BACKGROUND: We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). METHODS: A self-inflating bag resuscitator and a mechanical ventilator were used to test two experimental models: Model 1 (CPR manikin without chest compression) and Model 2 (CPR manikin with chest compression). Model 2 was divided into three subgroups according to ventilator pressure limits (P(limit)). The self-inflating bag resuscitator was set with a ventilation rate of 10 breaths/min with the volume-marked bag-valve procedure. The mode of the mechanical ventilator was set as follows: volume-controlled mandatory ventilation of tidal volume (Vt) 600 mL, an inspiration time of 1.2 seconds, a constant flow pattern, a ventilation rate of 10 breaths/minute, a positive end expiratory pressure of 3 cmH2O and a maximum trigger limit. Peak airway pressure (P(peak)) and Vt were measured by a flow analyzer. Ventilation adequacy was determined at a Vt range of 400-600 mL with a P(peak) of < or = 50 cmH2O. RESULTS: In Model 1, Vt and P(peak) were in the appropriate range in the ventilation equipments. In Model 2, for the self-inflating bag resuscitator, the adequate Vt and P(peak) levels were 17%, and the P(peak) adequacy was 20% and the Vt was 65%. For the mechanical ventilator, the adequate Vt and P(peak) levels were 85%; the P(peak) adequacy was 85%; and the Vt adequacy was 100% at 60 cmH2O of P(limit). CONCLUSIONS: In a manikin model, a mechanical ventilator was superior to self-inflating bag resuscitator for maintaining adequate ventilation during chest compression.
Cardiopulmonary Resuscitation* ; Manikins* ; Models, Theoretical ; Positive-Pressure Respiration ; Thorax ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical*

Hepatolithiasis is said to exist when stones are present in the right or the left hepatic ducts or their tributaries. Although it is a pathophysiologically benign disease, it causes frequently serious problems-recurrent cholangitis, liver abscess, obstructive jaundice, liver cirrhosis, and sepsis - and has challenged surgeons. Until recently, its fundamental pathogenetic mechanisms have not been elucidated, but bile duct stenosis, bile stasis, and secondary infection are considered as important pathogenetic factors. Therefore, the ultimate goal of the treatment is directed to the correction of these factors. We were retrospectively reviewed 119 cases of patients with hepatolithiasis treated by various surgical methods from Jul. 1989 to Dec. 1996 at the Department of Surgery of Maryknoll Hospital, Pusan. There were 72 women and 47 men, and the mean age was 45.5 years. Thirty-nine patients (32.8%) had previous histories of operations related to biliary stone diseases - cholecystectomy (n=13), T-tube choledocholithotomy (n=21), choledochoduodenostomy (n=9), Roux-en-Y choledochojejunostomy (n=6), and transduodenal sphincteroplasty (n=1). Operative procedures were 24 (20.2%) lithotomy, 60 (50.4%) drainages, and 35 (29.4%) hepatectomies and determined by the location of the stones, the general condition of the patient, and the anatomical change (stenosis or cystic dilatation) in intrahepatic duct. Postoperative complications occurred in 33 (27.7%) patients : wound infection (n=23), atelectasis (n=5), intra-abdominal bile collection (n=3), choledochocutaneous fistula (n=2), hemobilia (n=1), and adhesive ileus (n=1). Residual stones were detected in 39 (32.7%) patients by T-tube cholangiography, ultrasonography, computed tomography. The instances of residual stones was the lowest (17.1%) for hepatectomy compared to 45.8% for a lithotomy and 39.3% for a drainage. The follow-up study showed symptom improvement in 91.5% of the patients with a hepatectomy compared to 58.3% for a lithotomy and 71.7% for a drainage which was statistically significant(P<0.05). Since incomplete stone removal in hepatolithiasis and presence of stenosis in intrahepatic duct frequently require a repeat operation or other invasive management, the authors conclude that a hepatectomy, as an initial treatment for hepatolithiasis, is a safe, satisfactory treatment where possible.
Adhesives ; Bile ; Bile Ducts ; Busan ; Cholangiography ; Cholangitis ; Cholecystectomy ; Choledochostomy ; Coinfection ; Constriction, Pathologic ; Drainage ; Female ; Fistula ; Follow-Up Studies ; Hemobilia ; Hepatectomy ; Hepatic Duct, Common ; Humans ; Ileus ; Jaundice, Obstructive ; Liver Abscess ; Liver Cirrhosis ; Male ; Postoperative Complications ; Pulmonary Atelectasis ; Retrospective Studies ; Sepsis ; Sphincterotomy, Transhepatic ; Surgical Procedures, Operative ; Ultrasonography ; Wound Infection

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

No abstract available.
Cleft Lip* ; Diagnosis* ; Ultrasonography*

We report a case of Becker's nevus associated with smooth muscle hamartoma, in a 21-year-old male patient, which shows clinically match-head sized, flat topped, round to oval, grouped papules with hairs on the outer surface of the right arm, and microscopically reveals numerous bundles of smooth muscle fiber in the dermis.
Arm ; Dermis ; Hair ; Hamartoma* ; Humans ; Male ; Muscle, Smooth* ; Nevus* ; Young Adult

