BACKGROUND: Evidence has accumulated that opioids can produce potent antinociceptive effects by interacting with opioid receptors in peripheral tissues. Bupivacaine is potent analgesic with early peak onset in the postoperative period. The combination of intra-articular bupivacaine and morphine has been suggested as an ideal analgesic after knee arthroscopy. METHODS: Thirty patients scheduled for knee arthroscopy under general anesthesia were allocated randomly to two groups. Group 1 received morphine 5 mg in normal saline 25 ml, group 2 received morphine 5 mg in 0.25% bupivacaine 25 ml intraarticularly, and all solutions contained 1:200,000 epinephrine. Tourniquet was inflated above knee joint for 10 minutes after injection in each of the patients. Postoperative pain was assessed using the visual analogue scale at 1, 2, 3, 4, 6, 12 and 24 hours after the intra-articular injection. The need for supplemental analgesic was recorded. RESULTS: Patients in the group 2 had lower pain scores than group 1 at first and second hour. There were no significant differences from 3 hours to 24 hours postoperative period. Supplemental analgesic requirements were significantly greater in group 1 than group 2 for the first 3 hours. CONCLUSIONS: It is concluded that, after knee arthroscopy, intra-articular morphine 5 mg in 0.25% bupivacaine 25 ml results in satisfactory analgesia with small amount of supplementary analgesic.
Analgesia ; Analgesics, Opioid ; Anesthesia, General ; Arthroscopy* ; Bupivacaine ; Epinephrine ; Humans ; Injections, Intra-Articular ; Knee Joint* ; Knee* ; Morphine* ; Pain, Postoperative ; Postoperative Period ; Receptors, Opioid ; Tourniquets

No abstract available.
Typhlitis*

The clinicopathologic and immunohistochemical finding of 10 cases of nasal non-Hodgkin's lymphoma (NHL) and 23 cases of Waldeyer's ring NHL were studied. Immunohistochemically, nasal NHL expressed T-cell markers exclusively, whereas the NHL of Waldeyer's ring were of both T-cell (56.5%) and B-cell lineages (43.5%). Angioinvasiveness by tumor cells was exclusively noted in the T-lineage lymphomas. Epithelial hyperplasia, epitheliotropism by tumor cells, and extensive invasion of adjacent normal tissue were more prominent in T-cell lymphomas than in B-cell lymphomas. T-lineage lymphomas showed distant extranodal spread pattern involving the skin, soft tissue, stomach, spleen, and the liver, whereas B-lineage lymphomas tended to localize in the lymph nodes. The survival rate of Nasal NHL was similar to that of Waldeyer's ring NHL. Although not statistically significant because of small sample numbers, immunophenotype, histologic groups of monomorphic lymphoma, and stage had prognostic importance. In general, T-lineage lymphomas presented with a higher stage than B-lineage lymphomas (p < 0.05)-and overall survival was poor. Stage I disease showed a much more favorable prognosis than stage II disease. Monomorphic lymphomas had a shorter survival than polymorphic reticulosis (PR) or lymphomas with features of PR. This result in conjunction with the morphologic transition between them suggested that monomorphic lymphoma may represent the most advanced stage in the spectrum of PR, lymphoma with features of PR, and monomorphic lymphoma.
Adolescent ; Adult ; Aged ; Female ; Humans ; Immunophenotyping ; Lymphoma, Non-Hodgkin/mortality/*pathology ; Male ; Middle Aged ; Nasal Cavity/*pathology ; Neoplasm Invasiveness ; Neoplasm Staging ; Nose Neoplasms/mortality/*pathology ; Retrospective Studies ; Survival Rate ; Tonsillar Neoplasms/mortality/*pathology

BACKGROUND: It has been reported that etomidate has the relaxant effects on vascular, tracheal, and non-pregnant uterine smooth muscle in vitro. The purpose of this study was to investigate the relaxant effects of etomidate on the contraction of the pregnant rat uterine smooth muscle. METHODS: Uterine muscle tissues were obtained from pregnant rats (n = 15). The uterine segments were mounted in organ baths filled with Krebs solution. After oxytocin-induced contractile activity had been established, etomidate in incremental concentrations (10(-7) to 10(-3) M) was added cumulatively to the bath, each administered 20 min apart, and resultant changes in contractile activity were continuously recorded. EC5 (effective concentration of 5% reduction), EC25, EC50, EC75, and EC95 on active tension were calculated using a probit model. RESULTS: Etomidate (10(-7) to 10(-3) M) induced dose-dependent decreases in amplitude and frequency of uterine contraction. The EC50 of etomidate on active tension were 5.91 x 10(-5) M. CONCLUSIONS: These results demonstrate that etomidate had inhibitory effects on pregnant rat uterine muscle at supraclinical concentration (5.91 x 10(-5) M).
Animals ; Baths ; Contracts ; Etomidate ; Female ; Isotonic Solutions ; Mice ; Muscle, Smooth ; Myometrium ; Oxytocin ; Rats ; Uterine Contraction

