BACKGROUND: Various kinds of methods had been tried to reduce pain on injection of propofol. In this study, the effect of lidocaine pretreatment and that of temperature controlled injections were compared and evaluated its clinical utility. METHODS: One hundred and twenty patients were randomly allocated into 4 groups after permission. Room temperature propofol was used as induction agent in group P,. In group C, cooling (4 degrees C) propofol was used and warming propofol (37 degrees C) in group H. And room temperature propofol following lidocaine (1 mg/kg) was used in group L. Injection dosage of propofol was 2 mg/kg and injection speed was 2 ml/sec in all groups. In each patients, pain score and visual analog scale were measured and tested by ANOVA or Kruskal-Wallis test. RESULTS: There were no statistical significant difference in pain score among the 4 groups. But in visual analog scale analysis, group L markedly reduced values than the other groups by statistically significant manner (in Duncan grouping). CONCLUSION: The alleviating effect of lidocaine pretreatment on painful injection was better than that of changing temperature of propofol itself. More over effectiveness, in view of simplicity, we recommend lidocaine pretreatment.
Humans ; Lidocaine ; Propofol* ; Visual Analog Scale

BACKGROUND: Postintubational sore throat and hoarseness are usually mild symptoms but they are very common complaints among the patients after endotracheal general anesthesia. In addition, some might have severe discomfort and need invasive procedure to relieve these problems. We tried new method of endotracheal tube cuff filling with local anesthetics to reduce postoperative sore throat and hoarseness and evaluated the results. METHODS: Endotracheal cuff filling was done with air 5 ml in healthy 20 patients (ASA I-II, control group). And in another healthy (ASA I-II) 35 patients, the cuffs were filled with 4% lidocaine 3.5 ml and 8.4% sodium bicarbonate 1.5 ml mixture. After 24 hours following general anesthesia, patients were visited and asked whether there were sore throat or hoarseness, if any, how the degree was. RESULTS: In lidocaine-treated group, the incidence of postintubational sore throat was less compared to control group significantly. There was no difference in incidence of hoarseness between two groups. CONCLUSION: Endotracheal cuff filled with lidocaine and sodium bicarbonate mixture is suggested as an effective protective method that reduces the frequency of postintubational sore throat.
Anesthesia* ; Anesthesia, General ; Anesthetics, Local ; Hoarseness* ; Humans ; Incidence ; Lidocaine* ; Pharyngitis* ; Sodium Bicarbonate* ; Sodium*

BACKGROUNDS: Pancreaticoduodenectomy has been applied to diseases of periampullary region since 1935 by Whipple and associates, but this procedure is so complexed that associated with high morbidity and mortality. In the treatment of periampullary cancer, curative surgical resection only promises the possibilities of cure, because other methods of treatment including chemotherapy and radiation therapy have been of little or no benefit to improve the survival rate. METHODS: We performed the clinical analysis on 123 cases of pancreaticoduodenectomies at the department of Surgery, Chonnam University Hospital, during the past 11 years from June 1986 to May 1997 to assess the associated factors with postoperative complications and the survival rate. RESULTS: Among 123 cases, 104 cases(84.6%) were malignant tumor of periampullary region, 16 cases were benign lesion, and 3 cases were type IV pancreatic injury. Pancreaticoduodenectomy was performed in 115 cases, pylorus-preserving pancreaticoduodenectomy in 4 cases, total pancreatectomy in 2 cases and extended pancreaticoduodenectomy in 2 cases. Postoperative complications were developed in 28 cases(22.8%) and the major cause of postoperative complication was the anastomotic leakage, especially in the pancreatico-jejunostomy site. The overall operative and hospital mortality rate was 7.3%. Preoperative percutaneous transhepatic biliary drainage(PTBD) and the serum level of albumin and bilirubin were not related to the development of postoperative complications. Factors affecting survival after resection of malignant tumor were the size of tumor, presence of lymph node metastasis and tumor infiltration to adjacent tissue, but the level of CEA, alphaFP, and CA 19-9 and tumor differentiation were not related to the survival rate statistically. CONCLUSION: Optimal preoperative preparation of the patient and a meticulous and standarized operative technique are mandatory to minimize the operative morbidity and mortality after pancreaticoduodenectomy. In the treatment of periampullary cancer, radical surgical resection is recommended for long-term survival, as well as the development of other treatment modalities to prevent the postoperative recurrence.
Anastomotic Leak ; Bilirubin ; Drug Therapy ; Hospital Mortality ; Humans ; Jeollanam-do ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Pancreatectomy ; Pancreaticoduodenectomy* ; Postoperative Complications ; Recurrence ; Survival Rate

