BACKGROUND: The addition of various opioids to 0.5% hyperbaric bupivacaine intrathecally seems to potentiate analgesic effects of bupivacaine and to prolong the duration of analgesia. We compared the effect of intrathecal meperidine 0.25 mg/kg and 0.5 mg/kg, fentanyl 0.15 microgram/kg, and placebo when administered together with 0.5% hyperbaric bupivacaine 9 mg for cesarean section. METHODS: Forty-four healthy term parturients were randomly allocated (n = 11 per group) to receive the test solution (1 ml) containing preservative-free normal saline (control group), fentanyl 0.15 microgram/kg, meperidine 0.25 mg/kg, or meperidine 0.5 mg/kg intrathecally, immediately followed by the injection of 0.5% hyperbaric bupivacaine 9 mg. We observed the effective postoperative analgesic duration (time to VAS > or = 4), quality of anesthesia and side effects. RESULTS: The effective postoperative analgesic duration significantly increased in the groups receiving opioid compared with the control group (P < 0.05); control group 101.4 +/- 28.6 min; fentanyl group 192.3 +/- 29.2 min; meperidine 0.25 mg/kg group 208.8 +/- 21.7 min; meperidine 0.5 mg/kg group 289.8 53.6 min (data expressed as mean +/- SD). The quality of anesthesia was excellent in 100% of the meperidine group but in 82% of the fentanyl group and 91% of the control group. The incidence of nausea and vomiting were higher in the meperidine 0.5 mg/kg group (73%) than in the remaining groups (P < 0.05). CONCLUSIONS: The addition of fentanyl 0.15 microgram/kg or meperidine 0.25 mg/kg to 0.5% hyperbaric bupivacaine 9 mg for spinal anesthesia improves intraoperative analgesia and provides analgesia into the immediate postoperative period with no adverse effects on mother or neonate.
Analgesia ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Spinal ; Bupivacaine* ; Cesarean Section* ; Female ; Fentanyl* ; Humans ; Incidence ; Infant, Newborn ; Meperidine* ; Mothers ; Nausea ; Postoperative Period ; Pregnancy ; Vomiting

PURPOSE: The overuse of ciprofloxacin has recently increased the resistance of the Escherichia coli(E. coli). We studied the prevalence od the ciprofloxacin-resistant(CR) E. coli that were isolated from female patients with community-acquired urinary tract infection(CAUTI), and we demonstrated the resistant rate to other antibiotics to help physicians choose the suitable antibiotics to properly treat CAUTI. MATERIALS AND METHODS: From January 2006 to December 2007, we retrospectively analyzed 910 female patients with CAUTI. Among them, we chose 387 patients infected by E. coli and we evaluated the resistance rate to ciprofloxacin and its relationship with age, the disease causing the UTI and the previous antibiotics. We also compared the resistance to ciprofloxacin with that of other antibiotics, including cephalosporin and the other antibiotics recommended by the guidelines of the Infectious Diseases Society of America(IDSA). RESULTS: The incidence of UTI by E. coli increased with age(p<0.001), and it was highest in the 7th decade (59.0%). One hundred seventeen (30.2%) patients showed ciprofloxacin resistance. It was significantly related to an increased age(p=0.034), complicated UTI(p=0.04) and a previous history of antibiotic use(p=0.023). Trimethoprim/sulfamethoxazole(TMP/SMX) and fosfomycin showed similar resistance rates like ciprofloxacin; 31.8 and 28.2%, respectively. On the other hand, nitrofurantoin showed a low resistant rate of 5.7%. The resistance to cephalosporin was low in general; the lowest was cefepime(5.9%). CONCLUSIONS: Our results imply that the empirical use of ciprofloxacin for female patients with CAUTI is questionable, and especially for patients older than 40 years old, patients with complicated UTI and patients with a previous history of antibiotic use. Nitrofurantoin and cephalosporin can be useful agents for the treatment of female CAUTI.
Anti-Bacterial Agents ; Ciprofloxacin ; Communicable Diseases ; Community-Acquired Infections ; Drug Resistance, Bacterial ; Escherichia ; Escherichia coli ; Female ; Fosfomycin ; Hand ; Humans ; Incidence ; Nitrofurantoin ; Prevalence ; Retrospective Studies ; Urinary Tract ; Urinary Tract Infections

