Acute arterial occlusion of the extremity may result from obstruction of an artery by embolism or by thrombosis in situ. This results in the sudden cessation of blood flow to an extremity. So immediate managements are required to prevent propagation of the clot and to restore blood flow to the ischemic extremity promptly. We report a case of a acute arterial occlusion which was developed during prolonged fasting. A 59-year-old male was transferred due to severe ischemic pain, coldness and loss of pulse in left lower extremity during fast. The arteriogram shows a complete obstruction of external iliac artery and non-visualization of femoral artery and popliteotibial artery in the left lower extremity. Selective intra-arterial urokinase thrombolytic therapy and percutaneous transluminal angioplasty resulted in recannulation of obstructed artery and relief of symptoms.
Angioplasty ; Arteries ; Embolism ; Extremities ; Fasting* ; Femoral Artery ; Humans ; Iliac Artery ; Lower Extremity* ; Male ; Middle Aged ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator

No abstract available.
Animals ; Rats* ; Wounds and Injuries*

Background: Exogenous lipoid pneumonia is caused by inhalation or aspiration of animal, vegetable or mineral oil. Most cases are ascribed to aspiration of oil in laxatives or nose drops Petroleum, another pure hydrocarbon used as a base in various medications, is occasionally involved. Especially animal oil produces severe tissue inflammatory reaction, but most patients present with only abnormal chest X-ray and no specific clinical symptoms or signs. Method: Seven patients, 3 males and 4 females, with exogenous lipoid pneumonia, who was hospitalized or referred to pulmonary division at Samsung Medical Center from December 1994 to July 1996, were included. They hadn a history of taking shark liver oil(so-called "squalene") for varying period of time. We reviewed clinical, radioloic and pathologic findings. Result: Patients took 7 to 30 capsules of "squalene" a day for at least one month to 5 years. Six cases had chronic disease such as diabetes, hypertension, or cerebrovascular accident. Respiratory symptoms of mild fever, cough and sputum were present in 3 cases and in 3 cases there was no clinical symptoms and signs but abnormal findings by chest X-ray. The major radiologic findings by simple chest X-ray and computed tomography consisted of consolidation, infiltration involving mainly right middle and both lower lobes, and ground-glass opacity. Five of six bronchoscopic examinations demonstrated both lipid droplets floating on the surface of bronchoalveolar lavage fluid and lipid-laden macrophages in bronchoalveolar lavage fluid or lung tissue. Follow-up chest X-ray showed improvement in 4 cases but no marked interval change in 3 cases after removal of exposure to "squalene". Conclusion: Shark liver oil can induce lipoid pneumonia in adults. In case of high clinical suspicion, confirmation of "squalene" use by careful history taking is required and bronchoscopy is helpful in diagnosis.
Adult* ; Animals ; Bronchoalveolar Lavage Fluid ; Bronchoscopy ; Capsules ; Chronic Disease ; Cough ; Diagnosis ; Female ; Fever ; Follow-Up Studies ; Humans ; Hypertension ; Inhalation ; Laxatives ; Liver ; Lung ; Macrophages ; Male ; Mineral Oil ; Nose ; Petroleum ; Pneumonia* ; Sharks ; Sputum ; Stroke ; Thorax ; Vegetables

We recently had a patient(46 year-old) who was to undergo resection of a pheochromocytoma. The patient was treated with phenoxybenzamine for about 2 weeks preoperatively. Thiopental was used for induction followed by N2O-O2-halothane. An endotracheal semiclosed circle absorption technique with controlled ventillatian was employed. The course of anesthesia was rather stormy, reflectedby hypertension, arrhythmia and hypotension, but the patient talerated the anesthesia and surgery well with appropriate cardiovascular control using regitine, levophed, lidocaineand intravenous fluids. Importance of preoparative preparation, sufficient sedation, smooth induction, complete analgesia, good muscuar relaxation, adequate alveolar ventillation and proper cardiovascular control has been discussed. Recently some reviews of the literature on the anesthetic management of pheochromocytoma suggest that the selection of an anesthetic agent is not as important as the adequate management of the characteristics of these agents which affect the anesthetic procedures.
Absorption ; Analgesia ; Anesthesia* ; Arrhythmias, Cardiac ; Humans ; Hypertension ; Hypotension ; Norepinephrine ; Phenoxybenzamine ; Phentolamine ; Pheochromocytoma ; Relaxation ; Thiopental

