No abstract available.
Female ; Humans ; Plasma* ; Pregnant Women*

Although it has been suggested that the calcium antagonist verapamil has beneficial effects on ischemic myocardium, its effect during coronary reperfusion has not been studied in detail. The purpose of this study was to investigate the inhibitory effect of verapamil on myocardial damage quantitatively using 111 In-anticardiac myosin antibody (ACM Ab) and qualitatively using electronmicroscopic method. Anesthetized open-chest dogs were subjected to 1 hour of occlusion of the left anterior descending coronary artery (LAD) followed by 90 minutes of reperfusion. Regional myocardial blood flow was determined by injecting 85Sr-microsphere prior to LAD reperfusion, and regional myocardial damage was measured by injecting 111In-ACm Ab at 30 minutes after LAD reperfusion. Six dogs were randomly selected as saline control and verapamil-treated (0.6 mg/kg. hr) groups each. Saline or verapamil was infused at 40 minutes after LAD occlusion and continued through the experiment. 1) Verapamil produced significant (P<0.05 by Wilcoxon rank sum test) decrease in heart rate, mean arterial blood pressure and double product. There was no significant change in pulmonary hemodynamics or cardiac output. 2) Stroke volume was reduced significantly (P<0.05 by Wilcoxon rank sum test) after 30 minutes of LAD reperfusion in the control group, but it was preserved in the verapamil-treated group. 3) There was an inverse exponential relationship between 111In-ACm Ab localization and regional blood flow in both control (r=-0.86) and verapamil treated (r=-0.71) groups. Significant difference between the two groups was found in exponential curve (p[t]<0.05). 4) A lesser uptake of 111in-ACM Ab was observed in the verapamil treated group compared with that in the control group in the region where the regional blood flow was lower than 30+/- of normal. 5) In the control group, the myocardium showed swelling, contraction bands, and electron dense granules in the mitochondria which were proven to be calcium aggregates. In the verapamiltreated grooup, the myocardium showed fewer electro dense granules and mild degree of contraction bands. This study supports the concept that verapamil reduces the myocardial damage following coronary reperfusion in myocardial infarction and may reduce contraction band necrosis.
Animals ; Arterial Pressure ; Calcium* ; Cardiac Output ; Coronary Vessels ; Dogs ; Heart Rate ; Hemodynamics ; Mitochondria ; Myocardial Infarction* ; Myocardial Reperfusion* ; Myocardium* ; Myosins ; Necrosis ; Regional Blood Flow ; Reperfusion ; Stroke Volume ; Verapamil

