BACKGROUND: Epidural morphine has side effects, especially pruritus, nausea, and vomiting. Butorphanol has been added in studies to reduce these side effects in post cesarean patients. The purpose of this study was to evaluate the side effects and analgesic efficacy when a combination of epidural morphine and butorphanol was administered in patients having combined local anesthetic and opioid epidural infusion. METHODS: Sixty patients having epidural anesthesia for cesarean section were randomly divided into two groups. Group M (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and saline 0.75 ml, whereas group B (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and butorphanol 1.5 mg (0.75 ml). Continuous epidural infusion was done by Two-day Infusor containing either 0.25% bupivacaine 75 ml, morphine 5 mg, and saline 20 ml in group M or 0.25% bupivacaine 75 ml, morphine 5 mg, butorphanol 4 mg (2 ml), and saline 18 ml in group B. We compared the side effect and analgesic effect of group M to those of group B for 2 days. RESULTS: The incidence of pruritus and vomiting were reduced significantly in group B (p<0.05). There were no significant differences between both groups in the incidence of nausea or other side effects as well as no differences in analgesic effect. CONCLUSIONS: We conclude that the addition of butorphanol to morphine in combined local anesthetic and opioid epidural infusion for postoperative analgesia decreases the occurrence of pruritus and vomiting without significant increase of other side effects and adverse effect on analgesia.
Analgesia ; Anesthesia, Epidural ; Bupivacaine ; Butorphanol* ; Cesarean Section* ; Female ; Humans ; Incidence ; Infusion Pumps ; Morphine* ; Nausea ; Pregnancy ; Pruritus ; Vomiting

PURPOSE: Viagra(sildenafil citrate) is a new oral medication that selectively inhibits phsphodiestarase-5(PDE5) in the corpus cavernosum to facilitate penile erection for the treatment for male impotence. We report a case of retinal hemorrhage associated with Viagra intake. METHOD: A 71-year-old male without known systemic disease visited with suddenly decreased visual acuity of 4 days duration in the Rt. eye. He intermittenly took 2 tablets of Viagra(50 mg) during 2 months and the symptom occurred 2 days after his last taking of Viagra. His corrected visual acuity was 0.3 in the Rt. eye and 1.0 in the Lt. eye. Several ophthalmologic examination was performed. RESULTS: Fundus exam revealed multiple dot hemorrhage with corresponding block fluorescence in the superior area of macula and superotemporal area of posterior pole. Inferonasal area visual field defect was detected by Goldmann perimetry and ERG finding was decreased maximal scotopic b wave ampitude. Ten weeks later, retinal hemorrhage was almost absorbed, but visual field defect and visual acuity did not improve.
Aged ; Erectile Dysfunction ; Fluorescence ; Hemorrhage ; Humans ; Male ; Penile Erection ; Retinal Hemorrhage* ; Retinaldehyde* ; Tablets ; Visual Acuity ; Visual Field Tests ; Visual Fields ; Sildenafil Citrate

The brachial plexus block by interscalene approach is useful for any procedure on upper extremity, including the shoulder. Complications such as phrenic nerve block, Horner's syndrome, permanent neurologic damage, high epidural block, total spinal anesthesia, pneumothorax and cardiac arrest etc. were reported. We experienced a case of 56-year old male patient with ankylosing spondylitis who developed cervical spinal cord injury following the turning of head for brachial plexus block by interscalene approach. The patient developed quadriplegia and finally died after 28 days.
Anesthesia, Spinal ; Brachial Plexus* ; Head ; Heart Arrest ; Horner Syndrome ; Humans ; Male ; Middle Aged ; Phrenic Nerve ; Pneumothorax ; Quadriplegia ; Shoulder ; Spinal Cord Injuries* ; Spinal Cord* ; Spondylitis, Ankylosing ; Upper Extremity

