The influence of the intravenous injection of single-dose diazepam on plasma potassium, sodium and chloride concentions was studied in 36 healthy patients undergoing minor surgical operations and this investigation was limited to the first 10 minutes after the intravenous injection of diazepam, 10mg. A significant decrease of plasma potassium concentration(-0.24 ~ -0.25 mEq/1) was observed with diazepam at 5 and 10 minutes but the diazepam investigated in this study did not have a significant effect on the plasma sodium and chloride.
Diazepam* ; Humans ; Injections, Intravenous* ; Plasma* ; Potassium* ; Sodium*

A fall in systemic arterial pressure after implantation of acrylic cement into the acetabulum and proximal femoral shaft in the surgery of total hip prosthesis was observed and also the following results were obtained in three cases of total hip prosthesis under general anesthesia. 1) Blood pressure was usually decreased immediately after implantation of acrylic cement and returned to normal level approximately within 5 minutes. 2) The marked fall in blood pressure was more often observed with the introduction of bone cement into the proximal femoral shaft but less with the acetabular implantation of bone cement. 3) It is urged to measure blood pressureat the minute interval immediately after insertion of bone cement.
Acetabulum* ; Anesthesia, General ; Arterial Pressure ; Blood Pressure* ; Hip Prosthesis

The hypnotic activity of diazepam was compared with that of inactive placebo in a double- blind, randomized study in 40 surgical patients the night before their scheduled procedures. Diazepam per os (10mg) produces a pattern of response that differed markedly from that of the placebo. The patient receiving diazepam fell asleep sooner, slept more soundly and steadily and more felt they had been helped to sleep, while fewer awoke during the night. The significant difference Was obtained in both hypnotic and ataractic effects between diazepam and inactive placebo. Neither diaxepam nor inactive placbo caused marked changes in vital signs or any serious side effects.
Diazepam* ; Humans ; Vital Signs

Cardiac arrest is an alarming emergency. To be faced with it during strabismus surgery is a frightening experience for both surgeon and anesthesiologist. We have experienced with a case of cardiac arrest during traction of medial rectus muscle for strabismus surgery. Surgery was completed successfully after retrobulbar block with 2% lidocaine.
Emergencies ; Heart Arrest* ; Lidocaine ; Strabismus* ; Traction

BACKGROUND/AIMS: Colonoscopy is the golden standard used as a surveillance test and screen for colon cancer, and the current demand for colonoscopy exceeds its availability. This study is an assessment of the colonoscopic surveillance intervals currently practiced. METHODS: A multiple choice survey of the colonoscopic surveillance interval used in six case scenarios [hyperplastic polyp; two 0.5 cm tubular adenomas (TAs); a 1.5 cm TA; 0.8 cm triple TAs; a 1.5 cm TA with high grade dysplasia; current normal exam after polypectomy of a <1 cm sized TA 3 years ago] was sent via e-mail to members of the KASID. RESULTS: A total of 131 colonoscopists (104 men, 27 women) replied, and the mean age of the respondents was 36 years (range 28~58). All respondents were board- certified in their respective specialties (internal medicine 75, general surgery 3, and GI subspecialty 53). When compared with the AGA guidelines, 90.1~99.2% of the respondents performed the first post-polypectomy surveillance colonoscopy prematurely, and 75.6% of respondents performed the second surveillance prematurely. CONCLUSIONS: Most post-polypectomy surveillance colonoscopies were performed prematurely. It is quite possible that unnecessary surveillance may account for a significant portion of the demand for colonoscopy.
Adenoma ; Colonic Neoplasms ; Colonoscopy* ; Surveys and Questionnaires ; Electronic Mail ; Humans ; Male ; Polyps