The purpose of this study is to evaiuate the results of the reconstruction of acetabular bone defect with morselized bone graft and screw fixed hemispherical cup in revision of failed acetabular cup. Thirty four revisions of an acetabular component that had been performed in 34 patients between 1988 and 1993 at SNUH, and had followed more than four years were included in this study. The revised acetabulum was evaluated clinically by Harris hip score and radiologically by evaluating the osseous union, incorporation and resorption of graft, the amount of migration and cup angle change of revised components and periacetabular radiolucency. The mean Harris hip score was improved 52 to 84. All of the bone grafts united by 6.4 months and incorporated by 13.1 months. The graft bone resorption less than onefourth of the initial graft thickness was 91.2% (31 cases). There was no significant difference between pure allograft and allograft mixed with autograft in clinical and radiological results. Of 34 cases, 2 cases (5.9%) required rerevision of acetabulum for aseptic loosening. The two complications, postoperative infection and trochanteric bursitis were managed successfully with conservative methods. The results of the present study confirm the success of revision of the acetabulum with use of a hemispherical component stabilized with multiple small screws and morselized bone grafts filling bone defects.
Acetabulum* ; Allografts ; Autografts ; Bone Resorption ; Bursitis ; Femur ; Hip ; Humans ; Postoperative Complications ; Transplants*

No abstract available.
Carotid Artery, Common* ; Rupture*

Background: Subchondral fatigue fracture of the femoral head (SFFFH) is a rare disease, and its disease entity is established in recent decades. Although there are a few studies on SFFFH, most of them are case series involving around 10 cases, and the clinical course of SFFFH is still not well known. This study analyzed the factors affecting the clinical course of SFFFH. Methods: Patients who visited our institution from October 2000 to January 2019 were retrospectively evaluated. Of eligible cases, 89 hips (80 patients) were diagnosed with SFFFH and non-surgical treatment outcomes were analyzed. Radiographs and medical charts were reviewed for following factors: the degree of femoral head collapse, the interval between the onset of hip pain and the first hospital visit, hip dysplasia, osteoarthritic changes, sex, and age. Results: Hip pain decreased in 82 cases (92.1%) through non-surgical treatment, and 7 cases (7.9%) underwent surgery. Patients with good results of non-surgical treatment had improvement 2.9 months on average after the treatment. All cases without a collapsed femoral head (55 cases) had hip pain alleviation through non-surgical treatment. Cases with femoral head collapse of 4 mm or less and non-surgical treatment within 6 months from the onset of hip pain (22 cases) all had hip pain alleviation. Among 8 cases with femoral head collapse of 4 mm or less and non-surgical treatment after 6 months or more from the onset of hip pain, 3 underwent surgery and 1 had persistent hip pain. Those with femoral head collapse of over 4 mm (3 cases) all underwent surgery. The osteoarthritic changes, dysplastic hip, sex, and age were not statistically related to the success of non-surgical treatment. Conclusions The success of non-surgical treatment for SFFFH can be affected by the degree of femoral head collapse and the timing of non-surgical treatment.

PURPOSE: Atypical femoral fracture (AFF), periprosthetic femoral fracture (PPFF) and femoral nonunion (FNU) are recalcitrant challenges for orthopedic surgeons. Teriparatide (TPTD) had been demonstrated to have anabolic effects on bone in various studies. We postulated that adjuvant TPTD after operation would enhance biologic stimulation for bone formation. We investigated (1) whether the adjuvant TPTD could achieve satisfactory union rate of surgically challenging cases such as displaced AFF, PPFF and FNU; (2) whether the adjuvant TPTD could promote development of abundant callus after surgical fixation; (3) whether the adjuvant TPTD had medically serious adverse effects. MATERIALS AND METHODS: Thirteen patients who agreed to off label use of TPTD in combination of operation were included in this retrospective case series. Median patients' age was 68.7 years, and there were three male and ten female patients. Their diagnoses were nonunion in six patients and acute fracture in seven. Medical records and radiographic images were reviewed. RESULTS: Twelve of thirteen fractures were united both clinically and radiologically within a year after adjuvant TPTD. Union completed radiologically median 5.4 months and clinically 5.7 months after the medication, respectively. Callus appeared abundantly showing median 1.4 of fracture healing response postoperatively. There was no serious adverse reaction of medication other than itching, muscle cramp, or nausea. CONCLUSION: Even appropriate surgical treatment is a mainstay of treatment for AFF, PPFF, and FNU, the current report suggested that adjuvant TPTD combined with stable fixation results in satisfactory outcome for the challenging fractures of femur.
Anabolic Agents ; Bony Callus ; Diagnosis ; Female ; Femoral Fractures* ; Femur ; Fracture Healing ; Humans ; Male ; Medical Records ; Muscle Cramp ; Nausea ; Off-Label Use ; Orthopedics ; Osteogenesis ; Periprosthetic Fractures ; Pruritus ; Retrospective Studies ; Surgeons ; Teriparatide*