BACKGROUND: Potential benefits from parental presence during induction of anesthesia (PPIA) include reducing the need for preoperative sedatives and avoiding fear and anxiety that may occur on separation to the operating room (OR). In addition, the purpose of PPIA includes concern about possible adverse reactions of parents. The purpose of this study was to evaluate parental satisfaction after PPIA. METHODS: Subjects were obtained by approaching all parents of children from 1 to 7 years admitted for elective surgery. Ninety four pediatric patients were accompanied by their parents to the OR and then their anxiety level was checked. For anesthetic induction, intravenous thiopental sodium or sevoflurane with a mask was administrated. A questionnaire was given to parents after anesthesia and the operation to check the satisfaction of their presence. RESULTS: Over eighty eight percent of parents were satisfied with their presence with their children. However, there were no significant differences between parental satisfaction and the anxiety level of children, type of anesthetic induction or attempts of venipuncture. CONCLUSIONS: We concluded that the participation in induction of anesthesia in pediatrics may be effective in not only relieving anxiety of children but also increasing parental satisfaction.
Anesthesia ; Anxiety ; Child ; Humans ; Hypnotics and Sedatives ; Masks ; Operating Rooms ; Parents* ; Pediatrics ; Phlebotomy ; Surveys and Questionnaires ; Thiopental

One-step apexification using mineral trioxide aggregate (MTA) has been reported as an alternative treatment modality with more benefits than the use of long-term calcium hydroxide for teeth with open apex. However, orthograde placement of MTA is a challenging procedure in terms of length control. This case series describes the sequence of events following apical extrusion of MTA into the periapical area during a one-step apexification procedure for maxillary central incisor with an infected immature apex. Detailed long-term observation revealed complete resolution of the periapical radiolucent lesion around the extruded MTA. These cases revealed that direct contact with MTA had no negative effects on healing of the periapical tissues. However, intentional MTA overfilling into the periapical lesion is not to be recommended.
Adolescent ; Adult ; Aluminum Compounds ; adverse effects ; Apexification ; methods ; Calcium Compounds ; adverse effects ; Dental Fistula ; therapy ; Dental Pulp Necrosis ; therapy ; Drug Combinations ; Female ; Follow-Up Studies ; Foreign Bodies ; etiology ; Gutta-Percha ; therapeutic use ; Humans ; Incisor ; pathology ; Longitudinal Studies ; Male ; Oxides ; adverse effects ; Periapical Abscess ; therapy ; Root Canal Filling Materials ; adverse effects ; Root Canal Obturation ; adverse effects ; Root Canal Preparation ; methods ; Silicates ; adverse effects ; Tooth Apex ; pathology ; Treatment Outcome ; Wound Healing ; physiology

Nausea and emesis are a major side effect and obstacle for chemotherapy in cancer patients. Employ of antiemetic drugs help to suppress chemotherapy-induced emesis in some patients but not all patients. Ginger, an herbal medicine, has been traditionally used to treat various kinds of diseases including gastrointestinal symptoms. Ginger is effective in alleviating nausea and emesis, particularly, for cytotoxic chemotherapy drug-induced emesis. Ginger-mediated antiemetic effect has been attributed to its pungent constituents-mediated inhibition of serotonin (5-HT) receptor activity but its cellular mechanism of action is still unclear. Emetogenic chemotherapy drugs increase 5-HT concentration and activate visceral vagal afferent nerve activity. Thus, 5-HT mediated vagal afferent activation is essential to provoke emesis during chemotherapy. In this experiment, water extract of ginger and its three major pungent constituent's effect on 5-HT-evoked responses were tested on acutely dispersed visceral afferent neurons with patch-clamp methods. The ginger extract has similar effects to antiemetic drug ondansetron by blocking 5-HT-evoked responses. Pungent constituents of the ginger, [6]-shogaol, [6]-gingerol, and zingerone inhibited 5-HT responses in a dose dependent manner. The order of inhibitory potency for these compounds were [6]-shogaol>[6]-gingerol>zingerone. Unlike well-known competitive 5-HT3 receptor antagonist ondansetron, all tested ginger constituents acted as non-competitive antagonist. Our results imply that ginger and its pungent constituents exert antiemetic effects by blocking 5-HT-induced emetic signal transmission in vagal afferent neurons.
Antiemetics ; Drug Therapy ; Ginger* ; Herbal Medicine ; Humans ; Nausea ; Neurons* ; Neurons, Afferent ; Ondansetron ; Receptors, Serotonin, 5-HT3 ; Serotonin* ; Visceral Afferents* ; Vomiting ; Water

