BACKGROUND: The initiation of treatment seems to be important in provoking preemptive analgesia and to provide excellent postoperative pain control. To verify the effectiveness of postoperative analgesia and preemptive effects, pre-incisional and post-incisional epidural infusion of morphine and bupivacaine mixture were compared. METHODS: Patients scheduled for elective upper abdominal surgery were divided into 2 groups. Each group received 2 mg of morphine in 10 ml of 0.25% bupivacaine as a bolus followed by 0.1 mg/ml/hr of morphine infusion in 0.125% bupivacaine epidurally. In post-incisional group, the epidural injection of mixture was started 15 minutes after skin incision and in pre-incisional group, the epidural infusion of mixture was started 15 minutes before skin incision. Each groups were evaluated in visual analogue scales (VAS) for pain, pain scores in movement, and total administered doses in postoperative 1, 2, 4, 8, 24, 48, and 72 hours and compared with each others. RESULTS: There were no differences between pre-incisional and post-incisional start of continuous epidural mixture infusion of morphine and bupivacaine in VAS for pain, pain scores at movement, and total amount of infused doses for 72 hours postoperatively. Also, there were no differences in the incidence of complications and satisfactions of patients between two groups. CONCLUSIONS: The continuous epidural mixture infusion of morphine 0.1 mg/ml/hr in 0.125% bupivacaine following a bolus dose of 2 mg morphine in 0.25% 10 ml bupivacaine has no difference in postoperative analgesic effect whether it starts after or before surgical incision.
Analgesia ; Bupivacaine ; Humans ; Incidence ; Injections, Epidural ; Morphine* ; Pain, Postoperative ; Skin ; Weights and Measures

Background:Insulin dependent diabetes mellitus(IDDM) is known to be a disease characterized by a deficiency of insulin caused by destruction of the pancreatic beta-cells. It has been suggested that the clinical and immunological characteristics of IDDM in Korean are different from those of Caucasian. This study was undertaken to investigate the clinical characteristics and the prevalence of autoimmune markers in type I diabetic children and their prediabetic siblings in Korea. METHODS:Insulin autoantibody(IAA), antiglutamic acid decarboxylase(Anti-GAD) antibody, thyroid autoantibodies such as antithyroid antibody(ATA) and antimicrosomal antibody(AMA), and rheumatoid facter(RF) in 54 type I diabetic children have been measured. Diabetic autoimmune antibodies were also measured in 48 siblings. RESULTS: 1)Clinical characteristics of type I diabetic children were that age of onset was 8.6+/-4.4 years, duration of diabetes was 4.1+/-3.3 years. C-peptide at onset of diabetes was fasting 0.7+/-0.5ng/ml, and postprandial 1.2+/-0.5ng/ml, and HbA1c was 12.5+/-4.3%. 2)The positivity of IAA and anti-GAD antibody of type I diabetic children was 74% and 50% respectively. ATA and AMA positivity of type I diabetic children was 3.7% and 5.6%. however RF was not detected at all. Among the diabetic siblings, 48 persons for anti-GAD antibody, 21 for IAA, 27 for ICA were measured but 1 case was positive for IAA. 3)Clinical characteristics of type I diabetic children were not specific different between IAA and anti-GAD antibody positivity. But the mean age of onset of type I diabetic children was younger in case of both positivity of IAA and anti-GAD antibody than both negativity(7.8 vs 11.4 years old, P<0.05). 4)A case in whose brothers are diagnosed as IDDM has shown that autoantibody of elder brother was positive in both IAA and anti-GAD antibody, and younger brother was also strongly positive in IAA. Another case in whose sisters were IDDM, has shown that, while elder sister was positive in IAA, younger sister strongly positive in both IAA and anti-GAD antibody. 5)In a case of identical twin brother, the elder is type I diabetic child and the younger is normal, elder brother's onset of age was 6 years and 8 months old, and titer of anti-GAD antibody was measured as strong positive. Both ICA and anti- GAD antibody were negative in normal younger brother. First phase insulin release in IV GTT and the insulin levels in oral GTT showed reduction from the normal level in normal brother, and repeat check up showed normal ranges but on-going study is needed under observation. CONCLUSION: The prevalence of autoantibody positivity of type I diabetic children of Korea in this study were IAA 74%, and anti-GAD antibody 50%. Cases with both IAA and anti-GAD antibody positive were shown to be earlier onset. Though titers of auto-antibody in IDDM twins, brothers and sisters were strongly positive, auto-antibodies in siblings of IDDM patients were detected only one case with IAA positive(0.47%). We suggest that the pathogenesis of IDDM in Korean is different from foreign countries in terms of prevalence of autoimmune antibodies and more numbers of diabetic siblings should be tested for further study.
Age of Onset ; Antibodies* ; Autoantibodies ; C-Peptide ; Child* ; Diabetes Mellitus, Type 1 ; Fasting ; Humans ; Infant ; Insulin ; Korea ; Prevalence* ; Reference Values ; Siblings* ; Thyroid Gland ; Twins, Monozygotic

