BACKGROUND: Neuropathic rats created by spinal nerve ligation are known to show higher levels of p38, c-Jun NH2-terminal kinase, and extracellular signal-regulated kinase p44/42 (ERK 1/2) of the mitogen-activated protein kinases (MAPKs). The authors of this study aimed to understand the effect of ketamine on p38 MAPK and inflammatory responses, as well as its effect on the development of neuropathic pain. METHODS: The neuropathic rats were prepared by Chung's method with Sprague-Dawley rats. The research was carried out on three groups, a sham-operated group, a neuropathic pain and normal saline (NP + NS) group, and a neuropathic pain and ketamine (NP + Keta) group. The normal saline or ketamine was infused into the neuropathic rats through a mini-osmotic pump implanted in the subcutaneous space. After a week, the quantities of phospho-p38, p38 MAPK and pro-inflammatory cytokines were measured and compared through western blots and reverse transcriptase-polymerase chain reaction. RESULTS: In comparison to the control group, the NP + NS group showed a significant increase of phospho-p38 and p38 MAPK, as well as of the proinflammatory cytokines, tumor necrosis factor alpha (TNFalpha), and intercellular adhesion molecule 1 (ICAM1). However, in the NP + Keta group, phospho-p38, p38 MAPK and TNFalpha and, ICAM1 were reduced in comparison to the NP + NS group. The paw withdrawal threshold test also showed the trend of recovery from the mechanical allodynia in the NP + Keta group. CONCLUSIONS: In the development of neuropathic pain, p38 MAPK and inflammatory responses are significantly related, and the use of ketamine reduces p38 MAPK and proinflammatory cytokines. Thus, the adequate use of ketamine could be effective for the prevention and treatment of neuropathic pain following peripheral injury.
Animals ; Blotting, Western ; Cytokines* ; Hyperalgesia ; Intercellular Adhesion Molecule-1 ; Ketamine* ; Ligation ; Methods ; Mitogen-Activated Protein Kinases ; Neuralgia ; p38 Mitogen-Activated Protein Kinases* ; Phosphotransferases ; Rats* ; Rats, Sprague-Dawley ; Spinal Nerves ; Tumor Necrosis Factor-alpha

PURPOSE: To present a case of acute angle-closure glaucoma in a nanophthalmos patient. CASE SUMMARY: A 28-year-old woman visited the hospital for a sudden pain in the left eye, she had a small orbital bone and narrow palpebral fissurea in both eyes. Her intraocular pressure (IOP) was 58 mmHg in the left eye. The slit lamp examination showed shallow anterior chambers in both eyes, and the gonioscopic examination showed a closed angle in the left eye. The diameters of the corneas were 11 mm , and the axial lengths were 19.7 mm in the right eye and 19.6 mm in the left eye. The depths of the anterior chambers were 1.51 mm in the right eye and 1.82 mm in the left eye. The disease was diagnosed as acute angle-closure glaucoma in the left eye of the patient with nanophthalmos, and thus the IOP of the left eye was lowered using ophthalmic drugs and medications. Laser iridotomy was performed on both eyes. CONCLUSIONS: For around a year of follow-up after laser iridotomy, complications such as the rise of intraocular pressure and choroidal effusion were not observed. This suggests that laser iridotomy can be an effective treatment for acute angle-closure glaucoma accompanying nanophthalmos.
Adult ; Anterior Chamber ; Choroid ; Cornea ; Eye ; Female ; Follow-Up Studies ; Glaucoma, Angle-Closure ; Humans ; Intraocular Pressure ; Orbit

