INTRODUCTION: Patient-controlled analgesia (PCA) has become an important means for postoperative analgesia with parenteral opioid, but postoperative nausea and vomiting (PONV) remains a major problem using a PCA system. The present study was designed to assess the antiemetic effectiveness of droperidol in patients using an intravenous PCA during the first 24 hours after surgery. METHODS: For the postoperative analgesia, 80 patients underwent orthopedic surgery were randomly allocated to receive PCA with either a mixture of 3.75 mg droperidol and fentanyl 2500 microgram after initial bolus of 1.25 mg droperidol as the FD group, or a mixture of saline and fentanyl 2500 microgram as the FS group at the end of surgery. RESULTS: The incidence of PONV showed 52.5% in FS group and 15% in FD group respectively (P<0.05). The incidence of PONV was 2~3 times more in women (76% in FS group & 25% in FD group) than men (35% in FS group & 9% in FD group). CONCLUSION: The addition of droperidol to fentanyl in a PCA system reduces the PONV during the first 24 hours after surgery.
Analgesia ; Analgesia, Patient-Controlled* ; Antiemetics ; Droperidol* ; Female ; Fentanyl* ; Humans ; Incidence ; Male ; Orthopedics ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting*

BACKGROUND: Recent evidences suggest that anesthetic action within the spinal cord is important in suppressing somatic responses to painful stimuli. Intrathecal endothelin-1 (ET-1) is known to have antinociceptive effect. The purpose of this experiment was to determine whether intrathecal ET-1 may influence the minimum alveolar concentration (MAC) of isoflurane in rats and access the role of the spinal cord as the sites of anesthetic action in blocking somatic responsiveness. METHODS: In Sprague-Dawley rats fitted with an indwelling intrathecal catheter, we determined the MAC of isoflurane using a tail-clamp technique as a painful stimulus, combined with end-tidal anesthetic sampling. In experiment 1, the control MAC was determined and changes of control MAC were observed after intrathecal ET-1 (4x10-2 nmol, 4x10-3 nmol) administration. In experiment 2, we observed the effects of L or N type Ca++ channel blocker such as verapamil (50 g) or W-conotoxin (0.5 g) on the MAC after measurement of the control MAC. In experiment 3, after measurement of the control MAC, ET-1 (10-2 nmol) was administered intrathecally and the MAC was determined again. Next, intrathecal verapamil (50 g) or W-conotoxin (0.5 g) was injected. After that, the MAC was determined again. RESULTS: In experiment 1, ET-1 decreased the MAC of isoflurane and its effect was sustained over 2 hours. In experiment 2, the MAC, determined following administration of verapamil or W-conotoxin, was not different from that of the control. In experiment 3, the MAC was decreased after ET-1 administration and then increased following injection of verapamil or W-conotoxin. CONCLUSIONS: These results suggested that ET-1, in relation to calcium, might play an important role in determining the MAC of isoflurane in the spinal cord.
Animals ; Calcium ; Catheters ; Endothelin-1* ; Isoflurane* ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord ; Verapamil

PURPOSE: Drug resistance is one of the major obstacles to treatment of cancer. Multidrug resistance (MDR) caused by overexpression of p-glycoprotein (Pgp) in cancer cell membrane is a well-known mechanism of drug resistance in in vitro system and was reported to be a significant mechanism of resistance in non-Hodgkins lymphoma (NHL). Verapamil, a calcium channel blocker, is proven in vitro to overcome the MDR caused by Pgp. We performed a phase II trial of verapamil in patients with NHL refractory to EPOCH regimen (etoposide, prednisolone, vincristine, cyclophosphamide, and doxorubicin) to overcome the MDR caused by Pgp. MATERIALS AND METHODS: Verapamil was administered via intravenous route from 1 hour before to 12 hour after the 96-hour infusion of etoposide, doxorubicin, and vincristine which were known to be substrates of Pgp in EPOCH regimen. The dose of verapamil was 0.15 mg/Kg in bolus and 0.2 mg/Kg/hr in infusion at the beginning and escalated by 0.05 mg/Kg/hr every 24 hours if there was no dose-limiting toxicities such as 2nd or 3rd degree AV block, hypotension, or congestive heart failure. Plasma verapamil concentrations were measured every 24 hour by gas chromatography. Mdrl expression level in tumor tissues was measured by RT-PCR. RESULTS: From Feb. to Nov. 1994, 14 patients were treated with this protocoL However, poor tolerability and no response in these patients led to early closure of the study at this 1st stage of patient accrual according to Gehans method. Among 14 patients, 12 experienced 2nd or 3rd degree AV block and/or hypotension and required temporary cessation of infusion and reduction of verapamil dose. However, there was no congestive heart failure or treatment-related death. The peak concentrations of verapamil were 0.29-1.94 pM (mean 0.93 pM) and mean concentrations during the 4-day infusion were 0.22-1.21 pM (mean 0.6 pM). Mdrl expression levels measured in 6 patients were 0.99-14.43 U (median 4.39). CONCLUSION: These results suggest that verapamil in this dose and schedule was neither tolerable nor effective for the reversal of drug resistance in NHL patients.
Appointments and Schedules ; Atrioventricular Block ; Calcium Channels ; Cell Membrane ; Chromatography, Gas ; Cyclophosphamide ; Doxorubicin ; Drug Resistance* ; Drug Resistance, Multiple ; Etoposide ; Heart Failure ; Hodgkin Disease* ; Humans ; Hypotension ; Lymphoma, Non-Hodgkin ; P-Glycoprotein ; Plasma ; Prednisolone ; Verapamil* ; Vincristine

