BACKGROUND: Vasoconstrictors have been used as an adjunct to local anesthetics to prolong the duration of spinal anesthesia. Recently, clonidine, an 2-receptor agonist has been shown to prolong the duration of spinal anesthesia following intrathecal administration. Bupivacaine has been used for spinal anesthesia and compared with tetracaine in recent studies. We have undertaken this study to further evaluate the effect of clonidine in hyperbaric 0.5% bupivacaine spinal anesthesia. METHODS: Thirty patients who were scheduled for lower limb or urologic operation were divided into 2 groups: Group A (hyperbaric bupivacaine 13 mg, 2.6 ml + N/S 1 ml), Group B (hyperbaric bupivacaine 13 mg, 2.6 ml + clonidine 150 g, 1 ml). We used standardized techniques and injected above drugs to group A and B intrathecally for spinal anesthesia. We investigated the onset and the duration of spinal anesthesia along with hemodynamic changes (blood pressure and heart rate) in patients. RESULTS: There were no significant differences in the onset of spinal anesthesia and hemodynamic changes between two groups. The time taken to recover from the nerve block was more prolonged in the group B (touch 225, pain 262, foot dorsiflexion 271, knee flexion 290 minutes) than group A (touch 154, pain 188, foot dorsiflexion 198, knee flexion 216 minutes). There were no significant differences in sedation, and in experiencing dry mouth and other side effects between two groups. CONCLUSION: Intrathecal clonidine 150 g has been proved to prolong the duration of hyperbaric 0.5% bupivacaine spinal anesthesia without neurotoxicity or dangerous hemodynamic depression. Therefore, clonidine can be used as an effective adjunct in hyperbaric bupivacaine spinal anesthesia.
Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine* ; Clonidine* ; Depression ; Foot ; Heart ; Hemodynamics ; Humans ; Knee ; Lower Extremity ; Mouth ; Nerve Block ; Tetracaine ; Vasoconstrictor Agents

No abstract available.
Gonadotropin-Releasing Hormone* ; Humans ; Hypogonadism* ; Male*

BACKGROUND: Intertrochanteric fractures of the femur are the most common type of fracture, and are an increasing occurrence due to the aging of the population. The objectives of our study are to predict the fate of intertrochanteric fractures treated with intramedullary hip nails by assessing the postoperative fracture stability utilizing the newly developed scoring system, and to help rehabilitate these patients. METHODS: Eighty-two patients with intertrochanteric fractures that were treated with intramedullary hip nails between December, 2004 and January, 2011 were subjected to this study. The patients who could be followed for a minimum of one year postoperatively were enrolled. The immediate postoperative conditions were determined by radiograms: reduction status (3 parameters/4 points: contact accuracy of posteromedial cortex, severity of angulation, and distraction), fixation status (3 parameters/3 points: tip-apex distance, location of tip of the lag screw, entry point of the intramedullary nail), and fracture type (1 parameter/1 point: stable or unstable type by the Kyle's classification). Postoperative reduction loss and fixation failure were checked by radiograms taken at a minimum 3 months postoperative. RESULTS: Reduction loss and fixation failure were observed in 14 consecutive patients (17%). The fixation failure rate was 100% (2 patients) in score 1, 60% (3 out of the 5 patients) in score 2, 39% (3 out of the 8 patients) in score 3, and 50% (4 out of the 8 patients) in score 4 groups. There were fixation failures only in 1 out of 13 patients with score 5, and in 1 out of 18 patients with score 6. There was no fixation failure in 17 patients with score 7 and 11 patients with score 8. CONCLUSIONS: Maintenance of the fracture reduction by the stable fixation in the patient scores over 5 could be predicted by the postoperative radiograms.
Adult ; Aged ; Aged, 80 and over ; Bone Nails ; Early Ambulation ; Female ; Femur/surgery ; Fracture Fixation, Intramedullary ; Health Status Indicators ; Hip Fractures/classification/rehabilitation/*surgery ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Recovery of Function ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: The purpose of this study is to evaluate the role of cold knife conization in the diagnosis and management of cervical neoplasia. METHODS: Cold knife conization was performed in total 163 patients from January 1992 to December 2003. The results of PAP smear and colposcopy-directed biopsy were compared with the pathologic diagnosis of conization. And we evaluated the rate of positive margin and the presence of residual lesion. And then, we reviewed the pregnancy outcome after conization. RESULTS: The rate of agreement between PAP cytology and conization was 45.4%, and the rate of agreement between colposcopy-directed biopsy and conization was 65.6%. Hysterectomy was done in 102 patients (62.6%). The positive rate of resection margin was 19.6%. The incidence of residual lesion after conization was 31.2% in margin (+) and 1.4% in margin (-). We evaluated 7 cases of pregnancy after conization. CONCLUSION: Cervical conization as surgical treatment was effective in cervical neoplasia patients, especially young patients, with continuous follow-up.
Biopsy ; Conization* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Incidence ; Pregnancy ; Pregnancy Outcome