BACKGROUND: Peripheral arterial disease is frequently accompanied with systemic arteriosclerosis and more than half of the cause of deaths is due to the development of coronary arterial disease. Moreover, it is known that the most frequent cause of death after a bypass surgery of chronic arterial obstruction is heart related complications. Especially in patients with atherosclerotic arterial obstruction in the lower extremities who had no history of heart disease or had no presenting symptoms of ischemic heart disease showed a high rate of postoperative mortality and for this reason we suggest preoperative evaluation in these patients to evaluate whether or not coronary arterial disease is accompanied. MATERIAL AND METHOD: Since Feb. 2001 to Oct. 2004, we analyzed 52 patients who were operated on for atherosclerotic arterial obstruction in the lower extremities, with the exception of patients with a past history of heart disease or symptoms of ischemic heart disease. They underwent on the same day a coronary and femoral angiography for evaluation of accompanying coronary arterial disease. Of among these patients, we compared those who received bypass surgery of the arteries of the peripheral extremities alone to those who underwent combined coronary artery bypass surgery. RESULT: 63% of the reported cases of atherosclerotic arterial obstruction in the lower extremities were accompanied with coronary arterial disease. Old age, hypertension, diabetes mellitus, smoking, and hypercholesterolemia are known risk factors for arteriosclerosis and of these, only old age and hypertension had statistically significance in patients with severe atherosclerotic arterial obstruction in the lower extremities accompanied with coronary arterial disease. Diabetes, smoking, and hypercholesterolemia showed no statistical significance in this group. With the increase in severity of the range and the degree of atherosclerotic arterial obstruction, coronary arterial disease is frequently accompanied and its severity also increased. Patients who received both peripheral artery and coronary artery bypass surgery showed no difference in the period of hospitalization and ICU stay period compared with patients who received bypass surgery of the arteries of the lower extremities alone. CONCLUSION: Patients with atherosclerotic arterial obstruction in the lower extremities without symptoms of ischemic heart disease should undergo a preoperative coronary angiography to evaluate coronary arterial disease for active treatment, especially in the patients with old age, hypertension and high AVD scores.
Angiography ; Arteries ; Arteriosclerosis ; Atherosclerosis ; Cause of Death ; Coronary Angiography* ; Coronary Artery Bypass ; Diabetes Mellitus ; Extremities ; Heart ; Heart Diseases ; Hospitalization ; Humans ; Hypercholesterolemia ; Hypertension ; Lower Extremity* ; Mortality ; Myocardial Ischemia ; Peripheral Arterial Disease ; Peripheral Vascular Diseases ; Risk Factors ; Smoke ; Smoking

BACKGROUND: Peripheral arterial disease is frequently accompanied with systemic arteriosclerosis and more than half of the cause of deaths is due to the development of coronary arterial disease. Moreover, it is known that the most frequent cause of death after a bypass surgery of chronic arterial obstruction is heart related complications. Especially in patients with atherosclerotic arterial obstruction in the lower extremities who had no history of heart disease or had no presenting symptoms of ischemic heart disease showed a high rate of postoperative mortality and for this reason we suggest preoperative evaluation in these patients to evaluate whether or not coronary arterial disease is accompanied. MATERIAL AND METHOD: Since Feb. 2001 to Oct. 2004, we analyzed 52 patients who were operated on for atherosclerotic arterial obstruction in the lower extremities, with the exception of patients with a past history of heart disease or symptoms of ischemic heart disease. They underwent on the same day a coronary and femoral angiography for evaluation of accompanying coronary arterial disease. Of among these patients, we compared those who received bypass surgery of the arteries of the peripheral extremities alone to those who underwent combined coronary artery bypass surgery. RESULT: 63% of the reported cases of atherosclerotic arterial obstruction in the lower extremities were accompanied with coronary arterial disease. Old age, hypertension, diabetes mellitus, smoking, and hypercholesterolemia are known risk factors for arteriosclerosis and of these, only old age and hypertension had statistically significance in patients with severe atherosclerotic arterial obstruction in the lower extremities accompanied with coronary arterial disease. Diabetes, smoking, and hypercholesterolemia showed no statistical significance in this group. With the increase in severity of the range and the degree of atherosclerotic arterial obstruction, coronary arterial disease is frequently accompanied and its severity also increased. Patients who received both peripheral artery and coronary artery bypass surgery showed no difference in the period of hospitalization and ICU stay period compared with patients who received bypass surgery of the arteries of the lower extremities alone. CONCLUSION: Patients with atherosclerotic arterial obstruction in the lower extremities without symptoms of ischemic heart disease should undergo a preoperative coronary angiography to evaluate coronary arterial disease for active treatment, especially in the patients with old age, hypertension and high AVD scores.
Angiography ; Arteries ; Arteriosclerosis ; Atherosclerosis ; Cause of Death ; Coronary Angiography* ; Coronary Artery Bypass ; Diabetes Mellitus ; Extremities ; Heart ; Heart Diseases ; Hospitalization ; Humans ; Hypercholesterolemia ; Hypertension ; Lower Extremity* ; Mortality ; Myocardial Ischemia ; Peripheral Arterial Disease ; Peripheral Vascular Diseases ; Risk Factors ; Smoke ; Smoking

