We experienced a case of adenocarcinoma arising in sacrococcygeal teratoma. The patient was a 52-year-old woman. She was admitted due to one month of sacral pain. She had a sacral mass since birth. On physical examination, anal fistula was present at the perianal area and pus drainage was noted. MR image showed multiple variable-sized cysts with inhomogeneous density. Resected specimen, mesuring 12.5 7.0 cm in diameter, showed multiple variable-sized cystic lesions admixed with grayish solid portion. The cysts contained mucoid material. The microscopic examination showed mature teratoma composed of cysts lined by pseudostratified ciliated columnar epithelium, intestinal mucosa, mature cartilage, bone, and fat tissue. A moderately differentiated adenocarcinoma developed from the cystic area in the mass.
Adenocarcinoma* ; Adult ; Cartilage ; Drainage ; Female ; Humans ; Intestinal Mucosa ; Middle Aged ; Mucous Membrane ; Parturition ; Physical Examination ; Rectal Fistula ; Suppuration ; Teratoma*

BACKGROUND: Propofol is useful agents for anesthesia induction and maintenance, but pain on injection and possible hypotension are a commonly encountered problems during induction. Meanwhile, ketamine has potent analgesic and sympathomimetic effect. Therefore, we evaluated the effect of ketamine pretreatment on injection pain and hemodynamic changes during induction with propofol. METHODS: Premedicated one hundred and twenty ASA physical status I or II patients scheduled for elective surgery were randomly allocated into one of four groups (group 1; propofol only, group 2, 3, 4; pretreatment with 25%, 50%, 75% dose of hypnotic ED50 of ketamine, respectively) groups. Intensity and frequency of injection pain, mean arterial pressure and pulse rate were checked for evaluation of ketamine pretreatment on injection pain and hemodynamic changes during induction with propofol. RESULTS: Incidence of pain on injection was significantly reduced in group 2,3 and 4 compared with group 1. Group 2 and 3 showed more stable hemodynamic changes than Group 1 and 4. CONCLUSIONS: 25-50% of hypnotic ED50 of ketamine (0.17-0.33 mg/kg) pretreatment reduced pain on injection and hemodynamic changes during propofol induction significantly.
Anesthesia* ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Incidence ; Ketamine* ; Propofol* ; Sympathomimetics

BACKGROUND: Both propofol and ketamine are useful hypnotics for induction of anesthesia, and the combination of propofol and ketamine has been used for total intravenous anesthesia. The aim of this study was to evaluate the dose response of propofol, ketamine and combination of these drug, and determine possible interaction between two drugs in patients. METHODS: The effect of ketamine on the dose response curve for propofol was studied in unpremedicated 165 ASA physical status I or II patients who were scheduled for elective operation. As an endpoint of hypnosis, ability to open eyes on verbal command was checked. Dose response curves for propofol and ketamine were determined with a probit procedure and their type of pharmacologic interaction was determined by fractional and isobolographic analysis. RESULTS: At the hypnotic endpoint, the ED50s were 1.13 mg/kg propofol, 0.66 mg/kg ketamine, and the ED95s were 1.67 mg/kg propofol, 1.09 mg/kg ketamine. The type of interaction between two drugs for hypnosis was found to be additive and ketamine was 1.7 times potent than propofol as an equieffective dose of hypnosis. CONCLUSIONS: The type of interaction between propofol and ketamine for hypnosis was additive.
Anesthesia* ; Anesthesia, Intravenous ; Humans ; Hypnosis ; Hypnotics and Sedatives ; Ketamine* ; Propofol*

BACKGROUND: The prevalence of cancer pain was 64% in advanced or terminal cancer patients. In the world, about 25% of all cancer patients had been died without pain control despite of severe pain. We relieved cancer pain with the three methods of treatment such as continuous epidural morphine infusion, alcohol sympathetic block and continuous epidural morphine infusion with alcohol block in the patients requested from other departments. The change of pain was investigated retrospectively. METHODS: The alteration of cancer pain in 26 terminal cancer patients were recorded in visual analogue scale from June 1996 to May 1998 retrospectively. RESULTS: Patients lived average 38.5 days from beginning of pain control. All patients complained severe pain at the point of time requested to pain clinic. But 2 days after pain control, most patients were comfortable or tolerable to pain. At 1 week before death, pain were aggravated and sometimes uncontrolled. CONCLUSIONS: At first time, cancer pain was controlled but it becomes uncontrollable and aggravated in the patients time was drawing near.
Humans ; Morphine ; Pain Clinics ; Prevalence ; Retrospective Studies

