We present a case of acquired tracheoesophageal fistula (TEF) which was found during induction of general anesthesia for clipping of aneurysm. The patient had been intubated with endotracheal tube for 10 days and then done tracheotomy for 45 days. Thereafter, TEF was confirmed by MRI and treated with fistula repair and tracheal fenestration. Acquired TEF can occur under the condition of prolonged tracheal intubation with high cuff pressure (>30 mmHg) and can also result from intratracheal neoplasm, mediastinitis, and other tracheal or esophageal damages. If unrecognized during anesthetic induction, TEF can cause gastric dilatation and rupture, pulmonary aspiration and respiratory failure. So early diagnosis and proper management is very important whenever TEF is suspected during anesthetic induction.
Anesthesia, General ; Aneurysm ; Early Diagnosis ; Fistula ; Gastric Dilatation ; Humans ; Intubation ; Magnetic Resonance Imaging ; Mediastinitis ; Respiratory Insufficiency ; Rupture ; Tracheoesophageal Fistula* ; Tracheotomy

Higenamine was isolated originally from Aconiti tuber from Aconitum species and recently Higenamine was synthesized. The purpose of this study is to investigate the adrenergic effect of Higenamine on rabbit cardiovascular system. Blood pressure, cardic output, systemic vascular resistance and heart rate were measured after intravenous injection of Higenamine(2-100microg/kg/min). The effects of Higenamine were compared with those of other sympathomimetic drugs. The changes in the cardiovascular systems after pretreatment with Propranolol, Atenolol and Hexamethonium were also studied. The following results were obtained. 1) Higenamine increased the cardic output and the heart rate and decreased the blood pressure and the systemic vascular resistance. Those changes were dose-dependent. The duration of action of Higenamine was 5 to 8 minutes. 2) The effects of Higenamine were similar to those of Isoproterenol. The amount of Higenamine was more than 100 times the required amount of Isoproterenol in order to obtain the same casdiovascular effects. 3) The effects of Higenamine were blocked by Propranolol, The increase of cardic output and heart rate were blocked by Hexamethonium. Higenamine has stimulating action on beta1 and beta2 receptors. But Higenamine is much less potent than Isoproterenol.
Aconitum ; Adrenergic Agents* ; Atenolol ; Blood Pressure ; Cardiovascular System* ; Heart Rate ; Hexamethonium ; Injections, Intravenous ; Isoproterenol ; Propranolol ; Sympathomimetics ; Vascular Resistance

One case of renal infarction due to trauma in a 26 years old male patient, which was treated with partial nephrectomy, was presented with the brief review of literature.
Adult ; Humans ; Infarction* ; Male ; Nephrectomy

No abstract available.
Mandibular Fractures ; Osteomyelitis ; Transplants

PURPOSE: To compare the efficacy of photodynamic therapy (PDT) depending on the degree of hyperfluorescence based on indocyanine green angiography (ICGA) for treating chronic central serous chorioretinopathy (CSC). METHODS: Twenty-three eyes of 23 patients with chronic CSC were recruited for the present study. The minimum follow-up period was six months. The total energy of PDT was reduced to 25 J/cm2 for 83 seconds. The baseline middle-phase ICGA findings were classified as intense or low hyperfluorescence depending on the degree of hyperpermeability from choriocapillaris. The change in mean best-corrected visual acuity, the resolution of subretinal fluid, recurrence rate, and complication were analyzed in relation to each ICGA finding at baseline. RESULTS: The baseline ICGA findings showed intense hyperfluorescence in 11 eyes (47.8%) and low hyperfluorescence in 12 eyes (52.2%). The subretinal fluid resolved completely one month after a single application of low-fluence PDT in both groups. The subretinal fluid recurred in one of 12 eyes (8.3%) with low hyperfluorescence and in no eyes (0%) with intense hyperfluorescence. There was no statistically significant difference in the rate of recurrence between the two groups. CONCLUSIONS: Low-fluence PDT appears to be an effective and safe treatment option for long-standing chronic CSC regardless of the degree of hyperfluorescence based on the ICGA.
Angiography ; Central Serous Chorioretinopathy ; Choroid ; Eye ; Follow-Up Studies ; Humans ; Indocyanine Green ; Photochemotherapy ; Recurrence ; Subretinal Fluid ; Triazenes ; Visual Acuity

No abstract available.

