BACKGROUND: Recent studies suggest the hypothesis that blockade of nociceptive input with local anesthetics before surgery can decrease pain beyond the immediate postoperative period. The purpose of this study was to determine if the preincisional infiltration with local anesthetics affected postoperative pain relief. METHOD: Among 30 patients having tonsillectomy, 15 patients(group 1) given peritonsillar infiltration using lidocaine with epinephrine(1 : 200,000) were compared with 15 patients(group 2)given peritonsillar infiltration using saline with epinephrine(1 : 200,000). Following general anesthesia with a mixture of O2-N2O(50%) and enflurane(1-2vol.%), peritonsillar infiltration were performed 5 minutes before surgery. Constant incisional pain and pain on swallowing were assessed using a visual analogue scale at 4 hour, 1, 2, 3 and 4 days postoperatively. The time to emergence and behaviour of patient at 0.5, 1 and 4 hour were recorded postoperatively. RESULT: Preincisional infiltration with lidocaine resulted in a significant decrease in postoperative pain during 4 days after surgery and smoother emergence. CONCLUSION: There were significant difference in pain scores between lidocaine group and saline group during 4 days after surgery. Preincisional lidocaine infiltration seemed to have analgesic activity beyond the residual anesthetic period. The results of this study support the theory of pre-emptive analgesia.
Analgesia ; Anesthesia, General ; Anesthetics ; Anesthetics, Local ; Child* ; Deglutition ; Humans ; Lidocaine* ; Pain, Postoperative ; Postoperative Period ; Tonsillectomy

Peptic ulcer is known to rank very high among the diseases of the gastrointestinal system which seem most prevalent in this country. Although it's incidence in this country is difficult to know with any degree of precision at present because few statistical reports are available, it is frequently encountered in our daily practice. Many studies on the pathogenesis of the disease from the clincial aspect as well as the experimental, have been undertaken by many investigators. No definite conclusions, however, have been arrived at, and thus more diverse and intensified research is urgently required. The following studies, carried out in an effort to further elucidate the pathogenic mechanism, are reported here.
Female ; Human ; Male ; Peptic Ulcer/*etiology/pathology

Urinary excretion of 5-hydroxyindoleacetic acid was determined in 114 normal Korean adults and in 110 patients suffering from peptic ulcer. The amount of urinary 5-HIAA excreted during a period of 24 hours is fairly constant in each individual but varies widely between individuals. The mean daily output of urinary 5-HIAA in normal Korean adults is 1.93 +/-0.86 (S.D.) mg, which is similar to that found in normal Chinese adults. There is no significant difference between the urinary excretion of 5-HIAA in normal subjects and in patients with peptic ulcer. Furthermore, the amount of urinary 5-HIAA seems to be influenced by neither the sex of the subject nor by the degree of gastric acidity.
Adult* ; Asian Continental Ancestry Group ; Gastric Acid ; Humans ; Hydroxyindoleacetic Acid ; Peptic Ulcer*

Intrathecal clonidine injection induces analgesia without significant respiratory depression, but decreases blood pressure and causes sedation. Injection of spinal cholinesterase inhibitor alone increases blood pressure in animals, and enhances clonidine induced analgesia. To evaluate the effect of pretreated pyridostigmine on the change of blood pressure and heart rate, clonidine was injected intrathecally in cats. We divided fifteen cats into three groups and administered saline(0.5 cc) to group 1, pyridostigmine(0.5 cc, 2.5 mg) to group 2, pyridostigmine(0.5 cc, 2.5 mg) and glycopyrrolate(0.5 cc, 0.1 mg) to group 3 before 20 minute of clonidine injection and measured mean arterial pressure, heart rate, P CO2 and central venous pressure. The results were as follows: 1)After clonidine injection, all mean arterial pressure values were significantly reduced in group 1, but in group 3, 20, 30 and 40 minutes values were significantly reduced, and 10, 40 minutes values after clonidine injection were not reduced significantly in group 2 compared to group 1. 2)After clonidine injection, heart rates were significantly reduced in all groups, but there was no significant difference between group 1, group 2 and group 3. 3)There was no significant difference of central venous pressure in any groups. 4)There was no significant difference for reversal of pyridostigmines effect by glycopyrrolate. Based on these results, these data suggest that pyridostigmine pretreatment counteracts clonidine induced hypotension, but further study of spinal az adrenergic-cholinergic combination for pain therapy is needed before clinical application.
Analgesia ; Animals ; Arterial Pressure ; Blood Pressure* ; Cats* ; Central Venous Pressure ; Cholinesterases ; Clonidine* ; Glycopyrrolate ; Heart Rate* ; Heart* ; Hypotension ; Pyridostigmine Bromide* ; Respiratory Insufficiency

