PURPOSE: The evaluation of pain in neonates is difficult due to their limited means of communication. The aim of this study was to determine whether the behavioral reactions of facial action and cry provoked by an invasive pain-induced procedure could be discriminated from the reactions to a noninvasive pain-induced procedure in normal full-term neonates. METHODS: Thirty-six healthy full-term neonates received three pain-induced procedures in counterbalanced order:intramuscular injection, tactile stimulus, and rubbing thigh with alcohol. The facial actions to the pain-induced procedures were measured and analysed by Neonatal Facial Action Coding System (NFACS) and the cry measures were analysed by the speech analysis after recording. RESULTS: 1) A cluster of facial actions comprised of brow bulging, eye squeezing, deepening of nasolabial furrow and open mouth was associated most frequently with the invasive procedure and the total facial action was the highest score in intramuscular injection. 2) Acoustic analysis of cry showed the shortest latency to the first cry and the lonegst duration of the first cry in intramuscular injection. 3) Two variables, total facial action and duration of the first cry, were most statistically significant in discriminating the invasive pain-induced procedure from the noninvasve pain-induced procedure. CONCLUSION: The facial actions and cry responses to the invasive pain-induced procedure were significantly different from the responses to the noninvasive pain-induced procedure in healthy full-term neonates.
Acoustics ; Clinical Coding ; Humans ; Infant, Newborn ; Injections, Intramuscular ; Mouth ; Thigh

Harlequin baby may represent the extreme form of lamellar ichthyosis or may be a distinct entity. It is inherited as an autosomal recessive trait, but it's cause is unknown, although the abnormalities of keratinization and epidermal lipid metabolism have been suggested. We recently experienced a case of harlequin baby in a male neonate who showed the typical skin appearance at birth. His skin was markedly thickened and cracked, and large horny plates were formed over the entire body. His face was disfigured, and the nose and ear were flattened by the thickened skin. The chemosis and severe ectropion obscured the orbits, and his lips were everted and gaping. The inelastic skin resulted in flexion of all joints, and hands and feet appeared fixed and ischemic. The pathologic findings of skin biopsy were compatible to the lamellar ichthyosis and his family history was nonspecific. We managed the patient with supportive care for his special skin lesion, along with the trial of retinoic acid. However, the treatment was withheld and the baby was discharged against medical advice as the parents wised, and the baby died 5 days after discharge.
Biopsy ; Ear ; Ectropion ; Foot ; Hand ; Humans ; Ichthyosis, Lamellar ; Infant, Newborn ; Joints ; Lip ; Lipid Metabolism ; Male ; Nose ; Orbit ; Parents ; Parturition ; Skin ; Tretinoin

BACKGROUND: Perfusion scans are accurate predictors of postoperative lung function. There are few previous studies aimed at predicting the postoperative exercise capacity using the perfusion scanning and those that did reported contradictory results. METHOD: We prospectively studied the preoperative spirometric, exercise tests and perfusion scans from in 49 consecutive patients who were admitted to Inha University Hospital with surgically resectable lung cancer from Jan. 1998 to Jun. 1999 29 patients who had any condition affecting the lung function and exercise capacity, or refused a surgical resection or a follow-up study were excluded. Spirometric and exercise tests were performed 6 months after operation in 20 patients. RESULTS: The predicted postoperative FEV1, FVC and TLC correlated well with the following corresponding postoperative values : γs and p value, 0.809 and 0.000 for the FEV1 ; 0.895 and 0.000 for the FVC ; 0.741 and 0.006 for the TLC, respectively. The measured postoperative exercise values were slightly higher than the postoperative exercise values predicted, VO(2max) and Wr(max), were as 112% of VO(2max) predicted and 119% of WR(max) predicted. The change in FEV1, FVC and TLC had a weak correlation with the change in VO(2max) and WR(max). CONCLUSION: The perfusion scan was a useful tool for predicting the postoperative exercise capacity. However, they had a tendency to underestimate the exercise capacity, especially in the patients who had a pneumonectomy. A weak correlation between the change in lung function and exercise capacity was obseved.
Exercise Test ; Follow-Up Studies ; Humans ; Lung ; Lung Neoplasms ; Perfusion* ; Pneumonectomy ; Prospective Studies

When cerebral cortical hyperintensities on diffusion-weighted image are seen in patients with suspected acute stroke accompanying seizure, it is necessary to differentiate whether they are caused by infarction or seizure-related change. We report a case of seizure-related cortical hypertensities in a patient with suspected acute infarction. With perfusion MR imaging, we could differentiate from acute infarction.
Humans ; Infarction ; Magnetic Resonance Imaging* ; Perfusion* ; Seizures ; Stroke

