BACKGROUND: Morphine has a direct action on morphine receptors in the brain and spinal cord. Intrathecally administered L-NAME, a nitric oxide synthase inhibitor, is known to have an antinociceptive effect on formalin-induced pain in animal studies. Efficacy of intrathecally administered ketorolac, a cyclooxygenase inhibitor, is somewhat controversial. The interactions of intrathecally administered morphine, ketorolac and L-NAME on formalin-induced nociception was studied. METHODS: Male Sprague-Dawley rats were implanted with chronic lumbar intrathecal catheters and were tested for paw flinch by a formalin injection. Drugs were intrathecally administered 15 min before the formalin injection, and biphasic painful behaviors were observed. We obtained the ED50 for each agent (ketorolac, L-NAME and morphine). ED50 fractions (1, 1/2 and 1/4) of drug combinations of L-NAME-ketorolac, morphine-L-NAME and ketorolac-morphine were administered. The ED50 of each combined drug was established and isobolographic analysis of the drug interactions was carried out. RESULTS: Intrathecal administration of ketorolac, L-NAME and morphine produced a dose-dependent suppression of pain behaviors in phase 2. ED50 values were 297.04micro gram for ketorolac, 207.46micro gram for L-NAME and 0.17micro gram for morphine in phase 2. Isobolographic analysis showed that the combination of intrathecal morphine and L-NAME synergistically reduced pain behaviors in phase 2. CONCLUSIONS: Intrathecally administered morphine, L-NAME and ketorolac produced a dose-dependent decrease in the number of paw flinches in both phase 1 and phase 2 on the formalin test. Morphine with L-NAME showed synergistic analgesic effects on formalin-induced pain in phase 2.
Animals ; Brain ; Catheters ; Drug Combinations ; Drug Interactions ; Formaldehyde ; Humans ; Ketorolac* ; Male ; Morphine* ; NG-Nitroarginine Methyl Ester* ; Nitric Oxide Synthase ; Nociception ; Pain Measurement ; Prostaglandin-Endoperoxide Synthases ; Rats* ; Rats, Sprague-Dawley ; Receptors, Opioid, mu ; Spinal Cord

No abstract available.
Pregnancy*

BACKGROUND: Nitric oxide (NO) is known to play causative role in the development of neuropathic pain following peripheral nerve injury. However, it is yet to be investigated whether the role of NO differs in pain modalities, such as mechanical and thermal stimuli. Also, it has not been investigated whether NO has different roles in the stages of neuropathic pain - its development and maintenance. METHODS: Neuropathic pain was induced by a resection of the lumbar dorsal root 5, 6 (L 5, 6). After N-nitro-L-arginine methyl ester (L-NAME), an NO synthase inhibitor was injected intrathecally or locally around the dorsal root, we observed the behavioral response to the mechanical and thermal stimuli. RESULTS: Mechanical and thermal allodynia was inhibited by the application of L-NAME before the dorsal root injury. However, L-NAME did not affect the mechanical and thermal allodynia during the maintenance of neuropathic pain. CONCLUSIONS: We suggest that NO in the spinal cord or injured perineural site may play an important role in the induction of neuropathic pain, and may be associated with mechanical and thermal allodynia.
Animals ; Hyperalgesia* ; Neuralgia* ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase ; Nitric Oxide* ; Peripheral Nerve Injuries ; Rats* ; Spinal Cord ; Spinal Nerve Roots

