BACKGROUND: Postherpetic neuralgia (PHN) is usually managed pharmacologically. It is not uncommon for patients with chronic kidney disease (CKD) to suffer from PHN. It is difficult to prescribe a sufficient dose of anticonvulsants for intractable pain because of the decreased glomerular filtration rate. If the neural blockade and pulsed radiofrequency ablation provide only short-term amelioration of pain, spinal cord stimulation (SCS) with a low level of evidence may be used only as a last resort. This study was done to evaluate the efficacy of spinal cord stimulation in the treatment of PHN in patients with CKD. METHODS: PHN patients with CKD who needed hemo-dialysis who received insufficient relief of pain over a VAS of 8 regardless of the neuropathic medications were eligible for SCS trial. The follow-up period was at least 2 years after permanent implantation. RESULTS: Eleven patients received percutaneous SCS test trial from Jan 2003 to Dec 2007. Four patients had successfully received a permanent SCS implant with their pain being tolerable at a VAS score of less than 3 along with small doses of neuropathic medications. CONCLUSIONS: SCS was helpful in managing tolerable pain levels in some PHN patients with CKD along with tolerable neuropathic medications for over 2 years.
Anticonvulsants ; Electric Stimulation Therapy ; Follow-Up Studies ; Glomerular Filtration Rate ; Health Resorts ; Humans ; Kidney ; Kidney Diseases ; Neuralgia, Postherpetic ; Pain, Intractable ; Renal Insufficiency, Chronic ; Spinal Cord ; Spinal Cord Stimulation

Infectious complications are the biggest problem during bowel surgery, and one of the approaches to minimize them is the bowel cleaning method. It was expected that bowel cleaning could facilitate bowel manipulation as well as prevent infectious complications and further reduce anastomotic leakage. In the past, with the development of antibiotics, bowel cleaning and oral antibiotics (OA) were used together. However, with the success of emergency surgery and Enhanced Recovery After Surgery, bowel cleaning was not routinely performed. Consequently, bowel cleaning using OA was gradually no longer used. Recently, there have been reports that only bowel cleaning is not helpful in reducing infectious complications such as surgical site infection (SSI) compared to OA and bowel cleaning. Accordingly, in order to reduce SSI, guidelines are changing the trend of only intestinal cleaning. However, a consistent regimen has not yet been established, and there is still controversy depending on the location of the lesion and the surgical method. Moreover, complications such as Clostridium difficile infection have not been clearly analyzed. In the present review, we considered the overall bowel preparation trends and identified the areas that require further research.

The purpose of this study was to evaluate the influence of the AH-26 root canal sealer on the shear bond strength of composite resin to dentin. One hundred and forty four (144) extracted, sound human molars were used. After embedding in a cylindrical mold, the occlusal part of the anatomical crown was cut away and trimmed in order to create a flat dentin surface. The teeth were randomly divided into three groups; the AH-26 sealer was applied to the AH-26 group, and zinc-oxide eugenol (ZOE) paste was applied to the ZOE group. The dentin surface of the control group did not receive any sealer. A mount jig was placed against the surface of the teeth and the One-step dentin bonding agent was applied after acid etching. Charisma composite resin was packed into the mold and light cured. After polymerization, the alignment tube and mold were removed and the specimens were placed in distilled water at 37degrees C for twenty four hours. The shear bond strength was measured by an Instron testing machine. The data for each group were subjected to one-way ANOVA and Tukey's studentized rank test so as to make comparisons between the groups. The AH-26 group and the control group showed significantly higher shear bond strength than the ZOE group (p < 0.05). There were no significant differences between the AH-26 group and the control one (p > 0.05). Under the conditions of this study, the AH-26 root canal sealer did not seem to affect the shear bond strength of the composite resin to dentin while the ZOE sealer did. Therefore, there may be no decrease in bond strength when the composite resin core is built up immediately after a canal filling with AH-26 as a root canal sealer.
Crowns ; Dental Pulp Cavity* ; Dentin* ; Eugenol ; Fungi ; Humans ; Molar ; Polymerization ; Polymers ; Tooth ; Water ; Zinc*

