The computed tomography (CT) number is closely related to hematocrit level according to many of the previous reports. We measured the CT number in various organs, such as the frontal white matter, basal ganglia, occipital white matter, cerebrospinal fluid, liver, abdominal aorta, spleen, kidney, and psoas muscle. We correlated the CT numbers of the organs with hematocrit levels which were graded into 10% increments (20.0-29.9%, 30.0-39.9%, 40.0-49.9%). Thus the change of CT numbers in various organs according to the hematocrit level was analyzed. The increased CT numbers according to the 10% increment of hematocrit in the frontal white matter, basal ganglia, occipital white matter, liver, abdominal aorta, spleen, and psoas muscle were 1.3, 1.5, 1.6, 3.3, 5.3, 3.8, 2.4 respectively. Even though the CT numbers of the cerebrospinal fluid and kidney were not influenced by hematocrit level the CT numbers in most of the there organs postitively correlated with hematocrit level. Therefore, it was concluded that in the differential diagnosis using CT numbers, the hematocrit level of patient must be taken into consideration.
Aorta, Abdominal ; Basal Ganglia ; Cerebrospinal Fluid ; Diagnosis, Differential ; Hematocrit* ; Humans ; Kidney ; Liver ; Psoas Muscles ; Spleen ; White Matter

BACKGROUND: Epidural anesthesia (EA) has become most popular for cesarean section, but has some drawbacks such as incomplete block, inadequate muscle relaxation and delayed onset. Combined spinal epidural anesthesia (CSEA) has gained an increasing interest as it combines a reliability of the spinal block and the flexibility of an epidural block. We investigated the efficacy of CSEA which combines main spinal and supporting epidural anesthesia, comparing with pH adjusted EA, for cesarean section. METHODS: Sixty four pregnant women at full term were divided into two groups. Group 1 (n=32) received CSEA with 1.5~1.6 ml of 0.5% hyperbaric bupivacaine intrathecally, followed 10 minutes after by 10 ml of 0.25% plain bupivacaine through the epidural catheter. Group 2 (n=32) received EA with 20~25 ml of 2% lidocaine which was added 0.1 ml of 0.1% epinephrine, 100 microgram of fentanyl and 1.5 ml of 8.4% sodium bicarbonate. The quality and side effects of surgical anesthesia, neonatal state and postoperative course were compared between two groups. RESULTS: While 22% (7 cases) of Group 2 complained of intraoperative pain but none of Group 1 did (p=0.011). Muscle relaxation and motor block were much better in group 1 (p<0.001 and p=0.011 each). Significantly more women in group 2 had shivering (p=0.001) and they also had nausea and vomiting more, though that difference is not significant. Not only time to T4 (9.7 vs. 8.3 min., mean, p<0.001), but also stay at PACU, recovery of sensory and motor block and start of postoperative pain were all significantly shorter in Group 1. None of both groups had post-dural puncture headache (PDPH). CONCLUSIONS: We can conclude that CSEA, when combining main spinal and supporting epidural anesthesia, has greater efficacy and less side effects for cesarean section than pH adjusted EA.
Anesthesia ; Anesthesia, Epidural* ; Bupivacaine ; Catheters ; Cesarean Section* ; Epinephrine ; Female ; Fentanyl ; Humans ; Hydrogen-Ion Concentration ; Lidocaine ; Muscle Relaxation ; Nausea ; Pain, Postoperative ; Pliability ; Post-Dural Puncture Headache ; Pregnancy ; Pregnant Women ; Shivering ; Sodium Bicarbonate ; Vomiting

The use of osseointegrated implants is an accepted procedure for the treatment of Total, or partial edentulism and offers good predictability of long-term success. Osseointegration implies a firm and direct interlocking between vital bone and screw-shaped titanium implants. There should be not to interposed tissue between fixture and bone. This study was undertaken to assess the clinical condition, complication, and prosthodontic aftercare of different implant systems. One hundred fifty-nine patients treated with a total of 503 endosseous implants (364 Steri-oss threaded type, 69 Integral cylinder with HA coated type, 35 Steri-oss threaded with HA coated type, 21 Steri-oss cylinder with HA coated type and 14 3i implant type), Most of the implant were placed in type B and C bone quantity and type 2 and 3 bone quality according to Lekhorm and Zarb. The success rate of Steri-oss threaded type during healing and function was 92%, Steri-oss threaded type with hydroxyapatite coated was 91%, Steri-oss cylinder type with hydroxyapatite coated was 90%, Integral cylinder type with hydroxyapatite coated was 90% and 3i implant type was 93%. One hundred twenty-nine patients had been treated with implant prosthesis. 79 of these patients had received a fixed type prosthesis and 50 patients had received a removable type prosthesis. There were no differences between the implant systems with regard to age, gender. Failures were associated with poor bone quality, smaller implant sizes, a surgical installation technique and stress distribution when in function. Visual analgoue scales recorded as satisfied results functionally and esthetically, but 15% dissatified with chewing ability.
Aftercare ; Dental Implants* ; Durapatite ; Humans ; Mastication ; Mouth Rehabilitation* ; Mouth* ; Osseointegration ; Prostheses and Implants ; Prosthodontics ; Titanium ; Weights and Measures

