PURPOSE: Various vasopressor agents are used to raise systemic vascular resistance (SVR) during liver transplantation. After grafted liver was reperfused, postreperfusion syndrome could be treated with various vasopressors. However, epinephrine can decrease the splanchnic perfusion and oxygen saturation and then hepatic blood flow would be jeopardized. Decreased hepatic blood flow might result in centrilobular necrosis which contributes to disruption of liver functions. We tried to know the effect of epinephrine on tissue perfusion of the liver. METHODS: In this study, measurement of hepatic microcirculation (HMC) and hemodynamic changes was performed in eight dogs to investigate the effect of vasopressors on hepatic microcirculation. Animals were divided into four groups in which low-dose epinephrine (0.05mug/Kg/min) and high-dose epinephrine (0.5mug/Kg/min) were randomly infused into the systemic vein and portal vein (1/6 of systemic dose) for ten minutes. Hepatic microcirculation was measured by Thermal Diffusion Probe. RESULTS: At low-dose systemic infusion of epinephrine, mean arterial bloodpressure (MABP), cardiac output (CO), and hepatic microcirculation (HMC) were significantly increased but systemic vascular resistance (SVR) was decreased. On high-dose epinephrine, MABP, CO (P=0.01), and SVR were significantly increased without changes of HMC. Intraportal infusion of low- and high-dose epinephrine increased hepatic vein pressure and SVR, respectively. CONCLUSION: These results would provide clues that systemic low-dose epinephrine infusion is enough to raise HMC and high-dose infusion of epinephrine to raise SVR could be used without jeopardizing HMC.
Animals ; Cardiac Output ; Dogs ; Epinephrine ; Hemodynamics ; Hepatic Veins ; Liver ; Liver Transplantation ; Microcirculation* ; Necrosis ; Oxygen ; Perfusion ; Portal Vein ; Thermal Diffusion* ; Transplants ; Vascular Resistance ; Vasoconstrictor Agents ; Veins

Menigioma arising from the orbit is uncommonly encountered. Ectopic(extradural) meningiomas are exceedingly rare orbital tumors that do not originate from either the optic nerve or the intracranial meninges. We present a case of probable primary ectopic(extradural) orbital meningioma that was successfully treated with a complete surgical excision.
Meninges ; Meningioma* ; Optic Nerve ; Orbit

Internal abdominal hernia is an unusual cause of intestinal obstruction. Paraduodenal hernia is relatively rare congenital malformations resulting from incomplete rotation of the midgut with entrapment of the small intestine beneath the developing colon. We report a case of paraduodenal hernia treated by laparoscopic approach. The patient was a 45-year-old man presenting with severe abdominal pain for 5 hours. Left paraduodenal hernia with jejunum hernia containing jejunal loops showed in abdominal CT. At operation, herniation of the small intestine into a retroperitoneal space through a defect on the left mesocolon was noted. After the herniated bowel was fully reduced, the hernia orifice was closed intra-corporeally in the manner of interrupted sutures with absorbable suture materials. The patient was discharged home without any serious complications on postoperative day 9. Conclusively, we think laparoscopic surgery in left paraduodenal hernia is feasible.
Abdominal Pain ; Colon ; Hernia ; Hernia, Abdominal ; Humans ; Intestinal Obstruction ; Intestine, Small ; Jejunum ; Laparoscopy ; Mesocolon ; Middle Aged ; Retroperitoneal Space ; Sutures

Situs inversus refers to a mirror image of the viscera, while situs solitus is defined as the normal anatomical situation. Several cases of successful liver transplantation for situs inversus recipients have been reported, and modifications of the standard surgical techniques were used. We report here on a case of cadaveric liver transplantation in an end-stage liver disease patient with situs inversus. The donor liver was rotated clockwise 90 degrees to the left with the right lobe lying in the left upper quadrant and the left lobe pointing down into the left iliac fossa. The donor's suprahepatic vena cava was oversewn and the infrahepatic vena cava anastomosed end to side to the recipient's inferior vena cava. The postoperative course was good until the postoperative 26th day, when rupture of a hepatic artery pseudoaneurysm occurred. An emergency laparotomy was done and the hepatic artery was ligated. Despite the hepatic artery ligation, the liver function recovered quite well. But sudden intracranial hemorrhage developed on the postoperative 28th day and sadly, the patient expired on the postoperative 30th day. Complete preoperative evaluation of the recipient is essential for the operative planning, and careful donor selection should be attempted to obtain a smaller graft to allow maximum flexibility for placing the donor liver. The use of a reduced-sized graft should be considered in the case for which a smaller graft is not available. In conclusion, adult situs inversus is no longer a contraindication for a liver transplant, although technical difficulties do exist for this procedure.
Adult ; Aneurysm, False ; Cadaver ; Deception ; Donor Selection ; Emergencies ; Hepatic Artery ; Humans ; Intracranial Hemorrhages ; Laparotomy ; Ligation ; Liver Diseases ; Liver Transplantation* ; Liver* ; Pliability ; Rupture ; Situs Inversus* ; Tissue Donors ; Transplants ; Vena Cava, Inferior ; Viscera

