BACKGROUND: Epidural morphine is effective in the treatment of postoperative pain, but the incidence of associated side effects is high. To evaluate the reduction of opioid sideeffects by epidural use of droperidol mixture, this study was performed. METHODS: Randomly sampled sixty patients undergoing upper abdominal surgery were divided into two groups. To assess a reduction of opioid side effects by droperidol, group I (n=30) were received 3mg morphine and 0.15% bupivacaine 10ml through the indwelling epidural catheter before the conclusion of operation, followed by an infusion of 6 mg morphine plus 0.15% bupivacaine 100ml with the two day infusor. Group II (n=30) were treated with the same protocol as group I but 1.5 mg of droperidol was added to initial bolus and 5mg of droperidol to the two day infusor. Analgesic effect and side effect were 48 hours after operation. RESULTS: No significant differences in intensity of analgesiaand sedation were seen. The intensity of nausea and vomiting in the group II was significantly less than in the group I at 8, 12 hours after operation (p<0.05). The intensity of pruritus in group II was significantly less than in group I at 4, 8 hours of postoperative period (p<0.05). The frequency of nausea, vomiting, pruritus and urinary retention in group II were less than in group I. respiratory depression. Epidural injection of droperidol did not result in any local or systemic side effects. CONCLUSION: The addition of epidural droperidol significantly reduced the side effects of epidural morphine without altering the effect on analgesia.
Analgesia ; Bupivacaine ; Catheters ; Droperidol* ; Humans ; Incidence ; Infusion Pumps ; Injections, Epidural ; Morphine* ; Nausea ; Pain, Postoperative ; Postoperative Period ; Pruritus ; Respiratory Insufficiency ; Urinary Retention ; Vomiting

In order to correlate the frequency of neuroendocrine cells with pathologic parameters in gastric adenocarcinomas, immunoperoxidase staining for neuron specific enolase was performed on 250 consecutive cases of surgically resected gastric adenocarcinomas(201 advanced gastric carcinomas[AGCs], 49 early gastric carcinomas[EGCs] and 2 cases of gastric carcinoid tumors. Of the 252 cases of gastric carcinomas, pure exocrine carcinomas were 174 cases(69%), pure neuroendocrine(NE) carcinomas 2 cases(0.8%), mixed exocrine and NE carcinomas 32 cases(12.7%), and exocrine carcinomas with occasional NE cells 44 cases(17.5%). The frequency of gastric carcinomas with NSE-positive cells increased with age proportionally. NSE positivity was higher in polypoid or fungating tumors(AGC Borrmann type I, II, EGC I and IIa) than ulcerative or scirrhous tumors. There was no significant difference in frequency of NSE-positive cells by histologic type and differentiation of gastric adenocarcinomas. The above findings reflect that most gastric carcinomas are heterogeneous in their constituents and suggest that both exocrine and neuroendocrine carcinomas are the expression of the extreme ends of the exocrine-endocrine differentiation spectrum based on the assumption that they develop from the pluripotent stem cells differentiating into both exocrine endocrine carcinomas.

To delineate the individual role of follicular dendritic cells (FDC) and T cells at each stage of GC B cell differentiation at the clonal level and to analyze the signals required for the differentiation, we developed an experimental model using an FDC line, HK and a lymphoma cell line, L3055 for centroblasts. Phenotypic analysis of L 3055 revealed its origin of GC and the homogeneity. L3055 cells undergo spontaneous apoptosis when cultured in the absence of HK cells. L3055 cells proliferate continuously in the presence of HK cells, while they differentiate into a population with the phenotype of centrocytes after stimulation with CD40 ligand (CD 40L) plus IL-2, IL-4 and IL-10. L3055 undergo anti-Ig-mediated apoptosis, which is not protected by HK but by CD40L and the cytokines. These experimental results suggest that FDC provide signals for the survival and rapid proliferation of centroblasts and T cells trigger the differentiation of centroblasts into centrocytes.
Apoptosis ; CD40 Ligand ; Cell Differentiation* ; Cell Line ; Cytokines ; Dendritic Cells, Follicular ; Germinal Center* ; Interleukin-10 ; Interleukin-2 ; Interleukin-4 ; Lymphoma ; Models, Theoretical ; Phenotype ; T-Lymphocytes

Celiac plexus block with neurolytic agents is widely recommended for the management of intraabdominal pain due to malignant disease as a simple, asafe and effective method. We performed neurolytic celia: plexus block with 60% ethanol in lidocaine in 8 patients: with gastric cancer(4), hepatoma(2), pancreatic cancer(1), and chronic pancreatitis(1). Good to excellent pain relief was obtained in the 2 hepatoma cases, 1 pancreatic cancer, and a gastric cancer patient. In one patient with gastirc cancer, analgesia lasted for about 3 months but the second block was entirely unsatisfactory. The result was uncertain in one patient with chronic pancreatitis because the pain was non-specific and responded even to saline solution(placebo). In the remaing 2 patients, the result was entirely negative and eventually, epidural morphine was given periodically through an indwelling catheter.
Analgesia ; Carcinoma, Hepatocellular ; Catheters, Indwelling ; Celiac Plexus* ; Ethanol ; Humans ; Lidocaine ; Morphine ; Pancreatic Neoplasms ; Pancreatitis, Chronic ; Stomach Neoplasms

