To evaluate the effect of Morphine during spinal anesthesia with alpha-adrenergic agonist, we used 0.18 mg of epinephrine, 90 ug of clonidine and 0.3 mg of morphine with 12 mg of T-cain respectively and compared hemodynamic and analgesic effects of each drug. Eighty patients were divided into four groups as follows; Group I (n=20); T-cain with clonidine, Group II (n=20); T-cain with epinephrine, Group III (n=20); T-cain with clonidine and morphine, and Group IV (n=20); T-cain with epinephrine and morphine. The results were as follows; 1) The onset time of analgesia and the time reached to the highest level of sensory loss were most rapid in the epinephrine and morphine group. 2) The duration of analgesia was significantly prolonged in the group of epinephrine and morphine than the group of epinephrine and clonidine. 3) It was more likely complicated in the morphine groups than others but there was no significance. 4) Although the heart rate was gradually decreased over 60 min. after anesthesia, there was no significance between the groups. 5) Systolic and diastolic blood pressure were decreased mainly over 30~45 min. after anesthesia, but there was no significance. In conclusion, epinephrine can be sustituted for clonidine because analgesic duration was not significantly changed, and the duration of analgesia was prolonged by morphine.
Adrenergic alpha-Agonists ; Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Blood Pressure ; Clonidine* ; Epinephrine* ; Heart Rate ; Hemodynamics ; Humans ; Morphine*

The current patient management system has several limitations. To develop the critical pathway (CP) as a cost-effective method via continuous patient management, we investigated the medical records of 77 patients who underwent FP chemotherapy in Seoul National University Hospital from Feb, 1 to 28, 1999. And the pilot study was done to 12 patients admitted to undergo the FP chemotherapy. 1. The vertical contents in the CP consisted of 7 items; assessment, activity, diet, IV therapy, medication, education and evaluation. The duration of the horizontal axis was 6 days from admission to discharge. 2. The medical performance according to the vertical axis in the preliminary CP, consisted of 72 , and modified to 74 items in the final form of CP. 3. The nursing record consisted of a vertical axis of 4 items; assessment, IV therapy, medication and education. The duration of the horizontal axis was 6 days from admission to discharge of hospital days.
Axis, Cervical Vertebra ; Critical Pathways* ; Diet ; Drug Therapy* ; Education ; Humans ; Medical Records ; Nursing Records* ; Nursing* ; Pilot Projects ; Seoul

PURPOSE: This study was conducted to compare the clinical features and outcome of neonatal gastrointestinal perforation due to necrotizing enterocolitis (NEC) and other etiologic diseases (non-NEC). METHODS: The medical records of neonates, admitted to the neonatal intensive care unit of Dongsan Medical Center for gastrointestinal perforation between January 1999 and December 2009, were reviewed retrospectively. The admission records for clinical findings and mortality were reviewed and statistically analyzed for both groups. RESULTS: Among 28 neonates, NEC group was 35.7% and the other group (intestinal atresia, malrotation, meconium peritonitis, etc) was 64.3%. The mean gestational age was significantly shorter (32.8+/-4.6 weeks vs. 36.8+/-2.7 weeks, P=0.028) and the mean diagnostic day was significantly later (16.3+/-9.7 days vs. 2.2+/-1.8 days, P=0.001) in the NEC group than that of the non-NEC group. The mortality rate was markedly higher in the NEC group (50%) than that of the non-NEC group (5.6%)(P=0.013). By simple logistic regression analysis, gestational age (OR 0.69, 95% CI: 0.51-0.95, P=0.022) and NEC (OR 17.00, 95% CI: 1.60-181.36, P=0.019) were the significant risk factors to increase the mortality rate. Multiple logistic regression analysis showed NEC (OR 7.70, 95% CI: 0.55-108.06, P=0.130) and gestational age (OR 0.79, 95% CI: 0.58-1.09, P=0.151) were not the significant independent risk factors. CONCLUSIONS: This study found that gestational age was shorter and mortality rate was higher in the NEC group than the non-NEC group. However, after multiple logistic regression analysis, NEC or lower gestational age itself did not increase the mortality rate significantly.
Enterocolitis, Necrotizing ; Gestational Age ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Logistic Models ; Meconium ; Medical Records ; Peritonitis ; Retrospective Studies ; Risk Factors

OBJECTIVE: To understand the difference of defecation physiology between postpartum and postoperative women. METHODS: Between July 1998 to April 1999, we performed defecogram and pudendal nerve motor latency to 31 women, who were 8 postoperative women, 9 post cesarean-section state women, and 14 normal vaginal delivery-state women. RESULTS: According to the defecogram results, only squeezing angles of the anorectal angle were significantly increased(96.0 vs 72.3, 74.9 degree) in normal vaginal delivery-state women compared to post cesarean-section state and postoperative women, but rest and evacuation angles were not. And to pudendal nerve latency, there were no statistically significant difference. CONCLUSION: We concluded that the pudendal plexus was damaged during labor, therefore its ability to control puborectalis muscle was damaged. So, the anorectal angles of squeezing of postpartum women were significantly increased, compared to those of post cesarean section women or postoperative women.
Cesarean Section ; Defecation* ; Female ; Humans ; Physiology* ; Postpartum Period* ; Pregnancy ; Pudendal Nerve*

