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

PURPOSE: We evaluated the therapeutic efficacy and complications of percutaneous cholecystostomy in acalculou s acute cholecystitis. MATERIALS AND METHODS: We performed percutaneous cholecystostomy under ultrasound guidance for the treatment of 18 patients with acalculous acute cholecystitis. We retrospectively analyzed the therapeutic efficacy and complications. RESULTS: A dramatic improvement in clinical condition was observed in 16(88%) patients within 24 --48 hours. One patient was successfully treated with second trial because of technical failure at initial trial. No major complications occured except a gallbladder laceration. Most of patients complained minor symptoms such as fever, pain, mild dyspnea and refered pain to right shoulder, and these symptoms were resolved within one week. There was no complications related to vasovagal reflex. CONCLUSION: In the treatment of acalculous acute cholecystitis, percutaneous cholecystostomy is a safe and effective method.
Acalculous Cholecystitis* ; Cholecystitis, Acute ; Cholecystostomy* ; Dyspnea ; Fever ; Gallbladder ; Humans ; Lacerations ; Reflex ; Retrospective Studies ; Shoulder ; Ultrasonography

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

PURPOSE: To elucidate the effects of the irradiation and calcium-deficient diet on expression of interleukin(IL)-1 during tooth formation of rat molar MATERIALS AND METHODS: The pregnant three-week-old Spague-Dawley rats were used for the study. The control group was non-irradiation/normal diet group, and the experimental groups were irradiation/normal diet group and irradiation/calcium-diet group. The abdomen of the rats on the 9th day of pregnancy were irradiated with single dose of 350 cGy. The rat pups were sacrificed on the 14th day after delivery and the maxillae tooth germs were taken. The specimen were prepared to make sections for light microscopy, and some of tissue sections were stained immunohistochemically with anti-IL-1 antibody. RESULTS: In the irradiation/normal diet group, dental follicle showed fewer blood vessels, mononuclear cells, and fusions of mononuclear cells than in non-irradiation/normal diet group. Alveolar bone showed a few osteoblasts and osteoclasts. Periodontal ligament showed collagen fibers and fibroblasts with irregularity. Weak immunoreactivity for IL-1 was shown in dental follicle, alveolar bone, and periodontal ligament. In the irradiation/calcium-deficient diet group, dental follicle showed sparse cellularity. Alveolar bone showed diminished number of osteoblasts. Periodontal ligament showed irregular collagen fibers and atrophy of cementoblasts and fibroblasts. No immunoreactivity for IL-1 was shown in dental follicle, alveolar bone, and periodontal ligament. CONCLUSION: Irradiation and calcium-deficient diet seems to cause disturbance of the expression of interleukin-1 during tooth formation of rat molar.
Abdomen ; Animals ; Atrophy ; Blood Vessels ; Collagen ; Dental Cementum ; Dental Sac ; Diet* ; Fibroblasts ; Interleukin-1* ; Maxilla ; Microscopy ; Molar* ; Osteoblasts ; Osteoclasts ; Periodontal Ligament ; Pregnancy ; Rats* ; Tooth Germ ; Tooth*

Balloon dacryocystoplasty has been reported to be a safe, easy and effective nonoperative treatment for nasolacrimal stenosis. The results were not encouraging, however, because of its high failure and recurrence rates. To evaluate the feasibility of using modified Gianturco expandable metallic stents for maintenance of the dilated nasolacrimal system(NLS), 20 stents of 3 mm in diameter and 10mm long were placed in 20 nasolacrimal ducts of 10 dogs for 1 month to 10 months. It was more difficult to introduce the stents into the proximal portion(A) of the NLS than into the distal portion(B) due to the narrow and bony canal of the A portion. Twenty stents showed no migration in follow-up studies of up to 10 months. One complete occlusion occurred in a stent placed in A portion. Autopsy studies showed stents were covered with epithelium within 2 months after placement. Our experience suggest that the placement of Gianturco self-expandable stents may be a useful method of dilating and maintaining the luminal diameter of the NLS, although care must be taken to select the proper stent size.
Animals ; Autopsy ; Constriction, Pathologic ; Dogs* ; Epithelium ; Follow-Up Studies ; Methods ; Nasolacrimal Duct ; Phenobarbital ; Recurrence ; Stents*

PURPOSE: To observe the histologic pattern of healing in molar tooth extraction sockets of streptozotocin-induced diabetic rats following irradiation. MATERIALS AND METHODS: Mature Sprague-Dawley rats were divided into three groups: control, diabetic, and diabetic-irradiated groups. Diabetes mellitus was induced by injecting streptozotocin. Control rats were injected with a citrate buffer only. After 5 days, the right maxillary first molar was extracted under general anesthesia from each of the rats. After the extraction, rats in the diabetic-irradiated group were irradiated with a single absorbed dose of 10 Gy to the head and neck region. The rats were killed at 1, 3, 7, 14, 21, and 28 days after treatment. Tissue sections were stained with hematoxylineosin and Masson's trichrome. RESULTS: In the diabetic and diabetic-irradiated groups, the early healing process of the socket extraction was similar to the control group, but bone formation was delayed at 7 days after the treatment. In the diabetic-irradiated group, alveolar bone surrounding the extraction socket showed signs of necrosis at 3 days after treatment, and hemorrhage was observed in connective tissue within the extraction socket at 14 days after treatment. CONCLUSION: This experiment revealed that the healing process of the extraction socket was severely delayed and retarded by irradiation in the diabetic state.
Anesthesia, General ; Animals ; Citric Acid ; Connective Tissue ; Cranial Irradiation ; Diabetes Mellitus ; Head ; Hemorrhage ; Molar ; Neck ; Necrosis ; Osteogenesis ; Rats* ; Rats, Sprague-Dawley ; Streptozocin ; Tooth Extraction ; Wound Healing