We evaluated the clinical results of 43 patients (47 eyes) who underwent cataract extraction and implantation of domestic posterior chamber intraocular lens manufactured by Universal Optics Co. (UNI(R) IOL) and could be followed up over 6 months. The mean follow-up period was 10.2 months with a range of 6 to 15 months. The results were as follows: 1. The final corrected visual acuity of 0.5 or better was noted in 41 eyes (87.2%). 2. The difference between the calculated postoperative refraction and the actual postoperative refraction was less than +/-1.00 D in 33 eyes (70.2%). 3. The corneal thickness increased 8.2% at postoperative period of 3 days and returned to preoperative level at postoperative period of 4 weeks. 4. The corneal endothelial cell density decreased 11.2% at postoperative period of 4 weeks and 12.8% at postoperative period of 6 months. 5. The early postoperative inflammatory reaction in anterior chamber and deposits on the surface of intraocular lens decreased gradually in the course of postoperative period. 6. The postoperative complications included posterior capsular opacification (7 eyes), fibrinous membrane (3 eyes), and hyphema (2 eyes). The above results showed that the visual outcome and the safety of UNI(R) IOL were favorable.
Anterior Chamber ; Cataract Extraction ; Endothelial Cells ; Fibrin ; Follow-Up Studies ; Humans ; Hyphema ; Lens Implantation, Intraocular* ; Lenses, Intraocular* ; Membranes ; Postoperative Complications ; Postoperative Period ; Visual Acuity

Actinomycosis is relatively rare infection which is produced by an anaerobic organism, actinomycetes, normally residing in the mouth, bowel and female genital tract. This disease is characterized by chronic inflammatory induration with abscess and multiple sinus formation. In most cases, the onset of this is preceded by an inflammatory or traumatic history on abdomen but diagnosis can't be made until operation. Recently this disease is treated with antimicrobial therapy and wide surgical excision. We experienced a case of omental actinomycosis and report it with brief review of literatures.
Abdomen ; Abscess ; Actinobacteria ; Actinomycosis* ; Diagnosis ; Female ; Humans ; Mouth ; Omentum

Relapsing polychondritis (RP) is an uncommon disorder of unknown etiology characterized by inflammation and destruction of the cartilaginous structures of many organs, including the tracheobronchial tree. We experienced a rare case of RP diagnosed after stellate ganglion block. A 56-year-old female has been treated under impression of rheumatoid arthritis and bronchial asthma for several years, but her symptoms were not markedly relieved. We performed right stellate ganglion block with 8 mL of 1% mepivacaine for the relief of the right shoulder pain. About 5 minutes later, she complained severe dyspnea and became cyanotic. Bronchoscopic finding was diffuse bronchoconstriction during expiration. We confirmed the diagnosis of relapsing polychondritis by bronchoscopic biopsy finding. Unfortunately, she died 3 months later due to recurrent pneumonia and acute respiratory distress syndrome.
Arthritis, Rheumatoid ; Asthma ; Biopsy ; Bronchoconstriction ; Diagnosis ; Dyspnea ; Female ; Humans ; Inflammation ; Mepivacaine ; Middle Aged ; Pneumonia ; Polychondritis, Relapsing* ; Respiratory Distress Syndrome, Adult ; Shoulder Pain ; Stellate Ganglion*

