The subarachnoidal or epidural opioid reveals excellent analgesic effect for postoperative pain and intractable cancer pain, but its side effects such as nausea, vomiting, voiding difficulty, pruritus and respiratory failure limit its use. There were many studies for decreasing frequency and severity of side effects and reinforcing the analgesic effect of opioid by administrating other drugs. Clonidine is one of such drugs which is able to be administered epidurally with opioids for that purpose. We studied the changes of cardiovascular response, analgesic and sedative effect according to the dose of epidural clonidine. The analgesic effect of epidural clonidine was investigated in 30 patients who underwent anal surgery with epidural anesthesia using 15 ml of 1.5~2 % lidocaine.The time of maximal intensity of pain after disapperance of injected lidocaine was checked. Thirty patients were divided into three groups randomly. In group 1 (n=10), the dose of epidural clonidine was 50 ug; Group 2 (n=10) was 150 ug; Group 3 (n=10) was 450 ug. Changes in the arterial pressure, pulse rate, sedation state and SpO2 were observed before and during 60 minutes after epidural clonidine administration. And the analgesic effect was assessed by measuring VAS pain score. Blood pressures and pulse rates decreased according to increase of dosage of clonidine. Group 1 showed the analgesic effect of 34%, group 2 showed 77% and group 3 showed 81% at 60 minutes after administration. Sedation effect was seen in group 2 and 3 but SpO2 was not decreased significantly. We thought that the respiratory depression of epidural clonidine was not so significant to limit the use for the postoperative pain control. We conclude that it is better to administer clonidine with opioids epidurally than clonidine slone to get better analgesic effect and less sedative effect, because the analgesic effect of epidural clonidine increases according to increase of dosage but the sedative effect increases also.
Analgesics, Opioid ; Anesthesia, Epidural ; Arterial Pressure ; Clonidine* ; Heart Rate ; Humans ; Hypnotics and Sedatives* ; Lidocaine ; Nausea ; Pain, Postoperative ; Pruritus ; Respiratory Insufficiency ; Vomiting

INTRODUCTION: This study evaluated the bone regenerative effect of silk fibroin mixed with platelet-rich fibrin (PRF) of a bone defect in rabbits. MATERIALS AND METHODS: Ten New Zealand white rabbits were used for this study and bilateral round shaped defects were formed in the parietal bone (diameter: 8.0 mm). The silk fibroin mixed with PRF was grafted into the right parietal bone (experimental group). The left side (control group) was grafted only PRF. The animals were sacrificed at 4 weeks and 8 weeks. A micro-computerized tomography (microCT) of each specimen was taken. Subsequently, the specimens were decalcified and stained for histological analysis. RESULTS: The average value of plane film analysis was higher in the experimental group than in the control group at 4 weeks and 8weeks after surgery. However, the difference was not statistically significant.(P>0.05) The tissue mineral density (TMD) in the experimental group at 4 weeks after surgery was significantly higher than the control group.(P<0.05) CONCLUSION: Silk fibroin can be used as a scaffold of PRF for rabbit calvarial defect repair.
Animals ; Bone Regeneration ; Fibrin ; Fibroins ; Parietal Bone ; Rabbits ; Silk ; Skull ; Transplants

PURPOSE: To analyze the clinical and radiographic results after revision total knee arthroplasty (TKA) using Nexgen(R) LCCK (Legacy(R) knee constrained condylar knee, Zimmer, Warsaw, IN) with allograft. MATERIALS AND METHODS: Twenty patients (21 knees) taken revision TKA were analyzed. The average age of the patients was 69.2 years old and the average of follow-up duration was for 2 year to 8 years 2 months (average 3 years 5 months). The clinical result and radiographic measurements were assessed using the Hospital for Special Surgery (HSS) knee rating score and the roentgenographic method of the American Knee Society. RESULTS: The mean interval from TKA to revision surgery was 6 years 4 months. In all cases, allograft was used. The average range of motion was increased from 93degrees to 107degrees, HSS score was increased from an average of 45 to 87 points. Postoperative femorotibial alignment was averaged 5.7degrees valgus. In all cases, radiolucency was below 4 scores and there was no loosening of implant. But, three radiopaque lines around a stem. There were wound dehiscence in 1 case and superficial infection in 2 cases. CONCLUSION: Satisfactory results were obtained in revision TKA using a NexGen(R) LCCK with allograft. But, this study is favorable for the long term follow-up.
Arthroplasty ; Follow-Up Studies ; Humans ; Knee ; Range of Motion, Articular ; Transplantation, Homologous

