BACKGROUND: Mannitol is widely used in neurosurgical patients and may induce an increase in serum potassium concentration according to doses and administration rates with unknown mechanism. The treatment of hyperkalemia is aimed at eliminating the causes and includes calcium, sodium bicarbonate, glucose with insulin, loop diuretics and hyperventilation. This study was undertaken to observe the effects of hyperventilation on the serum potassium concentration following infusion of mannitol (2.0 gm/kg). METHODS: We studied 30 patients who were operated brain aneurysm clipping surgery and were divided into 3 groups (n=10). In control group, mild hypocapnia was maintained (PaCO2, 32 2 mmHg) before and after mannitol infusion. In group I, moderate hypocapnia was maintained (PaCO2, 27 2 mmHg) before and after mannitol infusion. In group II, mild hypocapnia (PaCO2, 32 2 mmHg) was maintained before 30 minutes of mannitol infusion and moderate hypocapnia (PaCO2, 27 2 mHg) after mannitol infusion. We started infusion of 20% mannitol with a dosage of 2.0 gm/kg, 15~20 min after cranium was opened. RESULTS: The changes of serum potassium were as follows (Mean SD mEq/l) (just before and 15min, 30min, 60min after mannitol infusion): 3.79 0.48, 4.66 0.60, 4.44 0.48, 4.13 0.40 (Control group), 3.62 0.18, 3.63 0.42, 4.14 0.51, 3.95 0.33 (Group I), 3.76 0.20, 3.91 0.15, 4.11 0.30, 4.04 0.23 (Group II). After 15 minutes of mannitol infusion, the serum potassium levels of group I and II were lower than that of control group (p<0.05) and there was no significant difference between group I and II. CONCLUSIONS: These results suggest that hyperventilation may blunt the increase in serum potassium concentration following rapid infusion of high dose mannitol.
Calcium ; Glucose ; Humans ; Hyperkalemia ; Hyperventilation* ; Hypocapnia ; Insulin ; Intracranial Aneurysm ; Mannitol* ; Potassium* ; Skull ; Sodium Bicarbonate ; Sodium Potassium Chloride Symporter Inhibitors

Isolated and severe left main coronary ostial stenosis is a rare case. In the majority of these patients ostial stenosis was associated with any of the conditions known to involve the coronary ostia. These conditions include syphilitic aortitis, Takayasu's aortitis, familial hypercholesterolemia, and aortic valve disease. A 34-year young female patient was presented with exertional and stabbing anterior chest pain. There was no history of syphilis, diabetes mellitus, hypertension, hyperlipidemia and smoking. Coronary angiogram showed isolated left main coronary ostial stenosis. Transesophageal echocardiography(TEE) showed acute angle takeoff of the left main coronary artery. She underwent surgical angioplasty of coronary ostia with a patch of autologous pericardium. After angioplasty, TEE showed dilatation of left main coronary ostium and her clinical symptom improved.
Angioplasty ; Aortic Valve ; Aortitis ; Chest Pain ; Constriction, Pathologic* ; Coronary Vessels ; Diabetes Mellitus ; Dilatation ; Female ; Humans ; Hyperlipidemias ; Hyperlipoproteinemia Type II ; Hypertension ; Pericardium ; Smoke ; Smoking ; Syphilis ; Syphilis, Cardiovascular

The management of the third molar tooth in mandibular angle fracture is still controversial. Retrospective analysis of 197 cases of mandibular angle fractures associated with third molar tooth was undertaken. Selective prophylactic extraction of the third molar teeth were undertaken in 66 cases. The third molar teeth were retained in 131 fractures. The indication of extraction of the third molar teeth in mandibular angle fracture were as follows: 1) interfering with reduction of the fracture; 2) excessive mobility; 3) exposure of tooth root due to distraction of the fracture; 4) fractured teeth; 5) severely carious tooth 6) infected supporting structure. There were no significant differences between the complication rate in the "tooth removed" group and "tooth retained" group. Complications were minimal. Therefore proper management of the third molar tooth in mandibular angle fracture will minimize complication.
Molar, Third* ; Retrospective Studies ; Tooth Root ; Tooth*

