Intrathecal injection of a small amount of morphine was used to provide obstetric analgesia in 20 primiparous women in labor. When the cervix was 3~4cm dilated approximately, 0.25mg or 0.5mg of morphine was injected intrathecally in each patient. In all parturients, labor pains were completery relieved after 10~60 min and analgesia lasted 8 to 15 hours. The vital signs of all parturients after intrathecal morphine injection were stable. The analgesia was well achieved but there was no alteration of motor power or pinprick sensation. The maternal side effects such as itching, nausea, vomiting, somnolence and urinary retention occured in a high proportion of parturients, but severity of these side effects were mild in most cases. Urinary retention was most severe side effect in our cases. All newborns were scored as having 8~10 on Apgar scores at 1 min after birth.
Analgesia ; Analgesia, Obstetrical* ; Cervix Uteri ; Female ; Humans ; Infant, Newborn ; Injections, Spinal ; Labor Pain ; Morphine* ; Nausea ; Parturition ; Pregnancy ; Pruritus ; Sensation ; Urinary Retention ; Vital Signs ; Vomiting

BACKGROUND: Recently authentic human growth hormone(hGH) has produced in the E coli K-12, W3110 by recombinant DNA tecbnology in Korea In this paper, the clinical efficacy and immunogenicity of this GH was shdied in 38 children with growth hormone deficiency during therapy of 1 year. METHODS: The subjects of this study were aged 4.9-13.9 years, diagnosed by failure of plasma GH to respond to insulin-induced hypoglycemia, arginine and/or L-dopa loading and height below -2 standard deviation of mean for their chronological age. Each patient received GH 0.5-0.7IU/kg/week subcutaneously in 6-7 divided doses. During treatment, vital signs, height, body weight and bone age were checked every 3 months. Complete blood count, urinalysis, blood chemistry and thyroid hormone were checked before and every 6 months. The measurement of serum IGF-1 level and antibody against hGH were performed before and every 6 months during therapy of I year. RESULT: The height velocities significantly increased from 3.3 +/- 1.5cm/year to 10.1 +/- 2.5 and 9.0 +/- 1.8cm/year at 6 and 12 months of therapy, respectively. The height standard deviation score for chronological age were significantly improved from -2.141.50 to -1.74 +/- 1.43 and -1.54 +/- 1.38 at 6 and 12 months of therapy with increasing ratio of bone age to chronological age from 0.72 +/- 0.15 at pretreatment to 0.76 +/- 0.15 at 6 month, 0.79 +/- 0.16 at 12 month of therapy. The plasma IGF-1 level significantly increased during treatment. One of 36 patients(2.8%) showed positive antibody against hGH after 1 year of treatment. During therapy of 1 year, unwanted and remarkable clinical side effect were not observed in all subjects. CONCLUSION: These results indicate that this E. coli derived authentic recombinant growth hormone is very effective in stimulating linear growth in children with growth hormone deficiency.
Arginine ; Blood Cell Count ; Body Height ; Chemistry ; Child* ; DNA, Recombinant ; Escherichia coli ; Growth Hormone* ; Human Growth Hormone ; Humans* ; Hypoglycemia ; Insulin-Like Growth Factor I ; Korea ; Levodopa ; Plasma ; Thyroid Gland ; Urinalysis ; Vital Signs

PURPOSE: To report the change of pupil sizes according to age and illuminance in the normal Korean population. METHODS: Normal Koreans outpatients who never had a history of ophthalmic disease were examined. The patients consisted of 320 eyes of 160 patients, which were classified into 8 age decades (teenage to 80's) with 40 eyes in each age group. The vertical and horizontal pupil size and area under 4 different illuminances (3,500, 1,200, 500, 5 lux) were measured using the Colvard pupillometer(R) (OASIS Medical, Glendora, CA, USA). RESULTS: The pupil size was significantly decreased as the age increased under each illuminance. The pupil area measured after dark adaptation was 47.30 mm2 in the teenage group, 43.32 mm2 in the 20's group, 41.94 mm2 in the 30's group, 40.98 mm2 in the 40's group, 40.61 mm2 in the 50's group, 38.60 mm2 in the 60's group, 37.78 mm2 in the 70's group and 35.45 mm2 in the 80's group. The decrease in pupil area was statistically significant. CONCLUSIONS: In the normal Korean population, a significant decrease in pupil size and area was observed with aging. The present study results provide good basic data for cataract and presbyopia refractive surgery.
Aging ; Cataract ; Dark Adaptation ; Eye ; Humans ; Outpatients ; Presbyopia ; Pupil ; Refractive Surgical Procedures

