Caudal analgesia is a widely accepted technique for providing pain relief. However, both permanent and transient neurologic complications, including paraplegia, have been reported. We report on a patient who developed paraplegia following a caudal block for an epidural mass. The cause of the paraplegia was unknown, but possibly spinal angioma may have taken part in the onset and progression of the paralysis. A mechanism is proposed by which the caudal injection may have caused a change in blood flow through the spinal angioma resulting in cord ischemia.
Analgesia* ; Hemangioma ; Humans ; Ischemia ; Paralysis ; Paraplegia*

The treatment of massive bone and soft tissue defect in the lower leg has a high complication rate of nonunion, chronic infection, and amputation without well-vascularized tissue coverage of the open fracture. Despite adequate free soft tissue coverage, massive skeletal defect may result in segmental bone defects, angulation deformity, and limb length discrepancies. In the last decade, major advances have occurred in the Ilizarov method of distraction osteogenesis in lower leg salvage as a delayed procedure or simultaneous distraction after free-tissue transfer. The authors have performed Ilizarov transport in conjunction with muscle and musculocutaneous flap coverage in nine cases of lower leg salvage. The flaps consist of rectus, gracilis, latissimus dorsi, parascapular, and serratus muscle or musculocutaneous fashioning using ipsilateral or contralateral pedicle in consideration of vessel condiation. Revision, recorticotomy and flap elevation were also used as a secondary procedure for satisfactory results. The conclusions, were as follows: 1) Multidisciplinary team approach with conjoining departments at the time of preoperative evaluation, postoperative care and rehabilitation care; 2) Muscle flap covered with split-thickness skin graft was preferred to musculocutaneous flap; 3) To reduce the total reconstructive period, simultaneous free tissue transfer with Ilizarov distraction should be considered.
Amputation ; Congenital Abnormalities ; Extremities ; Fractures, Open ; Ilizarov Technique ; Leg* ; Myocutaneous Flap ; Osteogenesis* ; Osteogenesis, Distraction ; Postoperative Care ; Rehabilitation ; Skin ; Superficial Back Muscles ; Transplants

BACKGROUND: Epidural narcotics are now widely used for postoperative pain relief, but their side effects are problematic. Thus, this study was undertaken to evaluate the analgesic effects and to minimize the side effects of the combination of epidural morphine and ketamine versus epidural morphine alone in pateints with postoperative pain. METHODS: The value of using a combined infusion of morphine with a variable dose of ketamine for postoperative analgesia following subtotal gastrectomy was assessed in a double-blind randomised study of 30 patients. Three groups of 10 patients received an infusion of morphine at 2 mg/day, either alone, or combined with ketamine at a rate of 0.4 or 0.6 mg/kg/day. RESULTS: Postoperative anlagesia, sedation, and side effects were not statistically significantly different between groups I and II. Postoperative sedation, and side effects were not statistically significantly different between groups I and III. VAS of group III at 1-2 h was lower than in group I. CONCLUSION: The addition of ketamine to a continuous infusion of morphine dose not significantly improve postoperative analgesia. In addition, increasing the dose of ketamine does not significantly improve postoperative analgesia, Nor does it increase sedation, or side effects.
Analgesia ; Gastrectomy* ; Humans ; Ketamine ; Morphine* ; Narcotics ; Pain, Postoperative*

