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

No abstract available.
Cardiomyopathy, Dilated* ; Doxorubicin

PURPOSE: To compare the improvement rates of distance visual acuity (VA) with that of near VA in amblyopic eyes of children with unilateral amblyopia. METHODS: The medical records of children with unilateral amblyopia successfully treated with patching were reviewed. During subsequent visits for amblyopia treatment, subjects had best-corrected VA measured at 4 meters and 1/3 meters every 2 months. Duration of treatment to achieve equal VA between both eyes and improvement rates were compared between distance and near, and analyzed according to the cause and severity of amblyopia, or age. RESULTS: A total of 76 children with amblyopia due to anisometropia and/or strabismus started amblyopia treatment at a mean age of 5.8 years and were followed up during a mean period of 16.4 months. Baseline VA was better at near than at distance in 52 children (68.4%), and better at distance than at near in 4 (5.3%). The mean duration of treatment was 5.4 months at distance and 3.9 months at near. However, the improvement rate considering the amount of improvement of VA was faster at distance; 0.11 log MAR/month at distance, and 0.08 log MAR/month at near (p = 0.016). The improvement rate differences between distance and near did not differ based on the cause of amblyopia, or age, whereas in mild amblyopia the improvement rate of distance VA was significantly faster than near. Additionally, children with better initial near VA tended to have a faster improvement rate of distance VA. CONCLUSIONS: Although baseline VA was better at near than at distance in more patients, the improvement rate was faster at distance than at near. Children with better initial near VA appeared to have a faster improvement rate of distance VA.
Amblyopia* ; Anisometropia ; Child* ; Humans ; Medical Records ; Strabismus ; Visual Acuity*

We report a 57-year-old man with bilateral cranial nerve IX and X palsies who presented with severe dysphagia. After a mild head injury, the patient complained of difficult swallowing. Physical examination revealed normal tongue motion and no uvular deviation. Cervical X-ray findings were negative, but a brain computed tomography revealed a skull fracture involving bilateral jugular foramen. Laryngoscopy indicated bilateral vocal cord palsy. In a videofluoroscopic swallowing study, food residue remained in the vallecula and pyriform sinus, and there was reduced motion of the pharynx and larynx. Electromyography confirmed bilateral superior and recurrent laryngeal neuropathy.
Brain ; Brain Injuries* ; Cranial Nerve Diseases ; Craniocerebral Trauma ; Deglutition ; Deglutition Disorders ; Electromyography ; Glossopharyngeal Nerve ; Humans ; Laryngoscopy ; Larynx ; Middle Aged ; Paralysis* ; Pharynx ; Physical Examination ; Pyriform Sinus ; Skull Fracture, Basilar ; Skull Fractures ; Tongue ; Vocal Cord Paralysis

PURPOSE: Androgen plays an important role during penile development and is essential for libido in the male, but its role in the regulation and maintenance of the erectile response has been controversial. We investigated the effect of castration and androgen replacement on penile erection in the adult rat. MATERIALS AND METHODS: Adult male Spargue-Dawley rats were divided into three groups: control, castration, and androgen replacement after castration. Androgen (testosterone, DHT) was administrated for 7 days at week 1, 2, 3, and 4 after castration. The intracavernosal pressure was recorded after submitting the rats to cavernous nerve stimulation. The percentages of cells in the penis expressing Ki-67 (proliferative index) and of apoptotic cells, assessed by morphologic analysis (apoptotic index), were analyzed. Nitric oxide synthase (NOS) activity was measured by the arginine-citrulline conversion ratio, and expression of nNOS and eNOS was determined by Western blot analysis. RESULT: After castration, a significant increase was noted in the apoptotic index, with a decrease in the expression of nNOS and eNOS. Replacement of androgen increased the proliferative index and the expression of cavernous nerve stimulation; NOS activity and erectile function were restored with androgen replacement. CONCLUSIONS: These results suggested that the penile tissue and NOS activity of the adult rat are affected by the androgen milieu and androgen such as testosterone and DHT play a direct role in the erectile function at the level of the erectile tissue.
Adult* ; Animals ; Apoptosis ; Blotting, Western ; Castration ; Humans ; Libido ; Male ; Nitric Oxide ; Nitric Oxide Synthase ; Penile Erection ; Penis* ; Rats* ; Testosterone

PURPOSE: This study was to explore subjectivity on childbearing in high school students. METHODS: A Q-methodology which provides a method of analyzing the subjectivity of each type was used. Forty-three high school students classified 40 selected Q-statements into 9 points standard. The obtained data were analyzed by using the pc-QUANL program. RESULTS: High school students' subjectivity on childbearing were analyzed into two types: Type 1 turned out to be 'FOLS (family oriented life style)' and Type 2 'CINK (couple important no kid)'. CONCLUSION: In order to resolve such problems as low birth rate and the advanced age of the population, effective youth and adult programs, policy and institution are required. The current demographic, economic and other factors such as personal values and policies may lower birth rate. In particular, youths' need for children and birth rate tend to be lower. There are positive and negative patterns in high school students' subjectivity on childbearing. Thus, national and social efforts are needed to change negative factors into positive ones. In order to maintain positive subjectivity on childbearing in high school students, it is necessary to apply family-centered educational programs and to implement birth-friendly and realistic programs for promoting child birth.
Adolescent ; Adult ; Birth Rate ; Child ; Humans ; Parturition

PURPOSE: To evaluate the efficacy of intravenous methylprednisolone pulse therapy in patients with idiopathic orbital inflammation. METHODS: Fifty-two patients who received three-day pulse methylprednisolone for acute severe swelling, loss of visual acuity, limitation of eye movement, diplopia, or pain were included in the present study. The lesions were divided into five subtypes using computed tomography or magnetic resonance imaging; anterior, lacrimal, myositic, diffuse and apical. A case diagnosed as sclerotic type was excluded. The response rate, recurrence rate and cure rate were assessed. RESULTS: The total response rate to intravenous methylprednisolone from all groups was 84.6%, with 100% in the anterior subtype and 71.4% in the diffuse subtype. During the mean follow-up period of 10.5 months, 15.9% of patients experienced a recurrence after a mean of 5.7 months. Overall, the cure rate was 71.2%. Recurrence was more common in the younger patients, and three of the seven patients with recurrence had myositic inflammation. CONCLUSIONS: Intravenous methylprednisolone was effective in patients with severe idiopathic orbital inflammation. However, combining other treatment modalities in patients with diffuse or myositic subtypes and in younger patients who show relatively low response or high recurrence is recommended.
Diplopia ; Eye Movements ; Follow-Up Studies ; Humans ; Inflammation ; Magnetic Resonance Spectroscopy ; Methylprednisolone ; Orbit ; Recurrence ; Visual Acuity

No abstract available.
Head* ; Humans ; Leukoencephalopathy, Progressive Multifocal* ; Lymphoma, T-Cell* ; Neck*

No abstract available.
Chylothorax*

no abstract available.