Hyperinsulinemic hypoglycemia is a relatively rare disease in childhood period except neonate, but hypoglycemia due to delicate imbalance between glucose production & consumption is evoked easily and left permanent damage to brain at these period. The definition is that serum insulin level is above 10microU/ml when blood sugar level is below the 40mg/dl and so I/G ratio is higher than 0.4. The clinical manifestations are irrtability, frequent feeding and seizures etc. and there is no specific pancreatic pathology in most cases. We experienced 2 cases of hyperinsulinemic hypoglycemia with pancreatic hyperplasia and pancreatic adenoma each other. The diagnosis was made on clinical manifestations, laboratory results, radiologic and pathologic findings. We reported these cases with brief review of literature.
Adenoma ; Blood Glucose ; Brain ; Diagnosis ; Glucose ; Humans ; Hyperplasia ; Hypoglycemia* ; Infant, Newborn ; Insulin ; Pathology ; Rare Diseases ; Seizures

In 101 jaundiced patients, gray scale ultrasonography of longitudinal scan in RAO position demonstrated themeasurable extrahepatic biliary system in 73 patient; 17 cases (50%) of those with nonobstructive jaundice and 56cases (84%) of those with obstructive jaundice. The size of the internal diameter of extrahepatic biliary systemindicated that obstructive jaundice was best differentiated from non-obstructive jaundice when diameter above 7mm served as abnormal extrahepatic duct in jaundiced patients, giving sensitivity 85.5% specificity 97% anddiagnostic accuracy 89.5% by decision matrix analysis. The overall etiological diagnostic accuracy in obstructivejaundice was 40% which had higher one in choledocholithiasis and pancreas head carcinoma than other diseases. Thesonography should be imaging procedure of choice in differential diagnosis of jaundiced patients, which is simple, safe, noninvasive and has high diagnostic accuracy in differentiation between the two.
Bile Ducts, Extrahepatic ; Choledocholithiasis ; Diagnosis, Differential ; Head ; Humans ; Jaundice ; Jaundice, Obstructive ; Pancreas ; Sensitivity and Specificity ; Ultrasonography

Chondrodysplasia punctata is a rare congenital disorder of bone, occuring in infants, which is characterized by radiographic manifestation of premature deposition of punctate calcific densitiy in epiphyseal areas, preformed in cartilage. We experienced a case of rhizomelic type-chondrodysplsia punctata in a two day old female who showed short stature, symmetric shortening of proximal limbs, cataract, icthyositic skin lesion and characteristic coronal clefts in lumbar vertebral bodies on X-ray.
Cartilage ; Cataract ; Chondrodysplasia Punctata ; Chondrodysplasia Punctata, Rhizomelic* ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Extremities ; Female ; Humans ; Infant ; Skin

Thirteen patients with visceroatrial situs abnormalities were evaluated by magnetic resonance(MR) imaging. Eleven patients were confirmed surgically. Two patitnts were diagnosed by MRI and cardiac catheterization. Right isomerism was found in seven patients, left isomerism in two, and situs inversus in four. For the determination of situs, we evaluated the morphology of atrial appendages and main bronchi, the relationship between abdominal aorta and inferior vena cava(IVC), and the status of upper abdominal viscera. The bilateral atrial morphology was differentiated in 8 of 12 patients. The bronchial situs was determined in 11 of 12 patients. Juxtaposition of abdominal aorta and IVC was found in 6 of 7 with right isomerism. IVC interruption with azygos continuation was found in all two with left isomerism. Incidentally three cases of short pancreas were found. MR imaging showed all structures relevant for the assessment of situs, thus obvrating the need for performing additional diagnostic procedures. MR imaging, therefore, is a valuable tool in the clinical management of patients who are suspected of having a situs abnormality.
Aorta, Abdominal ; Atrial Appendage ; Bronchi ; Cardiac Catheterization ; Cardiac Catheters ; Humans ; Isomerism ; Magnetic Resonance Imaging ; Pancreas ; Situs Inversus ; Viscera

