BACKGROUND: The pathophysiologies of Failed Back Surgery Syndrome (FBSS) are epidural adhesion& fibrosis; arachnoiditis, neural encroachment, mechanical instability. Epidural adhesiolysis alleviate back pain through blocking the neural activity of scar area and decreasing the inflammation & edema. There are two methods of adhesiolysis, endoscopic & non-endoscopic adhesiolysis. Present study was aimed to compare the pain relief & side effects between two methods. METHODS: We investigated 86 post-laminectomy patients with low back pain and radiculopathy, who do not relieved with any kinds of conservative treatment. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with MRI examination. Group I was consisted with non-endoscopic 41 patients, and Group II was endoscopic 45 patients. Evaluation included assessment of pain relief (visual analogue scale, VAS), rate of reprocedures and duration of pain relief (VAS < 5) at post-epidural adhesiolysis 2 week, and 1, 2, 6 months. We also looked for complication of adhesiolysis. RESULTS: Statistical analysis (t-test, chisquared test) demonstrated VAS & reprocedure rate was significantly low (P < 0.05) in group II at 6 month and duration of pain relief (VAS < 5) was more prolonged in group II. One patient in each groups complained skin eruption and pruritus, and one patient of group II was proved epidural abscess and one patient of group I complained headache. CONCLUSIONS: Endoscopic and non-endoscopic epidural adhesiolysis are effective and safe in patients, who was not relieved the symptoms with conservative treatment, but endoscopic epidural adhesiolysis is more recommendable because its more prolonged effect.
Arachnoid ; Arachnoiditis ; Back Pain ; Cicatrix ; Edema ; Epidural Abscess ; Failed Back Surgery Syndrome ; Fibrosis ; Headache ; Humans ; Inflammation ; Low Back Pain ; Magnetic Resonance Imaging ; Pathology ; Pruritus ; Radiculopathy ; Skin

BACKGROUND: Morphine for the intravenous patient controlled analgesia (IV-PCA) provides effective postoperative pain control, but it has side effects such as itching, nausea and vomiting. Meanwhile, butorphanol, a synthetic potent agonist-antagonist narcotic with low incidence of adverse side effects and minimal addiction, produce adequate analgesia for postoperative pain. The purpose of this study was to compare the suitability of butorphanol combining with or without morphine with that of morphine in terms of relieving postoperative pain and incidence of side effects. METHODS: Sixty ASA physical status I or II female patients undergoing total abdominal hysterectomy were randomly allocated into one of three groups according to type of drug used (n=20 for each group). The groups were divided to group M (morphine 100 mg), group M B (morphine 50 mg+butorphanol 10 mg) and group B (butorphanol 20 mg). Drugs for each group mixed with 90 ml of normal saline (total amount: 100 ml) for infusion. Loading dose, PCA dose, lockout interval, mode of infusion was 0.05 ml/kg, 0.02 ml/kg, 8 minute, and PCA only, respectively. In each group, visual analog scale (VAS), pain score, sedation score, degree of satisfaction, total amount of drug used, history of attempt/injetion and incidence of side effects were checked. RESULTS: There were no significant differences in analgesic effects and degree of satisfaction among three groups, but incidence of side effects (especially pruritis) were less in group M+B and B compared with group M (p<0.05). CONCLUSIONS: Butorphanol showed comparable postoperative pain relief and marked less side effects compared with morphine. Butorphanol was considered as a useful drug for postoperative pain relief using IV-PCA.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics ; Butorphanol* ; Female ; Humans ; Hysterectomy ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Pruritus ; Visual Analog Scale ; Vomiting

PURPOSE: In this paper we tried to evaluate the most appropriate surface for rhBMP-2 coating among 4 rough titanium surfaces. MATERIALS AND METHODS: We used machined surface as a control group and anodized, RBM and SLA surfaces as test groups. We coated rhBMP-2 on the 4 surfaces and with uncoated surfaces for each case, we cultured human mesenchymal stem cells on all 8 surfaces. 24 hours after we measured the stem cell'attachment with SEM, and on 3rd, 7th, and 14th days, we checked the cell proliferation and differentiation by using MTT and ALP activity assay. And on the 7th day after the culture, we performed RT-PCR assay to determine whether the expression levels of Type I collagen, osteocalcin, osteopontin were changed. RESULTS: We observed with SEM that 4 rhBMP-2 coated surfaces exhibited wider and tighter cell attachment and more cell process spreading than uncoated surfaces. The anodized rhBMP-2 surface caused robustest effects. In MTT assay we could not find any meaningful difference. In ALP assay there was a significant increase (P<.05) in the ALP activity of anodized rhBMP-2 coated surface compared with that of the control (3rd and 14th days) and with that of the RBM rhBMP-2 coated surface (14th day). In RT-PCR assay there was increased expressions in the anodized rhBMP-2 coated surface for osteocalcin, and osteopontin. CONCLUSION: We found that the anodized rhBMP-2 coated surface were most prominent stem cell attachment and differentiation in compared to control and Machined rhBMP-2 coated, RBM rhBMP-2 coated surface.
Cell Proliferation ; Collagen Type I ; Humans ; Mesenchymal Stromal Cells ; Osteocalcin ; Osteopontin ; Stem Cells ; Titanium

