BACKGROUND: Several reports have indicated that there are fewer postoperative complications after using a smaller spinal needle in young patients. However, no comparative report has been issued on the incidences of postoperative complications after using differently sized spinal needles for spinal anesthesia in elderly patients. Here, we compared a 22 G Quincke needle with a 25 G Quincke needle in elderly patients and investigated postoperative complications. METHODS: Fifty patients, aged over 60 years presented for an elective urological operation. Patients were randomized into two groups to receive spinal anesthetics using a 22 G Quincke needle (group L) or a 25 G Quincke needle (group S). The incidences of postdural puncture headache (PDPH), backaches, and the outcomes of spinal anesthesia were compared between the two groups. RESULTS: Two patients in group L and one in group S developed PDPH postoperatively with no significant statistical difference between the two groups. Four patients suffered backache in group L and two in group S again without significance. But the number of puncture attempts was significantly higher in group S. CONCLUSION: In conclusion, postoperative complications were similar for both groups. However, spinal anesthesia was performed more easily when using a larger spinal needle. Therefore, we recommend that a larger spinal needle be used when difficult spinal anesthesia is anticipated in elderly patients.
Aged* ; Anesthesia, Spinal* ; Anesthetics ; Back Pain ; Humans ; Incidence ; Needles* ; Post-Dural Puncture Headache ; Postoperative Complications* ; Punctures

Meta-analysis is the statistieal analysis of a collection of analytic result for the purpose of integrating the findings across studies. Such a systematic quantitative procedure through combination of statistic offers accumulation of evidence in terms of the effect size. Furthermore, the combination of data from several studies increases generalibility and statistical power with some criticisms. Schmidt-Hunter procedure is appropriate method for measuring d(the difference between the group mean divided by the standard deviation) statistics. In this paper we present the cumulation formulas for effect sizes and analyzed mean d statistics. Twenty-five research reports of clinical trials for prevention of hemodynamie changes after tracheal intubation were gathered. Three drugs(lidocaine, fentanyl, esmolol) were reported in detail sufficient to get for analyzing variables(systolic, diastolic and heart rate). Means of each variable were summarized and calculated by each drug between control and treatment group. Nine meta-analysis were performed. Lidocaine, fentanyl and esmolol all effectively decreased hemodynamic changes compared to control group(placebo group). Fentanyl provided reliable protection in systolic blood pressure as esmolol in heart rate. Range variation.of mean effect size was smallest and consistent in esmolol group. Variance of the effect size corrected for sampling error was large in all drugs and there should be a search for moderator variables(covariate) with need for stratification.
Blood Pressure ; Fentanyl ; Heart ; Heart Rate ; Hemodynamics* ; Intubation* ; Lidocaine ; Research Report ; Selection Bias

No abstract available.
Cardiomyopathy, Hypertrophic* ; Humans ; Twins, Monozygotic*

Castleman's disease is a rare lymphoproliferative disorder of uncertain etiology which most commonly occurs in the mediastinum. We describe a case of a benign Castleman 's disease of the hyaline vascular type affecting the upper extremity, an extremely rare site of the disease.
Giant Lymph Node Hyperplasia* ; Hamartoma ; Hyalin ; Lymphoproliferative Disorders ; Mediastinum ; Upper Extremity*

In the orbitozygomatic complex fracture, sensory impairment due to the damage of the infraorbital nerve is one of the most common symptom and complication. In this report, we have the assumption that surgical approach for rigid fixation method may have correlations to the damage and regeneration of the nerve. Among patients who had open reduction and internal fixation for unilateral orbitozygomatic complex fracture in our hospital from March 1997 to August 2000, we selected 40 cases. The pin-prick test and the 2-point discrimination test on the infraorbital nerve regions were done for testing the sensory impairments. Two different fracture classification methods were used in this research. First, Henderson's method was used. The results of preoperative test results showed that 17 patients out of 40 patients were abnormalities. More specifically, type IV patients had the highest sensory impairments. In a comparison of the approach methods, the patients who adopted both method showed higher tendency of recovery of sensory impairments. From these results, the degree of deviation in the fracture and the type of approach may be an important prognostic factor for the sensory impairments due to the orbitozygomatic complex fracture.
Classification ; Discrimination (Psychology) ; Humans ; Regeneration ; Retrospective Studies*

PURPOSE: Gastroesophageal reflux in infant is a physiological process. However, surgery is performed in high risk infants with severe gastroesophageal reflux disease (GERD) when medical management fails. This study focuses on efficacy and safety of Nissen fundoplication for GERD in infants under age 12 months. METHODS: This study was a retrospective case analysis of 11 neonates and infants under 12 months of age who underwent Nissen fundoplication following a failure of medical treatment between June 2010 and June 2013 at Pusan National University Children's Hospital. The records were reviewed to determine the effect of fundoplication on symptoms and post-operative complications. RESULTS: A total of 11 infants consist of four males and seven females. Mean birth weight was 2,305.5+/-558.6 g (1,390-3,130 g). They had some underlying disease, which are not related with GERD such as congenital heart disease (54.5%), prematurity (45.5%), neurologic disease (18.2%), respiratory disease (18.2%), and other gastrointestinal disease. Mean body weight at surgery was 3,803.6+/-1,864.9 g (1,938.7-5,668.5 g). Mean age at operation was 99.9+/-107.6 days (17-276 days). Duration from operation to full enteral feeding was 10.9 days. Symptoms related GERD disappeared in all patients including one who got reoperation. One infant died of congenital heart disease unrelated to surgery. There were no complications related to fundoplication. CONCLUSION: Fundoplication is effective and safe treatment in the neonates and infants with severe GERD.
Birth Weight ; Body Weight ; Busan ; Enteral Nutrition ; Female ; Fundoplication* ; Gastroesophageal Reflux* ; Gastrointestinal Diseases ; Heart Defects, Congenital ; Humans ; Infant* ; Infant, Newborn* ; Male ; Physiological Processes ; Reoperation ; Retrospective Studies