BACKGROUND: Significant aortic stenosis of various underlying etiologies presents with similar clinical characteristics and is usually treated with aortic valve replacement. We performed a clinical study to evaluate the clinical characteristics, changes of echocardiographic parameters before and after aortic valve replacement in adult aortic stenosis patients. METHODS: From January 1991 through December 1995, 159 patients underwent aortic valve replacement at Sejong General Hospital. Sixty-two cases(39%) of those patients were pure or predominant aortic stenosis. We observed the clinical characteristics, etiology, operative procedure, perioperative complication and mortality, And we observed the changes of echocardiographic parameters such as mean and peak pressure gradients at aortic valve, ejection fraction, systolic and diastolic left ventricular internal dimensions, left ventricular wall thickness, left ventricular mass index retospectively at preoperative and postoperative periods regularly within 1 month, 1 yr, 3 yrs after operation(mean follow up period : 16 months, 1-36 months). RESULTS: 1) The age of patients ranged from 31 to 71 years(mean 55+/-11), and 60%(37 cases) of them were men. 2) Regarding underlying heart disease, the most common etiology of aortic stenosis was rheumatic valvular heart disease(32 cases, 52%), followed by congenital bicuspid aortic valve(16 cases, 25%) and degenerative change(14 cases,23%). 3) 44 cases(77%) of the patients had dyspnea,12 cases(19%) had chest pain, and 5 cases(8%) had history of syncope at the time of operation. Asymptomatic patient was only 1 case. 4) Seven patients(11%) had associated coronary artery disease, and only 1 case(about 2%) underwent concomitant coronary bypass surgery. 5) Post-operative complications which developed within 1 month were bleedings(8 cases, 13%), arrhythmias(7 cases, 11%) and infections(4 cases, 6%). After 1 month, bleedings related with anticoagulation were most common(7 cases, 11%). Other complications were hemolytic anemia(1 case), and aortic dissection(1 case). There was one surgery related mortality(2%) which happened during operatin due to myocardial ischemia. 6) The size of implanted prosthetic valves ranged from 19 to 25mm(mean 22+/-2mm). Larger valves(23-25mm) showed lower peak(p=0.839) and mean pressure gradients(p=0.019) than smaller valves(19-21mm). 7) We observed that peak and mean pressure gradient, left ventricular internal dimension, and left ventricular mass index had decreased significantly after aortic valve replacement. 8) The average preoperative functional class(2.3) had improved significantly at 1 month after surgery(1.2), and 1 year after surgery(1.0). CONCLUSIONS: In our series, the most common etiology of aortic stenosis was rheumatic valvular disease(52%). The incidence of combined coronary artery disease was 11%, lower than other reports. And only 1 case(2%) underwent concomitant coronary artey bypass graft surgery. The average size of implanted valves was 22mm, and the larger size had lower transaortic peak and mean pressure gradients after operation. The most common perioperative complication was bleeding and mortality rate was about 2%. Echocardiography was useful for evaluation of postoperative changes, such as transaortic peak and mean pressure gradient, left ventricular internal dimension and left ventricular mass index.
Adult* ; Aortic Valve Stenosis* ; Aortic Valve* ; Bicuspid ; Chest Pain ; Coronary Artery Disease ; Echocardiography ; Follow-Up Studies ; Heart ; Heart Diseases ; Hemorrhage ; Hospitals, General ; Humans ; Incidence ; Male ; Mortality ; Myocardial Ischemia ; Postoperative Period ; Surgical Procedures, Operative ; Syncope ; Transplants

Biliary drainage in patients with malignant biliary obstruction relieves jaundice and prevents the development of cholangitis or hepatic failure from biliary obstruction. Therefore, this may result in better quality of life along with survival prolongation. Biliary stent placement is an effective and safe measure for biliary decompression and is preferred than bypass surgery in high risk patients. Entero-biliary perforation-communication is one of the rare complications of biliary stent. We herein report a case of duodeno-biliary perforation-communication in patient with distal cholangiocarcinoma who presented with duodenal ulcer and obstruction, occurring 4 years later from the metallic biliary stent insertion. Patient was managed with a pyloric metal stent and conservative care.
Aged, 80 and over ; Bile Duct Neoplasms/complications/*diagnosis ; Bile Ducts, Intrahepatic/pathology ; Biliary Fistula/*diagnosis/etiology/pathology ; Cholangiocarcinoma/complications/*diagnosis ; Duodenal Diseases/*diagnosis/etiology/pathology ; Female ; Humans ; Intestinal Fistula/*diagnosis/etiology/pathology ; Stents/*adverse effects ; Tomography, X-Ray Computed

