BACKGROUND: The combination of epidural opioids and local anesthetics provides synergistic analgesia and appears to provide superior analgesia with activity. But the effects of both drugs on bowel motility are oppositional. The object of this study is to evaluate the effect of combined epidural-general anesthesia and postoperative epidural analgesia on the recovery of bowel function and on complications in colon surgery. METHODS: 84 patients were allocated to three groups. 29 patients received intraoperative epidural- general anesthesia and continuous epidural analgesia with local anesthetic-opioid for 48 hours postoperatively (Group I). Group II (n = 25) and Group III (n = 30) received intraoperative general anesthesia alone with postoperative epidural analgesia with an intramuscular injection of analgesics, respectively. We compared the pain score and side effects of these analgesic methods, recovery of bowel movements, postoperative complications and postoperative hospital stay among groups. RESULTS: Groups I and II showed better analgesic effects at rest and upon coughing when compared with Group III (P<0.05). There were no significant differences in the incidences of nausea and vomiting, pruritus, motor blockade and the recovery time of bowel movement and postoperative hospital stay among groups. The incidences of ileus/wound complication and dysrhythmia were not different, but the incidence of pulmonary complication in group I (0%) was significantly lower than in group II (12%) and III (20%) (P<0.05). CONCLUSIONS: Combined epidural-general anesthesia and postoperative epidural analgesia results in decreases in the pain score and in the incidence of pulmonary complication. Moreover, epidural analgesia using local anesthetic and opioid does not affect side effects, recovery time of bowel motility, incidences of ileus/wound and dysrhythmia complications.
Analgesia ; Analgesia, Epidural* ; Analgesics ; Analgesics, Opioid ; Anesthesia* ; Anesthesia, General ; Anesthetics, Local ; Colon* ; Cough ; Humans ; Incidence ; Injections, Intramuscular ; Length of Stay ; Nausea ; Postoperative Complications ; Pruritus ; Vomiting

BACKGROUND: Ultrafiltration is a method to reduce capillary leak and the accumulation of extravascular water associated with cardiopulmonary bypass(CPB). There are two techniques of ultrafiltration, conventional and modified techniques. The effect of the former is controversial. The author investigated the effect of ultrafiltration performed in pediatric open heart surgery in our institute. METHODS: The retrospective study was done in 18 children who received surgical correction of congenital heart disease associated with left to right shunt. Eight children undergone ultrafiltration(UF group) were compared with 10 children who did not receive ultrafiltration(non-UF group). Ultrafiltration was performed mainly during rewarming of CPB(conventional UF) with or without modified technique for about 5 minutes immediately after bypass. Hematocrit(Hct), mean arterial pressure(MAP) and platelet count, 24-h blood loss, the amount of transfusion, fluid requirement, time to extubation, duration of ICU stay and the postoperative hospital stay were compared between groups. RESULTS: The volume of ultrafiltrate was 149+/-88 ml and ultrafiltrate/total blood volume(UF/TBV) ratio was 8.6+/-5.3%. The increase of Hct(5.4+/-1.7%) and of MAP(14+/-5.9 mmHg) after rewarming in UF group were significantly greater than 1.5+/-1.7% and 4+/-8.9 mmHg in non-UF group, respectively(p <0.05). There were no significant differences in platelet count, 24-h blood loss, the amount of transfusion, fluid requirement, maximum body temperature, time to extubation, duration of ICU stay and the postoperative hospital stay between groups. CONCLUSIONS: Ultrafiltration performed during open heart surgery in children significantly increases Hct and MAP immediately after ultrafiltration, but does not affect 24-h blood loss, the time to extubation, duration of ICU stay and the postoperative hospital stay.
Body Temperature ; Capillaries ; Child ; Heart Defects, Congenital ; Heart* ; Humans ; Length of Stay ; Platelet Count ; Retrospective Studies ; Rewarming ; Thoracic Surgery* ; Ultrafiltration*

To compare the effects of atracurium, 0.75 mg/kg, on the mean arterial pressures, heart rates and plasma histamine levels under 2%-enflurane inhalation with mask, 24 patients were allocated randomly into two groups; one(Group I, n=12) which atracurium was administered with rapid bolus injection for 5 seconds and the other(Group II, n=12) with the slow injection for 75 seconds. In both groups, there are the most significant decreases and the recovery in mean arterial pressure 1~2 min and 5 min after atracurium, respectively, Group I showed a significant decrease of mean arterial pressure about 10% more than Group II. In heart rate, there are the significant decreases gradually to 87~88% of control 5 min after atracurium in both graups except the only significant increase(104%) 1 min after atracurium in Group I. And Group I showed a significant increase(200%) in plasma histamine concentration (p< 0.05) 2 min after injection than before, but Group II did no significant change. In conclusion, the slow injection of atracurium over 75s during induction of anesthesia can attenuate the histamine-induced cardiovascular response.
Anesthesia* ; Arterial Pressure ; Atracurium* ; Heart Rate ; Histamine Release* ; Histamine* ; Humans ; Inhalation ; Masks ; Plasma