Millions of injection of sodium thiopental have been clinically used since it was introduced by Lundy in 1934. As with other barbiturates, cutaneous allergic manifestation are rather frequently seen, but reports of anaphlyactic reactions are rare. Probably many cases have not been recognized or have been misdiagnosed. It is believed that some cases of unexplained collapse or even death after thiopental inductions are very possibly due to an unrecognized anaphylactic action. This report presents a case of anaphylactic action due to injection of sodium thiopental and the references were reviewed.
Anaphylaxis* ; Barbiturates ; Sodium ; Thiopental*

In treatment of infected ununited fractures of the tibia, We have solved this disastrous problems by posterior bone graft through posterolateral approach. By this posterior bone graft, We can achieve both bone union and infection contral simultaneously. The results were as follows: 1. Total cases of the infected ununited fractures were 17 cases, among them 16 cases were open fracture initially. 2. They occured more commonly in young adult, 7 cases(41%) were in 4th decade, and all cases were male. 3. Tibial union was achieved in 16 cases and one patient can not walk without brace due to ain on fracture site. 4. Infection was cleared in 16 cases, but one case had intermittent drainage of pus. 5. The most common complication was stiffness of the ankle and tarsal joint. 6. There was no infection in grafted bone.
Ankle ; Braces ; Drainage ; Fractures, Open ; Fractures, Ununited ; Humans ; Male ; Suppuration ; Tarsal Joints ; Tibia ; Transplants ; Young Adult

Since shoulder have a higher proportion of muscle which would have low electrical resistance, there could be more electrical damage to the rotator cuff muscles. We present a patient with acute rotator cuff tear by sudden uncontrolled jerking contractions caused by an electrical shock. A case of 42-year-old man with acute rotator cuff tear due to electrical injury to the shoulder was presented. Magnetic resonance imaging showed a full thickness tear and an undulating appearance of the peripheral end of the torn supraspinatus and infraspinatus muscle, suggesting an acute complete rupture. By arthroscopic surgery, the torn rotator cuff tendons were repaired with a suture bridge technique. At the final follow-up, the patient had a full, pain-free range of motion and had fully recovered shoulder muscle power.
Adult ; Arthroscopy ; Burns, Electric ; Electric Impedance ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Muscle Contraction ; Muscles ; Range of Motion, Articular ; Rotator Cuff ; Rupture ; Shock ; Shoulder ; Sutures ; Tears ; Tendons

BACKGROUND AND OBJECTIVES: Stiffening of the aorta is a potential risk factor for increased cardiovascular morbidity and mortality. Increased aortic stiffness can be associated with an increased left ventricular (LV) mass and diastolic dysfunction. The aim of the study was to evaluate the relationship of the aortic stiffness to the LV hypertrophy (LVH) and diastolic dysfunction. SUBJECTS AND METHODS: A total of 188 consecutive patients, without overt cardiovascular disease or symptoms, were included. The LV mass and diastolic filling patterns were assessed. The aortic strain and distensibility were indirectly obtained from the aortic diameters, using echocardiography and blood pressure measurements. RESULTS: Of the 188 patients (92 males, 54+/-14 years old), hypertension was found in 57 and diabetes in 29, with both found in 32 patients. The aortic strain (3.77+/-2.42 vs. 5.13+/-4.27, p<0.001) and distensibility (0.11+/-0.09 vs. 0.22+/-0.21, p<0.001) were significantly lower, but the LV mass index (112.5+/-39.2 vs. 87.8+/-19.0 gm/m2, p<0.001) higher, in the hypertensive compared to normotensive patients. Also, the aortic strain (3.07+/-2.42 vs. 5.18+/-4.01, p<0.001) and distensibility (0.10+/-0.12 vs. 0.21+/-0.20, p<0.001) were lower in patients with LVH. The E/E' ratio was higher in the hypertensive patients (10.9+/-5.0 vs. 8.1+/-3.1, p<0.001) and in those with LVH (10.8+/-5.6 vs. 8.4+/-3.2, p<0.001). In a multivariate analysis, the parameters closely related with aortic strain were age (standardized coefficient beta=-0.240, p=0.001), LV mass index (beta=-0.158, p=0.025) and IVRT (beta=-0.155, p=0.035). The parameters significantly related with aortic distensibility were age (beta=-0.344, p<0.001) and LV mass index (beta=-0.224, p=0.001). CONCLUSION: Increased aortic stiffness is associated with an increased LV mass and diastolic abnormality.
Aorta ; Blood Pressure ; Cardiovascular Diseases ; Echocardiography ; Humans ; Hypertension ; Hypertrophy ; Hypertrophy, Left Ventricular ; Male ; Mortality ; Multivariate Analysis ; Risk Factors ; Vascular Stiffness*

