• The Korean Journal of Pain
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• v.19 no.2
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• pp.187-191
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• 2006

Background: Patient-controlled epidural analgesia (PCEA), using a local anesthetic-opioid mixture, has been effectively applied after total knee replacement (TKR) surgery, which is associated with intense postoperative pain that requires postoperative analgesia for both rehabilitation and the pain itself. However, adverse opioid-related effects, such as nausea, vomiting and pruritus, are commonly encountered. It was our hypothesis that the adverse opioid-related effects could be reduced by the addition of naloxone, an opioid antagonist, to a mixture of fentanyl-ropivacaine PCEA. Methods: In 120 patients undergoing elective TKR surgery, epidural or combined spinal-epidural (CSE) anesthesia was performed and PCEA applied. In the control group (n = 65), 0.16% ropivacaine and $3{\mu}g/ml$ fentanyl ($2.4{\mu}g/ml$ for those older than 65 yrs) were administered. In the naloxone group (n = 55), naloxone ($2{\mu}g/ml$) was coadministered with the above regimen. The incidence and severity of postoperative nausea and vomiting, and the frequency of pruritus, the visual analog score (VAS) and the PCEA volume used were assessed 6 and 24 hrs after surgery. Results: The incidence of nausea and vomiting during the early postoperative period, and those of pruritus during the late postoperative period were significantly lower in the naloxone group. The VAS pain scores, the PCEA volume used and amount of rescue IV meperidine were similar in the two groups. Conclusions: A small dose of naloxone mixed with an opioid significantly reduces the incidence and severity of adverse opioid-related effects in PCEA, without reducing the analgesic effect.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.437-444
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• 2009

Purpose: Transgender is a disorder of gender identity, who have appropriate chromosomal, hormonal and anatomical characteristics corresponding to their sexual phenotype but feel strongly with respect to their sexual identity, that they belong to the opposite sex. There is a persistence discomfort and sense of inappropriateness about one's assigned sex in a person who has reached puberty. Transgender is a psychiatric problem, but surgical method provides more satisfactory adjustment for patients. In gender reassignment surgery for female to male transgender, mastectomy, nipple reduction, hysterectomy, oophorectomy and phalloplasty are included. And as the final operation, recommended for scrotoplasty and artificial testes insertion. So we investigated the necessity and method of scrotoplasty in the final operation of female to male transgender. Method: The authors have long term follow-up of 75 cases female to male transgender during January, 1991 to February, 2008. Among them, 13 cases were evaluated in this study. During phalloplasty, the labium major skin preserved. And this labium majoral skin flap was made for the neoscrotum. At least six months later, artificial testes were inserted in neoscrotum with local anesthesia. Middle sized (3 cm diameter) artificial testes(silicon gel or carving soft silicone implant) were used because of the limitation of the neoscrotum. We evaluated the questionnaire and interview about the postoperative satisfaction in configuration of reconstructed scrotum, and the necessity of operation, the postoperative psychosocioeconomic improvement and limitation of body exposure activities such as swimming, public bathing. Results: Based on this study, satisfaction of reconstructed scrotum after scrotoplasty was improved(92%). The necessity of scrotoplasty was in 92.3% and the postoperative psychosocioeconomic well - being improvement was 77% in answers. Less limitation of activities requiring body exposure was 54% in answers. Most of the patients were satisfied with the results of surgical operation inspite of the operative procedure had some postoperative complications. Conclusion: This study was reported that the scrotoplasty in female to male transgender is not only a conversion of external genitalia but also an improvement of psychosocial state. Most patients sincerely hope to this operation, so we improve our surgical method for more good results.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.36-42
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• 1999

