Monitoring of the central venous pressure is a simple, relatively inexpensive method of assessing a patient's cardiac status, circulating blood volume, and vasomotor tone. The simplest way of checking the intrathoraeic location of the catheter tip is by observing oscillation of 2~4cmH2O in the manometer column, synchronous with respiratory cycle. Inaccurate measurements are often obtained by the misplacement of the central venous catheter tip, in addition to the other well-known complications. Radiographic identification of the catheter tip is essential to eliminate these problems. We experienced a case of arrhythmia which appeared upon misplacement of the central venous catheter tip, and confirmed its misplacement by radiographic study.
Arrhythmias, Cardiac ; Blood Volume ; Catheters ; Central Venous Catheters* ; Central Venous Pressure ; Methods

Splenoportography has been proved as a useful method for the evaluation of circulatory distrubances in portalhypertension. Authors analyzed the various aspects of these disturbances on splenoportography in 22 cases thatwere performed under the clinical suspicion of portal hypertension during recent 6 years, from May, 1976 to July,1982 at the Department of Radiology, National Medical Center. The results were as follows; 1. Liver cirrhosis wasthe most frequent cause of intrahepatic obstruction type in portal hypertenstion (86%). 2. The portal pressure wasmore than 400 mmH2O in 67% of the cases (range; 300-540 mmH2O). 3. In the majority of the cses, the higher theportal pressure was, the more dilated splenic and portal veins were. The diameter of portal vein was more than15mm in 79%, more than 21 mm in 47% of the cases (range; 10-26mm). The diameter of splenic vein was more than 15mmin 48% of the cases (range; 7-23mm). Especially the diameter of splenic vein was larger than that of portal veinin 20% of the cases. 4. There was no definite correlation between the development of collateral circulation andthe diameter of splenic and portal veins. 5. The filling of collateral circulation was definite sign of portalhypertenstion, though not regular. In portal hypertension, the collateral circulation was formed via coronary vein(91%), short gastric vein (64%), inferior mesenteric vein(36%). 6. Splenic-hilum time was delayed in 64% of thecases. Intrahepatic portal vein emptying time was more than 6 seconds in all the cases. 7. Most of the cases (91%)could be diagnosed as portal hypertension with vasculogram and hepatogram.
Collateral Circulation ; Hypertension, Portal ; Liver Cirrhosis ; Methods ; Portal Pressure ; Portal Vein ; Portography ; Splenic Vein ; Veins

Over a period of recent 3 years, the 5 cases of polyostotic fibrous dysplasia were proven histologically atNational Medical Center, and they were evaluated and analysed radiologically and clinically. The results were asfollows; 1. The age of 5 patients ranged from 12 to 21. 2. In general, clinical symptoms of thses patients werepain of affected sites and swelling, fracture, walking disturbance of lower extremities. 3. The order of frequentsite of polyostotic fibrous dysplasia was skull (4 cases), femur( 3 cases), maxilla (2 cases), humerus, tibia,rib, radius, metacarpal bone and phalanx. 4. The characteristic radiological findings of polyostotic fibrousdysplasia were multicystic lesions with ground glass appearance, osteoslcerosis, cortical thinning and pathologicfracture and deformity of long bones. Particularly, in the extremities, multicystic radiolucencies, groud glass appearance, shepherd's crook and coxa vara deformities were noticed, and in teh skull and maxilla, sclerotic changes wee principally demonstrated.
Congenital Abnormalities ; Coxa Vara ; Extremities ; Fibrous Dysplasia, Polyostotic ; Glass ; Humans ; Humerus ; Lower Extremity ; Maxilla ; Radius ; Skull ; Walking