PURPOSE: Early gastric cancer (EGC) is defined as gastric cancer confined to the mucosa or submucosa, regardless of lymph node (LN) metastasis. The prognosis of EGC is more favorable than that of advanced gastric cancer. Due to the variety of prognosis of EGC, in relation to LN metastasis, this study was undertaken to determine the impact of LN metastasis on the survival of patients with EGC, and to aid in planning therapeutic approaches for such patients. METHODS: A retrospective study of 517 patients with EGC, who had undergoing a gastrectomy with lymphadenectomy, between 1990 and 1999 was performed. Stages were classified using the UICC TNM classification (1997). RESULTS: LN metastasis was observed in 67 cases (13.0%). 6.7% (17/288) of the EGC within the mucosa, and 19.0% (50/281) within the submucosa, had LN metastasis. The overall Five-year survival rates (5YSR) of 517 EGC patients was 95.5%, and for the EGC patients in N0, N1, N2 and N3 groups were 98.3, 82.2, 27.8 and 0%, respectively (P<0.001). The 5YSRs for patients with mucosal and submucosal cancers were 98.9 and 92.4%, respectively (P= 0.023), and was poorer in those EGC patients with tumor sizes above 5 cm than in those below 5 cm (5YSR 96.3 and 86.7%, respectively. P=0.020). However, the survival rates for EGC patients did not differ significantly based on the gross and histological types. The 5YSR for EGC patients with stage IA, IB, II and IV were 98.3, 82.1, 40.0 and 33.3%, respectively (P<0.001). LN metastasis and depth of invasion were found to be significant risk factor from the multivariate analysis. CONCLUSION: Based on the results of this study, the significant prognostic factors of EGC were LN metastasis and depth of invasion. Although the prognosis of EGC is favorable, it depends upon the prognostic factors.
Classification ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Mucous Membrane ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis* ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms* ; Survival Rate

Background: Postoperative sore throat is a complaint after general anesthesia of multifactorial etiology. The laryngeal mask airway (LMA) reduces sore throat and discomfort during maintenance of the airway and make patients more comfortable. The purpose of this study was to compare effect of patient's position during operation on postoperative sore throat after the use of LMA. Methods: The fifty three patients were randomly divided into two groups. Group 1 (n=30) was underwent general anesthesia with supine position and group 2 (n=23) with prone position. After the LMA was positioned in the hypopharynx and the cuff inflated, fiberoptic laryngoscope was immediately passed down through the LMA. Number of attempts, degree of postoperative sore throat and other complications were also noted. Results: The incidence of postoperative sore throat after the use of LMA was 10% in supine position and 4% in prone position. But the difference between the groups was not statistically significant. All of the reported sore throats were rated as mild. Conclusions: Postoperative sore throat after the use of LMA is mild and the incidence is not affected by the prone position during the operation.
Anesthesia, General ; Humans ; Hypopharynx ; Incidence ; Laryngeal Masks* ; Laryngoscopes ; Pharyngitis* ; Prone Position* ; Supine Position

OBJECTIVE: The purpose of this study was to evaluate the influence of intraoral temperature changes on the orthodontic force level of a superelastic nickel-titanium alloy wire. METHODS: Nickel-titanium archwires of 0.016" x 0.022" thickness were tested with a three point bending test setup, and temperature changes were applied. The force level changes according to temperature changes were measured at a 1.5 mm deflection during the loading phase and a 1.5 mm deflection during the unloading phase from a deflection to 3.1 mm. Ten cycles of thermal cycling from baseline (37 degrees C) to cold (20 degrees C) or hot (50 degrees C) temperature were applied. RESULTS: After thermal cycling, the force level during the loading phase decreased and the force level during the unloading phase increased even after the temperature was changed to the initial 37 degrees C. CONCLUSIONS: The results suggest that the orthodontic force level can not return to the initial force level after temperature changes. When applying superelastic nickel-titanium archwires, we must consider that a lighter force than the loading force and a heavier force than the unloading force will be applied after intraoral temperature changes caused by eating and drinking.
Alloys ; Drinking ; Eating

OBJECTIVE: Periodontal ligament fibroblasts have an ectomesenchymal origin and are thought to play a crucial role for not only homeostasis of periodontal tissues but also bone remodeling, wound healing and regeneration of tissues. Recently, it has been reported that UNC-50 is not expressed in gingival fibroblasts but in PDL fibroblasts. The purpose of this study was to examine the expression of UNC-50 and osteocalcin in the periodontium after application of intermittent force. METHODS: Twelve rats had 40 grams of mesially-directed force applied at the upper molar for 1 hour/day. Four rats were sacrificed at 1, 3 and 5 days. Immunohistochemical localization of UNC-50 and osteocalcin antibody was carried out. The results showed apposition of new cellular cementum and a slight increase in periodontal space at the tension side. RESULTS: Strong UNC-50 expression was observed in the differentiating cementoblasts close to PDL fibroblasts in the tension side whereas it was barely expressed at the compression side. Expression was strong at day 3, and decreased at day 5. Osteocalcin immunoreactivity expression was strong in differentiating cementoblasts at the tension side. CONCLUSION: It can be suggested that UNC-50 is related to the differentiation of cementoblasts, and may be responsible for the molecular event in PDL cells under mechanical stress.
Animals ; Bone Remodeling ; Dental Cementum ; DNA* ; Fibroblasts ; Homeostasis ; Molar ; Osteocalcin ; Periodontal Ligament ; Periodontium ; Rats* ; Regeneration ; Stress, Mechanical ; Wound Healing