PURPOSE: The purpose of this study is to compare the rehabilitation effects between aquatic physiotherapy and land-based physiotherapy after total knee arthroplasty. PARTICIPANTS AND METHODS: The study was performed by patients with TKA caused by knee OA. The participants were divided into two groups based on random sampling method. One group received aquatic physiotherapy while the other received land-base physiotherapy. Each physiotherapy program lasted 40 minutes a day, 5 days a week, for 1 week starting a week after the operation. Pertinent indicators, knee extensor strength, knee flexor strength, walking speed, knee circumference, WOMAC index and Visual analogue scale were recorded before and after the physiotherapy programs, 1 week, 2weeks and 6 weeks after the operation. RESULTS: The aquatic physiotherapy group showed statistically significant improvements in knees circumference and VAS scores, compared to the land-based physiotherapy group between 1week and 2 weeks after the operation, whereas no statistical differences were found in Knee extensor strength, knee flexor strength, walking speed and WOMAC index. CONCLUSION: The aquatic physiotherapy group showed statistically significant improvements in knee circumference and VAS scores compared to the land-based physiotherapy group between 1 and 2 weeks after the operation. Further studies are required to confirm these findings. We were able to conclude that aquatic physiotherapy is an alternative rehabilitation program for patients with TKA.
Arthroplasty, Replacement, Knee ; Humans ; Knee ; Walking

PURPOSE: The purpose of this study is to compare the rehabilitation effects between aquatic physiotherapy and land-based physiotherapy after total knee arthroplasty. PARTICIPANTS AND METHODS: The study was performed by patients with TKA caused by knee OA. The participants were divided into two groups based on random sampling method. One group received aquatic physiotherapy while the other received land-base physiotherapy. Each physiotherapy program lasted 40 minutes a day, 5 days a week, for 1 week starting a week after the operation. Pertinent indicators, knee extensor strength, knee flexor strength, walking speed, knee circumference, WOMAC index and Visual analogue scale were recorded before and after the physiotherapy programs, 1 week, 2weeks and 6 weeks after the operation. RESULTS: The aquatic physiotherapy group showed statistically significant improvements in knees circumference and VAS scores, compared to the land-based physiotherapy group between 1week and 2 weeks after the operation, whereas no statistical differences were found in Knee extensor strength, knee flexor strength, walking speed and WOMAC index. CONCLUSION: The aquatic physiotherapy group showed statistically significant improvements in knee circumference and VAS scores compared to the land-based physiotherapy group between 1 and 2 weeks after the operation. Further studies are required to confirm these findings. We were able to conclude that aquatic physiotherapy is an alternative rehabilitation program for patients with TKA.
Arthroplasty, Replacement, Knee ; Humans ; Knee ; Walking

