One of the important anesthetic problems is cross-infection in anesthetic machines in operating rooms. This study is an attempt to determine the transfer of organisms through anesthetic apparatus. The bacteriological experiments were based on selective culture with blood agar media(Difco, U.S.A.) in the operating theater, recovery room and in anesthetic apparatus which was either sterilized with chemicals or without sterilization. Furthermore, nasopharyngeal culture also determined in normal healthy patients. The hypersensitivity test was performed by Kolmer's method. The results are as follows; 1) Most of the organisms in the operating room were Staphylococcus and Baeillus subtilis, (table 1.) 2) Bacteriological examination of unsterilized anesthetic acessories showed Staphylococcus, Streptococcus and Gram negative bacillus. (table 2) The sterilizaiton of anesthetic apparatus with Benzalkonium chloride solution for 40 minutes was superior to that with our standard Sterilized solution for one and half hours. (table 3.) 3) The majority of colonies responded to Albamycine, Erythromycine, Kanamycine and Achromycine. (table4, 4-a.) 4) Strep.nonhemolyticus (37.0%) was the most common bacterial flora of the nasopharynx isolated from healthy persons. (table 5.) In conclusion, it is most important to check the bacteriological examination of operating roon s and anesthetic apparatus at regular intervals and to clean hands before and after anesthesia.
Agar ; Anesthesia ; Bacillus ; Benzalkonium Compounds ; Erythromycin ; Hand ; Humans ; Hypersensitivity ; Kanamycin ; Nasopharynx ; Operating Rooms ; Recovery Room ; Staphylococcus ; Sterilization ; Streptococcus ; Tetracycline

Adult respiratory distress syndrome(ARDS) is described under various names in the medical literature: post-traumatic pulmonary insufficiency, wet lung. DaNang lung and shock lung etc., and the syndrome has been used to describe a serious and often fatal conditions which may develop in any patient subjected to severe trauma, major surgery or critical illness. ARDS is characterized by increasing intrapulmonary shunting, increasing work of breathing and decreasing lung compliance. There is still desagreement about exact nature of ARDS as well as its care and revention. In ARDS, the use of positive end-expiratory pressure(PEEP) has been widely debated since its introduction by Ashbaugh and Petty in 1969. Its purpose is to increase the lung volume, especially functional residual capacity at end expiration in order to obtain better alveolar expansion and improved pulmonary gas exchange. This report described two cases of ARDS following trauma, and respiratory care problems were reviewed and discussed.
Adult ; Male ; Female ; Humans

PURPOSE: The authors evaluated the relationships between the clinical factors and resistive indexes (RIs) of prostate and urethral blood flows by using power Doppler transrectal ultrasonography (PDUS) in men with benign prostatic hyperplasia (BPH). METHODS: The data of 110 patients with BPH and lower urinary tract symptoms (LUTS) treated between January 2015 and July 2015 were prospectively collected. PDUS was used to identify the capsular and urethral arteries of the prostate in order to measure RIs. International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), total prostate volume (TPV), transition zone volume (TZV), transition zone index (=TZV/TPV), presence of intravesical prostatic protrusion (IPP), and the RIs of capsular and urethral arteries were evaluated for all of the patients by one urologist. RESULTS: The 110 patients were categorized according to IPSS (mild symptoms, 0-7; moderate symptoms, 8-19; and severe symptoms, 20-35), Qmax (<10 and ≥10 mL/sec), TPV (<30 and ≥30 mL), and presence or absence of IPP. No significant relationship was found between the mean RI of any artery and IPSS or Qmax. The mean RIs of the urethral artery, and left and right capsular arteries were significantly dependent on prostate size and the presence of IPP. CONCLUSIONS: RI obtained by using PDUS correlated with the presence of IPP and prostate size. The RI of prostate blood flow can be used as a noninvasive diagnostic tool for BPH with LUTS.
Arteries ; Humans ; Lower Urinary Tract Symptoms ; Male ; Prospective Studies ; Prostate* ; Prostatic Hyperplasia* ; Ultrasonography