There have been a few reports on deep vein thrombosis (DVT) associated with compression of the left common iliac vein by the right common iliac artery, referred to as May-Thurner syndrome (MTS). However, there have been no reports on DVT associated with MTS in amyotrophic lateral sclerosis (ALS) patients exhibiting similar clinical features to paraplegic spinal cord injury patients. We hereby report a case of DVT associated with MTS in an ALS patient, who was treated successfully.
Amyotrophic Lateral Sclerosis ; Humans ; Iliac Artery ; Iliac Vein ; May-Thurner Syndrome ; Spinal Cord Injuries ; Venous Thrombosis

The neurotoxic effects of inorganic lead, a common environmental toxic substance, include peripheral neuropathy in adults and encephalopathy in children. Behavioral changes including hyperactivity, short attention span, easy distractibility and impulsiveness have also been noted in patients with chronic lead exposure in childhood. The level of norepinephrine in brain may relate to hyperactivity and chronic lead exposure. The purpose of this study was to determine the effect of inorganic lead (PbCl(2)) administration in neonatal rats using immunocytochemical and electron microscopical analysis of norepinephrinergic neurons of the locus ceruleus. Lead chloride were dissolved in distilled water at the concentration of 0.05%, 0.1% and 0.2% and the solution was administered orally via drinking water. After 4, 8 or 12 weeks of continuous administration, all rats were sacrificed and the brain was processed and immunostained with antibody against tyrosine hydroxylase, a rate limiting enzyme of norepinephrine synthesis antibody. The number of tyrosine hydroxylase immunostained cell bodies in locus ceruleus was estimated. Densitometric analysis of tyrosine hydroxylase immunoreactive profiles in electron microscopic photographs were done by using image analyzer. The number of tyrosine hydroxylase immunoreactive neurons in the locus ceruleus had increased statistically after lead administration. Density of tyrosine hydroxylase immunoreactive profiles in the electron microscopy had also increased. Degenerative changes, such as intra-axonal vacuolar space formation, were found within tyrosine hydroxylase immunoreactive axons. Somewhat widened intercellular spaces and retracted processes were also found in the region of the locus ceruleus. Increased tyrosine hydroxylase immunoreactivity may correlate with hyperreactivity of lead intoxicated children. Degenerative changes may be responsible for the short attention span, easy distractibility and impulsiveness observed in case of mild lead poisoning.
Adult ; Animals ; Axons ; Brain ; Child ; Drinking Water ; Extracellular Space ; Humans ; Immunohistochemistry ; Lead Poisoning ; Locus Coeruleus* ; Microscopy, Electron ; Neurons* ; Norepinephrine ; Peripheral Nervous System Diseases ; Rats* ; Tyrosine 3-Monooxygenase ; Water

Spinal dural arteriovenous fistula is a rare vascular lesion of the spinal cord associated with progressive myelopathy. Symptoms include progressive gait dysfunction, weakness, sensory loss, and bowel and bladder dysfunction. Because these symptoms overlap with other common causes of myelopathy and the disease is rare, spinal dural arteriovenous fistula is often not suspected and the time to diagnosis is long. We report the case of a 60-year-old woman who presented with progressive lower limb weakness and gait disturbance diagnosed as spinal dural arteriovenous fistula involving a fractured L1 vertebral body.
Central Nervous System Vascular Malformations ; Female ; Fistula ; Gait ; Humans ; Lower Extremity ; Middle Aged ; Spinal Cord ; Spinal Cord Diseases ; Urinary Bladder

Arteriovenous malformations (AVM) are an unusual cause of gastrointestinal (GI) bleeding. But most GI AVM can occur with GI bleeding. When conventional diagnostic studies have failed to reveal the source of GI bleeding, AVM have been one of the most common causes. But the incidence of AVM presented as bleeding of a gastric submucosal tumor is very low. A case of gastric submucosal tumor was experienced and reported as an AVM. This case is herein discussed with review of corresponding literature.
Arteriovenous Malformations* ; Hemorrhage ; Incidence ; Stomach

