Epidural anesthesia for cesarean section allows the mother to be awake, minimizes or completely avoids the problem of maternal aspiration and neonatal drug depression from general anesthetics. But epidural anesthesia has the potential to produce local anesthetic systemic toxicity or inadvertent high spinal block which is due to unintentional administration of drug into an epidural vessel or subarachnoid space. There are several ways to avoid these complications. These include careful aspiration of epidural catheter, fractionation of the epidural dose, and the use of epinephrine containing epidural test dose before injection of epidural dose. We report a case of a pregnant woman who had developed a seizure after an injection of the epidural anesthetic. This occurred despite using the techniques of aspiration and epinephrine containing epidural test dose injection. So we thought that the seizure occurred probably by the migration of epidural catheter while changing positions and it should be considered in all cases of epidural anesthesia.
Anesthesia, Epidural ; Anesthetics, General ; Catheters* ; Cesarean Section ; Depression ; Epinephrine ; Female ; Humans ; Mothers ; Pregnancy ; Pregnant Women ; Seizures ; Subarachnoid Space

Frozen shoulder is characterized by pain in the shoulder and limitation of glenohumeral movement. The underlying pathologic changes in frozen shoulder are synovial inflammation with subsequent reactive capsular fibrosis. Capsular fibrosis is the ultimate course of frozen shoulder suffering from various causes irrespectively. Therefore, adhesions that are affecting the joint movement must be released. Most important diagnostic method is thoughtful history taking and physical examination, and ultrasonography is very valuable device of diagnosis and treatment. Interventional microadhesiolysis and nerve stimulation (IMNS) is effective to manage frozen shoulder patients. IMNS for frozen shoulder is composed of three release approaches. These are (1) subacromial, (2) posterior inferior capsular, and (3) subdeltoidal & subcoracoidal release and round needle can be used for each release. We report this experiences and recommand this technique for the treatment of frozen shoulder patients.
Bursitis ; Fibrosis ; Humans ; Inflammation ; Joints ; Needles ; Physical Examination ; Shoulder ; Stress, Psychological

BACKGROUND AND OBJECTIVES: Etiology and pathogenesis of nasal polyps are still not fully understood. Transforming growth factor-beta (TGF-beta) and interleukin-10 (IL-10) are important cytokines for nasal polyp formation and immunomodulation. This study was aimed to evaluate the effect of systemic steroid, which is the most potent medications used for the treatment of nasal polyposis, on the expression of TGF-beta and IL-10 in nasal polyps. SUBJECTS AND METHOD: According to the status of steroid treatment, the polyps (n=22) removed during an endoscopic sinus surgery were divided into treatment or control groups. For treatment group, 30 mg of prednisolone per day was administered preoperatively for seven days. Eosinophil infiltration, expression and concentration of TGF-beta1 and IL-10 in nasal polyps were analyzed. RESULTS: Although there was no statistical significance, the infiltration of eosinophils decreased in the treatment group. In the immunohistochemical study, the expression of TGF-beta1 decreased in the epithelial layer of the treatment group compared with that of the control group (p=0.043). Expression of IL-10 increased in the stromal layer of the treatment group compared with that of the control group (p=0.008). TGF-beta1 concentration measured by ELISA showed no differences between each group. IL-10 concentration increased in the treatment group (p=0.021). CONCLUSION: These findings suggest that systemic steroid may exert a beneficial effect on nasal polyp treatment by at least following two mechanisms : the suppression of epithelial differentiation and proliferation, and squamous metaplasia through the down regulation of TGF-beta, and the down regulation of inflammatory responses by increasing IL-10.
Cytokines ; Down-Regulation ; Enzyme-Linked Immunosorbent Assay ; Eosinophils ; Immunomodulation ; Interleukin-10* ; Metaplasia ; Nasal Polyps* ; Polyps ; Prednisolone ; Transforming Growth Factor beta* ; Transforming Growth Factor beta1

The use of superselective embolization was assessed as a treatment for bleeding from arteriovenous fistulas and pseudoaneurysm after renal biopsy procedure. But unless it is sufficiently selective, the procedure results in loss of significant amount of renal parenchyme. We experienced one case of renal arterial pseudoaneurysm, which happened at 5days after percutaneous renal biopsy. Diagnosis of pseudoaneurysm was made by ultrasound examination with Doppler flow and was confirmed with arteriography. The rupture of pseudoaneurysm was occluded by transcatheter embolization with placement of a steel coli and polyvinlyl alcohol from the renal arterial approach. This procedure was allowed non surgical closure of the AV fostula and pseudoaneurysm without significant change of renal function.
Aneurysm, False* ; Angiography ; Arteriovenous Fistula ; Biopsy* ; Diagnosis* ; Hemorrhage ; Rupture ; Steel ; Ultrasonography

BACKGROUND AND OBJECTIVES: Mucus hypersecretion is a hallmark of many respiratory inflammatory diseases such as asthma, bronchitis and sinusitis. While the current therapeutic pharmacological approaches to reducing mucus hypersecretion are limited, clinical studies have suggested that glucocorticoids reduce mucus secretion in patients with airway disease. However, the effect of glucocorticoids on mucus hypersecretion is not clear. Recently, we observed that IL-1beta induces MUC2 gene expression and mucin secretion in a previous experiment. This study was designed to investigate the effects of budesonide on the IL-1beta-mediated MUC2/5AC genes expression and mucin secretion. MATERIALS AND METHOD: We observed the steady state mRNA level of MUC2/5AC genes using RT-PCR and mucin protein using immunoassay method in cultured human airway NCI-H292 epithelial cells. RESULTS: Budesonide attenuated IL-1beta-mediated MUC2/5AC gene expression as well as mucin secretion. The attenuated effect of budesonide was in a dose-dependent pattern. This attenuated effect of budesonide was blocked by glucocorticoid receptor antagonist, RU-486. CONCLUSION: This result suggests that budesonide suppresses the IL-1beta-mediated MUC2/5AC genes expression and mucin secretion via blockage of glucocorticoid receptor.
Asthma ; Bronchitis ; Budesonide* ; Epithelial Cells* ; Gene Expression ; Glucocorticoids ; Humans* ; Immunoassay ; Interleukin-1beta ; Mifepristone ; Mucins* ; Mucus ; Receptors, Glucocorticoid ; RNA, Messenger ; Sinusitis

