To assess the effect of postoperative pain control of upper abdominal surgery through lumbar epidural narcotic injection, the 3rd or 4th lumbar epidural puncture was done, and were injected 1 mg of morphine (Group I) or 10 mg of demerol (Group II) mixed with 10 ml of normal saline into the epidural space, after operation of the cholecystectomy in 10 patients and antrectomy and vagotomy, subtotal or total gastrectomy in 10 patients. Time interval of the postoperative analgesic effect between morphine and demerol groups were compared. The results of this study were as follows: 1. In the group I, average analgesic duration was 29.4 hours. 2. In the group II, average analgesic duration was 4.0 hours. It is concluded that postoperative pain control of upper abdominal surgery through the lumbar epidural narcotic injection was effective, and morphine injection was more effective than demerol.
Cholecystectomy ; Epidural Space ; Gastrectomy ; Humans ; Meperidine ; Morphine ; Narcotics* ; Pain, Postoperative ; Punctures ; Vagotomy

No abstract available.
Poisoning*

Pediatric patients often could not be cooperated with physician during various procedures. So, many agents such as inbalation anesthetics and intravenous anesthetics have been used to decrease pain, anxiety and awareness during regional anesthesia in children. The purpose of this study was to compare propofol with midazolam and inhalation anesthetics for emergence time from sedation in caudal anesthesia of children. Forty five patients were randomly divided three groups. In propofol group(Group P, n=15), induction dose of 1.0 mg/kg propofol(Diprivan) was received followed by continuous infusion of 3~5 mg/kg/hr. In midazolam group(Group M, n=15), induction dose of 0.15 mg/kg midazolam(Dormicum) was received followed by continuous infusion of 0.06~0.08 mg/kg/hr. In inhalation anesthetic group(Group E, n=15), O2-NO2-Enflurane(3L/min, 3L/min, 0.6~1.0 vo1% respectively) inhalated through face mask by non-rebreathing system for sedation. The blood pressure, heart rate, arterial oxygen saturation during anesthesia and emergence time, complications were measured. The results were as follows: 1) The blood pressure was significantly decreased in group M and E. Heart rate was also significantly increased in group M and E. 2) The arterial oxygen saturation was not significantly changed in each three groups. 3) In the group P and E, emergence time was shorter than in the group M. From the above results, we conclude that propofol is more excellent intravenous anesthetics than midazolam in respect to emergence time and hemodynamic changes in pediatric caudal anesthesia.
Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Conduction ; Anesthetics ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Anxiety ; Blood Pressure ; Child ; Heart Rate ; Hemodynamics ; Humans ; Hypnotics and Sedatives* ; Inhalation ; Masks ; Midazolam* ; Oxygen ; Propofol*

PURPOSE: Persistent pulmonary hypertension (PPHN) of the newborn has been treated with some vasodilators including tolazoline. But these drugs have many side effects, especially systemic hypotension . To investigate the usefulness of the nitroglycerin as a specific vasodilator with few side effects, this study was done. METHODS: Nitroglycerin was administered within 1st one day after birth in 8 newborn infants who were diagnosed as PPHN by echocardiography. They were born at Il Sin hospital from March 1994 to March 1996. Nitroglycerin was started as 2microgram/kg/min and its maximum dose was 6microgram/kg/min. Muscle relaxants and inotropic drugs were used together in all cases. Arterial blood gas analysis, systemic blood pressure, heart rate, renal function and electrolyte were checked in all patients. Alveolar-arterial oxygen difference (AaDO2) and oxygenation index (OI) were measured. RESULTS: 6 cases (75%) survived but 2 cases expired due to air leak.1) Basal mean AaDO2 was 631.4+/-21.7mmHg. It decreased to 493.9+/-1453.1 mmHg at 10hr after loading infusion and to 373.6+/-217.7mmHg at 48hr (P<0.05). 2) Basal mean OI was 35.1+/-15.7 and it decreased significantly to 12.6+/-14.8 (P<0.05) at 10hr. 3) There was no significant hypotension in systolic, diastolic and mean blood pressure during treatment of nitroglycerin. 4) There was no significant change in renal function, serum electrolyte and heart rate during treatment of nitroglycerin. CONCLUSIONS: Nitroglycerin produced systemic venodilatation and pulmonary arterial dilatation at the dose that produce only minimal systemic arterial dilatation. Nitroglycerin is an effective and safe drug in the treatment of PPHN.
Blood Gas Analysis ; Blood Pressure ; Dilatation ; Echocardiography ; Heart Rate ; Humans ; Hypertension, Pulmonary* ; Hypotension ; Infant, Newborn* ; Nitroglycerin* ; Oxygen ; Parturition ; Tolazoline ; Vasodilator Agents

