Extracorporeal shock wave lithotripsy(ESWL) for urinary calculi is usually performed under general anesthesia, regional anesthesia or intravenous anesthesia. We evaluated the sedativeanalgesic effeet and untoward effects of diazepam-fentanyl for ESWL. 60 patients were belonged to physical status 1 or 11 of ASA classification who injected diazepam(5~10 mg) and fentanyl(1.5 ug/kg) at 2 minutes were as follows The results were as follows; 1) Mean arterial pressure(MAP) was significantly decreased in 3-10 minutes after injection compared to baseline value. 2) Heart rate(HR) was statistically nonsignificant but slightly decreased from 2 minutes after injection. 3) Respiratory rate(RR) and arterial oxygen saturation(SaO2) were significantly decreased until 15 miuntes after injection but SaO was not decreased below 92.7% and RR was not decreased below 13 rates/minute. 4) Pain and movement during ESWL developed in 18 cases but repositioning and discon- tinuation of EWSL were not necessary. Episodes of desaturation(SaO2<90%) developed in 2 cases. 5) Postoperative dizziness developed in 24 cases. nausea and vomiting developed in a few cases. We concluded that intravenous administration of diazepam-fentanyl is more convenient and simpler than other anesthetic technique for ESWL.
Administration, Intravenous ; Analgesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Intravenous ; Classification ; Diazepam* ; Dizziness ; Fentanyl* ; Heart ; Humans ; Lithotripsy* ; Nausea ; Oxygen ; Shock* ; Urinary Calculi ; Vomiting

In our hospital we studied the effects of spinal anesthesia with 0.5% isobarie bupivacaine and hyperbaric T-caine in 60 patients undergoing operation of lower abdomen or lower limbs. The following results were obtained. 1) Maximum level of sensory loss were similar in both groups, the time taken to it was significantly faster in the T-caine group but the duration was significantly longer in the bupivacaine group. 2) Onset time of motor blockade was significantly faster in the T-caine group but the duration was significantly longer in the bupivacaine. 3) The fall in blood pressure appeared faster in the T-caine group but no significant value of difference between the two groups. No significant changes were noted in the pulse rates. 4) Post spinal headache developed in 5 patients out of 60 patients (8.3%). With the results, we can assume that 0.5% isobaric bupivacaine is a good local anesthetic agent for spinal anesthesia in operations of the lower abdomen and lower limbs.
Abdomen ; Anesthesia, Spinal* ; Anesthetics ; Blood Pressure ; Bupivacaine* ; Headache ; Heart Rate ; Humans ; Lower Extremity

In our department we selected 52 patients in ASA Class I, aged from 20 to 60 years old undergoing operation of lower limbs and lower abdomen, lasting 1 to 2 hours of duration. They were divided into 2 groups, group A (30 patients) using 0.5% hyperbaric Tcaine 13 mg (2.6 ml), group B (22 patiens) using 0.25% hyperbaric bupivacaine 10 mg (4 ml), which were injected into intrathecal space. Sensory loss level was significantly higher in group A than in group B. The time taken for the block to reach maximum level was significantly faster in group B. Analgesic duration was significantly shorter in group B. In group B, onset of motor blockade was significantly slower and also, the total duration was significantly shorter. In group A, significant decrease of diastolic and systolic blood presssure were noted. Hyperbaric 0.25% bupivacaine can be used for short timed operation of lower limbs and lower abdomen without changes of cardiovascular system.
Abdomen ; Anesthesia, Spinal* ; Anesthetics ; Bupivacaine* ; Cardiovascular System ; Humans ; Lower Extremity ; Middle Aged

OBJECTIVE: The authors report a retrospective analysis of the clinical effect of dorsal root entry zone (DREZ) lesioning for neuropathic intractable pain. METHODS: Fourteen patients who underwent dorsal root entry zone lesioning for various types of pain between September 1995 and August 2001 were evaluated retrospectively. Eleven male and three female patients whose ages ranging from 35 to 70 were studied. According to causes of intractable pain, patients were divided into paraplegic pain(7 patients), peripheral nerve injury pain(3), cancer pain(3), phantom limb pain(1) and root avulsion pain(1). Other preoperative pain managements showed no benificial effects. The changes in painful symtoms were closely observed during follow up period. The mean follow period after operation was 32.4 months. RESULTS: Postoperatively, the decrease in level of pain was classified into four groups : excellent, good, fair, poor. Excellent represented no pain without medication : Good, pain tolerable with non-opiate medicine ; Fair, pain tolerable with opiate medicine ; Poor, pain sustained. After operation, three patients were in excellent group, eight in good, one in fair, and two in poor. Twelve patients were in medically tolerable pain group accounting for 85.7%. There were no serious operation releated side effects. CONCLUSION: DREZ lesioning, in our series, provided substantial pain relief and this may be considered an option in management of these types of intractable neuropathic pain.
Female ; Follow-Up Studies ; Humans ; Male ; Neuralgia ; Pain Management ; Pain, Intractable* ; Peripheral Nerve Injuries ; Phantom Limb ; Retrospective Studies ; Spinal Nerve Roots*

