The authors dissected and examined a horseshoe kidney from the cadaver of a 54-year-old Korean female. The results were as follows. Other congenital anomalies or complications were not found, and no renal stones showed on plain radiography of the horseshoe kidney. The horseshoe kidney was located in the area between the 12 th thoracic vertebra and the 4th lumbar vertebra, with the superior extremity of the left kidney 10mm more inferior than that of the right. The isthmus connecting the bilateral kidneys was located at the level of the 3rd lumbar vertebra. The size of the kidney was 102mm × 52mm × 44mm (right) and 108mm × 62mm × 34mm (left), and the superoinferior and anteroposterior lengths of isthmus were 22mm and 10mm, respectively. The abdominal aorta and inferior vena cava passed posteriorly to the isthmus, with the inferior mesenteric artery and lumbar splanchnic nerve passing anteriorly. Some grooves were found on the anterior surface of the bilateral kidney. The hilum of the right kidney faced the anteromedial direction and that of the left kidney faced the anterolateral direction. At the hilar plane, the right renal arteries and veins passed anteriorly and posteriorly to the renal pelvis ; the left renal arteries passed posteriorly to the renal pelvis, with the left renal veins passing anteriorly and posteriorly. Three branches of the right renal arteries passed renal hilum, while two branches did not, and two branches of the left renal arteries passed renal hilum, while six branches did not. The two arteries arising from the aortic bifurcation were distributed to the isthmus. The number of renal veins passing the renal hilum were three in the right, and two in the left. The right and left ovarian veins drained to the renal veins. There were 12 minor calyces distributed normally in the right kidney, 13 minor calyces distributed radially in the left kidney, and 3 minor calyces in the isthmus, composed of parenchyme. The left portion of the horseshoe kidney was concluded to have developed poorly, on the basis of incomplete ascension and abnormal rotation during development, the imperfect configuration of the renal shape, and the abnormal distribution of the renal vessels and renal calyces.
Aorta, Abdominal ; Arteries ; Cadaver ; Extremities ; Female ; Fused Kidney* ; Humans ; Kidney ; Kidney Pelvis ; Mesenteric Artery, Inferior ; Middle Aged ; Radiography ; Renal Artery ; Renal Veins ; Spine ; Splanchnic Nerves ; Veins ; Vena Cava, Inferior

BACKGROUND: A number of factors can cause dark circles around the eyes including excessive pigmentation, thin and translucent lower eyelid skin overlying the orbicularis oculi muscle, and shadowing due to skin laxity and tear trough. Autologous fat graft is an effective method for the treatment of lower lid dark circles, but irregularities caused by leaving visible lumps of the fat can occur. Tonnard et al. suggested 'nanofat' grafting and introduced its characteristics and clinical applications. The authors used their nanofat grafting to correct lower eyelid dark circles. METHODS: Nanofat grafting was performed in 19 patients for dark lower eyelids. The grafts were injected into subdermal layer using blunt cannula. Microfat grafting with nasojugal fold was performed to all the patients. Among them, 18 patients received transconjunctival fat removal at the same time. RESULTS: All the patients showed much improvement from preoperative dark coloration. There were no visible lumps of fat, contour irregularities, or fat necrosis. Postoperative edema and ecchymosis were minimal. CONCLUSIONS: Nanofat grafting methods provide a good alternative for correcting dark circles by augmenting thin skin with lower complications. This simple, cost effective procedure is suitable for correction of dark circles and various skin rejuvenation purposes.
Catheters ; Ecchymosis ; Edema ; Eyelids* ; Fat Necrosis ; Humans ; Hyperpigmentation ; Pigmentation ; Rejuvenation ; Shadowing (Histology) ; Skin* ; Transplantation ; Transplants*

BACKGROUND: Aconitium species have been used for a material of oriental herb medicine for analgesic and anti-inflammatory effects. But Aconitium species were known to have the potent poisons like aconitine, mesaconitine and hypaconitine which are of C19 diterpenoid alkaloids. The intoxication symptoms are nausea, vomiting, discomfort and cardiac arrhythmias which are well known as a main cause of death. METHOD AND MATERIALS: We obtained the specimens from the five poisoned cases and analyzed those specimens by GC/MS-SIM for 2002-2004. These cases were divided into two groups. The first group was the victims who ingested raw Aconitium roots and leaves and were all dead. The second was those who ingested processed Aconitium roots. One of them drank Aconitium root-submersed alcohol (root wine) and died. Another victim had ingested some liquid extract of herb medicine for three months but the person's symptom was manifested by jaundice and hematuria without fatality. RESULTS: Autopsy pathology on the cases of raw Aconitium ingestion and root wine drinking revealed similar gross and microscopic feature. The benzoylaconine analogues were detected in root wine (dead case) and hypaconitine, benzoylmesaconine and benzoylhypaconine were detected in herb liquid (living case). The aconitine analogues are hydrolyzed to make less toxic benzoylaconine analogues but the toxicity of hydrolyzed products and the methods of detoxification are still in controversy. CONCLUSION: We could conclude that benzoylaconine is relatively more toxic than benzoylmesaconine and benzoylhypaconitine. And the hypaconitine is relatively less toxic than aconitine and mesaconitine.
Aconitine ; Alkaloids ; Arrhythmias, Cardiac ; Autopsy ; Cause of Death ; Chromatography, Gas ; Drinking ; Eating ; Hematuria ; Jaundice ; Mass Spectrometry ; Nausea ; Poisons ; Vomiting ; Wine

