In recent years the use of epidural opiates has increased and although this method of pain relief has shown good results in clinical practice it is still subject to certain drowba-cks, the most serious of which appears to be delayed respiratory depression. Since ketamine administered systemically is unlikely to produce respiratory depression it seemed worthwhile to investigate the possibility of exploiting the potent analgesic property to ketarnine by its epidural administration. The analgesic effect of ketamine 4 mg, administered epidural space, was evaluated. The duration of pain relief varied from less than 3 hours in 20% to over 24 hours in 30 % of the cases. In 62.5% of the cases pain relief exceeded 6 hours. There was no evidence of respiratery depression, and there no postoperative neurologic sequelae. The present results indicated the need for farther studios to compare the efficacy and safety of epidural ketamine with the response to epidural opioids for the relief of posto- peratiue pain.
Analgesics, Opioid ; Depression ; Epidural Space ; Ketamine* ; Pain, Postoperative* ; Respiratory Insufficiency

The MERA-F breathing circuit is a light in weight, disposable, multi-purpose breathing system corsisting of double coaxial tubes ; inner tube for inspiration and outer corrugate tube for expiration. This circuit is especially effective on head and neck operations that may lead to :Iccidental disconnection or extubation. And the circuit provides effective carbon dioxide elimination with only conventional total fresh gas flow(70 ml/kg/minute) and appropriate maintenance of heat and humidity of the airway mucosa.
Carbon Dioxide ; Head ; Hot Temperature ; Humidity ; Mucous Membrane ; Neck ; Respiration*

BACKGROUND: Routine management of postoperative pain have been changed as a result of technological advances in drug delivery systems. The purpose of this study was to compare the effect of continuous epidural analgesia(CEA) system and intravenous patient controlled analgesia (IV-PCA) system for pain relief after cesarean delivery. METHODS: Sixty adult women were randomly assigned to receive analgesics either IV-PCA or CEA after cesarean delivery with general anesthesia for operation. IV-PCA group was received 30 mg intramuscular injection of ketorolac after awakening, followed by IV-PCA. PCA unit was filled with 60 ml; mixed with morphine 10 mg, fentanyl 1000 microgram, ketorolac 180 mg, and normal saline. It had a flow rate of 0.5 ml/hr and lockout interval was 15minutes. CEA group was received a bolus of epidural morphine 3mg and 8ml of 0.25% bupivacaine before the end of operation, followed by CEA. CEA unit was filled with 100 ml; mixed with morphine 4 mg, fentanyl 500 microgram, 0.5% bupivacaine 20 ml, and normal saline. It had a flow rate of 2ml/hr. The degree of analgesia was subjectively evaluated by a visual analogue scale(VAS). Patients were evaluated 0, 1, 2, 6, 12, 24, and 48hours after operation for pain relief, sedation, nausea, vomiting, pruritus, and respiratory rate. RESULTS: VAS pain score were significantly lower in CEA group than IV-PCA group at 0(8.0+/-1.4 vs 3.9+/-0.7), 1(4.4+/-1.3 vs 3.3+/-0.9) and 2hours(3.9+/-1.2 vs 3.3+/-0.8)(p<0.05). There were no apparent cases of respiratory depression and motor weakness of lower extrimity. Nausea or vomiting occurred in 7 patients(23%) of IV-PCA group, and occurred in 3 patients(10%) of CEA group. Pruritus occurred in 6 patients(20%) of IV-PCA group, and occurred in 11 patients (37%) of CEA group. Sedation occurred in 9 patients(30%) of IV-PCA group. Conculsions: We conclude that the CEA with small dose of morphine, fentanyl and bupivacaine is an easy and effective method for pain control after cesarean delivery.
Adult ; Analgesia ; Analgesia, Epidural* ; Analgesia, Patient-Controlled* ; Analgesics ; Anesthesia, General ; Bupivacaine ; Drug Delivery Systems ; Female ; Fentanyl ; Humans ; Injections, Intramuscular ; Ketorolac ; Morphine ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Pruritus ; Respiratory Insufficiency ; Respiratory Rate ; Vomiting

