BACKGROUND: Caudal anesthesia is considered a safe and reliable anesthetic technique for many pediatric surgical procedures. It is well known that extradural clonidine produces analgesia in adult. The purpose of this study is to assess its efficacy in children. METHODS: We randomized 45 pediatric patients aged under 10 years, weighted under 25 kg presented for lower abdominal surgery with duration of operation would be shorter than 2 hours, into three groups of 15 each. After sedation with the use of intravenous thiopental sodium, caudal anesthesia was performed with the use of 1 mL/kg of 0.25% bupivacaine. We allocated randomly the patients who received no additional medication in 0.25% bupivacaine (group I), with epinephrine 1/200,000 (group II), and with 1 mcg/kg of clonidine (group III). The degree of postoperative analgesia was evaluated using the Broadman ""Objective Pain/discomfort Scale"" (OPS) at hourly intervals for 24 hours. RESULTS: Duration of sleep in the recovery room was significantly longer in group III than in group I and group II, and statistical significant difference was found between the group I and group II. Duration of analgesia was significantly longer in group III than in group I and group II. Overall hourly OPS scores were lower in group III than in group I and group II. CONCLUSION: Duration of postoperative analgesia with caudal bupivacaine was increased by addition of 1 mcg/kg of clonidine.
Adult ; Analgesia ; Anesthesia, Caudal* ; Bupivacaine ; Child ; Clonidine* ; Epinephrine ; Humans ; Recovery Room ; Thiopental

Muchz-Habermann disease is cutaneous disease of unknown etilogy and characterized by a, polymorphous eruption consisting of papulosquamous, bemorrhagic, ulceronecrotic lesion eventually into varioliform scars. It is also classified into parapsoriasis group according to Broq with parapsoriasis en guttata (pityriasis lichenoides chronica), parapsoriasis en plaques, parapsoriasis en lichenoides. The 61-year-old male patient visited to Dermatologic Department of Severance Hospital due to sudden onset of generalized eruption. He presented pea to fingr tip sized erythematous, silvery maculo-papulo-squamous eruptions on trunk, extre- mities and buttock, but didnt complain of any subjective symptoms except markel fatigue. Skin biopsy was done on right forearm and was confirrr.ed to pityriasis lichenoides et varioliformis acuta by histopathologic finding. The lesion was completely controlled by oral tetracycline 2. Ogm per daily for first 4 wecks and reduced dosage l. Ogin per day for second 2 weeks.
Biopsy ; Buttocks ; Cicatrix ; Fatigue ; Forearm ; Humans ; Male ; Middle Aged ; Parapsoriasis ; Peas ; Pityriasis Lichenoides* ; Pityriasis* ; Skin ; Tetracycline

It is well known that the incidence of revision arthroplasty for the loosened total hip has been progressively increasing recently. And the problem is that the loosening rate of revision arthroplasty for the failed total hip replacement is much higher as compared with that of primary total hip replacement. In revision arthroplasty, Amstutz, in 1982, reported 9% incidence of mechanical failure and 43% incidence of femoral and 61% incidence of acetabular progressive radiolucencies with follow-up for an average of 2.1 years, and Pellicci, in 1985, reported 29% incidence of failure for total hip replacement that have been revised once in the radiolucent zone with the follow-up for an average 8.1 years, and Kavanagh, in 1985, reported that probable loosening occurred in 25% of revised acetabular components with follow-up for an average of 4.5 years. Cementless total hip replacement is successful in more than 90 of the primary cases for the last 5 years in our department. Therefore, not only in primary total hip replacement but also in the revision, it seems to be reasonable to perform the cementless total hip replacement as an alternative, particularlly, in young age group. During the period from April 1982 to December 1984, we have revised 12 loosened total hip replacement with cementless type. Average follow up was 1 year and 7 months. The age range of the patients was 23 to 64. The results are very promising without any evidence of loosening in all cases.
Acetabulum ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Hip ; Humans ; Incidence

No abstract available.
Brain Abscess* ; Humans ; Infant, Newborn* ; Meningitis*

No abstract available.
Cerebral Palsy* ; Congenital Abnormalities* ; Forearm* ; Humans ; Muscle Spasticity* ; Pronation* ; Wrist*

We report a case of epidermolysis bullosa acqumta with characteristic clinical features, subepidermal vesicles in histopathology, and deposits of IgG in basement membrane zone at routine direct immunofluorescent test. 1M NaCl-treated immunofluorescent test was performed in order to correctly diagnose our case. In this method, linear immunofluorescent deposits of IgG were found only at the dermal part of separation induced by 1M NaC1 treatment to skin specimen.
Basement Membrane ; Epidermolysis Bullosa Acquisita* ; Epidermolysis Bullosa* ; Immunoglobulin G ; Methods ; Skin

