BACKGROUND: Epidural administration of morphine is a common method for postoperative analgesia in the lower abdominal surgery, but many complications can be produced. Since the pfannenstial incision lies within L1 dermatome, bilateral ilioinguinal and iliohypogastric nerve blocks(IINB) should provide analgesia after surgery through that incision. METHODS: Forty patients undergoing cesarean delivery or total abdominal hysterectomy(TAH) through a pfannenstiel incision were randomly assigned to one of two groups: epidural morphine group(n=20) received 3 mg of morphine epidurally after surgery with epidural anesthesia; IINB group(n=20) performed IINB with 0.5% bupivacaine, 10 ml to each side after surgery with general anesthesia. Visual analogue scale(VAS) scores at resting and moving state, and complications were checked at 0, 2, 4, 8, 12, 24 hours after surgery. RESULTS: Postoperative VAS scores did not show significant differences between the two groups at rest after 0, 2, 4, 8, 12, 24 hours and at moving state after 0, 2, 4 hours, but IINB group had less pain with movement than epidural morphine group at 8, 12, 24 hours after surgery(p<0.05). The incidence of pruritus was rare in IINB group(P<.05), but incidences of other complications were not significantly different between the two groups. CONCLUSIONS: IINB is effective for analgesia after surgery through a pfannenstiel incision because of a lower incidence of complications and less postoperative pain with movement than epidural morphine, and can be performed to patients who have contraindications and difficulty for epidural analgesia.
Analgesia* ; Analgesia, Epidural ; Analgesics ; Anesthesia, Epidural ; Anesthesia, General ; Bupivacaine ; Humans ; Incidence ; Morphine ; Nerve Block* ; Pain, Postoperative ; Pruritus

BACKGROUND: Postoperative nausea and vomiting are common postoperative complaints. The purpose of this study was to assess the effect of preoperative midazolam on vomiting after appendectomy. METHODS: Sixty patients, aged 10 64 yr, undergoing emergency appendectomy were randomly allocated to receive midazolam 30, 50, 75 microgram/kg or placebo after induction of anesthesia. Anesthesia consisted of 67% nitrous oxide, 33% oxygen and propofol infusion 6 10 mg/kg/h. Postoperative vomiting was checked by the recovery room nurse at 1 h after operation and we examined the incidence of postoperative vomiting at 24 h after operation. RESULTS: Midazolam reduced the overall incidence of vomiting, especially in the midazolam 50 and 75 microgram/kg groups, completely abolishing vomiting (P< 0.05). However, in the midazolam 75 microgram/kg group, there was a delay in eye opening time (P< 0.05). CONCLUSIONS: Preoperative injections of midazolam 30 or 50 microgram/kg were useful to prevent postoperative vomiting in patients undergoing appendectomy without delayed recovery.
Anesthesia ; Antiemetics* ; Appendectomy* ; Emergencies ; Humans ; Incidence ; Midazolam* ; Nitrous Oxide ; Oxygen ; Postoperative Nausea and Vomiting ; Propofol ; Recovery Room ; Vomiting

Cerebral vasospasm is one of most serious complication after subarachnoid hemorrhage due to aneurysmal rupture and a very important cause affecting to prognosis. The most reliable diagnostic assessment of cerebral vasospasm is angiography, but this is limited to perform because of complications such as neurological deficits or death, especially to repeat studdy. It seems likely that assessment of evoked elective, a much simpler and safer than the repeated study of angiography, will be of use in following the condition of patients with clinical vasospasm following SAH. In order to study relationship between clinical vasospasm and electrical activity, we traced SSEP from upper extremity by median nerve stimulation and lower extremity by posterior tibial stimulation which manifest the neurophysiologic function of cerebral ischemia. MN(Me-dian n.) and PTN(Posterior tibial n.)were performed simultaneously. Over 2 years period (1986 through 1988), 41 patients were performed SSEP and evaluated the relationship between SSEP and clinical or angiographic vasospasm in patients of SAH.
Aneurysm ; Angiography ; Brain Ischemia ; Humans ; Lower Extremity ; Median Nerve ; Prognosis ; Rupture ; Subarachnoid Hemorrhage ; Upper Extremity ; Vasospasm, Intracranial