The purpose of this study is to assess the usefulness of digital infrared thermographic image(DITI) in patients with surgically treated lumbar disc disease. A series of 480 patients with lumbar herniated disc was studied. The mean age of the patients was 37 years, with a range of 18 to 64 years. Of which 126 cases of chemonucleolysis. 18 cases of percutaneous endoscopic laser discectomy, and 336 cases of laminectomy with discectomy were performed. Among these patients, 336 cases of laminectomy were assessed by DITI preoperatively. The thermal differences(delta T) between the symptomatic and asymptomatic limbs were evaluated. We have categorized the types of herniations into 3 classes: 200 protruded, 99 extruded, and 37 sequestered. The thermal differences were classified into 3 groups: 177 patients had delta T < 0.5 degrees C, 74 patients had 0.5 degrees C < or = delta T < 0.8 degrees C and 85 patients had delta T > or = 0.8 degrees C. Among the group of patients with the sequestered disc, 30(i.e. 80%) had delta T > or = 0.8 degrees C. Among the surgically treated 336 patients, non-visualization of a part of the sciatic limb on preoperative DITI was the condition used to coin the term amputation sign by the authors. In the sequestered group, the "amputation sign" was observed in 28 cases(75%). We conclude that DITI can predict a sequestered disc disease, and it allows more precise indication regarding open surgery.
Amputation ; Diskectomy ; Extremities ; Humans ; Intervertebral Disc Chemolysis ; Intervertebral Disc Displacement ; Laminectomy ; Numismatics

The purpose of the present study was to examine the effect of naltrexone, an opioid antagonist, on secretion of catecholamines (CA) evoked by cholinergic nicotinic stimulation and membrane-depolarization from the isolated perfused rat adrenal gland and to establish the mechanism of its action. Naltrexone (3x10 (-6) M) perfused into an adrenal vein for 60 min produced time-dependent inhibition in CA secretory responses evoked by ACh (5.32x10 (-3) M), high K+ (5.6x10 (-2) M), DMPP (10 (-4) M) and McN-A-343 (10 (-4) M). Naltrexone itself did also fail to affect basal CA output. In adrenal glands loaded with naltrexone (3x10 (-6) M), the CA secretory responses evoked by Bay-K-8644, an activator of L-type Ca2+ channels and cyclopiazonic acid, an inhibitor of cytoplasmic Ca2+-ATPase, were also inhibited. However, in the presence of met-enkephalin (5x10 (-6) M), a well-known opioid agonist, the CA secretory responses evoked by ACh, high K+, DMPP, McN-A-343, Bay-K-8644 and cyclopiazonic acid were also significantly inhibited. Collectively, these experimental results demonstrate that naltrexone inhibits greatly CA secretion evoked by stimulation of cholinergic (both nicotinic and muscarinic) receptors as well as that by membrane depolarization. It seems that this inhibitory effect of naltrexone does not involve opioid receptors, but might be mediated by blocking both the calcium influx into the rat adrenal medullary chromaffin cells and the uptake of Ca2+ into the cytoplasmic calcium store, which are at least partly relevant to the direct interaction with the nicotinic receptor itself.
(4-(m-Chlorophenylcarbamoyloxy)-2-butynyl)trimethylammonium Chloride ; 3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; Adrenal Glands ; Adrenal Medulla* ; Animals ; Calcium ; Catecholamines ; Chromaffin Cells ; Cytoplasm ; Dimethylphenylpiperazinium Iodide ; Enkephalin, Methionine ; Membranes ; Naltrexone* ; Rats* ; Receptors, Nicotinic* ; Receptors, Opioid ; Veins

OBJECTIVE: The abnormal expression of fragile histidine triad (FHIT) gene has been frequently reported in a variety of epithelial malignancies including cervical carcinoma. Furthermore, in a recent study it was proposed that transcriptional inactivation of FHIT, as a consequence of aberrant 5'-CpG island methylation, plays an important role in the carcinogenesis of human cervical carcinoma. The authors sought to determine whether abnormal FHIT transcription occurs in human cervical carcinoma, and if so, whether this abnormal expression is associated with aberrant 5'-CpG island methylation. In addition, the clinical significance of FHIT inactivation was investigated in Korean women with cervical cancer. METHODS: To examine for abnormal transcripts of the FHIT gene, quantitative RT-PCR, genomic DNA-PCR and nonisotopic RT-PCR-SSCP analysis were performed using the standard method. The methylation status was determined by methylation specific PCR and bisulfite DNA sequencing. RESULTS: The FHIT gene was down-regulated in 15 of 58 (25.9%) cervical carcinomas. FHIT promoter hypermethylation was detected in 15 of 15 (100%) abnormally expression in cervical carcinomas. Bisulfite DNA sequencing confirmed these findings and a significant correlation was found between CpG site hypermethylation and low FHIT expression. However, no significant correlation was found between reduced FHIT expression and clinicopathological characteristics. CONCLUSION: In this study, FHIT inactivation in cervical cancer was found to be strongly correlated with 5'-CpG island hypermethylation rather than a genetic alteration. Furthermore, no significant relation was found between a lack of FHIT expression and the prognostic factors of cervical cancer in our Korean cohort.
Cohort Studies ; Female ; Histidine ; Humans ; Methylation ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Sulfites ; Uterine Cervical Neoplasms