BACKGROUND: Thoracic outlet syndrome(TOS) is caused by the compression of neurovascular structures that supply to the upper extremities. Only a few reports have been published in Korea, and this study attempts to investigate the clinical aspects and results of the patients who underwent surgical treatment. MATERIAL AND METHOD: This study consist of 16 patients who underwent operations for thoracic outlet syndrome from May, 2002 to October, 2004. The surgical indications were confined to patients with: 1) symptoms too severe to perform ordinary daily life because of pain, paresthesia, edema of upper extremities, 2) no improvement after proper physical therapy, 3) definite findings of compression confined by radiologic examinations (MRI, angiography, etc), and 4) no other diseases such as cervical intervertebral herniation, myositis, neurologic diseases below the brachial plexus. The surgical approaches were by transaxillary approaches in 12 cases, supraclavicular approaches in 2 cases, and infraclavicular approaches in 2 cases. RESULT: There were 15 males and one female with an average age of 23.9 years (range: 19~39). Rib anomalies were observed in four cases (25.0%), but the others had no abnormal ribs. Right lesions were found in eight cases (50.0%), left lesions in five cases (31.3%), and bilateral lesions in three cases (18.7%). The follow-up period was 9~26 months and recurrence rate was 12.5% (2/16). Complications were one case of ulnar nerve palsy, one case of persistent pain despite radiologic improvement and three cases of wound dehiscence due to fat necrosis and hematoma. CONCLUSION: Although the choice of treatment in patients with TOS has been disputed, patients who have no response with proper physical therapies can benefit from the surgical treatment which may help patients to return to normal daily activity in shorter period of time.
Angiography ; Brachial Plexus ; Edema ; Fat Necrosis ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Korea ; Male ; Myositis ; Paresthesia ; Recurrence ; Ribs ; Thoracic Outlet Syndrome* ; Ulnar Neuropathies ; Upper Extremity ; Wounds and Injuries

Objective: To investigate the reliability and validity of the Korean version of Children’s Depression Inventory 2 Short Version (CDI 2:S) in comparison with its full-length version (CDI 2) as a screening tool for depressive youth. Methods: A total of 714 children from the community and 62 psychiatric patients were enrolled in this study. The Korean version of the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL-K) served as the reference standard for computing receiver operating characteristic (ROC) curves. To evaluate the ability of the CDI 2 and CDI 2:S to discriminate major depressive disorders, areas under the curves (AUCs) were compared. To investigate psychometric properties of the CDI 2:S, internal consistency was calculated and confirmatory factor analysis was conducted. Results: For the CDI 2, the cutoff at 20 yielded the best balance between sensitivity (83%) and specificity (91%). For the CDI 2:S, the cutoff point of 10 resulted in high sensitivity (82%) and high specificity (93%). The short form was proven to be as sensitive and specific as the CDI 2. Further analyses confirmed that the CDI 2:S also had good reliability and validity. Conclusion The CDI 2:S, a sensitive and brief form of the CDI 2, may serve as a better option in time-constrained psychiatric settings.

Malignant fibrous histiocytoma (MFH) is a primitive sarcoma originating in the deep soft tissue and composed of fibrocytic and histiocytic cells in a storiform pattern. It is rare but the most common soft tissue sarcoma of adulthood. MFH occurred in various epithelial organs derived from the supportive mesenchymal elements. The lung represents an extremely rare primary site. We have experienced one case of MFH, arising in the lung parenchyme in 67 years old male patient with cough for 6 months. The patient was taken right upper lobe and right middle lobe lobectomy with good post-operative results. But another MFH was recurred in the left upper lobe 3 months after complete resection. So he had been treated with chemotherapy and radiofrequency ablation of tumor. Then he continued to be treated with chemotherapy
Aged ; Catheter Ablation ; Cough ; Drug Therapy ; Histiocytoma, Malignant Fibrous* ; Humans ; Lung* ; Male ; Sarcoma