PURPOSE: This study was performed to investigate the effects of environmental factors, genetic polymor phisms of cytochrome P450 2E1 (CYP2E1) and N-acetyltransferase 2 (NAT2), and their interactions on mutations of p53 and Ki-ras genes in Korean stomach cancer. METHODS: One hundred nine stomach cancer patients and 211 age- and sex-matched controls were enrolled in this study. Direct interview with a structured questionnaire was performed to get informations on the level of exposure to environmental factors. For genotyping of the metabolic enzymes, PCR-RFLP methods were used. RT-PCR and direct sequencing were carried out to detect mutations in the p53 and the Ki-ras genes of stomach cancer tissue. To evaluate the risk of stomach cancer, we calculated odds ratios for environmental and genetic factors, and their combinations. RESULTS: Past medical histories of gastritis, diabetes and asthma allergic rhinitis were significant risk factors for stomach cancer. Fried potatoes, squid and octopus, welsh onions and chestnuts and gingkonuts had protective effects against stomach cancer. On the contrary, chicken, soybean paste stew, and soybean milk were significantly related to an increased stomach cancer risk. The NAT2 rapid acetylator turned out to be a marginally significant risk factor for gastric cancer. Mutations of the p53 and the Ki-ras genes were detected in 27.5% and 10.7% of stomach cancer tissues, respectively. Frizzled rice, potato, beef, lard, pickled fish, chicken stew, anchovies, tempura, Welsh onions, eggs, bean-curd, Qing-style soybean paste stew, and ice cream were protective against p53 mutation whereas yogurt was a risk factor for p53 mutation in stomach cancer tissue. Ki-ras mutation was associated with less intake of pears and persimmons, melons, strawberries, grapes and milk and with more intake ofsoybean paste stew. In a multiple logistic analysis including genetic polymorphism, past medical history and diet intake, past history of gastritis, chicken, soybean paste stew, and soybean milk were significant risk factors for stomach cancer whereas past history of diabetes, squid and octopus, and Welsh onions were protective factors against stomach cancer. CONCLUSION: These results suggest that past medical history and diet are more important risk factors for stomach cancer than genetic polymorphism and that mutations of the p53 and the Ki-ras genes would be induced by the respective risk factors.
Asthma ; Carcinogenesis* ; Carcinogens, Environmental* ; Chickens ; Cucurbitaceae ; Cytochrome P-450 CYP2E1* ; Decapodiformes ; Diet ; Diospyros ; Eggs ; Fragaria ; Gastritis ; Genes, ras ; Humans ; Ice Cream ; Milk ; Octopodiformes ; Odds Ratio ; Onions ; Ovum ; Polymorphism, Genetic* ; Pyrus ; Surveys and Questionnaires ; Rhinitis ; Risk Factors ; Solanum tuberosum ; Soybeans ; Stomach Neoplasms ; Vitis ; Yogurt

Carcinoid tumors have been described in almost every organ and may affect virtually every body system. Cardiac involvement manifesting as right-sided valvular disease is characteristic of the carcinoid heart disease. Myocardial metastasis is an unusual manifestation of carcinoid heart disease and it was manifested as a mass lesion in the previous reports. We observed a myocardial metastasis of carcinoid tumor manifesting as diffusely infiltrative pattern.
Carcinoid Heart Disease* ; Carcinoid Tumor* ; Neoplasm Metastasis

No abstract available.
Humans ; Meningitis* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis*

Heart failure unresponsive to bed rest, low sodium diet, digitalis, diuretics, vasodilators and cardiac inotropic agents is a difficult therapeutic problem. Although remission was achieved with such treatment, its duration was short and easily recurred. We present a report of severe refractory congestive heart failure in three patients successfully treated with Continuous Ambulatory Peritoneal Dialysis (CAPD). These patients were admitted to the hospital many times and treated by conventional methods but cannon maintain their condition for a long time. In all three patients, edema, pulmonary congestion, electrolyte abnormalities, decreased ejection fraction and fractional shortening of myocardioum were eliminated or improved by CAPD. All three patients improved from Class IV congestive heart to Class II, as defined by the New York Heart Association, and experienced a define improvement in their sense of well being We conclude CAPD as an effective and the useful treatment for servere congestive heart failure refractory to conventional medical treatments.
Bed Rest ; Diet ; Digitalis ; Diuretics ; Estrogens, Conjugated (USP)* ; Heart ; Heart Failure* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory ; Pulmonary Edema ; Sodium ; Vasodilator Agents

We describe a 53-year-old woman with renal, gastric, and multiple intestinal metastases of invasive ductal carcinoma of breast. She was diagnosed as left breast cancer of stage II, received left modified radical mastectomy 10 years ago and has been followed up without any evidence of residual disease. During investigation for indigestion and lower abdominal pain, we found multiple masses in left kidney, multiple levels of colon, ovary, peritoneum and bone. The histology of the tissue taken from renal mass was adenocarcinoma, which had identical features with those of masses resected from her left breast 10 years ago. During 28 month palliative chemotherapy, we found gastric metastasis of breast cancer and finally, the colonic metastatic masses caused intestinal obstruction. The diagnosis of gastrointestinal metastases of breast cancer is very important in the view of improvement of survival and quality of life because they can lead to intestinal obstruction, bleeding, and perforation.
Abdominal Pain ; Adenocarcinoma ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Colon ; Diagnosis ; Drug Therapy ; Dyspepsia ; Female ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intestines ; Kidney ; Mastectomy, Modified Radical ; Middle Aged ; Neoplasm Metastasis* ; Ovary ; Peritoneum ; Quality of Life ; Stomach

