No abstract available.
Burns* ; Humans

No abstract available.
Burns* ; Humans

Pneumomediastinum is a relatively uncommon, infrequently reported entity, In the evaluation of these entity, it is important to exclude pathological causes, including Boerhaave's syndrome which carries a high mortality. Spontaneous pneumomediastinum is related to excessive intraalveolar pressure leading to rupture of perivascular alveoli in the setting of a Valsalva maneuver without communication to gut material. So, it has a benign self-limited course and rarely requires medical intervention. On the contrary, secondary pneumomediastinum caused by instrumental, traumatic, and spontaneous perforation of esophagus. Although the prognosis have been improved since the advent of broad-spectrum antibiotics and nutritional support, pneumomediastinum due to esophageal perforation still has a high morbidity and mortality. The most important prognostic factor is the time interval between perforation and initiation of therapy, and an awareness and a high clinical suspicion is critical in the early diagnosis and treatment. Recently, we have experienced 2 cases of pneumomediastinum, one case was spontaneous pneumomediastinum and the other may be caused by instrumental esophageal perforation. We report the clinical course of the patients with a current literature review.
Anti-Bacterial Agents ; Early Diagnosis ; Esophageal Perforation ; Esophagus ; Fibrinogen ; Humans ; Mediastinal Emphysema* ; Mortality ; Nutritional Support ; Prognosis ; Rupture ; Valsalva Maneuver

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most useful diagnostic tool in biliary and pancreatic disease. However, ERCP cannot be performed successfully in all patients. Cannulation failure is the most common cause of failure of ERCP. Mechanical pathologies, such as peri-Vater diverticulum, cancer of the papilla of Vater, and impacted stone were the common causes of cannulation failure. We experienced two cases of carcinoma of the papilla of Vater in whom cholangiography and insertion of the nasobiliary tube were performed througth an artificial choledoehoduodenal fistula made by a needle type diathermy knife, beacuse cannulation to the duct was failed due to the tumor.
Catheterization ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Diathermy ; Diverticulum ; Fistula* ; Humans ; Needles ; Pancreatic Diseases ; Pathology

To delineate the coronary anatomy and the left ventricular function during early myocardial infarction, coronary arteriography and left ventriculography were performed prospectively in 28(34%) of 83 patients who were admitted to the coronary care unit at Severance Hospital from November 1983 to August 1984 within 30 days(median : 14 days;range : 4 hours to 30 days) after the onset of symptoms. The frequency of total occlusion of the infarct related artery was evaluated in the time course of infarction. To prove spontaneous recanalization, 3 patients who had total coronary occlusion underwent serial study within 11-20 days after the first study. We categorized the patients into two comparable groups according to the infarction site, coronary angiographic findings, and age. Comparison of clinical and angiographic findings between each group was made. The following results were obained. 1) There were 23 patients with transmural myocardial infarction(82.1%) and 5 with nontransmural infarction(17.9%). Among 23 patients with transmural infarction, 14 had anterior infarction(60.9%) and 9(39.1%) inferior infarction. 2) The mean age was 51.3 years(range : 31-79 years). The ratio of male to female was 3.7:1. 3) Fifteen patients(53.6%) had one-vessel disease, 10(35.7%) two-vessel disease and 2(7.1%) three-vessel disease, One patient(3.6%) had insignificant disease(less than 50% reduction in luminal diameter). Nontransmural infarction had a tendency to be associated with higher prevalence of multivessel disease than transmural infarction(80% vs 34.8%). 4) In 23 patients with transmural infarction, 12(52.2%) had complete occlusion and 11(47.8%) incomplete occlusion of the infarct related artery. Three patients(13.0%) had subtotal occlusion(90-99%) and 4(17.4%) had lesions of 70-89% luminal diameter narrowing. Three patients(13.0%) had 50-69% lesions and the remaining 1(4.4%) had insignificant obstructive lesions. 5) Of the 23 patients with transmural infarction, 12 were studied within 14 days and 11 in 15-30 days after the onset of symptoms. The frequency of total coronary occlusion was significantly higher in the patients studied within 14 days of symptom onset vs those studied in the 15-30 days period(83.3% vs 18.2%;p<0.001). Serial studies of 3 patients with total coronary occlusion at the initial study demonstrated occurrance of spontaneous recanalization in 2 patients. 6) The left ventricular-ejection fraction was higher in the patients with nontransmural infarction, inferior infarction, and incomplete coronary occlusion(65+/-14%, 58+/-16% and 57+/-17%) than that of the patients with transmural infarction, anterior infarction, and complete coronary occlusion(51+/-15%, 47+/-14% and 46+/-13, p<0.05). But there was no significant difference in left ventricular ejection fraction between the young(<45 year) and the old(> or =45 year) age groups. And also 0-1 vessel disease and 2-3 vessel disease groups did not show significant difference in ejection fraction. The degree of congestive heart failure was more severe in the patients with anterior infarction than in those with inferior infaction. multi-vessel disease group was significantly older than 0-1 vessel disease group(55+/-8 yrs vs 46+/-12 yrs, p<0.05), and the young age group had a tendency to be associated with higher prevalence of single vessel disease. 7) As for the complications of angiocardiography in this study, there was ventricular finbrillation in 2 patients(7.1%) without mortality. It is concluded that coronary arteriography can be safely performed within one month after acute myocardial infarction;high prevalence of one-vessel disease in acute myocardial infarction in the Korean adult patients admitted to a general hospital;lower incidence of total coronary occlusion in the late time course of infarction due to spontaneous recanalization;better left ventricular function in the patient groups with nontransmural infarction, inferior infarction and incomplete coronary occlusion.
Adult* ; Angiocardiography ; Angiography ; Arteries ; Coronary Care Units ; Coronary Occlusion ; Female ; Heart Failure ; Humans ; Incidence ; Infarction ; Male ; Mortality ; Myocardial Infarction* ; Phenobarbital ; Prevalence ; Prospective Studies ; Stroke Volume ; Ventricular Function, Left

