Morphine administered via the intrathecal or epidural route can produce long-lasting analgesic effect for acute and chronic pain. Unfortunately, little was known about the action of opioid drugs on the peripheral nerve system. The author administered morphine and local anesthetic when performing brachial plexus block in 64 selected cases and observed the effects of morphine on postoperative pain relief and the duration time of the local anesthetic. The following results were obtained. 1) Morphine 10mg administered in the brachial plexus block produced no significant increase in the duration of the block and no significant effect on postoperative pain relief. 2) Morphine 10mg administered in the brachial plexus block produced systemic side effects.
Brachial Plexus* ; Bupivacaine* ; Chronic Pain ; Morphine* ; Pain, Postoperative ; Peripheral Nerves

No abstract available.
Chondrosarcoma* ; Sternum*

No abstract available.
Aneurysm*

It is rare to meet an uncontrolled hyperthyroid patient in elective surgery. But, in emergency surgery, recognition of hyperthyroidism may be difficult, as trauma or pain may mask hyperthyroidism. The patient may be unaware of its existence or incapable of transmitting the information. During or after surgery, untreated hyperthyroidism can cause thyrotoxic crisis (thyroid storm), which may be a highly fatal complication. Thyrotoxic crisis is an extreme accentuation of signs and symptoms of throtoxicosis. Clinical manifestations are sinus tachycardia or atrial fibrillation, marked increase in systolic pressure and pulse pressure, high temperature, profuse sweating, tremor, dehydration, tachypnea, extreme restlessness and agitation, delirium, and frank psychosis. In this case, atrial fibrillation and hypertension developed after induction, and severe thyrotoxic symptoms appeared after emergence, which were caused by undetected hyperthyroidism.
Anesthesia* ; Atrial Fibrillation ; Blood Pressure ; Dehydration ; Delirium ; Dihydroergotamine ; Emergencies ; Humans ; Hypertension ; Hyperthyroidism ; Masks ; Psychomotor Agitation ; Psychotic Disorders ; Sweat ; Sweating ; Tachycardia, Sinus ; Tachypnea ; Thyroid Crisis ; Tremor

No abstract available.
Aged* ; Humans

PURPOSE: To investigate the timing of colostomy closure and the associated risk factors that affect the development of complication after colostomy closure. METHODS: We have reviewed and analyzed the results of 28 patients with colostomy closure at the Kwangju Christian Hospital from January 1993 to December 1997. We investigated to associated literatures on this subject for timing of colostomy closure, preparing a patient for colostomy closure, suture technique, wound management, underlying disease process related to the incidence of complication and experience of surgeons. RESULT: Wound infection developed in 4 patients (14.4%). Anastomotic leakage occurred in one patient (3.6%). Small bowel obstruction developed in two patients (7.2%). Overall incidence of complication was 25%. The incidence of complications in patients with trauma who underwent colostomy was 44.4% and patients without trauma, 15.8%. Complication rate was 16.6% for loop colostomies and 40% for end colostomies. The morbidity was 40% for colostomies on the left side, 18.7% for transverse colostomies, and 0% for colostomies (2 ileostomies) on the right side. The morbidity rate for closures within 6 weeks for the initial operation was 50%; for those within 6 to 12 weeks, 8.3%; and for those after 12 weeks, 16.6%. CONCLUSION: The optimal timing of closure varies from patient to patient, but closure within 6 weeks of the initial operation significantly increased the morbidity. Colostomies on the left side are associated with a higher morbidity rate than transverse colostomies or colostomies on the right side.
Anastomotic Leak ; Colostomy* ; Gwangju ; Humans ; Incidence ; Risk Factors ; Suture Techniques ; Wound Infection ; Wounds and Injuries

