No abstract available.
Asthma*

PURPOSE: Surgical hemorrhoidectomy has a reputation for being a painful procedure. Many surgical methods have been devised for reducing posthemorrhoidectomy pain. Nevertheless, the result are unsatisfactory. Stapled hemorrhoidectomy is performed without leaving painful perianal wounds. The aim of this study was to assess any benefits, compared among three hemorrhoidectomy methods. METHODS: A total of 150 consecutive patients with 3rd and 4th degree of prolapsed hemorrhoids underwent hemorrhoidectomy with stapler group (n=50) or hemorrhoidectomy with ultrasonic dissector group (n=50) or Milligan's hemorrhoidectomy using by diathermy (n=50) (by same surgeon between January and September 2001). We evaluated the difference among three techniques in operative time, postoperative pain, and patient satisfaction (using visual analogue scale). RESULTS: Mean operative time for hemorrhoidectomy with ultrasonic dissector was 19 minute; for stapler group, it was 18 minute; for Milligan's group, it was 23.6 minute (P<0.05). There was significant difference in operative time between stapler and Milligan's group. There were significant difference in pain measurement reported on immediate (5.8 for stapler, 7.2 for ultrasonic dissector, and 9.2 for Milligan's group, P<0.01), day 1 (4.3, 5.5, and 6.8, P<0.01), day 2 (3.7, 4.7, and 6, P<0.01), day 3 (3.0, 3.6, and 4.6, P<0.01), day 4 (3.1, 3.5, and 4.6, P<0.01), day 5 (2.5, 3.4, and 4.6, P<0.01), day 6 (2.0, 3.2, and 4.3, P<0.01), day 7 (1.8, 3, and 4.2, P<0.01), and defecation (4.0, 7.0, and 8.9, P<0.01). The mean analgesic (piroxicam 20 mg) requirement was 0.3 times for stapler, 1.9 for Ultrasonic dissector, and 3.1 for Milligan's group (P<0.01). Mean hospital stay was 1.6 days for stapler, 1.7 for ultrasonic dissector, 2.8 for Milligan's group (P<0.01). Patient satisfaction on day 7 was 8.2 for stapler, 6.2 for ultrasonic dissector, and 5.2 for Milligan's group (P<0.01). There was no difference in catheterization for urinary retention. It is probably due to spinal anesthesia. CONCLUSION: The study demonstrates significantly reduced postoperative pain and shorter hospital day after stapled hemorrhoidectomy compared among three groups. This resulted in an earlier return to working activities for stapled technique.
Anesthesia, Spinal ; Catheterization ; Catheters ; Defecation ; Diathermy ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Length of Stay ; Operative Time ; Pain Measurement ; Pain, Postoperative ; Patient Satisfaction ; Return to Work ; Ultrasonics* ; Urinary Retention ; Wounds and Injuries

Experimental stem cell therapy for spinal cord injury (SCI) has been extensively investigated. The selection of effective cell transplantation route is also an important issue. Although various types of scaffold have been widely tried as a carrier of stem cells to the injured spinal cord, there was little comparative study to investigate the efficacy of transplantation comparing with conventional transplantation route. A total of 48 Sprague-Dawley rats were subjected to standardized SCI, followed by transplantation of allogeneic mesenchymal stem cells (MSCs), either via intralesional injection (IL group), or via the poly (lactic-co-glycolic acid) (PLGA) scaffold (IP group) or chitosan scaffold (IC group). Engraftment and differentiation of the transplanted cells, expression of neurotrophic factors in the injured spinal cord, and functional recovery were compared with those of the control group. The mean numbers of engrafted MSCs in the IL, IP, and IC groups were 20.6 ± 0.7, 25.6 ± 1.7 and 26.7 ± 1.8 cells/high power filed (HPF), respectively. Results showed higher success rate of MSCs engraftment in the scaffold groups compared to the IL group. Expression of neuroprotective growth factors in the SCI lesions showed no significant differences between the IL, IP, and IC groups. The mean Basso, Beattie and Bresnahan locomotor scales at 6 weeks post-transplantation in the IL, IP, IC, and control groups were 7.9 ± 1.1, 7.9 ± 2.1, 8.7 ± 2.1, and 2.9 ± 1.0, respectively. The functional improvement was most excellent in the IC group. The scaffold based MSC transplantation for acute SCI presented the better cell engraftment and neuroprotective effect compared to the intralesional injection transplantation.
Animals ; Cell Transplantation ; Chitosan ; Injections, Intralesional* ; Intercellular Signaling Peptides and Proteins ; Mesenchymal Stem Cell Transplantation ; Mesenchymal Stromal Cells* ; Nerve Growth Factors ; Neuroprotection ; Neuroprotective Agents ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord Injuries* ; Spinal Cord* ; Stem Cells ; Tissue Scaffolds ; Transplants ; Weights and Measures

