PURPOSE: Recently developed BMS(TM) (Zassi Bowel Management System(TM): Hollister Inc., Illinois, USA) can provide effective nonsurgical fecal diversion without the risks associated with colostomy creation and subsequent closure. Our aim is to evaluate the effectiveness of the BMS in diverting feces from the perianal wide surgical wound in patients with Fournier's gangrene. METHODS: BMS(TM) was applied in five patients (male: 2, median age; 44) with Fournier's gangrene from January 2000 to September 2001. The treatments consist of three times a day wound dressing after wide surgical debridement and intravenous antibiotic therapy. For evacuation of feces, twice daily warm saline irrigation was administered via BMS(TM) or low daily doses of polyethylene glycol solutions were orally taken in. An endoscopic and anorectal manometric study was done to evaluate possible mucosal complications and anorectal functional changes. RESULTS: The average duration of the BMS application was 41 (range, 22~63) days. The result of a manometric study after immediate removal of the BMS(TM) showed a decreased mean resting pressure (range: 22~36 mmHg) and a decreased mean squeezing pressure (range: 32~39 mmHg). After 3 days, the sphincter pressure had improved markedly: mean resting pressures of 38, 45, 60, and 63 mmHg and mean squeezing pressure of 78, 89, 91, and 101 mmHg respectively. Fecal incontience was not noted in any patient. Other possible mucosal complications were not noted. There were no mortalit. CONCLUSIONS: BMS(TM) application in Fournier's gangrene patients after surgery successfully avoids a defunctioning colostomy. Furthermore, no significant complications were noted over a prolonged period up to 63 days.
Bandages ; Colostomy ; Debridement ; Fasciitis, Necrotizing ; Feces ; Fournier Gangrene ; Humans ; Illinois ; Polyethylene Glycols

BACKGROUND: Morphine has a direct action on morphine receptors in the brain and spinal cord. Intrathecally administered L-NAME, a nitric oxide synthase inhibitor, is known to have an antinociceptive effect on formalin-induced pain in animal studies. Efficacy of intrathecally administered ketorolac, a cyclooxygenase inhibitor, is somewhat controversial. The interactions of intrathecally administered morphine, ketorolac and L-NAME on formalin-induced nociception was studied. METHODS: Male Sprague-Dawley rats were implanted with chronic lumbar intrathecal catheters and were tested for paw flinch by a formalin injection. Drugs were intrathecally administered 15 min before the formalin injection, and biphasic painful behaviors were observed. We obtained the ED50 for each agent (ketorolac, L-NAME and morphine). ED50 fractions (1, 1/2 and 1/4) of drug combinations of L-NAME-ketorolac, morphine-L-NAME and ketorolac-morphine were administered. The ED50 of each combined drug was established and isobolographic analysis of the drug interactions was carried out. RESULTS: Intrathecal administration of ketorolac, L-NAME and morphine produced a dose-dependent suppression of pain behaviors in phase 2. ED50 values were 297.04micro gram for ketorolac, 207.46micro gram for L-NAME and 0.17micro gram for morphine in phase 2. Isobolographic analysis showed that the combination of intrathecal morphine and L-NAME synergistically reduced pain behaviors in phase 2. CONCLUSIONS: Intrathecally administered morphine, L-NAME and ketorolac produced a dose-dependent decrease in the number of paw flinches in both phase 1 and phase 2 on the formalin test. Morphine with L-NAME showed synergistic analgesic effects on formalin-induced pain in phase 2.
Animals ; Brain ; Catheters ; Drug Combinations ; Drug Interactions ; Formaldehyde ; Humans ; Ketorolac* ; Male ; Morphine* ; NG-Nitroarginine Methyl Ester* ; Nitric Oxide Synthase ; Nociception ; Pain Measurement ; Prostaglandin-Endoperoxide Synthases ; Rats* ; Rats, Sprague-Dawley ; Receptors, Opioid, mu ; Spinal Cord

