PURPOSE: Nocturnal enuresis is one of the most common disorders of childhood, occurring in 15% of 5 year-old children. Although usually self-limiting, justification for early treatment has been founded in psyc hological impact on the child. Many investigators have reported upon the effectiveness of prospectively studied to compare the therapeutic effect between imipramine (Tofranil) and desmopressin (Minirin/1-Desamino-8-D-Arginine Vasopressin: DDAVP) on the monosymptomatic enuretic patients. MATERIALS AND METHODS: 83 enuretic patients (primary enuresis 64 cases, secondary enuresis 19 cases) were randomized th one of two groups: imipramine group(44 cases) or desmopressin group (39 cases). They were free of other abnormalities in the screening tests. In addition to drug therapy, all of cases were performed motivational counselling, reduction of fluid in take prior to bedtime and voiding diary. The efficacy of drug was measured in reduction of the number of wet nights per week. During the treatment period, 83 cases were classified as excellent (0 to 1 wet night per week), good (over 59% reduction of wet night)and failed responder(less than 50% reduction of wet night). RESULTS: Average age of imipramine group and desmopressin group was 9.3 years (range 5-17) and 9.6 years (range 5-17), respectively. The number of wet nights per week decreased respectively from a mean of 6.1 to 3.4 in imipramine group are from a mean of 6.4 to 2.3 in desmopressin group. Average therapeutic duration and overall response rate in the imipeamine group and desmopressin group was 9.1 weeks, 6.7 weeks (p<0.05) and 90.9%, 95.9%, respectively (p<0.05). The overall relapse rate of imipramine group and desmopressin group was 40.0% and 40.8% during the follow-up period of 3 months after cessation of medication in excellent responders. There was no difference in the therapeutic effects between primary and secondary enuresis on each drug therapy. There was also on no difference in the therapeutic response according to constipation. No serious side effects were observed in both groups. CONCLUSIONS: These data suggest that the overall effects of imipramine and desmopressin are excellent. But desmopressin has more effective therapeutic response and more shorter therapeutic duration as compared with imipramine.
Child ; Child, Preschool ; Constipation ; Deamino Arginine Vasopressin* ; Drug Therapy ; Enuresis ; Follow-Up Studies ; Humans ; Imipramine* ; Mass Screening ; Nocturnal Enuresis ; Prospective Studies ; Recurrence ; Research Personnel ; Vasopressins

No abstract available.
Cystitis* ; Pyelonephritis*

No abstract available.
Priapism* ; Ureter*

For the purpose of elucidating relation between red cell electrolyte concentrations and serum digoxin level, measurement of red cell electrolyte concentrations and seum digoxin level by radioimmunoassay were done in 46 normal controls and 63 patients of CHF including 8 patients with digitalis intoxication. The results obtained were as follows: 1. Red cell sodium concentration and ratio of red cell sodium to red cell potassium concentration in normal males were significantly higher than those of females, and red cell potassium concentration in normal males was significantly lower than that of normal females. 2. Red cell potassium concentration in patients of CHF was significantly higher than that of normal controls, but there was no difference in the red cell sodium concentration between the groups. 3. There was no relation between red cell electrolyte concentrations and serum digoxin level, and red cell electrolyte concentration did not exactly estimate serum digoxin level. 4. Red cell electrolyte concentrations in the patient of CHF were valuable in detecting digitalis toxicity.
Digitalis ; Digoxin* ; Female ; Humans ; Male ; Potassium ; Radioimmunoassay ; Sodium

Pain relief becomes a major concern when treating patients with rib fractures so adequate ventilation must be maintained. Many techniques have been described for the management of frectured ribs, including systemic analgesics, intercostal nerve blockade, intrathecal morphine, epidural bupivacaine and epidural morphine. This case report illustrates the successful use of epidural narcotics in a patient with multiple fractured ribs.
Analgesics ; Bupivacaine ; Humans ; Intercostal Nerves ; Morphine ; Narcotics* ; Rib Fractures ; Ribs* ; Ventilation

The popular term malignant hyperthermia syndrome (MHS) refers to a clinical syndrome classically observed during general anesthesia. It is characterized by a rapidly increasing .temperature and a high mortality rate. A case of MHS was experienced which developed 60 minutes after induction of general anesthesia with thiopental sodium, succinylcholine, halothane, N2O and 02. High fever, muscle rigidity and cyanosis developed and were followed by arrythmia and unstable blood pressure. Anesthesia was terminated and vigorous emergency treatment was attempted. The patient died about 6 hours after induction of anesthesia.
Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Blood Pressure ; Cyanosis ; Emergency Treatment ; Fever ; Halothane ; Humans ; Malignant Hyperthermia* ; Mortality ; Muscle Rigidity ; Succinylcholine ; Thiopental

