No abstract available.
Blister* ; Thoracotomy*

No abstract available.

BACKGROUND: Anesthesiologists often encounter patients who have acute, massive blood loss and severe hemodilution as the result of fluid therapy in the operating room. It is known that patients with normal heart function survive at hemoglobin 4 6 g/dl. Recently, the incidence of elderly patients with ischemic heart disease have been increasing progressively but studies about critical hematocrit level in patients with ischemic heart disease are rare. This study, therefore, was designed to evaluate the hemodynamic response of isovolemic hemodilution in myocardial ischemia-induced dogs. METHODS: In 12 anesthetized dogs, a Swan-Ganz catheter and left ventricle catheter were inserted and hemodynamic parameters were measured as control values. Myocardial ischemia was induced with a left anterior descending (LAD) coronary artery ligation. Thereafter, isovolemic hemodilutions were done several times to set the hematocrit levels of 36%, 31%, 26%, 21%, 16%, and 11%. Records and samples for hemodynamic parameters were obtained after LAD ligation and at each hematocrit level. RESULTS: There were significant decreases in diastolic blood pressures in hematocrits 21%, 16%, 11%, in mean arterial pressures in hematocrits 16%, 11% and in systolic blood pressure in hematocrit 11% (P < 0.05). Oxygen delivery progressively decreased in hematocrits 36%, 31%, 26%, 21%, 16% and 11% (P < 0.05). Oxygen extraction ratios progressively increased and were statistically significant in hematocrits 21%, 16% and 11% (P < 0.05). Arterial blood gases showed metabolic acidosis in hematocrits 16% and 11%. There was decreased PCO2 in hematocrit 11% (P < 0.05). Mixed venous blood oxy-hemoglobin saturation decreased in hematocrit 16% and 11% (P < 0.05). Other variables were not significant. CONCLUSIONS: Blood pressure decreased at hematocrit 16% so it is necessary to maintain a hematocrit level above 21% at least in cardiac depressed dogs.
Acidosis ; Aged ; Animals ; Arterial Pressure ; Blood Pressure ; Catheters ; Coronary Vessels ; Dogs* ; Fluid Therapy ; Gases ; Heart ; Heart Ventricles ; Hematocrit ; Hemodilution* ; Hemodynamics* ; Humans ; Incidence ; Ligation ; Myocardial Ischemia ; Operating Rooms ; Oxygen

OBJECTIVE: Although there are several explanations for a duplicated middle cerebral artery (DMCA), its embryological origin is still an open question. We reviewed these anomalous vessels to postulate a theory of their different origins, sizes, and courses. METHODS: A retrospective review of 1,250 cerebral angiographies, 1,452 computed tomography (CT)-angiographies, and 2,527 magnetic resonance (MR)-angiographies was performed to identify patients with DMCA. RESULTS: Twenty-five patients had 25 DMCAs. Conventional angiography detected nine patients with DMCA (9/1250, 0.72%), MR-angiography detected seven patients with DMCA (7/2527, 0.28%), and CT-angiography detected nine patients with DMCA (9/1452, 0.62%). The DMCAs originated near the internal carotid artery terminal in eight patients (type A), and between the origin of the anterior choroidal artery and the terminal internal carotid artery in 17 patients (type B). The diameters of the eight type A DMCAs were the same or slightly smaller than those of the other branch of the DMCA. All type A DMCAs showed a course parallel to that of the other branch of the DMCA. The diameters of the 17 type B DMCAs were the same, slightly smaller, or very much smaller than that of the other branch of the DMCA. Nine type B DMCAs showed parallel courses, and the other eight curved toward the temporal lobe. CONCLUSION: The two branches of the type A DMCAs can be regarded as early bifurcations of the MCA. The branches of the type B DMCAs had parallel courses or a course that curved toward the temporal lobe. The type B DMCA can be regarded as direct bifurcations of the MCA trunk or the early ramification of the temporal branch of the MCA.
Angiography ; Arteries ; Carotid Artery, Internal ; Cerebral Angiography ; Choroid ; Humans ; Magnetic Resonance Spectroscopy ; Middle Cerebral Artery ; Retrospective Studies ; Temporal Lobe

PURPOSE: We present a single surgeon experience of 52 cases of transperitoneal laparoscopic adrenalectomy for various adrenal diseases. MATERIALS AND METHODS: Transperitoneal laparoscopic adrenalectomy (n= 52) for various adrenal diseases was performed by a single surgeon from February 1998 to December 2004. Clinical diagnosis of the subjects included 17 cases of primary aldosteronism, 11 of adrenal adenoma causing Cushing's syndrome, 3 of pheochromocytoma and 21 of nonfunctioning adenoma. The 52 patients were divided into 3 groups according to the time when operations were performed: early group of 18 patients, intermediate group of 17 patients, and late group of 17 patients. The mean operative time, mean estimated blood loss (EBL) and complication of each group were investigated to analyze the single surgeon's learning curve. RESULTS: All laparoscopic adrenalectomies were successfully completed in all 52 patients. The mean operative time, mean EBL, mean tumor size, and mean postoperative hospital stay were 124 minutes (60-360), 56cc (30-300), 2.7cm (1-4.7), and 3.8 days (3-8), respectively. The mean time to solid diet and ambulation were 1.5 days and 1 day, respectively. There was no serious intraoperative or postoperative complication. Statistically, the mean operative time and estimated blood loss showed a significant reduction in the intermediate and late group compared with the early group. CONCLUSIONS: Our results showed that transperitoneal laparoscopic adrenalectomy is a safe and effective surgical treatment modality in adrenal diseases.
Adenoma ; Adrenal Gland Diseases ; Adrenalectomy* ; Cushing Syndrome ; Diagnosis ; Diet ; Humans ; Hyperaldosteronism ; Laparoscopy ; Learning Curve ; Length of Stay ; Operative Time ; Pheochromocytoma ; Postoperative Complications ; Walking

No abstract available.

