In postanesthetic period, infants and children have a risk of hypoxemia due to decreased functional residual capacity(FRC) and increased alveolar-arterial O2 tension gradient(A-a DO2). We measured arterial oxygen saturation(SaO2) with a pulse oximeter in 60 ASA class 1 infants and children. Group 1 was breathing with supplemental oxygen(4L/min) by mask and Group 2 was breathing with room air in recovery room after general anesthesia. SaO2 was measured on arrival in the recovery room, 2,4,6, 8,10,15, and 20 minute after arrival The results were as follows: 1) Postanesthetic SaO2 measured on arrival in the recovery room had decreased significantly(p<0.05) to preanesthetic SaO2 2) SaO2 measured in room air had decreased significantly compared with SaO measured in supplemental oxygen. As a result of the study, it is thought to be safe that supplemental oxygen is administered to patient on transfer and in recovery room.
Anesthesia* ; Anesthesia, General ; Anoxia ; Child ; Humans ; Infant ; Masks ; Oxygen* ; Recovery Room ; Respiration

Purpose: Laparoscopic hepatectomy has been widely performed by hepatobiliary surgeons for malignancy of liver and gained wide acceptance for various liver tumors, thanks to advances in surgical techniques and devices. But, there are some challenges for right side tumor in patients of cirrhotic liver. Especially, tumor located in right upper area is difficult for wedge resection in patients with marginal liver function, because trans-abdominal approach requires normal parenchymal dissection. Radiofrequency wave ablation is also difficult for such a lesion. So, we demonstrate unique technique of video-assisted transthoracic liver resection (VTLR) for overcome right upper side tumor abutting diaphragm. Methods: Four patients underwent VTLR. Four ports in right chest wall were created by a chest surgeon and diaphragm was open. Then traction of the diaphragm was done by suture. After exposure of liver surface, tumor localization was done by ultrasound. The mass excision was done by ultrasonic shear. Results: Four patients were discharged without complications within 11.3 days (range, 6–15 days). On average, patients started to consume a normal diet on an average of 2.4 days (range, 1–4 days). Conclusion VTLR is could be performed by an experienced surgeon and chest surgeon for right upper liver malignancy abutting diaphragm in patient of marginal liver function.

PURPOSE: To evaluate the relationship between the speed of enhancement of hepatic hemangiomas on gadolinium-enhanced MRI and ADC values by using various parameters, including the D, f, D* and ADC(fit) on intravoxel incoherent motion (IVIM) MR Imaging. MATERIALS AND METHODS: The institutional review board approved this retrospective study. A total of 47 hepatic hemangiomas from 39 patients were included (20 men and 19 women). The hemangiomas were classified into three types according to the enhancement speed of the hepatic hemangiomas on gadolinium-enhanced dynamic T1-weighted images: rapid (Type A), intermediate (Type B), and slow (Type C) enhancement. The D, f, D* and ADC(fit) values were calculated using IVIM MR imaging. The diffusion/perfusion parameters and ADC values were compared among the three types of hemangiomas. RESULTS: Both the ADC(fit) and D values of type C were significantly lower than those of type A (P = 0.0022, P = 0.0085). However, for the f and D*, there were no significant differences among the three types. On DWI with all b values (50, 200, 500 and 800 sec/mm2), the ADC values of type C were significantly lower than those of the type A (P < 0.012). For b values with 800 sec/mm2, the ADC800 values of the type C hemangiomas were significantly lower than those of type B (P = 0.0021). We found a negative correlation between hepatic hemangioma enhancement type and ADC50 (rho= -0.357, P = 0.014), ADC200 (rho= -0.537, P = 0.0001), ADC500 (rho= -0.614, P = 0.0001), and ADC800(rho= -0.607, P = 0.0001). Therefore, four ADC values of ADC50, ADC200, ADC500, and ADC800 were decreased with decreasing enhancement speed. CONCLUSION: Hepatic hemangiomas had variable ADCs according to the type of enhancement, and the reduced ADCs in slowly enhancing hemangiomas may be related to the reduced pure molecular diffusion (D).
Diffusion ; Ethics Committees, Research ; Hemangioma* ; Humans ; Magnetic Resonance Imaging* ; Male ; Retrospective Studies

