Percutaneous transhepatic cholangiography(PTC) is of value in differential diagnosis of cholestatic diseases. Authors had performed PTC in 120 patients with flexible needle of 23 gauge at the Department of Radiology, KangNam St, Mary's Hospital and Myung Dong St. Mary's Hospital during the period from Jan. 1976 to April 1980. PTC was accomplished successfully in 112 of 120 patients. Diagnoses included cholangiocarcinomas (27 cases), arcinomas ofpancreas head (21 cases), ampullary carcinomas (4 cases), metastatic carcinomas(4 cases), metastatic carcinomas (5cases), bile duct stones(27 cases), sclerosing cholangitis(6 cases), hepatitis(6 cases), liver cirrhosis(6 cases), post operative adhesions(5 cases), chronic pancreatitis(3 cases), stomach carcinomas(3 cases), clonorchiasis(2cases), blood clot (1 case), and remaining normal 4 cases. Some characteristic PTC findings were (1) segmentalannular narrowing and abrupt complete obstruction and polypoid filling defects of the bile duct incholangiocarcinoma, (2) typical nipple or rat-tail appearance of the distal commmon bile duct in pancreatic headcarcinoma, (3) single or multiple sharply and smoothly outlined filling defects whthin bile duct in all cases ofstones, (4) complete obstruction with shallow concavity in ampullary carcinoma, (5) diffuse or segmental narrowingof the intrahepatic bile duct and common bile duct in sclerosing cholangitis, (6) multiple tiny polypoid fillingdefects of gallbladder, common hepatic duct, and common bile duct in clonorchiasis, (7) normal appearance inhepatitis. The overall diagnostic accuracy of PTC in 66 operated cases was 89.4%, and complications following the examination were signficantly reduced by using a fine flexible needle(23 gauge). From the present study it is concluded as follows; 1. To evaluate obstructed or stenosed site accurately, aspiration of bile juice must bepreceded by a 23 gauge needle connected to either 10mo or 5ml syringe. 2. To diagose carcinoma of hte ampullaryportion, serial spot filmings were indispensible ot demonstrated modified appearance of obstructive lesions due tocontraction of Oddi sphincter. 3. In contrast to other reports, the most common site of cholangiocarcinomas wasthe common hepatic duct (12 of 27 cases) in our series. Rat-tail appearance was seen in both pancreatic headcarcinoma and carcinoma involving the distal end of the common bile duct. 4. PTC was a more valuable method for diagnosis of clonorchiasis.
Bile ; Bile Ducts ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; Cholangiography ; Cholangitis, Sclerosing ; Clonorchiasis ; Common Bile Duct ; Diagnosis ; Diagnosis, Differential ; Gallbladder ; Head ; Hepatic Duct, Common ; Humans ; Liver ; Methods ; Needles ; Nipples ; Sphincter of Oddi ; Stomach ; Syringes

PURPOSE: This study was retrospectively conducted to evaluate the clinical results of consecutive 167 myopic eyes of 117 patients undergoing laser in situ keratomileusis(LASIK) for myopia with either of the two excimer lasers, which differ in the method of laser delivery: flying spot scanning versus broad beam. METHODS: According to the laser used, the treated eyes were divided into two groups: Group I, 84 eyes of 58 patients with LaserScan LSX(R)(Lasersight Inc., USA); Group II, 83 eyes of 59 patients with OmniMed II(R)(Summit, USA). Each patient had been followed up for more than 6 months after surgery. Only single procedure outcomes were included. Mean preoperative spherical equivalents(SE) were -5.67+/-1.79 D(range:-1.50~-9.75 D) in group I and -6.40+/-1.79 D(range:-3.50~-9.75 D) in group II. RESULTS: At postoperative 6 months, mean uncorrected visual acuity increased to 0.94 in group I and 0.88 in group II. Uncorrected visual acuity of 20/40 or better occurred in 100% of group I and 96.4% of group II, and of 20/20 or better, in 57.2% and 48.2%, respectively. No eye in either group lost more than 1 line of best-corrected visual acuity. Mean SEs at postoperative 6 months were -0.28+/-0.50 D in group I and -0.55+/-0.60 D in group II(P<0.05). Manifest SEs were within +/-1.00 D in 97.6% of group I and 84.3% of group II, and +/-0.50 D in 73.8% and 60.2%, respectively. Intra- or postoperative complications were subconjunctival hemorrhage(4 eyes, group I; 5 eyes, group II), Sands of Sahara syndrome(7 eyes, group I; 5 eyes, group II), epithelial ingrowth(1 eye, group II only) and infectious keratitis(1 eye, group II only). No case had a central island or irregular astigmatism postoperatively. CONCLUSIONS: Our study suggests that LASIK using the LaserScan LSX(R)excimer effectively reduces myopia compared with OmniMed II(R). However, its predictability decreased as the attempted correction increased. LASIK for myopia less than -10 D with the LaserScan LSX(R)provided satisfactory refractive results that compare well with other reports in the literature.
Africa, Northern ; Astigmatism ; Diptera ; Humans ; Keratomileusis, Laser In Situ* ; Lasers, Excimer* ; Myopia ; Postoperative Complications ; Retrospective Studies ; Silicon Dioxide ; Visual Acuity