BACKGROUND: For many drugs, dosing scalars such as ideal body weight (IBW) and lean body mass are recommended over the use of total body weight (TBW) during weight-based dose calculations. Doses based on TBW are frequently used, and this may cause under- or over-dosing. Because dexmedetomidine (DEX) overdosing could increase the incidence of side effects, and spinal anesthesia may increase sensitivity to a sedative agent, determining an appropriate dose is critical. METHODS: Eighty patients were randomly divided into 2 groups, the IBW and TBW groups. Patients received a loading dose of DEX 1 µg/kg IBW or TBW for 10 min, followed by a continuous infusion at 0.5 µg/kg/h IBW or TBW after the induction of spinal anesthesia. The patients' vital signs, bispectral index (BIS), peripheral capillary oxygen saturation, time to reach a BIS of 80, airway obstruction score, and coughing were monitored and recorded at 0, 10, 30, and 50 min after the start of the loading dose injection. RESULTS: The changes in BIS, airway obstruction score, the incidence of side effects, and time to reach a BIS of 80 did not show statistically significant differences between the two groups. However, airway obstruction and/or coughing occurred in both groups, and the average BIS in both groups was lower than the target BIS of 60-80 at 30 and 50 min. CONCLUSIONS: A loading dose of DEX 1 µg/kg for 10 min, and a maintenance dose of DEX 0.5 µg/kg/h of either IBW or TBW, may induce excessive sedation, airway obstruction, and/or coughing under spinal anesthesia.
Airway Obstruction* ; Anesthesia, Spinal* ; Body Weight ; Capillaries ; Consciousness Monitors ; Cough ; Dexmedetomidine* ; Humans ; Ideal Body Weight ; Incidence ; Oxygen ; Vital Signs

Among exocrine pancreatic tumors, adenosquamous carcinoma is a rare, aggressive subtype with a poor prognosis and a high potential for metastases compared with its more conventional glandular counterpart, adenocarcinoma of the pancreas. We herein describe the imaging findings of pancreatic adenosquamous cell carcinoma with solitary liver metastasis showing different imaging features and also review the previous literature to recognize characteristic imaging features of pancreatic adenosquamous cell carcinoma.
Adenocarcinoma ; Carcinoma, Adenosquamous ; Liver* ; Neoplasm Metastasis* ; Pancreas ; Prognosis

PURPOSE: The purpose of the study was to develop and evaluate the effect of a metabolic syndrome prevention program using mobile application for university students. METHODS: A pretest-posttest design with content analysis as a triangulation method was used. The participants were 49 university students. Data were analyzed using descriptive statistics, chi2-test, t-test and Fisher's exact test with the SPSS WIN 18.0 program. RESULTS: The application consisted of six main menus as follows: 'basic education', 'nutrition education', 'exercise education', 'meal diary', 'exercise checkup', and 'tips'. The experimental group had higher recognition about metabolic syndrome prevention than the control group (F=7.919, p=.007). Understanding of metabolic syndrome among participants was mostly related to chronic diseases such as obesity, hypertension and diabetes in relation to the importance of eating habits and exercising. CONCLUSION: The results indicate that metabolic syndrome prevention education using mobile application is necessary and would be useful for university students.
Chronic Disease ; Eating ; Education ; Humans ; Hypertension ; Mobile Applications* ; Obesity