PURPOSE: This study evaluated powdered burn wound dressing materials from wild silkworm fibroin in an animal model. METHODS: Fifteen rats were used in this experiment. Full-thickness 2x2 cm burn wounds were created on the back of rats under anesthesia. In the two experimental groups, the wounds were treated with two different dressing materials made from silkworm fibroin. In the Control Group, natural healing without any dressing material was set as control. The wound surface area was measured at five days, seven days and 14 days. Wound healing was evaluated by histologic analysis. RESULTS: By gross observation, there were no infections or severe inflammations through 14 days post-injury. The differences among groups were statistically significant at seven days and 14 days, postoperatively (P<0.037 and 0.001, respectively). By post hoc test, the defect size was significantly smaller in experimental Group 1 compared with the Control Group and experimental Group 2 at seven days postoperatively (P=0.022 and 0.029, respectively). The difference between Group 1 and Group 2 was statistically significant at 14 days postoperatively (P<0.001). Group 1 and control also differed significantly (P=0.002). Group 1 showed a smaller residual scar than the Control Group and Group 2 at 14 days post-injury. Histologic analysis showed more re-epithelization in Groups 1 and 2 than in the Control Groups. CONCLUSION: Burn wound healing was accelerated with silk fibroin spun by wild silkworm Antheraea pernyi. There was no atypical inflammation with silk dressing materials. In conclusion, silk dressing materials can be used for treatment of burn wound.
Anesthesia ; Animals ; Bandages* ; Bombyx* ; Burns* ; Cicatrix ; Fibroins* ; Inflammation ; Models, Animal ; Moths* ; Rats* ; Silk* ; Wound Healing ; Wounds and Injuries*

Urothelial neoplasms in patients younger than 20 years old are extremely rare, and there is no established etiology, treatment guidelines, or surveillance for urothelial carcinoma in the pediatric population. A 17-year-old boy who presented with gross hematuria showed a smooth, round mass on the left lateral wall of the urinary bladder on cystoscopy. Histologic examination showed low grade papillary urothelial carcinoma of the urinary bladder without muscle layer invasion. We report a case of papillary urothelial carcinoma of the urinary bladder in a pediatric patient treated with transurethral resection.
Adolescent ; Cystoscopy ; Hematuria ; Humans ; Muscles ; Pediatrics ; Urinary Bladder

PURPOSE: This study evaluated woven silk textile for burn wound dressing materials in an animal model. METHODS: Ten rats were used in this experiment. Full-thickness 2x2 cm burn wounds were created on the back of the rats under anesthesia. In the experimental group, the wounds were treated with three different dressing materials from woven silk textile. In the control group, natural healing without any dressing material was set as control. The wound surface area was measured at five days, seven days, and 14 days. Wound healing was evaluated by histologic analysis. RESULTS: There were no statistically significant differences among groups at five days post injury. The mean defect size at seven days was largest in Group 3 (462.87 mm2), and smallest in Group 1 (410.89 mm2), not a significant difference (P =0.341). The mean defect size at 14 days was smallest at the Group 3 (308.28 mm2) and largest in the control group (388.18 mm2), not a significant difference (P =0.190). The denuded area was smaller in Group 1 (84.57 mm2) and Group 2 (82.50 mm2) compared with the control group (195.93 mm2), not statistically significant differences (P =0.066, 0.062). The difference between Group 3 and control was also not statistically significant (P =0.136). In histologic analysis, the experimental groups re-epithelialized more than control groups. No evidence was found of severe inflammation. CONCLUSION: The healing of burn wounds was faster with silk weave textile more than the control group. There was no atypical inflammation with silk dressing materials. In conclusion, silk dressing materials could be used to treat burn wounds.
Anesthesia ; Animals ; Bandages* ; Burns* ; Inflammation ; Models, Animal* ; Rats ; Silk* ; Textiles ; Wound Healing ; Wounds and Injuries*

