Epidural injection of morphine is widely used for relief of postoperative pain. However urinary retention, the side effect, following epidural morphine is troublesome for patient. A 45 year old male patient was admitted due to avascular necrosis of right hip joint and received bipolar endoprosthesis under continuous epidural anesthesia with 2% lidocaine 15 ml. In recovery room after operation, we applied 2 day,s continuous drug infusor (Baxter Infusor(R), Baxter Healthcare Co., USA) with morphine 2 mg and fentanyl 300 g in saline through epidural catheter. At 2 hour after operation, morphine 2 mg was added to the continuous drug infusor due to severe surgical pain. In ward, at 5 hour, he complained of voiding difficulty and abdominal distension. At 6 hour, Nelaton catheter was inserted and 1000 ml of urine was voided. On the 1st postoperative day, the continuous drug infusor was removed and he received naloxone 0.1 mg, two times, intravenously. But voiding difficulty was persisted. Intermittent Nelaton catheter or indwelling Foley catheter was inserted alternatively. Bethanechol chloride (Besacholine(R)) 15~90 mg/day and prazosin hydrochloride (Minipress(R)) 2~3 mg/day were administered orally and hot bag was applied on lower abdomen. On the 25th postoperative day, he was ultimately released from voiding difficulty and discharged without any problems. We suggested that the causes of urinary retention were bladder atony by overdistention of the bladder and contraction of internal urethral sphincter following epidural anesthesia, surgical pain and immobilization.
Abdomen ; Anesthesia, Epidural ; Bethanechol ; Catheters ; Delivery of Health Care ; Fentanyl* ; Hip Joint ; Humans ; Immobilization ; Infusion Pumps* ; Injections, Epidural ; Lidocaine ; Male ; Middle Aged ; Morphine* ; Naloxone ; Necrosis ; Pain, Postoperative ; Prazosin ; Recovery Room ; Urethra ; Urinary Bladder ; Urinary Retention*

No abstract available.
Acne Vulgaris* ; Hair Removal* ; Pigmentation Disorders*

PURPOSE: Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle is frequently found in association with a tear of the anterior cruciate liagment (ACL). The purpose of this study was to determine which ligamentous and meniscal tears are associated with kissing contusion. MATERIALS AND METHODS: We retrospectively reviewed the findings depicted by 323 consecutive MR images of the knee and confirmed at arthroscopy. For the diagnosis of disruption, ligaments, medial menisci (MM) and lateral menisci (LM) were evaluated using accepted criteria. We compared the prevalence and location of meniscal and ligamentous tears between group I (44 knees with kissing contusion) and group II (279 knees without kissing contusion). For statistical analysis the chi-square test was used. RESULTS: ACLs were torn in all 44 knees (100%) with kissing contusion, and 78 (28%) of 279 without kissing contusion. There were ten medial collateral ligament (MCL) tears (23%) in group I, and 17 MCL tears (6%), five lateral collateral ligament (LCL) tears (2%) and ten posterior cruciate ligament (PCL) tears (4%) in group II. In group I, meniscal tears were found in 22 MM (50%) and in 19 LM (43%), while in group II, they occurred in 128 MM (46%) and 128 LM (46%). In group I, 17 (77%) of 22 MM tears and 13 (68%) of 19 LM tears were located in the posterior horn, while in group II, the corresponding figures were 97/128 (76%) and 60 of 128 (47%). The differing prevalence of ACL and MCL tears between the groups was statistically significant (p<0.05), but differences in the prevalence and location of meniscal tears were not (p>0.05). CONCLUSION: Although kissing contusion was a highly specific sign of ACL tears, its presence was also significant among MCL tears. There was no signifficant difference in meniscal tears with or without kissing contusion.
Animals ; Arthroscopy ; Collateral Ligaments ; Contusions* ; Diagnosis ; Horns ; Knee ; Lateral Ligament, Ankle ; Ligaments* ; Menisci, Tibial ; Posterior Cruciate Ligament ; Prevalence ; Retrospective Studies

No abstract available.
Carcinoma, Squamous Cell* ; Cervix Uteri* ; Collagen Type IV* ; Female ; Laminin*

