While intrathecal morphine in small doses has been effective in controlling postoperative pain, many patients have been suffered from the side effects. In recent studies, it has been suggested that small dose of propofol can attenuate these side effects of intrathecal morphine. We have studied the effect of propofol and tried to find the optimum dose that can reduce side effects of intrathecal morphine. Sixty patients of ASA class 1 scheduled for anorectal surgery were allocated randomly to receive either a bolus dose of propofol 0.5 mg/kg followed by an infusion of 1 mg/kg/24hr(group Pl) or 2 mg/kg/24hr(group P2) and no bolus dose followed by 1,000 ml 5% dextrose water(control group). In this study, postoperartive sedation, nausea, vomiting, pruritus and urinary retention were evaluated immediate postoperatively, 12 hour, 24 hour and 48 hour after spinal anesthesia using 1% tetracaine 5 mg with 10% dextrose water 5 ml and morphine 0.3 mg. As time passed, all the complications subsided significantly. However, there was no significant difference among 3 groups except pruritus. The incidence of pruritus was lower in the group P1 and group P2(80%, 50% respectively) than the control group(90%). In the 12 hour-after evaluation, there was no patient of grade 3 pruritus in the group P2 but 5 patients in the control group(p<0.001) and 3 patients in the group Pl had itching(p<0.05). The higher doses of propofol, the greater sedative effect observed. However, there was no clinicaliy serious problem (e.g. respiratory depression, deep sedation). In conclusion, we recommend that an adequate infusion dose of propofol for reducing the incidence and severity of pruritus is 2 mg/kg/24hr.
Anesthesia, Spinal ; Glucose ; Humans ; Hypnotics and Sedatives ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative ; Propofol* ; Pruritus ; Respiratory Insufficiency ; Tetracaine ; Urinary Retention ; Vomiting ; Water

PURPOSE: Medullary sponge kidney (MSK) is a rare congenital disease characterized by diffuse ectasia or dilatation of precalyceal collecting tubules. MSK incidence and prevalence in the general population is uncertain and only a few patients are reported especially in the pediatric age. There has been increasing reports of patients with MSK who have other malformative disorders. Also several case reports concerning about etiological association of some genes. METHODS: Collaborative study through nation-wide survey was done to investigate the incidence and etiological association of some genes such as GDNF gene, ATP6V1B1, ATP6V0A4 gene in developing MSK in Korean children. RESULTS: Four cases of MSK who have various other malformative disorders were collected. There are no mutations of GDNF gene, ATP6V1B1, ATP6V0A4 gene in all patients. CONCLUSION: MSK is one of the very rare diseases in pediatric age. The etiological association of GDNF gene , ATP6V1B1, ATP6V0A4 gene in developing MSK in Korean children is not proved.
Child ; Dilatation ; Dilatation, Pathologic ; Glial Cell Line-Derived Neurotrophic Factor ; Humans ; Incidence ; Medullary Sponge Kidney ; Prevalence ; Rare Diseases

Spinal hemangioma is the uncommon, slowly growing benign tumor that arses from the blood vessels and was commonly located in the thoracic spine. The authors experienced 4 cases of spinal hemangioma from the thoracic spine that are diagnosed by simple spine X-ray, spine CT with myelography and confirmed by histological examination. We reviewed the literature concemed with spinal hemangioma.
Blood Vessels ; Hemangioma ; Myelography ; Spine

OBJECTIVES: To investigate whether smoking and the smoking status are predictors of the incident impaired fasting glucose (IFG) or type 2 diabetes in Korean men. METHODS: A cohort of 1,717 Korean men without IFG or diabetes, who underwent annual periodic health examinations for 4 years (2002-2006), were retrospectively investigated. IFG and diabetes were defined as a serum fasting glucose concentration of 100-125 mg/dL and more than 126 mg/dL, respectively. Cox's proportional hazards model was used to evaluate the association between smoking and development of IFG or type 2 diabetes. RESULTS: A total of 558 cases (32.5%) of incident IFG and 50 cases (2.9%) of diabetes occurred. After controlling for the potential predictors of diabetes, the relative risk for IFG, compared with the never smokers, was 1.02 (95% CI=0.88 to 1.19) for the ever-smokers, 0.96 (95% CI=0.79-1.16) for those who smoked 1-9 cigarettes/d, 1.15 (95% CI=1.01 to 1.30) for those who smoked 10-19 cigarettes/d, and 1.31 (95% CI=1.10 to 1.57) for those who smoked 20 or more cigarettes/d (the P value for the current smokers was only p<0.002). The respective multivariate adjusted relative risks for type 2 diabetes, compared with the neversmokers, were 1.07 (95% CI=0.64 to 1.92), 1.47 (95% CI=0.71 to 3.04), 1.84 (95% CI=0.92-3.04), and 1.87 (95% CI=1.13-3.67), respectively (the P value for the current smokers was only p=0.004). CONCLUSIONS: The smoking status and the number of cigarettes smoked daily are associated with an increased risk for developing IFG or type 2 diabetes in Korean men.
Adult ; Blood Glucose/*analysis ; Body Mass Index ; Diabetes Mellitus, Type 2/*metabolism ; Health Behavior ; Health Status ; Humans ; Korea/epidemiology ; Male ; Retrospective Studies ; Risk Factors ; Smoking/*adverse effects

