The mechanism of forward blood flow during closed chest cardiac massage remains controversial. Two theories have been suggested: the cardiac pump theory and the thoracic pump theory. Case report is presented to illustrate the use of transesophageal echocardiography during cardiopulmonary resuscitation. The findings included right and left ventricular compression, closure of the mitral valve during compression, opening of the mitral valve during the release phase, and atrioventricular regurgitation during compression, indicating a positive ventricular-to-atrial pressure gradient. These findings suggest that direct cardiac compression was the predominant mechanism of forward blood flow during cardiopulmonary resuscitation in this patient. Transesophageal echocardiography offers a new approach for study of the flows and cardiac morphologic features during chest compressions in humans. An understanding of the actual mechanisms involved is necessary if improved cardiopulmonary resuscitative techniques are to be rationally developed for enhancing the outcome of resuscitation.
Cardiopulmonary Resuscitation ; Echocardiography* ; Echocardiography, Transesophageal ; Heart Massage* ; Humans ; Mitral Valve ; Resuscitation ; Thorax*

The authors present a case of bilateral retinoblastoma occured in a six months old baby. The right eye, the advanced, was enucleated immediately and the left eye was treated with x-ray radiation giving 5,400r (tumor dose) in four weeks. A cataract developed in five years after the radiation therapy, which masked the pictures of the fundus and was extracted intracapsularily using alpha-chymotripsin. After the surgery, repeated funduscopy revealed no definite signs of recurrence.
Cataract ; Masks ; Recurrence ; Retinoblastoma*

No abstract available.
Myasthenia Gravis*

The authors retrospectively reviewed the efficacy of percutaneous catheter drainage in treatment of abdominal abscess associated with fistulas. One hundred sixty four consecutive patients with abdominal abscesses drained percutaneously since 1985 at department of Radiology, Wonkwang University Hospital were studied. Among these, 13 patients were found to have fistulous communications to the biliary duct, the intestinal tract, or the renal calyx. Eleven patients (85%) were successfully treated without surgical intervention while two patients (15%) needed surgical drainage and fistulectomy. The duration of drainage ranged from 7 days to 9 months. Initial drainage of abdominal abscess was performed in the hospital, but 5 of 13 patients were discharged with a tube in place and were followed up as outpatients. In conclusion, percutaneous catheter drainage is an effective and safe means of treating abdominal abscesses with fistulas.
Abdominal Abscess* ; Catheters* ; Drainage* ; Fistula* ; Humans ; Outpatients ; Retrospective Studies

BACKGROUND: The arterial to end-tidal carbon dioxide tension difference(Pa-ETCO2) can be increased in patients with congenital heart disease(CHD) and, therefore, end-tidal carbon dioxide tension(PETCO2) does not accurately approximates arterial carbon dioxide tension(PaCO2). The purpose of this study was to evaluate the stability of the Pa-ETCO2 in pediatric patients with congenital heart disease undergoing open heart surgery. METHODS: Forty three children with CHD were studied: twenty two were acyanotic and twenty one were cyanotic. Simultaneous PETCO2 and PaCO2 measurements, as well as pulse rate, blood pressure, pH and arterial oxygen tension(PaO2) were obtained for each patient during four intraoperative events: (1) after induction of anesthesia and before sternotomy, (2) after sternotomy and before cardiopulmonary bypass(CPB), (3) after weaning of CPB, and (4) after closure of sternotomy. RESULTS: The PETCO2 of cyanotic group were lower than that of acyanotic group throughout operation period, and did not change significantly after CPB. Cyanotic children demonstrated a greater Pa-ETCO2 difference before CPB as compared with acyanotic group. In acyanotic group, Pa-ETCO2 difference increased significantly after CPB(P <0.05), whereas it remained unchanged in cyanotic group. CONCLUSIONS: Since cyanotic children had higher Pa-ETCO2 differences intraoperatively and acyanotic children showed an increase in Pa-ETCO2 after CPB, the PETCO2 cannot be the alternative value to estimate reliably the PaCO2 during open heart surgery of pediatric CHD.
Anesthesia ; Blood Pressure ; Carbon Dioxide ; Child ; Heart Defects, Congenital ; Heart Diseases* ; Heart Rate ; Heart* ; Humans ; Hydrogen-Ion Concentration ; Oxygen ; Sternotomy ; Thoracic Surgery* ; Weaning