Purulent pericarditis is a rare disease in both end-stage renal disease (ESRD) patients and the general population. We report herein a case of acute purulent staphylococcal pericarditis with cardiac tamponade managed by intravenous antibiotics and pericardiocentesis with drainage. A 54-year-old man with ESRD, who had been on hemodialysis (HD) for the previous six months, was admitted to the hospital because of fever. He had a history of a recent episode of staphylococcal bacteremia associated with venography for arteriovenous fistula (AVF) malfunction. On the sixth day after admission, severe intradialytic hypotension arose during HD. Echocardiography showed a large pericardial effusion with hemodynamic significance. Emergency pericardiocentesis with drainage was performed. Acute purulent staphylococcal pericarditis with cardiac tamponade was diagnosed and intravenous vancomycin was administered for four weeks. On the 23rd day, the patient was discharged from the hospital after the drainage catheter's removal. Ten days after discharge, however, he was re-admitted because of dyspnea on exertion. Eventually, the patient expired because of heart failure caused by progressive constrictive pericarditis. We suggest that acute purulent pericarditis should be considered in dialysis patients who develop fever and severe hypotension during HD, especially after known staphylococcal infections.
Anti-Bacterial Agents ; Arteriovenous Fistula ; Bacteremia ; Cardiac Tamponade ; Dialysis ; Drainage ; Dyspnea ; Echocardiography ; Emergencies ; Fever ; Heart Failure ; Hemodynamics ; Humans ; Hypotension ; Kidney Failure, Chronic ; Middle Aged ; Pericardial Effusion ; Pericardiocentesis ; Pericarditis ; Pericarditis, Constrictive ; Phlebography ; Rare Diseases ; Renal Dialysis ; Staphylococcal Infections ; Vancomycin

PURPOSE: To investigate the value of image post-processing software (FreeSurfer, IBASPM [individual brain atlases using statistical parametric mapping software]) and inversion time (TI) in volumetric analyses of the hippocampus and to identify differences in comparison with manual tracing. MATERIALS AND METHODS: Brain images from 12 normal adults were acquired using magnetization prepared rapid acquisition gradient echo (MPRAGE) with a slice thickness of 1.3 mm and TI of 800, 900, 1000, and 1100 ms. Hippocampal volumes were measured using FreeSurfer, IBASPM and manual tracing. Statistical differences were examined using correlation analyses accounting for spatial interpretations percent volume overlap and percent volume difference. RESULTS: FreeSurfer revealed a maximum percent volume overlap and maximum percent volume difference at TI = 800 ms (77.1 +/- 2.9%) and TI = 1100 ms (13.1 +/- 2.1%), respectively. The respective values for IBASPM were TI = 1100 ms (55.3 +/- 9.1%) and TI = 800 ms (43.1 +/- 10.7%). FreeSurfer presented a higher correlation than IBASPM but it was not statistically significant. CONCLUSIONS: FreeSurfer performed better in volumetric determination than IBASPM. Given the subjective nature of manual tracing, automated image acquisition and analysis image is accurate and preferable.
Adult* ; Brain ; Hippocampus ; Humans

PURPOSE: The purpose of this study was to evaluate the associated brain parenchymal abnormalities of developmental venous anomalies (DVA) with susceptibility-weighted image (SWI). MATERIALS AND METHODS: Between January 2012 and June 2013, 2356 patients underwent brain MR examinations with contrast enhancement. We retrospectively reviewed their MR examinations and data were collected as per the following criteria: incidence, locations, and associated parenchymal signal abnormalities of DVAs on T2-weighted image, fluid-attenuated inversion recovery (FLAIR), and SWI. Contrast enhanced T1-weighted image was used to diagnose DVA. RESULTS: Of the 2356 patients examined, 57 DVAs were detected in 57 patients (2.4%); 47 (82.4%) were in either lobe of the supratentorial brain, 9 (15.7%) were in the cerebellum, and 1 (1.7%) was in the pons. Of the 57 DVAs identified, 20 (35.1%) had associated parenchymal abnormalities in the drainage area. Among the 20 DVAs which had associated parenchymal abnormalities, 13 showed hemorrhagic foci on SWI, and 7 demonstrated only increased parenchymal signal abnormalities on T2-weighted and FLAIR images. In 5 of the 13 patients (38.5%) who had hemorrhagic foci, the hemorrhagic lesions were demonstrated only on SWI. CONCLUSION: The overall incidence of DVAs was 2.4%. Parenchymal abnormalities were associated with DVAs in 35.1% of the cases. On SWI, hemorrhage was detected in 22.8% of DVAs. Thus, we conclude that SWI might give a potential for understanding of the pathophysiology of parenchymal abnormalities in DVAs.
Brain* ; Cerebellum ; Drainage ; Hemorrhage ; Humans ; Incidence ; Magnetic Resonance Imaging* ; Pons ; Retrospective Studies