In order to assess the effects of diazepam and meperidine as premedication for upper gastrointestinal endoscopy, eighty eight patients undergone an elective upper gastrointestinal endoscopy were studied. Studied patients were divided into two groups; one group was premedicated with buscopan and stropine(group I), and the other group was premedicated with diazepam and meperidien (group II). The results obtained were summarized as follows; 1) 83.0% of the group II (44/53) did not eomplain any discomfort by the procedure, but only 23.9% (8/35) of the group I showed no discopmort. The difference between two groups is statiatieally significant (p<0.005). 2) In 41 patients with previous experience of endoscopy, 22 patients from 27 of the graup Il(81.5%) did not feel any discomfort but it wes only 3 patients among 14 of the group I (21.4%) who did not feel discomfart (p<0,005). 3) In 47 patients without previous experience of endoscopy, 23 patients from 26 of the group II (88. 5%) did not show discomfort but it way only 5 patients among 21 of the group I (23.7%) (p<0.005). 4) In the patients with previous experience of endoscopy, 21 patients among 27 of the group II (77. 8%) felt better than that of the previous experience but it was only 3 patients among 14 of the group I (21.4%) (p<0.005). From the above results, we would emphasize that it is more effective to use diazepam and, meperidien as premendication for the gastrointestinal endoscopic procedure since it removes pstients apprehension rendering them a good cooperation with very minimal side effects,
Butylscopolammonium Bromide ; Diazepam ; Endoscopy ; Endoscopy, Gastrointestinal ; Humans ; Meperidine ; Premedication*

Hypotension immediately after spinal anesthesia has been considered as the result of pre-ganglionic sympathetic paralysis and secondarily due to changes in cardiac output. And also the increase of vascular bed space about 20~25% was pointed ont during spinal anesthesia which was another cause of spinal hypotension. Same degree of increased vascular bed space was produced by vasodilators such as Dibenzyline and Arfonad. Therefore, vasopressors have been used as the drug of choice to prevent and treat this spinal hypotension. This study was attempted to combat the hypotension during spinal anesthesia by filling this increased vascular bed space with Lactated-Ringer's or Dextrose solution instead of giving vasopressors. Lactated-Ringer's or Dextrose solution was administered to 141 cases, before and immediately after. spinal anesthesia was performed. The given amount of fluid was about 12.5~15% of estimated total blood volume (Group A). And no intravenous fluid was given to 101 cases as control (Group B). Changes of the systolic, diastolic blood pressure and pulse rate were observed. In the Group A, significant changes of the systolic (t=2.52, p<0.02) and diastolic blood pressure (t=1.98, p<0. 05) was observed. The changes of pulse rate were found not significant in the both group series.
Anesthesia, Spinal* ; Blood Pressure ; Blood Volume ; Cardiac Output ; Glucose ; Heart Rate ; Hypotension ; Paralysis ; Phenoxybenzamine ; Vasodilator Agents

Purple glove syndrome (PGS) is a rare complication of intravenous phenytoin use that is poorly understood and potentially serious. The characteristic features of PGS are pain, edema, and discoloration at the injection site that spreads to the distal limbs. Diagnosis of PGS can be made from clinical presentation, and treatment is usually restricted to conservative therapy. A 7-year-old girl was treated with phenytoin for epilepsy and was referred to our department for violaceous color change and edema on intravenous injection site of the left hand. It was consistent with PGS, and to our knowledge, it is first report in Korea.
Child ; Edema ; Epilepsy ; Extremities ; Hand ; Humans ; Injections, Intravenous ; Korea ; Phenytoin

No abstract available.
Cholesterol* ; Granuloma*

The prevalence of attention-deficit/hyperactivity disorder (ADHD) has been increasing, and the growing number of people with this disorder, especially the non-pediatric population, get prescriptions for this condition. However, controversies are also growing around this disease. In order to provide optimal treatment to a patient presumed to have adult ADHD, it is crucial to understand the implications of diagnosing and treating adult ADHD. We examined the history of ADHD and changes in the diagnostic criteria postulated by the DSM system (Part I), proposed a critical review on the concept of ADHD from various points of view and suggested the diagnostic and therapeutic implications of adult ADHD (Part II). This study may serve as a small cornerstone for a valid diagnosis and a proper treatment of ADHD, especially in the adult population.

The prevalence of attention-deficit/hyperactivity disorder (ADHD) has been increasing, and the growing number of people with this disorder, especially the non-pediatric population, get prescriptions for this condition. However, controversies are also growing around this disease. To provide optimal treatment to a patient presumed to have adult ADHD, it is crucial to understand the implications of diagnosing and treating adult ADHD. In this article, we proposed a critical review on the concept of ADHD from various points of view and suggested the diagnostic and therapeutic implications of adult ADHD. This article will serve as a small cornerstone for a valid diagnosis and a proper treatment of ADHD, especially in the adult population.