No abstract available.
Thoracotomy*

OBJECTIVE: To provide a perspective on the recent trends in the etiologies and levels of lower limb amputations in Korea. METHOD: Medical records of 284 patients discharged from Seoul National University Hospital between 1990 and 1999 who had amputation related procedure codes were reviewed. Data were used to calculate ratios of congenital anomaly, trauma related, tumor related, diabetes related, and vascular insufficiency related amputations, and ratios of each level of amputations. Trends over time were examined by comparing data from 1990 to 1994 with those from 1995 to 1999 using chi square tests. RESULTS: Dysvascular amputations accounts for 53.5% of lower limb loss in recent 10 years, and tumor (18.9%), congenital anomaly (14.5%), and trauma (6.1%) ranked the next common etiologies. The proportion of dysvascular amputations since 1995 was found to be significantly greater than the ratio before 1995 (p<0.05), and the ratio of amputations secondary to congenital anomaly was lower (p<0.05). There was no significant change in the level of amputations. CONCLUSION: Over recent 10 years, the risk of amputation secondary to dysvascular conditions has been increased, which warrants further investigations and efforts to improve our management of amputees.
Adolescent* ; Amputation ; Amputees ; Epidemiology ; Humans ; Korea ; Lower Extremity ; Medical Records ; Scoliosis* ; Seoul

Purpose: The aim of the present study was to evaluate the per-lesion sensitivity and specificity of the Korean Liver Cancer Association–National Cancer Center (KLCA-NCC) 2022 criteria for the noninvasive diagnosis of hepatocellular carcinoma (HCC), with intraindividual comparison of the diagnostic performance of magnetic resonance imaging with extracellular agents (ECA-MRI) and hepatobiliary agents (HBA-MRI). Materials and Methods: Patients at high risk for HCC who were referred to a tertiary academic institution for hepatic lesions with size ≥ 10 mm between July 2019 and June 2022 were enrolled. A total of 91 patients (mean age, 58.1 years; 76 men and 15 women) with 118 lesions who underwent both ECA-MRI and HBA-MRI were eligible for final analysis. The per-lesion sensitivities and specificities of the KLCA-NCC 2022 criteria using ECA-MRI and HBA-MRI were compared using McNemar’s test. Results: The 118 lesions were 93 HCCs, 4 non-HCC malignancies, and 21 benign lesions. On HBA-MRI, the “definite” HCC category showed significantly higher sensitivity than ECA-MRI (78.5% vs. 58.1%, p < 0.001), with identical specificity (92.0% vs. 92.0%, p > 0.999). For “probable” or “definite” HCC categories, there were no differences in the sensitivity (84.9% vs. 84.9%, p > 0.999) and specificity (84.0% vs. 84.0%, p > 0.999) between ECA-MRI and HBA-MRI. Conclusion The “definite” HCC category of the KLCA-NCC 2022 criteria showed higher sensitivity in diagnosing HCC on HBA-MRI compared with ECA-MRI, without compromising specificity. There were no significant differences in the sensitivity and specificity of “probable” or “definite” HCC categories according to ECA-MRI and HBA-MRI.

PURPOSE: The risk of posthepatectomy liver failure (PHLF) after right hepatectomy remains substantial. Additional parameters such as computed tomography volumetry, liver stiffness measurement by FibroScan, indocyanine green retention rate at 15 minutes, and platelet count used to properly assess future liver remnant volume quality and quantity are of the utmost importance. Thus, we compared the usefulness of these modalities for predicting PHLF among patients with hepatocellular carcinoma after right hepatectomy. METHODS: We retrospectively reviewed patients who underwent right hepatectomy for hepatocellular carcinoma between 2007 and 2013. PHLF was determined according to International Study Group of Liver Surgery consensus definition and severity grading. Grades B and C were defined as clinically relevant posthepatectomy liver failure (CRPHLF). The results were internally validated using a cohort of 97 patients. RESULTS: Among the 90 included patients, 15 (16.7%) had CRPHLF. Multivariate analysis confirmed that platelet count < 140 (109/L) (hazard ratio [HR], 24.231; 95% confidence interval [CI], 3.623–161.693; P = 0.001) and remnant liver volume-to-body weight (RVL/BW) ratio < 0.55 (HR, 25.600; 95% CI, 4.185–156.590; P < 0.001) were independent predictors of CRPHLF. Among the 12 patients with a platelet count < 140 (109/L) and RLV/BW ratio < 0.55, 9 (75%) had CRPHLF. Likewise, 5 of 38 (13.2%) with only one risk factor developed CRPHL versus 1 of 40 (2.5%) with no risk factors. These findings were confirmed by the validation cohort. CONCLUSION RLV/BW ratio and platelet count are more important than the conventional RLV/TFLV, indocyanine green retention rate at 15 minutes, and liver stiffness measurement in the preoperative risk assessment for CRPHLF.

