1.The Absent Lumbar Articular Process of the 4th Lumbar Vertebra: One Case Report
Chang Uk CHOI ; Yon Il KIM ; Byung Il LEE ; Byung Joon SHIN ; Hong Seop KIM
The Journal of the Korean Orthopaedic Association 1990;25(4):1276-1278
Unilateral absence of the articular process at a lumbar vertebra is a rare anomaly. The etiology of the congenital absence of articular process is not precisely determined yet, but it was explained as some of the possible embryologic bases. Absence of the articular process at the level of L5-Sl have been reported a few, but anomaly above L4 is rare. We are reporting a case of absence of articular process at the level of the 4th lumbar vertebra.
Spine
3.A Study of Abnormal Reflexes in the Cerebral Palsied Patients
Byung Ill LEE ; Jun Seop JAHNG ; Jung Soon SHIN ; Mun Ki HONG
The Journal of the Korean Orthopaedic Association 1979;14(2):249-253
Early diagnosis of persistent abnormal reflexes may be of great significance to a more effective functioning of the cerebral palsied child. It is important to know the normal and abnormal reflex responses and their effect upon motor development for providing a basis for evaluation in the diagnosis and treatment of the cerebral palsied child. We studied 28 cerebral palsied children, between 1 to 12 years old, who were treated at Sam Yook Childrens Rehabilitation Center from May 1975 to December 1977. The pathologic reflexes were checked, and the relationship between pathologic reflexes and walking was compared. The following results were obtained. 1. The following were the most important pathologic reflexes in non-walking fgroup: a. Positive supporting reaction b. Protective extensor thrust c. Moro reflex 2. If they are present, the prognosis for walking ambulation was bad and surgery will not improve for the chances of walking.
Child
;
Diagnosis
;
Early Diagnosis
;
Humans
;
Prognosis
;
Reflex
;
Reflex, Abnormal
;
Reflex, Startle
;
Rehabilitation Centers
;
Walking
4.Ramsay Hunt Syndrome during the Treatment of Zoster Sine Herpete.
Byung Seop SHIN ; Woo Seok SIM ; Yong Chul KIM
Korean Journal of Anesthesiology 2002;42(1):133-135
Ramsay Hunt syndrome (RHS) might cause serious complications, such as facial paralysis and hearing loss if diagnosis and treatments are delayed. Early diagnosis is therefore very important to avoid such serious complications. We report a case of RHS that was occurred during the treatment of postherpetic neuralgia resulted from zoster sine herpete. The patient showed severe segmental intercostal neuralgia at the right 11 and 12th thoracic level. There were no history of the trauma, operation and skin rash and vesicle on the lesion site. Varicellar-zoster virus (VZV) IgG Antibody was positive but VZV IgM antibody was negative. Pain nature was severe sharp, electrical shock like pain, but no paresthesia and dysesthesia was not existed. About two month later, small painful vesicular eruptions were occurred around the ipsilateral auricle. At this time, VZV IgM antibody was positive. Acyclovir, prednisolone, fexofenadine were immediately prescribed. The patient relieved from RHS without any complications. Clinician should be suspect the possibility of zoster sine herpete if the patient showed severe atypical chest wall pain.
Acyclovir
;
Diagnosis
;
Early Diagnosis
;
Exanthema
;
Facial Paralysis
;
Hearing Loss
;
Herpes Zoster Oticus*
;
Herpes Zoster*
;
Humans
;
Immunoglobulin G
;
Immunoglobulin M
;
Neuralgia
;
Neuralgia, Postherpetic
;
Paresthesia
;
Prednisolone
;
Shock
;
Thoracic Wall
;
Zoster Sine Herpete*
5.The Effect of Prior Dural Puncture with a 27G Spinal Needle on Epidural Anesthesia for Cesarean Section.
Duck Hwan CHOI ; Byung Seop SHIN ; Jie Ae KIM
Korean Journal of Anesthesiology 2000;38(1):63-68
BACKGROUND: If started with segmental block, epidural anesthesia appears to have an inadequate sacral block in the early part of cesarean deliveries. A dural puncture using the combined spinal-epidural technique making an early sacral blockade might be a solution. METHODS: A prospective, randomized, double-blinded study was performed on forty patients who were divided into two groups (C, DP; n = 20, each). An epidural infusion of 25 ml of 2% lidocaine with epinephrine was given to the group C. A dural puncture with a 27G Whitacre needle was done before the epidural infusion in the group DP. Two-way sensory levels were checked for 15 min, just before the operation. The side effects and recovery variables were also compared between the groups. RESULTS: Initial wider cephalic block (P = 0.038, 0 min) followed by more caudal block (P = 0.023, 0.013; 5, 10 min after the completion of the epidural infusion, respectively) occurred in the DP group. After 10 min, there were no differences in both block levels. The number of dermatomes blocked was bigger in the DP group at 10 min after. Fewer patients in the DP group had nausea and/or vomiting (P = 0.044). CONCLUSIONS: Early spread of the sensory blockade, initial cephalic and then caudal, was due to the dural puncture by a 27G needle. This fast onset could make the parturients more comfortable in the early part of cesarean sections.
