BACKGROUND: The addition of clonidine to local anesthetics for regional block has been shown to increase the duration of anesthesia and analgesia. This study was designed to determine whether the addition of clonidine to bupivacaine would produce an extension of the analgesic effect after intercostal nerve block (ICNB). METHODS: After informed consent, 30 ASA 1 or 2 patients undergoing appendectomy under general anesthesia were randomly divided into two groups. Before induction of anesthesia, ICNB using a posterior approach was performed with 15 ml of 0.25% bupivacaine plus epinephrine 1:200,000 with (Group BEC; n = 15) or without (Group BE; n = 15) clonidine 75 microgram. Analgesia was assessed by cold testing at 1/min intervals until cold sensation decreased. The duration of analgesia (time between injection and onset of pain) was recorded. We also recorded the visual analogue scale (VAS) of pain, the number of supplemental analgesics, heart rate and blood pressure, and side effects over 24 hours postoperatively. RESULTS: The onset time, duration of analgesia, number of analgesics, and heart rate and blood pressure were comparable in both groups. VAS scores were significantly lower in Group BEC than in Group BE at 12, 16, and 20 hours postoperatively. CONCLUSIONS: The addition of clonidine to bupivacaine with epinephrine may be a useful adjunct and can prolong the duration of analgesia after ICNB without significant side effects.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia and Analgesia ; Anesthesia, General ; Anesthetics, Local ; Appendectomy ; Blood Pressure ; Bupivacaine* ; Clonidine* ; Epinephrine ; Heart Rate ; Humans ; Informed Consent ; Intercostal Nerves* ; Pain, Postoperative* ; Sensation

BACKGROUND: It is well-known that the giant congenital nevi prcgress to malignant, melanama more frequently than other benign melanocytic nevi but to date the laor tory methods for early detection of such progression were not avsilable. The proliferating cell uncleai antigen(PCNA) staining has been regsrded as an useful marker in determining prognosis of some maignant diseases. OBJECTIVE: The PCNA taining was performed as a predictive value of malignant transformation from benign meanocytic skin lesions. We investigated the differcnces between malignant melanoma and the benign lesions. MATERIAL AND METHODS: Immunohistochemical study was employee using anti-PCNA, anti-S-100, and anti-CD45RO antibody in 6 giant congenital nevi, 8 small and medium sized congenital nevi, 10 acquired nevi, and 10 malignant meanomas. Only cells positive for both PCNA and S-100, and negative for CD45RO on the serial sections were identified as melanocyts. RESULTS: The number of PCNA-posit,ive cells per 1000 melanocy,es averaged 6.0+7.5 in giant, congenital nevi, 2.9+1,9 in small and medium sized congenital novi, 3.1+2.7 in acquired nevi, and 61.5+ 39.4 in malignant, melanomas. Malignant melanomas showed onger intensity of PCNA staining than the other melanocytir nevi. CONCLUSION: There was not significant difference of the numter of PCNA-positive cells among the groups of congenital neviind PCNA staining can't be used in prditive measure of malignant. progression and studying mechansm of malignancy in giant congenital nevi. But, PCNA staining is considered as an useful method in differentiat,ing malignant melanoma from mllanocytic nevi.
Melanoma ; Nevus ; Nevus, Pigmented ; Prognosis ; Proliferating Cell Nuclear Antigen* ; Skin*

The crossing laminar screw fixation might be the most recently developed approach among various fixation techniques for C2. The new construct has stability comparable to transarticular or transpedicular screw fixation without risk of vertebral artery injury. Quantitative anatomical studies about C2 vertebra suggest significant variation in the thickness of C2 lamina as well as cross sectional area of junction of lamina and spinous process. We present an elderly patient who underwent an occipito-cervical stabilization incorporating crossed C2 laminar screw fixation. We preoperatively recognized that she had low profiles of C2 lamina, and thus made a modification of trajectory for the inferiorly crossing screw. We introduce a simple modification of crossing C2 laminar screw technique to improve stability in patients with low laminar profiles.
Aged ; Humans ; Spine ; Vertebral Artery