BACKGROUND: Ketamine produces increasing in heart rate and arterial blood pressure, in vivo. However, the direct effects of ketamine itself on the porcine coronary arteries are not well determined. In this study, the direct effects of ketamine on the porcine coronary artery responses to vasoactive agents that operate through Ca2+ channel, K+ channels and endothelium related mechanisms were investigated, in vitro. METHODS: Adult porcine hearts(n=12) were obtained from a slaughter house. Coronary arteries were perfused and dissected with 4oC Krebs solution, and were cut into vessel rings and prepared with and without the endothelium(3~4mm in length). The ring segments were suspended in tissue bath(5ml) filled with Krebs solution at 37oC and bubbled with 95% O2-5% CO2 gas mixture. The effect of ketamine(5 10 5, 10 4, 2 10 4M) on vascular smooth muscle tone caused by Ca2+[voltage operated channel(VOC), receptor operated channel(ROC)] and K+channels(Ca2+activated K+ currents, ATP-sensitive K+ currents) regulation were studied with Ca2+ free solution and K+channel blocker. RESULTS: Ketamine induced vasorelaxation of porcine coronary rings that were precontracted by KCl(50 mM) or acetylcholine(3 10 7M). The changes of vascular tone in endothelium intact and removed group did not show statistical significance. In ketamine pretreated group(Ca2+ free solution), after ketamine pretreatment, the last vascular tone was same as that relaxed by ketamine. The other group that without pretreatment of ketamine, the last vascular tone was same as that precontracted with KCl or acetylcholine. In the TEA pretreated group, the porcine coronary artery relaxation was reversed. However, pretreatment with glybenclamide, the porcine coronary artery relaxation was not reversed. CONCLUSIONS: Ketamine induced vasorelaxation of the porcine coronary artery as concentration relating manner, in vitro. The vasorelaxation induced by ketamine was not associated with endothelium. Furthermore, an antagonism of Ca2+ channels(VOC, ROC) and activation of Ca2+ activated K+ channels may be responsible for the porcine coronary arterial relaxing effect of ketamine.
Acetylcholine ; Adult ; Anesthetics ; Arterial Pressure ; Arteries ; Coronary Vessels* ; Endothelium ; Glyburide ; Heart Rate ; Humans ; Ion Channels ; Ketamine* ; Muscle, Smooth, Vascular ; Pharmacology ; Potassium Channels, Calcium-Activated ; Relaxation ; Tea ; Vasodilation

BACKGROUND: Amrinone is a noncatecholamine, nonglycoside compound, which is known to possess both cardiac inotropic and vasodilatory actions. This drugs has been increasingly used in clinical practice for the management of low cardiac output syndrome during anesthesia, particularly for patients associated with right heart failure and pulmonary hypertension. The aim of this study was to explore the direct vasoactive effect of amrinone and its action mechanisms in the isolated rabbit pulmonary artery. METHODS: The rabbits' pulmonary arteries were dissected free and cut into rings (3 4 mm) and mounted for isometric tension in a tissue chamber. The effects of amrinone (5 10 6 5 10 4 M) on the vascular tension were assessed in the by KCl (40 mM)- or norepinephrine (NE, 10 6 M)- precontracted pulmonary arterial rings with or without endothelium. Also effects of K channel blockers (tetraethyl ammonium 20 mM, glybenclamide 2.5 10 5 M, 4-aminopyridine (4-AP) 5 10 4 M), protein kinase A & G inhibitor (H8), L-NAME, methylene blue and indomethacin on the amrinone- induced vascular responses were investigated. Also studied was effects of amrinone on the Ca2 influx through voltage operated channel (VOC) and receptor operated channel (ROC) of the vascular cells. RESULTS: Amrinone produced vasorelaxation of KCl- or NE-precontracted pulmonary artery in a dose-dependent fashion. The amrinone-induced vasorelaxation was not affected by the denudation of the endothelium. Pretreatment with L-NAME and methylene blue did not affect the vasodilatory effect of amrinone, suggesting that nitric oxide is not involved. Following pretreatment with indomethacin (a cyclooxygenase inhibitor) or K channel blockers, the amrinone-induced vasorelaxation was not altered. After exposure to Ca2 free solution, amrinone attenuated the KCl- or NE-induced contraction even in the presence of Ca2 , implying that VOC and ROC are blocked by amrinone. On the other hand, protein kinase A blocker (H8) completely abolished the amrinone-induced relaxation in the KCl-precontracted pulmonary artery. CONCLUSIONS: These findings suggest that the amrinone-induced vasorelaxations result from inhibition of VOC and ROC as well as from the activation of protein kinase A in the isolated rabbit pulmonary artery.
4-Aminopyridine ; Ammonium Compounds ; Amrinone* ; Anesthesia ; Cardiac Output, Low ; Cyclic AMP-Dependent Protein Kinases ; Endothelium ; Glyburide ; Hand ; Heart Failure ; Humans ; Hypertension, Pulmonary ; Indomethacin ; Methylene Blue ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Norepinephrine ; Prostaglandin-Endoperoxide Synthases ; Pulmonary Artery* ; Relaxation ; Vasodilation

