We report a case of 15-year-old man with beneficial effects of short term growth hormone treatment presenting with cardiomyopathy combined with neuromuscular dystrophy. Transthoracic echocardiography revealed that LV chamber was markedly dilated and global LV systolic function was severely reduced. The findings of electromyography were compatible with neuromuscular dystrophy. Under the impression of cardiomyopathy combined with neuromuscular disease, maximal medical treatments such as inotropic agents, diuretics and ACE inhibitor were tried but we could not attain remarkable clinical improvement. Finally, we started growth hormone injection and after treatment for 3 months, we could attain remarkable clinical and hemodynamic improvement without any side effect.
Adolescent ; Cardiomyopathies* ; Diuretics ; Echocardiography ; Electromyography ; Growth Hormone* ; Heart Failure* ; Heart* ; Hemodynamics ; Humans ; Neuromuscular Diseases

BACKGROUND: We studied the interaction between Succinylcholine (SCh) and mivacurium when mivacurium was administered during early and late recovery from SCh block was investigated. METHODS: Eighty patients undergoing elective surgery under general anesthesia were studied. General anesthesia was induced and maintained with propofol under TCI control. Neuromuscular function was measured in response to TOF stimulation of the ulnar nerve using an electromyographic method. The patients were allocated randomly to the following four groups; group 1 (n = 20): a bolus intravenous injection of 0.08 mg/kg mivacurium; group 2 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 2 minutes of 1 mg/kg SCh injection; group 3 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 25% recovery of initial twitch height from twitch height depression induced by 1 mg/kg SCh; group 4 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 75% recovery of initial twitch height from twitch height depression induced by 1 mg/kg SCh. The onset and duration of neuromuscular blockade, recovery rate and TOF ratio at T75% were measured. RESULTS: The onset of block in groups 3 and 4 were slower than in group 1 (5.2 +/- 0.7 and 2.3 +/- 0.6 vs 2.5 +/- 0.4 min P < 0.05). The clinical duration in groups 2 and 3 were longer than in groups 1 and 4 (12.5 +/- 2.1 min and 11.3 +/- 1.7 min vs 17.0 +/- 3.0 min and 18.5 +/- 2.6 min, p < 0.05). There was no difference in recovery index all groups. The TOF ratio of groups 2, 3 and 4 were smaller than for group 1 (38.2 +/- 5.3, 32.3 +/- 5.6 and 31.5 +/- 4.2 vs 56.0 +/- 7.3, P < 0.05). CONCLUSIONS: The Previous 1 mg/kg SCh injection was affected the time course of action of mivacurium 0.08 mg/kg-induced neuromuscular block.
Anesthesia, General ; Depression ; Humans ; Injections, Intravenous ; Neuromuscular Blockade* ; Propofol ; Succinylcholine* ; Ulnar Nerve

This article reports the case of a woman who developed a pure motor paraplegia following epidural analgesia. 80mg of Depomedrol and 2ml of 1% lidocaine were injected epidurally for relief of back pain. Within one day the patient complained of severe pain in both lower extremities and the left lower extremity rapidly became paraplegic. Myelography showed no obstruction and compression. The paraplegia was permanent in the left lower extermity. We note a number of potential etiologies and analyze their possible mechanism of action.
Analgesia, Epidural* ; Back Pain ; Female ; Humans ; Lidocaine ; Lower Extremity ; Myelography ; Paraplegia*

