PURPOSE: To analyze hemodynamic parameters of electrical bioimpedance on increased blood pressure induced by pneumoperitoneum and compare hemodynamic effects of propofol and isoflurane during laparoscopic cholecystectomy. METHODS: Systemic vascular resistance index(SVRI), index of contractility(IC), end diastolic index(EDI), mean arterial pressure(MAP) and heart rate(HR) were measured after anesthetic induction, 5, 10, 15 and 30 minutes after CO2 insufflation and after CO2 removal. RESULTS: In isoflurane group, MAP, IC, SVRI were increased but EDI was decreased after induction of pneumoperitoneum. In propofol group, MAP, SVRI were increased but IC was decreased after induction of pneumoperitoneum. HR was not changed during operartion. CONCLUSION: After induction of pneumoperitoneum, MAP is increased by increased IC and SVRI in isoflurane. In case of propofol, the MAP is increased by increased SVRI. It seems that increased transmural pressure of lymphatics and splanchnic vasculatures rather than sympathetic stimulation increases SVRI after pneumoperitoneum.
Blood Pressure* ; Cholecystectomy, Laparoscopic* ; Heart ; Hemodynamics* ; Insufflation ; Isoflurane ; Pneumoperitoneum* ; Propofol ; Vascular Resistance

PURPOSE: The mortality and morbidity rate after pancreaticoduodenectomy (PD) is still high, although the operative techniques and skills and the perioperative care has been improved. The incidence of PD for benign disease is 5~20%. The aim of this study is to determine the factors that differentiate between the benign group and the malignant group by comparing the clinical manifestations, and we studied the safety of performing PD for benign diseases by observing the early and late postoperative complications. METHODS: We retrospectively studied 124 patients who had been diagnosed with benign or malignant pancreatic diseases and who underwent PD between April 1995 and December 2005. We divided the patients into two groups, i.e., the benign group (20) and the malignant group (104), to compare their clinical characteristics and postoperative outcomes. Result: Chronic pancreatitis was the most common disease (35%) in the benign group and distal CBD cancer was the most common disease (40.4%) in the malignant group. Jaundice, weight loss, and elevation of CA 19-9 were more frequent in the malignant group than in the benign group (p<0.05). There were no statistical differences in the mortality rate (10.0% vs 6.7%), reoperation rate (5.0% vs 4.8%), hospital stays (27.1 days vs 24.0 days), early complications (30.0% vs 44.6%) and late complications (22.2% vs 26.4%) between the two groups. There were no mortality and newly developed malignancy during 33.4 months of follow-up period in benign group. CONCLUSION: On the preoperative evaluation, jaundice, weight loss, and elevation of CA 19-9 were more frequent in the malignant group. The postoperative early and late complications showed no difference between the two groups and complication rate was generally favorable. Thus, PD can be performed safely for benign diseases that cannot be treated in a conservative fashion and also for other clinically suspicious malignant diseases.
Follow-Up Studies ; Humans ; Incidence ; Jaundice ; Length of Stay ; Mortality ; Pancreatic Diseases ; Pancreaticoduodenectomy* ; Pancreatitis, Chronic ; Perioperative Care ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Weight Loss

Parkinsonism is not commonly associated with intracranial tumors. The most common brain tumor causing parkinsonism is meningiomas. We are presenting two cases of meningiomas whose major manifestations included parkinsonism. In one, parkinsonian symptoms initially partially responded to L-dopa and bromocriptine. A CT scan taken for a stroke-like episode revealed a meningioma of left frontal convexity. After neurological sequelae of CO poisoning, the patient poorly responded to antiparkinsonian drugs. Surgical treatment of meningioma did not result in satisfactory control of extrapyramidal symptoms. In the other with a parasagittal meningioma, parkinsonian symptoms were postoperatiYely improved. Because no curative treatment is available for the majority of parkinsonian patients, early detection of an underlying neoplasm may result in a most rewarding outcome. It would be desirable to perform CT or MRI in cases of parkinsonism with other associated neurological manifestation. Unilaterality of parkinsonian symptoms may also be indication.
Brain Neoplasms ; Bromocriptine ; Frontal Lobe* ; Humans ; Levodopa ; Magnetic Resonance Imaging ; Meningioma* ; Neurologic Manifestations ; Parkinsonian Disorders* ; Poisoning ; Reward ; Tomography, X-Ray Computed

