The use of opioids for chronic noncancer pain has increased in recent years, although evidence for its long-term effectiveness is weak and its potential for harm is significant. Most reports suggest that chronic opioid therapy can be effective for the reduction of chronic pain and for the improvement of functioning and health-related quality of life. However, opioids are also associated with potentially serious harm including pharmacologic adverse effects and socioeconomic problems such as abuse, addiction, and diversion. Physicians should use a structured approach that includes a biopsychosocial evaluation and treatment plan that encourages patients to reach functional goals. There should be a comprehensive evaluation of the cause of pain, assessment for risk of opioid complications (including misuse and addiction), and a detailed treatment history including a review of medical records. Regular monitoring for safety and effectiveness is essential including regular checking of functional improvement and progress towards the pretreatment goals. Ineffective or unsafe opioid therapy should be promptly tapered or stopped. In Korea until now, there are no adequate recommendations for opioid prescription in the management of chronic noncancer pain. A Korean guideline or task force team should be established to provide personalized treatment for carefully selected and monitored patients.
Advisory Committees ; Analgesics, Opioid ; Behavior, Addictive ; Chronic Pain ; Humans ; Korea ; Medical Records ; Prescriptions ; Quality of Life

Pheochromocytoma are functioning tumors which arise in chromaffin tissue of adrenal gland. The signs and symptoms of pheothromocytoma results from the release of the highly potent amines, epinephrine and norepinephrine by the tumors. This tumor release both epinephrine and norepinephrine into the blood stream for distribution to distant sites of action. Circulating norepinephrine produces widespread vasoconstriction, causing increased peripheral resistance and resulting in increased systolic, diastolic and mean arterial pressures. The direct effect on the heart is to increase the rate and force of contraction. As important effect is the reduction of plasma volume caused by prolonged increases in circulating norepinephrine and epinephrine. These adrenergic aminess have prominet metabolic as well as hemodynamic effects. The increase oxygen consumption and elevation of blood glucose and lactic acid level caused by epinephrine are much more marked than the increase produced by comparable amounts of norepinephrine. Anesthetic management of pheochromocytoma should considered prevent serious alterations in blood pressure. So, We present the case of anesthetic management for pheochromocytoma which control of hypertensive crises by the use of a intravenous infusion of sodium nitroprusside.
Adrenal Glands ; Amines ; Arterial Pressure ; Blood Glucose ; Blood Pressure ; Epinephrine ; Heart ; Hemodynamics ; Infusions, Intravenous ; Lactic Acid ; Nitroprusside ; Norepinephrine ; Oxygen Consumption ; Pheochromocytoma* ; Plasma Volume ; Rivers ; Vascular Resistance ; Vasoconstriction

Hemorrhagic cystitis is potentially life-threatening sequellae of chemotherapy using oxazaphosphorine alkylating agents (cyclophosphamide and ifosfamide). Mesna contains a sulfhydryl group that is believed to bind acrolein within the urinary collecting system and reduce the hemorrhagic cystitis without affecting the chemotherapeutic potential. To date, about thirty cases of hypersensitivity or allergic reactions of the delayed and urticarial type associated with mesna have been reported. We reported two patients with systemic lupus erythematosus who developed facial rash and flushing associated with mesna which imitate malar rash.
Acrolein ; Alkylating Agents ; Cyclophosphamide ; Cystitis ; Drug Therapy ; Exanthema* ; Flushing ; Humans ; Hypersensitivity* ; Lupus Erythematosus, Systemic ; Mesna*

BACKGROUNDS/OBJECTIVES: The effects of malnutrition on growth of toddlers and preschoolers by socioeconomic status are not well known. This study aimed to examine the effects of dietary intake on growth outcomes in toddlers and preschoolers by household income level. SUBJECTS/METHODS: The study population was a total of 1,687 children aged 1 to 5 years that participated in the KNHANES from 2009 to 2011. Growth of children was assessed by height for age (HFA) and weight for height (WFH). Children were classified into three groups according to children's HFA and WFH compared to the 10th and 90th percentiles of the 2007 Korean Children and Adolescent Growth Standard. Average monthly household income was divided into quartile groups. Dietary intake data were obtained by using the one day 24-hr recall method. Risks of inadequate intake of nutrients and unfavorable growth were estimated by using a multiple logistic regression model adjusted for sex, age, region, and energy intake. RESULTS: The low HFA group (< 10th percentile) had significantly lower intakes of energy, carbohydrate, and thiamin as compared with the high group (> or = 90th percentile). For WFH status, vitamin C intake was lower in the low group than in the high group. Household income level was related to WFH status but not HFA. Children from lower income households were more likely to have high WFH than those from higher income households (P for trend = 0.038). Household income status was also significantly related with risk of inadequate intake of micronutrients such as thiamin (P for trend = 0.032) and vitamin C (P for trend = 0.002), showing higher odds of inadequate intakes in children from lower income households. CONCLUSIONS: Children from lower income households were prone to be overweight and to have inadequate intakes of micronutrients such as thiamin and vitamin C. To reduce nutritional and health disparities, collective action in the public sector is required from early life.
Adolescent ; Ascorbic Acid ; Child ; Energy Intake ; Family Characteristics* ; Humans ; Logistic Models ; Malnutrition ; Micronutrients* ; Nutritional Status* ; Overweight* ; Public Sector ; Social Class