BACKGROUND: Epidural morphine has been commonly used to provide postoperative pain relief, but it has many side effects such as nausea, vomiting, respiratory depression, and pruritus. The purpose of this study was to evaluate the analgesic efficacy and side effects by combination use of epidural morphine and butorphanol. METHODS: Forty five patients were randomly divided into 3 groups. For group I, a bolus of 4.7 ml of saline and 3 mg of morphine were administered. For group II, a bolus of 4.2 ml of saline and 3 mg of morphine and 1 mg of butorphanol were administered. For group III, a bolus of 3.2 ml of saline and 3 mg of morphine and 3 mg of butorphanol were administered. Continuous epidural analgesia were administered for all groups; group I (saline 99.4 ml and morphine 6 mg), group II (saline 98.4 ml, morphine 6 mg, and butorphanol 2 mg), group III (saline 96.4 ml, morphine 6 mg, and butorphanol 6 mg) by two day infuser, 2 ml/hr. We compared the side effects and analgesic effect of the three groups for 2 days. RESULTS: The incidence of pruritus, nausea and vomiting was reduced significantly in the group II and III, but the incidence of somnolence increased in the group III. There were no significant differences in analgesic effect and the other side effects among the three groups. CONCLUSION: Above results suggest that the addition of butorphanol to morphine in epidural infusion reduce the incidence of pruritus, nausea and vomiting, but increase the incidence of somnolence.
Analgesia* ; Analgesia, Epidural ; Anesthesia, Epidural* ; Butorphanol* ; Humans ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative ; Pruritus ; Respiratory Insufficiency ; Vomiting

BACKGROUND: Epidural morphine has been commonly used to provide postoperative pain relief, but it has many side effects such as nausea, vomiting, respiratory depression, and pruritus. The purpose of this study was to evaluate the analgesic efficacy and side effects by combination use of epidural morphine and butorphanol. METHODS: Forty five patients were randomly divided into 3 groups. For group I, a bolus of 4.7 ml of saline and 3 mg of morphine were administered. For group II, a bolus of 4.2 ml of saline and 3 mg of morphine and 1 mg of butorphanol were administered. For group III, a bolus of 3.2 ml of saline and 3 mg of morphine and 3 mg of butorphanol were administered. Continuous epidural analgesia were administered for all groups; group I (saline 99.4 ml and morphine 6 mg), group II (saline 98.4 ml, morphine 6 mg, and butorphanol 2 mg), group III (saline 96.4 ml, morphine 6 mg, and butorphanol 6 mg) by two day infuser, 2 ml/hr. We compared the side effects and analgesic effect of the three groups for 2 days. RESULTS: The incidence of pruritus, nausea and vomiting was reduced significantly in the group II and III, but the incidence of somnolence increased in the group III. There were no significant differences in analgesic effect and the other side effects among the three groups. CONCLUSION: Above results suggest that the addition of butorphanol to morphine in epidural infusion reduce the incidence of pruritus, nausea and vomiting, but increase the incidence of somnolence.
Analgesia* ; Analgesia, Epidural ; Anesthesia, Epidural* ; Butorphanol* ; Humans ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative ; Pruritus ; Respiratory Insufficiency ; Vomiting

