Background: The continuous brachial plexus block brings about the prolongation of surgical anesthesia, postoperative pain relief, and sympathectomy. Methods: The twenty-five patients scheduled for upper extremity operations had been taken the continuous axillary brachial plexus block procedure to relief postoperative pain and, to get the sympathetic block effect. We used local anesthetics less than maximum recommended dose, 0.125% bupivacaine continuously infused at 4 ml/hour via catheter. We adopted the faces pain rating scale to evaluate postoperative pain degree. The faces pain rating scale composed of six faces, based upon the degree of pain. The patients has been asked to choose these rating scale according to their painfulness three times a day for five days. Results: Clinically, we have found the effective decrease in the degree of pain. Systemic toxic reactions, hematoma and infection sign at injected site were not found. Conclusion: The pain of upper extremity after operation was controlled by continuous infusion of 0.125% bupivacaine, 4 ml/hr, usually.
Anesthesia ; Anesthetics, Local ; Brachial Plexus* ; Bupivacaine ; Catheters ; Hematoma ; Humans ; Pain, Postoperative ; Sympathectomy ; Upper Extremity*

BACKGROUND: Epidurally administered clonidine represents an approach to control the pain after cesarean section that produces analgesia by an alpha 2-adrenergic mechanism and may provide postoperative analgesia without nausea, pruritus, and respiratory depression associated with systemic or intraspinal opioid administration. This study was undertaken to evaluate the analgesic effect according to the dose of appropriate bolus and the combination of epidural morphine and clonidine after cesarean section. METHOD: Forty five women, ASA physical status 1 or 2, scheduled for elective cesarean section were randomly assigned to receive epidural administration for postoperative pain control. Group A (n=15) received 1 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 150 g clonidine. Group B received 2 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 300 g clonidine. Group C received 3 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 450 g clonidine. Each combination of drug was injected at Bromage scale 1 after surgery. RESULTS: All groups showed relatively stable hemodynamic status. Analgesic effect was significantly better in Group B and C than Group A (p<0.05). Sedative effect was not a problem in all groups. The incidence of side effects in Group C was more than Group B, which than Group A, but almost cases did not require treatment. CONCLUSION: 2 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 300 g clonidine with excellent analgesic effect and less side effects is considered as adequate dose in postoperative pain control after cesarean section with epidural anesthesia.
Analgesia ; Anesthesia, Epidural* ; Cesarean Section* ; Clonidine* ; Female ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative ; Pregnancy ; Pruritus ; Respiratory Insufficiency

Dermatomyositis* ; Skin*

The complement system is known to be involved in the pathogenesis of the skin lesions in pernphigus vulgaris, bullous pemphigoid, dermatitis herpetiformis, epidermolysis bullosa acquisita, and systemic lupus erythematosus. Authors examined the skin specimens of each disease cases, who did not show any evidence of complement deficiency, to determine the deposition of complement components(C4, C3, Chb-9) and their inhibitors(C4bp, Factor H, S-protein) by modified direct immunofluorescence. We also looked at the staining pattern and localization, for further insights of their pathobiologic contributions in each disease. The findings of deposits of complement components up to C9, as well as inhibitor proteins at the primary histopathologic sites, in the majority of those cases, may indicate that the complement system, to certain extent, involves the inflamrnatory reactions in these diseases. The co-localization of C5b-9 and S-protein could be regarded as the consequence of in situ formation of SC5b-9 complexs or as the result of non-lytic adsorbed complexes of fluid phase SC5b-9. The pathologic role of the complement seems to depend mostly on the complement-fixing biologic property and the amount of the tissue bound immune complexes, which are often heterogeneous to different diseases and among different patients.
Antigen-Antibody Complex ; Complement Factor H ; Complement Membrane Attack Complex ; Complement System Proteins* ; Dermatitis Herpetiformis ; Epidermolysis Bullosa Acquisita ; Fluorescent Antibody Technique, Direct ; Humans ; Lupus Erythematosus, Systemic ; Pemphigoid, Bullous ; Skin ; Skin Diseases*

PURPOSE: The purpose of this study was to describe the clinical characteristics of neonatal urinary tract infection (UTI) caused by Klebsiella pneumoniae and non- Klebsiella pneumoniae UTI. METHODS: We compared clinical characteristics of 84 neonatal patients with UTI caused by Klebsiella pneumoniae who were hospitalized at the Department of Pediatricsat Han Dong University, Sunlin Hospital during the period between May, 1994 and August, 1998. The cases were divided into two groups depending upon causative organisms' Klebsiella pneumoniae UTI vs non-Klebsiella pneumoniae UTI, and the clinical characteristics of these groups were compared. RESULTS: Escherichia coli was the most common bacterial pathogen causing neonatal UTI, followed by Klebsiella pneumoniae. There was no significant difference in the sex distribution of Klebsiella pneumoniae UTI, but non-Klebsiella pneumoniae UTI showed male predominence. There were no significant differences in the incidences of hematologic, urologic, radiologic findings and perinatal complications in between these 2 groups. CONCLUSION: Klebsiella pneumoniae is the second most common pathogen causing neonatal UTI. There were no specific differences in the laboratory, symptomatologic, and radiologic findings in these two groups.
Escherichia coli ; Humans ; Incidence ; Klebsiella pneumoniae* ; Klebsiella* ; Male ; Pneumonia ; Sex Distribution ; Urinary Tract Infections* ; Urinary Tract*

