BACKGROUND: If two or more doctors prescribe for one patient, each doctor must be careful to minimize the number of drugs and the frequency of admistration, and also be careful to avoid duplicating drugs. The purpose of this study is to evaluate the appropriateness of prescription for the patient who visits two or more doctors. METHODS: In a tertiary hospital, outpatients who received prescriptions simultaneously from two or more doctors were selected, and the number of drugs, the frequency of admistration and duplication of drugs were evaluated. RESULTS: The number of eligible patients was 887. The number of drugs was 5.2 for patients who visited 2 doctors, and 8.1 for patients who visited 3 doctors. 13% of patients who visited 2 doctors received more than 8 drugs, and 32.6% of patients who visited 3 doctors received more than 10 drugs. The frequency of administration per day was 3.7 for patients who visited 2 doctors, and 5.0 for patients who visited 3 doctors. 12% of patients who visited 2 doctors had to take drug more than 6 times a day and 9.3% of patients who visited 3 doctors had to take drug more than 8 times a day. 9.2% of total patients received duplicated drugs. The duplication of drugs was more frequent among patients who visited 2 doctors than who visited 3 doctors. CONCLUSIONS: For the patients who visited two or more doctors, the number of drugs and frequency of admistration was inappropriate and duplication of drugs was found, therefore the doctors should make more efforts to avoid inappropriate prescription.
Drug Prescriptions* ; Humans ; Inappropriate Prescribing ; Outpatients ; Prescriptions ; Tertiary Care Centers

Island flaps have been widely used for the management of soft tissue defects in reconstructive surgery. The necrosis of the flap has been a catastrophe in clinical fields. It is well known that revascularization to the flap after ligation of its pedicle comes from the recipient bed and flap margins. The authors investigated the effects of the ischemic recipient bed on island flap survival after the ligation of its pedicle in the rats. One hundred and thirty inferior epigastric island flaps were divided into three groups (Group I, Group II, and Group III) according to the degree (0%,20%, and 60%) of interruption of contact of flap with the recipient bed, respectively. In Group I,the vascular pedicles were ligated before and on the 0, 2nd, 3rd, 4th and 5th days after flap elevation, and in Group II & III, the vascular pedicles were ligated on the 2nd, 3rd, 4th and 5th days after flap elevation. Flap survival was assessed on the 3rd day after pedicle ligation. Microangiographic studies were also performed on the 3rd day after pedicle ligation to study revascularization within the flap and the change of blood vessels around the flap margins. The results were as follows: 1. Flap survival was increased significantly in the flaps with pedicle ligation on the 4th and 5th postoperative days compared to those at the 2nd and 3rd postoperative days. 2. From the 3rd postoperative day, flap survival was not influenced significantly by the degree of limited bed contact and the date of pedicle ligation. 3. In spite of limited bed contact, the flap will likely survive with abundant revascularization from the flap margins. In conclusion, the flaps with limited bed contact were revascularized significantly from the flap margin by the 3rd postoperative day.
Animals ; Blood Vessels ; Ligation ; Necrosis ; Rats ; Surgical Flaps

CT was found to be highly accurate in predicting tumor size and assessing invasion of the surroundingstructures and distant metastasis. Also CT played an important role for determination of operability of esophagealcarcinoma. The CT findings with barium esophagogram in 21 patients with histologically proven esophageal carciomawere reviewed from Feb. 1985 to Feb. 1986 at the department of Radiology, Yonsei University ,College of Medicine.The results were as follows: 1. Number of patients in each stages were: 2 in stage 1, 6 in stage 2, 4 in stage 3,and 9 in stage 4. 2. Peak age distribution was in its 6th decasedes as 9 patiens (42.9%). Overall mean age was 60.8 years. Number of male patients were 19 and 2 of female. 3. Histologic types of esohageal carcinoma were 19cases of epidermoid (90.5%) and 2 cases of adenocarcinoma(9.5%). 4. The tumor location was 1 case in upper, 14cases(66.7%) in middle and 6 cases in lower one-third. 5. Various types of esophageal carcinoma were as follows: 3cases of fungating, 4 cases of infiltrating, 5 cases of ulcerofungating, and 9 cases of ulceroinfiltrating type.6. Average length of involvement in each stages were 4cm in stage 1, 5.5cm in stage 2, 8.8cm in stage 3, and 8.3cmin stage 4. The involved length was longer in advanced cases. In 11 cases(52.4%), the involved length was between4 and 8cm. 7. Angle of periaortic fat plane obliteration of the aortic circumference were as follows: Below 45degrees( 7 cases 33.3%), 45degrees-90degrees (3 cases 14.3%), over 90 degrees(11 cases, 52.4%). 8. Method oftreatment of esophageal carcinoma were as follows: Only radiotherapy in 11 cases(52.4%), radiotherapy withoperation in 5 cases, only operation in 1 cases, and no treatment in 4 cases. 9. Distant metastatic sites were:brain in 1, pericardium in 5, liver in 5, trachea in 2, bronchus in 9, and distant lymph node in 5 cases.
Age Distribution ; Barium ; Bronchi ; Female ; Humans ; Liver ; Lymph Nodes ; Male ; Methods ; Neoplasm Metastasis ; Pericardium ; Radiotherapy ; Trachea