We report a case of colonic type-papillary adenocarcinoma of appendiceal origin in a 73-year-old male patient. The patient presented with right lower quadrant mass and was operated for a preoperative diagnosis of inflammatory small bowel mass. The mid one-third of the appendix showed a 3.5x3.3 cm sized, broad-based, intraluminal papillary mass. Microscopically, it was a well differentiated papillary adenocarcinoma and revealed a strong immunoreactivity to carcinoembryonic antigen. Tumor desmoplasia and acute inflammatory change were prominent.
Male ; Humans ; Adenocarcinoma

Foreign body (FB) ingestion of children is a common pediatric emergency requiring medical attention. Pediatric emergency physicians and gastroenterologists often encounter nervous and distressed situations, because of children presenting with this condition in the common clinical practice. When determining the appropriate timing and indications for intervention, physicians should consider multiple patient- and FB-related factors. The utilization of a flexible endoscopy is considered safe and effective to use in these cases, with a high success rate, for the effective extraction of FBs from the gastrointestinal tract of a child. Additionally, a Foley catheter and a magnet-attached Levin tube have been used for decades in the case of FB removal. Although their use has decreased significantly in recent times, these instruments continue to be used for several indications. Using a Foley catheter for this purpose does not require special training and does not necessarily require sedation of the patient or fluoroscopy, which serve as advantages of utilizing this method for foreign object retrieval. An ingested magnet or iron-containing FB can be retrieved using a magnet-attached tube, and can be effective to retrieve an object from any section of the upper gastrointestinal tract that can be reached. Simple and inexpensive devices such as Foley catheters and magnet-attached tubes can be used in emergencies such as with the esophageal impaction of disk batteries if endoscopy cannot be performed immediately (e.g., in rural areas and/or in patients presenting at midnight in a facility, especially in those without access to endoscopes or emergency services, or in any situation that warrants urgent removal of a foreign object).
Catheters ; Child ; Eating ; Emergencies ; Endoscopes ; Endoscopy ; Esophagus ; Fluoroscopy ; Foreign Bodies ; Gastrointestinal Tract ; Humans ; Methods ; Upper Gastrointestinal Tract ; Urinary Catheterization

No abstract available.
Animals ; Blood Platelets* ; Butylated Hydroxytoluene* ; Rats* ; Streptococcus* ; Thrombin*

Public interventions have shown to optimize the use of antibiotics in children with acute otitis media (AOM). In this study, we describe the AOM-related antibiotic use among children in South Korea using national cohort data. We retrieved the Health Insurance Review & Assessment Service data to construct a national cohort of children aged 0–6 years who had been diagnosed with AOM between 2012 and 2018. Of 25,212,264 children included, the antibiotic prescription has increased for amoxicillin/amoxicillin-clavulanate from 56.1% in 2012 to 61.8% in 2018. Prescription has decreased for cephalosporin (35.1% in 2012 to 31.8% in 2018) and macrolide (8.7% in 2012 to 6.4% in 2018). National cohort data have shown an increased trend in AOM-related aminopenicillin prescription and downward trend cephalosporin and macrolide use in South Korea. A multi-faceted approach is required to control the antimicrobial resistance at a population level.

Truncus arteriosus is characterized by a single arterial vessel arising from the base of the heart and giving origin to the systemic, pulmonary and coronary circulation. To evaluate the incidence, types, and associated anomalies, 18cases of truncus arteriosus diagnosed by angiocardiography, were reviewed and were compared with other reports. Ten of them were confirmed by operation. The overall incidence of truncus arteriosus was 0.127%. Accordin to Collett and Edwards classification. Type I was encountered in 11cases(61%), type II in 4cases(22%), and type III in 3cases(17%), All the patients had subtruncal ventricular septal defects. Eight patients showed truncal valve regurgitation and valve stenosis was noted in one case. A right aortic arch was present in 9 cases. Associated anomalies were atrial septal defect(8cases), patent ductus arteriosus(3cases), coarctation of the aorta(2cases), isolation of the left subclavian artery(2 cases), and right aortic arch with an aberrant left subclavian artery(1case). Truncus arteriosus is an uncommon congenital cardio vascular malformation. In the group of cases which we encountered, type I was the most common anomaly. Frequently associated anomalies were right aortic arch, incompetent truncal valve and atrial septal defect.
Angiocardiography ; Aorta, Thoracic ; Classification ; Constriction, Pathologic ; Coronary Circulation ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Incidence* ; Truncus Arteriosus* ; Vascular Malformations