OBJECTIVE: This study was performed to elucidate the technical and patient-specific risk factors for postoperative ischemia in patients undergoing temporary arterial occlusion (TAO) during the surgical repair of their aneurysms. METHODS: Eighty-nine consecutive patients in whom TAO was performed during surgical repair of an aneurysm were retrospectively analyzed. The demographics of the patients were analyzed with respect to age, Hunt and Hess grade on admission, Fisher grade of hemorrhage, aneurysm characteristics, timing of surgery, duration of temporary occlusion, and number of temporary occlusive episodes. Outcome was analyzed at the 3-month follow-up, along with the occurrence of symptomatic and radiological stroke. RESULTS: In overall, twenty-seven patients (29.3%) had radiologic ischemia attributable to TAO and fifteen patients (16.3%) had symptomatic ischemia attributable to TAO. Older age and poor clinical grade were associated with poor clinical outcome. There was a significantly higher rate of symptomatic ischemia in patients who underwent early surgery (p = 0.007). The incidence of ischemia was significantly higher in patients with TAO longer than 10 minutes (p = 0.01). In addition, patients who underwent repeated TAO, which allowed reperfusion, had a lower incidence of ischemia than those who underwent single TAO lasting for more than 10 minutes (p = 0.011). CONCLUSION: Duration of occlusion is the only variable that needs to be considered when assessing the risk of postoperative ischemic complication in patients who undergo temporary vascular occlusion. Attention must be paid to the patient's age, grade of hemorrhage, and the timing of surgery. In addition, patients undergoing dissection when brief periods of temporary occlusion are performed may benefit more from intermittent reperfusion than continuous clip application. With careful planning, the use of TAO is a safe technique when used for periods of less than 10 minutes.
Aneurysm ; Brain Ischemia ; Craniotomy ; Demography ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Ischemia ; Reperfusion ; Retrospective Studies ; Risk Factors ; Stroke ; Troleandomycin

Adrenal cysts are rare lesions usually discovered incidentally during surgery, or at the time of autopsy. Most adrenal cysts are generally asymptomatic and small, less than 10 cm in diameter. When adrenal cysts enlarge sufficiently, they cause pain and gastrointestinal disturbances or become palpable. When cystic lesions in upper abdomen are found, many cystic lesions such as hepatic, splenic, renal and pancreatic cysts should be considered. It's difficult to differentiate between benign and malignant lesions. Usually these cystic lesions have been excised to rule out malignancy. Herein we report a case of adrenal endothelial cyst which was detected in a 63-year-old female patient during a routine health examination by ultrasonography.
Abdomen ; Adrenal Glands* ; Autopsy ; Female ; Humans ; Middle Aged ; Pancreatic Cyst ; Ultrasonography

BACKGROUND: Based on previously reported articles, magnesium sulphate seemed to cause a motor paralysis, but not complete analgesia when administered intrathecally alone, but is likely to have a partial analgesic effect. Accordingly, we tested a hypothesis that magnesium sulphate might potentiate the analgesic effect when coadministered intrathecally with bupivacaine. METHODS: Eighteen male Sprague-Dawley rats were allocated into three groups of six animals each. The duration of sensory blockade was determined by observing the period when the animal did not vocalize and/or withdraw (struggle) while forceps-pinch tests were applied to a hindlimb paw. The six animals in each of the following three groups were injected intrathecally with 0.03 ml of the different test substances: (group 1) 16.7% magnesium sulphate {50% magnesium sulphate (0.01 ml) + 0.9% sodium chloride (0.02 ml)}; (group 2) 50% magnesium sulphate (0.01 ml) + 0.5% bupivacaine (0.02 ml); (group 3) 0.33% bupivacaine {0.5% bupivacaine (0.02 ml) + 0.9% sodium chloride (0.01 ml)}. RESULTS: Sensory blockade in the hindlimbs was observed only in group 2 and lasted for 12 to 14 minutes, while there were no sensory blockades in group 1 and group 3. CONCLUSIONS: Magnesium sulphate potentiated the analgesic effect of bupivacaine when coadministered intrathecally with bupivacaine in rats. These results suggest that intrathecal administration of magnesium sulphate may be a useful adjunct to spinal bupivacaine anesthesia.
Analgesia ; Anesthesia ; Animals ; Bupivacaine* ; Hindlimb ; Humans ; Magnesium* ; Male ; Paralysis ; Rats* ; Rats, Sprague-Dawley ; Sodium Chloride

