Radiofrequcy(RF) treatment has a long history, more than hundred years, for the management of chronic intractable pain of various causes. With better understanding of pain mechanism and advancement of technology, along with previous valuable experience, a simpler and safer method of delivering RF thermo coagulation to ideal sites are now available that can be expected to provide more beneficial effects to these patients with chronic disabling pain. This type of treatment will be especially helpful in aged in whom surgery is often contraindicated or highly risky due to medical problems. Here, using up-to-dated, evidence based knowledge and personal experience, authors have tried to introduce briefly the history and basic mechanism of RF technique and various clinical situations where this type of therapy is currently known to be indicated or effective in providing substantial pain relief. In summary, the RF thermocoagulation is proven to be effective way of providing significant pain relief in many chronic refractory pain states with numerous advantages such as minimal invasive, quantitative lesioning with temperature-controlled, well-circumscription of lesions, simplicity and feasibility of procedure, and most of all safety and cost-effectiveness. When it is selected based on careful investigation on type and cause of pain it can be expected to provide relatively long duration of pain relief and also to help to recover functional disabilities from such pain. However, judicious use is warranted because some painful conditions are known to be ineffective or contraindicated from this type of therapy and because there are possible serious complications, although very few. Use of latest technique of pulsed, high-frequency, low-temperatured thermocoagulation will possibly bring hope and new insights in the management of chronic intractable pain of neuropathic in nature. Further research and experience will be required before justifying this type of therapy in appling broader and more challenging situations.
Electrocoagulation ; Hope ; Humans ; Neuralgia ; Pain, Intractable*

Chronic pain is a multifactorial condition with both physical and psychological symptoms, and it affects around 20% of the population in the developed world. In spite of outstanding advances in pain management over the past decades, chronic pain remains a significant problem. This article provides a mechanism- and evidence-based approach to improve the outcome for pharmacologic management of chronic pain. The usual approach to treat mild to moderate pain is to start with a nonopioid analgesic. If this is inadequate, and if there is an element of sleep deprivation, then it is reasonable to add an antidepressant with analgesic qualities. If there is a component of neuropathic pain or fibromyalgia, then a trial with one of the gabapentinoids is appropriate. If these steps are inadequate, then an opioid analgesic may be added. For moderate to severe pain, one would initiate an earlier trial of a long term opioid. Skeletal muscle relaxants and topicals may also be appropriate as single agents or in combination. Meanwhile, the steps of pharmacologic treatments for neuropathic pain include (1) certain antidepressants (tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors), calcium channel alpha2-delta ligands (gabapentin and pregabalin) and topical lidocaine, (2) opioid analgesics and tramadol (for first-line use in selected clinical circumstances) and (3) certain other antidepressant and antiepileptic medications (topical capsaicin, mexiletine, and N-methyl-d-aspartate receptor antagonists). It is essential to have a thorough understanding about the different pain mechanisms of chronic pain and evidence-based multi-mechanistic treatment. It is also essential to increase the individualization of treatment.
Analgesics, Opioid ; Antidepressive Agents ; Calcium Channels ; Capsaicin ; Chronic Pain ; Fibromyalgia ; Lidocaine ; Ligands ; Mexiletine ; N-Methylaspartate ; Neuralgia ; Neuromuscular Agents ; Norepinephrine ; Pain Management ; Serotonin ; Sleep Deprivation ; Tramadol

BACKGROUND: It has been known that arterial carbon dioxide tension is 4~5 mmHg higher than end-tidal carbon dioxide tension in healthy adults during general anesthesia. But negative arterial to end-tidal PCO2 difference was reported in pregnant patients undergoing cesarean section. The purpose of this study was to elucidate the difference between arterial and end-tidal PCO2 in anesthetized patients with reduced functional residual capacity. METHODS: 90 patients were divided into 3 groups i.e. control group (n=30), obese group (n=20, body weight more than 20% greater than ideal weight), pregnant group (n=40). All patients had no cardiac or respiratory abnormalities and never smoked. Arterial blood gas analysis and measurement of end-tidal PCO2 were done 20 minutes after induction of anesthesia in control and obese group and just before uterine incision and 20 minutes after fetal delivery in pregnant group. RESULTS: There were significant correlations between arterial and end-tidal PCO2 in all groups. The incidences of negative arterial to end-tidal PCO2 difference were 10% in control group, 40% in obese group, 42.5% in pregnant group (p<0.05). CONCLUSION: From this study, it is concluded that patients with reduced functional residual capacity have more incidences of negativity than normal patients in the values of arterial to end-tidal PCO2 difference during general anesthesia. So when the tight control of PaCO2 is required in patients with reduced FRC, we recommend to measure PaCO2 for better anesthetic management.
Adult ; Anesthesia ; Anesthesia, General ; Blood Gas Analysis ; Body Weight ; Carbon Dioxide* ; Carbon* ; Cesarean Section ; Female ; Functional Residual Capacity* ; Humans ; Incidence ; Pregnancy ; Smoke

No abstract available.
Neuroblastoma*

No abstract available.