No abstract available.
Carcinoma, Renal Cell/*complications/pathology/surgery ; Danazol/therapeutic use ; Humans ; Kidney Neoplasms/*complications/pathology/surgery ; Male ; Middle Aged ; Nephrectomy ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic/blood/drug therapy/*etiology

BACKGROUND: Liver transplantation (LT) is a complicated procedure with a high incidence of postoperative acute kidney injury (AKI). Previous studies indicate that even transient or mild post-LT AKI can result in critical conditions, including prolonged stays in hospitals and intensive care units and increased morbidity and mortality. The aim of this study was to investigate the association between body mass index (BMI) and occurrence of AKI in LT recipients. METHODS: Medical data from 203 patients who received LT surgery from January 2010 to August 2016 in a single university hospital setting were retrospectively collected and analyzed. Patients were classified as either underweight (BMI <20 kg/m²) or normal weight (20 ≤ BMI < 30 kg/m²). Demographic data, anesthetic methods, complications, and perioperative laboratory test values of each patient were assessed. Propensity analyses and logistic regression were performed to evaluate the association between BMI and post-LT AKI. RESULTS: There was no significant difference in occurrence of post-LT AKI between underweight and normal weight patients. The underweight patient group had significantly longer hospital stay compared with the normal weight patient group (P = 0.023). CONCLUSIONS: BMI classification was neither a positive nor negative predictor of postoperative AKI occurrence. However, patients with lower BMI had significantly longer hospital stay compared with their counterparts. Although our study was limited by its retrospective design, our observations suggest that lower BMI might play a role in post-LT AKI.
Acute Kidney Injury* ; Body Mass Index* ; Classification ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Liver Transplantation* ; Liver* ; Logistic Models ; Mortality ; Retrospective Studies* ; Thinness

Background: Posterior spinal fusion (PSF), commonly used for adolescent idiopathic scoliosis (AIS), causes severe postoperative pain. Intravenous (IV) administration of acetaminophen has shown promise for opioid-sparing analgesia; however, its analgesic effect and optimal timing for its standard use remain unclear. Our study aimed to evaluate the analgesic effect and optimal timing of IV acetaminophen administration in pediatric and adolescent patients undergoing PSF and requiring adequate pain control. Methods: This prospective, randomized, triple-blind trial was conducted in patients aged 11–20 undergoing PSF. Participants were randomized into three groups: the preemptive group (received IV acetaminophen 15 mg/kg after anesthetic induction/before surgical incision), the preventive group (received IV acetaminophen 15 mg/kg at the end of surgery/before skin closure), and the placebo group. The primary outcome was cumulative opioid consumption during the first 24 h postoperatively. Results: Among the 99 enrolled patients, the mean ± standard deviation (SD) amount of opioid consumption during the postoperative 24 h was 60.66 ± 23.84, 52.23 ± 22.43, and 66.70 ± 23.01 mg in the preemptive, preventive, and placebo groups, respectively (overall P = 0.043). A post hoc analysis revealed that the preventive group had significantly lower opioid consumption than the placebo group (P = 0.013). However, no significant differences between the groups were observed for the secondary outcomes. Conclusions The preventive administration of scheduled IV acetaminophen reduces cumulative opioid consumption without increasing the incidence of drug-induced adverse events in pediatric and adolescent patients undergoing PSF.

OBJECTIVE: To investigate whether higher resilience level predicts low levels of psychological distress in chronic SCI patients living in the community. METHOD: Thirty seven patients (mean age 41.5+/-10.9, male : female=28 : 9) with chronic spinal cord injury (duration 8.35+/-7.0 years) living in the community are included, who were hospitalized for annual checkups from November, 2010 to May, 2011. First, their spinal cord injury level, completeness and complications were evaluated. The patients completed questionnaires about their educational status, religion, employment status, marital status, medical and psychological history and also the following questionnaires: Hospital Anxiety and Depression Scale (HADS), Connor-Davidson Resilience Scale (CD-RISC), Alcohol Use Disorders Identification Test-alcohol consumption questions (AUDIT-C) and Health-related quality of life (EQ-5D). The patients were divided into two subgroups: patients with HADS > or =13 are classified as high psychological distress group and others as low psychological distress group. We compared the two groups to find statistically significant differences among the variables. RESULTS: CD-RISC, EQ-5D and employment status are significantly different between two groups (p<0.05). In a forward stepwise regression, we found that EQ-5D had a greater contribution than CD-RISC to the psychological distress level. CONCLUSION: In addition to health-related quality of life, resilience can be suggested as a possible predictor of psychological distress in chronic SCI patients.
Anxiety ; Dapsone ; Depression ; Educational Status ; Employment ; Humans ; Male ; Marital Status ; Quality of Life ; Spinal Cord ; Spinal Cord Injuries ; Surveys and Questionnaires