BACKGROUND: Because of improvement of economic state and eating habit changes in Korea, 60-70% of gallbladder stones are cholesterol stones. As ultrasonography was used increasingly, detection of asymptomatic gallstone were increased. There has been few studies about asymptomatic gallstone in Korea. So, this study was designed to obtain associated factor of prevalence of asymptomatic gallstone. METHODS: We screened adults over 20 years who were visited the health Promotion Center in a university hospital from May 1995 to May 1999. Subjects were defined as case group(584 subjects) who were diagnosed gallstone by abdominal ultrasonogaphy by radiologist. Control group(1153 subjects) were selected by random sampling from visitors of the Health Promotion Center. Every subjects were assessed with respect to gender, age, height, weight, fasting blood glucose, serum total cholesterol, high density lipoprotein-cholesterol, triglyceride. Social-Economic state, smoking were assessed by self-administered questionnaires. Associated factor of prevalence of asymptomatic gallstone were analyzed by Chi-square test and multiple logistic regression. RESULTS: Age, BMI(Body Mass Index), fasting blood glucose were associated with gallstone by Chi-square test(P<0.05). Multiple logistic regression showed that prevalence of asymptomatic gallstones was increased by age(>40 years old) and were associated with BMI(>25 kg/m2), fasting blood glucose. CONCLUSION: Associated factors of prevalence of asymptomatic gallstone were increased by age(>40 years old) and were associated with BMI(>25 kg/m2), fasting blood glucose, and were not different from those in West countries. further studies will be needed about associated factors according to the composition of gallstone and developing from asymptomatic gallstone to asymptomatic gallstone.
Adult ; Blood Glucose ; Cholesterol ; Eating ; Fasting ; Gallbladder ; Gallstones* ; Health Promotion ; Humans ; Korea ; Logistic Models ; Prevalence* ; Smoke ; Smoking ; Triglycerides ; Ultrasonography ; Surveys and Questionnaires

BACKGROUND: The number of illegal migrant workers has been increasing in Korea since late 1997 in what was called the IMF era. This study was conducted to evaluate and to recognize the medical utilization and health Status for migrant workers in Korea. The goal of this study was to understand the epidemiological characteristics of the migrant workers and family physician's role as a health provider and gate keeper to them and to provide basic data for public health policy. METHODS: In September 1999, self-administered questionnaires were distributed to the migrant workers in Seoul, Sung-Nam, Pucheon and An-Yang. We classified the reasons for clinical encounters and the prescribed drugs by reviewing the medical records of all patients who visited a clinic of shelter for migrant workers in Sung-Nam from January to December 1998 and analysed the report according to death certification of the shelter for migrant workers in Sung Nam from 1994 to September 1999 RESULTS: The major distribution of nationality were from China, Mongo, and Bangladesh (86.9 %). They were mostly between 30 and 39 years old, males are, and unmarried. Most had high school education. The average income was 756,700 won and the average working hours were 11.5 hours per day in migrant workers being in worse condition than those of Korean workers. Classified according to systems, the respiratory(21.2%), musculoskeletal (20.6%), digestive(15.8%), and cardiovascular(12.5%) symptoms were common. Repayment for death was different between before (87.7%) and after IMF era (13.0%), in late 1997. Average medical expenditure was 43,552 won comprising 5% of the total income of subjects only. Most of them did not benefit from medical insurance. CONCLUSION: Migrant workers' situation seemed poor. The patterns of the disease' were similar to those who visit family medicine clinics in general. Family physicians should take more interest in providing a more effective and better care to migrant workers.
Adult ; Bangladesh ; Certification ; China ; Education ; Ethnic Groups ; Gyeonggi-do ; Health Expenditures ; Humans ; Insurance ; Korea* ; Male ; Medical Records ; Physician's Role ; Physicians, Family ; Public Health ; Seoul ; Single Person ; Transients and Migrants* ; Surveys and Questionnaires