BACKGROUND: Intravenous patient-controlled analgesia (IV-PCA) has been widely used for pain relief after cesarean delivery under epidural anesthesia. However, IV-PCA alone has a limited effect on early postoperative pain relief. Epidural morphine injected intraoperatively could alleviate the early postcesarean pain. We evaluated the effects and side effects of intraoperative epidural morphine on postoperative IV-PCA. METHODS: Forty patients scheduled for cesarean section under epidural anesthesia were randomly assigned to one of two groups. The patients in the intravenous group (IV group, n = 20) received intravenous morphine 3 5 mg after the operation in the recovery room when patients complain of pain, and the patients in the epidural group (EPI group, n = 20) received intraoperative epidural morphine 3 mg after fetus delivery. After that, both groups received morphine IV-PCA (no basal infusion, bolus 1.0 mg, lock-out time 6 min). Analgesic efficacy, degree of patient satisfaction, drug consumption and side effects were compared at 4 and 24 hours after surgery. RESULTS: The EPI group had significantly lower VAS for pain at 4h after surgery on movement and resting than the IV group, whereas no significant difference was observed at 24h after surgery. The cumulative morphine consumptions at 4h and 24h after surgery were more in the IV group (each, P < 0.001). Fewer patients in the EPI group had drowsiness at 24h after surgery, but there were no significant differences in other side effects and degree of satisfaction between the two groups. CONCLUSIONS: We conclude that intraoperative epidural morphine was effective with less side effects for postoperative IV-PCA in the cesarean patients under epidural anesthesia.
Analgesia, Patient-Controlled* ; Anesthesia, Epidural ; Cesarean Section ; Female ; Fetus ; Humans ; Morphine* ; Pain, Postoperative ; Patient Satisfaction ; Pregnancy ; Recovery Room ; Sleep Stages

No abstract available.
Carcinoma, Renal Cell*

PURPOSE: This study was performed to evaluate differentiating features of spinal compression fractures between benign and metastatic lesions. MATERIALS AND METHODS: We reviewed MR imaging in 52 patients (benign 38, metastasis 14) with vertebral compression fracture. Signal intensity of fracture and uninvolved areas, presence of contrast enhancement, fragmentation, and paravertebral mass were analyzed retrospectively. RESULTS: Signal intensity of fracture site was variable in benign lesions, but low signal intensity on T1-weighted image and high on T2*-weighted image were seen in all cases of metastasis. Signal intensity of uninvolved area was high on T1-weighted image and low on T2*-weighted image in 84% of benign lesions. On the contrary, normal marrow signal intensity was not seen in the uninvolved areas of all metastatic fractures. Contrast enhancement were observed in all cases of benign & metastatic compression fractures. Fragmentation were seen in 1 case of metastasis(7%) and in 11 cases of benign lesions(29%). Paravertebral mass were seen in 5 cases of metastasis(36%) and in 7 cases of benign lesions(18%). CONCLUSION: Presence of normal marrow signal intensity in the uninvolved area of fracture site could be the most useful sign for differentiating benign causes from metastasis.
Bone Marrow ; Fractures, Compression* ; Humans ; Magnetic Resonance Imaging* ; Neoplasm Metastasis* ; Retrospective Studies

Common peroneal neuropathy during normal delivery is associated with instrumentation and prolonged time spent in a certain position. We report a case of unilateral common peroneal neuropathy in a vaginal delivery patient under labor analgesia with the combined spinal-epidural technique. A 29-year-old woman complained of weakness and numbness of the left foot two days after vaginal delivery. Neurologic examination and electrodiagnostic testing confirmed left common peroneal neuropathy. The patient was referred for rehabilitation, which substantially improved her mobility and function, and prevented secondary damage. The patient had not fully recovered at three months after the delivery. The possible etiology of the postpartum common peroneal neuropathy was most likely prolonged and excessive pressure around the knee by assistants. Excessive compression during delivery should be minimized or avoided. Patient education and awareness among the labor and delivery team will prevent this complication. Neurologic complications related to epidural analgesia should also be ruled out in these patients.
Adult ; Analgesia* ; Analgesia, Epidural ; Female ; Foot ; Humans ; Hypesthesia ; Knee ; Labor, Obstetric ; Neurologic Examination ; Patient Education as Topic ; Peroneal Neuropathies ; Postpartum Period ; Pregnancy ; Rehabilitation