No abstract available.
Humans

Torsion of a hernia sac is an extremely rare condition that presents as acute scrotum in children. We report a case of a 6-year-old boy who presented with an acute scrotum and was found during surgical exploration to have torsion of an indirect hernia sac associated with hydrocele. Upon scrotal exploration, deterioration of the scrotum due to inflammatory changes was found. A necrotic cyst was recognized within a communicating hydrocele of the scrotum and was twisted at an angle of about 360degrees. All urologists should be aware of this special condition in the differential diagnosis of acute scrotum.
Child ; Diagnosis, Differential ; Hernia ; Hernia, Inguinal ; Humans ; Scrotum ; Torsion Abnormality

Hemangioma is a benign vascular proliferation. Intramuscular hemangiomas are rare, accounting for less than 1% of all hemangiomas, and occur normally in the trunk and extremities. Approximately 10-20% of intramuscular hemangiomas are found in the head and neck region, most often in the masseter muscles. The typical clinical characteristic is a painful soft tissue mass without cutaneous changes. The suggested treatment is a surgical excision. We report a case of an intramuscular hemagnioma of the masseter muscle. The patient was a 56 year old male who visited our clinic complaining of left facial swelling after 2 years of follow up at a different clinic. After magnetic resonance imaging (MRI), the mass was excised under general anesthesia. The biopsy revealed the mass to be an intramuscular hemangioma. We report the clinical and pathological characteristics as well as the treatment of a case of an intramuscular hemangioma of the masseter muscle.
Accounting ; Anesthesia, General ; Biopsy ; Extremities ; Follow-Up Studies ; Head ; Hemangioma ; Humans ; Magnetic Resonance Imaging ; Male ; Masseter Muscle ; Neck

Fifteen cases of papillary cystic tumor of the pancreas (PCTP) were studied (14 female patients, one male patient; mean age: 23.5 years). Most tumors developed in the head of the pancreas as a well circumscribed large mass. The tumor had a mean diameter of 6.7 cm(range; 2 to 15 cm). Histopathologically abundant delicate papillary fragments, monomorphic tumor cells and degenerative changes of the solid area of the tumor were characteristic. All but two cases had completely circumscribed capsules. Two cases had duodenal invasion; one of all cases had cul de sac metastasis. Compared with 12 non-aggressive tumors, the aggressive cases had larger tumor size (more than 9 cm) with a thicker capsule (more than 2 mm). In studies to investigate the prognostic index using nucleolar organizing region (NOR), proliferating cell nuclear antigen (PCNA) and flow cytometry as well as nuclear grade and mitotic index, we could not find the useful parameter to detect the malignant potential of PCTP. In the flow cytometric analysis of cellular DNA contents, two invasive cases and the only one case of the male patient among the non-aggressive group were aneuploid. In conclusion, although it is hard to predict the prognosis by microscopic findings only, those with a thick capsule and aneuploidy tend to be related to malignant potential.
Adolescent ; Adult ; Cell Division/physiology ; Cystadenoma, Papillary/*chemistry/*pathology ; Female ; Flow Cytometry ; Human ; Immunohistochemistry ; Male ; Nucleolus Organizer Region/chemistry ; Pancreatic Cyst/*chemistry/*pathology ; Pancreatic Neoplasms/*chemistry/*pathology ; Predictive Value of Tests ; Prognosis ; Proliferating Cell Nuclear Antigen/analysis ; Silver Staining ; Support, Non-U.S. Gov't

