We performed tendon transfer with a microvascular free flap for recovery of handicapped function and reconstruction for the skin and soft tissue loss. We review the clinical data of 11 children who underwent these operation due to injured foot by pedestrian car accident from January, 1986 to June, l994. The mean age of patients was 5.6 years old (3-8). Five cases underwent tendon transfer and microvascular free flap simultaneously. Another 6 cases underwent operations separately. The time interval between tendon trasnfer and microvascular free flap was average 5.8 months (2-15 months). The duration between initial trauma and tendon transfer was average 9.6 months (2-21 months). The anterior tibial tendon was used in 6 cases. Among these, the technique of splitting the anterior tibial tendon was used in 5 cases. The posterior tibial tendon was used in 3 cases and the extensor digitorum longus tendon of the foot in 2 cases. Insertion sites of tendon transfer were the cuboid bone in 3 cases, the 3rd cuneiform bone in 3 cases, the 2nd cuneiform bone in I case, the base of 4th metatarsal bone in I case, and the remnant of the extensor hallucis longus in 3 cases. The duration of follow-up was average 29.9 months (12-102 months). The clinical results were analyzed by Srinivasan criteria. Nine cases were excellent and 2 cases were good. The postoperative complications were loosening of the tranferred tendon in 2 cases, plantar flexion contracture in l case, mild flat foot deformity in I case and hypertrophic scar in 2 cases. So we recommend the tendon transfer with a microvascular free flap in the case of injured foot of children combined with nerve injury and extensive loss of skin, soft tissue and tendon.
Child* ; Cicatrix, Hypertrophic ; Congenital Abnormalities ; Contracture ; Disabled Persons ; Flatfoot ; Follow-Up Studies ; Foot* ; Free Tissue Flaps* ; Humans ; Metatarsal Bones ; Postoperative Complications ; Skin ; Tarsal Bones ; Tendon Transfer* ; Tendons*

Laparoscopic cholecystectomy is a new surgical procedure which worldwidely applicated gallstone disease and is presenting now anesthetic challenges. The advantages of laparoscopic cholecystectomy are shorter hospital stay, more rapid retum to normal activies and less postoperative ileus, compared with open laparotomy. During the laparoscopic surgery to enable visualization of abdominal structures, pneumoperitoneum is made with CO2 insufflation but insufflation of CO2 into abdominal cavity has been reported several consequences. Hypercarbia, high peak airway pressure, cardiac arrhythmia which were all may result from CO2 insufflation. Also, increased intraabdominal pressure from the induced pneumoperitoneum can cause decreased venous return and may result in hypotension. To ascertain the cardiopulmonary effcts of the increased intraabdominal pressure by CO2 insufflation, a clinical study was performed in 80 patients who divided into four groups likes as control group (open cholecystectomy, number:No=20), group I (15 mmHg of pressure of pneumoperitoneum, No=20), group II (20 mmHg, No=20), group III (25 mmHg, No=20). We investigated the effect of CO2 insufflation to mean arterial pressure, heart rate, end-tidal CO2 partial pressure, mean airway pressure, and arterial blood gas components. The measurements were obtained from the time of skin incision(basic value) to 20 min every 5 min interval in all groups. The results are following, I. Mean arterial pressure significantly began to increase (p<0.05) at post-incision 5 min in control, group IIl & at 10 min in group I, II compared with pre-incision value(basic value), but there were no difference between control and other study groups. II. Heart rate(HR) significantly began to differ (p<0.05) at post-incision 5 min in group II, III. compared with control group. Also HR significantly began to increase (p<0.05) at post-incision 5 min in control, group III & to decrease at post-incision 15 min in group compared with basic value. III. There were significant difference in pH between control and study groups, pH change were in normal ranges clinically. PaCO2 was significantly began to decrease (p<0.05) at post-incision 5 min in study groups compared with basic value, but still in normal acceptable ranges. IV. PaCO2 significantly began to increase (p<0.05) at post-incision 10 min in group II & at 15 min in group IIl compared with control group. Also PaCO2 significantly began to increase (p<0.05) at 5 min in group I, II & at 10 min in group III compared with basic value. V. PETCO2 significantly began to increase (p<0.05) at 10 min in group II & at 15 min in group III compared with control group. Also PETCO2 significantly began to increase (p<0.05) at 10 min in group I,II,III compared with basic value. VI. PAW significantly began to increase (p<0.05) at 10 min in group I,II,III compared with basic value. Conclusively, insufflation of CO2 into abdominal cavity during laparoscopic operation was minimal change in cardiopulmonary system and arterial blood gas value at below 20 mmHg intraabdominal pressure.
Abdominal Cavity ; Arrhythmias, Cardiac ; Arterial Pressure ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Gallstones ; Heart ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Ileus ; Insufflation ; Laparoscopy ; Laparotomy ; Length of Stay ; Partial Pressure ; Pneumoperitoneum ; Reference Values ; Skin

