A 46 year-old female patient underwent cholecystectomy under general anesthesia. During the preoperative preparation, pulmonary edema developed from fluid overloading in the early septic condition. Pulmonary edema contributed significantly to the acute respiratory failure, which played a major role in the pathogenesis of multiple organ failure. For this condition, early surgical intervention is most important. After preoperative evaluaion, the authors anesthetized the patient with Morphine, used Enfluane intermitently, along with pancronium and oxygen and used endotracheal semiclosed circle absorption techniques with CMV incorporated PEEP. PEEP level was 5cm H2O. Inspired oxygen fraction was 1.0. Arterial oxygen tension increased from 62 torr to 183 torr despite the overt pulmonary edema. A-aDO2 was greater than 480 mmHg during the anesthesia of 2 hrs 40 minutes. For further treatment of pulmonary edema and postoperative respiratory care, synchronized IMV with PEEP, along with conventional methods for pulmonary edema and sepsis, were used in the ICU. After 6 days of intensive care, the patient was transferred to the general ward in good cardiovascular and respiratory function.
Absorption ; Anesthesia* ; Anesthesia, General ; Cholecystectomy ; Cholecystitis* ; Female ; Humans ; Critical Care ; Middle Aged ; Morphine ; Multiple Organ Failure ; Oxygen ; Patients' Rooms ; Pulmonary Edema* ; Respiratory Insufficiency ; Sepsis

No abstract available.
Adrenocorticotropic Hormone*

Adenoviridae ; Adhesives ; Cell Culture Techniques ; Culture Media, Serum-Free ; Fluorescence ; Vero Cells

Intertrochanteric fracture of femur is increasing in their incidence. Recently Ender nail and compression hip screw are very popular but they have disadvantage in the treatment of intertrochanteric fracture of femur. We have treated 49 cases of intertrochanteric fractures from December 1979 to October 1985 using Ender nail(31 cases) and compression hip screw(18 cases) respectively and compared the results. The summary of the results obtained were as follows: l. Average operation time was 72 minutes in Ender nail group and 146 minutes in compression hip screw group. 2. Average blood loss was 154ml in Ender nail group and 661ml in compression hip screw group. 3. Roentgenographic union was obtained in 12 weeks in both groups. 4. Minor postoperative complications were 24 cases in Ender nail group and 3 in compression hip screw group. Among 24 complications of Ender nail group, 19 were about the knee joint. Our conclusion is that Ender nailing is useful modality in the treatment of unstableintertrochanteric fractures who are old and high risk patients.
Femur ; Hip Fractures ; Hip ; Humans ; Incidence ; Knee Joint ; Postoperative Complications

Tuberculous spondylitis is not rare disease. Today the posterior instrumentation and posterior or posterolateral fusion concomitant with the anterior decompression and anterior interbody fusion have been used for the treatment of spinal tuberculosis. The authors experienced a case of tuberculous spondylitis complicated with descending aortic pseudoaneurysm. An aneurysm is defined as a localized dilatation of an artery that is at least one-half the size greater than is expected for that artery. Pseudoaneurysm occurring after previous operation, trauma, and infection. Erosion of the thoracic aorta with the development of an fistula in the presence of infection is an unusual and difficult problem to manage. We report a case and review related articles briefly.
Aneurysm ; Aneurysm, False* ; Aorta, Thoracic ; Arteries ; Decompression ; Dilatation ; Fistula ; Rare Diseases ; Spondylitis* ; Tuberculosis, Spinal

Fractures of the tibial shaft are the most common among the long bone fractures, and have much difficulty in treatment due to their numerous complications. Thirty patients with fractures of the tibial shaft were treated with Ender nails under the image intensifier at the Department of Orthopedic Surgery, Yeungnam University Hospital from December 1986 to November 1991. The following results were observed. 1. The average age was 37.3 years and the number of male was three times of the female. The most common cause was traffic accident. 2. Twenty cases out of thirty one were closed fracture and the remaining 11 were open. The comminuted and segmental fractures were 18 (57.7%) in number and the most common fracture site was the middle one third (53%). 3. Average interval from injury to operation was 7.6 days and 19 cases showed associated injuries. 4. The mean duration of the bone union was 18.9 weeks and 2 cases showed the delayed union. 5. Twelve complications were noted such as shortening, varus deformity, delayed union, ankle motion limitation, nail irritation, and soft tissue infection.
Accidents, Traffic ; Ankle ; Congenital Abnormalities ; Female ; Fractures, Bone ; Fractures, Closed ; Humans ; Male ; Orthopedics ; Soft Tissue Infections ; Tibia*