There are rare but serious complications-especially risk of paraplegia when instrumentation by surgery is used to correct a spinal deformity. Wake-up tests may be necessary during scoliosis or kyphosis surgery to ensure that spinal function remains intact. We tried four spinal fusions for ankylosing spondylitis of a 62 year-old woman. We were not able to fix the rod for fusion because of a presenting positive wake-up test in the previous two prone-positioned operations. In last operation we decided on normotensive anesthesia with fentanyl-propofol in a lateral decubitus position, and then surgical instrumentation was completed after we made sure of a negative weak-up test. There were no postoperative sequelae. The lateral approach to the thoracic disc space during spinal fusion may produce minimum disruption of the normal spinal musculoskeletal anatomy, avoid retraction of the spinal cord and preserve the neurovascular bundle and the segmental radicular arteries to the spinal cord.
Anesthesia ; Arteries ; Congenital Abnormalities ; Female ; Humans ; Kyphosis ; Middle Aged ; Paraplegia ; Scoliosis ; Spinal Cord ; Spinal Fusion* ; Spondylitis, Ankylosing ; Surgical Instruments

PURPOSE: Benign prostatic hyperplasia (BPH) is a representative urological disease in men at senescence. The etiology of BPH is multifactorial, with chronic conditions, such as non insulin dependent diabetes mellitus (NIDDM), treated hypertension, obesity, low and high density lipoprotein (HDL) cholesterol levels and high insulin levels, constitute for the development of BPH. The prevalence of metabolic syndrome in a BPH population was investigated and the relationship between BPH and metabolic syndrome evaluated. MATERIALS AND METHODS: The BPH group consisted of 162 patients (63.4+/-7.8 years old) diagnosed as BPH and the control group of 68 patients (59.7+/-6.4 years old) without voiding difficulties. In each group, the relating factors, prevalence of BPH and metabolic syndrome were investigated and analyzed for comparison. RESULTS: Comparing the voiding factors of the BPH and control groups, all of the measured values showed aggravation of the voiding difficulty in the BPH compared with the control group. The prevalence of metabolic syndrome in the BPH group was 64.2%, which was about double that in the control group (32.4%) (p<0.001). Among the components of metabolic syndrome, hypertension (70.4%) was found to have the highest prevalence. CONCLUSIONS: The probability of patients with BPH having metabolic syndrome is high compared to those without BPH. Consequently, in BPH patients, careful evaluation for metabolic syndrome is needed, with the early diagnosis and proper management of metabolic syndrome should accompany the treatment of BPH.
Aging ; Cholesterol ; Diabetes Mellitus ; Early Diagnosis ; Humans ; Hypertension ; Insulin ; Lipoproteins ; Male ; Obesity ; Prevalence ; Prostatic Hyperplasia* ; Urologic Diseases

Purpose: The occurrence of coronary artery disease is rising with the recent changes in diet and the westernization of lifestyle. In 1998, the World Health Organization (WHO) defined "metabolic syndrome" as a condition in which all the risk factors of coronary artery disease exist in an elderly individual. We investigated the relationship between metabolic syndrome and voiding difficulty of women. Materials and Methods: In 2004, we investigated 66 female out-patients who visited the endocrinology department and health care center between the months of March and October. We divided the patients into two groups: one which corresponded to the metabolic syndrome criteria (n=42, 56.0+/-5.6 years old) and one which did not (n=24, 55.7+/-05.2 years old), and we compared the voiding factors of these two groups. Results: When comparing the components of metabolic syndrome in the patient study group to that in the control study group, the metabolic syndrome patients scored poorly for all the metabolic syndrome components in comparison to the control group (p<0.05). On comparing the voiding factors of metabolic syndrome patients to that of the control group, the metabolic syndrome patient group scored substantially lower than the control group for all voiding factors (p<0.05). Conclusions: We proved that metabolic syndrome and voiding difficulty of women were related based on the results of this study. Therefore, performing more active investigation for metabolic syndrome in the patients who are admitted with voiding difficulty, earlier diagnosis of metabolic syndrome would be possible.
Aged ; Coronary Artery Disease ; Delivery of Health Care ; Diagnosis ; Diet ; Endocrinology ; Female ; Humans ; Life Style ; Metabolic Syndrome X ; Outpatients ; Risk Factors ; Urination Disorders ; World Health Organization

