Transcranial cerebral oximetry has been successfully used in a variety of neurosurgical conditions, primarily those associated with disturbed cerebral circulation. It has been also used in intraoperative monitoring of aortic dissection and surgical procedures performed under deep hypothermia and circulatory arrest. During disending aortic arch exposure, sudden cerebral oxygen saturation change from 63% to 48% was detected. After therapeutic bypass, cerebral oxygen saturation was increased to 65%. During aortic arch repair, deep hypothermic circulatory arrest with retrograde cerebral perfusion was applied for 130 min and cerebral oxygen saturation slowly decreased from 65% to 52%. Patient was discharged from hospital without neurologic complication and cognitive funtion disturbance.
Aorta, Thoracic ; Circulatory Arrest, Deep Hypothermia Induced ; Humans ; Hypothermia ; Monitoring, Intraoperative ; Oximetry ; Oxygen* ; Perfusion

BACKGROUND: Epidural morphine has side effects, especially pruritus, nausea, and vomiting. Butorphanol has been added in studies to reduce these side effects in post cesarean patients. The purpose of this study was to evaluate the side effects and analgesic efficacy when a combination of epidural morphine and butorphanol was administered in patients having combined local anesthetic and opioid epidural infusion. METHODS: Sixty patients having epidural anesthesia for cesarean section were randomly divided into two groups. Group M (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and saline 0.75 ml, whereas group B (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and butorphanol 1.5 mg (0.75 ml). Continuous epidural infusion was done by Two-day Infusor containing either 0.25% bupivacaine 75 ml, morphine 5 mg, and saline 20 ml in group M or 0.25% bupivacaine 75 ml, morphine 5 mg, butorphanol 4 mg (2 ml), and saline 18 ml in group B. We compared the side effect and analgesic effect of group M to those of group B for 2 days. RESULTS: The incidence of pruritus and vomiting were reduced significantly in group B (p<0.05). There were no significant differences between both groups in the incidence of nausea or other side effects as well as no differences in analgesic effect. CONCLUSIONS: We conclude that the addition of butorphanol to morphine in combined local anesthetic and opioid epidural infusion for postoperative analgesia decreases the occurrence of pruritus and vomiting without significant increase of other side effects and adverse effect on analgesia.
Analgesia ; Anesthesia, Epidural ; Bupivacaine ; Butorphanol* ; Cesarean Section* ; Female ; Humans ; Incidence ; Infusion Pumps ; Morphine* ; Nausea ; Pregnancy ; Pruritus ; Vomiting

This experiment was designed to investigate the histochemical and ultrastructural changes of the proximal tubules and glomeruli of rabbits treated with cyclosporin A (CsA) or cyclosporin A and concomitant administration of prednisolone (PD). Rabbits were given with CsA for 1 week (CsAlW) and for 2 weeks (CsA2W) and CsA plus PD for 1 week (CsA +PDIW) and for 2 weeks (CsA+PD2W). The dose of CsA was 5mg/kg/day i.v. and PD was 1 mg/kg/day i.m. At 1 week and 2 weeks after the treatments, the following items were studied of alkaline phosphatase (ALPase). peroxidase, 5'-nucleotidase (SNU) with the ultrastructural enzymatic changes and electron microscopic changes. CsAlW, CsA2W and CsA +PD2W groups showed a decrease of ALPase activity and CsA+PD2W and CsA2W groups showed weakly increased peroxidase activity CsA2W and CsA+PD2W showed a decrease of 5NU activity. Ultrastructural changes of CsAlW CsA2W and CsA+PD2W groups revealed swollen and disrupted mitochondria, loss of brush border in the proximal tubules and thickening of basement membranes, edematous podocytes and fusion of root processes of podocytes in the glomeruli showing the early stage of nephrotoxicity. The concomitant treatment of PD with CsA eased the nephrotoxicity of CsA within 1 week after the treatment.
5'-Nucleotidase ; Alkaline Phosphatase ; Basement Membrane ; Cyclosporine* ; Kidney* ; Microvilli ; Mitochondria ; Peroxidase ; Podocytes ; Prednisolone* ; Rabbits