The surgically treated 9 patients with anterior choroidal artery aneurysms were clinically analysed. The mean age of patients was fifty six and the size were between 3 mm and 12 mm. Anterior choroidal artery, although small, is important cerebral vessel because of its extensive strategic area of supply. We preserve anterior choroidal artery 8 out of 9 cases during clipping of aneurysm. Fortunately in the sacrificed case, no specific neurologic deficit was developed. So, we reviewed the anatomy & collateral circulation of this vessel.
Aneurysm* ; Arteries* ; Choroid* ; Collateral Circulation ; Humans ; Neurologic Manifestations

BACKGROUND: Cerebral blood vessels are innervated by sympathetic nerves that originate in the superior cervical ganglia (SCG). This study was conducted to determine the effect of an SCG block on brain injury caused by focal cerebral ischemia/reperfusion in a rat model. METHODS: Male Sprague-Dawley rats (270-320 g) were randomly assigned to one of three groups (lidocaine, ropivacaine, and control). After brain injury induced by middle cerebral artery (MCA) occlusion/reperfusion, the animals were administered an SCG bloc that consisted of 30 microliter of 2% lidocaine or 0.75% ropivacaine, with the exception of animals in the control group, which received no treatment. Twenty four hours after brain injury was induced, neurologic scores were assessed and brain samples were collected. The infarct and edema ratios were measured, and DNA fragmented cells were counted in the frontoparietal cortex and the caudoputamen. RESULTS: No significant differences in neurologic scores or edema ratios were observed among the three groups. However, the infarct ratio was significantly lower in the ropivacaine group than in the control group (P<0.05), and the number of necrotic cells in the caudoputamen of the ropivacaine group was significantly lower than in the control group (P<0.01). Additionally, the number of necrotic and apoptotic cells in theropivacaine group were significantly lower than inthe control group in both the caudoputamen and the frontoparietal cortex (P<0.05). CONCLUSIONS: Brain injury induced by focal cerebral ischemia/reperfusion was reduced by an SCG block using local anesthetics. This finding suggests that a cervical sympathetic block could be considered as another treatment option for the treatment of cerebral vascular diseases.
Anesthetics, Local ; Animals ; Blood Vessels ; Brain Injuries* ; Brain* ; DNA ; Edema ; Ganglia, Sympathetic* ; Humans ; Lidocaine ; Male ; Middle Cerebral Artery ; Models, Animal* ; Rats* ; Rats, Sprague-Dawley ; Superior Cervical Ganglion ; Vascular Diseases

Aorto-enteric fistula (AEF) is a rare cause of gastrointestinal (GI) bleeding but has a high mortality rate. PURPOSE: To find a better way to manage this rare vascular condition, we reviewed our series of surgical treatment for AEF. METHOD: We retrospectively reviewed the medical records of 5 patients with AEF. For the diagnosis of AEF, a contrast-enhanced abdominal CT scan was performed for all patients but conventional aortography was not performed. The surgical procedures for the AEF were determined by the operatvie findings. For 3 patients with no evidence of periaortic infection, enteric fistula closure and aortic aneurysm repair with prosthetic grafts were performed while the other 2 patients revealing periaortic infection underwent resection of infected aorta (or infected aortic graft), aortic suture closure, retroperitoneal coverage with omental pedicle and axillo-bifemoral bypass were performed. In a patient who underwent abdominal aortic resection, concomitant left colectomy was required due to colonic ischemia. RESULT: The underlying causes and features of AEF were 4 primary and 1 secondary AEF; 4 aorto-duodenal and 1 aorto-gastric fistula; 4 infrarenal and 1 type IV thoracoabdominal aneurysm, and 4 true and 1 paraanastomotic pseudoaneurysm. Episodes of herald bleeding and periaortic air bubble on CT scan was noted in 4/5 (80%) of patients. There was no operative mortality or graft infection during the follow up period (mean, 23 months, range 3~50 months). CONCLUSION: For the early diagnosis of AEF, periaortic air bubble shadow on abdominal CT scan in a patient with pulsating abdominal mass or previous history of aortic surgery was an important diagnostic clue. Prompt surgical treatment according to the operative finding resulted in good surgical outcomes.
Aneurysm ; Aneurysm, False ; Aorta ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Aortography ; Colectomy ; Colon ; Diagnosis ; Early Diagnosis ; Fistula* ; Follow-Up Studies ; Hemorrhage ; Humans ; Ischemia ; Medical Records ; Mortality ; Retrospective Studies ; Sutures ; Tomography, X-Ray Computed ; Transplants