No abstract available.
Dyskeratosis Congenita*

Primary cutaneous CD30+ large cell lymphoma(LCL) is a rare cutaneous peripheral T cell lymphoma with a favorable prognosis. This lymphoma characteristically presents itself as a solitary or localized skin tumor with frequent cutaneous relapses and partial or complete spontaneous remission. Recently we saw a sixty-three year old male who had developed primary cutaneous CD30+ large cell lymphoma that waxed and waned. He presented with localized multiple nodules that had shown repetitive spontaneous regression and recurrences with the same morphology in the same area for several years. There was no evidence of nodal and visceral involvement. The immunohistochemical studies demonstrated that most neoplastic cells in the tumor were positive for CD30 and pan-T cells and negative for pan-B cells, S-100 proteins, EMA and monocyte-macrophage related antigen(CD68).
Humans ; Lymphoma* ; Lymphoma, T-Cell, Peripheral ; Male ; Prognosis ; Recurrence* ; Remission, Spontaneous ; S100 Proteins ; Skin

Herpes zoster is characterized by several groups of vesicles on an erythematous base situated unilaterally within the distribution of a single spinal or cranial sensory ganglion. Recurrent herpes zoster is rare and may be associated with severe immunocompromised state. Human immunodeficiency virus(HIV) infection is associated with an increased incidence of zoster, which tends to be severe, presumably due to HIV-induced depression of cellular immunity. We report a case of a 46-year-old female who was presented with recurrent herpes zoster and concurrent HIV infection.
Depression ; Female ; Ganglia, Sensory ; Herpes Zoster* ; HIV Infections ; HIV* ; Humans* ; Immunity, Cellular ; Incidence ; Middle Aged

Background: Onychomycosis, a common fungal nail infection, particularly affects the elderly. The diagnostic accuracy of a potassium hydroxide (KOH) smear, a primary diagnostic method, can vary based on the examiner’s proficiency. Objective: To evaluate the diagnostic utility of KOH smears in a real-world setting and the influence of clinical and practical factors on onychomycosis. Methods: This study included 381 patients who underwent KOH smear and histopathological staining for nail diseases at Seoul National University Hospital between March 2020 and February 2023. The study evaluated the diagnostic utility of the KOH smear, including its sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic odds ratio. We investigated the influence of factors such as training duration of examiners, prior history of antifungal treatment, and lesion location on diagnostic utility. Results: Of the 381 patients, 139 were male (36.5%) and 242 were female (63.5%). Onychomycosis was the most common diagnosis (59.3%), with 34.1% of patients reporting prior antifungal therapy within the past 6 months. The sensitivity of the monthly KOH smear varied from 16.7% to 70.0% with an annual sensitivity of 48.1%. The specificity ranged from 83.3% to 100.0%, with an annual specificity of 90.3%. While prior antifungal therapy decreased the sensitivity and specificity, no statistical significance was observed. Examiner's experience, measured by training duration, was not associated with sensitivity or specificity. Among patients with a history of antifungal treatment, an increasing number of KOH smear tests showed reduced sensitivity. Conclusion Variations in the diagnostic utility of the KOH smear test, influenced by various factors, highlight the necessity for cautious interpretation in clinical settings.

OBJECTIVES: The purpose of this study was to define the underserved emergency medical services (EMS) areas in Daejeon metropolitan city, as well as to identify their distinctive characteristics in public health perspectives. METHODS: An underserved EMS area was operationally defined as an area in which it is difficult to arrive at an emergency medical center within 30 minutes. Using a cost-weighted distance algorithm with a geographic information system (GIS), the underserved EMS area was calculated. The characteristics of the underserved areas were analyzed by the Chi-square test. The SPSS statistical software package was used to perform the statistical analysis. All statistical tests were two-sided, and a p-value<0.05 was considered statistically significant. RESULTS: Twelve administrative sectors ('Dong' in Korean) were included in the underserved areas, accounting for a population of approximately 8,100 citizens. The relationships between underserved EMS area and populations of agriculture, fishery, and forestry; citizens who are recipients of national basic livelihood security program; disabled; or aged 65 or older were statistically significant. CONCLUSION: It was found that 12 administrative sectors were included in the underserved EMS areas. Revealing underserved EMS areas using GIS analysis based on a cost-weighted distance algorithm of road data was an effective analytic method. However, as this study was confined to Daejeon City, South Korea, a nation-wide study should be performed to provide a more accurate conclusion.
Accounting ; Aged ; Agriculture ; Emergencies ; Emergency Medical Services ; Fisheries ; Geographic Information Systems ; Humans ; Public Health ; Republic of Korea