Since 1967 the STA-MCA anastomosis has been popular procedure in neurosurgical operation. The meurosurgical teams at St. Paul's Hospital, Catholic Medical College, recently operated on 8 patients employing 9 times of this technique. The patients were diagnosed as four patients with complete stroke, one with traumatic middle cerebral stenosis, two with moyamoya disease, and one with huge aneurysm at intracavernous portion of ICA. The results were very encouraging of the 8 patients, 7 had favorably improved clinically, and proved by follow-up cerebral angiographies, CT Scanning, EEG or MEP recordings. The remaining one patient had intracerebral and intracerebellar hematoma, two months later after discharge, thus the result was poor. The authors would like to share with you their experiences employing the STA-MCA anastomosis technique, indications the results and the prognosis.
Aneurysm ; Cerebral Angiography ; Constriction, Pathologic ; Electroencephalography ; Follow-Up Studies ; Hematoma ; Humans ; Moyamoya Disease ; Prognosis ; Stroke ; Tomography, X-Ray Computed

Total hip replacement for adults with severe acetabular dysplasia presents a difficult problem because deficient bone stock and soft tissue contractures usually prevent sitting at the normal anatomic level. The rationales of high hip center are due to high failure rate of bulk structural weight bearing graft, good short-term result of hemispherical cementless acetabular component in revision surgery, high hip center but not lateral which does not adversely affect the biomechanics of the hip, and intimate apposition with viable host bone. We represented the short-term results of 21 total hip replacements with proximal placement of the acetabular cup than the anatomical position that is normally used. The mean duration of follow up was 18 months(range, 12-58 months) and the mean age of the patient was fifty-one years(range, thirty to sixty-seven years). Most of these hips had a major deficiency or defect of the acetabular bone stock. They had an aver- age Harris hip score of 47 points preoperatively and 90 points postoperatively. Roentgenographic measurements showed that the mean change in the height of the center of the hip postoperatively was only +6.6 millimeters and the mean change of horizontal location of them was 10 millimeters medial to the preoperative position. Postoperative complications included calcar fracture(1 case), trochanteric bursitis(1 case), postop- erative dislocation(1 case) and one case of radiological loosening of the acetabular component. The center of the hip in THR is not a crucial parameter with regard to the long-term stability of acetabular component, so our recommendation is to place the acetabular component at a more proximal but not lateral position if strong bone stock is available. But future studies of high hip center need to address femoral component longevity.
Acetabulum ; Adult ; Arthroplasty, Replacement, Hip ; Contracture ; Femur ; Follow-Up Studies ; Hip Joint ; Hip ; Humans ; Longevity ; Osteoarthritis ; Postoperative Complications ; Transplants ; Weight-Bearing

PURPOSE: To evaluate the efficacy and safety of 5-0 prolene ligation around the Ahmed glaucoma valve tube to prevent the postoperative hypotony and flat anterior chamber. METHODS: Medical records of twenty one eyes of 20 patients those had got Ahmed valve implant surgery with temporary ligation of the tube with 5-0 prolene were retrospectively evaluated for efficacy of the pressure control and complications before and after the remove of the ligation suture. RESULTS: Preoperative intraocular pressure(IOP) was 46.1+/-9.1 mmHg. The ligation suture was removed at 2.8+/-1.5 postoperative day. Postoperative IOP before the removal of the suture was 24.8+/-15.4 mmHg at the day of removal. After removal of the ligation suture, the IOP decreased to 15.6+/-5.9 mmHg and 12.2+/-4.2 mmHg at one day and 12 weeks after the removal respectively. Complications before the removal of the ligation suture were mild hyphema and corneal edema, developed in one eye each. After the removal, shallow anterior chamber and choroidal detachment was developed in one eye. CONCLUSIONS: Although the efficacy of the temporary ligation of the tube in Ahmed valve implant surgery in controlling the IOP was similar to that of conventional Ahmed valve implant surgery without ligation, the early postoperative complications associated with the overfiltration appeared to be less frequent than conventional Ahmed valve implant surgery.
Anterior Chamber ; Choroid ; Corneal Edema ; Glaucoma* ; Humans ; Hyphema ; Ligation* ; Medical Records ; Polypropylenes* ; Postoperative Complications ; Retrospective Studies ; Sutures

