Ketamine is a safe and effective drug for pediatric anesthesia, sedation and analgesia. We hoped to identify that surgeons could operate a pediatric hernia with the ketamine anesthesia without general anesthesia. The study was a consecutive case series of 2230 inguinal hernia patients aged 1 months to 17 years in a Joo's day-surgical clinic during 11-year period. The patients had pediatric inguinal hernia surgery without general anesthesia under the day-surgery system. We retrospectively analyzed the medical record of patients who were registered with the Diagnosis Related Group (DRG) system. All patients received ketamine (5mg/kg) and atropine (0.01mg/kg) intramuscularly before surgery. After anesthesia, we injected 1~2% lidocaine (Less than 5ml) subcutaneously at the site of incision and started operation. The surgical method was the high ligation method of the hernia sac.) In total 2230 patients, male were 1756 and female were 474. 2076 patients were a unilateral inguinal hernia at the time of surgery and 154 were bilateral hernia patients. Less than three months, depending on the age of the patients was 391, and less than 12 months the patient was 592 people (26.5%). After surgery, there were no accidents or long term complications associated with ketamine anesthesia. We think the surgeon can safely do the pediatric inguinal hernia surgery using ketamine and lidocaine without anesthesiologist through 11 years of our surgical experiences.
Analgesia ; Anesthesia ; Anesthesia, General ; Atropine ; Child ; Diagnosis ; Female ; Hernia ; Hernia, Inguinal* ; Hope ; Humans ; Ketamine* ; Lidocaine* ; Ligation ; Male ; Medical Records ; Retrospective Studies

BACKGROUND: Isolated lung perfusion (ILP) was developed as a new treatment approach to non-resectable primary or metastatic lung cancer, because of its ability to reduce systemic toxicity while delivering high-dose chemotherapeutic agents to the target organs. This research was planned to evaluate the direct toxic effect of high-dose cisplatin to the lung tissue during isolated lung perfusion. MATERIAL AND METHOD: Fifteen mongrel dogs were divided in the perfusate for 40 minutes. The second group was composed of 5 mongrel dogs which underwent ILP with cisplatin 2.5 mg/Kg added to the perfusate for 30 minutes and 10 minutes with washing solution without cisplatin. The third group underwent the same procedure as the second group except cisplatin 5.0 mg/Kg in the perfusate. Activities of serum angiotensin converting enzyme (ACE), tumor necrosis factor-alpha (TNF-alpha), and concentration of serum lactate dehydrogenase (LDH) and blood urea nitrogen/creatinine (BUN/Cr) were analyzed in each groups at the time of pre-perfusion, 1 hour, 1 day, 1 week, and 2 weeks after ILP. RESULT: Serum ACE activities before and 1 hour, 1 day, 1 week, and 2 weeks after ILP in control group were 45.1+/-6.3, 44.6+/-9.3, 46.7+/-9.5, 50.8+/-9.1, 46.1+/-4.3 U/L. Those in cisplatin 2.5 and 5.0 mg/Kg groups were 49.4+/-12.6, 39.0+/-8.6, 42.3+/-15.9, 50.0+/-2.6, 53.8+/-8.3 and 55.5+/-12.3, 47.0+/-6.3, 45.1+/-6.9, 74.8+/-19.5, 60.2+/-12.0 U/L, respectively. Serum TNF-alpha activities in each group before and after ILP were 5.0+/-1.5 / 7.7+/-2.2 / 6.6+/-2.5 / 4.3+/-1.3 / 5.2+/-1.1 (control), 8.7+/-1.6 / 9.9+/-2.2 / 7.9+/-1.5 / 6.3+/-2.2 / 7.4+/-2.4 (cisplatin 2.5 mg/Kg), and 6.9+/-0.7 / 8.9+/-3.4 / 7.9+/-4.0 / 3.3+/-0.9 / 5.8+/-1.3 pg/ml (cisplatin 5.0 mg/Kg). Mean LDH levels of each group were 225.7 / 271.3 / 328.9 / 350.8 / 255.7(control), 235.7 / 265.7 / 336.0 / 379.5 / 299.2 (cisplatin 2.5 mg/Kg), and 259.6 / 285.2 / 340.6 / 433.4 / 292.4 IU/L (cisplatin 5.0 mg/Kg). So there was no significant difference in serum ACE, TNF-alpha, and LDH activity changes after ILP between the 3 groups. And, there was no significant changes in BUN/Cr in each groups, which was independent of ILP and perfused concentration of cisplatin. In addition, all dogs survived the ILP and there was no significant evidence of pulmonary vascular injury after 2 weeks of ILP with cisplatin. CONCLUSION: There was no harmful effect of cisplatin to the lund tissue of the mongrel dog up to 5.0 mg/Kg in perfusate. Therefore, it is perceived to be safe and effective to deliver high-dose cisplatin to the lung without pulmonary toxicity and renal damage with ILP.
Animals ; Cisplatin* ; Dogs* ; L-Lactate Dehydrogenase ; Lung Neoplasms ; Lung* ; Peptidyl-Dipeptidase A ; Perfusion* ; Tumor Necrosis Factor-alpha ; Urea ; Vascular System Injuries

No abstract available.
Adult* ; Anatomic Landmarks* ; Humans ; Vertical Dimension*

