BACKGROUND: Shivering is a frequent event during spinal anesthesia and meperidine is a well-known effective drug for prevention and treatment of shivering. Nefopam is a non-opiate analgesic and also known to have an anti-shivering effect. We compared nefopam with meperidine for efficacy of prevention of shivering during spinal anesthesia. METHODS: Sixty five patients, American Society of Anesthesiologists physical status I or II, aged 20-65 years, scheduled for elective orthopedic surgery under spinal anesthesia were investigated. Patients were randomly divided into two groups, meperidine (Group M, n = 33) and nefopam (Group N, n = 32) groups. Group M and N received meperidine 0.4 mg/kg or nefopam 0.15 mg/kg, respectively, in 100 ml of isotonic saline intravenously. All drugs were infused for 15 minutes by a blinded investigator before spinal anesthesia. Blood pressures, heart rates, body temperatures and side effects were checked before and at 15, 30, and 60 minutes after spinal anesthesia. RESULTS: The incidences and scores of shivering were similar between the two groups. The mean arterial pressures in Group N were maintained higher than in Group M at 15, 30, and 60 minutes after spinal anesthesia. The injection pain was checked in Group N only and its incidence was 15.6%. CONCLUSIONS: We conclude that nefopam can be a good substitute for meperidine for prevention of shivering during spinal anesthesia with more stable hemodynamics, if injection pain is effectively controlled.
Aged ; Anesthesia, Spinal ; Arterial Pressure ; Body Temperature ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Meperidine ; Nefopam ; Orthopedics ; Research Personnel ; Shivering

BACKGROUND: An increase in ventilation is known to accelerate the rate of the rise of alveolar concentration of inhalation anesthetics and increase the rate of anesthetic induction. However, it is still debatable whether or not a rise of alveolar isoflurane concentrations by increased minute ventilation (MV) actually increases the depth of anesthesia. METHODS: After anesthetic induction by intravenous thiopental and succinylcholine, and after the bispectral index (BIS) had recovered to 75 after intubation, isoflurane anesthesia was begun (inspired concentration:2 vol.%, respiratory rate:12/min, tidal volume: group I; 8 ml/kg, group II; 12 ml/kg). BIS, spectral edge frequency (SEF), blood pressure, pulse rate were recorded 1 minute before induction, and 1, 2, 3, 4, 5, 7 and 10 minutes after isoflurane anesthesia. End-tidal concentrations of isoflurane and CO2 (ET-iso and -CO2) were recorded at 1, 2, 3, 4, 5, 7 and 10 minutes after isoflurane anesthesia. RESULTS: The increase of ET-iso and the decrease of ET-CO2 were significantly fast in group II. There was no difference in BIS and SEF between the two groups. CONCLUSIONS: Increasing MV induced a rapid rise of alveolar isoflurane concentrations, but changes of BIS and SEF were not affected by increased MV.
Anesthesia ; Anesthetics, Inhalation ; Blood Pressure ; Heart Rate ; Intubation ; Isoflurane* ; Succinylcholine ; Thiopental ; Tidal Volume ; Ventilation*

PURPOSE: The purpose of this study was to report the long-term clinical and radiological results of reverse hybrid total hip arthroplasty. MATERIALS AND METHODS: Between Oct. 1984 and Dec. 1987, reverse hybrid total hip replacements were performed using cemented all-polyethylene acetabular cup and porous coated tri-lock femoral stem. 26 cases in 25 patients were followed up more than 10 years. RESULTS: The average Harris hip score was 50 points preoperatively, 88 points at last follow-up. Two patients (7.7%) complained thigh pain at POD 1 years and 4 patients (15.4%) complained inguinal pain at last follow-up. On the radiologic findings, endosteal bone formation were observed with bone apposition mainly on the Gruen zone 2 and 6. Osteolysis developed in the proximal portion of the femoral stem, respectively. Definite loosening were found in 9 cases (34.6%) in the acetabulum and none in the femur. The mean rate of linear wear of polyethylene was 0.14 mm/year and the mean rate of volumetric wear was 108.75 mm3/year. CONCLUSION: The high incidence of acetabular loosening, presumably because of poor bone stock and great volumetric wear associated with use of the thirty-two-millimeter head. The result of tri-lock component can provide satisfactory clinical and radiological result.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Femur ; Follow-Up Studies ; Head ; Hip ; Humans ; Incidence ; Osteogenesis ; Osteolysis ; Polyethylene ; Thigh

Hypertrophic osteoarthropathy(HOA) is a systemic disorder characterized by proliferative periostitis of long bone and polysynovitis. Clubbing of the fingers and toes usually accompanies HOA. This syndrome is most frequently with lung cancer. Although disappearance of HOA with removal of the tumor is well known, very few typical cases are reported in Korea. We report case of lung cancer with HOA, which was dramatically relieved after the surgical resection of the tumor.
Fingers ; Korea ; Lung Neoplasms* ; Lung* ; Periostitis ; Toes