Cerebral cavernous hemangioma is very rare disease in the cerebral vascular malformations. We experienced a case of this vascular malformations at the left frontal lobe near the cortex which had symptoms and signs of abrupt generalized tonic-clonic seizure. This malformation is encountered more commonly in adult in the third to fifth decade, and is found most frequently in the white matter of the cerebral hemisphere. The value of computerized tomography(C-T) in the detection of such malformations is stressed. Good result was obtained by the microsurgical approach to these malformations.
Adult ; Cerebrum ; Frontal Lobe* ; Hemangioma, Cavernous* ; Hemangioma, Cavernous, Central Nervous System ; Humans ; Microsurgery ; Rare Diseases ; Seizures ; Vascular Malformations

BACKGROUND: In developed countries, food-born diseases have decreased and hospital laboratory have taken more simple method rather than complex enrichment-selective methods. But detection rate of pathogenic bacteria in stool culture was not so high. METHODS: We mixed 4 pathogenic bacteria (S. typhi, S. flexneri, V. cholerae and Y. enterocolitica) with 3 stool specimens from healthy persons (for Y. enterocolitica, 5 specimens) and innoculated directly or after enrichment (105 bacteria/plate). After proper incubation, we counted suspected colonies and calculated true positive rate after identification of each colonies. RESULTS: For S. typhi, in the case of direct innoculation on the MacConkey, XLD and SS agar, positive rate of selected colonies were below 36.6%. After enrichment in SF broth for 8 hours, the rate were 80.0%, 83.0% and 70.0% respectively. For S. flexneri, the rates were 86.7%, 100%, 93.3% in direct innoculation, and were highest after enrichment in GN broth for two hours (93.3% in MacConkey and 100.0% in both XLD and SS agar). For V. cholerae, inspite of screening by catalase and oxidase tests, positive rate of selected colonies were 0% (0/7 colonies) in direct innoculation on the MacConkey. After enrichment in APW about 1 day and on TCBS agar, the rate were 100%. For Y. enterocolitica, after incubation at room temperature for 2 days, most selected colonies were Y. enterocolitica on CIN media. CONCLUSION: For more efficient detection of pathogenic bacteria in stool culture, combination of direct innoculation on MacConkey agar and on one or two selective media after proper enrichment process, should be considered.
Agar ; Bacteria ; Catalase ; Cholera ; Developed Countries ; Humans ; Laboratories, Hospital ; Mass Screening ; Oxidoreductases ; Salmonella ; Shigella ; Vibrio ; Yersinia

Screw-shaped implants of commercially pure (c.p.) titanium, c.p. niobium, c.p. zirconium, and stainless(Sus 304) were inserted in the rabbit tibial over 12 weeks of follow-up. New developed torque gauge instrument was used to evaluate the implant holding power and a image analysis program coupled to a microscope was used for histomorphometry. The three best consecutive threads of each implant were measured. Quantitative analyses at 12 weeks revealed a partial bone contact to the four kinds investigated metals. There were no obvious adverse tissue reactions to any of the biomaterials. At 12 weeks the average removal torques for titanium, niobium and zirconium were better than that needed for Sus 304 screws, on the other hand high score of bony contact ratio of titanium and niobium were showed in comparison to those of zirconium and Sus 304. There was no significant differences in the amount of interfacial bone of zirconium and Sus 304 whereas there was significant differences in the torque forces of niobium and Sus 304. Three months after implant insertion, the average removal torque was 6.64 Ncm for the titanium, 6.57 Ncm for the niobium, 6.38 Ncm for the zirconium, and 4.25 Ncm for the Sus 304. On average bone contacts there were 51.24% in the titanium, 48.19% in the niobium, 31.79% in the zirconium, 23.54% in Sus 304. Biocompatibility of the titanium, niobium and zirconium was acceptable level in comparison to the Sus 304.
Biocompatible Materials ; Follow-Up Studies ; Hand ; Metals ; Niobium ; Titanium ; Torque ; Zirconium

This study was performed to analyze the long-term results of percutaneous radiofrequency thermal rhizotomy for trigeminal neuralgia. The authors analyzed 193 cases with trigeminal neuralgia which underwent percutaneous radiofrequency thermal rhizotomy documented from March, 1973 to December, 1992. The patients(122 cases) were followed-up for average 6.1 years. Initial pain relief was obtained in 97.4% of the patients with percutaneous thermal rhizotomy. Recurrence of trigeminal pain after surgery was observed in 47 cases(38.5%) during the follow-up period. Surgical complications were as follows; masseter weakness in 7 patients, oculomotor palsy in 1 patient, weakness of the corneal reflex in 10 patients(1 of them requested ocular management) for keratitis, and anesthesia dorosa in 2 patients. These results suggest that percutoneous radiofrequency thermal rhizotomy is a useful therapeutic tool to relieve pain immediately an safely in trigeminal neuralgia.
Anesthesia ; Follow-Up Studies ; Humans ; Keratitis ; Paralysis ; Recurrence ; Reflex ; Rhizotomy* ; Trigeminal Neuralgia*