PURPOSE: The C-14 urea breath test (C-14 UBT) is the most specific noninvasive method to detect Helicobacter (H) pylori infection. We investigated if the C-14 UBT can reflect the presence and degree of H. pylori detected by gastroduodenoscopic biopsies (GBx). MATERIALS AND METHODS: One hundred fifty patients (M:F=83:67, age 48.6+/-11.2 yrs) underwent C-14 UBT, rapid urease test (CLO test) and GBx on the same day. For the C-14 UBT, a single breath sample was collected at 10 minutes after ingestion of C-14 urea (137 KBq) capsule and counting was done in a liquid scintillation counter for 1 minute, and the results were classified as positive ( 200 dpm), intermediate (50~199 dpm) or negative (<50 dpm). The results of CLO tests were classified as positive or negative according to color change. The results of GBx on giemsa stain were graded 0 (normal) to 4 (diffuse) according to the distribution of H. pylori by the Wyatt method. We compared C-14 UBT results with GBx grade as a gold standard. RESULTS: In the assessment of the presence of H. pylori infection, the C-14 UBT global performance yielded sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 92.5%, 88.4%, 97.1%, 88.4% and 91.3%, respectively. However, the CLO test had sensitivity, specificity, PPV, NPV and accuracy of 83.2%, 81.4%, 91.8%, 81.4% and 82.7%, respectively. The quantitative values of the C-14 UBT were 45+/-27 dpm in grade 0, 707+/-584 dpm in grade 1, 1558+/-584 dpm in grade 2, 1851+/-604 dpm in grade 3, and 2719+/-892 dpm in grade 4. A significant correlation (r=0.848, p<0.01) was found between C-14 UBT and the grade of distribution of H. pylori infection on GBx with giemsa stain. CONCLUSION: We conclude that the C-14 UBT is a highly accurate, simple and noninvasive method for the diagnosis of ongoing H. pylori infection and reflects the degree of bacterial distribution.
Azure Stains ; Biopsy ; Breath Tests* ; Diagnosis ; Eating ; Helicobacter pylori* ; Helicobacter* ; Humans ; Scintillation Counting ; Sensitivity and Specificity ; Urea* ; Urease

Ewing's sarcoma is a highly malignant, small, round cell tumor that usually affects long bones. The acral part of the extremities is a very rare primary site for this neo plasm. A fifteen-year-old girl was seen for a lobulated, dome-shaped, 2.7cm diameter, denuded mass on the distal phalanx of the right middle finger which had increased in size over a 14-month period. The radiological featuies of the hand showed a cortical brick of distal phalanx and surrounding soft tissue mass. Histologically, the biopsy specimen showed sheets of small round to oval cells with scanty cytoplasm, that were closely packed and separated into lobules by trands of fibrous tissue. A periodic acid-Schiff stain demonsirated glycogen in the cytoplasm of the tumor cells. Electron microscopy showed large aggregates of glycogen in the cytoplasm of the neoaplastic cells. Immunohistochemical stains revealed positive staining for vimentin, glial fibrillary acid potein, and neuron specific enolase, stains for S-100, Factor VIII, and cytokeratin were negative.
Biopsy ; Coloring Agents ; Cytoplasm ; Extremities ; Factor VIII ; Female ; Fingers ; Glycogen ; Hand ; Humans ; Keratins ; Microscopy, Electron ; Phosphopyruvate Hydratase ; Sarcoma* ; Sarcoma, Ewing ; Vimentin

Ewing's sarcoma is a highly malignant, small, round cell tumor that usually affects long bones. The acral part of the extremities is a very rare primary site for this neo plasm. A fifteen-year-old girl was seen for a lobulated, dome-shaped, 2.7cm diameter, denuded mass on the distal phalanx of the right middle finger which had increased in size over a 14-month period. The radiological featuies of the hand showed a cortical brick of distal phalanx and surrounding soft tissue mass. Histologically, the biopsy specimen showed sheets of small round to oval cells with scanty cytoplasm, that were closely packed and separated into lobules by trands of fibrous tissue. A periodic acid-Schiff stain demonsirated glycogen in the cytoplasm of the tumor cells. Electron microscopy showed large aggregates of glycogen in the cytoplasm of the neoaplastic cells. Immunohistochemical stains revealed positive staining for vimentin, glial fibrillary acid potein, and neuron specific enolase, stains for S-100, Factor VIII, and cytokeratin were negative.
Biopsy ; Coloring Agents ; Cytoplasm ; Extremities ; Factor VIII ; Female ; Fingers ; Glycogen ; Hand ; Humans ; Keratins ; Microscopy, Electron ; Phosphopyruvate Hydratase ; Sarcoma* ; Sarcoma, Ewing ; Vimentin

