BACKGROUND: Postoperative nausea and vomiting remain troublesome problems, especially in women receiving the opioid analgesics. This study was performed to assess the antiemetic efficacy of ondansetron in patients using an intravenous patient-controlled analgesia (IV-PCA) after gynecologic surgery. METHODS: In this randomized placebo-controlled study, forty healthy gynecologic surgical patients received ondansetron 4 mg or placebo at the end of surgery. Patients in the recovery room received fentanyl by PCA which provided a bolus dose of 20 microgram, a lockout time of 6 minutes, and a basal infusion of 20 microgram/hr. We assessed the occurrence of nausea, vomiting, and the need for rescue antiemetics during the first 24 hours after operation. RESULTS: During the first 24 hr after operation, 40% of patients experienced no nausea or vomiting in the ondansetron group compared to 30% of patients in the placebo group. There was no significant difference in the incidence of nausea between groups (70% in placebo group vs 60% in ondansetron group). However, ondansetron reduced the incidence of vomiting from 50% to 15%, and the need for rescue antiemetics significantly from 25% to 0% (P< 0.05). CONCLUSIONS: Ondansetron in a dose of 4 mg does not prevent postoperative nausea during the first 24 hours after operation when used with fetanyl PCA. However, ondansetron significantly reduces the chance of postoperative vomiting and rescue antiemetics.
Analgesia, Patient-Controlled* ; Analgesics, Opioid ; Antiemetics ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Humans ; Incidence ; Nausea ; Ondansetron* ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Recovery Room ; Vomiting

PURPOSE: Bone bruises of patients with acute traumatic knee injuries, that are not found on simple radiograph, can be found on magnetic resonance imaging (MRI). The purpose of this study is to evaluate the frequency and locations of bone bruises on MRI in acute traumatic anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injury. MATERIALS AND METHODS: 25 and 19 MRls, in which acute traumatic ACL and PCL injury was pre sent and there was no abnormality in simple radiograph, were reviewed. MRI was taken within 51 days of injury. A bone bruise was determined as a geographic and nonlinear area of signal loss on T1 images and increased signal intensity on T2 images involving the subcortical bone. RESULTS: In 16 patients with bone bruises and acute ACL injury, bone bruises were found in the lateral compartment of the knee in 15 (93.8%) patients. The most common area was the lateral tibial plateau (11 cases, 68.8%) and the second was lateral femoral condyle (9 cases, 56.3%). In 5 patients with bone bruises and acute PCL injury, bone bruises were found in the lateral compartment of the knee in all 5 (100%) patients. The most common area was lateral tibial plateau (4 cases, 80%) and the second was lateral femoral condyle (2 cases, 40%). CONCLUSIONS: In patients with acute traumatic ACL or PCL injuries the bone bruises are often found on the lateral compartment of the knee, especially lateral tibial plateau and lateral femoral condyle on MRI.
Anterior Cruciate Ligament ; Contusions* ; Humans ; Knee ; Knee Injuries ; Magnetic Resonance Imaging* ; Posterior Cruciate Ligament

BACKGROUND: The purpose of this study is to report a modified transtibial technique to approach the center of anatomical femoral footprint in anterior cruciate ligament (ACL) reconstruction and to investigate the accurate femoral tunnel position with 3-dimensional computed tomography (3D-CT) and radiography after reconstruction. METHODS: From December 2010 to October 2011, we evaluated 98 patients who underwent primary ACL reconstruction using a modified transtibial technique to approach the center of anatomical femoral footprint in single bundle ACL reconstruction with hamstring autograft. Their femoral tunnel positions were investigated with 3D-CT and radiography postoperatively. Femoral tunnel angle was measured on the postoperative anteroposterior (AP) radiograph and the center of the femoral tunnel aperture on the lateral femoral condyle was assessed with 3D-CT according to the quadrant method by two orthopedic surgeons. RESULTS: According to the quadrant method with 3D-CT, the femoral tunnel was measured at a mean of 32.94% +/- 5.16% from the proximal condylar surface (parallel to the Blumensaat line) and 41.89% +/- 5.58% from the notch roof (perpendicular to the Blumensaat line) with good interobserver (intraclass correlation coefficients [ICC], 0.766 and 0.793, respectively) and intraobserver reliability (ICC, 0.875 and 0.893, respectively). According to the radiographic measurement on the AP view, the femoral tunnel angles averaged 50.43degrees +/- 7.04degrees (ICC, 0.783 and 0.911, respectively). CONCLUSIONS: Our modified transtibial technique is anticipated to provide more anatomical placement of the femoral tunnel during ACL reconstruction than the former traditional transtibial techniques.
Adolescent ; Adult ; Anterior Cruciate Ligament Reconstruction/*methods ; Female ; Femur/*radiography/surgery ; Humans ; Imaging, Three-Dimensional/*methods ; Male ; Middle Aged ; Surgery, Computer-Assisted/*methods ; Tibia/radiography/surgery ; Tomography, X-Ray Computed/*methods

No abstract available.

