OBJECTIVE: Barbiturate coma therapy (BCT) is a useful method to control increased intracranial pressure (IICP) patients. However, the complications such as hypotension and hypokalemia have caused conditions that stopped BCT early. The complications of low dose BCT with Bispectral(TM) index (BIS) monitoring and those of high dose BCT without BIS monitoring have been compared to evaluate the efficacy of low dose BCT with BIS monitoring. METHODS: We analyzed 39 patients with high dose BCT group (21 patients) and low dose BCT group (18 patients). Because BIS value of 40-60 is general anesthesia score, we have adjusted the target dose of thiopental to maintain the BIS score of 40-60. Therefore, dose of thiopental was kept 1.3 to 2.6 mg/kg/hour during low dose BCT. However, high dose BCT consisted of 5 mg/kg/hour without BIS monitoing. RESULTS: The protocol of BCT was successful in 72.2% and 38.1% of low dose and high dose BCT groups, respectively. The complications such as QT prolongation, hypotension and cardiac arrest have caused conditions that stopped BCT early. Hypokalemia showed the highest incidence rate in complications of both BCT. The descent in potassium level were 0.63 +/- 0.26 in low dose group, and 1.31 +/- 0.48 in high dose group. The treatment durations were 4.89 +/- 1.68 days and 3.38 +/- 1.24 days in low dose BCT and high dose BCT, respectively. CONCLUSION: It was proved that low dose BCT showed less severe complications than high dose BCT. Low dose BCT with BIS monitoring provided enough duration of BCT possible to control ICP.
Anesthesia, General ; Barbiturates ; Coma ; Heart Arrest ; Humans ; Hypokalemia ; Hypotension ; Incidence ; Intracranial Hypertension ; Intracranial Pressure ; Potassium ; Thiopental

Many drugs have been known to induce lupus-like syndrome, composing approximately 10% of all SLE cases. Isoniazid-induced lupus erythematosus affects either sex equally and the most common presenting feature is arthralgia or arthritis with anemia. Fever and pleuritis occur in approximately half of the cases, and pericarditis in approximately 30% of cases. We discribe a 28-year-old woman receiving antituberculous medications including isoniazid for one month. She was hospitalized with fever, arthralgia and newly developed pleural effusion The analysis of pleural fluid and serum revealed an elevated level of antinuclear antibody. We suspected of drug induced lupus and stopped isoniazid medication. After discontinuation of isoniazid and short course of prednisolone treatment, her symptoms and pleural effusion disappeared. This case is to our knowledge, the fist report of isoniazid induced SLE in Korea.
Adult ; Anemia ; Antibodies, Antinuclear ; Arthralgia ; Arthritis ; Female ; Fever ; Humans ; Isoniazid* ; Korea ; Lupus Erythematosus, Systemic* ; Pericarditis ; Pleural Effusion ; Pleurisy ; Prednisolone

PURPOSE: We conducted this study to assess the effect of oral application of bovine colostrum on the plasma endotoxin and TNF-alpha following the abdominal surgery. METHODS: 46 patients who underwent the abdominal surgery were evenly enrolled in a prospective, randomized, double blind and placebo-controlled study. The patients were preoperatively managed by oral application of 20 g of a bovine colostrums or placebo (nonfat dried milk) per a day for 3 days. In both groups, endotoxin was sequentially determined pre-, intra- and postoperatively by a modified limulus amebocyte lysate test. TNF-alpha and CRP were also measured. The clinical course was followed and compared in both groups. RESULTS: The colostrum group showed significantly lower level of endotoxin and TNF-alpha compared to the placebo group. CRP did not differ in both groups. Clinical event did not occur in both group until the discharge. Colostrum group tends to have a lower incidence of fever and leukocytosis without statistic significance. CONCLUSION: Prophylactic preoperative oral application of bovine colostrum lower the plasma level of perioperative endotoxin and TNF-alpha. Further studies were needed for the relation of clinical effect and preoperative oral application of bovine colostrum.
Colostrum* ; Endotoxemia* ; Fever ; Horseshoe Crabs ; Humans ; Incidence ; Leukocytosis ; Plasma ; Prospective Studies ; Tumor Necrosis Factor-alpha*