PURPOSE: High flow rate (FR) and pressure limit (PL) strategy with time-cycled pressure-limited (TCPL) ventilator is employed routinely in the neonates. Theoretical basis of this strategy is the two-compartment theory that the lung with acute respiratory failure consists of units with different compliance and resistance. But such constant pressure strategy has the risk of ventilator induced lung injury. We compared the ventilatory indices and clinical outcomes of two different strategies, high FR-constant pressure and low FR-constant FR in the ventilator care of the neonates with acute respiratory failure. METHODS: For the neonates born in our hospital and treated with mechanical ventilation from March to August in 1997, two different ventilator strategies were employed randomly with flow control ventilator. In the high-FR group, the FR was fixed at 10 L/ min and the PL was adjusted according to the arterial blood gas analysis (ABGA) results. In the low-FR group, the FR was adjusted to 10 mL/kg of tidal volume. Sixty neonates were enrolled, 32 in high-FR and 28 in low-FR group. Ventilatory indices and clinical outcomes were statistically cornpared in the two groups. RESULTS: Perinatal factors were not different in the two groups. Initial ventilator settings, ABGA results and ventilatory indices were not different. The tidal volume, fraction of inspired oxygen, peak inspired pressure and oxygenation index were higher and dynamic compliance was lower in the high-FR group compared to the low-FR group after 3 to 72 hours of ventilator care. In clinical outcomes, incidences of pulmonary interstitial emphysema, pneumothorax and chronic lung disease were significantly lower in the low-FR group. CONCLUSION: Low-FR with constant FR strategy resulted in better clinical outcomes in the ventilator care of neonates. We conclude that constant FR strategy prevents damage of the better compliant lung units and decreases the incidence of acute and chronic complications of ventilator care.
Blood Gas Analysis ; Compliance ; Emphysema ; Humans ; Incidence ; Infant, Newborn* ; Lung ; Lung Diseases ; Oxygen ; Pneumothorax ; Respiration, Artificial ; Respiratory Insufficiency* ; Tidal Volume ; Ventilator-Induced Lung Injury ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: Primary intervention by stent implantation during acute myocardial infarction is a novel strategy to provide better myocardial perfusion compared to thrombolysis or baloon angioplasty. We aimed to assess the reperfusion achieved by primary stenting, employing TIMI frame count for more objective and quantitative measurement. MATERIALS AND METHOD: Measurements for number of frames required to opacify standardized angiographic landmark branch(TIMI frame count) were determined for the coronary arteries of 77 normal controls and 65 patients with acute myocardial infarction who underwent primary stenting within 12 hours of symptom onset. RESULTS: In normal subjects, TIMI frame count for left anterior descending artery(LAD) was 1.3 times of mean count of right coronary artery(RCA) and left circumflex artery(LCx), and significant less than that of TIMI study(22.3+/-4.9 vs 36.2+/-2.6, p<0.05). TIMI frame count for RCA and LCx was similar to results of TIMI study. In infarct related arteries(IRA), corrected TIMI frame count(CTFC) after primary stenting was similar to those of normal control. Frame counts of RCA was larger compared to that of normal control, but statistically insignificant(23.0+/-7.5 vs 17.6+/-3.5, p>0.05). There was no difference of CTFC of non-infarct related arteries between patients and normal controls. CONCLUSION: The TIMI frame count of LAD artery in normal Korean subjects was significantly less than that of American counterpart. In patients with acute myocardial infarction, primary stenting appeared to provide improved coronary flow similar to that observed in normal subjects, as measured by TIMI frame counting.
Angioplasty ; Arteries ; Coronary Vessels ; Humans ; Myocardial Infarction* ; Perfusion ; Reperfusion ; Stents*

The 68 cervical cerclage operations of incompetent internal os of the cervix(IIOC) were performed at the Taegu Catholic Medical Center from Jan. 1, 1990 to Dec. 31, 1995. The results of this study were as follows: 1. The incidence of operation for IIOC was 0.23% of total delivery. 2. Highest number of IIOC was observed in the age group of 25 to 29, and the average number of pregnancy before operation was 4.1. 3. The significant contributory factor was previous history of the induced or spontaneous abortion. 4. In all cases, cerclage method was McDonald operation. 5. The average fetal salvage rate after operation was 82.5% and from the 14th week to 16th week of gestation(43 cases), the success rate of operation was 85%. 6. The causes of operation failure were premature labor in 6 cases(55%), premature rupture of membrane in 3 cases(27%) and abortion in 2 cases(18%) in order.
Abortion, Spontaneous ; Cerclage, Cervical ; Cervix Uteri* ; Daegu ; Female ; Humans ; Incidence ; Membranes ; Obstetric Labor, Premature ; Pregnancy ; Rupture

