The incidence of myocardial ischemia and silent myocardial infarction are higer in diabetic than in nondiabetic patients. We had a case of a disbetic, myocardial ischemic female patient, 54years old, who had cardiac arrest during an emergency surgery. The patient was admitted via emergency room with the diagnosis of rupture of basilar artery aneurysm. During the dissection for the exposure of the artery. The aneurysm ruptured. causing massive hemorrhage. At this time, cardiac arrest was revealed at the monitoring EKG, cardiopulmonary resuscitation with DC shock were performed to reverse venticular fibriliation but the EKG monitor showed T wave inversion and sinus tachycardia in several leads. And the blood pressure was hardly audible with systolic of about 50mmHg. So nitroglycerin 0.05mg, intravenous bolus injection was given twice and the systolic went up to 110mmHg with a diastolic of 80mmHg. So the operation proceeded and finished. The patient was sent to the ICU. On the third postoperative day, the patient again had cardiac arrest but this time could not be resuscitated. We experienced the dramatic effect of nitroglycerin on this ischemic patient during cardio pulmonary resuscitation and we would like to share this experience with our colleagues.
Aneurysm ; Arteries ; Blood Pressure ; Cardiopulmonary Resuscitation* ; Diagnosis ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Female ; Heart Arrest ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin* ; Rupture ; Shock ; Tachycardia, Sinus

BACKGROUND: Periampullary cancer is a relatively common malignancy, and its incidence is increasing. Prognosis in these patients depends upon resection of the tumor because surgery is the only effective treatment for irradicating the disease. There has, therefore, been a renewed interest in the role of serological markers early diagnostic tools for periampullary cancer. The potential role of serological markers is not limited only to early detection, but may also be of assistance in the difficult clinical dilemma of differentiating periampullary cancer from other diseases. Furthermore, serological markers of periampullary cancer might be used in follow-up patients after treatment, particularly after surgical resection, in order to select those with minimal disease likely to respond better to adjuvant treatment and/or radiotherapy. METHODS: From March 1989 to May 1997, 54 patients were admitted to Sanggye Paik Hospital, InJe University, and had pathologically confirmed periampullary cancer. Of those, 28 patients underwent a biliary bypass or a drainage procedure [Group I], and the others received resection procedures (Whipple's operation or pylorus-preserving pancreatoduodenectomy)[Group II]. Preoperative and postoperative serum levels of bilirubin, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9(CA19-9) were measured in all patients. We evaluated the relation of the postoperative increase or decrease in those tumor markers to survival, and we discuss the usefulness of those markers as prognostic indicators in periampullary cancer. In this study, we focused on the changes in the CEA and the CA19-9 levels as function of the serum bilirubin concentration change. RESULTS: The bilirubin, CEA, and CA19-9 concentrations decreased significantly in Groups I and II after operation. The correlation between the decreases of the bilirubin and the CEA levels was statistically significant, but that between the bilirubin and CA19-9 had no statistical significance, in spite of the fact that the preoperative and the postoperative tumor marker concentrations had changed markedly. The reason for the statistical insignificance of the CA19-9 result may be the its relatively small sample size and the wide standard variation. The overall median and mean survival time of Group I were 4 months and 11 months, respectively, and those of Group II were 17 months and 21 months. CONCLUSION: We found that the serum the CEA and the CA19-9 levels could be used as a useful prognostic indicator change according to the serum bilirubin concentration even after a biliary drainage procedure and a biliary bypass. We conclude that various biliary bypass and drainage procedures can be effective treatments in periampullary cancer. However, because it is thought that many tumor markers are greatly affected by hyperbilirubinemia, liver dysfunction or cholestasis, further studies of the exact mechanism for the decrease or the increase in the tumor marker level as a function of the serum bilirubin concentration are mandatory. Precise information obtained by using multivariate analysis of large samples is essential for more accurate evaluation.
Biomarkers, Tumor ; Bilirubin* ; Carcinoembryonic Antigen ; Cholestasis ; Drainage* ; Humans ; Hyperbilirubinemia ; Incidence ; Liver Diseases ; Multivariate Analysis ; Pancreaticoduodenectomy* ; Prognosis ; Pylorus* ; Radiotherapy ; Sample Size ; Survival Rate

