Air can be used as a carrier for volatile agent, ether, with a clear airway, normal pulmonary function and normal oxygenation. In 1858 John Snow, the Father of British Anesthesia stated in his book on Chloroform and Other Anesthetics that he believed it to be almost impossible for death to occur from ether administered with ordinary intelligence and attention. Today ether is probably still the safest anesthetic drug we possess. Ether is cheap and easily obtained; with controlled respiration 3% is adequate. Recovery smooth and rapid. Vomiting may be no different from other agents. Most machines depend upon cylinders of oxygen and other gases, and there are difficulties of refilling cylinders and the cost of transporting them. In such circumstances the E.M.O. Inhaler, allowing ether to be vaporized in known concentrations in air, has many advantages as an alternative to the open method administration. From all types of patients chosen at random 22 patients were studied for ether-air anesthesia. Anesthesia was induced with intravenous thiopental and subsequent endotracheal intubation was performed within 30 seconds with the aid of intravenous succinylcholine. SatO2, PaO2, pH, and Base E. were measured 3 times during pre-anesthesia, immediately after the intubation, and post-operatively by Radiometer, using the oxy-hemoglobin dissociation curve and the Siggard-Anderson alignment nomogram. Vital signs were recorded every 5 minutes. It is the purpose of this paper to present this series of 22 anesthetics by the use of the E.M.O. Inhaler with air and to discuss the possibility of hypoxia, advantages and limitations that became apparent. The results obtained may be summarized as follows. 1. It is essential that endotracheal intubation by carried out rapidly and that everything necessary be ready and immediately at hand before starting the anesthetic. 2. In all patients ventilated room air during anesthetic induction, no significant decreases of PaO2 and SatO2 were observed immediately after the endotracheal intubation. 3. The duration of any period of complete apnea inflicted on the patient must be carefully controlled. 4. 100% oxygen prevented the possibility of hypoxia on extubation after all the reflexes had returned. 5. Ether-air anesthesia is recommended without hesitation for use where economy and portability of anesthetic machine are needed.
Anesthesia* ; Anesthetics ; Anoxia ; Apnea ; Chloroform ; Ether ; Fathers ; Gases ; Hand ; Humans ; Hydrogen-Ion Concentration ; Intelligence ; Intubation ; Intubation, Intratracheal ; Nebulizers and Vaporizers ; Nomograms ; Oxygen ; Reflex ; Respiration ; Snow ; Succinylcholine ; Thiopental ; Vital Signs ; Vomiting

Grice extra-articular subtalar arthrodesis has been performed as either a temporizing or a definite procedure in young children to correct the dynamic hindfoot valgus deformity without affecting subsequent growth of the foot. Fifty eight extra-articular subtalar arthrodesis in thirty patients, performed at Seoul National University Children's Hospital from setpember 1985 to June 1989, were retrospectively reviewed to evaluate the clinical and radiographic results. There were 52 valgus feet in 26 patients and 6 varus feet in 4 patients secondary to cerebral palsy, meningomyelocele, congenital snomalies, and other neuromuscular diseases. In many instances, additional tendon surgeries were also required to correct deformities or achieve the muscle balance. The review consisted of personal interview, physical examination, and radiological assessment. On physical examination, preoperative hindfoot valgus deformty(mean: 14.3°clinically) was well corrected, postoperative hindfoot valgus ranging from neutral to valgus 5°clinically in 35 of 52 cases(67.3%). Correction of the lateral talocalcaneal angle on standing lateral radiographic view averaged 8.5 degrees(from 57.3 degrees preoperatively to 37.6 degrees postoperatively). In valgus feet, there were 3 cases with mild pain around the ankle joint. There were 5 cases of graft resorption and 2 cases of nonunion. Graft failure was more frequent when the proximal end of the graft was directed anterior to the weight bearing axis. With original Grice subtalar arthrodesis, satisfactory results were obtained in 34 of 52(65.4%) hindfoot valgus feet. In 6 varus feet, there were 1 undercorrection and 2 recurrence of varus deformity. We re-emphasize the importance of strict operative technique to obtain satisfactory results. We also believe that Grice procedure may be used for the correction of subtalar instability in selected cases of varus foot before muscle baancing procedures.
Ankle Joint ; Arthrodesis ; Cerebral Palsy ; Child ; Congenital Abnormalities ; Foot ; Humans ; Meningomyelocele ; Neuromuscular Diseases ; Physical Examination ; Recurrence ; Retrospective Studies ; Seoul ; Tendons ; Transplants ; Weight-Bearing

