BACKGROUND/AIMS: The caudal anesthsia is most commonly used for benign anorectal surgery, The combination of long-acting anesthetics and opiates has been used for longer duration and successful control of postoperative pain. But the side effects of peridural anesthesics and morphine have commonly occured in caudal anesthesia. This study was performed to assess the difference in clinical effects between peridural mepivacaine and bupivacaine with morphine. METHODS: We evaluated the clinical effects in 60 patients who had anal operation with Jack-Knife position under caudal anesthesia. We divided randomly these 60 patients into two groups, M and B groups (in each group, 30 patients included). Group M (n=30) was given 2% mepivacaine 20 ml with morphine 2 mg caudally, and Group B (n=30) was given 0.5% bupivacaine 20 ml with morphine 2 mg in the same manner. We measured the onset time, duration, postoperative analgesia, and side effects including urinary retention. RESULTS: The onset time for analgesia was significantly shorter in group M than in group B. The duration of postoperative pain complaints was significantly longer in group M than in group B. The postoperative analgesic effects and side effects were not significantly different between two groups. CONCLUSIONS: Caudal mepivacaine and morphine mixture is effective for control of postoperative pain without significant side effects.
Analgesia ; Anesthesia, Caudal* ; Anesthetics ; Bupivacaine* ; Humans ; Mepivacaine* ; Morphine* ; Pain, Postoperative ; Urinary Retention

BACKGROUND: We studied the incidence of trauma caused by alcohol related accidents, and the effects that has on the occurrence, the extent, and the outcome to the patient. METHODS: In our study we studied trauma patients excluding pediatric patients(15 years old and under) who came to the Emergency department of Korea University Medical School Anam Hospital from the 1st of january 1996 to 30th of June 1996, looked into their medical records, and studied the records in a retrospective manner. The trauma patients were divided into two groups, a) alcohol-related and b) alcohol-non-related. The two groups were then subdivided according to their sex, age, the time they came in, the anatomical part of the trauma, the mechanism of their injury, the extent of the injury, the length of their hospital stay, the length of their ED stay and were seperately compared and analysed. Statistically, ANOVA and logistic regression analysis using SAS were used in the study and then was assessed in Chi-square analysis methods. RESULTS: The total of the trauma patients, added up to 832 people, 577: male and 255: female. Among this sum, 16 trauma patients were alcohol related(male:127 & female 36). 115 people were in the age group of 21-40. Compared to the non-alcohol related trauma group, the alcohol-related group had more facial & scalp injuries and tended to come in the hours between 0-6 AM. The cause of the injuries were mossy by fast-fighting and suicide, compared to mostly accidental-slipping injuries in the non alcohol-related group. There were no difference in the degree of the injury(ISS) and the length of hospital stay between the two groups, whereas the length of the stay at the ED was longer alcohol-related trauma patients. CONCLUSION: Alcohol related trauma patients were mostly in their 20s and 30s, came to the hospital at a late time it the reason for their visit were mossy because of fist fighting. In the Emergency department, because prompt and correct diagnosis is quite difficult to make in this group, their ED stay tended to be longer. We can conclude that measuring the blood alcohol level of these patients, continuing the psychological therapy and educating people is needed.
Diagnosis ; Emergency Service, Hospital ; Female ; Humans ; Incidence ; Korea ; Length of Stay ; Logistic Models ; Male ; Medical Records ; Retrospective Studies ; Scalp ; Schools, Medical ; Suicide