Loss of best corrected visual acuity(BCVA)is a landmark of safety, as one of important complications of refractive surgery. To evaluate causes of 2 lines or more loss of BCVA after laser in situ keratomileusis(LASIK), 206 eyes of 139 patients, who had undergone LASIK and had been followed up for 6 months or more, were included in this study. During the follow-up, nineteen eyes(9.2%, 19/206)showed 2 lines or more loss of BCVA postoperatively. The causes of BCVA were irregular astigmatism(15 eyes, 7.3%), retinal complications(3 eyes, 1.5%), and infectious keratitis(1 eye, 0.5%). All irregular astigmatisms had occured within 1 month postoperatively and 13 eyes of all 15 eyes spontaneously recovered after postoperative 3 months. The persistent loss of BCVA occurred in 5 eyes(2.4%, 5/206). Three cases of all 5 persistent losses of BCVA were due to retinal complications. In conclusion, our results suggest that the most common cause of loss of BCVA after LASIK is irregular astigmatism. Irregular astigmatism is a temporary situation which has a tendancy of spontaneous recovery. Thus careful observation is recommended in irregular astigmatism after LASIK. The retinal complications of LASIK may lead to permanent loss of BCVA. Therefore it is needed to examine preoperative fundus closely and to explain possible postoperative complicaitons to the patients and their family.
Astigmatism ; Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ* ; Refractive Surgical Procedures ; Retinaldehyde ; Visual Acuity*

The diagnostic importance of finding an appendicolith in the plain x-ray of the abdomen has been well documented. However, most of the papers so far published have stressed x-ray findings of the preoperative abdomenin acute appendicitis. In the present study we have attempted to correlate incidences of appendicoliths insurgical specimen and plain x-ray of the abdomen. The materials were 37 surgical specimens of the appendix removed for acute appendicits at St. Mary's Hospital, St. Paul's Hospital, Kang Nam Hospital, Holy Family Hospital and Our Lady of Mercy Hospital of Catholic Medical College during the period of 6 months from August 1980. Each surgical specimen was subjected to soft tissue radiography to detect calcified appendicolith. Then the preoperative x-raysof abdomen were retrospectroscopically analysed for the presence of radiographically demonstrable appendicoliths.Our study revealed that in as many as 32% of 37 surgical specimens one or more calcified appendicoliths were demonstrated radiographically whereas only one of these was identified as such in the preoperative x-ray film ofthe abdomen. Such a great discrepancy between the incidences of appendicoliths in the surgical specimen andpreoperative x-ray films of the abdomen are ascribed to (1) relative smallness of appendicoliths (87% of the stones measured less than 1cm in diameter in radiographs of surgical specimen in our series), (2) overlapping of these small stones on the right iliac bone and (3) underpenetrating of the iliac bone area in x-ray films of theabdomen. For improving detctability of appendicoliths therefore it is recommended that the technique of radiography of plain abdomen should be such that a small appendicolity overlying the iliac bone can be brought outof trabecular shadows.
Abdomen ; Appendicitis ; Appendix ; Humans ; Incidence ; Radiography ; X-Ray Film

