Background: Bupivacaine was introduced to be a long-acting spinal anesthetic agent. It has been argued about whether the addition of epinephrine prolongs the bupivacaine action or not. The aim of this present investigation was to find out the effect of additional epinephrine on spinal anesthesia with bupivacaine. Methods: 47 patients undergoing an operation on lower extremity were randomly allocated to 2 groups. All patients were anesthetized by subarachnoid block with 0.5% bupivacaine in 8% glucose, which was mixed with 0.2 ml of normal saline in group non-E (n=24) and 0.2 ml of 1:1,000 epinephrine in group E (n=23). We evaluated blood pressure and heart rate, the sensory and motor blockade and voiding time after spinal anesthesia. Results: The systolic blood pressure (SBP) at 8 and 10 min after anesthesia were lower in group non-E than in group E (p<0.05). The trend of decreasing diastolic blood pressure was similar in both groups. The heart rate(HR) at 2 min after anesthesia was lower in group non-E than in group E (p<0.05). The sensory block in T10 was produced faster in group non-E (7 min) than in group E (11 min)(p<0.05). And the maximal sensory block level and its reaching time was T7 and 14 min in group non-E, and T8 and 17 min in group E (p=0.12, p=0.11). Two segment regression time was 124 min in group non-E, and 184 min in group E (p=011). The onset time of motor block to Bromage scale 3 was 12 min in group non-E and 16 min in group E (p=0.06). The recovery time from complete motor block to Bromage scale 1 after maximal motor block was 263 min in group non-E, and 278 min in group E. The time at which patients voided after anesthesia was 469 min in group non-E, and 466 min in group E. Three patients urinated by using a urinary catheter in each group. Conclusions: The addition of epinephrine to bupivacaine for spinal anesthesia can slow the decrease in SBP and increase the HR at early stage of anesthesia, and slow the sensory block.
Anesthesia ; Anesthesia, Spinal* ; Blood Pressure ; Bupivacaine* ; Epinephrine* ; Glucose ; Heart ; Heart Rate ; Humans ; Lower Extremity ; Urinary Catheters

No abstract available.
Humans

No abstract available.
Immunoglobulin G* ; Influenza, Human*

No abstract available.
Failed Back Surgery Syndrome*

No abstract available.
Humans ; Hyperhidrosis*

The patient with metastatic renal cell carcinoma at the time of presentation have an average survival of approximately 4 months, and only 10% can be expected to survive 1 year. The treatment of metastatic renal cell carcinoma remains a major public health problem in clinical medicine. Hormonal therapies, including progestational agents, and chemotherapies as single agent or in combinations seldom result in objective tumor regression or prolongation of survival and the response are usually temporary. Immunotherapic approaches to this tumor has not demonstrated a clear impact on growth of the tumor. But alpha-interferon therapy that initiated by deKernion produced 16. 5% response rate. The following results and conclusions are obtained with combination therapy such as a-interferon. nitrosourea, vinblastine and medroxyprogesteron acetate in metastatic renal cell carcinoma. 1. From March 1988 to August 1989, 15 patients with metastatic renal cell carcinoma were studied. Average patient age was 49.3 years. There was 11 men and 4 women. The disease was confined to lung in 46.7% of the patients and a Karnofsky performance status (PS) of 100 was identified in 7%: 13.3 % had PS score <70. 2. Of 15 patients, 4(26.7%) had a complete responses, 1 (6.7%) had a partial response, 3 (20.0%) had a minimal response and 7 (46.7%) had progression with no evidence of response to treatment. Of patients with pulmonary metastases alone, 5 (71.4%) had objective response or stabilization of disease and 2 (28.6%) had progression with no evidence of response to treatment. 1 (100.0%) patient with PS of 100 had partial response and no patients with PS<70 had response to therapy. 3. Median duration of survival in the overall subjects was 47 weeks : nonresponders survived for median of 21 weeks. Median duration of survival in nonresponders with pulmonary metastasis alone was 20 weeks. All responders are alive at least 33 weeks later. 4. The most common side effects were constitutional symptoms (73.3%). Hematologic toxicity (60%), gastrointestinal toxicity (40%), hepatic toxicity (26.7%) and nephrotoxicity (6.7%) occurred. Severe toxicity was noted only in 1 patient. 5. Natural killer cell activity in responders was 35.4 % and in nonresponders was 43.0%. Increased natural killer cell in responders was noted after treatment. T Lymphocyte subletting (T3 : cytotoxic T cell, T4 : helper T cell, T8 : suppressor T cell) performed at peritreatment had no statistic significance.In spite of short-term study, combination therapies includirrg alpha-interferon cause objective more regression and prolongation of survival. Futher trial with these regimens seem warranted in the management of metastatic renal cell carcinoma.
Carcinoma, Renal Cell* ; CD8-Positive T-Lymphocytes ; Clinical Medicine ; Drug Therapy ; Female ; Humans ; Interferon-alpha* ; Karnofsky Performance Status ; Killer Cells, Natural ; Lung ; Lymphocytes ; Male ; Neoplasm Metastasis ; Progestins ; Public Health ; Vinblastine

