Postherpetic neuralgia is the most frequent complication of herpes zoster. Treatment of this neuropathic pain syndrome is difficult and often disappointing. Although postherpetic neuralgia is generally a self-limited condition, it can last indefinitely. Continuous epidural blockade for patients with acute zoster can shorten the duration of treatment. However, continuous epidural block has some complications such as infection, dural puncture, and total spinal and nerve damages. We report a case of myoclonus during continuous epidural block with ropivacaine, morphine, and ketamine in an acute zoster patient.
Amides ; Analgesia ; Herpes Zoster ; Humans ; Ketamine ; Morphine ; Myoclonus ; Neuralgia ; Neuralgia, Postherpetic ; Punctures

Background: Our study aimed to investigate the mediating role of work–family conflict (WFC) on the relationship between long commutes and workers' anxiety and insomnia. Methods: Our study measured the two dimensions of WFC, time-related, and strain-related, which were considered multiple mediators. The mediating effect of WFC on anxiety and insomnia was investigated by decomposing the total effect into a direct effect (long commuting time → anxiety or insomnia) and an indirect effect (long commuting time → WFC → anxiety or insomnia). The combined indirect effect (joint indirect effect) of strain-related WFC and time-related WFC was estimated. The effects were presented as odds ratios and 95% confidence intervals (CIs). Results: The direct effect of 120 min or longer of commuting time was 1.39 (95% CI: 1.17–1.65) times increase in the odds of anxiety and 1.64 (95% CI: 1.41–1.90) times increase in the odds of insomnia than those whose commuting time was less than 60 min. In the case of indirect effects, those whose commuting time was 120 min or longer had 1.13 times higher odds of anxiety (95% CI: 1.07–1.18) and 1.12 times higher odds of insomnia (95% CI: 1.07–1.17) via WFC. The joint indirect effects accounted for 26.4% and 18.5% of the total effect on anxiety and insomnia, respectively. The longer the commuting time, the stronger both direct and indirect effects. Conclusions Our findings highlight the mediating effect of WFC on the relationship between long commuting times and workers' anxiety and insomnia.

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

Meningioma en plaque (MEP) is a rare tumor characterized more by its clinical and biological behavior than its histological appearance. Hyperostosis of the skull is one of the characteristic signs of MEP. This bony change can produce clinical symptoms and signs in MEP by pressing against adjacent structures. The authors report a rare case of an osteolytic MEP extending from the sphenoid wing into the orbital wall, middle fossa, and temporalis muscle.
Hyperostosis ; Meningioma ; Muscles ; Orbit ; Skull

Six cases of a rare variant of endocervieal adenocarcinoma (Adenoma maligum, AM) were collected for clinicopethologic analysis. The everage age of six patients was 49.3 years, and their chief com plaints were persis(ent mucid or watery discharge and intermittent vaginal spotting, The clinical im presaion was carcioma of The uterine cervix in faur out, of six cases. All except one were pathologically confirmed by initia1 biupey. two cases by colposcopic biopsies, two by cone biopsies, one by cone biopsy after suggested AM in calposcopic hiopsy. One case was incidentally found from hysterectnmised speeimen, which waas suspected as adennmyosis. On gross examination, the cervix usualty appeared either firm or indurated with thickening af the wall excepl one which was presented es a fungnting mass. The characteristic histologic feetures were ext,ensive arborizing endeervical glands with marked variation in size and shape, and the glands lined by mucin conyaining columnar epithelial cells with basal bland looking nuclei but with occasional cytologic atypia and rare mitose. The nenplasi.ic glands were characterized by deep stronml invasion be yond normal enddcervical glands, assosiated with loose edematous periglandular desmaplastic stromal reaction in moat cases. Immunohistochemical stainnings for carcinoembryonie antigen (CEA) revealed ey- toplasmic positivity in five cases. The clinical stage for all exeept one incidental case were : four Ib and one II b. In three cases, the radical hysterectomy with unilateral salpingooophorectomy plus dissection of bilateral pelvic and paraaortic lymph nodes was performed, and in one case radiotherapy was done prior to radical hysterectomy with bilateral salpingoophorectomy plus the dissection of left pelvic lymph nodes followed by chemotherapy. Total abdominal hysterectomy with bilateral salpingooophorectomy plus Burch's operation followed by radiation therapy was performed in on case. The remaining one case was treated with radiation therapy. Metastasis to the left obturator lymph node was discovered in one case with state IIb, and the patient expired 29 months after the radiotherapy. The remaining five cases are being carefully followed up. From our experience, we conclude that the early diagnosis of AM can be made based on comprehensive analysis concerning the clinical features, histopathological and immunohistochemical findings. The early diagnosis and proper therapy can lead to the better prognosis.
Adenocarcinoma ; Adenoma* ; Biopsy ; Cervix Uteri* ; Drug Therapy ; Early Diagnosis ; Epithelial Cells ; Female ; Humans ; Hysterectomy ; Lymph Nodes ; Metrorrhagia ; Mucins ; Neoplasm Metastasis ; Prognosis ; Radiotherapy

