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: To describe a simple and useful modification of the rendezvous technique using a PTBD tube as guidance. METHODS: From January 2005 to August 2006, a total of 436 ERCPs were performed. A diagnosis of choledocholithiasis was made in 235 cases. Deep cannulation of the bile duct using standard techniques was unsuccessful in 27 patients (11.5%). A precut papillotomy led to successful cannulation in 16 out of these 27 patients (59.3%). The remaining 11 patients (40.7%) underwent PTBD with the tube tip placed in the second portion of the duodenum. Bile duct cannulation was attempted with the guidance of a PTBD tube in 9 cases. In the other 2 cases, the transduodenal approach was impossible due to a previous Billroth II operation. RESULTS: Bile duct cannulation guided by a PTBD tube, which is also known as a modified rendezvous procedure, was successful in 9 out of 11 patients (81.8%). Deep cannulation of the bile duct was achieved in 100% of patients, who could be treated by endoscopy. There were 7 cases of transient hyperamylasemia (77.8%) but no procedure-related major complications or mortality. CONCLUSIONS: Bile duct cannulation guided by a PTBD tube in patients with choledocholithiasis can be recommended when ERCP is unsuccessful using the standard technique.
Bile Ducts* ; Bile* ; Catheterization* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Diagnosis ; Drainage* ; Duodenum ; Endoscopy ; Gastroenterostomy ; Humans ; Hyperamylasemia ; Mortality

BACKGROUND/AIMS: Although polyethethylene glycol (PEG) solution is widely used for bowel preparation, it is difficult to drink a large amount of fluid in a short period of time. We compared the quality of bowel preparation and compliance between the single-dose group and split-dose group. METHODS: Two hundred seventeen patients undergoing outpatient colonoscopy were randomly assigned to receive either 4 litre (L) of PEG solution (n=104, single-dose group) on the day of colonoscopy or 2 L of PEG solution on the day before colonoscopy and then 2 L of same solution on the day of colonoscopy (n=113, split-dose group). The quality of bowel preparation was assessed using Ottawa scale. Cecal intubation time, compliance and side effects were assessed. RESULTS: Split-dose group showed the better quality of bowel preparation than single-dose group (4.75+/-2.45 vs 5.52+/-2.24, p <0.05) because of lower residual volume scale. Patients who experienced very difficulty during ingestion (0.95% vs 5.8%) and left out more than 25% of PEG solution (3.5% vs 8.7%) were greater in single-dose group. There was no difference of side effects between two groups. CONCLUSIONS: Split-dose PEG preparation could be the useful method in than single-dose in colonoscopy preparation.
Colonoscopy* ; Compliance ; Eating ; Humans ; Intubation ; Outpatients ; Polyethylene* ; Residual Volume

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

BACKGROUND/AIMS: Considerable evidence indicates that patients with chronic hepatitis C virus (HCV) infection have a greater risk of developing insulin resistance (IR) compared with non-infected individuals or patients with hepatitis B virus (HBV) infection. Few reports have examined the prevalence of IR and hepatic steatosis in patients with chronic HCV infection in Korea. METHODS: Ninety subjects positive for HCV antibody who had normal fasting blood glucose levels and no history of diabetes mellitus were compared with 271 HCV non-infected, age- and sex-matched, healthy examinees between January 2005 and December 2006. RESULTS: No significant differences in the body mass index (BMI) and fasting blood glucose level were found between the anti-HCV-antibody-positive and non-infected groups. The serum fasting insulin level was significantly higher in the HCV-antibody- positive group than in the non-infected group (9.11+/-2.94 vs. 8.43+/-2.70 microU/mL (mean+/-SD), p=0.04). Although the homeostasis model assessment of insulin resistance (HOMA-IR) was not significantly different between the two groups (2.035+/-0.69 vs. 1.899+/-0.64, p=0.088), the prevalence of insulin resistance (HOMA-IR> or =2.7) was significantly higher in the anti-HCV positive group (18.9% vs. 10.3%, p=0.042). Hepatic steatosis identified by transabdominal ultrasonography was significantly more frequent in the non-infected group (20.3% vs. 11.1%, p=0.028). CONCLUSIONS: The anti-HCV positive subjects had significant hyperinsulinemia and a higher prevalence of insulin resistance than the non-infected group, whereas hepatic steatosis was more frequent in the non-infected group.
Blood Glucose ; Body Mass Index ; Diabetes Mellitus ; Fasting ; Hepatitis B virus ; Hepatitis C, Chronic ; Homeostasis ; Humans ; Hyperinsulinism ; Insulin ; Insulin Resistance ; Korea ; Prevalence ; Viruses

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