BACKGROUND: Bradycardia frequently occurs in intravenous anesthesia with propofol. Patients with sinus bradycardia have increased vagal tone at rest. The purpose of this study is to evaluate the effect of propofol on blood pressure and heart rate during induction of anesthesia in patients with sinus bradycardia. METHODS: Sixteen adult patients were studied. No anticholinergics were used before induction. Anesthesia was induced intravenously with midazolam 0.03 mg/kg, propofol 2 mg/kg, lidocaine 1 mg/kg and vecuronium 0.12 mg/kg. Anesthesia was maintained with continuous infusion of propofol 150 microgram/ kg/min and 100% O2. Hemodynamic data were recorded 3 minutes after midazolam injection, immediately after propofol injection, 1 and 2 minutes after propofol continuous infusion, and immediately, 1, 3 and 5 minutes after intubation. RESULTS: Heart rate significantly increased after intravenous injection of propofol (P < 0.05) and was maintained during the study. There was no incidence of bradycardia. CONCLUSIONS: Anesthesia induction and maintenance with propofol could be a suitable and safe ansethetic method for patients with sinus bradycardia.
Adult ; Anesthesia* ; Anesthesia, Intravenous ; Blood Pressure* ; Bradycardia* ; Cholinergic Antagonists ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Incidence ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal* ; Lidocaine ; Midazolam ; Propofol* ; Vecuronium Bromide

The link between toxic hepatitis and exposure to organic solvents is relatively well-documented, but there are no specific laboratory or histologic findings diagnostic of chemical-induced hepatitis. Clinical history, therefore, is very important in making a diagnosis. A history of glue sniffing is sometimes overlooked and glue sniffing has not received much attention as a cause of hepatitis. Toluene, a main organic solvent in glue, is known to cause disturbances in various organs such as the heart, nervous system, liver and kidneys. We present a case of hepatitis in an individual who has sniffed glue for euphoria for 3 years. There is an increasing tendency towards glue sniffing among young adolescents today, so toxicity caused by exposure to organic solvents should be considered as one possible cause of hepatitis in young adolescents.
Adhesives ; Adult ; English Abstract ; Hepatitis, Toxic/*etiology ; Humans ; Male ; Substance-Related Disorders/*complications ; Toluene

Neuropathic pain can be divided into sympathetically maintained pain (SMP) and sympathetically independent pain (SIP). Rats with tibial and sural nerve transection (TST) produce neuropathic pain behaviors, including spontaneous pain, tactile allodynia, and cold allodynia. The present study was undertaken to examine whether rats with TST would represent SMP- or SIP-dominant neuropathic pain by lumbar surgical sympathectomy. The TST model was generated by transecting the tibial and sural nerves, leaving the common peroneal nerve intact. Animals were divided into the sympathectomy group and the sham group. For the sympathectomy group, the sympathetic chain was removed bilaterally from L2 to L6 one week after nerve transection. The success of the sympathectomy was verified by measuring skin temperature on the hind paw and by infra red thermography. Tactile allodynia was assessed using von Frey filaments, and cold allodynia was assessed using acetone drops. A majority of the rats exhibited withdrawal behaviors in response to tactile and cold stimulations after nerve stimulation. Neither tactile allodynia nor cold allodynia improved after successful sympathectomy, and there were no differences in the threshold of tactile and cold allodynia between the sympathectomy and sham groups. Tactile allodynia and cold allodynia in the neuropathic pain model of TST are not dependent on the sympathetic nervous system, and this model can be used to investigate SIP syndromes.
Tibial Neuropathy/*classification/physiopathology ; Tibial Nerve/*injuries ; Sympathectomy ; Sural Nerve/*injuries ; Rats, Sprague-Dawley ; Rats ; Neuralgia/*classification/diagnosis ; *Models, Animal ; Male ; Animals

Neuropathic pain can be divided into sympathetically maintained pain (SMP) and sympathetically independent pain (SIP). Rats with tibial and sural nerve transection (TST) produce neuropathic pain behaviors, including spontaneous pain, tactile allodynia, and cold allodynia. The present study was undertaken to examine whether rats with TST would represent SMP- or SIP-dominant neuropathic pain by lumbar surgical sympathectomy. The TST model was generated by transecting the tibial and sural nerves, leaving the common peroneal nerve intact. Animals were divided into the sympathectomy group and the sham group. For the sympathectomy group, the sympathetic chain was removed bilaterally from L2 to L6 one week after nerve transection. The success of the sympathectomy was verified by measuring skin temperature on the hind paw and by infra red thermography. Tactile allodynia was assessed using von Frey filaments, and cold allodynia was assessed using acetone drops. A majority of the rats exhibited withdrawal behaviors in response to tactile and cold stimulations after nerve stimulation. Neither tactile allodynia nor cold allodynia improved after successful sympathectomy, and there were no differences in the threshold of tactile and cold allodynia between the sympathectomy and sham groups. Tactile allodynia and cold allodynia in the neuropathic pain model of TST are not dependent on the sympathetic nervous system, and this model can be used to investigate SIP syndromes.
Tibial Neuropathy/*classification/physiopathology ; Tibial Nerve/*injuries ; Sympathectomy ; Sural Nerve/*injuries ; Rats, Sprague-Dawley ; Rats ; Neuralgia/*classification/diagnosis ; *Models, Animal ; Male ; Animals