Intussusception of the appendix is an uncommon condition and the diagnosis is rarely made preoperatively. Intussusception of the appendix may mimic a neoplastic lesion. Colonoscopy is a valuable tool for diagnosis of the appendiceal intussusception. A 17-yr-old female admitted with repeated abdominal pain, nausea, vomiting and febrile sensation. We diagnosed as appendiceal intussusception by colonoscopy, which showed a polypoid tumor (about 1.5 cm) in the cecum. This sessile polypoid mass looks like foreskin or glans. We present colonoscopic finding of appendiceal intussusception and review the literature.
Adolescent ; *Appendix ; Cecal Diseases/*diagnosis ; *Colonoscopy ; Female ; Humans ; Intussusception/*diagnosis

BACKGROUND: We evaluated the optimal concentrations of eye opening and orientation after propofol- fentanyl TCI by CSDT of the pharmacokinetic model using DiprifusorTM in adults retrospectively. Furthermore, we tried to compare those data with the cases of using propofol TCI alone that had been reported. METHODS: After obtaining informed consent and IRB approval, 124 patients of ASA class I or II scheduled for elective surgery were allocated into 3 groups according to age. Three groups were group 1 (n = 40): 18 - 29 years, group 2 (n = 42): 30 - 39 years, group 3 (n = 42): 40 - 54 years. Propofol infusion was started at a propofol target concentration (CT) of 6 microgram/ml by using DiprifusorTM. Anesthesia was mostly maintained with propofol CT 3.5 microgram/ml and fentanyl CT 1.5 ng/ml using a Stelpump and 67% nitrous oxide in oxygen. We estimated the average concentrations of propofol at eye opening and orientation in each group with DiprifusorTM, and we also evaluated the correlation coefficient. RESULTS: Total requirements of propofol in cases of propofol-fentanyl TCI were decreased by 18-26% than in propofol TCI alone. The average concentrations of propofol at eye opening and orientation after surgery were 1.2 - 1.4 microgram/ml. The times to show eye opening and orientation after surgery from stopping of nitrous oxide and infusion were 10.4 - 14.5 min in the propofol-fentanyl group compared with 7.5 - 11 min using propofol TCI alone. CONCLUSIONS: We concluded that the optimal concentrations of propofol at eye opening and orientation after surgery in cases of combination with fentanyl were 1.2 - 1.4 microgram/ml instead of 1.4 - 1.6 microgram/ml with using propofol alone.
Adult ; Anesthesia ; Ethics Committees, Research ; Fentanyl ; Humans ; Informed Consent ; Nitrous Oxide ; Oxygen ; Propofol* ; Retrospective Studies

PURPOSE: Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical emergency of infants that exhibits clearly unique characteristic symptoms, but its etiology and pathogenesis are still obscure. The Fredet-Ramstedt pyloromyotomy has gained worldwide acceptance. The advantages of this operation are immediate solution of the problem and few complication. Cosmetically circumumbilical incision or laparoscopic pyloromytomy can be used. METHODS: Forty cases of IHPS admitted to the Chuncheon Sacred Heart Hospital from Jan 1997. to Dec 2002 were reviewed retrospectively. These cases underwent Fredet-Ramstedt's operation. RESULTS: The most prevalent age group was 21~30 days (10 cases: 25%), mean age was 41.4+/-9.9 days, and the males to females ratio was 4.7: 1. Among the 40 cases, 24 (60%) involved the first baby. The mean gestation age was 39.9+/-1.7 weeks and mean birth weight was 3.3+/-0.5 Kg. The mean duration of symptom was 4.1+/-1.6 days. The common symptoms were non-bile stained, projectile vomiting in all cases, an olive-shaped mass in the right upper quadrant abdomen in 21 cases (52.5%), visible peristalsis on epigastrium in 16 cases (40%), and jaundice in 1 case (2.5%). Hypokalemic alkalosis was observed in 3 cases (7.5%). The mean length and thickness of the stenotic canal, as measured in the operation, were 28.8+/-8.5 mm and 4.9+/-0.6 mm, respectively. Postoperative complications were one case each (2.5%) pneumonia, wound seroma, and recurrence. Conclusion: Fredet-Ramstedt's pyloromyotomy for IHPS is an effective operation after the correction of dehydration and electrolyte imbalance.
Abdomen ; Alkalosis ; Birth Weight ; Dehydration ; Emergencies ; Female ; Gangwon-do ; Heart ; Humans ; Infant ; Jaundice ; Male ; Peristalsis ; Pneumonia ; Postoperative Complications ; Pregnancy ; Pyloric Stenosis, Hypertrophic* ; Recurrence ; Retrospective Studies ; Seroma ; Vomiting ; Wounds and Injuries

