A retrospective study was made of 10 consecutive patients who underwent mandibular reconstruction with PCBM from December 1994 to July 1996. Free autogenous iliac bone in the from of particulate cancellous bone and marrow was densely packed into the crib that was adapted to bridge the mandibular discontinuity defect. Frozen-treated autogenous mandibular bone, splitted autogenous rib, and titanium mesh(Dumbach, Leibinger) were used as cribs carrying the PCBM. All ten cases underwent successful healing with the formation of a continuous bony union with the remaining mandible. The rate of resorption was assessed by sequential panoramic radiographs. The mean horizontal dimension of the madibular defects was 44mm and the mean vertical dimension of the reconstructed segments was 23mm. The bony height of the reconstructed segments retained about 90% of the bony height of over a 1-year period. We confirmed that PCBM grafts were the most successful and predictable grafts in mandibular discontinuity reconstruction.
Bone Marrow* ; Humans ; Infant Equipment ; Mandible ; Mandibular Reconstruction* ; Retrospective Studies ; Ribs ; Titanium ; Transplants ; Vertical Dimension

No abstract available.
Bronchi*

Tracheopathia osteoplastica is a rare, benign pathologic condition chahacterized the occurrence of numerous cartilage and bony nodules within the tissue of mucosa. We report a case of tracheopathia osteoplastica that involved both larynx and trachea. The patient was 73 years old male and had hoarseness. The neck CT showed thickened and irregular wall of the trachea extending to the level of the carina with multiple calcified nodules and plaques of bony density projecting into the lumen.
Cartilage ; Hoarseness ; Humans ; Larynx ; Male ; Mucous Membrane ; Neck ; Trachea

BACKGROUND: Bupivacaine is a amide type local anesthetic agent, widely used for its excellent quality of analgesia and long duration of action. But unintended intravenous injection causes severe complication such as convulsion and cardiovascular collapse, which is known for its difficulty in resuscitation. With all the study, the exact mechanism is still unclear and there are much debate on the method of resuscitation. METHOD: We studied the effect of clonidine pretreatment on bupivacaine-induced cardiac toxicity and resuscitation in anesthetized dog. Twelve dogs were divided into two groups. : saline pretreatment group (control, N=6) and clonidine pretreatment group (clonidine group, N=6). The dogs were anesthetized with N2O-O2-enflurane and vecuronium. Thoracotomy was done in 4th or 5th intercostal space for open cardiac massage. After confirming stability of vital signs, we administered clonidine (10 mcg/kg) or saline, and then administered bupivacaine with the rate of 2 mg/kg/min. When the electeocardiogram showed asystole, 20 mcg/kg of epinephrine was administered via central venous line and open cardiac massage with the rate of 120 beat/min. was performed. We observed electrocardiogram (lead II), arterial blood pressure, heart rate, dose of infused bupivacaine to be required for QRS widening and arrest, required time and administered dose of epinephrine for resuscitation. RESULTS: Clonidine group showed significant decrease of heart rate after pretreatment (p<0.05). There was no significant difference in required dose for QRS widening between two groups. The dose administered for inducing arrest was less in clonidine group than control group (p<0.05). The time required for resuscitation was shorter in clonidine group than control group (p<0.05). The total dose of epinephrine required for resuscitation was less in clonidine group than control group (p<0.05). The blood concentration of catecholamine did not showed significant difference during the whole course of experiment. CONCLUSIONS: Above results demonstrated that clonidine, a central nervous system-mediated sympatholytic agent, facilitated cardiac arrest when bupivacaine was infused intravenously and cardiac rescucitation.
Analgesia ; Animals ; Arterial Pressure ; Bupivacaine ; Clonidine* ; Dogs* ; Electrocardiography ; Epinephrine ; Heart Arrest ; Heart Massage ; Heart Rate ; Injections, Intravenous ; Resuscitation* ; Seizures ; Thoracotomy ; Vecuronium Bromide ; Vital Signs

BACKGROUND: To investigate the possibie difference, if any, between office blood pressure(BP) and home BP may be important in the diagnosis and treatment of hypersensive patients. This report deails the difference between the two BP's and the usefulness of digital electronic sphygmomanometer(DES) for self-monitoring of home BP. METHODS: The BP's of 14 patients with essential hypertension were measured with mercury sphygmomanometers at outpatient department by physician and with DES at home(twice a day) by the patients. Patients were followed up every 2 weeks for 4 weeks and previous 2 weeks' average home BP's were compared with the office BP's of each 2 weeks' end. RESULTS: There was a significant difference between office and home BP(both systolic and diastolic) ; office average BP(151/95mmHg) was higher than home average BP(136/86mmHg). CONCLUSION: Caution may be needed in the interpretation of office BP unless it is measured several times after adequate rest.
Blood Pressure* ; Diagnosis ; Humans ; Hypertension ; Outpatients ; Sphygmomanometers*