BACKGROUND: Although proton pump inhibitors (PPIs) combined with antibiotics have been known to increase the antimicrobial activity, the effect of PPIs on the eradication of Helicobacter pylori (H. pylori) is controversial. The aims of the present study were to evaluate the effect of omeprazole on the amoxicillin activity for the eradication of H. pylori using prospective double-blind clinical trial and to assess the inhibitory activity of amoxicillin on the H. pylori according to the pH in vitro. METHODS: Thirty healthy volunteers with endoscopically proven H. pylori infection were randomized to either OA group (n=14); 2 weeks omeprazole (20 mg, b.i.d.) plus amoxicillin (750 mg, b.i.d.) or PA group (n=16); 2 weeks placebo plus the same antibiotic. The H. pylori status was assessed at baseline and at 6-week after the initiation of treatment, and the eradication rate of H. pylori was compared between two groups. Intragastirc pH and serum gastrin level were measured before and 1-week after the treatment also. In vitro, minimal inhibitory concentrations (MICs) of amoxicillin were assessed at the different pHs of media. RESULTS: Intragastric pH significantly increased in OA group (p=0.02), however, did not change in PA group. The changes of intragastric pH parameters after 1-week treatment were significantly different between two groups (p<0.01). The eradication rates of H. pylori were 28.6% in OA group and 18.7% in PA group, and did not show a significant difference between two groups. In OA group, three intragastric pH parameters tended to be higher in the H. pylori eradication group than the non-eradication group, but the difference did not reach statistical significance. MIC of amoxicillin decreased with pH increment in vitro (r=-0.98, p=0.01). CONCLUSION: Intragastric pH increment using omeprazole might increase the antibacterial activity of amoxicillin, however, did not affect the apparent improvement (>50%) in the eradication rate of H. pylori.
Amoxicillin ; Anti-Bacterial Agents ; Gastric Acid ; Gastrins ; Healthy Volunteers ; Helicobacter pylori* ; Helicobacter* ; Hydrogen-Ion Concentration* ; Omeprazole* ; Prospective Studies ; Proton Pump Inhibitors

OBJECTIVES: Gastrectomy with lymph node dissec tion is the standard treatment for early gastric can cer(EGC). However, patients who have high risks demand modifications in surgical treatment for EGC. Recently, endoscopic mucosal resection(EMR) has become accepted in many institutions as a treatment for cancerous mucosal lesions of the stomach. Thus we investigated the efficacy and safety of EMR prospectively in the patients with EGC who have high risks in surgery and those with premalignant lesions. METHOD: Twenty-five patients were treated with EMR, thirteen were EGC and twelve were premalignant lesions such as tubular adenoma, severe dysplasia. We used standard snare method and endoscopic mucosal resection using a band ligation kits(EMRL). RESULTS: The complete resection rate at the first step of EMR was 100%(12/12) in premalignant lesions, 76.9%(10/13) in EGC. Of three EGC resected incomple tely at the first step, one patient was treated by surgery and two patients underwent the third step of EMR. The final complete resection rate was 92%(23/25) and it was 100%(12/12) in the premalignant lesions, 84.6%(11/13) in EGC. The final complete resection rate in according to the methods was 100%(5/5) by standard snare method, 75%(6/8) by EMRL. As pathologic results, all cases of EGC were limited to the mucosa. No serious complications such as perforation, major bleeding were encountered. CONCLUSION: We consider that EMR is effective and safe in treatment of the patients with EGC who have high risks in surgery and those with premalignant lesions.
Adenoma ; Gastrectomy ; Hemorrhage ; Humans ; Ligation ; Lymph Nodes ; Mucous Membrane ; Prospective Studies ; SNARE Proteins ; Stomach ; Stomach Neoplasms*

OBJECTIVES: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication of cirrhosis. In the most recently published studies, the prevalence of SBP among hospitalized cirrhotics with ascites has been estimated to be around 10-15%, the mortality rate related to this complication being more than 50%. SBP is thought to appear as a consequence of the impaired defensive mechanisms against infection present in cirrhotic patients, such as depressed reticuloendothelial system phagocytic activity, impaired leukocyte function, reduced serum compliment levels, and low antibacterial activity of ascitic fluid. It has proposed that ascitic fluid opsonin capacity is directly correlated to ascitic protein concentration and that this explains an observed predisposition to infection in patients with low ascitic fluid protein concentration. This present study aims to investigate the frequency of the recurrence of SBP in a large series of cirrhotic patient who recovered from the first episode of SBP and to identify any possible predictors of recurrent SBP. METHOD: We reviewed records of chart in 312 consecutive cirrhotics with ascites patients treated in our hospital between January, 1988 and August, 1995. RESULTS: The incidence of SBP was 21.8%(68 cases) and showed 80.9% in male, 19.1% in female. Seventeen(25%) of the 68 patients included in the study after the resolution of their first episode of SBP developed one or more episodes of SBP during follow-up. SBP recurred once in 16 of these patients, twice in 1 patients. The cumulative probability of SBP recurrence was 47.1% at 6 months, 64.7% at 12 months, and 82% at 18 months of follow-up. This study reveals that neither ascitic fluid total protein nor the severity of liver disease(Child's class) predicts the occurence of recurrent SBP. CONCLUSON: We conclude that the occurrence of recurrent SBP is unrelated to the type of liver disease, and severity of liver disease did not predict the presence of recurrent SBP. Also, ascitic fluid total protein < or =1.0 g/dl, prothrombin time < or =45% may not be a sensitive predictor of recurrent SBP.
Ascites ; Ascitic Fluid ; Female ; Fibrosis* ; Follow-Up Studies ; Humans ; Incidence ; Leukocytes ; Liver ; Liver Diseases ; Male ; Mononuclear Phagocyte System ; Mortality ; Peritonitis* ; Prevalence ; Prothrombin Time ; Recurrence