BACKGROUND/AIMS: Hepatic hydrothorax in patients with decompensated liver cirrhosis is a challenging problem. Treatment with diuretics and intermittent thoracentesis can be effective in selected patients. However, there are few effective therapeutic options in patients who are intolerant of these therapies. This study investigated the clinical usefulness of chemical pleurodesis with or without video-assisted thoracoscopic surgery (VATS) for patients with refractory hepatic hydrothorax. METHODS: Eleven consecutive patients with refractory hepatic hydrothorax who underwent chemical pleurodesis with or without VATS between July 2007 and February 2011 were enrolled in this study. The medical records and radiologic imagings of these patients were thoroughly reviewed. RESULTS: The median number of chemical pleurodesis sessions performed was 3 (range: 2-10). Successful pleurodesis was achieved in 8 of the 11 patients (72.7%), 5 (62.5%) of whom remained asymptomatic and hydrothorax free for a median follow-up of 16 weeks (range: 2-52 weeks). Complications were low-grade fever/leukocytosis (n=11, 100%), pneumonia (n=1, 9.1%), pneumothorax (n=4, 36.4%), azotemia/acute renal failure (n=6, 54.6%), and hepatic encephalopathy (n=4, 36.4%). Five patients were suspected as having procedure-related mortality (45.5%) due to the occurrence of acute renal failure with hepatic failure. The overall survival was significantly longer in the success group than in the non-success group. CONCLUSIONS: Although chemical pleurodesis may improve the clinical symptoms and the radiologic findings in as many as 72.7% of patients with refractory hepatic hydrothorax, a significantly high prevalence of procedure-related morbidity and mortality hinders the routine application of this procedure for such patients.
Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Hydrothorax/*etiology/mortality/*therapy ; Liver Cirrhosis/*complications/surgery ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed

Secondary achalasia due to submucosal invasion of esophageal squamous cell carcinoma (SCC) is a very rare condition. Here, we report a case of secondary achalasia diagnosed after distal esophagectomy, initially mistaken as primary achalasia. A 51-year-old man presented with progressive dysphagia for 2 months and mild weight loss. A barium swallow study, endoscopy, and manometry showed typical findings of primary achalasia. Pneumatic dilatation was performed, but esophageal perforation occurred as a complication. During surgical repair, no abnormalities around distal esophagus were found, and intraoperative esophageal biopsy revealed only inflammatory cells. During the following 8 months, the patient suffered from dysphagia caused by recurrent esophageal obstruction several times although of repeated balloon dilatation and esophageal stent insertion. Finally, he received a distal esophagectomy. The postoperative pathology revealed SCC at the distal esophagus and esophagogastric junction.
Barium ; Biopsy ; Carcinoma, Squamous Cell ; Deglutition Disorders ; Dilatation ; Endoscopy ; Esophageal Achalasia ; Esophageal Neoplasms ; Esophageal Perforation ; Esophagectomy ; Esophagogastric Junction ; Esophagus ; Humans ; Manometry ; Middle Aged ; Stents ; Weight Loss

BACKGROUND/AIMS: Although mucosal mast cell tryptase is known to significantly increase intestinal permeability, the relationship between mucosal mast cells and intestinal permeability remains unclear. The objective of this study was to evaluate the correlation among intestinal permeability, tryptase activity and mucosal mast cell count. METHODS: Rectal biopsies from 16 patients with diarrhea-predominant irritable bowel syndrome (IBS-D) and 7 normal subjects were assessed for tryptase activity and macromolecular permeability using horseradish peroxidase in Ussing chambers. In addition, mucosal mast cell levels were immunohistochemically quantified via image analysis. RESULTS: Rectal biopsy of tissues from IBS-D patients showed significantly increased permeability compared with those from normal controls (0.644 +/- 0.08 and 0.06 +/- 0.00 ng/2 hr/mm2, P < 0.01). Tryptase activity was also substantially higher in rectal biopsy samples from IBS-D patients than those from normal controls (0.86 +/- 0.18 and 0.28 +/- 0.04 mU/mg protein, P < 0.05). Mucosal mast cell counts were not significantly different between the 2 groups (P > 0.05). However, correlation analysis revealed that only mucosal mast cell count was significantly correlated with intestinal permeability in IBS-D patients (r = 0.558, P < 0.05). CONCLUSIONS: This study demonstrated a positive correlation between the number of mucosal mast cells and intestinal permeability, suggesting that mucosal mast cells play an important role for increased intestinal permeability in patients with IBS-D.
Biopsy ; Diarrhea ; Horseradish Peroxidase ; Humans ; Irritable Bowel Syndrome ; Mast Cells ; Permeability ; Tryptases