Background: The current maximal recommended doses of lidocaine are 7 mg/kg with $5\;{\mu}g/ml$ of epinephrine. But in clinical practice, sometimes more doses of lidocaine are required to produce adequate regional anesthesia. Method: Twenty-two healthy women patients were divided into two groups and pretreated with valium 5 mg p.o., morphine 5 mg i.m., and midazolam 2 mg i.v. before operation. Of these, 7 mg/kg of 2% lidocaine with $5\;{\mu}g/ml$ of epinephrine were given to 11 patients epidurally. Initial 3 ml of epinephrine mixed lidocaine was given as a test dose and remaining doses were given 5 ml/30 sec with 3 min intervals. Radial arterial blood were drawn at 5, 10, 15, 20, 30, 45, 60, 90, 120 min to measure plasma lidocaine concentrations. After confirming all of the peak plasma concentrations of 7 mg/kg lidocaine were absolutely under $5\;{\mu}g/ml$, the other 11 patients were given 10 mg/kg of 2% lidocaine with $5\;{\mu}g/ml$ of epinephrine epidurally and blood samplings were taken according to the same method of 7 mg/kg group. The peak plasma concentration ($C_{max}$), time to reach to $C_{max}$ ($T_{max}$), time to reach to $T_4$, maximal sensory block level, systemic toxicity, and vital sign changes were investigated. Result: $C_{max}$ was significantly higher in 10 mg/kg group ($5.1{\pm}1.3\;{\mu}g/ml$) than 7 mg/kg group($3.3{\pm}0.5\;{\mu}g/ml$), but $T_{max}$ ($10.5{\pm}2.7$ min vs $10.9{\pm}3.1$ min) was not different. Time to reach $T_4$ was significantly shorter in 10 mg/kg group ($9.5{\pm}2.7$ min) than 7 mg/kg group ($12.7{\pm}3.2$ min) but maximal sensory block level ($T_{3.7{\pm}0.7}$ vs $T_{2.7{\pm}1.0}$) was not different. In four patients of 10 mg/kg group, peak plasma concentrations exceeded $5\;{\mu}g/ml$, but no systemic toxicities appeared. No significant vital sign changes were observed. Conclusion: The current maximal recommended doses of lidocaine, merely based on body weight are not always appropriate. Further studies are needed to determine more precise guideline of maximal doses that include various pharmacokinetic components.

• Restorative Dentistry and Endodontics
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• v.30 no.3
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• pp.149-157
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• 2005

Mechanical removals in decayed teeth have been performed using drill and sharp hand instruments. These methods have some disadvantages such as pain, local anesthesia and overextended cavities Therefore chemo-mechanical excavation of dentin carious lesions has been introduced. The purpose of this study was to evaluate the efficacy of traditional mechanical methods using burs and chemo-mechanical methods (Carisolv) of caries dentin. Mechanical caries removal was carried with low speed round bur Chemo-mechanical caries excavation was performed with Carisolv (Medi-team), using the Carisolv hand instruments. The mean time to remove caries with two different methods was evaluated and the data analyzed with SPSS software (ver 11.5) by t-test (p < 0.05). For histomorphometry of caries removal were also carried with mechanical or chemo-mechanical (Carisolv) methods from 20 extracted caries permanent molars. Complete caries removal was verified with a $\#$23 sharp explorers, Caries Detector (Kuraray Co. Japan), and standard apical radiography. 1. Chemo-mechanical method was taken more times than mechanical method (1.5 fold) (p < 0.05) 2. Excavation for caries took more time for molar lesion than premolar lesion, and the least time was taken to remove the caries in incisor lesion (p < 0.05). 3. There were no significant differences to remove the caries between the maxilla and mandible (p > 0.05). 4. The remaining carious dentin was detected after the ckemo-mechanical removal of the carious dentin, and no smear layer were seen after the mechanical and chemo-mechanical removal of the carious dentin.

