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*

No abstract available.
Intussusception*

BACKGROUND: Crucial to the success of fiberoptic awake tracheal intubation is proper preparation of the patient; this technique will work well in most patients when they are quiet and cooperative and have a larynx nonreactive to physical stimuli. We have attempted to ascertain how well these conditions are achieved with a low-dose infusion of propofol, because of its pharmacological profile. METHODS: Thirty patients, physical status by American Society of Anesthesiologists (A. S. A.) I-II, scheduled for oral and maxillofacial surgery, were randomly assigned to receive either propofol infusion 1 mg kg-1 h-1 preceded by a 1 mg kg-1 bolus (Group P) or intravenous fentanyl 1ug kg-1 and midazolam 0.05 mg kg-1 (Group F). These two groups were compared in terms of hemodynamic profile, sedation score, condition for intubation, coughing and swallowing. RESULTS: There were no statistically significant differences in mean arterial blood pressures according to time between two groups. But in Group F, heart rates were significantly increased in immediately after transtracheal injection of lidocaine, immediately before the fiberoscopy was started, 1, 2 minutes after start of fiberoscopy, compared to Group P (p<0.05). The patients in Group P were more sedated than those in Group F (p<0.05) but there were no significant differences in condition for intubation, reflex of coughing and swallowing, duration of fiberoptic intubation. CONCLUSIONS: We conclude that propofol is useful sedative agent in fiberoptic awake intubation with similar efficacy to midazolam and fentanyl but with more profound sedation and stable hemodynamic profile. These represent significant advantages for severe anxious or hypertensive patients and prolonged procedure of intubation.
Arterial Pressure ; Cough ; Deglutition ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Larynx ; Lidocaine ; Midazolam* ; Propofol* ; Reflex ; Surgery, Oral

No abstract available.
Humans ; Infant, Newborn*

We analyzed retrospectively 58 patinets of retinoblastoma for the first, ocular symptoms, gender, family history, funduscopic findings, treatment modalities and results from 1987 to 1993. Fourteen patients were bilateral, forth-four were unilateral, and seventy-two eyes were affected in sum. The average of age of the patients was 25.6 months. Their first ocular symptoms were leukocoria, squint and etc. Three patients were suspected as familial type of retinoblastoma. We claasified the patients according to the affected degree of the retina;over three-fourths of the retina was affected in 34 eyes. We treated them with enucleation, radiation, chemotherapy, episcleral plaque radiotherapy, laser photocoagulation and cryotherapy. After these treatments, orbital recurrence was observed in one case and among the ten eyes treated with eye-conserving treatments, nine eyes are maintained with periodic examination under general anesthesia and the treatment of laser photocoagulation and cryotherapy until now.
Anesthesia, General ; Cryotherapy ; Drug Therapy ; Humans ; Light Coagulation ; Orbit ; Radiotherapy ; Recurrence ; Retina ; Retinoblastoma* ; Retrospective Studies ; Strabismus

PURPOSE: This study is to assess the occurence rate, severity, and duration of the back pain after lumbar puncture. METHODS: The occurence rate, severity and duration of the back pain that developed after lumbar puncture were recorded prospectively in patients with aseptic meningitis who had been admitted to the department of Pediatrics, St. Benedict Hospital in Pusan, from May 1993 to July 1993. The cases with traumatic taps, repeated taps, undelying diseases and age group below 2 year were excluded. The overall number of cases included in this study was 136. RESULTS: 1) In the 136 patients, back pain was developed in 53 cases (39.0%) after lumbar puncture and mean age of 53 cases was 5.4+/-2.8 years and male to female ratio was 1.4:1. 23 cases (16.9%) were mild, 17 cases (12.5%) were moderate and 13 cases (9.6%) were severe. 2) On each age group, the incidence of back pain was as followed : These were 21 patients (38.9%) out of 54 cases in group 1 (2-4 yrs), 22 patients (37.3%) out of 59 cases in group 2 (5-8 yrs) and 10 patients (43.5%) out of 23 cases in group 3 (9-12yrs). After lumbar puncture, there were no significant correlations between occurence rate of back pain and age groups. 3) The mean intervals between onset of back pain and lumbar puncture were 0.5 day in 8 patients, 0.5-1.0 day in 25 patients (47.2%), 1.0-1.5 days in 12 patients (22.6%), and 1.5-2.0 days in 4 patients. 4) The mean duration of the back pain was 2.4+/-1.3 days, and 1.4+/-0.8 days in mild pain group, 2.9+/-1.2 days in moderate pain group and 3.3+/-1.2 days in severe pain group. The mean duration of the back pain was significantly longer in moderate and severe pain groups than mild pain group (p<0.01). CONCLUSIONS: In the patient with aseptic meningitis, occurence rate of the back pain after lumbar puncture was 39.0%. All back pain were subsided within six days after onset of pain.
Back Pain* ; Busan ; Female ; Humans ; Incidence ; Male ; Meningitis, Aseptic* ; Pediatrics ; Prospective Studies ; Spinal Puncture*