PURPOSE: To determine the benefits of autogenous tooth bone (ATB) graft in combination with platelet-rich plasma (PRP) in the rates of success and survival of dental implants placed simultaneously with maxillary sinus floor augmentation (MSFA). MATERIALS AND METHODS: Patients who visited the Department of Oral and Maxillofacial Surgery at Ulsan University Hospital from 2012 to 2014 and underwent simultaneous placement of implants with MSFA using ATB plus PRP were included in the study. Success and survival rates of the implants were evaluated based on the parameters of age and sex of the patient, site, follow-up period, residual bone height before surgery, diameter, and length of implant, sinus mucosa impairment, and postoperative complications. RESULT: A total of 23 patients and 67 implants were included in this study. The average age of the patients was 53.78±10.00 years. The average follow-up period after installation of the prosthesis was 53±5 months. The success and survival rates of the implants after placement of prosthesis were 95.52% and 97.01%, respectively. CONCLUSION: Combination of ATB and PRP showed high overall success rate, and it can be concluded that this combination is a predictable bone graft procedure for MSFA.
Bone Substitutes ; Dental Implantation ; Dental Implants ; Follow-Up Studies ; Humans ; Maxillary Sinus ; Mucous Membrane ; Platelet-Rich Plasma ; Postoperative Complications ; Prostheses and Implants ; Sinus Floor Augmentation ; Surgery, Oral ; Survival Rate ; Tooth ; Transplants ; Ulsan

Purpose: This study examined the effects of training using the slime on the hand function and problem behavior in adults with intellectual disabilities. Methods: Five adults with intellectual disabilities who were judged as Level 1 or Level 2 were selected. The training consisted of one session (50 min)/day, one day/week for 10 weeks (preparatory activities: 5 min, slime activities: 40 min, finishing activities: 5 min) The functions of the hand (Purdue Pegboard Test [PPT], grip strength test [GST]) and problem behavior (Korean Behavior Problems Inventory [K-BPI]) were assessed three times (first assessment; pre, second assessment; post-5 weeks, third assessment; post-10 weeks). Wilcoxon signed-rank tests were used to analyze changes in the subjects’ performance before and after the intervention. Results: In the PPT, the use of the non-dominant hand was increased significantly (p<0.05). No significant differences were observed in the remaining results, but the mean value increased. In addition, although the problem behavior was not statistically significant, an increase in the problem behavior score was noted. Conclusion The training using the slime for adults with intellectual disabilities is effective in hand function improvement and reducing problem behavior.

Purpose: This study examined the effects of training using the slime on the hand function and problem behavior in adults with intellectual disabilities. Methods: Five adults with intellectual disabilities who were judged as Level 1 or Level 2 were selected. The training consisted of one session (50 min)/day, one day/week for 10 weeks (preparatory activities: 5 min, slime activities: 40 min, finishing activities: 5 min) The functions of the hand (Purdue Pegboard Test [PPT], grip strength test [GST]) and problem behavior (Korean Behavior Problems Inventory [K-BPI]) were assessed three times (first assessment; pre, second assessment; post-5 weeks, third assessment; post-10 weeks). Wilcoxon signed-rank tests were used to analyze changes in the subjects’ performance before and after the intervention. Results: In the PPT, the use of the non-dominant hand was increased significantly (p<0.05). No significant differences were observed in the remaining results, but the mean value increased. In addition, although the problem behavior was not statistically significant, an increase in the problem behavior score was noted. Conclusion The training using the slime for adults with intellectual disabilities is effective in hand function improvement and reducing problem behavior.