PURPOSE: The purpose of this study is to evaluate the difference of tear EGF(epidermal growth factor) concentration between in dry eyes and normal ones, and the relationship between the tear EGF concentration and the severity of corneal epithelial lesion in dry eyes. METHODS: In 43 normal eyes and 52 dry eyes, tear samples were collected with polyester rod(Transob) from the lower fornix after topical anesthesia. EGF concentration was determined by ELISA(enzyme linked immunosorbent assay). Other methods of dry eye examination were also used which include Schir-mer I test, measurement of tear film break up time and fluorescein scoring of corneal epithelial lesion. RESULTS: Tear EGF concentration was significantly lower in dry eyes with corneal epithelial lesion than in normal eyes or dry eyes without corneal epithelial lesion(P<0.05). There was a significant correlation between tear EGF concentration and the severity of corneal epithelial lesion in dry eyes(r=-0.65, P<0.05). In dry eyes with corneal epithelial lesion, tear EGF concentration decreased, which was correlated with the severity of corneal epithelial lesion. CONCLUSIONS: These findings suggest that EGF may be included in the therapeutic armamentarium of dry eyes with corneal erosion.
Anesthesia ; Dry Eye Syndromes ; Epidermal Growth Factor* ; Fluorescein ; Polyesters ; Tears*

For anesthesia of sixty children undergoing elective tonsillectomy, we randomly assigned the patients as 2 groups, intravenous propofol for induction and 6-12 mg/kg/hr propofol infusion with 66% nitrous oxide for maintenance(propofol group) or intravenous 4 mg/kg thiopental for induction and inhalation of enflurane with 66% nitrous oxide for maintenance(enflurane group). We compared the effects of two groups for induction time, hemodynamic change, recovery time, and side effects. The results were as follows. 1) Time for loss of eyelid reflex was significantly shorter in enflurane group than in propofol group(P <0.05). 2) Heart rate was increased significantly in both groups at 1 min after intubation, 1 min after operation, 5min after end of operation(P< 0.05). But there were no significant differences between groups. 3) Systolic and diastolic arterial pressure were increased significantly in both groups at 1 min after intubation(P<0.05). But there were no siginificant differences between groups. 4) The recovery time was shorter siginificantly in propofol group than in enflurane group(P< 0.05), and recovery scores according to modified Steward coma scale were higher in propofol group than in enflurane group until 25 min after end of anesthesia(P< 0.05). 5) Pain on injection at induction was siginificantly more frequent in propofol group than in enflurane group(P< 0.05), and excitatory effect during emergence was significantly more frequent in enflurane group than in propofol group(P< 0.05).
Anesthesia ; Arterial Pressure ; Child* ; Coma ; Enflurane* ; Eyelids ; Heart Rate ; Hemodynamics ; Humans ; Inhalation ; Intubation ; Nitrous Oxide ; Propofol* ; Reflex ; Thiopental ; Tonsillectomy*

BACKGROUND: Lidocaine has been used for spinal anesthesia in short surgical procedure. However, transient neurologic symptoms (TNS) frequently occur after spinal anesthesia with lidocaine. Mepivacaine which has a silimar duration of action and rare incidence of TNS may be an alternative to lidocaine for spinal anesthesia. This study was designed to compare the efficacy of hyperbaric 1.5% lidocaine and 1.5% mepivacaine for spinal anesthesia. METHODS: Sixty patients, ASA physical status I or II, scheduled for lower abdominal or lower extremity procedures under spinal anesthesia were randomly allocated into two groups. Lidocaine group received 2% lidocaine 75 mg with 10% dextrose 1.25 ml. Mepivacaine group received 2% mepivacaine 75 mg with 10% dextrose 1.25 ml. After intrathecal injection of the anesthetics, sensorimotor block and recovery, cardiovascular effect and quality of surgical anesthesia were evaluated. TNS was evaluated 1 day after the operation. RESULTS: Both groups were similar with regard to demographic data and surgical procedures. The onset of sensory and motor blocks was similar in both groups. Time to regression to L5 sensory level and complete resolution of motor blockade were significantly prolonged in mepivacaine group than in lidocaine group (p<0.05). The effect of cardiovascular system was similar in both groups. Fentanyl was required for 4 cases only in the lidocaine group. None of both groups developed TNS. CONCLUSIONS: Hyperbaric 1.5% mepivacaine produced longer duration of action than hyperbaric 1.5% lidocaine in spinal anesthesia. This study didn't prove what drug develops a higher incidence of TNS.
Anesthesia ; Anesthesia, Spinal* ; Anesthetics ; Cardiovascular System ; Fentanyl ; Glucose ; Humans ; Incidence ; Injections, Spinal ; Lidocaine* ; Lower Extremity ; Mepivacaine* ; Neurologic Manifestations