Fitz-Hugh-Curtis syndrome is a condition in which, as a result of pelvic inflammatory disease, the liver capsule becomes involved with inflammatory exudate that later leaves violin string adhesions. Although in the past Neisseria gonorrhea was thought to be the only etiological agent, recent data indicate that Chlamydia trachomatis may play an important role in perihepatitis. Perihepatic adhesions may be an aftereffect of the acute hepatic episode, and because the cause of ectopic pregnancy is thought to be salpingitis, women with an ectopic pregnancy may have a higher prevalence of coexisting perihepatic adhesion. The incidence of this conditon in ectopic gestation was reported to be 14-34 %. Direct observation of the liver and pelvis through laparoscope is the most definitive method of diagnosing salpingitis and perihepatitis. Standard treatement regimens recommended for salpingitis are adequate also for treatement of perihepatitis. We have experienced two cases of Fitz-Hugh-Curtis syndrome associated with ectopic pregnancy, and report with the brief review of the literatures.
Chlamydia trachomatis ; Exudates and Transudates ; Female ; Gonorrhea ; Humans ; Incidence ; Laparoscopes ; Liver ; Neisseria ; Pelvic Inflammatory Disease ; Pelvis ; Pregnancy ; Pregnancy, Ectopic* ; Prevalence ; Salpingitis

BACKGROUND: The management of postoperative pain with traditional narcotic analgesic regimen is associated with an unacceptably high failure rate and at best has represented a cautious compromise between adequate analgesia and the risk of complications, particularly that of respiratory depression. The purpose of this investigation was to compare the efficacy and safety of nalbuphine given by patient-controlled analgesia (PCA) with differential dosages after total knee replacement. METHODS: A double-blind clinical trial of 75 patients who received intravenous nalbuphine with patient- controlled analgesia during the postoperative first 48 hours after total knee replacement, was carried. Patients were assigned to three groups by the concentration of nalbuphine: Group 1 (n = 25), 2 mg/ml; Group 2, 4 mg/ml; Group 3, 6 mg/ml. The settings of PCA in three groups were same. RESULTS: Visual analog scale (VAS) scores were used to assess pain. Group 2 and 3 patients reported significant lower VAS over the postoperatively 6 hours and 12 hours at either rest or movement compared to group 1. PCA demands, delivered doses and PCA nalbuphine dosage per hours except supplemental analgesic doses in the first 48 hours were lower in group 2 and 3 compared to group 1. There were significant differences among groups at postoperatively 6 and 12 hours in nausea, vomiting and sedation of the side effects. CONCLUSIONS: IV PCA with nalbuphine is thought to be potent and safe for postoperative pain relief without the major morbidity like respiratory depression, in addition, the careful observation and treatment on the side effect like nausea, vomiting and sedation, is surely needed.
Analgesia ; Analgesia, Patient-Controlled* ; Arthroplasty, Replacement, Knee ; Humans ; Nalbuphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Respiratory Insufficiency ; Visual Analog Scale ; Vomiting

BACKGROUND: The motor neuronal death in amyotrophic lateral sclerosis (ALS) arise from several mechanisms including excitotoxicity, oxidative stress, immunologic or calcium dysregulation. Though the immunoglobulin mediated neuronal death has been implicated through changes of calcium influx, the direct evidence showing the increase of intracellular calcium level is rare. The purpose of our study is to directly measure the calcium in cultured neurons treated with immunoglobulins from ALS patients to further understand the role of calcium in motor neuron degeneration. METHODS: Immunoglobins purified from serum in patients with ALS (n=8) and in control (n=8) were incubated for 24 hours in PC12 cell line. The intracellular calcium level was measured by fluorometry using calcium chelating dye, fura-2. High concentration of potassium chloride were used to evoke calcium influx, and L-type calcium channel current were measured using nicardipine, the L-type specific calcium channel blocker. RESULTS: Basal level of intracellular calcium was higher in the cells treated with immunoglobulins from ALS. However, the calcium increase evoked by 30 mM or 140 mM potassium chloride were lower in ALS than in control. The calcium increase through L-type calcium channel in ALS group was not significantly different from control. Conclusions ; Considering the proposed role of the calcium in neuronal degeneration, present data suggest increased intracellular calcium is important in neurodegenerative mechanism caused by ALS immunoglobulins.
Amyotrophic Lateral Sclerosis* ; Animals ; Calcium Channels ; Calcium Channels, L-Type ; Calcium* ; Fluorometry ; Fura-2 ; Humans ; Immunoglobulins* ; Motor Neurons ; Neurons ; Nicardipine ; Oxidative Stress ; PC12 Cells* ; Potassium Chloride

