This article was conducted to understand the Buddhist doctrine of 'not-self' (anatta) in respect of psychotherapy. The author reviewed the earliest Buddhist canons (Nikayas) and extracted the thoughts of 'not-self'. The Buddhist self (or ego) is not equal to the recent psycological self (or ego). It is rather the systemic being than the single one, which is composed of 5 aggregates. 'Anatta' does not mean 'no self' but 'not-self'. Buddha regards that self or ego is not real but conceptual. The Buddhist doctrine of 'anatta' is based upon the theory of the dependent origination (paticcasamuppada). Buddhism and psychotherapy consent that one could be emancipated from sufferings not by belief, but by introspection. Just as the emotional insight may lead to the change of behavior and personality in psychotherapy, so the true insight to Enlightenment in Buddhism. The psychotherapeutic significance of 'not-self' implies both the recognition and extinction of the conscious and the unconscious adherence. Therefore psychotherapeutic analysis can be introduced into Buddhism and the meditative contemplation of 'paticcasamuppada' can be adopted by psychotherapy.
Buddhism ; Ego ; Psychotherapy

Purpose: To report a case of late-onset bleb-associated endophthalmitis caused by streptococcus cristatus (S. cristatus) after trabeculectomy.Case summary: A 59-year-old woman presented with left ocular pain and visual disturbance. She had undergone trabeculectomy of the left eye 2 years ago. At the initial visit, she was only able to count fingers from the left eye. Whitish thin bleb, conjunctival injection, and inflammation were observed in the left anterior chamber, and the fundus could not be visualized. Despite administering topical and systemic antibiotics, the chamber reaction worsened, and hypopyon and inflammatory membrane were noticed the next day. Vitrectomy with phacoemulsification and intravitreal antibiotic injection was performed, and the intravitreal antibiotic injections were repeated over the next two days. Bacterial culture of vitreous fluid showed a growth of S. cristatus 5 days after the surgery, and inflammation improved after 7 days. One month later, she was still only able to count fingers from the left eye, but there were no signs of endophthalmitis. Conclusions Postoperative endophthalmitis after glaucoma filtering surgeries caused by S. cristatus has not been reported previously from Korea. To the best of our knowledge, this is the first Korean case of late-onset bleb-associated endophthalmitis caused by S. cristatus. If gram-positive cocci are grown in samples from the patients with endophthalmitis after trabeculectomy, resident oral microflora such as S. cristatus should be considered as the causative pathogen.

This study was designed to compare the efficacy of an ephedrine intramuscular injection with crystalloidadministration for the prevention of hypotension during spinal anesthesia in geriatric patients undergoing hip fracture surgery. Twenty-seven ASA II patients scheduled for the .arthroplasty of femoral neck fracture under spinal anesthesia were randomly allocated to receive either 15 ml/kg of Ringer's lactated solution (crystalloid group) or an ephedrine intramuscular injection (ephedrine group). Spinal anesthesia was performed in a lateral decubitus position. According to the patient's height, 10-12 mg of hyperbaric 0,5% tetracaine was injected through a 23-25 gauge spinal needle at the L3-4 or L4-5 interspace. Patients in crystalloid group received Ringer's lactated solution 15 mVkg, over 20 minutes before spinal anesthesia. Patients in the ephedrine group were injectede 30 mg of ephedrine I.M immediately after spinal anesthesia. The incidence of hypotension was 8/12 (66%) in the crystalloid group and 6/15 (40%) in the ephedrine group (p<0.01). There was no significant difference between the groups in the level of anesthesia or heart rate, and hypertension did not occur in either group. The result of this study suggests that the intramuscular injection of ephedrine may be more effective than crystalloid infusion for the prophylaxis of hypotension associated with spinal anesthesia in geriatric patients.
Anesthesia ; Anesthesia, Spinal* ; Arthroplasty ; Blood Pressure ; Ephedrine* ; Femoral Neck Fractures ; Heart Rate ; Hip ; Humans ; Hypertension ; Hypotension* ; Incidence ; Injections, Intramuscular ; Needles ; Tetracaine