Perutaneous Transluminal Angioplasty(PTA) is an effective initial treatment modality in renovascularhypertension. For determination of PTA effect, the pulse pressure recording of renal artery is not simple ascompared with in femoral artery stenosis. We tried to evaluate the PTA effect of renal artery stenosis withtracing the pressure of distal renal artery. We used the cardiac catheterization apparatus(VR-12 Honeywell) as apressure monitor in two cases of focal renal arterial stenosis. The renal artery pressure was doubled after firstattempt of ballooning, and the pressure elevated up to 94% and 79% of aorta pressure in two cases, respectively,after third attempt. We believe that renal artery pressure monitoring is a good method of determination of PTAeffect in renovascular hypertension.
Angioplasty ; Aorta ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Constriction, Pathologic ; Femoral Artery ; Hypertension, Renovascular ; Methods ; Renal Artery Obstruction ; Renal Artery

After portal vein occlusion, portal to portal collaterals (hepatopetal) develop from preexisting periportal vessels or recanalization of the thrombosed portal vein, undergo compensatory enlargement, bypass the obstructed extrahepatic occlusion and reconstitute the intrahepatic portal branches. Angiographically, collateral veins are seen as multiple tortous winding veins in the porta hepatis and are described as a cavemous transformation of the portal vein. When the common bile duct or gall bladder is compressed by collateral veins, a cholangiogram demonstrates multiple smooth intramural defects and jaundice can develop due to the partial obstruction of the bile duct. Demonstration of the cavernous transformation of the portal vein can be done by ultrasonography, abdominal computed tomography and nuclear magnetic resonance, but Doppler ultrasonography and direct or indirect portography are needed to evaluate its hemodynamic change. We present a 35-year-old female patient complaining repeated jaundice, in whom common bile duct and gall bladder varices accompanied by cavernous transformation of the portal vein and intrahepatic stones were diagnosed by ultrasonography, abdominal computed tomography, ERCP, and Doppler ultrasonograpy and confirmed by surgery. ERCP demonstrated the irregular contour of the common bile duct and gall bladder due to multiple smooth intramural defects. Doppler utrasongraphy revealed the unique flow signal of portal vasculature from the tortous vessls in the porta hepatis and from the vascular structures on the wall of the gall bladder.
Adult ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct* ; Female ; Hemodynamics ; Humans ; Jaundice ; Magnetic Resonance Spectroscopy ; Portal Vein ; Portography ; Ultrasonography ; Ultrasonography, Doppler* ; Urinary Bladder* ; Varicose Veins* ; Veins ; Wind

