The peptic ulcer is the most common cause of the upper gastrointestinal bleeding. We evaluated the efficacy of the sclerotherapy by endoscopic injection of ethanol for the bleeding peptic ulcer patients. We also evaluated the need of the sclerotherapy on the bleeding peptic ulcer according to the bleeding stigmata on the ulcer base. We classified the bleeding stigmata on the ulcer base with 4 group: active bleeding(21/345, 6%), visible vessel(122/345, 35%), red spot(97/345, 28%), no stigmata(105/345, 31%). The patients who manifested hernatemesis, melena, or both initially, were diagnosed as benign gastric ulcer(BGU, 179 patients) and duodenal ulcer(BDU, 166 patients). The median age was 57 year-old in the BGU patients and 37 year-old in the BDU patients. The sclerotherapy was performed to the 109 patients(58 BGU and 51 BDU patients), 96 patients(96/109, 89%) show permanent hemostasis. The hemostasis rate was 77% with active bleeding in the BGU patients, 75% with active bleeding in the BDU patients. There was no significant difference between sclerotherapy and observation group with visible vessel and red spot on the ulcer base of the bleeding peptic ulcer patients. Conclusively, the endoscopic sclerotherapy was very useful and effective treatment method for the bleeding peptic ulcer, but we suggested that all the bleeding peptic ulcer patients should not have done the sclerotherapy.
Adult ; Christianity ; Ethanol* ; Hemorrhage* ; Hemostasis ; Humans ; Melena ; Middle Aged ; Peptic Ulcer* ; Sclerotherapy* ; Ulcer

This is a retrospective review of our experience with endoscopic extraction of 20 cases of foreign body on the upper gastrointestinal tract at sanggye paik hospital from Oct. 1989 to Nov. 1993. Among 20 cases, 3 cases were under 5years of age and 17 cases were over 27years of age. 9 cases (45%) were located in the esophagus, 8 cases (40%) were in the stomach and 3 cases (15%) were in the duodenum. All children (100%) have true foreign body, almost of all adults (82%) have food-related foreign body. Dysphagia with chest pain or vomiting was the most common symptom in the esophageal foreign body. Epigastric pain and vomiting or hematemesis were common symptoms in the stomach or duodenal foreign body, All of the esophageal foreign body (100%) were extracted within 72 hours, most of all (91%) stomach and duodenal foreign body were extracted after 72 hours.
Adult ; Chest Pain ; Child ; Deglutition Disorders ; Duodenum ; Esophagus ; Foreign Bodies* ; Hematemesis ; Humans ; Retrospective Studies ; Stomach ; Upper Gastrointestinal Tract* ; Vomiting

BACKGROUND: Discrepancy of central-peripheral arterial pressure after cardiopulmonary bypass may affect the reliability of arterial pressure waveform derived cardiac index (APCI) monitoring. METHODS: In 15 elective cardiac surgeries employing moderate hypothermic cardiopulmonary bypass (CPB), APCI from radial arterial cannula and pulmonary artery catheter derived cardiac index from thermodilution method (PACI) were measured 1) after anesthesia induction (T1), 2) before CPB (T2), 3) immediately after CPB (T3) and 4) 1 hour after CPB (T4). APCI and PACI were analyzed by using the Bland-Altman analysis. RESULTS: Biases of APCI and PACI at T1, T2, T3 and T4 were 0.093 L/min/m2, -0.053 L/min/m2, 0.485 L/min/m2 and -0.09 L/min/m2, respectively. The limits of agreement (2 SD) at T1, T2, T3 and T4 were from -2.285 to 2.471 L/min/m2, -2.475 to 2.369 L/min/m2, -2.255 to 3.225 L/min/m2 and -2.609 to 2.423 L/min/m2, respectively. Bias of APCI and PACI during entire period (T1-T4) was 0.095 L/min/m2 and 2 SD was from -2.387 to 2.557 L/min/m2. However, mean error % (2 SD/mean) of APCI at T1, T2, T3, and T4 were greater than 30%. CONCLUSIONS: Our results were not able to show that APCI measured from radial artery is comparable to PACI for hemodynamic monitoring during cardiac surgery employing moderate hypothermic CPB. Considering the limitations of PACI as a gold standard of hemodynamic monitoring in a certain clinical circumstance, further investigation employing other monitoring method than PACI may be followed to get more definitive conclusion.
Anesthesia ; Arterial Pressure ; Bias (Epidemiology) ; Cardiopulmonary Bypass ; Catheters ; Hemodynamics ; Pulmonary Artery ; Radial Artery ; Thermodilution ; Thoracic Surgery