Subcutaneous emphysema is one of the rare complication of tracheal intubation and it's mechanism has been known as airleakage to subcutaneous tissue from the perforated site of larynx, trachea and esophagus by the trauma of laryngoscopic blade, stylet and endotracheal tube. We experienced a case of subcutaneous emphysema during unexpected difficult endotracheal intubation. At the initial laparoscopic examination, the patient's laryngeal view was grade IV of Cormack and Lehane's calssification. After several trial of the intubation, cervical subcutaneous emphysema developed by the trauma of laryngoscopic blade, stylet and endotracheal tube, even though failed to confirm the perforated site at postanesthesia one day.
Esophagus ; Intubation ; Intubation, Intratracheal* ; Larynx ; Subcutaneous Emphysema* ; Subcutaneous Tissue ; Trachea

BACKGROUND: This study was conducted to investigate risk factors for perioperative periods between general anesthesia (GA group) and thoracic epidural blockade combined with general anesthesia (CEA group) for consecutive hepatic resections. METHODS: A retrospective chart review was carried out regarding 85 patients who had undergone hepatic resections. We compared the effects of postoperative pain control in the two groups, including pulmonary complications and durations of hospital stay. RESULTS: There was no significant difference in demographic data between the two groups. The perioperative fluid requirement and transfusions were lower in the CEA group. Supplemental analgesics requirement was significantly lower in the CEA group than the GA group in the 3 days postoperatively. There were no statistical difference between the two groups in nausea, vomiting, urticaria, constipation or urinary retention, but hypotension was more pronounced in the CEA group than the GA group. Postoperative pulmonary and surgical complications were similar between the two groups, but the duration of hospital stay was longer in the GA group than the CEA group. CONCLUSIONS: We conclude that the thoracic epidural blockade combined with general anesthesia provided lower surgical blood loss and better postoperative analgesia and hospital stay than general anesthesia for hepatic resections.
Analgesia ; Analgesics ; Anesthesia, General* ; Blood Loss, Surgical ; Constipation ; Hepatectomy* ; Humans ; Hypotension ; Length of Stay ; Nausea ; Pain, Postoperative ; Perioperative Period ; Retrospective Studies ; Risk Factors ; Urinary Retention ; Urticaria ; Vomiting

BACKGROUND: To ensure patient safety and improvements in the quality of hospital care, rapid response teams (RRTs) have been implemented in many countries, including Korea. The goal of an RRT is early identification and response to clinical deterioration in patients. However, there are differences in RRT systems among hospitals and limited data are available. METHODS: In Seoul St. Mary's Hospital, the St. Mary's Advanced Life Support Team was implemented in June 2013. We retrospectively reviewed the RRT activation records of 287 cases from June 2013 to December 2016. RESULTS: The median response time and median modified early warning score were 8.6 minutes (interquartile range, 5.6 to 11.6 minutes) and 5.0 points (interquartile range, 4.0 to 7.0 points), respectively. Residents (35.8%) and nurses (59.1%) were the main activators of the RRT. Interestingly, postoperative patients account for a large percentage of the RRT activation cases (69.3%). The survival rate was 83.6% and survival was mainly associated with malignancy, Acute Physiology and Chronic Health Evaluation-II score, and the time from admission to RRT activation. RRT activation with screening showed a better outcome compared to activation via a phone call in terms of the intensive care unit admission rate and length of hospital stay after RRT activation. CONCLUSIONS: Malignancy was the most important factor related to survival. In addition, RRT activation with patient screening showed a better outcome compared to activation via a phone call. Further studies are needed to determine the effective screening criteria and improve the quality of the RRT system.
Epidemiology* ; Humans ; Intensive Care Units ; Korea ; Length of Stay ; Mass Screening ; Patient Safety ; Physiology ; Reaction Time ; Retrospective Studies ; Seoul ; Survival Rate