The main goal of the surgical treatment of maxillofacial deformity is improved esthetic appearance and masticatory function. Recently, the purpose of orthognathic surgery has been focused on esthetic improvement of the patients. The purpose of this study was to investigate the changes in gonial angle to orthognathic surgery. For this study 30 patients were randomly selected. All patients with mandibular prognathism were operated upon with bilateral sagittal split ramus osteotomy and mandibular setback. The patients were cephalmetric lateral radiographs for 1 hear. Lateral cephalmetric radiographs taken preoperatively, over 6-months and 1 year follow up were traced and analysed. The following conclusions were reached. : 1. During following up period for 1 year, the change of gonial angle after orthognathic surgery was decreased, except 3 cases. The mean gonial angle change was decreased from 128.6 degrees(+/-4.83) to 123.4 degrees(+/-5.52) in female(p<0.05). 2. During follow up period for 1 year, the mean gonial angle was decreased after orthognathic surgery from 129.7 degrees(+/-6.47) to 123.3 degrees(+/-7.52), in all male patients(p<0.05). 3. The mean gonial angle changes after orthognathic surgery was about 5.2 degrees in female and 5.4 degrees in male. There was less statistical significance between male and female. 4. The ratio of mandibular setback amount from 6mm to 15mm was 83.3%, and from 1mm to 5mm was 10%.
Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Male ; Orthognathic Surgery ; Osteotomy, Sagittal Split Ramus ; Prognathism

BACKGROUND: It is known that laparoscopic surgery is associated with less pain than open surgery in many studies. We wanted to evaluate the postoperative pain by using intravenous patient-controlled analgesia (IV-PCA) in patients undergoing laparoscopic assisted vaginal hysterectomy (LAVH) or abdominal total hysterectomy (ATH). METHODS: Ninety one women with uterine myoma were prospectively assigned to undergo either LAVH (n = 49) or ATH (n = 42). IV-PCA was used for postoperative pain control in both groups. Pain scores were assessed using a visual analogue scale (VAS) and cumulative PCA-drug consumption and incidences of nausea and vomiting were recorded in 1, 2, 4, 24, 48 hours after surgery. RESULTS: There were no differences in terms of patient's age, BMI and total operation time between the both groups. Pain scores and the demand of analgesics of the IV-PCA in 1, 2, 4, 24, and 48 hours after surgery were not significantly different in both groups. Incidences of nausea and vomiting after surgery were more common in LAVH than ATH especially within 4 hours. CONCLUSIONS: The present study demonstrates that LAVH requires adequate postoperative pain control as ATH during the first 48 hours after surgery, and the effective prevention of PONV is required in LAVH compared with ATH.
Analgesia, Patient-Controlled ; Analgesics ; Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Incidence ; Laparoscopy ; Leiomyoma ; Nausea ; Pain, Postoperative* ; Postoperative Nausea and Vomiting ; Prospective Studies ; Vomiting

BACKGROUND: Recent studies suggest that additional use of alfentanil could provide the best condition for the laryngeal mask airway (LMA) insertion. The aim of this study is to compare the median effective dose (ED50) of propofol for the classic LMA insertion and the insertion condition following between fentanyl and alfentanil adjuvant. METHODS: We enrolled 53 patients scheduled for minor surgery under general anesthesia. Patients were randomly allocated to the fentanyl group (n = 24) and the alfentanil group (n = 29) in double blind manner. For fentanyl group, 1microgram/kg of fentanyl was injected intravenously 90 sec before propofol. The afentanil group received 4microgram/kg of alfentanil and propofol coincidently. The insertion of LMA was attempted 90 sec after propofol administration. In accordance with Dixon's up-and-down method, the dose of propofol for consecutive patients in each group was varied with increments or decrements of 0.5 mg/kg based on the previous insertion results of patients. RESULTS: In the fentanyl and alfentanil group, the ED50 of propofol for LMA insertion according to Dixon's method was 2.0 +/- 0.3 mg/kg and 1.8 +/- 0.3 mg/kg, respectively. In addition, the ED50 of propofol of the fentanyl and alfentanil group according to probit regression model, 1.7 mg/kg (95% confidence interval, 1.2-2.2) and 1.7 mg/kg (1.3-2.0) were calculated respectively. There is no significant difference between the two groups. CONCLUSIONS: There was no significant difference in propofol ED50 for insertion of LMA and insertion condition between the alfentanil and the fentanyl group.
Alfentanil* ; Anesthesia, General ; Fentanyl* ; Humans ; Laryngeal Masks ; Propofol* ; Surgical Procedures, Minor

