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

When an ankle lateral malleolar fracture is accompanied by a deltoid ligament rupture without a medial malleolar fracture, such an injury is called a bimalleolar equivalent fracture. This means that even if there is no bony injury on the medial side, there may be functional instability of the ankle joint due to damage to the deltoid ligament. Manual or gravity external rotational stress radiography is used to differentiate an ankle bimalleolar equivalent fracture from an isolated lateral malleolar fracture. If the medial joint gap is widened on the stress radiography, the deltoid ligament injury can be diagnosed, and surgical treatment for fibula fractures is recommended. After open reduction of the fibula fracture (with syndesmotic fixation if needed), a decision on the repair of the deltoid ligament is taken depending on the surgeons’ preference and intraoperative findings. The deltoid ligament repair is performed by inserting a suture anchor (or anchors) in the medial malleolus and fixing the deep and superficial deltoid ligaments to the medial malleolus. The only randomized study to evaluate the utility of deltoid ligament sutures in ankle fractures did not support the deltoid ligament suture, but the study itself had many limitations. An appropriately powered, randomized, controlled trial of the deltoid ligament repair with both patient-reported outcome and radiographic outcome evaluation is needed in the future.

BACKGROUND: Nausea, vomiting are among the most common postoperative complaints. We compared the effects of dexamethasone with or without propofol to the effects of conventional regimen consisting of enflurane-N2O in the prevention of postoperative nausea and vomiting. METHODS: Eighty healthy children, aged 3~14 yr, undergoing elective tonsillectomy were alldegrees Cated randomly to receive either 67% nitrous oxide and 1.5~2.0% enflurane or 67% nitrous oxide and propofol infusion 6~10 mg/kg/hr for maintenance of anesthesia. Dexamethasone 150 microgram/kg(maximum dose 8mg) or placebo was administered intrvenously(IV) in a double-blinded fashion before surgery. RESULTS: Dexamethasone reduced the overall incidence of vomiting from 45%(control) to 10%, Propofol also reduced from 45% to 15%. Combination of propofol anesthesia and dexamethasone administration reduced from 45% to 10%. CONCLUSIONS: Dexamethasone and propofol markedly decreased vomiting in healthy children after elective tonsillectomy.
Anesthesia* ; Child ; Dexamethasone* ; Enflurane ; Humans ; Incidence ; Nausea ; Nitrous Oxide ; Postoperative Nausea and Vomiting* ; Propofol* ; Tonsillectomy ; Vomiting

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

A retrospective review of 36 patients with infective endocarditis by strict case definition was performed from 1972 through April of 1984. Male to female ratio was 1:1.25, with mean age of 19.1. Thirty of the 36 patients(83.3%) had the history of predisposing heart diseases: congenital heart disease was most frequent one below the age of 20, rheumatic heart disease between the age of 20-39 and degenerative heart disease above the age of 40. The commonest presenting symptoms were fever, dyspnea, and malaise, and the commonest signs were fever, murmur, and hepatomegaly. Average hemoglobinand hematocrit were 10.1g/dl and 30.8% respectively, showing moderate degree of anemia. White cell count was 11,600+/-5400/mm3 and erythrocyte sedimentation rate was 46+/-18mm/hr. Over four fifths of the patients demonstrated proteinuria and elevated C-reactive protein. Two thirds of the patients showed microscopic hematuria and one third showed positive rheumatoid factor. Eight patients(22.2%) showed arrhythmia and 4(11.1%) showed conduction abnormalities on electrocardiography. The commonest etiologic microorganisms were alpha-hemolytic streptococcus(30.6%) and staphylococcus aureus(22.2%). Abacteremic cases were found in 38.9% of the patients. To compared with alpha-hemolytic streptoccus endocarditis the cases caused by staphylococcus aureus showed the shorter duration of symptoms before admission, the less frequent complication, the higher fever, and the more elevated white cell counts. To penicillin, alpha-hemolytic streptococcus was sensitive in most cultures and staphylococcus arueus was resistant in half of them, and to aminoglycosides vice versa. To cefazolin, both microorganisms were sensitive in most cultures. In 18 of 24(75%) patients vegetation was visualized by echocardiography. The most frequent site of involvement was the mitral valve. And in vegetation detected group complication rate by embolism was found to be higher. The common complications were congestive heart gailure in 24(66.75%), embolism in 8(22.2%), and metastatic infection in 6(16.7%). The mortality rate of infective endocarditis was 25%, and the causes of death were cerebral embolism in 3(8.3%), septic septic shock in 3(8.3%), congestive heart failure in 2(5.6%), and mycotic aneurysmal rupture in 1(2.8%). Conclusively in infective endocarditis the author observed the increasing prevalence of degenerative heart disease as a prdisposing heart disease and increasing incidence of staphylococcus aureus as a causative microorganism. Adn the differences of clinical characteristics between staphylococcus ureus and alpha-hemolytic streptococcus endocarditis would be helpful in diagnosis and treatment of infective endocarditis as well as recognition of prognosis.
Aminoglycosides ; Anemia ; Aneurysm, Infected ; Arrhythmias, Cardiac ; Blood Sedimentation ; C-Reactive Protein ; Cause of Death ; Cefazolin ; Cell Count ; Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography ; Embolism ; Endocarditis* ; Estrogens, Conjugated (USP) ; Female ; Fever ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Heart Failure ; Hematocrit ; Hematuria ; Hepatomegaly ; Humans ; Incidence ; Intracranial Embolism ; Male ; Mitral Valve ; Mortality ; Penicillins ; Prevalence ; Prognosis ; Proteinuria ; Retrospective Studies ; Rheumatic Heart Disease ; Rheumatoid Factor ; Rupture ; Shock, Septic ; Staphylococcus ; Staphylococcus aureus ; Streptococcus