PURPOSE: This study was done to examine levels of temperament, parent-child attachment and depression of adolescents and verify its effects. METHODS: Surveys were conducted with 500 students from two middle schools, one located in Seoul and one in Gyeonggi Province. Adolescent temperament was measured using the Junior Temperament and Character Inventory, parent-child attachment using the Revised Inventory of Parent and Peer Attachment and depression using the Children's Depression Inventory. Cluster, t-test, correlation and logistic regression were used for data analysis. RESULTS: Characteristics of temperament were classified into 2 groups. The 'Adaptation vulnerable group' showed high Harm Avoidance and the 'Adaptation protective group' showed high Reward Dependence, and Patience. The 'Adaptation vulnerable group' showed lower attachment and higher depression than the 'Adaptation protective group'. Novelty Seeking and Harm Avoidance correlated positively with depression and negatively with attachment. Students with higher levels of attachment reported lower levels of depression. The logistic regression analysis showed that the 'Adaptation vulnerable group' was 2.16 times more likely to be affected by depression than 'Adaptation protective group'. CONCLUSION: Results of this study can be used to develop depression intervention programs for adolescent psychological health and provide encouragement in the development of parent-child attachment.
Adolescent ; Depression ; Humans ; Logistic Models ; Parent-Child Relations ; Parents ; Reward ; Temperament ; Child Health

No abstract available.

BACKGROUND: Preemptive analgesia is an antinociceptive treatment that prevents the establishment of central sensitization, which amplifies the postoperative pain. In this study, we investigated the preemptive effect of local infiltration of bupivacaine on postoperative pain after inguinal herniorrhaphy. METHODS: Thirty adult patients scheduled for inguinal herniorrhaphy were randomly assigned to one of two groups. 0.25% bupivacaine 20 ml was infiltrated in the surgical wound site either 15 min before skin incision or immediately after skin closure. Postoperatively, visual analogue scale (VAS) at rest and movement were assessed. Also the time to the first request for postoperative analgesic and the total dose of postoperative analgesics were assessed. In addition, the number of patients who didn't require any analgesics during the postoperative period were assessed. RESULTS: The VAS at rest and movement was not significantly different between the two groups. The time to the first request for postoperative analgesic, the total dose of supplemental analgesics and the number of patients who didn't require any analgesics were not significantly different. CONCLUSIONS: In pain after inguinal herniorrhaphy, we could not demonstrate the pre-emptive analgesic effect of preincisional bupivacaine infiltration. Traction pain after inguinal herniorrhaphy was sustained during the study period and this kind of pain was not inhibited (or prevented) by local infiltration of bupivacaine.
Adult ; Analgesia ; Analgesics ; Bupivacaine* ; Central Nervous System Sensitization ; Herniorrhaphy* ; Humans ; Pain, Postoperative* ; Postoperative Period ; Skin ; Traction ; Wounds and Injuries

BACKGROUND AND OBJECTIVES: Altered environmental gravity, including both hypo- and hypergravity, may result in space adaptation syndrome. To explore the characteristics of this adaptive plasticity, the expression of immediate early gene c-fos mRNA in the vestibular system following an exposure to hypergravity stimulus was determined in rats. MATERIALS AND METHOD: The animals were subjected to 2 G force (two-fold earth's gravity) stimulus for 3 hours, and were examined at post-stimulus hours 0, 2, 6, 12, and 24. Real time reverse transcription-polymerase chain reaction (RT-PCR) was adopted to analyze temporal changes in the expression of c-fos mRNA. RESULTS: The hypergravity stimulation produced the expression of c-fos mRNA in the vestibular ganglion, medial vestibular nucleus, inferior vestibular nucleus, hippocampus, vestibulocerebellum, and vestibular cortex. The peak expression occurred at hour 6 in the animals hypergravity-stimulated for 3 hours. Bilateral labyrinthectomy significantly attenuated the degree of up-regulation in c-fos mRNA expression. MK-801, an NMDA receptor antagonist, also significantly attenuated the degree of up-regulation in c-fos mRNA expression. CONCLUSION: These results indicate that the adaptive neuroplasticity in response to an altered gravity occurs in the vestibular-related organs in the central nervous system, in which peripheral vestibular receptors and NMDA receptors play an important role.
Animals ; Central Nervous System ; Dizocilpine Maleate ; Ganglion Cysts ; Genes, fos ; Gravitation ; Hippocampus ; Hypergravity* ; N-Methylaspartate ; Neuronal Plasticity* ; Plastics ; Rats ; Receptors, N-Methyl-D-Aspartate ; RNA, Messenger ; Space Motion Sickness ; Up-Regulation ; Vestibular Nuclei