This study was designed to compare the efficacy of an ephedrine intramuscular injection with crystalloidadministration for the prevention of hypotension during spinal anesthesia in geriatric patients undergoing hip fracture surgery. Twenty-seven ASA II patients scheduled for the .arthroplasty of femoral neck fracture under spinal anesthesia were randomly allocated to receive either 15 ml/kg of Ringer's lactated solution (crystalloid group) or an ephedrine intramuscular injection (ephedrine group). Spinal anesthesia was performed in a lateral decubitus position. According to the patient's height, 10-12 mg of hyperbaric 0,5% tetracaine was injected through a 23-25 gauge spinal needle at the L3-4 or L4-5 interspace. Patients in crystalloid group received Ringer's lactated solution 15 mVkg, over 20 minutes before spinal anesthesia. Patients in the ephedrine group were injectede 30 mg of ephedrine I.M immediately after spinal anesthesia. The incidence of hypotension was 8/12 (66%) in the crystalloid group and 6/15 (40%) in the ephedrine group (p<0.01). There was no significant difference between the groups in the level of anesthesia or heart rate, and hypertension did not occur in either group. The result of this study suggests that the intramuscular injection of ephedrine may be more effective than crystalloid infusion for the prophylaxis of hypotension associated with spinal anesthesia in geriatric patients.
Anesthesia ; Anesthesia, Spinal* ; Arthroplasty ; Blood Pressure ; Ephedrine* ; Femoral Neck Fractures ; Heart Rate ; Hip ; Humans ; Hypertension ; Hypotension* ; Incidence ; Injections, Intramuscular ; Needles ; Tetracaine

BACKGROUND: Activation of N-methyl-D-aspartic acid (NMDA) receptors leads to Ca++ entry into the cell and initiates a series of central sensitization such as wind up and longterm potentiation in the spinal cord. Therefore, it can be postulated that the central sensitization would be prevented by blocking Ca++ entry with verapamil. In this double-blind study, we administered lumbar epidural bupivacaine or bupivacaine plus verapamil to verify whether preoperative epidural anesthesia can preempt postoperative pain and to investigate the possible role of calcium channel blocker, verapamil, in the central sensitization. METHODS: Sixty patients (ASA class I-II) scheduled for lower abdominal surgery were randomly assigned to one of three groups of equal size. Group 1 (PR) is preincisional epidural bupivacaine group. Group 2 (PO) is postincisional epidural bupivacaine group. Group 3 (PRV) is preincisional epidural bupivacaine and verapamil group. Visual analogue pain and mood scores, Prince Henry Scores, sedation scores, cumulative PCA (patient controlled analgesia) morphine consumptions, and the incidence of side effects were assessed at 2, 6, 12, 24, 48 hours after operation. RESULTS: Cumulative PCA morphine consumptions in PRV group was significantly lower than in PR and PO group at 24, 48 hours after surgery. The incidence of side effects had no difference among three groups. CONCLUSIONS: Preoperative epidural anesthesia with 10ml of bupivacaine would be insufficient to preempt postoperative pain in lower abdominal surgery. However, addition of verapamil to preoperative epidural bupivacaine would decrease postoperative pain possibly by preventing the establishment of central sensitization.
Anesthesia, Epidural ; Bupivacaine* ; Calcium Channels ; Central Nervous System Sensitization ; Double-Blind Method ; Humans ; Incidence ; Morphine ; N-Methylaspartate ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Spinal Cord ; Verapamil* ; Wind

