Backgronud : Postoperative pain control became anesthesiologist's familiar yield, so many anesthesiologists are very interested in opioid and local anesthetic's characterestics and there cardiovascular effects. It's important which anesthetic has the best pain killing and the least cardiovascular effect. We used epidural opioid and local anesthetics and intravenous opioid to investigate their pain killing and cardiovascular effects. METHODS: We studied 50 patients undergoing gastrectomy. An epidural catheter was placed via the T8-9 or L1-2 interspace. Epidural fentanyl group (Ep-F) received fentanyl 2 microgram/kg in 10ml saline, epidural bupivacaine group (Ep-B), 10 ml 0.25% bupivacaine, and epidural lidocaine group (Ep-L), 10 ml 1.5% lidocaine, epidurally; intravenous fentanyl group (IV-F) received fentanyl, 2 microgram/kg. 50% of the original dose was repeated every hour until the operation ended. Control group was given nothing before general anesthesia. Cardiovascular data was compared between those before and those at 1hour after skin incision. The time interval between end of the operation and the time of first analgesic requirement and the total number of intramuscular analgesic requirements during the first 48hours postoperatively were compared. RESULTS: Urinary output during surgery was significantly larger in group Ep-F. Group Ep-L developed more frequent episodes of hypotension. Group Ep-F, group IV-F and control group required higher enflurane concentrations. CONCLUSIONS: Group Ep-F was accompanied less hypotension and postoperative analgesic requirements were reduced.
Anesthesia, General* ; Anesthetics, Local ; Bupivacaine* ; Catheters ; Enflurane ; Fentanyl* ; Gastrectomy* ; Homicide ; Humans ; Hypotension ; Lidocaine* ; Pain, Postoperative ; Skin

A retrospective quality assurance study of intraoperative consultation (frozen section) was carried out to assess the accuracy and to determine the reasons of discordance. Of 14,977 surgical pathology cases accessioned over a 6-month period in Asan Medical Center, frozen sections were done on 1,270 (8.5%) patients and 2,392 frozen sections (1.88 frozen sections/case) were performed. Discordance was noted in 106 cases (4.4%) and diagnosis was deferred in 26 cases (1.1%). All deferred cases were reviewed with the result of 53.8% justified and 46.2% unjustified. The discordant cases were divided into three categories as to their clinical significances: category A (no affect on patient care) 61.3%, B (minimal affect) 9.4%, and C (major affect) 29.2%. Of 31 category C cases, 7 cases were false positive and 24 cases were false negative. Misinterpretation (70.8%) was the leading cause of discordance, followed by sampling error (15.1%), failure to identify lesion (8.5%), and technical problem (5.7%). More than one-third (35.8%) of all discordances were of central nervous system cases. Total central nervous system cases were 403 (16.8%) with a significantly higher disordance rate (9.8%) and deferral rate (2.5%) in comparison to the other cases with 3.4% discordance rate and 0.8% deferral rate. There were 43 colorectal cancer cases of intraoperative consultation for adequacy of resectional margins. The surgical margins were between 0.4 cm and 28 cm (mean: 6.7 cm) away from the tumor and there was no tumor-positive case. The study indicates surgical pathology should 1) promote interpretative skills in cases involving minute fragments of neurosurgical cases, 2) defer the diagnosis and ask for more tissue on inadequate or inappropriate specimens and 3) give only gross opinions without unnecessary frozen section procedures in the event of simple, clear-cut cases.
Abscess ; Anti-Bacterial Agents ; Biopsy ; Central Nervous System ; Chungcheongnam-do ; Colitis, Ulcerative ; Colorectal Neoplasms ; Diagnosis ; Diagnosis, Differential ; Endoscopy ; Enterocolitis, Pseudomembranous* ; Frozen Sections* ; Humans ; Mucous Membrane ; Necrosis ; Pathology ; Pathology, Surgical ; Retrospective Studies ; Selection Bias

A clinical study was conducted to compare effectiveness of IV Globulin with that of steriod in childhood acute ITP. We carried out an experiment to 36 patients of acute ITP who recovered over 50.000/mm(3) of platelet count and not to recur in 6 months. Study group consist of 10 children who were treated with steriod only (Group A), 13 children who were treated with IV Globulin (0.4g/kg/d, 5 days, Group B), and 13 children combined with steroid (Group C) Study period was from January 1988 to December 1992, folllowing results were obtained. 1) There were no significant difference in sex ratio. age distribution, pretreatment hemoglobin level, platelet count and prolonged bleeding time among study groups. 2) The days which platelet count reached to 50.000/mm(3), 100,000/mm(3) were 3.7 days (Group A), 2.1 days (Group B), and 2.3 days (Group C), respectively (p<0.05). 3) Complete response rates within 4 weeks did not show significant difference (90% in Group A, 84.6% in Group B, 92.3% in Group C), the complete response rate within 1 week were significantly different among three group (44.4% in Group A, 90.9% in Group B, 83.3% in Group C)(p<0.05). In conclusion, it is more desirable for early treatment of a childhood ITP because IV Globulin is easy to normalize platelet count in a short time.
Age Distribution ; Bleeding Time ; Child ; Humans ; Platelet Count ; Sex Ratio

