BACKGROUND: The addition of clonidine to local anesthetics for regional block has been shown to increase the duration of anesthesia and analgesia. This study was designed to determine whether the addition of clonidine to bupivacaine would produce an extension of the analgesic effect after intercostal nerve block (ICNB). METHODS: After informed consent, 30 ASA 1 or 2 patients undergoing appendectomy under general anesthesia were randomly divided into two groups. Before induction of anesthesia, ICNB using a posterior approach was performed with 15 ml of 0.25% bupivacaine plus epinephrine 1:200,000 with (Group BEC; n = 15) or without (Group BE; n = 15) clonidine 75 microgram. Analgesia was assessed by cold testing at 1/min intervals until cold sensation decreased. The duration of analgesia (time between injection and onset of pain) was recorded. We also recorded the visual analogue scale (VAS) of pain, the number of supplemental analgesics, heart rate and blood pressure, and side effects over 24 hours postoperatively. RESULTS: The onset time, duration of analgesia, number of analgesics, and heart rate and blood pressure were comparable in both groups. VAS scores were significantly lower in Group BEC than in Group BE at 12, 16, and 20 hours postoperatively. CONCLUSIONS: The addition of clonidine to bupivacaine with epinephrine may be a useful adjunct and can prolong the duration of analgesia after ICNB without significant side effects.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia and Analgesia ; Anesthesia, General ; Anesthetics, Local ; Appendectomy ; Blood Pressure ; Bupivacaine* ; Clonidine* ; Epinephrine ; Heart Rate ; Humans ; Informed Consent ; Intercostal Nerves* ; Pain, Postoperative* ; Sensation

Eating ; Female ; Hospitals, General ; Humans ; Male ; Mandible ; Mandibular Fractures ; Respiration ; Tooth ; Violence

PURPOSES: The purposes of this study were to identify factors related to burden and well-being in primary caregivers of patients who have had a stroke and examine the correlation between burden and well-being of the caregivers. METHODS: Between April 2006 to June 2007 data were collected using self-report questionnaires and interviews with 85 primary caregivers of stroke patients in C University Hospital. Data were analyzed using t-test, ANOVA, Duncan test and Pearson's correlation with SPSSWIN 15.0. RESULTS: Factors related to burden of primary caregivers were sex and activities of daily living of the patients, and age, education level and satisfaction with income of the caregivers. The factors related to well-being of primary caregivers were sex of patients, and age and education level of caregivers as well as cohabitation with the patient. A negative correlation was found between burden and well-being of the caregivers (r= -.393, p<.001). CONCLUSION: These results indicate a need to develop a nursing intervention program for caregivers and education program for other family members to reduce caregiver burden. These programs should lead to improvements in the well-being of the caregiver.
Activities of Daily Living ; Caregivers ; Humans ; Surveys and Questionnaires ; Stroke

Dermatofibrosarcoma protuberans (DFSP) is a dermal spindle cell neoplasm of intermediate malignancy. It typically forms a brown indurated plaque on which firm nodules subsequently arise, sometimes with ulceration. Atypical DFSP presentations are not unusual, including atrophic, pedunculated, morphea-like and angioma-like forms. However, subcutaneous variant of DFSP that may either arise without dermal involvement or with minimal dermal involvement is very rare. A 36-year-old man presented with a palpable nodule without surface change around the right nipple. Microscopically, the neoplasm was composed of spindle cells with monomorphic storiform arrangement. The superficial part of the neoplasm was located in the subcutaneous tissue. Immunohistochemical staining showed strong cytoplasmic positivity for CD34, but not for factor XIIIa. Dermatologists should pay careful attention to these unusual variant of DFSP, which can be confused with other soft tissue tumors.
Adult ; Breast ; Cytoplasm ; Dermatofibrosarcoma ; Factor XIIIa ; Humans ; Nipples ; Subcutaneous Tissue ; Ulcer

BACKGROUND: The purpose of this study was to compare the cost-effectiveness of propofol using a target-controlled infusion (TCI) with two currently used anesthetic regimens during major operations. METHODS: Forty-two patients undergoing major gynecological surgery were divided into three groups according to the period during which the surgeries were performed. Group propofol/TCI (n = 16) received 1% propofol using TCI-50% N2O, Group isoflurane (n = 14) received thiopental 5 mg/kg-isoflurane-50% N2O, and Group enflurane (n = 12) received thiopental 5 mg/kg-enflurane-50% N2O. All patients also received 2 microgram/kg of fentanyl before induction. Concentrations of propofol and volatile anesthetics were varied according to the patient's hemodynamic responses. Consumption of volatile anesthetics was measured by weighing the vaporizers by a precision weighing machine. RESULTS: Biometric data, duration of surgery and of anesthesia were similar in the three groups. Recovery from anesthesia was significantly shorter in the propofol/TCI group. Episodes of postoperative nausea and vomiting in the recovery room were less common in propofol/TCI group. Patient satisfaction was similar in all three groups. Total (intra- and postoperative) costs were significantly higher in the propofol/TCI group. CONCLUSIONS: When compared with the standard anesthetic regimens, the use of propofol using TCI anesthesia during major operations was associated with higher costs, but did not offer any clinically significant advantages in cost-effectiveness over the standard anesthesia regimens.
Anesthesia* ; Anesthetics ; Enflurane ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Hemodynamics ; Humans ; Isoflurane ; Nebulizers and Vaporizers ; Patient Satisfaction ; Postoperative Nausea and Vomiting ; Propofol* ; Recovery Room ; Thiopental

