In recent years there has been an increase in the number of outpatient surgical procedures performed using local anesthesia with intravenous sedation. However, many patients are reluctant to undergo surgery because of their concerns about pain and pain-awareness during the operation. We performed a study to evaluate the effectiveness and safety of midazolam during outpatient surgical procedures. Between March 1997 and December 1998, 50 patients were anesthetized with bolus intravenous injection of 0.1mg/kg of midazolam, followed by local anesthesia. The blood pressure, pulse and oximeter values were monitored. There was no significant change of arterial oxygen saturation. Midazolam induced antegrade amnesia in most cases. All patients except three (94%) said they would willingly choose this anesthetic technique again. Major complications were not noted. We concluded that midazolam is a good sedative agent in providing favorable antegrade amnesia, as well as reduced anxiety and fear of pain during surgical procedures. This suggests that midazolam may be used routinely in outpatient surgical procedures. Monitoring of oxygen saturation, however is essential in preventing severe hypoxia during procedures.
Amnesia ; Anesthesia, Local* ; Anoxia ; Anxiety ; Blood Pressure ; Humans ; Injections, Intravenous ; Methods ; Midazolam* ; Outpatients ; Oxygen

Recently, the proportion of extrapulmonary tuberculosis in patients has increased in Korea. Though intestinal tuberculosis in not infrequent, a duodenal fistula caused by tuberculosis is a rare condition. A 29-year-old man was admitted to the Department of Internal Medicine because of fever and weight loss. The patient was a doctor participating in a resident fellowship. The patient was diagnosed with intra-abdominal tuberculous lymphadenopathy and was given anti-tuberculous medication. One month after the administration of medication, the patient showed symptoms and signs of duodenal obstruction because of marked duodenal wall edema and a deep ulcer on the second portion of the duodenum. A computerized tomogram and duodenography revealed the formation of a fistula at the second portion of the duodenum and the presence of abscess-forming tuberculous lymphadenopathy. The use of continuous anti- tuberculous medication resulted in the improvement of the clinical symptoms, with complete healing of the duodenal fistula and tuberculous lymphadenitis. This case suggests that transient clinical worsening in intra-abdominal tuberculous lymphadenitis may occur during an early period of anti- tuberculous medication.
Adult ; Duodenal Obstruction ; Duodenum ; Edema ; Fellowships and Scholarships ; Fever ; Fistula ; Humans ; Internal Medicine ; Korea ; Lymphatic Diseases ; Tuberculosis ; Tuberculosis, Lymph Node ; Ulcer ; Weight Loss

OBJECTiVE We investigate the effects of multiple attempts of embryo transfer because of retained embryos in the catheter and of contaminated mucus on the transferred catheter. MATERiALS AND METHODS: We respectively analysed data between November 1998 and August 2002 from 305 patients of 369 cycles who underwent iVF-ET. Of these patients, 47 patients of 50 cycles (Group 2) were required multiple trial of embryo transfer. They were compared with an age-matched control groups (Group 1) with female factor infertility. Pearson's c2 and Fisher's tests were used to compare proportions between discrete variables. Non-categorical data were compared using t-test. Statistical significance was set at p<0.05. RESULTS: Embryos were significantly more likely to be retained when catheter was contaminated with mucus (Group 1: 22.4%; Group 2: 44.0%). The clinical pregnancy rates, however, for the contaminated mucus or not, were 46.8%, 43.5% respectively. There was no significant difference clinical pregnancy rate between those who had all their embryos transferred at the first attempt (45.4%) and those who required more than one attempt (48.0%). CONCLUSiONS: Contaminated mucus in the catheter is associated with failed embryo transferred at the first attempt. Embryo transfers, however, that are repeated attempts do not adversely affect pregnancy rates following iVF-ET.
Catheters ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization* ; Humans ; Infertility ; Mucus* ; Pregnancy Rate* ; Pregnancy*

INTRODUCTION: Cholecystokinin (CCK) belongs to a group of endogenous molecules known as brain-gut neuropeptides and functions as a neuropeptide as well as a gut hormone. It remains unclear whether genetic variation of the CCK receptor plays a role in irritable bowel syndrome (IBS). The aim of this study was to determine and compare the allele and genotype frequencies of the CCK1 receptor polymorphisms between healthy controls and patients with IBS. METHODS: Genotyping of 80 patients with IBS (who met the Rome III criteria) and 76 healthy controls was performed. We performed PCR amplification for the CCK1 receptor intron 1 779 T > C and Exon 1 G > A. We confirmed polymorphisms by direct sequencing method. RESULTS: There was a significantly different trend for genotypic distributions of the CCK1 receptor polymorphism between patients with IBS and healthy controls (p for trend = 0.048). The CCK1 receptor intron 1 779 T >C polymorphic type was more common in patients with 'IBS-constipation predominant (IBS-C) and IBS-mixed (IBS-M) forms' (19/31, 61.3%) than healthy controls 32/76, 42.1% adjusted odd ratio 2.43, 95% Confidence interval 1.01-5.86). The genotypic distributions of the CCK1 receptor exon 1 polymorphism were not significantly different between the two groups (p for trend = 0.223). CONCLUSIONS: CCK1 receptor polymorphisms were associated with IBS. In particular, the CCK1 receptor intron 1 779 T > C polymorphic type was associated with 'IBS-C and IBS-M'. Further studies are needed in larger number of patients with an even distribution of IBS subtypes.
Alleles ; Cholecystokinin ; Exons ; Genetic Variation ; Genotype ; Humans ; Introns ; Irritable Bowel Syndrome ; Neuropeptides ; Polymerase Chain Reaction ; Receptors, Cholecystokinin ; Rome