Deliberate hypotension in the surgery of intracranial aneurysm's used to diminish bleeding and render an aneurysmal sac slack to make clipping easy. It has been reported by Murtagh (1960) and Schettini et al. (1967) that deliberate hypotension induced with halothane anesthesia is a useful method. We are reporting clinical experience of halothane induced hypotension in 13 cases of intracranial aneurysm surgery. The results of clinical observation were as follows: 1. On the average, the systolic blood pressure lay between 60 and 80 mmHg. Hypctension by halothane was readily controllable by increasing and decreasing the inspired concentration of halothane. The use of vasopressors was not necessary to raise the blood pressure. Recovery from anesthesia was rapid. The mean of Mean Arterial Blood Pressure of 13 cases was 56.077 mmHg during the .hypotensive phase. The rate of fall of the mean arterial blood pressure was 1.862 mmHg per minute. 2. The common EKG finding was bradycardia associated with hypotension, but the pulse rate increased by raising the blood pressure. 3. The serum electrolytes, Na, K, Cl, and CO₂ combining power, checked in the pre and posto-perative period, showed no significant change. 4. Arterial blood gas study showed increased values for PaCO₂ and oxygen saturation during the hypotensive phase. The PaCO₂ was slightly lowered during hypotension. The pH was within normal limits. 5. The Hb and Hct, checked pre and postop ratively, showed lowered values in the postopertive period. During surgical clipping of the aneurysm, there were two cases of aneurysmal rupture, requiring blood transfusion; the amount of whole blood transfused was 500 ml to 1, 000 ml. 6. Urinary excretion, observed during hypoension, showed a decreased urine output at a systolic blood pressure of about 70 mmHg. 7. Postoperatively there was one death at the end of second week and the cause was thought to be cerebral infarction, not directly relnted to anesthesia.
Anesthesia ; Aneurysm ; Arterial Pressure ; Blood Pressure ; Blood Transfusion ; Bradycardia ; Cerebral Infarction ; Electrocardiography ; Electrolytes ; Halothane ; Heart Rate ; Hemorrhage ; Hydrogen-Ion Concentration ; Hypotension ; Hypotension, Controlled* ; Intracranial Aneurysm* ; Methods ; Oxygen ; Rupture ; Surgical Instruments

PURPOSE: To evaluate accuracy of magnetic resonance(MR) imaging for staging of lung cancer and to compare the accuracies of CT and MRI. MATERIALS AND METHODS: We retrospectively analyzed 25 cases of lung cancer, which were confirmed surgically and pathologically. Five experienced radiologists participated in the receiver operating characteristic (ROC) analysis to evaluate and compare accuracies of the CT and MR imaging in preoperative staging of non small cell lung cancer by assessing tumor invasion of bronchus, mediastinum, chest wall, and hilar or mediastinal lymph node metastasis. Imaging results were evaluated against "truth" data based on both surgery and pathologic examination. RESULTS: Sensitivity of CT in distinguishing T3-T4 tumors was 60% ;specificity was 76%. These values for MR imaging were not significantly different(53% and 72%). With ROC analysis, no difference existed between accuracies of CT and MR imaging in diagnosis of bronchial involvement, but MR imaging was significantly more accurate than CT(p<0.05) in diagnosis of mediastinal invasion. There was no significant difference between accuracies of CT and MR imaging in detecting mediastinal node metastasis(N2 or N3); sensitivities were 64% and 78%, respectively, and specificities were 64% and 66%. CONCLUSION: There was no significant difference in accuracies of CT and MR imaging in preoperative tumor classification and assessment of mediastinal node metastasis, but MR imaging was more accurate than CT in assessment of mediastinal invasion.
Bronchi ; Carcinoma, Bronchogenic* ; Classification ; Diagnosis ; Lung Neoplasms ; Lymph Nodes ; Magnetic Resonance Imaging* ; Mediastinum ; Neoplasm Metastasis ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Small Cell Lung Carcinoma ; Thoracic Wall

