No Abstract Available.
Keratomileusis, Laser In Situ*

BACKGROUND: Induced hypotension is effective in decreasing blood loss and providing better visibility in the surgical field. Extensive epidural block to T4 with intravenous infusion of low-dose epinephrine allows mean arterial pressure to 50 mmHg. We investigated the effects of hypotensive epidural anesthesia comparing with normotensive epidural anesthesia during total hip arthroplasty. METHODS: 40 patients scheduled for total hip arthroplasty under epidural anesthesia were randomly divided into two groups. In hypotensive group, 0.5% bupivacaine 20cc was injected into L1-2 epidural space and if sensory block reached to T4, then epinephrine 1~5 g/min was intravenously injected with continuous infusion pump. As a result, mean arterial pressure was maintained 50 mmHg, and heart rate, 55~80bpm. In normotensive group, 0.5% bupivacaine 20cc was injected into L4-5 epidural space, and sensory block reached to T8. Therefore blood pressure was maintained within 20% of preoperative baseline. RESULTS: There was apparent difference in blood loss between two groups (hypotensive group: 259 +/- 75 ml, normotensive group: 803 +/- 144*ml) (*:p<0.05). In addition, in the case of hypotensive epidral group, transfusion was not required and CVP, heart rate were not changed postoperatively. Cardiac, renal, and cerebral function were preserved too. CONCLUSIONS: Hypotensive epidural anesthesia with low dose of epinephrine infusion is safely lowering mean arterial pressure to 50 mmHg. This technique is associated with low blood loss, reduction in perioperative transfusion requirements, and has no side effects on CNS, liver, kidney and heart function.
Anesthesia, Epidural* ; Arterial Pressure ; Arthroplasty, Replacement, Hip* ; Blood Pressure ; Bupivacaine ; Epidural Space ; Epinephrine ; Heart ; Heart Rate ; Humans ; Hypotension ; Infusion Pumps ; Infusions, Intravenous ; Kidney ; Liver

Adrenal Cortex Hormones* ; Prospective Studies* ; Stents*

No abstract available.

No abstract available.
Ankle*

Management of bladder tumors depends upon early detection and adequate follow-up. Urine Cytology plays an increasingly important and prominent role in the multidisciplinary approach to this problem. Herein we review our experience with urine cytology in the diagnosis and follow-up of bladder cancer at Department of Urology, College of Medicine, Yonsei University from 1981 to 1985. 1. A total of 478 cytologic evaluations were performed in the 198 patients. 2. The overall incidence of positive cytology was 49.2%. 3. The incidence of positive cytology in the presence of biopsy proven bladder tumor was 71.1%. 4.The incidence of positive cytology after TUR followed by adriamycin instillation was 72.2% at diagnosis, 41.7% after 3 months, 31.0% after 6 months, 33.3% after 9 months and 36.8% after 12 months. 5. The Number of cases with negative cytology after TUR and adriamycin instillation was 11 cases after 3 months, 7 cases after 6 months, 2 cases after 9 months and 1 case after 12 months. 6. Of the 5 patients having recurred tumor, there was 4 patients who constantly class IV, and 1 patient who had conversion from class I or II to class IV.
Biopsy ; Diagnosis ; Doxorubicin ; Follow-Up Studies ; Humans ; Incidence ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urology

No abstract available.
Aneurysm ; Carotid Arteries

OBJECTIVE: We analyzed the clinical features of amniotic fluid embolism confirmed by autopsy or clinical dicision for making a plan of rapid diagnosis and intensive emergency care. STUDY DESIGN: We experienced 2 clincal cases in Ewha Mokdong Hospital and Severance Hospital at 1995, and reviewed the medical record & autopsy report of 15 cases in National Institute of Scientific Investigation from Jan, 1991 to Dec, 1995. RESULTS: The mean maternal age was 31+/-3 years. The mean gestational age was 40+/-1 weeks. The number of delivery were 1.4+/-0.8. The number of abortion history. were 2.6+/-2. The sexuality of fetus were six males (35 %), five females (29%), and unknown six cases (35 %) and the fetal mortality rate was 29 % (5 cases). The initial clinical symptoms and signs were hypotension (12 patients, 71%), vaginal bleeding(ll patients, 65%), cardiac arrest (6 patients, 35 %), dyspnea (5 patients, 29 %), and seizure (2 patients, 12%). In the case of normal spontaneous vaginal delivary (NSVD), the symptoms occurred during induction in 3 (18%), during delivery in 1 (6%), and after delivery in 9 (53%). In the case of Cesarean section, the symptoms occurred during section in 2 (12%), and after section in 1 (6%). There are one case whose symptoms occurred during 3rd gestational period. CONCLUSIONS: We should alert for the amniotic fluid embolism in the clinical findings of acute collapse and vaginal bleeding, respiratory symptoms, and seizure at any peripartum. With eary suspicion of this disease and aggressive intensive care we can reduce amniotic fluid embolism mortality rate and it's legal problem.
Abortion, Induced ; Amniotic Fluid* ; Autopsy ; Cesarean Section ; Diagnosis ; Dyspnea ; Embolism, Amniotic Fluid* ; Emergency Medical Services ; Female ; Fetal Mortality ; Fetus ; Gestational Age ; Heart Arrest ; Humans ; Hypotension ; Critical Care ; Male ; Maternal Age ; Medical Records ; Mortality ; Peripartum Period ; Pregnancy ; Seizures ; Sexuality ; Uterine Hemorrhage

Nutcracker syndrome is a rare disease caused by the compression of the renal vein between the aorta and superior mesenteric artery. It is known to cause of venous hypertension, peripelvic and periureteral varicosities. Clinical manifestations include varicocele, hematuria, and flank or abdominal pain. Surgical correction is needed in nutcracker syndrome cases with severe or recurrent hematuria and abdominal or flank pain. Reanastomosis of the renal vein at 5cm below the original insertion site at the inferior vena cava is the one of the most common corrective methods and the transabdominal approach is usually employed. This disease usually appears in healthy young people and in order to decrease postoperative complications such as intestinal obstruction and bowel adhesion by avoiding unnecessary intraperitoneal manipulation, the authors used the extraperitoneal approach through a flank incision. We report because, in selected cases, we consider that this extraperitoneal approach is one of the alternative methods for the usual transperitoneal approach.
Abdominal Pain ; Aorta ; Flank Pain ; Hematuria ; Hypertension ; Intestinal Obstruction ; Mesenteric Artery, Superior ; Postoperative Complications ; Rare Diseases ; Renal Veins ; Varicocele ; Vena Cava, Inferior

No abstract available.
Hemolytic-Uremic Syndrome*