PURPOSE: Recently developed BMS(TM) (Zassi Bowel Management System(TM): Hollister Inc., Illinois, USA) can provide effective nonsurgical fecal diversion without the risks associated with colostomy creation and subsequent closure. Our aim is to evaluate the effectiveness of the BMS in diverting feces from the perianal wide surgical wound in patients with Fournier's gangrene. METHODS: BMS(TM) was applied in five patients (male: 2, median age; 44) with Fournier's gangrene from January 2000 to September 2001. The treatments consist of three times a day wound dressing after wide surgical debridement and intravenous antibiotic therapy. For evacuation of feces, twice daily warm saline irrigation was administered via BMS(TM) or low daily doses of polyethylene glycol solutions were orally taken in. An endoscopic and anorectal manometric study was done to evaluate possible mucosal complications and anorectal functional changes. RESULTS: The average duration of the BMS application was 41 (range, 22~63) days. The result of a manometric study after immediate removal of the BMS(TM) showed a decreased mean resting pressure (range: 22~36 mmHg) and a decreased mean squeezing pressure (range: 32~39 mmHg). After 3 days, the sphincter pressure had improved markedly: mean resting pressures of 38, 45, 60, and 63 mmHg and mean squeezing pressure of 78, 89, 91, and 101 mmHg respectively. Fecal incontience was not noted in any patient. Other possible mucosal complications were not noted. There were no mortalit. CONCLUSIONS: BMS(TM) application in Fournier's gangrene patients after surgery successfully avoids a defunctioning colostomy. Furthermore, no significant complications were noted over a prolonged period up to 63 days.
Bandages ; Colostomy ; Debridement ; Fasciitis, Necrotizing ; Feces ; Fournier Gangrene ; Humans ; Illinois ; Polyethylene Glycols

No abstract available.
Breast Neoplasms* ; Breast* ; DNA* ; Humans ; Ploidies*

No abstract available.
Aneurysm, False* ; Embolization, Therapeutic* ; Hepatic Artery*

BACKGROUND: Morphine has a direct action on morphine receptors in the brain and spinal cord. Intrathecally administered L-NAME, a nitric oxide synthase inhibitor, is known to have an antinociceptive effect on formalin-induced pain in animal studies. Efficacy of intrathecally administered ketorolac, a cyclooxygenase inhibitor, is somewhat controversial. The interactions of intrathecally administered morphine, ketorolac and L-NAME on formalin-induced nociception was studied. METHODS: Male Sprague-Dawley rats were implanted with chronic lumbar intrathecal catheters and were tested for paw flinch by a formalin injection. Drugs were intrathecally administered 15 min before the formalin injection, and biphasic painful behaviors were observed. We obtained the ED50 for each agent (ketorolac, L-NAME and morphine). ED50 fractions (1, 1/2 and 1/4) of drug combinations of L-NAME-ketorolac, morphine-L-NAME and ketorolac-morphine were administered. The ED50 of each combined drug was established and isobolographic analysis of the drug interactions was carried out. RESULTS: Intrathecal administration of ketorolac, L-NAME and morphine produced a dose-dependent suppression of pain behaviors in phase 2. ED50 values were 297.04micro gram for ketorolac, 207.46micro gram for L-NAME and 0.17micro gram for morphine in phase 2. Isobolographic analysis showed that the combination of intrathecal morphine and L-NAME synergistically reduced pain behaviors in phase 2. CONCLUSIONS: Intrathecally administered morphine, L-NAME and ketorolac produced a dose-dependent decrease in the number of paw flinches in both phase 1 and phase 2 on the formalin test. Morphine with L-NAME showed synergistic analgesic effects on formalin-induced pain in phase 2.
Animals ; Brain ; Catheters ; Drug Combinations ; Drug Interactions ; Formaldehyde ; Humans ; Ketorolac* ; Male ; Morphine* ; NG-Nitroarginine Methyl Ester* ; Nitric Oxide Synthase ; Nociception ; Pain Measurement ; Prostaglandin-Endoperoxide Synthases ; Rats* ; Rats, Sprague-Dawley ; Receptors, Opioid, mu ; Spinal Cord

