BACKGROUND: Hydromorphone has an intermediate lipid solubility range that falls between morphine and fentanyl. Lipophilic activity during opioid epidural administration is important in relation to both the side effects and analgesic efficacy. The purpose of this study was to compare epidural hydromorphone and fentanyl when concomitantly infused with bupivacaine in patients undergoing a thoracotomy. METHODS: Seventy-seven thoracotomy patients, with patient-controlled epidural analgesia (PCEA), were blindly allocated into two groups [group F (n = 34); 0.1% bupivacaine and fentanyl 5microgram/ml, group H (n = 34); 0.1% bupivacaine and hydromorphone 16microgram/ml)]. The basal PCEA rate and demand dose were 4 ml/hr and 3 ml, respectively. The visual analogue scale (VAS) for pain, and pruritus, sedation and nausea were measured at 6, 12 and 24 hours after the operation. RESULTS: There were no significant differences in the VAS pain scores and the incidences of pruritus, nausea and sedation between the two groups. The total infused volume after 24 hours was lower in H compared to that of F group (P < 0.05). CONCLUSIONS: We conclude that epidural hydromorphone or fentanyl administration has a similar analgesic efficacy and shows similar incidences of side effects, when concomitantly infused with bupivacaine, in the management of acute pain following a thoracotomy.
Acute Pain ; Analgesia, Epidural* ; Analgesia, Patient-Controlled ; Bupivacaine ; Fentanyl ; Humans ; Hydromorphone ; Incidence ; Morphine ; Nausea ; Pruritus ; Solubility ; Thoracotomy*

BACKGROUND: The incidence of scabies in Korea decreased during the past 20 years. This might have been due to improved personal hygiene and public sanitation. Recently, however, not only the incidence of scabies, but also delayed or missed diagnosis, is likely to increase again. OBJECTIVE: This study was conducted to obtain a better understanding of the clinical characteristics of recent scabietic patients. METHODS: We reviewed the medical records and clinical photographs of 27 outpatients who had been diagnosed with scabies in our department between August 2006 and August 2008. We investigated personal and clinical information, including age, sex, onset, past history and clinical manifestations. RESULTS: Of the 27 patients, 14 (51.9%) were female and 13 (48.1%) were male. Their ages ranged from 4 to 93 years (mean=47.2 years). Over half (51.9%) of the patients had been misdiagnosed at private hospitals. The average time from symptom presentation to diagnosis was 68 days. The most common site of skin lesions was the lower abdomen (77.8%), and the most common primary lesion was erythematous papules (96.3%). Atypical cases of scabies were as follows: 7 nodular scabies (25.9%), 1 crusted scabies (3.7%) and 4 scabies incognito (14.8%). CONCLUSION: Currently, atypical cases of scabies may be increasing and frequently misdiagnosed. We suggest that dermatologists should suspect scabies for any patient who presents with pruritus that is persistent or resistant to treatment.
Abdomen ; Female ; Hospitals, Private ; Humans ; Hygiene ; Incidence ; Korea ; Male ; Medical Records ; Outpatients ; Pruritus ; Sanitation ; Scabies ; Skin

Myositis ossificans is a rare benign ossifying lesion in skeletal muscles which is commonly seen after trauma. However, it has been reported that myositis ossificans can be developed without any history of trauma and surgery. A 37-year-old female presented with a painful progressive swelling in her right femoral area, with no history of trauma or other diseases, which had been developed for 2 weeks. Initial X-rays were normal. An incision biospy specimen showed a lesion of fibroblastic tissue in which areas of osteoid and trabecular bone tissue, which was compatible with the early stage of myositis ossificans. The mass was excised totally and no signs of recurrence have been noted until now.
Adult ; Bone and Bones ; Female ; Fibroblasts ; Humans ; Muscle, Skeletal ; Myositis Ossificans* ; Myositis* ; Quadriceps Muscle* ; Recurrence

Ramsay Hunt syndrome (RHS) might cause serious complications, such as facial paralysis and hearing loss if diagnosis and treatments are delayed. Early diagnosis is therefore very important to avoid such serious complications. We report a case of RHS that was occurred during the treatment of postherpetic neuralgia resulted from zoster sine herpete. The patient showed severe segmental intercostal neuralgia at the right 11 and 12th thoracic level. There were no history of the trauma, operation and skin rash and vesicle on the lesion site. Varicellar-zoster virus (VZV) IgG Antibody was positive but VZV IgM antibody was negative. Pain nature was severe sharp, electrical shock like pain, but no paresthesia and dysesthesia was not existed. About two month later, small painful vesicular eruptions were occurred around the ipsilateral auricle. At this time, VZV IgM antibody was positive. Acyclovir, prednisolone, fexofenadine were immediately prescribed. The patient relieved from RHS without any complications. Clinician should be suspect the possibility of zoster sine herpete if the patient showed severe atypical chest wall pain.
Acyclovir ; Diagnosis ; Early Diagnosis ; Exanthema ; Facial Paralysis ; Hearing Loss ; Herpes Zoster Oticus* ; Herpes Zoster* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Neuralgia ; Neuralgia, Postherpetic ; Paresthesia ; Prednisolone ; Shock ; Thoracic Wall ; Zoster Sine Herpete*