PURPOSE: Even though the incidence of colorectal cancer (CRC) has increased in Korea, the colorectal cancer screening (CRCS) is lower than that of other cancer screenings. The purpose of this study was to identify CRCS rate and to predict factors in blue-color workers. METHODS: A descriptive survey design was employed. Data were collected with 327 workers, recruited from 32 companies, aged 40 and over using questionnaire from August 2010 to January 2011. Collected information included CRCS, demographic characteristics, job characteristics, health behaviors, and interpersonal relationship. The definition of CRCS included fecal occult blood test (FOBT), colonoscopy, or double contrast barium enema (DCBE). RESULTS: Among 94 workers receiving CRCS, workers having FOBT were 37, colonoscopy were 28, and DCBE was 6 in the past. Workers who aged over 50 (OR=2.30, 95% CI=1.11-4.77), middle school educated (OR=0.30, 95% CI=0.14-0.65), less working hours (OR=0.98, 95% CI=0.96-0.99), and had family members who carried out regular cancer screening (OR=1.89, 95% CI=1.01-3.55) were more likely to perform CRCS. CONCLUSION: The findings suggest that the information and notice about CRCS to increase screening uptake, providing the accessible screening method, and involving company administrators or health managers might be useful to increase the CRCS rate in workers.
Administrative Personnel ; Aged ; Barium ; Calcium Hydroxide ; Colonoscopy ; Colorectal Neoplasms ; Early Detection of Cancer ; Enema ; Health Behavior ; Humans ; Incidence ; Korea ; Mass Screening ; Occult Blood ; Zinc Oxide ; Surveys and Questionnaires

To detect the cardiac source of embolism in patient of ischemic stroke of uncertain etiology, biplane transesophageal echocardiography and contrast echocardiography with hand-agitated saline were performed 27 patients(sixteen men and eleven women) of transient ischemic attack and cerebral infarction without definitive cardiac symptom and sign. Transesophageal echocardiography showed potential sources of embolism in nineteen patients (70.4%) including atrial septal aneurysm(n = 9, three of them had patent foramen ovale), spontaneous contrast echo(n = 3), mitral valve prolapse(n= 1), unknown thickening of the tip of the mitral valve(n = 1) and atherosclerotic plaque in descending aorta(n = 7). Thus transesophageal echocardiography and contrast echocardiography identify potential cardiac source of embolism, and provide the rationale of the thrombolytic and anticoagulant therapy in patients with ischemic stroke without obvious cardiac disease.
Cerebral Infarction ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Heart Diseases ; Humans ; Ischemic Attack, Transient ; Male ; Mitral Valve ; Plaque, Atherosclerotic ; Stroke

BACKGROUND: Pressure damage to respiratory mucosa from overinflation of bronchial cuffs has been implicated as a cause of bronchial rupture, a rare but devastating complication of double-lumen endobronchial tubes. We evaluated the severity of bronchial mucosal damage by bronchial cuff pressure in Robertshaw double-lumen endobronchial tubes. METHODS: Eighteen patients were divided into two groups: in group 1(n=9), bronchial cuff pressure was maintained by 25 mmHg; in group 2(n=9), bronchial cuff pressure was maintained by 35 mmHg during one-lung ventilation. We evaluated the bronchial mucosa by using fiberoptic bronchoscopy before bronchial intubation and following extubation. According to the number of petechia and mucosal hemorrage or tearing, damage scoring was performed. RESULTS: Damage scores of Group 1 are represented by 0(normal mucosa) in number of 3 patients, 1 (small number of petechia) in 2 patients, 2 (large number of petechia) in 3 patients, 3 (mucosal hemorrhage) in 1 patient and above score 4 (mucosal tearing) was not existed. Scores of Group 2 are represented by 0 in number of 1 patient, 1 in 3 patients, 2 in 4 patients, 3 in 1 patient and above score 4 was not existed. CONCLUSION: Degree of bronchial mucosal damage was not related with the bronchial cuff pressure of double lumen tubes.
Bronchoscopy ; Humans ; Intubation ; Lung ; Mucous Membrane ; One-Lung Ventilation ; Respiratory Mucosa ; Rupture

No abstract available.
Nephritis, Interstitial* ; Yersinia pseudotuberculosis* ; Yersinia*