No abstract available.
Child ; Child Development* ; Humans ; Infant* ; Mass Screening*

Serous cystadenomas of the pancreas account for approximately a third of pancreatic cystic neoplasms. Their coexistence with a second tumor is extremely rare. We now report a case of a serous microcystic adenoma combined with an intraductal papillary mucinous tumor of the pancreas in a 69-year-old man. Abdominal computed tomography scans demonstrated an incidental cystic mass in the body with cystic dilatation of the duct in the head of the pancreas. Central pancreatectomy with pancreatico-jejunostomy, and cyst excision of the pancreatic head were performed. Histologic examination demonstrated a serous microcystic cystadenoma in the body coexisting with an intraductal papillary mucinous adenoma in the head of the pancreas. This case study highlights the importance of careful intra-operative and pathologic examination for synchronous pancreatic tumors.
Adenoma ; Aged ; Cystadenoma ; Cystadenoma, Serous ; Dilatation ; Head ; Humans ; Mucins ; Pancreas ; Pancreatectomy ; Pancreatic Cyst

No abstract available.
Focal Nodular Hyperplasia*

Various clinical evaluations in urological aspects were performed on 100 renal transplantations in the Department of Urology, Kosin Medical College from December 1984 to August l988. The following results were obtained. 1. Year distributions were as follows : 1 case was done in 1984, 5 cases in 1986, 31 cases in 1986, 30 cases in 1987, 33 cases in 1988. 2. Of 100 donors 44 cases were male and 56 cases were female. Sixth decade was most common. Of 100 recipients 71 cases were male and 29 cases were female. Fourth decade was must common. 3. Of all living-related donors 89 cases were related donors and 11 cases were unrelated donors. 4. The most common underlying renal disease requiring transplantation was chronic glomerulonephritis (90%) and reflux nephropathy was 2 cases(2 %). 5. All surgical approaches of donor nephrectomy were flank incision, usually with removal of 12th rib(59%). Selected kidney side was follow : 79 cases were left side and 21 cases was right side. 6. The ureteroneocystostomy was performed with modified Politano-Leadbetter method in initial 3 cases and extravesical Mac Kinnon method in 97 cases. 7. Our incidence of urological complications in 100 renal transplantations was 8%(8 cases). 6 cases were ureteral obstructions due to perinephric hematoma, 1 case was ureterotaneous fistula and 1 cases was bladder leakage. 8. Our incidence of complications in 100 donor nephrectomy was 3%(3 cases). 1 case was pleural effusion, 1 case was atelectasis and 1 case was perforation of stomach. 9. Results and prognosis in complicated cases were good.
Female ; Fistula ; Glomerulonephritis ; Hematoma ; Humans ; Incidence ; Kidney ; Kidney Transplantation* ; Male ; Nephrectomy ; Pleural Effusion ; Prognosis ; Pulmonary Atelectasis ; Stomach ; Tissue Donors ; Unrelated Donors ; Ureteral Obstruction ; Urinary Bladder ; Urology