• Journal of dental hygiene science
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• v.8 no.4
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• pp.353-359
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• 2008

To find out the relationship between the experience of clinical practice and the performance confidence, some 2nd and 3rd grade students in D health college who completed clinical practice in 2008. Sept. were surveyed. The results are as follows. 1. During the clinical practice of the dental hygiene students, the performance experience was highest in the basic prep. part among every part. As for the dental hygiene part, the students showed more than 70%, rather higher performance experience in the following parts: arrangement before and after treatment, suction, basic instruments setup, local anesthesia setup, extraction setup, resin filling setup, temporary filling setup, cements mixing, and ligation and removal setup. 2. As for performance confidence, those with performance experience showed higher performance confidence than those with only observation experience or with no experience in every treatment field except basic prep. (p < 0.001). 3. It was proven that the hygiene students have seldom had performance experience in other treatment parts except in assisting treatment part in clinical practice. In order to improve future performance experience on dental hygiene activities, subsequent research is needed to set more specific and objective criterion about the dental hygiene students' clinical practice.

• Journal of the korean academy of Pediatric Dentistry
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• v.33 no.1
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• pp.53-61
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• 2006

When routine behavior control is impossible, midazolam is often used for sedation, because it has wide margin of safety, relatively few side-effects and multiple route of administration. Although intramuscular administration of all administration route is frequently used, it is a major source of anxiety, discomfort, and trauma in children. To the contrary, oral administration of midazolam is easily administered and accepted by children. But, it's therapeutic drug concentration has not been established. The purpose of this study was to compare sedation effect and physiologic parameter of oral midazolam which palliate demerits of intramuscular administration in sedating young pediatric patients with intramuscular midazolam Twelve negative children, mean age 62.5 months, who needed at least two separate restorative visits, requiring local anesthesia participated in this study On every visit, one of the following 2 different sedative regimen was given : (1) 0.30mg/kg midazolam by intramuscular administration (2) 0.75mg/kg by oral administration. Physiologic parameter(oxygen saturation, heart rate) was recorded by ten procedure and behavior was videotaped and rated using Ohio State University Behavior Rating Scale and Automated Counting System by one investigator, blind to administration route The analyzed sedative effect of oral midazolam resulted in good sedative effect, comparing to intramuscular route, And there is no statistically difference between oral and intramuscular administration of midazolam (p>0.05).

• Journal of the korean academy of Pediatric Dentistry
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• v.39 no.2
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• pp.199-205
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• 2012

Although the stainless steel crowns have been recognized as the most effective and durable form of restoration for primary molars, they have been regarded by many dentists as having definite demerits such as invasive nature of procedural complexity and behavioral aspects of children. As an alternative to conventional technique of stainless steel crown restoration, the Hall technique was first introduced in 1988, which is characterized by just pushing the pre-contoured, cement filled crown form onto the abutment molar with no local anesthesia, no caries removal, no tooth preparation. According to several reports, this can slow, arrest, or even reverse the progress of caries. In addition, its atraumatic feature gives less discomfort and stress to children than conventional one, which is thought excellent especially in younger children. Also, It has been reported to be effective and acceptable to dentist, child patients and their parents. In this case study, three children with age of 4 years 5 months, 4 years 10 months, 6 years 4 months were treated with stainless steel crowns using Hall technique on first primary molar respectively. The teeth were free from pulpal, periapical pathology. After follow up of about 3 to 6 months period, the results showed clinically successful outcomes without any marked complication in pulp, tooth or soft tissue till now. But, it should be kept in mind that this technique is not proper to every child, every carious molar, or every dentist. Thorough distinction of indicated cases and continuous follow-up check is highly required. Conclusively, Hall technique might be an effective and realistic minimally invasive alternative for the carious primary molars especially in younger or disabled children, despite potential doubts on its efficacy and some definite limitations.

