BACKGROUND: Caudal injection of local anesthetics with morphine is the most common anesthetic technique for perianal operation and postoperative analgesia. This study was purposed to compare the onset time of caudal analgesia, postoperative analgesic effect and side effects. METHOD: Sixty healthy patients scheduled for perianal operation were divided into 2 groups randomly. Group I was given 2 mg of morphine in 20 ml of 2% mepivacaine via sacral hiatus. Group II was also given 2 mg of morphine in 20 ml of 0.5% bupivacaine caudally. We measured the onset time of caudal block, time to the first request of analgesics, the number of analgesics within 24 hours and the incidence of postoperative side effects. Analgesic effect was evaluated by visual analogue scales (VAS) at 1, 2, 6, 12 and 24 hours postoperatively. RESULT : The onset time of caudal block for operation and the first request time of analgesic for postoperative pain was significantly shorter in group I than group II. The analgesic use in the first 24 hours was significantly more in group I than group II. The side effects were similar in both groups. CONCLUSION: We concluded that the combined use of morphine and bupivacaine provided better postoperative analgesia than the combined use of morphine and mepivacaine.
Analgesia ; Analgesics ; Anesthetics, Local ; Bupivacaine* ; Humans ; Incidence ; Mepivacaine* ; Morphine* ; Pain, Postoperative ; Weights and Measures

It has been reported that ischernia causes changes in the concentration and tumover of monoamine neurotransmitters in brain. For the mechanism of cellular death in brain ischernia it is suggested that accumulation of intracellular calcium during ischemia is one of the main causes. Present study was undertaken to investigate the influence of ischemia on the contents and tumover of the biogenic anines in rat brain and further to investigate the effects of nimodipine, a calcium channel blocker, and cromakalim, a potassium channel opener, on them. Brain ischemia was induced by partial ligation of bilateral common carotid artery. Nimodipine (36 ,ug/kg, I.p.) or cromakalim (0.5mg/kg, I.p.) was administered 20 minutes before ligation. Nimodipine was administered every 4 hours in 24-hour ischemic group. Rats were sacrificed by decapitation 3 or 24 hours after induction of ischemia and whole brains were excised. The brain was divided into follow ing regions; cerebral cortex, corpus striatum, hippocampus, thalamus, hypothalamus, substantia nigra and cerebellum. The concentrations of biogenic amines and their metabolites were measured by high performance liquid chromatography-electrochemical detector (HPLC-ECD).
Animals ; Biogenic Amines* ; Brain Ischemia ; Brain* ; Calcium ; Calcium Channels ; Carotid Artery, Common ; Cerebellum ; Cerebral Cortex ; Corpus Striatum ; Cromakalim ; Decapitation ; Hippocampus ; Hypothalamus ; Ischemia ; Ligation ; Neurotransmitter Agents ; Nimodipine* ; Potassium Channels ; Rats* ; Substantia Nigra ; Thalamus

BACKGROUND: Triage and transportations are important and life-saving medical task performed at the site of mutiple-casualty incidents(MCIs). We pursued three road traffic accidents victims to find out any problem in triaging and transporting them, and to provide an information for equipping an local disaster planning. METHODS: The medical records of 70 consecutive patients who were transported to five emergency facilities in Kangnung, on three MCIs from 1998 to 2000, were analysed, retrospectively. The intervals and types of transport vehicles were analysed. We compared the prehospital time between severity-based groups, which were graded into 3 groups according to the Triage score(0, 1~8, 9). RESULTS: Among the 70 patients, 33 patients(47.1%), 21 patients(30%), and 16 patients(22.9%) were transported to Level I, Level II, and Level III trauma centers, respectively. The time elapsed from scenes to the Level I trauma center was significantly shorter(p=0.003) than to others, but no differences in the mean Triage score between trauma centers were seen(p>0.05). The 119 rescue services transported 58.6%(41 patients) of victims to emergency facilities, and 58.5%(24 patients) of them was concentrated to Level I. There were no significant differences in the prehospital time between three Triage score groups(p>0.05). CONCLUSION: There was no medical control such as triage and transportation in the cases of three MCIs. In the construction of emergency medical service system(EMSS) preparing MCIs or disasters, we suggest the integration and unification of 119 rescue services and emergency medical information centers for effective medical control. We propose to making a new and simple triage guideline. The prehospital personnel should be educated and disaster drills should be performed under the guideline.
Accidents, Traffic ; Disaster Planning ; Disasters ; Emergencies ; Emergency Medical Services ; Humans ; Information Centers ; Medical Records ; Retrospective Studies ; Transportation* ; Trauma Centers ; Triage*