0.05).CONCLUSION: The rabbit calvarial defect was not successfully repaired by silk fibroin/nano-hydroxyapatite/corn starch composite scaffold and may have been due to an inflammatory reaction caused by silk powder. In the future, the development of composite bone graft material based on various components should be performed with caution.]]>
Animals ; Bone Regeneration ; Fibroins ; Osteogenesis ; Parietal Bone ; Rabbits ; Silk ; Starch ; Transplants ; X-Ray Microtomography ; Zea mays

Head ; Neck ; Pterygoid Muscles

While the ability to develop nanomaterials and incorporate them into products is advancing rapidly worldwide, understanding of the potential health safety effects of nanomaterials has proceeded at a much slower pace. Since 2008, Korea Food and Drug Administration (KFDA) started an investigation to prepare "Strategic Action Plan" to evaluate safety and nano risk management associated with foods, drugs, medical devices and cosmetics using nano-scale materials. Although there are some studies related to potential risk of nanomaterials, physical-chemical characterization of nanomaterials is not clear yet and these do not offer enough information due to their limitations. Their uncertainties make it impossible to determine whether nanomaterials are actually hazardous to human. According to the above mention, we have some problems to conduct the human exposure risk assessment currently. On the other hand, uncertainty about safety may lead to polarized public debate and to businesses unwillingness for further nanotechnology investigation. Therefore, the criteria and methods to assess possible adverse effects of nanomaterials have been vigorously taken into consideration by many international organizations: the World Health Organization, the Organization for Economic and Commercial Development and the European Commission. The object of this study was to develop risk assessment principles for safety management of future nanoproducts and also to identify areas of research to strengthen risk assessment for nanomaterials. The research roadmaps which were proposed in this study will be helpful to fill up the current gaps in knowledge relevant nano risk assessment.
Commerce ; Cosmetics ; Hand ; Humans ; Korea ; Nanostructures ; Nanotechnology ; Risk Assessment ; Risk Management ; Safety Management ; Uncertainty ; United States Food and Drug Administration ; World Health Organization

BACKGROUND/AIMS: To determine factors predictive of discordance in staging liver fibrosis using liver biopsy (LB) and acoustic radiation force impulse (ARFI) elastography in patients with chronic hepatitis B (CHB). METHODS: Consecutive patients with CHB who underwent LB and ARFI elastography on the same day from November 2010 to March 2013 were prospectively recruited from three tertiary hospitals. RESULTS: We analyzed 105 patients (median age of 47 years). The F0-1, F2, F3, and F4 fibrosis stages were identified in 27 (25.7%), 27 (25.7%), 21 (20.0%), and 30 (28.6%) patients, respectively. The areas under the receiver operating characteristics curves for ARFI elastography in assessing ≥F2, ≥F3, and F4 was 0.814, 0.848, and 0.752, respectively. The discordance of at least one stage between LB and ARFI was observed in 68 patients (64.8%) and of at least two stages in 16 patients (15.2%). In a multivariate analysis, advanced fibrosis stage (F3-4) was the only factor that was negatively correlated with one-stage discordance (p=0.042). Moreover, advanced fibrosis stage was negatively (p=0.016) correlated and body mass index (BMI) was positively (p=0.006) correlated with two-stage discordance. CONCLUSIONS: Advanced fibrosis stage (F3-4) was a predictor of nondiscordance between LB and ARFI elastography; BMI also influenced the accuracy of ARFI elastography.
Body Mass Index ; Elasticity Imaging Techniques/*methods ; Female ; Hepatitis B, Chronic/*complications ; Humans ; Liver/diagnostic imaging/pathology ; Liver Cirrhosis/*diagnostic imaging/etiology ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Prospective Studies ; ROC Curve ; Republic of Korea