BACKGROUND: Intravenous and epidural clonidine both produce intraoperative hemodynamic stability and analgesia. The study was designed to investigate the analgesic effect of epidural or intravenous clonidine as the sole analgesic agent during and after operation. METHODS: Thirty nine patients undergoing total abdominal hysterectomy under general anesthesia with propofol were studied. At induction, clonidine infusion was started at the dose of 5 microgram/kg in 10 ml during 15 min, followed by 1 microgram/kg/hr (5 ml/hr) either by the epidural (n=19) or the intravenous route (n=20). During the operation, increase in blood pressure and heart rate that did not response to propofol (0.5 mg/kg) was treated with fentanyl (1 microgram/kg). Clonidine and propofol were discontinued at the beginning of peritoneal closure. Postoperative analgesia was assessed by patient-controlled analgesia (PCA) requirements and the visual analogue scale at rest and cough 0, 1.5, 3, 6, 12, 18, 24, 36 and 48 after surgery. Sedation score and side effects were also recorded. The concentrations of plasma epinephrine, norepinephrine and glucose were measured before and after clonidine infusion. RESULTS: The total doses of propofol and fentanyl used intraoperatively were not different between the two groups. Epidural and intravenous clonidine maintained the intraoperative hemodynamic stability at the same extent. The concentrations of plasma epinephrine and norepinephrine in the two groups were not increased after the clonidine infusion. Compared with intravenous clonidine, epidural clonidine significantly prolonged the time to first PCA use and reduced the postoperative PCA requirements during the first 12 hours. CONCLUSIONS: Epidural or intravenous clonidine used as the sole analgesic agent provided the hemodynamic stability associated with surgical stimulation without major side effect. Epidural clonidine produces better postoperative analgesia than intravenous clonidine.
Analgesia* ; Analgesia, Patient-Controlled ; Anesthesia, General ; Blood Pressure ; Clonidine* ; Cough ; Epinephrine ; Fentanyl ; Glucose ; Heart Rate ; Hemodynamics ; Humans ; Hysterectomy ; Norepinephrine ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Plasma ; Propofol

Spinal and epidural anesthesia were performed with a 26 gauge, long spinal needle through a 17 gauge Tuohy needle in thirty patients undergoing elective Caesarian section. To study the effects of subarachnoid local anesthetic solution, the thirty patients were classified into 3 groups on the anesthetics used respectively; a group treated with 0,5% hyperbaric tetracaine 10 mg alone (group I), a group treated 0.5% hyperbaric tetracaine 10 mg and fentanyl 10 mg (group II), a group treated 0.5% hyperbaric tetracaine 10 mg, fentanyl 10 ug and epinephrine 0.3 mg (group III). Each group contained 10 patients. The results were as follows. 1) Onset time of analgesia to T10 sensory level was significantly longer in group IlI than in remained groups and that to T4 sensory level was significantly shorter in group II than in other groups (p<0.05). 2) The time recovered from motor and sensory block was significantly longer in group III than in other groups (p<0.05). 3) The time requiring fentanyl from postoperative pain was significantly longer in group III than in other groups (p<0.05). 4) Complications after postoperative pain block were as follows; delayed awakening (3 cases), itching (3 cases), and one was nausea and vomiting. However serious complications such as respiratory depression did not occurred. In summary, We can concluded that use of needle-through-needle method of anesthesia for elective Caesarian section has benifits not only of spinal anesthesia but also of facilitating postoperative pain block.
Analgesia ; Anesthesia ; Anesthesia, Conduction* ; Anesthesia, Epidural ; Anesthesia, Spinal ; Anesthetics ; Epinephrine ; Fentanyl ; Humans ; Nausea ; Needles ; Pain, Postoperative ; Pruritus ; Respiratory Insufficiency ; Tetracaine ; Vomiting

PURPOSE: The purpose of this study was to analyze the relationship between apoptotic index and clinicopathological findings in laryngeal squamous cell carcinomas. MATERIALS AND METHODS: Fourty-one cases of laryngeal squamous cell carcinomas were analyzed for the detection of apoptotic bodies by in situ hybridization. RESULTS: The average apoptotic index was 9.38+/-2.89. The apoptotic indices were 11.26+/-1.86, 8.17+/-2.55, and 4.32+/-2.41 in well differentiated, moderately differentiated and poorly differentiated carcinoma, respectively. The histopathological differences and apoptotic index were statistically significant(p<0.05). But there was no relationship between apoptotic index and T stage, nodal status, recurrence and treatment results. CONCLUSION: The apoptotic index was only related to cellular differentiation. Also these results suggest that the numbers of apoptotic bodies in the tumor tissues can make it possible to presume indirectly the malignant potentiality of the tumor and will help us to understand the biologic behavior of head and neck cancer.
Apoptosis ; Carcinoma, Squamous Cell* ; Head and Neck Neoplasms ; In Situ Hybridization ; Recurrence

