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

OBJECTIVE: Juvenile rheumatoid arthritis (JRA) may occur in the wake of infection with several viruses including Ebstein-barr virus (EBV). EBV remains an interesting target. To determine the possible role of EBV infections in the clinical course of JRA, we attempt to demonstrate the radiologic changes and the frequency prescription of etanercept rather than classic therapy. METHODS: Total of 87 patients with JRA, who were hospitalized in Hangang Sacred Hospital and Kangnam Sacred Hospital in Seoul from 2002 to 2010, were assessed serologically for EBV infection (anti EBV VCA IgM and IgG) at admission. Patients with JRA were devided 2 groups, one is EBV VCA IgG (+) JRA patients who had been infected before and another is EBV VCA IgG (-) JRA patients who had not. RESULTS: EBV VCA IgG (+) were seen in 55 patients (63.2%). 31 boys (76%) and 24 girls (52%) were infected with EBV. The mean age of patients of EBV (+) JRA was 8.2+/-3.6 years and that of EBV (-) JRA was 5.3+/-3.4 years. 7 of EBV (+) JRA (13%) developed radiologic change within 2 years, compare with none of EBV (-) JRA. 22 of EBV (+) JRA (49%) with JRA did not respond to the classic therapy, compare with 7 of EBV (-) JRA (22%). CONCLUSION: JRA patients with past EBV infection were older in ages, more in male, more radiologic changes, needed more biologic treatment than those without past EBV infection.
Arthritis, Juvenile Rheumatoid ; Child ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Male ; Prescriptions ; Receptors, Tumor Necrosis Factor ; Viruses ; Etanercept

Malignant peripheral nerve tumors are very rare and derived from the neurofibromatosis in about 13%. There are two classes of malignant tumors in the peripheral nerve, one those of mesoblastic origin, is far most common and made up of malignant neurofibroma and much common fibrosarcoma, and metastasis in 20% of fibrosarcoma, and the other is neuroepithelial origin. These are characterized by increased cellularity, atypical form of cells, mitoses and invasiveness. The choice treatment is radical removal of the tumor, and not affected the prognosis by radiation or chemotherapy. We have been recently experienced of one case of malignant schwannoma on the cervical roots in a case of von Recklinhausen's disease.
Drug Therapy ; Fibrosarcoma ; Mitosis ; Neoplasm Metastasis ; Neurilemmoma* ; Neurofibroma ; Neurofibromatoses ; Peripheral Nerves ; Peripheral Nervous System Neoplasms ; Prognosis

BACKGROUND: Postoperative pain control following bone fusion and pedicle screw fixation is insufficient with IV-PCA alone. Therefore, the effect of preoperative epidural analgesia in addition to IV-PCA was evaluated for postoperative pain control following bone fusion and pedicle screw fixation surgery. METHODS: Eighty patients, scheduled to undergo bone fusion and pedicle screw fixation, were randomly assigned to two groups; the study (n = 40) or control groups (n = 40). After induction, the patient was turned into the prone position, and morphine 2 mg and 10 ml of 0.2% ropivacaine were injected into the L1/2 epidural space, after dye confirmation, under C-arm guidance for the study group, with 10 ml normal saline injected into the L1/2 epidural space for the control group. After induction, IV-PCA was applied in both groups. After the operation, the NRS (numerical rating scale) and side effects were evaluated immediately post-op, and at 24 and 48 hours after the operation. RESULTS: In the study group, the NRS was more reduced for all periods compared with the control group, but the incidences of nausea/vomiting and pruritus were no different from the control group. CONCLUSIONS: It was concluded that preoperative epidural analgesia, in addition to IV-PCA, was a good postoperative pain control method following bone fusion and pedicle screw fixation.
Analgesia, Epidural* ; Analgesia, Patient-Controlled* ; Epidural Space ; Humans ; Incidence ; Morphine ; Pain, Postoperative* ; Prone Position ; Pruritus