PURPOSE: With the development of bipolar device, which complement the weak points of conventional monopolar device, TURP became more appliable in large volume prostate. We evaluated the possibility and effectivity of bipolar TURP in large volume prostate by analysing treatment results. MATERIALS AND METHODS: Total 78 male patients who received bipolar TURP in our center between April 2004 and December 2006, were divided into two groups based on prostate volume (>75g = large volume prostate group, <75g = control group). We compared each of age, prostate volume, resection volume, operation time, IPSS, Qmax, change of serum Na+ & hemoglobin, and perioperative complications. RESULTS: There was no statistical difference between preoperative IPSS and postoperative IPSS between the both groups. In preoperative status, Qmax was statistically higher in small volumed prostate group. But, after bipolar TURP, Qmax of each group were significantly improved, and statistical difference between the two groups were disappeared. Patient age, prostate volume, resection weight, hemoglobin down, hospitalization day, catheterized duration were statistically higher in the large volume prostate group. But, in the clinical aspect, these differences were acceptable. Immediate postoperative hematuria and hypothermia were more frequent in large volume prostate group. Long term complication rates were almost the same in two groups, and there was no TUR syndrome in both groups. CONCLUSION: Transurethral resection of large volume prostate (>75g) using bipolar device is as effective as of general (<75g) prostate hyperplasia. Bipolar TURP can be another therapeutic option of large volume prostate, which in the past indicated open prostatectomy, to escape from higher surgical morbidity.
Catheters ; Complement System Proteins ; Hematuria ; Hospitalization ; Humans ; Hyperplasia ; Hypothermia ; Male ; Prostate* ; Prostatectomy ; Transurethral Resection of Prostate* ; United Nations

No abstract available.
Blood Transfusion, Autologous*

Many patients whose chief complaint is headache caused by accident such as traffic accident, falling, or assaults visit to emergency center. Majority of these patients has mild or moderate symptoms, and there is no need to treat surgically. However, the fact that head injury can cause SIADH(syndrome of inappropriate secretion of antidiuretic hormone) is likely to be overseen. Acute hyponatremia might have been associated with death or permanent brain damage. Hyponatremia is best handled by early recognition and correction of a downward trend in the serum sodium. Unfortunately, this is often difficult in the head-injured patient, where hyponatremia may occur fairly rapidly and is confused by symptoms of head injury. when moderate to severe hyponatremia occurs, it is important to determine its etiology and expeditiously initiate corrective action. There has not been any reported case of the occurrence of symptomatic SIADH after mild head injury in Korea yet. The authors report the experience of three cases of symptomatic SIADH after mild head injury with review of the literatures.
Accidents, Traffic ; Brain ; Craniocerebral Trauma* ; Emergencies ; Head* ; Headache ; Humans ; Hyponatremia* ; Inappropriate ADH Syndrome ; Korea ; Sodium

PURPOSE: The purpose of this study was to develop a computer decision making support system that enables nurses to utilize the computer in selecting the best decision for pain management for patients with dementia institutionalized in nursing homes. METHODS: To formulate the protocol for the management of patients' pain, the researcher analyzed content of interviews with 30 nurses in three nursing homes and an expert group. A decision support computer program was formalized based on existing protocols. To evaluate the effectiveness and applicability of the system, analysis of data on patient pain management and nurse satisfaction with the system were done after the formalized decision support computer program was complete. RESULTS: The decision support computer program for pain management for institutionalized patients with dementia was finalized after adjustments following the evaluation. Nurse satisfaction with the program was moderate. It also provided opportunity to reassess thinking about pain and pain management. CONCLUSIONS: The results indicate that this program provides nurses with useful knowledge for pain management in institutionalized patients with dementia and aids in decision making in nursing practice in nursing home.
Decision Making ; Dementia ; Humans ; Nursing Homes ; Pain Management ; Software ; Thinking