The epidural blood patch is a relatively new technique for treatment of post spinal headache. Injection of autologous blood into the epidural space afforded prompt and permanent relief. "Pathcing" the dura hole with autologous blood is the most direct therapy available. It has always been used within a few days of development of headache. This procedure may be considered for patients who continue to experience in capacitating symptoms following a trial of supportive therapy. In our patient the epidural blood patch was used successfully on four cases after the development of headache.
Blood Patch, Epidural ; Epidural Space ; Headache* ; Humans

OBJECTIVES: This study was conducted to compare emotional problems in children with neurosurgical diseases prior to surgery as well as levels of parenting stress experienced by mothers of children treated with surgery and those without surgery. The goals was to provide a basis on which comprehensive treatment interventions could be established. METHODS: Subjects included 78 elementary school children who visited the Department of Pediatric Neurosurgery as well as their mothers. The Children's Depression Inventory (CDI) and the Revised Children Manifest Anxiety Scale (RCMAS) were administered to children. The Parenting Stress Indexs (PSI) and Beck Depression Inventory (BDI) were administered to their mothers. RESULTS: The children with neurosurgical diseases showed higher levels of depression prior to surgery. In their mothers, parenting stress was relatively higher and parenting competence was lower. In particular, for those children who underwent surgery, depression was significantly higher. Specifically, they exhibited more negative expectations, and negative self-image. In mothers of children who underwent surgery, depression was significantly higher. CONCLUSION: Our results suggest higher levels of emotional distress and parental stress in children who undergo neurosurgical operations and their mothers, respectively. Based on this, the necessity for surgical and comprehensive psychological intervention is suggested.
Child ; Depression ; Humans ; Manifest Anxiety Scale ; Mental Competency ; Mothers ; Neurosurgery ; Parenting ; Parents ; Stress, Psychological

PURPOSE: Parenting stress could be different among mothers of children with brain tumors. The aim of this study was to explore subtypes of children with brain tumor based on their intellectual and psychological characteristics and to compare the parenting stress of their mothers among the subtypes. METHODS: Latent profile analysis was conducted on the Verbal IQ, Performance IQ, and the scores of Social Problem, Internalization Behavior Problem, and Externalization Behavior Problem in a total of 90 children with brain tumors. Furthermore, the mothers' parenting stress was compared among the explored subtypes. RESULTS: Four-categorization appeared the best way to describe the intellectual and psychological presentation of the children with brain tumors and they are as follows; (1) Borderline Intelligence-Socially Maladjusted (B-SM: 24.4%), (2) Average Intelligence-Internalization Behavior Problem (A-I: 44.4%), (3) Average Intelligence-Normal Behavior (A-N: 18.9%), and (4) Retarded Intelligence-Global Maladjusted (R-GM: 12.2%). Mothers of R-GM group reported higher levels of stress on total domain and the subfactors of distractibility and adaptability of Korean Parenting Stress Index compared to mothers of A-N group, and the highest level of stress on spouse subfactor among the mothers of all subtypes. Mothers of subtypes with either intellectual or psychological problems showed higher level of stress on demandingness subfactor compared to mothers of A-N group. CONCLUSION: Eighty percents of children with brain tumor showed intellectual or psychological problems and the mothers of the children with both problems reported the highest parenting stress. The tailored services are needed to manage the parenting stress of mothers of children with brain tumors.
Brain ; Brain Neoplasms ; Child ; Cognition ; Humans ; Mothers ; Parenting ; Parents ; Social Problems ; Spouses

PURPOSE: The aims of this study were to review our cases of missed Monteggia fracture treated by open reduction of the radial head with or without ulnar osteotomy and to investigate the indications for open reduction alone in surgical treatment of missed Monteggia fracture. MATERIALS AND METHODS: We retrospectively reviewed 22 patients who presented with missed Monteggia fracture. The patients' mean age at the time of surgery was 7.6 years. The mean interval from injury to surgery was 16.1 months. The surgical procedure consisted of open reduction of the radiocapitellar joint followed by ulnar osteotomy without reconstruction of the annular ligament. The mean period of follow-up was 3.8 years. Radiographic assessment was performed for the maximum ulnar bow (MUB) and the location of the MUB. Clinical results were evaluated with the Mayo Elbow Performance Index and Kim's scores. RESULTS: Five patients underwent open reduction alone, and 17 patients underwent open reduction and ulnar osteotomy. When the MUB was less than 4 mm and the location of the MUB was in the distal 40% of the ulna, we could achieve reduction of the radial head without ulnar osteotomy. The radial head was maintained in a completely reduced position in 21 patients and was dislocated in one patient at final follow-up. CONCLUSION: Open reduction alone can be an attractive surgical option in select patients with missed Monteggia fracture with minimal bowing of the distal ulna. However, ulnar osteotomy should be considered in patients with a definite ulnar deformity.
Child* ; Congenital Abnormalities ; Elbow ; Follow-Up Studies ; Head ; Humans ; Joints ; Ligaments ; Monteggia's Fracture* ; Osteotomy ; Retrospective Studies ; Ulna

