This is a case of an accidental prolonged tourniquet application on the lower extremity. A 31 year old, well developed male had an open reduction for a clavicle fracture and nerve graft of the injured arm. To obtain the nerve from the leg, a tourniquet was applied and remained on the right lower extremity for 4hours. Post-operatively, he developed severe edema with paralysis of that leg. Thereafter, progressively he had signs of acute tubularnecrosis with oliguria, myoglobinuria, elevation of BUN and creatinine, and finally pulmonary edema. He recovered graually from the renal failure, pulmonary edema and paralysis of the leg as he received intermittent peritoneal dialysis for renal failure and intensive respiratory care for pulmonary edema. He went home in good condition only with a slight residual sensory loss of the injured leg 90 days after his admission.
Adult ; Arm ; Clavicle ; Creatinine ; Edema ; Humans ; Leg* ; Lower Extremity ; Male ; Myoglobinuria ; Oliguria ; Paralysis* ; Peritoneal Dialysis ; Pulmonary Edema ; Renal Insufficiency* ; Tourniquets* ; Transplants

Rapid administration of solution containing dextroae results in marked hyperglycemia and osmotic diuresis hut a balanced electrolyte solution containing maltese does not increase blood sugar. 30 patients were chosen at random and divided into 3 groups j.e, one group received 5% dextrose in water, the second group received Hartmann solution and the third group, 5% maltose in a balanced electrolyte solution. The Patient's blood was collected in the operating room prior to the start l.V. infusion, for the measurement of blood sugar, insulin, osmolarity and electrolrtes in various conditions of N.P.O. Intravenous fluid was administered at a rate of 10 m1/kg/hour while anesthesia was induced and maintained with an endotracheal tube in place. Blood samples were taken one hour. 2 hours and 3 7ours f:on the time 1,V. infusion started, In the of 5% dextrose in water groups, the value of blood sugar and insulin was 88.5+/-12.1 mg% and 14.60+/-7.67 un/ml at NPO, 257.7+/-60.8mg% and 70.75+/-37.55 un/m1 at 1 hour, 298.8+/-84.4mg%: and 143.19+/-50.32 un/ml at 2 hours and 228.6+/-75.8% and 127.71+/-56.98 un/m1 at 3 hours. Although the b1ood sugar and insulin values increased markedly. but potassium and chloride were 4.74+/-0.55 mEq/l and 101.1+/-2.9 mEq/l and 4.11+/-0.31 mEq/l, 107.4+/-2.3 mEq/l and 3.75+/-0.41 mEq/l, 176.4+/-2.7mEq/l and 3.89+/-0.50mEq/l, 106.3+/-2.2 mEq/l and shoewed mild decrease, by the way, osmolarity and serum sodium did not changed. In contrast to the 5% dextrose in water groups, there are no changes in the blood glucose. insulin levels, osmolarity or and electrolrtes in the either Hartmann or Elitol (Elitol=5% maltose contained in a balanced electrolyte solution) groups. There was a slight increase in osmolarity with maltose but it was not significant. Accordingly it is concluded that rapid infusion of harmann or 5% maltose contained ina balanced electrolyte solution affects the blood sugar and insulin levels insignificantly compared to the dextrose cont5aining solution which increase the blood sugar and indulin levels markedly.
Anesthesia ; Blood Glucose* ; Diuresis ; Electrolytes* ; Glucose ; Humans ; Hyperglycemia ; Insulin* ; Maltose ; Operating Rooms ; Osmolar Concentration* ; Potassium ; Sodium ; Water

