Adequate radiographic demonstration of renal injury following blunt abdominal trauma is an important guide totherapy. The diagnostic evaluation of renal injuries usually begins with excretory urography, but not providedetailed information about the extent of injury. The need for a more accurate noninvasive modality led us toinvestigate the use of CT. We evaluated with CT and excretory urography 30 selected patients suspected of havingmajor renal injury. Of these patients 11 were also underwent arteriography for assessment of renal arterialinjuries. In this paper, we wish to analyze the result of the above modalites, particulary angiography and CT. Thebrief results were as follow. 1. Among 30 patients, 21 cases were male and 9 cases were female. About one third ofthese occured between the age of 20-29. 2. All cases were nonpenetrating blunt traumas. 3. Renal injuries werecategorized into 3 groups. Category I is minor renal injuries(14 cases), II is major renal injuries(1 cases), andIII is catastrophic renal injuries(3 cases). 4. IVP is the most common inital diagnostic modality and good forscreening of patients, but lack of specificity. In our study the specificity is about 33%. 5. CT is more accuratein detecting hematoma, parenchymal laceration, fracture and extravasation of urine, but agiography is moreconfirmative in diagnosis of vascular injuries. 6. Conservative management was done in 19 cases; 13 cases ofcategory I and 6 cases of II. Operation was performed in 11 cases: 1 case of category, I, 7 cases of II and 3cases of III. 7. Associated injuries were noted in 17 cases(57%).
Angiography ; Diagnosis ; Female ; Hematoma ; Humans ; Lacerations ; Male ; Sensitivity and Specificity ; Urography ; Vascular System Injuries

BACKGROUND: There have been recent reports on the effects of the addition of intrathecal midazolam to bupivacaine on spinal anesthesia. Therefore, the effects of the addition of intrathecal midazolam to bupivacaine on spinal anesthesia and peri-operative sedation were investigated. METHODS: Thirty one ASA class 1 and 2 patients, scheduled for transurethral resection of the bladder or prostate (TURB or TURP), were randomly divided into two groups. Group B (n = 15) received bupivacaine 12 mg, and normal saline 0.6 ml, whereas group BM (n = 16) received bupivacaine 12 mg, midazolam 2 mg, and normal saline 0.2 ml. The blood pressure (BP), heart rate (HR), arterial oxygen saturation (SaO2), bispectral index (BIS) and Observer's Assessment of Alertness/Sedation Scale (OAA/S scale) scores were recorded every 5 minutes, both before and during the spinal anesthesia. The sensory blockade was measured using a pin-prick test, and motor blockade evaluated using the Bromage motor scale. In addition, the side effects, including pruritus, nausea, vomiting, and headache, and so on, were observed for a period of 24 hours. RESULTS: There were no differences in the motor and sensory block and recovery between the two groups. However, a difference was found in the time to first recognition of pain and the BIS scores between the two groups. CONCLUSIONS: Intrathecal midazolam did not, itself, affect the spinal anesthesia, but was found to have a statistically prolonged postoperative analgesic and more sedative effects.
Anesthesia, Spinal* ; Blood Pressure ; Bupivacaine* ; Headache ; Heart Rate ; Humans ; Hypnotics and Sedatives ; Midazolam* ; Nausea ; Oxygen ; Prostate ; Pruritus ; Urinary Bladder ; Vomiting

In maxillofacial surgery endotracheal tube provides patent airway and prevents patient from aspirating the blood. But serious complications such as tube obstruction or injury have been reported. In this case, endotracheal tube injury by surgical saw during Lefort I osteotomy occurred. We could not exchange the defective tube for a good one using laryngoscope or fiberoptic bronchoscope due to edema and blood in nostril and oral cavity. We didn't have any tube exchanger available too. Therefore, to provide patent and safe airway, we packed gauze around the lacerated part of tube, provided positive end expiratory pressure ventilation and increased oxygen flow. After anesthesia, the damaged tube was safely removed and there were no respiratory complications.
Anesthesia ; Bronchoscopes ; Edema ; Humans ; Laryngoscopes ; Mouth ; Osteotomy* ; Oxygen ; Positive-Pressure Respiration ; Surgery, Oral ; Ventilation

Hiccup is caused by synchronous contractions of the diaphragmatic and intercostal muscles followed by the closure of the glottis. Intractable hiccup is defined as hiccup bouts lasting more than 48 hours or recurring despite various treatments. Recently we have experienced a case of postoperative intractable hiccup. We failed to stop intractable hiccup by pharmacological treatment, but succeeded by unilateral phrenic nerve block.
Glottis ; Hiccup* ; Humans ; Intercostal Muscles ; Nerve Block ; Phrenic Nerve*

