Endoscopic retrograde cholangiopancreatography(ERCP) is a new diagnostic method for pancreatic and biliarydiseases which has been made possible by the development of fiberoptic duodenoscopy. It has been thought that ERCPwell serve an important role in the early detection of pancreatic cancer, but in order to detect minor lesions ofthe pancreas and improve the diagnostic accuracy of resectable pancreatic cancer, Endoscopic RetrogradeParechymography of the pancreas (ERPP) was developed recently. The authors analyzed 117 cases of ERCP performed atthe Kwangju Christian Hospital between Jan. and Dec. 1980, and compared them with the final diagnosis. The resultswere as follows; 1. Out of 117 cases, successful visualization of the duct of concern was achieved in 105 cases.Of these, 25 cases were ERPP. 2. The ratio of males to female was 1.44:1. Most patients were in the 4th to 6thdecade. 3. The commmonest clinical manifestations were upper abdominal pain (77cases), jaundice(23 cases),indigestion, vomiting and abdominal mass, in order of frequency. 4. Out of 46 cases of suspected pancreaticdiseases, the pancreatic duct was visualized in 36 cases, and 24 cases revealed pathognomonic findings. These werediagnosed as 16 cases of pancreatic cancer, 4 cases of chronic pancreatitis, 2 cases of pancreatic pseudocyst and2 cases of periampullary cancer with pancreas invasion. In pancreatic cancer findings were; encasement, localdilatation, delayed excretion, poor filling, obstruction of pancreatic duct, accompanying C.B.D. obstruction orstenosis and so called double duct sign. The chronic pancreatitis findings included; ductal dilatation (with orwtihout) obstruction, tortuosity with dilated saccular lateral branching, stone formation and the parenchymalfilling defect. 5. Out of 71 cases of suspected biliary tract diseases, the biliary tract was visualized in 57cases, and in 31 cases abnormalities were suggested; such as 20 cases of biliary stone, 1 cases of ascariasis, 1case of clonorchiasis with cholangitis, 1 case of clonorchiasis with stone, 2 cases of C.B.D. ca. 2 cases of G.B.ca, 3 cases of intrahepatic disease, 1 case of stones in the biliary tree with ampullary ca. 6. Complications ofERCP and ERPP were extremely raare. Transient abdominal distention, abdominal discomfort and elevated serumamylase were noted, but were not clinically significant.
Abdominal Pain ; Ascariasis ; Biliary Tract ; Biliary Tract Diseases ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Clonorchiasis ; Diagnosis ; Dilatation ; Duodenoscopy ; Female ; Gwangju ; Humans ; Male ; Methods ; Pancreas ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreatic Pseudocyst ; Pancreatitis, Chronic ; Vomiting

Endoscopic Retrograde Cholangiopancreatography(ERCP) is one of the important diagnostic methods for pancreaticcancer. It has an essential role in the early detection of pancreatic cancer. The ERCP findings of 35 cases ofpathologically proven pancreatic cancer during the period of five and a half years from April 1977 through Nov.1982 at Kwangju Christian Hospital were studied. The resuls were as follows; 1. The ratio of male of female was3.4:1, and most of the patients were over 40 years of age (88.5%). 2. The locations of the lesions were the headin 28 cases (80%), the body in 7 cases(20%), and the ail in 3 cases (8.6%). 3. The ERCP findings of pancreaticcancers were as follows; 1) Encasement or obstruction of common bile duct, 18 cases (51.4%). 2) Obstruction ofpancreatic duct, 16 cases (45.7%). 3) Irregular stenosis of pancreatic duct, 8 cases (22.3%). 4) Double duct sign,7 cases (20%). 5) Diffuse narrowing of pancreatic duct, 2 cases (5.7%).
Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Constriction, Pathologic ; Female ; Gwangju ; Humans ; Male ; Pancreatic Ducts ; Pancreatic Neoplasms

