BACKGROUND: In previous our retrospective study, we concluded that administered fluid volume, duration of operation, operative procedures and anesthetic techniques were the major factors of postoperative urinary retention. However, the administered fluid volume, age, types and duration of the operation confined to hemorrhoidectomy was questioned as a precipitating factor. The high retention rate in spinal anesthesia is also questioned. METHODS: We investigated these possible precipitating factors of urinary retention in healthy patients (n=154) undergoing hemorrhoidectomy. The patients were randomly divided into three different anesthetic techniques: caudal (2% lidocaine 300 mg with 1 : 200,000 epinephrine), spinal (0.5% tetracaine 5 mg with epinephrine 0.1 mg or 5% lidocaine 40 mg) and general (enflurane, N2O, vecuronium). Urinary retentin was searched according to above factors following surgery. RESULTS: The overall urinary retention rate was 46.1%. The retention rate in patients with spinal anesthesia was higher than that in those with other anesthetic techniques (p<0.05). There was no significant difference between patients with lidocaine and tetracaine spinal anesthesia in urinary retention rate. The administered fluid volume in patients with urinary retention was significantly higher than that of patients without retention (p<0.05). Age, duration and types of hemorrhoidectomy did not significantly affect urinary retention rate. CONCLUSIONS: Restriction of fluid administration and avoidance of spinal anesthesia are necessary in reducing postoperative urinary retention following hemorrhoidectomy.
Anesthesia, Spinal ; Epinephrine ; Hemorrhoidectomy* ; Humans ; Lidocaine ; Precipitating Factors ; Retrospective Studies ; Surgical Procedures, Operative ; Tetracaine ; Urinary Retention*

No abstract available.
Immunoglobulin G* ; Pentetic Acid* ; Polymers*

PURPOSE: This study was designed to describe the experiences of dementia prevention program for older adults in nursing homes. METHODS: Four focus group interviews (FGI) after the program were conducted with 35 participants. All interviews were audio-taped and transcribed verbatim. The transcribed data were analyzed by Colaizzi's phenomenological method. RESULTS: Four themes emerged as a result of analysis. Participants without dementia reported “I don't have dementia yet.” This statement probably reflects ignoring potential dementia. Motivation for participating the dementia prevention program were to reduce boredom, to enjoy exercising and communicating with others, and to follow group activities. Participants reported the positive effects of the program; (a) benefits from the repeating learned activities; (b) improvements of memory and emotional stability. A few participants reported their inability to follow the program due to physical and environmental limits. However, other participants reported their efforts to overcome physical limits and perform the activities regardless their limits. People who performed the activities with physical limits reported that their self-satisfaction was increased. CONCLUSION: Results of this study showed that participants without dementia were able to actively participate in dementia prevention programs and showed memory, emotional and behavioral improvements. Therefore, these findings can be used for developing customized dementia prevention programs in nursing homes.
Adult* ; Aged ; Boredom ; Dementia* ; Focus Groups ; Humans ; Memory ; Methods ; Motivation ; Nursing Homes* ; Nursing* ; Qualitative Research

We present here the case of a 13-year-old male patient with Alexander's disease who underwent surgical correction of a femur fracture. Alexander's disease is a rare and fatal disorder that affects the white matter in the brain and it causes developmental delay, psychomotor regression, spasticity, megaloencephaly and seizure. The patient had the possibility of a seizure attack during the perioperative period. We discuss the anesthetic management of a patient with Alexander's disease and we review the relevant literature.
Adolescent ; Alexander Disease ; Anesthesia ; Brain ; European Continental Ancestry Group ; Femur ; Humans ; Male ; Muscle Spasticity ; Perioperative Period ; Seizures

A 25-year-old male patient was received emergency operation, open reduction and tenorrhaphy owing to degloving injury on the dorsum of his left hand, under axillary brachial plexus block using a transarterial approach. Following operation, he revealed the signs and symptoms of brachial plexus injury such as weakness, sensory deficit and tingling sensation on his left forearm and hand. The finding on electromyography (EMG), performed on the 16th postoperative day (POD), was indicative of left incomplete brachial plexus injury, mainly in medial cord and ulnar nerve, and partially median and radial nerve at/above the axillary level. The signs and symptoms were improved slightly on POD 8 and a lot on POD 23. The complete recovery of symptoms and regeneration of injured nerve on EMG were confirmed 3 months following operation. In this case, the causative factors of brachial plexus injury were suggested in stretching of the brachial plexus due to improper positioning of injured arm during or after operation, combined with or without injury due to nerve block or tourniquet compression.
Adult ; Arm ; Brachial Plexus* ; Electromyography ; Emergencies ; Forearm ; Hand ; Humans ; Male ; Nerve Block ; Radial Nerve ; Regeneration ; Sensation ; Tourniquets ; Ulnar Nerve