BACKGROUND: The effectiveness for vagal stimulation by ice water aplication to face during metronome-controlled respiration of 15 breaths/minute was examed. The importance of basal vagal tone and sympathovagal interaction in the individual variability of responsiveness to the vagal stimulation was investigated. METHOD: Fifty three 12~13 year old healthy volunteers were included. Vagal tone and sympathovagal interaction before and after application of ice water to the face were assessed by power spectral analysis of RR interval(heart rate) variability. RESULT: Basal heart rate, high frequency power, and low to high frequency power ratio were 81+/-13(58~110 beats/min), 791+/-1061(56~4161 msec2) and 1.08+/-1.22(0.04~4.85) during controlled respiration. After ice water application twenty three children developed 5 more nodal escape beats due to severe bradycardia. Minimum heart rate, high frequency power and low to high power ratio changed to 42+/-12(19~72/min), 1890+/-1882(221~7258msec2) and 0.64+/-0.43(0.12~1.46). The increased ratio of high frequency power, maximum heart rate decrement and its percent after stimulation were 5.44+/-5.62(0.63~24.26), 39+/-14(10~81/min) and 47+/-15(16~81%) respectively. The increased ratio of high frequency power was correlated with basal logarithmic high frequency power(r=-0.60, p=0.0004). Maximum heart rate decrement was correlated with basal logarithmic high frequency power(r=-0.41, p=0.0018) and low to high frequency power ratio(r=0.27, p=0.04). CONCLUSION: Application of ice water to the face during controlled respiration produces powerful vagal stimulation and bradycardia, however, there is a wide individual variability of responsiveness to it. The absolute basal vagal tone contribute to this individual variability.
Bradycardia ; Child ; Healthy Volunteers ; Heart Rate* ; Heart* ; Humans ; Ice* ; Respiration* ; United Nations ; Water*

The Cholecystectomy is the treatment of choice in patients with acute cholecystitis, but non-surgical gall stone therapies, such as a percutaneous cholecystostomy (PC) should be attempted in high risk critically ill patient with acute cholecystitis. Forty critically ill patients with complicated medical and surgical problems underwent an emergency PC at kwanju christran Hospital between 1993 and 1996. Diagnosis were made based on clinical and sonographic findings. The PCs were performed for patients with septic shock (9 cases), severe pain due to gall bladder empyema (9 cases), severe medical problems with acute cholecystitis (16 cases), a previous operation history (3 cases), and refusal of surgery (3 cases). The PCs were successfully performed under ultrasound guidance, and symptoms of patients were improved within several days after the PC. There were no immediate technical complications. We measured the arterial blood gas and analyzed of several factors influencing the acid-base change before and after the PC. The values of the pH and the PCO2 changed with an increasing WBC count, the presence of jaundice, a positive blood culture, a decreasing platelet count, and hypotension but returned to normal within several days after the PC. Although we can not attach statistical significance to the findings, we found that the acid-base balance changed with severe acute cholecystitis, as well as with septic shock and that the clinical symptoms and hemodynamics were improved by the PC. In conclusion, a PC as a nonsurgical management may be the procedure of choice for nonsurgical management of high-risk patients with acute cholecystitis, and as a definitive treatment, a laparoscopic or open cholecystectomy should be performed when symptoms are improved and the patients become stable.
Acid-Base Equilibrium ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute* ; Cholecystostomy* ; Critical Illness ; Diagnosis ; Disulfiram ; Emergencies ; Gallstones ; Gwangju ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Jaundice ; Platelet Count ; Shock, Septic ; Ultrasonography

PURPOSE: This study was conducted to provide basic data necessary to develop a program to improve infection control by examining nurses' perception of accreditation and by identifying its relationship with awareness and performance of infection control. METHODS: This cross-sectional study was performed using questionnaires. Data were collected from 210 nurses who were working at one hospital between May 14 and May 19, 2015. Data were analyzed using SPAW. RESULTS: The mean score for nurses' perception of accreditation was 3.10 points out of 5 points. Score for awareness of infection control was 4.63±0.39 points and for performance of infection control, 4.39±0.39 points. There were significant positive correlation among perception of accreditation, awareness of infection control, and performance of infection control. In the regression analysis, performance of infection control was influenced by awareness of infection control which accounted for 42.6% of the variance. It also showed additional improvement of 1.4% of the variance by when perception of accreditation was added. CONCLUSION: The result of this study show that nurses' perception of accreditation is relatively positive and that performance of infection control is highly enhanced according to nurses' positive recognition of accreditation as well as attaching importance to accreditation.
Accreditation* ; Cross-Sectional Studies ; Delivery of Health Care* ; Infection Control*

BACKGROUND: It is well known that systemic blood pressure oscillates with low(0.04~0.1Hz), mid(0.1~0.15Hz), and high(respiratory) frequency range. But there has been no study about oscillation of pulmonary artery pressure(PAP). METHOD: We measured PAP for 5 minutes in 32 patients of ventricular septal defect and stored them to computer files. Power spectral density curve was obtained. Low, mid, respiratory frequency power were measured by integrating the area within each frequency range below the power density curve. RESULT: The incidence of significant low frequency power(more than 5% of total power) were higher in patients of high PAP and hign Rp/Rs than those of low PAP and Rp/Rs(p<0.01 and p<0.005 respectively). The low frequency power positively correlates with PAP and Rp/Rs(r=0.62, p<0.0005 and r=0.61, p=0.0005 respectively). CONCLUSION: It can be said conclusively that as PAP and pulmonary vascular resistance elevates, the PAP tends to definitively oscillate in low frequency range.
Blood Pressure ; Heart Septal Defects, Ventricular ; Humans ; Incidence ; Pulmonary Artery* ; Vascular Resistance

Mucoepidermoid carcinoma of lung are rare carcinoma arising from the submucosal glands tissue of the proximal tracheobronchial tree. The carcinoma can be divided into low grade and high grade varienties. The most important factors in the prognosis include histological grading and the ability to achieve a complete surgical resection. We experienced a case of high grade mucoepidermoid carcinoma in pulmonary tuberculosis patient of 67 years old male who has been suffered from left chest pain for several weeks. He was not treated and died seventeen months later.
Carcinoma, Mucoepidermoid* ; Chest Pain ; Humans ; Lung ; Male ; Prognosis ; Trees ; Tuberculosis, Pulmonary*