In order to evaluate the accuracy of endoscopic findings in the diagnosis of gastric can the endoscopic findings of gastric lesion were compared with the macroscopic and pathologic findings of excised identical lesion. 105 operated gastric cancer paitients (advanced cancer 95 cases, early cancer 10 cases) who were diagnosed endoscopically at Pusan National University Hospital from January 1983 to August 1987 were studied. The results were as follows; 1) The accuracy of endoscopic findings were 94.7% in the advanced gastric cancer, and 45.5% in the early gastric cancer. 2) The accuracy of gross findings endoscopic and pathologic in advanced gastric cancer were 50.0% in Borrmann type I, 45.0% in Borrmann type II, 73.2% in Borrmann type III, and 66.7% in Borrmann tyye IV. 3) The accuracy of the endoscopy ia morphologic classification of advanced gastric cancer according to pathologic tumor location were 60.0% in C (upper 1/3), 43.9% in M(middle 1/3),76.3% in A (lower 1/3), 55.6% in the anterior wall, 50.0% in the posterior wall, 66.7% in the greater curavature, and 67.2% in the lesser curvature. 4) The accuracy of endoacopy in morphologic classification of gastric cancer to tumor size ware 54.5% in below 2 cm, 54.5% in from 2.1 cm to 4 cm, 65.4% in from 4.1 cm to 6.0 cm, 80% in from 6.1 cm to 8 cm, 75.0% in above 8.1 cm. 5) The accuracy of endoscopy in the morphologic classification according to the pathologic tumor stage in advanced gastric cancer were 55.6% in TNM stage I, 52.0% in TNM stage II, 65.4% in TNM stage III, and 73,7% in TNM stage IV.
Busan ; Classification ; Diagnosis ; Endoscopy ; Stomach Neoplasms*

Rats and mice are commonly used in experimental laboratories and anesthetic drugs are important for researchers to understand the details. Administration of fluids helps to stabilize the experimental animals before anesthesia via intravenously through the lateral vein in rats and in case of difficulty in catheterization and maintenance, fluids are usually administered as boluses. Large volumes of cool fluids will rapidly lead to hypothermia and all parenteral fluids must be warmed to body temperature before administration. Premedication with a sedative may ease induction with volatile anesthetic drugs. The first choice for rodent anesthesia is complete inhalational anesthesia. The second option is using injectable anesthesia. Recovery from the volatile agents that have been used rapid when the agent is no longer administered. Anesthetic monitoring equipment is an infant-size bell sthethoscope that can be used to ausculate the heart and lungs. Supplemental heating should be provided to reduce the heat loss supply and maintain core body temperature. The kinds of drugs, characteristics, route of administration and care after surgery were reviewed and summarized from the references. Anesthetic drugs, maintenance, monitoring and aftercare are important in the laboratories to keep the animal safe in all experimental procedures.
Aftercare ; Anesthesia ; Anesthetics ; Animals ; Body Temperature ; Body Temperature Regulation ; Catheterization ; Catheters ; Heart ; Heating ; Hot Temperature ; Hypothermia ; Lung ; Mice ; Premedication ; Rats ; Rodentia ; Veins

PURPOSE: To evaluate the clinical outcome of open repair of acute tibial posterior cruciate ligament (PCL) tibial avulsion injury using the posteromedial approach, and to examine the usefulness of pre-operative 3D-computed tomography (CT) imaging. MATERIALS AND METHODS: From July 2004 onwards, among the 33 patients with acute tibial avulsion injury of the PCL, 22 patients were available for a 1-year follow-up. Patients underwent internal fixation using screws, pullout sutures or staples through the posteromedial approach. Clinical evaluations were performed using the posterior drawer test, posterior drawer stress x-ray, range of motion and Tegner score. In addition, size of the fragment, visibility, comminution, displacement and presence of extension were studied and were compared to the pre-operative X-ray and 3D-CT imaging. RESULTS: Four cases demonstrated 10-degree restriction in flexion and 1 case demonstrated 10-degree restriction in extension compared to the unaffected side. Except for the 2 cases which had Grade I posterior instability on the posterior drawer test, the results of the post-operative joint stability were negative and the posterior drawer stress X-ray using the Telos device showed an average of 0.57+/-0.4 mm. Like the average pre-operative Tegner score of 6.7+/-0.9, the Tegner score was restored to 6.2+/-0.7 (p>0.05) at the last follow-up. 3D-CT showed an improved accuracy in visibility (55.6%), comminution (50%) and displacement (44.4%) compared to the simple X-ray. CONCLUSION: The acute tibial avulsion injury treated with the appropriate internal fixation through the posteromedial approach based on the fracture size demonstrated exellent outcomes. The pre-operative 3D-CT was useful for identifying the fracture pattern and choosing the appropriate internal fixation.
Displacement (Psychology) ; Follow-Up Studies ; Humans ; Joints ; Posterior Cruciate Ligament ; Range of Motion, Articular ; Sutures

