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

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

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: Chronic hepatitis C virus (HCV) infection is associated with a higher risk of the development of insulin resistance. If HCV is a causal factor for insulin resistance, then clearance of HCV might decrease insulin resistance. The aim of this study was to elucidate the effects of clearance of HCV on insulin resistance. METHODS: We analyzed 28 patients with HCV infection who received combination treatment of 180 microgram of pegylated interferon alpha-2a and ribavirin at our institution from May 2004 to November 2006. Insulin resistance was calculated according to the homeostasis model assessment of insulin resistance (HOMA-IR) method. RESULTS: Twenty-two patients (78.6%) achieved sustained virologic response (SVR), where the fasting plasma glucose level significantly decreased after antiviral treatment. Fasting serum insulin and HOMA-IR also significantly decreased after antiviral treatment, whereas the BMI value was not significantly affected. For the nonresponders (n=6), no significant changes were evident in BMI, fasting plasma glucose, fasting serum insulin, and HOMA-IR at 6 months after the end of antiviral treatment. Logistic regression analysis indicated that the only independent factor contributing to the reduction of insulin resistance was the complete disappearance of HCV RNA at 6 months after the end of antiviral treatment (SVR). CONCLUSIONS: The clearance of HCV by the combination therapy of pegylated interferon alpha-2a and ribavirin improves insulin resistance by reducing fasting serum insulin and glucose levels.
Fasting ; Glucose ; Hepatitis C, Chronic ; Homeostasis ; Humans ; Insulin ; Insulin Resistance ; Interferons ; Logistic Models ; Plasma ; Ribavirin ; RNA ; Viruses

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: Bamboo joint-like (BJL) appearance is an endoscopic finding characterized by swollen longitudinal folds transversed by erosive fissures or linear furrows on the lesser curvature side of gastric body and cardia. It has been reported to be associated with Crohn's disease (CD). This study was aimed to evaluate the incidence of BJL appearance in Korean patients with CD. METHODS: From January to December in 2005, we performed esophagogastroduodenoscopy (EGD) in patients diagnosed as CD and ulcerative colitis (UC) in our hospital. Non-inflammatory bowel disease (IBD) subjects with upper gastrointestinal symptoms who underwent EGD were consecutively enrolled during the same period. One endoscopist performed all the endoscopic examinations to avoid inter-observer variation. A dye-spraying technique with 0.4% indigocarmine was used to allow the detection of subtle changes during the endoscopic examination. RESULTS: A total of 21 patients with CD (mean age+/-SD, 40+/-15 yr; M/F, 13/8), 28 patients with UC (42+/-15 yr; 21/7), and 685 non-IBD subjects (49+/-14 yr; 354/331) were enrolled. EGD findings in CD patients were gastric erosions (11/21), chronic superficial gastritis (5/21), chronic atrophic gastritis (1/21), duodenal erosions or ulcers (2/21), and normal (2/21). Incidence of BJL appearance was significantly higher in patients with CD (47.6%, 10/21) than others (UC, 3.6%, 1/28; non-IBD, 0.1%, 1/685) (p<0.0001). Among patients with CD, incidence of BJL appearance was not significantly different according to the sex, status of H. pylori infection, Vienna classification for phenotype, medications or EGD findings. CONCLUSIONS: BJL appearance on the gastric body and cardia can be a diagnostic clue to CD.
Adult ; Crohn Disease/diagnosis/*pathology ; Endoscopy, Digestive System ; Female ; Humans ; Male ; Middle Aged ; Stomach/*pathology

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

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: There is an increased risk for inflammatory bowel disease (IBD) patients to develop infections due to the use of immunomodulators and biologics. Several infections are preventable by immunizations. This study investigated the knowledge and awareness of Korean gastroenterologists regarding the vaccination of patients with IBD. METHODS: A self-reported questionnaire was sent by e-mail to the faculty members of tertiary hospitals. Gastroenterologists were asked ten questions regarding the immunization of patients with IBD. A total of 56 gastroenterologists completed the questionnaire. RESULTS: A majority of gastroenterologists (>60%) had rarely or never recorded an immunization history from their patients with IBD. Moreover, 50% to 70% of the gastroenterologists did not know that live vaccines should be avoided in immunosuppressed patients. The most commonly mentioned resistance to vaccinations was "the lack of concern and knowledge regarding vaccination." Gastroenterologists more frequently asked about the immunization history of influenza, pneumococcal, hepatitis A, and hepatitis B vaccines and recommended these vaccines more often than others. CONCLUSIONS: Korean gastroenterologists' awareness and knowledge regarding the vaccination of patients with IBD were very poor. Intensive educational programs on immunization guidelines directed toward gastroenterologists who care for patients with IBD are required to ensure that these patients receive the necessary vaccinations.
Clinical Competence/*standards ; Female ; Gastroenterology/*standards ; Health Knowledge, Attitudes, Practice ; Humans ; Immunocompetence/physiology ; Immunocompromised Host/physiology ; Inflammatory Bowel Diseases/*complications ; Male ; Medical History Taking/standards ; Questionnaires ; Republic of Korea ; Vaccination/*standards