OBJECTIVE: Minimal data exist regarding non-operative management of suspected pseudarthrosis after pedicle subtraction osteotomy (PSO). This study reports radiographic and clinical outcomes of non-operative management for post-PSO pseudarthrosis at a minimum 5 years post-detection.METHODS: Nineteen consecutive patients with implant breakage indicating probable pseudarthrosis after PSO surgery (13 women/six men; mean age at surgery, 58 years) without severe pain and disability were treated with non-operative management (mean follow-up, 5.8 years; range, 5–10 years). Non-operative management included medication, intermittent brace wearing and avoidance of excessive back strain. Radiographic and clinical outcomes analysis was performed.RESULTS: Sagittal vertical axis (SVA), proximal junctional angle, thoracic kyphosis achieved by a PSO were maintained after detection of pseudarthrosis through ultimate follow-up. Lumbar lordosis and PSO angle decreased at final follow-up. There was no significant change in Oswestry Disability Index (ODI) scores and Scoliosis Research Society (SRS) total score, or subscales of pain, self-image, function, satisfaction and mental health between detection of pseudarthrosis and ultimate follow-up. SVA greater than 11 cm showed poorer ODI and SRS total score, as well as the pain, self-image, and function subscales (p<0.05).CONCLUSION: Non-operative management of implant failure of probable pseudarthrosis after PSO offers acceptable outcomes even at 5 years after detection of implant breakage, provided SVA is maintained. As SVA increased, outcome scores decreased in this patient population.
Animals ; Braces ; Follow-Up Studies ; Humans ; Joint Deformities, Acquired ; Kyphosis ; Lordosis ; Male ; Mental Health ; Osteotomy ; Pseudarthrosis ; Scoliosis ; Spine

Obstructive colitis is a rare inflammatory condition that occurs in a dilated segment of the colon proximal to an obstructing lesion. A 69-year-old patient presented with abdominal pain and distension. The colonoscopy findings revealed a near total obstruction from sigmoid colon cancer. The mucosa of the obstructive lesion was erythematous and hemorrhagic but normal mucosa was found immediately above the 3 cm long obstructive lesion. The proximal bowel of the normal mucosa showed colitis with hemorrhagic mucosal changes and yellowish exudative plaques. Surgery was performed as a segmental resection after placing a metallic stent to decompress the proximal colonic loop. In conclusion, obstructive colitis should be considered if an ulcero-inflammatory lesion with a colonic obstruction and a skip lesion in the proximal colon are detected.
Abdominal Pain ; Aged ; Colitis ; Colon ; Colonic Neoplasms ; Colonoscopy ; Humans ; Mucous Membrane ; Sigmoid Neoplasms ; Stents

Actinomycosis is a chronic suppurative granulomatous infectious disease caused by actinomyces species that is characterized by formation of characteristic clumps called as sulfur granules. Abdominal actinomycosis is a rare disease and is often difficult to diagnose before operation. Abdominal actinomycosis infiltrating into the abdominal wall and adhering to the colon is even rarer. Most abdominal actinomycosis develops after operation, trauma or inflammatory bowel disease, and is also considered as an opportunistic infection in immunocompromised patient with underlying malignancy, diabetes mellitus, human immunodefidiency virus infection, etc. Actinomycosis is diagnosed based on histologic demonstration of sulfur granules in surgically resected specimen or pus, and treatment consists of long-term penicillin based antibiotics therapy with or without surgical resection. Herein, we report an unusual case of abdominal wall actinomycosis which developed in a patient after acupuncture and presented as abdominal wall mass that was first mistaken for abdominal wall invasion of diverticulum perforation.
Abdominal Wall/surgery ; Actinomycosis/*diagnosis/drug therapy/pathology ; Acupuncture ; Anti-Bacterial Agents/therapeutic use ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

Rectal enema used for diagnostic and therapeutic purposes infrequently causes colitis. In medical practice, enemas are known to incidentally bring about colitis by mechanical, thermal, or direct chemical injuries. Coffee enema is told to ameliorate the constipation in alternative medicine. We hereby report a case of acute colitis resulting from coffee enema, which was presented with severe abdominal pain and hematochezia.
Acute Disease ; Aged ; Coffee/*adverse effects ; Colitis/chemically induced/*diagnosis/pathology ; Colonoscopy ; *Enema ; Gastrointestinal Hemorrhage ; Humans ; Male ; Rectal Diseases/*diagnosis ; Tomography, X-Ray Computed

Rectal enema used for diagnostic and therapeutic purposes infrequently causes colitis. In medical practice, enemas are known to incidentally bring about colitis by mechanical, thermal, or direct chemical injuries. Coffee enema is told to ameliorate the constipation in alternative medicine. We hereby report a case of acute colitis resulting from coffee enema, which was presented with severe abdominal pain and hematochezia.
Acute Disease ; Aged ; Coffee/*adverse effects ; Colitis/chemically induced/*diagnosis/pathology ; Colonoscopy ; *Enema ; Gastrointestinal Hemorrhage ; Humans ; Male ; Rectal Diseases/*diagnosis ; Tomography, X-Ray Computed