BACKGROUND: The postoperative pain control has improved with use of continuous epidural analgesia(CEA) and intravenous patient-controlled analgesia (IV-PCA). We compared the efficacy and safety of CEA using fentanyl-bupivacaine with IV-PCA using morphine in the postoperative pain control after total hysterectomy. METHODS: Sixty women undergoing hysterectomy were assigned to receive an epidural bolus of morphine 1 mg and 0.125% bupivacaine 10 ml, followed by a CEA with 0.00036% fentanyl and 0.075% bupivacaine at a rate of 5 ml/hr(CEA group) or intravenous bolus of morphine 2 mg followed by a IV-PCA with 0.1% morphine(IV-PCA group). Visual analog scales(VAS) for pain were recorded at 1, 6, 12, 24 and 48hr postoperatively and side effects and degree of satisfaction were noted. RESULTS: Resting and dynamic pain scores were significantly lower in the CEA group than in the IV-PCA group throughout the study period. The average pain scores using VAS in two groups were less than 4. There were no significant differences in side effects and degree of satisfaction between two groups. CONCLUSIONS: The continuous epidural infusion of fentanyl and bupivacaine provided better postoperative analgesia than IV-PCA morphine. The average pain scores of IV-PCA group was less than 4 and the incidence of side effects and degree of satisfaction were not significantly different between two groups. So, we think IV-PCA morphine is a convenient and effective alternative to CEA fentanyl -bupivacaine in patients declining to receive CEA.
Analgesia ; Analgesia, Epidural* ; Analgesia, Patient-Controlled* ; Bupivacaine ; Female ; Fentanyl ; Humans ; Hysterectomy ; Incidence ; Morphine* ; Pain, Postoperative*

BACKGROUND: We prospectively studied 615 patients who received postoperative pain control (epidural analgesia or intravenous patient controlled analgesia) to evaluate pain relief, side effects and complications. METHODS: All study patients receiving postoperative pain control were assessed three times a day by the pain control resident for pain relief, using a visual analogue scale. The presence of side effects and complications was assessed. RESULTS: Over 1year, 615 patients (65.9% women, aged 46.9+/-16.4yr) were studied. General surgery, gynecology and obstetrics in the department; and lower abdomen, upper abdomen and perineum in the operation site were order of decreasing frequency. The most common site of epidural puncture level was T12-L1 in the epidural analgesia. The average pain score using VAS in all groups was less than 3.0 and the degree of satisfaction in postoperative pain control was rated as good on 88% of the patients. Nausea occurred in 9.1% of all patients, vomiting in 6.3%, pruritis in 0.9%, urinary retention in 2.6%, hypotension in 3.2%, but there was no case of respiratory depression. Dislodgement of the epidural catheter occurred in 0.5% of all patients. CONCLUSIONS: Postoperative epidural fentanyl/bupivacaine infusions and IV PCA are an effective method of postoperative pain control with a low incidence of side effects. We believe that, with appropriate patient observations and careful drug selection and with the use of epidural catheters placed appropriately for the proposed surgery, that high quality postoperative pain control can be offered.
Abdomen ; Analgesia ; Analgesia, Epidural ; Catheters ; Female ; Gynecology ; Humans ; Hypotension ; Incidence ; Nausea ; Obstetrics ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Perineum ; Prospective Studies ; Pruritus ; Punctures ; Respiratory Insufficiency ; Urinary Retention ; Vomiting

BACKGROUND: A combination of epidural fentanyl and bupivacaine has been used for many years for the management of postoperative pain. The aim of this study was to compare the analgesia and side effects according to the site of epidural puncture on L2-3 or T12-L1 followed by infusion of fentanyl and bupivacaine after cesarean section. METHODS: Sixty female patients scheduled for cesarean section were assigned randomly to receive fentanyl and bupivacaine via an epidural catheter inserted at L2-3 (group I) or a T12-L1 (group II) for postoperative analgesia. Visual analogue scales (VAS) for pain were recorded at 1, 6, 12, 24 and 48 hr postoperatively and side effects and degree of satisfaction were noted. RESULTS: Rest pain scores at 1 hr and dynamic pain scores at 6 hr postoperatively in group II were significantly less than in group I. Rest pain scores in group II at 24 hr and 48 hr postoperatively were significantly more than in group I. Leg numbness and weakness occurred significantly less in group II than in group I. The average pain scores using VAS in two groups were less than 3. There were no significant differences in other side effects and degree of satisfaction between the two groups. CONCLUSIONS: The continuous epidural infusion of fentanyl and bupivacaine provides good postoperative analgesia and high degree of satisfaction after cesarean section. However, leg numbness and weakness occurred significantly less in T12-L1 group than in L2-3 group. We conclude that epidural analgesia performed on T12-L1 is a more advisable method for the cesarean patients in need of early ambulation.
Analgesia ; Analgesia, Epidural* ; Bupivacaine ; Catheters ; Cesarean Section* ; Early Ambulation ; Female ; Fentanyl ; Humans ; Hypesthesia ; Leg ; Pain, Postoperative ; Pregnancy ; Punctures ; Weights and Measures