OBJECTIVE: Although there are several risk factors to which related intraoperative aneurymal bleeding, the relationship between ventricular drainage to aneurysmal rebleeding is still controversial. We investigate to define the relationship of an immediate ventricular drainage after craniotomies in predissection stage rerupture of aneurysms. METHODS: Randomized prospective and retrospective analyses were performed on 197 consecutive patients with confirmed aneurysmal subarachnoid hemorrhage(SAH) who underwent aneurysmal clipping in acute stage during 5 years. The aneurysmal SAH patients were divided into two groups according to the use of intraoperative ventricular cerebrospinal fluid(CSF) drainage. Various variables including Hunt-Hess grade, Fisher grade, Glasgow coma scale, Glasgow outcome scale, location of aneurysms, and the presence of a "daughter" aneurysm and hydrocephalus were analyzed. RESULTS: Regardless the drained CSF amount, the incidence of the intraoperative aneurysmal rerupture in predissection stage during aneurysmal clipping has not showed any difference in both groups. Depending on the presence of the acute hydrocephalus, the rerupture incidence in dissection stage during aneurysmal surgery was not statistically significant. However, the frequency of rebleeding in patients with ventriculostomy(66% of 24) was significantly higher than in hydrocephalic patients without ventriculostomy(25% of 27) and patients without acute hydrocephalus(22% of 110). CONCLUSION: Routine intraoperative ventricular drainage does not increase the incidence of aneurysmal rebleeding and the more extensive arachnoid dissection is not necessary even during an early surgery. Moreover, it obtains an adequate intraoperative brain relaxation, which resulted in the decrease of retraction injury.
Aneurysm* ; Arachnoid ; Brain ; Craniotomy ; Drainage* ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence* ; Prospective Studies ; Relaxation ; Retrospective Studies ; Risk Factors ; Subarachnoid Hemorrhage

Spontaneously thrombosed cerebral arteriovenous malformations (AVM) are infrequently reported. Its pathophysiology, and natural course, however, are still not clarified yet. Authors report a case of symptomatic, spontaneously thrombosed cerebral AVM in a 34-year-old male with a follow-up of 16-year duration, which was surgically extirpated due to repeated bleeding and intractable seizure disorder, and histopathologically confirmed. Relevant literatures are reviewed and discussed.
Adult ; Epilepsy ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Male ; Seizures

PURPOSE: To evaluate the usefulness of fast magnetic resonance (MR) sequences combined with MR arterialportography in the preoperative assessment of hepatocellular carcinoma. MATERIALS AND METHODS: Twelve patients suffering from nodular hepatocellular carcinoma complicated by liver cirrhosis underwent T2-weighted turbo spinecho and T1-weighted multisection FLASH with and without fat-suppression MR imaging during single breath-holdsession in each sequence. MR arterial portography was performed with Gd-DTPA injected through a catheter into the superior mesenteric or splenic artery during the T1-weighted FLASH sequence. The pathologic findings of surgical specimen or follow-up lipiodol CT findings were compared with the MR imaging. RESULTS: MR arterial portography depicted 17 of the 19 masses (sensitivity, 89%) and the sensitivity of non-contrast fast MR sequences was 74%(14/19). The sensitivity for combined interpretation of all the above sequences was 89% (17/19). MR arterial portography showed perfusion defects from two cysts, one hemangioma, one inflammatory mass, and innumerable tiny regenerating nodules. Static T1-and T2-weighted imaging clearly differentiated, however, benign lesions and true hepatocellular carcinoma. CONCLUSION: MR arterial portography combined with other fast MR imaging allows tissue characterization as well as high detection rate in the evaluation of hepatocellular carcinoma complicated with cirrhosis.
Carcinoma, Hepatocellular ; Catheters ; Ethiodized Oil ; Follow-Up Studies ; Gadolinium DTPA ; Hemangioma ; Liver Cirrhosis ; Magnetic Resonance Imaging ; Perfusion ; Portography* ; Splenic Artery