PURPOSE: To compare the bleb morphology and surgical outcomes of a limbus-based group with those of a fornix-based group who underwent trabeculectomy with mitomycin C (MMC). METHODS: Sixty-five eyes of 59 patients who had undergone trabeculectomy with MMC and who were observed for one year or more were included in the present study. A limbus-based conjunctival flap was used for 34 eyes of 31 patients and a fornix-based conjunctival flap for the other 31 eyes of 28 patients. The bleb morphologies were classified and compared after one year or more postoperatively according to the Moorfield Bleb Grading System, and intraocular pressure and success rates were evaluated. RESULTS: The central bleb vascularity of the limbus-based group was statistically significantly lower than that of the fornix- based group (1.79 +/- 0.64; 2.16 +/- 0.73, p = 0.042). The risk of cystic bleb formation was higher in the limbus-based group (38.2%; 16.5%, p = 0.047). There were no differences in the IOP or success rate between the two groups. CONCLUSIONS: There were no differences between the two groups with regard to the IOP or cumulative success rate. However, in the fornix-based group, the central bleb vascularity was lower and the risk of avascular cystic bleb formation was higher than those in the limbus-based group.
Blister ; Eye ; Humans ; Intraocular Pressure ; Mitomycin ; Trabeculectomy

OBJECTIVE: In the human body the embryo initially gmws in the fallopian tube which is maintained in an 3-8% O2 concentration environment, and various substances such as growth factors and antioxidants present in tbe tubal fluid assists in maintaining a healthy environment for embryo development. But in IVF programs embryo cultures are conducted in incubators with 21.9% O2 and 5% CO2 condition, and such high oxygen concentrations have been reported to increase the production of oxygen free radicals within the embryo and is detrimental to the growth and development of the embryo. The objective of this study, therefore, is to determine the culture conditions which will decrease oxygen free radical production and thereby minimize the injury to the embryo. METHODS: Six to eight week old ICR strain mice embryos were cultured in 5% or 21.9% O2 conditions and in culture media to which inaement concentrations of superoxide dismutase (SOD) had been and the H2O2 concentration within the embryo, embryo developmental rate, and degree of fragmentation of the embryos was investigated. RESULTS: The control gmup embryos which were cultured in 21.9% O2 condition without addition of SOD showed developmental arrest at the 2-cell stage or fragmentation, while those cultured in 21.9% O2 condition with addition of SOD showed development to the blastocyst stage with deaeased fragmentation. In particular, the blastulation and fragmentation rates were the lowest in the group to which 500 IU/ml of SOD was added, but in the 5% O2 enviranment group many embryos reached the blastocyst stage and with no difference in frapnentation with or without addition of SOD. The HO relative intensity (120.5+/-20.2) within the embryos cultured in 21.9% O2 environment without SOD was significantly higher than that (56.8+/-10.8) of group with SOD (p<0.05). As showing that in the 5% O2 environment group without SOD it was 43.8+/-7.8 and in the group with SOD it was 37.3+/-5.4, the H2O2 concentration within embryos cultured in 5% 02 condition was significantly lower those that of 21,9% 02 environment regardless of SOD addition (p<0.05). CONCLUSION: The optimal oxygen concentration in incubator for mice embryo cultures is that which is similar to the 5% 0 concentration in vivo. When 20% 02 incubators are routinely used, the addition of SOD to the culture media will decrease the H2O2 concentration within the embryos with subsequent improvement in development. The optimal concentration which should be used is thought to be 500 IU/ml. It is suggested that the use of the above method in human IVF-ET programs will lead to improved embryo quality and enhanced pregnancy rates.
Animals ; Antioxidants ; Blastocyst ; Culture Media ; Embryonic Development ; Embryonic Structures* ; Fallopian Tubes ; Female ; Free Radicals ; Growth and Development ; Human Body ; Humans ; Incubators ; Intercellular Signaling Peptides and Proteins ; Mice* ; Oxygen* ; Pregnancy ; Pregnancy Rate ; Superoxide Dismutase* ; Superoxides*