No abstract available.
Animals ; Lordosis*

INTRODUCTION: Several methods, including loss of eye lash (eyelash) reflex and loss of verbal contact, have heen used as criteria for estimating the optimal hypnosis for anesthesia induction. However, these methods are too objective. We examined the hypnotic dose response of etomidate, using a bispectral index as a more subjective criterion for anesthesia induction. METHODS: Fourty-Five ASA I or II adult patients scheduled for elective orthopedic surgery were randomly allocated to three groups according to induction dose of etomidate. They were Group 1: 0.1 mg/kg ; Group 2: 0.15 mg/kg; Group 3: 0.2 mg/kg (n = 15 for each group), respectively. Etomidate diluted as 10 ml in a syringe injected through an 18G forearm intravenous catheter, using a syringe pump at the rate of 20 ml/min. Observer's Assessment of Alertness/sedation (OAA/S) scale of 1 was considered optimal for hypnosis. Bispectral index, OAA/S scale, and vital signs were checked every minute until spontaneous eye opening after end of drug infusion. Also, the correlation coefficient between BIS and OAA/S scale was checked for evaluating the bispectral index; this was a useful tool for estimating the degree of hypnosis. RESULTS: BIS and OAA/S showed their lowest scores around 60 sec. after the etomidate injection, which was very different from time to peak effect known to be the 2 min. The correlation coefficient (r) between BIS and OAA/S was 0.84 on average, suggesting the BIS as an good subjective indicator of optimal hypnosis for anesthesia induction. Vital signs were stable in all groups. Hypnotic ED50 and ED95 were 0.12 and 0.19 mg/kg, respectively. CONCLUSIONS: Bispectral index can be a useful tool for estimating the optimal hypnosis for anesthesia induction. Hypnotic ED50 of etomidate was 0.12 mg/kg.
Adult ; Anesthesia* ; Catheters ; Etomidate* ; Forearm ; Humans ; Hypnosis ; Orthopedics ; Reflex ; Syringes ; Vital Signs

INTRODUCTION: Several methods, including loss of eye lash (eyelash) reflex and loss of verbal contact, have heen used as criteria for estimating the optimal hypnosis for anesthesia induction. However, these methods are too objective. We examined the hypnotic dose response of etomidate, using a bispectral index as a more subjective criterion for anesthesia induction. METHODS: Fourty-Five ASA I or II adult patients scheduled for elective orthopedic surgery were randomly allocated to three groups according to induction dose of etomidate. They were Group 1: 0.1 mg/kg ; Group 2: 0.15 mg/kg; Group 3: 0.2 mg/kg (n = 15 for each group), respectively. Etomidate diluted as 10 ml in a syringe injected through an 18G forearm intravenous catheter, using a syringe pump at the rate of 20 ml/min. Observer's Assessment of Alertness/sedation (OAA/S) scale of 1 was considered optimal for hypnosis. Bispectral index, OAA/S scale, and vital signs were checked every minute until spontaneous eye opening after end of drug infusion. Also, the correlation coefficient between BIS and OAA/S scale was checked for evaluating the bispectral index; this was a useful tool for estimating the degree of hypnosis. RESULTS: BIS and OAA/S showed their lowest scores around 60 sec. after the etomidate injection, which was very different from time to peak effect known to be the 2 min. The correlation coefficient (r) between BIS and OAA/S was 0.84 on average, suggesting the BIS as an good subjective indicator of optimal hypnosis for anesthesia induction. Vital signs were stable in all groups. Hypnotic ED50 and ED95 were 0.12 and 0.19 mg/kg, respectively. CONCLUSIONS: Bispectral index can be a useful tool for estimating the optimal hypnosis for anesthesia induction. Hypnotic ED50 of etomidate was 0.12 mg/kg.
Adult ; Anesthesia* ; Catheters ; Etomidate* ; Forearm ; Humans ; Hypnosis ; Orthopedics ; Reflex ; Syringes ; Vital Signs

BACKGROUND: Anesthesia induction time is related to speed of injection, injected volume, and Keo. In the case of target controlled infusion, induction time can be controlled by adjusting the induction time mode. The aim of this study was to estimate the effect of induction time mode on variable parameters and vital signs during anesthesia induction with propofol using a target controlled infusion (TCI). METHODS: Sixty unpremedicated adult patients (ASA class I or II, 18 55 yrs) scheduled for elective surgery were randomly allocated to four groups according to induction mode. Group 1 was assigned a flash induction mode, and groups 2, 3 and 4 were assigned 2, 3 and 4min respectively. The end point of anesthesia induction was loss of eyelash reflex. Various parameters including induction time, infused volume, current/effect concentration at induction, and vital signs were compared. RESULTS: As the induction time mode was prolonged, induction time was delayed, but there was no difference in infused volume. Also, the current concentration decreased gradually, but the effect concentration did not show any difference. The vital signs were more stable in groups 3 and 4 compared with groups 1 and 2. CONCLUSIONS: For anesthesia induction, a rapid induction mode showed more rapid induction and low current concentration, but vital signs were relatively unstable and the effect concentration at induction showed no difference. For critically ill patients or patients with unstable hemodynamics, a more gradual induction mode for anesthesia induction in propofol TCI is recommended.
Adult ; Anesthesia* ; Critical Illness ; Hemodynamics ; Humans ; Propofol* ; Reflex ; Vital Signs*