No abstract available.
Extremities* ; Liposarcoma*

PURPOSE: The aim of this retrospective study was to evaluate the risk of local recurrence such as patients who were treated for Dukes stage B and C low rectal cancer by abdominoperineal resection (APR) or low anterior resection (LAR). METHODS: From 1985 to 1995, 81 patients with low rectal cancers which were within 3~8 cm from the anal verge were treated by curative resection, 38 by APR and 43 by LAR. The present study examined clinical and tumor characteristics, type of intervention as potential predictors of local recurrence. Retrospective data were analysed by univariate Chi-square tests. RESULTS: Local recurrence was diagnosed in 17 of 81 patients with a median follow-up period of 24 months. The local recurrence rate was 23.6% (9 of 38) after APR and 18.6% (8 of 43) after LAR. There was no difference in local recurrence between patients who had APR and LAR (P=0.58). Also we could not find any significant differences among age (< or =65 vs >65 years, P=0.53), sex (M vs F, P=0.57), sized of tumors (< or =5 vs >5 cm, P=0.32), distance from anal verge (< or =5 vs >5 cm, P=0.57), Dukes stage (B vs C, P=0.22), histological grade (well and moderate vs poorly, P=0.17), distance from distal resection margin (< or =2 vs >2 cm, P=0.35). CONCLUSIONS: The tumor factors such as Dukes' stage were more critical for pelvic recurrences than other patient factors.
Follow-Up Studies ; Humans ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies

We report a case of fungal melanonychia caused by Trichophyton (T.) rubrum in a 69-year-old female patient. She had brownish to black pigmentation affecting all toe nails that clinically simulated melanonychia. Mycologic examination of toe nails revealed T. rubrum. The causes of melanonychia are numerous, but fungal origin is rare. Although T. rubrum is known to be one of the frequently isolated organisms of fungal melanonychia, there have been no reports of T. rubrum-induced melanonychia yet in Korea.
Aged ; Female ; Humans ; Korea ; Pigmentation ; Toes ; Trichophyton*

The prognosis of ovarian cancer remains poor, and there is a need to identifiy patients who are less likely to respond to treatment, in the hope that the identification of these patients with a poorer prognosis may allow the administration of more intensive or different treatment. But, most clinical and pathological factors were considered to lack satisfactory predictive power. Recently, essential role of protease in tumor cell invasion and metastasis have been elucidated in tumor biology. Urokinase-type plasminogen activator (uPA) and its inhibitor, plasminogen activator inhibitor-1 (PAI-1), play a key role in tumor-associated proteolysis. Thus, the presence of both uPA and PAI-1 modulates the invasive and metastatic phenotype of cancer cells. Genetically, nm23 protein from chromosome 17q may act independently as a metastasis suppressor. The purpose of this study was to determine the relative predictive power of some of those prognostic variables such as uPA, PAI-1 and nm23 protein in a selected group of patients of ovarian cancer. Immunohistochemical staining was used to determine the overexpression of uPA, PAI-1 and nm23 protein. Specimens were rated positive and negative. Then, scored '1' in case of positive for uPA, PAI-1, and negative for nm23, and '0' in case of negative for uPA, PAI-1, and positive for nm23, respectively. The sum of scores were divided into three groups (I, II and III groups), and compared with clinico-pathologic parameters, clinical response, lymph node metastasis, recurrence and 5-year survival rate, retrospectively. In univariate analysis, the positive rate of uPA was 36% (29/80), that of PAI-1 was 35% (28/80), and the negative rate of nm23 was 43% (34/80). The overexpression of uPA was higher in the low-grade tumor (p=0.0053), the overexpression of PAI-1 was positively correlated with the advanced stage of tumor (p=0.0001), more malignant histologic type (serous) of tumor (p=0.0013) and larger residual tumor mass (>2 cm)(p=0.0480). The overexpression of nm23 protein was negatively correlated with advanced stage of tumor (p=0.0068) and low-grade tumor (p=0.011). In scoring system, the number of patients with first group (I: score 0) was 24, II group (score: 1~2) was 49, and III group (score: 3) was 7. The mean age of patients was 46.4 years and mean follow-up time was 59 months. The rate of lymph node metastasis were 16.7%, 37%, and 75% respectively(p=0.0632). With increasing score in each group, the less clinical response rate was found (75% vs 71% vs 29%, p=0.0532). The 5-year survival rate of each group were 70% in I group, 65% in II group, and 14% in III group(p=0.0096). In conclusion, the scoring system using immunohistochemical staining with rating of overexpression uPA, PAI-1 and nm23 protein may be useful as an important and powerful predictive prognostic indicator in patients with epithelial ovarian cancer.
Biology ; Follow-Up Studies ; Hope ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm, Residual ; Ovarian Neoplasms* ; Phenotype ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators* ; Plasminogen* ; Prognosis ; Proteolysis ; Recurrence ; Retrospective Studies ; Survival Rate ; Urokinase-Type Plasminogen Activator