BACKGROUND: One of the main disadvantages of caudal block is the long latent period before a satisfactory blockade is obtained. Many investigators have used various preparations of local anesthetic solutions to improve the speed of onset. This study was performed to evaluate the effectiveness of prewarming of lidocaine HCl for caudal block. METHODS: Fifty healthy young patients (ASA I) were allocated into two groups, A and B. In group A, the local anesthetic solution were injected at room temperature (25 degrees C), while in group B, they were injected at 37oC. All the caudal block were performed using 2% lidocaine HCl 20 ml with fentanyl 100ug and epinephrine 1:200,000. The onset time was defined as the period from completion of injection until the patient first noticed loss of sensation to pin-prick on perianal region. Assessment of sensory loss was made at 15 seconds interval. We have compared the onset of sensory blockade between groups. The duration of analgesia and any significant side effects were also recorded. RESULTS: The onset of sensory blockade was significantly faster in group B (3.5 +/- 0.5 minutes) than group A (6.2 +/- 0.9 minutes). The duration of analgesia were not significantly changed between groups. Side effects of urinary retention, pruritus and nausea were noted between both groups but the difference was not significant. CONCLUSIONS: We have found that the onset time was 44% faster with warm lidocaine-fentanyl mixture (37 degrees C) than with the room temperature (25 degrees C). The improved clinical usefulness was achieved with no increase in side effects. The technique is a safe and effective method to reduce the latency of onset.
Analgesia ; Epinephrine ; Fentanyl ; Humans ; Lidocaine ; Nausea ; Pruritus ; Research Personnel ; Sensation ; Urinary Retention

PURPOSE: The aim of this study is to evaluate the effectiveness and surgical morbidity of preoperative chemoradiotherapy for locally advanced rectal cancer. METHODS: Between December 1997 and March 2000, 36 patients with locally advanced rectal cancer (clinical stage II or III) were treated with preoperative chemoradiation: bolus i.v. leucovorin, 20 mg/m2, plus 24-h continuous infusion i.v. 5-Fluorouracil, 425 mg/m2, Days 1-5, 29-33 and concurrent radiotherapy 4,500 cGy over 5 weeks. Surgery was performed 4-8 weeks after completion of the chemoradiotherapy. RESULTS: Grade 3-4 toxicity during chemoradiotherapy was low: hematological toxicities 2.8%, gastro-intestinal toxicities 5.5% and skin toxicities 8.3%. Complete response rate was 16.7% and partial response rate was 47.2%, the rate of downstaging for tumor was 65.5%. The overall rate of resectability was 94.1%. In 13 of 22 (59.1%) patients planned APR, the sphincter was preserved. The overall rate of surgical morbidity was 23.5%, but there was no postoperative mortality. One patient needed a reoperation because a complication may be associated with preoperative chemoradiotherapy. CONCLUSIONS: Preoperative chemoradiotherapy for locally advanced rectal cancer seems to afford some potential advantages: patients are able to tolerate higher chemotherapy doses with low toxicities; tumor downstaging and resectability rates are high; sphincter preservation is feasible; But perioperative morbidity has generally tolerable complications. And so we recommend the preoperative chemoradiotherapy may be one of the best treatments for locally advanced rectal cancer.
Chemoradiotherapy* ; Drug Therapy ; Fluorouracil ; Humans ; Leucovorin ; Mortality ; Radiotherapy ; Rectal Neoplasms* ; Reoperation ; Skin

No abstract available.
Endometriosis* ; Female ; Pregnancy*

PURPOSE: A prospective randomized controlled trial was performed to investigate the effects of intravenous hydration, both with and without diuretics, on the fragmentation and passage of an upper ureteral stone during ESWL. MATERIALS AND METHODS: We analyzed 65 patients with upper ureteral stones, primarily treated with piezoelectric LT-02 lithotripter, between November, 2001 and March, 2002. The patients were divided in 3 groups; the 20 patients in group A were injected with 500ml of normal saline for intravenous hydration, and 20mg of furosemide for diuretic effect during the ESWL; the 20 patients in group B were injected with normal saline without furosemide, and the remaining 25, group C, were used as controls. The same energy settings for the shockwaves in one session were equally applied to all the patients during the ESWL, with a 4Hz shockwave frequency, 100% power, a 50 minute treatment and 43 minute storage time. After 2 weeks, the degrees of stone fragmentation, and the residual fragments, were evaluated on the post-ESWL KUB and compared with the pre-ESWL KUB. RESULTS: After a single ESWL treatment, the stone-free rate was 70% (14 of 20 patients) in group A, 60% (12 of 20 patients) in group B and 28% (7 of 25 patients) in group C (p<0.05). The stone-free rates of groups A and B were significantly higher than that of group C, but there was no statistical difference between groups A and B. The stone-free rates, after a single session, according to the stone size was higher in groups A (77.8%) and B (73.3%) than in group C (38.9%) for stones smaller than 10mm (p<0.05), but they were similar between the three groups for stones larger than 10mm (p>0.05). CONCLUSIONS: Intravenous hydration with normal saline, both with and without a furosemide injection for diuretic effect, during ESWL would be an effective method to facilitate the fragmentation and passage of upper ureteral stones smaller than 10mm.
Diuretics* ; Furosemide ; Humans ; Lithotripsy* ; Prospective Studies ; Shock* ; Ureter* ; Ureteral Calculi