PURPOSE: Rib and sternal fractures are common complications of chest compressions during cardiopulmonary resuscitation (CPR). The aim of this study is to investigate skeletal chest injuries following chest compressions and factors associated with skeletal chest injuries. METHODS: A retrospective study was conducted for 10 years from January 2005 to February 2015. Skeletal chest injuries in patients who underwent computerized tomography (CT) after return of spontaneous circulation (ROSC) were analyzed. The exclusion criteria were patients with insufficient medical records, under 18 years old, traumatic cardiac arrest, and out-of-hospital cardiac arrest. RESULTS: During the period 106 patients were included. The CT scan after ROSC showed that 47 patients (44.3%) had rib fractures, and 20 patients (18.9%) had sternal fractures. The rib fracture group showed higher age (73 vs 61, p<0.001), longer CPR time (10 vs 6 min, p<0.001), and higher incidence of sternal fracture (34% vs 6.8%, p<0.001). The sternal fracture group showed longer CPR time (10 vs 7, p<0.05) and higher incidence of rib fractures (80% vs 4.7%, p<0.001). In multivariate logistic regression analysis, age (OR 1.087; 95% CI 1.041 to 1.134, p<0.001), CPR time (OR 1.200; 95% CI 1.087 to 1.323, p<0.001), and sternal fracture (OR 4.524; 95% CI 1.259 to 16.697, p=0.021) showed significant association with rib fracture. CONCLUSION: Rib and sternal fractures are frequent complications in patients who underwent CPR. In hospital cardiac arrest patients with older age, longer CPR time, and sternal fracture needed more precaution for rib fractures and other complications.
Cardiopulmonary Resuscitation* ; Heart Arrest* ; Humans ; Incidence ; Logistic Models ; Medical Records ; Out-of-Hospital Cardiac Arrest ; Retrospective Studies ; Rib Fractures ; Ribs ; Thoracic Injuries* ; Thorax* ; Tomography, X-Ray Computed

Continuous epidural pain block with a local anesthetic agents is a commonly employed technique for pain relief after thoracotomy. In this study, we evaluated the effectiveness of the continuous epidural pain block in 19 patients undergoing elective lateral or posterolateral thoracotomy with control group(n=19) from November 1994 to July 1995. Epidural lidocaine and morphine mixtures were injected via an epidural catheter as a bolus after operation, and then bupivacaine and morphine mixtures were injected continuously following 5 or 6 days. The pain score, upper arm elevation(ROM score), and respiratory rate were significantly changed(P<0.05) from 30min after injection. The CO2 tension of arterial blood was decreased significantly(P<0.05) from 2hr after injection. The postoperative hospital days were decreased significantly(P<0.05). Side effects of the epidural pain block were urinary retention(n=10), urticaria(n=2) and a case of headache. There was no postoperative lung atelectasis. We conclude that the continuous epidural pain block is good for prevention of the postoperative lung complication and early recovery after thoracotomy.
Anesthesia, Epidural ; Anesthetics ; Arm ; Bupivacaine ; Catheters ; Headache ; Humans ; Lidocaine ; Lung ; Morphine ; Pulmonary Atelectasis ; Respiratory Rate ; Thoracotomy*

Prepubertal Sertoli cell tumor of testis is very rare and most of them are benign. The choice of treatment is radical orchiectomy but careful follow-up for possible retro peritoneal spread is appropriate. We report a rare case of Sertoli cell tumor of testis in a 8-year-old boy. His chief complaint was a painless left testicular swelling from birth. Serum levels of tumor markers were within normal limits. Radical orchiectomy was performed, and cut surface of testis was yellowish and was completely displaced by lobulated tumor mass. Postoperative CT and chest x-ray showed no evidence of metastasis. The patient is alive without evidence of disease for 8 months postopera tively.
Child* ; Follow-Up Studies ; Humans ; Male ; Neoplasm Metastasis ; Orchiectomy ; Parturition ; Sertoli Cell Tumor* ; Testis* ; Thorax ; Biomarkers, Tumor