PURPOSE: To evaluate the efficacy of venous stenting in the treatment of venous obstruction or stenosis of symptomatic deep vein thrombosis (DVT). METHOD: Eight consecutive patients with lower extremity DVT underwent venous stenting. The duration of symptoms were 20 days or less in 6 cases (acute) and above than 20 days in 2 cases (chronic). The cause of DVT was venous thrombophlebitis in 7 cases and extrinsic compression in 1 case. The indication of venous stenting is venous obstruction or stenosis after aspiration thrombectomy and direct catheter thrombolysis. The exclusion criteria were successful treatment of DVT with aspiration thrombectomy, direct catheter thrombolysis and percutaneous angioplasty. The follow-up examination was performed 1 week, 2~3 month interval by Doppler ultrasound, which was evaluated thrombi formation and patency of venous stenting. If the lesion detect in Doppler, second intervention was performed. RESULT: The venous stenting was successfully performed in all cases. Initial aspiration thrombectomy was performed in all cases. The urokinase was performed in 4 cases which was 500,000~750,000 IU (mean, 675,000) during from 2 to 8 hours (mean, 4). After that, the venous stenting was performed at the site of the venous occlusion and stenosis. The direct venography after stenting showed good reconstruction of vein and adequate restoration of venous flow. Seven patients relieved from lower extremity swelling without recurrence. One patient had re-thrombosis after venous stenting, which was successfully treated with percutaneous angioplasty. The follow-up duration was from 3 to 14 months (mean, 8 months). There were no thrombi in follow-up Doppler and normal regular life was resumed without lower extremity swelling. CONCLUSION: Venous stenting in the treatment of deep vein thrombosis is an effective and safe treatment method in the venous obstructive or stenotic remnant lesion despite following aspiration thrombectomy, direct catheter thrombolysis and percutaneous angioplasty.
Angioplasty ; Catheters ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Lower Extremity* ; Phlebography ; Recurrence ; Stents* ; Thrombectomy ; Thrombophlebitis ; Thrombosis ; Ultrasonography ; Urokinase-Type Plasminogen Activator ; Veins ; Venous Thrombosis*

Mesenteric lymphangioma was first recognized when an autopsy case was recorded in 1507 by Benevieni. It has been known clinically rare disease and probably a congenital developmental abnormality due to failure of drainage of peripheral primary lymphatic spaces. We experienced a case of abnormal rotation in intestine by mesenteric lymphangioma in a 8 years old male who showed vomiting and abdominal pain. A brief review of related literatures is also presented.
Abdominal Pain ; Autopsy ; Child ; Drainage ; Humans ; Intestines ; Lymphangioma* ; Male ; Rare Diseases ; Vomiting

PURPOSE: Conventional contrast dacryocystography(C-DCG) has been used mainly for anatomical assessment of the lacrimal drainage apparatus, due to its limited information on the dynamics of the lacrimal system, and thus correlation role in epiphora. The purpose of study was to improve the diagnostic value in epiphora by utilizing RI dacryocystography(RI-DCG) with quantitative criteria. MATERIALS AND METHODS: The patient for RI dacryocystography set erect with the head fixed in front of gamma camera fitted with a standard 6 mm pinhole collimater. Both eyes of 85 patients(170 eyes) were scanned with 99rnTc-pertechnetate followed by conventional dacryocystography. The data from gamma camera were recorded simultaneously on a computer system for subsequent quantitative analysis. RESULTS: In 94 of 96 eyes without epiphora, RI-DCG was correlated with normal C-DCG and % of emptying was at least over 50%. In 58 of 74 eyes with epiphora, RI-DCG was correlated with abnormal C-DCG and % of emptying was at most below 50%. In 16 eyes with functional block, quantitative RI-DCG showed abnormal % of emptying. CONCLUSION: Nuclear DCG with quantitation had higher diagnostic yield in functional block and correlated higher with epiphora. Thus nuclear DCG with quantitation would be a valuable functional test after postprocedures such as dacryocystoplasty.
Computer Systems ; Drainage ; Gamma Cameras ; Head ; Humans ; Lacrimal Apparatus Diseases* ; Radionuclide Imaging*

Nutritionally supporting the malnourished tumor bearing host may not benefit the disease outcome, but, rather, may preferentially "feed the cancer". We hypothesized that repletion is beneficial only when it augments an anti-tumor immune response. To support this hypothesis, 240 A/J mice were assigned to isocaloric dietary groups (24%, 5%, or 2.5% protein). On day 14 the mice received either immunogenic C1300- neuroblastoma (NB) or non-immunizing TBJ-NB. On day 21 half of the restricted animals were repleted with 24% protein chow. At day 35, chromium-release cell-mediated cytotoxicity was measured. In the group of mice that received 2.5% protein chow, nutritional repletion specifically augmented anti-tumor activity for C1300-NB which elicits a host immune response (33.78 L.U. (repleted) vs 3.47 L.U. (depleted) p less than 0.01), in contrast, nutritional repletion was detrimental for non-immunizing TBJ-NB, where further depression of cytotoxicity was seen (1.37 L.U. (repleted) vs 2.06 L.U. (depleted) 0 less than 0.01). This suggests that the influence of nutritional repletion in tumor nearing animals is dependent on the integrity of host's anti-tumor immunity.
Animals ; Body Weight ; Immunity, Cellular ; Male ; Mice ; Neoplasms, Experimental/*immunology ; Nutrition Disorders/*immunology