BACKGROUND/AIMS: We aimed to explore the risk factors contributing to the recurrence of common bile duct (CBD) stones after successful endoscopic stone clearance, focused on the anatomical factors of CBD and presence or absence of ursodeoxycholic acid (UDCA)/Rowachol(R) medication. METHODS: One hundred fourteen patients who underwent CBD stone(s) extraction by endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy at our institution from August 2004 to January 2007 were included. Univariate and multivariate analyses for the risk factors including the distal CBD angle, length of the distal CBD arm and medication such as ursodeoxycholic acid (UDCA) and/or Rowachol(R) for recurrent CBD stone(s) were performed. RESULTS: The recurrence of CBD stone(s) was found in 22 (19.3%) patients. On univariate analysis, presence of pneumobilia, presence of type 1 or type 2 periampullary diverticulum, mechanical lithotripsy and multiple sessions of ERCP were significant contributors for the recurrence of CBD stone(s). On multivariate analysis, the presence of type 1 periampullary diverticulum (OR 7.90, 95% CI: 1.56-40.16) and multiple sessions of ERCP (OR 7.56, 95% CI: 2.21-25.87) were significant contributors. Acute distal CBD angulation (< or =135degrees), shorter distal CBD arm (< or =36 mm), technical difficulty of CBD stone(s) clearance, and the prescription of UDCA and/or Rowachol(R) were not significantly associated with the recurrence of CBD stone(s). CONCLUSIONS: The recurrence of CBD stone(s) was more commonly found in the patients group with type 1 periampullary diverticulum and multiple sessions of ERCP. Therefore, patients with these risk factors should be on regular follow up.
Aged ; Cholangiopancreatography, Endoscopic Retrograde ; *Common Bile Duct/radiography ; Data Interpretation, Statistical ; Female ; Gallstones/prevention & control/radiography/*surgery ; Humans ; Male ; Middle Aged ; Prospective Studies ; Recurrence ; Risk Factors ; *Sphincterotomy, Endoscopic ; Treatment Outcome ; Ursodeoxycholic Acid/pharmacology

BACKGROUND/AIMS: Many patients with inflammatory bowel disease (IBD) often complain of fatigue. To date, only a few studies in Western countries have focused on fatigue related to IBD, and fatigue has never been specifically studied in Asian IBD patients. The aim of the present study was to investigate the fatigue level and fatigue-related factors among Korean IBD patients. METHODS: Patients in remission or with mild to moderate IBD were included. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue and the Brief Fatigue Inventory. Corresponding healthy controls (HCs) also completed both fatigue questionnaires. RESULTS: Sixty patients with Crohn disease and 68 patients with ulcerative colitis (UC) were eligible for analysis. The comparison group consisted of 92 HCs. Compared with the HCs, both IBD groups were associated with greater levels of fatigue (p<0.001). Factors influencing the fatigue score in UC patients included anemia and a high erythrocyte sedimentation rate (ESR). CONCLUSIONS: Greater levels of fatigue were detected in Korean IBD patients compared with HCs. Anemia and ESR were determinants of fatigue in UC patients. Physicians need to be aware of fatigue as one of the important symptoms of IBD to better understand the impact of fatigue on health-related quality of life.
Adult ; Case-Control Studies ; Colitis, Ulcerative/*complications/ethnology ; Crohn Disease/*complications/ethnology ; Fatigue/ethnology/*etiology ; Female ; Humans ; Male ; Republic of Korea/ethnology