Postherpetic neuralgia (PHN) is a sequela of acute herpes zoster infection and is defined as pain persisting more than 1 month. The patients with PHN suffer from a persistent neuropathic pain. There are many treatments for PHN but some people occasionally do not respond to the conventional therapies. Neurodestruction using neurolytic agents are beneficial to patients with severe intractable pain because of it's prolonged pain-relief and simplicity, inexpensiveness. We report a case that we managed successfully a patient with intractable thoracic PHN using intrathecal alcohol neurolysis.
Herpes Zoster ; Humans ; Neuralgia ; Neuralgia, Postherpetic* ; Pain, Intractable

BACKGROUND: Pulmonary venous flow velocity pattern (PVFVP) is widely used to assess LV diastolic function. It is known that the parameters of PVFVP have a significant correlation with the ratio of peak early diastolic filling velocity (E) to peak filling velocity at atrial contraciton (A) measured in the transmitral flow. However, the correlations between parameters of superior vena caval flow (SVCF) and transtricuspid E/A ratio have not been reported. Therefore the present investigation was performed to elucidate these correlations. METHODS: Fifty patients (26 men, mean age 63.1+/-11.1 years), who did not have significant tricuspid valvular disease and restrictive filling pattern on tricuspid and superior vena caval doppler, were included in this study. SVCF was recorded with the transducer positioned at subxiphoid area and the sample volume placed 2 cm within the superior vena cava. Blood flow across the tricuspid valve was obtained from standard four chamber view or modified parasternal four chamber view with the sample volume placed on leaflet tips. Recording was made during midexpiratory apnea. The following doppler parameters were measured: transtricuspid E and A velocity, E/A ratio: systolic (S) and diastolic (D) peak velocities and time velocity integrals (TVI), S/D velocity ratio, S/D TVI ratio, atrial reversal peak velocity (ArV) and TVI (ArTVI) in SVCF. RESULTS: 1) In SVCF, S velocity (63.7+/-11.8 cm/s vs 73.4+/-13.6 cm/sec, p<0.05), S TVI (17.4+/-3.6 cm vs 21.1+/-6.2 cm, p<0.05), ArV (30.0+/-6.9 cm/s vs 37.2+/-7.3 cm/s, p<0.005), and ArTVI (2.7+/-0.8 cm vs 3.3+/-0.8 cm, p<0.01) were significantly decreased in group E/A>1. And D TVI (7.1+/-3.0 cm vs 5.2+/-3.1 cm, p<0.05) and D/S TVI ratio (0.41+/-0.13 vs 0.26+/-0.14, p<0.05) were significantly increased in group E/A>1. 2) As E/A ratio increased, diastolic TVI (r=0.315, p<0.05) and D/S TVI ratio (r=0.448, p<0.001) increased, and ArTVI (r=-0.376, p<0.01) and ArV (r=-0.416, p<0.01) decreased. 3) As E peak velocity increased, SVCF D peak velocity increased (r=0.305, p<0.05). CONCLUSIONS: Tricusupid E/A ratio has positive correlations with D TVI and D/S TVI ratio, and negative correlations with ArTVI and ArV. But there were no correlations in S velocity, D velocity, and S/D velocity ratio as the relation of mitral E/A ratio with PVFVP.
Apnea ; Humans ; Male ; Transducers ; Tricuspid Valve ; Vena Cava, Superior

Background/Aims: Adequate bowel preparation is important for successful colonoscopy. We aimed to evaluate the clinical feasibility and effectiveness of abdominal vibration stimulation in bowel preparation before therapeutic colonoscopy. Methods: A single center, prospective, randomized, investigator-blinded study was performed between January 2016 and December 2016. Patients for therapeutic colonoscopy were prospectively enrolled and assigned to either the vibrator group or walking group. Patients who refused to participate in this study as part of the experimental group consented to register in the control group instead. During the preparation period, patients assigned to the walking group walked ≥3,000 steps, whereas those assigned to the vibrator group received abdominal vibrator stimulation and restricted walking. All patients received the same colon cleansing regimen: 4-L split-dose polyethylene glycol (PEG) solution. Results: Three hundred patients who received PEG solution for therapeutic colonoscopy were finally enrolled in this study (n=100 per group). Bowel cleansing with abdominal vibration stimulation showed almost similar results to that with walking exercise (Boston Bowel Preparation Scale score for the entire colon: vibrator vs walking vs control, 7.38±1.55 vs 7.39±1.55 vs 6.17±1.15, p<0.001). There were no significant differences between the vibrator group and walking group regarding instances of diarrhea after taking PEG, time to first diarrhea after taking PEG, total procedure time, and patient satisfaction. Conclusions This study indicates that, compared with conventional walking exercise, abdominal vibration stimulation achieved similar rates of bowel cleansing adequacy and colonoscopy success without compromising safety or patient satisfaction.