BACKGROUND: Surgical trauma is a potent stimulus for the neurohormonal axis. The catecholamine response to surgical stress may be modulated by the anesthetic regimen utilized. We compared the hemodynamic response and catecholamine concentration to lower abdominal surgery during anesthesia with propofol or enflurane. METHODS: Forty six patients undergoing lower abdominal surgery were assigned randomly to two groups. In group I, anesthesia was induced with thiopental sodium 5.0mg/kg and maintained with enflurane-N2O. In group II, anesthesia was induced with propofol 2.0mg/kg and maintained with propofol 12 mg/kg/min by infusion pump. Hemodynamic responeses were recorded at tracheal intubation. Blood samples for later determination of plasma catecholamine were drawn and hemodynamic responses were recorded at preinduction, 1 minute after skin incision, 30minutes after skin incision. RESULTS: There was no statistical significance in systolic and diastolic pressure between two groups. There was statistical significance in heart rate 30minutes after skin incision between two groups. There was no statistical significance in epineprine concentration between two groups. There was statistical significance in norepineprine 30 minutes after skin incision between two groups. CONCLUSIONS: Propofol may be useful alternative at lower abdominal surgery and it may be convenient and safe intravenous anesthetics.
Anesthesia* ; Anesthetics ; Anesthetics, Intravenous ; Axis, Cervical Vertebra ; Blood Pressure ; Enflurane* ; Epinephrine ; Heart Rate ; Hemodynamics ; Humans ; Infusion Pumps ; Intubation ; Plasma ; Propofol* ; Skin ; Thiopental

BACKGROUND: Epidurally administered clonidine produces analgesia by an alpha 2-adrenergic mechanism and may provide postoperative analgesia without nausea, pruritus and respiratory depression associated with opioid administration. Many studies have shown the beneficial effects of epidural clonidine in postoperative pain management. Pre-administered epidural analgesic agent before the skin incision may prevent the nociceptive input. We provided the pre-emptive analgesia and compared the postoperative analgesic effects of epidural clonidine when used as the sole analgesic agent with epidural fentanyl and epidural bupivacaine. METHODS: Thirty-nine gynecologic patients, ASA physical status 1, 2, undergoing elective lower abdominal surgery under general anesthesia, were studied. They were not taking any premedications. Before anesthesia, an epidural catheter was inserted at the L2~3 interspace. Patients were divided into 3 groups randomly. Group 1 received 0.125% bupivacaine 20 ml through the epidural catheter, group 2 received 100 microgram fentanyl in normal saline 20 ml, and group 3 received 150 microgram clonidine in normal saline 20 ml. During the operation, we recorded the vital signs and side effects. Just before suturing peritoneum, we injected the corresponding drugs on individual groups through the epidural catheter. In the recovery room, the postoperative analgesia was assessed by VAS (visual analogue scale). Vital signs, sedation score and side effects were also checked. RESULTS: VAS and systolic blood pressure were significantly lower in group 3 than group 1 or group 2 at the recovery room. The diastolic blood pressure, heart rate and sedation score were not significantly different between three groups at the recovery room. Also the vital signs during the operation were notsignificantly different between three groups. The incidence of hypotension was 3 out of 13 in group 3 and 1 out of 13 in group 1. CONCLUSION: Epidural bolus clonidine 150 microgram produces more profound and longer postoperative analgesic effects than fentanyl 100 microgram or 0.125% bupivacaine at the lower abdominal surgery. But hypotension may occur more frequently. So, if we select the patient cautiously, epidural clonidine is a good alternative analgesic agent for the postoperative analgesia.
Analgesia ; Anesthesia ; Anesthesia, General* ; Blood Pressure ; Bupivacaine ; Catheters ; Clonidine* ; Fentanyl ; Heart Rate ; Humans ; Hypotension ; Incidence ; Nausea ; Pain, Postoperative ; Peritoneum ; Premedication ; Pruritus ; Recovery Room ; Respiratory Insufficiency ; Skin ; Vital Signs

Renal oncocytoma is a rare, benign tumor, which is characterized by homogenous oncocytic cellular features without central necrosis or hemorrhage regardless of its size. Necrosis, although absence of which is emphasized in the most literatures, can rarely occur in oncocytoma. We reported here a case of renal oncocytoma in a 46-year old man, which tumor of his right kidney had exceptionally massive central necrosis and hemorrhage.
Adenoma, Oxyphilic* ; Hemorrhage* ; Humans ; Kidney ; Middle Aged ; Necrosis*

BACKGROUND: Intrathecal injection of analgesic agents such as opioids, clonidine, ketamine and nalbuphine with a local anesthetic produces analgesia in patients. Recently, the analgesic effect of intrathecal neostigmine has been investigated; however, the use of epidural neostigmine has not been investigated. The purpose of this study was to define the analgesic effectiveness and the side effects of epidural neostigmine. METHODS: Forty patients undergoing a total abdominal hysterectomy were divided into 4 groups. After intramuscular 0.1 mg/kg midazolam premedication, patients were randomized to receive epidural bupivacaine with saline (control group), 1 microgram/kg epidural neostigmine (Group I), 2 microgram/kg epidural neostigmine (Group II), or 3 microgram/kg epidural neostigmine (Group III) postoperatively. The concept of the visual analog scale, which consisted of a 10-cm line with 0 equaling "no pain at all" and 10 equaling "the worst possible pain" was introduced. Pain was assessed by using the visual analog scale at 1, 3, 6, 9, 12, and 24 h postoperatively, and intramuscular 90 mg diclofenac was available at the patient's request. RESULTS: The visual analog scale score at first rescue analgesic and the incidence of adverse effects were similar among neostigmine groups. The analgesic consumption in 24 hours and the pain visual analog scale score at 3 h, 12 h, and 24 h were significantly decreased in neostigmine groups compared with control groups. CONCLUSIONS: Epidural neostigmine coadministered with bupivacaine produces a dose-independent analgesic effect compared to the control group and a reduction in postoperative rescue analgesic consumption without increasing the incidence of adverse effects.
Analgesia ; Analgesics ; Analgesics, Opioid ; Anesthesia, General* ; Bupivacaine* ; Clonidine ; Diclofenac ; Humans ; Hysterectomy ; Incidence ; Injections, Spinal ; Ketamine ; Midazolam ; Nalbuphine ; Neostigmine* ; Premedication ; Visual Analog Scale

The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements.