BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

Heart failure is a recognized, although uncommon, cause of massive liver cell necrosis, the clinical consequence of which are intermingled with those of cardiac insufficiency in most case. But, hepatic coma is rerely caused by hepatic congestion only. We report the three cases with heart failure resulted in massive liver cell necrosis and fulminant hepatic failure. The manifestations of fulminant hepatic failure were hepatic encephalopathy, jaundice, marked increase of prothrombin time and serum transaminase and there were no evidences of viral hepatitis and toxic hepatitis as a cause of liver failure.
Drug-Induced Liver Injury ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Hepatic Encephalopathy ; Hepatitis ; Jaundice ; Liver ; Liver Failure ; Liver Failure, Acute* ; Necrosis ; Prothrombin Time

Pneumomediastinum is a relatively uncommon, infrequently reported entity, In the evaluation of these entity, it is important to exclude pathological causes, including Boerhaave's syndrome which carries a high mortality. Spontaneous pneumomediastinum is related to excessive intraalveolar pressure leading to rupture of perivascular alveoli in the setting of a Valsalva maneuver without communication to gut material. So, it has a benign self-limited course and rarely requires medical intervention. On the contrary, secondary pneumomediastinum caused by instrumental, traumatic, and spontaneous perforation of esophagus. Although the prognosis have been improved since the advent of broad-spectrum antibiotics and nutritional support, pneumomediastinum due to esophageal perforation still has a high morbidity and mortality. The most important prognostic factor is the time interval between perforation and initiation of therapy, and an awareness and a high clinical suspicion is critical in the early diagnosis and treatment. Recently, we have experienced 2 cases of pneumomediastinum, one case was spontaneous pneumomediastinum and the other may be caused by instrumental esophageal perforation. We report the clinical course of the patients with a current literature review.
Anti-Bacterial Agents ; Early Diagnosis ; Esophageal Perforation ; Esophagus ; Fibrinogen ; Humans ; Mediastinal Emphysema* ; Mortality ; Nutritional Support ; Prognosis ; Rupture ; Valsalva Maneuver

BACKGROUND: The pathophysiologies of Failed Back Surgery Syndrome (FBSS) are epidural adhesion& fibrosis; arachnoiditis, neural encroachment, mechanical instability. Epidural adhesiolysis alleviate back pain through blocking the neural activity of scar area and decreasing the inflammation & edema. There are two methods of adhesiolysis, endoscopic & non-endoscopic adhesiolysis. Present study was aimed to compare the pain relief & side effects between two methods. METHODS: We investigated 86 post-laminectomy patients with low back pain and radiculopathy, who do not relieved with any kinds of conservative treatment. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with MRI examination. Group I was consisted with non-endoscopic 41 patients, and Group II was endoscopic 45 patients. Evaluation included assessment of pain relief (visual analogue scale, VAS), rate of reprocedures and duration of pain relief (VAS < 5) at post-epidural adhesiolysis 2 week, and 1, 2, 6 months. We also looked for complication of adhesiolysis. RESULTS: Statistical analysis (t-test, chisquared test) demonstrated VAS & reprocedure rate was significantly low (P < 0.05) in group II at 6 month and duration of pain relief (VAS < 5) was more prolonged in group II. One patient in each groups complained skin eruption and pruritus, and one patient of group II was proved epidural abscess and one patient of group I complained headache. CONCLUSIONS: Endoscopic and non-endoscopic epidural adhesiolysis are effective and safe in patients, who was not relieved the symptoms with conservative treatment, but endoscopic epidural adhesiolysis is more recommendable because its more prolonged effect.
Arachnoid ; Arachnoiditis ; Back Pain ; Cicatrix ; Edema ; Epidural Abscess ; Failed Back Surgery Syndrome ; Fibrosis ; Headache ; Humans ; Inflammation ; Low Back Pain ; Magnetic Resonance Imaging ; Pathology ; Pruritus ; Radiculopathy ; Skin

Purpose: This study aims to investigate the effect of gonadotropin-releasing hormone agonist (GnRHa) on the growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis and to evaluate whether -202 A/C IGF binding protein-3 (IGFBP-3) promoter polymorphism affects growth velocity in females with central precocious puberty (CPP) during treatment. Methods: Data was collected from 97 females younger than 9 years, diagnosed with precocious puberty and treated with GnRHa for at least 1 year at Kangdong Sacred Heart Hospital from 2014 to 2015. Their body height, weight, change in height standard deviation score (∆SDS), serum IGF-1, serum IGFBP-3, bone age, and -202 A/C IGFBP-3 promoter polymorphism were measured before and after GnRHa treatment. The interrelationships between the variables were calculated. Results: During treatment, height SDS, IGF-1 SDS, IGFBP-3 SDS, and IGF-1/IGFBP-3 ratio significantly decreased. A significant correlation was observed between ∆IGF-1 SDS and ∆height SDS (r=0.405, P<0.001). The presence of the C allele was significantly correlated with IGF-1 SDS after treatment (P=0.049) and with IGFBP-3 SDS before and after treatment (P=0.012 and P=0.001), but not with ∆IGF-1 SDS, ∆IGFBP-3 SDS, ∆IGF-1/IGFBP-3 ratio, or ∆height SDS. Conclusion Growth velocity during GnRHa treatment is related to ∆IGF-1 SDS, indicating the apparent impact of GnRHa on the GH-IGF-1 axis. The -202 A/C IGFBP-3 promoter polymorphism does not affect the growth velocity of GnRHa in CPP girls.

No abstract available.

PURPOSE: Sling procedures have become the gold standard for treating all types of stress urinary incontinence (SUI) in women because of their simplicity of procedure and good outcomes. We compared the outcomes of anterior vaginal wall sling with cadaveric fascia lata sling. MATERIALS AND METHODS: Between October 1996 and April 2000, 43 women with SUI who were treated with anterior vaginal wall sling and 23 women with SUI who were treated with cadaveric fascia lata sling were analyzed. Mean follow-ups were 43.0 months (29-56) for anterior vaginal wall sling and 21.5 months (16-30) for cadaveric fascia lata sling. All patients were evaluated preoperatively with a detailed history, pelvic examination, urinalysis, voiding diary, and urodynamic study including Valsalva leak point pressure. Parameters of comparison included presence of stress incontinence, length of hospital stay, duration of catheterization, operation time, and complication and success rates. RESULTS: The success rates, including satisfaction rates, were 83.7% in the anterior vaginal wall sling group and 82.6% in the cadaveric fascia lata sling group. The complication rates were 23.3% in the anterior vaginal wall sling group and 26.1% in the cadaveric fascia lata sling group. CONCLUSIONS: Both procedures were equally effective in the management of female SUI with high cure rates and acceptably low complication rates. However, further long-term follow-up study of these procedures is required to determine the persistence of the good results in women with SUI.
Cadaver* ; Catheterization ; Catheters ; Fascia Lata* ; Fascia* ; Female* ; Follow-Up Studies ; Gynecological Examination ; Humans ; Length of Stay ; Urinalysis ; Urinary Incontinence* ; Urodynamics

To observe the influence of kidney transplantation (KT) on erectile and endocrine function, we evaluated the PBI, penile pulse volume plethysmography, RigiScan and endocrine study before and after KT in 21 patients. We also interviewed with these patients or their sexual partners before KT. at 3 months and 6 months after KT. 7 cases (33%) were improved, 8 cases (38%) were same and 4 cases(19%) were aggravated in sexual desire and erectile function and 2 cases (10% ) had been suffered from erectile dysfunction since 19 months and 6 years prior to KT. The PBI was changed from 0.97 +/- 0.09 to 0.95 +/- 0.16 and it was not a significant difference. The penile plethysmography was not a good screening test in the evaluation of erectile function in KF. But the Rigiscan could detect all of the tested aggravated cases and it was thought to be a good screening test. In the endocrine studies, testosterone and FSH were decreased and LH and prolactin were increased before KT but testosterone and LH were significantly decreased after KT. It was thought to be the influence of KT and immunosuppressive agent (cyclosporin A). In conclusion, sexual desire and erectile function may be improved by the KT and most reliable screening test was Rigiscan. Endocrine function may be affected by the KT and cyclosporin A.
Cyclosporine ; Erectile Dysfunction ; Humans ; Kidney Transplantation* ; Kidney* ; Male ; Mass Screening ; Plethysmography ; Prolactin ; Sexual Partners ; Testosterone ; Transplantation