BACKGROUND: Leukocytes, both polymorphonuclear leukocytes(PMNL) and monocytes/macrophages have been implicated in the pathogenesis of the cerebral ischemia and stroke. Neutrophils accumulate in post-hypoxic-ischemic neonatal rat brain prior to the evolution of necrosis and neutrophil depletion attenuates hypoxic-ischemic brain injury. However, the mechanisms leading to post-hypoxic-ischemic neutrophil accumulation are unknown yet. We hypothesized that Intercellular Adhesion Molecule-1 might mediate post-hypoxic-ischemic injury in the immature brain; thus, we evaluated ICAM-1 gene expression in post-hypoxic-ischemic neonatal(postnatal day 7) rat brain. METHODS: Neonatal rats(n=36) underwent right carotid ligation followed by exposure in 8% O2 for 2.5 hours; this procedure typically produces ipsilateral striatal, hippocampal and cortical infarction. Control groups are included by carotid ligation alone, hypoxia alone, and neither hypoxia nor ligation. For RNA extraction, rats were killed 0, 1, 2, 4, 8, 12, 24 and 48 h post- hypoxia-ischemia and RT-PCR was carried out. RESULTS: ICAM-1 mRNA was barely detected in the controls including normal and sham operated animals. In the cortex, striatum and hippocampus, ICAM-1 mRNA was significantly induced in the ipsilateral(right) side compared to the contralateral(left) side just after hypoxia-ischemia. The elevated ICAM-1 mRNA gradually reached a peak at 4 or 8 h and then decreased to an almost basal level by 24 to 48 h. In contrast, the less pronounced contralateral(left-sided) ICAM-1 mRNA expression appeared to peak earlier, within 2 h post-hypoxia-ischemia. CONCLUSION: The temporal profiles of post-hypoxic-ischemic ICAM-1 mRNA expression are consistent with a role in post-hypoxic-ischemic neutrophil recruitment and in the evolution of subsequent brain injury.
Animals ; Anoxia ; Brain Injuries* ; Brain Ischemia ; Brain* ; Gene Expression ; Hippocampus ; Infarction ; Intercellular Adhesion Molecule-1* ; Leukocytes ; Ligation ; Necrosis ; Neutrophil Infiltration ; Neutrophils ; Rats* ; RNA ; RNA, Messenger* ; Stroke

No abstract available.
Vena Cava, Superior*

The Laugier-Hunziker syndrome is a rare syndrome characterized by macular hyperpigmentation of the lips and buccal mucosa associated with melanonychia. Onset is usually in adult life and no consistent systemic associations have been reported. Here we report a 39-year-old wonam with a longitudinal pigmented band on a finger and pigmented macules on the lip. We suggest that this is the first report in Korea and the syndrome is presumably more common than recognized.
Adult ; Fingers ; Humans ; Hyperpigmentation ; Korea ; Lip ; Mouth Mucosa

Fluid resuscitation is a basic treatment in hemorrhagic shock. We compared the circulatory responses to fluid resuscitation of 10% pentastarch with those of fresh whole blood and plasmanate in hemorrhagic shock. Eighteen mongrel dogs were bled 24 ml/kg and replaced by equivalent amounts of fresh whole blood(n=6, group B), pentastarch(n=6, group P) and plasmanate(n=6, group PL). Hemodynamic measurements and calculations were performed before and after bleeding and after volume therapy. The decrease of hematocrit and platelet count after volume replacement indicate that hemodilutional effect was maximum 30 min after volume therapy and significantly greater in group P than PL(p<0.05). Central venous pressure(CVP), pulmonary capillary wedge pressure(PCWP) and cardiac index(CI) were increased to 146-189%, 146-172% and 146-175% in group P, respectively during 60 min. These changes were significantly greater than group B and PL(p<0.05). There was delayed recovery of mean arterial pressure in group PL(92% 30 min after volume therapy) compared with group B and P(92% and 93% 5 min). Also group P and PL showed significant prolongation in prothrombin time and partial thromboplastin time during experiment(120 min) and these were significantly more prolonged in group P than PL(P<0.05). And group P showed similar O transport and O extraction ratio to those of group B. The increases in plasma catecholamine were observed after hemorrhage, but no significant changes 5 and 30 min after volume therapy. This suggests that the neurohumoral response to hemodilution was not marked. Mixed venous O2 saturation(SvO2) was directly proportional to CI during experiment(r=0.69, p<0.01), indicating that SvO2 can represent CI during shock and volume therapy. In conclusion, l0% pentastarch is useful as a substitute for fresh whole blood or plasmanate.
Animals ; Arterial Pressure ; Blood Transfusion, Autologous* ; Capillaries ; Dogs* ; Hematocrit ; Hemodilution ; Hemodynamics ; Hemorrhage ; Hydroxyethyl Starch Derivatives ; Partial Thromboplastin Time ; Plasma ; Platelet Count ; Prothrombin Time ; Resuscitation* ; Shock ; Shock, Hemorrhagic*

