BACKGROUND: We observed fentanyl known as centrally-acting antitussive agents provoke a cough response in some patients at induction of anesthesia. This may be of clinical importance. METHOD: 121 patients (ASA class I) were assigned randomly to 4 groups. Each group was given different doses of fentanyll Group 1 (n=30); 0.5ug/kg, Group 2 (n=30); 1ug/kg, Group 3 (n=33); 2ug/kg, Group 4 (n=28); 4 g/kgl, within 1 second through a peripheral venous cannula before induction of anesthesia. All patients were observed carefully in order to detect a cough response and any side effects. RESULT: The incidences of FCR (Fentanyl Cough Response) were 0% in Group 1, 10.0% in Group 2, 30.3% in Group 3, and 39.3% in Group 4. The ED50 of FCR was 4.25ug/kg. The mean onset-time from the end of fentanyl administration to the beginning of coughing was 12.5 seconds. FCR was decreased with aging, but not affected by weight, height, or smoking. Other serious side effects were not accompanied. CONCLUSION: Fentanyl can evoke the pulmonary chemoreflex dose-dependently and the ED50 was 4.25 g/kg.
Aging ; Anesthesia ; Antitussive Agents ; Catheters* ; Cough* ; Fentanyl* ; Humans ; Incidence ; Reflex* ; Smoke ; Smoking

We evaluated thirty normal human eyes(aged from 22 to 95) to investigate the changes with age of the cellularity and acid mucopolysaccharides in the trabecular meshwork. The cellularities were evaluated from the number of the cells per unit area of trabecular meshwork and the number of cells per unit length of trabecular meshwork. In addition, acid mucopolysaccharides(AMS) were investigated by counter staining the trabecular meshwork specimens, with Van Gieson following colloidal iron. The results were as follows: 1. With age, cellularities of the whole trabecular meshwork and the counterpart of filtration region decreased significantly(p0.05). 2. The trabecular meshwork cellularity and the absolute number of cells were decreased by 40.0% and 35.9%, respectively, for those aged from 22 to 95. 3. There was no strong relation between the change of acid mucopolysaccharides of the trabecular meshwork and aging process. The grade +1 AMS was observed in 15 eyes(50.0%) and was the most prevalent.
Aging ; Colloids ; Filtration ; Glaucoma ; Glycosaminoglycans* ; Humans ; Iron ; Trabecular Meshwork*

Herpes zoster is primarily a disease of sensory portion of the nervous system and one of motor portion as well. Herpes zoster radiculopathy can be usually easily diagnosed in the presence or previous history of the characteristic cutaneous eruptions. Motor involvement dose not always coincide in location with the cutaneous lesions. Along with the radicular distribution of pain, motor neuron involvement can mimic other clinical conditions such as disc herniation, tumor infiltration, or infection. Even if the diagnosis of herpes zoster radiculopathy may be delayed, it must be put off until any other diseases or underlying causes are ruled out, especially in case motor symptoms and signs are major clinical features, or there is a topographic dissociation between dermatomes and myotomes involved. We report a patient with spinal cord tumor revealed in the evaluation and management of herpes zoster-related radiculopathy.
Diagnosis ; Herpes Zoster* ; Humans ; Motor Neurons ; Nervous System ; Paresis ; Radiculopathy* ; Spinal Cord Neoplasms* ; Spinal Cord*

Herpes zoster is primarily a disease of sensory portion of the nervous system and one of motor portion as well. Herpes zoster radiculopathy can be usually easily diagnosed in the presence or previous history of the characteristic cutaneous eruptions. Motor involvement dose not always coincide in location with the cutaneous lesions. Along with the radicular distribution of pain, motor neuron involvement can mimic other clinical conditions such as disc herniation, tumor infiltration, or infection. Even if the diagnosis of herpes zoster radiculopathy may be delayed, it must be put off until any other diseases or underlying causes are ruled out, especially in case motor symptoms and signs are major clinical features, or there is a topographic dissociation between dermatomes and myotomes involved. We report a patient with spinal cord tumor revealed in the evaluation and management of herpes zoster-related radiculopathy.
Diagnosis ; Herpes Zoster* ; Humans ; Motor Neurons ; Nervous System ; Paresis ; Radiculopathy* ; Spinal Cord Neoplasms* ; Spinal Cord*

