As the treatment of chronic non-cancer pain gradually increases, clinicians have more opportunities to encounter opioid prescription. However, guidelines for prescribing opioids for chronic non-cancer pain have never been published in Korea. The present guidelines were prepared by reviewing various research data. In cases in which the data were insufficient, recommendations were presented following discussion among experts affiliated with the Opioids Research Group in the Korean Pain Society. The present guidelines may need to be continuously revised and amended as more clinical evidence is acquired.
Analgesics, Opioid* ; Korea* ; Prescriptions

PURPOSE: The aim of the current study is to assess the spectrum of genetic variation in the BRIP1 gene among Korean high-risk breast cancer patients who tested negative for the BRCA1/2 mutation. MATERIALS AND METHODS: Overall, 235 Korean patientswith BRCA1/2 mutation-negative high-risk breast cancerwere screened for BRIP1 mutations. The entire BRIP1 gene was analyzed using fluorescent-conformation sensitive gel electrophoresis. In silico analysis of BRIP1 variants was performed using PolyPhen-2 and SIFT. RESULTS: A total of 20 sequence alterations including 12 exonic and eight intronic variantswere found. Among the 12 exonic variants, 10 were missense and two were silent mutations. No protein-truncating mutation was found among the tested patients. Among the 10 missense variants, four (p.L263F, p.L340F, p.L474P, and p.R848H) were predicted to be pathogenic by both PolyPhen-2 and SIFT, and these variants were found in five patients. Of the four missense variants, p.L263F, p.L474P, and p.R848H localize to regions between the helicase motifs, while p.L340F resides in an iron-sulfur domain of BRIP1. CONCLUSION: No protein-truncating mutation in BRIP1 was found among the tested patients. The contribution of BRIP1 variants is thought to be minor in Korean non-BRCA1/2 high-risk breast cancer.
Breast Neoplasms* ; Breast* ; Computer Simulation ; Electrophoresis ; Exons ; Genetic Variation ; Hereditary Breast and Ovarian Cancer Syndrome ; Humans ; Introns ; Korea ; Silent Mutation

Benzoylureas are chemical compounds best known for their use as insecticides. Diflubenzuron is one of the more commonly used benzoylurea pesticides. Others include chlorfluazuron, flufenoxuron, hexaflumuron, and triflumuron. They act as insect growth regulators by inhibiting synthesis of chitin in the body of the insect. They have low toxicity in mammals because mammals have no chitin. Chlorfluazuron insecticides, which are mixed with solvent naphatha, are commonly used. Thus we assume that in the presented case mental change outcome of poisoning was connected with toxic effects of solvent naphtha rather than with chlorfluazuron action. Components of solvent naphtha, particularly trimethylbenzenes, exert strong irritant action on the gastric mucosa and are very well absorbed from the gastrointestinal tract. We report on a 67-year-old man with stuporous mentality after intentional ingestion of approximately 200 ml of liquid chlorfluazuron in a suicide attempt. He was discharged after conservative treatments including gastric irrigation, charcoal, mechanical ventilation, hydration, and antibiotics for aspiration pneumonia without complications.
Aged ; Anti-Bacterial Agents ; Charcoal ; Chitin ; Diflubenzuron ; Eating ; Gastric Lavage ; Gastric Mucosa ; Gastrointestinal Tract ; Humans ; Insecticides ; Insects ; Juvenile Hormones ; Mammals ; Pesticides ; Pneumonia, Aspiration ; Poisoning* ; Respiration, Artificial ; Stupor ; Suicide

