No abstract available.
Anemia* ; Chromatids* ; Humans ; Siblings*

The shortage of available organ donors is a significant problem and various efforts have been made to avoid the loss of organ donors. Among these, extracorporeal membrane oxygenation (ECMO) has been introduced to help support and manage potential donors. Many traumatic brain injury patients have healthy organs that might be eligible for donation for transplantation. However, the condition of a donor with a fatal brain injury may rapidly deteriorate prior to brain death determination; this frequently results in the loss of eligible donors. Here, we report the use of venoarterial ECMO to support a potential donor with a fatal brain injury before brain death determination, and thereby preserve donor organs. The patient successfully donated his liver and kidneys after brain death determination.
Brain Death* ; Brain Injuries* ; Brain* ; Extracorporeal Membrane Oxygenation* ; Humans ; Kidney ; Liver ; Tissue and Organ Procurement ; Tissue Donors*

The shortage of available organ donors is a significant problem and various efforts have been made to avoid the loss of organ donors. Among these, extracorporeal membrane oxygenation (ECMO) has been introduced to help support and manage potential donors. Many traumatic brain injury patients have healthy organs that might be eligible for donation for transplantation. However, the condition of a donor with a fatal brain injury may rapidly deteriorate prior to brain death determination; this frequently results in the loss of eligible donors. Here, we report the use of venoarterial ECMO to support a potential donor with a fatal brain injury before brain death determination, and thereby preserve donor organs. The patient successfully donated his liver and kidneys after brain death determination.
Brain Death ; Brain Injuries ; Brain ; Extracorporeal Membrane Oxygenation ; Humans ; Kidney ; Liver ; Tissue and Organ Procurement ; Tissue Donors

Fibrolipoma is an uncommon variant of lipomas which shows a distinct pathologic findings with both component of mature adipose cells and broad bands of dense fibrous connective tissue. A 30-year-old woman developed an 5×7cm sized, indurated, ill-defined, subcutaneous mass on the right axilla. Microscopically, the tumor contained broad bands of dense connective tissue with mature adipose tissue scattered throughout the mass, but it did not show encapsulation. The lesion was excised and she showed no evidence of recurrence after 6 months of follow-up.
Adipose Tissue ; Adult ; Axilla ; Connective Tissue ; Female ; Follow-Up Studies ; Humans ; Lipoma ; Recurrence

PURPOSE: We evaluated the efficacy and safety of a tension free vaginal tape (TVT) procedure for the treatment of stress urinary incontinence in women. MATERIALS AND METHODS: Forty-one women (32 with genuine stress urinary incontinence and 9 with mixed urinary incontinence) underwent a TVT procedure under spinal, epidural or general anesthesia. Three women experienced previously failed anti-incontinence surgery and nine women experienced previous pelvic surgery. The mean follow-up period was 17.1 0.4 months. RESULTS: The mean operation time was 31.8 1.2 minutes and mean hospital stay was 1.7 0.2 days. There were no significant intra- and postoperative complication. Four patients (9.8%) had immediate postoperative voiding difficulties necessitating an extra procedure (cutting or release of the tape) under local anesthesia. Six patients (14.6%) with de novo detrusor instability were improved by anticholinergics medication and release of the tape. Six (66.7%) of 9 women with urge incontinence were significantly improved or cured after surgery. Success rate was 97.6% in postoperative 3 months, 95.1% in postoperative 12 months. The patients satisfied with this procedure were 38 (92.7%) in postoperative 3 months and 37 (90.2%) in postoperative 12 months. There were no significant changes in the postoperative outcome over time. CONCLUSIONS: We consider the TVT procedure is a safe and effective surgical procedure for the treatment of female stress urinary incontinence, though longer follow-up is necessary to determine long term effect.
Anesthesia, General ; Anesthesia, Local ; Cholinergic Antagonists ; Female* ; Follow-Up Studies* ; Humans ; Length of Stay ; Postoperative Complications ; Suburethral Slings* ; Urinary Incontinence* ; Urinary Incontinence, Urge