Endoscopic sphincterotomy (E.S.T.) has relatively low complications and is the theraphy of choice in patients with common bile duct stones. It is also an useful technique for decompression of biliary tract obstruction. Thirty two cases of patients were selected according to opedrative risks: old age, severe jaundice and recurrent or retained bile duct stones after cholecystecomy from 1986 to 1988. The results were as follows, 1) In thirty two cases nf E.S.T., male to female ratio was 1:1.46. Most frequent age was older than 40 years. (male, 84.6%, female, 84.2%). 2) Out of thirty two cases, 20 cases (62.5% were under post clholecystectomy state, 12 eases (37.5%) were obstructive jaundice. 3) Spontaneous stone passage after E.S.T. was 81.3% (26 cases), and total stone remoral rate was 87.5% (28 cases), 4) Complications of E.S.T. were noted in three cases. In the two cases of bleeding, it was spontaneously improved and a case of acute pancreatitis was treated by medical care.
Bile Ducts ; Biliary Tract ; Common Bile Duct* ; Decompression ; Female ; Hemorrhage ; Humans ; Jaundice ; Jaundice, Obstructive ; Male ; Pancreatitis ; Sphincterotomy, Endoscopic*

PURPOSE: Pyomyositis is a rare disease in temperature climate region. The diagnosis of pyomyositis is often delayed, and pyomyositis is often misdiagnosed in the emergency department. METHODS: The medical records of 11 patients who were diagnosed as having traumatic pyomyositis in the emergency department at Samsung Medical Center in Seoul, Korea, between 2000 and 2006 were reviewed. Their clinical features, such as history, symptoms, clinical findings, duration from onset of symptoms to diagnosis, medical history, laboratory data, results of imaging studies and clinical course were collected. RESULTS: The psoas muscles were most commonly involved. Computer tomography and magnetic resonance imaging aided in accurate diagnosis of the infection and of the extent of involvement. Incision, drainage, and antibiotics therapy eradicated the infectioin in all patients CONCLUSION: Pyomyositis should be a part of the differential diagnosis for patients with traumatic muscle pain. Radiologic evaluation, such as computer tomography and magnetic resonance imaging, must be considered in the diagnosis of traumatic pyomyositis.
Anti-Bacterial Agents ; Climate ; Diagnosis ; Diagnosis, Differential ; Drainage ; Emergencies* ; Emergency Service, Hospital ; Humans ; Korea ; Magnetic Resonance Imaging ; Medical Records ; Myalgia ; Psoas Muscles ; Pyomyositis* ; Rare Diseases ; Seoul

In order to evaluate the accuracy of endoscopic findings in the diagnosis of gastric can the endoscopic findings of gastric lesion were compared with the macroscopic and pathologic findings of excised identical lesion. 105 operated gastric cancer paitients (advanced cancer 95 cases, early cancer 10 cases) who were diagnosed endoscopically at Pusan National University Hospital from January 1983 to August 1987 were studied. The results were as follows; 1) The accuracy of endoscopic findings were 94.7% in the advanced gastric cancer, and 45.5% in the early gastric cancer. 2) The accuracy of gross findings endoscopic and pathologic in advanced gastric cancer were 50.0% in Borrmann type I, 45.0% in Borrmann type II, 73.2% in Borrmann type III, and 66.7% in Borrmann tyye IV. 3) The accuracy of the endoscopy ia morphologic classification of advanced gastric cancer according to pathologic tumor location were 60.0% in C (upper 1/3), 43.9% in M(middle 1/3),76.3% in A (lower 1/3), 55.6% in the anterior wall, 50.0% in the posterior wall, 66.7% in the greater curavature, and 67.2% in the lesser curvature. 4) The accuracy of endoacopy in morphologic classification of gastric cancer to tumor size ware 54.5% in below 2 cm, 54.5% in from 2.1 cm to 4 cm, 65.4% in from 4.1 cm to 6.0 cm, 80% in from 6.1 cm to 8 cm, 75.0% in above 8.1 cm. 5) The accuracy of endoscopy in the morphologic classification according to the pathologic tumor stage in advanced gastric cancer were 55.6% in TNM stage I, 52.0% in TNM stage II, 65.4% in TNM stage III, and 73,7% in TNM stage IV.
Busan ; Classification ; Diagnosis ; Endoscopy ; Stomach Neoplasms*

PURPOSE: Gastric emptying after a gastric resection has been studied in early gastric cancer. Most reports are retrospective and show that gastric emptying after gastroduodenal reconstruction is faster than normal. This study was designed to evaluate the gastric-emptying pattern after a gastroduodenal reconstruction with preservation of the truncal vagus nerve had been performed on a patient whose preoperative gastric-emptying time had been normal. METHODS: From July 1996 to February 1998, we performed a distal gastrectomy with gastroduodenal reconstruction with preservation of the truncal vagus nerve in 11 patients (9 patients with early gastric cancer, 1 patient with advanced gastric cancer, and 1 patient with high-grade dysplasia) whose preoperative gastric-emptying times was normal. To evaluate the gastric emptying after the gastrectomy and gastroduodenal reconstruction, we analyzed the lag time (when 10% of food is delivered to the duodenum), T1/2 (when 50% of food is delivered to the duodenum), and the residual food in the stomach after 100 minutes (%) by means of radionuclide scintigraphy using a single-head gamma camera after ingestion of an 99mTc-tin-colloid steamed egg. We defined the delayed gastric emptying as T1/2 longer than the mean of the preoperative value by 2 standard deviation. RESULTS: Among the 11 patients with gastroduodenal reconstruction, gastric emptying was normal in 4 patients and delayed in 7 patients; only one of the delayed cases has GI symptoms such as early satiety. There were no rapid gastric emptying cases. CONCLUSION: Rapid gastric emptying after gastroduodenal recon struction with preservation of the truncal vagus nerve was rare.
Eating ; Gamma Cameras ; Gastrectomy ; Gastric Emptying ; Humans ; Ovum ; Radionuclide Imaging ; Retrospective Studies ; Steam ; Stomach ; Stomach Neoplasms ; Vagus Nerve*