BACKGROUND: The use of caudal morphine for postoperative analgesia has been increased in popularity since 1981. The purpose of this study was to compare the effect of analgesia and incidence of side effects of a mepivacaine-morphine mixture with mepivacaine alone. METHODS: Forty patients were randomly divided into two groups. In group 1, caudal block was performed with 1% mepivacaine 1 ml/kg alone. In group 2, caudal block was performed with 1% mepivacaine 1ml/kg-morphine 0.03 mg/kg mixture. Postoperative five-point pain scores and side effects were measured. RESULTS: There were no significant differences in sedation dose, incidence of side effects and supplemental analgesics. Pain scores were significantly lower at postoperative 2 and 3 hours in mepivacaine-morphine mixture group. CONCLUSIONS: Caudal epidural mepivacaine-morphine (0.03 mg/kg) mixture is effective in children for control of postoperative pain without significant side effects.
Analgesia* ; Analgesics ; Child* ; Humans ; Incidence ; Mepivacaine ; Morphine* ; Pain, Postoperative

No abstract available.
Anesthesia* ; Anesthesia, General* ; Humans

Abrupt increase in the size of cervico-mediastinal tumor due to infection or spontaneous hemorrhage into cyst can induce severe tracheal compression and therefore sudden death. A 5 year old boy, who had a history of URI, had an enlarging cystic hygroma on the right side of the neck and anterior mediastinum. Under diagnosis of the cervico-mediastinal cystic hygroma, surgical removal was scheduled. After induction of anesthesia, intubation was done without any difficulty. A few minutes later, signs of partial airway obstruction were appeared. And within a very short period, total airway occlusion occurred. The tracheal tube was removed and manual ventilation was performed with positive airway pressure, but ineffective. We attempted to puncture cricothyroid membrane with 14 Gauge needle in order to ventilate manually. As soon as we puncture cricothyroid membrane, straw-colored fluid, not air, gushed out through a needle. After aspiration of about 200ml of cystic fluid, the obstructive signs disappeared and the patency of the airway was maintained. Intraoperatively, no more airway problems occured and vital signs were stable. And postoperatively, patient had no specific complications and discharged on the 7th day after operation.
Airway Obstruction* ; Anesthesia ; Child, Preschool ; Death, Sudden ; Diagnosis ; Hemorrhage ; Humans ; Intubation ; Intubation, Intratracheal* ; Lymphangioma, Cystic* ; Male ; Mediastinum ; Membranes ; Neck ; Needles ; Punctures ; Ventilation ; Vital Signs

We performed laparoscopic pelvic lymphadenectomy in 7 patients with squamous cell carcinoma in the uterine cervix. Among them, 5 cases were subsently laparotomy with radical hysterectomy. The others, one case was performed Laparoscpic pelvic lymphadenectomy as Staging Procedure and the other was laparoscopically assisted radical vaginal hysterectomy with pelvic lymphadenectomy without complication. The following results were obtained 1. Total number of pelvic nodes obtained at laparoscopy in 7 cases were 104 2. Averege number of pelvic nodes obtained at laparoscopy were 14.2+/-6.38(7-23) 3. Average number of additional pelvic nodes obtained at laparotomy were 10.4+/-279(7-13) 4. % yield by laparoscopy/laparoscopy+laparotomy was 71/123(58%) 5. No positive metastatic lymph nodes were missed by laparartomy 6. Average time, blood loss at laparoscopic lymphadenectomy was 172.1min and 304.3ml, seperately 7. surgical staging procedure was performed at Case 3 8. Laparoscopic Pelvic lym phadenectomy with radieal vaginal hysterectomy (type II radical) was done in Case 5. without Laparotomy or complication.
Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Laparoscopy ; Laparotomy ; Lymph Node Excision* ; Lymph Nodes ; Uterine Cervical Neoplasms*

We have experienced three cases of mucinous ductal ectasia of the pancreas. They showed the characteristic duodenoscopic findings and underlying pathology was hyperplasia in two cases and adenocarcinoma in one case. When endoscopic retrograde pancreatography was performed, bulging ampulla of Vater, patulous ampullary orifice and mucus leakage from papillary orifice were noted. Also cyst-like dilatation of main duct or side branch of the uncinate process were observed.
Adenocarcinoma ; Ampulla of Vater ; Dilatation ; Dilatation, Pathologic* ; Hyperplasia ; Mucins* ; Mucus ; Pancreas* ; Pathology

Retinoblastom is the most common intraocular malignancy in childhood and the survival rate has recently been raised by an adequate method of examination and treatment. We report a case that a child having bilateral retinoblastoma treated with enucleation, external beam irradiation, and chemotherapy is diagnosed as an osteosarcoma of the distal radius 9 years after the initial treatment, and died. This case shows the regular examinations for long bone of the extremities are necessary in a child survived after the treatment of bilateral retinoblastoma.
Child ; Drug Therapy ; Extremities ; Humans ; Osteosarcoma* ; Radiotherapy ; Radius ; Retinoblastoma* ; Survival Rate ; Survivors*

