BACKGROUND: One of the main disadvantages of caudal block is the long latent period before a satisfactory blockade is obtained. Many investigators have used various preparations of local anesthetic solutions to improve the speed of onset. This study was performed to evaluate the effectiveness of prewarming of lidocaine HCl for caudal block. METHODS: Fifty healthy young patients (ASA I) were allocated into two groups, A and B. In group A, the local anesthetic solution were injected at room temperature (25 degrees C), while in group B, they were injected at 37oC. All the caudal block were performed using 2% lidocaine HCl 20 ml with fentanyl 100ug and epinephrine 1:200,000. The onset time was defined as the period from completion of injection until the patient first noticed loss of sensation to pin-prick on perianal region. Assessment of sensory loss was made at 15 seconds interval. We have compared the onset of sensory blockade between groups. The duration of analgesia and any significant side effects were also recorded. RESULTS: The onset of sensory blockade was significantly faster in group B (3.5 +/- 0.5 minutes) than group A (6.2 +/- 0.9 minutes). The duration of analgesia were not significantly changed between groups. Side effects of urinary retention, pruritus and nausea were noted between both groups but the difference was not significant. CONCLUSIONS: We have found that the onset time was 44% faster with warm lidocaine-fentanyl mixture (37 degrees C) than with the room temperature (25 degrees C). The improved clinical usefulness was achieved with no increase in side effects. The technique is a safe and effective method to reduce the latency of onset.
Analgesia ; Epinephrine ; Fentanyl ; Humans ; Lidocaine ; Nausea ; Pruritus ; Research Personnel ; Sensation ; Urinary Retention

No abstract available.
Plasminogen Activators* ; Plasminogen* ; Pulmonary Embolism*

The cell cycle is composed of G1, S, G2 and M phase. The transitions between different phases are regulated at checkpoint such as Start(restriction), S phase and mitotic checkpoint. These checkpoints are regulated by specific cyclins and Cdks(cyclin-dependent kinases). Especially, Start checkpoint in late G1 is though to be very important in control of cell cycle. In this study, it was shown various CDKN2(p16ink4A) alteration, including deletions, mutations, down regulations, and performed differential expression of p53, Cdk4, PCNA and pRb in stomach cancer tissues. 1. The frequency of CDKN2 mutations was not observed in the 19 primary stomach cancer tissues. In contrast to the mutations of CDKN2, mRNA levels was showed by Northern blot analysis that expression of CDKN2 was absent or decreased in 10 of the 19(53%) primary stomach adenocarcinoma. Western blot analysis was performed to determine the differential expression of p53, Cdk4, PCNA related to Start checkpoint. Overexpression of p53 was shown 38%, Cdk4 was expressed in all each specimens, and expression of PCNA was not shown. 2. As the other method to determine the differential expression of p53, Cdk4, PCNA and pRb, immunohistochemical analyses were performed on each 14 formalin-fixed and paraffin embedded tumor tissues of stomach adenocarcinoma. p53 overexpression was showed to clear nuclear staining only in tumor cells not in nonneoplastic cells. In staining for cdk4, the tumor was considered to be cdk4 positive if there was nuclear staining in tumor cells, regardless of cytoplasmic staining. PCNA staining for carcinoma tissues showed more intense nuclear staining in tumor cells than in nonneoplastic cells. pRb overexpression was show in tumor cells. Significant differences were observed in the expression of the proteins among the cancers from different anatomic site. Overexpression of adenocarcinomas had high rate of p53(57.1%) and pRb(71.4% ), and low late of cdk4(7.1% ) and PCNA(14.3% ), As these results, deletion of CDKN2 gene in human stomach cancer was not observed but mRNA expression was down regulated in restriction checkpoint, G1 phase. Inactivation of the CDKN2 gene due to hypermethylation may play an important role in development of cancer. And one of the abnormalities in p53, Cdk4, PCNA or pRb function occurs very common in various cancers, especially oral adenocarcinoma, osteosarcoma and squemous cell carcinoma, suggest that components in restriction checkpoint also play an critical role in the carcinogenesis and progression of cancers.
Adenocarcinoma ; Blotting, Northern ; Blotting, Western ; Carcinogenesis* ; Cell Cycle ; Cell Division ; Cyclins ; Cytoplasm ; G1 Phase Cell Cycle Checkpoints ; Genes, p16 ; Humans ; M Phase Cell Cycle Checkpoints ; Osteosarcoma ; Paraffin ; Proliferating Cell Nuclear Antigen ; RNA, Messenger ; S Phase ; Social Control, Formal ; Stomach ; Stomach Neoplasms