Congenital myotonia is a hereditary disorder of the skeletal muscle. The most characteristic features of the disease are myotonia and variable muscular hypertrophy. Molecular biologic investigations have revealed that mutations in the gene of the human skeletal muscle chloride ion channel protein are a cause of the disease. The Becker's type congenial myotonia is clinically similar to the autosomal dominantly inherited congenital myotonia (Thomsen's disease). Both disorders are characterized electrophysiologically by increased excitability of muscle fibers, reflected in clinical myotonia. In general, Becker's type congenital myotonia is more severe than Thomsen's disease in muscular hypertrophy and weakness. The authors recently experienced a 25-year-old female patient who has no family-related disease history and who has conspicuous muscular hypertrophy and the stiffness with muscles which occurred from the age of 3 or 4. Clinically she showed the authors a percussion myotonia. On electrophysiological study, exercise and repetitive stimulation of the abductor digiti quinti muscle disclosed a decline in the compound muscle action potential. Biopsy of biceps muscle revealed enlargement of muscle fibers with marked nuclear internalization. After the oral taking the Mexiletine, the patient showed a favorable turn a little with her stiffness of muscles. So we authors are reporting one case of Becker's type congenital myotonia with review of literatures.
Action Potentials ; Adult ; Biopsy ; Chloride Channels ; Female ; Humans ; Hypertrophy ; Mexiletine ; Muscle, Skeletal ; Muscles ; Myotonia ; Myotonia Congenita*

Retroperitoneal fibrosis sometimes causes urological problem involving the ureter, but the mechanism is uncertain. An aortic aneurysm, including an iliac artery aneurysm, is thought to be one of the mechanisms of retroperitoneal fibrosis. However, cases caused by an isolated iliac artery aneurysm are very rare, and symptoms tend to be non-specific; therefore, no definitive treatment has been established. Herein, we report our recent experience of a patient with a left common iliac artery aneurysm involving the ureter, who underwent successful surgical therapy.
Aneurysm* ; Aortic Aneurysm ; Constriction, Pathologic* ; Humans ; Iliac Artery* ; Retroperitoneal Fibrosis* ; Ureter*

Heterotopic pregnancy is the coexistency of intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy is about 1 to 30,000 pregnancy in a natural cycle. However, the frequency of heterotopic pregnancy has steadily increased because of rising incidence of pelvic inflammatory disease, pelvic surgery and the development of ovulation induction and assisted reproduction. Because heterotopic pregnancy is difficult to diagnose and it has high morbidity and mortality rate, one should always take this into consideration and should conduct careful and thorough gynecologic evaluation. We have experienced a case of heterotopic pregnancy in a 29-year old woman who presented with acute abdominal pain in a natural cycle and report this case with a brief review of literature.
Abdominal Pain ; Adult ; Female ; Humans ; Incidence ; Mortality ; Ovulation Induction ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Reproduction

No abstract available.
Sinusitis*

Almost 50% of patients with inflammatory bowel disease (IBD) exhibit at least one extra-intestinal manifestation in their lifetime. Extra-intestinal manifestations of IBD are often associated with the intestinal disease activity, reducing the quality of life of the patient but rarely leading to fatal complications. Musculoskeletal involvement is the most frequent extra-intestinal manifestation of patients with IBD but this rarely occurs before IBD is diagnosed. They are manifested in various forms, such as arthropathy, fibromyalgia, and osteoporosis. Therefore, a multidisciplinary team approach including gastroenterologists and rheumatologists are necessary for optimal treatment. This review focuses on the diagnosis and treatment of musculoskeletal manifestations of IBD from the perspectives of rheumatologists who can assist gastroenterologists.
Diagnosis ; Fibromyalgia ; Humans ; Inflammatory Bowel Diseases ; Intestinal Diseases ; Joint Diseases ; Musculoskeletal Diseases ; Osteoporosis ; Quality of Life

Almost 50% of patients with inflammatory bowel disease (IBD) exhibit at least one extra-intestinal manifestation in their lifetime. Extra-intestinal manifestations of IBD are often associated with the intestinal disease activity, reducing the quality of life of the patient but rarely leading to fatal complications. Musculoskeletal involvement is the most frequent extra-intestinal manifestation of patients with IBD but this rarely occurs before IBD is diagnosed. They are manifested in various forms, such as arthropathy, fibromyalgia, and osteoporosis. Therefore, a multidisciplinary team approach including gastroenterologists and rheumatologists are necessary for optimal treatment. This review focuses on the diagnosis and treatment of musculoskeletal manifestations of IBD from the perspectives of rheumatologists who can assist gastroenterologists.
Diagnosis ; Fibromyalgia ; Humans ; Inflammatory Bowel Diseases ; Intestinal Diseases ; Joint Diseases ; Musculoskeletal Diseases ; Osteoporosis ; Quality of Life