PURPOSE: Tunneling is a periodontal surgical procedure that creates access for patient cleansing and maintenance within the furcal area of a molar tooth with severe furcation involvement. Up to date, there are few studies about a long term clinical and radiographic stability of tunneling. The purpose of this retrospective study is to evaluate the long term prognosis after tunnel preparation of molars with through and through furcation. MATERIAL AND METHODS: 25 teeth of 23 patients aged 36 to 70 (mean age 51.7) were treated surgically with tunnel preparation. These cases were followed for 2 to 13 years (mean 6.5years) after surgery. Patients were recalled for an evaluation which was based on a questionnaire, a clinical examination, and radiographic analysis. Clinical assessment included plaque index, caries registration, probing pocket depth, bleeding on probing, tooth mobility. Baseline and over 2-year follow-up radiographs were collected and evaluated for this study. RESULT: 3 teeth(12%) had been extracted and 1 tooth(4%) hemisected. Root caries was detected in 3 teeth(12%). Thus 72% of the teeth were still caries free and in function. Clinical parameters including PI, PD, BOP, mobility showed somewhat favourable results. Radiographic furcal bone loss showed no statistically significant difference compared to interproximal crestal bone loss (3.59+/-1.69% vs 3.42+/-2.95%) when root length was used as reference. There was no correlation between root trunk length and furcal bone loss. CONCLUSION: Over 2 years after tunneling procedure, teeth showed a clinically and radiographically stable condition, despite of slight root caries and alveolar bone loss within clinically acceptable range. The tunnel procedure may be considered as a viable periodontal treatment option for molar teeth with severe furcation involvement in individuals following a regular maintenance program.
Aged ; Alveolar Bone Loss ; Follow-Up Studies ; Hemorrhage ; Humans ; Molar ; Periodontitis ; Prognosis ; Surveys and Questionnaires ; Retrospective Studies ; Root Caries ; Tooth ; Tooth Mobility

Cellular schwannoma is a very rare benign tumor involving peripheral nerves, mimicking malignant nerve sheath tumor in histological appearance. It is a clinico-pathological variant of benign schwannoma characterized by a high cellularity, increased mitotic figures and occasional presence of bone destruction. A 6-month-old female patient was admitted with progressive quadriparesis. Magnetic resonance imaging of the cervical spine showed a well-enhancing extramedullary mass on the C4 to C6 area. Total laminectomy was performed on C4-7, and intradural extramedullary tumor was removed. Histologically, the tumor was composed of proliferated spindle cells. Most of the tumor was composed of Antoni A area with hypercellular spindle cells arranged in fascicular pattern. The tumor cells showed mild atypism with mitotic figure upto 4/10HPF and diffuse, strong S-100 protein immunostaining. The patient was improved postoperatively.
Female ; Humans ; Infant* ; Laminectomy ; Magnetic Resonance Imaging ; Neurilemmoma* ; Peripheral Nerves ; Quadriplegia ; S100 Proteins ; Spinal Cord Neoplasms ; Spine*