Preoxygenation is a standard anesthetic technique which prevents significant hypoxemia during the induction of anesthesia. Complete oxygenation is especially important in clinical situations of difficult intubation or in patients with decreased FRC, and in siturations where oxygen saturation is critical. During the induction of anesthesia in children, airway obstruction and apnea are associated with rapid development of hypoxemia. The decreasing speed of oxyhemoglobin saturation was faster in smaller infants than bigger infants. The most important factor determining the speed with which hypoxemia develops in healthy children is probably the oxygen reserve contained in the lungs and its relation to the oxygen consumption of the child. With deaeasing age, the arterial oxygen consumption increases and the ratio of FRC to body weight decreases. Due to the anatomical structure of an infant's upper airway, it is more difficult to obtaine patient airway in infants than in children. During repeated atttempts to intubate the trachea or while waiting for recovery from laryngeal spasms hypoxia can occur easily resulting in visible cyanosis in infants. This study was carried out to measure the time permissible for apnea before occurance of hypoxia following full oxygenation. The subjects consisted of 6 randomly selected infants 1-2 month of age, 4.6+/-0.6 Kg of body weight with no abnormalities of cardiorespiratory functions. After the intramuscular injection of atropine, patients were anesthetized through mask using oxygen and halothane. SpO2 and pulse rates were recorded throughout the study. After the patients were intubated, a plug was placed on the distal end of the tube to induce obstructive apnea. As soon as SpO2 decreased to just below 90%, the patients were ventilated again. In 2 of the infants, the time required to obtaine 90% saturation was 60 seconds. Within less than 70 seconds, four out of 6 infants had SpO2 below 90% and SpO2 below 80% were noticed in 3 cases. After the reestablishment of ventilation, SpO2 returned to the preapneic value within 10 second in all subjects. There was no evidence of increasing pulse rate as SpO2 levels decreased. However, pulse rate decreased in all subjects thoughout the study. In summary, maximum time permissible for apnea in neonate and young infant is approximately one minute. Furthermore, tachycardia should not be used as a sign for the onset of hypoxia.
Airway Obstruction ; Anesthesia ; Anoxia ; Apnea* ; Atropine ; Body Weight ; Child ; Cyanosis ; Halothane ; Heart Rate ; Humans ; Infant* ; Infant, Newborn ; Injections, Intramuscular ; Intubation ; Laryngismus ; Lung ; Masks ; Oxygen Consumption ; Oxygen* ; Oxyhemoglobins ; Tachycardia ; Trachea ; Ventilation

Purpose: The Life Transition Scale (LTS) consists of 24 items that assess the life transition process of parents of autistic children. This study aimed to examine the validity and reliability of the LTS in parents of children with a wide spectrum of disabilities. Methods: Data were collected from 260 parents of children with disabilities through self-report questionnaires. Validity was examined using exploratory and confirmative factor analysis to determine the factor structures of the LTS; socio-demographic differences in LTS scores were examined using the t-test or ANOVA. Reliability was examined using Cronbach's ⍺ coefficient. Results: A four-factor structure was validated (x2=640.0, p<.001, GFI=.81, RMSEA=.07, NNFI=.89, CFI=.89, PNFI=.74, Q [x2/df]=2.60). The validity of the LTS was verified by exploratory factor analysis, with factor loading ranging from .30 to .80. There were significant differences in the accepting phase according to children's and parents' age and the type of disability, and in the wandering phase according to parental gender, educational level, job, and socioeconomic status. The Cronbach's ⍺s for the reliability of each of the four structures were acceptable, within a range of .80~.90. Conclusion The LTS is a valid and reliable measurement to assess the life transition process of parents with disabled children.