PURPOSE: evaluate the effectiveness of minimally invasive plate osteosynthesis (MIPO) in unstable fractures of the distal tibia. MATERIALS AND METHODS: From March 2001 to December 2003, 21 cases with unstable fractures of the distal tibia were treated with MIPO technique and followed for at least one year. Eighteen cases were extra-articular and three cases were intra-articular fractures. According to AO classification, six cases were 42-A, four 42-B, one 42-C, seven 43-A, and three 43-C. There was only one case of Gustilo-Anderson type II open fracture. We reviewed the results of fracture healing, axial and rotational deformity, ankle motion, and complications RESULTS: All fractures were healed in an average of 16.1 weeks (range, 11 to 24 weeks). There was only one case of 7-degree posterior angular deformity, but no cases of rotational malalignment. Recovery of ankle motion was satisfactory in all patients within 5-degree loss of motion. Subcutaneous abscess was developed in one case after fracture healing and cured by a drainage with implant removal. CONCLUSION: Although MIPO technique is technically more demanding than the traditional open technique, MIPO technique is an effective method for unstable fractures of the distal tibia because it minimizes incidence of soft-tissue compromise and infection and provides good fracture healing.
Abscess ; Ankle ; Classification ; Congenital Abnormalities ; Drainage ; Fracture Healing ; Fractures, Open ; Humans ; Incidence ; Intra-Articular Fractures ; Tibia*

No abstract available.
Helicobacter pylori* ; Helicobacter* ; Stomach Neoplasms*

Adult-onset Still's disease is an uncommon systemic inflammatory disease of unknown etiology and pathogenesis. It is characterized by an evanescent rash, spiking fever (>39degrees), arthralgia, sore throat, abnormal liver function tests and leukocytosis (>10,000/mm3). We report a case involving a 41-year-old male with initial symptoms suggestive of anaphylactic and septic shock. Steroid therapy led to recovery. Adult-onset Still's disease was ultimately confirmed.
Acute Kidney Injury ; Adult ; Anaphylaxis ; Arthralgia ; Exanthema ; Fever ; Humans ; Leukocytosis ; Liver Function Tests ; Male ; Pharyngitis ; Renal Insufficiency ; Shock ; Shock, Septic ; Still's Disease, Adult-Onset

Adult-onset Still's disease is an uncommon systemic inflammatory disease of unknown etiology and pathogenesis. It is characterized by an evanescent rash, spiking fever (>39degrees), arthralgia, sore throat, abnormal liver function tests and leukocytosis (>10,000/mm3). We report a case involving a 41-year-old male with initial symptoms suggestive of anaphylactic and septic shock. Steroid therapy led to recovery. Adult-onset Still's disease was ultimately confirmed.
Acute Kidney Injury ; Adult ; Anaphylaxis ; Arthralgia ; Exanthema ; Fever ; Humans ; Leukocytosis ; Liver Function Tests ; Male ; Pharyngitis ; Renal Insufficiency ; Shock ; Shock, Septic ; Still's Disease, Adult-Onset