BACKGROUND: A reliable non-invasive cardiac output measurement could enhance patient safety and reduce risk. Partial rebreathing cardiac output (RBCO) measurement is a non-invasive method based on a differential form of the CO2 Fick equation. The relative change in CO2 and ETCO2 in response to addition of dead space to the breathing circuit is used to measure cardiac output. The aim of this study was to compare this method in coronary artery bypass graft (CABG) patients during pre-cardiopulmonary bypass (CPB) and post-CPB with the currently accepted technique of intermittent thermodilution cardiac output (TDCO) measurement. METHODS: Eleven patients (n = 11, age = 50 +/- 13 years) undergoing CABG operations with CPB were studied. We measured the cardiac output non-invasively by using a RBCO monitor (NICO(R) , Novametrix Medical Systems Inc., USA) and used SpO2 and FiO2 to correct for intrapulmonary shunts. Invasively, using a pulmonary artery catheter (Hands-Off Thermodilution Catheter(R) , Arrow Co., USA) and 10 ml of iced 5% dextrose, an average of three consecutive TDCO was measured during end-expiration and compared with corresponding RBCO during pre-CPB and post-CPB for a total of 6 times respectively. Data was analyzed by paired T-test with significance set at P value < 0.05. RESULTS: Pre-CPB paired T-test analysis revealed no significant difference between partial rebreathing and bolus thermodilution cardiac output measurements. On the other hand, post-CPB differences between the two methods were significant (P < 0.05) and tended to decrease with time. Similarly, Pa-ETCO2 was increased abnormally after CPB, then decreased with time to a normal value. CONCLUSION: Post-CPB, partial rebreathing cardiac output did not correlate well with the thermodilution cardiac output. As a cause for the differences of the two cardiac output measurements, we couldconsider a thermal noise during thermodilution and an inadequate correction for the shunts in partial rebreathing measurements, but further investigation is needed.
Cardiac Output* ; Catheters ; Coronary Artery Bypass* ; Coronary Vessels* ; Glucose ; Hand ; Humans ; Noise ; Patient Safety ; Pulmonary Artery ; Reference Values ; Respiration ; Thermodilution* ; Transplants

BACKGROUND: Venous regurgitation into the infusion line and subsequent occlusion frequently occurs during blood pressure (BP) measurement. The purpose of this study was to obtain the pattern and the actual range of peripheral venous pressure (PVP) change during NIBP measurement before and during enflurane anesthesia. METHODS: Adult size NIBP cuff was placed on the same arm on which IV infusion set was placed. PVP waveforms during BP measurement were recorded from 6 subjects. PVPs were measured before induction and at 30 min after induction of enflurane anesthesia (n=19). As the PVP waveform during NIBP measurement was biphasic in shape, values of baseline PVP (BEFORE), first peak (PEAK1), notch between two peaks (NOTCH), second peak (PEAK2) were measured. Timed control data were obtained from six volunteers. RESULTS: PEAK2 was always higher than PEAK1. Range of peak PVP was 12-130 mmHg (57.6 2.5 mmHg, mean S.E.) and PVP change was augmented during enflurane anesthesia (p<0.05). Enflurane anesthesia accentuated correlationship between mean arterial pressure and PVP. CONCLUSION: Our observation showed that peak PVP occurred during deflation phase and its range of variation was substantial. Changes in the pattern and the autoregulation of PVP by enflurane needs further investigation.
Adult ; Anesthesia* ; Arm ; Arterial Pressure ; Blood Pressure* ; Enflurane* ; Homeostasis ; Humans ; Venous Pressure* ; Volunteers

