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

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

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*

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*

Traumatic aneurysm is known to be very rare vascular disease. The authors experienced one case of traumatic aneurysm that occured on pericallosal artery after closed head injury. Traumatic aneurysm was suspected by enlarged traumatic ICH on the corpus callosum in brain CT scan and presence of signal voiding at the center of the hematoma in brain MRI scan and then confirmed by transfermoral carotid angiography. Clipped neck of this traumatic aneurysm successfully via interhemispheric approach, we report a case of traumatic pericallosal artery aneurysm with review of literatures.
Aneurysm* ; Angiography ; Arteries* ; Brain ; Corpus Callosum ; Head Injuries, Closed ; Hematoma ; Magnetic Resonance Imaging ; Neck ; Tomography, X-Ray Computed ; Vascular Diseases

OBJECTIVE: To determine the effect of the addition of Vit. D3 (1,25-Dihydroxychole calciferol D3) to the conventional postmenopausal hormone replacement therapy on bone mineral density(BMD) DESIGN: A 2-year retrospective , randomized study Setting : Department of Obstetrics and Gynecology of Catholic university hospital Patients : 388 postmenopausal women were recruited and divided into 5 groups according to treatment regimen; A: conjugated estrogens only treated group(n=146), B : conjugated estrogens and progesterone treated group(n=103), C : conjugated estrogens and Vit.D3 treated group (n=36), D : conjugated estrogens, progesterone and Vit.D3 treated group (n=41), E : control group (n=60). METHODS: The bone mineral density of the lumbar spines and femoral neck were determined by dual-energy X-ray absorptiometry(DEXA) every 2 years. STATISTICS: The difference between before and after treatment was determined by paired t-test. The comparison among the groups were determined by one way ANOVA test and student's t-test. RESULTS: The addition of progesterone to estrogen showed insignificant increase in the lumbar and femoral neck BMD. The addition of Vit. D3 compared with conventional hormone replacement therapy insignificantly influened bone density in women with initially normal BMD, but definitely increase in women with initially osteopenic and osteoporotic BMD of femoral neck rather than lumar spine(p<0.05). CONCLUSIONS: The use of Vit. D3 combined with postmenopausal estrogen replacement effects the increase of BMD in low bone density than normal bone density, especially femoral neck.
Bone Density* ; Estrogen Replacement Therapy ; Estrogens ; Estrogens, Conjugated (USP) ; Female ; Femur Neck ; Gynecology ; Hormone Replacement Therapy ; Humans ; Obstetrics ; Progesterone ; Retrospective Studies ; Spine ; Vitamins*

PURPOSE: Cost-effectiveness of myocardial SPECT f'or the diagniosis of coronary artery disease was investigated considering the present and amended costs of myocardial SPECT and exercise ECG in Korea. MATERIALS AND METHODS: Four diagnostic tactics such as 1) coronary angiography (CAG) after exercise ECG, 2) CAG after myocardial SPECT, 3) direct CAG, and 4) CAG after myocardial SPECT following exercise ECG were chosen. Costs were calculated using the present costs of various tests and effects represented by Quality Adjusted Life Year (QALY) were estimated. Difference of QALY (deltaQALY) was calculated by subtracting QALY of diagnosed/treated cases from QALY of undiagnosed cases, Cost/delta QALY was calculated and compared between four different tactics according to pre-test probability, RESULTS: When pre-test probability was equal to or larger than 0.6, direct CAG was the most cost-effective. When pre-test probability was between 0.2 and 0.6, CAG after myocardial SPECT following exercise ECG was the most cost-effective. CAG after myocardial SPECT was the second most cost-effective. Cost-effectiveness was similar when the costs of exercise ECG were doubled or quadrupled. CAG after exercise ECG was always the least cost-effective, CONCLUSION: Myocardial SPECT with or without preceding exercise ECG was the most cost-effective method to diagnose coronary artery disease in the present or expected amended cost system.
Coronary Angiography* ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis* ; Electrocardiography* ; Korea* ; Perfusion* ; Quality-Adjusted Life Years ; Tomography, Emission-Computed, Single-Photon*