The neuromuacular blocking effects of the repeated bolus injection and continuous injection of vecuronium have been compared in 20 patients by means of evoked twitch tension. Group I received a loading dose (0.08 mg/kg) of vecuronium and followed by maintenance doae (0.02 mg/kg) when twitch tension had recovered to 25% of control. Group II received a loading doses (0. 08mg/kg) of vecuronium plus a continuous infusion delivering 0.06 mg/kg/hr. Anesthesia was maintained with nitrous oxide, oxygen and 1.5% enflurane. The neuromuscular blocking effect were reversed by the neostigmine 1.0 mg and robinul 0.2 mg when twitch tension had recovered 25% control in both groups near the end of operation. With repeated injection of vecuronium (group I), the duration of blockade of 25% recovery was 21.6+/-4.2 minutes and the recovery times from 25% to 75% was 6.8+/-1.9 minutes The continuous infusion of vecuronium (group II) produced consistent neuromuscular blockade at the average level of 90% twitch depression. The times from the end of infusion to 25% and fr,om 25% to 75% are averaged 16.0+/-2.5 and 4.2+/-0.7 minutes respectively. The reeovery index was more rapid in infusion group than maintenance group (P<0.05).
Anesthesia ; Depression ; Enflurane ; Humans ; Neostigmine ; Neuromuscular Blockade ; Nitrous Oxide ; Oxygen ; Vecuronium Bromide*

Pulmonary comp1ications following surgery continue to be a major cruse of postoperative mobidity. The purpose of this study was to measure the effects of various surgical procedures upon arterial blood gas tension and ventilatory function in the early postoperative period. 30 patients with no history of cardiopulmonary disease before surgery were selectively chosen and divided into 4 categories depending on the location of the operative incision and the type of anesthesia. Group l was composed of upper abdominal incision cases, Group ll lower abdominal incision cases, and Groups lll and lV had nonabdominal surgery. Groups, l, ll and lll received general anesthesia, while lV was liven spinal anesthesia. Lung volumes were measured and blood samples were taken preoperatively and 70 minutes after surgery. Patients were maintained in semisitting position before and after surgery. Vital capacities were significantly reduced in the postoperative period in the general ane- sthesia groups, and tidal volumes were significantly reduced in the upper and lower abdominal incision groups. The mean PaO2 value after anesthesia decreased significantly in the upper and lower abdominal incision groups, but there were no significant differencea in the PaCO2 value. It seems that supplemental oxygen and encouragement of deep inspirations are essential and beneficial in the early postoperative period, especially for the patients with abdominal surgery.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal ; Humans ; Lung ; Oxygen ; Postoperative Period ; Tidal Volume ; Vital Capacity

This study was undertaken to observe whether an adult ventilator with a preset volume could be used as a controlled ventrolled ventilator far pediatric anesthesia. 35 Patients ranging in age from 3months to 7 years were divided into two groups based on body weight(Group 1: 5~10kg, 14 cases, Group 2: 11~15kg, 21 cases) and anesthetized with halothane-N2O/O2 - pancuronium using the Mapleson B system. Immediately after induction, the reservoir bay of the Mapleson B system was replaced by the reservoir tube of the adult ventilator (MCM 801). Arterial blood gas studies 30 and 60 minutes after induction were performed, and the data from group 1 was compared with that of group 2. The magnitude of PCO2 increase 30 minutes after induction was not significantly different from that at 60 minutes(p>0.05), and alterations of PCO2 in group 1 were not stati-stically significant with group 2 (P>0.05). In conclusion, it is suggested that the Mapleson B system attached to adult ventilator is an useful and convenient device for controlled ventilation in pediatric patients.
Adult ; Anesthesia ; Bays ; Humans ; Pancuronium ; Ventilation* ; Ventilators, Mechanical

We prospectively studied the clinical effect of intravenous bupivacaine for regional anes-thesia in the lower & upper extremities in sixty consecutive patient from September, 1985 to truly 1986. 0.2% bupivacaine was used and dosage was varied between 1.0mg/kg and 2.5mg/kg. according to the 7ype of surgery, site, body weight and the size of the limb. The amount of bupivaeaine required was rather depend upon the size of the limb thats the patient's body weight. The effect of the anesthesia for a variety of extremity procedures was rated as exoellent, good or fair in 98.3% of the patient.
Anesthesia ; Body Weight ; Bupivacaine* ; Extremities ; Humans ; Prospective Studies ; Upper Extremity