BACKGROUND: In pregnant woman, the respiratory system is influenced by the hormonal environment and an enlarged gravid uterus. After delivery of the fetus, and contraction of the uterus, changes in the respiratory system produced by the mechanical effect of the gravid uterus may decrease or be reversed. We designed this study to observe changes in the respiratory mechanics in pregnant woman under general anesthesia for cesarean section. METHODS: 15 pregnant women at term, ASA 1 were studied. Induction was performed with thiopental/succinylcholine and maintained with O2, N2O and enflurane until delivery. Just before delivery, enflurane was discontinued. Vecuronium was given at 0.1 mg/kg iv 4 min after induction, and after delivery, 1 mg was given as needed. Inspired tidal volume, expired tidal volume, inspired minute ventilation, expired minute ventilation, airway peak pressure, plateau pressure, expired volume during the first 1 second/expired tidal volume (V1.0), dynamic compliance and end-tidal CO2 were continuously measured just after induction, at delivery and 5, 10, 15, 20, 25, 30, 40 and 50 min after delivery. Blood pressure, heart rate and oxygen saturation were also measured. RESULTS: Compared to the value after induction, values after delivery showed no significant changes in inspired tidal volume or minute volume, but significantly increased in expired tidal volume and minute volume and dynamic compliance, and a significant decrease in airway peak pressure, plateau pressure, V1.0 and end-tidal CO2. Blood pressure and heart rate increased significantly after induction, compared to before induction. Oxygen saturation was maintained at 99-100%. CONCLUSIONS: After delivery, the effects of the gravid uterus on the respiratory system rapidly disappeared, in particular changes of pressure in the airway preceded the respiratory volume changes.
Anesthesia, General* ; Blood Pressure ; Cesarean Section* ; Compliance ; Enflurane ; Female ; Fetus ; Heart Rate ; Humans ; Oxygen ; Pregnancy ; Pregnant Women* ; Respiratory Mechanics* ; Respiratory System ; Tidal Volume ; Uterus ; Vecuronium Bromide ; Ventilation

BACKGROUND: Sevoflurane is characterized by the lack of an unpleasant odor, airway irritation and its low blood/gas partition coefficient (0.68), which provides rapid and smooth induction. Inhaled induction with sevoflurane is commonly used in pediatric patients, but not in adult patients. This study was designed to investigate the time to completion of LMA insertion and end-tidal sevoflurane concentration during induction with sevoflurane 8% and N2O 50%, after midazolam administration, in adults. METHODS: Twenty eight patients, aged 20(-60) years, were administered intravenous midazolam 30 microgram/kg and after one minute, sevoflurane 8% and N2O 50% were inhaled with tidal-volume breathing. One minute after loss of consciousness, jaw thrust and mouth opening were checked and an LMA was inserted. The end-tidal concentration of sevoflurane, and the times to loss of consciousness and completion of insertion were recorded. The mean arterial pressure and heart rate were also recorded. RESULTS: From initiation of sevoflurane and N2O inhalation, it took 48 +/- 14 seconds until loss of consciousness, and 143 +/- 19 seconds until the completion of LMA insertion. The end-tidal sevoflurane concentration was 4.1 +/- 0.6% at loss of consciousness, 5.0 +/- 0.7% at one min after loss of consciousness, and 4.1 +/- 0.5% after LMA insertion. In all patients LMA insertion was successful and satisfactory. After LMA insertion, compared to baseline, the mean arterial pressure was reduced and the heart rate increased. CONCLUSIONS: After small-dose of midazolam, inhaled induction with sevoflurane 8% and N2O 50% allowed successful and satisfactory LMA insertion in adults.
Adult ; Arterial Pressure ; Heart Rate ; Humans ; Inhalation ; Jaw ; Laryngeal Masks ; Midazolam* ; Mouth ; Nitrous Oxide ; Odors ; Respiration ; Unconsciousness