BACKGROUND: There were a lot of problems in the health care system of Korea, which was divided into Western and Korean Traditional Medicine since 1951. In 1976 WHO published program of The promotion and development of traditional medicine. In 1977, Korean Medical Association(KMA) asked unification of health care system to government. But there was no progress because there were the lacks of mutual respect and understanding be-tween doctors of Western and Korean Traditional Medicine. As one health care group competed with the other, so KMA proposed the unification of health system again in 1997. The objectives of this research are to analyze attitude and opinions of western medical doctors on Korean Traditional Medicine and to analyze the opinions on the unification of medical care system in Korea. METHODS: A list of western medical doctor in Seoul and Incheon was obtained from Korean Medical Association. We sampled 937 doctors by stratified random sampling method. We sent them a postal questionnaire with a prepaid return envelope two times during March and April 1997. Of the 937 questionnaire, 266 replies were received. We analyzed the preference score related referral, Korean Traditional Medicine education and unification of medical care system We analyzed the data by Chisquare test, t-test, ANCOVA. RESULTS: This study shows that the western doctors have negative attitude on Korean Traditional Medicine(M=1K8, SD=5.2). They thought Korean Traditional Medicine was not reliable because it was not scientific(79.4%). Doctor, who didn't take oriental medical education, preferred unification of health care system, but it was not statistically significant. Those who experienced oriental medical education used oriental medical treatment more frequently(F=1.17, p=0.04). The more positive attitude they have about Korean Traditional Medicine, the more frequently they refereed the patient to oriental medical doctor(t =3.57, p =0.0004). CONCLUSIONS: Western medical doctors have a negative attitude on Korean Traditional Medicine. Doctors, who did not have oriental medical education, preferred unification of health care system, but it was not statistically significant. In summary, the lack of mutual respect and understanding between doctors of the Western and Korean Traditional Medicine prevent unification of medical care system.
Delivery of Health Care ; Education ; Education, Medical ; Humans ; Incheon ; Korea ; Medicine, Korean Traditional* ; Medicine, Traditional ; Referral and Consultation ; Seoul ; Surveys and Questionnaires

In recent years, health care cost containment concerns have resulted in an increase in outpatient (or same-day) surgery. Many procedures previously performed on an inpatient surgery basis have been shifted to outpatient settings. Anesthesia for outpatient surgery is exactly the same as inpatient anesthesia, except that the primary concern is the selection of patients who can be discharged safely on the day of surgery. The anesthesiologist should have a sound rational basis for choice of pharmacologic agents that are geared to expeditious patient discharge from the hospital. Cost concerns aside, outpatient surgery has many additional advantages in the pediatric setting. It minimizes the length of time the child is hospitalized, decreases separation anxiety, promotes parental involvement in the child's postoperative care in the more congenial environment of home, and decreases risk of nosocomial infection and iatrogenic illness.
Ambulatory Surgical Procedures ; Anesthesia* ; Anxiety, Separation ; Child ; Containment of Biohazards ; Cross Infection ; Health Care Costs ; Humans ; Inpatients ; Outpatients* ; Parents ; Patient Discharge ; Postoperative Care

A 39-year-old male patient presented with chronic abdominal pain and intermittent diarrhea for 8 months. Colon study showed an annular stricture at the ileocecal value. He underwent ileocecectomy with clinica impression of intestinal tuberculosis. The resected intestinal wall along the lieocecal junction demonstrated a localized, annular constriction and intramural nodular inflammatory growth in which were clusters of multiple microabscesses as well as acute and chronic inflammatory cell infiltration including eosinophils and fibrosis. Encountered were a few resolving phase of parasitic granulomatous tunnels in which fragments of degenerated sparganum with foreign body reaction were found in one focus. He had history of ingesting uncooked frogs 2 years ago. The above case suggests that differential diagnosis of inflammatory tumorous lesions in the intestine should include sparganosis in Korea.
Male ; Humans ; Diagnosis, Differential