Malignant mixed miillerian tumor (MMMT) was one of the rare uterine sarcoma. This tumor is composed of sarcoma and carcinoma. Primary MMMT in the peritoneum is among the rarest sites for MMMT. MMMT is highly malignant and the prognosis is grave due to frequent recurrence and metastasis. In the world literature, only 22 cases with primary MMMT of the peritoneum have been reported and most of these were single report. We report one case of primary MMMT in the peritoneum with a brief review.
Neoplasm Metastasis ; Peritoneum* ; Prognosis ; Recurrence ; Sarcoma

PURPOSE: The purpose of this study is to examine how well patients who had hip arthroplasty comply with medical regimens given to them after the operation. METHOD: The subjects of the study were patients who had arthroplasty at P Hospital between April 1. 2001 and August 30, 2002. 20 patients of the subjects experienced complications after the operation and the other 20 did not. Data from a survey using the qustionnaire were statistically analyzed in terms of real number, percentage point, mean and standard deviation by using chi2test. t-test and ANOVA. RESULT: 1) the surveyed patients were significantly different in the compliance of medical regimen among them according to their education background as one of the subjects general characteristics. 2) It was found that the group of complication was higher in the compliance of medical regimen than that of non-complication. The two groups showed statistically significant difference with each other in the degree of compliance with therapeutic instructions than the experimental group in terms of the maintenance of abduction after the operation, training instructions on step-by-step basis, urination cotrol on bed, accurate use of crutch, compliance with medication, balance among medical treatment, training, leisure, rest and nutrition. instructions by physicians, nurses and physical therapists, use of low armchairs and toilet bowels and no bending of the body forward, and use of a non-operated leg in case of go upstairs or downstairs. CONCLUSION: It seems necessary to develop systematic and sessional education programs for improving the compliance of medical regimen. ultimately reducing complications following hip arthroplasty.
Arthroplasty* ; Compliance ; Education ; Hip* ; Humans ; Leg ; Leisure Activities ; Patient Compliance* ; Physical Therapists ; Urination

To characterize the immunopathologic phenotype of the cells in the lesional ti.:sue and to further examine the mechanism of the development of the annular lesions in leprosy, we have studied immune cells (T lymphocyte and its subsets, Langerhans cells, and HLA-DR antigen expressing cells) at different anatomical sites inside, active border, and outside normal skin in the annular lesions of leprosy. We took biopsy specimens from 4 patients of BT type, then processed the specimens by the staining methods eif indirect immunoperoxidase with monoclonal antibodies. In the active border the number of T cell was over 50g of the total cells infiltrated in the dermis. Helper T cells were dominant in number, and about three fourths of the cells were positive for HLA-DR staining. In two patients they had expression of DR antigen on the surfaces of the keratinocytes in the epidermis, in contrast to that of the inside, even the intensities were not. strong. At the inside of the annular lesions T cells were about 40% and the ratio of helper/suppressor T cell was approxiinately 1: 1, However, HLA-DR positive immune cells were not more than 10g among the total infiltrates. Langerha,ns cells were increased in number and in size either in the border or at the inside of the annular lesions. With these results we presume that the T cell mediated imrnune responses against Mycobacterium leprae may play an important role in the formation and extension of the annular lesions in leprosy.
Antibodies, Monoclonal ; Biopsy ; Dermis ; Epidermis ; HLA-DR Antigens ; Humans ; Keratinocytes ; Langerhans Cells ; Leprosy* ; Lymphocytes ; Mycobacterium leprae ; Phenotype ; Skin ; T-Lymphocytes ; T-Lymphocytes, Helper-Inducer

