It was uneventful during perioperative period, however, nystagmus was observed in post anesthesia care unit (PACU), about 1 h after induction of general anesthesia. There were no other neurologic abnormalities except nystagmus and vital sign were stable during PACU stay. Nystagmus subsided spontaneously and it was confirmed there was no evidence of any central nervous system lesion on imaging study. The patient was discharged 5 days later without any complications.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal ; Barbiturates ; Bupivacaine ; Central Nervous System ; Dobutamine ; Humans ; Medication Errors ; Perioperative Period ; Sodium ; Vital Signs

OBJECTIVE: The purpose of this study was to evaluate value of methotretrexate (MTX) in the treatment of tubal pregnancy. METHODS: 28 patients with unruptured tubal pregnancy were treated alternately with four doses of intramuscular MTX (1.0 mg/kg) and four doses of intramuscular citrovorum factor (0.1 mg/kg). Patients considered eligible for MTX treatment of tubal pregnancy were those with unruptured tubal pregnancy Alopecia ; Bone Marrow ; Chorionic Gonadotropin ; Dermatitis ; Diagnosis ; Diarrhea ; Female ; Fetal Heart ; Gestational Age ; Gestational Sac ; Gingivitis, Necrotizing Ulcerative ; Humans ; Leucovorin ; Methotrexate* ; Pneumonia ; Pregnancy ; Pregnancy, Tubal* ; Salpingectomy ; Ultrasonography ; Vomiting

OBJECTIVE: To report our experience with laparoscopically assisted vaginal hysterectomy (LAVH) and evaluate the advantages of LAVH. This is a retrospective study. METHODS: From Jan. 2001 to Aug. 2002, 204 LAVHs were performed at the Department of Obstetrics and Gynecology, Our Lady of Mercy Hospital, The Catholic University of Korea. We studied the results with regard to the age, parity, previous abdominal surgery, surgical indications, operation time, weight of uterus, change of hemoglobin, hospital stay, concomitant procedures, and complications. RESULTS: The mean age was 43.9+/-6.4 years. The mean parity was 2.1+/-1.3. Tubal ligation was most common previous abdominal surgery. As a surgical indication, leiomyoma (52.9%) and adenomyosis (33.3%) were more common indications than any other gynecological problem. The mean operation time was 85.7+/-22.4 minutes. The mean uterine weight was 206.2+/-103.7 g. The mean hemoglobin change was 1.2+/-0.7 g/dl. The mean hospital stay was 3.3+/-0.8 days. Unilateral salpingoophorectomy was most common operation as concomitant procedure. Surgical complication rate was 3.4%. CONCLUSION: LAVH is a safe and effective alternative to abdominal hysterectomy with advanced technologic development in laparoscopic instruments and skills.
Adenomyosis ; Female ; Gynecology ; Hysterectomy ; Hysterectomy, Vaginal* ; Korea ; Leiomyoma ; Length of Stay ; Obstetrics ; Parity ; Retrospective Studies ; Sterilization, Tubal ; Uterus

OBJECTIVES: Head and neck reconstruction is still challenging in terms of esthetic and functional outcomes. This study investigated the feasibility of the angular branch-based scapular tip free flap (STFF). METHODS: This was a retrospective study of 17 patients undergoing maxillectomy and mandibulectomy and either primary or secondary reconstruction by STFF. This study included surgical, esthetic, and functional outcomes, and detailed data are presented regarding the flap, such as pedicle length, size of the harvested bone, and failure rate. Medical photographs were used to estimate the esthetic outcome, and computed tomography was used to check the flap status postoperatively. RESULTS: The data were collected from April 2013 to April 2014. Eight patients underwent maxillary reconstruction, and nine underwent mandibular reconstruction. Maxillary defects usually included unilateral alveolar structures and the palate; mandibular defects were usually those involving mandibular angle and short segment. Vein grafting was not required in any of the patients. Flap failure occurred in one of the 17 patients (5.9%) with successful reconstruction after revision. Of the eight maxillectomy patients, orbital revisions for diplopia after maxillary reconstruction were performed in two patients (25%), and oroantral fistula repair was performed in one patient (12.5%). CONCLUSION: This study demonstrated the reconstructive advantages of the angular branch-based STFF, long pedicle, low flap failure, 3-dimensional nature of bone and soft tissues (chimeric flap), and small rate of donor site morbidity with free ambulation. This flap is an excellent option for use in complex three-dimensional head and neck reconstruction.
Diplopia ; Free Tissue Flaps* ; Head and Neck Neoplasms ; Head* ; Humans ; Mandibular Reconstruction ; Neck* ; Orbit ; Oroantral Fistula ; Palate ; Retrospective Studies ; Scapula ; Tissue Donors ; Transplants ; Veins ; Walking

Pantoea infections are rare in humans and an unusual cause for sepsis in immunocompetent patient. It is a gram-nagative bacillus of the family Enterobacteriaceae. Infections are usually associated with plant thorn injury or outbreak traced to comtaminated parenteral nutrition. We experienced a case of pantoea species cholecystitis and cholangitis with bacteremia. The patient was administrated intravenous antibiotics, and then patient was improved.
Anti-Bacterial Agents ; Bacillus ; Bacteremia ; Cholangitis ; Cholecystitis ; Enterobacteriaceae ; Humans ; Pantoea ; Parenteral Nutrition ; Plants ; Sepsis