External fixation was improved in its material, design and techniques as a specific method of open fracture treatment. Seventy-three, tibial open fracture, patients were treated with external fixator in Korea Veterans Hospital from January 1983 to April 1988. Each fixation method was divided into two types;one-plane unilateral frame and one-plane bilateral frame. 1. The duration of external fixation was 14.3 weeks in averge, 15.4 weeks in one plane unilateral frame and 13.2 weeks in one plane bilateral frame. 2. Secondary operation for bony union was performed 19 cases in one plane unilateral frame and 8 cases in one plane bilateral frame. 3. The union time was 23.6 weeks in average, 26.8 weeks in one plane unilateral frame and 21.4 weeks in one plane bilateral frame. 4. The common complications were delayed union and nonunion (7 cases) and pin tract infection (5 cases) in one plane unilateral frame, and pin tract infection ( 9 cases), joint stiffness (4 cases) and delayed union and nonunion (3 cases) in one plane bilateral frame. 5. External fixation gave rigid fixation and easy wound access, but did not give excellent bony union. 6. One plane bilateral frame showed more or less better result than one plane unilateral frame except some complications.
External Fixators ; Fractures, Open ; Hospitals, Veterans ; Humans ; Joints ; Korea ; Methods ; Wounds and Injuries

The incidence of the tuberculosis infection has decreased worldwide, but it is still easy to find the patients in some areas or some races. And it is very difficult to diagnose and treat the patients who are infected by the atypical tuberculosis. Facial skin infection by atypical tuberculosis has not been reported. We report the case of a 62-year-old woman who developed facial skin and soft tissue necrosis caused by Mycobacterium abscessus after receiving liquid silicone injections and face lift operation. We cultured the pathogenic organism and treated the wound with radical curettage, debridement, skin graft and tuberculosis medication.
Continental Population Groups ; Curettage ; Debridement ; Female ; Humans ; Incidence ; Middle Aged ; Mycobacterium* ; Necrosis ; Rhytidoplasty ; Silicones ; Skin* ; Transplants ; Tuberculosis ; Tuberculosis, Cutaneous* ; Wounds and Injuries

This study was performed to report psychosocial aspects of breast reconstruction patients through the prospective analysis. Total 35 patients who underwent reconstruction with free TRAM flap were surveyed from October, 1999 to January, 2003. Patients were surveyed by questionnaires both before reconstruction and 1 year after reconstruction. These questionnaires consisted of 6 parts. The delayed reconstruction group had more expectations about the operation than the immediate reconstruction group. Preoperative body image of the delayed reconstruction group showed more negative aspects than the immediate reconstruction group, which means that the reconstruction of breast helps the patient's body image change in a positive way. Psychological status was improved in both groups in terms of somatization, obsessive-compulsive, depression and anxieties. The satisfaction of the operation was higher in delayed reconstruction group than in the immediate reconstruction group in subjective evaluation. Regarding the quality of life, physical health domain was improved after reconstruction in the immediate group. On the other hand, not only physical health domain but also psychological domain and social relationships domains were improved in the delayed group. To sum up, results of this study show differences between both groups according to the reconstructive time. Nevertheless, in both breast reconstruction groups the body image, psychological state, and quality of life were improved. This study reports that breast reconstruction contributes to improve psychosocial aspects as well as to correct physical deformity.
Anxiety ; Body Image ; Breast* ; Congenital Abnormalities ; Depression ; Female ; Hand ; Humans ; Mammaplasty* ; Prospective Studies* ; Quality of Life ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Dobutamine stress echocardiography (DSE) with 2D echocardiography (2DE) is one of the time-consuming procedures in the diagnosis of coronary artery disease (CAD). Moreover, the accuracy of DSE with 2DE depends on the operator's skill or bias during the image acquisition. This study was conducted to determine the feasibility and accuracy of DSE with real-time 3D echocardiography (RT3DE) for the diagnosis of CAD. SUBJECT AND METHODS: 62 patients (RT3DE: 36, 2DE: 26), suspected of angina pectoris and post-revascularization ischemia, underwent DSE and coronary angiography (CAG). Image acquisition was performed at the baseline, and at 4 times during the dobutamine infusion and recovery stages. The procedure time (from the baseline to the end of the peak dose stage) was recorded. Off-line analyses of the volumetric images acquired with RT3DE were performed using 3D computer software (TomTec, Co.). Digitized quad-screen images acquired with 2DE were analyzed using the 2DE review system (ProSolv 4.0). >50% luminal diameter stenosis of any coronary artery on CAG was defined as significant coronary artery stenosis. RESULTS: The procedure time of DSE with RT3DE was significantly shorter than that of DSE with 2DE (25+/-4 vs. 37+/-4 mins, p<0.001). There was no significant difference in the sensitivity (p>0.05) or specificity (p>0.05) between the two procedures. CONCLUSION: DSE with RT3DE seems to be a feasible and less time consuming diagnostic procedure, probably providing comparable sensitivity and specificity for the detection of coronary artery stenosis, than DSE with 2DE.
Angina Pectoris ; Bias (Epidemiology) ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis* ; Dobutamine* ; Echocardiography* ; Echocardiography, Stress* ; Echocardiography, Three-Dimensional* ; Humans ; Ischemia ; Phenobarbital ; Sensitivity and Specificity