BACKGROUND: The management of postoperative pain with traditional narcotic analgesic regimen is associated with an unacceptably high failure rate and at best has represented a cautious compromise between adequate analgesia and the risk of complications, particularly that of respiratory depression. The purpose of this investigation was to compare the efficacy and safety of nalbuphine given by patient-controlled analgesia (PCA) with differential dosages after total knee replacement. METHODS: A double-blind clinical trial of 75 patients who received intravenous nalbuphine with patient- controlled analgesia during the postoperative first 48 hours after total knee replacement, was carried. Patients were assigned to three groups by the concentration of nalbuphine: Group 1 (n = 25), 2 mg/ml; Group 2, 4 mg/ml; Group 3, 6 mg/ml. The settings of PCA in three groups were same. RESULTS: Visual analog scale (VAS) scores were used to assess pain. Group 2 and 3 patients reported significant lower VAS over the postoperatively 6 hours and 12 hours at either rest or movement compared to group 1. PCA demands, delivered doses and PCA nalbuphine dosage per hours except supplemental analgesic doses in the first 48 hours were lower in group 2 and 3 compared to group 1. There were significant differences among groups at postoperatively 6 and 12 hours in nausea, vomiting and sedation of the side effects. CONCLUSIONS: IV PCA with nalbuphine is thought to be potent and safe for postoperative pain relief without the major morbidity like respiratory depression, in addition, the careful observation and treatment on the side effect like nausea, vomiting and sedation, is surely needed.
Analgesia ; Analgesia, Patient-Controlled* ; Arthroplasty, Replacement, Knee ; Humans ; Nalbuphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Respiratory Insufficiency ; Visual Analog Scale ; Vomiting

BACKGROUND: The greater occipital nerve (GON) block has been frequently used for different types of headache, but performed with rough estimates of anatomic landmarks. Our study presents the values of the anatomic parameters and estimates the effectiveness of the ultrasound-guided GON blockade. METHODS: The GON was detected using ultrasound technique and distance from external occipital protuberance (EOP) to GON, from GON to occipital artery and depth from skin to GON was measured in volunteers. Patients with occipital headache were divided into two groups (ultrasound-guided block: group S, conventional blind block: group B) and GON block was performed. The same parameters were measured on group S and VAS scores were assessed at pretreatment, 1 week and 4 weeks after treatment on both groups. RESULTS: The GON had distance of 23.1 +/- 3.4 mm (right) and 20.5 +/- 2.8 mm (left) from EOP to GON. Its depth below the skin was 6.8 +/- 1.5 mm (right) and 7.0 +/- 1.3 mm (left). The distance from GON to occipital artery was 1.5 +/- 0.6 mm (right) and 1.2 +/- 0.6 mm (left) in volunteers. Initial VAS score of group S and group B patients were 6.4 +/- 0.2 and 6.5 +/- 0.2. VAS score of 4 weeks after injection were 2.3 +/- 0.2 on group S and 3.8 +/- 0.3 on group B (P = 0.0003). CONCLUSIONS: The parameters measured in this study should be useful for GON block and ultrasound-guided blockade is likely to be a more effective technique than blind blockade in occipital headache treatment.
Anatomic Landmarks ; Arteries ; Follow-Up Studies ; Headache ; Humans ; Nerve Block ; Skin

