BACKGROUND: Tourniquet pain is probably mediated by C-fiber. The ability of fentanyl to interrupt this nociceptive conduction was studied by administering either fentanyl or saline intrathecally along with hyperbaric bupivacaine for spinal anesthesia. METHOD: The incidence of tourniquet pain was evaluated in 60 patients having orthopedic surgery of the lower extremities during spinal anesthesia by administering either 30 mcg fentanyl (group 2) or saline (group 1) along with 0.5% hyperbaric bupivacaine 10 mg. We measured the maximal sensory spread of analgesia to pinprick, the incidence of tourniquet pain, and the sensory anesthesia to pinprick at the onset of tourniquet pain. RESULTS: The average maximal sensory spread of analgesia was the same in both groups (T9). The incidence of tourniquet pain was significantly greater in group 1 (33%) than in group 2 (10%). The sensory levels of anesthesia at the onset of tourniquet pain were not different in two groups. CONCLUSIONS: Intrathecal fentanyl was effective against tourniquet pain for 2 hours of the orthopedic surgery of the lower extremities.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Bupivacaine* ; Fentanyl* ; Humans ; Incidence ; Lower Extremity ; Orthopedics ; Tourniquets*

Thirty one free vascularized fibula bone grafts were performed for treatment of osteonecrosis of the femoral head in 26 patients, 24 men and 2 women aged from 16 to 48(mean:32 years). Twenty one patients had unilateral disease. Five patients had bilateral disease underwent staged bilateral free vascularized fibula grafts three months apart. Associated etiological factors included alcohol(9 patients), steroid(7 patients), and trauma(one patient). The condition was considered idiopathic in the remaining 9 patients. Radiologic staging by Ficat included stage 1 in one hip, stage II in 15 hips, stage III in 14 hips, and stage IV in one hip. A skin island flap was used for monitoring purpose for the grafted fibula. One monitoring, flap was necrotized due to vascular occlusion but the fibula bone graft was left in place to use as a nonvascularized bone graft. Average follow-up period was 21 months in 31 hips. Pain was relieved in 28 hips(93.3 percent) and aggravated in 2 hips(6.7 per cent). On radiographic evaluation, 26 hips(86.7 per cent) demonstrated excellent preservation of the femoral head contour. Progressive collapse of the femoral head (greater than 1-2 mm) occurred in 2 hips, i mm depression in one hip with stage III and 2 mm collapse in one hip with stage IV. In conclusion, the free vascularized fibula bone graft is an excellent treatment modality for preserving the femoral head and relieving symptoms in cases of the osteonecrosis of the femoral head.
Depression ; Female ; Fibula* ; Follow-Up Studies ; Head* ; Hip ; Humans ; Male ; Osteonecrosis* ; Skin ; Transplants

It is notoriously difficult to obtain a sound bony union of large segmental bone defects secondary to trauma or following tumor resection, infected nonunion, congenital pseudarthrosis of the tibia, and avascular necrosis of the femoral head with conventional methods. Recent advances in microsurgery have made it possible to provide a continuing circulation of blood in bone grafts so as to ensure viability. With the nutrient blood supply preserved, healing of the graft to the recipient bone is facilitated without the usual replacement of the graft by creeping substitution. Thus, the grafted bone is achieved more rapid stabilization of bone fragments separated by a large defect without sacrificing viability. Thirty nine cases of the free vascularized fibular graft had been performed in the Department of Orthopedic Surgery, Kyung Hee University Hospital during the period of 3 years from October 1978 to December 1981. Of these, ll cases were congenital pseudarthrosis of the tibia, 4 cases were tuberculous spondylitis, 4 cases were infected nonunion, 7 cases were large segmental bone defects secondary to trauma, 9 cases were avascular necrosis of the femoral head and the other was one case. The results were obtained as follows: 1. The advantages of free vascularized living fibular graft are one stage procedure, resistance of torsion and angular stress, union with rapid hypertrophy of the graft, a shorter immobilization period and more rapid incorporation of the graft into the recipient area. 2. Free vascularized fibular graft can be widely used in the field of Orthopedic surgery. 3. The fibula is the bone best suited for reconstruction of a defect in a long bone. 4. In children, distal tibiofibular synostosis must be performed. 5. For prevention of clawing toe, the muscles around the bone is meticulously dissected, 6. Evaluation by selective arteriography and isotopic scanning both before and after operation may be used to assess the viability of the fibula graft.
Angiography ; Animals ; Child ; Fibula ; Head ; Hoof and Claw ; Humans ; Hypertrophy ; Immobilization ; Microsurgery ; Muscles ; Necrosis ; Orthopedics ; Pseudarthrosis ; Spondylitis ; Synostosis ; Tibia ; Toes ; Transplants