Anesthesia, Epidural*
;
Cesarean Section*
;
Epinephrine
;
Female
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Humans
;
Lidocaine
;
Nausea
;
Needles*
;
Pregnancy
;
Prospective Studies
;
Punctures*
;
Vomiting
6.Clinical Analysis of Deep Vein Thrombosis in Lower Extremity.
Jong Seop YOON ; Byung Ho SON ; Yong Shin KIM
Journal of the Korean Society for Vascular Surgery 1999;15(2):297-306
PURPOSE: The natural history of deep vein thrombosis (DVT) has been of increasing interest since the mid-1960s. Prevention, diagnosis & management of DVT has been continously development. Howerver, Early diagnosis for prevention & effectivly choice of management method of DVT has been difficult problem. METHODS: We reviewed retrospectively 42 patients who were admitted and out patients department follow up to Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, for treatment of DVT from November, 1990 to August, 1998. RESULTS: There was a wide age distribution from teenage to 9th decade, and peak age distribution was 7th decade (23.8%). It occured more old age than younger age. Sex distribution, male to female, was about 1.2 : 1 and occured more male than female. Main chief complaint in pateints with DVT at initial our hospital visit was painful swelling (57.1%), and followed by swelling (33.3%) of lower extremity. Duration of sign and symptom in pateints with DVT at initial our hospital visit was more than 1 month (38.1%), and followed by less than 1 weeks (31.0%). The left side of lower extermities was more frequently involved than that of right side, left to right ratio was 2.1:1. Most location of involved vein of lower extremity was Popliteal vein (71.4%), and followed by Superficial femoral vein (55.4%), Calf vein (44.6%), and Common femoral vein (39.4%) in ration of 56 limbs. More frequent risk factor of DVT was major surgery (28.6%), and followed by immobility (16.7%). but most frequent risk factor was idiopathic (31.0%). Diagnosis of DVT was made with color doppler (90.5%) and venogram (57.1%). Treatment was done with intravenous or oral anticoagulants in most pateints (90.5%), Forgarty thrombectomy (7.1%), and Bypass and A.-V. fistula (2.4%) and followed by only or combined oral anticoagulants theraphy. Treatment of DVT was wide duration from less than 3 month to more than 1 years. It was done for less than 3 month (52.4%), and followed by 6 to 12 month (19.0%), 3 to 6 month (14.3%) and 14.3% were continued more than 1 years. During oral anticoagulant theraphy, GOT/GPT elevation was observed in 26.2%, and 23.8% was detected bleeding tendency (hematuria). Post-treatment response of DVT was divided three group, good (31.0%), moderated (42.9%), no response group (26.3%) in pateint complaint of before or after treatment. Most pateint were improved in 3 month. CONCLUSION: We have been thick that DVT in the lower extremity must done early diagnosis and choiced more massively intensively method of treatment and with only or combined oral anticoagulant therapy after operation was prevented for reccured and serious complication.
Age Distribution
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Anticoagulants
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Diagnosis
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Early Diagnosis
;
Extremities
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Female
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Femoral Vein
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Fistula
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Follow-Up Studies
;
Hemorrhage
;
Humans
;
Lower Extremity*
;
Male
;
Natural History
;
Outpatients
;
Popliteal Vein
;
Retrospective Studies
;
Risk Factors
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Sex Distribution
;
Thrombectomy
;
Veins
;
Venous Thrombosis*
7.Comparison of cardiopulmonary hemodynamic changes according to different ethanol bolus injection doses in piglets: the applicability of the study of ethanol injection effects on cardiopulmonary hemodynamic changes in sclerotherapy of congenital arterioven.
