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

There hundred and twenty five cases of meningitis, in infancy and childhood, consisting of 117 cases of purulent meningitis, 59 cases of aseptic meningitis and 149 cases of tuberculons meningitis, which were admitted to the wonju christian hospital between April 1966 and March 1976, were clinically observed and the following results were obtained. 1.Sex ratio was 2.0:1 in purulent meningitis, and aseptic meningitis and 1.9:1 in tuberculons meningitis. 2. The highest incidence in infancy was purulent meningitis (78.5%) and over 6 years was aseptic meningitis (44.1%) and under 6 years was tuberculous meningitis (71.6%). 3. The seosonal peak incidence was spring and summer for purulent meningitis and summer and winter for aseptic and tuberculer meningitis. 4. Fever was the most comon symptom followed by vomiting, headache, and unconsciousness in that order of frequency and the most common neurologic finding on admission was neck stiffness, kernig's sign, Burudzinsk's sign, etc in three meningitis. 5. Among preceding and associated chiseases, U.R.I. was the common(19.7%) in purulent ans aseptic meningitis (28.8%) and pulmonary tuberculous (24.8%) and miliary tuberculeus (16.1%) in tuberculous meningitis. 6. In C.S.F. examination on admissin day. Cell count were frequent 50~500/mm3 in aseptic meningitis (76.9%) and tuberculous meningitis (80.5%). Sugar levels under 40mg/dl showed 62.5% of cases of purulent meningitis, 76.6% of cases of tuberculous meningitis and 8.5% of cases of the aseptic meningitis. Protein levels were the most common in 100~500mg/dl in the purulent meningitis (61.5%) and the tuberculous meningitis (53%) and under 40mg/dl(54.2%) in the asephicmeningitis. 7. Known mortality rate was 64% for the purulent meningitis, 67.5% for the aseptic meningitis, and complications showed in 7.7% in the purulent meningitis 10% in the tuberculous meningitis.
Cell Count ; Fever ; Gangwon-do ; Headache ; Incidence ; Meningitis* ; Meningitis, Aseptic ; Mortality ; Neck ; Neurologic Manifestations ; Tuberculosis, Meningeal ; Unconsciousness ; Vomiting

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

Some malignant melanoma cells regress spontaneously by terminal differentiation, and understanding the mechanisms of this spontaneous regression can contribute to the development of a new therapy not only for melanoma but also for other cancers. The signal transducing G protein is one component of the signaling pathways for the differentiation-inducing molecules such as alpha-melanocyte-stimulating hormone (alpha-MSH) and cAMP. To investigate the role of G proteins in the differentiation process, we analyzed the expression of various G proteins by quantitative Western blot and cAMP response in human malignant melanoma cell lines. SK-MEL-3 cells expressed the largest amount of stimulatory G protein alpha subunit (G(s) alpha) and the largest amount of inhibitory G protein alpha subunit (G(i) alpha) was expressed in Malme-3M cells among the 4 melanoma cell lines analyzed in this experiment. The SK-MEL-28 cells exhibited largest amount of alpha subunit of G(q) and the beta subunits. The cAMP formation by forskolin stimulation was largest in the Malme-3M. The amount of cAMP formation did not show any correlation with the expression of G(s) alpha nor that of G(i) alpha. The population doubling time was longest in Malme-3M cells. In this experiment, we found that the melanoma cells vary widely both in the expression of various G proteins and in cAMP production depending on the cell lines.
alpha-MSH ; Blotting, Western ; Cell Line* ; Colforsin ; GTP-Binding Protein alpha Subunits ; GTP-Binding Proteins* ; Humans* ; Melanoma*

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

This study investigated reduction of the bandgap of silica by applying nano-silver doping technique and possible application of such silica as a filler in dental resin. Due to reduce band gap, newly fabricated nano-silver doped silica was able to release ROS in accordance with exposure of visible light. Nano-silver doped silica was composed of below 20 nm size crystal silver nanoparticle and 100~500 nm size amorphous silica. These two components were chemically attached to each other (Si-O-Ag). The reduced bandgap was 2.10 eV, which the value could be interpreted as occurrence of surface plasmon resonance generating ROS in visible light exposure conditions. When such nano-silver doped silica was used as a filler in dental resin, increased antibacterial property of nano-silver ion was observed which was related to releasing of ROS when exposed in visible light. The antibacterial properties were statistically significant following exposure to visible light when 0.7 to 1.5 wt% of nano-silver doped silica were incorporated into resin. When the contents of nano-silver doped silica were below 0.7 wt%, minimal ROS release resulted in no significant increase in antibacterial properties as there would be less exposed nano-silver doped silica on the resin surface by visible light. Meanwhile, more than 1.5 wt% of nano-silver doped silica also resulted no significant increase in antibacterial properties following exposure to visible light as the antibacterial effects from nano-silver ion itself were greater than effects from released ROS. Hence, it was concluded that dental resin containing 0.7 to 1.5 wt% of nano-silver doped silica would provide antibacterial properties when exposed to visible light, significantly greater than in dark conditions.

