No abstract available.
Bandages*

This study aimed to investigate the mechanism of action of baclofen on the detrusor muscle isolated from rat. Rats (Sprague-Dawley) were sacrificed by decapitation and exsanguination. Horizontal muscle strips of 2 mm x 15mm were prepared for isometric myography in isolated muscle chamber bubbled with 95% / 5%-OZ / CO2 at 371C, and the pH was maintained at 7.4 Detrusor strips. contracted responding to the.. electrical field stimulation (EFS) by 2 Hz, 2U msec, monophasic square wave of 60 VDC. The initial peak of EFS-Induced contraction was tended to be suppresed by a,p-methylene-adenosine 5'-triphosphate (mATP), a partial agonist of purinergic receptor, and baclofen, a GABAB receptor agonist (statistically nonsignificant). The late sustained contraction by EFS was suppressed significantly (p < 0.05) by additions of atropione, a cholinergic muscarinic receptor antagonist and baclofen. The adenosine 5'-triphosphate-induced contraction was completely abolished by mA TP but not by baclofen. In the presence of atropine, the subsequent addition of acetylcholine could not contract the muscle strips: but the addition of acetylcholine in the presence of baclofen evoked a contraction to a remarkable extent.
Acetylcholine ; Adenosine ; Animals ; Atropine ; Baclofen* ; Decapitation ; Exsanguination ; Hydrogen-Ion Concentration ; Myography ; Rats* ; Receptors, Muscarinic

OBJECTIVES: To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. METHODS: In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. RESULTS: The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.9% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). CONCLUSIONS: After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.
Academies and Institutes ; Diagnosis ; Diagnosis-Related Groups* ; Insurance* ; Medical Records

The main symptoms of adult isthmic spondylolisthesis are frequently low back pain and radicular leg pain. Laminectomy and posterolateral fusion is somtimes unsuccessful because nerve roots are compressed by fibrocartilagenous tissue at pars defect, degenerated disc and slipped bony edge. The patients need complete neural decompression, reduction of slipping and stable fixation. We have operated 22 patients with PLIF using carbon cage and transpedicular screw fixation after posterior decompression by Gill's operation and complete removal of intervertebral disc. We studied the patients postoperatively to evaluate the symptomatic improvement, reduction rate of slipping and stability of lumbar spine. Twenty-two patients were operated from April, 1996 to June, 1997. Mean age was 46, ranging from 35 to 68. Mean follow-up duration was thirteen months. The levels of operarion were 9 at L4-5 and 9 at L5-S1, 4 at both levels. Mean preoprative slip was 17.2%, which was reduced to 11.3% postoperatively. Nineteen patients(86%) were satisfied with the result of operation. The fusion rate of PLIF was 86%. There was no breakage of instrumentation or postoperative instability. We consider that PLIF and transpedicular screw fixation for adult isthmic spondylolisthesis with radicular leg pain is a good methods to obtain complete neural decompression, reduction of slip and stable lumbar fixation.
Adult ; Carbon ; Decompression ; Follow-Up Studies* ; Humans ; Intervertebral Disc ; Laminectomy ; Leg ; Low Back Pain ; Sciatica* ; Spine ; Spondylolisthesis*

Pulmonary sequestration is a rare congenital malformation during embryouic development which results in a cystic mass of nonfunctioning lung tissue. A diagnosis of a pulmonary sequestration has traditionally relied upon identifying the pathological arterial vessels by arteriography, computed tomography, and magnetic resonance imaging. We reported a case of pulmonary sequestration diagnosed by Doppler sonography and subsequent CT angiography. A 21-year-old-woman admitted to hospital for an investigation of recurrent pneumonia with left lower chest pain. A doppler ultrasound sonography showed an aberrant blood supply from the descending thoracic aorta to the left lower chest lesion. The pulmonary sequestration was confirmed by the subsequent CT angiograph.
Female ; Humans

PURPOSE: Splenic flexure mobilization in an anterior resection is a subject of controversy, but a tension-free anastomosis is needed in case of a low anterior resection or a coloanal anastomosis. Classical splenic flexure mobilization by means of the lesser sac opening is technically difficult in the laparoscopic era. METHODS: This study retrospectively analyzed the medical records and operation videos of 16 patients who underwent laparoscopic splenic flexure mobilization in Our Lady of Mercy Hospital, The Catholic University of Korea by using a medial approach. The operation procedure is as follows: Under general anesthesia, the patient was placed in the Trendelenburg position, after making pneumoperitoneum, the inferior mesenteric artery (IMA) and the inferior mesenteric vein (IMV) were ligated and divided. A medial-to-lateral mesocolon dissection was done, and the pancreas was dissected from the mesocolon of the transverse colon; then, the greater omentum was dissected. RESULTS: The mean age was 60 years old, and the male- to-female sex ratio was 9:7. The mean operation time was 293 minutes. The mean distal margin was 5.3 cm, and the mean number of harvested lymph nodes was 15. An anterior resection was done in 2 cases, a low anterior resection is 10 cases, and a coloanal anastomosis in 4 cases. The mean time from ligation of the IMA to splenic flexure mobilization was 45 minutes. There was no mortality or morbidity. CONCLUSIONS: Laparoscopic medial splenic flexure mobilization is a technically feasible and safe method.
Anesthesia, General ; Colon, Transverse* ; Head-Down Tilt ; Humans ; Korea ; Laparoscopy ; Ligation ; Lymph Nodes ; Medical Records ; Mesenteric Artery, Inferior ; Mesenteric Veins ; Mesocolon ; Middle Aged ; Mortality ; Omentum ; Pancreas ; Peritoneal Cavity ; Pneumoperitoneum ; Retrospective Studies ; Sex Ratio