BACKGROUND: Much time and cost have been consumed for just a treatment of a simple disease and inappropriate management has taken place because of misjudgement by laymen. To establish a desirable health care system, need for the usual-medical-provider system (U.MP. system) has been suggested. This study was performed to find some data that would be helpful to establish the U.MP. system by surveying some factors influencing on choosing care providers of children. METHODS: 440 questionnaires were gathered from surveys administered to the parents of the students in a primary school. The period for study was 1 week of September in 1999 and the response rate was 88.0%. The questionnaire was composed of sociodemographic variables, a question for having U.MP. and some factors related with choosing U.MP. RESULTS: The fourth and fifth decade of age showed higher proportion for having U.MP. than sixth decade. The proportion of having U.MP. was also higher in respondents with higher educational attainment and higher income. The proportion of visiting local clinics or hospitals was about 65.7% in groups having U.MP., whereas the proportion was about 41.5% in group not having U.MP., The frequency of visiting local clinics or hospitals for a year was higher for groups having U.MP., compared with groups not having U.MP.. The factors related with choosing U.MP. were `doctors who explain the disease in detail and easily', `doctors who provide care meticulously', and `effective treatment'. CONCLUSION: To establish the U.MP. system, a kinder attitude and care would be necessary for doctors who will provide care to the patients and their family.
Child ; Surveys and Questionnaires ; Delivery of Health Care ; Humans ; Parents

PURPOSE: To investigate the influence of the change in medial rectus resection amount caused by traction with muscle hooks on surgical results in exotropia. METHODS: In this prospective study 38 exotropia patients underwent unilateral lateral rectus recession-medial rectus resection (R & R). After isolation of the medial rectus muscle, the length of the muscle was measured with a muscle hook, and the portion to be resected was marked using gentian violet stain with calipers. After the medial rectus was retracted with two muscle hooks in either direction, its length was measured again with the calipers. Group 1 includes the patients with the planned resection amount changed to a more 0.5-1.0 mm when the rectus muscle was retracted, while group 2 did not change with the second muscle hook. The surgical results were compared between the 2 groups at postoperative 6 months. RESULTS: Mean resection amount was changed from 5.07 +/- 0.76 mm to 5.36 +/- 0.73 mm after pulling the second muscle hook. Sixteen patients (42.1%) were included in group 1 and 22 patients (57.9%) in group 2. There was no significant statistical difference in mean preoperative and postoperative deviated angle between the two groups. Success rates defined as the ocular alignment within +/- 10 PD in the primary position at postoperative 6 months were 75.0% in group 1 and 86.3% in group 2, which is not stastistically different (p > 0.05). CONCLUSIONS: Medial rectus resection amounts can be changed with the muscle traction with two muscle hooks, which induced the planned amount of resection less than first measured resection amount. However, there was little influence on surgical outcomes from the change occurred to a maximum 1 mm in resection measurement due to traction with two muscle hooks.
Exotropia ; Gentian Violet ; Humans ; Muscles ; Prospective Studies ; Strabismus ; Traction

