Crossed pulmonary arteries is an uncommon anomaly in which the ostium of the left pulmonary artery originates superiorly and to the right of the right pulmonary artery. The pulmonary arteries then cross each other and supply their respective lungs. The recognition of this rare anomaly is important because of its association with significant cardiac and extracardiac congenital abnormalities. These congenital conotruncal malformations have long been considered part of the clinical spectrum of DiGeorge syndrome, velocardiofacial(Shprintzen) syndrome, and conotruncal face syndrome. More recent reports have shown that a high percentage of patients with these syndromes have microscopic deletions of chromosomal region 22q11. We experienced a case of crossed branch pulmonary arteries in Dandy-Walker malformation. The diagnosis of crossed branch pulmonary arteries was made by echocardiography and this case had no evidence of 22q11 deletion in high resolution chromosome study and fluorescence in situ hybridization. This case of both conotruncal malformation and Dandy-Walker malformaltion was due to an abnormal developmental process involving the neural crest. We report this case with related literature.
Congenital Abnormalities ; Dandy-Walker Syndrome* ; Diagnosis ; DiGeorge Syndrome ; Echocardiography ; Fluorescence ; Humans ; In Situ Hybridization ; Lung ; Neural Crest ; Pulmonary Artery*

Salivary gland papillary cystadenocarcinomas are rare lesions, and particularly when they are found in the oral cavity. They have been recognized as being low grade carcinomas of the salivary glands. The author reports here on a case of recurrent papillary cystadenocarcinoma in the right retromolar area. The initial mass had multicystic and papillary structures with low grade features. The recurred mass showed basically the same histologic features. However the layer of papillae and the solid portion were increased and the tumor cells were larger and more pleomorphic with prominent nucleoli and frequent mitoses. Focal comedo type tumor necrosis and spindle cell proliferations in the surrounding soft tissue were present. This is a very rare report of a minor salivary gland papillary cystadenocarcinoma in a Korean, and the morphologic dedifferentiation was accompanied by the clinical recurrence.
Cystadenocarcinoma, Papillary* ; Mitosis ; Mouth ; Necrosis ; Recurrence ; Salivary Glands ; Salivary Glands, Minor

Aim To avoid the limitation of the use of cationic polyethlenimine (PEI)-complexed plasmid DNA use for in vitro or in vivo gene delivery due to its cytotoxicity and lower efficiency in the presence of serum. Methods A polyplex with decreased positive charge on the complex surface was designed. The PEI/DNA (PD) complexes coated with an anionic biodegradable polymer, alginate were prepared and their gene delivery behavior with PD was compared. Results The alginate-coated PD polyplex, where alginate: PEI: DNA [alginate: DNA, 0. 15 (w/w); PEI: DNA, N: P = 10] showed about 10 -30 fold-increased transfection efficiency compared to corresponding non-coated complexes to C3 cells in the presence of 50% serum. The surface charge of the alginate-coated complex was approximately half of that of the alginate-lacking complex. The size of alginate-coated complex was slightly smaller than that of the corresponding complex without alginate. The former complex also showed a reduced erythrocyte aggregation activity and decreased cytotoxicities to C3 cells in comparison with PD complex. Conclusion The alginate-coated PD polyplexes as a new gene delivery system can improve transfection efficiency in high serum concentration with low cytotoxicity to C3 cells.

BACKGROUND: The purpose of this study was to determine the clinical effective dose of alfentanil required for successful tracheal intubation during inhalation induction using 5% sevoflurane without neuromuscular blockade in children sedated with ketamine. METHODS: Twenty-one children, aged 3-10 years, undergoing surgeries under general anesthesia were enrolled into the study. All patients were premedicated with 0.004 mg/kg glycopyrrolate intramuscularly 30 min before anesthesia.To facilitate separation of the child from the parents, intravenous 1 mg/kg ketamine was given prior to transfer into the operating room.After inhalation induction with 5% sevoflurane and 100% oxygen, pre-determined dose of alfentanil was injected over 20 sec. The dose of alfentanil was determined by modified Dixon's up-and-down method (2microgramkg as a step size starting from 12microgramkg).The study ended when six independent pairs of patients, who manifested cross over from 'failure' to 'success' for tracheal intubation, were recruited. RESULTS: In 50% of children, the effective bolus dose (ED50) (95% confidence intervals) of alfentanil for successful tracheal intubation was 7.2microgram/kg (6.3-8.1microgram/kg) during sevoflurane inhalation induction.From isotonic regression, 95% effective dose (ED95) (95% confidence intervals) of alfentanil was 9.9microgram/kg (2.2-16.0microgram/kg). CONCLUSIONS: During inhalation induction using 5% sevoflurane without neuromuscular blockade after ketamine sedation, the ED50 and ED95 of alfentanil for successful tracheal intubation were 7.2 microgram/kg and 9.9microgram/kg in children, respectively.
Aged ; Alfentanil ; Anesthesia, General ; Child ; Glycopyrrolate ; Humans ; Inhalation ; Intubation ; Ketamine ; Methyl Ethers ; Neuromuscular Blockade ; Oxygen ; Parents