• Journal of the korean academy of Pediatric Dentistry
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• v.29 no.3
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• pp.413-417
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• 2002

Mucocele is a mucous retention phenomenon which is caused by a laceration to the duct of minor salivary glands causing extravasation of mucin into the connective tissue forming a cyst-like space. Sialolithiasis of minor salivary glands and chronic obstruction of salivary glands may also cause such a phenomenon. Mucocele is a smooth, rounded sessile mass with diameters varying from 1 to 15mm of sudden appearance. Mucocele tying directly beneath the mucosa may rupture spontaneously and decrease in size, but frequently recurs. Lower lip is most frequently affected, and the mouth floor and buccal vestibule may also be affected. Enucleation of the cyst is needed and removal of minor salivary glands, marsupialization and cryotherapy may also be done. The mucocele frequently recurs after its removal. A 1-year-old female patient visited the hospital with a complaint of a swelling on the lower lip since 4 months before. She had no pain history but 4 months ago, fell and such symptom appeared since then. On her first visit, a bullous solid, opaque lesion of 5mm in diameter was noted. Treatment choice of surgical approach and nonsurgical approach were explained to the guardian. Considering the patient's age, the guardian agreed to a nonsurgical procedure. Treatment was carried out by tieing 3-0 silk to the base of the lesion. One week later, the tie loosened and was re-tied. A week later, the mucocele disappeared. Mucocele on the lower lip may be usually be treated by surgical removal, but this may traumatize the surrounding minor salivary gland causing it to recur. Also, surgicial removal may induce an ischemic change causing sialometaplasia. In case of young patients or children with management problems, non-surgical methods such as this tie method may be used. This tie method does not need any local anesthesia and has no pain, no secondary infection, and low bleeding tendency.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1977.06a
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• pp.9.2-9
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• 1977

A Statistical study was carried out on 64 cases of the foreign bodies in the food and air passages, who visited the Dept. of Otolaryng. of Korea General Hospital from Jan. 1971 to Dec. 1976. The following results were obtained. 1. The total number of foreign bodies were 64 cases, which is approximately 0.69% of the total number of new patients who visited the out patient department during the same period. Among them 55 cases were foreign bodies in the food passage and 9 cases were foreign bodies in the air passage. The ratio between the food and air passages was about 6.1 : 1. 2. The frequently encountered foreign bodies in the esophagus were coin, bone, meat and food particle in order. Bean and peanut were male and 31 case the most frequent foreign bodies in the air passage. 3. In sex distribution, 33 cases were male and 31 cases were female, and the ratio between male was 1.1:1. 4. In the age distribution, 35 cases (54.7%) of all foreign bodies were under 5-year-old, especially coin was 96.2%. 5. The most prevalent site of lodgement in the food passage was the 1st esophageal narrowing, which corresponds to 69.1%. 6. In duration of lodgement, 38 cases (69.1%) of foreign bodies in the food passage were removed within 24 hours, and the longest duration was 90 days. 7. Almost all of the foreign bodies in the food and air passages were removed under local or no anesthesia by esophagoscopy, laryngoscopy.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.6
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• pp.567-571
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• 2008

Purpose: The purpose was to assess the usefulness of midazolam in patients undergoing minor oral surgery under conscious sedation. Materials and methods: Bispectral index was examined in 20 patients receiving oral minor surgery with conscious sedation supplemented with local anesthesia. All patients included were ASA I and had no contraindications to the study medications. The patients were escorted to the day surgery operation room where, before the commencement of the sedation and surgical procedures, routine monitoring was applied, including the noninvasive monitoring of arterial blood pressure, arterial oxygen saturation, and 3-lead electrocardiogram (Electrocardiogram). Bispectral index electrodes were applied on the frontotemporal region after cleansing the skin with alcohol. Bispectral index was calculated with the Electrocardiogram monitor (A-2000; Aspect Co.). Midazolam was then titrated (initially 3mg wait 2min and 2mg). Vital sign and Bispectral index checked every 5 minute until the end of the procedure. The results were then compared. Results: The Bispectral index index values throughout the sedation study period alter many level. The index was dropped at 5 minutes after administration, but raised at injection and odontomy procedure. During the operation, mean Bispectral index index was higher than conscious sedation index range($60{\sim}80$). The amnesic effect was shown 17 cases out of 20 cases(85%). Conclusion: Conscious sedation technique using midazolma is a safe and effective method of controlling behavior in oral and maxillofacial surgery.