An adenocarcinoma of the appendix is a rare tumor, and so far only 130 cases have been reported worldwide. We report one patient with peritoneal seeding of an adenocarcinoma. A 51-year-old man was admitted to our hospital with the impression of intestinal obstruction. He had undergone an appendectomy 5 years ago due to acute appendicitis. At that time, postoperative histopathological analysis had revealed an adenocarcinoid tumor in the appendix. The patient had been told to visit our hospital for follow-up but he hadn't visited. When he finally visited our hospital diagnostic laparoscopy revealed the peritoneal seeding of a recurrent adenocarcinoma. A palliative right hemicolectomy was done to relieve the bowel obstruction. After recovering from operation, the patient was treated with the 5-fluoruracil, leucovorin, and oxaloplatin (FOLFOX). The patient was discharged in improved general condition with a future plan for regular cyclic chemotherapy.
Adenocarcinoma ; Appendectomy ; Appendicitis ; Appendix* ; Carcinoid Tumor ; Drug Therapy ; Follow-Up Studies ; Humans ; Intestinal Obstruction ; Laparoscopy ; Leucovorin ; Middle Aged ; Neoplasm Metastasis*

In gastric cancer, the significance of lymphatic invasion as a prognostic factor is controversial. This study was performed to investigate the significance of lymphatic invasion as a prognostic factor in early results of gastric cancer after gastrectomy. We had been prospectively analyzed 362 consecutive patients resected from June 1994 to June 1996 in the Department of Surgery, Ajou University Hospital. Grading of the lymphatic invasion was determined by pathologists according to the JRSGC classification. The difference in the survival rate between the ly0 group and the ly1 group was statistically insignificant, so we only used ly2 and ly3 as the risk group. The prognostic values of lymphatic invasion as a single parameter for survival and early recurrence were determined by using univariate and multivariate analyses. Lymphatic invasion was observed in 90 (24.9%) of the 362 gastric cancer cases, and ly2 or ly3 were 66 (18.3%)cases. The incidence of ly> or =2 steadily increased with advancing TNM stage : stageI, 9/124 (7.3%); stageII, 5/50 (10.0%); stageIII, 24/111 (21.6%); stageIV, 28/78 (35.9%). The incidence of ly> or =2 was significantly correlated with other prognostic factors such as lymph node metastasis, the depth of the primary tumor, and the stage (p<0.05). The cummulative 2-year-survival rate determined by the Kaplan-Meirer method was 56.4% in patients with ly> or =2 and 90.9% in patients with ly<2. The log-rank test showed significant differences between the ly<2 group and the ly> or =2 group (p<0.05). Multivariate analysis of the survival function showed that the depth of the primary tumor had the highest prognostic value followed by lymphatic invasion (ly> or =2) as an independent prognostic factor (p=0.0008, Exp(B)=3.55). The cummulative recurrence free rate determined by the Kaplan-Meirer method was 78.7% in the ly> or =2 group and 90.54% in the ly<2 group. There was statistically significant difference (p<0.05). Univariate analysis for recurrence after radical resection showed that lymphatic invasion had a prognostic impact in the ly> or =2 group (p=0.0055). Therefore lymphatic invasion with ly2 or ly3 grade is an independent prognostic factor that is associated with poor prognosis for early results after gastrectomy. In grading of lymphatic invasion by gastric cancer, simple differentiation of whether lymphatic invasion is present or not was insignificant in the results of our study. In the future, the grade of lymphatic invasion in gastric cancer should be carefully classified by pathologists.
Classification ; Fibrinogen ; Gastrectomy ; Humans ; Incidence ; Lymph Nodes ; Lymphatic Vessels* ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Prospective Studies ; Recurrence ; Stomach Neoplasms* ; Survival Rate