Byung Seop SHIN ; Byung Dal LEE ; Tae Soo HAHM ; Chung Su KIM
Korean Journal of Anesthesiology 2008;55(2):204-209
BACKGROUND: Ethanol injection during a sclerotherapy for the treatment of arteriovenous malformation, which performed under general anesthesia, can cause significant hemodynamic changes, even cardiovascular collapse. However, guideline for adequate management of hemodynamic change or preventing detrimental complication has still not been proposed. METHODS: Twenty-two piglets were randomly allocated to one of two groups: a 2.5 ml and a 4.0 ml ethanol. After baseline hemodynamic measurements, 2.5 ml or 4.0 ml of absolute ethanol was repeatedly administered in distal portion of renal vein with 10 minute intervals, and hemodynamic parameters were measured immediately before and after bolus injection of absolute ethanol until 10 minutes after final injection. RESULTS: Compared with 2.5 ml group, systolic, mean and diastolic pulmonary arterial pressures (PAP) and pulmonary vascular resistance (PVR) of 4.0 ml group showed significant differences from the first bolus injection of absolute ethanol. Hemodynamic parameters of 2.5 ml group did not show the increasing or decreasing tendency during a session, whereas, in 4.0 ml group, systolic, mean and diastolic PAP and PVR showed significantly increasing tendency. However, systemic arterial blood pressure, heart rate, central venous pressure, pulmonary capillary wedge pressure, cardiac output, and systemic vascular resistance did not show increasing or decreasing tendency in both groups. CONCLUSIONS: Based on the hemodynamic alterations observed from piglet model, the bolus injection of absolute ethanol during sclerotherapy in congenital arteriovenous malformation requires careful hemodynamic monitoring. We strongly recommend that anesthesiologist should carefully monitor the hemodynamic parameters after injection of relatively large amount of absolute ethanol.
Anesthesia, General
;
Arterial Pressure
;
Arteriovenous Malformations
;
Cardiac Output
;
Central Venous Pressure
;
Ethanol
;
Heart Rate
;
Hemodynamics
;
Organothiophosphorus Compounds
;
Pulmonary Wedge Pressure
;
Renal Veins
;
Sclerotherapy
;
Vascular Resistance
8.A Case of Bilateral Macronodular Adrenocortical Hyperplasia
Yoon Sang CHOI ; Soo Mi KIM ; Shin Gon KIM ; Ie Byung PARK ; Sei Hyun BAIK ; Dong Seop CHOI ; Seung Woon RHA ; Dong Hyun SHIN
Journal of Korean Society of Endocrinology 1996;11(4):523-530
Cushing's syndrome associated with nodular adrenal glands will be divided into four main categories: adrenal adenoma, adrenal carcinoma, primary pigmented nodular adrenal dysplasia (PPNAD) and macronodular adrenal hyperplasia(MAH). The term macronodular adrenal hyperplasia is restricted to the presence of multiple nodules visible to the naked eye, ranging in size from 0.5 to 7.0 cm. We report a case of Cushings syndrome caused by bilateral macronodular adrenal hyperplasia (MAH). A 45-year-old man presented with Cushingoid features, hypertension and diabetes mellitus. Urine free cortisol was 449.9 mmol/day(27-276) and were not suppressed after administration of low-dose and high-dose dexamethasone. Plasma ACTH was very low(1.87 pmol/L(18)) and was not stimulated by administration of ovine CRH. In abdominal CT, both adrenal glands were markedly enlarged and nodular in appearance. Pituitary MRI showed no abnormal finding. Bilateral adrenalectomy was done. Histologic examination revealed multiple nodules and internodular hyperplasia. This case and other reports suggested that because of variable biochemical, radiologic and pathologic findings, macronodular adrenal hyperplasia represents a heterogeneous group of patients with varying degrees of adrenal autonomy.