OBJECTIVE: The acidic saline animal model of pain has been suggested to mimic fibromyalgia (FM). In this model, repeated intramuscular (IM) injections of acidic saline produce a widespread hyperalgesia that persists without evidence of significant peripheral tissue damage or inflammation, and is believed to be centrally maintained. We examined the changes of pain-related neurotransmitters in specific brain regions of this model after deep-sea water (DSW) drinking. METHODS: Rats were injected with 100microliter of acidic saline (pH 4.0) at days 0 and 5 into the left gastrocnemius muscle. Control rats received identical injections of physiological saline (pH 7.2) on the same schedule. Two acidic saline rats were given DSW from 1 week following the last IM injection to sacrifice. All rats were sacrificed on day 20. All regions of interest were examined for the changes of pain-related neurotransmitters with immunohistochemistry. RESULTS: Preliminary results showed that compared to controls, acid injected rats demonstrated strong expression of serotonin in red and raphe nucleus. Acid injected rats showed significant reductions of the serotonin expression in red and raphe nucleus after DSW drinking. CONCLUSION: IM acid injections increased the expression of serotonin in red and raphe nucleus of rats. The overwhelming reduction of serotonin expression in the nuclei after DSW drinking suggests DSW might be helpful for pain and anxiety. These preliminary data support the validity of acidic saline treatment as a model of FM, and provide a foundation for future analyses of specific brain regions that contribute to this syndrome.
Rats ; Animals

Intractable pain associated with advanced cancer is an important and complicated clinical problem. One hundred and forty cases with cancer pain were treated by several nerve blocking techniques at the pain clinic of Yonsei Medical Center during 4 year period from January 1978 to December 1981. These cases had intractable pain from non-resectable or recurrent cancer of the stomach (35 cases), pancreas(24 cases), lung (17 cases), uterine cervix(14 cases), rectum (13 cases), colon, lymphoma, liver, gall bladder and the others. After careful evaluation, they were given celiac plexus block with pure and/or 50% alcohol in 73 cses, intrathecal block with 10% phenol glycerine in 19 cases, continuous epidural block with 1% lidocaine in 35 cases and micellaneous nerve blocks including sympathetic ganglion block and local infiltration in 13 cases. Good to excellent pain relief was achieved in the aobve groups as follows: celiac pleuxs, 93.2%: intrathecal, 89.5%: continuous epidural, 60,5%: miscellaneous, 61.5%. Over all after block, life duraion ranged from 2 weeks to 12 months with an average of 2.4 months. When patients are selected carefully, and the block is performed with great caution, risk is minimal, and long lasting relief of intractable pain is possible in the majority of these patients led normal lives until they died.
Celiac Plexus ; Colon ; Ganglia, Sympathetic ; Glycerol ; Humans ; Lidocaine ; Liver ; Lung ; Lymphoma ; Nerve Block* ; Pain Clinics ; Pain, Intractable ; Phenol ; Rectum ; Stomach Neoplasms ; Urinary Bladder

Cavernous hemangioma of the scrotum is a rare tumor with only 36 cases having previously been reported in literature and one case in Korea. We would like to add two cases of cavernous hemangioma of the scrotum with review of literature
Hemangioma, Cavernous* ; Korea ; Scrotum*

BACKGROUND: It is well established that vascular contraction is caused by not only an increase in cytosolic Ca2+ level but also activations of Ca2+-sensitizing mechanisms including protein kinase C (PKC) and low molecular GTP binding protein. However, the roles of PKC and RhoA, a low molecular GTP-binding protein, on the receptor agonist-mediated contraction in swine pulmonary artery has not been clarified. In the present study, we examined the contribution of PKC isoform and RhoA to the arterial stimulants-induced contraction in swine pulmonary artery. METHOD: The large (> 5 mm), medium (1-3 mm) and small (< 1 mm in outer diameter) sized pulmonary arteries were excised and the contractions were recorded isometrically. The contents and subcellular distribution of PKC isoforms and RhoA were detected using immunoblotting. RESULTS: In medium pulmonary artery, norepinephrine (NE, 10 nM-30micrometer) led contraction in a dose-dependent manner. In large and small pulmonary arteries, however, NE failed to induce a contraction. Adding of 12-deoxyphorbol 13-isobutyrate (DPB, 1micrometer), a PKC activator, developed muscle force in 1 mM EGTA-contained Ca2+-free physiological salt solution. The expressions of PKC alpha, elsilon were significantly increased in medium pulmonary artery. NE (10micrometer) evoked the translocation of RhoA from cytosol to the membrane but not those of PKC isoforms. In Ca2+-free physiological salt solution, DPB (1micrometer) caused a translocation of PKC isoforms. CONCLUSIONS: These results support that NE induces contraction via RhoA pathway but not PKC pathway in swine pulmonary artery.
Cytosol ; GTP Phosphohydrolases* ; GTP-Binding Proteins ; Immunoblotting ; Membranes ; Norepinephrine ; Protein Isoforms ; Protein Kinase C* ; Protein Kinases* ; Pulmonary Artery* ; Swine*