Presented here in are two cases of chronic subdural hematoma in children which were spontaneously resolved. The first case has developed as the complication of a ventriculoperitoneal shunt in bilateral cerebral convexities of a 14-year-old boy while in the other case, the hematoma was developed in the posterior fossa of a 19 days-old neonate are complication of delivery. The etiology, clinical couse, treatment and mechanism of spontaneous resolution of chronic subdural hematomas in children and adult are discussed.
Adolescent ; Adult ; Child* ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Infant, Newborn ; Male ; Ventriculoperitoneal Shunt

Forty two patients were diagnosed as having subcortical(lobar) intracerebral hemorrhage among 407 consecutive patients presenting with spontaneous intracerebral hemorrhage. Brain CT and MRI or angiography were performed in 39 patients. The authors analyzed clinical features, brain CT, etiological factors, and outcome. Headache(69%) and vomiting(55%) were most common symptoms. The incidence of seizure was 14%. The volume of hematoma on CT was below 20cc in 21 patients, between 20cc and 40cc in 16 patients, and aove 40cc in 5 patients. The most common site of hemorrhage was parietal lobe in 32 of 42 patients. The mortality rate was 9.5% and the functional outcome of the patients was generally better than in other forms of intracerebral hemorrhage. Thirty one patients had arterial hypertension which was the leading cause. Two patients had AVMs and two patients had blood dyscrasias. Unknown etiology occurred in 7 patients. Neither brain MRI nor cerebral angiography showed abnormal vascular lesion in all of the pa tients who had arterial hypertension. We conclude that no further evaluation if recommended in patients with subcortical hemorrhage who were definitely diagnosed as having arterial hypertension.
Angiography ; Brain ; Cerebral Angiography ; Cerebral Hemorrhage ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Magnetic Resonance Imaging ; Mortality ; Parietal Lobe ; Seizures

BACKGROUND: Cortical suspensory femoral fixation is commonly performed for graft fixation to the femur in anterior cruciate ligament (ACL) reconstruction using hamstring tendons. The purpose of this study was to compare graft healing in the femoral tunnel, implant-related failure, and clinical results between fixed- and adjustable-length loop devices in outside-in ACL reconstruction. METHODS: A total of 109 patients who underwent ACL reconstruction using the outside-in technique from December 2010 to July 2014 were included. For femoral graft fixation, a fixed-length loop device was used in 48 patients (fixed-loop group) and an adjustable-length loop device was used in 61 patients (adjustable-loop group). For evaluation of graft healing in the femoral tunnel, magnetic resonance imaging was performed at postoperative 6 months and the signal-to-noise ratios (SNRs) of the tendon graft and tendon-bone interface in the femoral bone tunnel were evaluated. The presence of synovial fluid was evaluated to determine loop lengthening at the femoral tunnel exit. Clinical results assessed using International Knee Documentation Committee score, Tegner-Lysholm Knee Scoring scale, and knee instability tests were compared between groups. RESULTS: The SNRs of the tendon graft and tendon-bone interface were not statistically different between groups. The presence of synovial fluid at the femoral exit showed no statistical difference between groups. Clinical results were not significantly different between groups. CONCLUSIONS: The adjustable-length loop device provided comparable graft healing, implant-related failure, and clinical results with the fixed-length loop device, allowing adaptation of the graft to the different tunnel lengths. Therefore, it could be effectively used with an adjustment according to the femoral tunnel length.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Femur ; Humans ; Knee ; Magnetic Resonance Imaging* ; Signal-To-Noise Ratio ; Synovial Fluid ; Tendons ; Transplants

