OBJECTIVE: The purpose of this non-randomized prospective study was to evaluate the safety and efficacy of continuous intravenous nalbuphine-ketorolac-droperidol(CIA) versus continuous infusion of epidural morphine-bupivacaine(CEA) for pain control after lumbar spinal surgery. METHODS: Twenty-one patients who underwent spine surgery including laminectomy, fusion with fixation were assigned to receive an intravenous bolus of nalbuphine 5mg and ketorolac 15mg, followed by a continuous infusion of nalbuphine 25mg, ketorolac 105mg, and droperidol 5mg mixed with normal saline 98cc(2cc/hr). Twenty patients received a bolus infusion of morphine 2mg and 0.125% bupivacaine 8cc followed by a continuous intravenous infusion of 100cc 0.125% bupivacaine and morphine sulfate 8.0mg(2cc/hr). Pain score was measured on a visual analogue scale(VAS). It's safety and efficacies were compared with the results of continuous infusion of epidural morphine-bupivacaine, which was reported previously by same authors. A continuous infuser was used to give epidural morphine-bupivacaine and intravenous nalbuphine-ketorolac-droperidol. RESULTS: In general, mild pain, pain less than 3 VAS scores, was observed postoperatively from 30minutes to 72hours in CEA group, and from 6 hours to 72 hours in CIA group. The early postoperative pain was controlled easily in 6 hours in CEA group, compared to CIA group(p<0.05). However, there was no statistical significance in 72 hours on pain scores between CEA and CIA groups after 6-12hours of pain managements. Pruritus, nausea and vomiting, and urinary retention were more frequent in CEA group. CONCLUSION: CIA and CEA are considered effective methods in postoperative pain managements. However, adequate doses in early intravenous infusion and continuous intravenous analgesia with nalbuphine-ketorolac-droperidol will be needed for better control in early postoperative pain with less side effects.
Analgesia* ; Analgesia, Epidural* ; Anesthesia, Epidural ; Anesthesia, Intravenous ; Bupivacaine ; Droperidol ; Humans ; Infusions, Intravenous ; Ketorolac ; Laminectomy ; Morphine ; Nalbuphine ; Nausea ; Pain Management ; Pain, Postoperative ; Prospective Studies* ; Pruritus ; Spine ; Urinary Retention ; Vomiting

PURPOSE: To evaluate the potential advantage for "sandwich" technique radiotherapy compared to postoperative radiotherapy in respectable rectal cancer. METHODS AND MATERIALS: Between January 1989 and May 1994, 60 patients with respectable rectal cancer were treated at Inje University Seoul and Sanggye Paik Hospital.Fifty one patients were available for analysis : 20 patients were treated with sandwich technique radiotherapy and 31 patients were treated with postoperative radiotherapy. In sandwich technique radiotherapy(RT), patients were treated with preoperative RT 1500 cGy/5fx. followed by immediate curative resection. Patients staged as Astler-Coller B2, C were considered for postoperative RT with 2500-4500 cGy. In postoperative RT, total radiation dose of 4500-6120 cGy, 180 cGy daily at 4-6weeks was delivered. Patients were followed for median period of 25 months. RESULTS: The overall 5-year survival rates for sandwich technique RT group and postoperative RT group were 60% and 71%, respectively(p>0.05). The 5-year disease free survival rates for each group were 63%. There was no difference in local failure rate between two groups(11% versus 7%). Incidence of distant metastasis was 11%(2/20) in the sandwich technique RT group and 20%(6/31) in the postoperative RT group(p>0.05). The frequencies of acute and chronic complications were comparable in both groups. CONCLUSION: The sandwich technique radiotherapy group shows local recurrence and survival similar to those of postoperative RT alone group but reduced distant metastasis compared to postoperative RT group. But long term follow-up and large number of patients is needed to make an any firm conclusion regarding the value of this sandwich technique RT.Key Words : Rectal cancer, Sandwich technique, Radiotherapy
Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Neoplasm Metastasis ; Radiotherapy* ; Rectal Neoplasms ; Recurrence ; Seoul ; Survival Rate

Arteriovenous malformation(AVM) is the rare cause of neonatal intracranial hemorrhage. It is a congenital vascular lesion that can arising anywhere in the body. We report here on an unusual case of AVM in a full-term newborn infant who has no symptoms except enlarged bulging anterior fontanelle. AVM of other organs or adult cases were reported occasionally, but postoperative surviving intracranial AVM in a newborn infant has not been reported in Korea so far. The hematoma which was in the cortex of left temporal area, was removed surgically and the baby is living well under regular neurological check up.
Adult ; Arteriovenous Malformations ; Cerebral Hemorrhage* ; Cranial Fontanelles ; Hematoma ; Humans ; Infant, Newborn* ; Intracranial Hemorrhages ; Korea

BACKGROUND: Pulmonary Langerhans cell histiocytosis (PLCH) is characterized by a proliferation of Langerhans cells and this results in granulomas that involve multiple organs of the body. Because the incidence of PLCH is very low in Korea and worldwide, collecting the clinical data of patients with PLCH nationwide is needed to determine the clinical features of Korean patients with PLCH. METHODS: The patients with PLCH confirmed by biopsy at any body site were included and the patients should have lung lesions present. A questionnaire that had items on the symptoms, lung function tests, the roentgenographic findings and the treatment was collected retrospectively at a Korean ILD Research Meeting. RESULTS: A total of 56 cases were collected. The number of males and females was 48 and 8, respectively, and their median age was 43 years (range: 18~67 years). The patients were current or ex-smokers in 79% of the cases. The most frequent symptom was coughing (39%), followed in decreasing order by dyspnea (38%), sputum (20%) and chest pain (20%). Pneumothorax was observed in 16 (29%) patients. Lung function tests showed a normal, restrictive, mixed or obstructive pattern in 26 (61%), 7 (16%), 7 (16%) and 3 patients (7%), respectively. Nodular-cystic lesion was most frequently observed in 59% of the patients on HRCT. The lung lesions were located in the middle and upper lobes in almost the cases. The median follow-up period was 90 months (range: 1~180 months) and only two patients died during this period. CONCLUSION: This study provides a national survey of the patients with PLCH during a long follow-up period.
Biopsy ; Chest Pain ; Cough ; Dyspnea ; Female ; Follow-Up Studies ; Granuloma ; Histiocytosis ; Histiocytosis, Langerhans-Cell ; Humans ; Incidence ; Korea ; Langerhans Cells ; Lung ; Lung Diseases ; Male ; Pneumothorax ; Surveys and Questionnaires ; Respiratory Function Tests ; Retrospective Studies ; Sputum