No abstract available.
Cushing Syndrome*

Transhiatal gastric transpositions were performed in two case of long gap esophageal atresia without tracheoesophageal fistula. The patients were a 12 months old female and an 18 months old male. Stamm type gastrostomies were performed at other hospitals in both cases. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. The proximal and distal esophageal pouches were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up to the neck through esophageal hiatus and posterior mediastinal route. The esophagogastrostomy, the only one anastomosis of this procedure, was performed in the neck. There was no clinical evidence of anastomotic leakage, stricture, regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. Transhiatal gastric transposition seems to be a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.
Anastomotic Leak ; Arteries ; Constriction, Pathologic ; Esophageal Atresia* ; Female ; Gastric Emptying ; Gastroepiploic Artery ; Gastrostomy ; Hoarseness ; Humans ; Infant ; Male ; Neck ; Spleen ; Stomach ; Tracheoesophageal Fistula

BACKGROUND: Acute normovolemic hemodilution (ANH) is known as the easieat and most economical and the quality of autologous blood saved by it is the best of all methods of autotransfusion. To investigate the efficacy of ANH, we studied whether it could reduce the transfusion requirement in spinal surgery. METHODS: Forty patients were randomly divided into 2 groups. In the hemodilution group (n=20), 2 or 3 units of autologous blood were procured immediately before or after anesthetic induction while Ringer's lactate and pentastarch were infused to maintain normovolemia. All patients received deliberate hypotension induced by labetalol. Perioperative changes of hemoglobin, hematocrit and platelets, the transfusion requirement and the amount of postoperative drainage were compared between each group. RESULTS: Perioperative changes of hemoglobin, hematocrit and platelet showed no significant differences between each group. Less packed RBC were used in the hemodilution group (1.9 2.0 units) than in control group (5.9 6.8 units) (p<0.05). In the control group, 4 patients were transfused with fresh frozen plasma (mean 4.8 units), 3 patients with platelets (mean 13 units) and 1 patient with cryoprecipitate (10 units) while only one patient was transfused with 3 units of fresh frozen plasma in the hemodilution group. Postoperative drainage was significantly less in the hemodilution group (1,494 488 ml) than in the control group (2,476 1,730 ml). CONCLUSION: ANH seems to decrease the transfusion requirement in spinal surgery. Reduction of postoperative wound drainage appears to play an important role in that.
Blood Platelets ; Blood Transfusion, Autologous ; Drainage ; Hematocrit ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Hypotension ; Labetalol ; Lactic Acid ; Plasma ; Wounds and Injuries

BACKGROUND: Aging is associated with increased cardiovascular risk and firmly established as a risk factor for the development of atherosclerosis. However the exact mechanism of age-related damage to the arterial wall and its relation to the atherosclerotic process are not well known.The endothelium plays an important role for the regulation of vascular tone and the endothelial function is impaired in the presence of risk factors early in the process of atherosclerosis. Assessment of endothelial function appears to be a valuable tool for the diagnosing and therapeutic monitoring of coronary artery disease. Anti-oxidants are known to improve endothelial dysfunction in atherosclerosis patients. The aim of this study was, (1) to evaluate the endothelial function in elderly, (2) to investigate whether vitamin C administration has benefit on the endothelial function in elderly. METHODS: The endothelial function was estimated using venous occlusion plethysmography(VOP) in 7 elderly and 7 young healthy volunteers. The strain guage was connected to plethysmograph to record the forearm volume change. A rapid cuff inflator was used to inflate the arm cuff to 40 mmHg instantaneuosly thus occluding venous return from the forearm. The measurement of forearm volume change was repeated for 7 times each stage. The change of the forearm blood flow(FBF) was measured with the acetylcholine infusion through brachial artery and also with intra-arterial vitamin C. RESULTS: Endothelium-dependent vasodilatation was significantly impaired in the elderly group compared to the young group(321 +/-17% in elderly group vs 509 +/-81%, mean+/-SEM) Forearm blood flow response to acetylcholine was significantly enhanced with inraarterial infusion of vitamin C in elderly group(321+/-17% in elderly group vs 78% in vitamin C) Coinfusion of L-NMMA, an inhibitor of nitric oxide synthase, blunted forearm blood flow response to acetylcholine. CONCLUSIONS: Even though the mechanisms leading to drpressed endothelial function in elderly remains to be elucidated, our study shows that vitamin C result in demonstrable improvement by a mechanism that is probably related to antioxidant activity.
Acetylcholine ; Aged* ; Aging ; Arm ; Ascorbic Acid* ; Atherosclerosis ; Brachial Artery ; Coronary Artery Disease ; Endothelium ; Forearm ; Healthy Volunteers ; Humans ; Nitric Oxide Synthase ; omega-N-Methylarginine ; Risk Factors ; Vasodilation* ; Vitamins*