The signal intensity of paranasal sinus mucocele is highly variable, ranging from high to low on both T1 weighted and T2 weighted sequence, This variation is likely due to the combined effects of decreased free water concentration, cross-linking and polymerization of the macromolecular mucus glycoprotein, and increased viscosity. We have experienced three cases of the paranasal sinus mucocele with different signal intensity on Magnetic Resonance Imaging. We describe MR characteristics of the paranasal sinus mucocele and compare with MR characteristics for other paranasal sinus disease.
Glycoproteins ; Magnetic Resonance Imaging ; Mucocele* ; Mucus ; Paranasal Sinus Diseases ; Polymerization ; Polymers ; Viscosity ; Water

BACKGROUND: The combination of a local anesthetic and an opioid has been shown to produce effective epidural labor analgesia. It was reported that the combination of intrathecal opioid and bupivacaine could produce labor analgesia with longer duration and less side effects. This study was done to evaluate the effect of intrathecal bupivacaine mixed with sufentanil for labor analgesia. METHODS: Eighty women requesting labor analgesia were randomly assigned to receive intrathecal 10 mcg of sufentanil (S group, n = 40) or 2.5 mg of bupivacaine plus 10 microgram of sufentanil (SB group, n = 40) diluted in a total volume of 2.2 ml with normal saline. The analgesia was performed using combined spinal-epidural technique in the lateral position. Visual analogue scales (VAS) for pain, sensory changes to cold, duration of analgesia, motor block, hypotension, fetal heart rate, pruritus, and other side effects were assessed for 30 minutes after intrathecal drug injection. RESULTS: There were no significant differences in the VAS pain scores and sensory levels at 5 minutes after intrathecal drug injection between groups. However, VAS pain scores were significantly lower and sensory levels higher in the SB group at 15 minutes and 30 minutes after intrathecal drug injection. The duration of analgesia provided by intrathecal sufentanil (n = 31) was 103.4 41.1 min, by intrathecal sufentanil plus bupivacaine (n = 29) 113.0 32.1 min (P = 0.30). Motor block assessed by a modified Bromage scale was significantly frequent in the SB group (P< 0.001). Not only adverse effects such as hypotension, fetal bradycardia, pruritus, and nausea, but also satisfaction scores were similar in both groups. CONCLUSIONS: The addition of bupivacaine to intrathecal sufentanil produced more frequent motor block and extensive sensory block, but better analgesia. However, duration of analgesia, side effects and satisfaction score did not change.
Analgesia* ; Bradycardia ; Bupivacaine* ; Female ; Heart Rate, Fetal ; Humans ; Hypotension ; Labor Pain ; Nausea ; Pregnancy ; Pruritus ; Sufentanil* ; Weights and Measures

BACKGROUND: Regional anesthesia for cesarean section is associated with a high incidence of nausea and/or vomiting (N&V) during the operation. Metoclopramide and droperidol have been known to be effective in the prevention of N&V. However, they have been reported to induce some adverse effects such as sedation. We evaluated the efficacy of metoclopramide and droperidol in the prevention of N&V in spinal and epidural anesthesia for cesarean section. METHODS: A prospective randomized double-blind study was performed on 180 parturients scheduled for elective cesarean section. They were allocated into spinal or epidural (n = 90, each) anesthesia groups and each group into either a placebo, metoclopramide, or droperidol drug group (n = 30, each). After delivery, 2 ml saline, 10 mg metoclopramide, or 0.625 mg droperidol was given to the parturients, respectively. Incidences of N&V and sedation during the operation were checked, and the other adverse effects of the anesthesias such as hypotension and visceral pain were compared among the groups. The height of sensory blockade was also checked. RESULTS: Epidural anesthesia was more related with N&V than spinal (P = 0.030). Among the groups there was a significant difference in the incidence of N&V (P = 0.002). There were fewer parturients with N&V in the droperidol group than in the placebo group during epidural anesthesia (P = 0.021). During both spinal and epidural anesthesia more parturients in the droperidol group had sedation than placebo or metoclopramide groups (P = 0.0001) and more in the metoclopramide group than in the pacebo group (P = 0.01). No differences were found in incidences of hypotension and in the height of sensory block among the groups. There were more parturients with visceral pain during epidural anesthesia (P = 0.031). CONCLUSIONS: Epidural anesthesia provoked N&V more frequently than spinal anesthesia for cesarean section. Only droperidol was effective in the prevention of N&V during epidural anesthesia, but had a more sedative effect than metoclopramide during either spinal or epidural anesthesia.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, Epidural* ; Anesthesia, Spinal ; Cesarean Section* ; Double-Blind Method ; Droperidol* ; Female ; Hypnotics and Sedatives ; Hypotension ; Incidence ; Metoclopramide* ; Nausea* ; Pregnancy ; Prospective Studies ; Visceral Pain ; Vomiting*