No abstract available.
Mandibular Reconstruction* ; Ribs* ; Transplants*

Clincal studies were made on 166 cases of spontaneous subarachnoid hemorrhage (SAH), were admitted to the keimyung university Dongsan hospital from January 1981 to March 1984. The age and sex distribution, causes of SAH, clinical symptoms and signs, computed tomographic (CT) findings, aneurysmal site, number and size, comparison between the highest density on CT findings and site of aneurysm confirmed by angiography,relationship between CT class and clinical grade, complication, and relationship between hospital course and clinical grade on admission were analysed. The results summarized as follow. 1. The most prevalent age group was between 41-60 years of age, and above 61 years, 31-40 years and below 30 years of age in the order of frequency. Male to female ratio was 43.4 : 56.6. 2. The most common causes of 100 cases of SAH confirmed by cerebral angiography was cerebral aneurysm (75 cases), and the other causes were unknown cause (16 cases), arteriovenous malformation (6 cases), moyamoya disease (3 cases) in the order of frequency. 3. The clinical symptoms on admission in the order of frequency were headache, nausea and vomiting, brief loss of consciousness, dizziness, seizure, and urinary incontinence. The neurological findings showed stiffneck, hemiparesis, cranial nerve palsies, papilledema and/or hemorrhage on the fundus, and Babinski sign in that order. 4. CT findings (158 cases) revealed typical high densities consistent with SAH in 125 cases (79.1%), associated with the low density (13 cases), and visible cerebral aneurysm (5 cases), while negative findings were 33 cases (20.9%). 5. The most common site of aneurysm among the 75 cases of SAH confirmed by the cerebral angiography was the region of the anterior communicating artery (AcomeA) which accounted for 30 cases (35.3%), and posterior communicating artery (PcomeA) and middle cerebral artery (MCA) 23 cases (27%), respectively, the internal carotid artery 5 cases (5.9%), the anterior ecrebral artery (ACA) 2 cases (2.4%), the posterior inferior cerebellar artery and basilar artery 1 cases (1.2%), respectively in the order of frequency. Among the 75 cases of cerebral aneurysms, single aneurysms were 67 cases (89.3%) and multiple aneurysms were 8 cases (10.7%). The most common size of the aneurysms was 6-10 mm (47 cases), and below 5 mm (30 cases), and above 10 mm (8 cases) in the order of frequency. 6. Sixteen out of 27 cases of AcomA aneurysms present the highest density on CT scan in the anterior hemispheric fissure, 9 out of 22 cases of PcomA aneurysms in syulvian fissure and 6 cases in suprasellar cistern, and all cases of MCA aneurysm (21 cases) in the ipsilateral aneurysmal site. 7. Comparison between CT grade by Davis (1980) and clinical grade by Hunt-Hesse (1968) revealed that the 93 of 94 patients (pts) with CT class 1 or 2 belong to under clinical grade 3, the 17 of 64 pts with CT class 3 or 4 belong to clinical grade IV or V, and the 17 of 18 pts with clinical grade IV or V belong to CT class 3 or 4. 8. The most common complication was the hydrocephalus (30.1%), and cerebral arterial spasm (24.1%), SIADH (8.4%), and rebleeding confirmed by lumbar puncture and/or CT (4.2%), in the order of frequency. 9. One hundred and four pts (62.7%) out of total 166 patient with SAH were improved, whereas 39 pts (23.5%) were not improved or signed out without clinical improvement, and 23 pts (13.8%) were died. The 81 (77.9%) of 104 pts who were improved belong to clinical grade I or II on admission, the 18 (78.3%) of 23 pts who were expired belong to clinical grade III or IV, and the 19 (48.7%) of 39 pts who were signed out without improvement belong to clinical grade III to V.
Aneurysm ; Arteries ; Arteriovenous Malformations ; Basilar Artery ; Carotid Artery, Internal ; Cerebral Angiography ; Cranial Nerve Diseases ; Dizziness ; Female ; Headache ; Hemorrhage ; Humans ; Hydrocephalus ; Inappropriate ADH Syndrome ; Intracranial Aneurysm ; Male ; Middle Cerebral Artery ; Moyamoya Disease ; Nausea ; Papilledema ; Paresis ; Reflex, Babinski ; Seizures ; Sex Distribution ; Spasm ; Spinal Puncture ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed ; Unconsciousness ; Urinary Incontinence ; Vomiting

Though femoral neck fractures in adults are usually treated by fixation with multiple screws, subtrochanteric fracture at the insertion site is an uncommon complication, and in children, there has been a few reports about this complication after treatment of slipped capital femoral epiphysis. We report a subtrochanteric fracture at the insertion site of cannulated screws used in femoral neck fracture of a 9-years old boy.
Adult ; Child* ; Femoral Neck Fractures* ; Femur ; Femur Neck* ; Humans ; Male ; Slipped Capital Femoral Epiphyses

Coronary artery bypass grafting(CABG) without cardiopulmonary bypass is now an accepted technique of myocardial revasculization in terms of preventive method from various complications of cardiopulmonary bypass. Despite danger of myocardial ischemia, induced hypotension with bradycardia are sometimes necessary for the convenience of operative approach to beating heart. We report a case of induced hypotension with bradycardia during general anesthesia for CABG without cardiopulmonary bypass. After induction and maintenance of balanced anesthesia with fentanyl-midazolam-isofluranepiperocuronium for the 68 kg, 55 years old male stable angina patient, we induced controlled hypotension(systolic blood pressure: 70~80 mmHg) and bradycardia(heart rate: 50~60/min.) by bolus injections of verapamil 5 mg and esmolol 30 mg followed by continuous infusion of esmolol 0.1~0.3 mg/kg/min. during 50 minutes of main graft implantations without bypass. Any significant ischemic changes on EKG were not detected during induced hypotension and bradycardia. Patient was recovered without any signs of myocardial ischemia postoperativery and discharged 8 days after operation.
Anesthesia, General* ; Angina, Stable ; Arteries* ; Balanced Anesthesia ; Blood Pressure ; Bradycardia* ; Cardiopulmonary Bypass* ; Coronary Artery Bypass ; Electrocardiography ; Heart ; Humans ; Hypotension* ; Male ; Middle Aged ; Myocardial Ischemia ; Transplants* ; Verapamil