PURPOSE: The objective of this study was to ascertain the incidence of congenital heart disease in the western part of Gyeongnam Province in Korea. METHODS: We enrolled 849 children (M:F=390:459) who were diagnosed with congenital heart disease (CHD) and received echocardiography during January 1997 to December 2005 in Gyeongsang National University Hospital. The subjects were limited to patients born from 1997 to 2004. The CHDs were classified into acyanotic types and cyanotic type. Further, acyanotic type CHDs were divided into shunt type and valvular types. RESULTS: Numbers of initially diagnosed patients from 1997 to 2004 were as follows: 113, 128, 116, 104, 129, 97, 84, and 78. The median age of initially diagnosed CHD patients was 1 month in the acyanotic type and 0.5 months in cyanotic type. Also, an annual frequency among CHD types and gender ratio were no significant difference in every year. Incidences of CHD from 2000 to 2004 in the western part of Gyeongnam Province were 8.9, 12.7, 10.9, 10.0, and 9.7 per 1,000 live births, respectively. CONCLUSION: From 1997 to 2001, 100-130, and from 2002 to 2004, less than 100 patients were diagnosed with CHD. This showed a decrease in the numbers of CHD patients in the last three years. However, the Incidence of CHD was 0.89-1.24% during the last five years. Therefore, the decrease in the annual frequency of CHD was due to the recent decline in birth rate in Korea.
Birth Rate ; Child ; Echocardiography ; Heart ; Heart Diseases ; Humans ; Incidence ; Korea ; Live Birth

STUDY DESIGN: We retrospectively evaluated the value of magnetic resonance imaging (MRI) in the diagnosis of lumbar lateral disc herniations. SUMMARY OF LITERATURE REVIEW: MRI is known to be a reliable study for the diagnosis of a lumbar disc herniation. However, recent studies of its diagnostic value for lateral disc herniation have been rare. OBJECTIVES: We aimed to assess the diagnostic value of simple MRI, to determine the need for additional imaging studies and to investigate mimicking lesions. MATERIALS AND METHODS: In a lateral herniation group composed of 21 cases, including 10 foraminal and 11 extraforaminal herniations, the diagnostic value of simple MRI was evaluated, and the potential requirement for additional studies investigated. In a mimicking lesion group(5 cases), the entity of each lesion was identified. RESULTS: All 10 foraminal disc herniation cases were able to be confirmed with simple MRI, six of which were confirmed using sagittal images alone. In contrast, for the eleven extraforaminal disc herniations, sagittal MR images were not at all helpful in the diagnosis; however, six(55%) were confirmed from axial images, but the other five could not be confirmed until additional studies, such as enhanced MRI(4 cases), 1 mm-sliced CT (1) and CT-discography (3), were carried out. All 5 mimicking lesions were upper endplates of the lower vertebrae. CONCLUSIONS: Simple MRI is useful in the diagnosis of foraminal herniations, but not so helpful for extraforaminal herniations; particularly, sagittal images are of little use. Therefore, whenever a patient complaining of severe radiating pain presents with no causative finding on simple MRI, the extraforaminal regions on the axial images should be diligently scrutinized again, and additional studies considered when necessary. Conversely, mimicking lesions, such as an upper endplate, should be differentiated when a lateral disc herniation is suspected.
Diagnosis* ; Humans ; Magnetic Resonance Imaging* ; Retrospective Studies ; Spine

OBJECTIVES: This report seeks to introduce some cases of the patients who received magnetic resonance imaging (MRI)-guided high intensity focused ultrasound (HIFU) surgery (MRgFUS)-based intramural uterine fibroids treatment where the post-MRgFUS intramural uterine fibroids decreased in its volume and protruded towards the endometrial cavity to be expelled by hysteroscopy. METHODS: Of the 157 patients who had received MRgFUS treatment in the Obstetrics and Gynecology of the Hospital from March, 2015 to February, 2016; this study examined 6 of the cases where, after high intensity focused ultrasound treatment, intramural uterine fibroids protruded towards the endometrial cavity to be removed by hysteroscopic myomectomy. The high intensity focused ultrasound utilized in the cases were Philips Achieva 1.5 Tesla MR (Philips Healthcare, Best, The Netherlands) and Sonalleve HIFU system. RESULTS: The volume of fibroids ranged from 26.0 cm³ to 199.5 cm³, averaging 95.6 cm³. The major axis length ranged from 4.0 cm to 8.2 cm, averaging 6.3 cm. Fibroid location in all of the patients was in intramural uterine before treatment but after the high intensity focused ultrasound treatment, the fibroids were observed to protrude towards the endometrial cavity in at least Day 5 or up to Day 73 to allow hysteroscopic myomectomy. CONCLUSIONS: In some cases, after an intramural uterine fibroid is treated with MRgFUS, fibroid volume is decreased and the fibroid protrudes towards the endometrial cavity. In this case, hysteroscopic myomectomy can be a useful solution.
Delivery of Health Care ; Gynecology ; High-Intensity Focused Ultrasound Ablation ; Humans ; Hysteroscopy ; Leiomyoma* ; Magnetic Resonance Imaging ; Obstetrics ; Ultrasonography* ; Uterine Myomectomy