BACKGROUND: The self-inflating bag-valve resuscitator is an useful breathing support equipment in the cardiopulmonary resuscitation, the transportation of patients who required ventilation assist, or respiratory therapy. The inspiratory oxygen concentration (FiO2) or tidal volume (VT) delivered to the patient depends on various conditions during bag-valve ventilation. METHODS: During bag-valve ventilation without a reservoir at oxygen flow rates of 10 l/min, we evaluated fifty six volunteers to determine the FiO2 and VT at ventilatory frequencies of 10, 12 and 15 cycles per minute and to observe the effect of hand size and grasp power on FiO2 and VT in two-hand compression methods. RESULT: The FiO2 at frequency of 10 cycles/min were 50.1% and it was higher than other ventilatory frequencies. However, the VT was not statistically different among the changes of ventilatory frequency. In the change of VT according to characteristics of the hand, the operator's hand size exerted influence on VT(larger vs. smaller ; 942ml vs. 885ml, p<0.05), but the grasp power of the hand did not significantly affect. Separate analyses with size or grasp power of the hand failed to reveal significant differences of the FiO2. CONCLUSION: The results suggest that a slowing of ventilatory frequency within the allowable ranges for adequate gas exchange increase the FiO2 during bag-valve ventilation without reservoir, and that hand size may exert influence on the VT without FiO2 changes but grasp power may not be a contributing factor to the VT or FiO2 changes.
Cardiopulmonary Resuscitation ; Hand Strength ; Hand* ; Humans ; Oxygen* ; Respiration ; Respiratory Therapy ; Tidal Volume* ; Transportation of Patients ; Ventilation* ; Volunteers

Priapism is a relatively rare condition of persistent painful erection unaccompanied by sexual desire. We report two cases of priapism, one etiology is related to leukemia and the other is idiopathic. The former was treated with continuous Hemo-Vac drainage, the latter with corporal cavernosum spongiosum shunt, and the results were good.
Drainage ; Leukemia ; Priapism*

BACKGROUND: The management of postoperative pain with traditional narcotic analgesic regimen is associated with an unacceptably high failure rate and at best has represented a cautious compromise between adequate analgesia and the risk of complications, particularly that of respiratory depression. The purpose of this investigation was to compare the efficacy and safety of nalbuphine given by patient-controlled analgesia (PCA) with differential dosages after total knee replacement. METHODS: A double-blind clinical trial of 75 patients who received intravenous nalbuphine with patient- controlled analgesia during the postoperative first 48 hours after total knee replacement, was carried. Patients were assigned to three groups by the concentration of nalbuphine: Group 1 (n = 25), 2 mg/ml; Group 2, 4 mg/ml; Group 3, 6 mg/ml. The settings of PCA in three groups were same. RESULTS: Visual analog scale (VAS) scores were used to assess pain. Group 2 and 3 patients reported significant lower VAS over the postoperatively 6 hours and 12 hours at either rest or movement compared to group 1. PCA demands, delivered doses and PCA nalbuphine dosage per hours except supplemental analgesic doses in the first 48 hours were lower in group 2 and 3 compared to group 1. There were significant differences among groups at postoperatively 6 and 12 hours in nausea, vomiting and sedation of the side effects. CONCLUSIONS: IV PCA with nalbuphine is thought to be potent and safe for postoperative pain relief without the major morbidity like respiratory depression, in addition, the careful observation and treatment on the side effect like nausea, vomiting and sedation, is surely needed.
Analgesia ; Analgesia, Patient-Controlled* ; Arthroplasty, Replacement, Knee ; Humans ; Nalbuphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Respiratory Insufficiency ; Visual Analog Scale ; Vomiting

Laryngeal mask airway(LMA) is a new type of airway, which may be used as an alternative to either the endotracheal tube or the face-mask with either spontaneous or positive pressure ventilation without penetration of the larynx or esophagus. LMA have many advantages of easy intubation without laryngoscope and muscle relaxants, decreasing damages of larynx and pharynx., and also useful in difficult intubation or emergency airway care. Recently its interesting has been increased. Clinical studies of LMA was done in 242 patients, about hemodynamic changes, volume and pressure changes of cuff, problems and complications during insertion and maintaining of LMA. The results were as follows: 1) The average time taken to insert the laryngeal mask airway was 9.9sec(range:5~60sec), and 43 cases were correct placement at the second attempt. And the total insertion time was 103 min(range:15~355min). 2) Total ari volume of cuff was 20.5ml(range:15~35ml) in LMA No 3, 28.1 ml(range:25~60ml) in LMA No 4. The least volume of cuff without air leakage was 15ml in LMa No 3 and 25ml in LMA No 4. During positive pressure ventilation the peak airway pressure was 20 cmH2O(15mmHg). 3) In hemodynamic changes, blood pressure was increased about 27.5 mmHg in systolic, 21.2 mmHg in diastolic, and 22.4 mmHg in mean arterial pressure after LMA insertion. 4) Cuff pressure was increased from 70.5mmHg at insertion to 98.9mmHg after 1hours with use of N2O for anesthesia and more increased than without N2O. 5) LMA was used 229 patients in supine position and 5 patients in lateral position. In 8 cases was failed to insertion of LMA. 6) Compilcations were 3 cases of gastric distention, 1 case of difficult nasogastirc tube insertion, and 1 case of severe sore throat with mucosal bleeding on pharyax. Sor throat was complained 26.9% without regard to severity.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Emergencies ; Esophagus ; Hemodynamics ; Hemorrhage ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks* ; Laryngoscopes ; Larynx ; Pharyngitis ; Pharynx ; Positive-Pressure Respiration ; Supine Position

No abstract available.