BACKGROUND: Recently doubts have been raised regarding the diagnostic significance of some of the minor clinical features of atopic dermatitis (AD) proposed by Hanifin and Rajka. Some of them may be nonspecific and racial difference was suggested. OBJECTIVE: The purpose of this study is to evaluate the diagnostic significance of 14 minor clinical features out of Hanifin and Rajka's 23 minor features of AD in the Korean pediatric population. The significance of 5 more items was evaluated as additional minor features. METHODS: The difference in frequency of the total 19 features of AD was compared between 100 patients with AD and 76 controls. RESULTS: Fourteen of these were shown to be significantly more frequent in patients than in controls including our 5 additional clues such as scalp scaling, postauricular fissure, infraauricular fissure, forehead lichenification, and infragluteal eczema. CONCLUSION: Our study about the minor features may be a valuable guideline for the diagnosis of AD in the Korean pediatric population.
Dermatitis, Atopic* ; Diagnosis ; Eczema ; Forehead ; Humans ; Scalp

BACKGROUND: Recently doubts have been raised regarding the diagnostic significance of some of the minor clinical features of atopic dermatitis (AD) proposed by Hanifin and Rajka. Some of them may be nonspecific and racial difference was suggested. OBJECTIVE: The purpose of this study is to evaluate the diagnostic significance of 14 minor clinical features out of Hanifin and Rajka's 23 minor features of AD in the Korean pediatric population. The significance of 5 more items was evaluated as additional minor features. METHODS: The difference in frequency of the total 19 features of AD was compared between 100 patients with AD and 76 controls. RESULTS: Fourteen of these were shown to be significantly more frequent in patients than in controls including our 5 additional clues such as scalp scaling, postauricular fissure, infraauricular fissure, forehead lichenification, and infragluteal eczema. CONCLUSION: Our study about the minor features may be a valuable guideline for the diagnosis of AD in the Korean pediatric population.
Dermatitis, Atopic* ; Diagnosis ; Eczema ; Forehead ; Humans ; Scalp

Monilethrix is a rare hereditary disorder of hair which was described by smith in 1879. The scalp hair is most frequently affected but the body or sexual hair are rarely affected. The affected hair shows periodic constrictions that break easily, so the hair could not grow more than a few millimetere long. It is thought that the node of the affected hair is normal and the thin internodal segment is deficient in hair matrix. Keratosis pilaris is generally an associated feature. We experienced a case of monilethrix with keratosis pilaris. The 4 years old male patient with monilethrix affected only scalp hair with keratosis. The family history was non-contributory.
Child, Preschool ; Constriction ; Hair ; Humans ; Keratosis* ; Male ; Monilethrix* ; Scalp

Fifty-one consecutive 186 patients with aneurysmal subarachnoid hemorrhage were treated from the day of admission with nimodipine which was given first as an IV infusion at 30ug/kg/hr for 1 week and then orally in a dose of 360mg/day for 2 weeks and compared with 135 patients which were treated without nimodipine for the past 2 years. A comparision based on clinical and radiological variables influencing both the coruse and the outcome of the disease showed no significant difference between the nimodipine treated group and the control group except the delayed timing of surgery in the control group. There was no significant difference in the outcome between the nimodipine treated patients and the patients treated without nimodipine, however in Hung & Hess grade IV patients nimodipine treatment was associated with a significantly better outcome. Nimodipine treatment reduced the occurrence of delayed ischemic deficts(DID) in grade III, IV patients. Significant improvement in the outcome occurred in the nimodipine treated patients with subarachnoid hemorrhage of large amount(Fisher classification III).
Aneurysm* ; Classification ; Humans ; Intracranial Aneurysm ; Nimodipine* ; Subarachnoid Hemorrhage*

