No abstract available.
Dinoprostone* ; Suppositories*

BACKGROUND: Local steroid injections for the treatment of carpal tunnel syndrome have become common, but median nerve injuries after the injections have rarely been reported. In our study, we checked the occurrence of a severe pain during local steroid injections through the flexor carpi radialis, and we evaluated the efficacy of injections for several short-term period. METHODS: A total of 24 patients with 32 affected hands were studied. The patients who presented with known medical causes or thenar muscle atrophy or a previous trauma history at the affected wrist were excluded from the study. The diagnosis was made both clinically and electrophysiologically, and then the injections were performed through the flexor carpi radialis with the hand in the supine position. Triamcinolone Acetonide (TA) 40 mg was injected first, and TA 20 mg was reinjected when the recovery rate on a 100 mm visual analog scale (VAS) score was below 50% 1 week after the injection. The patients were reevaluated with the VAS score before and 1, 3 and 6 months after the injections. RESULTS: In our study, no patients reported severe pain indicating there was median nerve injury during the injections. The mean VAS scores were 64.9, 9.5, 31.1 and 47.3 before and 1, 3 and 6 months after the injections respectively. As a result, the injections were deemed for the short-term period (P < 0.05). CONCLUSIONS: In our study, we concluded that local steroid injection through the flexor carpi radialis for treating carpal tunnel syndrome is a safe and effective method.
Carpal Tunnel Syndrome* ; Diagnosis ; Hand ; Humans ; Median Nerve ; Muscular Atrophy ; Supine Position ; Triamcinolone Acetonide ; Visual Analog Scale ; Wrist

BACKGROUD: Ephedrine has been most commonly used for the prevention and treatment of hypotension occurring frequently during spinal anesthesia for cesarean section. But recent studies reported that phenylephrine was more effective for treatment of maternal hypotension and for prevention of fetal acidosis than ephedrine. We compared effect of phenylephrine, ephedrine, and ephedrine combined with phenylephrine to maternal hypotension and fetal acidosis. METHODS: This study compared ephedrine 2 mg/min infusion with 6 mg bolus (n = 30), phenylephrine 33.3microgram/min infusion with 50microgram bolus (n = 30), and ephedrine combined phenylephrine with half the dose infusion rate & bolus (n = 30). Hypotension, defined as systolic blood pressure less than 100 mmHg and less than 80% of baseline, was treated with additional bolus injection. RESULTS: In ephedrine group, the number of bolus given for hypotension was larger than other groups (P < 0.001), the incidence of hypotension was also higher than other groups (P = 0.02). The heart rate was lower in phenylephrine group than other groups, but bradycardia which needs to be treated didn't occur. Umbilical blood gas analysis and Apgar score were similar for three groups, but only one patient in ephedrine group had fetal acidosis (pH = 7.130). Nausea and vomiting were more frequent in ephedrine group than other groups. CONCLUSIONS: In our study, giving phenylephrine alone was more effective in the prevention and treatment of maternal hypotension and nausea & vomiting than giving ephedrine alone or combined phenylephrine.
Acidosis ; Anesthesia, Spinal* ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Bradycardia ; Cesarean Section* ; Ephedrine* ; Female ; Heart Rate ; Humans ; Hypotension ; Incidence ; Nausea ; Phenylephrine* ; Pregnancy ; Vomiting

BACKGROUND: To investigate the change of corpus callosal area in juvenile myoclonic epilepsy (JME), the mid-sagittal areas of corpus callosum and its seven sub-regions were measured in JME patients and normal subjects. METHODS: Nineteen JME patients (22.6+/-5.0 year-old, 6 males, 13 females) and 19 normal controls (22.9+/-7.3 year-old, 6 males, 13 females) underwent 1.6 mm thickness whole brain SPGR MRI. Exact mid-sagittal image was obtained with image reconstruction and geometric correction. According to Witelson's work, the area of corpus callosum was divided into 7 sub-regions (a1 to a7 from anterior to posterior) with a semi-automated method. In each sub-region, the pixel number was counted according to ROI definition. The whole cerebral volume was measured. The mid-sagittal cerebral area was measured by tracing inner surface of skull and basal cortical surface of the cerebrum except for corpus callosum and cerebellum. The difference of corpus callosum areas between JME patients and normal controls were tested by t-test and ANCOVA. RESULTS: There was no difference in sex [chi-square(1)=1.00, chi square] and age (p=0.941, Mann-Whitney U test). The areas of rostrum (p<0.001) and rostral body (p < or = 0.05) were significantly smaller in JME group by t-test and ANCOVA (adjusted by age and cerebral volume). Cerebral volume and mid-sagittal cerebral area were not different between JME and normal groups (p>0.25, t-test). CONCLUSION: Rostrum and rostral body are significantly smaller in JME patients, which suggests frontal lobe abnormality in JME. This finding is consistent with previous studies reported structural and functional abnormalities of frontal lobe in JME.
Brain ; Cerebellum ; Cerebrum ; Corpus Callosum ; Frontal Lobe ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging* ; Male ; Myoclonic Epilepsy, Juvenile* ; Skull

We experienced two cases of congenital localized skin defect and neonatal onset of relapsing subepidermal blisters associated with minor trauma in a female newborn infant and her mother. The mother of index case showed toe nail dystrophy at delivery of her daughter, but the index case did not reveal nail dystrophy until 14 months of age. The congenital skin defects healed with hypopigment, and mild atrophic scars and relapsing blisters healed without scars in both mother and daughter. These cases were considered as hereditary Bart's syndrome with respects to family history, clinical manifestations and histopathological findings.
Blister ; Cicatrix ; Epidermolysis Bullosa ; Female ; Humans ; Infant, Newborn ; Mothers* ; Nuclear Family* ; Skin ; Toes

BACKGROUND: In many cases, spinal anesthesia is performed in cesarean section. Many women want postoperative pain control. The purpose of this study was to compare the effects of intravenous patient-controlled analgesia (IV-PCA) and epidural patient-controlled analgesia (Epi-PCA) in patients undergoing cesarean section with spinal anesthesia. METHODS: Forty healthy women were randomly assigned to receive IV-PCA or Epi-PCA after cesarean section with spinal anesthesia. The IV-PCA group received ketorolac 30 mg and butorphanol 0.5 mg intravenously when the peritoneum was sutured, followed by IV-PCA with 0.15% ketorolac and 0.005% butorphanol 100 ml (basal infusion rate 2 ml/hr, bolus 2 ml, lock-out time 15 mins). The Epi-PCA group received 0.01% morphine 10 ml via an epidural catheter when the peritoneum was sutured, followed by Epi-PCA with 0.004% morphine and 0.1% bupivacaine 100 ml (basal infusion rate 2 ml/hr, bolus 2 ml, lock-out time 15 mins). The degree of pain was subjectively evaluated using a visual analogue scale (VAS). Patients were evaluated at 2, 6, 12, 24 and 48 hours after operation. Statistical analyses were performed using T-test, Mann White U test and the Chi-square test. RESULTS: VAS was not significantly different at any time, and the incidences of pruritus and sensory and motor changes of the lower extremities were significantly higher in Epi-PCA than IV-PCA. CONCLUSIONS: Although VAS in the two groups was not significantly different, we conclude that IV-PCA is more beneficial than Epi-PCA in patients undergoing cesarean section with spinal anesthesia, because of the side effects of Epi-PCA.
Analgesia, Patient-Controlled* ; Anesthesia, Spinal* ; Bupivacaine ; Butorphanol ; Catheters ; Cesarean Section* ; Female ; Humans ; Incidence ; Ketorolac ; Lower Extremity ; Morphine ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Peritoneum ; Pregnancy ; Pruritus

BACKGROUND: Although a number of visual evoked potentials (VEPs) studies have been performed to elucidate the pathophysiology of migraines, their results have been controversial. We studied the pattern-reversal visual evoked potentials (PRVEPs) during long periods of stimulation to show whether or not PRVEPs in migraines are abnormal. METHODS: Patients were divided into two groups; Group 1 (migraine with aura; MWA, n=29) and Group 2 (migraine without aura ; MOA, n=32) according to the International Headache Society criteria. PRVEPs were performed in both groups and in healthy volunteers (n=62). PRVEPs were averaged in 100 responses for a total duration of 10 minutes after an initial 3 minutes during stimulation and were analysed in terms of latencies and peak to peak amplitudes of N1-P1 and P1-N2 peaks. RESULTS: Amplitudes of PRVEPs in migraines showed significant increases compared to normal subjects (p<0.001), and amplitudes of PRVEPs in MWA showed significant increases compared to those in MOA (p<0.05). CONCLUSIONS: These results are explained by cortical hypoexcitability and hyper-responsiveness in migraine and by additional cortical hyper-responsiveness (another hyper-responsiveness) in MWA compared to MOA. We suggest that serotonergic and noradrenergic hyperactivity could be responsible for cortical hypoexcitability and hyper-responsiveness in a migraine brain. Another hyper-responsiveness in MWA could also be thought of as some evidence for cortical neuronal abnormality in MWA in addition to serotonergic and noradrenergic hyperactivity in a migraine brain. (J Korean Neurol Assoc 19(3):239~244, 2001)
Brain ; Epilepsy ; Evoked Potentials ; Evoked Potentials, Visual ; Headache ; Healthy Volunteers ; Humans ; Migraine Disorders* ; Neurons*

BACKGROUND: Clonidine has been regarded as an adequate supplementary anesthetic during epidural anesthesia and has been used with local anesthetics such as bupivacaine or lidocaine to support the effects of these anesthetics. The authors would examine whether clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia. METHODS: Thirty-two healthy patients undergoing a hip or lower limb surgery were divided into two groups. In group 1, 0.5% ropivacaine 15 ml was administered. In group 2, 0.5% ropivacaine 15 ml combined with clonidine 150 micro gram was administered. Onset, duration and maximal height of sensory block were assessed. Sedation score, blood pressure and heart rate were measured. RESULTS: Duration of sensory block of group 2 was significantly longer than that of group 1. Sedation score of group 2 was significantly higher than that of group 1. Blood pressure of group 2 was significantly lower than that of group 1 at 50 min, 70 min and 90 min after epidural injection. No significant differences were observed in onset of sensory block and heart rate between the two groups. CONCLUSIONS: The addition of clonidine to ropivacaine during epidural anesthesia prolonged duration of sensory block and produced useful sedation. It caused relatively stable hemodynamic changes. These results suggest that clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia.
Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local ; Blood Pressure ; Bupivacaine ; Clonidine* ; Heart Rate ; Hemodynamics ; Hip ; Humans ; Injections, Epidural ; Lidocaine ; Lower Extremity ; Sympathetic Nervous System

BACKGROUND: Although spinal anesthesia has a lot of advantages, it has some disadvantages or undesirable effects. Hypotension and unnecessarily long neural blockade are included among them. Although using small dose local anesthetics fairly solves these problems, it is insufficient to provide reliable surgical anesthesia by itself. Therefore the authors investigated whether such an opioid as fentanyl and a small dose local anesthetic used together during spinal anesthesia can prevent hypotension and unnecessarily long neural blockade and provide reliable surgical anesthesia simultaneously. METHODS: Thirty patients undergoing knee or below knee surgery were randomized into two groups. Group 1 received bupivacaine 5 mg combined with fentanyl 20 micro gram, and group 2 received 10 mg bupivacaine. Hypotension was recorded and was treated with intravenous ephedrine. Sensory blockade, intraoperative analgesia, motor blockade and side effects were assessed. RESULTS: No significant differences were observed in values for assessing hypotension, sensory blockade or intraoperative analgesia between the two groups. Also no significant differences were observed in intensity of the motor blockade and side effects between the two groups. However the duration of the motor blockade of group 1 was longer significantly than that of group 2. CONCLUSIONS: Small dose bupivacaine and fentanyl administered together intrathecally reduced duration of motor blockade and didn't augment of side effects and provided reliable anesthesia for surgery of knee or below knee simultaneously.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine* ; Ephedrine ; Fentanyl ; Humans ; Hypotension ; Knee

BACKGROUND: Clonidine has been regarded as an adequate supplementary anesthetic during epidural anesthesia and has been used with local anesthetics such as bupivacaine or lidocaine to support the effects of these anesthetics. The authors would examine whether clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia. METHODS: Thirty-two healthy patients undergoing a hip or lower limb surgery were divided into two groups. In group 1, 0.5% ropivacaine 15 ml was administered. In group 2, 0.5% ropivacaine 15 ml combined with clonidine 150 micro gram was administered. Onset, duration and maximal height of sensory block were assessed. Sedation score, blood pressure and heart rate were measured. RESULTS: Duration of sensory block of group 2 was significantly longer than that of group 1. Sedation score of group 2 was significantly higher than that of group 1. Blood pressure of group 2 was significantly lower than that of group 1 at 50 min, 70 min and 90 min after epidural injection. No significant differences were observed in onset of sensory block and heart rate between the two groups. CONCLUSIONS: The addition of clonidine to ropivacaine during epidural anesthesia prolonged duration of sensory block and produced useful sedation. It caused relatively stable hemodynamic changes. These results suggest that clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia.
Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local ; Blood Pressure ; Bupivacaine ; Clonidine* ; Heart Rate ; Hemodynamics ; Hip ; Humans ; Injections, Epidural ; Lidocaine ; Lower Extremity ; Sympathetic Nervous System