BACKGROUND: Tourniquet pain is probably mediated by C-fiber. The ability of fentanyl to interrupt this nociceptive conduction was studied by administering either fentanyl or saline intrathecally along with hyperbaric bupivacaine for spinal anesthesia. METHOD: The incidence of tourniquet pain was evaluated in 60 patients having orthopedic surgery of the lower extremities during spinal anesthesia by administering either 30 mcg fentanyl (group 2) or saline (group 1) along with 0.5% hyperbaric bupivacaine 10 mg. We measured the maximal sensory spread of analgesia to pinprick, the incidence of tourniquet pain, and the sensory anesthesia to pinprick at the onset of tourniquet pain. RESULTS: The average maximal sensory spread of analgesia was the same in both groups (T9). The incidence of tourniquet pain was significantly greater in group 1 (33%) than in group 2 (10%). The sensory levels of anesthesia at the onset of tourniquet pain were not different in two groups. CONCLUSIONS: Intrathecal fentanyl was effective against tourniquet pain for 2 hours of the orthopedic surgery of the lower extremities.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Bupivacaine* ; Fentanyl* ; Humans ; Incidence ; Lower Extremity ; Orthopedics ; Tourniquets*

No abstract available.
Breast Neoplasms* ; Breast*

No abstract available.
Humans ; Peritoneal Dialysis* ; Spinal Cord*

Twenty four patients with gap nonunions of the tibia were treated with the Ilizarov intercalary bone transport method. The purpose of this retrospective study is to evaluate the results and complications in gap nonunions of the tibia treated using the Ilizarov method. There were 22 males and two females with an average age of the 35.8 years(range, 23-63 years). The mean follow up period was 30.2 months(range, 17-70 months). Ten of the 24 patients had no external shortening with bone gap, 13 external shortening with gap and one hemicircumferential defect. On average, the size of bone loss measured 8.2 cm(range, 3-18 cm). Twenty-one of 24 patients were treated by whole segment internal transport(fifteen were proximal fragment transport, five were distal fragment transport, one was proximal and distal fragment transport), one patient by anterior hemicircumferential corticotomy and partial bone fragment internal transport and tow patients by fibula transfer. All patients healed with solid bony union, although twelve patients required bone grafts, eleven at the docking site and one at the distraction site. On average, the healing index was 49 days/cm(range, 18-82 days/cm). There was on relationship between the percentage transport(size of the distraction gap/the transporting fragment length x 100) and healing index. Numerous complications were encountered, most commonly delayed union and pin site infection, Conclusively, the application of Ilizarov techniques to gap nonunions of the tibia was very effective, but required correct technique and careful follow-up examination.
Female ; Fibula ; Follow-Up Studies ; Humans ; Ilizarov Technique ; Male ; Methods ; Retrospective Studies ; Tibia ; Transplants

Intramural duodenal hematoma (IDH) is a quite rare disese entity which results from the collection of blood and body fluid between mucosa and serosa. Various degrees of duodenal obstruction may be caused by IDH as it gradually enlarges and compresses the mucosa against the opposite side of duodenum. The most common cause of IDH is blunt abdominal trauma and the spontaneous IDHs are generally casused by coagulation disorder such as blood dyscrasia, anticoagulation treatment or pancreaticoduodenal aneurysm. The diagnosis is usually made by the typical imaging on abdominal computed tomographic scan with a previous history of blunt abdominal trauma. For spontaneous IDH without coagulation disorder, an abdominal angiogram may be considered to exclude vascular anomalies. Medical treatment is recommended unless the associated visceral injuries require immediate laparotomy. Here, we report a case of acute duodenal obstruction due to IDH which had resolved completely without an operative management.
Aneurysm ; Body Fluids ; Diagnosis ; Duodenal Obstruction* ; Duodenum ; Hematoma* ; Laparotomy ; Mucous Membrane ; Serous Membrane

No abstract available.
Prolactin* ; Prolactinoma* ; Radiosurgery*

An increase has been see in fall injuries at construction sites and in penetrating injuries by iron bars or pipes associated with the fall. In particular, a thoraco-abdominal penetrating injury had the worse prognosis, and multiple organ injury occurred because of blunt trauma associated with fall. Iron bars were the most common penetrating materials, and pipe penetrating injuries were uncommon. However, because the diameter of the pipes were large than those of the bars, penetrating injuries associated with pipes were more often fatal. A secondary thoraco-abdominal injury worsened the prognosis. We reported a case of a 33-year-old man with a thoraco-abdominal trauma secondary to a penetrating injury with a scaffolding pipe following a fall.
Adult ; Humans ; Iron ; Prognosis