The characteristics of hand trauma are changing due to automation of industrial facilities, improved access to health care, and the aging population. Since the inception of hand surgery as a subspecialty, hand defects have been reconstructed with the restoration of the original functionality as the primary goal. With advancement and maturation of surgical techniques, however, restoration of aesthetics also began to take hold as an important aspect of hand surgery practice. After the first successful replantation of an amputated digit, the rapid development of microsurgical techniques had a significant impact on the field of reconstructive hand surgery. In the first two decades, the success of replantation was evaluated by the survival rate for a single operator or a specialized institution. These days, however, microsurgical techniques have been widely adopted, with digital replantation possible even for infants. In addition to various local flaps, the evolution of free flaps has vastly expanded the repertoire of reconstructive options for hand surgeons. With the wide variety of free flaps available, it is possible for a severely injured hand to be salvaged and restored to its original functional and aesthetic status. In South Korea, hand surgery is becoming an established profession with a separate subspecialty certification. Hand surgery has a bright outlook, with future research directed at new biocompatible materials and novel reconstructive methods.
Aging ; Automation ; Biocompatible Materials ; Certification ; Esthetics ; Free Tissue Flaps ; Hand* ; Health Services Accessibility ; Humans ; Infant ; Korea ; Microsurgery ; Replantation ; Survival Rate

The common carotid artery is an artery which supplies the head and neck with oxygenated blood. Although unilateral common carotid artery occlusion or bilateral internal carotid artery occlusion have been reported, the incidence of both common carotid artery occlusion is very rare. As previous report which reviewed 5400 carotid duplex ultrasonograms, 2.5% of internal carotid artery occlusion, 0.24% of unilateral common carotid artery occlusion and none of bilateral common carotid artery occlusion were reported. Common carotid and subclavian arteries are important in the blood supply to the vasculatures of head and upper extremities. Bilateral common carotid artery occlusion might be a cause of stroke, transient ischemic attack or other neurologic sequalae. Cerebral oximetry is a simple method of measuring regional cerebral oxygen saturation (rSO2), which appears to reflect changes in cerebral perfusion and it has been increasingly applicated in many clinical situations such as vascular surgeries involving head/ neck and operations adopting cardiopulmonary bypass. This case describes a successful anesthetic management in a patient with occlusion of bilateral common carotid and subclavian arteries using continuous cerebral oxygenation monitoring during laparoscopic cholecystectomy.
Anesthesia ; Arteries ; Cardiopulmonary Bypass ; Carotid Artery, Common ; Carotid Artery, Internal ; Cholecystectomy, Laparoscopic ; Equipment and Supplies ; Head ; Humans ; Incidence ; Ischemic Attack, Transient ; Neck ; Oximetry ; Oxygen ; Perfusion ; Stroke ; Subclavian Artery ; Upper Extremity

The inferior pyramidal dermal technique has many advantages in various reduction mammoplasty procedures. It has been possible to increase the amount of breast tissue removed, which enhances the quality of the final result. However, the main disadvantage of this method is the large and long reverse T scars, particularly in Asian women. Twenty breasts of 10 patients, who underwent an operation by the inferior pyramidal dermal technique with several modification from March 1989 to March 2001 were followed up. The mean age was 35 and the mean follow up period was 5.5 years. The mean resection amount was 692 gm per breast. In order to prevent a boxy breast, the inferior margin of the medial flap had a gentle curve, and the lateral flap had a "lazy S" contour. A small triangle of the skin was leaved with its base on the inframammary fold to relieve the T-junctional tension. In order to ensure nipple projection, the skin was deepithelialized at the recipient site for the relocated nipple-areola complex and 2 cm around areola. Because the vascular supply to the nipple-areola complex of the pyramidal flap was derived from the intercostal perforating vessels, the full-thickness removal of the skin from the pyramidal flap was made to reduce the operation time. A sufficient parenchyma resection beneath the lateral flap was performed to minimize a boxy breast. A postoperative hyperpigmented scar became light after 2 years and was inconspicuous after 3 years. An immediate postoperative boxy breast was noticed. However, it has been observed that there was gradual increase in the distance from the inframammary fold to the areola, because of the descent of the breast parenchyma due to gravity, along with the displacement of the nipple-areola complex superiorly. It is believed that this problem can be overcome by pedicle trimming, medial and superior fixation sutures with the nipple areola complex 1-2cm being situated below the expected position.
Asian Continental Ancestry Group ; Breast ; Cicatrix ; Female ; Follow-Up Studies* ; Gravitation ; Humans ; Mammaplasty ; Nipples ; Skin ; Sutures