Background/Aims: Vascular disease is an established risk factor for stroke in patients with atrial fibrillation (AF), which is included in CHA2DS2-VASc score. However, the role of carotid atherosclerosis remains to be determined. Methods: Three hundred-ten patients with AF who underwent carotid sonography were enrolled. Results: During a median follow-up of 31 months, 18 events (5.8%) of stroke were identified. Patients with stroke had higher carotid intima-media thickness (CIMT) (1.16 ± 0.33 mm vs. 0.98 ± 0.25 mm, p = 0.017). CIMT was significantly increased according to the CHA2DS2-VASc score (p < 0.001) and it was correlated with left ventricular mass index and early diastolic mitral annular velocity (e’), a ratio of early transmitral flow velocity to e’ (E/e’) and pulmonary artery systolic pressure (all p < 0.05). Cox regression using multivariate models showed that carotid plaque was associated with the risk of stroke (hazard ratio, 3.748; 95% confidence interval [CI], 1.107 to 12.688; p = 0.034). C-statistics increased from 0.648 (95% CI, 0.538 to 0.757) to 0.716 (95% CI, 0.628 to 0.804) in the CHA2DS2-VASc score model after the addition of CIMT and carotid plaque as a vascular component (p = 0.013). Conclusions Increased CIMT and presence of carotid plaque are associated with a high risk of ischemic stroke, and CIMT is related to myocardial remodeling and diastolic dysfunction, suggesting that carotid atherosclerosis can improve risk prediction of stroke in patients with AF, when included under vascular disease in the CHA2DS2-VASc scoring system.

BACKGROUND/AIMS: Controversy remains over the optimal approach to preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma. We compared the clinical outcomes of endoscopic biliary drainage (EBD) with those of percutaneous transhepatic biliary drainage (PTBD) in patients undergoing preoperative biliary drainage for perihilar cholangiocarcinoma. METHODS: A total of 106 consecutive patients who underwent biliary drainage before surgical treatment were divided into two groups: the PTBD group (n=62) and the EBD group (n=44). RESULTS: Successful drainage on the first attempt was achieved in 36 of 62 patients (58.1%) with PTBD, and in 25 of 44 patients (56.8%) with EBD. There were no significant differences in predrainage patient demographics and decompression periods between the two groups. Procedure-related complications, especially cholangitis and pancreatitis, were significantly more frequent in the EBD group than the PTBD group (PTBD vs EBD: 22.6% vs 54.5%, p<0.001). Two patients (3.8%) in the PTBD group experienced catheter tract implantation metastasis after curative resection during the follow-up period. CONCLUSIONS: EBD was associated with a higher risk of procedure-related complications than PTBD. These complications were managed properly without severe morbidity; however, in the PTBD group, there were two cases of cancer dissemination along the catheter tract.
Aged ; Aged, 80 and over ; Bile Duct Neoplasms/*surgery ; Bile Ducts/surgery ; Cholangitis/etiology ; Drainage/adverse effects/*methods ; Endoscopy, Gastrointestinal/adverse effects/*methods ; Female ; Humans ; Klatskin Tumor/*surgery ; Liver/surgery ; Male ; Middle Aged ; Pancreatitis/etiology ; Postoperative Complications/etiology ; Preoperative Care/adverse effects/*methods ; Treatment Outcome

Diffuse pulmonary nodular lesions have many causes. When they are caused by infection, the likely organisms are M. tuberculosis and various fungi. Silicosis, eosinophilic granuloma and pulmonary metastasis should be considered for differential diagnosis. Differential diagnosis needs detailed clinical history, physical examination and various laboratory tests. A case of persistent diffuse pulmonary nodular lesions which had persisted 5 years is reported. The patient was a 25 years old man with minimal pulmonary symptoms. Detailed past history and physical examination suggested thyroid tumor. Chest radiography showed numerous evenly sized well-defined nodules scattered in entire lung fields. Previous chest X-rays showed similar nodular lesions, which had lasted for 5 years. The number of nodules was slightly increased. Neck CT showed heterogenous mass in left lobe of thyroid gland and multiple lymphadenopathies along both internal jugular chains. Total thyroidectomy was performed. A case of lung metastasis which progressed slowly in papillary thyroid cancer is reported.
Diagnosis, Differential ; Eosinophilic Granuloma ; Fungi ; Humans ; Lung ; Neck ; Neoplasm Metastasis ; Physical Examination ; Radiography ; Silicosis ; Thorax ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Tuberculosis