PURPOSE : To evaluate MR image qualities we developed a new MRI phantom with the fixation structures necessary to position it into coil firmly. MATERIALS AND METHODS : We designed MRI phantom for eight evaluation items such as slice thickness accuracy, high contrast spatial resolution, low contrast object detectability, geometry accuracy, slice position accuracy, image intensity uniformity, percent signal ghosting and signal to noise ratio. For the positioning of phantom at coils, the fixation structures were set up on the surface of phantom. Six different MRI units were used for test the possibility for the clinical application and their image qualities were evaluated. RESULTS : We acquired appropriate MR image qualities enough for the evaluation on all used MR units and confirmed that their evaluations were within reliable values compared to real ones for some items. The positioning of our phantom into head coils with fixation structures worked well for proper imaging. CONCLUSION : We found that our prototype of MRI phantom had the possibility of clinical application for MR image quality assessment.
Head ; Magnetic Resonance Imaging* ; Quality Control ; Signal-To-Noise Ratio

Phakomatosis pigmentovascularis(PPV) was first described in 1947 as a distinctive association of vascular and pigmentary nevi by Ota et al. Hasegawa et al subclassified the disorder into eight types and type I a is characterized by the coexistence of nevus flammeus and nevus pigmentosus et verrucous, which is not associated with systemic organ involvement. PPV type I a is relatively rare and a case with multiple pyogenic granulomas developed in pregnancy, is not reported yet. We present a case of PPV type I a with multiple pyogenic granulomas developed in pregnancy within nevus flammeus in a 29-year-old female.
Adult ; Female ; Granuloma, Pyogenic* ; Humans ; Neurocutaneous Syndromes* ; Nevus ; Port-Wine Stain ; Pregnancy*

Symphysis pubis separation is an uncommon but not rare complication of delivery. Characteristic symptoms of symphyseal separation include suprapubic pain and tenderness which radiate to the back or legs, difficult ambulation, and bladder dysfunction. Clinical history, presenting symptoms, and response to therapy are sufficient to make the diagnosis, although radiographic documentation of symphyseal separation by x-ray or ultrasound are frequently used to confirm the diagnosis. The underlying etiology of symptomatic symphyseal separation has not been fully elucidated. Associations with macrosomia, pathological joint loosening, and increased force placed on the pelvic ring have been suggested as possible etiologies. Conservative therapy, including bed rest, pelvic binders, ambulation devices, and mild analgesics usually result in complete recovery within 4-16 weeks. Our experience of three cases of peripartum symphysis pubis separation delivered from 1998 to 1999 were reviewed with related articles.
Analgesics ; Bed Rest ; Diagnosis ; Joints ; Leg ; Peripartum Period ; Pregnancy ; Ultrasonography ; Urinary Bladder ; Walking

The authors present a 67-year-old man who developed trigeminal neuralia caused by a dolichoectatic vertebrobasilar artery. Brain magnetic resonance imaging showed a tubular structure traversed the anterior surface of the sbrainstem, which compressed the left ven trilateral pons in the region of the trigeminal root entry zone. Vertebral angiography demonstrated a tortuous dilated vertebrobasilar artery. Microvascular decompression of the trigeminal nerve from the dolichoectatic vertebral artery and simultaneous selective trigeminal rhizotomy were performed. Postoperatively, the patient was relieved of pain but suffered a hearing deficit in the ipsilateral side.
Aged ; Angiography ; Arteries ; Brain ; Hearing ; Humans ; Magnetic Resonance Imaging ; Microvascular Decompression Surgery ; Pons ; Rhizotomy ; Trigeminal Nerve ; Trigeminal Neuralgia* ; Vertebral Artery*