No abstract available.
Child* ; Humans

TO determine the normal neonatal adrenal gland size, ultrasonographic examinations were performed in 145 newborn infants. They were divided into 3 groups according to the days of age. The group I is 1~3 days, group II is 6~9 days and group III is 21~50 days of age. 1) The adrenal gland size was as follows. In group I, the length was 29.05mm and the width was 4.02mm. In group II, the length was 24.04mm and the width was 2.79mm. In group III, the length was 19.54mm and the width was 2.21mm. 2) With increasing age, the size of adrenal gland became smaller. 3) The size of adrenal gland correlated well with the birth weight and height. We conclude that the ultrasonographic examination is useful in infant adrenal gland disease.
Adrenal Gland Diseases ; Adrenal Glands* ; Birth Weight ; Humans ; Infant ; Infant, Newborn

Pulmonary comp1ications following surgery continue to be a major cruse of postoperative mobidity. The purpose of this study was to measure the effects of various surgical procedures upon arterial blood gas tension and ventilatory function in the early postoperative period. 30 patients with no history of cardiopulmonary disease before surgery were selectively chosen and divided into 4 categories depending on the location of the operative incision and the type of anesthesia. Group l was composed of upper abdominal incision cases, Group ll lower abdominal incision cases, and Groups lll and lV had nonabdominal surgery. Groups, l, ll and lll received general anesthesia, while lV was liven spinal anesthesia. Lung volumes were measured and blood samples were taken preoperatively and 70 minutes after surgery. Patients were maintained in semisitting position before and after surgery. Vital capacities were significantly reduced in the postoperative period in the general ane- sthesia groups, and tidal volumes were significantly reduced in the upper and lower abdominal incision groups. The mean PaO2 value after anesthesia decreased significantly in the upper and lower abdominal incision groups, but there were no significant differencea in the PaCO2 value. It seems that supplemental oxygen and encouragement of deep inspirations are essential and beneficial in the early postoperative period, especially for the patients with abdominal surgery.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal ; Humans ; Lung ; Oxygen ; Postoperative Period ; Tidal Volume ; Vital Capacity

Hypersensitivity myocarditis is an inflammatory disease of the myocardium usually related to drug allergy. The clinical manifestation may be nonspecific, and the diagnosis is seldom suspected or established during the life. So in most of the reported patients, the diagnosis was made at autopsy. Although, retrospectively, more than 90% of the patients described have had clinically recognizable cardiac involvement before death, tole clinical suspicion of hypersensitivity myocarditis is rare. The presence of nonspecific cardiac finding in a patient receiving any drug associated with hypersensitivity should alert the clinician to the possibility of drug related myocarditis. We experienced a case of hypersensitivity myocarditis accompanying allergic skin lesion in a 58 years old man with a history of taking cefadroxil. Fortunately, the outcome was favorable, therefore we do not have histologic confirmation of the diagnosis.
Autopsy ; Cefadroxil ; Diagnosis ; Drug Hypersensitivity ; Humans ; Hypersensitivity* ; Middle Aged ; Myocarditis ; Myocardium ; Retrospective Studies ; Skin

No abstract available.
Adenocarcinoma* ; Fallopian Tubes* ; Female

No abstract available.
Bowen's Disease ; Foot

Bone Regeneration ; Connective Tissue ; Guided Tissue Regeneration ; Membranes ; Osteogenesis ; Palpation ; Rabbits ; Rubber Dams ; Rubber ; Skull

PURPOSE: Xanthoma in the eyelids is a common dermatologic disorder. Generally these lesions do not affect the function of the eyelids. We report a case of xanthoma that has caused lid edema and ptosis. METHODS: A 46-year-old woman presented with ptosis and mass of the right upper eyelid for several months. We tried oral corticosteroid treatment, but the lesion was not lessened. We performed an excisional biopsy for the mass and ptosis correction. RESULTS: Histopathological examination of the mass revealed xanthoma. Lipid-laden histocytes infiltrated through the subcutaneous tissue, dermis, muscle layer and the preaponeurotic fat tissue. After surgical treatment, the patient was treated with Fenofibrate. There was a mild recurrence after a 18 months of follow-up.
Biopsy ; Blepharoptosis* ; Dermis ; Edema ; Eyelids ; Female ; Fenofibrate ; Follow-Up Studies ; Humans ; Middle Aged ; Recurrence ; Subcutaneous Tissue ; Xanthomatosis*