Zoster sine herpete (ZSH) is a varicella zoster virus (VZV) reactivation without a zoster that is difficult to diagnose early after onset. This study examined 12 patients who presented with intercostal neuralgia, had no history of trauma, cutaneous eruption and no scar of a herpes zoster on the lesion. Two patients had a vertebral compression fracture. Two patients had a history of a zoster in the other site. No other suspicious findings were observed. Ten of the twelve patients were checked for the IgG and IgM varicellar zoster virus antibody. All the patients tested positive to the Ig G antibody test and only one patient tested positive to the IgM antibody test. One patient was confirmed to have ZSH and the other patients were suspected of having ZSH. All the patients were treated for postherpetic neuralgia, resulting in a significant decrease in the intercostal neuralgia.
Cicatrix ; Fractures, Compression ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Neuralgia* ; Neuralgia, Postherpetic ; Zoster Sine Herpete

Ramsay Hunt syndrome (RHS) refers to herpes zoster infection of the geniculate ganglion of the facial nerve. Cases complicated by multicranial nerve involvement in the process of reactivation of the virus, which are known to show virulent clinical course and worse prognosis, are not common in literature as in practice, and there has been only one reported case of suspected co-involvement of the trigeminal nerve in Korean literature. Therefore, in cases of RHS with severe rash over the face and neck, it is pertinent to give consideration to such multiple involvement in their early presentation. Facial nerve palsy and herpes related pain are the two worrisome complication, which could be alleviated by early treatment with neural blockade in addition to oral medication. Especially, nerve blocks are known to decrease the extent of nerve inflammation or damage, thereby facilitating recovery and probably preventing postherpetic neuralgia. We report two rare cases of Ramsay Hunt syndrome with trigeminal nerve involvement, where early implementation of blockade of somatic peripheral nerve branches, in addition to the conventional treatment, promoted early recovery.
Exanthema ; Facial Nerve ; Geniculate Ganglion ; Herpes Zoster ; Herpes Zoster Oticus ; Humans ; Inflammation ; Neck ; Nerve Block ; Neuralgia, Postherpetic ; Paralysis ; Peripheral Nerves ; Polyneuropathies ; Prognosis ; Trigeminal Nerve ; Viruses

Pyodermatitis-pyostomatitis vegetans (PD-PSV) is a rare, benign pustular and vegetating mucocutaneous dermatosis with a tendency to affect the oral mucosa and the skin of the groin and axilla. The cutaneous lesions begin as crusted erythematous papulopustules, which coalesce to form large vegetating plaques, usually in the axillae, genital area and scalp. PD-PSV is known to be frequently associated with inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn's disease. We report a rare case of PD-PSV, which showed typical clinical and istopathological features, but was not accompanied by inflammatory bowel disease.
Axilla ; Colitis, Ulcerative ; Crohn Disease ; Groin ; Inflammatory Bowel Diseases ; Mouth Mucosa ; Scalp ; Skin ; Skin Diseases

PURPOSE: Tic disorder is a neurodevelopmental disorder which begins in early childhood and continues into adolescence and adults. Tic disorder affects 1-2% of the population. In order to make a correct diagnosis and treatment of tic disorder, the clinical psychological analysis is needed because children with tic disorder tend to have higher rates of emotional and behavioral difficulties than those of the general population. The aim of this study was to evaluate the clinical and psychological characteristics of child with tic disorder. METHODS: The sample consisted of 69 patients with tic disorder who visited to the pediatric neurology clinic of Kangnam sacred heart hospital from January 2007 to June 2010. Fifty patients who visited our clinic without tic disorder were included in the control group. Patients were classified as the DSM-IV, Tourette's disorder, chronic motor or vocal tic disorder, transient tic disorder and tic disorder not otherwise specified. Korean child behavior checklist (K-CBCL), K-WISC-III, ADS, K-ARS was conducted in the tic disorder patients and T score of K-CBCL was compared with the control group. RESULTS: Male to female ratio was 2.5:1 in the study group and the mean age was 9.5+/-3.2 years old. The symptom period was 16.7+/-17.2 months at their first visit. Twelve subjects (18%) presented with Tourette syndrome, 14 subjects (20%) had multiple chronic motor or phonic tic disorder, 20 subjects (29%) had transient tic disorder and 23 subjects (33%) had tic disorder not otherwise specified. The Medications were given in 26 patients and risperidone was the primary drug for most of them. The mean T scores of K-CBCL were 55.5+/-6.1 for attention scale, 56.9+/-6.9 for anxiety-depression scale, 56.5+/-7.4 for withdrawn scale, 52.0+/-3.4 for emotional lability scale. All of them were higher than control group (P<0.05). CONCLUSION: In order to make a correct diagnosis and treatment of tic disorder, the clinical psychological assessment is mandatory due to their higher rates of emotional and behavioral difficulties.
Adolescent ; Adult ; Checklist ; Child ; Child Behavior ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Heart ; Humans ; Male ; Neurology ; Risperidone ; Tic Disorders ; Tics ; Tourette Syndrome