BACKGROUND: Caudal anesthesia is considered a safe and reliable anesthetic technique for many pediatric surgical procedures. It is well known that extradural clonidine produces analgesia in adult. The purpose of this study is to assess its efficacy in children. METHODS: We randomized 45 pediatric patients aged under 10 years, weighted under 25 kg presented for lower abdominal surgery with duration of operation would be shorter than 2 hours, into three groups of 15 each. After sedation with the use of intravenous thiopental sodium, caudal anesthesia was performed with the use of 1 mL/kg of 0.25% bupivacaine. We allocated randomly the patients who received no additional medication in 0.25% bupivacaine (group I), with epinephrine 1/200,000 (group II), and with 1 mcg/kg of clonidine (group III). The degree of postoperative analgesia was evaluated using the Broadman ""Objective Pain/discomfort Scale"" (OPS) at hourly intervals for 24 hours. RESULTS: Duration of sleep in the recovery room was significantly longer in group III than in group I and group II, and statistical significant difference was found between the group I and group II. Duration of analgesia was significantly longer in group III than in group I and group II. Overall hourly OPS scores were lower in group III than in group I and group II. CONCLUSION: Duration of postoperative analgesia with caudal bupivacaine was increased by addition of 1 mcg/kg of clonidine.
Adult ; Analgesia ; Anesthesia, Caudal* ; Bupivacaine ; Child ; Clonidine* ; Epinephrine ; Humans ; Recovery Room ; Thiopental

Large cell neuroendocrine carcinoma (LCNEC) of the lung is a newly recognized entity of pulmonary neuroendocrine carcinoma. Histologically, it is very difficult to differentiate LCNEC from other pulmonary carcinomas and the prognosis is significantly poor. The cutaneous metastasis of LCNEC of the lung shares some features with Merkel cell carcinoma of the skin in light microscopy and yet it is negatively stained with cytokeratin 20. We report a case of cutaneous metastasis of LCNEC of the lung, previously misdiagnosed as squamous cell carcinoma. Our patient showed a poor response to the chemotherapy and also revealed a brain metastasis on follow-up brain CT scan.
Brain ; Carcinoma, Merkel Cell* ; Carcinoma, Neuroendocrine* ; Carcinoma, Squamous Cell ; Drug Therapy ; Follow-Up Studies ; Humans ; Keratin-20 ; Lung* ; Microscopy ; Neoplasm Metastasis ; Prognosis ; Skin ; Tomography, X-Ray Computed

BACKGROUND: Sore throat is one of the most common complications of intubation. There are many factors that affect the incidence of sore throat and the succinylcholine-induced myalgia. Our study is to reveal the influences of these factors on the postoperative sore throat and the succinylcholine-induced myalgia. METHODS: One thousand and seven patients in ASA class I or II undergoing elective surgery under general anesthesia were studied, except patients undergoing brain surgery, open heart surgery, operation in oro-, naso-pharynx and larynx, and uncooperated psychiatric. We checked age, sex, patient controlled analgesia and nasogastric tube, size and kind of tube, operation position, duration of intubation and anesthetic agent. At 24~38 hours after operation, the patients were questioned about pre- and postoperative sore throat, or myalgia. RESULTS: Sore throat after endotracheal intubation developed more frequently in woman (32.8%) than man (25.9%). The older the patients, the lower the incidence of sore throat (p<0.05). The longer the anesthesia duration, the lower the incidence of sore throat (p<0.05). Succinylcholine, patient controlled analgesia, nasogastric tube, endotracheal tube, operation position, maintenance anesthetic agents and the amount of smoking did not affect the incidence of sore throat. The incidence of succinylcholine-induced myalgia was lower in elderly or patients who were administered nondepolarizing muscle relaxant. CONCLUSIONS: The incidences of sore throat and myalgia were 29% and 15%, respectively. There were significant differences in incidence of sore throat and myalgia depending on the gender, age, duration of operation, but the controllable factors which reduce the incidence of sore throat were not found. Nondepolarizing muscle relaxants could reduce the occurrence of postoperative myalgia.
Aged ; Analgesia, Patient-Controlled ; Anesthesia ; Anesthesia, General ; Anesthetics ; Brain ; Female ; Humans ; Incidence* ; Intubation* ; Intubation, Intratracheal ; Larynx ; Myalgia ; Pharyngitis* ; Smoke ; Smoking ; Succinylcholine ; Thoracic Surgery