No abstract available.
Neoplasm Metastasis*

Abdominal wall leakage of dialysate in continuous ambulatory peritoneal dialysis (CAPD) patients is uncommon complication. We experienced one case of abdominal wall leakage in CAPD patient confirmed by CT peritoneography. She complained weight gain, decreased ultrafiltration volume, and localized abdominal wall edema without clinical evidence of hernia. CT peritoneography of the abdomen showed leakage of contrast dye from the site of insertion of the CAPD catheter into the anterior abdominal wall. The dialysate was completely drained and CAPD was discontinued. She was switched temporally to hemodialysis and abdominal wall edema disappeared. When CAPD was restarted seven days later, the edema appeared. After CAPD catheter was removed and reinserted at the opposite site, she returned to CAPD without leakage.
Abdomen ; Abdominal Wall* ; Catheters ; Edema ; Hernia ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis ; Ultrafiltration ; Weight Gain

Pulmonary thromboembolism (PTE) originating from a renal vein thrombosis (RVT) is very rare, especially in relatively healthy young women. The patient described herein presented with a syncope-associated massive PTE. She was previously healthy, except for termination of an ectopic pregnancy with methotrexate 4 months before. The only medication she was taking was an oral contraceptive (OC), which was started 3 months before the PTE. She had no family history of venous thromboembolism (VTE) or any other underlying risk factors. We report the case of a woman who had a PTE originating from a RVT associated with OC use after an ectopic pregnancy.
Contraceptives, Oral ; Female ; Humans ; Methotrexate ; Pregnancy ; Pregnancy, Ectopic ; Pulmonary Embolism ; Renal Veins ; Risk Factors ; Thrombosis ; Venous Thromboembolism

Paraneoplastic neurologic syndrome is a group of assorted disorders resulting from damage to the nervous system in cancer, remote from primary site, and not related to metastasis, infection, or metabolic disorder associated with cancer. Patient with small cell lung cancer sometimes shows various neurological syndromes, but patient with non-small cell lung cancer rarely shows neurologic syndromes and few antineuronal antibodies have been found. Here, we report a case of 53-year-old male patient who developed ptosis and extraocular muscular limitation of left eye due to third and forth cranial nerve palsy in non-small cell lung cancer without brain metastasis. These neurologic symptoms improved after lobectomy without any other treatment immunotherapy.
Antibodies ; Brain ; Carcinoma, Non-Small-Cell Lung ; Cranial Nerve Diseases ; Cranial Nerves ; Eye ; Humans ; Immunotherapy ; Male ; Middle Aged ; Neoplasm Metastasis ; Nervous System ; Neurologic Manifestations ; Paraneoplastic Syndromes ; Paraneoplastic Syndromes, Nervous System ; Small Cell Lung Carcinoma

PURPOSE: The surgical treatment of gastric cancer that invades adjacent organs is a radical gastrectomy with combined resection including the adjacent organs or a palliative operation by performing either a gastrojejunostomy or gastrectomy. However, since it is impossible to determine the exact stage of the cancer, either T or N, in the case of palliative surgery, it is inappropriate to predict patient prognosis. This study analyzes the prognoses for patients whose final TNM stages are determined by a combined resection performed due to macroscopical infiltration into the adjacent organs. MATERIALS AND METHODS: Of 2,452 patients that underwent surgery for gastric cancer at our hospital from 1983 to 2002, we evaluated 102 patients where a combined resection was performed because direct infiltration into the adjacent organs was discovered. RESULTS: Univariate analysis showed that the survival rate differed by the depth of invasion into the gastric walls, the degree of lymph node metastasis, distant metastasis, pathological TNM stage, surgical curability, the location of tumor, and histological differentiation. By multivariate analysis, it was found that the surgical curability, the location of the tumor and the degree of lymph node metastasis were independent prognostic factors. CONCLUSION: It is suggested that even when infiltration into adjacent organs is suspected, radical surgery should be performed as to allow a prediction of prognosis through an exact determination of disease stage, and to improve the survival rate.
Gastrectomy ; Gastric Bypass ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Palliative Care ; Prognosis ; Stomach Neoplasms* ; Survival Rate