BACKGROUND: It has been documented that certain prognostic factors may affect the outcomes of the old aged victims by trauma. Considering that trauma is the sixth most common cause of death in people over the age of 65 years and there is a rapid growth of elderly population, it is paramount to understand the prognostic factors when dealing with geriatric trauma patients. Hypothesis and Goals : It can be hypothesized that the prognostic factors should be determined independently between populations being consisted of different races, countries, socio-economic states, cultures, or so on. Thus, study was designed to evaluate the factors affecting the outcomes of elderly Korean trauma patients. METHODS: One hundred forty six patients aged over 65 years were retrospectively reviewed, who visited the Emergency Canter of Korea University from January, 1997 to June, 1998. Of 146 patients, 7 were excluded due to discharge against advice or transfer to the other hospitals. Parameters analysed were age, sex, mechanism of injuries, body region injured, Injury Severity Score (ISS), previous medical illness, hospital morbidity, duration of hospital stay, and cost. Each patient was classified into improved or not-improved groups depending on the outcomes, and young-old or old-old group depending on the age. The factors affecting the hospital stay in improved patients were analyzed in the parameters of previous medical illness, hospital morbidity, multiple injuries, ISS, and age. All statistical tests were conducted with two-tailed levels of 0.05. RESULTS: Of 139 patients, the mean age was 74+/-7.1 years, mean ISS 9.3+/-7.26, mean hospital stay 27+/-27.1 days. Most commonly injured body region was the extremities due to fall from a level surface. Rate of previous illness showed 0.94 medical diseases per person and were aggravated after trauma in 39 patients (60.9%). Hospital morbidity rate was 0.46 incidents per person. There were no differences in age and duration of hospital stay between the improved and the not-improved group. Substantial differences were noted in affected body region, incidence of previous illness, and hospital morbidity between the groups (p=NS). Not-improved group had higher ISS (p<0.05). ISS, previous illness and hospital morbidity affected the duration of hospital stay in the improved group. Hospital stay was 40+/-25.1 days in patients with ISS over 6 while 6+/-8.6 days in those with ISS 5 (p<0.05). Hospital stay in the improved was 26+/-26.9 days while 31+/- 24.8 days in the improved old-old group (P=NS). Hospital stay in the young-old minor trauma (ISS5) patients with previous illness and hospital morbidity was 26+/-10.1 days while 4+/-7.3 days in those without previous illness and hospital morbidity (p<0.05). CONCLUSION: Previous medical illness and hospital morbidity, not age, are predictive of outcomes of geriatric trauma patients with respect to hospital stay. As most of the hospital morbidity was a trauma-induced aggravation of previous medical illness and hospital morbidity contributing poor outcomes can be potentially avoidable, routine aggressive care far the geriatric trauma patients with previous medical illnesses is needed.
Aged ; Body Regions ; Cause of Death ; Continental Population Groups ; Emergencies ; Extremities ; Humans ; Incidence ; Injury Severity Score ; Korea ; Length of Stay ; Multiple Trauma ; Retrospective Studies

A 41-year-old female complaining of easy fatigue, headache, thickened extremities and deepened facial folds was admitted to the hospital. As early as 6 years ago, she had been told by family members that her voice was changed and both hands was thickened. Cranial plain radiography indicated ballooning of sella turcica. Sella MRI disclosed 2.2cm sized pituitary tumor with suprasellar extension. The pituitary tumor with hypothalamic extension was removed via a transsphenoidal approach. The postoperative course was uneventful until hyponatremia with sudden headache and respiratory arrest was developed. The case was due to hyponatremic encephalopathy on the basis of the clinical course and symptoms, and 3% hypertonic saline was infused for 12 hours until the hyponatremia was corrected. We have experienced a mortality case of hyponatremic encephalopathy in which surgieal removal of a pituitary tumor from a female acromegalic patient in menstruant period was followed by the sudden occurrence of hyponatremia, which in turn was later associated with marked brain edema.
Adult ; Brain Edema ; Extremities ; Fatigue ; Female ; Hand ; Headache ; Humans ; Hyponatremia ; Magnetic Resonance Imaging ; Mortality ; Pituitary Neoplasms ; Radiography ; Sella Turcica ; Voice