PURPOSE: The Suprapubic Arc (SPARC) procedure has recently been introduced as a new surgical treatment option for stress urinary incontinence in women. We have reported our early results of SPARC procedures. MATERIALS AND METHODS: A total of 23 patients received SPARC procedures at our hospital between November 2002 and August 2003. All the patients were evaluated with history taking, physical examination, urodynamic study and cystography preoperatively. The procedure was carried out under IV propofol or spinal anesthesia. The enrolled patients were followed-up for more than 3 months postoperatively. The cure rate was evaluated and perioperative and postoperative complications were assessed. RESULTS: The mean age of the patients was 48.8 years (ranges from 32 to 67 years) and eight patients had past history of previous abdominal or pelvic surgery. The mean hospital stay was 1.9 days (ranges from 1 to 7 days). Mean follow-up period was 7.9 months (ranges from 3.7 to 14.0 months). Nineteen of the 23 patients (82.6%) were completely cured and 2 patients (8.7%) were much improved, hence the total success rate of the procedure was 91.3%. Bladder perforation during procedure occurred in 7 patients (30.4%) but conservative management sufficed. No serious complication was occurred. CONCLUSION: Our early results show that the SPARC procedure is a effective treatment option for the management of stress urinary incontinence. But we suggest that surgeons should be careful to avoid the bladder injury especially in their early period of experience.
Anesthesia, Spinal ; Female* ; Follow-Up Studies ; Humans ; Length of Stay ; Physical Examination ; Polypropylenes ; Postoperative Complications ; Propofol ; Urinary Bladder ; Urinary Incontinence* ; Urodynamics

PURPOSE: There has been great demand for indwelling stents for preventing pain, obstructive symptoms and other complications after endoscopic procedures. However, there is no consensus on the placement of a ureteral stent after an ureteroscopy. Inherent stent related problems warrant the minimum possible stenting duration without compromising the results of an ureteroscopy. A prospective randomized trial was performed to evaluate whether 3-day stenting is sufficient for ureteroscopic lithotripsy. MATERIALS AND METHODS: A total of 38 patients underwent an ureteroscopic lithotripsy. There were no severe operative complications. The patients were randomized into 2 groups; Group A: 18 patients who had an internal stent for 3 days after the ureteroscopic lithotripsy, and group B: 20 patients with a stent for 2 weeks. The ureteroscopic lithotripsies were performed with an 8Fr. or 10Fr. ureteroscope, under intravenous propofol anesthesia. Postoperative symptom questionnaires were acquired from each patient. A radiological follow-up was performed at least 4 weeks after the stent removal in all patients. RESULTS: There were no significant differences in the age, sex, stone size or usage of the instrument between the 2 groups. Of the 38 patients, 32 (84%) had discomfort associated with the indwelling stent. The most common symptom was irritative voiding symptom. There were no significant differences in the flank pain and ureteral stricture between the 2 groups. CONCLUSIONS: There was no difference between the 3-days and 2-weeks indwelling stented groups with respect to complications. Therefore, 3 days seems to be a more adequate duration for the decrease stent related complications and symptoms after an ureteroscopic lithotripsy, with no serious intraoperative complications.
Anesthesia ; Calculi ; Consensus ; Constriction, Pathologic ; Flank Pain ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Lithotripsy* ; Propofol ; Prospective Studies ; Surveys and Questionnaires ; Stents* ; Ureter ; Ureteroscopes ; Ureteroscopy

We describe a case of priapism after perineal blunt trauma in a 32-year old man who complained of painless and persistent erection. We confirmed high-flow priapism by cavernosal blood gas analysis, Doppler ultrasonography, and arteriography. A pseudoaneurysm was blocked by selective carvernosal artery embolization with autologous clot. Penile tumescence did not completely disappear during the following 4 weeks, and the patient complained of penile discomfort. Reembolization of the cavernosal artery with autologous clot was successful in reversing the erection. The patient has normal erectile status and no complaints during 30 months follow-up.
Adult ; Aneurysm, False ; Angiography ; Arteries ; Blood Gas Analysis ; Follow-Up Studies ; Humans ; Male ; Penile Erection ; Priapism* ; Ultrasonography, Doppler

