No abstract available.
Oncogene Proteins* ; Oncogenes* ; Teratocarcinoma*

Since the introduction of epidural corticoateroid injections for the management of sciaticall, luintosacral radiculopathy has become one of the most common pain problems enco-untered by anesthesiologists. In order to function effectively, anesthesiologiats should be able to: 1) recognize those syndromes which may respond to nerve block: 2) understand the pathophysiology of the conditions being treated and 3) be familiar with alternate ther-apeutic pathways for patientg not responding to merre b1ock. There are many etiologic factors of low back pain and lumbosacral radiculopathy. Particularly, Nerve root compression caused by a protruding disc, a osteophyte or tumors are usually responsible for pain. Neural inflammation, therefore, is considered to play a major role in pain production.The use of local anesthetics in mixture with steroids is believed to break down neural inflammation. Steroids and local anesthetics were injected lumbar or caudal epidmal to 106 patients for the purpose of relieving low back pain and lumbosacral radiculopathy. The resu1ts are as follows : Excellent Pain relieved group : 27 Patients (25.5%) Good Pain relieved group: 49 Patients(46.1%) Fair pain relieved group : IS patients(14.2%) Not effective group : 15 Patients (14.2%).
Anesthetics, Local ; Humans ; Inflammation ; Low Back Pain ; Nerve Block ; Osteophyte ; Pain Management* ; Radiculopathy ; Steroids

Intrathecal administration of morphine for pain relief became popular since Pert, et al (1973) reported the opioid receptors in spinal cord. It is obvious now morphine bas prolonged and profound analgesic effect with few compl-ications but the leant dose which produces sufficient analgsia with insignificant complication is still controversial. The dosage of intrathecal morphine used for postoperative analgesia has varied from 0.1 mg to 2 mg, but significantly low dosage was required br direct intrathecal route than by epidural one to reach the appropriate analgesic CSF concentration. We selected 60 Patients (50 for cesarean section, 10 for total hysterectomy) and divided into 3groups to compare the effects respectively. Group l : 20 patients receiving 0.05mg of intrathecal morphine, Group ll : 20 patients receiving 0.1 mg of intrathecal morphine, Group lll : 20 Patients receiving 0.2 mg of intrathecal morphine The results are as follows ; 1) The analgesic effects of group l and ll were good and similiar, but 2 of group l and 1 of group ll required a single supplementary intramuscular demerol 6 hours after intrathecal morphine injection. The quality of analgesia was judged to be better in group lll than in group I and ll. 2) The duration of analgesia of group lll was a little longer than group I and ll, which showed similar duration. 3) The side effects of group l, ll and lll were similar, but pruritus was noted twice as much in group in lll than in group l and ll.
Analgesia ; Cesarean Section ; Female ; Humans ; Meperidine ; Morphine* ; Pregnancy ; Pruritus ; Receptors, Opioid ; Spinal Cord

Laparoscopic lysis for intraperitoneal adhesion should be performed only in selective patients with small bowel obstruction by experienced surgeons. Current evidence is insufficient to postulate that laparoscopic surgery is safe and effective alternative treatment option for small bowel obstruction.

No abstract available.
Intussusception*

There are many epidemiologic studies to find the tracking phenomenon. In repeated measurement data, a population is said to have tracking phenomenon with respect to particular chracteristic if, for each individual, the relative rank of observed value maintained over time. Understanding tracking phenomena in epidemiologic study is quite important. If the risk factors of chronic disease have tracking phenomenon, early detection of these risk factors can lead to the possibility of early treatment. In this study, we defined tracking as relative maintenance and proposed new measure of tracking by using random coefficient model. We compared our measure with McMahan's using simulation study. And we applied ours to real data. We may conclude that our new measure of tracking is adequate in explaining and dectecting the tracking phenomenon.
Chronic Disease ; Risk Factors

Purpose: This retrospective study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the time interval from symptom onset to surgery and on the operative outcomes of laparoscopic appendectomy for patients with acute appendicitis. Methods: Between October 2018 and July 2021, laparoscopic appendectomy was performed in 502 patients with acute appendicitis admitted to Hallym University Chuncheon Sacred Heart Hospital in Chuncheon, Korea. We compared demographic data, serum levels of inflammatory markers, time to event of appendicitis, and operative outcomes between the pre-COVID-19 and post-COVID-19 pandemic groups. Results: Laparoscopic appendectomy was performed in 271 patients in the pre-COVID-19 group and in 231 patients in the post-COVID-19 group. There were no differences in baseline characteristics, serum inflammatory marker levels, or the proportions of complicated appendicitis between the groups (25.1%, pre-COVID-19 vs. 31.6%, post-COVID-19; P = 0.106).The time intervals between symptom onset and hospital arrival (24.42 hours vs. 23.59 hours, P = 0.743) and between hospital arrival and the start of surgery (10.12 hours vs. 9.04 hours, P = 0.246) did not increase post-COVID-19. The overall 30-day postoperative complication rate did not differ significantly between the groups (9.6% vs. 10.8%, P = 0.650), and the severity of 30-day postoperative complications was also similar in both groups (P = 0.447). Conclusion This study demonstrates that hospitalization and surgeries were not delayed in patients with acute appendicitis and that the operative outcomes of laparoscopic appendectomy did not worsen despite the COVID-19 pandemic.