BACKGROUND: Ketamine enhances local anesthetic and analgesic effects of bupivacaine by peripheral mechanisms. We evaluated the additive effects of ketamine (30 mg) on 0.5%, and 0.75% ropivacaine (total 30 ml) for an interscalene brachial plexus blockade (IBPB). METHODS: Thirty five adult patients scheduled for major forearm or hand surgery were prospectively randomized to receive one of the following solutions. Group 1 received 0.75% ropivacaine 28 ml with normal saline 2 ml, group 2 received 0.75% ropivacaine 28 ml with 5% ketamine 0.6 ml and normal saline 1.4 ml, group 3 received 0.75% ropivacaine 20 ml with normal saline 10 ml, and group 4 received 0.75% ropivacaine 20 ml with 5% ketamine 0.6 ml and normal saline 9.4 ml. At 1 minute intervals after IBPB, patients were assessed to determine loss of shoulder abduction, elbow flexion, wrist flexion and loss of pinprick in the deltoid, radial, median, and ulnar dermatomes. At 5 minute intervals after IBPB, pulse rate, blood pressure, sedation score and level of discomfort were assessed. Before discharge, patients were asked to document when incisional discomfort began and when full sensation and motor control returned to the arm. RESULTS: The onset time of loss of pinprick and motor blockade were similar. Duration of sensory and motor blockade were similar in all groups. Hemodynamic changes and sedation scores were not significantly different in all groups. CONCLUSIONS: We demonstrated that 30 mg of ketamine didn't enhance the onset and duration of sensory or motor blockade of ropivacaine during the 0.75% or 0.5% ropivacaine IBPB.
Adult ; Arm ; Blood Pressure ; Brachial Plexus* ; Bupivacaine ; Elbow ; Forearm ; Hand ; Heart Rate ; Hemodynamics ; Humans ; Ketamine* ; Prospective Studies ; Sensation ; Shoulder ; Wrist

BACKGROUND: Ropivacaine is a new local anesthetic approved for epidural analgesia. The addition of fentanyl improves analgesia from epidural ropivacaine. We studied the effects of two solutions of ropivacaine/fentanyl for postoperative pain after a total abdominal hysterectomy. METHODS: Twenty five female patients scheduled for an elective total abdominal hysterectomy were prospectively randomized to receive one of two solutions. Group 1 (n = 13) received 0.2% ropivacaine and 5 microgram/ml of fentanyl at a rate of 2 ml/hour (bolus: 10 ml). Group 2 (n = 12) received 0.08% ropivacaine and 2 microgram/ml fentanyl at a rate of 5 ml/h (bolus: 25 ml) postoperative for two days. After an epidural bolus injection, we assessed the blood pressure, pulse rate, respiratory rate, visual analog scale (VAS), level of sensory block, motor block and sedation score among the two groups. Additional analgesic requirements and side effects such as nausea, itching and urinary retention were assessed for 48 hours post operation. RESULTS: There were no significant differences in the blood pressure, pulse rate and respiratory rate between the two groups. The sum of VAS for 48 hours, the level of sensory block after an epidural bolus injection, additional analgesics, and the number of patients showing motor blockade were similar. Although statistically insignificant, the incidence of nausea, and urinary retention in group 2 was higher than group 1. CONCLSIONS: Both the continuous epidural infusion of 0.2% ropivacaine with fentanyl (2 ml/hour) and 0.08% ropivacaine with fentanyl (5 ml/h) showed similar quality of analgesia on postoperative pain. To reduce the side effect of fentanyl, the volume of ropivacaine/fentanyl solution is important.
Analgesia ; Analgesia, Epidural* ; Analgesics ; Blood Pressure ; Female ; Fentanyl ; Heart Rate ; Humans ; Hysterectomy ; Incidence ; Nausea ; Pain, Postoperative ; Prospective Studies ; Pruritus ; Respiratory Rate ; Urinary Retention ; Visual Analog Scale

We report a case of pulmonary edema developed in a 33-year-old female who underwent two-stage bilateral carotid body tumor excision. About 1 month ago, she had undergone a left carotid body tumor excision. After the operation, her tongue was deviated to left side. Bilateral hypoglossal nerve injury was suspected. These injuries should be carefully monitored in patients who will undergo a similar procedure on both sides because a bilateral deficit of the hypoglossal nerve is poorly tolerated, resulting potentially serious pulmonary edema. In recovery room, she became pale and SpO2 was fall down. We reintubated her immediately and the pulmonary edema was treated using a supportive management. She was discharged without any signs of dyspnea or airway obstruction, but hypoglossal nerve injury remained. We discuss the possible etiology of the upper airway obstruction after the neck surgery and review the literatures associated with the pulmonary edema following upper airway obstruction.
Adult ; Airway Obstruction ; Carotid Body Tumor* ; Carotid Body* ; Dyspnea ; Female ; Humans ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases ; Hypoglossal Nerve Injuries ; Neck ; Pulmonary Edema* ; Recovery Room ; Tongue