BACKGROUND: Ketamine, a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, is known to inhibit "wind-up" and hence central hyperexcitability of dorsal horn neurons. However the results of clinical studies for its preemptive analgesic effect are controversial. The object of this study is to evaluate the effects of preincisional and postincisional low-dose ketamine on postoperative pain. METHODS: In a randomized, double-blind study, postoperative pain was assessed in 60 patients undergoing spinal fusion with general anesthesia who were allocated to three groups. Twenty patients were received 0.15 mg/kg of ketamine and the same volume of saline 5 min before and 15 min after surgical incision, respectively (group I). Patients in group II received 0.15 mg/kg of ketamine and the same volume of saline 15 min after and 5 min before surgical incision, respectively (n = 20), and in control group, patients received saline 5 min before and 15 min after surgical incision (n = 20). IV patient-controlled analgesia (PCA) with a morphine-ketorolac mixture was started in all patients at skin closure. Visual numerical scale (VNS) pain score, total analgesic consumption, and side effects were recorded at 1, 3, 6, 12, 24 and 48 h postoperatively. RESULTS: No significant intergroup differences were seen in the VNS pain scores, total analgesic consumption and incidence of side effects at 1, 3, 6, 12, 24 and 48 h postoperatively. CONCLUSIONS: This result indicates that postoperative pain cannot be decreased when ketamine in low doses is added to general anesthesia before and after surgical stimulation.
Analgesia, Patient-Controlled* ; Anesthesia, General* ; Double-Blind Method ; Humans ; Incidence ; Ketamine* ; N-Methylaspartate ; Pain, Postoperative* ; Posterior Horn Cells ; Skin ; Spinal Fusion

The malignant fibrous histiocytoma (MFH) was first introduced in 1963 to refer to a group of soft-issue tumors characterized by a storiform or cartwheel-ike growth pattern and predominantly fibroblastic appearance. It was postulated that they were derived from histiocytes that could assume the appearance and function of fibroblasts. MFH has been recognized to be the most common sarcoma in the soft tissue of late adult life which involves the deep fascia or skeletal muscles of the extremities or retroperitoneum. It has been noted in other organs, however, it rarely arises in the liver. We report two cases of primary malignant fibrous histiocytoma of the liver histopathologically confirmed after surgical resection-storiform pleomorphic and myxoid subtypes in the 55 year old male and 49 year old female patients, respectively, and describes the clinical courses, characteristics and pathologic aspects with review of the related literatures.
Adult ; Extremities ; Fascia ; Female ; Fibroblasts ; Histiocytes ; Histiocytoma, Malignant Fibrous* ; Humans ; Liver* ; Male ; Middle Aged ; Muscle, Skeletal ; Sarcoma

BACKGROUND: Interactions between nimodipine, a calcium channel blocker, used perioperatively for the treatment of subarachnoid hemorrhage, and vecuronium, rocuronium, and atracurium were studied with phrenic nerve-hemidiaphragm preparations of rats. METHODS: Male 200-300 g Sprague-Dawley rats were randomly allocated into four groups (control, NMD(5), NMD(50) and NMD(500) group, n = 10, respectively) according to the nimodipine concentration, and three groups (control, NMD(2D) and NMD(7D), n = 10, respectively) according to the pretreatment duration. A square wave 0.1 Hz supramaximal stimuli was applied to the phrenic nerve-hemidiaphragm preparation and the twitch height response was recorded with mechanomyography. The dose-response curves were measured, and ED(5), ED(50), ED(90), and ED(95) of each vecuronium, rocuronium, and atracurium in different concentrations of nimodipine of 5, 50, and 500 ng/ml and rocuronium in pretreatment with nimodipine 2.5 mg/kg/d for 2 and 7 days were calculated using an inhibitory sigmoid Emax model. RESULTS: The dose-response curves of rocuronium and atracurium were significantly shifted to the left in NMD(500) group, and significantly shifted to the right in NMD(7D) group (P < 0.05). In NMD(500) group, ED(50), ED(90), and ED(95) of rocuronium and atracurium were significantly reduced, and those of rocuronium in NMD7D group were significantly increased compared with the control group (P < 0.05). CONCLUSIONS: Nimodipine 500 ng/ml in the phrenic nerve-hemidiaphragm preparation of rat increased sensitivity to rocuronium and atracurium, and the dose-response curve was significantly shifted to the left, but following pretreatment for 7 days, nimodipine decreased the potency of rocuronium, and the dose-response curve was significantly shifted to the right.
Animals ; Atracurium* ; Calcium Channels ; Colon, Sigmoid ; Humans ; Male ; Nimodipine* ; Rats* ; Rats, Sprague-Dawley ; Subarachnoid Hemorrhage ; Vecuronium Bromide*