Echocardiography has been the most widely applicable noninvasive cardiovascular imaging technique. Recent advances in this technique have extended its use into the operating room by development of transesophageal approach. Many anesthesiologists use transesophageal echocardiography (TEE) because it provides a more direct and rapid method of assessing cardiac anatomy and function. Intraoperative TEE done by anesthesiologists or cardiologists makes it possible for operation team to get useful informations such as cardiac filling, valvular function, cardiac contractility, intracardiac shunt, segmental wall motion abnormality and adequacy of coronary blood flow, etc. We analyzed our clinical experiences of forty six cases of TEE (6.0%) in 767 cases of anesthesia for open heart surgery at the Sejong General Hospital during the period from September 1993 to August 1994. 767 open heart surgical cases were divided into 4 groups by disease entity ; 498 cases of group I(congenital), 190 cases of group II(valvular), 63 cases of group III(ischemic) and 16 cases of group IV(miscellaneous). TEE was done for 22 cases of male patients and 24 cases of female patients. 32 cases of TEE were done for the age group between 21 to 30 years old. The number of TEE was 26 cases of group II, 11 cases of group I, 7 cases of group III and 2 cases of group IV, respectively. The main purpose of TEE in descending order was 27 cases for assessment of cardiac contractility, 18 cases for valvular function after valvuloplasty, 7 cases for the evaluation of low cardiac output syndrome(LCOS), and 7 cases for adequacy of coronary blood flow respectively. Two cases of Biopump in group I, 2 cases of Biopump in group II, 3 cases of intraaortic baloon pump(IABP) in group II, III and IV were applied after TEE. Two cases of mitral valvular replacement(MVR) were done immediately after confirmation of valvular insufficiency by TEE. These results have demonstrated that TEE is one of the useful monitoring devices for the anesthesia in open heart surgery by assessment of variable informations about patients' cardiac status.
Adult ; Anesthesia ; Cardiac Output, Low ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Heart* ; Hospitals, General ; Humans ; Male ; Operating Rooms ; Thoracic Surgery*

No abstract available.
Surgery, Oral* ; Transplants* ; Veins*

Menetrier's disease is a rare illness that is characterized by diffuse tremendous thickening of the gastric wall caused by excessive proliferation of the mucosa of unknown cause. An exact diagnosis is crucial due to the excellent prognosis as compared to other malignant lesions such as a gastric lymphoma and infiltrative gastric carcinoma. A 23-year-old woman presented with epigastric discomfort and dyspepsia. A rapid urease test, a test for H. pylori using serum IgG antibody, and a (13)C-urea breath test were all negative. A gastroscopic examination revealed a wide lesion encircling the lumen, which showed diffusely hard and thickened folds from an angle to the upper body near the cardia. Endoscopic ultrasonography showed diffusely hypoechoic thickness of the second wall layer, but the other wall layers were well preserved. The patient was diagnosed with Menetrier's disease without H. pylori infection, and the patient rapidly improved after short-term treatment with a proton pump inhibitor.
Breath Tests ; Cardia ; Dyspepsia ; Endosonography ; Female ; Gastritis, Hypertrophic ; Humans ; Immunoglobulin G ; Lymphoma ; Lymphoma, Non-Hodgkin ; Mucous Membrane ; Prognosis ; Proton Pumps ; Protons ; Stomach Neoplasms ; Urease ; Young Adult

The present study was performed to determine the incidence and predictive factors of benign renal lesions in Korean patients undergoing nephrectomy for presumed renal cell carcinoma on preoperative imaging. We analyzed the pathologic reports and medical records of 1,598 eligible patients with unilateral, nonmetastatic, and nonfamilial renal masses. Of the 1,598 renal masses, 114 (7.1%) were benign lesions, including angiomyolipoma in 47 (2.9%), oncocytoma in 23 (1.4%), and complicated cysts in 18 (1.1%) patients. On univariate analysis, the proportion of benign lesions was significantly higher in female patients, and in patients with smaller tumors, cystic renal masses, and without gross hematuria as a presenting symptom. When renal lesions were stratified by tumor size, the proportion of benign as opposed to malignant lesions decreased significantly as tumor size increased. On multivariate analysis, female gender, smaller tumor size, and cystic lesions were significantly associated with benign histological features. The findings in this large cohort of Korean patients show a lower incidence (7.1%) of benign renal lesions than those of previous Western reports. Female gender, cystic renal lesions, and smaller tumor size are independent predictors of benign histological features.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Angiomyolipoma/diagnosis/epidemiology/surgery ; Carcinoma, Renal Cell/*diagnosis/epidemiology/surgery ; Child ; Cohort Studies ; Cysts/diagnosis/epidemiology/surgery ; Diagnostic Imaging ; Female ; Hematuria ; Humans ; Kidney Neoplasms/*diagnosis/epidemiology/surgery ; Male ; Middle Aged ; Nephrectomy ; Republic of Korea ; Retrospective Studies