PURPOSE: This study was performed to find out the effects of lidocaine or 8.4% sodium bicarbonate mixed with rocuronium on mean arterial pressure, heart rate and withdrawal movement. METHODS: Data collection was performed from December 15, 2006 through May 31, 2007. Seventy-five patients with American Society Anesthesiologist (ASA) physical status I & II, under general anesthesia, were randomly assigned to 1 of 3 groups: R group (RG) received rocuronium 0.6 mg/kg; RL group (RLG), rocuronium 0.6 mg/kg mixed with 2 mL of 2% lidocaine; RS group (RSG), rocuronium 0.6 mg/kg with the same volume of 8.4% sodium bicarbonate. Mean arterial pressure, heart rate and withdrawal movement were observed from its injection until 5 min after endotracheal intubation. RESULTS: The incidence of withdrawal movement with its corresponding injections was 72%, 40% and 4% in RG, RLG and RSG, respectively (p<.001). Score of withdrawal movement was the lowest in RSG of all groups (p<.001). While mean arterial pressure (p=.011) in RSG decreased significantly, and heart rate (p=.003) in RG increased more with its injection than before induction of anesthesia. CONCLUSION: Administration of the equivalent volume of 8.4% sodium bicarbonate with rocuronium is more effective than that of lidocaine with rocuronium compared with rocuronium only, in preventing withdrawal movement and in stabilizing mean arterial pressure and heart rate.
Adult ; Androstanols/administration & dosage/*adverse effects ; Anesthetics, Local/administration & dosage/*therapeutic use ; Blood Pressure/*drug effects ; Female ; Heart Rate/*drug effects ; Humans ; Injections, Intravenous ; Lidocaine/administration & dosage/*therapeutic use ; Male ; Middle Aged ; Neuromuscular Nondepolarizing Agents/administration & dosage/*adverse effects ; Pain/*prevention & control ; Sodium Bicarbonate/*administration & dosage

PURPOSE: Clinical and radiologic results of operative versus nonoperative treatment were compared in patients 70 years or older who had an unstable distal radius fracture. MATERIALS AND METHODS: From March 2007 to April 2009, 49 patients who had an unstable distal radius fracture treated nonoperatively (22 patients) or operatively (27 patients) were investigated. The radiologic results between the two patient groups were compared based on bone union, dorsal tilt, radial inclination and radial shortening. The clinical results were compared based on disabilities of arm, shoulder & hand (DASH) score, the patient-rated wrist evaluation (PRWE) score, the grip strength and the motion range of the wrist joint. RESULTS: At the last follow-up examination, DASH score, PRWE score, the flexion, supination and radial deviation of wrist joint and the grip strength did not showed significant difference. Among the patients who received non-operative treatments, 18 of 22 showed radiologically recognizable deformation; average dorsal tilt of 11.9degrees, the average radial inclination of 18.9degrees, and average radial shortening of 3.8 mm. The patients who received operative treatments showed average volar tilt of 3.3degrees, radial inclination of 18.8degrees+/-3.7degrees, and radial shortening of 1.5 mm. Three patients showed radiologically recognizable deformation. CONCLUSION: Our results suggest that nonoperative treatment is initially recommended in patients with the age of 70 years or older who have an unstable distal radius fracture in terms of functional results.
Arm ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Radius ; Radius Fractures ; Shoulder ; Supination ; Wrist ; Wrist Joint