BACKGROUND/AIMS: The Helicobacter pylori(H. pylori) infection induces gastric mucosal injury through the various bacterial cytotoxins, the inflammatory reaction of the host and the increased gastric acid secretion. Urease is a kind of adaptive protein of H. pylori to survive in strong acid environment of the stomach, may increase the pH of the gastric mucosal surface and induces gastrin release by the feedback mechanism. This study was performed to evaluate whether 0.1% phenol red solution without urea is useful as a pH indicator of the gastric mucosa for the diagnosis of H. pylori infection in stomach and whether the pH of the gastric mucosal surface is changed by H. pylori infection. METHODS: The gastric mucosa was stained by 0.1% phenol red solution without urea during endoscopy in 89 patients with non-ulcer dyspepsia. The patterns of staining of the gastric mucosa were divided into unstained, patchy regional and diffuse staining by the area of color change from yellow to red. The pH of the gastric mucosal surface was measured directly on the stained and unstained areas of the gastric mucosa by using pH meter and antimony pH electrode through the biopsy channel. RESULTS: The pH of the stained areas after spray of phenol red solution was significantly higher(6.9) than that(1.9) of the unstained gastric mucosa(P<0.01). The patterns of the staining were different between antrum and body. The patterns of unstaining and patchy staining were more common in the body than in the antrum. But the patterns of regional and diffuse staining were more common in the antrum than in the body(P<0.05). The positive rates of H. pylori in antrum, body and total gastric biopsies were higher in stained than in unstained mucosa significantly(P<0.05). Severity of active inflammatory reactions was higher in stained mucosa than unstained mucosa in the antrum. But there was no difference in severity of active inflammatory reactions between stained mucosa and unstained mucosa in the body. CONCLUSIONS: 0.1% phenol red solution without urea is useful as a pH indicator for the diagnosis of the H. phlori infection in the stomach. H. pylori infection may increase the pH of gastric mucosal surface and induce severe active inflammation of the gastric mucosa in non-ulcer dyspepsia.
Antimony ; Biopsy ; Cytotoxins ; Diagnosis ; Dyspepsia* ; Electrodes ; Endoscopy ; Gastric Acid ; Gastric Mucosa ; Gastrins ; Helicobacter pylori* ; Helicobacter* ; Humans ; Hydrogen-Ion Concentration* ; Inflammation ; Mucous Membrane ; Phenolsulfonphthalein ; Stomach ; Urea ; Urease

MATERIAL AND METHOD: Esophageal reconstruction by the hypopharyngointestinal anastomosis was done in 7 patients of corrosive upper esophageal stricture at St. Mary's Hospital from August 1995 to January 1997. RESULT: There were one male and six female patients ranging from 20 to 63 years of age. The causative agents were acid in 6 patients and alkali in 1 patient. The esophageal reconstruction was made by hypopharyngcolojejunostomy in 4 patients and hypopharyngocologastrostomy in 3 patients. There were no operative mortalities. One patient developed anastomotic stenosis but others were free from dysphagia. All gained 4 kg to 13 kg of body weight during the follow-up period. CONCLUSION: In this experience right colon and terminal ileum including ileocecal valve was revealed as a good substitute for the esophagus and the esophageal reconstruction by hypopharyngocologastro (jejuno)stomy seems to be a satisfactory method with acceptable morbidity and mortality in corrosive upper esophageal stricture patient.
Alkalies ; Body Weight ; Colon ; Constriction, Pathologic ; Deglutition Disorders ; Esophageal Stenosis* ; Esophagus ; Female ; Follow-Up Studies ; Humans ; Ileocecal Valve ; Ileum ; Male ; Mortality

In mitral valve disease, mural thrombus in the left atrium is common, particulary in the atrial appendage in patients with atrial fibrillation. Occasionally, the angiographic sign of "neovascularity" and "fistula" in the region of the left atrial appendage during coronary arteriography has been reported to indicate the presence of thrombus in the left atrium, which might not even be revealed by transthoracic two-dimensional echocardiography. We observed coronary neovascularity and fistula formation in two pateints with mitral stenosis and these findings were due to organized mural thrombus that was adherent to the wall of the left atrial appendage. So we report 2 cases with brief review of literature.
Angiography ; Atrial Appendage ; Atrial Fibrillation ; Echocardiography ; Fistula* ; Heart Atria ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Thrombosis*

OBJECTIVES: The goals of the study were to compare the middle ear (ME) volumes from both normal and lesioned ears, and these ME volumes were measured by a digital image processing computed tomography (CT) program in patients with unilateral chronic otitis media, and we wanted to compare the ME volumes of the lesioned ears by comparing the ME volumes obtained by tympanometry with those ME volumes measured by the digital image processing CT program. METHODS: Forty-four patients who had unilateral chronic otitis media (COM) and contralateral normal tympanic membranes (TM) and 100 subjects with normal TMs were included in the study. The normal volumes of the external auditory canal (EAC) were measured in the normal group. The tympanometric ME volumes in the ears with a perforated TM were calculated as the difference of the tympanometric volumes measured from the both ears in patients with unilateral COM. The CT ME volumes were measured by a digital image processing program. RESULTS: The tympanometric volumes of the EACs in the ears with normal TMs were 1.4+/-0.3 mL. There were no significant differences according to gender, age and the side of the face the ear was on. The tympanometric volumes of the EAC in the normal-side ear of the patients with unilateral COM showed no significant differences when compared with those from the normal group. The ME volumes of the intact ears, as measured by CT, showed significantly higher values than those ME volumes of the lesioned ears. The ME volumes of the lesioned ears, as measured by tympanometry, showed a strong, significant linear correlation with those ME volumes calculated by CT; however, the ME volumes of the lesioned ears, as measured by tympanometry (1.5+/-1.4 mL), were significantly larger than those ME volumes measured by CT (1.1+/-0.8 mL). CONCLUSION: Our results show that chronic otitis media causes reduced ME volumes compared to those ME volumes of the contralateral normal ears. Tympanometry can provide a valuable estimation of the ME volumes in chronic ears, although it tends to overestimate the ME volumes, and especially for the ears with a larger ME volume.
Acoustic Impedance Tests ; Aminocaproic Acids ; Ear ; Ear Canal ; Ear, Middle ; Humans ; Mastoid ; Otitis ; Otitis Media ; Tympanic Membrane