Supraglottic airway devices (SADs) have become prevalent in children because they avoid many of the adverse effects associated with endotracheal intubation. The laryngeal mask airway (LMA) Classic and the LMA Proseal have proven safe and efficacious for routine cases in pediatric patients. The LMA Proseal provides a better airway seal and protection against aspiration than the LMA Classic in children. Most SADs are designed for airway maintenance during routine anesthesia, but other roles include rescue airway after failed intubation, conduit to facilitate difficult intubation and as an adjunct device for special situations in or outside the hospital (e.g., neonatal resuscitation). Recently developed second-generation SADs, the i-gel and the LMA Supreme may be a suitable alternative for airway management when a single-use device with gastric access is needed in children. The Air-Q intubating laryngeal airway may be feasible as a conduit for tracheal intubation for pediatric patients with a difficult airway. This review article discusses the safety and efficacy of SADs in children.
Airway Management ; Anesthesia ; Child* ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks

BACKGROUND: Cyclosporin A (CsA), a potent immunosuppressant, has been reported to be effective in the treatment of severe atopic dermatitis (AD). OBJECTIVE: The aim of this study was to evaluate the efficacy and side-effects of CsA in Korean patients with severe AD. MATERIALS AND METHODS: 16 patients with recalcitrant AD took CsA for at least 6 weeks. Among them, 11 patients were followed up for more than 16 weeks. Initial dose was 5mg/kg/day (maximum 300 mg/day) and the dose was reduced according to their therapeutic responses. SCORAD (Scoring AD) was used to evaluate clinical efficacy of CsA. During the 1st month of therapy, the therapeutic efficacy and side-effects were evaluated every 2weeks and after 1 month, every month. We checked blood pressure and laboratory abnormalities including liver function test, blood urea nitrogen (BUN), creatinine (Cr) and urinalysis at each visit in addition to observing clinical adverse effects. RESULTS: Significant reduction of SCORAD was noted in 15 patients after 6 weeks of CsA therapy. Only one patient stopped CsA therapy because of the elevation of blood pressure. Three patients showed albuminuria, which disappeared after CsA dose reduction. CONCLUSION: CsA can be used effectively and safely in severe Korean AD patients. Albuminuria seems to be a peculiar side-effect in Korean patients.
Albuminuria ; Blood Pressure ; Blood Urea Nitrogen ; Creatinine ; Cyclosporine* ; Dermatitis, Atopic* ; Humans ; Liver Function Tests ; Urinalysis

No abstract available.
Myasthenia Gravis* ; Thymectomy*

BACKGROUND: The large volume of blood products are required during orthotopic liver transplantation. Any preoperative and intraoperative factors may influence the intraoperative blood products usage. METHODS: We retrospectively reviewed the demographic information, coagulation screens, thrombelastographic variables, and intraoperative blood requirements in 952 adult patients, who underwent orthotopic liver transplantation at the University of Pittsburgh Medical Center between January 1992 and December 1995. A preoperative coagulation abnormality score (CAS) was calculated by assigning one point of each abnormal result of the coagulation tests (PT, aPTT, platelet count) and thrombelastographic variables (reaction time, alpha angle, maximal amplitude, clot lysis index). Intraoperatively, blood products and pharmacologic coagulation therapy were administered based on thrombelastographic and hemodynamic data. RESULTS: Underlying liver disease, retransplantation one month after the first transplantation, poor preoperative coagulation profiles were predictive of intraoperative blood usage. Age, preoperative PT >15 sec, and CAS were not predictive of intraoperative blood usage. The severe fibrinolysis during operation occurred. More blood products were required in patients with severe fibrinolysis. CONCLUSIONS: The understanding of preoperative and intraoperative factors affecting blood product requirements can help the management of blood component therapy during liver transplantation.
Adult ; Blood Platelets ; Fibrinolysis ; Hemodynamics ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Retrospective Studies ; Risk Factors*