Percutaneous vertebroplasty was first introduced in 1984. It allows reduction in pain and strengthening of bone. Main indications for this procedure are an osteoporotic compression fracture, hemangioma or a malignant spine tumor. Metastases to the vertebrae are not rare and often painful. Radiation therapy results in delayed (10 14 days) pain relief and minimal bone strengthening. Surgical procedures require significant postoperative recovery and have associated morbidity and mortality. However, a percutaneous vertebroplasty in patients with an osteolytic spinal metastatic tumor results in quick (1 3 days) disappearance of pain, vertebral consolidation, and spinal stability. We encontered a patient with severe back pain due to an osteolytic spinal metastatic tumor that had not responded to radiation therapy but which responded successfully to pain relief by a percutaneous vertebroplasty.
Back Pain ; Fractures, Compression ; Hemangioma ; Humans ; Mortality ; Neoplasm Metastasis ; Spine ; Vertebroplasty*

BACKGROUND: Theoretical advantages in maintaining an effective blood concentration of the analgesic medication using basal infusions with or without standard intermittent PCA dosing regimens is controversial. The purpose of this study was to compare the effectiveness and incidence of side effects among three modes which include PCA only(group 1), PCA+ basal infusion(group 2), and basal infusion only(group 3). METHODS: Sixty ASA physical status 1 or 2 female patients who scheduled elective cesarean section were randomly allocated into one of three modes. Loading/PCA/basal infusion dose and lockout interval was 0.05 mg/kg, 0.02 mg/kg, 0.015 mg/kg/hr, and Smin, respectively. In each group, visual analog scale(VAS), pain score, sedation score, degree of satisfaction, total amount of morphine used, history of attempt or injection and incidence of side effects were checked. RESULTS: Group 2 did not show any improvement of VAS, and group 3 showed significantly higher VAS from 2 hours after initiation of morphine infusion compared to group 1(P<0.05). Degree of satisfaction was lower in group 3 compared to group 1 and 2(P<0.05). Total amount of morphine was increased in group 2(P<0.05) and reduced significantly in group 3 compared to group 1(P<0.01). There was no evidence of respiratory depression. Incidence of nausea and pruritus did not show any difference among groups. CONCLUSIONS: Addition of basal infusion did not show any improvement of postoperative pain control compared to conventional PCA method.
Analgesia ; Cesarean Section* ; Female ; Humans ; Incidence ; Morphine ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Pregnancy ; Pruritus ; Respiratory Insufficiency

OBJECTIVES: Aminoglycosides are commonly used antibiotic agents, and they are known to generate free oxygen radicals within the inner ear and to cause vestibulo-cochlear toxicity and permanent damage to the sensory hair cells and neurons. Melatonin, a pineal secretory product, has the properties of being a powerful direct and indirect antioxidant. The aim of the present study was to prove the antioxidant effect of melatonin against gentamicin-induced ototoxicty. METHODS: The utricular maculae of Sprague-Dawley rats were prepared from postnatal day 2-4, and these maculae were were divided into 6 groups as follows: 1) control, 2) melatonin only, 3) gentamicin only, and 4), 5), and 6) gentamicin plus melatonin (10, 50, and 100 micrometer, respectively). To count the number of hair cells, 5 utricles from each group were stained with phalloidin-FITC on the 1st, 4th, and 7th days after drug administration. Reactive oxygen species (ROS) was assessed by using the fluorescent probe hydrofluorescent diacetate acetyl ester. The caspase-3 activity was also examined with using the fluorescent caspase-3 substrate and performing Western blotting. RESULTS: The result of this study showed that gentamicin induced the loss of utricular hair cells, and this loss of hair cells was significantly attenuated by co-administration of melatonin. Melatonin reduced ROS production and caspase-3 activation in the gentamicin treated utricular hair cells. CONCLUSION: Our findings conclusively reveal that melatonin has protective effects against gentamicin-induced hair cell loss in the utricles of rat by inhibiting both ROS production and caspase-3 activity.
Aminoglycosides ; Animals ; Antioxidants ; Blotting, Western ; Caspase 3 ; Ear, Inner ; Gentamicins ; Hair ; Hair Cells, Vestibular ; Melatonin ; Neurons ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species ; Saccule and Utricle