The purpose of this study is to assess abdominal sensation after free TRAM flap for breast reconstruction. 74 patients underwent breast reconstruction with free TRAM flap by authors and were followed up to check the sensation on abdomen following the surgery at the out patient clinic. They are compared with 20 female volunteer controls. Abdomens were divided into 13 zones, and assessed for superficial touch, superficial pain, temperature, two-point discrimination, and vibration. For all five sensory modalities, subjects were found to have decreased sensation in the umbilical and infraumbilical regions. This was statistically significant compared with controls. Division following pedicle dissection showed more reduction of sensation than non-dissection side. Both Inguinal areas below the donor site closure also showed markedly decreased sensation. Sensation on most area of abdomen recovered in postoperative 1 year, however, there were remained hypoesthesia in umbilical and infraumbilical area after post operative 1 year. This study clearly demonstrates that there is a significant and persistent reduction in abdominal sensibility following free TRAM flap surgery.
Abdomen* ; Breast* ; Discrimination (Psychology) ; Female ; Humans ; Hypesthesia ; Mammaplasty* ; Sensation ; Tissue Donors ; Vibration ; Volunteers

Blow-in orbit fracture is relatively rare fracture which is an inward displacement of the orbital rim or wall fragment, resulting in decreased orbital volume. The objective of this article is to analyze blow-in fracture status of orbit and to suggest appropriate management in this unusual fracture. The study included 23 cases who had treatment of blow-in fractures of orbit from July, 1995 to June, 2001. Their ages ranged from 4 years to 63 years. There were 17 males and 6 females. The diagnosis of blow-in fracture was accomplished with physical examination, ophthalmologic examination, plain X-ray, and facial CT scan. According to Antonyshyn's classification, we classified them into 2 large groups which were pure type and impure type. Pure type blow-in fractures are relatively uncommon and 5 cases were documented in a series of 23 patients. Impure type fractures included the orbital rim and 18 cases were documented. Clinical symptoms of blow-in fractures were proptosis, limitation of eyeball movement, diplopia, blepharoptosis, subconjunctival hemorrage and blindness. 2 patients with globe rupture and blindness underwent enucleation due to direct injury by bony segment. We conclude that early and appropriate surgical treatment with complete examination is very important to prevent blepharoptosis, proptosis, limitation of eyeball movement and optic nerve compression. However, when globe rupture and blindness by direct injury of bony segment happened, the operation of enucleation was needed in this particular case.
Blepharoptosis ; Blindness ; Classification ; Diagnosis ; Diplopia ; Exophthalmos ; Female ; Humans ; Male ; Optic Nerve ; Orbit* ; Physical Examination ; Rupture ; Tomography, X-Ray Computed