PURPOSE: To review the feasibility of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end in various distal ureteral lesions. MATERIALS AND METHODS: We conducted a retrospective review of 5 laparoscopic procedures of ureteroneocystostomy with extracorporeal eversion of the ureteral end. Of these, 4 patients (range, 45 to 54 years) had distal ureter stricture or obstruction after gynecological surgeries for endometriosis or a large uterine myoma. One patient (male, 67 years) had low-grade distal ureter cancer. The laparoscopic procedure was combined with cystoscopic insertion of a ureteral stent and extracorporeal eversion of the ureter through the 10-mm port on the affected side. RESULTS: The laparoscopic ureteral reimplantations with and without a psoas hitch in patients with distal ureteral lesions was successful in all patients. The mean operation time was 137 minutes (range, 104 to 228 minutes). Two patients underwent additional psoas hitch. In all patients, short-term success was confirmed by voiding cystourethrography and intravenous pyelography conducted 3 months after the operation. The mean follow-up of the entire group was 12 months (range, 3 to 30 months). We noted no major or minor complications over the follow-up period. CONCLUSIONS: The technique of laparoscopic ureteroneocystostomy for benign or malignant ureteral strictures continues to evolve. Surgeons should be versatile with various options and technical nuances when dealing with these cases. Simple modifications of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end, nonreflux extravesical anastomosis, and simultaneous cystoscopy will be crucial to the ease of performance and a successful outcome.
Constriction, Pathologic ; Cystoscopy ; Endometriosis ; Female ; Follow-Up Studies ; Gynecologic Surgical Procedures ; Humans ; Laparoscopy ; Myoma ; Replantation ; Retrospective Studies ; Stents ; Ureter ; Ureteral Neoplasms ; Urography

BACKGROUND: The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask device with a larger cuff and a drainage tube. This study was designed to assess the usefulness and the safety of the PLMA in a laparoscopic cholecystectomy. METHODS: Forty patients undergoing a laparoscopic cholecystectomy were randomly allocated to two groups; an endotracheal tube (ETT) group or a PLMA group. Anesthesia was induced with intravenous fentanyl and propofol and maintained with TCI-propofol. Blood pressure, heart rate, peak inspiratory pressure, peripheral O2 saturation (SpO2), end-tidal CO2 tension (PETCO2) and PaCO2 was measured during the operation. The incidence of gastric content regurgitation and gross pulmonary aspiration were evaluated. Postoperatively, SpO2, the visual analogue scale (VAS) of pain, nausea and vomiting (PONV), and sore throat were evaluated at 30 minutes intervals in post-anesthetic care unit (PACU) and at night. RESULTS: There were no significant differences in intraoperative PIP, SpO2, PETCO2, postoperative SpO2, VAS scores, PONV, and sore throat between the two groups. Gross pulmonary aspiration was not found in either group, but minimal gastric regurgitation occurred in 2 cases of the ETT group and 1 case of the PLMA group. CONCLUSIONS: We concluded that there were no differences in patient safety and adequate ventilation for a laparoscopic cholecystectomy between the ETT group and PLMA group. Moreover, there were no increases in blood pressure and heart rate in PLMA group during insertion/intubation.
Anesthesia ; Blood Pressure ; Cholecystectomy, Laparoscopic* ; Drainage ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Laryngeal Masks* ; Laryngopharyngeal Reflux ; Nausea ; Patient Safety ; Pharyngitis ; Postoperative Nausea and Vomiting ; Propofol ; Ventilation ; Vomiting

Measurement of arterial preseure, either intermittently or continuously has teen used for almost 100 clears. A prospective study was conducted on 22 patients to compare the accuracy of arterial pressures treasured br a non-invasive (ACCUTORR,ACC) and an invasive (intra-arterial Line, IAL) arterial pressure monitoring systems. Overall, the accuracy or regroducibility of each method, as expressed in the individual variarlce, was shown to be statistically in significant between ACC and IA7. The difference in arterial pressures was particularly marked between ACC and IAL when srstalic BP was either less than 100 mmHg or greater than 140 mmHg.
Adolescent ; Anesthesia* ; Arterial Pressure ; Blood Pressure* ; Humans ; Prospective Studies