PURPOSE: To evaluate accuracy of magnetic resonance(MR) imaging for staging of lung cancer and to compare the accuracies of CT and MRI. MATERIALS AND METHODS: We retrospectively analyzed 25 cases of lung cancer, which were confirmed surgically and pathologically. Five experienced radiologists participated in the receiver operating characteristic (ROC) analysis to evaluate and compare accuracies of the CT and MR imaging in preoperative staging of non small cell lung cancer by assessing tumor invasion of bronchus, mediastinum, chest wall, and hilar or mediastinal lymph node metastasis. Imaging results were evaluated against "truth" data based on both surgery and pathologic examination. RESULTS: Sensitivity of CT in distinguishing T3-T4 tumors was 60% ;specificity was 76%. These values for MR imaging were not significantly different(53% and 72%). With ROC analysis, no difference existed between accuracies of CT and MR imaging in diagnosis of bronchial involvement, but MR imaging was significantly more accurate than CT(p<0.05) in diagnosis of mediastinal invasion. There was no significant difference between accuracies of CT and MR imaging in detecting mediastinal node metastasis(N2 or N3); sensitivities were 64% and 78%, respectively, and specificities were 64% and 66%. CONCLUSION: There was no significant difference in accuracies of CT and MR imaging in preoperative tumor classification and assessment of mediastinal node metastasis, but MR imaging was more accurate than CT in assessment of mediastinal invasion.
Bronchi ; Carcinoma, Bronchogenic* ; Classification ; Diagnosis ; Lung Neoplasms ; Lymph Nodes ; Magnetic Resonance Imaging* ; Mediastinum ; Neoplasm Metastasis ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Small Cell Lung Carcinoma ; Thoracic Wall

PURPOSE: To assess the diagnostic role of FNA, PCNB, and a combination of both methods in patients who underwent percutaneous transthoracic biopsy for a malignant or benign intrathoracic lesion. MATERIALS AND METHODS: We retrospectively reviewed the findings of 213 patients with an intrathoracic mass or consolidation who underwent FNA (Group A, n=98), PCNB (Group B, n=31) or a combination of both methods (Group C, n=84). Under fluoroscopic guidance, diagnoses were based on the findings of surgery, biopsy at another site or clinical and radiologic follow-up. In the differential diagnosis of benign and malignant disease, and in the diagnosis of small-cell lung cancer, pulmonary tuberculosis, non-tuberculous infectious disease and benign mass, sensitivity, specificity and accuracy were statistically analysed in each group. RESULTS: Among 213 patients, lesions were malignant in 134 and benign in 79. In group A, sensitivity and specificity were 90.1% and 100% for malignant lesions, and 91.5% and 90.1% for benign, while in group B, the corresponding findings were 90.4% and 100%, and 90.0% and 90.1%. In group C, corresponding rates of 95.1% and 100% (p<0.05) and 100% and 92% (p<0.05) were recorded. In group C, accuracy and sensitivity were higher than in group A or (p<0.05). Post-procedural pneumothorax occurred in 15.3% of group A, 13.3% of group B, and 20.6% of group C, while hemoptysis was found in 7.1% of group A, 13.3% group B, and 2.9% of group C. Among the three groups, the complication rate showed no statistically significant variation (p<0.05). In the specific diagnosis of small-cell lung cancer, the sensitivity and specificity of FNA and PCNB were, respectively, 100% and 98.5%, and 90.0% and 98.0% (p<0.05) ; for tuberculosis, the corresponding figures were 35.0% and 100%, and 20.0% and 97.2 (p<0.05). FNA was better in the diagnosis of non-tuberculous infectious disease, while PCNB was better in the specific diagnosis of benign masses, without statistical significance. Conclusion: FNA is superior to PCNB in the diagnosis of tuberculosis and the differentiation of small cell lung cancer, and is thus the indicated initial approach for the majority of patients who are to undergo transthoracic bigosy. A combination of FNA and PCNB can provide more accurate differentiation between malignant and benign thoracic disease, without increasing the complication rate, than can one method used alone.
Biopsy* ; Biopsy, Fine-Needle* ; Biopsy, Needle* ; Communicable Diseases ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Hemoptysis ; Humans ; Lung Neoplasms ; Needles* ; Pneumothorax ; Retrospective Studies ; Sensitivity and Specificity ; Small Cell Lung Carcinoma ; Thoracic Diseases ; Tuberculosis ; Tuberculosis, Pulmonary

A fifty-five year old male was admitted because of fever and chill for one month. He complained of upper abdominal pain, malaise, anorexia and weight loss. So diagnostic procedures were performed: stool exam., bload chemistry testing, ultrasonography, radionuclide scintigraphy. ERCP, abdominal CT, and sonoguided liver aspiration, which revealed intrahepatic cholangiocarcinoma associated with clonorchiasis.
Abdominal Pain ; Anorexia ; Chemistry ; Cholangiocarcinoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Clonorchiasis* ; Fever ; Humans ; Liver ; Male ; Radionuclide Imaging ; Tomography, X-Ray Computed ; Ultrasonography ; Weight Loss ; Cholangiocarcinoma