Phytolaccae had been used as a pharmaceutical drug or food But nowadays, due to its toxicity, Phytolaccae is rarely used and cases of patients poisoned with it are seldom reported. The case presented here was of 43 year-old male who after ingesting extract of Phytolacca esculenta suffered from abdominal pain, diarrhea, nausea, vomiting, tachycardia, hypotension, pruritus, paresthesia, oliguria and azotemia. Kidney biopsy revealed tubular necrosis and some protein casts in tubular lumens. These findings suggested that acute renal failure was mainly caused by nephrotoxicity of Phytolacca extracts. Through continuous arteriovenous hemofiltration and two times of hemodialysis, he was completely recovered from acute renal failure. Other symptoms also disappeared by symptomatic management, but paresthesia of both lower extremities still remained. So we reported this case with a brief review of literature.
Abdominal Pain ; Acute Kidney Injury* ; Adult ; Azotemia ; Biopsy ; Diarrhea ; Hemofiltration ; Humans ; Hypotension ; Kidney ; Lower Extremity ; Male ; Nausea ; Necrosis ; Oliguria ; Paresthesia ; Phytolacca* ; Poisoning* ; Pruritus ; Renal Dialysis ; Tachycardia ; Vomiting

BACKGROUNDPermanent vegetative state is defined as the impaired level of consciousness longer than 12 months after traumatic causes and 3 months after non-traumatic causes of brain injury. Although many studies assessed the cerebral metabolism in patients with acute and persistent vegetative state after brain injury, few studies investigated the cerebral metabolism in patients with permanent vegetative state. In this study, we performed the voxel-based analysis of cerebral glucose metabolism and investigated the relationship between regional cerebral glucose metabolism and the severity of impaired consciousness in patients with permanent vegetative state after acquired brain injury.

METHODSWe compared the regional cerebral glucose metabolism as demonstrated by F-18 fluorodeoxyglucose positron emission tomography from 12 patients with permanent vegetative state after acquired brain injury with those from 12 control subjects. Additionally, covariance analysis was performed to identify regions where decreased changes in regional cerebral glucose metabolism significantly correlated with a decrease of level of consciousness measured by JFK-coma recovery scale. Statistical analysis was performed using statistical parametric mapping.

RESULTSCompared with controls, patients with permanent vegetative state demonstrated decreased cerebral glucose metabolism in the left precuneus, both posterior cingulate cortices, the left superior parietal lobule (P(corrected) < 0.001), and increased cerebral glucose metabolism in the both cerebellum and the right supramarginal cortices (P(corrected) < 0.001). In the covariance analysis, a decrease in the level of consciousness was significantly correlated with decreased cerebral glucose metabolism in the both posterior cingulate cortices (P(uncorrected) < 0.005).

CONCLUSIONOur findings suggest that the posteromedial parietal cortex, which are part of neural network for consciousness, may be relevant structure for pathophysiological mechanism in patients with permanent vegetative state after acquired brain injury.

Adult ; Brain ; metabolism ; Brain Injuries ; metabolism ; Female ; Fluorodeoxyglucose F18 ; Glucose ; metabolism ; Humans ; Male ; Middle Aged ; Persistent Vegetative State ; metabolism

Soft fibromas are benign skin lesions that primarily occur in the neck, axillae, and groin locations. The occurrence of soft fibroma lesions in the nipple is extremely rare. Herein, we present two cases of soft fibroma of the nipple, which occurred in a 51-year-old woman (Case 1) and a 32-year-old woman (Case 2). The mammographic and ultrasonographic features of each case are described in this report. Mammography revealed an oval-shaped isodense mass in Case 1 and an irregular-shaped isodense mass in Case 2. On ultrasonography, Case 1 showed an oval-shaped hypoechoic mass with increased vascularity, whereas Case 2 presented a microlobulated, irregular-shaped, iso- to hypo-echoic mass with subtly increased vascularity at the stalk. In both cases, surgical excision was performed and pathological examination revealed soft fibroma.

Myoepithelioma is a rare benign tumor, most frequently located in the salivary gland. However, involvement of an extra-salivary gland is even rarer and very few cases involving the nasal cavity have been reported in the literature. A 51-year-old female patient presented with a complaint of progressive nasal obstruction and occurrence of recurrent epistaxis in the left nasal cavity over several months. A hemorrhagic and erythematous mass occupying the left nasal cavity was observed on physical examination using a nasal endoscope. A preoperative angiogram confirmed that he tumor was receiving blood supply from the sphenopalatine artery. We performed embolization to prevent hemorrhage during surgery; one day later, the lesion was successfully removed through endoscopic excision. Histopathological examination revealed that the tumor contained myoepithelial cells and myxoid stroma. Immunohistochemical studies showed that the tumor was positive for cytokeratin marker and S-100 protein, confirming the diagnosis of myoepithelioma. The patient recovered without any nasal symptoms or postoperative deficits.