OBJECTIVE: Ovarian failure is often common complication by the conditioning protocol used for bone marrow transplantation (BMT). To determine the frequency of recovery of ovarian function after allo-BMT and the major factor that predict recovery, we monitored ovarian function in 24 premenopausal women METHOD: Twenty-four women met the inclusion criteria, which were (1) moderate to severe aplastic anemia before BMT, (2) disease-free at least 18 month after transplantation, (3) age younger than 40 years and more than 3 years after menarche at transplantation and (4) regular menstrual periods before transplantation. Recovery of ovarian function was determined by regular menses without menopausal symptom and sign. we divided conditioning regimen to two groups, Group I : cytoxan alone(n=17), Group II : cytoxan plus total body irradiation (TBI)(n=7). RESULTS: All women became amenorrhea after BMT and the clinical characteristics were not significant between two groups. 17 patients who received only cytoxan all recovered ovarian function between 1 to 14 months(median : 7.28) after BMT. The median age at BMT of women with regained ovarian function was 26 years (range, 21 to 33) versus 30 (range, 21 to 37) for those who did not. The age at transplantation was not significant between two groups in our study and the most predictive independent factor in ovarian recovery is the presence of total body irradiation. None of women who received TBI regained ovarian function during 19-49 month follow up. CONCLUSION: Gonadal insufficiency due to pre-BMT conditioning is more severe in radiation based regimen than cytoxan alone. therefore, we recommend early hormone replacement therapy in radiation treated women to prevent the complication of premature menopause.
Amenorrhea ; Anemia, Aplastic* ; Bone Marrow Transplantation* ; Bone Marrow* ; Cyclophosphamide ; Female ; Follow-Up Studies ; Gonads ; Hormone Replacement Therapy ; Humans ; Menarche ; Menopause, Premature ; Whole-Body Irradiation

Primary carcinoma of the male urethra are rare. Among the malignant tumors of the male urethra, squamous cell carcinoma is the most common. Transitional cell carcinoma is very rare, particularly in the distal urethra. We experienced a case of distal urethral transitional cell carcinoma, arising at the fossa navicularis of the penis, which we report here with a review of the literature. A 68-year-old male patient presented with bloody discharge from the prepuce for 1 month. Ultrasonography showed a poorly marginating, heterogeneous mass, invading the glans penis and the corpus spongiosum. The mass encircled the glandular urethra of the penis glans, and obstructed the glandular urethra and the fossa navicularis. A Doppler ultrasonogram revealed hypervascularity in this mass. The mass was isointense to the corpus carvernosum on the T1-weighted images and slightly hypointense to the corpus carvernosum on the T2-weighted images. Contrast-enhanced MR imaging showed a poorly enhancing mass in the glans penis. This mass was confirmed as a transitional cell carcinoma by histologic study and a partial penectomy was performed.
Aged ; Carcinoma, Squamous Cell ; Carcinoma, Transitional Cell* ; Humans ; Magnetic Resonance Imaging* ; Male ; Penis ; Ultrasonography ; Urethra

In the last decade Computed Tomography(CT) has played a critical role in the diagnostic evaluation of the patients with focal brain injury. But it is apparent from pathologic studies that CT underestimates the severity of the many forms of cerebral injury such as primary brain stem injury, non-hemorrhagic cortical contusion and diffuse axonal injury(DAI). Magnetic Resonance Imaging(MRI), however, has been shown to be highly sensitive in detecting diffuse brain injury(DBI). Among the consecutive 13 cases of DBI patients in this series for 10 months, twelve patients were verified as MR evidence of injury in prospective studies. The anatomical distribution of the injuries were 11 cases of corpus callosal lesion, 6 cases of lobar white matter lesion, 1 case of primary brain stem lesion. The sensitivities of MR imaging in detecting the primary lesion were 76.9%(10/13) in T1WI and 92.3%(12/13) in T2WI. In DBI, patients with callosal injuries had higher incidence(8/12) than lobar white matter and primary brain stem lesion, the corpus callosal atrophy by midsaggital MR imaging and behavioral seguellae in survivous of severe head injury implicate the corpus callosal injury and degeneration. More accurate detection and delineation of traumatic lesions with MR should permit more accurate prediction of neurologic and cognitive recovery and assist in optimizing form of treatment.
Atrophy ; Axons ; Brain ; Brain Injuries* ; Brain Stem ; Craniocerebral Trauma ; Humans ; Magnetic Resonance Imaging* ; Prospective Studies