BACKGROUND AND OBJECT: Immunostimulatory CpG-oligodeoxynucleotides (ISS CpG-ODN) up-regulate the TH1-type immune response and down-regulate the TH2-type response. This study was performed to investigate the immune response changes resulting from ISS CpG-ODN on bronchial hyperrestponsiveness, eosinophilic inflammation and mucus hypersecretion in rat asthma. MATERIALS AND METHODS: 10 normal controls(NC) and 26 asthmatic rats, which were generated by ovallbumin(OVA) sensitization and challenge, were studied. The asthmatic rats were randomized into 11 asthma controls(AC) and 15 in the asthma-CpG treatment group(CpG). The CpG group was administered ISS CpG-ODN intramuscularly and the AC group was administered a placebo(0.9% NaCl)on day 15 and 20. After CpG-ODN or placebo administration, we measured the IFN-(TH1-type cytokine) and IL-4(TH2-type cytokine) levels in the bronchoalveolar lavage fluid(BALF), the specific airway resistance(sRaw), eosinophilic fraction in BALF, eosinophilic infiltration, goblet cell dysplasia and MUC5AC gene expression in the lung tissue. RESULTS: In the BALF of the CpG group, the IFN-γ concentration was significantly high and the IL-4 concentration was significantly low when compared with the AC group. Both the sRaw and eosinophilic fraction, and infiltration into the BALF and lung tissue significantly lower in the CpG group when compared with the AC group. However, little difference in goblet cell dysplasia and MUC5Ac gene expression was observed between the CpG group and the Ac group. CONCLUSION: ISS CpG-ODN decreases bronchial hyperresponsiveness and eosinophilic inflammation in the rat asthma model through the up-regulation of the TH1-type immune response with the down-regulation of the TH2-type response. However, the effect of these immune response changes on mucus hypersecretion was is not remarkable in this study.
Animals ; Asthma* ; Bronchoalveolar Lavage ; Down-Regulation ; Eosinophils ; Gene Expression ; Goblet Cells ; Inflammation ; Interleukin-4 ; Lung ; Mucus ; Rats* ; Up-Regulation

The syndrome of ectopic production of ACTH by non-pituitary neoplasm occurs with various types of tumors. ACTH-producing thymic carcinoid tumor is rare and has not been reported in Korea. We have experienced a 36-year-old male patient with ACTH-producing thymic carcinoid tumor, presenting symptoms of generalized weakness and weight gain. Clinical presentation, radiologic and hormonal evaluation, and pathologic examination were compatible with ACTH-producing thymic carcinoid tumor. The immunohistochemical staining of the thymic carcinoid tumor showed positivity for ACTH. Primary and metastatic tumor and both adrenal glands were resected. Radiation therapy and chemotherapy were performed. The prognosis of this patient is thought to be poor.
ACTH Syndrome, Ectopic* ; Adrenal Glands ; Adrenocorticotropic Hormone ; Adult ; Carcinoid Tumor* ; Drug Therapy ; Humans ; Korea ; Male ; Prognosis ; Weight Gain

Intracardiac hemangiopericytomas are rare tumors which originates from the pericyte in the external wall of capillaries. 1) The tumors are known to usually develop in the lower extremities, pelvic cavity and retroperitoneum, 2) but are very rare in the heart. 3) The symptoms and signs of a hemagiopericytoma depend on the size and location of the tumor. 2) A hemagiopericytoma has a high potential for local recurrence and metastasis, so regular follow-up is needed following surgical excision. 2) A 36-year-old man presented with shortness of breath and chest discomfort. Before operating, a chest CT scan showed that a compressive collapse of the left lung had developed next to a large mediastinal tumor. Because of impending respiratory failure due to collapse of the left lung, an operation was performed. The operation showed that the mediastinal tumor was a large loculated hemopericardium accompanied by pericardial bleeding. A hematoma evacuation with a pericardiectomy was performed, and the pathology of the thickened pericardial wall revealed a malignant hemangiopericytoma. The patient has followed up for 6 months without symptoms or sign of tumor recurrence following the radiation therapy.
Adult ; Capillaries ; Dyspnea ; Follow-Up Studies ; Heart ; Hemangiopericytoma ; Hematoma ; Hemorrhage ; Humans ; Lower Extremity ; Lung ; Mediastinal Neoplasms ; Neoplasm Metastasis ; Pathology ; Pericardial Effusion ; Pericardiectomy ; Pericytes ; Recurrence ; Respiratory Insufficiency ; Thorax ; Tomography, X-Ray Computed