PURPOSE: We had proceeded seven iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defects and followed-up average for 5 years and 9 months to evaluate the survival rate, neurosensory function and cosmesis in final results. MATERIALS AND METHODS: From January 1999 through October 2012, we have performed iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defect (average around 3.6x2.4 cm) in 7 cases and average age was 41.6 years (21.5 to 59.0 years). Lesion site was posterior heel in 4 cases, distal anterior leg in 3 cases. Donor structure was the dorsalis pedis artery and the first dorsal metatarsal vessel and deep peroneal nerve in 3 cases and the dorsalis pedis artery and the first dorsal metatarsal vessel in 4 cases. RESULTS: Seven cases (100%) were survived and defect area was healed with continuous dressing without skin graft. The sensory function in the neurovascular flap was restored to normal in 3 cases. Cosmesis was good and fair in 7 cases (85.7%). CONCLUSION: Ipsilateral dorsalis pedis vascularized pedicle flap in the distal leg and foot is one of the choice to cover the exposed bone and soft tissues without microsurgical procedure.
Ankle ; Arteries ; Bandages ; Foot* ; Heel ; Humans ; Leg* ; Metatarsal Bones ; Peroneal Nerve ; Sensation ; Skin ; Surgical Flaps ; Survival Rate ; Tissue Donors ; Transplants

PURPOSE: To compare the clinical outcomes of floating knee according to the presence of knee joint injury. MATERIALS AND METHODS: Between March 2004 and March 2009, we investigated 36 patients, who underwent surgical treatment for floating knee injuries. We classified the floating knee into two groups as type I (12 cases) has no knee joint injury and type II (24 cases) has knee joint injury. We compared two groups about combined injury (orthopedics or other part), open fracture or not, neurovascular injury,union time, range of motion, and complication rate. RESULTS: There is statistically no significant difference between two groups as type I (6 cases, 50%) and type II (13 cases, 54.2%) in orthopedic combined injury (p=0.813), and also same as type I (3 cases, 25%) and type II (12 cases, 50%) in combined injury on the other department (p=0.151), and in floating knee with open fracture as 4 type I (33%) and 12 type II (50%) of 16 cases (44%), and Gustilo-Anderson 3 type I, 4 type II, 1 IIIA, 4 IIIB, and 4 IIIC (p=0.423). There is statistically no significant difference between two groups in neurovascular injury as 1 type I (8.3%), and 3 type II (12.5%) (p=0.708). There is a statistically significant difference between two groups in the mean bone union time as 18.2+/-5.37 weeks (12~24 weeks) for type I and 24.95+/-9.85 weeks (16~33 weeks) for type II (p=0.045), and in the mean range of knee joint motion as 133+/-12.74 degree (120~150 degree) for type I and 105+/-19.00 degree (80~135 degree) for type II (p=0.012). CONCLUSION: Floating knee with knee joint injury is severe itself and related with severe combined injuries, subsequent range of knee joint motion limitation, the delay of union time, and high complication rate. Therefore, we should take care in surgical treatment for this trauma entity.
Femur ; Fractures, Open ; Humans ; Knee ; Knee Injuries ; Knee Joint ; Orthopedics ; Range of Motion, Articular

Isolated left main coronary ostial stenosis is a very rare condition. In the majority of cases there are coexisting diseases in multiple coronary vessels. Here, a case of isolated left main coronary ostial stenosis due to an acute angle take-off, with clockwise rotation of the coronary sinus, confirmed by cardiac MRI is presented. A 44-year old female patient presented with an exertional and stabbing anterior chest pain. The patient had no premedical history. A coronary angiogram showed an isolated left main coronary ostial stenosis due to an acute take-off of the left main coronary artery. A cardiac MRI showed an acute angle take-off of the left main coronary artery, with clockwise rotation of the coronary sinus. The patient underwent surgical angioplasty of the coronary ostia, with a patch of autologous pericardium. This acute angle take-off may be due to rotation of the coronary sinus.
Adult ; Angioplasty ; Chest Pain ; Constriction, Pathologic* ; Coronary Sinus* ; Coronary Stenosis ; Coronary Vessels ; Female ; Humans ; Magnetic Resonance Imaging* ; Pericardium