Purpose: The risk of suicide is approximately two times higher in patients with breast cancer compared to the general population. Suicide risk factors are widely investigated but research on the protective factors is lacking. We investigated whether each subscale of grit, consistency of interest, and perseverance of effort, could serve as a protective factor against suicidality. Materials and Methods: Participants were recruited at the Stress Clinic for Cancer Patients, a psycho-oncology clinic at Asan Medical Center from May 2019 to March 2021. A total of 140 female patients with breast cancer completed self-administered questionnaires including Grit scale, Distress thermometer, and Mini International Neuropsychiatric Interview (MINI) suicidality module. We used PROCESS macro for analyzing the mediation model to identify the protective factors for suicidality. Results: Our findings showed that perseverance of effort showed statistically non-significant associations with psychological distress (p=0.403) and suicidality (p=0.945), however, consistency of interest decreased suicidality through psychological distress (β=–0.015; 95% confidence interval, –0.035 to –0.002). Conclusion The result shows that consistency of interest can be a protective factor against suicidality by reducing psychological distress.

Purpose: The risk of suicide is approximately two times higher in patients with breast cancer compared to the general population. Suicide risk factors are widely investigated but research on the protective factors is lacking. We investigated whether each subscale of grit, consistency of interest, and perseverance of effort, could serve as a protective factor against suicidality. Materials and Methods: Participants were recruited at the Stress Clinic for Cancer Patients, a psycho-oncology clinic at Asan Medical Center from May 2019 to March 2021. A total of 140 female patients with breast cancer completed self-administered questionnaires including Grit scale, Distress thermometer, and Mini International Neuropsychiatric Interview (MINI) suicidality module. We used PROCESS macro for analyzing the mediation model to identify the protective factors for suicidality. Results: Our findings showed that perseverance of effort showed statistically non-significant associations with psychological distress (p=0.403) and suicidality (p=0.945), however, consistency of interest decreased suicidality through psychological distress (β=–0.015; 95% confidence interval, –0.035 to –0.002). Conclusion The result shows that consistency of interest can be a protective factor against suicidality by reducing psychological distress.

Purpose: The risk of suicide is approximately two times higher in patients with breast cancer compared to the general population. Suicide risk factors are widely investigated but research on the protective factors is lacking. We investigated whether each subscale of grit, consistency of interest, and perseverance of effort, could serve as a protective factor against suicidality. Materials and Methods: Participants were recruited at the Stress Clinic for Cancer Patients, a psycho-oncology clinic at Asan Medical Center from May 2019 to March 2021. A total of 140 female patients with breast cancer completed self-administered questionnaires including Grit scale, Distress thermometer, and Mini International Neuropsychiatric Interview (MINI) suicidality module. We used PROCESS macro for analyzing the mediation model to identify the protective factors for suicidality. Results: Our findings showed that perseverance of effort showed statistically non-significant associations with psychological distress (p=0.403) and suicidality (p=0.945), however, consistency of interest decreased suicidality through psychological distress (β=–0.015; 95% confidence interval, –0.035 to –0.002). Conclusion The result shows that consistency of interest can be a protective factor against suicidality by reducing psychological distress.

PURPOSE: To evaluate MRI findings of lateral lumbar disc herniations (LLDHs) and to determine whether those correlate with clinical symptoms. MATERIALS AND METHODS: The study included 105 patients with LLDHs that were diagnosed by MRI. The distribution and location of the LLDHs (foraminal, extraforaminal, and foraminal and extraforaminal), the displacement of adjacent nerves, and the detection rate of LLDHs from axial and sagittal images were reviewed retrospectively by two radiologists. 36 patients were included in evaluating whether location of LLDHs and displacement of adjacent nerve correlate with radiculopathy. RESULTS: The distributions of the LLDHs were 3.4% at L1-2, 14.4% at L2-3, 33% at L3-4, 33% at L4-5, and 16.9% at L5-S1. The locations were foraminal in 38.6% of cases, extraforaminal in 45.4% of cases, and foraminal and extraforaminal in 16% of cases. In addition, 77.3% of the diagnosed LLDH cases displaced the adjacent nerve. The detection rates of LLDHs in the axial and sagittal images were 100% and 77.3%, respectively. In 36 patients, 47.4% had radiculopathy related to LLDHs. Location of LLDHs and displacement of adjacent nerve had no statistically significant difference between patients with or without radiculopathy. CONCLUSION: MRI is an effective method for evaluating the location of LLDHs and their influence on adjacent nerves. The axial image is more important than the sagittal image in diagnosing LLDHs. The location of LLDHs and the displacement of adjacent nerve were not found to be related to radiculopathy.
Displacement (Psychology) ; Humans ; Intervertebral Disc ; Lumbar Vertebrae ; Radiculopathy ; Retrospective Studies