Malignant mixed mullerian tumor (MMMT) is a tumor in which carcinoma (an epithelial malignancy) is mixed with sarcoma (a nonepithelial malignancy). Extrauterine MMMTs are extremely rare, and only 32 cases are reported according to the literature. We experienced a case of primary peritoneal MMMT and repot with a brief review of literature.
Peritoneum* ; Sarcoma

BACKGROUND: Despite advances in chemotherapy, the treatment of inoperable non-small cell carcinoma of the lung remains poor. According to the recent reports, the response rates of mitomycin, vinblastine, and cisplatin(MVP) chemotherapy are higher than those of other cisplatin based polychemotherapy and MVP chemotherapy can be used as neoadjuvant chemotherapeutic regimen. But the overall response rates of MVP chemotherapy range from 17 to 53 percent, so we studied the effect of MVP chemotherapy in advanced non-small cell lung cancer. METHOD: We treated forty patients with stage III or IV non-small cell lung cancer with two courses of MVP chemotherapy (8mg/m2 of mitomycin on day 1, 6mg/m2 of vinblastine on day 2 & day 14, and 100mg/m2 of cisplastin on day 1) at 4 weeks interval. Then all patients were evaluated the response of chemotherapy 4 weeks later, and received further chemotherapy, palliative radiotherapy or supportive therapy according to the patient's condition. We also determined the median survival time and prognostic factors. RESULTS: 1) Nine patients(23%) had a partial reponse, 23 patients(57%) had a stable disease, and disease progressed in 8 patients(20%). There were no patients with complete response. 2) The overall median survival time was 36 weeks(range, 9 to 119+ weeks). The median survival time of responder(partial response) and non-responder(stable and progressed) groups were 60 weeks(range, 36 to 82+ weeks) and 31 weeks(range, 9 to 119+ weeks) respectively(p=0.03). 3) The median survival time of the female group was 71 weeks and significantly prolonged in comparision with 35 weeks of the male group(p=0.01). But, the other prognostic factors didn't affect the survival time and response rate. 4) The median survival times of chemotherapy group and chemotherapy with palliative radiotherapy group were not significantly different. CONCLUSION: MVP combined chemotherapy is unsatisfactory in improving survival in advanced non-small cell lung cancer. Therefore, further studies are needed to find more active new agents and to estabilish the efficacy of the combined treatment with radiotherapy and/or surgery.
Carcinoma, Non-Small-Cell Lung* ; Cisplatin ; Drug Therapy* ; Drug Therapy, Combination ; Female ; Humans ; Lung ; Male ; Mitomycin* ; Radiotherapy ; Vinblastine*

Herpes zoster in infancy is very rare but can be developed following intrauterine or postnatal exposure to varicella zoster virus. We report a case of herpes zoster in a 4-month-old male infant. He had no prior history of primary varicella or varicella vaccination. His mother had no history of varicella infection and no contact history with varicella during pregnancy. He had a history of exposure to his father with herpes zoster 3 months ago, and to his cousin with convalescent chickenpox 2 months ago. Multinucleated, giant cells were shown on a Tzanck smear. He was treated with acyclovir and first generation cephalosporin for herpes zoster with Staphylococcal skin infection, with complete resolution without sequelae.
Acyclovir ; Chickenpox ; Fathers ; Giant Cells ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Infant ; Male ; Mothers ; Pregnancy ; Staphylococcal Skin Infections ; Vaccination

Midgut volvulus is commonly complicated with malrotation, and develops mainly in infants before 1 year old, especially in neonate. Intrauterine midgut volvulus is an extremely rare disease therefore is difficult to diagnose. Furthermore unless the fetus has malrotation, symptoms and results of tests suspicious of fetal midgut volvulus are nonspecific. There are some reports that meconium ileus could be a cause of intrauterine midgut volvulus from foreign countries, however has never been reported in Korea. So we report a case of prematurity born with bowel perforation and gangrene due to intrauterine midgut volvulus caused by meconium ileus.
Fetus ; Gangrene ; Humans ; Ileus ; Infant ; Infant, Newborn ; Intestinal Volvulus ; Korea ; Meconium ; Rare Diseases

Teratoma originate from one or more germ cell layer and commonly arise from sacrococcygeal area in neonate. Teratoma arising from the oropharyngeal cavity is called "epignathus tumor" and is extremely rare in neonate. Clinical manifestation of epignathus tumor vary from asymptomatic to severe respiratory distress symptom. It is reported that most of the tumor are benign in nature. Large teratoma can be diagnosed by prenatal ultrasonography, but most cases were diagnosed with computed tomography or magnetic resonance image after birth. Prognosis is determined by the need for neonatal resuscitation for respiratory distress at the time of birth and the extent of tumor, involving large vessles, skull base or communication with the brain. We experienced a case of epignathus tumor in a neonate with severe respiratory distress immediately after birth, so that reported with review of the literature.
Brain ; Germ Cells ; Humans ; Infant, Newborn ; Magnetic Resonance Spectroscopy ; Parturition ; Prognosis ; Resuscitation ; Skull Base ; Teratoma ; Ultrasonography, Prenatal