PURPOSE: The aim of this study was to evaluate the long term therapeutic results and complications of an anterior vaginal wall sling (AVWS) for female patients with stress urinary incontinence (SUI) followed up for over 3 years. MATERIALS AND METHODS: We analyzed 23 of 43 patients who could have been followed up for more than 3 years following an AVWS operation. The mean follow-up period was 40.2+/-5.3 months. The cystography and urodynamic study, including preoperative valsalva leak point pressure and subjective SEAPI scores, were examined in the patients. Postoperative analyses, including subjective SEAPI scores, success rates, satisfaction and complications were performed 3 years following the operations. RESULTS: The total preoperative subjective SEAPI score of 6.1+/-3.4 decreased postoperatively to 1.4+/-1.5 (p<0.001). Twenty one patients (91.3%) answered as "completely resolved" and one patient (4.3%) as "improved". Of the 12 patients accompanied by urgency preoperatively, 8 were completely improved directly following the operation, but the remaining 4 suffered longstanding urgency. De novo urgency occurred in 3 patients, but they all improved within 3 months with conservative management. Five patients (21.7%) suffered from postoperative inguinal pain, which improved in 4 after 3 months, an in about 9 months in the other. Subjective satisfaction exceeding 3 years following the operation was "very satisfactory" in 22 patients (95.6%). CONCLUSIONS: After more than 3 years, the 3 year follow-ups after AVWS operations in female patients with SUI showed a high success rate, high patient subjective satisfactions and reasonable complications. We think that an AVWS operation is an effective therapeutic procedure for female patients with SUI.
Female* ; Follow-Up Studies* ; Humans ; Urethra ; Urinary Incontinence* ; Urodynamics ; Vagina

PURPOSE: Most patients who finally diagnosed as the cecal and ascending colonic diverticulitis would complain pain on right low quadrant of abdomen. So many of them unfortunately would be performed emergency operation for presumed appendicitis. We are purposed to verify the usefulness of colonoscopy for the diagnosis and aimed to treat many patients with this disease conservatively. METHODS: We reviewed retrospectively the medical records of the 46 patients who diagnosed as the cecal and ascending colonic diverticulitis under admission at general surgery department during 4 years from January, 1997 to December, 2000. RESULTS: The mean age was 40.1 years and the male to female ratio was 1.2:1. Most common clinical manifestation was abdominal pain (46 cases) and nausea/vomiting (13 cases), fever/chill (4 cases) followed. On physical examination on abdomen, 26 patients had tenderness with rebound tenderness on right low quadrant and 18 patients showed only tenderness on right low quadrant. The mean peripheral WBC count was 10,600.9/mm2. Diagnostic tools were abdominal ultrasonography (34 cases), abdominal CT (13 cases), barium enema (8 cases) and colonoscopy (22 cases). The sensitivities of each modalities were 52.6%, 46.2%, 33.3% and 81.8% respectively. The respective mean hospital days depending on the treatment arms were as follows: 6.0 days of the conservatively treated group, 8.0 days of whom were operated as exploratory laparotomy with incidental appendectomy and 16.9 days of whom were operated as Right-hemicolectomy. 17 patients of 24 colonoscopy-done patients were recovered with conservative treatment, compared with only 7 patients of 22 colonoscopy-undone patients (P=0.0005). 2 cases of the conservatively managed groups were operated later due to recurrences (mean follow up periods=20 months). 2 operated patients had complications of postoperative ileus. CONCLUSIONS: Based on our study, the indications of colonoscopy are that in whom impressed clinically as acute appendicitis, on physical examination there be obvious tenderness on right low quadrant but obscure rebound tenderness, on peripheral blood smear the WBC counts range from normal to mild increased (<15,000/mm2), and on ultrasonography, appendix couldn't be detected or colonic wall show thickening. In patients who selected fit for indications, colonoscopy is safe and highly sensitive. We would manage these patients more conservatively, and may reduce their hospital stay.
Abdomen ; Abdominal Pain ; Appendectomy ; Appendicitis ; Appendix ; Arm ; Barium ; Cecum ; Colon* ; Colon, Ascending ; Colonoscopy* ; Diagnosis ; Diverticulitis ; Diverticulitis, Colonic* ; Emergencies ; Enema ; Female ; Follow-Up Studies ; Humans ; Ileus ; Laparotomy ; Length of Stay ; Male ; Medical Records ; Physical Examination ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVES: The prognosis of spontaneous intracerebral hemorrhage often depends on initial neurologic condition, size and location of hemorrhage and associated intraventricular hemorrhage. However, age of patient, coagulation state and other associated vascular diseases may also play a role when present. In recent years, the geriatric population has been increasing. The age distribution of the patients with intracerebral hemorrhages also has been increased, accordingly. However, such patients, especially when associated with poor initial conditions often tend to be managed rather conservatively. The authors analyzed retrospectively on forty-five patients with spontaneous intracerebral hemorrhage over the seventies with poor initial condition to find out whether there exists a difference of outcome between surgery and non-surgery group. MATERIAL AND METHOD: A total of 45 patients over seventies with spontaneous intracerebral hemorrhage with Glasgow Coma Scale(GCS) 4-8 treated over last six years were included. The validity of surgical management for these patients as well as clinical variables which might have been operated on the outcome of these patients were evaluated. The Glasgow Outcome Scale(GOS) after three months was used for comparison of outcome. RESULTS: In surgical group(19 cases), mean age was 74.5 years old, mean hematoma volume 67.2ml and mean GCS score 5.7 points. In nonsurgical group(26 cases), mean age was 79.3 years old, mean hematoma volume 32.1ml, and mean GCS score 6.8 points. Mortality rate in surgical group was 47.4%(9 patients), including 2 cases of post-operative rebleeding, while that in nonsurgical group was 46.2%. However, when patients with initial GCS 4-6 points and over 30ml in hematoma volume were regrouped, mortality rate in surgical group was 46.2%, whereas mortality rate in nonsurgical group was 66.7%. CONCLUSION: It is concluded that the mortality rate is much low in surgery group with initial GCS less than 6 points and hematoma volume over 30cc. There was no significant difference of outcome in patients with basal ganglia and thalamic hemorrhage. However, surgical treatment lowered the mortality and morbidity rate in patients with subcortical and cerebellar hemorrhage.
Age Distribution ; Basal Ganglia ; Cerebral Hemorrhage* ; Coma ; Geriatrics ; Hematoma ; Hemorrhage ; Humans ; Mortality ; Prognosis* ; Retrospective Studies ; Vascular Diseases