The infradiaphragmatic type of Total Anomalous Pulmonary Venous Return(TAPVR) is a rare congenital cardiacanomaly which usually results in death during the period of early infancy. A two month-old baby boy with cyanosisand respiratory distress was suspected of having a TAPVR clinically and the two-dimensional echocardiographicfindings were compatible with the infradiaphragmetic type of TAPVR. The subsequent cardiac catheterization andcineangiogram revealed the common pulmonary vein connected with portal vein and inferior vena cava in theinfradiaphragmetic area with obvious obstruction. The surgery and the autopsy confiremd the preopeative diagnosis.Among infants presenting pulmonary venous congestion in the newborn period. TAPVR below the diaphragm shold be oneof the important diagnostic cosiderations.
Autopsy ; Cardiac Catheterization ; Cardiac Catheters ; Diaphragm ; Humans ; Hyperemia ; Infant ; Infant, Newborn ; Male ; Portal Vein ; Pulmonary Veins ; Scimitar Syndrome ; Vena Cava, Inferior

The authors reviewed 11 consecutive patients with hemorrhage in pituitary adenomas, which were treated by transsphenoidal approach from Jan. 1992 to Dec. 1997. We evaluated nine cases of female and 2 cases of male patients(mean age: 43.4 years old). The diagnosis of pituitary apoplexy was made by severe neurologic sign with sudden onset of headache and visual disturbance, in the setting of hemorrhage in the pituitary adenoma on computed tomographic or magnetic resonance imaging scans. Two cases were diagnosed as pituitary apoplexy and the remaining cases were diagnosed as intratumoral hemorrhages. In our series, the most common symptoms were headache(81.8%) and visual disturbance(81.8%). Other symptoms and signs were hormonal symptoms(63.6%) due to preexisting tumor, cranial nerve signs(18.2%) and alteration of mentality(18.2%). Radiologic findings were changes of sellar contour(double floor sign, widened sellae and obliteration of anterior or posterior clinoid processes) on plain skull X-ray, high density lesion in sellar area on computed tomographic scan. The magnetic resonance images were taken in all patients. Among 11 patients, 9 cases showed subacute hemorrhage(high signal intensity on T1 weighted image) and 2 showed that of chronic stage(iso signal intensity on T1 image and high signal intensity on T2 image). According to the hormonal type, the most common type of tumors associated with intratumoral hemorrhage was non-functioning adenoma(7 cases) compared to other types(GH secreting: 2, ACTH secreting: 1, Prolactin secreting: 1). All patients showed significant improvement of symptoms after surgery(average follow-up, 12.5 months). Rapid diagnosis with computed tomography and/or magnetic resonance imaging, hormonal replacement and transsphenoidal decompression constituted effective therapy.
Adrenocorticotropic Hormone ; Cranial Nerves ; Decompression ; Diagnosis ; Female ; Follow-Up Studies ; Headache ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Pituitary Apoplexy ; Pituitary Neoplasms* ; Prolactin ; Skull

BACKGROUND: Controlling postoperative pain after knee replacement while reducing opioid-induced adverse effects and improving outcomes remains an important challenge. To assess the effect of combined capsicum plaster at the Korean hand acupuncture point on opioid consumption and outcomes after total knee replacement. METHODS: One hundred and two patients, received total knee replacement, were included in a randomized, double-blinded study: 51 patients were in the placebo group, and 51 patients were in K-M26 group. Capsicum plaster was applied at the K-M26 point in K-M26 group, whereas in the placebo group, an inactive tape was fixed at K-M26 point of both hands. The capsicum plaster was applied before induction of anesthesia for 8 h, and attached during 3 days postoperatively. They received postoperative pain treatment with intravenous patient-controlled analgesia (PCA) during the first postoperative 48 h. Visual analog scale (VAS) scores at rest were used to assess pain. Total PCA volume delivered, number of PCA requests, supplemental analgesics, overall satisfaction score and adverse events were evaluated. RESULTS: K-M26 group reported significant lower VAS and supplemental analgesic doses at 3 days postoperatively compared with placebo group. No significant differences were found in delivered doses and requested number of PCA, and satisfaction score between two groups. There was a tendency of decrease in postoperative nausea and vomiting in K-M26 group, but no significant differences. CONCLUSIONS: PCA with capsicum plaster at in K-M26 point is thought to be potent and safe for postoperative pain relief after total knee replacement with the lesser adverse events.
Acupuncture Points* ; Acupuncture* ; Analgesia, Patient-Controlled ; Analgesics ; Anesthesia ; Arthroplasty, Replacement, Knee ; Capsicum* ; Hand* ; Humans ; Knee* ; Pain Management* ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Visual Analog Scale

