• Journal of Korean Academy of Nursing
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• v.38 no.5
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• pp.720-729
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• 2008

Purpose: This study investigated the preemptive analgesic effects of Morphine and Ketorolac on postoperative pain, cortisol, $O_2$ saturation and heart rate for the first 24 hr after abdominal surgery. Methods: Data collection was performed from April 1 to September 30, 2006. Forty patients undergoing a gastrectomy under general anesthesia were randomly allocated to the experimental or control group. The experimental group (20 patients) was administered Morphine and Ketorolac approximately 1 hr prior to skin incision, but the control group (20 patients) was administered Morphine and Ketorolac at peritoneum closure through a patient-controlled analgesia (PCA) pump. Postoperative pain, blood pressure, heart rate, cortisol, $O_2$ saturation, frequency of the PCA button pressed and doses of additional analgesics were observed through post operative 24 hr. Collected data was analyzed using t-test, $X^2$ test, repeated measures ANOVA, and Bonferroni methods. Results: Postoperative pain, cortisol, the frequency of PCA button pressed, and dose of additional analgesics of the experimental group were significantly lower than the control group. There were no statistical differences in blood pressure, heart rate and $O_2$ saturation between the experimental group and control group. Conclusions: We concluded that administration of morphine and ketorolac at 1 hr prior to skin incision resulted in decreasing postoperative pain, but it didn't affect blood pressure, heart rate or $O_2$ saturation for 24 hr after abdominal surgery.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.11
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• pp.5735-5739
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• 2012

Background: Malignant mesothelioma (MM) is an insidious tumor with poor prognosis, arising from mesothelial surfaces such as pleura, peritoneum and pericardium. We here aimed to evaluate the demographic, clinical, and radiological features of patients with MM followed in our center as well as their survival. Methods: The study included 228 patients (131 male, 97 female) who were followed up in our institution between 1993 and 2010 with the diagnosis of MM. Results: The mean age was 59.1 years in men and 58.7 years in women and the sex ratio was 1.4:1 in favor of males. Environmental asbestos exposure was present in 86% of the patients for a mean duration of $40{\pm}20$ years (range: 3-70). Pleural effusion and thoracic/abdominal pain were the most common presenting signs and symptoms (70.2% and 57.8%, respectively). One hundred-thirteen (66%) patients were treated with platinum-based combination chemotherapy (PBCT) plus supportive care (SC) and 67 (34%) patients received SC alone. The median follow-up time was 10.0 months. The median overall survival was significantly improved with PBCT plus SC compared to SC alone (11.4 vs. 5.1 months; p=0.005). The 6, 12, 18, and 24-month survival rates were significantly improved with PBCT plus SC compared to SC alone (72%, 43%, 19%, and 2% vs. 49%, 31%, 11%, and 1%). Conclusion: The survival of patients with MM improved in patients treated with PBCT. The survival advantage continued 12- and 24-month after the initial time of combination chemotherapy.

• Physical Therapy Rehabilitation Science
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• v.7 no.3
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• pp.95-101
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• 2018

Objective: To determine if the provision of visual biofeedback using real-time rehabilitative ultrasound imaging (RUSI) enhances the acquisition and retention of diaphragm muscle recruitment during exercise. Design: Two group pretest posttest design. Methods: Thirty healthy subjects were randomly assigned to the verbal feedback group (VG, n=15) or the visual and verbal feedback group (VVG, n=15). The VG performed breathing exercises 10 times with verbal feedback, and the VVG also performed breathing exercises 10 times with verbal feedback and visual feedback with the use of RUSI to measure changes in diaphragm thickness (DT). For DT, the mid-axillary lines between ribs 8 and 9 on both sides were measured in standing, and then the chest wall was perpendicularly illuminated using a linear transducer with the patients in supine to observe the region between rib 8 and 9 and to obtain 2-dimensional images. DT was measured as the distance between the two parallel lines that appeared bright in the middle of the pleura and the peritoneum. After one week, three repetitions (follow-up session) were performed to confirm retention effects. Intra- and between- group percent changes in diaphragm muscle thickness were assessed. Results: In the VVG, the intervention value had a medium effect size compared to the baseline value, but the follow-up value decreased to a small effect size. In the between-group comparisons, during the intervention session, the VVG showed no significant effect on percent change of DT but had a medium effect size compared to the VG (p=0.050, Cohen's d=0.764). During the follow-up session, retention effect did not persist (p=0.311, Cohen's d=0.381). Conclusions: RUSI can be used to provide visual biofeedback and improve performance and retention in the ability to activate the diaphragm muscle in healthy subjects. Future research needs to establish a protocol for respiratory intervention to maintain the effect of diaphragmatic breathing training using RUSI with visual feedback.