Painful fat hemiation is characterized. by the soft, skin colored painful papules on the heels that appears only when weight is bome and disappears when weight. is taken off the heels. The papules were thought to be caused by hemiation of adipose tissue through connective tissue defect. To our knowledge, such a case or similar one has not been reported previously in Korea. The patient was 30 year-old housewife, who have had soft, skin colored painful papules on the medial aspect of the both heels when weight was placed on the foot. Routine laboratory findings were within normal limit. Skin biopsy revealed nodules of lobulated adipose tissue on the mid-dermis far above the original subcutaneous tissue and large venous channels with thick muscular walls. Hypertrophied peripheral nerve trunks were scattered adjacent to the above vascular structure. Diagnosis was confirmed by clinical and histopathological features. Literatun was briefly reviewed.
Adipose Tissue ; Adult ; Biopsy ; Connective Tissue ; Diagnosis ; Foot ; Heel ; Humans ; Korea ; Peripheral Nerves ; Skin ; Subcutaneous Tissue

PURPOSE: Detrusor instability (DI) is a main cause of persistent voiding difficulty after TURP in patients with benign prostatic hyperplasia (BPH). So we retrospectively estimated the effect of TURP in BPH patients with DI. MATERIALS AND METHODS: Of the 81 patients who had undergone TURP due to prostatism, 35 patients with BPH were followed at 3 weeks and 6 months postoperatively (21 without DI cases vs. 14 with DI; 6 persistent DI, 7 resolved DI, 1 missing case at 3 weeks and 4 persistent DI, 7 resolved DI, 2 missing cases at 6 months). We compared each group using symptom score (IPSS) and urodynamic parameters. RESULTS: Each irritative and obstructive symptoms were significantly improved in both group (p<0.05). The maximal flow rate (from 12.2 to 25.4ml/sec), average flow rate (from 8.9 to 15.2ml/ sec), residual urine volume (from 135.9 to 39.1ml) in patients without DI and maximal bladder volume (from 150.0 to 203.7ml), maximal flow rate (from 12.5 to 18.6ml/sec), residual urine volume (from 65.7 to 26.0ml) in patients with DI were improved significantly (p<0.05) after TURP, but other parameters were not improved (p>0.05). There were no significant differences in all parameters between 3 weeks and 6 months postoperative period (p>0.05). The amplitude of improvement had no significant difference between two group. There were no significant differences in IPSS and urodynamic parameters between persistent and resolved DI group. CONCLUSION: We suggest that TURP is good therapeutic option even in BPH patients with DI at short term postoperative period, but attempt to predict which patients would have persistent DI following TURP was failed.
Humans ; Postoperative Period ; Prostatic Hyperplasia ; Prostatism ; Retrospective Studies ; Transurethral Resection of Prostate* ; Urinary Bladder ; Urodynamics*

BACKGROUND: The prognostic value of motor evoked potentials(MEP) by transcranial magnetic timulations(TMS) in acute stroke has not been well established. To determine the value of MEP as predictors of motor and functional recovery we examined correlations of neurophysiological measurements of central motor conduction time(CMCT) and functional assessments. METHOD: A longitudinal study was performed on 32 first-ever acute ischemic stroke patients. The cortical and cervical motor evoked potentials(MEPs) along with the degree of extremity weakness, the NIH stroke scale, and the Barthel index were performed in the period immediately following stroke and after 3-4 months of the onset. RESULTS: Five groups of patients were divided on the basis of MEP responses following the cortical stimulation; initial normal response following the normal one (group I; 11), initial delayed response following a normal or still delayed one (group II; 3/group III; 0), and an initial absent response with the reappearance of CMCT or still absent one (group IV; 8/group V; 10). Patients in group I,II and IV had consistently lower scores in motor weakness degree and NIH scale and higher scores in the Barthel index both at initial and follow-up studies, and achieved significantly better functional recovery(p<0.01). CONCLUSIONS: Discordant results of MEP in predicting the prognosis of stroke may result from the disregard of group IV, which had previously been considered as a poor outcome group solely because no cortical MEP responses were recorded at the initial study. As the MEP alone during the acute stage could not differentiate group IV from group V which had a persistent absence of cortical MEP responses, the evaluation of the neurological deficit at the same time is needed for better prediction of prognosis.
Evoked Potentials ; Evoked Potentials, Motor* ; Extremities ; Follow-Up Studies ; Humans ; Longitudinal Studies* ; Prognosis ; Stroke*