Rhabdomyosarcoma is a highly aggressive malignant tumor with an incidence of 1/500,000 children per year. Head and neck is the most common site of the embryonal rhabdomyosarcoma. We experienced four cases of embryonal rhabdomyosarcoma, each case originating from temporalis muscle, nasal cavity, parapharynx and nasopharynx. The median age of four patients was 12.5 years old (range, 3-25 years), and the male and female ratio was 2:2 . Two patients were treated with operation and postoperative chemotherapy and irradiation. One patient was treated with induction chemotherapy before operation, and then received postoperative chemotherapy and irradiation. The remaining one patient was incidentally confirmed by excisional biopsy and treated with chemotherapy and irradiation. The median follow-up period was 24 months (range, 6-56 months). Three patients recovered completely with no further evidence of disease. One patient showed breast metastasis after 3 months later.
Biopsy ; Breast ; Child ; Drug Therapy ; Female ; Follow-Up Studies ; Head* ; Humans ; Incidence ; Induction Chemotherapy ; Male ; Nasal Cavity ; Nasopharynx ; Neck* ; Neoplasm Metastasis ; Rhabdomyosarcoma* ; Rhabdomyosarcoma, Embryonal

BACKGROUND AND OBJECTIVES: Although tonsillectomy is one of the most often performed surgeries in Otorhinolaryngology, there has not been any long-term postoperative follow-up studies until now. The authors aimed to validate once more, in a long-term follow up study, the need for performing tonsillectomy. MATERIALS AND METHODS: Medical records of 180 adult patients who have received tonsillectomy were retrospectively studied, and telephone surveys were made to the patients. The telephone questionnaire was designed to find out the postoperative pain, complications such as bleeding, the time each patient took to return to the normal diet and social life, the degree of improvement in the symptoms and the satisfactory rate. RESULTS: The chief complaints were recurrent sore throat. There was no immediate postoperative bleeding, but secondary bleeding occurred in 12.8% of the patients. The postoperative pain scored 7.4 in a scale of one to ten. The average time in returning to the normal diet and the normal life was 17.9, 21.1 days, respectively. Studies in the symptomatic improvement showed almost no or minimal residual symptom in 99% of the patients and about 95% of the patients answered positively in satisfactory category. CONCLUSION: Tonsillectomy caused great pain postoperatively in most of the patients and returning to the normal diet and life took fairly a long time. However, the positive answers about the symptomatic improvement and the high satisfaction rate validates tonsillectomy as an effective surgical treatment for patients with recurrent tonsillitis.
Adult* ; Diet ; Follow-Up Studies ; Hemorrhage ; Humans ; Medical Records ; Otolaryngology ; Pain, Postoperative ; Palatine Tonsil ; Pharyngitis ; Surveys and Questionnaires ; Retrospective Studies ; Telephone ; Tonsillectomy* ; Tonsillitis

Methotrexate (MTX) is commonly employed in the management of chronic inflammatory skin diseases. We report the case of a 73-year-old man who presented with a persistent cough lasting for 1 month. He had an 11-year history of psoriasis and had received MTX (10.0 mg/wk) over the past 21 months. High-resolution chest computed tomography revealed diffuse ground-glass opacities and bronchiectasis affecting both lung fields. Based on clinical and radiological assessments, the patient was diagnosed with MTX-induced interstitial pneumonia. Notably, significant clinical and radiological improvement was observed 1 month after the discontinuation of MTX and corticosteroid administration. Although some reports have demonstrated lung toxicity in patients receiving high-dose MTX therapy, cases of adverse pulmonary effects following low-dose treatment in patients with psoriasis are rare.This case report underscores the rarity of interstitial pneumonia in a patient with psoriasis undergoing MTX treatment in Korea.