• Archives of Reconstructive Microsurgery
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• v.21 no.1
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• pp.8-13
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• 2012

Purpose: Purpose: The free deep inferior epigastric artery perforator (DIEP) flap is a popular option for autologous breast reconstruction. However, the anatomy of the deep inferior epigastric artery(DIEA) may vary from one individual to another. Unexpected vascular anomaly can confuse the surgeon and affects on the safety of the free DIEP flap. Materials and Methods: Thirty five consecutive patients who underwent free DIEP/TRAM flap for immediate breast reconstruction between Mar. 2010 and Oct. 2010 were enrolled in this study. Computed tomography angiography (CT angiography) of abdomen was evaluated part of our standard preoperative assessment: atypical patterns of DIEA/DIEP were evaluated by preoperative CT angiography and compared with intraoperative finding. Results: Atypical patterns of DIEA/DIEP which may affect preoperative planning were noted as the following: Circummusclar/subfascial DIEA (n=1), DIEA running underneath rectus muscle (n=8), septocutaneous perforator (n=3), peritoneo-cutaneous perforator (n=1), a large branch going into peritoneum (n=1), and very early division and muscle penetration of DIEA (n=1). Conclusion: Atypical DIEA/DIEP that might change the operation plan is not rare, so the individualized planning based on the preoperative CT angiography is recommended. Preoperative CT angiography could help to select reliable and easy-to-dissect perforator in free DIEP/TRAM breast reconstruction.

• The Journal of Internal Korean Medicine
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• v.26 no.4
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• pp.767-775
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• 2005

This study was carried out to investigate the preventive effect of Salviae Miltiorrhizae Radix, Rhei Rhizoma and Carthami Flos combined with Samgijiwhang-Tang(SJTSRC) on streptozotocin(STZ)-induced diabetic nephropathy. Rats were divided into a control group of rats with STZ-induced diabetic nephropathy, a sample group of those given SJTSRC, and a normal group. In the experiment diabetic nephropathy was induced by giving STZ(60mg/kg) to rats via the peritoneum, and effects were assessed with measures of serum creatinine, serum BUN, secretion content of albumin and glucose content of urine, malondialdehyde(MDA) and glutathione(GSH) content in cortex of kidney. When STZ was injected into sample rat, the value of creatinine and BUN increased validly and STZ did damage to the kidney. When applying SJTSRC to sample rats, the value of serum creatinine decreased validly but the value of serum BUN decreased invalidity. It was confirmed that SJTSRC had an effect on recovery after kidney damage and secretion content of albumin increasedafter administration of SJTSRC but there was no change in glucose content of urine compared with the control group. The decrease of secretion of albumin after injection of STZ was taken to mean progressive diabetic nephropathy, and that reversal of that trend after SJTSRC administration showed that kidney function had improved, not through decreasing blood sugar, but through other factors. Results suggest that diabetic nephropathy was induced by STZ, and SJTSRC was effective in restricting the extent of damage to the kidney and halting the progression of diabetic nephropathy with improvement in levels of serum creatinine and albumin secretion. More study is needed, particularity pertaining to anti-oxidative effects in the kidney cortex.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.1
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• pp.57-63
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• 2009

Calcifying fibrous tumors (CFTs) are unusual benign tumors of childhood, located primarily in soft tissues, pleura, and peritoneum. The cause and pathogenesis are unclear. We report a rare case of a CFT in a 2-year-old boy who presented with vomiting and abdominal distension. An abdominal X-ray showed an elliptical, calcific shadow in the LUQ area mimicking a foreign body. An internally protruding mass along the lesser curvature of the gastric body was an incidental finding during upper endoscopy, biopsies of which were negative. Abdominal CT showed a 4.5${\times}$3.2 cm soft tissue mass of the gastric wall with calcifications. A diagnosis of gastric submucosal mass was suspected and a wedge resection of the stomach was performed. On microscopic examination, the tumor was composed of whorls of dense hyalinized collagen bundles with a few fibroblasts. There were also amorphous dystrophic calcifications and nodular aggregates of mononuclear inflammatory cells. Immunohistochemically, spindle cells did not stain for anaplastic lymphoma kinase-1 (ALK-1), CK, smooth muscle actin (SMA), or desmin. Taken together, the mass was compatible with a CFT of the gastric wall. This is the first reported case of CFT in a Korean child.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.385-389
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• 1996