The internal morphology of the right and left atria of rabbit, cat, pig, and human, particularly on the luminal structures of the auricle, were observed by stereomicroscope improving corrosion casting method using latex. Structures of the right auricular casts markedly differ from those of the left side, consisting of defined surface sturctures with distinct folds and branching patterns. The main atrial region consists of smooth surfaced single mass of the latex, and the auricular region is characterized by well developed branching patte and delicate small folds. The results of this study indicate that auricula have well organized duct-like luminal structures and many small pouches (out-pocketings) expanding the internal wall of the duct-like structures and small pouches. The endocardial nuclear imprints on the surface of the folds in the auricular region appeared larger and deeper than those on the atrium proper region of the atrial cast. These morphological observation will be aid in understanding structures of auricular lumen, regional differences of the endocardium and their function to the secretory process of atrial natriuretic peptide (ANP) release.
Animals* ; Cats ; Corrosion Casting* ; Corrosion* ; Endocardium ; Humans ; Latex ; Methods* ; Phenobarbital* ; Secretory Pathway

BACKGROUND: Diverticulosis of the cecum and ascending colon is a rare disease in Western countries, it is more common in the Orient. Making the diagnosis preoperatively could be difficult, and the intraoperative assessment and decision of optimal treatments are difficult. METHODS: Therefore, we reviewed the patient's charts of diverticulosis of the cecum and ascending colon at our hospital from 1992 to 1997. RESULTS: During the past 5 years, a total of 53 cases of diverticulosis of the cecum and ascending colon had been treated at this hospital. Mean age was 41.8 years (range 20-70). The male to female ratio was 1.8 : 1. Frequent complaints were abdominal pain (46 cases, 86.8%), followed by diarrhea (5 cases, 9.3%), indigestion (4 cases, 7.5%), and bowel habits change (2 cases, 3.8%). Mean duration of illness was 3.5 days(range 24 hours~15 days). In non-surgical cases, diagnoses were established with barium enema, CT scan, or ultrasonography. The accuracy of these methods was 91%, 75%, and 25%. In surgical cases, the preoperative diagnoses were appendicitis(13 cases, 50.1%), diverticulitis (7 cases, 31.8%), and abscess (2 cases, 9.1%). Treatments of the cecum and ascending colon diverticulitis were conservative management (3 teases,58.5%) and surgical treatment (22 cases,41.5%). The operative procedures were right hemicolectomies (2 cases), ileocecal resections (2 cases), diverticulectomies (6 cases) and appendectomies only (11 cases). CONCLUSION: These results suggest that correct diagnosis of the diverticulitis of the cecum and ascending colon made before treatment is very important because correct assessment of diverticulitis intraoperatively is difacut. Liberal use of diagnostic modalities could facilitate to make correct diagnosis to set a proper plan for treatment.
Abdominal Pain ; Abscess ; Appendectomy ; Barium ; Cecum* ; Colon, Ascending* ; Diagnosis ; Diarrhea ; Diverticulitis ; Diverticulum* ; Dyspepsia ; Enema ; Female ; Humans ; Male ; Rare Diseases ; Surgical Procedures, Operative ; Tomography, X-Ray Computed ; Ultrasonography

This study was conducted to see the role of cellular immune function in the pathogenesis of minimal change nephrotic syndrome. Study patients consisted of 19 children with biopsy-proven minimal change nephrotic syndrome, aged 2-15 yr. Controls were 10 age-matched healthy children. The proportion of T4 and T8 in peripheral blood were measured with flocytometer using monoclonal antibodies during relapse and 1 month after remission. Serum soluble interleukin-2 receptor(sIL-2 R) was measured using ELIZA kit in both periods. The following results were obtained: (1) No significant change of serum sIL-2 R was noted between relapse and remission period. Both values of serum sIL-2 R did not show any significant change compared to the control value. (2) The proportion of T8 peripheral blood during relapse significantly increased compared to those of controls or remission period(p<0.01). (3) Increased proportion of T8 during relapse was not related to the history of taking immunosuppressive agent such as cyclophosphamide recently, and not correlated with values of serum albumin or cholesterol during relapse. Conclusively, it can be said that increased proportion of T8 in peripheral blood may play an important role in the pathogenesis of minimal change nephrotic syndrome, and this increment of T8 seems not to be the secondary change caused by cytotoxic therapy or nephrotic syndrome itself.
Antibodies, Monoclonal ; Child* ; Cholesterol ; Cyclophosphamide ; Humans ; Interleukin-2* ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Recurrence ; Serum Albumin