BACKGROUND: Cerebral blood vessels are innervated by sympathetic nerves from the superior cervical ganglion (SCG). The purpose of the present study was to evaluate the neuroprotective effect of superior cervical sympathetic ganglion block in rats subjected to permanent focal cerebral ischemia. METHODS: Thirty male Sprague-Dawley rats (270-320 g) were randomly assigned to one of three groups (control, lidocaine and ropivacaine). A brain injury was induced in all rats by middle cerebral artery occlusion with a nylon thread. The animals of the local anesthetic group received 30 microl of 2% lidocaine or 0.75% ropivacaine in the SCG. Neurologic scores were assessed 24 hours after brain injury. Brain samples were then collected. The infarct and edema ratios were measured by 2.3.5-triphenyltetrazolium chloride staining. RESULTS: There were no differences in the death rates, neurologic scores, or infarction and edema ratios between the three groups. CONCLUSIONS: These findings suggest that superior cervical sympathetic ganglion block may not influence the brain damage induced by permanent focal cerebral ischemia in rats.
Amides ; Animals ; Blood Vessels ; Brain ; Brain Injuries ; Brain Ischemia ; Edema ; Ganglia, Sympathetic ; Humans ; Infarction ; Infarction, Middle Cerebral Artery ; Lidocaine ; Male ; Neuroprotective Agents ; Nylons ; Rats ; Rats, Sprague-Dawley ; Superior Cervical Ganglion

The brain is the highly organized organ which attributes to consciousness, memory and language. Approximately 85ml of oxygenated blood from the heart is delivered to the brain each minute. In human beings, a steady cerebral blood flow is maintained which cerebral structures are perfused roughly in proportion to their metabolic demands which are actively depend on function. Therefore, cerebral function is the most important physiologic regulator of cerebral blood flow. The measurement of cerebral blood flow is a very important toolin exploring the function of the human brain in healthand disease. An impairment of normal cerebral blood flow indicates clinical derangement of central neruous system. Besides the clinical sympatoms, cerebral blood flow investigation has become our main guideline for judging the timing of operation and prognosis of disease as well as evaluation of treatment. The determination of normal cerebral blood flow in Korean seemed to be enormously important for further study on this subject. For the purpose of establishing normal value of cerebral blood flow in Korean, the author have studied 93 healthy persons with 133Xe-inhalation method using Obrist's two compartmental analysis. Followings were the results. 1) Normal values of FI, ISI, and WIin children below the age of 9 were 113.5+/-36.9, 62.5+/-13.0 and 55.6+/-6.4 each. 2) Normal values of FI, ISI, and WI in the group above the age of 9 were 75.5+/-15.5, 44.6+/-5.7 and 43.1+/-3.95 each. 3) There was no significant difference between mean values of right and left side hemisphere. 4) There was significant decrease in r-CBF in the group above the age of 9, but the decrement by age since after the age of 9 was not significant statistically. 5) The difference of mean values among each lobe was not significant statistically.
Brain ; Child ; Consciousness ; Heart ; Humans ; Memory ; Oxygen ; Prognosis ; Reference Values

There are many causes of chronic abdominal pain and abdominal protrusion. But, they are likely to be confused with diabetic thoracic polyradiculopathy. Differentiation between this self-limiting complication and abdominal herniation is important to avoid unnecessary procedure. We describe the case of 77-years-old man with 10 years history of non-insulin dependent diabetes mellitus, who was suffering from postherpetic neuralgia for 10 months and presented with a abdominal segmental paresis and protrusion. The paraspinal electromyography showed bilateral lower thoracic radiculopathy.
Abdominal Pain ; Diabetes Mellitus ; Electromyography ; Humans ; Neuralgia, Postherpetic ; Paresis ; Polyradiculopathy ; Radiculopathy ; Stress, Psychological ; Unnecessary Procedures