To investigate kinetics of free 177Lu and 177Lu-labeled thermally cross-linked superparamagnetic iron oxide nanoparticles (TCL-SPION), suspensions were intravenously injected into the tail vein of mice at a dose of 5 microCi/mouse or 15 mg/kg body weight, respectively. Free 177Lu radioactivity levels were highest in kidney followed by liver and lung 1 day post-injection. 177Lu-labeled TCL-SPION radioactivity in liver and spleen was significantly higher compared to that of other organs throughout the experimental period (p < 0.05). Radioactivity in blood, brain, and epididymis rapidly declined until 28 days. Based on these results, TCL-SPION could be a safe carrier of therapeutics.
Animals ; Body Weight ; Brain ; Epididymis ; Iron* ; Kidney ; Kinetics ; Liver ; Lung ; Male ; Mice ; Mice, Inbred ICR* ; Nanoparticles* ; Radioactivity ; Spleen ; Suspensions ; Veins

Percutaneous epidural neuroplasty may lead to complications such as hematoma, infection, epidural abscess, meningitis, hypotension, respiratory depression, urinary and fecal dysfunction, sexual dysfunction and paresthesia. Other technical complications may include shearing or tearing, misplacement, blockage and migration of the catheter. We report a case of a 41-year-old female patient, who underwent surgical removal of a sheared catheter, which was retained for 30 months after cervical Racz neuroplasty.
Adult ; Catheters* ; Epidural Abscess ; Epidural Space* ; Female ; Hematoma ; Humans ; Hypotension ; Meningitis ; Neck ; Paresthesia ; Respiratory Insufficiency

BACKGROUND: Comprehensive knowledge of the anatomical features of trigeminal schwannomas (TSs) is essential in planning surgery to achieve complete tumor resection. In the current report, we propose a modified classification of TSs according to their location of origin, shape, and extension into the adjacent compartment, and discuss appropriate surgical strategies with this classification. METHODS: We retrospectively analyzed 49 patients with TS who were treated surgically by a single neurosurgeon at the Asan Medical Center between 1993 and 2013. RESULTS: There were 22 males and 27 females, with the median age of 40 years (range, 21-75 years). Median tumor size was 4.0 cm in diameter (2.0-7.0 cm). Tumors were classified as follows: Type M (confined to the middle fossa; 8 cases, 19.0%), P (confined to the posterior fossa; 2 cases, 4.8%), MP (involving equally both middle and posterior fossae; 5 cases, 11.9%), Mp (predominantly middle fossa with posterior fossa extension; 6 cases, 14.3%), Pm (predominantly posterior fossa with middle fossa extension; 16 cases, 38.1%), Me (predominantly middle fossa with extracranial extension; 4 cases, 9.5%). Surgical approach was chosen depending on the tumor classification. More specifically, a frontotemporal craniotomy and extradural approach with or without zygomatic or orbitozygomatic osteotomy was applied to M- or Mp-type tumors; a lateral suboccipital craniotomy with or without suprameatal approach was applied to the majority of P- or Pm-type tumors; and a posterior transpetrosal approach was used in four tumors (three Pm and one MP). Gross total resection was achieved in 95.9% of patients, and the overall recurrence rate was 4.1% (2 patients). Postoperatively, trigeminal symptoms were improved or unchanged in 51.0% of cases (25 patients). Surgical complications included meningitis (5 patients) and cerebrospinal fluid leakage (3 patients). There was no mortality. CONCLUSION: TSs are well to be classified with our modified classification and able to be removed effectively and safely by selecting appropriate surgical approaches.
Cerebrospinal Fluid ; Chungcheongnam-do ; Classification* ; Craniotomy ; Female ; Humans ; Male ; Meningitis ; Mortality ; Neurilemmoma* ; Osteotomy ; Recurrence ; Retrospective Studies ; Trigeminal Nerve

A total of 631 species of spiders have been reported in Korea. However, there are no spiders with noxious venom such as Latrodectus sp. Because of this, to date, no serious medical problems due to spider bites have been reported in Korea, and only two cases of spider bite were officially reported. However, as the number of earning spiders from other countries is increased, the number of cases of spider bite has also shown a recent increase. A 17-year-old man presented with numbness of both extremities after being bitten by a spider which he had as a pet. The spider is called an Indian ornamental tree spider (Poecilotheria regalis sp.), one kind of tarantula species. Herein, we report on a case of a spider bite by a tarantula.
Adolescent ; Extremities ; Humans ; Hypesthesia ; Korea ; Spider Bites* ; Spider Venoms ; Spiders ; Venoms