Postoperative atrial arrhythmia after thoracotomy is relatively common, with a reported incidence ranging from 8% to 30%. These arrhythmias may cause hypotension, congestive heart failure and lengthen the period of postoperative hospitalization. The most important precipitating factor is atrial dilation and identified risk factor is an advanced age of the patient. The effect of various prophylactic regimens to reduce atrial arrhythmias is controversial. We report a case of postoperative atrial fibrillation in a 73 year-old female patient undergoing repair of esophageal hiatal hernia.
Aged ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Female ; Heart Failure ; Hernia, Hiatal* ; Hospitalization ; Humans ; Hypotension ; Incidence ; Precipitating Factors ; Risk Factors ; Thoracotomy

BACKGROUND: Dobutamine and amrinone, phosphodiesterase-III inhibitor, are known to have both inotropic and vasodilatory properties. We evaluated the effects of both drugs on systemic and pulmonary hemodynamics in patients with pulmonary hypertension (PH). METHODS: With Institutional Review Board approval, 45 patients whose mean pulmonary arterial pressure was greater than 30 mmHg were studied. After sternotomy under the steady state of anesthesia and controlled ventilation (30 mmHg < PaCO2 < 40 mmHg), patients recieved one of following drugs for 30minutes (min); dobutamine 5.0ug/kg/min (Group I), low dose amrinone (loading dose 1.0 mg/kg, followed by infusion 7.5 g/kg/min, Group II) or high dose amrinone (loading dose 2.0 mg/kg, followed by infusion 10 g/kg/min, Group III). Hemodynamic variables were measured at 10 min and 30 min after start of infusion. RESULTS: Dobutamine didn't decrease pulmonary arterial pressure (PAP) and cause no hemodynamic change while low and high dose amrinone reduced PAP and especcially decrease of PAP in low dose amrinone group was statistically significnat. High dose amrinone increased cardiac index (CI) and decreased both systemic vascular resistance index (SVRI) and central venous pressure (CVP) more significantly than control value. CONCLUSIONS: In patients with chronic right ventricular failure associated with PH, amrinone may decrease the PAP and improve cardiac performance more effectively than dobutamin does. Increment of dosage of amrinone may not result in significant reduction of PAP.
Amrinone* ; Anesthesia ; Arterial Pressure ; Central Venous Pressure ; Dobutamine* ; Ethics Committees, Research ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Sternotomy ; Vascular Resistance ; Ventilation

Protruding atheromas of the aorta have been identified as one of the sources of a systemic emboli and a major cause of stroke following cardiac surgery. We report a case of surgical modification in a 58-year-old man with an atheromatous aortic arch detected by an intraoperative transesophageal echocardiography (TEE) during coronary artery bypass grafting (CABG). After induction of anesthesia, protruding atheromatous plaques with a mobile element in the aortic arch were identified by a TEE that was not noticed by a preoperative angiography and transthoracic echocardiograpy. Based on the TEE finding, the surgical technique was modified to CABG combined with an aortic atherectomy under deep hypothermic circulatory arrest. The atheromatous areas correlated well with the TEE finding and the patient recovered from anesthesia and surgery without neurologic deficit. Therefore, an intraoperative TEE examination is considered as a safe and reliable technique to identify atherosclerotic disease of the thoracic aorta in patients undergoing CABG and to minimize unexpected neurologic complications after CABG.
Anesthesia ; Angiography ; Aorta ; Aorta, Thoracic* ; Atherectomy ; Circulatory Arrest, Deep Hypothermia Induced ; Coronary Artery Bypass* ; Coronary Vessels* ; Echocardiography, Transesophageal* ; Humans ; Middle Aged ; Neurologic Manifestations ; Plaque, Atherosclerotic ; Stroke ; Thoracic Surgery

