The preanesthetic management of preschool children is rather difficult. They worry about separation from their parents, the strange hospital environment, surgery, and are not always amenable to reasoned explanation. Therefore, the preoperative sedation is necessary to reduce anxiety and minimize psychologic trauma to children. To determine which type of intrarectal administration is the most effective in preanesthetic sedation, 90 children were randomly assigned to three groups. Group I was administered with intrarectal midazolam (0.5 mg/kg), group II, intrarectal ketamine (5 mg/kg), and group III, intrarectal midazolam (0.5 mg/kg) with ketamine (5 mg/kg). Most of children separated easily from their parents 30 minutes after intrarectal administration (above 80%). In all groups, the loss of consciousness were below 40% and sedation states were above 80%. But in group III, the loss of consciousness and the sedation states were much better than those of the other two groups. The anxiety level of group III was lower than that of the other groups (p<0.05) and the sedation level of group I and III were better than that of group II (p<0.001). Complications and recovery time were similar among each group. Following intrarectal administration of 0.5 mg/kg of midazolam with 5 mg/kg of ketamine, reliable sedation was obtained 20-30 min after intrarectal administration. Therefore we believe that intrarectal midazolam with ketamine is a useful teehnique for the reliable preoperative sedation in children.
Anxiety ; Child* ; Child, Preschool ; Humans ; Ketamine* ; Midazolam* ; Parents ; Premedication* ; Unconsciousness

Laryngoscopy and endotracheal intubation are potent stimuli that can induce increased sympathetic activity, tachycardia and hypertension. The authors studied the effects of intravenous clonidine pretreatment, a centrally acting a2-adrenoceptor agonist, on hemodynamic responses to laryngoscopy and tracheal intubation, and on anesthetic requirements during operation. Forty ASA I -II patients undergoing elective minor general surgery were allocated randomly to receive either 5ug/kg clonidine or 3 ml of 0.9% normal saline as control intravenously 10 minutes before induction of anesthesia. The results obtained were as follows. Compared to baseline values, blood pressure and heart rate at 1 minute after intubation were significantly increased in control group, but significantly decreased in clonidine group. They were maintained at lower values throughout the whole duration of operation in clonidine group than in control group. More doses of fentanyl were needed in the control group but not in the clonidine group during operation, and because of bradycardia and hypotension, atropine or ephedrine was needed in the clonidine group. In conclusion, the elevation of blood pressure and heart rate accompanying tracheal intubation were preventable with less requirement of supplemental fentanyl, but bradycardia and hypotention were infrequently seen as a side effects, when 5ug/kg intravenous injection of clonidine 10 minutes before induction.
Anesthesia ; Anesthesia, General* ; Atropine ; Blood Pressure* ; Bradycardia ; Clonidine* ; Ephedrine ; Fentanyl ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypertension ; Hypotension ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Tachycardia

BACKGROUND: Endoscopic ultrasound-guided fine needle aspiration cytology (EUS-FNAC) is currently the most commonly used procedure for obtaining cytologic specimens of the pancreas. It is accurate, minimally invasive, safe and cost-effective. However, there is discrepancy between cytological and surgical diagnoses. This study was aimed at evaluating the diagnostic accuracy of EUS-FNAC of the pancreas. METHODS: We performed a retrospective review of 191 cases of pancreatic lesions initially diagnosed by EUS-FNAC with subsequent histological diagnosis between 2010 and 2012 in the Department of Pathology, Seoul National University Hospital. Cytologic and surgical diagnoses were categorized into five groups: negative, benign, atypical, malignant, and insufficient for diagnosis. Subsequently, 167 cases with satisfactory yield in both surgical and cytology specimens were statistically analyzed to determine correlations with diagnosis. RESULTS: In comparison to surgical diagnoses, cytologic diagnoses were true-positive in 103 cases (61.7%), true-negative in 28 cases (16.8%), false-positive in 9 cases (5.4%), and false-negative in 27 cases (16.1%). The diagnostic accuracy was 78.4%, sensitivity was 79.2%, and specificity was 75.7%. The positive predictive value was 92.0%, and negative predictive value was 50.9%. CONCLUSIONS: EUS-FNAC has high accuracy, sensitivity, specificity and positive predictive value. Overcoming the limitations of EUS-FNAC will make it a useful and reliable diagnostic tool for accurate evaluation of pancreatic lesions.
Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration* ; Pancreas ; Pathology ; Retrospective Studies ; Sensitivity and Specificity ; Seoul

BACKGROUND: A few recent studies have demonstrated a possible role of transglutaminase 2 (TG2) in tumorigenesis or progression of renal cell carcinoma (RCC). The aim of this study was to examine TG2 expression and its clinicopathologic significance in a large number of human clear cell RCCs (CCRCCs). METHODS: We analyzed 638 CCRCC patients who underwent partial or radical nephrectomy between 1995 and 2005. The expression of TG2 was determined by immunohistochemistry and categorized into four groups, according to staining intensity: negative (0), mild (1+), moderate (2+), and strong (3+). RESULTS: TG2 staining intensity was negative in 8.5% of CCRCC (n=54), 1+ in 32.6% (n=208), 2+ in 50.5% (n=322), and 3+ in 8.5% (n=54). Strong TG2 expression was correlated with high Fuhrman nuclear grade (p=.011), high T category (p=.049), metastasis (p=.043) and male sex (p<.001) but not with N category.The survival analysis showed a significant association between strong TG2 expression and worse overall and cancer-specific survival (p=.027 and p=.010, respectively). On multivariate analysis, strong TG2 expression was a marginally significant prognostic indicator for Fuhrman nuclear grade and TNM staging (p=.054). CONCLUSIONS: Our study is the first to demonstrate the clinicopathologic significance of TG2 expression in a large number of human CCRCC samples. Strong TG2 expression was associated with high nuclear grade and poor prognosis.
Carcinogenesis ; Carcinoma, Renal Cell* ; Humans ; Immunohistochemistry ; Male ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm Staging ; Nephrectomy ; Prognosis ; Transglutaminases