BACKGROUNDS AND OBJECTIVES: C-Reactive protein (CRP) levels are powerful predictors of cardiac complications and death in patients with unstable angina unrelated with myocardial cell damage or myocardial ischemia. This study was performed to determine the optimal timing to measure CRP to predict cardiac events in patients with unstable angina. MATERIALS AND METHOD: The study was comprised 50 patients with unstable angina (Braunwald Class IIIb). We randomized the study subjects by the time of CRP elevation (> 8mg/L): Group A (on admission, 15 patients), Group B (during hospitalization, 19 patients), and Group C (at discharge, 19 patients). RESULTS: 1) CRP levels (median and range) of Group A, B, and C were 10.6 (8.2-24.2), 12.8 (8.1-33.7), and 10.3 (8.1-18.7) mg/L, respectively (p=S). 2) During clinical follow-up at a mean duration of 12 months, there were 1 death, 1 myocardial infarction, 6 revascularization therapy (PTCA or CABG) and 11 recurrent angina. 3) In Group A, 10 cardiac events (1 myocardial infarction, 4 revascularization therapy, and 5 recurrent angina) occurred. The elevated levels of CRP predicted cardiac events during clinical follow-up with sensitivity of 53%(10/19), positive predictive value of 67%(10/15), and negative predictive value of 74%(26/35). In Group C, 13 cardiac events were occurred. Sensitivity, positive and negative predictive value to predict cardiac events of elevated levels of CRP were 68%(13/19), 68%(13/19) and 81%(25/31), respectively. 4) Elevated levels of CRP (>8mg/L) were predictors for cardiac events in patients with unstable angina (Group A; p<0.05, Group B; p<0.05, Group C; p<0.001). However, by logistic regression analysis, CRP values > 8mg/L at discharge were only predictive of cardiac events with odd ratio of 6.01 (95% CI 1.50-44.3, p<0.05). CONCLUSIONS: CRP (> 8mg/L) was elevated in 38% of patients at discharge and elevated levels of CRP at discharge were only predictive of cardiac events in patients with unstable angina.
Angina, Unstable* ; C-Reactive Protein* ; Follow-Up Studies ; Hospitalization ; Humans ; Logistic Models ; Myocardial Infarction ; Myocardial Ischemia