PURPOSE: Clinical and pathological prognostic factors of idiopathic IgA nephropathy have been reported, but mostly in adults and a few in children. Especially studies about correlation between those factors are very rare. METHODS: We studied 58 children patients who were hospitalized to our clinics and diagnosed as IgA nephropathy by renal biopsy from Jan. 1989 to Jun 1996. They got divided into several clinical groups, which are heavy proteinuria group (group A), asymptomatic urinary abnormalities group proteinuria and/or microscopic hematuria (group B), and recurrent gross hematuria group (group C). They are also divided into younger group (younger than 10 years of age) and older group (older than 10 years og age). We compared their pathological findings of bad prognosis, if they have, in different clinical groups. RESULTS: Group A had most pathological factors of bad prognosis such as higher Meadow grade, crescent formation, necrosis, glomerulosclerosis, tubular atrophy, interstitial fibrosis, two or more kinds of immune deposit except IgA, high frequency of electron dense deposits of glomerular capillary wall. Group B treded to have some poor prognostic factors such as tubular atrophy and interstitial fibrosis. in terms of age groups, older group was more apt to be heavily proteinuric than younger group, have such pathological factors of poor prognosis that group A had. CONCLUSION: Heavy proteinuria and relative old age in childhood IgA nephropathy, considered clinically poor prognostic, appears significantly correlated with pathologically poor prognostic factors.
Adult ; Atrophy ; Biopsy ; Capillaries ; Child* ; Fibrosis ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Necrosis ; Prognosis ; Proteinuria

PURPOSE: Clinical and pathological prognostic factors of idiopathic IgA nephropathy have been reported, but mostly in adults and a few in children. Especially studies about correlation between those factors are very rare. METHODS: We studied 58 children patients who were hospitalized to our clinics and diagnosed as IgA nephropathy by renal biopsy from Jan. 1989 to Jun 1996. They got divided into several clinical groups, which are heavy proteinuria group (group A), asymptomatic urinary abnormalities group proteinuria and/or microscopic hematuria (group B), and recurrent gross hematuria group (group C). They are also divided into younger group (younger than 10 years of age) and older group (older than 10 years og age). We compared their pathological findings of bad prognosis, if they have, in different clinical groups. RESULTS: Group A had most pathological factors of bad prognosis such as higher Meadow grade, crescent formation, necrosis, glomerulosclerosis, tubular atrophy, interstitial fibrosis, two or more kinds of immune deposit except IgA, high frequency of electron dense deposits of glomerular capillary wall. Group B treded to have some poor prognostic factors such as tubular atrophy and interstitial fibrosis. in terms of age groups, older group was more apt to be heavily proteinuric than younger group, have such pathological factors of poor prognosis that group A had. CONCLUSION: Heavy proteinuria and relative old age in childhood IgA nephropathy, considered clinically poor prognostic, appears significantly correlated with pathologically poor prognostic factors.
Adult ; Atrophy ; Biopsy ; Capillaries ; Child* ; Fibrosis ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Necrosis ; Prognosis ; Proteinuria

raumatic shoulder dislocations are one of the most common major dislocations in the general population. Injury to major vessels is rarely reported as a complication of shoulder dislocations. This case report presents the traumatic dissection of the axillary artery after a simple shoulder dislocation that was managed successfully with the placement of a self-expanding stent. With the clinical manifestations of a brachial plexus injury and progressive vascular compromise in the affected arm, a major vascular injury was detected on an angiogram, and a self-expanding stent was deployed. Through immediate diagnosis and prompt intervention, serious complications, such as hypovolemic shock and even death, were averted, ultimately achieving a favorable patient outcome.

Acute bilateral reexpansion pulmonary edema after pleurocentesis is a rare complication. In one case, bilateral reexpansion pulmonary edema after unilateral pleurocentensis in sarcoma was reported. Verious hypotheses regarding the mechanism of reexpansion pulmonary edema include increased capillary permeability due to hypoxic injury, decreased surfactant production, altered pulmonary perfusion and mechanical stretching of the membranes. Ragozzino et al suggested that the mechanism leading to unilateral reexpansion pulmonary edema involves the opposite lung when there is significant contralateral lung compression. Here we report a case of bilateral reexpansion pulmonary edema and acute respiratory distress syndrome after a unilateral pleurocentesis of a large pleural effusion with contralateral lung compression and increased interstitial lung marking underlying chronic liver disease.
Capillary Permeability ; Liver Diseases ; Lung ; Membranes ; Perfusion ; Pleural Effusion ; Pulmonary Edema* ; Respiratory Distress Syndrome, Adult ; Sarcoma