BACKGROUND: Brucellosis is a zoonosis caused by the gram-negative coccobacilli Brucella. Humans are infected by ingestion of unpasteurized milk or dairy products from or by direct contact with infected animals. Although human brucellosis is known to be rare, there has been an increase in bovine brucellosis in Cheju island since the 1980s. The purpose of this study was to investigate the prevalence of anti- Brucella antibody in people from endemic areas. METHODS: Sera obtained from 2,372 residents in Cheju island were screened for anti-Brucella antibody by slide agglutination test and confirmed by duplicated tube agglutination test. Sera with titers equal to or above 1:80 were considered positive. RESULTS: Fourteen of 2,372 sera were positive (0.59%). Positive rate was 0.34% in males and 0.82% in females. There was no significant difference in the positive rates between males and females. Seropositive rate was slightly higher in persons at 40 years or older. Seropositive rates in different areas of Cheju island were as follows : South Cheju-gun 0.97%, North Cheju-gun 0.64%, Cheju city 0.46%, and Sogwipo city 0.0%. The antibody titers of positive sera were determined: 7 sera were positive at 1:80, 4 at 1:160, and 3 were positive at 1:320. Occupations of seropositive persons were as follows : 7 farmers; 3 stockbreeders; 1 engaged in service trade; 1 engaged in food processing; 1 working at a stable; one unknown. Seropositive rates among people at a relatively high risk were 0.94%. Seropositive rate of people who were proven to be not at risk for Brucella infection was 0.51%. There was no significant difference in the seropositive rates between the two groups(P>0.05). CONCLUSION: These findings confirmed the occurrence of human Brucella infection in Cheju island and suggest the need for surveillance in other parts of the country as well.
Agglutination Tests ; Animals ; Brucella ; Brucellosis* ; Brucellosis, Bovine ; Cattle ; Dairy Products ; Eating ; Female ; Food Handling ; Humans ; Jeju-do* ; Male ; Milk ; Occupations ; Prevalence ; Seroepidemiologic Studies*

BACKGROUND: The patient-controlled sedation (PCS) allows for rapid individualized titration of sedative drugs. Propofol has been the most widely used IV adjuvant, during the monitored anesthesia care (MAC). This study was designed to compare the sedation quality, side effect and recovery of the propofol alone, and propofol-remifentanil combination, using PCS for breast biopsy. METHODS: Seventy five outpatients, undergoing breast biopsy procedures with local anesthesia, were randomly assigned to receive propofol alone (group P), propofol-25 ug/ml of remifentanil (group PR25), and propofol-50 ug/ml of remifentanil (group PR50), using PCS. Pain visual analogue scores (VAS) and digit symbol substitution test (DSST), Vital signs, bi-spectral index (BIS) and observer assessment of alertness and sedation (OAA/S) score were recorded. RESULTS: Apply/Demand ratio in the group PR50 had a significant increase over the other groups (P < 0.05). The incidence of excessive sedation and dizziness were significantly more frequent in the group PR50 (P < 0.05). BIS and OAA/S score significantly decreased in the group PR25, PR50 at 15 min after the operation, the end of surgery (P < 0.05). At 5 min after the start of PCS, patients in the group PR25 and PR50 gave significantly less correct responses on the DSST than that of the group P (P < 0.05). CONCLUSIONS: Compared with the propofol alone, intermittent bolus injection of propofol-remifentanil mixture could be used, appropriately, for the sedation and analgesia during MAC. The group PR25 in a low dose of remifentanil has more advantages in terms of sedation and satisfaction because of the group PR50's side effects.
Analgesia ; Anesthesia ; Anesthesia, Local ; Biopsy ; Breast ; Dizziness ; Humans ; Incidence ; Outpatients ; Piperidines ; Propofol ; Vital Signs

Gastric rupture after cardiopulmonary resuscitation (CPR) is a rare complication. In most cases, it is associated with bystander-provided CPR, bag-mask ventilation, and difficult airway management. To the best of our knowledge, there has been only one previous case report in the literature regarding gastric rupture after CPR via supraglottic airway. We present a case of a gastroesophageal junction rupture secondary to CPR with supraglottic airway. Healthcare providers should consider that gastric rupture can be a complication from performing CPR.
Airway Management ; Cardiopulmonary Resuscitation* ; Esophagogastric Junction* ; Health Personnel ; Humans ; Laryngeal Masks ; Pneumoperitoneum* ; Rupture* ; Stomach Rupture ; Ventilation