Pulmonary edema in surgical patients is known to be a complication resulting from various causative factors. We have analysed 10 cases observed in the Dong San Medical Center and 18 cases reported in the Journal of the Korean Society of Anesthesiologists in terms of sex, age, causing factor, onset, therapy etc. As a result of this study, the summary is as follows: 1) The most common causes of pulmonary edema in surgical patients were overloading, followed by heart failure, hypoalbuminemia, sepasis, severe trauma and unknown causes in that order. 2) Pulmonary edema can develop in any surgical patient without a direct realtionship to age, sex or type of peration. 3) The incidence tended to be higher in emergency patients than in elective patients because their general condition was worse and the surgical procedures were done in such haste. 4) The onset of pulmonary edema seems to occur commonly at the end of surgery, particularly when the patients were extubated and then followed by endotracheal suction because negative pressure is applled for suction as the positive pressure was removed for extubation. 5) Active therapy for pulmonary edema has been generally successful because of advanced respiratory care with various sophisticated respirators.
Emergencies ; Heart Failure ; Humans ; Hypoalbuminemia ; Incidence ; Pulmonary Edema* ; Suction ; Ventilators, Mechanical

Pelioid hepatocellular carcinoma (HCC), a type of atypical HCC, is a rare histologic type of HCC. The radiologic findings of the pelioid HCC is differ from the typical type of HCC. To our knowledge, this case report is the second literature to show the enhancing features of a pelioid HCC on dynamic computed tomography (CT). Here we describe the dynamic CT findings in a case of surgically confirmed pelioid HCC.
Carcinoma, Hepatocellular

No abstract available.
Byssinosis*

Gastric high-grade dysplasia is an important premalignant lesion in gastric epithelial cells and has a high possibility of transforming to adenocarcinoma. Therefore, biopsy-proven high-grade dysplasia should be treated with en bloc resection methods such as endoscopic mucosal resection or endoscopic submucosal dissection (ESD). We report the case of a 63-year-old male patient, diagnosed with gastric high-grade dysplasia at the angle and lesser curvature side of the lower body. The patient was initially treated with ESD, although histopathology subsequently showed horizontal margin involvement. Since the lesion was diffusely edematous and margins were uncertain because of the previous ESD treatment, we chose to treat the patient with laparoscopy-assisted endoscopic full-thickness resection (EFTR). EFTR is a recently developed procedure, which uses both endoscopic and laparoscopic techniques to resect the full-thickness of the tissue. The final pathologic report revealed high-grade dysplasia and a focal intramucosal carcinoma of 0.8x0.7 cm. We conclude that EFTR can be an effective alternative treatment in gastric high-grade dysplasia unsuitable for ESD.
Adenocarcinoma ; Epithelial Cells ; Humans ; Male ; Middle Aged

The authors experienced a case of myoglobinuria accompanied by generalized myalgia and mild fever that developed 3 hours 30 minutes after general anesthesia. Tracheal intubation was done smoothly 5 minutes after injection of thiopental sodium(275 mg) and pancuronium bromide(6 mg), and anesthesia was maintained with ethrane/N2O/O2(1.5-2%/21/21/min). There was no specific event except tachycardia and fluctuation of blood pressure throughout operation. In this case, we assume that the myoglobinuria is a presentation of the sign of an abortive type of malignant hyperthermia. However, it was not confirmed. We had good patient outeome with the supportive measures of hydration and diuresis. The patient was discharged twenty three days after operation without any complication.
Anesthesia ; Anesthesia, General* ; Blood Pressure ; Diuresis ; Fever ; Humans ; Intubation ; Malignant Hyperthermia ; Myalgia ; Myoglobinuria* ; Pancuronium ; Tachycardia ; Thiopental

BACKGROUND/AIMS: Acute exacerbation (AE) of chronic hepatitis B (CHB) can occur spontaneously, and may be followed by HBeAg clearance. HBeAg seroconversion often coincides with the normalization of liver biochemical tests and clinical remission. The purpose of this study was to identify the etiology and the clinical consequence of severe AE in Korean patients with CHB. METHODS: The medical records of CHB patients with severe AE (defined by the sudden increase of ALT above 400 IU/L) who were admitted to Kyung Hee University Hospital between January 1992 and December 2001, were reviewed retrospectively. Forty-four patients were included in the severe AE group. RESULTS: The most common etiology of severe AE was spontaneous exacerbation (77%). Drugs (16%), alcohol (5%), and HCV coinfection (2%) were suspected of causing AE in the remaining patients. HBeAg seroconversion at 12, 18, and 24 months following severe spontaneous AE was 18.5%, 40.7%, and 48.1%, respectively. These were significantly higher compared to CHB patients without AE (4.3%, 4.3%, and 10.9%, respectively). Seroconversion within 3 months, however, occurred in only 15% of CHB patients with AE. There was a tendency to progress to liver cirrhosis more frequently in the patients with AE as compared to the patients without AE (17.6% vs. 5.5%, P<0.08). CONCLUSIONS: Severe AE in patients with CHB is mainly caused by spontaneous exacerbation. Although HBeAg seroconversion occurs frequently in these patients, the rates are relatively low compared to those reported in other countries and early seroconversion is expected only in a small proportion. Further studies will be warranted to determine the efficacy of the early use of antiviral agents at the time of AE.
Acute Disease ; Adult ; Alanine Transaminase/blood ; English Abstract ; Female ; Hepatitis B e Antigens/blood ; Hepatitis B, Chronic/*complications/diagnosis/virology ; Humans ; Male ; Middle Aged

