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*

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

No abstract available.
Intussusception*

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

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*

BACKGROUND: The auditory evoked potential (AEP) index and bispectral (BIS) index have been proposed as methods to measure the depth of sedation. A prospective study was designed to assess the performance of both these methods for measuring the depth of sedation induced by propofol patient-controlled sedation (PCS) under spinal anesthesia. METHODS: Forty ASA I and II adult patients under spinal anesthesia using 0.5% hyperbaric bupivacaine were studied. Group 1 (10 mg bolus, 30 mg loading) and Group 2 (20 mg bolus, 60 mg loading) received propofol and maintained PCS with 1min lockout interval and 100 mg/hr continuous infusion. AEP, BIS and Observer's assessment of alertness/sedation (OAA/S) scale were monitored during the operation. RESULTS: AEP and BIS decreased and increased following the changes on the patient's OAA/S scores and correlated with sedation significantly. There were no significant difference in mean AEP index (group 1; 13.4 +/- 8.4, group 2; 8.9 +/- 6.2), BIS index (group 1; 76.2 +/- 9.7, group 2; 71.2 +/- 9.8), and OAA/S scale (group 1; 3.8 +/- 1.3, group 2; 3.2 +/- 1.5) between the groups. Incidence of perioperative respiratory depression was significantly higher in group 2 (25%) than group 1 (5%), and incidence of involuntary movement was significantly higher in group 1 (20%) than group 2 (5%) (P < 0.05). CONCLUSIONS: Both AEP and BIS correlated well with the depth of sedation induced by propofol PCS under spinal anesthesia. AEP seems to be more valuable in measuring the change between consciousness and unconsciousness, and BIS seems to be more effective in measuring the depth of sedation.
Adult ; Anesthesia, Spinal ; Bupivacaine ; Consciousness ; Dyskinesias ; Evoked Potentials, Auditory* ; Humans ; Incidence ; Propofol* ; Prospective Studies ; Respiratory Insufficiency ; Unconsciousness

The cystic duct syndrome is defined as noncalculous partial mechanical obstruction of the cystic duct with painful gallbladder contraction. In this condition, the gallbladder is able to fill by slow entry of bile from the common hepatic duct, however ejection of bile from the gallbladder is prohibited by partial obstruction of the cystic duct. The main symptom of the cystic duct syndrome is postprandial right upper abdominal pain which oecasionally radiates to back and right shaulder. This sayndrome can be diagnosed by CCK-biliary drainage, CCK-cholecystogram, CCK-cholescintigraphy and ERCP. Since the causes are mechanical, patients with the cyetic duct syndrome are best treated surgically by means of cholecystectomy. We had experienced 2 cases of cystic duct syndrome whose ERCP finding and 24hour delayed film disclosed typical findings. The cholecystectomy was performed and the gross specimen showed narrowed lumen or fibrosis of cystic duct, The symptoms were subsided after cholecystectomy.
Abdominal Pain ; Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cystic Duct* ; Drainage ; Fibrosis ; Gallbladder ; Hepatic Duct, Common ; Humans

PURPOSE: To determine the presence of cruciate ligament tears following avulsion injuries involving the ACL and PCL, and to correlate the findings with those of surgery. MATERIALS AND METHODS: Between March 1997 and May 2002, avulsion injury involving the ACL or PCL was diagnosed in 19 patients. Ten of these [8 males and 2 females aged 10-51 (avergae, 27.7) years] were included in this study. We assessed the presence of cruciate ligament tears at MR imaging, correlating the findings with those of surgery. Associated intra-articular injuries, treatment methods and follow-up results were also evaluated. RESULTS: Among Seven patients with ACL avulsion injury, this was assessed at MR imaging as complete tear (n=1), partial tear (n=5), or intact (n=1), while all MR images of PCL avulsion injury (n=3) showed that this was partial tear. All imaging findings corresponded with the surgical findings. In four patients there was associated knee injury involving, respectively, tears of the medial meniscus, lateral meniscus, PCL and MCL, and popliteal ligament. CONCLUSION: Our findings showed that with one exception, patients with avulsion injury of the ACL or PCL had suffered either a partial or complete tear. MR imaging may be useful in the diagnosis of tears of the cruciate ligament which have not been noticed at surgery or arthroscopy in avulsion injuries involving the ACL and PCL.
Arthroscopy ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Knee Injuries ; Knee* ; Ligaments* ; Magnetic Resonance Imaging* ; Male ; Menisci, Tibial ; Spine*