BACKGROUND: The afferent and efferent pathways of fentanyl cough response (FCR) and central organization are poorly understood at present. The aim of this study was to investigate the pretreatment effects of morphine, propofol, atropine, and midazolam on FCR. METHOD: The 120 healthy patients were randomly assigned to six equal pretreatment groups. They received 2ug/kg fentanyl rapidly through a peripheral venous catheter. The patients in each group were pretreated before the time necessary for peak plasma levels with different drugs as follows: group 1, no premedication; group 2, morphine 0.05 mg/kg iv; group 3, morphine 0.05 mg/kg iv naloxone 0.01mg/kg iv; group 4, propofol 0.5 mg/kg iv; group 5, atropine 0.01 mg/kg iv; group 6, midazolam 0.05 mg/kg iv. The patients were observed for any coughing or side effects, including oxygen desaturation, bronchoconstriction, chest wall rigidity and seizure. RESULT: 40% of patients in group 1 (control) had a cough response to fentanyl. Group 2 (morphine) and group 3 (morphine naloxone) showed a reduced FCR of 10%. The incidence of coughing was 60% of the patients in group 4 (propofol), 30% in group 5 (atropine), and 40% in group 6 (midazolam). These were not statistically significant. CONCLUSION: FCR is not altered by pretreatment with propofol, atropine, or midazolam, but morphine inhibits cough response and this antitussive effect was not antagonized by naloxone.
Atropine* ; Bronchoconstriction ; Catheters ; Cough* ; Efferent Pathways ; Fentanyl* ; Humans ; Incidence ; Midazolam* ; Morphine* ; Naloxone ; Oxygen ; Plasma ; Premedication ; Propofol* ; Seizures ; Thoracic Wall

BACKGROUND: We observed fentanyl known as centrally-acting antitussive agents provoke a cough response in some patients at induction of anesthesia. This may be of clinical importance. METHOD: 121 patients (ASA class I) were assigned randomly to 4 groups. Each group was given different doses of fentanyll Group 1 (n=30); 0.5ug/kg, Group 2 (n=30); 1ug/kg, Group 3 (n=33); 2ug/kg, Group 4 (n=28); 4 g/kgl, within 1 second through a peripheral venous cannula before induction of anesthesia. All patients were observed carefully in order to detect a cough response and any side effects. RESULT: The incidences of FCR (Fentanyl Cough Response) were 0% in Group 1, 10.0% in Group 2, 30.3% in Group 3, and 39.3% in Group 4. The ED50 of FCR was 4.25ug/kg. The mean onset-time from the end of fentanyl administration to the beginning of coughing was 12.5 seconds. FCR was decreased with aging, but not affected by weight, height, or smoking. Other serious side effects were not accompanied. CONCLUSION: Fentanyl can evoke the pulmonary chemoreflex dose-dependently and the ED50 was 4.25 g/kg.
Aging ; Anesthesia ; Antitussive Agents ; Catheters* ; Cough* ; Fentanyl* ; Humans ; Incidence ; Reflex* ; Smoke ; Smoking

PURPOSE: While conventional hemorrhoidectomy is notorious for postoperative pain, stapled hemorrhoidopexy has been reported less painful because it has no anal wound. However, the safety of stapled hemorrhoidopexy is not established completely yet. Therefore, the purpose of this study is to evaluate the safety of stapled hemorrhoidopexy through analyzing the postoperative complications. METHODS: The author analyzed the complications of 63 patients treated with stapled hemorrhoidopexy by reviewing the medical records. All of the operations were performed by one surgeon. RESULTS: There were 39 men and 24 women with a mean age of 47.7 years. The majority of cases were carried out under spinal anesthesia except 4 cases of general anesthesia. The combined operations were performed in 16 cases (25.4%) including skin tag excision, external hemorrhoid excision, and polypectomy. The postoperative complications were 2 cases (3.2%) of rectal stenosis, 1 case (1.6%) of thrombosis, 1 case (1.6%) of abscess, and 1 case (1.6%) of late bleeding. Three patients were needed to rehospitalized and reoperation was needed in 1 case of thrombosis. One case of rectal stenosis was treated easily by manual dilatation. However, the other rectal stenosis was treated by Hega dilatation. CONCLUSION: Complications after stapled hemorrhoidopexy may be different from complications after conventional hemorrhoidectomy. However, most of the complications after stapled hemorrhoidopexy can be avoided by respecting the rectal wall anatomy during the procedure. Therefore, in terms of postoperative complications, the stapled hemorrhoidopexy may be a safe procedure.
Abscess ; Anesthesia, General ; Anesthesia, Spinal ; Constriction, Pathologic ; Dilatation ; Female ; Hemorrhage ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Male ; Medical Records ; Pain, Postoperative ; Postoperative Complications ; Reoperation ; Skin ; Thrombosis ; Wounds and Injuries