Adenoma
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Adrenal Glands
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Adrenalectomy
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Adrenocorticotropic Hormone
;
Cushing Syndrome
;
Dexamethasone
;
Diabetes Mellitus
;
Humans
;
Hydrocortisone
;
Hyperplasia
;
Hypertension
;
Magnetic Resonance Imaging
;
Middle Aged
;
Plasma
;
Tomography, X-Ray Computed
9.Camprison of Diagnostic and Therapeutic scans in Patients with Differentiated Thyroid Cancer
Yoon Sang CHOI ; Soo Mi KIM ; Shin Gon KIM ; Don Hyun SHIN ; Ie Byung PARK ; Sei Hyun BAIK ; Dong Seop CHOI ; Jae Myung YU
Journal of Korean Society of Endocrinology 1996;11(4):431-437
Background: Whole body scan using 131-iodine is performed to detect local recurrence or metastasis after thyroidectorny in differenciated thyroid cancer patients. The sensitivity of this procedure is related to the dose of radiopharmaceutical administered. It was reported that 131I posttreatment whole body scan demonstrate foci of tracer uptake not previously observed in diagnostic scan in 10~30% of cases. Posttreatment scans were most likely to reveal new foci in young patients(<45) and patients who had previously received radioactive iodine therapy. Method: We observed the frequency of discordant posttreatment scans and analysed the clicnical significance in 33 differenciated thyroid cancer patients who were admitted for radioiodine ablation from June, 1995 to April, 1996. Results: In 7 cases(21.2%), post treatment scan demonstrated cme or more foci of uptake and revealed less sites of uptake than diagnostic scan in 3 cases(9.1%). In one case with elevated thyroglobulin level and negative diagnostic scan, post treatment scan revealed new uptake sites with thyroid bed and cervical 1ymph node. The sites of discordant uptake were cervical lymph nodes in 4 cases and rnediastinal lymph node in one case, lung in one case, thyroid bed and cervical lymph nodes in one case, 3 cases of 7 pts(43%), demonstrated ane or more foci of uptake in post treatment scan, had history of previous radioiodine treatent. Conclusion: Post treatment scan confirmed uptake into remnant and metaststic tissues identified on the corresponding low dose diagnostic scans. Scanning after high dose radioiodine treatment frequently demonstrated one or more foci of uptake, especially in patients with previous radioiodine treatment, which were not visualized on the diagnostic low dose scan. Treatment scan may be useful for detection of remnant tissue or metastatic lesion in patients with elevated thyroglobulin and negative diagnostic scan.
Humans
;
Iodine
;
Lung
;
Lymph Nodes
;
Methods
;
Neoplasm Metastasis
;
Recurrence
;
Thyroglobulin
;
Thyroid Gland
;
Thyroid Neoplasms
;
Whole Body Imaging
10.The Comparison of Coagulation Status in the Cadaveric Donor and Living-Related Liver Transplantation.
Byung Seop SHIN ; Im Hyoung HA ; Gaab Soo KIM ; Mi Sook GWAK ; Ik Soo CHUNG
Korean Journal of Anesthesiology 2002;43(1):49-57
BACKGROUND: Orthotopic liver transplantation is widely regarded as the only effective treatment for many acute or chronic end-stage liver diseases. However, the shortage of cadaveric organs is one of the most crucial limitations to the liver transplantation. Recently, in our hospital, living-related liver transplantation (LR LT) cases have remarkably increased during the last two years. Because there are differences in the surgical procedure and graft volume between the cadaveric donor liver transplantation (Cd LT) and LRLT, the intraoperative coagulation status may be different, too. With the knowledge of coagulation status, the anesthetic mangement of liver transplantation will be improved. METHODS: A retrospective evaluation was performed on 36 patients, who underwent an orthotopic liver transplantation between October 1999 and April 2001. Seventeen patients received a Cd LT and 19 patients underwent a LRLT. We compared the two groups in the aspects of coagulation related parameters; 1) ischemic time, 2) venovenous bypass (VVB) flow, 3) the percentages of occurrence of postreperfusion syndrome (PRS), 4) the ratio of activated clotting time (ACT) exceeding 200 seconds after reperfusion, 5) the ratio of hyperfibrinolysis, LY60 > 20%, on a thromboelastograph (TEG) after reperfusion, and 6) the amounts of transfusion and fluid administration before and after reperfusion. RESULTS: The ischemic time was shorter in the LR LT group than the Cd LT group (115.4 +/- 25.4 min versus 409.2 +/- 115.6 min). The VVB flow was greater in the Cd LT group than the LR LT group. The ratio of occurrence of PRS was also lower in the LR LT group (11%) than the Cd LT group (53%). The percentage of ACT exceeding 200 seconds after reperfusion was only 11% in the LR LT group, but 59% in the Cd LT group. The percentages of LY 60 > 20% on the TEG after reperfusion were not statistically different in each group, but the percentage of tranexamic acid administration due to persistent, severe hyperfibrinolysis was higher in the Cd LT group than the LR LT group. The amounts of transfusion and fluid administration were significantly smaller in the LR LT group compared to those in the Cd LT group. CONCLUSIONS: We found that there were many differences in the coagulation status between the Cd LT and the LR LT groups. Therefore, anesthesiologists should consider these differences and manage each case of liver transplantation properly.
Cadaver*
;
Humans
;
Liver Diseases
;
Liver Transplantation*
;
Liver*
;
Reperfusion
;
Retrospective Studies
;
Tissue Donors*
;
Tranexamic Acid
;
Transplants