OBJECTIVES: This study was conducted naturalistically in order to observe the long-term effects of attention-deficit hyperactivity disorder (ADHD) medications on growth rates among Korean school-aged boys with ADHD. METHODS: Participants in the study were boys with ADHD aged 6 to 11 years who have taken ADHD medication, methylphenidate (extended release) or atomoxetine. They attended scheduled visits monthly or bimonthly for clinical assessment with measurement of height and weight. In this study, 35 boys with ADHD (mean age at baseline=7.90+/-1.77 years ; mean age at endpoint= 12.54+/-1.91 years) were included, with a mean follow-up period of 4.64 years (+/-1.62 years), ranging from 2 to 9.7 years. Height, weight, and body mass index (BMI) measurements were converted to "age-corrected Z-scores" using data from Growth Charts provided by the Korean Center for Disease Control and Prevention from 2007. RESULTS: Age-corrected endpoint growth parameters (height, weight, BMI Z-scores) did not differ significantly from the baseline values (height t=0.027 ; weight t=-0.61 ; BMI t=-1.86, in paired t-test). Especially high correlation was observed between the baseline and endpoint height Z-scores (r=0.876, p<.001), for which the coefficient of determination r2 was 0.767, meaning that the amount of variability in endpoint height Z-scores explained by the baseline height Z-scores was 76.7%. CONCLUSION: Our results suggested that the long-term effects of ADHD medications on growth parameters to be tolerable in Korean school-aged boys with ADHD.
Body Mass Index ; Centers for Disease Control and Prevention (U.S.) ; Drug Therapy ; Follow-Up Studies ; Growth Charts ; Methylphenidate ; Atomoxetine Hydrochloride

BACKGROUND: According to the report that KCNK activity in transfected COS-7 and HEK-293 cells was modulated by volatile anesthetics and activation of KCNK channels by neuroprotectants, the importance of KCNK2 were emphasized. In this study, we studied the effect of halothane and isoflurane on KCNK2 in the KCNK2 transfected HEK-293 cells. METHODS: Multiple patch clamp experiments with halothane and isoflurane were conducted to characterize KCNK2 in the KCNK2 transfected HEK-293 cells. KCNK2 cDNA were transiently transfected with FuGENE6 transfection reagents and whole cell recordings were made using predesigned pulse protocol. RESULTS: KCNK2 transfected HEK cells exhibited rapid rising, a time-independent, non-inactivating, outward-rectifying currents and had no threshold for activation by voltage. Multiple patch clamp experiments showed the presence of outward-rectifying K+ selective channels with a conductance of 1.31 +/- 0.59 nS (n = 16) at positive potentials. Recordings of halothane 448microM (-2 MAC) increased outward currents from control by 218% in standard saline perfusate (n = 4, P<0.05, paired t-test) and that of isoflurane 822microM (-3 MAC) increased outward currents by 172% in standard saline perfusate (n = 12, P<0.05, paired t-test). Channel activity enhanced during the duration of the exposure to volatile anesthetics returned to the baseline quickly upon wash. CONCLUSIONS: Considering the activation of KCNK2 by neuroprotectants such as riluzole and PUFA, we might think of the possibility of halothane and isoflurane as neuroprotectants because these anesthetics activated background K+ channels in KCNK2 transfected HEK-293 cells.
Anesthetics ; DNA, Complementary ; Halothane* ; Indicators and Reagents ; Isoflurane* ; Neuroprotective Agents ; Riluzole ; Transfection