Purpose: Proper use of antibiotics during emergency abdominal surgery is essential in reducing the incidence of surgical site infection. However, no studies have investigated the type of antibiotics and duration of therapy in individuals with abdominal trauma in Korea. We aimed to investigate the status of initial antibiotic therapy in patients with solitary abdominal trauma. Methods: From January 2015 to December 2015, we retrospectively analyzed the medical records of patients with solitary abdominal trauma from 17 institutions including regional trauma centers in South Korea. Both blunt and penetrating abdominal injuries were included. Time from arrival to initial antibiotic therapy, rate of antibiotic use upon injury mechanism, injured organ, type, and duration of antibiotic use, and postoperative infection were investigated. Results: Data of the 311 patients were collected. The use of antibiotic was initiated in 96.4% of patients with penetrating injury and 79.7% with blunt injury. Initial antibiotics therapy was provided to 78.2% of patients with solid organ injury and 97.5% with hollow viscus injury. The mean day of using antibiotics was 6 days in solid organ injuries, 6.2 days in hollow viscus. Infection within 2 weeks of admission occurred in 36 cases. Infection was related to injury severity (Abbreviated Injury Scale of >3), hollow viscus injury, operation, open abdomen, colon perforation, and RBC transfusion. There was no infection in cases with laparoscopic operation. Duration of antibiotics did not affect the infection rate. Conclusion Antibiotics are used extensively (84.2%) and for long duration (6.2 days) in patients with abdominal injury in Korea.

We experienced a case of mitral incompetence due to rupture of anterolateral papillary muscle in a 56-year-old male who complained of abdominal pain and mild dyspnea after being struck by car. Clinical manifestation immediately following injury was minimal, but heart failure progressed rapidly 3 days after injury. Echocardiopraphic evaluation revealed ruptured anterolateral papillary muscle and severe mitral regurgitation on color flow imaging. There was no evidence of coronary artery disease on coronary angiography. Operation revealed that the haed of anterolateral papillary muscle was torn out of its insertion. Mitral valve replacement with mechanical prosthesis was performed on the 50th day after injury.
Abdominal Pain ; Coronary Angiography ; Coronary Artery Disease ; Dyspnea ; Heart Failure ; Humans ; Male ; Middle Aged ; Mitral Valve ; Mitral Valve Insufficiency ; Papillary Muscles* ; Prostheses and Implants ; Rupture* ; Thorax*

PURPOSE: Anastomotic leakage following surgery is one of the most significant causes of morbidity and mortality. Therefore, prevention of anastomotic leakage is crucial for safe rectal surgery. The aim of this study is to determine the effect of Mallecot(R) insertion on the prevention of anastomotic leakage after low rectal anastomosis. METHODS: From January 2002 to December 2006, 264 rectal cancer surgeries were performed in one center and by one surgeon. Among them, 110 cases whose anastomosis was located below 6 cm from the anal verge were collected and reviewed retrospectively. We made a diverting stoma on 6 out of 20 patients with high risk of anastomotic leakage, and inserted Mallecot(R) on the remaining 14 patients transanally. Removal of Mallecot(R) was done at the 7th postoperative day after a digital rectal examination to identify the completeness of anastomosis had been performed. RESULTS: Totally, anastomotic leakage occurred in 8 of 110 patients (73%). Among the 90 patients without any preventive measures, 7 incidents of anastomotic leakage were observed; on the other hand, 1 of 14 patients with Mallecot(R) insertion suffered anastomotic leakage. In two of the patients with leakage, including 1 in the Mallecot(R) group, the leakage was resolved via percutaneous drainage; in the other 6 patients were reoperated. CONCLUSIONS: The importance of preventing an anastomotic leakage after low rectal surgery cannot be overemphasized to reduce morbidity and to improve the prognosis. In addition, Mallecot(R) insertion may be an alternative method for diverting stoma formation.
Anastomotic Leak ; Digital Rectal Examination ; Drainage ; Hand ; Humans ; Mortality ; Prognosis ; Rectal Neoplasms ; Retrospective Studies

No abstract available.
Death, Sudden, Cardiac* ; Resuscitation*