Irradiation which acts directly and produces the reactive oxygen radicals by ionizing water molecules, causes significant morbidity and mortality. The muscle is damaged by direct action, oxygen radicals and the alterations of microcirculation and metabolism after irradiation. The changes of SOD immunoreactivities in muscles of the rats after irradiation were observed. The ultrastructural changes of the irradiated muscles with the pretreatment of SOD (superoxide dismutase) or without were also investigated. A total of 60 healthy Sprague-Dawley male rats weighing from 200g to 250g were used as experimental animals. Under urethane (1.15g/kg. IP.2 times) anesthesia,30 Gy irradiation to lower extremities by PICKER-C9 Cobalt-60 teletherapy unit was done. 15,000 unit/kg of SOD was administered intraperitoneally 1 hour before irradiation. The experimental animals were sacrificed 1 day, 3 days, 7 days, 2 weeks and 4 weeks after irradiation. The superficial portions of the mid-belly of the rectus femoris muscles were obtained and sliced into portions, 2 mm in length, 1 mm in width and in thickness. The specimens were prepared by routine methods for the electron microscopic observation. All preparations were stained with uranyl acetate and lead citrate and observed with a Hitachi-600 electron microscope. The other parts of mid-belly of the rictus femoris muscles were sectioned in 14 micrometer thickness with cryostat at -20 degrees C. The immunoreactivities of SOD by use of antihuman Cu, Zn-and Mn-SOD antibodies were observed. The results were obtained as follows . 1. After irradiation, the immunoreactivities of SOD in the rictus femoris muscle were decreased. 2 weeks after irradiation, the immunoreactivities of Cu, Zn-SOD were trace, which was lowest.4 weeks after irradiation, the immunoreactivities were trace or weak. 1 day after irradiation, the immunoreactivities of Mn-SOD were trace, which was lowest. The immunoreactivities of Mn-SOD were increased gradually 4 weeks after irradiation, the immunoreactivities of Mn- SOD were moderate or weak. 2. The ultrastructural changes in the rectus femoris muscles of the rats were getting severer and severer after irradiation. 2 weeks after irradiation, unclear A band and I band, myofibrillolysis, increased and dilated cistemae of sarcoplasmic reticulum and mitochondria with dilated cristae and electron lucent matrix were seen. 4 weeks after irradiation, lysis of sarcomere and increased cisternae of sarcoplasmic reticulum were seen. 3. The ultrastructural changes in the rectus femoris muscles of the rats were getting worse and worse after 3 days of irradiation with the pretreatment of SOD. 2 weeks after irradiation with the pretreatment of SOD, myofibrillolysis, increased and dilated cisternae of sarcoplasmic reticulum and damaged mitochondria were seen. 4 weeks after irradiation with the pretreatment of SOD, the ultrastructures of rectus femoris muscles were recovered to normal. Consequently, after irradiation of 30 Gy, the immunoreactivities of SOD are decreased and SOD attenuates the reversible changes of ultrastructures in muscles.
Animals ; Antibodies ; Citric Acid ; Humans ; Lower Extremity ; Male ; Metabolism ; Microcirculation ; Mitochondria ; Mortality ; Muscles ; Quadriceps Muscle* ; Rats* ; Rats, Sprague-Dawley ; Reactive Oxygen Species ; Sarcomeres ; Sarcoplasmic Reticulum ; Superoxide Dismutase ; Urethane

No abstract available.

Anomalous development of the odonteid precess is an uncommon clinical occurence that can seriously impair the integrity af the atlantoaxial articulation. Absence of the odontoid process may be either congenital or acquired, but clinically the etiology is of little importance as the clinical signs and symptoms and the treatment are identical in both. We experienced a case of congenital absence of the odontoid process and good result was obtained from the posterior atlantoaxial fusion with hale-cast.
Odontoid Process