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

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

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: 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

Postpneumonectomy syndrome is a disease entity which arises after right pneumonectomy in left aortic arch and left pneumoncectomy in right aortic arch. This syndrome have a feature of severe mediastinal deviation and rotation, and induces severe respiratoy insufficiency. This syndrome is rare, but should be considered when pneumonectomized patient complaints who have severe dyspnea. In Samsung medical center, We report a sucessfully treated patient with postpneumonectomy syndrome, who had experienced right pneumonectomy at 1 years ago.
Aorta, Thoracic ; Dyspnea ; Humans ; Pneumonectomy ; Postoperative Complications

BACKGROUND: The target of lumbar sympathetic ganglion block is the anterolateral surface of the L2, 3 and 4 vertebral bodies, where the lumbar sympathetic ganglion usually lies. In most cases, a block-needle is inserted approximately 5-8 cm lateral to spinous process on the skin and directed to the anterolateral surface of vertebral body obliquely. The purpose of this study is to determine the safe entry angle and entry point in Korean by using the abdominal CT scan images. METHODS: The abdominal CT images of eighty five patients were recruited to this study. The minimal angle aimed at the lumbar sympathetic ganglion that can pass through the lateral aspect of body and maximal angle that avoids puncturing the kidney, ureter or retroperitoneal space were measured. The distance from midline to skin entry point was also measured. RESULTS: There was no significant difference in entry angle among L2, 3, and 4 level. The entry angle was similar in the right and left side, and in males and females. The entry angle of old age group was significantly smaller than that of young age group. The calculated safe entry angle was 30.5 +/- 0.4degrees and entry point was 7.7 +/- 0.2 cm and 6.7 +/- 0.1 cm lateral from midline in males and females respectively. CONCLUSION: These measurements can be used as a reference for lumbar sympathetic ganglion block and radiofrequency lesioning. Prior to performing the lumbar sympathetic ganglion block for cancer patients, the abdominal CT scan should be reviewed to prevent complications.
Female ; Ganglia, Sympathetic ; Humans ; Kidney ; Male ; Retroperitoneal Space ; Skin ; Ureter

Tinea capitis, a dermatophyte infection involving the hair shaft on the scalp, is primarily a disease of preadolescent children. Trichophyton or Microsporum species of dermatophytes transmitted by humans or animals are commonly associated with this disease. Clinical presentations are seborrheic-like scale, 'black dot' pattern, inflammatory tinea capitis with kerion or tiny pustules in the scalp. We report an interesting case of tinea capitis with rapid progression caused by Trichophyton mentagrophytes in an 11-year-old girl. The patient was treated with 125 mg of oral terbinafine and topical flutrimazole cream for one month.
Animals ; Arthrodermataceae ; Child ; Clotrimazole ; Hair ; Humans ; Microsporum ; Naphthalenes ; Scalp ; Tinea ; Tinea Capitis ; Trichophyton