PURPOSE: Recent studies show that chorioamnionitis has an important role in the pathogenesis of bronchopulmonary dysplasia(BPD) and it induces thymic involution. The purpose of this study is to test the usefulness of thymic size at birth as a predictor of BPD. METHODS: This study was conducted on 91 very low birth weight infants of <1, 500 g with mean gestational age of 29.3 weeks and mean birth weight of 1, 161 g who were admitted at NICU of Dong Kang General Hospital for past 4 years of whom 21 infants had BPD. Thymic size was measured on routine chest radiographs taken in the first 3 hours after birth and measured as the ratio between the width of the cardiothymic shadow at the level of the carina and that of the thorax at the costophrenic angles (CT/ T). RESULTS: Correlation of thymic size with gestational age was statistically significant (P=0.003). CT/T of BPD group was smaller than that of non-BPD group (0.27+/-0.06, 0.33+/-0.07, respectively, P<0.01). A significant positive correlation between small thymus at birth and BPD was detected (P=0.003, odds ratio, 21.7), but not in other disease groups. CONCLUSIONS: We concluded that a small thymus at birth on the chest radiograph could be used as an early predictive parameter of the BPD.
Birth Weight ; Bronchopulmonary Dysplasia* ; Chorioamnionitis ; Female ; Gestational Age ; Hospitals, General ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Odds Ratio ; Parturition* ; Pregnancy ; Radiography, Thoracic ; Thorax ; Thymus Gland

Polymorphous low-grade adenocarcinoma (PLGA) is a distinctive salivary gland neoplasm with a propensity to arise from minor salivary glands, particularly of the palate. Reports of PLGA have increased with the establishment of specific histopathological criteria characterizing the PLGA, but there are only a few reports of major salivary gland origin. PLGA shares histological features with adenoid cystic carcinoma, so histopathologic diagnosis is essential and immunohistochemistry is an important tool when making differential diagnosis. The treatment of choice is wide surgical excision, and long-term follow up is necessary to evaluate local recurrences. We herein report a case of PLGA arising in a submandibular gland with a review of the relevant literature.
Adenocarcinoma* ; Carcinoma, Adenoid Cystic ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Immunohistochemistry ; Palate ; Recurrence ; Salivary Gland Neoplasms ; Salivary Glands ; Salivary Glands, Minor ; Submandibular Gland*

Hypertrophy of salivary gland was developed by sialadenitis, sialolithiasis, autoimmune diasease and other tumorous conditions. Mikulicz's disease has been used to describe symptomless hypertrophy of the salivary gland and lacrimal gland. In the past, it was thought that Mikulicz's disease is included within the diagnosis of Sjogren's syndrome. However, Mikulicz's disease represents Immunoglobulin G4 (IgG4)-related hypertrophy of salivary gland and lacrimal gland by an elevated level of IgG4 in the serum of the patient and good responsiveness to glucocorticoid, eventually leading to recovery of gland function. We have experienced a case of IgG4-related sialadenitis and dacryoadenitis with bilateral hypertrophy of parotid, submandibular and lacrimal glands. We report this case with a brief review of the literature.
Dacryocystitis ; Humans ; Hypertrophy ; Immunoglobulin G ; Immunoglobulins ; Lacrimal Apparatus ; Salivary Gland Calculi ; Salivary Glands ; Sialadenitis ; Sjogren's Syndrome

OBJECTIVE: To determine if the physical design and organizational structure of rehabilitation stroke unit (RSU) is related to the amount of patients' activity pattern. METHOD: An observational study was conducted using behavioral mapping method. Time samples of the motor activity of patients following stroke were taken at 10-minute interval, between 7 AM and 7 PM both on weekdays and weekends. At each observation, physical activity patterns, location in which the patients spent their time, and other person present were recorded. RESULTS: RSU patient spent less time in non-therapeutic activity and more time in therapeutic activity (p<0.05). There were significant differences in the locations of patient's position between the two types of ward (p<0.05). RSU patients had significantly more interaction with formal carerand less time disengaged (p<0.05). The proportion of time in therapeutic activity was low in all location, with patients spending many hours in bed and doing nothing. There was no significant differences in total Functional Independence Measure (FIM) scores at admission and on discharge, FIM gain, and FIM efficiency between RSU and mixed rehabilitation ward (p<0.05). CONCLUSION: In spite of quantitative difference, the two wards had similar patterns of treatment activity and deployment of staff. These maybe resulted in similar treatment experiences for patient and no functional differences between two wards. It appears that strategies are required so that patients can be practicing at an more appropriate level.
Humans ; Motor Activity ; Observational Study ; Rehabilitation* ; Stroke*