BACKGROUND: It has long been suggested that neutrophils and their products are implicated as the central mediators of the acute lung injuries. Contrary to the dominant role of neutrophils in ARDS, many cases of ARDS has occurred in the setting of severe neutropenia without pufrnonary neutrophil infiltration. Therefore it is certain that effector cell(s) other than neutrophil play an important role in the pathogenesis of ARDS. This experiment was performed to define the mechanism of ARDS in the setting of neutiopenia, 1) by comparing the severity of endotoxin-induced lung injury, 2) by measurement of hydrogen peroxide production and cytokine concentration in the bronchoalveolar lavage cells and fluids obtained from different rats with and without cyclophosphamide-pretreatment. METHOD: The male Sprague-Dawleys were divided into the normal control (NC)-, endotoxin (ETX)-, and cyclophosphamide (CPA)-group in which neutropenia was induced by injecting cyclophosphamide intraperitoneally. Acute lung injury was evoked by injecting lipopolysaccharide (LPS) into a tail vein. The bronchoalveolar lavage (BAL) was performed at 3 and 6 hour after administration of LPS to measure the change of cell counts and concentrations of protein and cytokines, tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). Hydrogen peroxide (HPO) production from BAL cel]s was measured at 6 hour after LPS administration by phenol red microassay with and without zymosan stimulation. RESULTS: The results were as follows. A change of leukocyte counts in the peripheral blood after treatment with CPA More than 95% of total leukocytes and neutrophils were reduced after CPA administration, resulting in severe neutropenia. A change of BAL cells In the ETX-group, the number of total cells (p<0.01) and of macrophage and neutrophll (p<0.05) were increased at 3 and 6 hour after LPS administration compared to those of NC- group. In the CPA-group, the number of total leukocyte and macrophage were not changed after LPS administration, but neutrophil counts were significantly reduced and jt took part in less than 0.1% of total BAL cells (p<0.01 vs NC-group). BAL cells in this group were almost all macrophages (99.7%). A change of protein concentration in the BALF In the ETX-group, protein concentration was increased at 3 hour and was more increased at 6 hour after LPS administration (p<0.05 and <0.01 vs NC-group, respectively). In the CPA-group, it was also significantly elevated at 3 hour after LPS administration (p<0.05 vs NC-group) , but the value was statistically not different from that of ETh-group. The value measured at 6 hour after LPS administration in the CPA-group became lower than that of ETX-group (p<0.05), but showed still a higher value compared to that of NC-group (p<0.05). A change of cytokine concentration in the BALF TNF-alpha and IL-6 were elevated in the ETX- and CPA-group compared to those of NC-group at both time intervals. There was no statistical difference in the values of both cytokines between the ETX- and CPA-groups. Measurement of hydrogen peroxide production from BAL cells There was no intergroup difference of HPO production from resting cells. HPO production after incubation with opsonized zymosan was significantly elevated in all groups. The percent increment of HPO production was highest in the ETX-group (89.0%, p<0.0008 vs NC-group ), and was 42.85 in the CPA-group (p = 0.003 vs NC-group ). Conclusion Acute lung injury in the setting of neutropenia might be caused by functional activation of resident alveola r macrophages.
Acute Lung Injury* ; Animals ; Bronchoalveolar Lavage ; Cell Count ; Cyclophosphamide ; Cytokines ; Humans ; Hydrogen Peroxide ; Interleukin-6 ; Leukocyte Count ; Leukocytes ; Lung Injury ; Macrophages* ; Male ; Neutropenia ; Neutrophil Infiltration ; Neutrophils ; Phenolsulfonphthalein ; Rats* ; Tumor Necrosis Factor-alpha ; Veins ; Zymosan

PURPOSE: In many centers, voiding cystourethrography(VCUG) is routinely performed to identify some abnormalities which may compromise the success of transplantation and assess the abnormality of lower urinary tract. To evaluate the value of VCUG as routine pretransplatation workup, we retrospectively reviewed this investigation for renal transplant candidates. MATERIALS AND METHODS: 251 patients underwent transplantation at our center over a 7-year period from August 1990 to July 1996. 229 patients were fully evaluable excluding 22 patients due to incomplete records. All of them were taken VCUG. We tried to find an abnormal VCUG including vesicoureteral reflux, postvoid residual urine(PVR>50ml) and decreased bladder capacity(<100ml). RESULTS: An urological abnormality is identified by VCUG in 29 of 229 patients(12.7%). These abnormalities include 20 patients with VUR alone, 5 patients with increased PVR due to urethral stricture(1), benign prostatic hyperplasia(1), and unknown(3), 1 patient with decreased bladder capacity, 2 patients with unilateral VUR combined PVR, and 1 patient with bilateral VUR combined decreased bladder capacity. 4 of 29 patients had a known urological abnormality as the etiology of end stage renal disease. 41 of 229 patients evaluated had a previous urological history such as frequency, nocturia, urgency, incontinence and dysuria, recurrent UTI and pyelonephritis. But all 29 patients with abnormal VCUGs had a previous those history. 4 of 29 patients were managed due to increased PVR after transplantation as followings: clean intermittent catheterization(3), medication of alpha-blocker for BPH(1). Others were not required further managements. Hence, abnormal findings on VCUG did not lead to a surgical procedure for the abnormality before and/or after transplantation. CONCLUSIONS: These results show that VCUG may be not essential for the routine evaluation for renal transplantation. Therefore, it will necessary in selected individuals with a previous urological history.
Dysuria ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Nocturia ; Pyelonephritis ; Retrospective Studies ; Urinary Bladder ; Urinary Tract ; Vesico-Ureteral Reflux