OBJECTIVES: The objective of this study was to compare the Korean Personality Rating Scale for Children (K-PRC) profile between children with attention-deficit hyperactivity disorder (ADHD) and typically developing children. We also aimed to investigate the association of K-PRC and ADHD symptoms. METHODS: Ninety-nine youth (age 8.3+/-2.4 years, 72 boys) with ADHD and 84 controls (age 9.2+/-2.5 years, 43 boys) were recruited from the Department of Pediatric Psychiatry of the Asan Medical Center Children's Hospital. Diagnoses of ADHD and comorbid psychiatric disorders were confirmed with the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). The parents of the subjects completed the ADHD rating scale, and K-PRC. Independent t-tests, analysis of covariance, partial correlation analyses, and Mc Nemar test were used for analysis. RESULTS: Children and adolescents with ADHD showed higher K-PRC scores in verbal development, physical development, depression, delinquency, hyperactivity, family dysfunction and psychoticism. Delinquency and hyperactivity were significantly correlated with parent-rated ADHD rating scales and ADHD scores on K-SADS-PL. The hyperactive/impulsive and combined subtypes showed higher scores on hyperactivity and delinquency than the inattentive subtype, and the inattentive subtype showed higher scores on depression and social dysfunction of the K-PRC. CONCLUSION: Our results suggest that K-PRC could be used to comprehensively evaluate symptoms, combined psychopathologies, developmental delay and family dysfunction of children with ADHD.
Adolescent ; Child* ; Chungcheongnam-do ; Comorbidity ; Depression ; Diagnosis ; Humans ; Mood Disorders ; Parents ; Weights and Measures

Corynebacterium minutissimum is a non-spore forming, gram-positive, aerobic or facultative anaerobic bacillus. It is the causative organism of erythrasma, a common superficial infection of skin, which typically presents as reddish-brown macular patches. To date, it has rarely been found to cause invasive disease, although other non-diphtheria corynebacteria are becoming increasingly common as opportunistic pathogens. We report on a rare case of abdominal infection due to C. minutissimum in an immunocompetent adult who was successfully treated with intravenous amoxicillin/sulbactam.
Abdomen ; Adult ; Bacillus ; Corynebacterium* ; Erythrasma ; Humans ; Skin

Psoas abscess is rarely encountered with various etiologies and nonspecific clinical presentation, frequently resulting in delayed diagnosis, with increased morbidity and mortality. Two types of psoas abscess are recognized. The primary psoas abscess is generally following hematogenous dissemination of an infectious agent and the source is usually occult. The most frequently isolated pathogen is Staphylococcuss aureus. On the other hand, the secondary abscess is the result of local extension of an infectious process near the psoas muscle, especially in diabetes, malnutrition, alcoholism, and steroid abuse. A 83-year-old woman presented with high fever and progressive back pain. Abdominal CT scan showed bilateral psoas abscesses combined with lobulated kidney. Both cultures of blood and urine showed Klebsiella pneumoniae. By prolonged antibiotic treatment and abscess drainage, she showed clinical, and radiological improvement. Here, we report an unusual case of bilateral pyogenic psoas abscess complicated by acute pyelonephritis due to Klebsiella pneumonia.
Abscess ; Aged, 80 and over ; Alcoholism ; Back Pain ; Delayed Diagnosis ; Drainage ; Female ; Fever ; Hand ; Humans ; Kidney ; Klebsiella pneumoniae* ; Klebsiella* ; Malnutrition ; Mortality ; Pneumonia ; Psoas Abscess* ; Psoas Muscles ; Pyelonephritis* ; Tomography, X-Ray Computed

Guillain-Barre syndrome (GBS) is clinically characterized by acute, progressive, symmetrical weakness and areflexia. However there have been several reports of patients with the acute motor axonal neuropathy type of GBS showing hyperreflexia. We experienced a patient with acutely developed ascending progressive weakness of low extremities up to face following enteritis and concomitantly developed hyperreflexia following initial treatment with IVIG. The spinal MRI scan revealed radiological features of acute diffuse myelitis. The treatment with steroid resulted in fairly good clinical and electrophysiological outcome.
Axons ; Enteritis ; Extremities ; Guillain-Barre Syndrome* ; Humans ; Immunoglobulins, Intravenous ; Magnetic Resonance Imaging ; Myelitis* ; Reflex, Abnormal