BACKGROUND: Pulmonary artery ligation during pneumonectomy increase the pulmonary blood flow of dependent lung and may increase the pulmonary arterial pressure and pulmonary vascular resistance. The purpose of this study is to evaluate the hemodynamic effect of pulmonary artery ligation during pneumonectomy. METHODS: Nine patients who were supposed to receive pneumonectomy were studied. Hemodynamic measurements were performed following two lung ventilation (TLV), one lung ventilation (OLV), after pulmonary artery ligation and after pneumonectomy. RESULTS: There is no significant differences in heart rate, systemic arterial pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac index and pulmonary vascular resistance index. Arterial oxygen tension significantly reduced during OLV and increased after pulmonary artery ligation and after pneumonectomy. CONCLUSIONS: These results suggest that pulmonary artery ligation during pneumonectomy may not affect the cardiopulmonary hemodynamics.
Arterial Pressure ; Arteries ; Heart Rate ; Hemodynamics* ; Humans ; Ligation* ; Lung ; One-Lung Ventilation ; Oxygen ; Pneumonectomy* ; Pulmonary Artery* ; Pulmonary Wedge Pressure ; Vascular Resistance ; Ventilation

Tracheobronchial rupture following tracheal intubation with double-lumen endobronchial tube (DLT) is a rare complication, but may result in a massive air leakage with resultant pneumothorax, mediastinal emphysema and extensive subcutaneous emphysema in the postoperative period. We report a case of sustained laceration of the posterior membranous part of the trachea possibly due to overinflation of the double-lumen endobronchial tube. A 76-year-old, 45 kg, female was scheduled for a repair of her bronchopleural fistula. Following induction of anesthesia, intubation was performed with Robertshaw's DLT, and a tracheal cuff was inflated with 6 ml of air, but the sound of an air leak was heard coming from the patient's mouth during controlled ventilation. A further 5 ml of air was added 1 ml at a time into the tracheal cuff but the air leak sound continued. At that point, the sound was considered to originate from the bronchopleural fistula rather than from lack of sufficient air. After a thorough deflation of the tracheal cuff, 6 ml of air was reinjected and the operation was resumed. A 4 cm split was unexpectedly noticed in the posterior wall of the trachea during the operation and was repaired without complication.
Aged ; Anesthesia ; Female ; Fistula ; Humans ; Intubation ; Lacerations ; Mediastinal Emphysema ; Mouth ; Pneumothorax ; Postoperative Period ; Rupture* ; Subcutaneous Emphysema ; Trachea ; Ventilation

BACKGROUND: Though the mivacurium is the short acting nondepolarizing neuromuscular blocking agent, the action duration of it is not prospected in condition of hepatic failure owing to its being metabolized by serum cholinesterase and other esterase produced in liver. The purpose of this study is to evaluate neuromuscular effect of the mivacurium in cats with acute hepatic failure. METHODS: Six cats administrated only mivacurium are the control group, and six cats with acute hepatic failure by galactosamine hydrochloride are the experimental group. The force of the anterior tibialis muscle in response to supramaximal common peroneal nerve stimulations were recorded, the time intervals from mivacurium administration to attain 100% twitch depression (onset time), from mivacurium administration to recovery of 25% twitch tension (duration) and from 25% to 75% of twitch recovery (recovery index) were compared between the control group and the experimental group. RESULTS: In experimental group, SGOT and SGPT prior to administration of galatosamine were 28.8+/-5.6 (IU/L) and 43.0+/-7.9 (IU/L), respectively, SGOT and SGPT in acute hepatic failure were 5004.0+/-8113.2 (IU/L) and 3763.0+/-5416.4 (IU/L), respectively, and there were significant differences between the control group and the experimental group. The action duration{47.6+/-18.0 (min)} and the recovery time{7.7+/-3.7 (min)} of mivacurium in the experimental group were more prolonged than the action duration{21.9+/-5.0 (min)} and the recovery time{4.4+/-0.7 (min)} of mivacurium in the control group. CONCLUSIONS: These results indicate that the hepatic failure can prolong the action duration and the recovery index of mivacurium, but the other factors affecting the action of mivacurium must be studied.
Alanine Transaminase ; Animals ; Aspartate Aminotransferases ; Cats* ; Cholinesterases ; Depression ; Galactosamine* ; Liver ; Liver Failure ; Liver Failure, Acute* ; Neuromuscular Agents ; Neuromuscular Blockade* ; Peroneal Nerve