For the pharmacokinetic analysis of isoniazid transfer into CSF, steady-state isoniazid concentrations of plasma and CSF were measured in eleven tuberculous meningitis patients confirmed with findings of CSF and neuroimazing. Peak plasma levels (4.17-21.5 micrograms/mL) were achieved at 0.25 to 3 hours after multiple isoniazid dose (600 mg/day). Terminal half-life, total clearance (CI/F) and volume of distribution (Vd/F) were 1.42 +/- 0.41 hr, 0.47 +/- 0.22 L/kg/hr and 0.93 +/- 0.48 L/kg, respectively. Isoniazid concentrations in CSF collected intermittently were highest at 3 hr (Mean, 4.18 micrograms/mL) and were 0.54 +/- 0.21 micrograms/mL at 12 hrs after the last dose of isoniazid 10 mg/kg/day. CSF/plasma partitioning of isoniazid and equilibration rate were estimated using modified pharmacokinetic/pharmacodynamic model. Disposition rate constant from CSF to plasma and CSF/plasma partitioning ratio of isoniazid were estimated to be 0.39 h-1 and 1.17, respectively.
Administration, Oral ; Humans ; Isoniazid/*cerebrospinal fluid ; Metabolic Clearance Rate ; Models, Biological ; Tuberculosis, Meningeal/*cerebrospinal fluid

No abstract available.
Pleura* ; Rhabdomyosarcoma*

PURPOSE: The success rate for the replantation of an amputated digit in children is low. It demands precise anastomosis of vessels and nerves and expert technique. This paper reports upon cases of digital replantation in children. MATERIALS AND METHODS: From April 1994 to December 1999, 34 amputated digits of 30 patients were replanted. According to the age distribution, there were 18 children under 5 years of age, 5 between 6 and 10, and 7 between 11 and 15. Guillotine type of amputation was dominant and 19 cases were at zone I. End to end anastomosis of the digital artery and dorsal vein, vein graft, and the external bleeding method and epineurial suture were performed. RESULTS: The overall success rate was 88.2%, in zone I 16/19 cases, in zone II 10/11 cases and zone III 4/4 cases. CONCLUSION: The rate of survival of the amputated part in children was 88.2%. Although it is difficult to perform anastomosis of small vessels, postoperative physical therapy and the external bleeding method, digital replantation in children is recommended, when feasible, in order to prevent functional and growth disturbances for cosmetic reasons.
Age Distribution ; Amputation ; Arteries ; Child* ; Fingers* ; Hemorrhage ; Humans ; Replantation* ; Sutures ; Transplants ; Veins

A 73-year-old woman presented to the emergency department with submandibular pain and swelling. The patient was diagnosed to have Ludwig's angina, and she was planned to undergo urgent incision and drainage under general anesthesia. However, her physical examination revealed severe diffuse swelling extending from the bilateral submandibular spaces to the submental space and further down to the neck. As our view was blocked by the patient's neck swelling, we did not perform a regional anesthesia of the airway or a transtracheal block. Several non-invasive alternatives were considered. The “spray-as-you-go” technique was chosen, and it was performed using the OptiScope®. However, the OptiScope did not have a working channel or syringe adaptor for the administration of the local anesthetic solution. To solve this problem, we combined the OptiScope with a 27-G tunneled epidural catheter (100 cm) for the administration of lidocaine and this combination made the awake intubation successful.
Aged ; Anesthesia, Conduction ; Anesthesia, General ; Catheters* ; Drainage ; Emergency Service, Hospital ; Female ; Humans ; Intubation* ; Lidocaine ; Ludwig's Angina* ; Neck ; Physical Examination ; Syringes

PURPOSE: Thumb hypoplasia gives rise to various derangement of hand functions, leading to various degrees of malformation. The treatment of choice for grade IV or V congenital hypoplasia of the thumb, classified by Buck-Gramcko's criteria, is the pollicization of the index finger. The purpose of this article is to review the clinical usefulness of pollicization for more than grade IV hypoplasia. MATERIALS AND METHODS: Three grade IV and 3 grade V hypoplastic thumbs in 6 patients, one with radial club hand, were reviewed retrospectively. They underwent pollicization between 1987 and 1997. The index metacarpi were osteotomized for shortening and readjusted by pronation. To evaluate postoperative function, authors used the criteria of Sundararaj and Mani. RESULTS: Except for the exclusion of one patient, four had excellent and one had good functional statuses. CONCLUSION: Pollicization was considered to be worthwhile for functional improvement of the hands in more than grade IV congenital hypoplasia of the thumb.
Fingers ; Hand ; Humans ; Pronation ; Retrospective Studies ; Thumb*

When faced with an irrepairable meniscus or a patient who has had a total or subtotal meniscectomy, meniscus allograft transplantation (MAT) is the preferred modality to restore biomechanical function of the meniscus. The indications for meniscus allograft transplantation are yet to be established. However, currently, MAT has previously been indicated for symptomatic patients who have mild or early osteoarthritis, are younger than 50 years of age, and present with an Outerbridge grade II or lower. The short- to intermediate-term results confirmed noteworthy clinical improvements and consistent objective findings. On the other hand, the successful outcome would be reduced by various complications. Therefore, long-term observation required to evaluate the longevity of these results. The purpose of this article is to review the current research of concerns on the results of MAT, and to describe the technical tips and pitfalls so as to successful clinical results.
Hand ; Humans ; Knee ; Longevity ; Osteoarthritis ; Transplantation, Homologous ; Transplants