BACKGROUND/AIMS: The caudal anesthsia is most commonly used for benign anorectal surgery, The combination of long-acting anesthetics and opiates has been used for longer duration and successful control of postoperative pain. But the side effects of peridural anesthesics and morphine have commonly occured in caudal anesthesia. This study was performed to assess the difference in clinical effects between peridural mepivacaine and bupivacaine with morphine. METHODS: We evaluated the clinical effects in 60 patients who had anal operation with Jack-Knife position under caudal anesthesia. We divided randomly these 60 patients into two groups, M and B groups (in each group, 30 patients included). Group M (n=30) was given 2% mepivacaine 20 ml with morphine 2 mg caudally, and Group B (n=30) was given 0.5% bupivacaine 20 ml with morphine 2 mg in the same manner. We measured the onset time, duration, postoperative analgesia, and side effects including urinary retention. RESULTS: The onset time for analgesia was significantly shorter in group M than in group B. The duration of postoperative pain complaints was significantly longer in group M than in group B. The postoperative analgesic effects and side effects were not significantly different between two groups. CONCLUSIONS: Caudal mepivacaine and morphine mixture is effective for control of postoperative pain without significant side effects.
Analgesia ; Anesthesia, Caudal* ; Anesthetics ; Bupivacaine* ; Humans ; Mepivacaine* ; Morphine* ; Pain, Postoperative ; Urinary Retention

Vasoactive intestinal polypeptide (VIP) has a vasodilatory effect as a non-adrenergic, non-cholinergic neurotransmitter. The role of VIP on penile erection has been controversial. This study was undertaken to elucidate the effect of VIP on penile erection in-vivo and to predict whether this drug can be clinically applied to the diagnosis and/or treatment of impotence. The results are as follows. Intracavernosal injection of VIP alone (0.000000001to 0.00001M, n=10) did not show any increase in basal ICP Pretreatment of VIP (0.000005M, 0.00001M, n=7) enhanced partial erection induced by electric intensity with suboptimal level(frequency; 1 Hz, intensity; 1.2-2.0 volt, pulse duration, 1 msec.) (p<0.05)Intracavernosal injection of VIP-antagonist (0.000000001 to 0.00001M,n=7) was found to suppress the full erection induced by the optimal electric stimulation(frequency; 1 Hz, intensity; 3-4 volt, pulse duration; 1 msec.) in dose dependent manner (p<0.05). These results suggest that VIP may induce penile erection in rat through its receptor on corpus cavernosum, although it requires the cooperative action of other neurotransmitter(s).
Animals ; Diagnosis ; Erectile Dysfunction ; Male ; Neurotransmitter Agents ; Penile Erection* ; Rats* ; Vasoactive Intestinal Peptide*

Early diagnosis of persistent abnormal reflexes may be of great significance to a more effective functioning of the cerebral palsied child. It is important to know the normal and abnormal reflex responses and their effect upon motor development for providing a basis for evaluation in the diagnosis and treatment of the cerebral palsied child. We studied 28 cerebral palsied children, between 1 to 12 years old, who were treated at Sam Yook Childrens Rehabilitation Center from May 1975 to December 1977. The pathologic reflexes were checked, and the relationship between pathologic reflexes and walking was compared. The following results were obtained. 1. The following were the most important pathologic reflexes in non-walking fgroup: a. Positive supporting reaction b. Protective extensor thrust c. Moro reflex 2. If they are present, the prognosis for walking ambulation was bad and surgery will not improve for the chances of walking.
Child ; Diagnosis ; Early Diagnosis ; Humans ; Prognosis ; Reflex ; Reflex, Abnormal ; Reflex, Startle ; Rehabilitation Centers ; Walking

PURPOSE: To evaluate the clinical significance of renal excretion of oral Gastrografin in gastric resectionpatients. MATERIAL AND METHOD: Seven days affter gastric resection, eight normal volunteers and 30 patientsunderwent abdominal and CT scanning before and 1-1.5 his after oral administiration of Gastrografin. Theattenuation coefficients of the bladder were measured and the maximal attenuation difference between pre-andpost-gastrografin administration was calculated. RESULTS: In the control group, there was no abnormal renalexcretion of oral Gastrografin, though in 83 % of patients(25 of 30), this was demonstrated as focal increase inthe density (> or = 20 HU) of the bladder and/or collecting system, or ureteral opacification. Mean maximal densitydifference was 84.4+/-82.9HU in the patient group (n=24), with renal excretion of enteral Gastrografin and,3.5+/-4.4 HU in the control group (n=7), with statistical significance (Student's t-test, p<0.01). No patientshowed either radiological or clinical evidence of direct leakage from the suture site. Patients who underwenttotal gastrectomy showed a higher maximal density difference than those in whom gastrectomy was subtotal. CONCLUSION: Unless direct leakage is visvalized on fluoroscopy or spot films, renal excretion of oralGastrografin should not be regarded as a sign of anastomotic leakage. Situations other than leakage, e. g.increased mucosal permeability or absorption, or increased bowel transit time in postoperative duration, should beconsidered as possible causes.
Absorption ; Administration, Oral* ; Anastomotic Leak ; Diatrizoate Meglumine* ; Fluoroscopy ; Gastrectomy ; Healthy Volunteers ; Humans ; Permeability ; Sutures ; Tomography, X-Ray Computed ; Ureter ; Urinary Bladder

