No abstract available.

BACKGROUND: Gabapentin is a safe and well-tolerated anticonvulsant with a wide therapeutic index, and it is used for neuropathic pain. The aim of this study was to compare previous dosing methods with the administration of four different doses of gabapentin while maintaining the same maximum daily dose for the safe administration of high doses of the medication. METHODS: The subjects were outpatients with various neuropathic pain syndromes, with at least two of the following symptoms: allodynia, burning pain, shooting pain, or hyperalgesia. The TID group received equal doses of gabapentin 3 times per day, while the QID group received 4 different doses of gabapentin per day. The pain score, frequency of breakthrough pain (BTP), severity and the duration of pain, sleep disturbance due to nocturnal pain, and adverse effects were recorded each day. RESULTS: The average daily pain score and sleep disturbance were significantly reduced in the QID group between days 3 and 10 of the experiment. The adverse effects of the medication were also reduced in the QID group. However, the frequency of BTP and severity and duration of pain were not significantly different between two groups. CONCLUSIONS: Administration of 4 different doses of gabapentin during the initial titration in outpatients with neuropathic pain resulted in a significant reduction in awakening from breakthrough pain and a reduction in the adverse effects of the medication.
Ambulatory Care ; Amines ; Breakthrough Pain ; Burns ; Cyclohexanecarboxylic Acids ; Drug Administration Schedule ; gamma-Aminobutyric Acid ; Humans ; Hyperalgesia ; Neuralgia ; Outpatients

OBJECTIVE: To assess the gestational age adjusted values of umbilical cord artery blood pH in term pregnancy METHODS: We retrospectively analyzed umbilical arterial blood pH values and obstetric data of 1,918 term singleton deliveries without maternal medical disease, pregnancy induced hypertension and fetal distress during labor periods at Kangnam St. Mary's Hospital, Catholic University medical college between January 2004 and December 2006. Low pH was defined as less than 7.10 as a stationary cutoff value, whereas pH less than (mean -2 standard deviations [SDs]) was used when gestational age was considered. We evaluated the risk of 5 minute Apgar score of less than 7 and meconium staining more than grade II at low pH. RESULTS: A significant negative correlation was found between gestational age and umbilical artery pH (p=0.000). We evaluated the umbilical artery pH value in different delivery mode. Vaginal delivery cases showed negative correlation (p=0.000), but elective cesarean section cases didnt. Low pH patients defined by both criteria of pH less than 7.10 and pH less than (mean -2SD) showed significantly increased risk of 5 minutes Apgar score of less than 7 (pH less than 7.10: p=0. 000, pH less than (mean -2SD): p=0.001) and meconium staining more than grade II (pH less than 7.10: p=0. 001, pH less than (mean -2SD): p=0.001). CONCLUSION: Our results suggest that umbilical cord pH has a negative relation with gestational age during term period.
Apgar Score ; Arteries ; Cesarean Section ; Female ; Fetal Distress ; Gestational Age ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pregnancy-Induced ; Meconium ; Pregnancy ; Retrospective Studies ; Umbilical Arteries ; Umbilical Cord

Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system associated with longitudinally extensive myelitis and optic neuritis. It is characterized by relapses that lead to blindness and paralysis sequelaes. But, this is rare disease; therefore high clinical suspicion for a correct diagnosis and proper examinations are not easy. However, early diagnosis is essential to prevent sequelae. We report the case of NMO with headache. A 30-year male patient who suffered headache visited our pain clinic because of aggravated pain despite treatment. The cause of the pain was revealed as NMO by more detailed previous history and examination.
Blindness ; Central Nervous System ; Demyelinating Diseases ; Diagnosis ; Early Diagnosis ; Headache ; Humans ; Male ; Myelitis ; Neuromyelitis Optica* ; Optic Neuritis ; Pain Clinics ; Paralysis ; Post-Traumatic Headache* ; Rare Diseases ; Recurrence