Spontaneous complete chorioamniotic membrane separation (CMS) without invasive fetal procedure is extremely rare and associated with adverse perinatal outcomes. A woman with complete CMS which was detected at the 21 weeks' gestation. She did not take any fetal invasive procedures before the diagnosis. At 27 weeks' gestation, an emergency Caesarean section was performed because of fetal distress. The defect of the uterine muscle was detected on the fundus. The baby has grown well without any morbidity. This is the first reported case of complete CMS relative to uterine scar. And we suggest that the pregnancy can be maintained successfully if there is no fetal abnormality when complete CMS is detected on ultrasound.
Animals ; Cesarean Section ; Cicatrix* ; Diagnosis ; Emergencies ; Female ; Fetal Distress ; Humans ; Live Birth* ; Membranes* ; Mice ; Myometrium ; Pregnancy ; Ultrasonography

Lymphangioleiomyomatosis (LAM) is a rare disease in women of childbearing ages that eventually leads to respiratory failure. Lung transplantation is the only conclusive therapeutic modality in end-stage LAM. While single-lung transplantation is the preferred operation, the graft failure or recurrence of LAM was reported. We performed a single lung transplantation on a 36-year-old woman suffering from respiratory failure due to lymphangioleiomyomatosis. After a 1-year follow up, the patient was readmitted because of graft failure with collapsed transplanted lung. The lung volume reduction surgery (LVRS), tracheostomy and ventilator care were performed. However, neither the medical nor surgical treatment had any effect. Subsequently, we performed a contralateral single lung re-transplantation and had a good postoperative results.
Adult ; Female ; Follow-Up Studies ; Humans ; Lung Transplantation ; Lung* ; Lymphangioleiomyomatosis* ; Pneumonectomy ; Rare Diseases ; Recurrence ; Reoperation ; Respiratory Insufficiency ; Tracheostomy ; Transplants* ; Ventilators, Mechanical

BACKGROUND: Marked changes in systemic hemodynamics during liver transplantation may lead to changes in cerebral hemodynamics and metabolism. Therefore, continuous monitoring of the jugular venous oxygen saturation (SjvO2) may help the anesthetic management of liver transplantation. METHODS: We observed changes in SjvO2 using a double lumen oximetry catheter for continuous monitoring and analyzed the correlation between SjvO2 and hemodynamic measurements in thirty patients undergoing liver transplantation. RESULTS: There were no significant changes in SjvO2 compared to initial SjvO2 during liver transplantation. SjvO2, however, increased from 72.5 to 79.6 % (P < 0.05), before and after reperfusion. There was a weak correlation between changes in SjvO2 and cardiac output (r = 0.38, P < 0.05), whereas no correlation was found among changes in SjvO2 and arterial carbon dioxide tension, mean arterial pressure, central venous pressure, or mixed venous oxygen saturation before and after reperfusion. CONCLUSIONS: SjvO2 that reflects changes in cerebral oxygen demand-supply balance was well maintained during liver transplantation except the reperfusion period. Continuous monitoring of changes in SjvO2 at this period may provide further insight to understand physiology of cerebral oxygenation during liver transplantation and merits further studies.
Arterial Pressure ; Carbon Dioxide ; Cardiac Output ; Catheters ; Central Venous Pressure ; Hemodynamics ; Humans ; Liver Transplantation* ; Liver* ; Metabolism ; Oximetry ; Oxygen* ; Physiology ; Reperfusion

Juvenile granulosa cell tumor (JGCT) is one of the rare sex cord stromal tumors of the ovary. The majority of JGCT are found in prepubertal girls and young women. Unlike adult granulosa cell tumor (AGCT), JGCT is characterized by high frequency of mitosis and early relapse after treatment. Patients with JGCT in FIGO stage Ia have an excellent outcome with an event-free survival of about 90% following surgical resection alone, while those in advanced stages have an unfavorable outcome. We report two cases of JGCT in stage Ic, who showed a quite different outcome. One was managed initially with surgical resection alone and died of subsequent relapse. Another was managed with multimodality treatments including surgical resection, adjuvant chemotherapy and radiotherapy, and didn't show any evidence of relapse during 16 months of follow-up period. Further studies to evaluate the beneficial effects of chemotherapy and/or radiotherapy are required in patients with JGCT in stage Ic.
Adult ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Granulosa Cell Tumor* ; Granulosa Cells* ; Humans ; Mitosis ; Ovary ; Radiotherapy ; Recurrence ; Sex Cord-Gonadal Stromal Tumors