Introduction: Giving two intravenous anaesthetic agents simultaneously generally results in an additive effect. The aim of this study was to investigate the interaction between propofoland thiopental when given to patients who have had sedative premedication. Methods: Fifty patients were admitted into the study. All patients received oral midazolam 3.75mg and intravenous fentanyl 100mg before induction of anaesthesia. Twenty patients received an infusion of their propofol or thiopental while 30 patients received an infusion of an admixture of both drugs. Results: The interaction between propofol and thiopental was additive. The average dose at loss of the eyelash reflex for propofol and thiopental was 0.71mg kg-1 and 1.54mg kg-1 respectively. Premedication decreased the induction dose by 38.2%. Conclusion: Propofol and thiopental interact in an additive fashion when given at induction of anaesthesia

Introduction: The aims of this randomised study were to compare the induction characteristics of sevoflurane using vital capacity breath technique to that of tidal breathingtechnique in adults undergoing day-care surgery., and to compare patients' acceptance of these two techniques. Methods: Sixty ASA I and II adult patients undergoing day-care surgery were randomly allocated to receive either the vital capacity breath or tidal breathing technique for induction of anaesthesia with 7.5% sevoflurane in nitrous oxide and oxygen. Haemodynamic changes, induction characteristics and patients' acceptance were compared. Results: The mean time for induction was significantly faster with the vital capacity breath technique. There were no significant differences in haemodynamic changes and oxygenation during induction between these two groups. There was a significant increase in incidence of exictatory movement in patients receiving the tidal breathing technique. Either technique was found to be acceptable by most of the patients studied. Conclusion: The vital capacity breath technique appears to be better tolerated with shorter onset time and less movement during induction of anaesthesia. As it is well accepted by the patients and has a stable haemodynamic profile, its use should be encouraged.

Polycstic kidney was rare problem of pediatric disease category. We have experienced one case of polycstic kidney(Potter type I) with pulmonary hypoplasia who born after 35 weeks of gestation to a 34 year-old mother. The clinical course of this infant was characterized by respiratory difficulty with apnea, cyanosis and marked abdominal distension. Chest X-Ray film showed no airation in the both lung fields. He died from respiratory failure due to pulmonary hypoplasia, 3 hrs after birth. We tried discussion about polycstic kidney with literature review.
Adult ; Apnea ; Cyanosis ; Humans ; Infant ; Infant, Newborn* ; Kidney ; Lung ; Mothers ; Parturition ; Polycystic Kidney Diseases* ; Pregnancy ; Respiratory Insufficiency ; Thorax ; X-Ray Film

No abstract available.
Cryptorchidism* ; Humans ; Infant* ; Male

PURPOSE: The cost and effectiveness of extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PNL), and combined therapy in the treatment of renal calculi larger than 2cm were examined. MATERIALS AND METHODS: A total of 122 patients with renal calculi larger than 2cm, including twenty three cases of staghorn calculi, were divided into two groups, the ESWL group (97 cases) and the PNL group (25 cases), according to the first line of treatment modalities. Each group was divided into two sub-groups according to the need for additional procedures. The stone free rate and duration of treatment of each group were examined. The costs were calculated per patient and based on the cumulative charge of the procedures, which included cost for in-patient care, and treatment of additional procedures and treated complications. RESULTS: In the ESWL group, eighty cases were treated with ESWL only and had a 69% stone free rate. Seventeen cases needed additional procedures including percutaneous nephrostomy, or ureteroscopic procedures, and had a stone free rate of only 41%. In the PNL group, six cases became stone free with PNL only. Nineteen cases required ESWL for residual fragments after PNL, and had a 90% stone free rate. The cumulative average cost per group was as follows: ESWL only, 1,593,260 won; ESWL with additional procedures, 2,130,475 won; PNL only, 1,654,760 won; and PNL with ESWL, 1,973,270 won. The average duration of treatment per group was 47, 112, 5.3 and 8.8 days, respectively. CONCLUSIONS: PNL followed by ESWL, if necessary, is considered the most cost effective method of treating large renal calculi.
Calculi ; Humans ; Kidney Calculi* ; Lithotripsy ; Nephrostomy, Percutaneous ; Shock

To evaluate the sensitivity and specificity of transthoracic fine needle aspiration cytology(TFNAC) in the preoperative diagnosis of pulmonary nodules, a retrospective analysis was carried out on a consecutive series of 200 TFNACs. They included 186 primary malignant tumors, 66 squamous cell carcinomas, 65 adenocarcinomas, 36 small cell carcinomas, 7 large cell carcinomas, 4 carcinoids, 8 others, 9 metastatic tumors, and 5 benign tumors. On cytohistologic correlation of malignant pulmonary tumors, the pro- cedure had a sensitivity of 97.3% and a specificity of 100%. A 86.6% correct correlation between the cytologic and histologic diagnoses was achieved. Five out of the 7 undifferentiated large cell carcinomas, 10 out of the 65 adenocarcinomas, 2 out of the 36 small cell carcinomas, and 2 out of the 66 squamous cell carcinomas were turned out to be mistyped in cytologic diagnosis. We concluded that TFNAC is a highly sensitive and specific preoperative diagnostic procedure in the investigation of patients with discrete pulmonary nodules in whom the specific cell type of the malignant neoplasm has important implications in treatment modality and prognosis.
Adenocarcinoma ; Bezafibrate ; Biopsy, Fine-Needle ; Carcinoid Tumor ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Endometrial Neoplasms ; Female ; Humans ; Hydronephrosis* ; Kidney* ; Natural History* ; Papanicolaou Test ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity

Wilms' tumor is the most common renal malignancy in childhood. However Wilms' tumor originating in horseshoe kidney is rare. We present a case of Wilms' tumor arising from the isthmus of horseshoe kidney, and aim to highlight the problems faced in the diagnosis and management.
Diagnosis ; Kidney* ; Wilms Tumor*

Amiodarone is a di-iodated benzofuran derivative that is commonly used to treat patients with various cardiac arrhythmias. It is associated with side effects that involve the liver, thyroid, and other organs. Approximately 1-3% of patients treated with amiodarone suffer from symptomatic liver disease. Thyroid dysfunction occurs in 10% of patients treated with amiodarone. A 65-year-old woman with coronary heart disease and atrial fibrillation was administered with amiodarone. She developed nausea, vomiting, dyspepsia, and sweating within 9 months of amiodarone administration (200 mg orally once a day). Results of the laboratory finding showed increased hepatic enzymes, and low thyroid hormone levels. A liver biopsy showed irregular arrangement of hepatocytes and diffuse micro- and macrovesicular fatty changes. Electron microscopy findings showed pleomorphic mitochondria with crystalloid inclusions and membrane-bound lysosomal structures. The liver and thyroid functions returned to normal, after the amiodarone was stopped. We describe an unusual case in which amiodarone induced hepatitis and hypothyroidism simultaneously. Physicians should take a close look to the adverse event when using amiodarone which can cause adverse effects in multiple organs.
Aged ; Amiodarone/*adverse effects/therapeutic use ; Arrhythmias, Cardiac/drug therapy ; Drug-Induced Liver Injury/*complications/pathology/*radiography ; Female ; Fibrosis/pathology ; Humans ; Hypothyroidism/*chemically induced/*complications ; Microscopy, Electron ; Mitochondria/drug effects/metabolism ; Tomography, X-Ray Computed ; Treatment Outcome

INTRODUCTION: Cast immobilisation remains the mainstay of treatment for various fractures in paediatric patients, yet patients commonly complain of skin irritation and discomfort. This study aimed to perform a qualitative and quantitative evaluation of the effects of cast immobilisation on the skin of children and adolescents. MATERIALS AND METHODS: Patients aged 6-17 years of age with a fracture treated in a fiberglass short-arm or short-leg cast were recruited. Transepidermal water loss (TEWL), stratum corneum (SC) hydration, hair density and presence of any skin signs were assessed before and after cast. Patients were required to complete a weekly questionnaire to rate itch, malodour, warmth, and dampness of the skin under the cast. RESULTS: A total of 60 subjects completed the study. Thirty-six patients received a short-arm cast; 24 received a short-leg cast. Upon cast removal, TEWL was significantly increased on the volar surface of the arms and legs ( <0.05), and the dorsal surface of the arm ( <0.05). Likewise, SC hydration was significantly increased at most sites ( <0.05), except the volar surface of the leg ( = 0.513). There was no change in hair density. Throughout the duration of casting, there was an increase in itch and malodour scores. CONCLUSION Moderate but significant changes in TEWL, SC hydration and subjective symptoms were observed during the duration of cast immobilisation, demonstrating that cast immobilisation for up to 4 weeks exerts moderate adverse impact on patients' skin. Further studies to explore the use of better materials for cast immobilisation to improve skin barrier function and overall patient satisfaction are warranted.

Isaacs' syndrome consists of spontaneously occurring muscle activity of peripheral nerve origins. This syndrome arises in association with/without polyneuropathy and rarely with malignancy. A 63-year-old man was admitted to our hospital due to generalized painful muscle stiffness. He complained of difficulty with standing and with finger exten-sion after grasping. Chvostek's and Trousseau's signs were noticed. Electrolytes, calcium, CK, and LDH were in the normal range. Small cell lung cancer was diagnosed by a needle biopsy. Electrophysiological testing revealed normal nerve conduction studies with the exception of a grossly abnormal EMG. Continuous neuromyotonic discharges with firing rates of 120-200 Hz were seen at rest. The amplitude of the response typically waned with 0.5-1.5 seconds of duration. The discharges persisted throughout sleep, after diazepam injection, and with brachial plexus blockage.Muscle stiffness improved with the administration of oral phenytoin. Under chemotherapy and radiotherapy, tumor remission was partially achieved and neurological symptoms markedly improved.
Biopsy, Needle ; Brachial Plexus ; Calcium ; Diazepam ; Drug Therapy ; Electrolytes ; Fingers ; Fires ; Hand Strength ; Humans ; Isaacs Syndrome* ; Middle Aged ; Neural Conduction ; Peripheral Nerves ; Phenytoin ; Polyneuropathies ; Radiotherapy ; Reference Values ; Small Cell Lung Carcinoma*