Abdominal desmoid tumor is a very rare neoplasm and arises from musculoaponeurotic structures. Approximately 80% of cases occur in woman, usually between the ages of 20 and 40 years, but they have been described in both men and women of all ages. Typically, abdominal desmoid tumor occurs most commonly in the rectus abdominis muscle and in young, gravid, or parous women during gestation or, more frequently, during first year following childbirth. The rates of recurrence following local excision of desmoid tumors have been reported to be about 24%, but metastases do not occur. We experienced one case of desmoid tumor of the rectus abdominis muscle in a 28-year old woman with pregnancy and so present it with brief review of literatures.
Adult ; Female ; Fibromatosis, Aggressive* ; Humans ; Male ; Neoplasm Metastasis ; Parturition ; Pregnancy* ; Rectus Abdominis* ; Recurrence

The recent introduction of an intraoperative near infrared fluorescence (INIF) imaging system installed on the da Vinci Si(R) robotic system has enabled surgeons to identify intravascular NIF signals in real time. This technology is useful in identifying hidden vessels and assessing blood supply to bowel segments. In this study, we report 3 cases of patients with rectal cancer who underwent robotic low anterior resection (LAR) with INIF imaging for the first time in Asia. In September 2012, robotic-assisted rectal resection with INIF imaging was performed on three consecutive rectal cancer patients. LAR was performed in 2 cases, and abdominoperineal resection was performed in the third case. INIF imaging was used to identify the left colic branch of the inferior mesenteric artery and to assess blood supply to the distal rectum. We evaluated the utility of INIF imaging in performing robotic-assisted colorectal procedures. Our preliminary results suggest that this technique is safe and effective, and that INIF imaging may be a useful tool to colorectal surgeons.
Aged ; Digestive System Surgical Procedures/*methods ; Female ; Fluorescence ; Humans ; Image Processing, Computer-Assisted/instrumentation/*methods ; *Intraoperative Care ; Male ; Middle Aged ; Rectal Neoplasms/*surgery ; Rectum/*surgery ; Robotics/*methods ; Spectroscopy, Near-Infrared/*methods ; Treatment Outcome

PURPOSE: This study investigated the relationship between body composition and platelet-to-lymphocyte ratio (PLR) in patients with colorectal cancer (CRC).METHODS: This retrospective study included 110 patients who underwent anthropometric measurement by bioelectrical impedance analysis before surgical treatment for CRC between May 2015 and June 2018.RESULTS: According to PLR, 45 patients (40.9%) had low PLR (PLR<150), and 65 patients (59.1%) had high PLR (PLR≥150). Serum hemoglobin (P<0.001) and albumin levels (P=0.021) were significantly lower in high PLR group. Tumor mass diameter was significantly larger in high PLR group (P=0.048) and the proportion of poorly differentiated or mucinous tumors was significantly higher in high PLR group (P=0.037). All indices related to fat (body fat mass, percent body fat, body fat mass of trunk, visceral fat area, fat mass index, measured fat thickness of abdomen) and two indices related to muscle (arm muscle circumference, measured muscle circumference of abdomen) were significantly lower in high PLR group (P<0.05). According to subgroup analysis based on the sex, all indices significantly differed between PLR groups; however, in females no index was significantly different between PLR groups.CONCLUSION: Body composition indices including fat and muscle indices measured by InBody 770 were related to PLR in CRC, especially in male patients. These results suggest that low muscle and fat indices may be related to poor prognosis of CRC.
Adipose Tissue ; Body Composition ; Colorectal Neoplasms ; Electric Impedance ; Female ; Humans ; Intra-Abdominal Fat ; Male ; Mucins ; Nutrition Assessment ; Prognosis ; Retrospective Studies