The authors had five cases of penoplasty from more than half of the scrotum to the suprapubic region using a fasciocutaneous radial forearm free flap (RFFF) after extensive excision of sclerosing lipogranuloma. Although the harvested RFFF was a rectangular shape, the authors made the shape of scrotum, penile shaft, and suprapubic region by using well designed geometry and several quilting sutures on junction of scrotum and penis. The contour of scrotum and penis was well maintained, and there were no complications, such as scrotal contracture, penile deformity, and erectile dysfunction during the one year follow up period in all five cases. There were no recurrent lesions and no need for further surgery.
Congenital Abnormalities ; Contracture ; Erectile Dysfunction ; Follow-Up Studies ; Forearm* ; Foreign-Body Reaction ; Free Tissue Flaps* ; Granuloma ; Male ; Penis ; Scrotum* ; Sutures

Recently, laser treatment of benign prostatic hyperplasia (BPH) is considered as a promising alternative to traditional transurethral resection of the prostate (TURP). To evaluate the effectiveness and safety of laser therapy on BPH, we compared the results of transurethral balloon laser thermotherapy (TUBALT, n=13) and Hybrid laser prostatectomy (HLP, n=21) with those of TURP (n=25) in 58 patients with mild and moderate BPH. Following data were evaluated at postoperative 1, 3 and 6 months : AUA symptom score (SS), maximal flow rate (Qmax), subjective symptom improvement (SI), postoperative complications. All 3 groups show significant improvement after treatment in the Qmax values. Among 3 groups, the Qmax value was lower in TUBALT group (12.9+/-3.3 ml/sec) than those in HLP group (15.5+/-5.2 ml/sec) and TURP group (18.7+/-5.3 ml/sec) on postoperative 6 months. The Qmax values were not significantly different between HLP and TURP groups. In the SS values, all 3 groups show significant improvement after treatment and, TUBALT (9.9+/-9.7) and HLP (10.3+/-9.4) group were comparable to TURP group (5.2+/-4.2) on postoperative 6 months. In global assessment of SI, both HLP (87.5%) and TUBALT (75%) group were also comparable to TURP (90%) group on postoperative 3 months. but TUBALT group showed delayed symptom improvement compared to TURP group. Postoperative complications were minimal both in HLP and TUBALT groups, compared to TURP group. These results suggest that both HLP and TUBALT are effective in mild and moderate BPH, Further more, HLP treatment could be considered a promising alternative to TURP.
Humans ; Hyperthermia, Induced* ; Laser Therapy ; Postoperative Complications ; Prostate ; Prostatectomy* ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate

PURPOSE: The Snyder's classification of SLAP lesion has many limitations in clinical use, His classification has no correlation with the mechanism of jnjury and treatment. Therefore, new rational classification oriented with injury mechanism and its treatment was needed. MATERIALS AND METHODS: This is a retrospective study of 74 patients with SLAP lesion which were found during arthroscopic treatment of 194 patients diagnosed with recurrent shoulder dislocation, impingement syndrome or SLAP lesion between March 1989 and January 1997. Mean follow-up time was 36 months (range, 18 to 72 months) and average age of patients was 26 years old (range, 17-47 yrs). All patients were arthroscopically examined and treated. We classified the SLAP lesion into 3 groups according to the stability of biceps anchor. Group I had superior labral tear (flap tear or bucket-handle tear or degenerative tear) with intact biceps stability, group II had disturbed biceps anchor (unstable shoulder), and group III is a mix of group I and II. By our classification, group I was 32 cases, group II was 31 cases, and group III was 11 cases. We treated the SLAP lesion according to our new classification. Group I was treated with arthroscopic debridement, group II with stabilization of biceps anchor, and group III with arthroscopic debridement and stabilization of biceps anchor. RESULTS: The result by the Rowe rating scale was excellent or good in 29 cases of 32 in group I, 25 cases of 29 in arthroscopic transglenoid suture technique group and 1 case of 2 in the group treated with biodegradable tack (Suretec) in group II, and 10 of 11 cases in group III. There was only one case of postoperative recurrence and no complication was found. Our transglenoid suture technique had a reasonable recurrence rate with few complications. CONCLUSIONS: Thus we propose our new classification and treatment of SLAP lesion, and arthroscopic transglenoid suture technique for the treatment of SLAP type II and III.
Adult ; Arthroscopy ; Classification* ; Debridement ; Follow-Up Studies ; Humans ; Recurrence ; Retrospective Studies ; Shoulder ; Shoulder Dislocation ; Suture Techniques