PURPOSE: The aim of this study was to analyze the outcomes of patients with gastrointestinal stromal tumors (GISTs) of the stomach who were treated in our hospital. MATENRIALS AND METHODS: We retrospectively studied 31 patients who were treated for primary gastrointestinal stromal tumors of the stomach from 1990 to 1999 at Korea University Guro Hospital. Clinical characteristics, including age, sex and tumor size were analyzed. In addition, the relation between the 5-year survival rate and tumor size, operative procedure, and malignancy were analyzed to identify the factors that predict survival. RESULTS: The malignant GISTs were 11 cases, borderline GISTs were 2 cases, and benign GISTs were 18 cases. The overall 5-year cumulative survival rate of the patients was 84.6%, and the 5-year survival rates according to malignancy were 100% for benign and borderline GISTs and 78.1% for malignant GISTs, p=0.1119. The 5-year survival rates according to tumor size were 100% for tumor sizes smaller than 5 cm and 78.4% for tumor sizes larger than 5 cm, p=0.0453. The 5-year survival rate according to lymph node dissection during operative procedure of malignant GISTs was not significant statistically. CONCLUSION: GISTs of the stomach are infrequently encountered tumors. Tumor size was the most important factor for predicting survival in a clinical situation, and performing a complete resection of the tumor, especially tumors larger than 5 cm, will improve the outcome of treatment.
Gastrointestinal Stromal Tumors* ; Humans ; Korea ; Lymph Node Excision ; Retrospective Studies ; Stomach* ; Surgical Procedures, Operative ; Survival Rate

OBJECTIVES: Posttraumatic stress disorder(PTSD) has been primarily associated with emotional problems. Recently, however, the impact of PTSD on cognitive processes has interested a growing number of researchers. The current study is aimed at investigating the cognitive aspects of PTSD at both behavioral and neurological levels. METHODS: We recruited individuals with PTSD who survived the Daegu subway explosion in 2003 as well as non-PTSD individuals as a control group. To evaluate the inhibitory processes and the neural mechanisms, we had these individuals perform the negative priming task simultaneously with functional MRI scanning. RESULTS: Behaviorally, the negative priming effect was intact in the control group but was not evident in the PTSD group. In the imaging results, only the PTSD group showed the negative priming effect (i.e., increased activation of the negative priming condition as opposed to the neutral condition) in the dorsolateral prefrontal cortex, anterior cingulate cortex, and inferior temporal gyrus. The PTSD group also showed increased activity for the positive priming condition as opposed to the neutral condition in the claustrum. These results confirm and extend the previous findings that the integrity of the ACC is compromised in the trauma survivors due to disrupted white matter tract. CONCLUSIONS: The current results suggest that deteriorated performance of the PTSD group may be due to the functional problem as well as the structural abnormalities.
Basal Ganglia ; European Continental Ancestry Group ; Explosions ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Prefrontal Cortex ; Railroads ; Stress Disorders, Post-Traumatic ; Survivors

PURPOSE: We evaluated the effect of cable fixation of the lesser trochanter for treating unstable intertrochanter fractures. MATERIALS AND METHODS: In this retrospective study, we assessed the availability of cable fixation of the lesser trochanter and the cause of complications in a series of 47 unstable intertrochanteric femoral fractures that were seen between February 2001 to May 2008 at our hospital. The fractures were classified using the Evans-Jensen classification system. The lesser trochanters were fixed in 21 cases. The correlations between the lag screw position, comminution of the fracture site and the radiological results were studied. Nonunion was diagnosed if patients experienced pain and the radiographs revealed a persistent, radiolucent defect at the fracture site 6 months after fracture fixation. RESULTS: Union was observed in 43 cases (91.5%). The average union time was 3.75 months. Nonunion was observed in 4 cases (8.5%) 1 in group l and 3 in group ll. The average sliding distance of the lag screw was 8.76 mm. In groups l and ll, the distance was 4.92 mm and 12.45 mm, respectively. Excessive sliding, which was defined as more than 15mm, developed in 9 cases, and 7 of these 9 cases were in group ll. The average neck-shaft angle change was 1.28degrees and 5.81degrees, respectively. CONCLUSION: Additional cable fixation of the lesser trochanter for treating intertrochanter fractures, including large posteromedial fragments, is recommended for preventing the excessive sliding of lag screws and varus deformity.
Congenital Abnormalities ; Femoral Fractures ; Femur ; Humans ; Retrospective Studies

3degrees).CONCLUSION: This study evaluated the amount of horizontal relapse, and the degree of relapse. Stable results were obtained. Although there was no statistical significance between the degree of openbite and the amount of horizontal relapse, the group with a greater amount of openbite had a greater amount of relapse.]]>
Genioplasty ; Humans ; Malocclusion ; Mandible ; Open Bite ; Organothiophosphorus Compounds ; Orthognathic Surgery ; Recurrence

The advent and wide use of antibiotics have decreased the incidence of deep neck infection. When a deep neck infection does occur, however, it can be the cause of significant morbidity and death, resulting in airway obstruction, mediastinitis, pericarditis, epidural abscesses, and major vessel erosion. In our clinic, a patient with diffuse chronic osteomyelitis of mandible and fascial space abscess and necrotic fasciitis due to odontogenic infection at the time of first visit came. We successfully treated the patient by early diagnosis using contrast-enhanced CT and follow up dressing through the appropriate use of radiographic images.
Abscess ; Airway Obstruction ; Anti-Bacterial Agents ; Bandages ; Early Diagnosis ; Epidural Abscess ; Fasciitis ; Fasciitis, Necrotizing ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Incidence ; Mandible ; Mediastinitis ; Neck ; Osteomyelitis ; Pericarditis ; Porphyrins