BACKGROUND AND OBJECTIVE: The outcome of asthma treatment has traditionally been assessed by measuring the conventional clinical parameters such as symptoms, expiratory flow rates and needs for medications. But none of them tells us whether the patients are actually able to function properly in their lives. Only assessment of the quality of life (QOL) can reflect the parts of patients lives affected by the disease. However, there is no measure to assess the quality of life of patients with any chronic diseases in Korea yet. We developed the QOL Questionnaire for Korean Asthmatics and evaluated its measurement properties. METHOD: The questionnaire was composed of 18 items in four domains : i.e. activity limitation (6 items), symptoms (5 items), emotional function (3 items) and environmental stimuli (4 items). At our out-patient clinic, 32 adults with moderate to severe persistent bronchial asthma were enrolled. The study design consisted of 4 week unblinded single cohort with visits at 0 and 4 weeks, and the patients were asked to answer the questionnaire by self administration method at the two separate visits. Forced expiratory volume for 1 second (FEV1) and peak expiratory flow rate (PEFR) were recorded at each visit. According to the patients and physicians global assessment, the patients were divided into two groups, i.e. stable and changed (improved). The responsiveness, reproducibility and validity of the questionnaire were evaluated. RESULTS: The total QOL scores at the second visit in the changed group were significantly higher than those at the first visit. The score differences between the two visits in the changed group were higher than in the stable group. In the stable group, the responses to the questionnaire were reproducible. The QOL scores showed good longitudinal correlation with the expiratory flow rates, whereas FEV1 did not correlate with the QOL in cross-sectional analysis. CONCLUSION: The questionnaire proved to be reproducible, responsive and valid in the subjects. It could be recommended for the outcome evaluation of Korean asthmatics.
Adult ; Asthma ; Chronic Disease ; Cohort Studies ; Cross-Sectional Studies ; Forced Expiratory Volume ; Humans ; Korea ; Outpatients ; Peak Expiratory Flow Rate ; Quality of Life* ; Self Administration ; Surveys and Questionnaires

Trichoblastic fibroma is a rare benign tumor of hair germ with mixed epithelial-mesenchymal components. A 64-year-old female presented with an asymptomatic, skin-colored, firm nodule on the left knee joint. Histopathologic examination showed multiple tumor islands and strands eomposed of basaloids cells embedded in a moderately cellular fibroblastic stroma and the for vation of bud-like extension of tumor cell nest. The peripherel basaloid cells shovred a palisading arrangement and small keratinous cysts were formed in tumor islands.
Female ; Fibroblasts ; Fibroma* ; Hair ; Humans ; Islands ; Knee Joint ; Middle Aged

Nicotine is one of the major components of cigarette smoking which causes various systemic and local diseases to human body. The purpose of the present study was to investigate the effects of nicotine on bone mineralization in human fetal osteoblasts cell line(hFOB1). To compare the alkaline ph-osphatase(ALP) synthesis, hFOB1 were cultured with DMEM/F-12 1:1 Mixture and 100 pg/ml, 1 ng/ml, 10 ng/ml, 100 ng/ml, 1 microgram/ml, 10 microgram/ml, 100 microgram/ml of nicotine. And to compare the calcium accumulation, hFOB1 cultured for 23 days were quantified and photographed. ALP activity of hFOB1 exposed to nicotine was not significantly changed at a lower concentrations of nicotine, but was significantly decreased at a higher concentrations (10 microgram/ml, 100 microgram/ml) of nicotine (p<0.05). A quantified calcium acculation in hFOB1 was significantly decreased at 1, 10, and 100microgram/ml of nicotine (p<0.05). Significantly decreased calcium deposition was observed at 1, 10, and 100microgram/ml of nicotine. These results indicate that a higher concentration of nicotine show a negative effects on mineralization of hFOB1.
Calcification, Physiologic ; Calcium ; Human Body ; Humans* ; Nicotine* ; Osteoblasts* ; Smoking

No abstract available.
Animals ; Coculture Techniques* ; Embryonic Structures* ; Mice*

Trichorhinophalangeal syndrome (TRPS) is a rare genetic disorder characterized by a number of clinical features including slowly growing sparse scalp hair, a pear-shaped nose, and cone-shaped epiphyses of the phalanges. The syndrome has three subgroups: type I, II, and III. TRPS III is the rarest and most recently recognized form and inherited in an autosomal dominant manner. We describe a 19-year-old male with TRPS III, who presented with characteristic clinical and radiological features. To our knowledge, this is the first report of TRPS III in Korea.
Epiphyses ; Hair ; Humans ; Korea ; Male ; Nose ; Scalp ; Young Adult

The incidence of male breast cancer is very low, accounting for less than 1% of that of female breast cancer. Because of its low incidence, the experience of individual physicians with male breast cancer is limited. Futhermore, screening and clinical trials do not exist for men. Thus, there is a delay to seek medical consultation. We describe a case of breast cancer occurring in an 82-year-old man. He presented with a solitary, asymptomatic, and rigid subcutaneous mass under the areolar area of the left breast. Histopathologic examination showed an infiltrating ductal carcinoma of the breast. Immunohistochemically, estrogen and progesterone receptors were expressed in 90% and 70% of tumor cell nuclei, respectively.
Aged, 80 and over ; Breast ; Breast Neoplasms ; Breast Neoplasms, Male* ; Carcinoma, Ductal ; Cell Nucleus ; Estrogens* ; Female ; Humans ; Incidence ; Male ; Male* ; Mass Screening ; Progesterone* ; Receptors, Progesterone

No abstract available.
Adrenocortical Carcinoma* ; Stomach Neoplasms*