Mishaps related to valve malfunction in a self-inflating bag-valve unit can lead to fatal complications. We report a case of severe hypotension that resulted from the locking of the Laerdal valve in the inspiratory position during transport in the operating room. A 36 year old man had undergone an off-pump coronary artery bypass graft. Immediately before leaving the operating room, severe hypotension developed abruptly. But an EKG showed only a reduction of heart rate. We started closed cardiac massage with an intravenous bolus injection of epinephrine 0.5 microgram and reconnected the anesthesia breathing circuit. The patient was manually ventilated using the anesthesia reservoir bag. Vital signs immediately recovered. At that time, the patient's abdomen was distended and we suspected an expiratory abnormality. The self-inflating bag-valve unit was tested with an anesthesia reservoir bag as a test lung. Expiration did not occur. Another self-inflating bag-valve unit was substituted and normal ventilation was restored. It is essential that before use, a self-inflating bag-valve unit should be tested for proper function during both expiration and inspiration using a test lung such as, an anesthesia reservoir bag.
Abdomen ; Adult ; Anesthesia ; Coronary Artery Bypass, Off-Pump ; Electrocardiography ; Epinephrine ; Heart Massage ; Heart Rate ; Humans ; Hypotension* ; Lung ; Operating Rooms ; Respiration ; Resuscitation ; Transplants ; Ventilation ; Vital Signs

Purpose: In the Republic of Korea, the use of trauma centers was recently adopted and is expected to have better outcome for severely injured patients. This study aimed to evaluate the clinical outcomes and treatment methods for unstable pelvic bone fractures in trauma centers. Methods: The annual number of patients, clinical outcomes, and treatment methods of unstable pelvic bone fractures in three trauma centers from 2016 to 2020 were retrospectively reviewed. The patients were dichotomized into survivors and deceased, and demographic data, treatment, and clinical outcomes were compared. Multivariable analysis was performed to identify the factors associated with survival. Results: Among 237 patients, 101 (42.6%) were deceased. Mortality was lower in the later period (2019- 2020) compared with the early period (2016-2018; 33.6% vs. 50.0%, p = 0.011). Direct admission of an increasing number of patients to trauma centers reduced prehospital time. Although the use of angioembolization in treating pelvic bone fracture (p < 0.001), and the use of other treatment methods did not change significantly (2016-2020). Lower age, lowest systolic blood pressure in the trauma bay, and higher lactate level, international normalized ratio, the amount of packed red blood cell transfusion at 24 hours were positively associated with mortality in the multivariate analysis. Conclusion Increasingly more patients with unstable pelvic bone fracture were admitted to trauma centers; mortality improved. Angioembolization increased significantly and multi-disciplinary modality for early bleeding control was still essential.

PURPOSE: This study investigated the effect of bioactive Yeonsan Ogye peptides (YOPs) intake on changes in the hepatic anti-oxidant indexes in male rats. METHODS: Sprague-Dawley male rats were divided into 3 groups and given a casein-based AIN-93G diet and distilled water ad libitum without any added YOPs (control), distilled water with 250 mg of YOPs (Y250), or 500 mg of YOPs (Y500) per kg of body weight for 4 weeks. YOP dose was decided as referred to in the referenced study where toxicity did not occur. The hepatic anti-oxidant indexes were determined using a commercial kit. Statistical analysis was performed using SPSS version 23.0 and are expressed as mean ± standard error of mean. Differences among the groups were evaluated by one-way analysis of variance followed by post hoc Duncan's multiple comparisons test. RESULTS: There were no differences in the body weights, weight gain, food intake, food efficiency ratio, or organ weight, including liver, kidney, spleen, thymus, and epididymal fat, among all of the groups. The hepatic nitric oxide (NO) level in the Y500 group was lower than that in the control and Y250 groups, and the hepatic malondialdehyde (MDA) level was lower in the Y500 group than in the Y250 group. The differences in hepatic superoxide dismutase (SOD) and catalase (CAT) activities were not statistically significant between the groups. From these results we speculated that YOPs may have anti-oxidative abilities to regulate NO and MDA production without affecting SOD and CAT activities. CONCLUSION: YOPs are presumed to act as anti-oxidants in the animal or human body.
Animals ; Body Weight ; Catalase ; Cats ; Diet ; Eating ; Human Body ; Humans ; Kidney ; Liver ; Male ; Malondialdehyde ; Nitric Oxide ; Organ Size ; Peptides ; Rats ; Rats, Sprague-Dawley ; Spleen ; Superoxide Dismutase ; Thymus Gland ; Water ; Weight Gain

