BACKGROUND: Tetracaine has been the most commonly used long-acting spinal anesthetic agent. Recently, hyperbaric bupivacaine was introduced to be useful agent, and has been reported to produce the better quality of anesthesia. The aim of the present investigation was to compare the anesthetic effects of 0.5% hyperbaric bupivacaine and 0.5% hyperbaric tetracaine spinal anesthesia. METHODS: 40 ASA Class I patients undergoing lower extremity operation were randomly distributed to two groups. Group A (n=20) received 15mg, 0.5% bupivacaine in 8% glucose, while Group B (n=20) received 15mg, 0.5% tetracaine in 10% glucose in the lateral decubitus position (L3,4 interspace). We evaluated the sensory and motor blockade, cardiovascular effects and the incidence of tourniquet pain. RESULTS: The mean maximum cephalad spread of analgesia was higher in bupivacaine group (T5) than in tetracaine group (T6) and the spread time was more rapid in bupivacaine group (13.1 +/- 3.3min.) than in tetracaine group (15.8 +/- 4.3min.), but there were no statistical significances. Tetracaine group was earlier onset of motor block and the duration of complete motor block in tetracaine group was significantly longer than in bupivacaine group. The mean decrease in systolic and diastolic blood pressure was 10% to 25% in both groups and more marked in tetracaine group. The incidence of tourniquet pain was greater in tetracaine group than in bupivacaine group. CONCLUSIONS: The quality of anesthesia obtained with bupivacaine may be superior to that produced by tetracaine. We concluded that 0.5% hyperbaric bupivacaine was suitable for short orthopedic or lower abdominal surgery because of less incidence of hypotension, shorter duration of motor block and lower incidence of tourniquet pain.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Anesthetics ; Blood Pressure ; Bupivacaine ; Glucose ; Humans ; Hypotension ; Incidence ; Lower Extremity ; Orthopedics ; Tetracaine* ; Tourniquets

No abstract available.
46, XX Disorders of Sex Development* ; Adrenal Hyperplasia, Congenital* ; Female* ; Humans

No abstract available.
Aorta* ; Endothelium-Dependent Relaxing Factors*

BACKGROUND: The survival rate of children with neuroblastoma has been improved over 20 years, excluding the metastatic disease, in which it does not exceed 20% so far. New treatment modalities have been developed to improve the outcome in metastatic disease. Preoperative chemotherapy reduce the size, the vascularity and the adhesiveness, so increase the resectability of the primary tumor. This retrospective clinical study was designed to review the survival rate in neuroblastoma and to analyze the effect of preoperative chemotherapy in the view point of neoadjuvant therapy on long-term survival in advanced disease. METHODS: One hundred and thirty-four cases were reviewed from 135 patients with neuroblastoma registered at the Department of Pediatrics in Seoul National University Children's Hospital from January, 1985 till December, 1995. The survival rate was reviewed according to the stage. The age, sex of the patients, the stage, anatomical site of the tumor, the level of serum ferritin and neuron-specific enolase were analyzed for the risk factors on survival. RESULTS: Ranges of age at diagnosis were from 1 month to 166 months with the median of 39 months. Five year survival rates and five year disease-free survival rates were 100%, 100% in stage 1(n=5), 90.9%, 90.9% in stage 2(n=13), 43.4%, 40.6% in stage 3(n=19), 27.1%, 19.8% in stage 4(n=95) and 100%, 100% in stage 4S(n=2), respectively. In stage 3, five year survival rate was 52.5% in group receiving neoadjuvant chemotherapy, 28.6% in control group(P=0.02). Five year disease-free survival rate was also noted as 48.6%, 28.6% in each group(P=0.02). In stage 4, five year and ten year survival rates were 27.6%, 23.6% in group receiving neoadjuvant chemotherapy, 26.9%, 0% in control group(P=0.02). Five year and ten year disease-free survival rates were 14.3%, 14.3% in group receiving neoadjuvant chemotherapy, 20%, 0% in control group (P=0.11). In univariate analysis, the age, the stage, and the site of primary tumor appeared to affect the long-term survival. CONCLUSION: Neoadjuvant chemotherapy and delayed primary surgery contribute for advance in survival in advanced neuroblastoma via increasing the resectability of the primary tumor.
Adhesiveness ; Child ; Diagnosis ; Disease-Free Survival ; Drug Therapy* ; Ferritins ; Humans ; Neoadjuvant Therapy ; Neuroblastoma ; Pediatrics ; Phosphopyruvate Hydratase ; Retrospective Studies ; Risk Factors ; Seoul ; Survival Rate

With advancement of endoscopical instruments and technique, gallstone diseases can be managed with laparoscopic cholecystectomy which has rapidly and radically changed the surgical treatment of gallstone diseases. The ideas of laparoscopic surgery was introduced by Germany gynecologist Semm, in 1967 and was first performed by French surgeon Mouret, Dubois in 1987. Although many reports of early laparoscopic cholecystectomy were excellent, many surgeons want to know the surgical results of laparoscopic cholecystectomy are enough good to perform comparing with the conventional cholecystectomy, especially in early complications and late complications. (continue...)
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Gallstones ; Germany ; Laparoscopy