OBJECTIVE: To observe the changes in protein expression induced by botulinum toxin A (BoNT-A) injection and to characterize the molecular and cellular action of mechanisms of BoNT-A injection on skeletal muscles using proteomic elements as biomarkers. METHODS: BoNT-A was injected into left gastrocnemius muscles of 12 Sprague-Dawley rats (2 months of age) at a dosage of 5 units/kg body weight. For the controls same volume of normal saline was injected to right gastrocnemius muscle of each rat. Muscle samples were obtained at 4 time points (3 rats per time point): 3, 7, 14, and 56 day post-injection. To reveal the alterations in muscle protein, we performed 2-dimensional electrophoresis (2DE) and compared Botox group and normal saline group at each time point. Altered protein spots in 2DE were identified using matrix-assisted laser desorption/ionization-time-of-flight mass spectrometer (MALDI-TOF MS) proteomics analysis. RESULTS: Compared with normal saline group, 46 protein spots showed changed protein expression. Twelve protein spots demonstrated increased volume and 34 protein spots demonstrated decreased volume. Among spots of decreased volume, 17 spots showed statistically significant differences. Thirty-eight identified proteins were associated with alterations in energy metabolism, muscle contractile function, transcription, translation, cell proliferation, and cellular stress response. CONCLUSION: BoNT-A gives influences on muscle contractile function and energy metabolism directly or indirectly besides neurotoxic effects. Proteomic expression provides better understanding about the effect of BoNT-A on skeletal muscle.
Animals ; Body Weight ; Botulinum Toxins ; Botulinum Toxins, Type A ; Cell Proliferation ; Electrophoresis ; Electrophoresis, Gel, Two-Dimensional ; Energy Metabolism ; Muscle Proteins ; Muscle, Skeletal ; Muscles ; Proteins ; Proteomics ; Rats ; Rats, Sprague-Dawley

BACKGROUND: Left ventricular diastolic dysfunction is often observed in hypertensive patients with normal left ventricular systolic function and can cause heart failure symptoms. Doppler echocardiography has become a standard tool for examining left ventricular diastolic function. This study was performed to evaluate the left ventricular diastolic function in hypertensive patients with normal left ventricular systolic function and to determine the changes in left ventricular diastolic function after antihypertensive treatment. METHODS: Mitral inflow and pulmonary venous Row velocities were evaluated by transthoracic pulsed-wave Doppler study in patients with hypertension before antihypertensive treatment(n= 50) and after antihypertensive treatment for 4 months(n=24). The patients were randomly assigned to group I to receive ACE inhibitor or group II to receive other antihypertensive drugs. RESULTS: Before antihypertensive treatment, mitral inflow E/A ratio was 0.94+/-0.27, decele- ration time was 222+/-47 msec, and pulmonary venous flow S/D ratio was 1.62+/-0.42. Follow- up Doppler study was completed in 24 patients after 4 months of antihypertensive treatment. Mitral inflow E/A ratio was significantly increased(0.96+/-0.24 vs. 1.16+/-0.25, p<0.001), but deceleration time showed no significant changes. Pulmonary venous flow S/D ratio was signi- ficantly decreased(1.75+/-0.27 vs. 1.50+/-0.24, p<0.001). There was no significant difference in changes in mitral inflow E/A ratio, deceleration time and pulmonary venous flow S/D ratio between ACE inhibitor group and other antihypertensive group. CONCLUSION: There was some improvement in left ventricular diastolic function in patients with hypertension after 4 months of antihypertensive treatrnent. But, there was no significant difference in changes in diastolic parameters between ACE inhibitor group and other antihy- pertensive group.
Antihypertensive Agents ; Deceleration ; Echocardiography, Doppler ; Heart Failure ; Humans ; Hypertension*

BACKGROUNDS: The exacerbations of asthma and chronic obstructive pulmonary disease (COPD) have been suggested to be associated with respiratory tract viral infections (RTVIs). However, the rates of virus detection in previous studies have been quite variable, with lower rates for the exacerbation of COPD. Therefore, the virus detection of patients with exacerbation of asthma and COPD were investigated. METHODS: 20 and 24 patients with exacerbation of asthma and COPD, respectively, were enrolled. Nasal and sputum samples were taken, and polymerase chain reaction (PCR) for rhinovirus and coronavirus and virus culture for influenza A, B, RSV and parainfluenza virus performed. RESULTS: The mean FEV1/FVC in the exacerbation of asthma and COPD patients were 1.9/2.9 L (65.5%) and 1.1/2.6 L (42.3%), respectively. Respiratory virus was detected in 13 (65%) patients with exacerbation of asthma and rhinovirus was detected in 9. Coronavirus, influenza A, RSV and parainfluenza virus were detected in 2, 2, 1 and 1 patients with asthma. Among patients with exacerbation of COPD, a virus was detected in 14 (58.3%) patients, with rhinovirus, coronavirus and influenza A detected in 10, 3 and 4, respectively. CONCLUSIONS: This study suggested that RTVIs may have a role in the exacerbation of COPD as well as asthma.
Asthma* ; Coronavirus ; Humans ; Influenza, Human ; Paramyxoviridae Infections ; Polymerase Chain Reaction ; Pulmonary Disease, Chronic Obstructive* ; Respiratory System ; Rhinovirus ; Sputum

