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

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

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

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

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

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

The purpose of this study was to evaluate the effectiveness of Centers for Child-care Foodservice Management (CCFSM)'s support on menu management in child-care centers and kindergartens by comparing two perspectives of pre-support vs. post-support and established vs. non-established. To evaluate dietary variety, we used methods that considered both Dietary Diversity Score (DDS) and Dietary Variety Score (DVS). For surveying pre-support and post-support state by CCFSM, we collected and analyzed menus of June and September, 2012, targeting 7 CCFSM supported institutions. Meanwhile, for surveying state in CCFSM established and non-established areas, we collected and analyzed menus of June, 2012, which were implemented in institutions in CCFSM established (181 places) and non-established (106 places) areas. The results of evaluation on the dietary support by CCFSM showed that post-supporting state by CCFSM (95.3%) was significantly higher than pre-supporting state (77.2%) (p < 0.001) and established areas (87.4%) were significantly higher than non-established ones (77.2%) (p < 0.05) on 'Meeting the DRI for infant'. Evaluation of dietary variety between pre- and post-support state by CCFSM showed that post-support state (total 77.3 point) was higher than pre-support state (total 76.4 point). Evaluation of dietary variety between established and non-established areas showed that established areas (total 81.1 point) were significantly higher than non-established ones (total 77.1 point) (p < 0.001). Therefore, it is considered that dietary support service conducted by CCFSM contributes to improve variety level of diet provided by child-care centers and kindergartens.
Diet

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

BACKGROUND: Cerebral blood vessels are innervated by sympathetic nerves from the superior cervical ganglia (SCG), and these nerves may influence the cerebral blood flow. The purpose of the present study was to evaluate the neuroprotective effect of superior cervical sympathetic ganglion block in rats that were subjected to focal cerebral ischemia/reperfusion injury. METHODS: Eighty male Sprague-Dawley rats (270-320 g) were randomly assigned to one of two groups (the ropivacaine group and a control group). In all the animals, brain injury was induced by middle cerebral artery (MCA) reperfusion that followed MCA occlusion for 2 hours. The animals of the ropivacaine group received 30microl of 0.75% ropivacaine, and their SCG. Neurologic score was assessed at 1, 3, 7 and 14 days after brain injury. Brain tissue samples were then collected. The infarct ratio was measured by 2.3.5-triphenyltetrazolium chloride staining. The terminal deoxynucleotidyl transferase mediated dUTP-biotin nick-end labeled (TUNEL) reactive cells and the cells showing caspase-3 activity were counted as markers of apoptosis at the caudoputamen and frontoparietal cortex. RESULTS: The death rate, the neurologic score and the infarction ratio were significantly less in the ropivacaine group 24 hr after ischemia/reperfusion injury. The number of TUNEL positive cells in the ropivacaine group was significantly lower than those values of the control group in the frontoparietal cortex at 3 days after injury, but the caspase-3 activity was higher in the ropivacaine group than that in the control group at 1 day after injury. CONCLUSIONS: The study data indicated that a superior cervical sympathetic ganglion block may reduce the neuronal injury caused by focal cerebral ischemia/reperfusion, but it may not prevent the delayed damage.
Amides ; Animals ; Apoptosis ; Blood Vessels ; Brain ; Brain Injuries ; Caspase 3 ; DNA Nucleotidylexotransferase ; Ganglia, Sympathetic ; Humans ; In Situ Nick-End Labeling ; Infarction ; Male ; Middle Cerebral Artery ; Neurons ; Neuroprotective Agents ; Rats ; Rats, Sprague-Dawley ; Reperfusion ; Superior Cervical Ganglion