No abstract available.
Heart Valve Prosthesis* ; Heart Valves*

No abstract available.
Membranes* ; Pregnancy* ; Rupture*

BACKGROUND: Vasoconstrictors have been used as an adjunct to local anesthetics to prolong the duration of spinal anesthesia. Recently, clonidine, an 2-receptor agonist has been shown to prolong the duration of spinal anesthesia following intrathecal administration. Bupivacaine has been used for spinal anesthesia and compared with tetracaine in recent studies. We have undertaken this study to further evaluate the effect of clonidine in hyperbaric 0.5% bupivacaine spinal anesthesia. METHODS: Thirty patients who were scheduled for lower limb or urologic operation were divided into 2 groups: Group A (hyperbaric bupivacaine 13 mg, 2.6 ml + N/S 1 ml), Group B (hyperbaric bupivacaine 13 mg, 2.6 ml + clonidine 150 g, 1 ml). We used standardized techniques and injected above drugs to group A and B intrathecally for spinal anesthesia. We investigated the onset and the duration of spinal anesthesia along with hemodynamic changes (blood pressure and heart rate) in patients. RESULTS: There were no significant differences in the onset of spinal anesthesia and hemodynamic changes between two groups. The time taken to recover from the nerve block was more prolonged in the group B (touch 225, pain 262, foot dorsiflexion 271, knee flexion 290 minutes) than group A (touch 154, pain 188, foot dorsiflexion 198, knee flexion 216 minutes). There were no significant differences in sedation, and in experiencing dry mouth and other side effects between two groups. CONCLUSION: Intrathecal clonidine 150 g has been proved to prolong the duration of hyperbaric 0.5% bupivacaine spinal anesthesia without neurotoxicity or dangerous hemodynamic depression. Therefore, clonidine can be used as an effective adjunct in hyperbaric bupivacaine spinal anesthesia.
Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine* ; Clonidine* ; Depression ; Foot ; Heart ; Hemodynamics ; Humans ; Knee ; Lower Extremity ; Mouth ; Nerve Block ; Tetracaine ; Vasoconstrictor Agents

PURPOSE: To investigate the relationship of refraction, geometry of the posterior corneal surface and the residual corneal thickness after excimer laser photorefractive keratectomy. METHODS: Thirty eyes of 15 patients were treated with Star S2 Smooth Scan (VISX, U.S.A.) and followed up for 3 months. The refractive, anteroposterior changes in the posterior corneal surface and residual corneal thickness were measured using slit-scanning topography, Orbscan IIR (Orbtek, Bausch & Lomb) at 1 week preoperatively, and 1 and 3 months postoperatively. RESULTS: Mean forward shift of the posterior cornea surface was 8.83+/-1.34 micrometer, 11.53+/-4.23 micrometer and 14.70+/-3.50 micrometer at 1 week, 1 month, and 3 months respectively. Mean spherical equivalence of posterior cornea was = -7.01+/-0.31 D preoperatively; it changed to -7.17+/-0.47 D, -7.22+/-0.21 D and -7.17+/-0.6 D at 1 week, 1 month and 3 months. The degree of forward shift of posterior corneal surface is correlated with the posterior corneal refractive changes (r=-0.808, P< 0.01). The forward shift of the posterior corneal surface is correlated with the residual corneal thickness (r=-0.483, P< 0.01). CONCLUSIONS: Photorefractive keratectomy significantly influenced the forward shift of the cornea, which is correlated with the residual corneal thickness.
Cornea ; Humans ; Lasers, Excimer ; Photorefractive Keratectomy*

The term pseudolymphoma is not specific, and a variety of infl; m atory reactions may simulate clinically and histopat,hologically a cutaneous malignant lymphomas udolymphoma induced by drug therapies, especially anticonvulsants, have been reportecl. These pseidayrnphornas most commonly appear as single lesions. Characteristically, few localized lesions disappear after discontinuing therapy with the offending drug. Multiple and generalized tumors are very rate. We report a case of generalized cutaneous pseudolymphoma assocated with phenytoin therapy in a 52-year old male patient.
Anticonvulsants ; Drug Therapy ; Humans ; Lymphoma ; Male ; Middle Aged ; Phenytoin* ; Pseudolymphoma*

In the present study, culture conditions to secrete proteinases from C. albicans, C. tropicalis and C. parapsilosis were examined. All three Candida species were found to secrete proteinases from acceleration phase to stationary phase, although the proteinase activities in culture filtrate were maximal during late exponential or early stationary phase. The proteinase activity in the culture filtrate of C. albicans cells grown at 30'C, was much higher than those grown at either 20 or 37'C. In culture of C. tropicalis and C. parapsilosis, the highest activity was found in culture filtrate grown at 37C. C. albicans secreted proteinases well in medium at initial pH 4.0-7.0. The optimal initial pH of medium for proteinase secretion was 7.0 for C. tropicalis and 5.0-6.0 for C. parapsilosis. All three Candida species secreted proteinases to greater amount in aerobic state. The most effective carbon source for proteinase secretion was xylose, glucose, maltose and sucrose for C. albicans, xylose for C. tropicalis and trehalose for C. parapsilosis. The effects of proteins, hydrolyzed proteins, ammonium sulfate as a sole nitrogen source on proteinase secretion were examined. Bovine serum albumin was the most effective nitrogen source of those tested and a little proteinase activity was detected in the culture filtrates when yeast cells were incubated in the medium containing ammonium sulfate. C. parapsilosis secreted proteinases to greater amount than the other Candida species in all nitrogen sources under study, indicating that C. parapsilosis proteinase would not be a inducible but a constitutive enzyme.
Acceleration ; Ammonium Sulfate ; Candida albicans* ; Candida* ; Carbon ; Glucose ; Hydrogen-Ion Concentration ; Maltose ; Nitrogen ; Peptide Hydrolases* ; Serum Albumin, Bovine ; Sucrose ; Trehalose ; Xylose ; Yeasts

No abstract available.
Humans ; Infant* ; Rhabdomyoma* ; Tetralogy of Fallot*