An 8-year-old boy presented with abdominal pain and poor oral intake for two months. Serum amylase and lipase levels were elevated. CT of the abdomen and chest X-ray showed two pseudocysts at the pancreatic uncinate process, pancreatitis with a parenchymal defect, a large amount of ascites, and a right pleural effusion. MR cholangiography and endoscopic retrograde cholangiopanreaticography revealed a pancreatic duct disruption. The patient was successfully treated with a chest tube placement and percutaneous drainage. After surgery, his general condition improved; the serum level of amylase normalized and the pleural effusion resolved. Pancreatic injuries are rare in pediatric blunt trauma; however, diagnostic difficulty is common with isolated blunt trauma. Therefore, a high index of suspicion should follow such an injury. We report the case of an 8-year-old boy with pancreas transection, ductal disruption, ascites, and pleural effusion who was successfully treated.
Abdomen ; Abdominal Pain ; Amylases ; Ascites ; Chest Tubes ; Child* ; Cholangiography ; Drainage ; Humans ; Lipase ; Male ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Pleural Effusion* ; Thorax

Primary ovarian pregnancy is rare form of ectopic pregnancy. It can be diagnosed if the only implantation occurs in the ovary. The clinical diagnosis of ovarian pregnancy is difficult. Owing to the availability of sensitive assays for human chorionic gonadotropin and the development of transvaginal ultrasonography, early diagnosis of an ectopic pregnancy has been made more feasible. But clinical and even intraoperative diagnosis of ovarian pregnancy is still difficult and only microscopic examination of tissue specimen can confirm the diagnosis. Misdiagnosis is common because it can be confused with a ruptured corpus luteum. Laparoscopic wedge resection is treatment of choice. The authors present a case of ovarian pregnancy with a brief review of the literatures.
Chorionic Gonadotropin ; Corpus Luteum ; Diagnosis ; Diagnostic Errors ; Early Diagnosis ; Female ; Ovary ; Pregnancy ; Pregnancy, Ectopic* ; Ultrasonography

Infantile hepatic hemangioma is benign vascular tumor and the most common liver tumor in infants. Small hepatic hemangioma is usually asymptomatic and seldom require therapy. Giant hepatic hemangioma, defined as more than 4 cm in diameter, is rare, but can lead to life-threatening complications such as consumptive coagulopathy, anemia, hemorrhage after tumor rupture and congestive heart failure due to arteriovenous shunting. Neonatal mortality rate is about 70-90%. The differential diagnosis of a fetal liver mass includes hemangioma, hepatoblastoma, and mesenchymal harmatoma. Although hepatic hemangioma represents the most common tumor of the liver in infant, the prenatal diagnosis of this condition has been rarely reported in the literature. we experienced a case of fetal hepatic hemangioma by prenatal sonography and report our case with a brief review of literature.
Anemia ; Diagnosis* ; Diagnosis, Differential ; Heart Failure ; Hemangioma* ; Hemorrhage ; Hepatoblastoma ; Humans ; Infant ; Infant Mortality ; Liver ; Prenatal Diagnosis ; Rupture ; Ultrasonography*

BACKGROUND: Increasing age and loss of teeth weaken oral muscle strength. This study aimed to investigate the positive effects of orofacial myofunctional training on elderly people.METHODS: Thirty six elderly individuals in a welfare center and a senior citizen center were included in this study. A survey regarding lip and tongue strength suvsequent to orofacial myofunctional training and oral health-related quality of life was conducted from April to June, 2019. Data were analyzed using PASW statistics ver. 18.0.RESULTS: The experimental group, showed an increase in lip strength (from 9.79 to 10.31) and tongue strength (from 41.26 to 43.97) after orofacial myofunctional training. The perception of oral health-relatedquality of life was enhanced (from 2.26 to 2.07). In particular, the frequency of dry cough for food removal while swallowing decresed due to an incresed in the secretion of saliva (p<0.05). Correlation analysis showed that the number of functional teeth was positively related to oral health-related quality of life.CONCLUSION: Orofacial myofunctional training for improving lip and tongue strength is effective in the elderly. In older societies, oral strength should be maintained to improve oral health-related quality of life. It also suggests the interest of oral health workers and applying orofacial myofunctional training programs.
Aged ; Cough ; Deglutition ; Education ; Humans ; Lip ; Muscle Strength ; Myofunctional Therapy ; Oral Health ; Quality of Life ; Saliva ; Tongue ; Tooth