Neurofibromatosis is an autosomal dominant abnormality that may affect multiple organ systems. The eyelids, the orbits, the adjacent tissues and bones may be involved with varying frequency and severity. The management of orbitotemporal neurofibromatosis depends very much on the type and severity of the orbital involvement and on the functional state of the eye. Experience with surgical management of orbitotemporal neurofibromatosis involved in the orbit, the temporal soft tissue and bone with blind eye is reported. The goal of surgery is tumor resection, reconstruction of the orbital socket, aesthetic eyelids, and insertion of the artificial prosthesis. A two stage approach is recommended. In the first stage, tumor is resected and the orbital socket is reconstructed with titanium mesh plate and cranial bone graft. After reconstruction of the orbital socket, galeal flap is rotated posteriorly to cover the mesh plate and canthopexy is accomplished. Mask lift is performed to enhance aesthetics. In the second stage, correction of the bulky eyelids is achieved and orbital space for insertion of the artificial prosthesis is reconstructed. Authors have managed a orbitotemporal neurofibromatosis with blind eye of a 41-year-old male using titanium mesh plate and bone graft with satisfactory results.
Adult ; Esthetics ; Eyelids ; Humans ; Male ; Masks ; Neurofibromatoses* ; Neurofibromatosis 1 ; Orbit ; Prostheses and Implants ; Titanium ; Transplants

No abstract available.

A 23-month-old male patient with treated bronchitis underwent a surgery for the repair of bilateral Hutch's diverticulum of bladder under general anesthesia. He treated bronchitis during 2 weeks since 3 weeks before operation. Arriving operating room, he had mild coughing with sputum. During anesthesia, he was well ventilated but endotracheal secretion was profuse. At ABGA of 2 hours after starting anesthesia, severe hypercapnea(PaCO2: 190.2 mmHg) and severe acidosis(PH: 6.746) were checked. Active treatment was done by suction of endotracheal secretion, hyperventilation, PEEP(5~10 cmH2O), increasing fresh gas flow rate(3.6 L/min --> 7 L/min), and administration of sodium bicarbonate, orciprenaline sulfate and methyl- prednisolone. After 3 hours of treatment, ABGA was normalized and symptoms including wheezing were relieved.
Anesthesia ; Anesthesia, General ; Bronchitis* ; Child* ; Cough ; Diverticulum* ; Humans ; Hypercapnia* ; Hyperventilation ; Infant ; Male ; Metaproterenol ; Operating Rooms ; Prednisolone ; Respiratory Sounds ; Sodium Bicarbonate ; Sputum ; Suction ; Urinary Bladder*

BACKGROUND: The technique using target-controlled infusion (TCI) with propofol produces safe intraoperative sedation during regional anesthesia with rapid recovery and high patient satisfaction. The objective of this study was to define the blood propofol concentration necessary for conscious sedation in regional anesthesia patients according to age. METHODS: Sixty patients scheduled to undergo regional anesthesia were allocated into one of three groups according to age, such as group 1 (n = 20): 16 24 yr, group 2 (n = 20): 30 39 yr, group 3 (n = 20): 40 55 yr. Thirty minutes after performing regional anesthesia, TCI of propofol started at a target plasma level of 1 microgram/ml adjusted in steps of 0.2 microgram/ml to maintain a sedation level 3 on a 5-point sedation scale. RESULTS: The mean target concentration was 0.9 microgram/ml (group 1), 0.8 microgram/ml (group 2), 0.7 microgram/ml (group 3). The mean propofol consumption was 38.5 microgram/kg/min (group 1), 34.3 microgram/kg/min (group 2), and 30.8 microgram/kg/min (group 3). The recovery time was significantly delayed in group 3 (2.8 min) compared to group 1 (1.5 min) and group 2 (1.8 min). CONCLUSIONS: TCI of propofol within at 0.7 0.9 microgram/ml blood concentration range produces safe intraoperative sedation during regional anesthesia with rapid induction, rapid recovery and high patient satisfaction without severe complications in 16 55 yr old patients.
Anesthesia, Conduction* ; Conscious Sedation* ; Humans ; Patient Satisfaction ; Plasma ; Propofol*