BACKGROUND: Gejang (marinated crab) is a favorite traditional food and a main source of crab intake among Koreans. The present study aimed to identify the possibility of cadmium inflow to the body through gejang; accordingly, the relationship between gejang intake frequency and amount, and blood cadmium concentrations was investigated. METHODS: Using data from the first Korea National Health and Nutrition Examination Survey in the sixth period in 2013, means and standard errors of blood cadmium concentrations in relation to gejang intake frequency and amount, as well as the monthly intake of gejang, were obtained from 1381 participants for whom data regarding blood cadmium concentration measurements was available. RESULTS: After adjustment for confounding factors, a gejang intake frequency of four or fewer times per week and a monthly intake of 200 cm3 or less had no significant effect on blood cadmium concentrations. However, participants with gejang intake of at least five times per week had a weighted mean cadmium concentration of 2.12 μg/L (p < 0.001), and participants who had a gejang monthly intake of more than 200 cm3 had a weighted mean cadmium concentration of 1.76 μg/L (p < 0.001). CONCLUSION: These results suggest that to minimize the effect of gejang consumption on blood cadmium level, gejang intake should be limited to four or less times per week and 200 cm3 or less per month. Weekly intake of at least five times and monthly intake of more than 200 cm3 may increase blood cadmium levels.
Cadmium* ; Korea ; Nutrition Surveys

OBJECTIVE: During anterior clinoidectomy for aneurysms of ophthalmic artery or paraclinoidal lesions, not only optic nerve but also cranial nerves passing through the superior orbital fissure (SOF) can be damaged by mechanical or thermal injury. Particularly, revision for paraclinoidal lesions can give further damage to the cranial nerves because of the obscure anatomical structure resulting from the tight fibrous adhesion. Thus, to reduce the damage of the cranial nerves passing through the SOF during the anterior clinoidectomy or optic canal decompression via the extradural or intradural route, morphometric relationship of juxta-clinoidal cranial nerves were studied. MATERIALS AND METHODS: Using 15 adult formalin fixed cadavers, the anatomical landmarks for measurements were chosen as follows: lateral entry point of optic nerve into the optic canal (LON), tip of anterior clinoid process (ACP), tip of posterior clinoid process (PCP), upper border of lesser wing of sphenoid bone, and lateral end of SOF. The measurements were carried out as follows: 1) distance from the LON to the dural entry point (DEP) of the third (III), fourth (IV), and ophthalmic branch of the fifth (V1) nerves into the tentorium, 2) distance from the tip of PCP to the DEP of III and VI cranial nerves, 3) distance from the LON to the cranial nerves within intradural space before passing through SOF, 4) The shortest depth from the tip of ACP and the edge of lesser wing to the cranial nerves passing through the cavernous sinus, 5) distance from the lateral end of SOF to the cranial nerves just before passing through the annular tendon. RESULTS: The mean distance from the LON to the DEP of the III, IV, and V1 cranial nerves were 10.4 mm, 18.8 mm, and 23.4 mm, respectively. The mean distance from the tip of PCP to the DEP of the III and VI cranial nerves were 5.4 mm and 18.6 mm, respectively. DEP of the III cranial nerve was corresponded with the just anterior coronal plane of PCP. The mean distance from the LON to the III, IV, and V1 cranial nerves passing through the SOF were 7.2 mm, 10.0 mm, 10.5 mm and 10.6 mm, respectively. The III cranial nerve located at a mean depth of 3.4 mm from the tip of ACP. The IV, V1 , and VI cranial nerves located at a mean depth of 2.1 mm, 2.4 mm and 7.4 mm from the upper border of lesser wing of sphenoid bone, respectively. The III cranial nerve splitted into superior and inferior divisions at a mean distance of 1.51 mm from the lateral end of SOF, just before where it passes through the SOF. The mean distance from the lateral end of SOF to the lateral margins of the III, IV and frontal nerves of V1 were 12.5 mm, 11.0 mm and 10.2 mm, respectively. CONCLUSION: DEP of the III cranial nerve was corresponded with the just anterior coronal plane of PCP and was about a half distance from PCP than from LOP. DEP of the IV cranial nerve looks like same site as that of V1 cranial nerve, but IV cranial nerve located at just superior to V1. From the LON, III, IV, V1 , and VI CNs latero-inferiorly passed through the SOF. The III cranial nerve located at the most medial portion of SOF with a mean distance of 7 mm, and the IV, V1 and VI cranial nerves were arranged in the same order as vertical arrangement with a mean distance of 10 mm. The cranial nerves just before passing through SOF were located at a range of 7.8 to 20 mm from the lateral end of SOF. This study facilitates an understanding of the anatomy of juxta-sellar region and may help to reduce the cranial nerve injury at the surgery around juxta-clinoidal CNs.
Adult ; Aneurysm ; Cadaver ; Cavernous Sinus ; Cranial Nerve Injuries ; Cranial Nerves* ; Decompression ; Formaldehyde ; Humans ; Ophthalmic Artery ; Optic Nerve ; Orbit ; Sphenoid Bone ; Tendons