We analysed retrospectively pharmacokinetic parameters of gentamicin and amikacin in 44 and 58 Korean pediatric patients, respectively, with normal renal function. Pharmacokinetic parameters were calculated from two concentrations in serum by method of Sawchuck. There was wide individual variation in peak serum concentrations of gentamicin and amikacin, Administration of the usually recommended doses yielded subtherapeutic concentrations in 47% and 82%, respectevely, of patients in the peak concentrations of gentamicin and amikacin. The volumes of distribution of gentamicin and amikacin in children of over 1 year of age were 0.37+/-0.13L/kg and 0.41+/-0.13L/kg which are greater than those reported from the western countries. We conclude that the wide individual variation and high frequency of subtherapeutic levels in the peak concentrations of gentamicin and amikacin obtained by usually recommended dosage as well as the narrow safety margin of these drugs necessitate monitoring of serum concentration and adjustment of individual dosage regimen early in the course of treatment with aminoglycosides.
Amikacin* ; Aminoglycosides ; Child* ; Gentamicins* ; Humans ; Pharmacokinetics* ; Retrospective Studies

BACKGROUND: Nucleoplasty is a minimally invasive spinal surgery using a Coblation(R) technique that creates small voids within the disc. The purpose of this study was to evaluate the efficacy of cervical nucleoplasty in patients with cervical disc disorder. METHODS: Between March 2008 and December 2009, 22 patients with cervical disc disorders were treated with cervical nucleoplasty after failed conservative treatment. All procedures were performed under local anesthesia, and fluoroscopic guidance and voids were created in the disc with the Perc(TM) DC Spine Wand(TM). Clinical outcomes were evaluated by the Modified Macnab criteria and VAS score at preprocedure, postprocedure 1 month, and 6 months. RESULTS: Six patients had one, eight patients had two and eight patients had three discs treated; a total of 46 procedures was performed. Mean VAS reduced from 9.3 at preprocedure to 3.7 at postprocedure 1 month and to 3.4 at postprocedure 6 months. There was no significant complication related to the procedure within the first month. Outcomes were good or excellent in 17/22 (77.3%) cases. Postprocedure magnetic resonance imaging was acquired in two patients after two months showing morphologic evidence of volume reduction of protruded disc material in one patient but not in the other. CONCLUSIONS: Percutaneous decompression with a nucleoplasty using a Coblation(R) technique in the treatment of cervical disc disorder is a safe, minimally-invasive and less uncomfortable procedure, with an excellent short-term clinical outcome.
Anesthesia, Local ; Decompression ; Diskectomy ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Spine

BACKGROUND AND OBJECTIVES: To evaluate the brain MR angiography(MRA) as a tool of diagnosis and follow up study in acute ischemic stroke. METHODS: We reviewed 90 patients of acute ischemic stroke who received thrombolytic therapy and underwent brain MRI with MRA from September 1994 to July 1995. They were divided into two groups according to carotid system and vertebrobasilar system and then positive MRA findings were defined as stenosis or occlusion of vessels in relation with MRI lesions. RESULTS: The positive MRA was shown more than 80% in large arteries and lower than 23% in small arteries. And also the MRA was shown the degree stenosis and underlying vessel abnormalities but could not precisely analyze the degree of improvement of vascular patency in this study. CONCLUSIONS: The MRA as a routine method addition to the MRI provides relatively reliable and noninvasive screening test and provides information that can be more complete evaluation and prognosis in patients of acute ischemic stroke.
Angiography* ; Arteries ; Brain ; Constriction, Pathologic ; Diagnosis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Mass Screening ; Prognosis* ; Stroke* ; Thrombolytic Therapy ; Vascular Patency

BACKGROUNDS: The importance of toxic extracellular levels of excitatory amino acids, as well as of high extracellular levels of inhibitory amino acids, is considered to be related with the pathophysiology of neuronal cell loss during cerebral ischemia. METHODS: The extracellular concentration of glutamate, glycine, and taurine in the hippocampus were determined during and after transient global ischemia in the New Zealand white rabbit. Because the cerebroprotective effects of profound hypothermia are well known and clinically widely used,we used the hypothermia group as an experimental group compared with normothermic control group in the experimental protocol. To derive a quantitative descriptor reflecting the magnitude of amino acid neurotransmitter changes with ischemia, we defined the 'taurine index' as: [glutamate]x[glycine]/[taurine]. RESULTS: Ischemia led to large increases in both excitatory (glutamate and glycine) and inhibitory amino acids(taurine) in the normothermic group. Taurine index was increased during ischemia and after reperfusion and had a close relationship with the severity of ischemia-induced neuronal damage. CONCLUSIONS: The taurine index appears to be a reliable biochemical marker to determine the severity of ischemic injury.
Amino Acids ; Biomarkers ; Brain Ischemia ; Excitatory Amino Acids ; Glutamic Acid ; Glycine ; Hippocampus ; Hypothermia ; Ischemia ; Neurons ; Neurotransmitter Agents ; New Zealand ; Reperfusion ; Subject Headings ; Taurine*