Background: Nowadays, epidural morphine is commonly used in postoperative pain control. But epidural morphine may produce some side-effects, e.g. pruritus, nausea, vomiting, urinary retention and respiratory depression. Especially, pruritus is the most common complaint in pain-controlled patients by epidural morphine. So we evaluated whether addition of epidural butorphanol affects the degree of pruritus and pain score in pain controlled patients who by epidural morphine after hysterectomy. Methods: Group 1(N=15) received postoperative epidural 0.1% bupivacaine 100ml plus morphine 10 mg, group 2(N=15) received the mixture of butorphanol 2 mg with same regime as in group 1, group 3(N=15) received the mixture of butorphanol 4 mg with same regime as in group 1. All of the three groups received these solutions by infusion pump, 1 ml/hour, for postoperative 4 days. all groups received additional morphine 1.2 mg in 0.2% bupivacaine 6ml epidurally when the peritoneum was closed under general anesthesia. The severity of pain, pruritus, nausea and vomiting was estimated by 10 cm VAS(visual analogue scale) and somnolence by positive or negative during postoperative 4 days. Results: Severity of pruritus, but not nausea and vomiting was decreased in group 2 and 3 compared with group 1(p<0.05). Pain score was increased in group 3 at postoperative day(POD) 0 and 2 compared with group 1(p<0.05). Incidence of somnolence in group 1, 2 and 3 were $2.7{\pm}0.7,\;5.3{\pm}0.7$ and $10.0{\pm}1.0$ respectively. Conclusion: These results suggest that butorphanol reduce the degree of pruritus, the most common side effect of morphine, but increase the incidence of somnolence.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.38-43
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• 2000

Background: Preemptive analgesia may decrease postoperative pain by preventing nociceptive inputs generated during surgery. The preemptive effect of intravenous nalbuphine was examined in gynecological surgery. Methods: Forty female patients scheduled for gynecological surgery were randomly allocated into two groups. Each patient received 10 mg of intravenous nalbuphine as a bolus dose at the closure of peritoneum in group I (n=20) and before the skin incision in group II (n=20). After the bolus dose, the intravenous patient controlled analgesia (IV-PCA) which contained 50 mg of nalbuphine, 120 mg of ketorolac, 0.25 mg of droperidol and 90 ml of 5% dextrose water was given continuously at the rate of 2 ml/min. The postoperative visual analogue scale pain score (VAS), the total amount of the analgesics used, the degree of satisfaction of the patients and the developement of side effects were examined for 2 days. Results: VAS were significantly lower in group II than in group I after 9 and 12 hours. The cumulative consumption of analgesics in group II was significantly less than in group I. Most patients were satisfied with this regimen. There were no remarkable side effects. Conclusions: Preemptive analgesia with intravenous nalbuphine decreased postoperative pain and analgesic requirement. The analgesic effect of IV-PCA with nalbuphine-ketorolac was effective in control of postoperative pain in gynecologic surgery.

• Journal of Preventive Medicine and Public Health
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• v.23 no.1 s.29
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• pp.77-86
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• 1990

Between 1977 and 1987, 20 patients with mesothelioma were treated at Severance Hospital. Data was gathered from medical charts at the time of hospitalization of mesothelioma patients and from a follow-up questionnaire by mail or telephone. The results acquired were as follows : 1. Among the 20 patients, 11 men and 9 women with mesothelioma were identified. The mean age at hospitalization was 47 years and 11 mesothelioma patients were known or presumed to be dead during the different observation periods. 2. Only one mesothelioma patient had a definite history of occupational asbestos exposure. 3. The sites of origin of mesothelioma were the pleura(13), peritoneum(2), pericardium(2), mediastinum (2), and pelvis(1). Common symptoms included dyspnea, chest pain, abdominal distension, etc. 4. Pathologically, mesotheliomas were divided into 14 malignant types and 6 benign types ; and histologically, 8 fibrous mesotheliomas and 3 epithelial mesotheliomas were shown. 5. There was a statistically significant difference in survival rate according to pathologic type and smoking status. In the groups with malignant mesothelioma, 50% survival time from first symptoms was 18 months and that from diagnosis was 11 months. Also, 75% survival time from diagnosis was 6 months in the smoking groups and 19 months in the non-smoking groups.

• Journal of Trauma and Injury
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• v.24 no.1
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• pp.56-59
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• 2011

Abdominal compartment syndrome (ACS) is a life-threatening disorder caused by rapidly increasing intra-abdominal pressure. ACS can result in multiorgan failure and carries a mortality of 60~70%. The treatment of choice in ACS is surgical decompression. There are very few reports of ACS and experience in Korea. We report 12-year-old male patient who developed an abdominal compartment syndrome due to traffic-accident-induced retroperitoneal hematomas, Which was successfully treated by performing a bedside emergency surgical decompression with open linea alba fasciotomy with intact peritoneum. When patients do not respond to medical therapy, a decompressive laparotomy is the last surgical resort. In patients with severe abdominal compartment syndrome, the use of a linea alba fasciotomy is an effective intervention to lower intra-abdominal hypertension (IAH) without the morbidity of a laparotomy. Use of a linea alba fasciotomy as a first-line intervention before committing to full abdominal decompression in patients with abdominal compartment syndrome improves physiological variables without mortality. Consideration for a linea alba fasciotomy as a bridge before full abdominal decompression needs further evaluation in patients with polytrauma abdominal compartment syndrome.