This study was undertaken to make current fetal growth curve throughout later part of pregnancy. 5,110 normal singleton deliveries at Il Shin Christian Hospital were included. The 10th, 25th, 50th, 75th, 90th percentiles of birth weight were calculated from 21 to 42 weeks' gestation and the 10th, 50th, 90th percentiles of birth weight compared by fetal sex, maternal parity and height were graphed to know the potency of factors. There was a linear growth pattern between 28 and 38 weeks' gestation. During last month of prgnancy, three factors have significant effect on median birth weight but no significant differences in 10th percentiles. Maternal height & parity significantly affeect on 90th percentiles. So, these factors must be considered when diagnosing large for date.
Birth Weight* ; Female ; Fetal Development ; Gestational Age* ; Parity ; Parturition* ; Pregnancy

This study was performed to observe the changes of oxygen saturation after tracheal extubation, which depends on the following tracheal extubation methods of the group 1. 2A. 2B, has done. One hundred twenty-five healthy patients that had been selected out of 1~15 year-old at random were divided as follows; Group 1; extubation performed in being awake (n=49) Group 2; anesthetized extubation (n=76) 2A: extubation done in 5 min after discontinuing N2O (n=38) 2B: extubation under anesthesia (GOE or GOF) (n=38) The grouping, which has at random been assigned to the patients, was done just before the end of operation. Oxygen saturation was measured continuously by pulse-oximeter (Minolta Pulsox TS-7, Japan) and was recorded in the process of operation, immediately after extubation and at 1.2.4.6.8.10.20.30 min after extubation while they were spontaneously breathng room air. In case oxygen saturation were less than 90%, supplementary oxygen was administered to them. The frequency of hypoxemia was higher in Group 2 (19.7%) than in Group 1 (10.2%). In group 2B, 2 patients developed severe hypoxemia and 1 patient developed PVC immediately after extubation. Changes of oxygen saturation were as follows; Oxygen saturation in Group 2B was higher than that in Group 1 at each 2 min and 4 min and was also higher than that in Group 2A at 4 min after extubation. As a result, Group 1 is the safest extubation method because of its low risk of hypoxemia. If anestltized extubation must be needed, Group 2A would be preferable to Group 2B method because the frequency of hypoxemia was higher in Group 2B than in Group 2A.In addition, It is suggested that monitoring oxygen saturation continuously by the patients should be safe.
Airway Extubation* ; Anesthesia ; Anoxia ; Humans ; Oxygen*

PURPOSE: To compare the effect of breast milk containing fortifier with preterm formula on bone mineral metabolism in premature infants, we evaluated the state of bone mineralization, biochemical alteration and the frequency of rickets during the first five months of life. METHODS: Fourteen fortified breast milk-fed infants and eleven preterm formula-fed infants who were born at Il-Sin Christian Hospital from August, 1996 through July, 1997, were studied. The breast milk-fed group received human milk fortifier. The intake of Ca, P, Mg, protein, and fat was calculated at one month of age. Birth weight and weight at one, two and five months of age were measured. Serum Ca, P, alkaline phosphatase and 25-hydroxyvitamine D were measured at one month of age, and the wrist received X-ray examinations monthly. Total body bone mineral content was measured by Dual energy X-ray absorptiometry (Lunar WI) at two and five months of age. RESULTS: The two groups were similar in birth weight, gestational age, and weight at one, two and five months of age. Enteral Ca, P, protein, Mg, and fat intake, and urinary excretion of Ca, P were similar among the two groups. Serum Ca, P, ALP and 25-hydroxyvitamin D were not different. Occurrence of rickets and bone mineral content were similar among the two groups. CONCLUSION: Fortified breast milk-fed infants and preterm formula-fed infants showed no difference in total body bone mineral content and occurrence of rickets. Ultimately, we could enhance the advantage of breast milk fed to premature infants by adding fortifier.
Absorptiometry, Photon ; Alkaline Phosphatase ; Birth Weight ; Bone Density ; Breast ; Calcification, Physiologic ; Gestational Age ; Humans* ; Infant ; Infant, Newborn ; Infant, Premature ; Metabolism* ; Milk, Human* ; Rickets* ; Wrist