The intravenous administration of midazolam is widely used as sedative premedication for upper gastrointestinal endoscopy. We performed a study to evaluate the effectiveness and safety of midazoiam as premedication for upper gastrointestinal endoscopy. Between June 1995 and October 1995, 112 patients of diagnostic esophago-gastroduodenoseopy were enrolled in the study. The patients were recieved a bolus midazolam 0.~03mg/kg or placebo, followed by typical anesthesia. The blood pressure, pulse and oximeter values were monitored. The systolic blood pressure and heart rate were increased during endoscopy in compared with before premedication, and normalized immediately. There was no significant change of arterial oxygen saturation. Midazolam induced amnesia completely in 49.2% and partially in 27.2%, and all patients were recovered completely in 1 hour. The tolerance score is higher in the midazolam group as compared with the placebo group(p<0.05), and midazolam group would accept the same sedation for repeated endoscopies(p<0.01). We conclude that midazolam has beneficial effects as premedication for upper gastrointastinal endoscopy without significant altteration in cardiopulmonary parameters. This suggest that midazolam may be used more frequently as premedication, especially in the cases of repeated endoscopy.
Administration, Intravenous ; Amnesia ; Anesthesia ; Blood Pressure ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal* ; Heart Rate ; Humans ; Midazolam* ; Oxygen ; Premedication*

During the period from Jan. 1980 to Dec. 1982, 57 patient were taken RGP and the followings were obtained. 1) RGP was performed 57 patients. 2) Indication was 15 cases (26.3%) of non-visualizing kidney, 17 cases (29.8%) of hydronephrosis, 6 cases (10.5%) of delayed visualization, 13 cases (22.8%) of abnormal findings of calices and pelvis, 2 cases(3.5%) of congenital anomalies of ureter, 1 case (1.8%) of allergy to contrast medium and 3 cases (5.3%) of impaired renal function. 3) Of the 57 patients, 47 patients were defined with RGP and remained 10 patients had been taken other urologic examination for further evaluation.
Humans ; Hydronephrosis ; Hypersensitivity ; Kidney ; Pelvis ; Ureter ; Urography*

To elucidate the argument on the hypertensive effect of repeated stress, morphological study on the juxtaglomerular apparatus of pain-stressed mice was carried out. Following the repeated stress on mice by subcutaneous injections of formalin every day, animals were sacrificed on 1, 3, 6, 12 hours and 1, 2, 3, 6 days after the 5th injection. Kidneys fixed in 10%, Zenker-formol solution were routinely processed, and 4um sections were stained by Bowie's stain. For the precise interpretation, following protocols were applied; Comparing the amount of secretory granules, juxtaglomerular granulation index (JGI) was weighted on every 1000 glomeruli according to their granulaities. Comparing the proportional appearance of juxtaglomerular apparatus, granulation cell index (GCI) was counted as a mean number of granular juxtaglomerular apparatus among every 100 glomeruli. Comparing the cellularities of a single juxtaglomerular apparatus, juxtaglomerular granular cell count (JGCC) was counted as a mean number of granular juxtaglomerular cells appearing in a longitudinally. sectioned afferent arteriole. Comparing the functional relationship between the juxtaglomerular cells and macula densa cells, macula densa cell count (MD count) was counted as the mean number of macular densa cells having contacts with granular juxtaglomerular cells. Result of this experiment was processed and interpreted as followings. 1. Repeated pain-stress give rise to the prominant effect to juxtaglomerular cells, as high as double granular amount as compared to normal one, during 3-6 hours after the last stress. 2. Functional relationship between the distal convoluted tubule and Juxtaglomerular cells, checked out by MD contacts, was also highest during 3 to 6 hours term. 3. The effects were decreased afterwards, but still most counts were higher than those of normal data until 6th day, the last term of this experiment. 4. Present study show that the repeated pain-stress initiate the significant pressure-rising effect to animals during the first day after the last stress, and these effects may be latent during some days afterwards. 5. As the precise mechanism involved in this aspect remains to be elucidated, further studies includingelectron microscopic and histochemical methods shall be suggested.
Animals ; Arterioles ; Cell Count ; Formaldehyde ; Injections, Subcutaneous ; Juxtaglomerular Apparatus ; Kidney ; Mice* ; Secretory Vesicles

No abstract available.
Humans ; Infant, Newborn* ; Pneumonia*

The incidence of spinal tuberculosis has been decreased because of the development of anti-tuberculosis drugs, the use of radical surgical procedures and the improvement in the nations general hygiene. The anterior fusion is the most frequently used surgical measure in the treatment of spinal tuberculosis. One-hundred-eighty cases of spinal tuberculosis were treated by surgery during the 5 years from 1976 to 1980 at Presbyterian Medical Center with the following results: 1. The age distribution showed the peak incidence to be in the third decade. 2. The predilection site was the lumbar area and the percentage was 43.3. 3. In 17.2% of the cases, anti-tuberculosis drug was ingested before surgery. 4. Paraplegia was present in 16.1% of spinal tuberculosis. 5. In paraplegia, most of the location of the involved bodies was in the thoracic and the thoracolumbar vertebrae and the percentage was 79.3. 6. In paraplegia, complete recovery was 82.8%, and incomplete recovery was 10.3%. 7. In 90% of the patients, anterior fusion was done and the union rate was 91%. 8. Kyphosis was the most common in late complication.
Age Distribution ; Clinical Study ; Humans ; Hygiene ; Incidence ; Kyphosis ; Paraplegia ; Protestantism ; Spine ; Tuberculosis, Spinal