OBJECTIVE: This study was performed to evaluate the potential clinical value of concurrent chemotherapy and pulsed high intensity focused ultrasound (HIFU) therapy (CCHT), as well as the safety of pulsed HIFU, for the treatment of unresectable pancreatic cancer. MATERIALS AND METHODS: Twelve patients were treated with HIFU from October 2008 to May 2010, and three of them underwent CCHT as the main treatment (the CCHT group). The overall survival (OS), the time to tumor progression (TTP), the complications and the current performance status in the CCHT and non-CCHT groups were analyzed. Nine patients in the non-CCHT group were evaluated to determine why CCHT could not be performed more than twice. RESULTS: The OS of the three patients in the CCHT group was 26.0, 21.6 and 10.8 months, respectively, from the time of diagnosis. Two of them were alive at the time of preparing this manuscript with an excellent performance status, and one of them underwent a surgical resection one year after the initiation of CCHT. The TTP of the three patients in the CCHT group was 13.4, 11.5 and 9.9 months, respectively. The median OS and TTP of the non-CCHT group were 10.3 months and 4.4 months, respectively. The main reasons why the nine patients of the non-CCHT group failed to undergo CCHT more than twice were as follows: pancreatitis (n = 1), intolerance of the pain during treatment (n = 4), palliative use of HIFU for pain relief (n = 1) and a poor physical condition due to disease progression (n = 3). No major complications were encountered except one case of pancreatitis. CONCLUSION: This study shows that CCHT is a potentially effective and safe modality for the treatment of unresectable pancreatic cancer.
Adult ; Aged ; Antineoplastic Agents/*therapeutic use ; Combined Modality Therapy ; Deoxycytidine/*analogs & derivatives/therapeutic use ; Female ; High-Intensity Focused Ultrasound Ablation/*methods ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/*therapy ; Survival Rate ; Treatment Outcome

BACKGROUND: Laparoscopic surgery was first applied in appendectomies. However, the use of laparoscopic surgery has become more popular in other operation than appendectomies such as cholecystectomies and herniorrhaphies. Many surgeons have abandoned the laparoscopic appendectomy because they think the procedure is tedious and has no advantage over the simple open appendectomy. However, the incisional scar is an unavoidable sequela of an open appendectomy, and post-operative pain is bothersome in many cases. METHODS: We carried out laparoscopic appendectomies in 49 consecutive patients by using antepubic trocar insertion to achieve maximum cosmetic effect and to minimize the post-operative pain. Fifteen patients (control group) underwent laparoscopic appendectomies with conventional trocar sites 2~3 cm above the symphysis pubis. Thirty-four patients (studied group) received a newly designed operation using an incision site on the symphysis pubis to maximize the cosmetic effect. We made a short subcutaneous tunnel from antepubic incision to facilitate the intra-abdominal dissection. RESULTS: When we compare the post-operative results, there was no difference between the two groups with respect to operation time, post-operative pain, post-operative hospital stay, or complications. CONCLUSIONS: A greater of the proportion patients who received the newly designed operation were satisfied with the cosmetic result.
Appendectomy* ; Cholecystectomy ; Cicatrix ; Herniorrhaphy ; Humans ; Laparoscopy ; Length of Stay ; Surgical Instruments*

Primary melanoma of the vagina is rare, accounting for 2.6-2.8% of all primary malignant tumor of the vagina and 0.4-0.8% of all malignant melanomas in the female. Melanocytes are the presumed precursors of malignant melanoma of the vagina; they are embryologically derived from neural crest cells and can be found in the basal portion of the vaginal epidermis in 3% of normal adult females. Though malignant melanoma may occur anywhere in the vagina, it is most commonly found on the anterior wall and in the distal one-third. Vaginal bleeding is the most common symptom. Histochemical and immunohistochemical procedures confirm the initial diagnosis. Vaginal melanoma is a highly malignant disease; due to the extensive lymphatic invasion and melanoma's propensity for hematogeneous spread, so early metastases are very common. The treatment modalities for the primary management of vaginal melanoma are varied according to the location and extend, individually or in combination, wide local incision, radical surgical extirpation, irradiation, or chemotherapy. Although there have been no consensus as to comprehensive treatment, in the case of upper vaginal melanoma, radical abdominal hysterectomy with bilateral salpingo-oophorectomy with pelvic lymph node dissection is generally advocated. Regardless of primary therapy chosen, result of the treatment of vaginal melanoma has been uniformly poor. We experienced a case of malignant melanoma of the vagina confirmed pathohistologically after radical abdominal hysterectomy with bilateral salpingo-oophorectomy and presented with a brief review of literature.
Adult ; Consensus ; Diagnosis ; Drug Therapy ; Epidermis ; Female ; Humans ; Hysterectomy ; Lymph Node Excision ; Melanocytes ; Melanoma* ; Neoplasm Metastasis ; Neural Crest ; Uterine Hemorrhage ; Vagina*