BACKGROUND: Recently authentic human growth hormone(hGH) has produced in the E coli K-12, W3110 by recombinant DNA tecbnology in Korea In this paper, the clinical efficacy and immunogenicity of this GH was shdied in 38 children with growth hormone deficiency during therapy of 1 year. METHODS: The subjects of this study were aged 4.9-13.9 years, diagnosed by failure of plasma GH to respond to insulin-induced hypoglycemia, arginine and/or L-dopa loading and height below -2 standard deviation of mean for their chronological age. Each patient received GH 0.5-0.7IU/kg/week subcutaneously in 6-7 divided doses. During treatment, vital signs, height, body weight and bone age were checked every 3 months. Complete blood count, urinalysis, blood chemistry and thyroid hormone were checked before and every 6 months. The measurement of serum IGF-1 level and antibody against hGH were performed before and every 6 months during therapy of I year. RESULT: The height velocities significantly increased from 3.3 +/- 1.5cm/year to 10.1 +/- 2.5 and 9.0 +/- 1.8cm/year at 6 and 12 months of therapy, respectively. The height standard deviation score for chronological age were significantly improved from -2.141.50 to -1.74 +/- 1.43 and -1.54 +/- 1.38 at 6 and 12 months of therapy with increasing ratio of bone age to chronological age from 0.72 +/- 0.15 at pretreatment to 0.76 +/- 0.15 at 6 month, 0.79 +/- 0.16 at 12 month of therapy. The plasma IGF-1 level significantly increased during treatment. One of 36 patients(2.8%) showed positive antibody against hGH after 1 year of treatment. During therapy of 1 year, unwanted and remarkable clinical side effect were not observed in all subjects. CONCLUSION: These results indicate that this E. coli derived authentic recombinant growth hormone is very effective in stimulating linear growth in children with growth hormone deficiency.
Arginine ; Blood Cell Count ; Body Height ; Chemistry ; Child* ; DNA, Recombinant ; Escherichia coli ; Growth Hormone* ; Human Growth Hormone ; Humans* ; Hypoglycemia ; Insulin-Like Growth Factor I ; Korea ; Levodopa ; Plasma ; Thyroid Gland ; Urinalysis ; Vital Signs

BACKGROUNDS/AIMS: MRI performed preoperatively for Hepatocellular Carcinoma(HCC) not only detects and provides information on the tumor characteristics but can also be used as a noninvasive method via MR-angiogram. MR-angiogram can reconstruct the tumor and its relation to vessels in three dimension. Therefore, it has the advantage of presenting the exact relations of the tumor and the intrahepatic vessels. Recently, preoperative imaging in HCC has become more complex. The invasive angiography is at the center of these various, complex tests and there is a tendency for unnecessary, repeated testing. The cost of these complex tests is hard to ignore. The purpose of this study was to compare single preoperative MRI with other tests and weigh the advantages. METHODS: The subjects were thirty-nine patients who underwent surgery for HCC from November, 1997 through October, 1998. Ten of these patients who had HCC with the diameter of less than 5cm, were evaluated with MRI and when necessary MR angiogram only. The control group were eleven patients with tumor of the same size as above but whom were evaluated with abdominal CT + Hepatic angiogram + Transcatheter arterial chemoembolization(TACE) + lipodol CT, abdominal CT + Hepatic angiogram + CT - AP + TACE + lipodol CT or abdominal CT + Hepatic angiogram + CT - AP + TACE during the identical period. RESULTS: The average cost of preoperative testing was lowest with MRI only. There were no deaths in either group and complication occured in one case of each group. Comparison of the duration of admission between these groups showed a statistically significant difference(p=0.003). The MRI only group with an average of 22.5 days and the control group of 30.8 days. This was due to shortening of the preoperative testing time. Another point worth noting is that patients who underwent MRI alone complained less of discomfort. CONCLUSION: MRI alone group was comparable to control group in providing of preoperative anatomical information. Not performing angiography did not increase risks technically during operation. The authors suggest that MRI as the single preoperative imaging test can be in alternative to the various preoperative imaging test.
Angiography ; Carcinoma, Hepatocellular* ; Humans ; Magnetic Resonance Imaging* ; Tomography, X-Ray Computed