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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

No abstract available.

Ouarian tumors of low malignant potential(OTLMP) or borderline tumors account for approximately 10% of all ovarian neaplasms. Borderline tumors have some but not all of the histologic characteristics af ma lignancy : stratification of epitheliial cells, with some degree of nuclear atypia a,nd inereased mitotic actitity but. without stromal invasion. We reviwed 20 published Rnglish written articlea from 1978 to 1992 and Korean gynecologic cancer regestry of 1990. In this review, we tried to concentrate on several debating is sues in OTLMP: 1) What kind of surgery is needed for each stages?, 2) Is postoperative adjuvant t.herapy needed?, 3) Jf needed, which type? Following result were obtained from the besis of 1516 patients with OTLMP. Patients withh OTLMIP are younger than those with invasive ovarian cancers', mean age was in their forties. The majority of patients(74.5%) had stage I disease, and the incidence dropped ahruptly to 9.4% for stage ll, 15.7% for stage III and 0.4% for stage IV. The most cammon histologic subtype was serous(56.7%), followed by muci noua(38.1%), However, interestingly in Korea and Japan, the mucinous type was the most common one. The primary treatment for OTLMP was surgery, and the conservative surgery to preserve fertility in young women was sufficient for stage I disease with careful follow-up. The majority of patients(79.1%) with stage I disease were treated by surgery alone. Adjuvant such as chemotherapy (CT) and/or radiotherapy(RT) could prolong the recurrence of disease a little later, but failed to increase diaease-free survival significantly in stage I disease. In stageII disease, the surgery should be a total abdominal hysterectomy and bilateral salpingo-oophorectomy with multiple sampling of the peritoneal cavity. About a third of patients with stageII disease received no adjuvant therapy and the others received CT and/or RT, however, there was no difference in outcome of recurrence and survival. In advanced stage. 15% of patients received no adjuvant therapy after initial debulking surgery, and the rest of patients received CT and/or RT. No differences in recurrence and survival between each groups were noticed , too. The status of second-look laparotomy(SLL) did not depend on the stage of the disease. Positive rate of SLL for stage I diaease was not statistically different from that for the combined stages II-IV. Survival for stage I at 5 years was reported to range from 80 to 100%, and even stage III had survival ranging from 64 to 96%. Long-term survival at 15~20 years was also good. Although it is quite difficult to make conclusions because of the lack of prospective randomized studies from this review, it appears clear that surgical removal of the tumor and careful follow-up of patients are all that are necessary in stage I disease and further multi-center prospective study for the effect of adjuvant therapy in advanced disease is definitely needed.
Drug Therapy ; Female ; Fertility ; Follow-Up Studies ; Humans ; Hysterectomy ; Incidence ; Japan ; Korea ; Mucins ; Peritoneal Cavity ; Prospective Studies ; Recurrence

The transition from preinvasive to invasive disease is a crucial juncture in the development of cervical cancer. The clinical experience that microvasive lesions carry a better prognosis justifies a sepetate diagnostic category. Besides clinical and cliagmostic problerns, the rnicroinvasive cervical cancer presents morphological peculiarities. To investigate the clinieal and pethological aspects of micrenvasive eervical carcinornn, a retrospective study was made on 40 cases, histologically reconfirrned surgical specimens, which had been treated during the period from March, 198I3 to March, 1992 at, Departrnent of Obstetrics and Gynecology, Pusan Paik Hospital, Inje University. The results obtained were as follows ; 1. Mean age of 40 patents was 44.6 year old, all were rnultipatous. Nineteen cases helonged to I s, and 21 cases to I a2. 2. Main presenting symptoms were leukorr hea and/or genital bleeding and the majority of patients showed cervical erosion on groas finding, 3. The corresponding rate of Pap, smear to histologic diagnosis was approximately 67.5%, However, corresponding rate within one histologie grade was about 85%. 4, Aecording to the eolpuacapie examination, less than half of the examined cases revealed suspected abnormal findings suggeeting invasive lesion. 5. As to the reports of punch biopsy, 64.8% of cases showed microinvasive and/or inuasive lesian. With additional diagnostic conization of cervix, the preoperative diagnosis were correct in 82.5%. 6. Histopathological reevaluatin ef surgiral specimens revealed positive correlation between depth of stromal invasion and width of leaior, confluent growth pattern, numher of invasive foci, and invasion of capillary-like spaee, respectively.
Biopsy ; Busan ; Cervix Uteri* ; Conization ; Diagnosis ; Female ; Gynecology ; Hemorrhage ; Humans ; Obstetrics ; Prognosis ; Retrospective Studies ; Uterine Cervical Neoplasms

This study was conducted to invetigate the effect of high-dose steroid administration on adipogenesis and secretion of PAI-1 in rat. Sixty healthy Wistar rats were divided into three groups. Group A consisted of 20 control animals received 5 ml/kg isotonic saline for 1 weeks. Group B consisted of 20 animals received 10 ml/kg of methylprednisolone intraperitoeally for 1 week. Group C comprized 20 animals received 10 ml/kg of methylprednisolone intraperitoneally for 1 week. After the completionof treatment, blood sampling was performed for measurenement of PAI-1 and the animale were sacrificed for histopathologic examination and immunohistochemical study. The PAI-1 protein expressin of femoral heads were evaluated with Western-blotting. Blood level of PAI-1 increased significantly in high-dose steroid treated group(Group B and C) compared to control group. In histopathologic examination, significant fat morrow conversion, fat cell hypertrophy and fat cyst formation were observed in high-dose steroid treated group. Immunohistochemically, PAi-1 expression was sprominent in the fat cells. Protein expression of PAI-1 of femoral heads increased significantly in highdose steroid treated group compared to control group. In lights of above results, it is postulated that increased secretion of PAI-1 from fat cells could play a major role in the pathogenesis of osteonecrosis of the femoral head in rats treated with high-dose steroid.
Adipocytes ; Adipogenesis* ; Animals ; Head ; Hypertrophy ; Methylprednisolone ; Osteonecrosis ; Plasminogen Activator Inhibitor 1* ; Rats* ; Rats, Wistar

Epidermolysis Bullosa Simplex is characterized by autosomal dominant rnheritance, and chronic noninflammatory conditions in which the clinical lesions, erosion, blisters usually result from relatively minor mechanical trauma to the skin, especially joints of hands, elbows, knees, and feet and other sites subject to repeated trauma The lesiona are present or appeared after a few days after birth or shortly after especialy of the lower legs or feet, and not involved at naiIs or mucous membranes. Though infection is not common on the feet or hands, even infected lesions generally heal with out scarring. 2 cases of Epidermolysis bullosa simplex were experienced, the one was 5 month old male baby who had fresh vesiculobullous, hemorrhagic bulla, crusts, exfoliation, no nail dystrophy, since a few days after birth. The another was 5 month old female baby, who had pea sized tense bulla, and exfoliations on the hands and feet. Diagnosis confirmed by clinical features and histological findings. Literature were reviewed in comparison with mechanobulIous disease.
Blister ; Cicatrix ; Diagnosis ; Elbow ; Epidermolysis Bullosa Simplex* ; Epidermolysis Bullosa* ; Female ; Foot ; Hand ; Humans ; Infant ; Joints ; Knee ; Leg ; Male ; Mucous Membrane ; Parturition ; Peas ; Skin ; Transcutaneous Electric Nerve Stimulation