PURPOSE: To evaluate changes in muscle length when retracting the extraocular rectus muscle with muscle hooks during strabismus surgery. METHODS: Forty-four rectus muscles of 42 patients consecutively resected in two hospitals (A, B) were included in this study. After isolation of the rectus muscle, the length of the muscle was recorded and the portion to be resected was marked using gentian violet stain on the tip of calipers. After the rectus muscle was retracted with two muscle hooks in either direction, its length was measured again with the calipers. RESULTS: The length of the rectus muscle was not changed by retraction in 25 of 44 muscles (56.8%). The length of the muscle was changed by 0.5 mm in 13 muscles (29.5%) and by 1mm in six muscles (13.6%). Changes of rectus muscle length over 0.5 mm were observed in 15 of 27 muscles of patients treated at hospital A (55.5%) and four of 17 muscles of patients treated at hospital B (23.5%). The results for the two hospitals were significantly different (p=0.037). CONCLUSIONS: Small errors in measurement can occur when muscle resections are performed during strabismus surgery. Institutional or clinician related factors may explain variations in error rates between hospitals.
Gentian Violet ; Humans ; Muscles ; Strabismus ; Traction

Adipose tissue stem cells (ADSCs) would be an attractive autologous cell source. However, ADSCs require invasive procedures, and has potential complications. Recently, urine stem cells (USCs) have been proposed as an alternative stem cell source. In this study, we compared USCs and ADSCs collected from the same patients on stem cell characteristics and capacity to differentiate into various cell lineages to provide a useful guideline for selecting the appropriate type of cell source for use in clinical application. The urine samples were collected via urethral catheterization, and adipose tissue was obtained from subcutaneous fat tissue during elective laparoscopic kidney surgery from the same patient (n = 10). Both cells were plated for primary culture. Cell proliferation, colony formation, cell surface markers, immune modulation, chromosome stability and multi-lineage differentiation were analyzed for each USCs and ADSCs at cell passage 3, 5, and 7. USCs showed high cell proliferation rate, enhanced colony forming ability, strong positive for stem cell markers expression, high efficiency for inhibition of immune cell activation compared to ADSCs at cell passage 3, 5, and 7. In chromosome stability analysis, both cells showed normal karyotype through all passages. In analysis of multi-lineage capability, USCs showed higher myogenic, neurogenic, and endogenic differentiation rate, and lower osteogenic, adipogenic, and chondrogenic differentiation rate compared to ADSCs. Therefore, we expect that USC can be an alternative autologous stem cell source for muscle, neuron and endothelial tissue reconstruction instead of ADSCs.
Adult Stem Cells/*cytology/*immunology/transplantation ; Biomarkers/metabolism ; Cell Differentiation ; Cell Lineage ; Cell Proliferation ; Cell Separation ; Chromosomal Instability ; Colony-Forming Units Assay ; Humans ; Karyotyping ; Multipotent Stem Cells/cytology/immunology/transplantation ; Subcutaneous Fat, Abdominal/*cytology ; Transplantation, Autologous ; Urine/*cytology

PURPOSE: As cardiomyopathy is more prevalent and currently the leading cause of death in Duchenne muscular dystrophy (DMD), early detection of myocardial involvement is important. The purpose of this study was to analyze myocardial strain in DMD children, for the possibility of early detection of myocardial dysfunction. MATERIALS AND METHODS: We reviewed medical records of DMD patients who were >10 years of age (15.6±1.6 years, 12.5-18 years), from March 2013 to June 2014. Data of 24 DMD children who underwent echocardiography with three-layer specific myocardial strain were compared with 24 controls (age: 9.3±4.0 years, 5.5-17 years). RESULTS: Epicardial longitudinal strain was lower in DMD (DMD: -9.3±3.8%; control: -12.3±4.3%; p=0.012). Radial strain (DMD: 24.1±11.1%; control: 37.3±25.9%; p=0.027) and strain rate (SR) (DMD: 1.68±0.91; control: 2.42±0.84; p=0.006) on parasternal short axis view were lower in DMD. Circumferential strains in the endocardium (DMD: -17.5±4.7%; control: -24.2±5.3%; p<0.001), myocardium (DMD: -12.7±3.8%; control: -18.0±4.0%; p<0.001), and epicardium (DMD: -8.4±4.0%; control: -12.2±5.0%; p=0.006) were significantly decreased in DMD. Circumferential SRs were lower in the endocardial (DMD: -1.46±0.38; control: -1.78±0.27; p=0.002) and myocardial layers (DMD: 1.02±0.27; control: -1.28±0.22; p=0.001). CONCLUSION: In DMD patients, deteriorations in myocardial circumferential strain might be an indicator for predicting cardiomyopathy.
Adolescent ; Cardiomyopathies/*diagnostic imaging/*etiology ; Case-Control Studies ; Child ; Child, Preschool ; Early Diagnosis ; *Echocardiography ; Female ; Humans ; Male ; Muscular Dystrophy, Duchenne/*complications/*diagnostic imaging ; Predictive Value of Tests