Digoxin is commonly used in treatment of various heart conditions, such as atrial fibrillation, atrial flutter, and sometimes heart failure. The therapeutic range of digoxin is narrow. Therefore, Digoxin toxicity is common. However, severe digoxin intoxication is uncommon. Many cases involving application of Digoxin immune Fab for digoxin intoxication in other countries have been reported. However, no cases have been reported in Korea. We reported on one case, a 34-year-old male with acute and severe digoxin intoxication who was treated with digibind(R). His chief complaint was gastrointestinal symptoms, including nausea and vomiting. Electrocardiography (ECG) showed third degree atrioventricular (AV) block. After an infusion of digibind(R), third degree AV block rhythm was changed to first degree AV block. Nowadays, we can obtain a digoxin antidote from the national poisoning information center. Therefore, we should actively consider application of Digoxin immune Fab in patients with severe digoxin intoxication.
Adult ; Atrial Fibrillation ; Atrial Flutter ; Atrioventricular Block ; Digoxin* ; Electrocardiography ; Heart ; Heart Failure ; Humans ; Information Centers ; Korea ; Male ; Nausea ; Poisoning ; Vomiting

BACKGROUND AND OBJECTIVES: Hypopharyngeal cancer is notorious for its poor prognosis and severe surgical morbidity with functional deficits. This study was conducted to compare the efficacy between the neoadjuvant chemotherapy followed by radiotherapy and surgery with postoperative radiotherapy in the treatment of hypophayngeal cancer. MATERIAL AND METHOD: Medical records of 64 patients, treated for hypopharyneal cancer at Pusan National University Hospital from March 1986 through May 2000, were retrospectively reviewed. Thirty-three patients were grouped into the chemotherapy and radiotherapy (CRTx) group, who received neoadjuvant chemotherapy and radiotherapy. Thirty-one patients were grouped into the operation and radiotherapy (ORTx) group, who received laryngectomy with or without reconstruction and postoperative radiotherapy. RESULTS: There was no significant difference of three years survival rate between CRTx group and ORTx group (p>0.05). Laryngeal preservation rate was 45% in CRTx group but 3% in ORTx group (p<0.05). CONCLUSION: Although this had not been a randomized study of chemotherapy followed by radiotherapy versus surgery plus postoperative radiotherapy, the survival rate of CRTx group appears to be as identical as ORTx group and more effective in the preservation of the larynx.
Busan ; Drug Therapy* ; Humans ; Hypopharyngeal Neoplasms* ; Laryngectomy ; Larynx ; Medical Records ; Neoadjuvant Therapy ; Organ Preservation ; Prognosis ; Radiotherapy* ; Retrospective Studies ; Survival Rate

PURPOSE: Nodular lesions of the thyroid gland, composed predominantly of Hürthle cells, are so rare as to be difficult for pathologists to interpret properly and, consequently, for surgeons to treat appropriately. Our intent in evaluating these lesions was to try to establish pathologic and clinical criteria that could be used to differentiate more accurately between malignant and benign tumors. METHODS: We retrospectively evaluated 5 patients presenting with Hürthle cell tumors over the past 10 years. We focused on the clinicopathological analysis correlated with the tumor size, the type of operation and the prognosis. RESULTS: Five female patients were included in the study, their average age was 48.8 years (19~69 years). One case was carcinoma and the other 4 were adenomas. Average size of the tumor was 3.34 cm in diameter. Total thyroidectomy was performed in two cases including the carcinoma case. None of them died as a result of the disease, nor had a recurrence. No preoperative study was useful in differentiating between malignancy and benignancy. CONCLUSION: Many more cases need to be evaluated to determine the exact biological behavior of the Hürthle cell tumor of the thyroid gland. Clinical and pathological factors are required for surgeons to decide the type of operation appropriate in order to avoid compromising the therapeutic goals. We recommend total thyroidectomy for tumors with the intraoperative frozen section raising the suspicion of malignancy and for those with diameters over 2.5 cm.
Adenoma ; Adenoma, Oxyphilic* ; Female ; Frozen Sections ; Humans ; Prognosis ; Recurrence ; Retrospective Studies ; Surgeons ; Thyroid Gland* ; Thyroidectomy