BACKGREOUND: The pneumonectomy may depress the right ventricular (RV) function transiently. The thermodilution ejection/volumetric catheter is known to be most useful method assessing the changes in RV performance during pulmonary resection. The purpose of this study was to examine the RV function during and immediately after pneumonectomy using thermodilution methods. METHODS: 16 patients undergoing pneumonectomy were studied. After induction of anesthesia, a multilumen thermodilution catheter mounted with a rapid response thermister was inserted. Using computer system, RV ejection fraction (RVEF), cardiac output, and RV end-diastolic volume (RVEDV) were measured when the patient was in lateral position (control), after one lung ventilation (OLV) and the main pulmonary artery ligated, and at the completion of resection. Arterial blood gases were analyzed and pulmonary vascular resistance (PVR) was calculated. RESULTS: Systolic pulmonary blood pressure (SPAP)(28.3 +/- 6.2 mmHg) increased compared to the control (24.6 +/- 5.9) without a significant change of PVR. No statistically significant difference was found in either RVEF or RVEDV at each times. CONCLUSIONS: Our study demonstrate the pneumonectomy do not depress the RV function immediately and RVEF do not show any correlation with PVR or RVEDV.
Anesthesia ; Blood Pressure ; Cardiac Output ; Catheters ; Computer Systems ; Gases ; Humans ; One-Lung Ventilation ; Pneumonectomy* ; Pulmonary Artery ; Thermodilution ; Vascular Resistance ; Ventricular Function, Right*

PURPOSE: The aim of this study was to present our experience before establishing laparoscopic left lateral sectionectomy (LLLS) of the liver as a standard procedure, and to show efficacy of a totally LLLS compared to an open left lateral sectionectomy (OLLS). METHODS: We retrospectively analyzed and compared clinical outcomes (operation time, blood loss, hospital stay, complication rate, etc) for 29 patients who underwent LLLS and 27 patients who underwent OLLS between January, 2002 and December, 2009. To see the learning curve for LLLS, we arbitrarily divided the LLLSs we did into an early group (ELLLS) and a late group (LLLLS) based on when they were operated on relative to case number 14. RESULTS: Mean operative times for the ELLLS, LLLLS and OLLS groups were 269.7+/-102.6, 210.0+/-47.9 and 289.1+/-72.8 minutes, respectively. Mean operative time was significantly shorter (p<0.05) in the LLLLS than the OLLS group. Mean intra-operative blood loss was also less in the LLLLS group than the OLLS group (80.00+/-224.2 ml vs. 195.15+/-405.4 ml). Post-operative hospital stay was shorter in the LLLLS group than the OLLS group (9.9+/-4.0 versus 16.9+/-9.1, p=0.071). CONCLUSION: The totally LLLS is a safe, feasible treatment option that can be a standard procedure with better outcomes in selected patients after an initial learning curve.
Humans ; Laparoscopy ; Learning Curve ; Length of Stay ; Liver ; Operative Time ; Retrospective Studies

A 51-yr-old man underwent mitral valve replacement and tricuspid valve repair due to mitral and tricuspid regurgitation under cardiopulmonary bypass. The pulmonary artery (PA) catheter was inserted easily via right internal jugular vein and functioned well until the end of surgery. The surgery was uneventful and patient's hemodynamics were stable both in the operating room and intensive care unit. All PA catheter functions were normal, but the balloon rupture was suspected because it was unable to obtain pulmonary capillary wedge pressure. On attempted removal of the PA catheter at the next day, considerable resistance was encountered and pulmonary artery tracing was dampened. A followed-up chest X-ray revealed the catheter to be in the right pulmonary artery without evidence of knotting. Suture related entrapment was suspected, and on reoperation, PA catheter was found to be sutured at the left atriotomy site. The PA catheter was removed under cardiopulmonary bypass and revealed a hole between proximal port and thermal filament.
Cardiopulmonary Bypass ; Catheters* ; Hemodynamics ; Intensive Care Units ; Jugular Veins ; Mitral Valve* ; Operating Rooms ; Pulmonary Artery* ; Pulmonary Wedge Pressure ; Reoperation ; Rupture ; Sutures ; Thorax ; Tricuspid Valve ; Tricuspid Valve Insufficiency