In order to search for anti-Herpes simplex virus (HSV) type-1 agents from Korean medicinal herbs and Korean traditional prescriptions (herb complexes), we selected 80 medicinal herbs and 45 prescriptions, based on a review of the Korean traditional medicine books. Both methanol extracts and boiling-water extracts were tested by means of the MTT assay (tetrazolium based colorimetric assay). Ten of the 125 methanol extracts: CM-11, CM-18, CM-19, CM-21, CM-22, CM-39, MM-3, MM-18, MM-29, MM-73 (see explanation of nomenclature below), showed efficacy against HSV-1. Twelve of the water extracts: CW-2, CW-3-I, CW-3-II, CW-18, MW-3, MW-5 MW-6, MW-12, MW-47, MW-69, MW-73 and MW-75 were active. #3 (individual herb) and #73 (individual herb) were interesting because both water and methanol extracts were active. Especially, #3 is a part of composition of Hong-il-laksamd ngbang and Hojanghaedokt'ang which have anti-HSV-1 activitives. The SI value of MW-69 and CW-18 was relative high as 10.2+/-0.7 and 11.8+/-2.2. The cytotoxic effect on Vero cells of Panch' n-ch' ngbang, Taraxacum platycarpum H. Dahlst. and acycloguanosine was determined by MTT assay. Water extracts of Panch' ngch' ngbang (prescription) and Taraxacum platycarpum H. Dahlst. showed very weak cytotoxic effects on Vero cells at > 100 mug/ml but acycloguanosine showed strong cytotoxic effects on Vero cells at > 100 mu g/ml. As a result, #3, #73, MW-69 and CW-18 are considered as potentially useful for anti-HSV-1 agent and will be the focus of further research. Abbreviations: CM - methanol extracts of traditional prescriptions; CW - water extracts of traditional prescriptions; MM - methanol extracts of individual herbs; MW - water extracts of individual herbs.
Abbreviations ; Acyclovir ; Herpes Simplex* ; Herpesvirus 1, Human ; Mass Screening* ; Medicine, Korean Traditional ; Methanol ; Plants, Medicinal* ; Prescriptions* ; Simplexvirus* ; Taraxacum ; Vero Cells ; Water

The Q-switched ruby laser has been used in clinics since the early 1980s. It was tried to remove tattoos at first with good effects. Thereafter, some physicians reported the usefulness of the laser in the treatment of some kinds of pigmented lesions such as nevus of Ota, freckles and lentigines. The reason why the Q-switched ruby laser has a lot of effect on tattoos and some pigmented lesions is that the laser has the function of selective photothermolysis on those cutaneous lesions. The authors have treated 185 patients with tattoos and cutaneous pigmented lesions using the Q-switched ruby laser during last 4 years ago. Patients had tattoos, nevus of Ota, freckles, lentigines, melasma, postinflammatory hyperpigmentation, and were followed up over 5 months after the end of the laser treatment. The authors analysed the results and compared them with other's results in Caucasians, and we intended to present a guide of the treatment using Q-switched ruby laser in Koreans. The results were as follows 1. Tattoos showed good results after the treatment because the most of tattoos are black or dark blue in color and cheated by amateur. We repeated the laser treatments with the interval of 2 weeks. 2. Nevus of Ota, freckles and lentigines showed good results after treatment of the Q-switched ruby laser 3. Melasma showed no improvement after the treatment. 4. The treatment of postinflammatory hyperpigmentation using the Q-switched ruby laser must be confined within a part of the lesion at the first visit of patient, because the therapeutic effects were observed in some patients only and the degree of depigmention after treatment was diverse. 5. The most common complication after Q-switched ruby laser treatment was pigmentary change, including hyperpigmentation in most of the cases and hypopigmentation in some cases. However, there was no visible scar or remarkable change of skin texture in all of the cases.
Asian Continental Ancestry Group ; Cicatrix ; Humans ; Hyperpigmentation ; Hypopigmentation ; Lasers, Solid-State* ; Lentigo ; Melanosis ; Nevus of Ota ; Skin