Diffuse axonal injury(AI) s a severe form of traumatic brain injury and it is associated with immediate coma lasting from six hours to prolonged coma. Object of this study was to review various clinical parameters which might have been related to outcome of patients with DAI and, thus, to provide some valuable guidelines in management. A series of 41 patients of DAI treated in our institution between October 1992 to September 1997 are included in this study. Clinical factors such as age, sex, Glasgow Coma Scale(CS), duration of coma, presence of hypotension at admission, hypoxemia, signs of hypothalamic injury, abnormal eyeball movement, abnormal light reflex, abnormal electrocardiography, cerebral infarct, and seizure are reviewed and analyzed in conjunction with outcome. Among all clinical factors evaluated for the statistical significances only initial GCS, hypoxemia, abnormal light reflex, signs of hypothalamic injury, abnormal motor response(decortication or decerebration) at admission revealed to have significant correlation with outcome. Factors such as age, hypotension, abnormal ECG, cerebral infarct, seizure were not statistically significant in our study. Other findings, such as causes of deaths(old age associated with either expanding hemorrhage or hemorrhage in posterior fossa) in 2 of 9 patientswith initial GCS greater than 13 and highest mortality rate for patients with combined hypoxemia and hypotension, should also be stressed. These findings suggest that when such clinical settings are evident physicians should be borne in mind that these will play unfavorable role to patients in terms of outcome and prognosis. Thus, careful and prompt attention should be given to these patients, especially treating elderly patients, even though they may have good initial GCSs.
Aged ; Anoxia ; Axons ; Brain Injuries ; Coma ; Craniocerebral Trauma ; Diffuse Axonal Injury* ; Dyskinesias ; Electrocardiography ; Hemorrhage ; Humans ; Hypotension ; Mortality ; Prognosis ; Reflex ; Reflex, Abnormal ; Seizures

GVHD (Graft-versus-Host Disease) results from the cytotoxic T lymphocytes from the bone marrow recognizing the recipient's minor histocompatibility antigens. In experimental murine models, either CD4+ or CD8+ T-cell subsets can cause GVHD, depending upon the particular strain combination utilized. Recent studies suggest that the keratinocyte undergo apoptosis in GVHD. However, morphological data supporting this concept are still lacking. The present study was undertaken in order to document apoptosis in experimental acute GVHD via sequential analysis of ultrastructure .Acute GVHD was produced across minor histocompatibility loci using appropriately matched murine strains. Acute GVHD was mediated with the use of highly purified preparations of donor CD4+ and CD8+ T-cell subsets. Whole T cells were used as a positive control and T cell depleted bone marrow as a negative control. Conventional transmission electron microscopy was used to define apoptosis structurally Sequential ultrastructure revealed that the keratinocyte underwent apoptosis in CD4+, CD8+ and whole T cell groups. This study demonstrates the sequential ultrastructure of the keratinocyte undergoing apoptosis from the beginning to the end. Both of the basal and the suprabasal keratinocytes show the morphology of early apoptosis, and the detachment of the tonofibril from the basement membrane and the adjacent cell was the general findings in the apoptotic cell Sequences of the cytoplasmic condensation was demonstrated . Through ultrastructural quantitation the apoptotic indices were depicted in all the experimental groups. Characteristically, numerous lymphocytes underwent apoptosis in CD8+ groups at day 28 and 35.
Apoptosis* ; Basement Membrane ; Bone Marrow Transplantation* ; Bone Marrow* ; Cytoplasm ; Epidermis* ; Humans ; Keratinocytes ; Lymphocytes ; Microscopy, Electron, Transmission ; Minor Histocompatibility Antigens ; Minor Histocompatibility Loci ; T-Lymphocyte Subsets ; T-Lymphocytes ; T-Lymphocytes, Cytotoxic ; Tissue Donors