OBJECTIVE: The patients with spinal cord injury (SCI) suffered by a lot of complications that influence the quality of life both physically and mentally. The purpose of this study was to evaluate the epidemiology of patients with spinal cord injury in incidence of the complication according to the injury level and period. METHOD: Retrospective study was done in 554 patients with SCI who discharged from Yonsei University Medical Center from January, 1987 to December, 1996. We investigated the incidence of each complication such as respiratory, cardiovascular, genitourinary, musculoskeletal, and dermatologic complications according to the neurologic level and each period (1987~1991, 1992~1996). RESULTS: Among the 554 cases, urologic complication (40.3%) was the most common complication followed by dermatologic (39.0%), musculoskeletal (33.6%), cardiovascular (27.1%) and so on. The most common complications of each system were autonomic dysreflexia (13.2%) in cardiovascular, pneumonia (9.6%) in respiratory, contracture (27.8%) in musculoskeletal, urinary tract infection (34.3%) in urologic, hemorrhoid in gastrointestinal, and central pain (24.0%) in neurogenic complications. The most common site of pressure sore was sacral area (58.9%). There was no significant difference in each complication according to the injury period. CONCLUSION: Urologic complication was the most prevalent in patients with SCI followed by dermatologic, musculoskeletal and so on. These basic results would be helpful for prevention and management of the complication of SCI.
Academic Medical Centers ; Autonomic Dysreflexia ; Contracture ; Epidemiologic Studies* ; Epidemiology ; Hemorrhoids ; Humans ; Incidence ; Pneumonia ; Pressure Ulcer ; Quality of Life ; Retrospective Studies ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Tract Infections

PURPOSE: We wanted to retrospectively determine the accuracy of an ultrasonographic diagnosis of superficial soft tissue masses in the extremities by using the histologic results as the reference standard. MATERIALS AND METHODS: From January 2005 to June 2010, 154 patients with soft tissue masses in the extremities and who underwent ultrasonographic evaluation followed by biopsy or resection were retrospectively evaluated. The ultrasonographic and histologic diagnoses of the soft tissue masses were lipoma, ganglion cyst, hemangioma, neurogenic tumor, giant cell tumor of the tendon sheath, epidermoid cyst, fibroma, glomus tumor, Baker's cyst and neurofibromatosis. RESULTS: Out of 154 patients, 114 (74%) patients showed concordance between the histologic diagnosis and the ultrasonographic diagnosis, and the remaining 40 (26%) patients did not. The diagnostic accuracy of each soft tissue mass was 95% for lipoma, 83% for ganglion cyst, 75% for hemangioma, 72% for neurogenic tumor, 50% for giant cell tumor of the tendon sheath, 43% for epidermoid cyst, 33% for fibroma and 100% each for glomus tumor, fibromatosis and Baker's cyst. Aside from these tumors, there were also sarcoma, malignant melanoma, elastofibroma, Kimura disease and pilomatricoma. Among the cases that showed discordance between the histologic diagnosis and the ultrasonographic diagnosis, three of them were notable; pilomatricoma being misdiagnosed as dermatofibroma protuberans, angiolipoma being misdiagnosed as vascular leiomyoma and malignant fibrous histiocytoma being misdiagnosed as a malignant soft tissue mass. CONCLUSION: The accuracy of an ultrasonographic diagnosis for soft tissue masses in the extremities varies greatly according to each type of mass. Lipoma, ganglion cyst, hemangioma, glomus tumor, neurogenic tumor and Baker's cyst showed a relatively high rate of concordance between the ultrasonographic diagnosis and the histologic diagnosis, but epidermoid cyst and fibroma showed a relatively lower rate of concordance.
Angiolipoma ; Angiolymphoid Hyperplasia with Eosinophilia ; Angiomyoma ; Biopsy ; Epidermal Cyst ; Extremities ; Fibroma ; Ganglion Cysts ; Giant Cell Tumors ; Glomus Tumor ; Hemangioma ; Histiocytoma, Benign Fibrous ; Histiocytoma, Malignant Fibrous ; Humans ; Lipoma ; Melanoma ; Pilomatrixoma ; Popliteal Cyst ; Retrospective Studies ; Sarcoma ; Soft Tissue Neoplasms ; Tendons