Stomach carcinoma is more common disease in korea than western contries. The reported ultrasonographicfindings of gastric carcinoma were thickening of gastric wall and “pseudokidney” sign. The auther analizedultrasonographic findings of 101 cases with gastric carcinoma who were performed ultrasonography and gastroscopyat Kyung Hee Universtiy Hospital from Oct. 1982 to Oct. 1985. The results were as followings; 1. Types of gastriccarcinoma were consisted with infiltrative type 68 cases, infiltrative type with ulceration 16 cases, polypoidtype with ulceration 1 cases, infiltrative and polypoid type 4 cases, linities plastica type 3 cases, lcerativetype 1 case and polypoid type 1 case. 2. Extent of the lesions were in body and antrum 45 cases, entire stomach 18cases, antrum 18 cases, body 12 cases, body and fundus 6 cases. 3. Ultrasonography was useful in demonstrating theextent of the tumor and the presence of materials elsewhere in abdoment.
Korea ; Stomach ; Ulcer ; Ultrasonography

PURPOSE: To report the first case of lattice corneal dystrophy, gelsolin type in Korea. CASE SUMMARY: A 61-year-old man visited our clinic with severe dry eye symptom in both eyes. Clinical examination revealed in both eyes a visual acuity of 0.7 without correction and intraocular pressure of 18 mm Hg. On slit-lamp examination, both corneas had scattered lattice lines at various depths within the stroma with punctate epithelial erosions. The patient had characteristic features of Meretoja syndrome, including cranial neuropathy characterized by dermatochalasis and facial weakness, and was positive for the gelsolin mutation according to DNA analysis. This is the first description of a patient with lattice corneal dystrophy, gelsolin type in Korea. CONCLUSIONS: This is the first description of a patient with lattice corneal dystrophy, gelsolin type in Korea and demonstrates the importance of recognizing the systemic and ophthalmic features for appropriate management of the condition.
Amyloidosis ; Cornea ; Corneal Dystrophies, Hereditary ; Cranial Nerve Diseases ; DNA ; Eye ; Gelsolin ; Humans ; Intraocular Pressure ; Korea ; Visual Acuity

OBJECTIVE: It is known that risperidone induces weight gain moderately which has been previously considered of little clinical concern. And there was no specific effective treatment for atypical antipsychotics-induced weight gain. The study was performed to evaluate the effectiveness of topiramate as an weight-reducing medicine for schizophrenia patients with risperidone-induced weight gain. METHODS: Topiramate, 100-200 mg/day, was administered to 12 schizophrenia patients with risperidone-induced weight gain. Body weight and body mass index (BMI) were measured at baseline, 4-week and 8-week. Brief Psychatric Rating Scale (BPRS) and Positive And Negative Syndrome Scale (PANSS) were used to evaluate psychotic symptoms. RESULTS: Body weight and BMI were decreased significantly at 4-week and 8-week treatment compared to baseline (weight loss: 1.17+/-1.80 kg and 2.50+/-2.24 kg; BMI: -0.41+/-0.65 kg/m2 and -0.88+/-0.82 kg/m2 on 4-week and 8-week). Psychiatric symptoms were improved significantly in BPRS and PANSS. Adverse effects were showed such as fatigue, paresthesia, difficulty in concentration and diarrhea, which were mild and self-limited. CONCLUSION: It is suggested that topiramate have significant effects on patients with risperidone-induced weight gain. Randomized controlled study would be necessary in the near future.
Body Mass Index ; Body Weight ; Diarrhea ; Fatigue ; Humans ; Paresthesia ; Pilot Projects* ; Risperidone ; Schizophrenia ; Weight Gain*