To find out the differences between periodontal ligament cells (PDL cells) and gingival fibroblast cells (GFB cells), alkaline phosphatase, a marker enzyme for osteoblast, was used to measure the activities and 45CaCl2 isotope was used to find out cellular and release of 45Ca, a requisite for bone formation,. PDL cells and GFB cells from 1 to 5 passages were also measured in alkaline phosphatase activity assay. By the use of above methods, followings were concluded that the PDL cells and the GFB cells have characteristics that are different from each other. In that PDL cells showed large amount of calcium uptake and large amount of calcium release in initial stage, they seem to possess characteristics which are similar to osteoblast-like cells. 1. The PDL cells, in contrast to the gingival fibroblast, showed exceedingly high alkaline phosphatase activity which was highest at the second passage, decreasing thereon. But gingival fibroblasts cells showed no distinct differences in alkaline phosphatase activity as the passage were elapsed. 2. For both PDL cells and GF cells, the 45Ca uptake was greatest at 2 hours period. The PDL cells showed higher measuring than GFB cells through out the whole time period. 3. Whereas the GFB cells showed slow increase of 45Ca release as time relapsed, the PDL cells showed rapid increase of 45Ca release.
Alkaline Phosphatase ; Calcium ; Fibroblasts ; Humans* ; Osteoblasts ; Osteogenesis ; Periodontal Ligament*

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

Styela clava, called non-native tunicate or sea squirt, is habitat which include bays and harbors in Korea and several sites in the sea faced world. We fabricate cellulose membrane nerve conduit (CMNC) from this native sea squirt skin, and evaluate the capacity of promoting peripheral nerve regeneration in the rat sciatic nerve defect model. After processing the pure cellulose membrane from the sea squirt skin as we already published before, CMNC was designed as a non-tubular sheet with 14 mm length and 4 mm width. Total eleven male Spraque-Dawley rats (12 weeks, weighing 250 to 300g) were divided into sham group (n=2), silicone tube grafted control group (n=3) and experimental group (n=6). Each CMNC grafted nerve was evaluated after 4, 8 and 12 weeks in the experimental group, and after 12 weeks, sciatic function was evaluated with sciatic function index (SFI) and gait analysis, and histomorphology of nerve conduit and the innervated tissues of sciatic nerve were all examined using image analyzer and electromicroscopic methods in the all groups. The regenerated axon and nerve sheath were found only in the inner surface of the CMNC after 4 weeks and became more thicker after 8 and 12 weeks. In the TEM study, CMNC grafted group showed more abundant organized myelinated nerve fibers with thickened extracellular matrix than silicone conduit grafted group after 12 weeks. The sciatic function index (SFI) and ankle stance angle (ASA) in the functional evaluation were -47.2+/-3.9, 35.5.+/-4.9.in CMNC grafted group (n=2) and -80.4+/-7.4, 29.2.+/-5.3.in silicone conduit grafted group (n=3), respectively. And the myelinated axon was 41.59% in CMNC group and 9.51% in silicone conduit group to the sham group. The development of a bioactive CMNC to replace autogenous nerve grafts offers a potential and available approach to improved peripheral nerve regeneration. As we already published before, small peptide fragment derived from the basement membrane matrix proteins of squirt skin, which is a kind of anchoring protein composed of glycocalyx, induced the effective axonal regeneration with rapid growth of Schwann cells beneath the inner surface of CMNC. So the possibilities of clinical application as a peripheral nerve regeneration will be able to be suggested.
Animals ; Ankle ; Axons ; Basement Membrane ; Bays ; Cellulose* ; Ecosystem ; Extracellular Matrix ; Gait ; Glycocalyx ; Humans ; Korea ; Male ; Membranes* ; Myelin Sheath ; Nerve Fibers, Myelinated ; Peripheral Nerves* ; Rats ; Regeneration* ; Schwann Cells ; Sciatic Nerve ; Silicones ; Skin ; Transplants ; Urochordata