A 53-year-old woman was admitted with epigastric discomfort and weakness. Laboratory examination at admission showed mild anemia and proteinuria. Esophagogastroduodenoscopy revealed marked mucosal atrophy, diffuse nodularity and granular appearance with mucosal friability. Biopsy was performed on the antrum and body of the stomach. On the next day, the patient began to complain of severe dyspnea, and hypoxia was present on pulse oximetry. Therefore, emergency echocardiography was conducted and it showed restrictive cardiomyopathy along with thrombus in the left atrium. With time, heart failure was aggravated despite intensive management. The result of gastric biopsy revealed amyloid deposits which stained positively with Congo red. On immunohistochemistry study, kappa and lambda chain were present. In addition, kappa chain was significantly elevated in urine and serum on electrophoresis. Although the patient was finally diagnosed as having primary gastric amyloidosis with restrictive cardiomyopathy, her general condition rapidly deteriorated and died at 12th hospital day. When obscure gastric lesion is encountered, performing gastric biopsy is strongly recommended since it be primary gastric amyloidosis. Herein, we present an unusual case of primary gastric amyloidosis.
Amyloidosis/complications/*diagnosis/pathology ; Endoscopy, Digestive System ; Female ; Heart Atria/diagnostic imaging ; Heart Failure/complications/*diagnosis ; Humans ; Immunoglobulin kappa-Chains/blood/urine ; Immunoglobulin lambda-Chains/blood/urine ; Immunohistochemistry ; Magnetic Resonance Imaging ; Middle Aged ; Stomach Diseases/complications/*diagnosis/pathology ; Thrombosis/diagnosis/diagnostic imaging ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUND: There are some studies concerning fasting insulin and insulin resistance in normal healthy Korean adults, but none exists especially for adolescence. Therefore, we investigateck insulin resistance and its related factors in adolescence. METHODS: We analyzed 582 10th grade high school students. Height, weight, abdominal circumference, systolic and diastolic blood pressure, fasting glucose, total cholesterol, hemoglobin were measured. Fasting state and parent's and student's previous medical history were guestioned. We used Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) as an indicator of insulin resistance. RESULTS: By HOMA-IR 2.15, the subjects were divided into the insulin sensitive and the resistant groups. Two groups showed significant differences in body mass index, systolic diastolic blood pressure, fasting glucose, fasting insulin, total cholesterol and abdominal circumference (P <0.05). HOMA-IR was strongly related to the body mass index (r=0.53) and abdominal circumference (r=0.52), but weakly related to the total cholesterol (r= 0.20). According to logistic regression analysis of HOMA-IR, the odds ratio of the body mass index was 1.17 and that of abdominal circumference was 1.06 (P <0.05). CONCLUSION: HOMA-IR showed strong relationship with body mass index, abdominal circumference, but showed weak relationship with total cholesterol. There was no significant correlation with the parent's diabetic medical history. Therefore we conclude that in adolescence the body mass index or the abdominal circumference is far more important factor than the parent's diabetic history.
Adolescent* ; Adult ; Blood Pressure ; Body Mass Index ; Cholesterol ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin Resistance* ; Insulin* ; Logistic Models ; Odds Ratio ; Seoul*