PURPOSE: Breast carcinoma in young patients has been reported to present with more aggressive biologic characteristics and to behave poorer compared with the disease in older patients. However, the association between the age and the prognosis in premenopausal patients has rarely been reported on. This study aimed to reveal the clinicopathologic characteristics and prognostic significance of young age (age< or =35) for the breast cancer of premenopausal women. METHODS: We retrospectively analyzed 1033 premenopausal women with breast cancer who underwent surgery in our institution between 1985 and 2003. A total of 180 patients were aged >35 years (the younger premenopausal group) and 853 patients were aged >35 years (the older premenopausal group). The clinicopathologic characteristics and treatment outcomes were compared between the younger and older groups. RESULTS: Compared to the older premenopausal group, the younger group showed earlier menarche (15.2+/-19 years old versus 16.0+/-1.7 years old, respectively, p<0.001), larger tumor (3.7+/-2.1cm versus 3.2+/-2.0cm, respectively, p=0.002), more metastatic axillary lymph nodes (3.8+/-7.0 versus 2.4+/-5.7, respectively, p=0.001), more advanced TNM stage (p=0.015), a lower PR positive rate (47.7% versus 59.9%, respectively, p=0.011), and a higher P53 positive rate (71.7% versus 54.9%, respectively, p=0.034). The recurrence rate for the younger group was 26% as compared with 14.4% for the older group. The overall 5-year and 10-year survival rates of younger group were 79.3% and 68.5%, respectively and these of older group were 91.1% and 84.3%, respectively. CONCLUSION: In premenopausal women with breast cancer, patients with an age< or =35 years have a greater chance of having an endocrine non-responsive tumor, and they are more likely present with larger tumor, more metastatic axillary lymph nodes and a more advanced TMN stage. These results show that younger premenopausal patients have a worse prognosis than older premenopausal patients.
Breast Neoplasms* ; Breast* ; Female ; Humans ; Lymph Nodes ; Menarche ; Population Characteristics ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: The usefulness of mechanical bowel preparation (MBP) in colon surgery was recently challenged by many multicenter clinical trials and meta-analyses. The objectives of this study were to investigate current national opinions about MBP and prophylactic antibiotics (PA) and to provide preliminary data for developing future Korean guidelines for MBP and PA administration in colorectal surgery. METHODS: A questionnaire was mailed to 129 colorectal specialists. The questionnaires addressed the characteristics of the hospital, the MBP methods, and the uses of oral and intravenous antibiotics. RESULTS: A total of 73 questionnaires (56.6%) were returned. First, in regard to MBP methods, most surgeons (97.3%) used MBP for a mean of 1.36 days. Most surgeons (98.6%) implemented whole bowel irrigation and used polyethylene glycol (83.3%). Oral antibiotic use was indicated in over half (52.1%) of the responses, the average number of preoperative doses was three, and the mean time of administration was 24.2 hours prior to the operation. Finally, the majority of responders stated that they used intravenous antibiotics (95.9%). The responses demonstrated that second-generation cephalosporin-based regimens were most commonly prescribed, and 75% of the surgeons administered these regimens until three days after the operation. CONCLUSION: The results indicate that most surgeons used MBP and intravenous antibiotics and that half of them administered oral PA in colorectal surgery preparations. The study recommends that the current Korean guidelines should be adapted to adequately reflect the medical status in Korea, to consider the medical environment of the various hospitals, and to establish more accurate and relevant guidelines.
Anti-Bacterial Agents ; Colon ; Colorectal Surgery ; Korea ; Polyethylene Glycols ; Postal Service ; Specialization ; Surveys and Questionnaires

PURPOSE: Anastomotic leakage following surgery is one of the most significant causes of morbidity and mortality. Therefore, prevention of anastomotic leakage is crucial for safe rectal surgery. The aim of this study is to determine the effect of Mallecot(R) insertion on the prevention of anastomotic leakage after low rectal anastomosis. METHODS: From January 2002 to December 2006, 264 rectal cancer surgeries were performed in one center and by one surgeon. Among them, 110 cases whose anastomosis was located below 6 cm from the anal verge were collected and reviewed retrospectively. We made a diverting stoma on 6 out of 20 patients with high risk of anastomotic leakage, and inserted Mallecot(R) on the remaining 14 patients transanally. Removal of Mallecot(R) was done at the 7th postoperative day after a digital rectal examination to identify the completeness of anastomosis had been performed. RESULTS: Totally, anastomotic leakage occurred in 8 of 110 patients (73%). Among the 90 patients without any preventive measures, 7 incidents of anastomotic leakage were observed; on the other hand, 1 of 14 patients with Mallecot(R) insertion suffered anastomotic leakage. In two of the patients with leakage, including 1 in the Mallecot(R) group, the leakage was resolved via percutaneous drainage; in the other 6 patients were reoperated. CONCLUSIONS: The importance of preventing an anastomotic leakage after low rectal surgery cannot be overemphasized to reduce morbidity and to improve the prognosis. In addition, Mallecot(R) insertion may be an alternative method for diverting stoma formation.
Anastomotic Leak ; Digital Rectal Examination ; Drainage ; Hand ; Humans ; Mortality ; Prognosis ; Rectal Neoplasms ; Retrospective Studies