BACKGROUND: Recent studies have suggested that the cardioprotective effect of ischemic preconditioning (IP) is closely related to glycogen depletion and attenuation of intracellular acidosis. In the present study, the authors tested this hypothesis by perfusion isolated rabbit hearts with glucose(G) is closely related to glycogen depletion and attenuation of intracellular acidosis. In the present study, the authors tested this hypothesis by perfusion isolated rabbit hearts with glucose(G)-free perfusate. MATERIAL AND METHOD: Hearts isolated from New Zealand white rabbits (1.5~2.0 kg body weight) were perfused with Tyrode solution by Langendorff technique. After stabilization of baseline hemodynamics, the hearts were subjected to 45 min global ischemia followed by 120 min reperfusion with IP(IP group, n=13) or without IP(ischemic control group, n=10). IP was induced by single episode of 5 min global ischemia and 10 min reperfusion. In the G-free preconditioned group(n=12), G depletion was induced by perfusionwith G-free Tyrode solution for 5 min and then perfused with G-containing Tyrode solution for 10 min; and 45 min ischemia and 120 min reperfusion. Left ventricular functionincluding developed pressure(LVDP), dP/dt, heart rate, left ventricular end-distolic pressure (LVEDP) and coronary flow (CF) were measured. Myocardial cytosolic and membrane PKC activities were measured by 32P-gamma-ATP incorporation into PKC-specific peptide and PKC isozymes were analyzed by Western blot with monoclonal antibodies. Infarct size was determined by staining with TTC (tetrazolium salt) and planimetry. Data were analyzed by one-way analysis of variance (ANOVA) and Turkey's post-hoc test. RESULT: In comparison with the ischemic control group, IP significantly enhanced functional recovery of the left ventricle; in contrast, functional significantly enhanced functional recovery of the left ventricle; in contrast, functional recovery were not significantly different between the G-free preconditioned and the ischemic control groups. However, the infarct size was significantly reduced by IP or G-free preconditioning (39+/-2.7% in the ischemic control, 19+/-1.2% in the IP, and 15+/-3.9% in the G-free preconditioned, p<0.05). Membrane PKC activities were increased significantly after IP (119%), IP and 45 min ischemia(145%), G-free [recpmdotopmomg (150%), and G-free preconditioning and 45 min ischemia(127%); expression of membrane PKC isozymes, alpha and beta, tended to be increased after IP or G-free preconditioning. CONCLUSION: These results suggest that in isolated Langendorff-perfused rabbit heart model, G-free preconditioning (induced by single episode of 5 min G depletion and 10 min repletion) colud not improve post-ischemic contractile dysfunction(after 45-minute global ischemia); however, it has an infarct size-limiting effect.
Acidosis ; Antibodies, Monoclonal ; Blotting, Western ; Cytosol ; Glucose ; Glycogen* ; Heart ; Heart Rate ; Heart Ventricles ; Hemodynamics ; Ischemia ; Ischemic Preconditioning* ; Isoenzymes ; Membranes ; Perfusion ; Rabbits ; Reperfusion

BACKGROUND AND OBJECTIVES: "Recovery only" ST-segment depressions are sometimes detected during an exercise treadmill test. We undertook this study in order to clarify the predictive value of exercise-induced ST-segment depression occurring in recovery only. SUBJECTS AND METHODS: The study included 931 patients who had both a sign or symptom -limited treadmill test. Of the 66 patients who demonstrated abnormal ST-segment responses, 43 experienced ST-segment depressions during exercise (Group A) and 23 displayed such responses only during recovery (Group B). RESULTS: The positive predictive value of an exercise treadmill test for significant angiographic disease in group A (81.3%) was statistically different from the predictive value in group B (30.4%). Horizontal ST-segment depression in recovery periods and female sex were statistically significant factors favoring negative coronary angiographic results. CONCLUSION: The occurrence of horizontal mild ST-segment depression during only the recovery periodgenerally represents a "false positive" response, particularly in female patients.
Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Depression* ; Exercise Test* ; Female ; Humans