This study intended to identify the need for the legalization and development of a systematic program for physician assistants (PAs) by understanding the actual state of PA operation in hospitals. In 114 hospitals assigned as resident training hospitals for surgery, a survey was conducted on the personnel working as PAs in those hospitals; the survey included general personal information, working conditions, training time, and satisfaction. A total of 192 PAs in surgery at 35 hospitals responded to the survey. The types of PAs are Surgical Assistant, Clinical Physician Assistant, Wound Ostomy Care Nurse, Coordinator, and Clinical Research Coordinator. Types of work PAs preformed are surgical assistance, wound dressing, educating patients, overlooking consultation, doing paper works, writing operation records, and confirming examination results which were ordered. The satisfaction level for the position which PAs hold were 29.1% and and satisfaction level which doctors see towards PA was 15%. The role and the job descriptions of PAs are not clear cut, there are many discrepancies among hospitals we studied. As a result, legalization and the implementation of standardized role of PAs will lead to increase level of satisfactions in the work force and the quality of work which PAs perform will be greater.
Adult ; Female ; General Surgery ; Humans ; Job Description ; Male ; Physician Assistants/*statistics & numerical data ; Questionnaires ; Republic of Korea ; Task Performance and Analysis ; Workload

Gastric cancer patients with acute disseminated intravascular coagulation experiences a rare but severe complication resulting in a dismal prognosis. We report a case of advanced gastric cancer complicated with disseminated intravascular coagulation with intractable tumor bleeding which was successfully treated with chemotherapy consisting of 5-fluorouracil and oxaliplatin. The patient was a 63-year-old man who complained of abdominal pain, melena, and dyspnea on 24 November 2010. We diagnosed stage IV gastric cancer complicated by disseminated intravascular coagulation. Gastric tumor bleeding was not controlled after procedures were repeated three times using gastrofiberscopy. With the patient's consent, we selected the 5-fluorouracil and oxaliplatin combination chemotherapy for treatment. After one cycle of 5-fluorouracil and oxaliplatin therapy, symptoms of bleeding improved and the disseminated intravascular coagulation process was successfully controlled. The primary tumor and multiple metastatic bone lesions were remarkably shrunken and metabolically remitted after eight cycles of chemotherapy. In spite of progression, systemic chemotherapy is effective in disease control; further, the patient gained the longest survival time among cases of gastric cancer with disseminated intravascular coagulation.
Abdominal Pain ; Disseminated Intravascular Coagulation ; Drug Therapy, Combination ; Dyspnea ; Fluorouracil ; Hemorrhage ; Humans ; Melena ; Organoplatinum Compounds ; Prognosis ; Stomach Neoplasms

BACKGROUND: Nosocomial candidemia is one of the most common blood-stream infection and associated with a high fatality rate in burn patients. To determine the clinical characteristics, strains of Candida species and to identify contributing factors to death, we analyzed severely burned patients with candidemia. METHODS: 60 cases with candidemia were reviewed retrospectively from January 1999 to December 2003 at a tertiary burn center in Korea. Candidemia was defined as at least one blood culture that grew Candida organisms. RESULTS: Burn size of all patients were 46+/-20.9% of total body surface area burn and overall mortality was 41.7%. 97 strains of Candida species from 60 cases were isolated. Candida albicans was the most frequently isolated species (53.6%), followed by C. tropicalis (20.6%), C. glabrata (15.5%) and C. parapsilosis (10.3%). Among various predisposing factors for candidemia, significant factors associated with death were endotracheal tube insertion or tracheostomy, mechanical ventilation, the use of vasoactive agents, arterial catheterization and nasogastric tube insertion in univariate analysis, but significant independent factors for mortality were mechanical ventilation (OR=26.63, 95% CI; 1.60, 444.18, p=0.022) and the use of vasoactive agents (OR=23.18, 95% CI; 2.80, 192.35, p=0.004) in multivariate analysis. Among 59 patients indwelling central venous catheters, only 24 patients (40.7%) received antifungal therapy with catheter removal while 19 patients (32.2%) had antifungal therapy without catheter removal. CONCLUSIONS: Clinical severity, such as mechanical ventilation or vasoactive agents dependencies, may contribute to high fatality in severely burned patients with candidemia.
Body Surface Area ; Burn Units* ; Burns* ; Candida ; Candida albicans ; Candidemia* ; Catheterization ; Catheters ; Causality ; Central Venous Catheters ; Humans ; Korea ; Mortality* ; Multivariate Analysis ; Respiration, Artificial ; Retrospective Studies ; Tracheostomy