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BACKGROUND: Propofol and alfentanil are frequently combined to provide total intravenous anesthesia (TIVA). The goals of this study were to determine the target plasma concentration (predicted plasma concentration) of propofol required to provide satisfactory anesthesia in the presence of nitrous oxide over a range of alfentanil infusions for analgesia and to determine the dosing rates required to achieve adequate anesthesia. METHODS: Sixty patients undergoing plastic surgery were anesthetized with 50% nitrous oxide, alfentanil (0 [A0 group] or 5ng/kg loading followed by 0.12ng/kg/min [A5 group] or 10ng/kg loading followed by 0.25ng/kg/min [A10 group] or 20ng/kg loading followed by 0.5ng/kg/min [A20 group]) and propofol using a target-controlled infusion (TCI). The mean target concentration and infusion rate of propofol, and induction and recovery time according to changes of the alfentanil regimen were checked. RESULTS: Induction and recovery time were prolonged in the A0 group more than other groups, and recovery time was shortened in the A10 group more than the other three groups (P < 0.05). The infusion rate and mean target concentration of propofol had significant impact among the groups (P < 0.05). Side effects did not differ among the groups. CONCLUSIONS: The optimal target plasma propofol concentrations and infusion rates of alfentanil, both with satisfactory intraoperative anesthetic conditions and speed of recovery, are 3.51, 3.02, 2.35ng/ml and 0.12, 0.25, 0.5ng/kg/min with 5, 10, 20ng/kg loading in plastic surgery patients. We recommand 0.25ng/kg infusion with 10ng/kg loading of alfentanil combined with 3.02ng/ml of target plasma concentration of propofol as the best combination dosage to shorten recovery time.
Alfentanil* ; Analgesia ; Anesthesia ; Anesthesia, Intravenous ; Humans ; Nitrous Oxide ; Plasma ; Propofol* ; Surgery, Plastic*

We measured serum levels of CA-125 and Tissue polypeptide antigen(TPA) in 135 patients with pelvic tumors(129 benign pelvic tumors and 6 malignant ovarian tumors) preoperatively. Each tumor marker was measured by immunoradiometric assay. Serum CA-125 levels of 35.0U/ml, 65.0U/ml and TPA levels of 80.0U/ml, 100.0U/ml were determined as cut-off values. The results were evaluated by each tumor marker and two tumor markers coincidently. The results were as follows : (continue)
Humans ; Immunoradiometric Assay ; Biomarkers, Tumor

BACKGROUND: Ketamine is a noncompetitive antagonist that blocKs the ion channel coupled to the N-methyl-D-aspartate receptor. This class of drugs may be useful for treatment of acute postoperative pain due to prevention of central sensitization of nocieceptors. We examined the effect of adding Ketamine to a patient-controlled epidural analgesia (PCEA) regimen. METHODS: Sixty parturients undergoing a Cesarean section received lumbar epidural anesthesia using 0.75% ropivacaine with 50ng of fentanyl and a PCEA using 0.15% ropivacaine and 50ng/mL of butorphanol with the addition of Ketamine 50 mg (K50, n = 20), 100 mg (K100, n = 20), or without (control, n = 20). The PCEA device was programmed to deliver 4 mL of a regimen (total 300 mL of solution with 0.15% ropivacaine plus 50ng/mL of butorphanol) with a 10 minute locKout interval. Visual analogue pain score, side effects and PCEA drug consumption were checKed during 48 hours postoperatively. RESULTS: PCEA drug consumption and incidence of nausea and vomiting were decreased by 25% and 25% (K50) and 35% and 29% (K100) compared with the control group. The severity of sedation was increased in the K50, and K100 groups more than the control group (P < 0.05). There were no differences in visual analogue pain score and other side effects among the groups. CONCLUSIONS: We conclude that adding low-dose Ketamine in a PCEA regimen using ropivacaine and butorphanol decreases the consumption of the PCEA drug and the incidence of nausea and vomiting and increases the severity of sedation.
Analgesia, Epidural ; Anesthesia, Epidural ; Butorphanol ; Central Nervous System Sensitization ; Cesarean Section ; Female ; Fentanyl ; Incidence ; Ion Channels ; Ketamine* ; N-Methylaspartate ; Nausea ; Pain, Postoperative ; Pregnancy ; Vomiting

PURPOSE: To evaluate the radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies. MATERIALS AND METHODS: Thirteen patients with fourteen cases of carotid-vertebrobasilar anastomosis collectedfrom January 1992 to December 1997 were reviewed. Clinical diagnosis refered for cerebral angiography werecerebral infarction(n=3), intracranial hemorrhage(n=2), subarachnoid hemorrhage(n=1), brain tumor(n=3),arteriovenous malformation(n=3) and trigeminal neuralgia(n=1). Cerebral angiograms and clinical symptoms wereretrospectively analyzed. RESULTS: The fourteen carotid-vertebrobasilar anastomsis consisted of eleven cases ofpersistent trigeminal artery and three cases of type I proatantal intersegmental artery. Persistent trigeminalarteries were associated with anterior communicating artery aneurysm(n=1), posterior fossa arteriovenousmalformation(n=2) and persistent trigeminal artery variant(n=5). Type I proatantal intersegmental arteries wereassociated with hypoplastic vertebral arteries(n=2) : only proximal segment in one, and proximal and distalsegments in one case. Only one patient had clinical symptom related to the carotid-vertebrobasilar anastomosiswhich was trigeminal neuralgia. CONCLUSION: Knowledge of the anatomical and radiologic findings ofcarotid-vertebrobasilar anastomosis and associated anomalies will aid in the accurate diagnosis of neurovasculardisease and prevent possible complications during surgical and interventional procedures.
Arteries ; Brain ; Cerebral Angiography ; Diagnosis ; Humans ; Trigeminal Neuralgia