The authors evaluated the stress response to cardiopulmonary bypass by measuring plasma Ig G, A, M and C3, C4concentrations. Anesthesia was induced with fentanyl, and all patients were underwent open heart surgery using bubble type heart-lung machine. Blood samples were obtained pre-induction, sternotomy, 10 min. and 30 min. after cardiopulmonary bypass, and 10 min. after termina tion of cardiopulmonary bypass and after transport to L.C.U. IgG, A, M and complement C3, C4concentrations were measured by Turbidmeter using Behring Turbidquant. The results were as follows: 1) Plasma concentrations of IgG, A, M and C3, C4 at preinduction period were 1345. 00+/-194. 42, 289. 10+/-100.4, 177.43+/-72.65, 59.20+/-16.33, 20.50+/-7.54 mg/dl., respectively. 2) Ten min. after cardiopulmonary bypass, the plasma concentration was significantly decreased when compared with the baseline values (p<0.01). 3) Thirty min. after cardiopulmonary bypass, the plasma concentration of the complenent C3, C4 were significantly decreascd (p<0.01). 4) In the 1ntensive care unit, Ig and complement C3, C4 were increased, but did not reach control values. Considering the above results, we conclude that the decrease of plasma Ig G, A, M and complenent C3, C4concentrations are related to mechanical stress of the cardiopulmonary bypass, and to certain activators such as denaturated protein, heterogenous RBCs, and foreign materials, etc.
Anesthesia* ; Cardiopulmonary Bypass* ; Complement C3* ; Complement C4 ; Complement System Proteins* ; Fentanyl* ; Heart-Lung Machine ; Humans ; Immunoglobulin G* ; Immunoglobulins* ; Plasma ; Sternotomy ; Stress, Mechanical ; Thoracic Surgery

No abstract available.
Humans ; Renal Insufficiency, Chronic* ; Rhabdomyolysis*

Suppression of cellular immunity is the host responses to surgical stress. When the body is exposed to surgical stress, decreased immunocyte function is one of the surgical stress-induced biologic responses. In all patients exposed to the surgical stress, peripheral blood lymphocyte numbers and function were suppressed until at least 2 weeks postoperatively. This immunosuppression was mainly due to a decrease of helper-inducer T cells, cytotoxic T cells, natural killer cells, and an increase of suppressor T cells. The blood levels of interleukin-6(IL-6) cytokine increase in response to surgical stress and cause an increase of so-called acute phase reactants, including C-reactive protein(CRP). In the previously damaged patients group, expected to early stress expose, immunosuppression was more developed than other normal groups. Cellular immunosuppression by surgical stress was mainly due to an increase of lymphocyte subsets that depress cellular immunity coupled with a decrease of the subsets that promote it. Overproduction of CRP in response to surgical stress may play an important role in the development of immunosuppression.
Acute-Phase Proteins ; Humans ; Immunity, Cellular ; Immunosuppression ; Interleukin-6 ; Killer Cells, Natural ; Lymphocyte Count ; Lymphocyte Subsets ; T-Lymphocytes

Chronic recurrent multifocal osteomyelitis (CRMO) is one of the most severe form of chronic non-bacterial osteomyelitis (CNO), which could result in bone and related tissue damage. This autoinflammatory bone disorder (ABD) is very difficult for its clinical diagnosis because of no diagnostic criteria or biomarkers. CRMO in the jaw must be suspected in the differential diagnosis of chronic and recurrent bone pain in the jaw, and a bone biopsy should be considered in chronic and relapsing bone pain with swelling that is unresponsive to treatment. The early diagnosis of CRMO in the jaw will prevent unnecessary and prolonged antibiotic usage or unnecessary surgical intervention. The updated researches for the identification of genetic and molecular alterations in CNO/CRMO should be studied more for its correct pathophysiological causes and proper treatment guidelines. Although our trial consisted of reporting items from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), there are very few articles of randomized controlled trials. This article was summarized based on the author's diverse clinical experiences. This paper reviews the clinical presentation of CNO/CRMO with its own pathogenesis, epidemiology, recent research studies, and general medications. Treatment and monitoring of the jaw are essential for the clear diagnosis and management of CNO/CRMO patients in the field of dentistry and maxillofacial surgery.
Biomarkers ; Biopsy ; Dentistry ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Epidemiology ; Humans ; Jaw ; Osteomyelitis ; Surgery, Oral