Many authors have studies to relieve the pain after arthniscopic knee surgery. We undertook a randomized, double-blind trial to compare the efficacy of intraarticular morphme and bupivacaine between arthroscopic meniscus surgery group and cruciate ligament reconstruction group. As an results, intraarticular injection of morphine-bupivacaine combination is effective to control pain after minor athroscopic surgery such as menisectomy and meniscal repair ancf intraarticu]ar injection of mor- phine-bupivacaine combination is not effective to relieve pain after major arthroscopic surgery including cru- ciate ligament reconstruction. So, more potent analgesics should be adminishated.
Analgesia ; Analgesics ; Arthroscopy ; Bupivacaine* ; Injections, Intra-Articular ; Knee* ; Ligaments ; Morphine*

Various methods for the treatment of fracture of the femur neck including total hip arthroplasty have been developed and performed, but it is still called the ""unsolved fracture"" in certain situations. The role of bipolar hemiarthroplasty as primary treatment of fracture of the femur neck, however, continues to be controversial. The authors reviewed and analysed 38 cases of cementless bipolar hemiarthroplasty in patients between the ages of 51 and 69 at the Department of Orthopaedic Surgery, Chosun University, during the period from January, 1989 to December, 1994. The purposes of the study were to analyse the clinical and radiological results and to detect the motions of bipolar cup. At the average 38 months follow up, 31 (81.6%) of the patients were satisfied by Lunceford methods. But, 24 (63.2%) of the patients suffered from inguinal area pain and discomfort while they resumed their normal Korean life-styles. As time elapsed, the amount of the outer bearing motion was more than that of the inner bearing motion. the acetabular erosion were present in 2 patients.
Acetabulum ; Arthroplasty, Replacement, Hip ; Femoral Neck Fractures ; Femur Neck* ; Follow-Up Studies ; Hemiarthroplasty* ; Humans

No abstract available.
Hyponatremia* ; Hypopituitarism*

Several approaches to the cerebellopontine angle and internal auditory canal have been described for the removal of large acoustic tumors. Of these, the translabyrinthine removal of the large cerebellopontine angle tumors requires extensive removal of bones in order to manage the low-lying tegmen, the anterior sigmoid sinus, and the high jugular bulb. We removed 4 large cerebellopontine angle tumors by the translabyrinthine approach alone. All tumors were totally removed with acceptable facial nerve function. There was a case of CSF leak which was repaired at the revision surgery.
Cerebellopontine Angle* ; Colon, Sigmoid ; Facial Nerve ; Neuroma, Acoustic*

BACKGROUND: The aim of this study was to investigate the development of neuropathic pain by radiofrequency thermocoagulation on a rat infraorbital nerve (IoN). METHODS: Male Sprague-Dawley rats (n = 35) were divided into three groups, consisting of the S, T and sham operation. In the experimental groups, rats were thermocoagulated by subjecting them to 70oC for 60 sec (S group, n = 12) or 20 sec (T group, n = 11) on IoN. In the control group (sham operation, n = 12), IoN was not thermocoagulated. The ipsilateral grooming count and escape threshold by von Frey filament (mechanical allodynia) was measured at 1, 3, 5, 7, 9, 11, 13 postoperative days. After two weeks, a 5% formalin solution was injected into the rat upper lips and grooming time was measured for 45 minutes. RESULTS: Grooming count and mechanical allodynia significantly increased in the thermocoalgulation groups (S and T groups) compared to control group (sham operation) for the postoperative days. Nerve injury by radiofrequency thermocoagulation enhanced the grooming time after formalin injection in the rat upper lips. CONCLUSIONS: These results lend support to the hypothesis that thermal injury using radiofrequency thermocoagulation can induce neuropathic pain in rat IoN and this type of nerve injury increases the responsiveness of chemical nocieptive stimuli.
Animals ; Electrocoagulation* ; Formaldehyde ; Grooming ; Humans ; Hyperalgesia ; Lip ; Male ; Neuralgia* ; Rats* ; Rats, Sprague-Dawley ; United Nations

PURPOSE: The aim of this study was to investigate the usefulness of mortise angle and fibular length measured in radiologic findings in predicting the ankle stability. MATERIALS AND METHODS: One hundred cases fifty cases were randomly selected volunteers with normal ankle function and the other fifty cases were randomly selected patients whose ankle were treated in our hospital and who were followed for over 1 years with good results. A specific experimental fixture were made to get the even AP and lateral view and objective stress view. RESULTS: The mortise angle and fibular length was not statistically significant to the degree of talar tilt angle under valgus or varus stress and that of displacement under anterior or posterior stress. CONCLUSION: The mortise angle and fibular length was not the objective predicting factors on the ankle stability. Maintenance of constrained talus in dynamic status is most important factors in determining the ankle stability.
Ankle* ; Humans ; Talus ; Volunteers

Ventilatory management of tracheal reconstruction surgery may require sophisticated anesthetic techniques. Most airway problems that occurred during the tracheal surgery can be prevented by passing an endotracheal tube of small size through the tracheal narrowing or locating a normal endotracheal tube just above the stenotic lesion. However, in case of high tracheal stenosis sited near the vocal cord, it is difficult to manage airway using a cuffed endotracheal tube because of high possibility of injury of the vocal cord, shallow placement of the tube and inability to apply positive pressure ventilation. The laryngeal mask airway has been used as an efficient ventilatory device in this situation. We report one case of high tracheal stenosis requiring end to end anastomosis, where airway management was successful without any complications using the proseal laryngeal mask airway (PLMA).
Airway Management ; Laryngeal Masks* ; Positive-Pressure Respiration ; Tracheal Stenosis ; Vocal Cords