PURPOSE: Internal fixation of distal humerus fracture is problematic. A modified lateral approach was assessed to determine its role in the surgical management of these injuries. MATERIALS AND METHODS: From 1994 to 1998, we had operated 15 patients with distal humerus fracture. Eight patients who had intraarticular fracture were classified into group A, and seven patients who had transitional zone fracture were classified into group B. Both groups were operated by modified lateral approach. In group A, triceps muscle was elevated from medial and lateral intermuscular septum. Functional outcome was assessed with Broberg and Morrey's functional rating scale and anatomical measurement was also performed. RESULTS: All fractures united without complication. The results of functional rating scale were as follows; 3 exellent, 9 good and 3 fair. Anatomical measurement of the average proximal extent of the plate from the lateral epicondyle was 16 +/- 2.7 cm (range 12.3 to 19.8 cm) and in 3 patients, more than 70% of the entire length of the humerus. CONCLUSION: On the bases of these results, intraarticular fracture and transitional zone fracture of the distal humerus can be operated successfully with the modified lateral approach.
Humans ; Humerus* ; Intra-Articular Fractures

BACKGROUND: The renin-angiotensin-aldosterone system is closely associated with volume status and vascular tone in septic shock. The present study aimed to assess whether plasma renin activity (PRA) and plasma aldosterone concentration (PAC) measurements compared with conventional severity indicators are associated with mortality in patients with septic shock. METHODS: We evaluated 105 patients who were admitted for septic shock. Plasma levels of the biomarkers PRA and PAC, the PAC/PRA ratio, C-reactive protein (CRP) level, and cortisol level on days 1, 3, and 7 were serially measured. During the intensive care unit stay, relevant clinical information and laboratory results were recorded. RESULTS: Patients were divided into two groups according to 28-day mortality: survivors (n = 59) and non-survivors (n = 46). The survivor group showed lower PRA, PAC, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and Sequential Organ Failure Assessment (SOFA) score than did the non-survivor group (all P < 0.05). The SOFA score was positively correlated with PRA (r = 0.373, P < 0.001) and PAC (r = 0.316, P = 0.001). According to receiver operating characteristic analysis, the areas under the curve of PRA and PAC to predict 28-day mortality were 0.69 (95% confidence interval [CI], 0.58 to 0.79; P = 0.001) and 0.67 (95% CI, 0.56 to 0.77; P = 0.003), respectively, similar to the APACHE II scores and SOFA scores. In particular, the group with PRA value ≥3.5 ng ml⁻¹ h⁻¹ on day 1 showed significantly greater mortality than did the group with PRA value <3.5 ng ml⁻¹ h⁻¹ (log-rank test, P < 0.001). According to multivariate analysis, SOFA score (hazard ratio, 1.11; 95% CI, 1.01 to 1.22), PRA value ≥3.5 ng ml⁻¹ h⁻¹ (hazard ratio, 3.25; 95% CI, 1.60 to 6.60), previous history of cancer (hazard ratio, 3.44; 95% CI, 1.72 to 6.90), and coronary arterial occlusive disease (hazard ratio, 2.99; 95% CI, 1.26 to 7.08) were predictors of 28-day mortality. CONCLUSIONS: Elevated PRA is a useful biomarker to stratify the risk of critically ill patients with septic shock and is a prognostic predictor of 28-day mortality.
Aldosterone* ; APACHE ; Arterial Occlusive Diseases ; Biomarkers ; C-Reactive Protein ; Critical Illness* ; Humans ; Hydrocortisone ; Intensive Care Units ; Mortality ; Multivariate Analysis ; Plasma* ; Renin* ; Renin-Angiotensin System ; ROC Curve ; Shock, Septic* ; Survivors

No abstract available.
Renal Artery* ; Ureter* ; Veins*