PURPOSE: DNA mismatch repair gene is responsible for hereditary nonpolyposis colorectal cancer. But it is not well known its role in sporadic colorectal cancer patients. We analysed normal hMSH2, hMLH1 protein expression in colorectal adenocarcinoma tissues and corresponding normal tissues to find out the role of mismatch repair gene in sporadic colorectal cancer by Western blotting. METHODS: Normal hMSH2 and hMLH1 protein expression was studied on 25 colorectal cancer and corresponding normal tissue by Western blot with hMSH2 and hMLH1 monoclonal antibody. Normal protein band was expressed on 100 kD in hMSH2 and 87 kD in hMLH1. SW480 and LoVo cell line was used as positive and negative control for hMSH2 and LoVo and SW480 as positive and negative for hMLH1. And we analysed the relation between the hMSH2, hMLH1 protein expression and clinicopathological parameters. RESULTS: It was 2 cases (8%) that both hMSH2 and hMLH1 protein expression was not observed. Three cases (12%) were negative for hMSH2 and 2 cases (8%) for hMLH1. One or both hMSH2, hMLH1 protein expression was not observed in 7 cases (28%) in total. There was no correlation for proximal occurrence (25% vs 35%), young age (37.5% vs 23.5%) and lymph node metastasis (50% vs 47%). But poorly and mucinous differentiation was regarded as having relation with negative expression of hMSH2 and hMLH1 (50% vs 17.6%) but not significant statistically. CONCLUSION: Sporadic colorectal cancer with negative expression of normal hMSH2 and hMLH1 protein showed no relation to younger age, proximal site preference and lymph node metastasis. But it was suggested that mismatch repair gene protein was involved in cancer cell differentiation in sporadic colorectal cancer.
Adenocarcinoma ; Blotting, Western ; Cell Differentiation ; Cell Line ; Colorectal Neoplasms* ; Colorectal Neoplasms, Hereditary Nonpolyposis ; DNA Mismatch Repair ; Humans ; Lymph Nodes ; Mucins ; Neoplasm Metastasis

PURPOSE: Abnormalities in calcium(Ca), vitamin D and bone mineral density (BMD) associated with antiepileptic drug(AED) are reported, but the results are inconsistent. In case of intractable epilepsy, poor growth and altered bone mineral metabolism may be prominent, possibly related to previous long-term use of multiple AED and poor activity. The aim of this study was to assess growth status, concentrations of calcium regulating hormones and BMD in children with intractable epilepsy. METHODS: Sixty-six intractable epilepsy patients aged 0.8 to 14.7 years(mean+/-D:4.6+/-.6 years) were included in the study. Height and weight were measured and then height SDS and weight SDS were calculated. Serum Ca, i-Ca, P, Mg, Zinc, osteocalcin, intact-PTH, 25-OHD, 1,25(OH)2D were measured. BMD of the lumbar spine was measured by dual energy X-ray absorption. RESULTS: Most of the patients showed normal height SDS and weight SDS. Percentage of severe short stature(height SDS <-2) was 1.5% and tall stature(height SDS >2) was 4.5%. Percentage of severe thin(weight SDS <-2) was 1.5% and obesity(weight SDS >2) was 6%. Duration of AED was not related to height SDS or weight SDS. Etiology of epilepsy and physical activity were not related to height SDS and weight SDS. Most of them had normal Ca, iCa, P, Mg, Zinc, intact-PTH, osteocalcin, 25-OHD and 1,25(OH)2D concentrations. BMD was not related to the levels of Ca, i-Ca, P, Mg, intact-PTH, osteocalcin, 25-OHD, 1,25(OH)2D. BMD was not related to the duration of AED. BMD positively correlated with age(r=0.75, P>0.01) and body weight(r=0.72, P<0.01). CONCLUSION: Most of the children with intractable epilepsy, who regularly visits epilepsy clinic, showed normal growth and normal bone mineral metabolism, but careful monitoring about growth and bone mineral metabolism is needed.
Absorption ; Bone Density* ; Calcium* ; Child* ; Epilepsy* ; Humans ; Metabolism ; Motor Activity ; Osteocalcin ; Spine ; Vitamin D ; Zinc