BACKGROUND: Vecuronium and Pancuronium have been proven to be associated with nicotinic receptor of skeletal muscle. Generally, nondepolarizing muscle relaxant is associated with contraction of smooth tracheal muscle, but there have been few studies about effects of nondepolarizing muscle relaxant on the smooth tracheal muscle. METHODS: We studied the acetylcholine dose response curve of the tracheal smooth muscle contraction and effects of propranolol, L-NAME after pretreating with vecuronium and pancuronium. RESULTS: Vecuronium shifted the acetylcholine dose-response curve of the tracheal contraction to the left, and pancuronium shifted the curve to the right. Vecuronium and Pancuronium reduced the contraction of smooth tracheal muscle with the use carbachol. Propranolol and L-NAME had no effect on the contraction of smooth tracheal muscle after pretreating with vecuronium and pancuronium. CONCLUSION: We suggest that vecuronium has an anticholinergic effect, while pancuronium has some effect on the muscarinic receptor in addition to its anticholinergic effect.
Acetylcholine ; Animals ; Carbachol ; Muscle, Skeletal ; Muscle, Smooth* ; NG-Nitroarginine Methyl Ester ; Pancuronium* ; Propranolol ; Rats* ; Receptors, Muscarinic ; Receptors, Nicotinic ; Trachea* ; Vecuronium Bromide*

BACKGROUND: We postulate that a delay in the implementation of hepatic arterial embolization for traumatic liver injury patients will negatively affect patient prognosis. Our work also seeks to identify factors related to the mortality rate among traumatic liver injury patients. METHODS: From January 2008 to April 2014, patients who had been admitted to the emergency room, were subsequently diagnosed with traumatic liver injury, and later underwent hepatic arterial embolization were included in this retrospective study. RESULTS: Of the 149 patients that underwent hepatic arterial embolization, 86 had the procedure due to traumatic liver injury. Excluding the 3 patients that were admitted to the hospital before procedure, the remaining 83 patients were used as subjects for the study. The average time between emergency room arrival and incidence of procedure was 164 min for the survival group and 132 min for the non-survival group; this was not statistically significant (p = 0.170). The average time to intervention was 182 min for the hemodynamically stable group, and 149 min for the hemodynamically unstable group, the latter having a significantly shorter wait time (p = 0.047). Of the factors related to the mortality rate, the odds ratio of the Glasgow Coma Score (GCS) was 18.48 (p < 0.001), and that of albumin level was 0.368 (p = 0.006). CONCLUSIONS: In analyzing the correlation between mortality rate and the time from patient admission to arrival for hepatic arterial embolization, there was no statistical significance observed. Of the factors related to the mortality rate, GCS and albumin level may be used as prognostic factors in traumatic liver injury.
Coma ; Embolization, Therapeutic ; Emergency Service, Hospital ; Humans ; Incidence ; Liver* ; Mortality* ; Odds Ratio ; Patient Admission ; Prognosis ; Retrospective Studies ; Time Factors

No abstract available.
Bone Diseases, Developmental/diagnosis/drug therapy/*genetics ; Child ; Fibrillin-1/*genetics ; Hand/diagnostic imaging ; Heterozygote ; Human Growth Hormone/therapeutic use ; Humans ; Limb Deformities, Congenital/diagnosis/drug therapy/*genetics ; Male ; Pelvis/diagnostic imaging

BACKGROUND: Etomidate is an intravenous anesthetic which has properties of hemodynamic stability, minimal respiratory depression, and cerebral protection. Also, it is a useful induction agent for patients compromised by asthma and other reactive airway diseases. The aim of this study was to investigate the effect and action mechanism of etomidate on isolated tracheal smooth muscle in rats. METHODS: The rat's trachea was dissected free, cut into rings (2 mm) and mounted for isometric tension in Tris Tyrode solution. Cumulative dose-response curves for etomidate (3 X 10(-7) 3 X 10 (-4) M) were obtained from the tension measurements of acetylcholine (10 (-5)M)-contracted rings. The effects of propranolol, L-NAME and indomethacin on the etomidate induced tracheal response were investigated. Also, the effect of etomidate on the extracellular Ca2+ influx and Ca2+ release from internal stores was investigated. RESULTS: Etomidate produced relaxation of acetylcholine-precontracted trachea in a dose-dependent fashion. Pretreatment with propranolol, L-NAME had no effects on concentration-response curves to acetylcholine. Pretreatment with indomethacin had an effect on the concentration-response curve to acetylcholine. Pretreatment with etomidate inhibited acetylcholine-induced contractions in the absence of extracelluar Ca2+ and the presence of extracellular Ca2+ . CONCLUSIONS: The tracheal smooth muscle relaxation by etomidate is not related with beta-adrenergic activation and NO synthesis but related with prostaglandin production. The relaxation effect of etomidate is induced by a decrease in concentration of intracellular Ca2+ through the blockade of extracellular Ca2+ influx and the simultaneous release of Ca2+ from internal stores.
Acetylcholine ; Animals ; Asthma ; Etomidate* ; Hemodynamics ; Humans ; Indomethacin ; Muscle, Smooth* ; NG-Nitroarginine Methyl Ester ; Propranolol ; Rats* ; Relaxation ; Respiratory Insufficiency ; Trachea