Warty squamous cell carcinoma (WSCC), a rare variant of squamous cell carcinoma occurring in younger women, is primarily associated with human papillomavirus (HPV) infection. Although WSCC appears to exhibit less aggressive behavior than typical well-differentiated squamous cell carcinoma, it bears the risk of regional metastasis. Accordingly, WSCC should be differentiated from other verruciform neoplasms. We describe a rare case of WSCC with a short disease duration occurring in a woman of old age. We found the presence of HPV DNA different from other well-known types of high risk and low risk HPV by DNA chip microarray. These results suggest that various types of HPV can be associated with the pathogenesis of WSCC.
Aged ; Carcinoma, Squamous Cell/pathology/*virology ; Female ; Humans ; Papillomavirus Infections/*complications/pathology ; *Papillomavirus, Human ; Skin Neoplasms/pathology/*virology ; Vulvar Neoplasms/pathology/*virology

Pedunculated malignant melanoma is a rare type of melanoma. It has long been considered to be the more aggressive variant of nodular melanoma. It has an earlier age of onset and commonly presents as an exophytic lesion which frequently ulcerates and does not necessarily appear pigmented, allowing it to be confused with benign conditions such as pyogenic granuloma, intradermal nevus, or a fibroepithelial polyp. We report a case of a pedunculated malignant melanoma presented with a pedunculated reddish nodule on the left upper arm of a 31 year-old man.
Adult ; Age of Onset ; Arm ; Granuloma, Pyogenic ; Humans ; Melanoma* ; Nevus, Intradermal ; Polyps ; Ulcer

PURPOSE: To evaluate the long-term therapeutic efficacy and durability of lamivudine in Korean children with chronic hepatitis B. METHODS: A total of 48 children (31 male and 17 female; age, 1~18 years, mean, 8 years) with chronic hepatitis B who received lamivudine for at least six months from March 1999 to September 2004 were followed for a mean period of 29 months (8~66 months) at Department of Pediatrics, Kyungpook National University Hospital in Korea. Response to treatment was defined as the normalization of ALT and HBV DNA levels, and HBeAg seroconversion after the initiation of treatment. RESULTS: Twenty nine (60%) among the 48 children treated with lamivudine responded and nine (19%) children lost HBsAg during therapy. ALT and HBV DNA level had normalized in 94% one year after the initiation of treatment. Kaplan-Meier estimates of cumulative HBeAg seroconversion rates over the years were 13% (0.5 year), 34% (1 year), 50% (1.5 years), 68% (2 years), 79% (2.5 years) and 90% at 3 years respectively. Above all, among the 22 children treated before the age of seven, loss of HBsAg occurred in eight (36%), which showed superior rate of HBsAg loss (p=0.002 vs age >7). CONCLUSION: Long-term treatment of lamivudine improved the rate of HBeAg seroconversion in Korean children with chronic hepatitis B. After three years' observation, most of treated children have sustained HBeAg clearance. We believe that lamivudine should be tried as the first therapeutic option for children with chronic hepatitis B in immune clearance phase.
Child* ; DNA ; Female ; Gyeongsangbuk-do ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Korea ; Lamivudine* ; Male ; Pediatrics

BACKGROUND: Minimal flow anesthesia preserves the moisture content of CO2 absorbents and seems to be a factor inhibiting carbon monoxide generation. In order to assess the safety of minimal flow anesthesia, we studied carboxyhemoglobin (COHb) level in minimal flow anesthesia. METHODS: Forty women, ASA physical status I or II, undergoing total abdominal hysterectomy were randomly allocated to one of two groups with N2O-enflurane anesthesia. Anesthesia was maintained with O2 2 l/min and N2O 2 l/min (group 1) or O2 0.3 l/min and N2O 0.2 l/min (group 2). The arterial COHb levels were measured immediately after induction (T1), 45 min after induction (T2), 75 min after induction (T3), and after recovery from anesthesia (T4). RESULTS: Although there was no statistically significant change in both groups, the COHb level at T3 and T4 increased more than that at T1 in group 1, and that at T3 and T4 decreased more than that at T1 in group 2. There was a significant difference in the COHb level at T4 between group 1 (0.93 0.31%) and 2 (0.68 0.36%) (P <0.05). CONCLUSIONS: These results show that minimal flow anesthesia does not increase the COHb level and may be performed safely.
Anesthesia* ; Carbon Monoxide ; Carboxyhemoglobin* ; Female ; Humans ; Hysterectomy

No abstract available.
Knee Joint* ; Knee*