BACKGROUND: Cardiopulmonary resuscitation (CPR) can lead to various neurologic outcomes in patients with hypoxicischemic encephalopathy (HIE). This study investigated the usefulness of clinical markers and electroencephalography (EEG) in predicting the neurologic prognosis of HIE after CPR. METHODS: We reviewed the clinical findings of 51 patients with HIE, including the medical history, the duration from the onset of symptoms to the recovery of spontaneous circulation, Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness (FOUR) scores, and presence of seizure or status epilepticus. Patients were divided into three outcomes groups: death, persistent vegetative state, and recovering alertness and awareness. Digital EEG and visual and quantitative analyses were performed in each patient. For quantitative EEG (qEEG) analysis, we defined and compared the distance in the spatial band-power patterns and phase coherence patterns between healthy normal subjects and each patient. RESULTS: Patients with HIE showed a high mortality rate (54.9%, 28/51), and their neurologic prognosis was significantly related to the initial GCS and FOUR scores. In the qEEG analysis, patients' groups showed a prominent delta frequency band, and the healthy normal group presented a marked alpha predominance. As the severity decreased, the similarity in the spatial band-power pattern and functional connectivity pattern between normal subjects and patients increased. CONCLUSIONS: Low initial GCS and FOUR scores could be predictive of a poor neurologic prognosis in patients with HIE, and qEEG analysis might be a useful predictor of their neurologic outcomes.
Biomarkers ; Cardiopulmonary Resuscitation ; Electroencephalography ; Glasgow Coma Scale ; Humans ; Hypoxia-Ischemia, Brain ; Persistent Vegetative State ; Prognosis ; Seizures ; Status Epilepticus

BACKGROUND: Epileptic seizures can be associated with changes in autonomic functions. This study evaluated heart rate (HR) changes at the transition from the preictal to the ictal state in patients with epileptic seizures, and investigated whether peri-ictal HR changes can help to predict electroencephalography (EEG) seizures prior to their onset. METHODS: We retrospectively studied 94 seizures in 33 patients who underwent video-EEG monitoring with scalp EEG and electrocardiography. The existence and initial timing of HR changes relative to the onset of EEG seizures were determined by analyzing consecutive RR-interval changes in 10-minute recordings. We evaluated the correlation between the peri-ictal HR changes and the type of localization-related epilepsy. RESULTS: Peri-ictal HR changes were documented in 70.2% (66/94) of all seizures, of which 62 were tachycardia (66.0%) and 4 were bradycardia (4.3%). Peri-ictal tachycardia occurred significantly with seizures as an ictal manifestation, more often in seizures with a right hemispheric onset than in those with a left hemispheric onset (77.4% vs. 50%, p=0.016). Peri-ictal HR changes were observed much earlier in seizures of mesial temporal lobe epilepsy (TLE) than in those of extratemporal lobe epilepsy (-54.4 s vs. -6.7 s, p<0.001). CONCLUSIONS: Peri-ictal HR changes were observed in 70.2% of seizures, 94% of which were tachycardia. These changes could be helpful in predicting seizure onset, especially in mesial TLE.
Bradycardia ; Electrocardiography ; Electroencephalography ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Temporal Lobe ; Heart ; Heart Rate ; Humans ; Retrospective Studies ; Scalp ; Seizures ; Tachycardia

BACKGROUND/AIMS: EUS is a useful method to differentiate malignant from benign gastric subepithelial tumors (SETs) and to determine resection. However, this results in unnecessary resections of benign gastric SETs. The aim of our study is 1. to investigate clinical factors that may predict malignancy in gastric SET and 2. to determine how many of them have malignant potential in resected gastric SETs. MATERIALS AND METHODS: We retrospectively identified 111 patients who underwent pathologic confirmation for gastric SETs by surgical (104/111, 93.6%) and endoscopic resection between February 2003 and April 2012 and analyzed the clinical, EUS findings and final pathologic diagnosis for these patients. RESULTS: The diagnostic accuracy of EUS for SETs was 58.6% (51/87) and the rate of resection for benign SETs was 31.5% (35/111). In multivariate analysis, old age (> or =65), as well as tumor size (> or =2 cm) and location (upper or middle) were significant predictive factors for malignant potential of gastric SETs. CONCLUSIONS: One-third of endoscopic and surgical resections are performed for benign SETs. Patient's age, tumor size, and location should be considered before resection of gastric SETs. In addition, more accurate tools for histologic confirmation should be developed in order to avoid unnecessary resection.
Endosonography ; Humans ; Multivariate Analysis ; Prevalence ; Retrospective Studies ; Stomach