BACKGROUND: Elevated blood pressures during emergence from general anesthesia in patients with hypertension often result in undesirable complications such as myocardial ischemia, intracranial hemorrhages. The aim of this study was to assess the effect of intracuff 4% lidocaine on the dosage of nitroglycerine required to maintain the stable blood pressure during peri-extubation period in patients with hypertension. METHODS: Forty-nine patients scheduled for elective surgery were randomly allocated to group 1 and 2. We filled endotracheal tube's cuff with normal saline for group 1 and with 4% lidocaine for group 2. Blood pressures and heart rates were recorded before operation, during emergence, and after extubation. Nitroglycerine infusion was adjusted to maintain systolic blood pressure below 150 mmHg. Total infused dosages of nitroglycerine were recorded during operation and after stop of inhalational anesthetics for comparison of both groups' hemodynamic stability. RESULTS: Mean infused volume (microg/kg/min) of nitroglycerine during peri-extubation period was less in the group 2 than group 1. CONCLUSIONS: Intra-cuff 4% lidocaine in patients with hypertension during emergence from general anesthesia reduces the nitroglycerine dosage required to maintain hemodynamic stability.
Anesthesia, General ; Anesthetics ; Blood Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension* ; Intracranial Hemorrhages ; Lidocaine* ; Myocardial Ischemia ; Nitroglycerin*

BACKGROUND: General anesthesia for cesarean section is usually maintained at a low dose after induction with using other agents. Many anesthesiologists have experience difficulty in maintaining stable blood pressure at intubation, as compared with nonobstetric anesthesia. We wanted to determine the efficacy of nicardipine for treating rising blood pressure that is related to intubation. METHODS: Twenty one parturient women, who were scheduled for elective cesarean section, were randomly allocated to two groups. Group 1 (n = 10) received no nicardipine and group 2 (n = 11) received nicardipine (7microg/kg) 60 seconds before intubation. The systolic blood pressures, diastolic blood pressures and heart rates were measured at preoperation, after induction of anesthesia, before intubation, immediately after intubation and at 1, 5, 10, 15 and 30 minutes after intubation. RESULTS: The systolic and diastolic blood pressures were lower in group 2 than group 1 at immediate after intubation. Yet the heart rate was higher in group 2 than in group 1 at the same time. CONCLUSIONS: Intravenous nicardipine given 60 seconds before intubation has some benefit from the viewpoint of blood pressure stability at intubation during cesarean section.
Anesthesia ; Anesthesia, General* ; Blood Pressure* ; Cesarean Section* ; Female ; Heart Rate ; Humans ; Intubation ; Intubation, Intratracheal* ; Nicardipine* ; Pregnancy

BACKGROUND: The aim of this study was to determine the clinical effective dose of rocuronium for tracheal intubation using a lightwand after induction with propofol, alfentanil, and a low concentration of sevoflurane. METHODS: Twenty-eight adults scheduled to undergo elective surgery lasting less than one hour were enrolled in this study. All patients received alfentanil (10 microgram/kg) and propofol (1.5 mg/kg) for the induction of anesthesia. Tracheal intubation using a lightwand was attempted 3 minutes after administering rocuronium and mask ventilation with 2 vol% of sevoflurane. The initial rocuronium dose was 0.5 mg/kg. The rocuronium dose for consecutive patients, determined by Dixon's up-and-down method, was increased or decreased by 0.05 mg/kg according to the result of the previous patient. The mean arterial pressure and heart rate were recorded before induction, 1 min before intubation, 1 and 2 min after intubation. RESULTS: The 50% clinical effective dose (cED(50)) of rocuronium for tracheal intubation using a lightwand was 0.20 +/- 0.05 mg/kg according to Dixon's up and down method. Isotonic regression revealed the cED(50) and cED(95) (95% confidence intervals) to be 0.20 mg/kg (0.10-0.3 mg/kg) and 0.35 mg/kg (0.16-0.49 mg/kg), respectively. CONCLUSIONS: The cED(50) and cED(95) of rocuronium for tracheal intubation using the lightwand were 0.20 mg/kg and 0.35 mg/kg, respectively, after induction with alfentanil, propofol, and a low concentration of sevoflurane.
Adult ; Alfentanil ; Androstanols ; Anesthesia ; Arterial Pressure ; Heart Rate ; Humans ; Intubation ; Masks ; Methyl Ethers ; Propofol ; Ventilation