Cardiovascular changes has been reported eating and digestion. Experimental studies showed an early rise in cardiac output during eating which was attributable to an increased heart rate. This changes reverted to baseline valuse at the end of eating. To investigate postprandial cardiac functional change, we studied 20 healthy young men(average age 27 years) nonivasively with BP measurement, electrocardiography and M-mode echocardiohrapy before, 30 minutes and 3 hours after a lunch(600 Kcal). There was no significant changes in mean blood pressure after eating. On echocardiography, diastolic and systolic left ventricular internal dimensions were 4.9+/-0.4 and 3.1+/-0.4cm before meal and 4.9+/-0.4 and 2.9+/-0.3cm 30 minutes after eating. There was an average increase of 9% in cardiac output 30 minutes after meal. Fractional shortening was 36.4+/-6.4% before meal and 40.4+/-6.1(p<0.05) 30 minutes after eating. Ejection fraction changed from 73.5+/-7.9% to 78.2+/-6.3%(p<0.05) at postprandial 30 minutes. Myocardial contractility index assessed by the ratio of systolic BP to end-systolic volume was 4.3+/-1.6mgHg/ml before and 5.3+/-2.2mmHg/ml 30 minutes after eating. Peripheral resistance index as the ratio of mean blood pressure divided by cardiac index changed from 2,536+/-1,120dynesdSdcm-5/m2 to 2,048+/-472dynesdSdcm-5/m2 at postprandial 30 minutes. Electorcardiographic study revealed no changes in ST SE segment, T wave and heart rate after a meal. In conclusion, the increase of cardiac output after a moderate meal in healthy young men was associated with an increase in myocardial contractility and a decrease in peripheral vascular resistance.
Blood Pressure ; Cardiac Output ; Digestion ; Eating ; Echocardiography* ; Electrocardiography ; Heart Rate ; Humans ; Male ; Meals* ; Vascular Resistance

PURPOSE: To report a suprachoroidal hemorrhage by Valsalva maneuver during vitrectomy under general anesthesia. CASE SUMMARY: A healthy 26-year-old man had vitrectomy under general anesthesia due to rhegmatogenous retinal detachment in his right eye. During scleral indentation and endolaser photocoagulation, he took a sudden and severe bucking reflex because the effect of general anesthesia was insufficient. After the bucking reflex, suprachoroidal hemorrhage occurred in his right eye. Immediate IOP elevation and hyperfluorocarbon tamponade was performed to remove the suprachoroidal hemorrhage and reattach the retina and choroid. The patient's corrected visual acuity was 20/50 and slender crescent shaped choroidal rupture remained around the temporal area of the macula, unlike traumatic choroidal rupture. Following fluorescein angiography, staining was evident at the choroidal rupture site; no fluorescein leakage was evident. CONCLUSIONS: We report a case of acute suprachoroidal hemorrhage which we investigated by fundus examination and fluorescein angiography.
Adult ; Anesthesia, General ; Choroid ; Eye ; Fluorescein ; Fluorescein Angiography ; Hemorrhage ; Humans ; Light Coagulation ; Reflex ; Retina ; Retinal Detachment ; Rupture ; Valsalva Maneuver ; Visual Acuity ; Vitrectomy

PURPOSE: To report central retinal vein and artery occlusion after retrobulbar anesthesia for a cataract operation. CASE SUMMARY: A 65-year-old woman was transferred to our facility 4 days after she had undergone cataract extraction with IOL implantation. She could count fingers and had a relative afferent papillary defect in her left eye. As seen upon fundus examination, dot-shaped, circular-shaped irregular, and partially linear-shaped retinal hemorrhages were evident. Fluorescein angiography revealed that branch arteries around the nasal and temporal areas were not filled, and that the filling of veins was delayed. After two weeks, the patient was only able to recognize hand motion, and her intraocular pressure was 10 mmHg. According to a fundus examination, the size and quantity of retinal hemorrhages increased, and a pale, macular edema was observed. Following fluorescein angiography, the filling defect of branch vessels on the nasal and temporal areas was still evident, and the blocked fluorescence of capillaries on the fundus was prominent. After two months, she could still only recognize hand motion, and her intraocular pressure had increased to 35 mmHg; we therefore diagnosed a neovascular glaucoma. CONCLUSIONS: A patient experienced a serious central retinal vessel occlusion after retrobulbar anesthesia for cataract extraction. Retrobulbar injections should therefore be administered with great caution to prevent this outcome.
Aged ; Anesthesia ; Arteries ; Capillaries ; Cataract ; Cataract Extraction ; Eye ; Female ; Fingers ; Fluorescein Angiography ; Fluorescence ; Glaucoma, Neovascular ; Glycosaminoglycans ; Hand ; Humans ; Intraocular Pressure ; Macular Edema ; Retinal Hemorrhage ; Retinal Vein ; Retinal Vessels ; Veins

Endoscopic sphincterotomy(EST) is now an established therapeutic procedure for various disorder of the pailla of Vater, the biliary tract, and the pancreas. From November 1992 to September l993, 123 cases of E.S.T were performed in our hospital. The success rate of EST was 97.8%, and choledocholithiasis was the indication for EST in 63. 4% of cases. Among 78 cases of choledocholithiasis, 47 cases were presence of gall bladder with stone (16 cases) or without stone (31 cases), especially 46 cases were assisted with needle type papillotome and 23 cases were assisted with guidewire. EST hae relatively low complications and is the therapy of choice for choledocholithiasis and various diisease of biliary tract. Guidewire assisted stanard papillotome probable reduce the use of needle type papillotome in the difficult cases that EST with pull type papillotome was impossible.
Biliary Tract ; Choledocholithiasis ; Needles ; Pancreas ; Sphincterotomy, Endoscopic* ; Urinary Bladder