BACKGROUND: Hyperhidrosis is the troublesome disorder of excessive perspiration, which affects as much as 0.15-1% of the population. There are many methods for treating hyperhidrosis. In this report, we present our experience of dorsal percutaneous thoracic sympathetic ganglion block (TSGB) using 99.9% ethyl alcohol for treating palmar hyperhidrosis. METHODS: Between March 1992 and July 2003, a total of 856 patients underwent TSGB for the treatment of palmar hyperhidrosis of which 625 were followed up for 2 years. There were 297 and 328 male and female patients, respectively, with a mean age of 23.9+/-7.7 years. TSGB was performed under fluoroscopic guidance using 99.9% ethyl alcohol at the T2 and T3 sympathetic ganglia. RESULTS: In the 625 patients, the recurrence rates within the 1st and 2nd years were 29 and 8%, respectively. Compensatory sweating occurred in 42.1% of patients, which was severe in 7.5%. Of the 625 patients 21.0 and 36.9% were either very satisfied or relatively satisfied with the outcome, respectively. CONCLUSIONS: Our report confirms that TSGB may be a good alternative to endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis.
Ethanol ; Female ; Ganglia, Sympathetic* ; Humans ; Hyperhidrosis* ; Male ; Recurrence ; Sweat ; Sweating ; Sympathectomy

There have been reports of abnormalities in the lumbosacral region involving a lower-than-normal termination of the dural sac, which is caused by disease or anatomical variation. Inadvertent dural puncture or other unexpected complications can occur during caudal epidural block or adhesiolysis in patients with these variations, but only a small number of case reports have described this issue. We report a case of dural puncture by the introducer needle before attempting caudal epidural adhesiolysis, which occurred even though the needle was not advanced upward after penetrating the sacrococcygeal ligament. Dural puncture was caused by a morphological abnormality in the lumbosacral region, with no pathological condition; the dural sac terminal was located more distally than normal. However, dural puncture could have been prevented if we had checked for such an abnormality in the magnetic resonance imaging (MRI) taken before the procedure.
Humans ; Ligaments ; Lumbosacral Region ; Magnetic Resonance Imaging ; Needles ; Punctures

Eagle's syndrome is a disease without a clear lesion that is associated with repeated episodes of pharyngalgia, odynophagia, the sensation of a foreign body in the pharynx, tinnitus, and otalgia in which patients displaying these types of symptoms must be given a differential diagnosis. It is known to be characterized by styloid process elongation or increasing compression to adjacent anatomical structures through stylohyoid ligament calcification. In serious cases, continuous pressure to the carotid artery can lead to a stroke. Diagnosis is confirmed through clinical symptoms, radiological findings, and physical examinations. The most common type of treatment consists of a surgical excision of elongated styloid process. Nonetheless, this study presents a case of treating Eagle's syndrome with conservative management.
Carotid Arteries ; Diagnosis, Differential ; Earache ; Foreign Bodies ; Humans ; Ligaments ; Ossification, Heterotopic ; Pharynx ; Physical Examination ; Sensation ; Stroke ; Temporal Bone ; Tinnitus

No abstract available.
Candidiasis* ; Fluconazole* ; Humans

BACKGROUND: Prolonged air leak is a common complication after thoracoscopic bullectomy. MATERIALS AND METHODS: A technique is described to minimize postoperative air leak in thoracoscopic surgery for the treatment of recurrent or persistent spontaneous pneumothorax. RESULTS: A 3.5cm utility incision is made in the anterior axillary line at the level of the third intercostal space, and blebs and bullae are stapled and sutured without excision, using standard surgical instruments and stapler. CONCLUSIONS: This technique may be useful to reduce prolonged air leak after removal of the bleb and bullous lesion, and may minimize the delayed recurrence of ipsilateral pneumothorax.
Blister* ; Pneumothorax ; Recurrence ; Surgical Instruments ; Thoracoscopy*

Cholinergic urticaria with acquired generalized hypohidrosis, and its pathophysiology is not well known. Autoimmunity to sweat glands or to acetylcholine receptors on sweat glands has been mentioned as one of the possible etiologies. Systemic steroid therapy, antihistamines, anticholinergics, and avoidance of the stimulatory situations are recommended for treatment. We experienced a case of cholinergic urticaria with acquired generalized hypohidrosis in a patient who had no other associated disease, and the symptoms eased after repeated bilateral stellate ganglion block. Stellate ganglion block normalized the elevated sympathetic tone and may relieve symptoms in patients with this condition.
Autoimmunity ; Cholinergic Antagonists ; Histamine Antagonists ; Humans ; Hypohidrosis ; Receptors, Cholinergic ; Stellate Ganglion ; Sweat Glands ; Urticaria