PURPOSE: Anorectal malignant melanomas (AMM) are rare and have poor survival. The study aims to evaluate the clinicopathologic characteristics and outcomes of patients with AMM, and to devise a staging system predictive of survival outcome. MATERIALS AND METHODS: This was a retrospective study of 28 patients diagnosed with, and treated for AMM. Patients classified by clinical staging of mucosal melanoma (MM) were reclassified via rectal and anal TNM staging. Survival outcomes were compared among patients grouped by the three different staging systems. RESULTS: The three staging systems were equated with similar figures for 5-year overall survival (OS) and 5-year disease-free survival (DFS) of patients diagnosed with stage I disease. Patients (n=19) diagnosed with MM stage II disease were reclassified by rectal TNM staging into three subgroups: IIIA, IIIB, and IIIC. For these patients, both 5-year OS and 5-year DFS differed significantly between the subgroups IIIA and IIIC (OS: IIIA vs. IIIC, 66.7% vs. 0%, p=0.002; DFS: IIIA vs. IIIC, 51.4% vs. 0%, p < 0.001). CONCLUSION: The accuracy of prognosis in patients diagnosed with AMM and lymph node metastasis has improved by using rectal TNM staging, which includes information regarding the number of lymph node metastases.
Disease-Free Survival ; Humans ; Lymph Nodes ; Melanoma* ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis* ; Rectum ; Retrospective Studies

BACKGROUND: Previous studies have suggested that chronic infection may play a role in the pathophysiology of restenosis after coronary angioplasty. The purpose of our study was to investigate the relation between Helicobacter pylori(H. pylori) or cytomegalovirus (CMV) infection, and restenosis. METHODS: Fifty nine patients with coronary artery disease underwent percutaneous transluminal coronary angioplasty (PTCA) and follow-up coronary angiography (59+/-13 years, 66% male). H. pylori and CMV IgG antibody titers were measured prospectively. The minimal luminal diameter and reference diameter before and immediately after angioplasty and at follow-up were measured with quantitative analysis. RESULTS: Restenosis occurred in 23 of the 59 (39%) patients. For H. pylori, patients with high antibody titer (upper half, > or =40 U/ml) had a higher restenosis rate than patients with low antibody titer (lower half, < 40 U/ml). Seventeen of the 29 (59%) patients with high antibody titer had restenosis, while 6 of the 30 (20%) patients with low antibody titer had restenosis (p=0.002, RR=2.39, 95% CI 1.35 to 6.37). After adjustment for covariates, including age, sex, body mass index, hypercholestrolemia, hypertension, diabetes mellitus, smoking, diagnosis at admission, modality of intervention, postprocedure minimal luminal diameter, lesion length, and lesion type, H. pylori antibody titer was independently predictive of restenosis (p=0.005). For CMV, patients with high antibody titer did not have a higher restenosis rate than patients with low antibody titer. CONCLUSION: High antibody titer against H. pylori may be an independent risk factor of restenosis after PTCA. However, there was no association between CMV antibody titer and the risk of restenosis.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Body Mass Index ; Coronary Angiography ; Coronary Artery Disease ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Diabetes Mellitus ; Diagnosis ; Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Hypertension ; Immunoglobulin G ; Phenobarbital ; Prospective Studies ; Risk Factors ; Smoke ; Smoking

PURPOSE: We report herein 119 patients with pheochromocytoma at our institute over the last 23 years. MATERIALS AND METHODS: Between 1986 and 2009, 119 patients were diagnosed with pheochromocytoma at our institute. We reviewed the medical records of these patients. RESULTS: Of 119 patients, 45 were male and 74 were female, and mean age was 43.83 +/- 13.49 years. Forty-three patients (36.1%) were diagnosed incidentally, and 8 patients (6.7%) were found to have familial pheochromocytoma. The mean dimension of the tumors was 5.89 +/- 3.18 cm. 4 patients had bilateral tumors; three of these patients were found to have familial pheochromocytoma and 1 patient was diagnosed with malignant pheochromocytoma. A total of eight patients (6.7%) were found to have malignant pheochromocytoma. In 1 patient, metastasis to a lymph node was found at the time of diagnosis. Metastases were found at a mean of 49 +/- 25.83 (6-75) months after surgery in the other seven patients. 6 patients died of malignant pheochromocytoma at a mean of 31 +/- 28.71 months (1-81) after diagnosis, and the other 2 patients survived for 15 and 24 months, respectively. CONCLUSION: Approximately 35% of patients with pheochromocytoma are diagnosed incidentally, and the number of detected cases is increasing. Although familial pheochromocytoma was found only in 6.7% of the patients, genetic testing should be considered in all patients, especially in patients with a family history, young age, or multifocal, bilateral, extra-adrenal, or malignant tumors. Given that malignant pheochromocytomas are frequently diagnosed during the follow-up period, long-term follow-up is necessary to confirm the absence of recurrence or metastasis.
Adolescent ; Adrenal Gland Neoplasms/diagnosis/pathology ; Adult ; Aged ; Child ; Female ; Humans ; Male ; Middle Aged ; Pheochromocytoma/*diagnosis/pathology ; Young Adult