Pseudoaneurysm of splenic artery may arise from a vascular erosion by the inflammatory processes around the splenic artery, particularly in acute pancreatitis and chronic pancreatitis, which may cause rupture of pseudoaneurysm and life threatening hemorrhage. Collective experience with this massive hemorrhage is attended by a high mortality rate even with prompt therapy, and conservative management is associated with an almost 100 per cent of mortality rate. Identification of the bleeding site at laparotomy may be exceedingly difficult, which makes the preoperative detection of bleeding source desirable. Peripancreatic vascular lesions can be identified by angiography, and in selected cases the risk of urgent operation to control massive hemorrhage may be obviated by embolization. The authors have recently experienced a case of ruptured splenic artery pseudoaneurysm combined with a pancreatic pseudocyst in a 6 years old boy. A bolus enhanced CT scan and angiography were essential to confirm these complications of pancreatic pseudocyst. We managed this child successfully with an urgent procedure of transcatheter arterial embolization and another elective surgery of pancreatic pseudocyst.
Aneurysm, False* ; Angiography ; Child* ; Hemorrhage ; Humans ; Laparotomy ; Male ; Mortality ; Pancreatic Pseudocyst ; Pancreatitis ; Pancreatitis, Chronic ; Rupture ; Splenic Artery* ; Tomography, X-Ray Computed

Fibrous dysplasia is a benign disorder of bone consisting of intramedullary proliferation of fibrous tissue and irregularly distributed, poorly developed bone. The disease manifests itself in the monostotic form in which only one bone is involved and the polyostotic form in which multiple bones at different sites are affected. We reported a extensive case of polyostotic fibrous dysplasia with involvement of craniofacial bones, mandible, ribs, extremities. A 18-year-old man showed remarkable right facial swelling who had been treated on right femur 3 years ago with a bone graft for pathologic fracture and he recognized facial swelling 5 years ago. Extraoral radiograms and computed tomogram showed diffuse sclerosis with a ground glass appearance of the most calvarial bones, facial bones. The right mandibular lesion showed very expansile lesion with mottled appearance. Bone scans showed mutifocal increased uptakes in craniofacial bones, right mandible, bilaterally in ribs, humerus, femur, tibia and characteristic varus deformity of right femur (shepherd's crook defomity). This case showed exceptionally bilateral, extensive nature of bone lesion and didn't show any features of skin pigmentation and endocrine disturbances.
Adolescent ; Congenital Abnormalities ; Extremities ; Facial Bones ; Femur ; Fibrous Dysplasia, Polyostotic* ; Fractures, Spontaneous ; Glass ; Humans ; Humerus ; Mandible ; Ribs ; Sclerosis ; Skin Pigmentation ; Tibia ; Transplants

Transhiatal gastric transposition was performed in a long gap esophageal atresia without tracheoesophageal fistula. The patient was a 12 months old female infant with previous stamm-type gastrostomy. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. The proximal and distal blind pouches of esophagus were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up into the neck through esophageal hiatus and posterior mediastinal route. The esophagogastrostomy, the only one anastomosis of this procedure, was safely performed in the neck. There were neither anastomotic leak nor early anastomotic stricture. The oral feeding was quickly established. There was no clinical evidence of regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. The low morbidity combined with satisfactory functional result indicates that the transhiatal gastric transposition is a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.
Case Report ; Esophageal Atresia/radiography/*surgery ; Female ; Gastrostomy ; Human ; Infant ; Medical Illustration ; Reoperation ; Stomach/radiography/*surgery