We experience a case of 34-year-old Turner's syndrome(45, XO) associated with atrial septal defect(secondum type) and mitral valve prolapse who was admitten due to moderate exertional dyspnea. It is well know hat chromosomal abnormality is one of the etiology of congenital heart disease. In case of Turner's syndrome, coarctation of aorta or bocuspid aortic valve is frequently combined, but atrial septal defect simultaneously with mitral valve prolapse is not reported till now in Krea. We report this case with a brief review of the literature.
Adult ; Aortic Coarctation ; Aortic Valve ; Chromosome Aberrations ; Dyspnea ; Heart Defects, Congenital ; Heart Septal Defects, Atrial* ; Humans ; Mitral Valve Prolapse* ; Mitral Valve* ; Turner Syndrome*

BACKGROUND: This clinical trial was performed to evaluate the hemodynamic and side effects of enoximone, a newly developed phosphodiesterase inhibitor, in moderately severe congestive heart failure in Korean population and to base the development of long acting oral preparations in the future. METHODS: Principal admission criteria for this trial were a left ventricular ejection fraction of less than 45% by radionuclide ventriculography, NYHA functional class II or III and a documented congestive cardiomyopathy. Exclusion criteria were restrictive cardiomyopathy, valvular heart disease, multisystemic lillness and uncontrolled ventricular tachyarrhythmia. The hemodynamic measurements were made by using the thermodilution Swan-Ganz catheter and radial arterial canulation. Enoximone was administered(continuous infusion) for 24 hours after initial bolus. The hemodynamic parameters to be observed were blood pressure, heart rate, cardiac output, pulmonary capillary wedge pressure, systemic and pulmonary vascular resistance. The clinical reponse, hematology, blood chemistry, and Holter monitoring were checked before and after enoximone trial. RESULTS: The following results are obtained. 1) The included patients were 15 females, 24 males, total 39 patients and mean age of 55.3 years old(28-70 years old). 2) The causes of congestive cardiomyopathy were idiopathic 35(89.9%), hypertensive 3(7.7%), and alcoholic 1(2.6%). 3) The mean ejection fraction measured by radionuclide left ventriculography were 28. 6%. 4) THe cardiac output was significantly increased(50%), and pulmonary capillary wedge pressure(38%), systemic vascular resistance(34%), pulmonary vascular resistance(27%) were significantly decreased during enoximone infusion. 5) NYHA Functional Class was improved by 1 step with enoximone. 6) There were no significant changes in hematology, blood chemistry, and Holter monitoring with enoximone. CONCLUSION: From the above results, the short term intravenous enoximone was very effective in moderately severe congestive heart failure in congestive cardiomyopathy without major adverse effects in Korean.
Alcoholics ; Blood Pressure ; Capillaries ; Cardiac Output ; Cardiomyopathy, Dilated ; Cardiomyopathy, Restrictive ; Catheters ; Chemistry ; Electrocardiography, Ambulatory ; Enoximone* ; Estrogens, Conjugated (USP)* ; Female ; Heart Failure* ; Heart Rate ; Heart Valve Diseases ; Hematology ; Hemodynamics* ; Humans ; Male ; Pulmonary Wedge Pressure ; Radionuclide Ventriculography ; Stroke Volume ; Tachycardia ; Thermodilution ; Vascular Resistance

Cases of acute myocardial infarction (AMI) that occur during pregnancy or postpartum are rarely reported. Ergot derivatives are known to induce the spasmodic contraction of coronary arteries. Administration of ergot derivatives can cause AMI, even in normal healthy people. In several reported cases, ergot derivatives triggered severe AMI during the postpartum period. Here, we report the case of a forty-year-old woman who was successfully impregnated by artificial fertilization and died after treatment with ergot derivatives. The autopsy revealed AMI with severe coronary atherosclerosis. This is the first case that reports aggravation of pre-existent severe coronary atherosclerosis after postpartum infusion of ergot derivtives.
Pregnancy ; *Postpartum Period ; Myocardial Infarction/*chemically induced/diagnosis/pathology ; Maternal Age ; Humans ; Female ; Ergot Alkaloids/*adverse effects ; Coronary Arteriosclerosis/chemically induced/diagnosis/pathology ; Adult