PURPOSE: Although an extended colon resection with high ligation of the inferior mesenteric artery (IMA) generally has been recommended as curative surgery for advanced left colon cancer (LCC), it shows little or no survival advantage over segmental resection with low ligation of IMA. The present study is to determine the risk factors associated with IMA-origin lymph-node (LN) metastasis and to clarify the implication of IMA-origin LN metastasis. METHODS: We examined the clinicopathological results of 200 cases of LCC. LN dissection was performed as follows: D2 en-bloc resection of the primary tumor, IMA-origin LN dissection, and paraaortic LN dissection. RESULTS: The incidence of IMA-origin LN metastasis of LCC was 4.5% (9 cases), and all cases involved sigmoid colon cancer. The independent risk factors of IMA-origin LN metastasis were four or more regional LN metastases (hazard ratio: 16.51, 95% confidence interval: 1.60~164.12) and a preoperative CEA level of greater than 6 ng/ml of (hazards ratio: 6.63, 95% confidence interval: 1.06~41.32). The incidence of IMA-origin LN metastasis among stage IIIC patients was 26.7%. Five of the 9 (55.6%) cases of IMA-origin LN metastasis had a concomitant paraaortic LN metastasis. CONCLUSIONS: The incidence of IMA-origin LN metastasis among patients with LCC was low; however, IMA-origin LN metastasis should be considered as a systemic metastasis.
Colon ; Colonic Neoplasms ; Humans ; Imidazoles ; Incidence ; Ligation ; Lymph Nodes ; Mesenteric Artery, Inferior ; Neoplasm Metastasis ; Nitro Compounds ; Risk Factors ; Sigmoid Neoplasms

Developmental information aids stem cell biologists in producing tissue-specific cells. Recapitulation of the developmental profile of a specific cell type in an in vitro stem cell system provides a strategy for manipulating cell-fate choice during the differentiation process. Nurr1 and Foxa2 are potential candidates for genetic engineering to generate midbrain-type dopamine (DA) neurons for experimental and therapeutic applications in Parkinson's disease (PD), as forced expression of these genes in neural stem/precursor cells (NPCs) yields cells with a complete battery of midbrain DA neuron-specific genes. However, simple overexpression without considering their expression pattern in the developing midbrain tends to generate DA cells without adequate neuronal maturation and long-term maintenance of their phenotype in vitro and in vivo after transplantation. We here show that the physiological levels and timing of Nurr1 and Foxa2 expression can be replicated in NPCs by choosing the right vectors and promoters. Controlled expression combined with a strategy for transgene expression maintenance induced generation of fully mature midbrain-type DA neurons. These findings demonstrate the feasibility of cellular engineering for artificial cell-fate specification.
Cell Engineering ; Dopamine* ; Dopaminergic Neurons* ; Genetic Engineering ; In Vitro Techniques* ; Mesencephalon ; Neurons ; Parkinson Disease ; Phenotype ; Stem Cells ; Transgenes

PURPOSE: With the recent changes in eating habits and the westernization of peoples' lifestyle, the occurrence of coronary artery disease is on the rise. In 1998, the World Health Organization (WHO) defined "metabolic syndrome" as a condition in which all the risk factors of coronary artery disease exist in an elderly individual. We investigated the relationship between metabolic syndrome and voiding difficulty. MATERIALS AND METHODS: In 2004, we investigated 123 male out-patients who visited the endocrinology department and the health care center between the months of March and October. We divided the patients into two groups: one group met the criteria for metabolic syndrome (n=90, 58.7+/-8.9 years old) and one group didn't met the criteria (n=33, 57.8+/-9.5 years old), and we compared factors of voiding difficulty between the these two groups. RESULTS: When comparing the components of metabolic syndrome in the patient study group to the control study group, the metabolic syndrome patients scored poorly for all the metabolic syndrome components in comparison to the control group (p<0.05). When comparing the voiding factors of the metabolic syndrome patients to the control group, the metabolic syndrome patient group scored substantially lower than the control group for all the voiding factors (p<0.05). CONCLUSIONS: The results of this study proved that metabolic syndrome and voiding difficulty are related. Therefore, the earlier diagnosis of metabolic syndrome should be possible by performing a more active investigation for metabolic syndrome in the patients who are admitted with voiding difficulty.
Aged ; Coronary Artery Disease ; Delivery of Health Care ; Diagnosis ; Eating ; Endocrinology ; Humans ; Life Style ; Male ; Metabolic Syndrome X ; Multiple Endocrine Neoplasia Type 1* ; Outpatients ; Prostatic Hyperplasia ; Risk Factors ; Urination Disorders ; World Health Organization