No abstract available.
Abscess* ; Animals ; Immunoglobulin G* ; Mice*

BACKGROUND: Epidural adhesiolysis is advocated in radiculopathy due to epidural adhesion following previous back surgery. Traditionally, a Racz catheter through a R-K needle is used as a standard tool in this procedure. We report our experiences of clinical results and the usage of various catheters for epidural adhesiolysis in patients with failed back surgery syndrome. METHODS: We investigated the medical records of 15 patients with failed back surgery syndrome who received epidural adhesiolysis. An R-K epidural needle was inserted through the sacral hiatus and a Racz catheter was advanced through the needle and repeatedly passed through the adhesion site under fluoroscopic visualization. The authors used Racz catheter in addition to the several kinds of catheter, e.g., the Fogarty balloon, and pulmonary artery or ureteral catheters to improve the epidural adhesion lysis. Bupivacaine, triamcinolone, hypertonic saline and/or hyaluronic acid were injected through the catheter daily for 3 days. Patients were evaluated for pain intensity and side effects 3 days and 2 months after the procedure. RESULTS: Pain scores (numerical rating scale) were significantly lower at 3 days and 2 months (3.1 +/- 1.8, 5.7 +/- 2.0, respectively P <0.01) than pre-procedure values (8.6 +/- 0.9). Complications were 2 mild posterior neck pain during procedure and 1 myoclonus in the recovery room. CONCLUSIONS: We conclude that epidural adhesiolysis is a relatively effective therapeutic means in patients with failed back surgery syndrome. Furthermore, a new balloon catheter with the advantages of Racz and Fogarty catheters, should be made available to improve the quality of lysis.
Bupivacaine ; Catheters ; Failed Back Surgery Syndrome* ; Humans ; Hyaluronic Acid ; Medical Records ; Myoclonus ; Neck Pain ; Needles ; Pulmonary Artery ; Radiculopathy ; Recovery Room ; Triamcinolone ; Urinary Catheters

Malignant clear cell hidradenoma is a rare eccrine gland malignancy characterized by a solitary nodule on the head, trunk or distal extremity. We report a case of malignant clear cell hidradenoma in the left sole of a 66 year old female patient. Despite wide resection, regional lymph node dissection and radiation therapy, wide spread regional invasion and multiple distant metastasis were developed. As the malignant clear cell hidradenoma is reported rarely in the world and not yet reported in Korea, we report its clinical process of the diagnosis and treatment to patient's death.
Acrospiroma* ; Aged ; Diagnosis ; Eccrine Glands ; Extremities ; Female ; Head ; Humans ; Korea ; Lymph Node Excision ; Neoplasm Metastasis

Long QT Syndrome is characterized by syncope and fatal ventricular arrhythmia. Monotherapy with beta blockers is the first-line therapy. In patients with recurrent syncope despite therapy with beta blockers, combinations of the following modalities of treatment may be considered: pacemakers, left cervicothoracic sympathectomy, and implantable cardioverter defibrillators. Recently, we anesthetized a patient with Long QT Syndrome who underwent thoracoscopic left upper ganglionectomy for recurrent episodes of syncope and ventricular arrhythmia despite aggressive use of propranolol. Because of the increased risk of developing fatal ventricular arrhythmias during anesthesia and surgery, we performed a left stellate ganglion block prior to induction of anesthesia to prevent the ventricular arrhythmia that may be triggered by stimulation of the sympathetic nervous system and to assess the effect of surgical ganglionectomy on the QT interval. Following the block, the QT interval was shortened, and anesthesia and surgery was uneventful though anesthetic induction caused serious sympathetic responses. We recommend a left stellate ganglion block prior to induction of anesthesia in patients with Long QT Syndrome resistant to beta blocker to prevent fatal arrhythmia and to predict the efficacy of the surgical sympathectomy on the QT interval.
Anesthesia* ; Arrhythmias, Cardiac ; Defibrillators, Implantable ; Ganglionectomy ; Humans ; Long QT Syndrome* ; Propranolol ; Stellate Ganglion* ; Sympathectomy* ; Sympathetic Nervous System ; Syncope

No abstract available.