BACKGROUND: The management of postoperative pain with traditional narcotic analgesic regimen is associated with an unacceptably high failure rate and at best has represented a cautious compromise between adequate analgesia and the risk of complications, particularly that of respiratory depression. The purpose of this investigation was to compare the efficacy and safety of nalbuphine given by patient-controlled analgesia (PCA) with differential dosages after total knee replacement. METHODS: A double-blind clinical trial of 75 patients who received intravenous nalbuphine with patient- controlled analgesia during the postoperative first 48 hours after total knee replacement, was carried. Patients were assigned to three groups by the concentration of nalbuphine: Group 1 (n = 25), 2 mg/ml; Group 2, 4 mg/ml; Group 3, 6 mg/ml. The settings of PCA in three groups were same. RESULTS: Visual analog scale (VAS) scores were used to assess pain. Group 2 and 3 patients reported significant lower VAS over the postoperatively 6 hours and 12 hours at either rest or movement compared to group 1. PCA demands, delivered doses and PCA nalbuphine dosage per hours except supplemental analgesic doses in the first 48 hours were lower in group 2 and 3 compared to group 1. There were significant differences among groups at postoperatively 6 and 12 hours in nausea, vomiting and sedation of the side effects. CONCLUSIONS: IV PCA with nalbuphine is thought to be potent and safe for postoperative pain relief without the major morbidity like respiratory depression, in addition, the careful observation and treatment on the side effect like nausea, vomiting and sedation, is surely needed.
Analgesia ; Analgesia, Patient-Controlled* ; Arthroplasty, Replacement, Knee ; Humans ; Nalbuphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Respiratory Insufficiency ; Visual Analog Scale ; Vomiting

PURPOSE: An obstructed colorectal cancer (OB) has a poorer survival than a non-obstructed cancer (NOB). This study examined the prognostic impact of bowel obstruction on colorectal cancer. METHODS: From December 1999 to December 2005, patients undergoing single stage operation for OB were examined prospectively. OB (n= 193) was compared with a NOB (n=444) used in a primary tumor resection during the same period. 637 colorectal cancers were examined in this study. RESULTS: The overall operative mortality was 21 (3.3%) and the postoperative mortality was significantly higher in the OB (OB: 16, 8.3%) group than in the NOB (NOB: 5, 1.1%) group. The proportion of OB was higher in the left-colon (52.8%) than in the right colon (16.0%) and rectum (31.1%, P<0.001). However, OB was associated with an older age (P=0.013). The proportion of advanced tumor stage was higher in OB (II: 35.8%, III: 39.5%, IV: 24.7%) than in NOB (II: 53.2%, III: 35.8%, IV: 11.0%, P<0.001). The 5-year cancer-related survival for OB was worse than NOB (OB: 77.3%, NOB: 57.8%, P<0.05). However, in the cases of a colorectal cancer performed curative resection (stage II and III), the survival for OB was not worse than NOB: stage II (OB: 82.8%, NOB: 92.2%, P=0.24), stage III (OB: 65.2%, NOB: 56.9%, P=0.43). CONCLUSIONS: OB has older and more advanced disease characteristics. However, if an oncologically curative resection is performed, the survival for OB is similar to that of a NOB.
Colon ; Colorectal Neoplasms ; Humans ; Prospective Studies ; Rectum

The Department. of Anesthesiology of Hanyang University had a case of operation for pheo- chromocytoma. For the operation of pheochromocytoma, used to prazosin for preoperative treatment of hypertension and used to enflurane as inhalational anesthetic, treated with sodium nitroprusside for severe elevation of blood pressure during operation, used to vecuronium for neuromuscular blocker. Also we tried to get the knowledge about the variation of catecholamine concentration in blood through operation. As we used to the other drugs with adequate amount of fluid without any other complication in this operation we reported here with other references and our experience of a case of operation for remove of pheochromocytoma.
Anesthesiology ; Blood Pressure ; Enflurane* ; Hypertension ; Neuromuscular Blockade ; Nitroprusside ; Pheochromocytoma* ; Prazosin ; Vecuronium Bromide