PURPOSE: This study was undertaken to investigate the spectrum and the prognosis of neonate with cardiovascular malformation delivered from diabetic mothers. METHODS: From January 2004 to December 2008, 70 neonates born to diabetic mothers who were delivered at Dongsan Medical Center, Keimyung University, and received echocardiographic study between 3rd and 14th days of life to identify the presence of cardiac anomaly were included. Cases combined with chromosomal anomaly were excluded. And follow up results (rate of cardiac operation and mortality) were assessed. RESULTS: Among 67 neonates, 22 cases (32.8%) had combined cardiovascular malformation. They were interventricular septal hypertrophy (10 cases), atrial septal defect (7 cases), significant patent ductus arteriosus (5 cases), ventricular septal defect (2 cases) and tetralogy of Fallot (1 case). Among them, 20 neonates (29.9%) were preterm babies, and 21 neonates (31.3%) were large babies. On follow up echocardiograpic examination between 2 and 12 months of life, all but 2 infants (received cardiac operation due to VSD or Tetralogy of Fallot) was improved spontaneously. And combined extracardiac anomalies were tracheoesophageal fistula (2 cases), imperforated anus (1 case) and corpus callosum agenesis (1 case). Only one preterm baby was dead due to necrotizing enterocolitis, but did not have cardiac disease. CONCLUSION: Pre-existing maternal diabetes was associated with the development of neonatal cardiac anomalies, but the prognosis was good in this study.
Agenesis of Corpus Callosum ; Anal Canal ; Ductus Arteriosus, Patent ; Echocardiography ; Enterocolitis, Necrotizing ; Follow-Up Studies ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Hypertrophy ; Infant ; Infant, Newborn ; Mothers ; Prognosis ; Tetralogy of Fallot ; Tracheoesophageal Fistula

We describe here our experience with a neonate presenting with cyanosis, grunting, and cardiome galy, who was diagnosed with isolated left ventricular noncompaction (IVNC) by echocardiography. The patient had high levels of N-terminal pro-B-type natriuretic peptide (NT pro-BNP) and symptoms of heart failure including poor feeding and tachypnea. During the period in which NT pro-BNP levels steadily increased, the patient suffered sudden cardiac arrest despite heart failure management. Following cardiopulmonary resuscitation, cardiac arrest was resolved, NT pro-BNP levels decreased, and all symptoms showed improvement. We consider that assessment of NT pro-BNP with cardiac functional analysis using echocardiography could help in the prediction of disease progress in IVNC.
Brain ; Cardiopulmonary Resuscitation ; Cyanosis ; Death, Sudden, Cardiac ; Echocardiography ; Heart Arrest ; Heart Failure ; Humans ; Infant, Newborn ; Myocardium ; Tachypnea

Wegener's granulomatosis is a necrotizing and granulomatous vasculitis which involves upper and lower respiratory tract, kidney and skin. The patient who have the protracted Wegener's granulomatosis live a long peroid without major organ imvolvement, In mild cases, the progression is slow and may not need systemic cyclophosphamide treatment. Some cases, however, demonstrate renal involvement and may result in renal failure and death if adequate treatment is not provided. We experienced a case of protracted Wegener's granulomatosis that was a new concept and has not been reported !n Korea. The diagnosis was confirmed by clinical finding and histopathologic features of tiasue biopsy. This case represents a protracted Wegener's granulomatosis with paranasal sinusitis, rhinitis and skin purpura and progress to a gener alized form with kidney involvement after 6years. Treatment with oral cyclophosphamide, steroid and sulfamethoxazole-trimethoprime result improvement of skin, nasal symptom and labratory parameters.
Biopsy ; Cyclophosphamide ; Diagnosis ; Humans ; Kidney ; Korea ; Purpura ; Renal Insufficiency ; Respiratory System ; Rhinitis ; Sinusitis ; Skin ; Vasculitis ; Wegener Granulomatosis

OBJECTIVE: Our purpose was to determine whether abnormal triple marker in the second trimester may be associated with adverse pregnancy outcomes. METHODS: Between November 1996 and April 1998, we evaluated 1,158 pregnant women undergoing second trimester triple marker screening tests who delivered at our hospital. The pregnancy outcomes of 48 women with false positive screens were compared with 1,158 screen negative controls. The pregnancy outcomes were obtained from hospital delivery records. RESULTS: Women with abnormal triple marker showed increased risks for low birth weight(p<0.01). But there was no significant differences between study and control groups with respect to preterm labor, pregnancy induced hypertension, oligohydroamnios, premature rupture of membrane, placenta previa, abruptio placenta, fetal death in utero. CONCLUSION: Abnormal triple marker in the second trimester was associated with low birth weight.
Female ; Fetal Death ; Humans ; Hypertension, Pregnancy-Induced ; Infant, Low Birth Weight ; Infant, Newborn ; Mass Screening* ; Membranes ; Obstetric Labor, Premature ; Parturition ; Placenta ; Placenta Previa ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Pregnancy, High-Risk* ; Pregnant Women ; Rupture

Castleman's disease is a rare disorder of unknown etiology that results in the unregulated growth of lymphoid tissue. It can be classified as unicentric and multicentric based on clinical and radiological findings, and also as hyaline vascular and plasma cell type based on histopathology. Castleman's disease may present as an asymptomatic involvement of one lymph node group or as a multicentric disease with systemic features. However, renal involvement is very rare. Here we report a 50-year old male patient with histopathologically proven multicentric plasma cell type of Castleman's disease who presented with weight loss, palpable cervical lymphadenopathy, azotemia and proteinuria. The finding of a percutaneous needle renal biopsy was compatible with plasma cell type of Castleman's disease. After treated with systemic corticosteroid, azotemia and proteinuria disappeared.
Azotemia ; Biopsy ; Giant Lymph Node Hyperplasia* ; Humans ; Hyalin ; Kidney* ; Lymph Nodes ; Lymphatic Diseases ; Lymphoid Tissue ; Male ; Middle Aged ; Needles ; Plasma Cells ; Proteinuria ; Weight Loss

No Abstract Available.
Animals ; Base Sequence* ; Cattle* ; Serotyping*