PURPOSE: To determine the different of enhancement patterns of hepatic hemangioma according to the lesionsize, using dual-phase spiral CT. MATERIALS AND METHODS: Fify-nine lesions in 45 patients with hepatichemangiomas were subjected to spiral Ct. According to size, the lesions were divided into two groups(< 2.5cm :n=34 ; >_2.5cm : n=25). The enhancement patterns of the lesions were classified as one of four types (homogeneoushyperdense, peripheral hyperdense, central hyperdense, or hypodense) during the early phase, and as one of fivetypes homogeneous hyperdense, peripheral hyperdense, central hyperdense, hypodense or isodense) during the delayedphase. We evaluated differences in enhancement patterns during the early and delayed phase according to lesionsize. RESULTS: During the early phase, the enhancement patterns of lesions large than 2.5cm were peripheralhyperdense(96%) or homogeneous hyperdense (4%);those of less than 2.5cm were peripheral hyperdense (53%),homogeneous hyperdense(26%), hypodense(18%), or central hyperdense(3%). Thus, hemangiomas in these two groupsusually showed a peripheral enhancement pattern during the early phase, but in those which were smaller than2.5cm, atypical enhancement patterns were more common. During the delayed phase, the enhancement patterns oflesions larger than 2.5cm were peripheral hyperdense (60%) or homogenous hyperdense (40%), while the patterns ofthose smaller than 2.5cm were homogeneous hyperdense (67%), peripheral hyperdense (24%), central hyperdense (3%),hypodense (3%), or isodense (3%). Thus, the enhancement patterns of lesions larger than 2.5cm were usuallyperipherally hyperdense during the delayed phase, while those smaller than 2.5cm showed a homogeneous enhancementpattern. CONCLUSION: The enhancement patterns of hepatic hemangiomas differ according to lesion size. A knowledgeof these differences is helpful in the diagnosis of hepatic hemangioma.
Diagnosis ; Hemangioma* ; Humans ; Tomography, Spiral Computed*

Recently, Stevens-Johnson syndrome associated with methazolamide has been reported in Koreans, more frequently. Methazolamide is a carbonic anhydrase inhibitor commonly used for lowering intraocular pressure in glaucoma and other ophthalmologic diseases. We reported five cases of Stevens-Johnson syndrome induced by methazolamide. All patients showed atypical clinical manifestations, compared to classical Stevens-Johnson syndrome. Methazolamide induced Stevens-Johnson syndrome showed scattered or confluent maculopapular eruptions initially, which are similar to morbiliform drug eruption with mild lip erosion and palmar erythema. Even though there was no skin erosion initially, it showed rapid progression to severe erosion on the trunk and palmoplantar erythema within 5 to 7 days. Therefore, our data indicated that methazolamide induced Stevens-Johnson syndrome should be checked for a patient who has a history of ophthalmologic treatment with a drug eruption like skin lesion.
Carbonic Anhydrases ; Drug Eruptions ; Erythema ; Glaucoma ; Humans ; Intraocular Pressure ; Lip ; Methazolamide ; Skin ; Stevens-Johnson Syndrome

PURPOSE: To evaluate the correlation between the severity of diabetic retinopathy, decrease of corneal sensitivity and conjunctival impression cytology. METHODS: 150 eyes of 75 patients were enrolled. The patients were divided into two groups. The study group is 110 eyes of 55 patients with diabetic retinopathy and the control group is 40 eyes of 20 patients without diabetic retinopathy. The hemoglobin A1C (HbA1C) and fasting plasma glucose (FPG) were measured for the index of diabetic control. Corneal sensitivity was measured with Cochet-Bonnet aesthesiometer, and conjuctival impression cytology and fundus examination were done in two groups after topical anesthesia instillation. The classification of diabetic retinopathy was based on the ETDRS. RESULTS: In corneal sensitivity, the study group was 3.8 +/- 3.6 g/mm2, the control group 1.1 +/- 2.16 g/mm2, showing statistically significant difference (p<0.05). The severity of diabetic retinopathy had negative correlation with corneal sensitivity (R2=0.26, p<0.05). Conjunctival impression cytology had negative correlation with corneal sensitivity (R2=0.41, p<0.05), and positive correlation with retinopathy (R2=0.26, p<0.05). Corneal sensitivity was affected by the hemoglobin A1C (p<0.01), but fasting plasma glucose (p=0.7). CONCLUSIONS: Conjucntival impression cytology had negaitive correlation with corneal sensitivity and positive correlation with diabetic retinopathy. It can be thought that corneal sensitivity is affected by chronic glycemic control.
Anesthesia ; Blood Glucose ; Classification ; Diabetic Retinopathy* ; Fasting ; Humans