No abstract available.
Aneurysm*

BACKGROUNDS: Intestinal obstruction is one of the main causes of neonatal operations. It is caused by congenital factors, inherited diseases, and acquired diseases. A study was made to understand the status of neonatal intestinal obstruction cases at our hospital. METHODS: This was a clinical analysis of 53 cases of neonatal intestinal obstruction which had been experienced from March 1992 to February 1998 at the Department of General surgery, Sung-Ae General Hospital. RESULTS: 1) Operations for neonatal intestinal obstructions accounted for 42.4% of all neonatal operations. 2) There were 38 males and 15 females; the male-to-female ratio was 2.5:1. 3) Gestational period of 9 cases (16.9%) was less than 36 weeks and the weight in 10 cases (18.8%) wre below 2,500 gm at birth. 4) The main clinical symptoms on admission were vomiting or abdominal distension. 5) There were 49 cases (92.4%) of mechanical obstruction and 4 cases of a paralytic ileus. 6) Associated anomalies were present in 9 cases (16.9%). 7) The postoperative complication and motality rates were 30.1% and 7.5% respectively. CONCLUSIONS: Our clinical data might provide clinical suspicisions leading to early diagnosis and treatment.
Early Diagnosis ; Female ; Hospitals, General ; Humans ; Intestinal Obstruction* ; Intestinal Pseudo-Obstruction ; Male ; Parturition ; Postoperative Complications ; Vomiting

BACKGROUND: Intrathecal fentanyl has been known to have rapid analgesic effect for the first stage of labor, but pruritus usually occurs, and respiratory depression can happen. The addition of bupivacaine during intrathecal analgesia has been known to have synergistic action with intrathecal opioids. We observed the efficacy of the intrathecal injection of morphine, fentanyl, and bupivacaine on labor parturients. METHODS: 20 laboring patients were studied. Each patients received morphine 0.2 mg, bupivacaine 2.5 mg, and fentanyl 10 microgram intrathecally. Analgesia was assessed using visual analogue scale (VAS) score as the time elapsed from the drug administration to the delivery. Side effects such as nausea, vomiting, pruritus, urinary retention, respiratory depression, and hypotension were evaluated. RESULTS: The onset of analgesia was rapid (within 5 minutes) and VAS scores were significantly lower than pre-treatment value for 5 hours. The incidence of nausea or vomiting was 55% (11/20). Pruritus occurred 50% (10/20). The occurrence of urinary retention was 35% (7/20). Hypotension occurred 10% (2/20). No patient developed post dural-puncture headache, respiratory depression, fetal bradycardia, or motor weakness. More than 90% of the patients in this study said that they were satisfied with this analgesic procedure. CONCLUSIONS: Intrathecal injection of morphine 0.2 mg, fentanyl 10 microgram, and bupivacaine 2.5 mg provided rapid and effective analgesia in labor patients.
Analgesia* ; Analgesics, Opioid ; Bradycardia ; Bupivacaine* ; Female ; Fentanyl* ; Headache ; Humans ; Hypotension ; Incidence ; Injections, Spinal* ; Labor Pain ; Morphine* ; Nausea ; Pregnancy ; Pruritus ; Respiratory Insufficiency ; Urinary Retention ; Vomiting