Type II mucopolysaccharidosis (MPS II) commonly known as Hunter syndrome, is a rare X-linked lysosomal storage disorder caused by iduronate-2-sulfatase deficiency, which in turn causes otorhinolaryngological manifestations, including sensorineural hearing loss (SNHL). Previously, the median survival age of patients with MPS was approximately 13.4 years. However, in the era of enzyme replacement therapy and other multidisciplinary care modalities, the life expectancy has increased. Herein, we report a rare case of an adolescent with MPS II who underwent SNHL treatment with cochlear implantation (CI). Based on unexpected findings of mastoid emissary veins and overgrowth of the vessels around the temporal bone, CI was performed using the transmeatal approach instead of the conventional transmastoid method, to avoid damage to the vessels. The average hearing threshold after CI was 35 dB and no surgical complications were encountered. Adolescent MPS II may present vessel abnormalities, which can reduce the success rate of surgery. In patients with MPS II with SNHL, CI should be performed under careful monitoring of vessel overgrowth. Moreover, with regard to feasibility of CI in adolescent patients with MPS II with SNHL, surgical techniques such as the transmeatal approach should be selected based on adequate assessment of the case.

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

PURPOSE: Recently, the emergency medical information center has evolved into a new alternative institution providing emergency medical dispatching in Korea. The objective of this study is to analyze the recognition level of the emergency medical information center, the compliance of the emergency medical dispatch, and the accuracy of dispatching questions for appropriate triage. METHOD: A telephone survey of Gwangju citizens and a retrospective analysis of audio recordings of dispatcher-caller conversations collected by the Gwangju Emergency Medical Information Center for one year were conducted. RESULT: Of 105 respondents, only 21 (21.9%) were aware of the existence of the emergency medical information center and it's telephone number '1339' while 92 (87.6%) respondents were aware of 119, another emergency call number for ambulance service. Distributions of calls are as follows: The most frequent age was 0~9 (43.1%) years and the busiest hour was between 18:00 and 23:59. Also, most callers asked about abdominal pain (19.7%), high fever (10.9%), and injury (10.5%). The compliance of callers to dispatcher's recommendation, 'reassurance or self-care,' 'visit a physician's office,' 'use emergency room service,' 'immediately visit emergency medical center,' was 66.7%, 70.1%, 64.0%, and 92.6%, respectively. Overall, caller's compliance and satisfaction rate were 75.95% and 68.4%, respectively. Logistic regression models showed no significant association between the cardinal dispatcher questions and appropriate triage of trauma patients. CONCLUSION: The recognition level of the emergency medical information center was very low. This result indicates that some new strategies are needed to increase community knowledge and usage of the emergency medical information center. The utilization pattern of emergency medical information center was similar to that of emergency room. It is expected that non-urgent patients could be diverted from overcrowded emergency medical centers to other medical resources by improving the emergency medical information center. Lastly, if prehospital care is to be improved further, the dispatch protocol should be refined and revised with a comprehensive emergency medical system considered.
Abdominal Pain ; Ambulances ; Compliance* ; Surveys and Questionnaires ; Emergencies* ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; Emergency Service, Hospital ; Fever ; Gwangju ; Humans ; Information Centers* ; Korea ; Logistic Models ; Retrospective Studies ; Telecommunications ; Telephone ; Triage

Neurogenic pulmonary edema (NPE) leading to cardiopulmonary dysfunction is a potentially life-threatening complication in patients with central nervous system lesions. This case report describes a 28-yr woman with life-threatening fulminant NPE, which was refractory to conventional respiratory treatment, following the rupture of an aneurysm. She was treated successfully with extracorporeal membrane oxygenation (ECMO), although ECMO therapy is generally contraindicated in neurological injuries such as brain trauma and diseases that are likely to require surgical intervention. The success of this treatment suggests that ECMO therapy should not be withheld from patients with life-threatening fulminant NPE after subarachnoid hemorrhage.
Adult ; Brain/radiography ; Decompressive Craniectomy ; Extracorporeal Membrane Oxygenation ; Female ; Humans ; Intracranial Aneurysm/complications/*diagnosis ; Pulmonary Edema/*diagnosis/etiology/therapy ; Subarachnoid Hemorrhage/etiology ; Tomography, X-Ray Computed

No abstract available.
Ring Chromosomes*