BACKGROUND: Epidural anesthesia has been shown to a have direct sedative effect and to markedly reduce the amount of hypnotic agents required for sedation. A Bispectral Index (BIS) is a useful monitor of the level of sedation and loss of consciousness for several anesthetics including propofol. In this study, we investigated whether BIS monitoring could detect the sedative effect of epidural anesthesia during propofol induction. METHODS: Twenty patients scheduled for elective lower abdominal surgery were included. A Target controlled infusion (target effect concentration 5micro gram/ml, induction time 3 min) of propofol was administered to the patients with or without epidural anesthesia (2% lidocaine 15 ml) at the L2-3 level. The OAA/S scale and BIS were evaluated 20 min after epidural injection. Hypnotic requirements of propofol were determined using loss of eye opening in response to verbal command as an endpoint. At the time of induction of hypnosis, the target concentration, target effect concentration and BIS were recorded. RESULTS: Epidural lidocaine significantly decreased the hypnotic dose of propofol (1.0 +/- 0.2 micro gram/ml vs. 1.3 +/- 0.1 micro gram/ml; P = 0.0008), hypnotic calculated concentration (3.3 +/- 0.6 micro gram/ml vs. 4.1 +/- 0.3 micro gram/ml; P = 0.0007), and the hypnotic effect concentration (0.7 +/- 0.3micro gram/ml vs. 1.1 +/- 0.1 micro gram/ml; P = 0.0007). In the patients with epidural anesthesia, the OAA/S scale was decreased without a change of the BIS after epidural anesthesia and BIS recorded at the time of induction of hypnosis was much higher in patients with epidural anesthesia than in patients without epidural anesthesia (92.7 +/- 2.2 vs. 85.5 +/- 6.2; P = 0.0029) CONCLUSIONS: Epidural anesthesia induced a sedative effect without a change of the BIS and then induced the hypnosis with lesser dose of propofol. At the time of hypnosis, a higher BIS was noticed with epidural anestheia. These results concluded that BIS monitoring could not detect the sedative effect induced with epidural anesthesia.
Anesthesia, Epidural* ; Anesthetics ; Consciousness Monitors* ; Humans ; Hypnosis ; Hypnotics and Sedatives* ; Injections, Epidural ; Lidocaine ; Propofol ; Unconsciousness

PURPOSE: Leptomeningeal carcinomatosis occurs in about 5% of patients with solid tumor and is being diagnosed with increasing frequency as patients live longer and as neuro-imaging studies improve. In general, the most commom cancers that involved the leptomeninges are breast cancer, lung cancer, and malignant melanoma. MATERIALS AND METHODS: We investigated 25 patients presented with multiple neurologic symptoms and signs who were diagnosed with leptomeningeal carcinomatosis at the Yonsei Cancer Center from January 1990 to December 1999. RESULTS: The primary disease of leptomeningeal carcinomatosis were stomach cancer (10 cases), breast cancer (7 cases), lung cancer (5 cases), unknown primary cancer (2 cases) and common bile duct cancer (1 case). All patients were presented with multiple neurologic symptoms and signs involving the central nervous system (CNS), cranial nerve or spinal nerves. Twenty-one of twenty- five patients were treated with intrathecal chemotherapy, radiotherapy, or combination therapy. Fourteen of them (66.7%) experienced improvement or stabilization of neurologic symptom and sign. The median survival was 122 days (10-2190). CONCLUSION: In conclusion, although early diagnosis and active treatment of leptomeningeal carcinomatosis may improve the quality of life in selected patients, the median survival was relatively short. Therefore, new diagnostic and therapeutic strategy for leptomeningeal carcinomatosis were needed.
Breast Neoplasms ; Central Nervous System ; Common Bile Duct ; Cranial Nerves ; Drug Therapy ; Early Diagnosis ; Humans ; Lung Neoplasms ; Melanoma ; Meningeal Carcinomatosis* ; Neurologic Manifestations ; Quality of Life ; Radiotherapy ; Spinal Nerves ; Stomach Neoplasms

Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare form of primary liver cancer composed of cells with histopathologic features of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). Because of its low incidence, the information on clinical outcomes of cHCC-CC is very limited and there are no published reports describing non-surgical treatment options for cHCC-CC. We report a case of cHCC-CC exhibiting a favorable response to systemic chemotherapy with doxorubicin and cisplatin. A 62-year-old man who recurred after a right lobectomy for cHCC-CC received sorafenib for palliative systemic therapy, but follow up imaging studies showed disease progression. He received 2nd line chemotherapy with doxorubicin at 60 mg/m2 together with cisplatin at 70 mg/m2. After 2 cycles of chemotherapy, a computed tomography scan of the chest showed markedly decreased size and number of the multiple lung metastases. After completing 8 cycles of 2nd line therapy, we changed the regimen to a fluorouracil (5-FU) mono therapy because of the toxicities associated with doxorubicin and cisplatin. To date, the patient has completed his 15th cycle of 5-FU mono therapy with the disease status remaining stable during 18 months of follow-up.
Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Cisplatin ; Disease Progression ; Doxorubicin ; Fluorouracil ; Follow-Up Studies ; Humans ; Incidence ; Liver Neoplasms ; Lung ; Middle Aged ; Neoplasm Metastasis ; Niacinamide ; Phenylurea Compounds ; Thorax