BACKGROUND: Epinephrine used in surgery to provide hemostasis may elicit ventricular arrhythmias. A desirable anesthetic would not sensitize the myocardium to exogenously administered epinephrine. So the effect of sevoflurane, which was introduced to clinical anesthesia recently, on cardiac arrhythmias induced by the infusion of epinephrine was compared with those of halothane which was already known to epinephrine-induced arrhythmia in the 14 mongrel dogs. METHODS: The authors compared the arrhythmogenicity (three or more premature ventricular contractions, PVCs)of intravenously administered epinephrine in 14 mongrel dogs who were randomly assigned to receive sevoflurane (1.7 vol%) or halothane (0.75 vol%) anesthesia equipotently. The arrhythmogenic doses of epinephrine determined in this comparative study were expressed by both infusion rates of epinephrine during sevoflurane and halothane anesthesia. RESULTS: The mean values of the arrythmogenic infusion rates of epinephrine were 27.1 7.6 g/kg for sevoflurane and 2.7 0.8 g/kg for halothane. CONCLUSIONS: We concluded that the arrythmogenic doses of epinephrine during sevoflurane were significantly higher than those during halothane anesthesia.
Anesthesia* ; Animals ; Arrhythmias, Cardiac ; Dogs* ; Epinephrine* ; Halothane* ; Hemostasis ; Myocardium ; Ventricular Premature Complexes

Zygomatic arch fracture is one of the most commonly seen facial bone fractures and there have been many methods of reduction designed so far. However, for a simple fracture, the Gillies temporal approach is most commonly used because of the easy reducibility, and also because the depressed fracture can be approached without a facial incision. The Gillies temporal approach starts in the temporal area, between the temporalis muscle and deep temporal fascia. We have developed a new route which starts in the postauricular hair margin area and then reaches to the periosteum of the temporal bone. An elevator is then inserted to penetrate the periosteum and subperiosteal dissection is performed toward the zygomatic process of the temporal bone. At the origin of the zygomatic process, the route of dissection changes to the posterior aspect of the zygomatic arch using a curved palate elevator or the authors' modified Langenbeck elevator. This method of approach has been used in 6 cases of zygomatic arch fracture with good results and we report this method along with written reports.
Elevators and Escalators ; Facial Bones ; Fascia ; Hair ; Palate ; Periosteum ; Temporal Bone ; Zygoma*

In this study, effects of incision of retrodiscal tissue and unilateral occlusal reduction on temporomandibular joint of rabbit were investigated. Twenty-seven adult New Zealand White Rabbits, weighing over 3.5kg, were utilized in this study. Temporomandibular joint surgery was performed in left temporomandibular joint of 24 rabbits to displace disc anteriorly through incising the retrodiscal tissue 1-2mm posterior to the disc. They were divided into two groups: twelve were left untreated after surgery, occlusal reduction was performed on left posterior teeth every 2 weeks in the other twelve rabbits. The remaining three served as the control group. The sample were sacrificed by 8, 12, and 16 weeks after surgery. Histologic examinations were performed after sacrificing them. The results were as follows: 1. Histologic findings which were manifested by flat articular fossa, broad articular surface, generalized recession of articular cartilage and sclerosis of subchondral bone were observed. These findings were similar to internal derangement. 2. In the rabbits untreated after surgery, thin cartilagenous layer and necrotic tissue were observed in 8 weeks group, calcifying cartilagenous layer was observed in 12 weeks group, and cartilagenous layer on anterior portion was observed in 16 weeks group. So, it showed gradual healing pattern into the normal tissue except displaced disc. 3. Occlusal trauma after surgery resulted in generalized recession of upper and lower articular surface. Necrosis and vertical split on condylar process of mandible were observed in 8 weeks group. Osteoclasts, exposure of subchondral bone due to erosion on upper and lower articular surface, and degenerative changes on retrodiscal tissue were observed in 16 weeks group. So, it showed continuous progress pattern of osteoarthrosis.
Adult ; Cartilage, Articular ; Humans ; Mandible ; Necrosis ; Osteoarthritis ; Osteoclasts ; Rabbits ; Sclerosis ; Temporomandibular Joint* ; Tooth

Eating ; Female ; Hospitals, General ; Humans ; Male ; Mandible ; Mandibular Fractures ; Respiration ; Tooth ; Violence

Melorheostosis is a rare disease entity of bone with an etiology and pathogenesis. It cause pain and stiffness in an affected limb, and dense bone formation along the side of bone resembles the flow of candle dripping. Two cases of the disease involving left hand and wrist, and right lower leg are reported with the review of literature.
Extremities ; Hand ; Hyperostosis ; Leg ; Melorheostosis ; Osteogenesis ; Rare Diseases ; Wrist

Recently, studies have emphasized the importance of anatomical placement of the lateral meniscal allograft to decrease postoperative extrusion. However, it is infeasible to identify the exact rotation of the allograft during transplantation. We present a patient who underwent a lateral meniscal transplantation using a wire for correct positioning of the allograft. The use of a wire intraoperatively shaped to resemble the contour of the lateral meniscal allograft will aid in more accurate and anatomical graft placement.
Allografts* ; Humans ; Menisci, Tibial ; Transplants

V. parahaemolyticus was isolated from blood culture of a 34-year old female patient with HCV viral hepatitis and liver cirrhosis. V. parahaemolyticus is one of the frequent causative agents of gastrointestinal infection, but rarely causes septicemia. This case is thought to be the 3rd report of V. parahaemolyticus septicemia in Korea.
Adult ; Female ; Hepatitis ; Humans ; Korea ; Liver Cirrhosis* ; Liver* ; Sepsis* ; Vibrio parahaemolyticus* ; Vibrio*