Metastatic malignant tumors involving the spine cause destruction of vertebral body, kyphosis and neural deficit. Irradiation relieves the pain and decreases the tumor mass, but sometimes the spine is progressively destroyed and becomes unstable. Traeatment of metastatic tumor involving the spine is difficult. Replacement of the vertebral body with bone cement and high dosage of radiation therapy was recommended by Harrington. The advantages are excision of the tumor mass, firm immobilization and enough irradiation not to recur. Two cases of metastatic carcinoma involving cervical spine were treated by anterior decompression, bone cement fixation and irradiation. One case died seventeen days after surgery due to severe pleural effusion. Another case was treated with irradiation (6,000 rads) after surgery and the pain was relieved. The spine is stable one year after surgery. There is no local recurrence.
Decompression ; Immobilization ; Kyphosis ; Pleural Effusion ; Recurrence ; Spine

The courses of the progression in the fibrous dysplasia are characterized by asymptomatic progression or spontaneous regression in some cases after the growth has ceased and the aims of treatment for a fibrous dysplasia are prevention of the pathologic fractures and correction of the deformities. The osteogenic potentiality of the cambium layer in the periosteum and the beneficial effect on the osteogenesis of the impregnating bone graft with autologous red marrow are well documented. We experienced an extensive fibrous dysplasia with cortical thinning and pathologic fracture and it was managed with subperiosteal combined xenograft of Kiel bone with autologous red marrow for the induction of cortical thickening and prevention of the pathologic fractures because of the inoperability of curettage due to extensive lesion over the entire femur, limitations in obtaining large amount of autogenous cancellous bone for the graft and lack of the facilities of the bone bank. This subperiosteal composite xenograft with autologous red marrow for a fibrous dysplasia gave an excellent result of a remarkable cortical thickening and we think this can be a type of management for a entensive fibrous dysplasia. So we are reporting this case with bibliographic reviews.
Bone Banks ; Bone Marrow ; Cambium ; Congenital Abnormalities ; Curettage ; Femur ; Fractures, Spontaneous ; Heterografts ; Osteogenesis ; Periosteum ; Transplants

Wide resection is an acceptable alternative to amputation for the management of primary sarcomas of the long bones or pelvis. The resected bone can be debrided of gross tumor tissue, autoclaved, and than replaced to reconstruct the limb anatomically. The procedure can be combined with prosthetic reconstruction of adjacent joints with sufficient strength to allow early unprotected weight-bearing. We had an experience of a large segmental defect in the shaft of the humerus after wide resection due to.a low grade malignant chondrosarcoma without extension to the surrounding soft tissues and this case had been managed by reimplantation after autoclaving the locally resected segment and autogenous iliac bone graft with a sound union and the favorable functional outcomes. So we are reporting this case with bibliographic reviews as a possible method of reconstruction for the management of the segmental defect which was produced by a local resection for a low grade malignancy.
Amputation ; Chondrosarcoma ; Extremities ; Humerus ; Joints ; Methods ; Pelvis ; Replantation ; Sarcoma ; Transplants ; Weight-Bearing

BACKGROUND: Healthcare quality can be improved by avoiding patient discomforts and customizing care to meet the needs of the patient. Therefore, the goal of this study was to quantify patients' discomfort for postoperative anesthesia outcomes for healthcare quality improvement. METHODS: One hundred orthopedic surgical patients were asked to tell possible undesirable postoperative outcomes preoperatively. In addition, they were also asked to tell undesirable postoperative outcomes from their most undesirable to least undesirable outcomes that they have experienced postoperatively. RESULTS: Patients expressed the following undesirable outcomes from most frequent to least frequent (in order); incisional pain, nausea/vomiting, shivering, headache, dizziness, sore throat, residual weakness, generalized myalgia, and somnolence. However, the severity of the symptoms were in the following order; nausea/vomiting, incisional pain, headache, dizziness, shivering, generalized myalgia residual weakness, sore throat, and somnolence. CONCLUSIONS: Although there is variability in how patients expressed postoperative outcomes, anesthesiologists can improve the quality of anesthesia by designing anesthesia regimens and methods that most closely meet each individual patient's preferences.
Anesthesia ; Dizziness ; Headache ; Humans ; Myalgia ; Orthopedics ; Pharyngitis ; Quality of Health Care ; Shivering

We have recently experienced with 3 cases of bilateral lung volume reduction surgery (LVRS) in patients with severe emphysematous disease in an effort to improve pulmonary mechanics. We compared intraoperative total dynamic lung compliance (CT) and % of breath exhaled in one second (V1.0%) obtained immediately pre-lung reduction and immediate post-lung reduction. In addition we also compared preoperative pulmonary function test (PFT) [FEV1, TLC, TG (trapped gas) and FRC] with 3 month postoperative values. Two of the three patients demonstrated post-reduction improvement in dynamic CT while only one patient demonstrated post-reduction improvement in V1.0%. All three patients demonstrated an increase in FEV1 and a decrease in TLC, TG and FRC with the greatest change in one patient who also had a significant reduction in CT and an improvement in V1.0% intraoperatively, and post-lung reduction. Although our results of the 3 cases are preliminary, it appears that side stream spirometry with immediate intraoperative measurement of dynamic CT and V1.0% could play a role in predicting expected follow-up objective pulmonary function tests; improvement in both CT and V1.0% may predict significant improvements in PFT.
Emphysema* ; Follow-Up Studies ; Humans ; Lung Compliance ; Lung* ; Mechanics ; Pneumonectomy* ; Respiratory Function Tests ; Rivers ; Spirometry