The purpose of this study was to evaluate clinical changes in graft size after treatment with connective tissue autograft in human. 40 premolar teeth in 23 patients having the following mucogingival problemswere selected. The width of extension, attached gingiva including free marginal gingiva, width of transplant and clinical sulcus depth were measured at the initial examination, 2, 12 and 24 weeks following the connective tissue autograft and free gingival autograft. The change of width of extension, attached gingiva including free marginal gingiva, width of transplant and clinical sulcus depth according to healing process in both graft procedures was statistically analyzed by ANOVA test and independent t-test using SPSS program. The results were as follows: 1. The change of keratinized gingiva in both grafting procedures was increased significantly at 24 weeks post-op. 2. The clinical sulcus depth exhibited no marked changes throughoutthe entire investigation in both grafting procedures. 3. After 12 weeks, no dimensional variation was seen in graft size in both grafting procedures. 4. Shrinkage differs significantly in both grafting procedures. From the day of graft to 24 weeks after surgery the percentages of shrinkage were connective tissue autograft 55% and free gingival autograft 29%.
Autografts* ; Bicuspid ; Connective Tissue* ; Gingiva ; Humans ; Tooth ; Transplants*

The residual effect of muscle relaxant given during anesthesia can be assessed by clinical evaluation or by the use of peripheral nerve stimulator. Clinical evaluation of the recovery from neuromuscular blockade is often accompanied by some dangers of residual curarization after anesthsia because many of patinets evaluated by subjective clinical performance often have train-of-four ratio of less than 0.7 that is usually taken to reflect adequate reovery. Clinically the magnitude of antagonism of neuromuscular blockade appears to be dependent on the amount of muscle twitch at the time of anticholinesterase administration rather than on the total dose of muscle relaxant given during anesthesia. Authors evaluated the residual effect of pancuronium after anesthesia by the use of train-of-four(TOF) stimulation to the ulnar nerve. The degree of muscle relaxation was assessed by the train-of-four count, according to which varied dose of anticholinesterase was administered and the reversal time to a train-of-four ratio of 0.7 was checke.The result of this study is summerized below. 1) Reversal time without administration of neostigmine from 4th response to a TOF stimulation to a TOF ratio of 0.7 was 45.4+/-9.3 min. 2) Reversal time to a TOF ratio of 0.7 after adminstration of neostigmine 20ug/kg the 4th response to a FOF stimulation was 14.2+/-3.2 min. 3) Reversal time to a TOF ratio of 0.7 after administration of neostigmine 25ug/kg at the 3rd response to a TOF stimulation was 14.9+/- 4.7 min. 4) Reversal time to a TOF ratio of 0.7 after administration of neostigmine 40ug/kg at the 2nd response to a TOF stimulation was 10.6+/-3.4 min.
Anesthesia* ; Muscle Relaxation ; Neostigmine ; Neuromuscular Blockade ; Pancuronium* ; Peripheral Nerves ; Ulnar Nerve

Currently, the cell surface antigen A,B,O(H) is thought to be an important indicator of malignant potential in bladder carcinoma. Herein, we performed SRCA test in 54 bladder carcinoma for detection of such an isoantigen, comparing the SRCA result to its tumor grade and stage. Also, various significances including the clinical application of SRCA test for the management of the bladder carcinoma were discussed. The results were as follows: 1. Of 54 patients, 34 patients were low stage(0-A) and low grade(1-2). 2. There is a significant correlation between tumor grade and SRCA test: Of 38 patients with low grade. 19 patients were SRCA positive, but of 16 patients with high grade. all were SRCA negative. 3. There is a significant correlation between tumor stage and SRCA test: Of 36 patients with low stage, 18 patients were SRCA positive, but of 18 patients with high stage(above B1), only one patient was SRCA positive. 4. There is a high possibility of false-negative results in detecting O(H) isoantigen: Of 36 patients with low stage, 6 patients were blood group 0 who were all SRCA negative. but 30 patients with other blood groups showed variable SRCA results. 5. There is a considerable correlation between tumor recurrence and SRCA result: Of 20 patients who were followed more than one year after initial TUR, 8 patients were SRCA positive, of these 4 patients were recurred, but 9 patients of 12 patients with SRCA negative were recurred.
Antigens, Surface* ; Blood Group Antigens ; Humans ; Isoantigens ; Recurrence ; Urinary Bladder*

Currently, uric acid disorders, especially including hyperuricosuria, are thought to be important in the formation Of idiopathic calcium urolithiasis. Herein, we estimated the serum concentration and urinary excretion of uric acid in I22 stone-formers, comparing to those in 56 controls. Also, various theories about the pathogenesis of uric acid disorder and stone formation were discussed. The results were as follows: 1. Serum uric acid levels of stone-formers were significantly higher than those of controls, in total and female, but, not in male. 2. Urinary uric acid levels of stone-formers were significantly higher than those of controls in total, male and female. 3. Hyperuricemia was significantly more frequent for stone-formers in total, male and female. 4. Hyperuricosuria was significantly more frequent for stone-formers in total, but, not significantly more frequent for stone-formers in male and female. 5. The incidence of stone-formers, in whom hyperuricemia and hyperuricosuria were not present at the sometime, was significantly less than that Of controls. These results suggest the possibility that uric acid disorder may play some roles in the genesis of urinary stone.
Calcium ; Female ; Humans ; Hyperuricemia ; Incidence ; Male ; Uric Acid* ; Urinary Calculi* ; Urolithiasis