Anaplastic large cell lymphoma(ALCL) is a recently recognized large cell lymphoma characterized by large pleomorphic cells, with prominent nucleoli, expressing the CD3O(Ki-1) antigen. It is often misdiagnosed as metasfatic carcinoma, malignant histiocytosis or Hodgkin's disease. Primary pulmonary ALCL is extremely rare although it frequently involves extranodal sites, e.g. skin, bone, gastrointestinal tract, soft tissue and lung. We report a case of ALCL suspected as primarily involving lung.
Gastrointestinal Tract ; Histiocytic Sarcoma ; Hodgkin Disease ; Lung ; Lymphoma ; Lymphoma, Large-Cell, Anaplastic* ; Skin ; Tuberculosis, Pulmonary*

BACKGROUND: Pulmonary aspergillomas usually arise from colonization and proliferation of Aspergillus in preexisting cavitary lung disease of any cause. About 15% of patients with tuberculous pulmonary cavities were found to have aspergilloma. We analyzed the clinical features and course of 91 patients with pulmonary aspergllloma. METHODS: During the ten-year period from June 1986 to May 1996, 91 patients whose condition was diagnosed as pulmonary aspergilloma at 4 university hospitals in Taegu city were reviewed. All patients fulfilled one of the following criteria: 1) histologic evidence of aspergilloma within abnormal air space in tissue sections, or 2) a positive Aspergillus serum precipitin test with the radiologic finding of a fungus ball. The histological diagnosis was established in 81 patients(89.0%) and clinical diagnosis in 10 patients(11.0%). RESULTS: 1) The age range was 22 to 65 years, with an average of 45 years. A male and female ratio was 1.7:1 (57men and 34 women). 2) Hemoptysis was far the most frequent symptom(89%), followed by cough, dyspnea, weakness, weight loss, fever, chest pain. 3) In all but 14 cases(15.4%) there had been associated conditions. Pulmonary tuberculosis was far the most frequent underlying condition found(74.7%), followed by bronchiectasis(6.6%), cavitary neoplasm(2.2%), pulmonary sequestration(1.1%). 4) The involved area was usually in the upper lobes ; the right upper lobe was involved in 39(42.9%), the left upper lobe in 31(34.1%), the left lower lobe in 13(14.3%), the right lower lobe in 7(7.7%), and the right middle lobe in 1(1.1%). 5) On standard chest roent geno gram the classic "bell-like" image of a fungus ball was found in 62.6% of the subjects. On CT scan, 88.1% of the subjects in which they were done. 6) The surgical therapy was undertaken in 76 patients, and medical therapy in 15 patients, including 4 patients with intracavitary instillation of amphotericin B. 7) The surgical modality was lobectomy in 55 patients(72.4%), segmentectomy in 16 patients(21.1%), pneumonectomy in 4 patients(5.3%), wedge resection in 1 patient(1.3%). The mortality rate was 3.9% (3 patients) ; 2 patients died of sepsis and 1 died of hemoptysis. The postoperative complications were encountered in 6 patients(7.9%), including each one patient with respiratory failure, bleeding, bronchopleural fistula, empyema, and vocal cord paralysis. 8) In the follow-up cases, each 2 patients of 71 patients with surgical treatment and 10 patients with medical treatment had recurrent hemoptysis. CONCLUISON: During follow-up of the chronic pulmonary disease with abnormal air space, if the standard chest roentgenograms are insufficient to detect a fungus ball, computed tomographic scan and serum precipitin test are likely to aid the diagnosis of patients with suspected pulmonary aspergilloma. A reasonable recommendation for management of a patient with aspergilloma would be to reserve surgical resection for those patients who have had severe, recurrent hemoptysis. And a well controlled cooperative study to the medical treatment such as intracavitary antifungal therapy is further needed.
Amphotericin B ; Aspergillus ; Chest Pain ; Colon ; Cough ; Daegu ; Diagnosis ; Dyspnea ; Empyema ; Female ; Fever ; Fistula ; Follow-Up Studies ; Fungi ; Hemoptysis ; Hemorrhage ; Hospitals, University ; Humans ; Lung Diseases ; Male ; Mastectomy, Segmental ; Mortality ; Pneumonectomy ; Postoperative Complications ; Precipitin Tests ; Respiratory Insufficiency ; Sepsis ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary ; Vocal Cord Paralysis ; Weight Loss