An increase has been see in fall injuries at construction sites and in penetrating injuries by iron bars or pipes associated with the fall. In particular, a thoraco-abdominal penetrating injury had the worse prognosis, and multiple organ injury occurred because of blunt trauma associated with fall. Iron bars were the most common penetrating materials, and pipe penetrating injuries were uncommon. However, because the diameter of the pipes were large than those of the bars, penetrating injuries associated with pipes were more often fatal. A secondary thoraco-abdominal injury worsened the prognosis. We reported a case of a 33-year-old man with a thoraco-abdominal trauma secondary to a penetrating injury with a scaffolding pipe following a fall.
Adult ; Humans ; Iron ; Prognosis

STUDY DESIGN: A retrospective study. PURPOSE: To comparatively investigated the rate of the adjacent segment degeneration and the clinical outcomes in patients with spondylolytic spondylolisthesis, spinal stenosis or degenerative spondylolisthesis. OVERVIEW OF LITERATURE: There have been few studies reported on the adjacent segment degeneration following posterior lumbar interbody fusion(PLIF). Many risk factors for the adjacent segment degeneration following PLIF have been proposed. The range of decompression has been presented as one of the risk factors, yet controversial. METHODS: This study enrolled sixty-three patients who had been treated with single-level PLIF and who were followed up for more than two years. The patients were divided into 3 groups based on the preoperative diagnosis. We analyzed the difference between the preoperative and postoperative intervertebral disc heights of the superior adjacent segments. The incidence rates of instability and the clinical outcomes were comparatively analyzed between each group. RESULTS: The average age of the patients was 55.8 years in the spondylolytic spondylolisthesis group, 65.9 years in the degenerative spondylolisthesis group and 60.4 years in the spinal stenosis group. The average follow-up period was 44 months, 43 months and 42 months, respectively. At the last follow-up, compared to the preoperative period, the intervertebral disc height decreased in all three groups. A statistically significant decrease (p < 0.01) was observed only in the spondylolytic spondylolisthesis group and no significant difference was observed between each group (p = 0.41). The incidence rate of instability and the clinical outcome were not significantly different between each group. CONCLUSIONS: Spondylolytic spondylolisthesis with total laminectomy and single-level PLIF showed no significant difference in the superior adjacent segment degeneration and instability, and the clinical outcome as compared to that of partial laminectomy with single-level PLIF for treating degenerative spondylolisthesis or spinal stenosis.
Decompression ; Follow-Up Studies ; Humans ; Incidence ; Intervertebral Disc ; Laminectomy ; Preoperative Period ; Retrospective Studies ; Risk Factors ; Spinal Stenosis ; Spondylolisthesis

BACKGROUND: Urapidil is a new antihypertensive agent known to diminish total peripheral vascular resistance by postsynaptic alpha 1-adrenergic blockade and central sympatholytic activity. The purpose of this study was to determine its effectiveness and safety in preventing hemodynamic responses to endotracheal intubation under general anesthesia. METHODS: Thirty normotensive, ASA physical status I patients for elective surgery were selected randomly. They were divided into three groups(Group 1: control group with saline, Group 2: urapidil 0.4 mg/kg, Group 3: urapidil 0.5 mg/kg, n=10 in each group). The drugs were injected 3 minutes before induction with thiopental sodium(4 mg/kg) and succinylcholine(1 mg/kg). Endotracheal intubation was performed 5 minutes after the drugs injection. After endotracheal intubation, vecuronium 0.1 mg/kg was injected and 50% nitrous oxide in oxygen and 2Vol% enflurane were inhaled. We measured the blood pressure and the heart rate with noninvasive method at one minute interval for 5 minutes. RESULTS: In group 3, no significant increase in systolic blood pressure after endotracheal intubation was noted(p<0.05). Urapidil groups showed increase in heart rate at 1, 2 minutes after urapidil injection(p<0.05) and did not blunt increase in heart rate after endotracheal intubation. The side effects of urapidil(hypotension, dizziness, headache and chest tightness) occured in a patient of group 3. CONCLUSIONS: We found that the blood pressure response was effectively controlled, but the change in heart rate was not controlled by urapidil 0.5 mg/kg injection before induction.
Anesthesia, General ; Arterial Pressure* ; Blood Pressure ; Dizziness ; Enflurane ; Headache ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal* ; Nitrous Oxide ; Oxygen ; Thiopental ; Thorax ; Vascular Resistance ; Vecuronium Bromide