Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty.
Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled ; Analgesics ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Hip* ; Humans ; Pain Management* ; Peripheral Nerves ; Quality of Life ; Rehabilitation

Pulmonary cryptococcosis is rare in immunocompetent subjects. Here, we present the case of a 16-year-old boy who was referred to our pediatric department for the management of multiple consolidations detected on chest radiography, which was routinely performed when the patient was being evaluated for an ankle fracture. Fine needle aspiration biopsy was performed, and the definitive diagnosis was established as cryptococcal pneumonia. After 8 weeks of antifungal treatment, the pulmonary nodules on the chest radiographs disappeared.
Adolescent ; Animals ; Ankle ; Biopsy ; Biopsy, Fine-Needle ; Child ; Cryptococcosis ; Humans ; Multiple Pulmonary Nodules ; Pneumonia ; Thorax

Benign metastasizing leiomyoma (BML) is a rare entity, characterized by the occurrence of multiple smooth muscle nodules in the lung with histologically benign leiomyoma. Both the uterine and pulmonary tumors have been found to express estrogen and progesterone receptors, which suggest that the pulmonary lesions represented metastases from leiomyoma. We experienced a 41-year-old female patient with BML and report here with the literature review.
Adult ; Estrogens ; Female ; Humans ; Leiomyoma* ; Lung Neoplasms ; Lung* ; Metastasectomy ; Muscle, Smooth ; Neoplasm Metastasis ; Receptors, Progesterone

OBJECTIVES: This study was conducted to evaluate the reliability and the validity of the Korean version of the Scale to Assessment Unawareness of Mental Disorder (SUMD-K). METHODS: The subjects were 55 schizophrenic patients between ages of 26 and 58 who were recruited from the psychiatric unit of the university hospital and the out-patient clinic. The SUMD-K and insight scale of PANSS were applied to the patients. RESULTS: The range of inter-rater (Spearman's rho) of the general items of SUMD-K were .97-. 98 on the current illness and .58-.98 on the past illness. The correlation coefficient between the sum and the general items of the SUMD-K showed high scores. The concurrent validity between SUMD-K and insight item of PANSS was high (scores between .59-.96). However, the reliability and the validity of the attribution items of symptoms showed low scores compared to the current symptoms. CONCLUSION: The SUMD-K was confirmed in its reliability and validity. It can be a useful clinician-rating scale for evaluating insight in schizophrenic patients as well as patients with other neuropsychiatric conditions.
Humans ; Mental Disorders* ; Outpatients ; Reproducibility of Results*

Meckel Gruber syndrome consisting of an occipital encephalocele, polycystic kidney disease and polydactyly is a rare autosomal recessive disorder with a recurrence risk of 25%. Targeted ultrasonography in late embryonic or early fetal stages of pregnancy has great importance in diagnosis and management of affected pregnancy in high risk groups due to incomplete genetic mapping of meckel syndrome gene (MKS). We present a case of prenatal diagnosis at 14 weeks' gestational age of Meckel Gruber syndrome in a woman, who experienced same disorder in her previous pregnancy.
Diagnosis ; Encephalocele ; Female ; Gestational Age ; Humans ; Polycystic Kidney Diseases ; Polydactyly ; Pregnancy ; Prenatal Diagnosis ; Recurrence ; Ultrasonography

PURPOSE: 18F-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography (PET) is known to be useful in the detection of lung cancer. However, the degree of FDG uptake was variable. To correlate FDG activity on PET with various histopathologic factors,we assessed the relationships between 18F-FDG uptake and glucose transporter 1 (Glut1) expression, histologic subtypesand Ki-67 labelling indices. MATERIALS AND METHODS: One hundred two patients with non-small cell lung cancer (NSCLC) who had surgery and preoperative 18F-FDG PET scan as a part of the staging work-up were enrolled in this study. The amount of FDG uptake in the primary lesion was measured by a standardized uptake values (SUVs) and correlated with tumor size, histologic subtypes, and immunohistochemical results of Glut1 and Ki-67 labelling indices. RESULTS: Cell type of NSCLC were 52 adenocarcinomas, 36 squamous cell carcinomas, 14 other NSCLC. All tumors could be detected by FDG PET. Uptake was correlated with tumor size (p<0.01). The FDG uptake was significantly lower in adenocarcinomas than in squamous cell carcinomas or other NSCLC (p<0.001). The percentages of Glut1- positive area and staining intensity of the tumor were also significantly lower in adenocarcinomas than in squamous cell carcinomas or other NSCLC (p<0.001). Ki-67 labelling indices of the tumor correlated with the percentage of Glut1 intensity and SUVs in NSCLC (p7lt;0.001). CONCLUSION: These results suggest that overexpression of Glut1 and proliferating activity is related to 18F-FDG uptake in NSCLC. Glut1 expression appear to be different among histologic subtypes. Glut1 expression, as well as FDG uptake, is lower in adenocarcinomas than squamous cell carcinomas or other NSCLC.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Fluorodeoxyglucose F18 ; Glucose Transport Proteins, Facilitative ; Humans ; Lung Neoplasms ; Lung* ; Positron-Emission Tomography

