PURPOSE: Vulvodynia is characterized by chronic vulvar pain caused by sexual intercourse and often results in female sexual dysfunction. Because the causes of vulvodynia are not clear, many patients do not receive optimal treatment. Recently, gabapentin and botulinum toxin A have both been shown to be effective treatments for vulvodynia. In this study, we retrospectively analyzed the clinical outcomes of botulinum toxin A and gabapentin treatment for chronic pain in women with this condition. MATERIALS AND METHODS: Seventy-three women with vulvar pain were administered either gabapentin (n=62) or botulinum toxin A (n=11) injections. Effectiveness was measured by use of a visual analogue scale (VAS). We analyzed the treatment method, treatment duration, success of treatment, and side effects or adverse reactions. RESULTS: Pain levels in both groups significantly decreased after treatment. In the gabapentin group, the VAS score decreased from 8.6 before treatment to 3.2 after treatment (p<0.001). The VAS score in the botulinum toxin A group was reduced from 8.1 to 2.5 (p<0.001). Side effects for both therapies were few and subsided with treatment with general antibiotics and nonsteroidal antiinflammatory drugs. CONCLUSIONS: Gabapentin and botulinum toxin A are safe and effective treatments for vulvodynia. This condition can cause sexual dysfunction and affect quality of life. However, with proper management, satisfactory outcomes for women with vulvodynia can be achieved.
Amines ; Anti-Bacterial Agents ; Botulinum Toxins ; Chronic Pain ; Coitus ; Cyclohexanecarboxylic Acids ; Dyspareunia ; Female ; gamma-Aminobutyric Acid ; Humans ; Quality of Life ; Retrospective Studies ; Vulvodynia

Pulseless electrical activity refers to a heterogeneous group of cardiac rhythm disorders, all characterized by pulselessness in the presence of some type of electrical activity other than ventricular tachycardia or ventricular fibrillation. We experienced a case of sudden pulseless electrical activity and cardiac arrest during hetastarch infusion in general anesthesia in an adult who had total gastrectomy. We report this experience with a brief review of literature.
Adult ; Anesthesia, General ; Gastrectomy* ; Heart Arrest ; Humans ; Hydroxyethyl Starch Derivatives ; Tachycardia, Ventricular ; Ventricular Fibrillation

BACKGROUND: Unfractionated heparin is commonly used for anticoagulation in extracorporeal membrane oxygenation (ECMO). Several studies have shown that nafamostat mesilate (NM) has comparable clinical outcomes to unfractionated heparin. This study compared anticoagulation with NM and heparin in a large-animal model. METHODS: Beagle dogs (n=8; weight, 6.5–9 kg) were placed on venovenous ECMO. Blood samples were taken every hour and the following parameters were compared: hemoglobin level, activated partial thromboplastin time (aPTT), thromboelastography (TEG) data, platelet function, and inflammatory cytokine levels. RESULTS: In both groups, the aPTT was longer than the baseline value. Although the aPTT in the NM group was shorter than in the heparin group, the TEG parameters were similar between the 2 groups. Hemoglobin levels decreased in both groups, but the decrease was less with NM than with heparin (p=0.049). Interleukin (IL)-1β levels significantly decreased in the NM group (p=0.01), but there was no difference in the levels of tumor necrosis factor alpha or IL-10 between the 2 groups. CONCLUSION: NM showed a similar anticoagulant effect to that of unfractionated heparin, with fewer bleeding complications. NM also had anti-inflammatory properties during ECMO. Based on this preclinical study, NM may be a good alternative candidate for anticoagulation in ECMO.
Animals ; Anticoagulants ; Blood Platelets ; Dogs ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Heparin ; Interleukin-10 ; Interleukins ; Mesylates* ; Partial Thromboplastin Time ; Thrombelastography ; Tumor Necrosis Factor-alpha

BACKGROUND: This study aimed to review the long-term clinical outcomes and graft patency of coronary artery bypass grafting (CABG) using arterial grafts in patients with Kawasaki disease (KD) affecting the coronary artery. METHODS: Twenty patients with KD who underwent CABG from January 2002 to June 2014 were enrolled. There were 4 male (20%) and 16 female (80%) patients with ages at operation ranging from 2 to 42 years (median, 17.5 years). Our routine operative strategy was off-pump CABG with arterial grafts. The mean follow-up duration was 59.5 ± 48.5 months (range, 1–159 months). Coronary angiogram or computed tomography angiogram was used to evaluate graft patency in 16 patients (80%). RESULTS: All patients survived CABG without late mortality. Left internal thoracic arteries were used in 19 patients, while right internal thoracic arteries were used in 10 patients. Right gastroepiploic arteries were used in 3 patients, and a saphenous vein graft (SVG) was used in 1 patient. Among the 20 patients, 2 patients underwent coronary reintervention with balloon angioplasty because of graft failure. Two patients underwent coronary reintervention because of new obstructive lesions that were not significant at the time of the initial operation. Patency rates at 5 and 10 years were 94% and 87%, respectively. The rate of freedom from coronary reintervention at 10 years was 82%. CONCLUSION: Off-pump CABG with mainly arterial graft revascularization may be considered a good surgical option for coronary lesions caused by KD.
Angioplasty, Balloon ; Coronary Artery Bypass* ; Coronary Vessels* ; Female ; Follow-Up Studies ; Freedom ; Gastroepiploic Artery ; Humans ; Male ; Mammary Arteries ; Mortality ; Mucocutaneous Lymph Node Syndrome* ; Saphenous Vein ; Transplants