BACKGROUND: The preoperative administration of opioids recently has been evaluated for potential analgesic effects that extend beyond the duration of action of the opioids. The aim of this study was to compare the effect of balanced anesthesia using fentanyl-midazolam with inhalation anesthesia on the postoperative pain control and requirement of analgesics in the patients receiving intravenous patient- controlled analgesia (IV-PCA). METHODS: Sixty female patients scheduled for abdominal hysterectomy were divided into two groups. In group I (n=30), thiopental and succinylcholine were used at the induction of anesthesia and followed by N2O-O2-enflurane-pancuronium. In group II (n=30), thiopental, succinylcholine, fentanyl 2 microgram/kg and midazolam 0.1 mg/kg were used at the induction of anesthesia and followed by fentanyl- midazolam-N2O-O2-pancuronium. After surgery, patients were received IV PCA with 0.1% morphine. Visual analogue scales (VAS) for pain were recorded at 1, 2, 4, 6, 12, 24 and 48hr postoperatively and the consumptions of morphine, side effects and degree of satisfaction were noted. RESULTS: Hourly consumptions of morphine and rest and dynamic pain scores in group II were significantly less than in group I at first 1hr postoperatively. All the rest pain scores were less than 3 in both groups. CONCLUSIONS: The balanced anesthesia using fentanyl-midazolam reduced analgesic requirements and pain scores at first 1hr postoperatively compared with the inhalational anesthesia. However, we failed to show the potential preemptive analgesic effects beyond the duration of action of the opioids in balanced anesthesia.
Analgesia ; Analgesics ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Inhalation ; Balanced Anesthesia ; Female ; Fentanyl ; Humans ; Hysterectomy* ; Inhalation* ; Midazolam ; Morphine ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Succinylcholine ; Thiopental ; Weights and Measures

BACKGROUND: Puncture of the dura can lead to a severe and often incapacitating headache. There is a report that the frequency of headache following accidental dural puncture with a 17 or 18 gauge needle is 86.7%. We reviewed the records to evaluate the efficacy of management for all patients whose epidural for postoperative pain control was complicated by dural puncture during a 3-year period. METHODS: The subject of patients in whom dural puncture occurred (35 cases in 1574 epidurals) was divided into two group. Group W5 consisted of 16 patients who received epidural saline and drugs in a rate of 5 ml/hr. Group W10 consisted of 19 patients who received epidural saline and drugs in a rate of 10 ml/hr. All patients were monitored daily by the pain control resident for occurrence of headache. RESULTS: The frequency of accidental dural puncture was 2.2% (35 cases of 1574 epidurals). In group W5, 6 of 16 patients (38%) experienced headache. In group W10, 6 of 19 patients (32%) experienced headache. There were no significant differences between both groups. CONCLUSIONS: The results of this study suggest that the epidural infusion with high volume of 0.9% saline and drugs should be considered as an alternative effective method of managing postdural puncture headache.
Headache* ; Humans ; Needles ; Pain, Postoperative ; Post-Dural Puncture Headache ; Punctures*

BACKGROUND: The endogenous and exogenous factors influence the distribution of local anesthetic solutions within the subarachnoid space. This study was designed to examine the influence of direction of pencil-point tip needle sideport using a 25 gauge Whitacre needle(Vygon, France). METHODS: Thirty adult male patients undergoing orthopedic, urologic or anal surgery were divided randomly into two groups according to the direction of the needle sideport(cephalad or caudad). Intrathecal anesthesia were performed with 10mg of 0.5% hyperbaric bupivacaine. The technique was typically performed using a midline approach at L4-5 interspace in the lateral decubitus position and the patients were turned to supine position immediately after the block. After the injection, we registered the segmental spread of analgesia(pin-prick). Duration of block(two segment regression time) and degree of motor block(Bromage scale) were measured. RESULTS: There were no significant differences in onset time to maximal level of sensory and motor block, two segment regression time between groups. Mean maximal sensory level was T6.1+/-1.6 for the cephalad group vs T7.0+/-1.8 for the caudad group, but no statistical significance was found. CONCLUSIONS: This study suggests that needle sideport direction of Whitacre needles does not significantly influence extent and duration of hyperbaric spinal anesthesia.
Adult ; Anesthesia ; Anesthesia, Spinal* ; Anesthetics ; Bupivacaine ; Humans ; Male ; Needles* ; Orthopedics ; Subarachnoid Space ; Supine Position