Beyond the target of scientific researches, meditation is now one of the main tools for palliative and integrative medicine in Western society. Despite theof valuable heritages of meditation in Korea, meditation is not considered to have clinical implications as in Western medical society. It is partly due to the fact that while the mysterious aspect of meditation has been emphasized, a large number of scientific researches on meditation had not been known to Korean medical society. The authors reviewed several studies that examined the clinical effect of meditation and speculated its possibility as a method of clinical intervention.
Integrative Medicine ; Korea ; Meditation* ; Palliative Care ; Societies, Medical

Conjunctival tuberculosis, a very rare disease, is thought to be a relatively rare cause of ocular diseases. This is because of a decreased incidence of tuberculosis as well as lessened emphasis on its diagnosis. We have experienced a 19-years old female who had a injection and hypertrophic granulomatous inflammation, on the left lower palpebral conjunctiva. We performed excisional biopsy under the clinical diagnosis of the chronic conjunctivitis and confirmed the histopathological diagnosis of conjunctival tuberculosis. So, the literature of the conjunctival tuberculosis was briefly reviewed with clinical history.
Biopsy ; Conjunctiva ; Conjunctivitis ; Diagnosis ; Female ; Humans ; Incidence ; Inflammation ; Rare Diseases ; Tuberculosis* ; Young Adult

Cervical pregnancy is a rare and dangerous form of ectopic pregnancy in which the blastocyst implants within the cervical canal below the internal os of the uterine cervix. The characteristic clinical sign is a severe asymptomatic uterine bleeding in early pregnancy or during curettage. Most cervical pregnancies result in early spontaneous abortion, complicated by severe hemorrhage from the eroded blood vessels within the cervical tissue. Because of uncontrolled profuse vaginal bleeding, total hysterectomy has been the mostly necessitated to control life-threatening bleeding. Transvaginal sonography allows early diagnosis, and conservative treatment (two-time treatment : first treatement with systemic or intraamnionic methotrexate, secondly with curettage or ligature of the uterine arteries) improves the patient's fertility. Successful treatment is defined as elimination of the cervical pregnancy with preservation of the uterus. We report two cases of cervical pregnancy managed, successfully with methotrexate, leucovorin and curettage.
Abortion, Spontaneous ; Blastocyst ; Blood Vessels ; Cervix Uteri ; Curettage ; Cytochrome P-450 CYP1A1 ; Early Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Leucovorin ; Ligation ; Methotrexate ; Pregnancy* ; Pregnancy, Ectopic ; Uterine Hemorrhage ; Uterus

PURPOSE: The main purpose of this study is to develop new payment rates for services of Radiation Oncology, considering costs of treating patients. MATERIAL AND METHODS: A survey of forty hospitals has been conducted in order to analyze the costs of treating patients. Before conducting the survey, we evaluated and reclassified the individual service items currently using as payments units on the fee-for-service reimbursement system. This study embodies the analysis of replies received from the twenty four hospitals. The survey contains informations about the hospitals' costs of 1995 for the reclassified service items on Radiation Oncology. After we adjust the hospital costs by the operating rate of medical equipment, we compare the adjusted costs with the current payment rates of individual services. RESULTS: The current payment rates were 5.05-6.58 times lower than the adjusted costs in treatment planning services, 2.22 times lower in block making service, 1.57-2.86 times lower in external beam irradiation services, 3.82-5.01 times lower in intracavitary and interstitial irradiation and 1.12- 2.55 times lower in total body irradiation. CONCLUSION: We could conclude that the current payment system on Radiation Oncology does not only reflect the costs of treating patients appropriately but also classify the service items correctly. For an example, when the appropriate costs and classification are applied to TBI, the payment rates of TBI should be increased five times more than current level.
Classification* ; Fee-for-Service Plans ; Hospital Costs ; Humans ; Radiation Oncology* ; Whole-Body Irradiation