PURPOSE: Giant cell tumor of tendon sheath is benign soft tissue tumor and recurrence rate is 7~40%. It is second most common tumor of the hand after ganglion cyst. It is generally non-tender mass and size of it is varied. We experienced the case that asymptomatic giant cell tumor of tendon sheath changed to symptomatic mass with pain after flame burn injury and then we report about this case. METHODS: 49 years old man was hospitalized because of flame burn with TBSA 30% involving scalp, face, both arm, right hand. About 30 days after burn injury, he complained about palpable tender mass at volar side of right hand. In past medical history, he had recognized the slow-growing palpable mass without pain from about 10 years ago. We planed excision and biopsy about the mass. Intraoperatively we found mass that was attached to flexor tendon sheath and the size of mass was about 5x7x4 cm3. RESULTS: The mass was defined as giant cell tumor of tendon sheath in result of biopsy. After surgery, there was no any specific symptom like pain, and in follow-up after about 5 months, there was no recurrence and motor function and sensory was normal. CONCLUSION: Generally giant cell tumor of tendon sheath is common benign tumor of hand and clinically the treatment is surgical excision because of discomfort from enlarged palpable mass rather than pain. In this case, we think inflammatory reaction of tumor itself or inflammation of soft tissue around tumor due to flame burn is cause of emerged pain of giant cell tumor.
Arm ; Biopsy ; Burns* ; Follow-Up Studies ; Ganglion Cysts ; Giant Cell Tumors* ; Giant Cells* ; Hand ; Inflammation ; Recurrence ; Scalp ; Tendons*

No abstract available.
Animals ; Cell Adhesion* ; Female ; Leiomyoma* ; Mice ; Myometrium* ; Neural Cell Adhesion Molecules*

OBJECTIVES: Donepezil is a widely used drug for the treatment of patients with Alzheimer's disease(AD). The aim of the present study was to clarify the efficacy and the characteristics of responders to donepezil. METHODS: Patients with probable AD(n=80 ; 75.7 years) and small vessel dementia(SVD)(n=18 ; 77.8 years) who received donepezil were retrospectively analyzed using Alzheimer's registry, and three questions were asked: 1) Does donepezil therapy improves cognitive symptoms in patients with dementia? 2) If donepezil improves cognitive symptoms, which items of the K-MMSE are improved? 3) What are the characteristics of responder to donepezil medication? RESULTS: 1) After donepezil medication, cognitive function measured by the K-MMSE was significantly improved in both types of dementia(AD and SVD), However, statistical differences were not found between these groups. 2) In a clinical trial of donepezil, the patients performed better than before mediation on K-MMSE items assessing orientation, recall, construction, concentration, calculation. 3) In AD, the K-MMSE score before medication was closely related with response of donepezil. CONCLUSION: This study suggests that donepezil improves various cognitive functions in both types of dementia, and the responsive group had significantly lower K-MMSE scores than the non-responsive group before medication.
Alzheimer Disease* ; Dementia* ; Humans ; Negotiating ; Neurobehavioral Manifestations ; Retrospective Studies

Myofibroblasts are mesenchymal spindle cells that share morphologic and functional features with fibroblasts and smooth muscle cells, especially in relation to matrix production and contractility. Myofibroblastic sarcomas have been described recently and such lesions are relatively rare and almost unknown, especially developed in the skin. Most examples of myofibrosarcoma occur de novo. We herein report a case of solitary myofibrosarcoma occurred after several laser and pharmacological treatment of a wart. A 28-year-old woman had a 10-month history of small firm painless papule on the lower margin of her nostril. Her lesion was once treated with laser at a local clinic. At first visit to our hospital, the lesion was 0.4 x 0.3 cm solitary skin colored keratotic flat papule and it was diagnosed as a wart and ablated with carbon dioxide laser. Two subsequent recurrences occurred within 6 months and repeatedly ablated with the same laser. One year later the patient appeared with 1.5 x 1.5 cm pale red rubbery-firm nodule on the same site. On punch biopsy, it showed thickened collagen with mild inflammatory infiltrate. We performed intra-lesional triamcinolone injection every three weeks under the impression of hypertrophic scar after the wart removal, and no improvement was made and the lesion's growth was accelerated. On exicisional biopsy of lesion, a myofibroblastic tumor of uncertain malignant potential was suggested and subsequent wide excision and lateral lip advancement flap was done. The patient has been free of recurrence 14 months after wide excision. This report emphasizes the possibility that iatrogenic manipulation of the normal wound healing process may well contribute to the development of myofibrosarcoma.
Adult ; Biopsy ; Cicatrix, Hypertrophic ; Collagen ; Female ; Fibroblasts ; Humans ; Lasers, Gas ; Lip ; Myocytes, Smooth Muscle ; Myofibroblasts ; Recurrence ; Sarcoma ; Skin ; Triamcinolone ; Warts* ; Wound Healing