BACKGROUND: Caudal anesthesia is considered a safe and reliable anesthetic technique for many pediatric surgical procedures. It is well known that extradural clonidine produces analgesia in adult. The purpose of this study is to assess its efficacy in children. METHODS: We randomized 45 pediatric patients aged under 10 years, weighted under 25 kg presented for lower abdominal surgery with duration of operation would be shorter than 2 hours, into three groups of 15 each. After sedation with the use of intravenous thiopental sodium, caudal anesthesia was performed with the use of 1 mL/kg of 0.25% bupivacaine. We allocated randomly the patients who received no additional medication in 0.25% bupivacaine (group I), with epinephrine 1/200,000 (group II), and with 1 mcg/kg of clonidine (group III). The degree of postoperative analgesia was evaluated using the Broadman ""Objective Pain/discomfort Scale"" (OPS) at hourly intervals for 24 hours. RESULTS: Duration of sleep in the recovery room was significantly longer in group III than in group I and group II, and statistical significant difference was found between the group I and group II. Duration of analgesia was significantly longer in group III than in group I and group II. Overall hourly OPS scores were lower in group III than in group I and group II. CONCLUSION: Duration of postoperative analgesia with caudal bupivacaine was increased by addition of 1 mcg/kg of clonidine.
Adult ; Analgesia ; Anesthesia, Caudal* ; Bupivacaine ; Child ; Clonidine* ; Epinephrine ; Humans ; Recovery Room ; Thiopental

Primary pyogenic psoas abscess is rare lesion, and often is not suspected. Reasons for delayed diagnosis are unfamility with the lesion and the fact that symptoms often resemble those of primary disease of the hip. We present a case of primary pyogenic psoas abscess in child, which was diagnosed by MRI, and completely recovered after surgical treatment.
Child ; Delayed Diagnosis ; Hip ; Humans ; Magnetic Resonance Imaging ; Psoas Abscess

Fracture healing in the hand is not an isolated goal. The functional end result is of paramount importance. When the correct techniques are used, miniplate fixation for metacarpal and phalangeal fractures of the hand provides rigid internal fixation, stabilizes the skeleton, preserves the gliding tissue, and therefore allowing immediate active range of motion exercise as well as minimizing joint and tendon complications. The authors have reviewed 39 patients, 52 cases of metacarpal and phalangeal fractures of the hand which were treated with miniplate in the department of orthopaedic surgery, Chang Ang Gil hospital from Sep. 1989 to Feb. 1993. The following results were obtained. 1. Miniplate fixation, in terms of fracture reduction and maintenance, allows on accurate anatomic reduction with rigid fixation which in turn affords on early mobilization without loss of reduction alignment. 2. The roentgenographic union was obtained within 15.1 weeks in average. The mean total acitve motion at the fractured finger was 230°. The complication rate was 11.5%. 3. In the treatment of metacarpal and phalangeal fractures of the hand, especially fractures of metacarpal bones, fixation with miniplate is considered to be an useful method in terms of getting fracture union and good range of motion with relative low complication rates.
Early Ambulation ; Fingers ; Fracture Healing ; Hand ; Humans ; Joints ; Metacarpal Bones ; Methods ; Range of Motion, Articular ; Skeleton ; Tendons

To characterize the sympathetic nervous system response to congestive heart failure in infants and children, plasma norepinephrine levels were measured in 29 patients aged 4 months to 15 years undergoing routine cardiac catheterization at Dong San Hospital, Keimyung University during the period of 4 months from November 1990 to February 1991. Plasma norepinephrine levels were significantly higher in patients with heart disease and congestive heart failure than in those without congestive heart failure(P<0.001). A significant association was found between the level of plasma norepinephrine and severity of the symptoms of congestive heart failure. Plasma norepinephrine levels correlated well with size of the shunt (Qp/Qs)(gamma=0.75), degree of pulmonary arterial pressure (gamma=0.79) and degree of right ventricular pressure (gamma=0.82).
Arterial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Child* ; Estrogens, Conjugated (USP)* ; Heart ; Heart Diseases ; Heart Failure* ; Humans ; Infant* ; Norepinephrine* ; Plasma* ; Sympathetic Nervous System ; Ventricular Pressure

No abstract available.

No abstract available.
Electrocardiography* ; Heart Septal Defects, Ventricular* ; Hemodynamics*

No abstract available.
Child* ; Heart Diseases* ; Heart* ; Humans ; Incidence* ; Tricuspid Valve Insufficiency*

A Statistical observations were done on 587 pediatric patients who were diagnosed as having congenital heart disease by cardiac catheterization angiography and operation at Dong San Hospital Keimyung University, during the period of January 1982 to june 1987. The results were as follows 1) Out of 587 patients, 317 cases were male and 276 cases were female. There were female preponderance in atrial septal defect and patent ductus arteriosus, whille in male tetralogy of Fallot, pulmonary stenosis, and ventricular septal defect. 2) The incidence of congenital heart disease were as folliws;ventricular septal defect 35.7% tetralogy of Fallot 17.5%, patient ductus arteriousus 13.9%, arterial septal defect 7.5% and pulmonary stenosis 2.9%. 3) Most of the patients were visited hospital for the first time between the age of 2 and 10 years. 4) Assosiated anomalies of major congenital heart disease were as follows:the most commonly associated anomaly in ventricular septal defect were pulmonary stenosis and patent ductus arteriosus. Pulmonary stenosis was frequently associated with atrial septal defect. Right sided aortic arch and pentalogy were assosiated with tetralogy of Fallot. The mitral regurgitation was associated with patent ductus arteriosus mostly. 5) The overall surgical mortality was 6.8%. The mortality was high in tetralogy of Fallot(16.1%), transposition of great vessels(28.5%).
Angiography ; Aorta, Thoracic ; Cardiac Catheterization ; Cardiac Catheters ; Ductus Arteriosus, Patent ; Female ; Heart Defects, Congenital* ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Incidence ; Male ; Mitral Valve Insufficiency ; Mortality ; Pulmonary Valve Stenosis ; Statistics as Topic* ; Tetralogy of Fallot

No abstract available.
Electrocardiography* ; Heart Septal Defects, Atrial* ; Hemodynamics*

Historically, genetic counselling was developed in the West and in the field of neonatal medicine, and a non-directive approach has been its central ethos since the 1950s to 60s. In today's changing world, the question of whether non-directive genetic counselling with its emphasis on patient autonomy may in some occasions be perceived as unprofessional practice. Through these 4 case studies in cancer genetic counselling, we seek to highlight the conundrums, dilemmas and various other considerations of patients and their families faced during the genetic counselling process. We also address the pitfalls of a 'one-size fi ts all' approach of non-directive counselling and how we could best practice cancer genetic counselling in the Singapore context, taking into consideration respect for patient autonomy and healthcare professionalism.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ethics, Medical ; Female ; Genetic Counseling ; Genetic Testing ; Humans ; Male ; Middle Aged ; Mutation ; Neoplasms ; genetics ; Pedigree ; Personal Autonomy ; Professional Practice ; ethics ; Risk Assessment ; Risk Factors ; Singapore ; Young Adult