A case of fatal hematemesis due to an aberrant right subclavian arterioesophageal fistula which is a rare complication of the vascular ring is presented. A 42-year-old man with multiple injury by traffic accident presented severe upper gastrointestinal bleeding and was taken emergent operation. He was keeping tracheostomy tube and nasogastric tube for 7 weeks. We could find an aberrant right subclavian arterioesophageal fistula through left thoracotomy which was made by irritation of the prolonged nasogastric tube. We carried division of the aberrant right subclavian artery and fistulectomy. He was doing well postoperatively. But massive bleeding occurred at the fifth postoperative day. We performed emergent reoperation at CCU and found the tear point on the suture site of the aorta, which might be developed due to irritation of the chest tube and/or infection of the surrounding tissues. He was expired at the 8th postoperative day due to ischemic brain damage.
Accidents, Traffic ; Adult ; Aorta ; Brain ; Chest Tubes ; Fistula* ; Hematemesis ; Hemorrhage ; Humans ; Multiple Trauma ; Reoperation ; Subclavian Artery* ; Sutures ; Thoracotomy ; Tracheostomy

BACKGROUND:Rocuronium is a commonly used muscle relaxant, however, it has severe injection pain.We supposed that injection pain of rocuronium was due to acidity of solution.We studied whether pH elevation of rocuronium with bicarbonate relieves injection pain. METHODS:We included 140 adult patients with 18 G intravenous catheter in arm for general anesthesia and they were randomly allocated to two groups.All patients received 0.6 mg/kg of rocuronium, one group (Group C) received rocuronium only (pH = 4.04) and the other group (Group B) received bicarbonate mixed rocuronium (rocuronium:bicarbonate = 5 ml :1 ml, pH of mixture = 7.14).The severity (none, mild, severe) of injection pain was assessed.Just after assessment, 5 mg/kg of thiopental was injected for loss of conciousness. Twitch of supramaximal stimuli was monitored and intubation time was considered the interval from injection to 75% depression and onset time the interval from injection to maximal depression. RESULTS:The incidence of injection pain of group C was 96.9% and 18.8% in group B (P< 0.01). Intubation time and onset time were 79.5 +/- 24.4 sec and 114.3 +/- 43.6 sec in group C and 80.6 +/- 27.0 sec and 115.2 +/- 46.2 sec in group B.There was no significant difference between groups. CONCLUSIONS:Our result shows that adding bicarbonate to rocuronium is effective to relieve injection pain of rocuronium without change of onset of rocuronium.
Adult ; Androstanols ; Anesthesia, General ; Arm ; Catheters ; Depression ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Intubation ; Muscles ; Sodium Bicarbonate ; Thiopental

BACKGROUND:Rocuronium is a commonly used muscle relaxant, however, it has severe injection pain.We supposed that injection pain of rocuronium was due to acidity of solution.We studied whether pH elevation of rocuronium with bicarbonate relieves injection pain. METHODS:We included 140 adult patients with 18 G intravenous catheter in arm for general anesthesia and they were randomly allocated to two groups.All patients received 0.6 mg/kg of rocuronium, one group (Group C) received rocuronium only (pH = 4.04) and the other group (Group B) received bicarbonate mixed rocuronium (rocuronium:bicarbonate = 5 ml :1 ml, pH of mixture = 7.14).The severity (none, mild, severe) of injection pain was assessed.Just after assessment, 5 mg/kg of thiopental was injected for loss of conciousness. Twitch of supramaximal stimuli was monitored and intubation time was considered the interval from injection to 75% depression and onset time the interval from injection to maximal depression. RESULTS:The incidence of injection pain of group C was 96.9% and 18.8% in group B (P< 0.01). Intubation time and onset time were 79.5 +/- 24.4 sec and 114.3 +/- 43.6 sec in group C and 80.6 +/- 27.0 sec and 115.2 +/- 46.2 sec in group B.There was no significant difference between groups. CONCLUSIONS:Our result shows that adding bicarbonate to rocuronium is effective to relieve injection pain of rocuronium without change of onset of rocuronium.
Adult ; Androstanols ; Anesthesia, General ; Arm ; Catheters ; Depression ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Intubation ; Muscles ; Sodium Bicarbonate ; Thiopental