Human immunodeficiency virus type 1 (HIV-1) virus causes severe defect in the immune system and affects the host cell gene expression profoundly. The gene expression pattern will be characterized by changes in cellular mRNA levels that are dependent on both the stage of infection and the biological state of the infected cells. The expression levels of 7,404 cellular RNA transcripts were assessed in H9 cells at different time points after HIV-1 IIIB infection. In total 7 time-points, 959/7,404 (13%) genes were a 2-fold or greater expressed. 387 of 959 genes (40.4%) were up-regulated, and other 572 genes (59.6%) were down-regulated. Three hundred seventeen genes were up-regulated a 2-fold or greater at 72 hr postinfection and 2 to 139 genes were up-regulated at the other time-points. In contrast, 126 to 349 genes were down-regulated a 2-fold or greater in all time-points, excepting 6 hr postinfection. Twenty-three genes were up-regulated a 2-fold or greater over at least four of seven time-points, which were mostly ribosomal proteins and MHCs. Especially, MHCs including HLA-DRA were steadily up-regulated from 24 hr postinfection. Thirty genes were down-regulated a 2-fold or greater in all the time-points, which were mainly related with synthesis and metabolism. These results show that host cell gene expression was altered by HIV-1 infection according to time-points and will provide a framework for studies on interactions between host and HIV-1 infection.
Gene Expression ; HIV-1 ; HLA-DR alpha-Chains ; Immune System ; Metabolism ; Oligonucleotide Array Sequence Analysis ; Ribosomal Proteins ; RNA ; RNA, Messenger

Left ventricular thrombosis is a frequent and potentially dangerous complication in acute myocardiac infarction, but its occurrence and adequate therapy has not been known in patients with Dor procedure for the ischemic cardiomyopathy. We report a patient, 45 year-old male, who had a new left ventricular thrombus developed after coronary arterial bypass graft, Dor procedure, and removal of the left ventricular thrombus for ischemic cardiomyopathy. Left ventricular thrombus was disappeared on the follow-up cardiac MRI following intravenous heparin injection and oral coumadin therapy. This case suggest that anticoagulation therapy may prevent patients with the severe left ventricular dysfunction and apical aneurysm and dyskinesia from developing the left ventricular thrombus, and that thrombi will resolve without clinical evidence of systemic embolism.
Aneurysm ; Cardiomyopathies ; Dyskinesias ; Embolism ; Follow-Up Studies ; Heart Aneurysm ; Heparin ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Thrombosis* ; Transplants ; Ventricular Dysfunction, Left ; Warfarin

The major manifestations of aplastic anemia are characterized by persistent bone marrow aplasia and peripheral pancytopenia due to defective stem cells in which differentiation is not curtailed or preferential elimination of stem cells with self-renewal capacity, which results in serious complications such as bleeding and infection. Recent advances in the therapeutic modalities, such as bone marrow transplantation and immunosuppressive therapy, and in supportive measures as component transfusion and infection control with better quality of antibiotics resulted in an improved survival and subsequently increased possibility of complications which need surgical intervention. Considering the fact that surgery may not only control complications, but offers the opportunity to give effective therapy for aplastic anemia and therefore improves chances for survival, it is strongly suggested that active surgical intervention should be performed. We report a case of patient with aplastic anemia who had been performed surgical intervention of partial maxillectomy for the squamous cell carcinoma on maxilla without serious complications during perioperative and postoperative period.
Anemia, Aplastic* ; Anti-Bacterial Agents ; Bone Marrow ; Bone Marrow Transplantation ; Carcinoma, Squamous Cell* ; Hemorrhage ; Humans ; Infection Control ; Maxilla ; Pancytopenia ; Postoperative Period ; Stem Cells

PURPOSE: To establish the incidence of deep vein thrombosis among Koreans after primary total hip arthroplasty and the usefulness of color doppler ultrasonography for routine noninvasive screening for deep vein thrombosis. MATERIALS AND METHODS: We performed prospective, randomized routine venography and color doppler ultrasonography before and after operation in a consecutive series of 89 primary total hip arthroplasty in which no form of prophylaxis was used. RESULTS: Of the 89 cases, eleven (12.4%) were found to have deep vein thrombosis (three proximal veins and eight distal veins) by bilateral venography. Most of the thromboses except two were asymptomatic. No patient had a symptomatic pulmonary embolism. Statistical analysis of risk factors, age, gender, weight, height, fixation method, and duration of operation time, were performed and there was no statistical difference (P>0.05). The reliability of color doppler ultrasonography for detection of deep vein thrombosis was demonstrated. CONCLUSIONS: We found insufficient evidence to recommend routine thromboprophylaxis in primary total hip arthroplasty among Koreans. The authors recommend that routine bilateral color doppler ultrasonography screening be considered after primary total hip arthroplasty for detection of deep vein thrombosis
Arthroplasty, Replacement, Hip* ; Humans ; Incidence ; Mass Screening ; Phlebography ; Prevalence* ; Prospective Studies ; Pulmonary Embolism ; Risk Factors ; Thrombosis ; Ultrasonography, Doppler, Color ; Veins ; Venous Thrombosis*