PURPOSE: Chronic prostatitis displays various pathophysiologies due to various causes, and is a life time affliction, but the diagnosis and treatment are still unclear. Therefore, it is important to find if some elements influence the incidence and progress of the disease; attempts were made to recognize the risk factors for chronic prostatitis. MATERIALS AND METHODS: 184 chronic prostatitis patients were selected, and divided, after treatment, into the improvement (IG; n=147) and non-improvement groups (NIG; n=37). 40 healthy men were chosen as the control group (CG) for a comparative analysis. Subjects were investigated for their professional stati and form of work, driving, motorcycle or bicycle utilization, drinking, smoking, sex and their style of diet. RESULTS: The ratio of sedentary desk workers in the NIG (73.0%) was higher than in the other groups. The ratio of those that drove for more than 1 hour was much high in the NIG by 54.1%. The ratio of the people who ejaculated more than once a week, either through sexual intercourse or masturbation, was lower in the NIG by 56.5%, but that of people who ejaculated every day was higher in the NIG (13.5%). People drinking more than once a week was greater in the NIG (67.6%), and those who drank more than 1 bottle of Korean wine, Soju, were showed an expressively higher ratio in the NIG (72.0%). In relation to dietary behavior, the NIG showed a high ratio (73.0%) for a preference for salty food only. CONCLUSIONS: Factors that may influence the prognosis of chronic prostatitis are thought to be the form of profession, number ejaculations, frequency and amount of drinking, an a habit of eating salty food. Therefore, these factors should be considered together when looking for a cure for chronic prostatitis.
Coitus ; Diagnosis ; Diet ; Drinking ; Eating ; Ejaculation ; Humans ; Incidence ; Male ; Masturbation ; Motorcycles ; Prognosis ; Prostatitis* ; Risk Factors* ; Smoke ; Smoking ; Wine

We experienced a complication of brachial plexus palsy secondary to operative position during thoracoscopic thoracic sympathectomies. His general health was excellent and no previous histories vulnerable to peripheral nerve systems were observed. The thoracic sympathectomies were done under general anesthesia. The patient was placed left lateral position with his right arm abduced 150o on padded arm board. An operation was lasted 2 hours and 30 minutes at this position because of severe right apical lung adhesion. The controlateral side was performed same procedure and lasted 20 minutes. After the patient recovered from the anesthesia, the patient had a complete paralysis of right arm. There was also slightly diminished sensation to pinprick on the arm and hand. Neurologic examination and EMG study revealed brachial plexus palsy. Nerve blocks and physiotherapy were performed to treat brachial plexus injuries. His motor functions were improved day by day and he was discharged with a complete range of motion against gravity on 14th. postoperation day. However, there were loss of muscle powers against some resistances and tingling sensations of fingertips. Two months later, he was recovered completely and there was no residual disabilities.
Anesthesia ; Anesthesia, General ; Arm ; Brachial Plexus* ; Gravitation ; Hand ; Humans ; Lung ; Nerve Block ; Neurologic Examination ; Paralysis* ; Peripheral Nerves ; Range of Motion, Articular ; Sensation ; Sympathectomy*

No abstract available.
Classification* ; Humans ; Spinal Cord* ; Urodynamics*

Retroperitoneal liposarcoma comprises 12 to 45 percent of all liposarcoma. It has been a therapeutic dilemma and a less prognosis because of its tendency to attain a tremendous size due to early silent growth and difficult wide en bloc excision in the retroperitoneum. Here in we report a case of retroperitoneal liposarcoma in 51 year old male patient with a brief review of the literatures.
Humans ; Liposarcoma* ; Male ; Middle Aged ; Prognosis

When examining in the patients with epiphora, it is common to evaluate only the insufficiency or obstruction of lacrimal pathway by irrigation or dacryocystography and to over look the conjunctival conditions near the punctum in most cases. Authors found marked redundancy of conjunctival tissue around the punctal area in 8 patients(12 eyes) who complained of epiphora. They have neither lacrimal pathway insufficiency and obstruction, nor facial palsy or lid laxity that can impass the lacrimal pump action, and also no anatomical anomaly of the puncta. In fluorescein dye dissappearence test of these patients, the clearance of dye was markedly delayed on the lesion site(Grade 3 to 4). Epiphora was dramatically improved after simple resection of redundant conjunctiva under surgical microscope. The Hematoxylin-Eosin and Toluidine-Blue staining of resected conjunctiva revealed infiltration of many inflammatory cells and increase of metachromatic cells in the conjunctival stroma.
Conjunctiva ; Facial Paralysis ; Fluorescein ; Humans ; Lacrimal Apparatus Diseases*

Background: Cardiovascular risk is a modifiable factor that can help prevent dementia.Given the dearth of optimal treatment options, managing dementia risk factors is crucial. We examined the association between cardiovascular risk, as measured by the Korean coronary heart disease risk score (KRS), and cognitive function in dementia-free elderly individuals. Methods: We enrolled 8,600 individuals (average age: 69.74 years; 5,206 women) who underwent a medical evaluation from the National Health Insurance Service. KRS was calculated using age, sex, blood pressure, lipid profile, diabetes, and smoking status. Cognitive function was evaluated using Korean Dementia Screening QuestionnaireCognition (KDSQ-C). Scores of ≥ 6 indicated a cognitive decline. Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI). Weight, height, stroke history, coronary heart disease history, alcohol consumption, and physical activity engagement were adjusted. Results: The lowest, middle, and highest groups, according to the KRS, were 5,923 (68.9%), 2,343 (27.2%), and 334 (3.9%), respectively. The highest KRS group in all participants exhibited a greater risk of cognitive decline than the lowest KRS group (OR, 1.339; 95% CI, 1.034–1.734; P = 0.027). The highest KRS female group aged 71–75 years old exhibited greater cognitive decline than the corresponding lowest KRS group (OR, 1.595; 95% CI, 1.045–2.434; P = 0.031). Conclusion Individuals with high cardiovascular risk were associated with poorer cognitive function than those with low risk, especially older women. Cardiovascular risk factors should be carefully managed to promote healthy mental aging in dementia-free elderly individuals.