Nerve injury associated with cardiac surgery and anesthesia is a well-recognized complication with a predilection for the upper half of the body. We report four cases of common peroneal nerve palsy following cardiac surgery that were not subject to external compression to fibular head. The diagnosis of nerve palsy was delayed because of a complicated postoperative course and intensive care, which prevented our determining the causes. The mechanisms of nerve injury are reviewed. We postulate that the etiology is multifactorial, including, old age, subnormal body habitus, prolonged knee flexion and rotation, coexisting disease, postoperative cardiovascular complications, and cardiopulmonary bypass.
Anesthesia ; Cardiopulmonary Bypass ; Diagnosis ; Head ; Critical Care ; Knee ; Paralysis* ; Peroneal Nerve* ; Thoracic Surgery*

The neutron beam has higher relative biological effectiveness (RBE) than conventional X or gamma ray because it is densely ionizing radiation which is presented by high linear energy transfer (LET). This physical and radiobiological characteristic plays an important role in killing of cancer cells in the state of biologically radio-resistant to the conventional radiation. The rationale of high LET radiation in the application to clinical radiotherapy is summarized as, high oxygen enhancement ratio (OER), less repair of cell damage, and less dependence of radio-sensitivity on cell cycle. Neutron therapy alone or combined with conventional radiotherapy was performed in 12 patients with stage C or D1 prostatic cancer from Mar. 1987 to Dec. 1989 in Korea Cancer Center Hospital. Local control rate at the time of 24 months after therapy was 67% (4/6) in stage C and 67% (4/6) in stage DI. Two-year actuarial survival rate after therapy was 82% in stage C and 67% in stage D1. The problem of neutron therapy was relatively high incidence of major complication rate, but it could be lessened by the accumulation of experience for neutron therapy. We think neutron therapy to be one of adequate treatment modalities for local control of stage C or Dl prostatic cancer.
Cell Cycle ; Gamma Rays ; Homicide ; Humans ; Incidence ; Korea ; Linear Energy Transfer ; Neutrons* ; Oxygen ; Prostatic Neoplasms* ; Radiation, Ionizing ; Radiotherapy ; Relative Biological Effectiveness ; Survival Rate

Cutaneous fistula of dental origin is the most common type of cutaneous fistula that is formed on the face and neck. This lesion can be a diagnostic challenge to clinicians who are not familiar with cutaneous fistula since many patients with cutaneous fistula of dental origin do not have any complaints such as toothache. Diagnostic errors may result in multiple excisions, biopsies, and ineffective long-term antibiotic therapy. However, if the lesion could be suspected of being of dental origin, the diagnosis can be easily confirmed by radiologic examinations. We report four cases of cutaneous fistula of dental origin. All four patients had a characteristic cutaneous findings with chronically draining, fixed, erythematous papule on their nasolabial fold or submental region. Ultrasonography, fistulography or plain roentgenography were needed to confirm the diagnosis of cutaneous fistula originating from dental problems.
Biopsy ; Cutaneous Fistula* ; Diagnosis ; Diagnostic Errors ; Humans ; Nasolabial Fold ; Neck ; Radiography ; Toothache ; Ultrasonography

Prolonged soft tissue compression results in discomfort and pain secondary to local ischemia in normal individuals. During surgery, patients are immobile and unable to perceive the discomfort of prolonged pressure, and the anesthetized patient lacks a protective mechanism to prevent pressure sores. Many intrinsic and extrinsic factors are associated with pressure sore development; however, the intensity and duration of pressure are critical components in the etiology of pressure sores. We conclude that interface pressure on a patient lying on an operating table during a long operation is a primary factor of postoperative occipital pressure sores.
Deception ; Humans ; Ischemia ; Operating Tables ; Pressure Ulcer*

BACKGROUND: Recent studies have suggested that the outcomes of the patients with acute renal failure (ARF) may related to delivered dose of dialysis. In such context, a number of investigators have reported about delivered dose of dialysis and its contribution to outcomes of ARF, using Kt/V. The purpose of the study was to evaluate actual delivered dose of dialysis in intermittent hemodialysis (HD) in critically ill ARF patients, clinical factors contributing delivery of dialysis dose, and relationship of delivered dialysis dose and survival. METHODS: Delivered and prescribed dose of dialysis, presented as Kt/V, were measured in ARF patients intermittent HD in intensive care unit of Inha University Hospital from January 1999, until December 1999, using single pool urea kinetic model. RESULTS: All subjects received intermittent HD of 6.4+/-4.8 times with mean of 225.6+/-40.4 min per session. Overall survival was 55.5%. Prescribed Kt/V in all subjects was 1.24+/-0.39, but actual delivered Kt/ V was 1.08+/-0.17. A mean delivered/prescribed Kt/V ratio was 87.1+/-43%. Duration of HD session (R= -0.547, p=0.019), Cleveland Clinic Foundation Severity Score (R=-0.486, p=0.041), and frequency of hypotensive episodes (R=-0.419, p=0.043) were significantly correlated with delivered/prescribed Kt/V ratio. Delivered dose was under 1.2 in 66.7% of the subjects. Survival rate of these patients was 50.0%, which was lower as compared to 66.6% of the patients with delivered dose over 1.2. Patients with low delivered dose (Kt/V<1.2) showed significantly low prescribed dose and short HD time (p<0.05). Delivered Kt/V was correlated with BUN at initiation of dialysis, HD duration, and prescribed Kt/V (p<0.05). Non-survivors showed significantly low initial serum creatinine, low CCF severity score, high frequency of hypotensive episodes, and less use of heparin (p< 0.05). Prescribed Kt/V was not different between survivors and non-survivor (1.22+/-0.30 vs 1.31+/-0.45), but delivered Kt/V (1.17+/-0.17 vs. 1.04+/-0.17; p<0.05) and delivered/prscribed Kt/V (95.9+/-22.6% vs. 73.9+/-15.6%; p<0.05) were significantly higher in survivors than in non-survivors. CONCLUSION: In ARF patients, the delivery of dialysis was significantly lower than as was expected. Delivered/prescribed Kt/V was about 87% and more than half of the patients received intermittent HD of Kt/V less than 1.2. Better survival was associated with higher delivered dose of dialysis. We need further prospective studies about the causal relationship between delivered dose of dialysis and outcomes in ARF patients.
Acute Kidney Injury* ; Creatinine ; Critical Illness ; Dialysis* ; Heparin ; Humans ; Intensive Care Units ; Prospective Studies ; Renal Dialysis* ; Research Personnel ; Survival Rate ; Survivors ; Urea