BACKGROUND/AIMS: The Barrett's esophagus is confirmed by performing a biopsy when the gastroesophageal junction (GEJ) and Z-line do not coincide. In Japan, the GEJ is at the distal end of the palisading vessel while Western countries define it as the proximal tip of the gastric fold. However, there is little data on the prevalence of an endoscopic Barrett's esophagus and the inter-observer variation. METHODS: Four experienced endoscopists reviewed the endoscopic still images of 111 consecutive patients. The level of inter-observer agreement was expressed as a kappa value. RESULTS: The average percentage of patients with an endoscopically confirmed esophagus was 34.2%. The level of inter-observer agreement was substantial (kappa=0.698). CONCLUSIONS: The prevalence of an endoscopic confirmed Barrett's esophagus was high, and the inter-observer variation was substantial when the GEJ was defined as the distal end of the palisading vessel. Considering the low incidence of esophageal adenocarcinoma and the risk of hemorrhage from a biopsy, a more specific marker is needed in this high-risk group.
Adenocarcinoma ; Barrett Esophagus* ; Biopsy ; Esophagogastric Junction ; Esophagus ; Hemorrhage ; Humans ; Incidence ; Japan ; Observer Variation* ; Prevalence*

BACKGROUND: The signal pathways and their precise roles for acute respiratory distress syndrome caused by endotoxin (ETX) has not been established. Since there has been several in vitro experiments suggesting that activation of protein kinase C (PKC) pathway may be responsible for endotoxin-induced inflammatory reaction, we performed in vivo experiments in the rats with the hypothesis that PKC-inhibition can effectively prevent endotoxin-induced acute lung injury. METHODS: We studied the role of PKC in ETX-induced ALl using PKC inhibitor (staurosporine, 5Th) in the rat. Specific pathogen free male Sprague-Dawley weighted from 165 to 270g were used for the study. Animals were divided into the normal control (NC)-, vehicle control (VC)-, ETX-, PMA (phorbolmyristateacetate)-, STP+PMA-, and STP+ETX-group. PMA (50mg/kg) or ETX (7mg/kg) was instilled through polyethylen catheter after aseptic tracheostomy with and without STP (0.2mg/kg) pretreatment. STP was injected via tail vein 30mm before intratracheal injection (IT) of PMA or ETX. Bronchoalveolar lavage (BAL) was done 3- or 6-hrs after IT of PMA or FTX respectively, to measure protein concentration, total and differential cell counts. RESULTS The results were as follows. The protein concentrations in BALF in the PMA- and ETX-group were very higher than that of VC-group (p<0.001). When animals were pretreated with STP, the %reduction of the protein concentration in BALF was 64.8 8.5 and 30.4 2.5% in the STP+PMA- and STP+ETX-group, respectively (p=0.028). There was no difference in the total cell counts between the PMA-and VC-group (p = 0.26). However the ETX-group showed markedly increased total cell counts as compared to the VC- (p=0.003) and PMA group (p=0.0027), respectively. The total cell counts in BALF were not changed after pretreatment with STP compared to the PMA- (p=0.22) and ETX-group (p=0.46). The percentage of PMN, but not alveolar macrophage, was significantly elevated in the PMA-, and ETX-group. Especially in the ETX-group, the percentage of PMN was 17 times higher than that of PMA (p<0.001). The differential cell counts was not different between the PMA and STP+PMA. On the contrary the STP+ETX-group showed decreased percentage of PMN (p = 0.016). There was no significant relationship between the protein concentration and the total or differential cell counts in each group. CONCLUSION: Pretreatment with PKC-inhibitor (staurosporine) partially but significantly inhibited ETX-in-duced ALI.
Acute Lung Injury* ; Animals ; Bronchoalveolar Lavage ; Catheters ; Cell Count ; Humans ; Macrophages, Alveolar ; Male ; Protein Kinase C* ; Protein Kinases* ; Rats ; Rats, Sprague-Dawley ; Respiratory Distress Syndrome, Adult ; Signal Transduction ; Specific Pathogen-Free Organisms ; Staurosporine ; Tracheostomy ; Veins