BACKGROUND: Thromboelastography (TEG) has recently become popular for assessment of whole blood coagulation in the operating room. Ketorolac, a potent injectable nonsteroidal anti-inflammatory drug (NSAID), is commonly used for postoperative analgesia. NSAID inhibit platelet aggregation in coagulation process. This study was designed to determine whether ketorolac used for postoperative analgesia can affect hemostatic function using a TEG. METHODS: Seventy-four female patients, ASA physical status 1 or 2, scheduled for an elective gynecologic surgery were randomly allocated into one of four groups (Group 1: n = 10, control without patient-controlled analgesia (PCA); Group 2: n = 21, PCA with morphine 60 mg; Group 3: n = 20, PCA with morphine 30 mg + ketorolac 90 mg; Group 4: n = 23, PCA with ketorolac 180 mg). Blood samples were obtained for TEG analysis preoperatively and 24, 48 and 72 h after surgery. Cumulative drug dosage, visual analog pain scale, satisfaction degree and side effects were measured at 24, 48 and 72 h after surgery. RESULTS: There were no significant differences in TEG parameters among the four groups at each time. There were no significant differences in visual analog pain scales and satisfaction degrees among the three groups using PCA for postoperative analgesia. Among the three groups using PCA for postoperative analgesia, Group 2 experienced more side effects. CONCLUSIONS: Ketorolac does not affect hemostatic function for 3 days after surgery when administrated as a PCA drug.
Analgesia* ; Analgesia, Patient-Controlled ; Blood Coagulation ; Female ; Gynecologic Surgical Procedures ; Hemostasis ; Humans ; Ketorolac* ; Morphine ; Operating Rooms ; Pain Measurement ; Passive Cutaneous Anaphylaxis ; Platelet Aggregation ; Thrombelastography

BACKGROUND/AIMS: The prognosis of primary hepatocellular carcinoma is extremely poor because of its large size, portal vein thrpombosis, extrahepatic metastasis and underlying liver cirrhosis. The aim, of this study is to evaluate the usefulness of ultrasound screening test for early detection of hepatocellular carcinoma in high-ridk populations. METHODS: We analysed 119 patients who were diagnosed with hepatocellular carcinoma by ultrasonography screening test in Yonsei University Severance Hospital from the period of January 1990 to December 1996. RESULT: The mean follow-up duration to the diagnosis of hepatocellular carcinoma was 30 months (range 3-75). The number of patients with single lesion was 89(75%). The mean diameter of the tumor was 3.0 cm (range 1-10) , 82 patients (70%) had masses measured less than 3cm in diameter. The Number of patients with elevated serum alphafetoprotein level above 400ng/ml was 29(25%). The median survival was 28 months in screening group, significant compared with 7 months in control group (p<0.001). CONCLUSIONS: Ultrasound follow-up in high-ridk group of hepatocellular carcinoma mede it possible to detect small tumors in a high percentage of cases. This may lead to an increase in the number of potentially curable tumors and hence an increase in the overall survival rate. So ultrasound screening test is important in the high-ridk group of hepatocellular carcinoma.
Carcinoma, Hepatocellular* ; Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Humans ; Liver Cirrhosis ; Mass Screening* ; Neoplasm Metastasis ; Portal Vein ; Prognosis ; Survival Rate ; Ultrasonography*