BACKGROUND: A non-randomized, uncontrolled study was undertaken with a retrospective medical record review to evaluate the effect of pain relief of chemical lumbar sympathectomy in patients with peripheral vascular occlusive disease. This was conducted to assess whether the long term outcome of ischemic limbs could be changed and to identify predictable medical factors of patients who would be helped by this procedure. METHODS: A total of 47 patients with Buerger's disease (n = 20) and arteriosclerosis obliterans (n = 17) referred by vascular surgery for the management of ischemic pain were enrolled. All other conservative and surgical management efforts had already failed and were not indicated. The following were evaluated before and after the neurolytic lumbar sympathetic blocks: the stages of disease by Fontaine classification, main sites and numbers of occlusion, pain scores before and after the procedure, physical findings, amputation sites, and medications as well as amounts given and other risk factors. RESULTS: Buerger's disease tends to progress rapidly and aggressively. It is more painful than arteriosclerosis obliterans and is peripherally involved, with higher incidences of complications. Chemical sympathectomy has significant pain relief effects in both groups. Differences in long term outcome measured by amputation could not be found in both groups. No significant risk factors could be identified. No side effects were reported in both groups. CONCLUSIONS: Chemical lumbar sympathectomy has a good analgesic effect for pain in walking. This, however showed no long-term limb-saving effect.
Amputation ; Arterial Occlusive Diseases* ; Arteriosclerosis Obliterans* ; Arteriosclerosis* ; Classification ; Extremities ; Humans ; Incidence ; Medical Records ; Retrospective Studies ; Risk Factors ; Sympathectomy ; Sympathectomy, Chemical ; Thromboangiitis Obliterans* ; Walking

Nerve injury can arise as a complication of peripheral nerve block. Three factors are of special etiologic interest: nerve lesion due to the needle injury or intraneural injection; toxic effects of drugs injected overall when epinephrine is used; ischemic trauma. The symptoms of such nerve lesions are dysesthesia, motor weakness or paralysis. We report a case of severe neurologic symptoms of left shoulder after interscalene nerve block in a 23-year-old ASA I male patient. Interscalene block utilizing nerve stimulator and elicitation of paresthesia was performed smoothly for incision and drainage of 2nd finger mass. Total 30 cc of 2% lidocaine with epinephrine was used. After the procedure, the patient developed a severe dysesthesia and motor weakness of left shoulder which gradually improved over the next 6 months through the extensive rehabilitation program. The block should be handled with care: rough paresthesia seeking techniques and intraneural injections should be avoided; short bevel needles and plain solutions should be used to avoid complications.
Drainage ; Epinephrine ; Fingers ; Humans ; Lidocaine ; Male ; Needles ; Nerve Block* ; Neurologic Manifestations ; Paralysis ; Paresthesia* ; Peripheral Nerves ; Rehabilitation ; Shoulder* ; Young Adult

Nerve injury can arise as a complication of peripheral nerve block. Three factors are of special etiologic interest: nerve lesion due to the needle injury or intraneural injection; toxic effects of drugs injected overall when epinephrine is used; ischemic trauma. The symptoms of such nerve lesions are dysesthesia, motor weakness or paralysis. We report a case of severe neurologic symptoms of left shoulder after interscalene nerve block in a 23-year-old ASA I male patient. Interscalene block utilizing nerve stimulator and elicitation of paresthesia was performed smoothly for incision and drainage of 2nd finger mass. Total 30 cc of 2% lidocaine with epinephrine was used. After the procedure, the patient developed a severe dysesthesia and motor weakness of left shoulder which gradually improved over the next 6 months through the extensive rehabilitation program. The block should be handled with care: rough paresthesia seeking techniques and intraneural injections should be avoided; short bevel needles and plain solutions should be used to avoid complications.
Drainage ; Epinephrine ; Fingers ; Humans ; Lidocaine ; Male ; Needles ; Nerve Block* ; Neurologic Manifestations ; Paralysis ; Paresthesia* ; Peripheral Nerves ; Rehabilitation ; Shoulder* ; Young Adult