BACKGROUND/AIMS: Early intestinal mucosal damage plays an important role in severe acute pancreatitis (AP). Previous studies have shown that intestinal permeability (IP), serum endotoxin and cytokines contribute to the early intestinal barrier dysfunction in AP. This study explored the predictive capacity of IP, endotoxemia and cytokines as prognostic indicators in AP patients. METHODS: Eighty-seven AP patients were included in the study. The patients were classified into three groups according to the Balthazar computed tomography severity index (CTSI). We compared the biochemical parameters, including IP, serum endotoxin level and cytokine level among the three groups. The associations of IP with serum endotoxin, cytokines, CTSI, and other widely used biochemical parameters and scoring systems were also examined. RESULTS: IP, serum endotoxin, interleukin (IL-6) and tumor necrosis factor (TNF)-alpha had a positive correlation with the CTSI of AP. Endotoxin, IL-6, TNF-alpha, CTSI, the Ranson/APACHE II score, the duration of hospital stay, complications and death significantly affect IP in the AP patients. CONCLUSIONS: We believe that IP with subsidiary measurements of serum endotoxin, IL-6 and TNF-alpha may be reliable markers for predicting the prognosis of AP. Further studies that can restore and preserve gut barrier function in AP patients are warranted.
Cytokines ; Endotoxemia ; Endotoxins ; Humans ; Interleukin-6 ; Interleukins ; Length of Stay ; Pancreatitis ; Permeability ; Prognosis ; Tumor Necrosis Factor-alpha

BACKGROUND AND OBJECT: Transradial percutaneous coronary intervention enables early ambulation and caused less complications at the puncture site. This study was performed to evaluate the safety of transradial coronary intervention with early discharge in selected patients. MATERIALS AND METHOD: Thirty patients were studied retrospectively. Twenty five patients had transradial percutaneous coronary intervention with next morning discharge and 5 patients had transradial percutaneous coronary intervention on an outpatient basis. Each patient was checked for cardiovascular complication and any other problems at the puncture site immediately after, 2 weeks after and 1 month after the procedure. RESULTS: This study group consisted of 30 patients with a mean age of 60+/-10 years. The indication for intervention were unstable angina (63.3%), stable angina (20.0%), and restenosis at 6-month follow-up after intervention. A total of 21 stents were implanted at 40 lesions. No major cardiovascular complication nor puncture site complication was reported at 1 month follow-up. CONCLUSION: Early discharge is supposed to be safe for those with optimal angiographic results and no clinical problems for at least 5 hours after intervention.
Angina, Stable ; Angina, Unstable ; Early Ambulation ; Follow-Up Studies ; Humans ; Outpatients ; Percutaneous Coronary Intervention ; Punctures ; Radial Artery ; Retrospective Studies ; Stents

BACKGROUND: Pulmonary venous diastolic flow follows the pattern of mitral flow and is dependent on the pressure difference between the pulmonary vein and the left atrium (LA). The magnitude of the decrease in LA pressure in early diastole depends on both the volume of the blood leaving the LA and the stiffness of the left ventricle (LV) and the LA. Relaxation process is known to govern early diastolic compliance. We hypothesized that in patients with decreased early diastolic compliance due to LV relaxation abnormality, there may be rapid rise in LV and LA pressure, resulting in early peak of pulmonary venous D wave as early LV diastolic filling progress. This study was undertaken to define this hypothesis and to examine the relation of the time interval between E wave peak and D wave peak to mitral doppler indexes. METHOD: Patients with significant mitral or aortic valvular disease, or patients with LV ejection fraction below 60%, or patients who have pseudonormal or restrictive LV filling pattern on mitral and pulmonary venous Doppler, were excluded from this study. Mitral Doppler indexes including peak E velocity, peak A velocity, E wave acceleration time (EAT) and deceleration time (EDT) were measured. E/A ratio was calculated. The isovolumic relaxation time from aortic valve closure (Ac) to the onset of E wave , the time interval from Ac to the peak of E wave (AcE), the time interval from Ac to the peak of D wave, and the diastolic time from Ac to R of electrocardiogram (AcR) were measured by the pulsed wave Doppler and phonocardiography. The time interval from the peak of E wave to the peak of D wave (ED) was calculated by the subtraction of AcE from AcD. RESULTS: 1) ED is significantly shorter in patients with E/A<1 than those with E/A> or =1 (58.9+/-27.4 msec versus 74.7+/-17.2 msec, p<0.05). 2) ED correlated with IVRT (r=-0.400, p<0.01), AcR (r=0.414, p<0.01), but not with E/A ratio, EDT, or EAT. 3) Multivariate linear regression analysis with all the previously mentioned variables showed that IVRT, AcR, and EAT were independent determinants of the ED. CONCLUSION: This study demonstrates that the ED is shortened in patients who are regarded as having LV relaxation abnormality and that ED is affected by IVRT, AcR, and EAT.
Acceleration ; Aortic Valve ; Compliance ; Deceleration ; Diastole ; Electrocardiography ; Heart Atria ; Heart Ventricles ; Humans ; Linear Models ; Phonocardiography ; Pulmonary Veins ; Relaxation