PURPOSE: This correlational study was performed to identify the impacts of maternal child rearing attitudes on the menstrual attitudes and the determinants of positive menstrual attitudes in female middle school students. METHODS: With convenience sampling, 198 middle school female students were recruited living in one major city and its surrounding areas in Korea. Data was collected using a self administered questionnaire including menstrual attitudes and maternal child rearing attitudes from April 1 to July 15, 2008. RESULTS: Among the Maternal child rearing attitudes, affectionate, achievement oriented and rational attitudes had positive correlations to a positive menstrual attitude, and an autonomous attitude had a negative correlation to a negative menstrual attitude. As determinants of positive menstrual attitudes, feeling of menarche, mother's response at first menstruation, and rational maternal child rearing attitudes were delineated and their explained variance for a positive menstrual attitude was 18.5%. There was no difference on menstrual attitudes by K clustering in terms of maternal child rearing attitudes. CONCLUSION: These results support the critical role of the mother. Especially desirable maternal child rearing attitudes in relation to a positive menstrual attitude would be affectionate, achievement oriented and rational for early adolescent girls. In further studies, considerations are needed for menstruation related education and research for early adolescents and active involvement of the mother & daughter together.
Adolescent ; Attitude to Health ; Child ; Child Rearing/*psychology ; Female ; Humans ; Menarche ; Menstruation/*psychology ; Mother-Child Relations ; Mothers/*psychology ; Questionnaires

This experimental study was conducted to evaluate the effect of indomethacin and methylprednisolone on PAN-induced nephrosis in rats. Sprague-Dawley rats weighing 150~200gm were used and divided into controls, group I (PAN intraperitoneally), group II(PAN intraperitoneally, followed by indomethacin peritoneally for 12 days), group III (PAN intraperitoneally, followed by methylprednisolone peritoneally for 12 days) and group IV (PAN intraperitoneally, followed by cyclosporin subcutaneously for 12 days). Twenty four-hour urinary protein excretion was measured on day 0, 5, 10 and 17. On the 17th day, rats were sacrificed for the determination of total serum protein, albumin and cholesterol levels. Foot process widths of glomerular epithelial cells were measured, and anionic sites of lamina rara externa were determined by using PEI as cationic probes. The following results were obtained. Twenty four-hour urinary protein excretion (mg/day) of group I was significantly increased to 455.7+/-188.8 on the 5th day compared to 15.2+/-3.7 on day 0 (p<0.01), and increased gradulally to 525.6+/-203.5 on the 10th day, then decreased to 280.6+/-25.2 on the 17th day. In group III, 24 hr urinary protein excretion on 17 th day (180.7+/-64.5) was significantly lower than that of group I (280.6+/-25.2). Total serum protein of group III was significantly lower than that of group I, and serum albumin and cholesterol did not show any significant difference among Group I, II, III and IV. Foot process widths (nm) of glomerular epithelial cells in group I, II, III and IV were 409.5+/-15.2, 387.8+/-49.2, 279.9+/-36.9 and 398.3+/-38.3, respectively. And the value of group of group III was significantly lower than that of group I (p<0.01). The number of anionic sites per 1micrometer length of glomerular basement membrane in Group I, II, III and IV were 10.3+/-1.3, 10.1+/-1.6, 12.5+/-1.5and 10.2+/-1.5, respectively. And the value of group III was significantly lower than that of group I (P<0.01). In conclusion, cyclosporin and indomethacin did not show any significant effect on PAN nephrosis in rat. However, methylprednisolone reduced the urinary protein excretion and showed significant recovery of foot process widths and number of anionic sites of glomerular basement membrane.
Animals ; Cholesterol ; Cyclosporine* ; Epithelial Cells ; Foot ; Glomerular Basement Membrane ; Indomethacin* ; Methylprednisolone* ; Nephrosis* ; Nephrotic Syndrome ; Rats* ; Rats, Sprague-Dawley ; Serum Albumin

No abstract available.
Hantaan virus* ; Hemorrhagic Fever with Renal Syndrome* ; Prevalence*

Marginal degenration of the cornea was first described by Triimpy in 1881. Since then other investigators have reported many marginal degenerations of the cornea in various different clinical nomenclatures but it has never been described in Korea. Marginal or peripheral degeneratoin of the cornea was also reported by Terrien in 1900. The condition is uncommon and usually bilateral although one side may be more advanced than the other. It occurs most often (about 75%) in male in the age brancket of 10 to 70 but majority of cases were noted before the age of 40. Clinically the disease starts with peripheral opacity in punctate pattern simulating an arcus seniHs and vascularized. As the problem advances, furrow gradually develops and spreads all around the periphery of the cornea in circumferential fashion. The cornea becomes extremely thin in this area but epithelium is intact. At the central margin of the furrow, one may see an advancing edge of lipid. The two cases reported in the following are a 20 year old Korean lady with unilateral marginal corneal degeneration in the inferior part of the cornea, and a 68 year old man with typical bilateral marginal corneal degeneration which has developed since his age of 27.
Aged ; Cornea* ; Epithelium ; Humans ; Korea ; Male ; Research Personnel ; Young Adult