No abstract available.
Esophageal Atresia* ; Tracheoesophageal Fistula*

PURPOSE: Exposure to blood and body fluids represents a significant occupational risk for nurses. This study was done to identify the level of knowledge of and compliance with blood-borne pathogen prevention of hospital nurses according to clinical experience, and to identify factors affecting compliance with blood-borne pathogen prevention. METHODS: A descriptive correlational study was conducted in which self-reported knowledge of and compliance with blood-borne pathogen prevention was assessed. The relationships between variables were examined. Registered nurses who were employed (n=345) were surveyed. Data were analyzed using, t-test, ANOVA, Pearson correlation, and multiple linear regression. RESULTS: Nurses with more than 5 years experience had greater knowledge of blood-borne pathogen prevention than nurses with less than 5 years experience. However, there was no significant difference in compliance with blood-borne pathogen prevention between the two groups. No significant correlation was found between knowledge and compliance with blood-borne pathogen prevention according to experience standards. In nurses with less than 5 years experience, gender, age, reported exposure to a blood-borne pathogen, and compliance with principles of prevention had a significant impact on compliance with blood-borne pathogen prevention. For nurses with more than 5 years experience, reporting after exposure to blood-borne pathogen was a contributing factor to compliance with blood-borne pathogen prevention. CONCLUSION: The study results show that to improve the implementation of preventive measures against blood-borne pathogens different strategies are needed, depending on clinical experience of the nurses.
Blood-Borne Pathogens ; Body Fluids ; Career Mobility ; Compliance ; Humans ; Linear Models ; Nurses

No abstract available.
Humans ; Twins*

Apoptosis is a distinct mechanism of cell death involved in many physiological and pathological processes. Various stimuli, including phagocytosis of bacteria, can induce apoptosis. As the cells proceed through apoptosis, functional activities decline in accord with phenotypic changes. However, decline in functional activities does not mean instantaneous shut-down of all functions, which is rather the characteristic of necrosis. Phagocytosis and oxidative burst are two of the major tasks of mloid cells for engulfment and killing of microbes. It was reported that the myeloid cells which phagocytosed bacteria underwent apoptosis, rendering resolution of acute inflammation. On the contrary, it was known that phagocytosis of latex beads did induce apoptosis. However, we found phagocytosis of latex beads within the apoptotic cell fraction. Thus we investigated whether phagocytosis of latex beads induced apoptosis or apoptotic cells phagocytosed the beads. We used human promyelocytic cell line HL-60 cultured for 4 days in RPMI1640 supplemented with 10% fetal bovine serum and 1 uM all-trans retinoic acid for phagocytic assay. Phagocytic activity was analyzed by flow cytometry after shaking incubation of HL- 60 cells (5 x 10 cells/ml) with fluorochrome-cougated latex beads for 1 hour at 37C followed by elimination of the un-phagocytosed beads by centrifugation on the density of fetal bovine serum. Apoptotic cells were identified as subdiploid fraction by staining the cells with DNA-dye. To investigate whether phagocytosis of latex beads leads to apoptosis or apoptotic cells phagocytose the beads, the cells wbich had phagocytosed the beads were sequentially analyzed before and after 1, 3, 6, 12 and 24 hours of incubation. On the other hand, the apoptotic cell fraction was sorted to be analyzed for phagocytic activity. The sorted cells were also analyzed by chemiluminescence assay for capability of oxidative burst by stimulation with PMA (5 mM). The results showed little increase in the apoptotic fraction among phagocytic cells during incubation up to 24 hours. Rather the sorted apoptotic cells did phagocytose latex beads. But the sorted cells did not show any capability of oxidative burst. Taken these results into consideration, the apoptotic cells seemed to be on the way of dying process in which oxidative burst was lost while phagocytic activity remained. Thus it was suggested that the primitive function of phagocytosis remained longer in the cells proceeding through apoptosis, while oxidative bunt, requiring mitochondrial function, was lost earlier.
Apoptosis ; Bacteria ; Cell Death ; Cell Line ; Centrifugation ; Flow Cytometry ; Hand ; Homicide ; Humans ; Inflammation ; Luminescence ; Microspheres ; Myeloid Cells ; Necrosis ; Pathologic Processes ; Phagocytes ; Phagocytosis ; Respiratory Burst ; Tretinoin

OBJECTIVE: To investigate simple radiographic findings on painful heels in ankylosing spondylitis (AS). Heel radiography in most studies was from AS patients' non-painful heel. METHODS: Seventy AS patients (34 bilateral cases) with heel pain at the time digital radiographs were taken were studied. Standing lateral views (104 radiographs) of the heel were reviewed. Associations between radiologic abnormalities and disease duration and among various abnormal findings were analyzed. RESULTS: Ninety-six (93.4%) had radiographic abnormalities (82.7% in soft tissues/61.5% in bone). Abnormalities of bone only were observed in 9.6%, of the soft tissues only in 30.8%, and of both were 51.9%. These included Kager's triangle's blurring (77.9%), posterior soft tissue swellings near the Achilles tendon insertion (65.4%), obliterations of the retrocalcaneal recess (65.4%), erosions of the superior pole of the posterior calcaneus (31.7%), subplantar irregular spurs (20.2%), posterior traction spurs (16.3%), subplantar erosions (14.4%) and cortical thickenings of the inferior calcaneal body (5.8%). There was a significant association between swelling in the posterior soft tissue and obliteration of the retrocalcaneal recess (p<0.001). CONCLUSION: Digital radiography in AS is useful for observing not only bony lesions but also soft tissue abnormalities of the heel, particularly of the posterior heel. For assessing the symptomatic enthesitis of the Achilles, this simple and quick diagnostic tool is valuable when examining for soft tissues' alterations of the posterior heel.
Achilles Tendon ; Calcaneus ; Heel* ; Humans ; Radiographic Image Enhancement ; Radiography ; Spondylitis, Ankylosing* ; Traction