A clinical analysis of 249 patients with maxillo-facial trauma, who underwent general anes- thesia from January 1992 to December 1993 at Lee-Rha General Hospital, were made in order to investigate various case characteristics such as sex ratio, age distribution, types of trauma, fracture sites, associated injuries, underlying medical problems, abnormal laboratory findings, intubation, and preoperative physical condition. It was found that males outnumbered females showing the peak age incidence in 20's and 30's. The high velocity motor vehicle accidents was the most common cause of trauma and the mandible was the most frequent fracture sites. Among 96 associated injury cases, 63 cases were neumsurgical problems. Underlying medical problems or abnormal laboratory findings were present in 28.9% of the patients studied and preoperative physical status 1 or 1E (ASA classification) was most common accounting for 54.8% of the patients studied. Of the patients who received endotracheal intubation, 73.5% were done via a nasotracheal route.
Age Distribution ; Anesthesia ; Female ; Hospitals, General ; Humans ; Incidence ; Intubation ; Intubation, Intratracheal ; Male ; Mandible ; Motor Vehicles ; Sex Ratio

OBJECTIVE:The purpose of this study is to evaluate the CT findings of the carcinoma of the ampulla of Vater and to differentiate from other periampullary carcinoma including the carcinoma of the distal common bile duct and pancreas head. MATERIALS AND METHODS: We retrospectively reviewed the CT findings of 13 cases of the carcinoma of the ampulla of Vater, 20 cases of the carcinoma of the distal common bile duct and 20 cases of the carcinoma of the pancreas head confirmed by pathology. Five millimeter consecutive settings of CT scan were performed in all cases on ampulla level with supine position. The CT findings were retrospectively evaluated in view of common bile duct dilatation, pattern of termination of bile duct, pancreatic duct dilatation, protruding mass in duodenal lumen, and regional lymph node metastasis. RESULTS: All case of the carcinoma of the ampulla of Vater(13/13) and distal common bile duct(20/20) showed common bile duct dilatation with abrupt termination. Among the 10 cases of the carcinoma of the pancreas head with common bile duct dilatation, five cases each had is abrupt termination(5/20) and gradual stenosis of bile duct(5/20). Five cases of the carcinoma of the ampulla of Vater(5/13) and four cases of the carcinoma of distal common bile duct(4/20) showed pancreatic duct dilatation and all cases of the carcinoma of pancreas head show pancreatic duct dialtation(20/20). Twenty cases of the carcinoma of the ampulla of Vater showed protruding mass in the medial wall of the second portion of the duodenum(12/13) but only one case of the carcinoma of the distal common bile duct(I/20) and five cases of the carcinoma of the pancreas head (5/20) had protruding mass in the duodenal lumen. Only one case of the carcinoma of the ampulla of Vater showed(1/13) regional lymph node metastasis but three cases of the carcinoma of the distal common bile duct(3/20) and 18 cases of the carcinoma of the pancreas head(18/20) showed regional lymph node metastasis. CONCLUSION: Common bile duct dilatation with abrupt termination, protruding mass in the duodenal lumen and rare lymph node metastasis in CT may suggest the carcinoma of the ampulla of Vater.
Ampulla of Vater* ; Bile ; Bile Ducts ; Common Bile Duct ; Constriction, Pathologic ; Dilatation ; Head ; Lymph Nodes ; Neoplasm Metastasis ; Pancreas ; Pancreatic Ducts ; Pathology ; Retrospective Studies ; Supine Position ; Tomography, X-Ray Computed

BACKGROUND: Outpatient surgery has grown in many hospitals. This rapid recently been on the increase in ambulatory surgery would not have been possible without the changing role of the anesthesiolosist and the development of new and short-acting anesthetic drugs. Specific care and knowledge are required for outpatient anesthesia. The aim of this study was to review the clinical experiences of postanesthetic patients at the Oneday Surgery Center (OSC). METHODS: We reviewed the 720 records of the recovery unit in OSC and the 620 records of telephone interviewers? after discharge from January to December 1997. The PACU Record contained Aldrete scores and discharge summaies (about such things as vital signs, alertness and orientation, dizziness, nausea and vomiting, pain, the state of the neurovascular system, the ability to ambulate or dress, voiding, oral intake, etc). Records of telephone interviewers? after discharge contained questionnaires about wound status, limitations a activity and other abnormal symptoms relating to feeding, nausea and vomiting, pain, and medications. RESULTS: The most largest percentages of parameters of patients were below 10 years of age; They had undergone general anesthesia in method, and Herniorraphies. All the patients achieved Alderete score of 7 10 on arrival at the First recovery unit (1st RU) in OSC and achieved 10 points within an hour, when they were transfered to the Second recovery unit (Comfortable room). 41 (5.4%) patients suffered from nausea or vomiting in the Recovery unit. One (0.1%) patient had nausea or vomiting and 5 (0.7%) patients had pain at discharge. The mean durations of stay at the 1st RU and Comfortable room were 90 min and 240 min respectively. Records of telephone visits after discharge showed that 30 (4.8%) patients had nausea or vomiting and 27 (4.3%) patients had postoperative pain after discharge. 20 patients (3.2%) had abnormal symptoms (e.g., fever, coughing, dysuria, epistaxis). There were no limitations in activities or feeding. CONCLUSIONS: For the assurance of a rapid and complication-free recovery in the increasings needed ambulatory surgery, much effort is reguired to increase its quality and safety.
Ambulatory Surgical Procedures* ; Anesthesia ; Anesthesia, General ; Anesthetics ; Cough ; Dizziness ; Dysuria ; Fever ; Humans ; Interviews as Topic ; Nausea ; Outpatients* ; Pain, Postoperative ; Telephone ; Vital Signs ; Vomiting ; Wounds and Injuries