Cellular schwannoma is a very rare benign tumor involving peripheral nerves, mimicking malignant nerve sheath tumor in histological appearance. It is a clinico-pathological variant of benign schwannoma characterized by a high cellularity, increased mitotic figures and occasional presence of bone destruction. A 6-month-old female patient was admitted with progressive quadriparesis. Magnetic resonance imaging of the cervical spine showed a well-enhancing extramedullary mass on the C4 to C6 area. Total laminectomy was performed on C4-7, and intradural extramedullary tumor was removed. Histologically, the tumor was composed of proliferated spindle cells. Most of the tumor was composed of Antoni A area with hypercellular spindle cells arranged in fascicular pattern. The tumor cells showed mild atypism with mitotic figure upto 4/10HPF and diffuse, strong S-100 protein immunostaining. The patient was improved postoperatively.
Female ; Humans ; Infant* ; Laminectomy ; Magnetic Resonance Imaging ; Neurilemmoma* ; Peripheral Nerves ; Quadriplegia ; S100 Proteins ; Spinal Cord Neoplasms ; Spine*

No abstract available.
Desmin* ; Intermediate Filament Proteins* ; Intermediate Filaments* ; Muscle, Skeletal* ; Muscular Diseases* ; Sciatic Nerve* ; Vimentin*

Isolated ACTH deficiency is a rare cause of secondary adrenocortical insufficiency caused by the defect of synthesis or release of ACTH in pituitary gland. The clinical presentation can be simiilar to that of primary adrenal insufficiency, but there is a greater tendency for hypoglycemia and absence of hyperpigmentation. The patient, 80 year-old female, was admitted in chief complaint of deteriorated mental states. On admission, serum sodium was 127mEq/L, potassium 4.4mEq/L, blood glucose 27mg/dL and on routine E.C.G. was atrial fibrillation was revealed. The basal morning serum cortisol level was 9.97 pg/dL it dosent respond to insulin-induced hypoglycemia enoughly, but other pituitary functions were intact in pituitary cocktail stimulation test. In CRH stimulation test, there was no remarkable response in serum ACTH and cortisol level. Brain MRI failed to reveal any anatomic abnormalities of the sellar or suprasellar area consistent with the defect of pituitary ACTH secretion. This case was a isolated ACTH deficiency, So, we conclude that associated with atrail fibrillation and hypoglycemia.
Addison Disease ; Adrenocorticotropic Hormone* ; Aged, 80 and over ; Atrial Fibrillation* ; Blood Glucose ; Brain ; Female ; Humans ; Hydrocortisone ; Hyperpigmentation ; Hypoglycemia* ; Magnetic Resonance Imaging ; Pituitary Gland ; Potassium ; Sodium

While paleoparasitologists in Korea reported scientific evidences for the infection patterns of various parasite species among the pre-modern Joseon people, historical study is also needed for understanding the socio-cultural aspects of parasitic infections of the past. In this study on the historical documents, we revealed the socio-cultural environment of Joseon society by which people were easily infected by trematode parasites. The historical records showed that Joseon people enjoyed raw fish cuisines, that might have caused Clonorchis sinensis and Metagonimus yokogawai infection, much more frequently than originally expected. It is also proven that Joseon people ate raw crab and crayfish, the intermediate host of Paragonimus westermani, as the seasonal delicacy or miracle cure drug for incurable diseases. We also found many Joseon records on raw-oyster dishes, possibly having caused Gymnophalloides seoi infection among the people. By this study, we could get the historical clues on how Joseon people could have been infected by various trematode parasites.
Astacoidea ; Clonorchis sinensis ; Heterophyidae ; Korea ; Paragonimus westermani ; Parasites* ; Seasons