Bronchiolitis obliterans (BO), which is associated with graft-versus-host disease after allogenic hematopoietic stem cell transplantation, is a major obstacle to survival after bone marrow transplantation due to its gradual progress, eventually leading to respiratory failure. Pumpless extracorporeal interventional lung assist (iLA) is effective in treatment of reversible hypercapnic respiratory failure. In this paper, we present a 23-year-old female patient who underwent allogeneic peripheral blood stem cell transplantation (PBSCT) for acute lymphocytic leukemia. After 6 months, she complained of shortness of breath and was diagnosed with BO. Five months later, she developed an upper respiratory tract infection that worsened her BO and caused life-threatening hypercapnia. Since mechanical ventilation failed to eliminate CO2 effectively, iLA was applied as rescue therapy. Her hypercapnia and respiratory acidosis showed significant improvement within a few hours, and she was successfully weaned off iLA after 12 days. This is the first case report of iLA application for temporarily aggravated hypercapnia of PBSCT-associated BO followed by successful weaning. This rescue therapy should be considered in ventilator-refractory reversible hypercapnia in BO patients.
Acidosis, Respiratory ; Bone Marrow Transplantation ; Bronchiolitis Obliterans* ; Bronchiolitis* ; Dyspnea ; Female ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Hypercapnia ; Lung* ; Peripheral Blood Stem Cell Transplantation* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Tract Infections ; Weaning ; Young Adult

Metastases Pilomatrix carcinoma is a rare locally aggressive hair-follicle tumor. We report a 54-year-old man who presented with a tumor in the left flank that was found by skin biopsy to be pilomatrix carcinoma. A contrast-enhanced computed tomographic scan of the chest, abdomen, and pelvis showed multiple small nodules in both lungs and lymphadenopathy in the abdomen. Video-assisted thoracoscopic biopsy of the lung lesions was consistent with metastatic pilomatrix carcinoma. After intravenous cisplatin and 5-fluorouracil, the skin, lung, and lymph node lesions shrank
Abdomen ; Biopsy ; Cisplatin ; Fluorouracil ; Humans ; Lung ; Lymph Nodes ; Lymphatic Diseases ; Middle Aged ; Neoplasm Metastasis ; Pelvis ; Skin ; Thorax

Liver transplantation is a current definitive treatment for those with end-stage liver disease. Hepatic encephalopathy is a common complication of hepatic failure, which can be improved and aggravated by various causes. It is important to differentiate hepatic encephalopathy from other diseases causing brain dysfunction such as cerebral hemorrhage, which is also related to high mortality after liver transplant surgery. A 37-year-old patient was presented with acute liver failure and high ammonia levels and seizure-like symptoms. Computed tomography (CT) of his brain showed mild brain atrophy, regarded as a symptom of hepatic encephalopathy, and treated to decrease blood ammonia level. Deceased donor liver transplantation was performed and liver function and ammonia level normalized after surgery, but the patient showed symptoms of involuntary muscle contraction and showed loss of pupil reflex and fixation without recovery of consciousness. Brain CT showed brain edema and bilateral cerebral infarction, and the patient died after a few days. The purpose of this case report is to emphasize the importance of preoperative neurological evaluation, careful transplantation decision, and proper perioperative management of liver transplantation in patients with acute hepatic encephalopathy.
Adult ; Ammonia ; Atrophy ; Brain ; Brain Edema ; Cerebral Hemorrhage ; Cerebral Infarction ; Consciousness ; Hepatic Encephalopathy* ; Humans ; Liver Diseases ; Liver Failure ; Liver Failure, Acute* ; Liver Transplantation* ; Liver* ; Mortality ; Muscle, Smooth ; Pupil ; Reflex ; Seizures ; Tissue Donors