Ankylosis ; Arthroplasty ; Humans ; Jaw ; Joint Diseases ; Mandibular Condyle ; Prostheses and Implants ; Temporomandibular Joint Disorders ; Temporomandibular Joint

Parathyroid carcinoma is very rare malignant neoplasm, accounting for less than 0.005% of all cancers. Most parathyroid carcinoma is a functioning tumor that causes hyperparathyroidism, leading to hypercalcemia. We report a parathyroid carcinoma case that was suspicious for spontaneous infarction of cancer, leading to resolution of hypercalcemia. A 29-year-old male visited our hospital presenting with right neck swelling and pain. He has been experiencing frequent urolithiasis for four years but laboratory tests showed normal serum calcium level. Right vocal cord paresis was identified with laryngoscopy. Ultrasonography revealed a 3.7 × 3.5 cm mass in the right thyroid containing a focal cystic portion. Computed tomography confirmed the presence of a low-density right thyroid mass. Right thyroid lobectomy was performed and pathological evaluation revealed parathyroid carcinoma with central necrosis. We report this very rare case with a literature review.

OBJECTIVES: With the observation of factors influencing depression, self-reported happiness, self-reported stress and suicidal attempt, this study compared and evaluated the mental health of adolescents from multicultural families and monocultural families in Korea. METHODS: This study compared the characteristics of adolescents from multicultural and monocultural families based on the analysis of data of The Tenth Korea Youth Risk Behavior Web-based Survey and analyzed the factors influencing adolescent depression, self-reported happiness, self-reported stress and suicidal attempt. RESULTS: There was no significant difference in the levels of depression, self-reported happiness, and self-reported stress between adolescents from multicultural and monocultural families. However, suicidal ideation and suicidal attempt were significantly higher in adolescents from multicultural families. CONCLUSION: There was no significant difference between the mental health of adolescents from multicultural and monocultural families. Because depression is the greatest factor for suicidal attempt, and violence has stronger relationship with depression of adolescents from multicultural families, further study is needed to prevent this trend.
Adolescent ; Depression ; Happiness ; Humans ; Korea* ; Mental Health* ; Risk-Taking ; Suicidal Ideation ; Suicide ; Violence

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the neonatal population. The aim of this study is to evaluate surgical indication and prognostic factors of NEC. Clinical data of seventy patients, diagnosed as NEC between January 2000 & January 2007, were reviewed retrospectively. Fifty-seven patients had medical treatment and 7 of them died. Thirteen patients who presented with pneumoperitoneum on plain abdominal film or were refractory to medical treatment received surgical treatment, and 5 of them died. All the expired 12 patients weighed less than 2500g. Twenty out of seventy patients showed thrombocytopenia, and 11 patients of them died. The finding of pneumoperitoneum and thrombocytopenia could be the most important surgical indication. Prematurity, low birth weight and thrombocytopenia were related to a bad prognosis. NEC patients who presents with these findings must be considered for close observation and intensive care.
Emergencies ; Enterocolitis, Necrotizing ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Pneumoperitoneum ; Prognosis ; Retrospective Studies ; Thrombocytopenia

An ectopic parathyroid gland is a major cause of persistent and recurrent hyperparathyroidism. Surgical success depends on accurate preoperative localization of the parathyroid adenoma. We herein report the case of a 52-year-old male patient who suffered from primary hyperparathyroidism for several years. He initially presented with urinary frequency, hypercalcemia, and a ureter stone. Ultrasonography and a 99mTc-sestamibi scan were performed, but failed to localize the parathyroid lesion. Four years later, the patient revisited our hospital, complaining of general weakness, headache, dyspepsia, and recurrent urinary symptoms secondary to persistent primary hyperparathyroidism. In addition, renal function was decreased and severe osteoporosis was found. We performed a 99mTc-sestamibi scan with single photon emission computed tomography (99mTc-MIBI SPECT) and contrast-enhanced neck CT, and detected an ectopic parathyroid adenoma in the upper anterior mediastinum. In conclusion, the combination of both 99mTc-MIBI SPECT and neck CT could permit better preoperative parathyroid localization, especially for mediastinal adenomas.
Adenoma ; Dyspepsia ; Headache ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Male ; Mediastinum ; Middle Aged ; Neck ; Osteoporosis ; Parathyroid Glands ; Parathyroid Neoplasms ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon ; Ureter