Autoimmune polyglandular syndrome (APGS) is characterized by the association of two or more endocrine disorders that are mediated by autoimmune mechanism. We herein report a case of alopecia areata associated with APGS type III. This particular case involved autoimmune Hashimoto thyroiditis, systemic lupus erythematosus (SLE), and vitiligo, and so met the criteria of APGS type III.
Alopecia Areata* ; Alopecia* ; Hashimoto Disease ; Lupus Erythematosus, Systemic ; Polyendocrinopathies, Autoimmune* ; Vitiligo

PURPOSE: To evaluate the factors affecting intervertebral foramen stenosis and nerve root compression in spondylolytic spondylolisthesis. MATERIALS AND METHODS: We investigated 120 intervertebral foramina of 60 patients with spondylolytic spondy-lolisthesis who had undergone lumbar MRI. A retrospective review of their MR images revealed the degree of intervertebral foramen stenosis and causes of nerve root compression. The relationship between disk height diminution following spondylolysis and degree of intervertebral foramen stenosis was also evaluated. RESULTS: Forty eight of 60 patients showed a similar degree of intervertebral foramen stenosis, and in 12 patients the degree of stenosis was different. In 110 intervertebral foramina, stenosis of both the superior and inferior compartments of intervertebral foramina was demonstrated. In 37 of 120 cases (30.8 %), stenosis was mild; in 44 of 120 (36.7 %) it was modcrate, and in 29 of 120 (24.2%) it was severe. Stenosis of the inferior compartment was demonstrated in ten of 120 intervertebral foramina (8.3 %). Nerve root compression was caused by posterior bulging of the intervertebral disk (65/120), descent of the pedicle (51/120), an isthmic bony segment above the site of spondylolysis (44/120), a bony spur formed at a spondylolytic site (11/120), and fibrocar-tilaginous callus at a spondylolytic site (5/48). In all cases there was degenerative change of the intervertebral disk at the affected level. There was no relationship between degree of disk height diminution and degree of intervertebral foramen stenosis (p>0.05). CONCLUSION: The degree of intervertebral foramen stenosis and causes of nerve root compression in spondy-lolytic spondylolisthesis are variable, and MRI demonstrates them precisely. There was no positive relationship between degree of nerve root compression at an intervertebral foramen and degree of spondylolysis and degeneration of an intervertebral foramen. The degree of nerve root compression is believed to be another criterion for describing spondylolytic spondylolisthesis.
Bony Callus ; Constriction, Pathologic ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging* ; Radiculopathy* ; Retrospective Studies ; Spine ; Spondylolisthesis* ; Spondylolysis

BACKGROUND: A large amount of blood is lost during spinal fusion surgery; therefore, a blood transfusion is required. In this study, we analyzed the amount of transfusion and hemodynamic changes in relation to the count of fusion segments in lumbosacral spinal surgeries. METHODS: We analyzed 67 patients who had undergone lumbosacral fusion. They were divided into five groups according to the levels of fusion segments (one level: Group 1, two levels: Group 2, three levels: Group 3, four levels: Group 4 and above three levels: Groups 3+4). Total amounts of transfusion and perioperative hemodynamic changes were compared among each group. RESULTS: Of the total 67 cases, 40 cases were Group 1, 19 cases were Group 2, five cases were Group 3, three cases were Group 4, and eight cases were Groups 3+4. Average volume of Red Blood Cell (RBC) transfusion per operation was 703+/-463 mL (Group 1), 934+/-372 mL (Group 2), 1,677+/-847 mL (Group 3), 1,231+/-412 mL (Group 4), and 1,509+/-669 mL (Group 3+4); and average volume of fresh frozen plasma (FFP) per operation was 55+/-141 mL (Group 1), 108+/-181 mL (Group 2), 306+/-368 mL (Group 3), 567+/-260 mL (Group 4), and 404+/-317 mL (Groups 3+4). Eight patients received transfusion of Platelet Concentrate (PC); each patient received 10 units (400 mL). The preoperative mean level of hemoglobin and platelet was 13.62+/-1.47 g/dL and 245+/-60x10(3)/microliter, postoperatively, 10.26+/-1.14 g/dL and 150+/-46x10(3)/microliter. CONCLUSION: As the fusion segments increase, the need for transfusion of RBC, FFP, and PC increases. Application of the Maximum Surgical Blood Order Schedule (MSBOS) system is required in the planning of spinal fusion, especially in multiple segments.
Appointments and Schedules ; Blood Platelets ; Blood Transfusion ; Erythrocytes ; Hemodynamics ; Hemoglobins ; Humans ; Lumbosacral Region ; Plasma ; Spinal Fusion