We report a case of gastric adenoma which was found incidentally on 18F-FDG PET/CT study for cancer screening in asymptomatic patient. It showed focal and intensely increased FDG uptake in the antrum of stomach. On the gastroduodenoscopy, it showed flat elevated lesion with irregular margin. Histologically, the lesion was confirmed gastric adenoma with high grade dysplasia and removed by endoscopic mucosal resection.
Adenoma* ; Early Detection of Cancer ; Fluorodeoxyglucose F18 ; Humans ; Positron-Emission Tomography and Computed Tomography ; Stomach

Plasmablastic lymphoma is a recently identified entity that is considered to be a type of diffuse large B-cell lymphoma with a unique immunophenotype and a predilection for the oral cavity of human immunodeficiency virus (HIV) positive patients. We report a case of plasmablastic lymphoma presenting in nasal cavity of a 48-year-old, HIV-negative man. Cytologic and histologic examinations demonstrated a large cell lymphoma with plasmablastic differentiation. The tumor cells were positive for CD138, epithelial membrane antigen, but lacked expression of leukocyte common antigen, T-cell, and B-cell markers. Abundant Epstein-Barr virus-encoded RNA transcripts were identified by in situ hybridization. The lambda-light-chain restriction was demonstrated by in situ hybridization. These findings were compatible with plasmablastic lymphoma. Subsequent whole body FDG-PET scan revealed hypermetabolic lesions in the nasal cavity and left cervical lymph nodes level II,III,IV. To our knowledge, this is the first case of plasmablastic lymphoma in Korea.
Antigens, CD45 ; B-Lymphocytes ; HIV ; Humans* ; In Situ Hybridization ; Korea ; Lymph Nodes ; Lymphoma* ; Lymphoma, B-Cell ; Middle Aged ; Mouth ; Mucin-1 ; Nasal Cavity* ; RNA ; T-Lymphocytes

Granulocytic sarcoma (GS) is an extramedullary tumor composed of immature myeloid cells, typically occurring during the course of acute myelogenous leukemia. Non-leukemic GS, that is, GS with no evidence of overt leukemia and no previous history of leukemia, is very rare, and even more unusual is nonleukemic GS of the bile duct. We report a case of nonleukemic GS of the bile duct. The patient was initially misdiagnosed as a bile duct carcinoma arising in the hilum of the liver (so-called Klatskin tumor), and received a right lobectomy of the liver. Histological examination of the tumor yielded the diagnosis of GS, and the bone marrow biopsy did not show any evidence of leukemia. Considering the risk of subsequent development of overt leukemia, the patient was treated with two cycles of combination chemotherapy as used in the cases of acute myelogenous leukemia. To date, he has remained free of disease 15 months after treatment.
Tomography, X-Ray Computed/methods ; Sarcoma, Granulocytic/*diagnosis/metabolism/radiography ; Radiography, Abdominal ; Peroxidase/analysis ; Male ; Immunohistochemistry ; Humans ; Diagnosis, Differential ; Bile Ducts/chemistry/pathology ; Bile Duct Neoplasms/*chemically induced/metabolism/radiography ; Antigens, CD45/analysis ; Adult

The family of T-cell immunoglobulin domain and mucin domain (TIM) proteins is identified to be expressed on T cells. A member of Tim family, Tim-3 (T cell immunoglobulin mucin 3) is selectively expressed on the surface of differentiated Th1 cells. Tim-3 might have an important role in the induction of autoimmune diseases by regulating macrophage activation and interacts with Tim-3 ligand to regulate Th1 responses. To determine the variation sites in the coding and promoter region of human Tim-3 gene, we performed variation scanning by direct sequencing using the genomic DNA isolated from the patients with asthma or allergic rhinitis and healthy controls without asthma and allergic rhinitis. We identified four single nucleotide polymorphisms (SNPs) including one novel SNPs (-1541C>T) and two variation sites (-1292_-1289delTAAA and -1282_-1278dupTAAAA) in the coding and promoter region of human Tim-3 gene in both the patients and healthy groups.
Asthma/genetics ; Exons/genetics ; Gene Frequency/genetics ; Humans ; Membrane Proteins/*genetics/metabolism ; Polymorphism, Single Nucleotide/*genetics ; Promoter Regions (Genetics)/genetics ; Research Support, Non-U.S. Gov't ; Respiratory Hypersensitivity/*genetics ; Rhinitis, Allergic, Perennial/genetics ; Th1 Cells/metabolism