Inability to synthetize adequate amounts of IL-2 has been suggested to be the basis of defective T-cell function following anesthesia with the operation. The present study was designed to examine the effect of anesthesia and operation on host defence mechenism. serum soluble IL-2R(sIL-2R) levels and hemo-dynamic parameters were measured in 30 patients. Patients were divided into two groups (G: general anesthesia with isoflurane, E:epidural anesthesia with bupivacaine) according to the method of anesthesia. Venous blood samples were taken before anesthesia(T1), 10 mins after induction of anesthesia(T2), 10 mins after injection of bupivacaine in epidural anesthesia(T2), 1 hour after skin incision(T3), 30 mins after completion of operation(T4), and 24 hours after completion of operation(T5). Simultaneously arterial blood pressure and heart rate were measured. Six mililiter of perip-heral blood was obtained for sIL-2R studies in plain tubes. Serum concentration of sIL-2R was measured by human IL-2 receptor ELISA kit(Boehringer Mannheim Biochemica, Mannheim, Germany). Any significant change in IL-2R level was not seen in patients under general anesthesia with isoflurane and operation. Also any significant change in IL-2R level was not seen in patients who had an epidural anesthesia with bupivacaine and operation. The results suggest that suppression of T-lymphocyte function and decrease in lymphocyte counts induced by anesthesia and operation is not due to alteration of intracellular metabolism, but due to extracellular immune depressor. And general anesthesia operation with isoflurane as well as epidural anesthesia with bupivgcaine is safe and can be selected for immunosuppressive patients.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General* ; Arterial Pressure ; Bupivacaine* ; Enzyme-Linked Immunosorbent Assay ; Heart Rate ; Humans ; Interleukin-2* ; Isoflurane* ; Lymphocyte Count ; Metabolism ; Receptors, Interleukin-2 ; Skin ; T-Lymphocytes

Grisel’s syndrome is a non-traumatic atlantoaxial rotatory subluxation for which the underlying mechanism has not yet been identified. It is known to occur following upper respiratory infections, tonsillitis, ear, nose, and throat (ENT) surgeries such as tonsillectomy and adenoidectomy. The diagnosis of Grisel’s syndrome can be made by plain x-ray, CT scanning, and/or MRI scanning. The first choice of treatment is conservative therapy such as bed rest, muscle relaxation, analgesic therapy, antibiotics, and simple traction. While Grisel’s syndrome occurs rarely, delayed treatment may lead to neurological complications or requires surgical treatment. Early diagnosis and treatment are important in preventing fatal outcome. We report the case of a 9-year-old male who developed Grisel’s syndrome after tonsillectomy and adenoidectomy.

BACKGROUND: To decrease the risk of pulmonary aspiration of gastric contents, patients are routinely asked not to eat or drink anything for at least 6 to 8 hours before surgery. We studied to evaluate whether the volume and pH of gastric fluid immediately after induction of anesthesia is correlated with water ingestion. METHODS: Fifty patients, scheduled for elective surgery, were randomly divided into two groups. Control group(n=25) were fasted overnight and received no water. Experimental group(n=25) were fasted overnight and received 150 ml water approximately 2 hours before the induction of anesthesia. Gastric fluid was obtained via multiorifice gastric tube with the patient in three different positions. The volume of gastric fluid was recorded and its pH was measured. RESULTS: The gastric volumes were no differences between the two groups. The gastric pH values were significant differences. The incidence of patients with the high risk factors of gastric volume greater than 25 ml and pH less than 2.5 was decreased in experimental group. CONCLUSIONS: We concluded that surgical patients could be permitted to ingest 150 ml water approximately 2 hours before the induction of anesthesia.
Adult* ; Anesthesia ; Eating* ; Humans ; Hydrogen-Ion Concentration* ; Incidence ; Risk Factors ; Water*

The epidural abscess, while rare, should be taken seriously, as it can result in permanent neurological complications. Fever, back pain, leukocytosis and elevation of Erythrocyte Sedimentation Rate (ESR) are major signs and symptoms of epidural abscesses. But clinical recognition of such abscesses may be very difficult because of nonspecific symptoms or signs as well as previous or underlying painful disorders. Few cases has been reported of epidural abscess and epidural fibrosis associated with back surgery or temporary epidural blocks. In these cases, however, fever, low back pain, sciatica and elevation of ESR were the major findings. Magnetic Resonance Imaging findings after Gadolinium- diethylenetriaminopenta-acetic acid (Gd-DTPA) enhancement show central low signal intensity and surrounding high signal intensity at the anterior epidural space between the 5th lumbar and 1st sacral vertebrae. We suspected an epidural abscess caused by epidural block, and so operated. But our operative finding was epidural fibrosis without abscess. Our final pathological diagnosis was epidural fibrosis.
Abscess ; Back Pain ; Blood Sedimentation ; Diagnosis* ; Epidural Abscess* ; Epidural Space ; Fever ; Fibrosis* ; Leukocytosis ; Low Back Pain ; Magnetic Resonance Imaging ; Sciatica ; Spine