OBJECTIVE: Various lesions including tumors occupying in the presellar and suprasellar regions have been traditionally removed by the transcranial approach. The new modified transsphenoidal approaches(TSAs) have been proposed to avoid the craniotomy and to get better surgical view. MATERIALS AND PATIENTS: The sellar floor and presellar anterior cranial fossa were removed through the sublabial transseptal transsphenoidal technique in the "transsphenoidal supradiaphragmatic intradural approach". One tuberculum sella meningioma and a suprasellar Rathke's cleft cyst confined to the pituitary stalk were removed via this approach. RESULTS: The dissection of the anterior intercavernous sinus, diaphragma sella, and arachnoid membrane allowed a wide surgical field of pre- and suprasellar areas and facilitated a safe removal of lesions without significant surgical complications in our cases. CONCLUSION: From the authors' limited experience, the advantages of this technique are as follows: 1) it can be easily applicable through a minor modification of the standard TSA, 2) excellent anatomical exposure of the structures located in the supradiaphragmatic suprasellar cistern, and 3) might be suitable to remove small lesions located in the presellar and adjacent to the pituitary stalk region.
Arachnoid ; Cranial Fossa, Anterior ; Craniotomy ; Humans ; Membranes ; Meningioma ; Pituitary Gland

PURPOSE: The purpose of this study was to evaluate the CT findings of thyroglossal duct cysts MATERIALS AND METHODS: Sixteen patients with pathologically proved thyroglossal duct cysts were included in the study. CT scans were assessed'retrospectively for shape, size, location, density of the central portions, septations, rim enhancement, changes in the adjacent fascial planes and investment within the strap muscles in the infrahyoid cysts. RESULT: Thirteen cases of thyroglossal duct cysts were seen as round or oval cystic masses, two cases of them were seen as irregular-shaped Iobulated cystic masses, and one case was seen as ovoid soft tissue mass. The cysts were from 1.4 to 5.7cm in diameter(mean, 2.6cm). The cyst was infrahyoid in 15 cases and suprahyoid in one case. The cyst was located in midline in eight cases, off midline in four cases, and both midline and off midline in four cases. The density of the central portions ranged from 15 to 82HU(mean, 32HU). Septations were noted in four cases. Rim enhancement was seen in 14 cases(93%), and heterogenously enhancing soft tissue mass was seen in one case. In four cases, abnormal fascial planes were observed. All but one of the infrahyoid cysts(14/15) were embedded within the strap muscles, and one case of them was located anteriorly to strap muscles. CONCLUSION: CT permits one to make the diagnosis a thyroglossal duct cyst with a high degree of accuracy, as it can differentiate thyroglossal duct cysts from the other anterior neck masses by their typical location, characteristic morphology, and investment within the strap muscles.
Diagnosis ; Humans ; Investments ; Muscles ; Neck ; Thyroglossal Cyst* ; Tomography, X-Ray Computed