BACKGROUND: Epidural morphine is effective in the treatment of postoperative pain, but the incidence of associated side effects is high. To evaluate the reduction of opioid sideeffects by epidural use of droperidol mixture, this study was performed. METHODS: Randomly sampled sixty patients undergoing upper abdominal surgery were divided into two groups. To assess a reduction of opioid side effects by droperidol, group I (n=30) were received 3mg morphine and 0.15% bupivacaine 10ml through the indwelling epidural catheter before the conclusion of operation, followed by an infusion of 6 mg morphine plus 0.15% bupivacaine 100ml with the two day infusor. Group II (n=30) were treated with the same protocol as group I but 1.5 mg of droperidol was added to initial bolus and 5mg of droperidol to the two day infusor. Analgesic effect and side effect were 48 hours after operation. RESULTS: No significant differences in intensity of analgesiaand sedation were seen. The intensity of nausea and vomiting in the group II was significantly less than in the group I at 8, 12 hours after operation (p<0.05). The intensity of pruritus in group II was significantly less than in group I at 4, 8 hours of postoperative period (p<0.05). The frequency of nausea, vomiting, pruritus and urinary retention in group II were less than in group I. respiratory depression. Epidural injection of droperidol did not result in any local or systemic side effects. CONCLUSION: The addition of epidural droperidol significantly reduced the side effects of epidural morphine without altering the effect on analgesia.
Analgesia ; Bupivacaine ; Catheters ; Droperidol* ; Humans ; Incidence ; Infusion Pumps ; Injections, Epidural ; Morphine* ; Nausea ; Pain, Postoperative ; Postoperative Period ; Pruritus ; Respiratory Insufficiency ; Urinary Retention ; Vomiting

Hemorrhagic cellulitis consists of an acute onset of extremely painful erythema which affects dependent areas, followed by dermal hemorrhaging and sloughing of the overlying epidermis. Hemorrhagic cellulitis in the initial stage is frequently misdiagnosed as bacterial cellulitis. The disease differs from cellulitis because of it's large area of hemorrhaging, which is an unusual feature in bacterial cellulitis. Failure to recognize and treat the early stage of the disease results in necrosis of the skin and sometimes gangrene down to the deep fascia. Treatment in the early stages consists of corticosteroids in combination with antibiotics. We report a case of hemorrhagic cellulitis in the right lower leg of a 66-year-old male with diabetes mellitus. Begining as a tender erythematous streak, the lesions became hemorrhagic and evolved progressively through the hemorrhagic vesicobullous stage, to necrotic crusts in about 2 weeks. Cultural isolation showed Enterobacter cloacea.
Adrenal Cortex Hormones ; Aged ; Anti-Bacterial Agents ; Cellulitis* ; Diabetes Mellitus ; Enterobacter ; Epidermis ; Erythema ; Fascia ; Gangrene ; Humans ; Leg ; Male ; Necrosis ; Skin

Depression is common in the patients with rheumatoid arthritis (RA). Estimates of the prevalence of depression in the patients with RA have ranged from 14 to 46%, depending on the criteria used and the patient subgroups studied. Our objectives were to show how frequently depression occur among patients with RA, to compare depression in RA and osteoarthritis (OA) patients, and to identify the disease and sociodemographic variables with which depression are associated. Subjects included in this study were 119 RA patients, and 140 OA patients. The Korean version of the Center for Epidemiological Studies-Depression Scale (CES-D) was used to assess depression. The Korean health assessment questionnaire (KHAQ) was used to assess physical function in patients with RA. The associations of sociodemographic variables, disability, severity and other variables with CES-D score were evaluated by multiple regression analysis. RESULTS: When CES-D cut-off score of 25 was used, 54 (50.9%) of 106 RA patients, and 32(23.5%) of 122 OA patients had scores suggestive of depression, and the difference was still significant after adjusting age, sex, disease duration, pain scale and fatigue scale (p<0.05). RA patients had higher mean scores on CES-D than OA patients after adjusting above variables, too (p<0.05). The bivariate analysis showed that age, sex, education level, fatigue scale, pain scale, KHAQ-disability score, WBC, ESR were significantly associated with CES-D scores in RA patients; and the duration of disease, pain scale and fatigue scale were associated with those in OA patients (p<0.05). By stepwise selection in multiple logistic regression model, the age, pain scale and KHAQ-disability score were selected as significant independent variables in RA patients. In OA patients, the duration of disease and pain scale were selected as significant independent variables. CONCLUSION: RA patients are significantly more depressed than OA patients, and the associated factors with depression are patient? age, pain scale and KHAQ disability score in RA.
Arthritis, Rheumatoid* ; Depression* ; Education ; Fatigue ; Humans ; Logistic Models ; Osteoarthritis ; Prevalence ; Surveys and Questionnaires

OBJECTIVE: Productivity loss was compared by 3-stage of disease activity and associations between higher disease activity and high productivity loss were identified. METHODS: Data were extracted from Rheumatoid Arthritis (RA) Patient-reported Outcomes Research, which enrolled 2,000 RA patients (>20-year) on disease-modifying-antirheumatic-drugs (DMARDs) (≥6-month) from December 2012 to June 2013. This included 1,457 RA patients with the disease activity score (DAS-28-ESR) in their medical charts. Productivity loss in time and indirect cost was estimated using The World Health Organization Health and Work Performance Questionnaire (HPQ). Baseline characteristics and productivity loss outcomes were compared according to DAS-28-ESR groups. RESULTS: 84.4% were females, 54.2% had low DAS-28-ESR ( < 3.2), and 38.2% and 7.6% had moderate (3.2∼5.1) and high DAS-28-ESR (>5.1). Patients with moderate to high DAS-28-ESR had higher lost productivity time (LPT) and monthly costs of LPT than those with low DAS-28-ESR (time in hours: 110.0±58.4 vs. 132.4±57.2 vs. 71.5±52.0, p < 0.0001; monthly costs of LPT in 1,000 Korean won: 1,097±607 vs. 1,302±554 vs. 741±531, p < 0.0001). Multiple regression analyses revealed significant associations with high LPT in high (adjusted odds ratio [OR]=3.87, 95% confidence interval [CI]: 2.18∼6.87) and moderate DAS-28-ESR (adjusted OR=1.88, 95% CI: 1.41∼2.52) compared to low DAS-28-ESR. In addition, positive associations with high monthly costs of LPT were observed in high (adjusted OR=3.45, 95% CI: 1.98∼5.99) and moderate DAS-28-ESR (adjusted OR=1.93, 95% CI: 1.43∼2.54) compared to low DAS-28-ESR. CONCLUSION: Timely therapeutic strategies should be taken into consideration given that the RA patients with moderate to high DAS-28-ESR showed strong associations with high productivity loss for effective management of RA.
Arthritis, Rheumatoid* ; Efficiency* ; Female ; Humans ; Odds Ratio ; Outcome Assessment (Health Care) ; Work Performance ; World Health Organization