PURPOSE: This study was intended to evaluate the positional relationship between the hyoid bone and the mandible in patients with mandibular protrusion after mandibular set-back surgery by means of 3D-CT. MATERIALS AND METHODS: Preoperative(3 weeks before) and postoperative (6 weeks after) 3D-CT and cephalogram were taken on 32 patients(12 male, 20 female, mean age of 23.2) treated by bilateral sagittal split osteotomy with rigid fixation. The angular measurement on 3D-CT basilar view were deviation of Me and H, long axis angle of left and right cornu majus. The lineal measurement on 3D-CT basilar view were composed of intercondylar line and coordinates(x,y) of Me and H. The angular and lineal measurement of lateral cephalogram were composed of mandibular plane angle, SNA, SNB, ANB, FH-NA and FH-NB, and coordinates(x,y) of B, Pog, Me and H, PAS, Lpw, MPH and IAS. On the frontal cephalogram, deviation of Me were evaluated. RESULTS: The mean mandibular set-back was 8.0mm horizontally and mandibular plane angle was slightly increased. The hyoid bone was displaced postero-inferiorly, the distance between MP(mandibular plane) and H(hyoid bone) was increased and the posterior airway space values (PAS, Lpw, IAS) were decreased. The coordinates Me(x,y), H(x,y) and deviation angle Me' and H'were revealed the strong positive correlation. CONCLUSION: The results revealed that the horizontal, vertical and transverse relationship of the mandibular and the hyoid bone movements were significantly correlated in patients performed mandibular set-back surgery.
Axis, Cervical Vertebra ; Female ; Humans ; Hyoid Bone* ; Male ; Mandible* ; Orthognathic Surgery* ; Osteotomy

Broncho-gastric fistula caused by benign gastric ulcer perforation after esophagectomy is very rare. In general anesthesia of a patient with broncho-gastric fistula, in spite of hyperventilation, leakage of the anesthetic gases through fistula may make the patient hypercapneic, and positive pressure ventilation may increase the risk of the pulmanary aspiration by the regurgitation of gastric fluid by stomach distension. For that reason, in this patient, denitrogenation was performed during patient's voluntary respiration with 100% oxygen for 5 minutes, and induction was performed without positive pressure ventilation, and one lung ventilation was carried out. Hypoxemia was followed by one lung ventilation because his pulmonary function was moderate obstructive type and his lung was damaged by aspiration of gastric fluid via broncho-gastric fistula. A low level of continuous positive airway pressure (CPAP) has no significant hemodynamic effect and can maintain the patency of nonventilated lung, so hypoxemia induced by one lung ventilation may be reduced. Thus we carried out one lung ventilation with CPAP (10 cmH2O) in nonventilated lung and blocked broncho-gastric fistula with a bronchial blocker for prevention of both regurgitation of gastric fluid and leakage of anesthetic gases. One lung anesthesia was performed without any problem in this case.
Anesthesia ; Anesthesia, General* ; Anesthetics, Inhalation ; Anoxia ; Continuous Positive Airway Pressure ; Esophagectomy ; Fistula* ; Hemodynamics ; Humans ; Hyperventilation ; Lung ; One-Lung Ventilation ; Oxygen ; Positive-Pressure Respiration ; Respiration ; Stomach ; Stomach Ulcer

Injuries to the pelvic nerve plexus following major pelvic ablative surgery are commonly observed conditions in urologic field and often related to voiding difficulty with flaccid type of neurogenic bladder. The pathophysiological background for voiding difficulty is unknown and also it is difficult to investigate in human. The present study was undertaken to investigate the functional changes on the bladder and urethra in major pelvic ganglion denervated rats (experimental group). Injury to the pelvic nerve plexus was created by selective removal of bilateral major pelvic ganglions of mature Sprague-Dawley rats (male, 250-300 gm). One week after operation, urodynamic evaluation and NADPH diaphorase histochemistry were performed in each rat. The whole bladder wet weight and residual urine of experimental group significantly increased to 1.6 times and 29 times that of control group, respectively. For urodynamic investigations, the bladder and the urethra were completely disconnected by means of ligation between the bladder neck and the proximal urethra, and simultaneous recordings of the intravesical and proximal urethral pressure were performed. During simultaneous urethro-vesical filling in experimental group, vesical contraction and urethral relaxation were not induced. However, an administration of L-arginine (120 mg/kg intravenously), a nitric oxide substrate, resulted in a gradual decrease in urethral pressure when the bladder pressure was reached at submaximal level. On NADPH diaphorase histochemistry in control group, a large number of NADPH positive nerve fibers were found in the proximal urethra, whereas those were found less commonly in the bladder. In experimental group, the number of NOS positive nerve fibers in the bladder was similar to that in control group. But in the proximal urethra, the number of NOS positive nerve fibers (84.7 +/- 12.7) decreased significantly in contrast to that (185.9 +/- 56.3) in control group. These results indicate that failure to empty in neurogenic bladder may be resulted from relaxation impairment of bladder outlet, which can be explained by the reduction of neuronal NOS in the proximal urethra in experimental group.
Animals ; Arginine ; Denervation ; Ganglion Cysts* ; Humans ; Ligation ; NADP ; NADPH Dehydrogenase ; Neck ; Nerve Fibers ; Neurons* ; Nitric Oxide ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type I* ; Rats* ; Rats, Sprague-Dawley ; Relaxation ; Urethra* ; Urinary Bladder* ; Urinary Bladder, Neurogenic ; Urodynamics

No abstract available.

No abstract available.
Ultrasonography