Traditionally postpartum hemorrhage is a bleeding more than 500 ml that occurs immediately after the placenta is delivered. It remains one of the most common causes of maternal mortality. Morbid adhesion of the placenta is emerging as a major cause of massive postpartum hemorrhage unresponsive to medical therapy. We experienced three cases of major postpartum hemorrhage over 5,000 ml, developed from anterior placenta previa totalis with adhesion of placenta. The hemorrhage had been controlled successfully by compressing abdominal aorta intermittently with the operator's hand during Cesarean hysterectomy. In immediate life- threatening postpartum hemorrhage this simple and safe technique can be used in slowing the bleeding while stabilizing the patient and preparing for definitive treatment.
Aorta, Abdominal ; Hand ; Hemorrhage ; Humans ; Hysterectomy ; Maternal Mortality ; Placenta ; Placenta Previa ; Postpartum Hemorrhage* ; Postpartum Period*

Acute pancreatitis in pregnancy is rare and occurs in approximately 3 in 10,000 pregnancies. It rarely complicates pregnancy, and can occur during any trimester, however over half (52%) of cases occur during the third trimester and during the post-partum period. Gallstones are the most common cause of acute pancreatitis. On the other hand, acute pancreatitis caused by hypertriglyceridemia due to increase of estrogen during the gestational period is very unusual, but complication carries a higher risk of morbidity and mortality for both the mother and the fetus. We experienced a case of pregnant woman who died of acute exacerbation of hypertriglyceridemia-induced acute pancreatitis at 23 weeks of gestation. We report on progress and management of this case along with literature reviews.
Estrogens ; Female ; Fetus ; Gallstones ; Hand ; Humans ; Hypertriglyceridemia ; Maternal Death* ; Mortality ; Mothers ; Pancreatitis* ; Pregnancy Trimester, Third ; Pregnancy* ; Pregnant Women

BACKGROUND: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates. METHODS: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. RESULTS: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital, 101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). CONCLUSION: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.
Death Certificates* ; Education ; Emergencies ; Mortality ; Retrospective Studies ; Seoul

Two cases of cavernous hemangioma of the cauda equina are presented. Cavernous hemangioma of the cauda equina is rare vascular malformation. This is the fifth and sixth case of cavernous hemangioma of the cauda equina in the literature. These cases are female patients. MRI is more sensitive method than spinal myelography and CT in diagnosis of cavernous hemangioma of the cauda equina. Total removal was possible without immediate post-operative complication.
Cauda Equina* ; Diagnosis ; Female ; Hemangioma, Cavernous* ; Humans ; Magnetic Resonance Imaging ; Myelography ; Vascular Malformations

BACKGROUND/AIMS: Needle-knife sphincterotomy (NKS) is an alternative technique to EST when selective bile duct cannulation can not be achieved with a variety of techniques or accessories. The risk of post-procedure pancreatitis is high, however, when papillary edema, sphincter of Oddi spasm, and the resulting restriction of pancreatic juice flow are induced by both mechanical injury associated with repeated cannulation attempts and possible burn injury due to NKS itself. Recently, nasopancreatic drainage and pancreatic stenting were suggested to be effective in preventing pancreatitis in patients with high risk of postprocedure pancreatitis and in patients who underwent NKS, respectively. The purpose of this study is to evaluate the role of pancreatic stenting on the clinical outcomes in patients with high risks of postprocedure pancreatitis who undergo NKS. METHODS: Of the 119 patients who had undergone NKS, pancreatic stenting with 2-4 cm, 7Fr polyethylene biliary stent was performed prior to NKS in 13 patients (pancreatic stent group), and an incision was begun without pancreatic stenting at the papillary roop avoiding trauma of the papillary orifice and thus, reducing the risks of pancreatitis in 15 patients (control group). Both groups were at high risks of pancreatitis associated with repeated, unsuccessful bile duct cannulation attempts. In the two groups, the success rate of bile duct cannulation and the incidence of pancreatitis were analyzed and compared.
Bile Ducts ; Burns ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Edema ; Humans ; Incidence ; Needles* ; Pancreatic Juice ; Pancreatitis ; Polyethylene ; Spasm ; Sphincter of Oddi ; Stents*