PURPOSE: We tried to evaluate the usefulness of the cementless Zweymuller stem for treating hip fracture in those patients older than 80 years with severe osteoporosis. MATERIALS AND METHODS: Thirty cases were treated with bipolar hemiarthroplasty with a cementless Zweymuller stem and they served as group I (the study group), and 30 cases treated with a cemented stem served as group II (the control group). We performed a comparative study between the two groups. RESULTS: The admission period (days) was 24.6+/-10.7 and 32.8+/-16.8 (p=0.047) for the 2 groups, respectively, and the average operation time (minutes) was 75.8+/-17.6 and 89.2+/-28.1 (p=0.024), respectively; the total blood loss (ml) was 457.2 and 548.3 (p=0.035) in group I and II, respectively. The incidence of staying in the intensive care unit (ICU) and the average time to start postoperative ambulation showed no significant differences between the two groups. Pulmonary embolism occurred in 1 case in group I and in 4 cases in group II, and intraoperative fracture of calcar occurred in 2 cases of group I. There was no case of position change of the femoral stem at 1 year postoperatively in both groups. CONCLUSION: The cementless Zweymuller stem, inserted by press fit in the patients who are older than 80 years and who have hip fracture with severe osteoporosis showed clinically better results as compared with the cemented stem.
Case-Control Studies* ; Hemiarthroplasty ; Hip* ; Humans ; Incidence ; Intensive Care Units ; Osteoporosis* ; Pulmonary Embolism ; Walking

PURPOSE: To investigate the feasibility and accuracy of Proton Resonance Frequency (PRF) shift based magnetic resonance (MR) temperature mapping utilizing the selfdeveloped center array-sequencing phase unwrapping (PU) method for non-invasive temperature monitoring. MATERIALS AND METHODS: The computer simulation was done on the PU algorithm for performance evaluation before further application to MR thermometry. The MR experiments were conducted in two approaches namely PU experiment, and temperature mapping experiment based on the PU technique with all the image postprocessing implemented in MATLAB. A 1.5T MR scanner employing a knee coil with T2* GRE (Gradient Recalled Echo) pulse sequence were used throughout the experiments. Various subjects such as water phantom, orange, and agarose gel phantom were used for the assessment of the self-developed PU algorithm. The MR temperature mapping experiment was initially attempted on the agarose gel phantom only with the application of a custom-made thermoregulating water pump as the heating source. Heat was generated to the phantom via hot water circulation whilst temperature variation was observed with T-type thermocouple. The PU program was implemented on the reconstructed wrapped phase images prior to map the temperature distribution of subjects. As the temperature change is directly proportional to the phase difference map, the absolute temperature could be estimated from the summation of the computed temperature difference with the measured ambient temperature of subjects. RESULTS: The PU technique successfully recovered and removed the phase wrapping artifacts on MR phase images with various subjects by producing a smooth and continuous phase map thus producing a more reliable temperature map. CONCLUSION: This work presented a rapid, and robust self-developed center arraysequencing PU algorithm feasible for the application of MR temperature mapping according to the PRF phase shift property.
Artifacts ; Citrus sinensis ; Computer Simulation ; Heating ; Hot Temperature ; Knee ; Magnetic Resonance Spectroscopy ; Protons ; Sepharose ; Thermography ; Thermometry ; Water

BACKGROUND: Asthma can be described as the hypersensitivity of the airway to various stimuli. Injury to tracheal epithelial cells could be the reason for tracheal hypersensitivity in asthma or upper respiratory infection. This study is based on the hypothesis that the dysfunction of the airway in asthma is caused by epithelial cell injury. METHODS: After isolating guinea-pig tracheal preparations, in order to examine the role of airway epithelium in response to smooth muscle, we measured the contractile responses to acetylcholine, carbachol, and histamine on the isolated epithelium-denuded or epithelium-intact guinea-pig tracheal preparations. When tracheal tones were stabilized, each contractile agent was added cumulatively to the organ baths to obtain concentration-response curves, and ED50 and ED95 were calculated. RESULTS: In both groups, tracheal tones increased in response to contractile agents, in concentration- dependent manners. In comparing both groups, the contractility of denuded trachea was increased by 10 7 and 10 6 M in acetylcholine, and by 10 6 M in histamine significantly. In denuded trachea, ED50 and ED95 increased significantly in response to both acetylcholine and histamine. However, they did not increase in carbachol. CONCLUSIONS: The removal of the epithelium increased the contractile responses to acetylcholine and histamine.
Acetylcholine ; Asthma ; Baths ; Carbachol ; Epithelial Cells ; Epithelium ; Histamine ; Hypersensitivity ; Muscle, Smooth* ; Trachea