At the end of the operation, residual neuromusular blookade may be antagonized by anticholines-terase (edrophonium, neostigmine and pyridostigmine). Neostigmine is probably commonly used antagonist of nondepolarizing neuromuscular blocking agents. But, because of an apparent longer duration of action and lesser muscarinic effects, pyridos- tigmine has been suggested as possibly superior to neostigmine as an antagonist of nondepolarizing neuromuscular blockade. Accordingly, present study observed the heart rate, systolic and diastolic blood pressure changes following equipotent doses of pyridostigmine and neostigmine given with glycopyrrolate in inhalation anesthesia (halothane and enflurane). Eighty patients were randomly divided in four groups as follows: Group I: halothane, glycopyrrolate + neostigmine Group II: halothane, glycopyrrolate + pyridostigmine Group IIl: enflurane, glycopyrrolate + neostigmine Group IV: enflurane, glycopyrrolate +pyridostigmine The results were as follows: 1) In halothane and enflurane anesthesia, the changes in heart rate were significant in each group after 4 minutes and especially, the group I, III showed more decrease than the group II, IV. 2) Tachycardia were observd until 6 minutes after administration of anticholinesterase in each group. Bradycardia were appeared at 6 minutes in the group I, IIl and at 14 minutes in the group II, IV and, each group showed bradycardia which continued over 20 mintes. 3) Even though the decrease of systolic and diastolic blood pressure showed transiently with time, there were no significant difference in the changes in ach group. 4) When the same anticholinesterase was administered, the cardiovascular responses were no significant difference between the halothane and enfurane anesthesia. In conclusion, pyridostigmine with glycopyrrolate seems to produce minimal changes in the cadiovascular responses in halothane and enflurane anesthesia.
Anesthesia ; Anesthesia, Inhalation* ; Blood Pressure ; Bradycardia ; Cholinergic Agents ; Enflurane ; Glycopyrrolate ; Halothane ; Heart Rate ; Humans ; Inhalation* ; Mentha ; Neostigmine* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pyridostigmine Bromide* ; Tachycardia

PURPOSE: The aim of this study was to determine the role of the CT scan in blunt hepatic injury and the significance of CT degree of hepatic injury in the decision making of treatment plan. MATERIALS AND METHODS: We retrospectively analysed the CT findings of 22 patients with hepatic injury. We graded hepatic injury on CT scan into five according to the severity. Clinical records, type of management and clinical outcome of the patients were also reviewed. RESULTS: Of the 22 patients, 17 had conservative treatment and five had surgery. The numbers of patients treated conservatively were 0, 4, 11, 2 and 0 in the grade 1, 2, 3, 4 and 5, respectively and the numbers of surgically treated cases were 0, 0, 3, 2 and 0 respectively. There was no significant statistical difference between surgically and conservatively treated groups(p-value > 0.05). All patients with conservatively treated group were hemodynamically stable and had no complication during hospitalization. Hemoperitoneum was observed in 11 of 22 patients. CONCLUSION: In blunt hepatic injury, CT plays an important role in the demonstration of location and extent of the hepatic injury, size of hemoperitoneum and the post operative course. However, we believe that physiologic status of the patients may be more important than the extent of CT based hepatic injury for determining a mode of treatment.
Decision Making ; Hemoperitoneum ; Hospitalization ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed

During the last 2 decades, there has been an increasing impetus to avoid general anesthesia in women undergoing cesarean delivery because of the increased of failed endotracheal intubation in pregnant women compared with nongravid patients. The past decade has seen major changes in the practice of obstetric anesthesiology, as evidenced by an improved understanding by anesthesiologists of many disease entities seen in obstetric patients, as well as by the enhancements of new techniques and drugs. Recent advances in the practice of this specialty include the refinement of the combined spinal-epidural technique for both labor analgesia and cesarean delivery, the use of continuous infusions of dilute solution of local anesthetics combined with opioids, the development of multiorifice epidural catheters, the dramatic increase in the use of subarachnoid anesthesia for elective cesarean delivery, and the introduction of new amide local anesthetics. Because of the tremendous increase in the application of neuraxial techniques, the administration of general anesthesia for cesarean delivery has dramatically decreased. Also the number of deaths associated with regional anesthesia declined markedly with the withdrawal of 0.75% bupivacaine and probably due to increasing awareness of local anesthetic toxicity and increased use of test dosing. The discussion includes new methods and drugs associated with regional anesthesia for cesarean delivery and highlight their benefits and risks.
Analgesia ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesiology ; Anesthetics, Local ; Bupivacaine ; Catheters ; Female ; Humans ; Intubation, Intratracheal ; Pregnant Women ; Risk Assessment