BACKGROUND: Mechanical ventilation is frequently used in the intensive care unit. Sedation is usually required to tolerate the presence of a tracheal tube and other unpleasant stimulus during mechanical ventilation. The ideal regimen for sedation has not yet been determined. This study was designed to compare the characteristics of safety and effectiveness of propofol to those of midazolam for sedation in patients undergoing mechanical ventilation in surgical intensive care unit. METHODS: 44 mechanically ventilated patients were randomized to receive either propofol (loading dose 20~40 mg, followed by 10~50 microgram/kg/min) or midazolam (loading dose 1~2 mg, followed by 0.2~0.8 microgram/kg/min). Infusion rates were titrated to 3~5 points of Ramsay scale. All patients also received morphine 0.5 microgram/kg/24 h without any muscle relaxants. Hemo-dynamic changes (SBP, DBP, HR), ventilatory parameters and recovery time were evaluated. Hepatic and renal functions were measured before start of infusion and after discontinuation of both drugs. RESULTS: The mean initial loading and maintenance dose were 0.35 mg/kg and 1.5 mg/kg/hr for the propofol, 29.2 microgram/kg and 29.1 microgram/kg/h for midazolam group, respectively. There was no difference between the two groups regarding the sedation score evaluated by Ramsay scale. Patients receiving propofol recovered more rapidly than those receiving midazolam (40.5+/-20.1 min vs. 88.2+/-29.5 min respectively; P<.05). No one in either group showed marked hemodynamic(>30% of pre-injection value) or hepatic or renal function changes. CONCLUSIONS: Propofol is a sedative agent with shorter awakening time than midazolam but with the same safety and clinical effectiveness for the continuous sedation of mechanically ventilated patients.
Humans ; Critical Care ; Intensive Care Units ; Midazolam* ; Morphine ; Propofol* ; Respiration, Artificial

BACKGROUND: Mechanical ventilation is frequently used in the intensive care unit. Sedation is usually required to tolerate the presence of a tracheal tube and other unpleasant stimulus during mechanical ventilation. The ideal regimen for sedation has not yet been determined. This study was designed to compare the characteristics of safety and effectiveness of propofol to those of midazolam for sedation in patients undergoing mechanical ventilation in surgical intensive care unit. METHODS: 44 mechanically ventilated patients were randomized to receive either propofol (loading dose 20~40 mg, followed by 10~50 microgram/kg/min) or midazolam (loading dose 1~2 mg, followed by 0.2~0.8 microgram/kg/min). Infusion rates were titrated to 3~5 points of Ramsay scale. All patients also received morphine 0.5 microgram/kg/24 h without any muscle relaxants. Hemo-dynamic changes (SBP, DBP, HR), ventilatory parameters and recovery time were evaluated. Hepatic and renal functions were measured before start of infusion and after discontinuation of both drugs. RESULTS: The mean initial loading and maintenance dose were 0.35 mg/kg and 1.5 mg/kg/hr for the propofol, 29.2 microgram/kg and 29.1 microgram/kg/h for midazolam group, respectively. There was no difference between the two groups regarding the sedation score evaluated by Ramsay scale. Patients receiving propofol recovered more rapidly than those receiving midazolam (40.5+/-20.1 min vs. 88.2+/-29.5 min respectively; P<.05). No one in either group showed marked hemodynamic(>30% of pre-injection value) or hepatic or renal function changes. CONCLUSIONS: Propofol is a sedative agent with shorter awakening time than midazolam but with the same safety and clinical effectiveness for the continuous sedation of mechanically ventilated patients.
Humans ; Critical Care ; Intensive Care Units ; Midazolam* ; Morphine ; Propofol* ; Respiration, Artificial

We report a case of intrasellar arachonoid cyst with extension to the sphenoid sinus, which is a very uncommon lesion. Preoperatively, we studied the PNS CT & Brain MRI and these images showed a large cyst in the widened sellar turcica with extension to the sphenoid anterior wall. We planned endoscopic surgery via transnasal-transphenidal approach. The endoscopic surgery was performed with no complication. We reviewed the literature and discussed the treatment of the intrasellar arachnoid cyst.
Arachnoid ; Brain ; Sphenoid Sinus