No abstract available.
Hydronephrosis* ; Turner Syndrome*

Cardiopulmonary resuscitation is frequently required for severely depressed congenital diaphragmatic hernia patients. If the exact condition of the patient is not diagnosed prior to delivery, fatal complications such as tension pneumothorax occur often during the resuscitation process. In this case we report the difficulties in diagnosing congenital diaphragmatic hernia and the unusual responses and complications during cardiopulmonary resuscitation. We should know the various methods of management developed over the recent 10 years for these highly stressed patients.
Cardiopulmonary Resuscitation ; Heart Arrest* ; Hernia, Diaphragmatic* ; Humans ; Pneumothorax ; Resuscitation

The importance of garlic as a cause of hand eczema has been a matter of debate. Diallyldisulfide is considered as the main allergen in garlic. Twentv two antigens of the modified European standard series and diallyldisulfide of 5%, 2%, 1%, 0.5%, 0.1% in petrolatum were patch tested in 44 patients with hand eczema. Diallylclisi.!lfide was also tested in 13 women as a control. The results were summerized as follows. l. In patch testing with the European standard series, nickel sulfate (22.7%), cobalt chloride (18.2%), fragrance mix (13.6%), balsam of Peru (9.1%) and termerosal (6.8%) were the cornmon allergens which showed positive reactions. The overal positive rate was 59.1 % (26/44). 2.5% diallyldisulfide showed an irritant reaction in 6 (46.2%) out of 13 controls and in 16 (36.4% ) out of 44 patients. 2% diallyldisulfide showed an irritant reaction in 2/13 (15.4 %) in the control group and 6/44 (13.6%) in the patient group. All 13 controls and 44 patients were negative iin tests with diallyldisulfide of 1%, 0.5%, 0.1%. Our results indicate that patch testing with diallyldisulfide of 1% petrolatum is reommended in order to avoid an irritant reaction when contact allergy to garlic is suspetel. 3. Garlic is suspected as an irritant in provoking hand eczema. True contact allergy to garlic in hand eczema seems to be rare.
Allergens ; Cobalt ; Eczema* ; Female ; Garlic* ; Hand* ; Humans ; Hypersensitivity ; Nickel ; Patch Tests ; Peru ; Petrolatum

Peripheral nerve injury occurs mostly in company with tendon and muscle injuries, fractures, or dislocations. Because of the disabilities and socioeconomic loss caused by such injuries, much attention must be paid to the initial treatment, and later to the reconstruction and rehabilitation. At department of Orthopedic Surgery, Seoul National University Hospital, 336 patients of nerve lesion were treated from Jan, 1980 to Dec, 1988. Among them 128 patients were nerve compression syndrome (carpal tunnel 52 patients, cubital tunnel 40 patients, thoracic outlet 16 patients, others 20 patients), and 50 patients were brachial plexus injury, and 168 cases were peripheral nerve injury. 50 patients of the peripheral nerve injury were treated with reconstruction and 118 patients were treatred with neurorrhaphy, nerve graft, and neurolysis. Of the 118 patients, 94 patients were followed up for more than one year, and the results of neurorrhaphy, nerve graft and neurolysis were analyzed. In 46 patients (73.0%) of the patients treated with neurorrhaphy, 7 patients (58.3%) with nerve graft, and 15 patients (78.9%) with neurolysis, good or excellent results were obtained.
Brachial Plexus ; Dislocations ; Humans ; Nerve Compression Syndromes ; Orthopedics ; Peripheral Nerve Injuries ; Peripheral Nerves ; Rehabilitation ; Seoul ; Tendons ; Transplants