We present a case with rare complication of percutaneous vertebroplasty with polymethylmethacrylate (PMMA). A pulmonary embolus was detected in a 79-year-old woman with osteoporotic compression fracture after percutaneous verteroplasty. Chest radiography, computed tomography, and ventilation perfusion lung scan con-firmed pulmonary infarction and the presence of PMMA in the pulmonary arteries. She was treated with anticoagulants and responded favorably. Although venous leakage of PMMA has shown to be not uncommon, only a few cases of symptomatic pulmonary embolism have been reported. Adequate preparation of PMMA, optimal injection technique, and confirmation with biplane fluoroscopy are mandatory to minimize this type of complication.
Aged ; Anticoagulants ; Embolism ; Female ; Fluoroscopy ; Fractures, Compression ; Humans ; Lung ; Perfusion ; Polymethyl Methacrylate* ; Pulmonary Artery ; Pulmonary Embolism* ; Pulmonary Infarction ; Radiography ; Thorax ; Ventilation ; Vertebroplasty*

Plain radiographs of an 88-year-old woman who had experienced vomiting and abdominal distention for 3 days revealed a severely obstructed ileus, and abdominopelvic computed tomography revealed an incarcerated Morgagni hernia. The endoscope was passed through the constrictions from the diaphragmatic indentations and a thin catheter was placed for decompression. The obstructive ileus regressed markedly after the procedure; the patient underwent elective laparoscopic repair of the hernia 1 week later. This is believed to be the first case of endoscopic preoperative decompression for an incarcerated Morgagni hernia.
Aged, 80 and over ; Catheters ; Colonoscopy ; Constriction ; Decompression ; Endoscopes ; Female ; Hernia ; Hernia, Diaphragmatic ; Humans ; Ileus ; Vomiting

Various venous approaches are available for chemoport insertion. The subclavian vein and jugular vein are commonly used. The cephalic vein has several advantages for chemoport insertion. The authors introduce chemoport insertion using cephalic vein. Operation methods were as follows: patient was placed in supine position. Under local anesthesia, the incision was made in the infraclavicular portion, dissection was performed along the deltopectoral groove and the cephalic vein was identified and isolated. Dissection was performed between the subcutaneous fat layer and the muscle layer to make space for chemoport placement. The cephalic vein was incised and the catheter was introduced to the cephalic vein directly and examined by fluoroscopy. Chemoport insertion using cephalic vein is a useful method of chemoport insertion.
Anesthesia, Local ; Catheters ; Fluoroscopy ; Humans ; Jugular Veins ; Muscles ; Subclavian Vein ; Subcutaneous Fat ; Supine Position ; Veins

PURPOSE: In general, laparoscopic surgery has many advantages such as the improved cosmesis and the reduced pain, postoperative recovery and hospital stay. We evaluated the minimal invasive technique for the treatment of radiologically irreducible intussusceptions. METHODS: From January 1997 to April of 2007, the medical records of patients who underwent operation due to radiologically irreducible intussusceptions were reviewed. Age, gender, body weight, clinical symptoms, duration of symptoms, operation time, time to pass flatus, day of starting an oral diet, length of the hospital stay and complications were compared between the conventional surgery group and the laparoscopic group. RESULTS: 86 cases were enrolled in this study. 9 patients (10.5%) underwent laparoscopic surgery and 86 patients (89.5%) underwent conventional surgery. There were no differences between the two groups in terms of age, gender, body weight, duration of symptoms, clinical symptoms, operative time and the surgical morbidity. Postoperative flatus passing, starting the postoperative diet and the length of the hospital stay were significantly reduced in the laparoscopic group. CONCLUSION: The laparoscopic approach is one of the effective treatments for radiologically irreducible intussusceptions.
Body Weight ; Diet ; Flatulence ; Humans ; Intussusception ; Laparoscopy ; Length of Stay ; Medical Records ; Operative Time ; Pain, Postoperative