PURPOSE: To evaluate the usefulness of a new technique for the subciliary approach to the surgical management of anophthalmic, shallow inferior fornices. METHODS: Six patients with difficulty retaining an ocular prosthesis, due to anophthalmic, shallow inferior fornices with sufficient conjunctiva, underwent this operation from October 2003 to April 2005. Surgery consisted of the fixation of the conjunctival fornix to the periosteum immediately posterior to the inferior orbital rim through the subciliary approach. This study was prospective. RESULTS: The mean age of the patients was 40.1+/-14.7 years (range, 21~62 years). Three of six patients were male, and three were female. The mean duration of surgical anophthalmos was 16.8+/-13.2 years (range, 0.6~40 years), and the mean follow-up period was 9.3+/-8.4 months (range, 3~25 months). All 6 patients who could not wear prostheses because of shallow fornices could wear ocular prostheses successfully after the operation. An ocular prosthesis could be fitted at a mean duration of 1.83+/-0.75 weeks (range, 1~3 weeks), postoperatively. Only one patient had mild entropion, but there were no conjunctival contractures or loss of fornices postoperatively. CONCLUSIONS: The authors believe that this new technique through the subciliary approach is simple and easy to perform and enables the patient to wear an ocular prosthesis earlier than does forniceal reconstruction through the transconjunctival approach. This technique is very useful in patients with anophthalmic, shallow inferior fornices who have sufficient conjunctiva but loose attachments of the fornix to the underlying tissue, causing shallow fornices.
Anophthalmos ; Conjunctiva ; Contracture ; Entropion ; Eye, Artificial ; Female ; Follow-Up Studies ; Humans ; Male ; Orbit ; Periosteum ; Prospective Studies ; Prostheses and Implants

Purpose: A laparoscopic radical nephrectomy is known to cause less morbidity than a traditional open radical nephrectomy. In our institution, the laparoscopic approach, with intact specimen removal, has become the standard technique for radical nephrectomies. Herein, we report the results and oncological outcome of the experience of a single center. Materials and Methods: We reviewed 68 transperitoneal laparoscopic radical nephrectomies, performed for suspected renal cell carcinoma between December 1999 and June 2006. All data were collected from the patient's medical records. Results: The mean tumor size, surgical time and estimated blood loss were 4.82cm (1.7-14), 228.5 min (120-480) and 409.1cc (32-1,312), respectively. Conversion to open surgery was required in one case due to Endo-GIA malfunction, and conversion to hand-assisted surgery was performed in one case. The histological findings were pT1, pT2 and pT3 in 40 (59.7%), 9 (13.4%) and 18 patients (26.9%), respectively. In one case, the histology confirmed a non-malignant disease. The follow-up period was from 3 to 80 months (median 18). Distant metastasis was observed in 2 cases, but there was no local recurrence or port metastasis. Conclusions: A laparoscopic radical nephrectomy is a safe and feasible treatment for localized renal cell carcinomas. Longer follow-up and large scale studies are necessary to evaluate the long-term survival and disease- free rates, and confirm the effectiveness of performing a radical laparoscopic nephrectomy.
Carcinoma, Renal Cell ; Conversion to Open Surgery ; Follow-Up Studies ; Humans ; Laparoscopy ; Medical Records ; Neoplasm Metastasis ; Nephrectomy* ; Operative Time ; Recurrence