It is easy to view the laryngeal aperature with a flexible fiberscope through a laryngeal mask airway (LMA). This is a case report that the LMA could facilitate a fiberscope-aided tracheal intubation easily. Patient was a 59 year old female who had some limitation of mouth opening due to ankylosis of bilateral temporomandibular joints. After thiopental (200 mg) and succinylcholine chloride (50 mg) were given intravenously, a number 3 sized LMA was inserted and the lungs were ventilated via the LMA. The anesthesia cirele system is then disconnected from the LMA and a fiberscope, with the proximal end jacketed with a well-lubricated, cuffless, 6-mm-ID endotracheal tube (ETT); was inserted into the trachea through the lumen of the LMA. The 6-mm-ID ETT was threaded over the fiberscope into the trachea before fiberscope was withdrawn, and a traeheal tube exchanger was inserted through the ETT after enough ventilation for a while, followed withdrawal of the LMA and ETT. Finally, we can make the 7 mm-ID ETT with cuff insert into the trachea over a tracheal tube exchanger very easily without any difficulties.
Anesthesia ; Ankylosis ; Bronchoscopes* ; Female ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngeal Masks* ; Lung ; Middle Aged ; Mouth ; Succinylcholine ; Temporomandibular Joint ; Thiopental ; Trachea ; Ventilation

No abstract available.

Nine patients of mean age 47.8 years, with suspected sinus node dysfunction, underwent extensive electrophysiological studies. Sinus bradycardia(6the electrophysiological study, AH and HV intervals were prolonged in 2/9 and 1/9 patients, respectively. Maximal sinus node recovery times were prolonged in 7/9 patients, ranging from 1,330 msec to 12,330msec. Sinoatrial conduction times measured by atrial premature stimulation technique were prolonged in 5/7 patients, ranging from 137msec to 310 msec. And sinoatrial conduction time measured by continuous pacing technique also revealed prolonged value in 4/6 patients ranging from 140 msec to 195 msec. The effective refractory periods, of atrium were prolonged in 6/8 patients (320 msec to 470 msec). The effective and functional refractory periods of AV node were prolonged in 3/8 patients (440 csec to 490 msec) and 4/8 patients (530 msec to 560 msec), respectively. Retrograde VA conduction could be observed in 3/7 patients and ventricular effective refractory periods were normal in 7/7 patients. Atrial flutter was induced in 1/9 patients by electric stimulation during electrophysiological study. Above data suggest that the electrophysiological study is very useful in assessing the sinus node function and other electrophysiological properties in sick sinus syndrome patients and also suggest that the data could be utilized in choosing the proper mode of artificial pacemaker for each patient.
Atrial Flutter ; Atrioventricular Node ; Electric Stimulation ; Humans ; Pacemaker, Artificial ; Sick Sinus Syndrome* ; Sinoatrial Node

Norwegian, or crusted scabies, is a fulminant and highly infectious form of scabies in which a large number of Sarcoptes scabiei mites infest the epidermis. This is often seen in the physically or mentally handicapped, immunocompromised, and institutionalized persons. The characteristic skin lesions in this form are gross scaling and hyperkeratotic plaques with erythematous papules, especially on hands, feet, elbow, and subungual area with varying degrees of pruritus. It may be difficult to differentiate Norwegian scabies from tinea unguium when Norwegian scabies involves nail and subungual area. We report a case of tinea unguium hidden by Norwegian scabies with nail involvement in a 71-year-old patient. This is the first report of such a case in Korea.
Aged ; Elbow ; Epidermis ; Foot ; Hand ; Humans ; Institutionalization ; Korea ; Mentally Disabled Persons ; Mites ; Nails ; Onychomycosis ; Pruritus ; Sarcoptes scabiei ; Scabies ; Skin ; Tinea