Clinically detectable metastatic follicular thyroid carcinoma to the thymus is very rare in the literature and sometimes confused with false positive uptake of Iodine
Adenocarcinoma, Follicular/*secondary ; Adult ; Case Report ; Female ; Human ; Iodine Radioisotopes/diagnostic use ; Thymus Neoplasms/*secondary ; Thyroid Neoplasms/*pathology/radionuclide imaging/surgery ; Tomography, Emission-Computed

BACKGROUND: There is considerable experimental evidence to indicate that tumor growth is dependent on angiogenesis. To investigate how tumor angiogenesis correlates with clinical factors and prognosis in breast carcinoma, we counted microvessels (capillaries and venules) and graded the density of micro vessels within the invasive ductal carcinomas of 59 patients. METHODS: Using light microscopy, we highlighted the vessels by staining their endothelial cells immu nohistochemically for rabbit antihuman factor-VIII related antigen (Dako L1809, USA). The microvessels were carefully counted (per 200 field) in the most active areas of neovascularization without knowledge of either the outcome in the patient or the clinical variables. RESULTS: The mean age was 47.8 years. There was no statistical correlation between angiogenesis and either estrogen receptor status or age. However, there was a statistical correlation with tumor size (p< or =0.05). There was a statistical difference between lymph-node-metastasis positive group and negative group (p= 0.006). Angiogenesis correlated statistically with TMN stage (microvessels count:stage I= 31.27, stage II= 40.74, and stage III= 78.9)(p= 0.001). There was a statistical correction between angiogenesis and follow-up results (microvessels counts:disease free group= 42.11, living metastatic group= 63.64, and expired group= 73.60)(p= 0.031). CONCLUSIONS: In this study, the degree of angiogenesis (the number of microvessels per 200 field in the area of most intensive neovascularization) may have a predictive value in invasive breast carci nomas. Therefore, assessment of tumor angiogenesis may give us useful information for selecting thera peutic and follow-up plan for patients with breast carcinomas.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Endothelial Cells ; Estrogens ; Follow-Up Studies ; Humans ; Microscopy ; Microvessels ; Noma ; Prognosis

BACKGROUND: In previous study, most patients with bronchial anthracofibrosis (BAF) were non-miners, and non-occupational old aged females. However, the clinical significance of BAF in patients with coal workers' pneumoconiosis (CWP) is unknown. METHODS: Among patients with CWP who transferred to our hospital for an evaluation of associated pulmonary diseases, 32 patients who had undergone a bronchofibroscopy (BFS) and chest computed tomography (CT) examination were evaluated for the association of the BAF using a retrospective chart review. RESULTS: Nine of the 32 CWP patients (28%) were complicated with BAF. Four of the 16 simple CWP patients (25%) were complicated with BAF. According to the International Labor Organization (ILO) classification by profusion, 2 out of 3 patients in category 1, 1 out of 8 patients in category 2 and 1 out of 3 patients in category 3 were complicated with BAF. Five out of 16 complicated CWP patients were complicated with BAF. Three out of 7 patients in type A and 2 out of 5 patients in type C were complicated with BAF. CWP patients with BAF had significantly greater multiple bronchial thickening and multiple mediastinal or hilar lymph node enlargement than the CWP patients without BAF. There was no difference in the other clinical features between the CWP patients with BAF and those without BAF. CONCLUSION: Many CWP patients were complicated with BAF. The occurrence of BAF was not associated with the severity of CWP progression. Therefore, a careful evaluation of the airway with a bronchoscopy examination and chest CT is warranted for BAF complicated CWP patients who present with respiratory symptoms and signs, even ILO class category 1 simple CWP patients.
Aged ; Bronchoscopy ; Coal ; Female ; Humans ; Lung Diseases ; Lymph Nodes ; Pneumoconiosis ; Retrospective Studies ; Thorax