V.parahaemolyticus or V.alginolyticus infections are usually associated with consumption of raw or undercooked shellfish, contaminated food, and exposure of wounds to warm seawater. V.parahaemolyticus causes gastroenteritis(the most common syndrome), wound infections, and septicemia. V alginolyticus occasionally causes extraintestinal infections in humans. so far, the authors have not found the report of V.parahaemolyticus and V.alginolyticus isolation from a patient. So, we report a case of concurrent isolation of V.parahaemolyticus and V.alginolyticus from a patient who had a history of intestinal diarrhea and vomiting.
Diarrhea ; Humans ; Seawater ; Sepsis ; Shellfish ; Vibrio alginolyticus* ; Vibrio parahaemolyticus* ; Vibrio* ; Vomiting ; Wound Infection ; Wounds and Injuries

V.parahaemolyticus or V.alginolyticus infections are usually associated with consumption of raw or undercooked shellfish, contaminated food, and exposure of wounds to warm seawater. V.parahaemolyticus causes gastroenteritis(the most common syndrome), wound infections, and septicemia. V alginolyticus occasionally causes extraintestinal infections in humans. so far, the authors have not found the report of V.parahaemolyticus and V.alginolyticus isolation from a patient. So, we report a case of concurrent isolation of V.parahaemolyticus and V.alginolyticus from a patient who had a history of intestinal diarrhea and vomiting.
Diarrhea ; Humans ; Seawater ; Sepsis ; Shellfish ; Vibrio alginolyticus* ; Vibrio parahaemolyticus* ; Vibrio* ; Vomiting ; Wound Infection ; Wounds and Injuries

Fecal incontinence is a common disorder, affecting all ages and both sexes. It is a devastating condition and has a major impact on quality of life. The level of treatment must be appropriate for the severity of symptoms. Nonsurgical techniques are appropriate for patients with minor degrees of incontinence. Patients with sphincter disruption or rectal prolapse can benefit from the appropriate surgical therapy. Patients with intractable, clinically significant fecal incontinence, caused by trauma or the failure of surgical therapy, need salvage options. In the past if a patient was not amenable to a tissue repair or failed a tissue repair, a colostomy was his or her only surgical option. However, new innovations can give patients more options to regain continence. The artificial bowel sphincter (ABS) is one of those newer options. It is an implantable device used to treat the patients with severe fecal incontinence, who have failed, or are not candidates for less invasive forms of restorative therapy. It is intended to mimic the natural process of bowel control. This device is reserved for patients with severe fecal incontinence that is not amenable to lesser forms of therapy. Because it is an artificial device, ABS is unfortunately associated with high morbidity and low success rate. With experience, however, the infection rate has declined due to new standardized prophylactic antibiotics regimen. Therefore, the ABS has become a good option for patients with severe fecal incontinence. The results are quite impressive with a significant number of patients obtaining complete continence. This review presents the technique of ABS implantation and the current status of ABS.
Anti-Bacterial Agents ; Colostomy ; Fecal Incontinence* ; Humans ; Quality of Life ; Rectal Prolapse

No abstract available.
Neurofibromatoses* ; Pseudarthrosis* ; Ulna*

Real-time ultrasonogram was performed in 31 Pt. with CHPS, who was admitted at the pediatric department of Wonkwang University hospital from January 1991 to June 1993. Those who had positive results of pyloric volume for diagnosis of CHPS and were confirmed by surgery. The results were at follows: 1) The average ultrasonographic measurements of pyloric muscle thickness, pyloric diameter, pyloric length were 4.9+/-1.09mm, 14.42+/-2.69mm, 19.17+/-2.37mm, and pyloric volume was 3.26+/-1.39ml. 2) The diagnostic reliabilities with the ultrasonographic measurements of muscle thickness (>4mm), pyloric diameter (>12mm) and pyloric length (>15mm) by Stunden's criteria in 31 cases were compared, which were not significant difference among them. 3) In ultrasonographic measurements of 31 cases for diagnosis of CHPS, positive results with 3 parameters were 80.6% and with 2 parameters and double tract signs were 87.1%. So. we conclude pyloric volume greater than 1.4ml was the most reliable parameter, which was satisfied 100% with diagnosis of CHPS.
Diagnosis* ; Pyloric Stenosis, Hypertrophic* ; Ultrasonography

No abstract available.
Rectal Neoplasms

No abstract available.
Acetylcholinesterase* ; Aluminum* ; Animals ; Brain* ; Choline O-Acetyltransferase* ; Choline* ; Rats*