Amyloidosis is a group of disorders resulting from the extracellular deposition of amyloid fibrils in tissues and organs. Primary systemic amyloidosis may be myeloma-associated or idiopathic. It involves the kidney, heart, liver, peripheral nerves, autonomic nervous system and skin. We report a case of a 76 year-old woman with primary systemic amyloidosis who suffered from ecchymotic purpura on the periorbital, flexural area with hemorrhagic bulla, and macroglossia for two years. She showed typical symptoms of AL amyloidosis, and while primary systemic amyloidosis was suspected from electrophoresis results, no amyloid was found in the skin, tongue, and bone marrow. Upon her admission due to panperitonitis from diverticulitis, she was diagnosed with primary systemic amyloidosis after amyloid deposition was confirmed in the skin and colon biopsy. She had been treated with bortezomib, but she expired from methicillin-resistant Staphylococcus aureus septic shock.
Amyloid ; Amyloidosis ; Autonomic Nervous System ; Biopsy ; Blister ; Bone Marrow ; Boronic Acids ; Colon ; Diverticulitis ; Electrophoresis ; Female ; Heart ; Humans ; Kidney ; Liver ; Macroglossia ; Methicillin-Resistant Staphylococcus aureus ; Peripheral Nerves ; Plaque, Amyloid ; Purpura ; Pyrazines ; Shock, Septic ; Skin ; Tongue ; Bortezomib

Mesenteric cysts are rare intra-abdominal lesions occurring during childhood, which were first described in 1507. Cases of mesenteric cysts have been continuously reported, but these cases were very small in number. They are often asymptomatic and incidentally found while patients are undergoing work-up or receiving treatment for other conditions such as appendicitis, small-bowel obstruction, or diverticulitis; however, patients may still have lower abdominal pain and symptoms that are frequently associated with other abdominal conditions. The symptoms are variable and non-specific, including pain (82%), nausea and vomiting (45%), constipation (27%), and diarrhea (6%). An abdominal mass may be palpable in up to 61% of patients. We are to report the clinical course and literature of a child with mesenteric cysts who complained of acute abdominal pain, distension, and vomiting and were surgically treated after being diagnosed with mesenteric cysts based on radiological examination.
Abdominal Pain* ; Appendicitis ; Child* ; Child, Preschool* ; Constipation ; Diarrhea ; Diverticulitis ; Humans ; Mesenteric Cyst* ; Nausea ; Vomiting

Mesenteric cysts are rare intra-abdominal lesions occurring during childhood, which were first described in 1507. Cases of mesenteric cysts have been continuously reported, but these cases were very small in number. They are often asymptomatic and incidentally found while patients are undergoing work-up or receiving treatment for other conditions such as appendicitis, small-bowel obstruction, or diverticulitis; however, patients may still have lower abdominal pain and symptoms that are frequently associated with other abdominal conditions. The symptoms are variable and non-specific, including pain (82%), nausea and vomiting (45%), constipation (27%), and diarrhea (6%). An abdominal mass may be palpable in up to 61% of patients. We are to report the clinical course and literature of a child with mesenteric cysts who complained of acute abdominal pain, distension, and vomiting and were surgically treated after being diagnosed with mesenteric cysts based on radiological examination.
Abdominal Pain* ; Appendicitis ; Child* ; Child, Preschool* ; Constipation ; Diarrhea ; Diverticulitis ; Humans ; Mesenteric Cyst* ; Nausea ; Vomiting