BACKGROUND: The efficacy and safety of propacetamol, an injectable prodrug of acetaminophen, in combination with morphine administered by patient controlled analgesia(PCA) were studied in 40 patients after gynecological surgery requiring lower abdominal incision. METHODS: Using a double-blind, randomized, parallel-group design, the effects of four (every 6 hr) intravenous injections of 2 g propacetamol(=1 g acetaminophen) were compared with four injections of placebo in the recovery room immediately after surgery. Efficacy was assessed over 24hr by automated recording on the PCA device of the cumulative dose of morphine and the number of boluses requested. It was assessed on pain scores rated on a ten-point verbal scale, at 30 minutes, 1hr, 2hr, 4hr and then every 4hr until the 24hr after administration. Any side effects were recorded throughout the duration of the study, and the ability to tolerate the drug was assessed by recording of hemodynamic changes, patient satisfaction, the frequency of side effects and sedation scores at the predetermined time interval as above. RESULTS: The 24-hr morphine consumption was significantly decreased in the propacetamol group. Analysis of the hourly morphine doses showed a significant decrease from the fourth hour. Although there was no significant difference in pain scores between the two groups, 80% of patients in the morphine group versus 85% of the propacetamol group found it "good" or "extremely good". The incidence of nausea was less in the propacetamol group. The incidence of other side effects were statistically insignificant. CONCLUSION: Propacetamol has demonstrated a morphine sparing effects(=37%) in gynecological postoperative pain, thus confirming that it is a useful and safe injectable non-NSAID, nonopioid analgesic in postoperative period.
Acetaminophen ; Analgesia ; Analgesia, Patient-Controlled* ; Female ; Gynecologic Surgical Procedures* ; Hemodynamics ; Humans ; Incidence ; Injections, Intravenous ; Morphine ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Postoperative Period ; Recovery Room

No abstract available.
Animals ; Linoleic Acid* ; Mice* ; Sarcoma 180* ; Sarcoma*

STATEMENT OF PROBLEM: Recently Yttrium-stabilized tetragonal zirconia polycrystal (Y-TZP) has been introduced due to superior flexural strength and fracture toughness compared to other dental ceramic systems. Although zirconia has outstanding mechanical properties, the phenomenon of decrease in the life-time of zirconia resulted from degradation in flexural strength after low temperature aging has been reported. PURPOSE: The objective of this study was to investigate degradation of flexural strength of Y-TZP ceramics after various low temperature aging treatments and to evaluate the phase stability and micro-structural change after aging by using X-ray diffraction analysis and a scanning electron microscope (SEM). MATERIAL AND METHODS: Y-TZP blocks of Vita In-Ceram YZ (Vita Zahnfabrik, Bad Sackingen, Germany) were prepared in 40 mm (length) x 4 mm (width) x 3 mm (height) samples. Specimens were artificially aged in distilled water by heat-treatment at a temperature of 75, 100, 125, 150, 175, 200, and 225degrees C for 10 hours, in order to induce the phase transformation at the surface. To measure the mechanical property, the specimens were subjected to a four-point bending test using a universal testing machine (Instron model 3365; Instron, Canton, Mass, USA). In addition, X-ray diffraction analysis (DMAX 2500; Rigaku, Tokyo, Japan) and SEM (Hitachi s4700; Jeol Ltd, Tokyo, Japan) were performed to estimate the phase transformation. The statistical analysis was done using SAS 9.1.3 (SAS institute, USA). The flexural strength data of the experimental groups were analyzed by one-way analysis of variance and to detect statistically significant differences (alpha= .05). RESULTS: The mean flexural strength of sintered Vita In-Ceram YZ without autoclaving was 798 MPa. When applied aging temperature at below 125degrees C for 10 hours, the flexural strength of Vita In-Ceram YZ increased up to 1,161 MPa. However, at above 150degrees C, the flexural strength started to decrease. Although low temperature aging caused the tetragonal-to-monoclinic phase transformation related to temperature, the minimum flexural strength was above 700 MPa. CONCLUSION: The monoclinic phase started to appear after aging treatment above 100degrees C. With the higher aging temperature, the fraction of monoclinic phase increased. The ratio of monoclinic/tetragonal + monoclinic phase reached a plateau value, circa 75% above 175degrees C. The point of monoclinic concentration at which the flexural strength begins to decrease was between 12% and 54%.
Aged ; Aging ; Aluminum Oxide ; Ceramics ; Collodion ; Dental Porcelain ; Electrons ; Humans ; Phenothiazines ; Tokyo ; Water ; X-Ray Diffraction ; Yttrium ; Zirconium

No abstract available.
Pregnancy*