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

Recently, laparoscopic cholecystectomy becomes a favorite surgical treatment of cholelithiasis instead of traditional open cholecytectomy. The reasons include small wound, small pain and short hospital-stay. But it also has disabvantages by pneumoperitoneum made of carbon dioxide insuffulation. We attempted to investigate the effect on hemodynamics, arterial blood gas parameters and pulmonary function of each surgical technique-laparoscopic(Group I) vs open cholecystectomy(Group II). We randomly selected realative healthy 30 patients for each group and baseline arterial blood gas and pulmonary function test were measured. During the operative proeedure, hemodynamic parameters(blood pressure and heart rate) were measured by 5-minute interval. Postoperatively, arterial blood gas and pulmonary function test were measured. The results are following; 1) In group I, blood pressure was increased to l14.2+/-18.0mmHg significantly(p<0.01) compared to preoperative value 101.4+/-21.5 mmHg. Heart rate was not shown significant change in both technique groups. 2) PaO2 was significantly decreased to postoperative 24hr value 82.2+/-15.8mmHg in group II and 82.3+/-19.4 mmHg in group I compared to preoperative 24hr value 98.7+/-14.8 mmHg and 94.4+/-ll.3mmHg, respectively. There was no significant difference of PaCO2 of between two groups. pH was significantly increased to postoperative 24hr value 7.42+/-0.02 in group II compared to preoperotive 24hr value 7.39+/-0.03 but no significant change in group I compared to preoperative 24hr value 7.39+/-0.03. 3) In group I, FVC and FEV1 were decreased preoperative 24hr value 77.9% and 81.1% to postoperative 24hr value 61.1% and 62.3%, respectively. But in group II, FVC and FEV1 were decreased more significantly, compared preoperative 24hr value 90.8% and 95.6% with postoperative 24hr value 59.4% and 58.6%. FEV1,/FVC value was not changed in two groups. 4) Postoperative analgesics requirement was 53% in group I, 80% in group II at the day of surgery. Also frequency was 1.8 in group I, 2,4 in group II at the day of surgery. 5) Mean Operation time was 43 min in group I, 52 min in group II and mean hospital days were 6 days in group I, 12 days in group II. Conclusively, in case of group I, blood pressure change was more labile than group II. But postoperative pulmonary function derangement, requirement of analgesics and hospital day were reduced in case of group I.
Analgesics ; Blood Pressure ; Carbon Dioxide ; Cholecystectomy* ; Cholecystectomy, Laparoscopic ; Cholelithiasis ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Pneumoperitoneum ; Respiratory Function Tests ; Wounds and Injuries

Inverted papilloma of the urinary tract is a unique and rare tumor. It is generally considered a benign lesion, although previous reports have alluded to the possibility of malignant change. The lesion is believed to arise mainly from trigon and bladder outlet as a result of chronic. proliferative cystitis. The most commonly associated clinical symptoms are hematuria and those of urinary obstruction. We report two cases of vesical inverted papilloma which were proved histologically.
Cystitis ; Hematuria ; Papilloma, Inverted* ; Urinary Bladder* ; Urinary Tract

PURPOSE: The placement of a ureteral stent following a ureteroscopy (URS) with a stone extraction is routine. However, many patients complain of stent pain and urinary symptoms in the postoperative period. Reducing the frequency of stenting would decrease the need for re-instrumentation, reduce costs, and increase patient satisfaction provided that the efficacy and safety are not compromised. In order to evaluate the necessity of stenting, a comparison of patients with and without stenting after URS for ureteral calculi is reported. MATERIALS AND METHODS: 45 patients with ureteral calculi amenable to ureteroscopic management were prospectively randomized into stented (23 patients) and unstented (22 patients) groups. Standard ureteroscopic basketing and lithotripsy were performed with a ureteroscope (8.5Fr) with or without ureteral dilatation. Postoperative symptom questionnaires were obtained from each patient. Radiographic follow-up to assess the stone-free rate and evidence of obstruction was performed in all patients. RESULTS: There was no statistically significant difference in the age, stone size, operation time, and hospital stay, between the unstented and stented groups (p>0.05). In addition, there was no statistically significant difference in the flank pain and urinary symptoms (p>0.05), except for hematuria between the 2 groups. Hematuria was more severe and long standing in the stent group (p=0.001). CONCLUSIONS: Uncomplicated ureteroscopy for calculus retrieval can safely be performed without the placement of a postoperative stent. Considering its complications and side effects, we do not believe that a routine placement of a ureteral stent following an uncomplicated ureteroscopy for a stone is necessary.
Calculi ; Dilatation ; Flank Pain ; Follow-Up Studies ; Hematuria ; Humans ; Length of Stay ; Lithotripsy ; Patient Satisfaction ; Postoperative Period ; Prospective Studies ; Surveys and Questionnaires ; Stents* ; Ureter* ; Ureteral Calculi ; Ureteroscopes ; Ureteroscopy*

PURPOSE: To investigate the effects of pupil dilation and constriction agents on the survival and production of nitric oxide (NO) in cultured human trabecular meshwork cells (HTMC). METHODS: Primarily cultured HTMC were exposed to 0, 0.01, and 0.1 mg/ml of tropicamide, cyclopentolate, atropine, or pilocarpine for 2 hours. Cellular survival and production of NO were assessed using the MTT assay and Griess assay, respectively. RESULTS: Tropicamide, cyclopentolate, atropine, and pilocarpine decreased cellular survival at the concentration of 0.1 mg. At the concentration of 0.01 mg/ml, all agents decreased production of NO to some extent, although the reduction was not statistically significant. CONCLUSIONS: Pupil dilation and constriction agents may be toxic to HTMC if used at high concentrations or if used frequently in the short-term but may not affect trabecular outflow.
Atropine ; Constriction ; Cyclopentolate ; Humans ; Nitric Oxide ; Pilocarpine ; Pupil ; Trabecular Meshwork ; Tropicamide

No abstract available.