This study was investigated the change of concentration and toxicity of thermally cross-linked superparamagnetic iron oxide nanoparticles (TCL-SPION) on tissues of Sprague-Dawley rats. TCL-SPION at the dose of 15 mg/kg body weight was intravenously injected into the tail vein of the male Sprague-Dawley rats. The fate of TCL-SPION in serum, urine and tissues was observed during 28 days. Serum iron level was maximal at 0.25 h post-injection and gradually declined thereafter. In addition, the sinusoids of liver and the red pulp area of spleen were mainly accumulated iron from 0.5 h to 28-day post-injection. In kidney, iron deposition was detected in the tubular area until 0.5 h after injection. Malondialdehyde concentration in the liver slightly increased with time and was not different with that at zero time. In the liver and spleen, TNF-alpha and IL-6 levels of TS treated with TCL-SPION were not different with those of the control during the experimental period. From the results, TCL-SPION could stay fairly long-time in certain tissues after intravenous injection without toxicity. The results indicated that TCL-SPION might be useful and safe as a contrast for the diagnosis of cancer or a carrier of therapeutic reagents to treat diseases.
Animals ; Body Weight ; Diagnosis ; Humans ; Indicators and Reagents ; Injections, Intravenous ; Interleukin-6 ; Iron* ; Kidney ; Liver ; Male ; Malondialdehyde ; Nanoparticles* ; Rats ; Rats, Sprague-Dawley* ; Spleen ; Tumor Necrosis Factor-alpha ; Veins

Pulsed radiofrequency treatment has an analgesic effect by neuromodulation of the central pain pathway without neural injury. However, lack of knowledge regarding the exact mechanism on neuropathic pain makes the use of pulsed radiofrequency treatment controversial. Here, we describe a case of satisfactory pain relief after ultrasound-guided pulsed radiofrequency treatment in a patient with supraorbital herpetic pain refractory to medication. This case indicates the potential of ultrasound-guided pulsed radiofrequency treatment in patients with postherpetic supraorbital neuralgia.
Humans ; Neuralgia ; Neuralgia, Postherpetic* ; Pulsed Radiofrequency Treatment* ; Ultrasonography

Free Cy5.5 dye and Cy5.5-labeled thermally cross-linked superparamagnetic iron oxide nanoparticles (TCL-SPION) have been routinely used for in vivo optical imaging. However, there is little information about the distribution and accumulation of free Cy5.5 dye and Cy5.5-labeled TCL-SPION in the tissues of mice. Free Cy5.5 dye (0.1 mg/kg body weight) and Cy5.5-labeled TCL-SPION (15 mg/kg body weight) were intravenously injected into the tail vein of ICR mice. The biodistribution and accumulation of the TCL-SPION and Cy5.5 were observed by ex vivo optical imaging and fluorescence signal generation at various time points over 28 days. Cy5.5 dye fluorescence in various organs was rapidly eliminated from 0.5 to 24 h post-injection. Fluorescence intensity of Cy5.5 dye in the liver, lung, kidney, and stomach was fairly strong at the early time points within 1 day post-injection. Cy5.5-labeled TCL-SPION had the highest fluorescence density in the lung at 0.5 h post-injection and decreased rapidly over time. Fluorescence density in liver and spleen was maintained over 28 days. These results suggest that TCL-SPION can be useful as a carrier of therapeutic reagents to treat diseases by persisting for long periods of time in the body.
Animals ; Carbocyanines/*pharmacology ; Ferric Compounds/*pharmacology ; Fluorescent Dyes/*pharmacology ; Kinetics ; Male ; Mice ; Mice, Inbred ICR ; Nanoparticles/*metabolism ; Time Factors ; Tissue Distribution