Recent evidence suggests that surgical incision and other noxious perioperative events may induce prolonged changes in central neural function that later contribute to postoperative pain, Inhibition of these changes may be of value in the reduction of postoperative pain. Several clinical studies have shown that pretreatment with local anesthetics, opioids, NASAIDs and N-methyl-D-aspartate(NMDA) antagonist are effective in relieving postoperative pain. We compared the efficacy of pre-emptive and post-incisional epidural analgesia with morphine 2 mg in 0.25% bupivacaine(8 ml) on the postoperative pain. Seventy patients (ASA physical status I, 2) scheduled for elective lower abdominal surgery were randomized to one of two groups of equal size and prospectively studied in a double-blind manner. Group I received epidural morphine(2 mg, in 8 ml 0.25% bupivacaine) before surgical incision followed by epidural normal saline(8 ml) just before termination of the surgery. Group 2 received epidural normal saline(8ml) before surgical incision, followed by epidural morphine(2 mg, in 8 ml 0.25% bupivacaine) just before termination of the surgery. Anesthesia was induced with thiopental sodium(4~6 mg/kg) and maintained with N2O/O2 and enflurane. Paralysis was achieved with pancuronium. Percentage of maximal possible effect(MPE) was significantly higher(P<0.05) in group 1 (85.3%) than in group 2 (70.8%). Secondary analgesic requirement was less in group 1(9/35 patients, 25.7%) than in group 2 (15/35 patients, 42.9%). Visual analog scale pain and mood score and Prince-Henry pain score are not significantly different between two groups. We conclude that pre-emptive epidural analgesia with morphine and bupivacaine may be more effective in relieving postoperative pain than post-incisional analgesia in lower abdominal surgery.
Analgesia* ; Analgesia, Epidural ; Analgesics, Opioid ; Anesthesia ; Anesthetics, Local ; Bupivacaine ; Enflurane ; Humans ; Morphine* ; Pain, Postoperative ; Pancuronium ; Paralysis ; Prospective Studies ; Thiopental ; Visual Analog Scale

BACKGROUND: Recently, functional direct cortical stimulation mapping is frequently used during craniotomy for the surgery of brain pathology (tumors, epileptic foci etc.) within or close to the central motor area. We reviewed and analyzed our experiences to evaluate the safety and efficacy of our hospital's anesthetic management regimens. METHODS: We used three anesthetic regimens (isoflurane fentanyl; propofol fentanyl; awake craniotomy, conscious sedation analgesia) in 44 patients. We evaluated the success ratio of mapping and the incidence of intraoperative problems (seizures, changes in vital signs etc) in each regimens. RESULTS: In awake craniotomy group, functional mapping is performed successfully in all patients but there were some intraoperative problems (hypertension; 3 in 11 patients, hypercapnia; 3 in 11 patients, change to general anesthesia required; 1 in 12 patients). In general anesthesia groups, there were no significant differences between isoflurane treated patients and propofol treated patients in the success ratio of mapping (17/20 vs 11/12) and the incidence of intraoperative problems (seizure; 3/20 vs 1/12, hypertension; 2/20 vs 1/12). CONCLUSION: This results suggest that the anesthetic management regimens used in our hospital provide suitable conditions for craniotomies when brain mapping is required.
Anesthesia, General ; Brain Diseases ; Brain Mapping ; Conscious Sedation ; Craniotomy* ; Fentanyl ; Humans ; Hypercapnia ; Hypertension ; Incidence ; Isoflurane ; Propofol ; Vital Signs

Collagenous gastritis, a counterpart of collagenous colitis, is an extremely rare disorder. The first case of collagenous gastritis in a Korean boy in his preteens who had been receiving treatment for refractory iron deficiency anemia has been reported. The patient had been suffering from intermittent abdominal pain, recurrent bloodtinged vomiting and poor oral intake. The gastric endoscopy revealed diffuse cobblestone appearance of the mucosa with easy touch bleeding throughout the stomach but no abnormalities in the esophagus, duodenum, and colon. Pathologic examination of the gastric biopsies from the antrum, body and cardia showed a subepithelial collagen deposition with entrapped dilated capillaries, moderate infiltrates of lymphoplasma cells and eosinophils of the lamina propria, and marked hypertrophy of the muscularis mucosa. The collagen deposition appeared as discontinuous bands with focally irregular extension into the deeper part of the antral mucosa. It measured up to 150 micrometer. Helicobacter pylori infection was not detected. The biopsies from the duodenum, esophagus and colon revealed no pathologic abnormalities.
Biopsy ; Child ; Colitis/*diagnosis/pathology ; Collagen/metabolism ; Endoscopy ; Gastric Mucosa/pathology ; Gastritis/pathology ; Gastrointestinal Hemorrhage/diagnosis/pathology ; Helicobacter pylori/metabolism ; Humans ; Korea ; Male ; Mucous Membrane/pathology ; Stomach Diseases/diagnosis/pathology