BACKGROUND: Lowe and Ernst's square root of time model employs direct injection of liquid agent into breathing circuit for low flow anesthesia. Intermittent injections of the agent by Lowe's method change rapidly arterial partial pressure of the agent and fail to maintain hemodynamic stability to surgical stimuli. We designed to investigate the possibility and safety of low flow anesthesia with continuous infusion of liquid enflurane into breathing circuit. METHODS: Twenty patients, ASA physical status I or II, undergoing gastrectomy under inhalational general anesthesia were randomly divided into two groups. Anesthesia was maintained with a fresh gas flow of O2 500 ml/min and continuous infusion of liquid enflurane. An identical semiclosed Dr ger circle anesthesia system was used to all patients. Liquid enflurane calculated by the Lowe's method (group I) or simplified by patient's weight (group II) was continuously infused directly into inspiratory limb of breathing circuit using syringe pump. Inspiratory and expiratory concentrations of enflurane, enflurane consumptions, hemodynamic parameters, carboxyheomoglobin were checked intraoperatively. Hepatic and renal functions were evaluted postoperatively. RESULTS: Liquid enfurane was initially infused at a rate in ml/hr of 16.1 0.8 weight in kg in group I and 1.0 weight in kg in group II. After 5 minutes the infusion rate was reduced to 20% of this value and then well adjusted to maintain blood pressure within 20% of the reference preoperative value. Enflurane consumptions and recovery time were similar between the two groups. There were no clinical significant changes in arterial blood gas, carboxyheomoglobin, and hepatic and renal functions. CONCLUSIONS: These data show that low flow anesthesia with continuous infusion of liquid enflurane into breathing circuit is safe and effective, and that the infusion method simplified by patient's weight may easily be applied to clinical practice for low flow anesthesia.
Anesthesia* ; Anesthesia, General ; Blood Pressure ; Enflurane* ; Extremities ; Gastrectomy ; Hemodynamics ; Humans ; Partial Pressure ; Respiration* ; Syringes

The prognostic factors for extrahepatic biliary atresia (EHBA) after Kasai portoenterostomy include the patient's age at portoenterostomy (age), size of bile duct in theporta hepatis (size), clearance of jaundice after operation (clearance) and the surgeon's experience. The aim of this study is to examine the most significant prognostic factor of EHBA after Kasai portoenterostomy. This retrospective study was done in 51 cases of EHBA that received Kasai portoenterostomy by one pediatric surgeon. For the statistical analysis, Kaplan-Meier method, Logrank test and Cox regression test were used. A p value of less than 0.05 was considered to be significant. Fifteen patients were regarded as dead in this study, including nine cases of liver transplantation. There was no significant difference of survival to age. The age is also not a significant risk factor for survival in this study (Cox Regression test; p = 0.63). There was no significant difference in survival in relation to the size of bile duct. However, bile duct size was a significant risk factor for survival (Cox Regression test; p = 0.002). There was a significant difference in relation to survival and clearance (Kaplan-Meier method; p = 0.02). The clearing was also a significant risk factor for survival (Cox Regression test; p = 0.001). The clearance of jaundice is the most significant prognostic factor of EHBA after Kasai portoenterostomy.
Bile Ducts ; Biliary Atresia* ; Humans ; Jaundice ; Kaplan-Meier Estimate ; Liver Transplantation ; Prognosis ; Retrospective Studies ; Risk Factors

Posterior lingual mandibular bony defect is rare disease entity. Diagnosis of this entity is almost incidental because it has neither symptoms nor signs. However, it has characteritic features in radiologic images that radiolucent defect located near the mandibular angle. Many of this defects are filled with sublingual salivary gland tissues and some includes fat tissue. Various terms such as aberrant salivary gland defect, mandibular embryonic defect, developmental submandibular bone defect, are available for this disease entity bacause cause of this entity is controversal. Operation for reconstruction of the defect is not necessary except this entity has symptoms or diagnosis of this is unclear. Authors experienced one case of this entity incidentally, and operated for defect reconstruction by osteotomy and filled the defect with hydroxyapatite. The result is satisfactory without any complications.
Diagnosis ; Durapatite ; Osteotomy ; Rare Diseases ; Salivary Glands

The cyto-histologic correlation and cytologic accuracy are reported in thirty cases of consecutive aspirated cells and their biopsied tissues of patients with clinical and neuroradiologic evidences of central nervous system tumors and other lesions investigated at the Pathology and Neurosurgery Department, Korea University Hospital, from Apr. 1987 to Apr. 1988. The series comprised of 17 benign and 12 malignant histopathologically verified brain neoplasms and 1 infectious lesion. In 78% of the cases, the cytologic diagnosis was concordant with the histologic diagnosis provided adequate sample was obtained. In 17 benign tumors, the diagnostic rate was 87% ; the diagnostic accuracy for 12 malignant CNS tumors was 63% cytologically. In almost all cases, differentiation of non-neoplastic lesion from neoplastic one and that of benign tumors from malignant ones were possible. Most discordance stemmed from failure to distinguish different types of malignant tumors. In meningioma, neurilemmoma, pituitary adenoma, and medulloblastoma, cytologic diagnostic accuracy was high, but germinoma, malignant ependymoma, and hemangioblastoma were difficult to diagnose by cytology alone.