No abstract available.

No abstract available.
Head* ; Magnetic Resonance Imaging* ; Necrosis*

Deliberately induced hypotension reduces bleeding in operative fields, therby facilitating the surgical manipulation of a highly vascularized lesion and enabling a better dissection to be made. Hypocapnia is a technique by which the regional cerebral blood flow is reduced, effecting a decrease in the intracranial volume. The monitoring of end-tidal CO2 tension(PECO2) is widely done since the amount of end-tidal CO2 tension reflects indirectly the value of the degree of arterial CO2 tension(PaCO2). During hypotension, increased physiologic dead space my produce the widened PaCO2-PECO2 gradient and this large gradient makes PECO2 an unreliable indication of PaCO2. There are many reports on hypotensive agents and techniques. Induced hypotension with halothane has been reported to be a relatively safe and useful method by Murtagh(1960) and Schettini, et al (1967). We reported 100 cases of halothane induce hypotensive anesthesia for intracranial aneurysm surgery in 1979. The present study reports concerning the hypotensive anesthesia for 259 cases of intracranial aneurysm surgery, which were performed at Severance Hospital of the Yonsei University College of Medicine from 1972 to 1985. We evaluated prospectively the PaCO2-PECO2 gradient with modern infrared capnographs during the induced hypotension of 25 cases, which was performed for intracranial aneurysm surgery at this hospital. The result of the retrospective and prostpective studies were as follows. A. Retrospective study 1) Halothane and enflurane were used as the primary anesthetics in 246 and 13 cases, respectively. Hydralasine, nitroprusside, and trimetaphan were supplementarily used for inducing hypotension in 29, 19 and 15 cases, respectively. 2) The mean arterial blood pressure of the lowest blood pressure in the induced hypotension group was 57.2+/-9.3 mmHg, and the mean arterial blood pressure of the highest blood pressures during the induction fo anesthesia was 111.3+/-20.8mmHg. 3) There was no significant difference in the perioperative hemoglobins, hematocrits, and serum electrolytes. 4) In the introperative period gas analysis revealed respiratory alkalosis(arterial CO2 tension and pH were 29.7+/-6.7mmHg and 7.485+/-0.078, respectively). In other values there was no significant change. 5) The mortality rate in 259 cases of intracranial aneurysm surgery was 6.2%. B. Prospective study There was no significant difference in the PaCO2-PECO2 gradients between in the hypotensive period (5.5+/-3.8 mmHg) and in the normotensiveperiod(4.3+/-3.4mmHg). In conclusion, the technique of using induced hypotension with the inhalation anesthetics, halothane or enflurane, is a safe and useful one to use in performing surgery for intracranial aneurysm, and end-tidal carbon dioxide tension can be used as an indirect measure of arterial carbon dioxide during the induced hypotension.
Anesthesia* ; Anesthetics ; Anesthetics, Inhalation ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide ; Electrolytes ; Enflurane ; Halothane ; Hematocrit ; Hemorrhage ; Hydrogen-Ion Concentration ; Hypocapnia ; Hypotension ; Intracranial Aneurysm* ; Mortality ; Nitroprusside ; Prospective Studies ; Retrospective Studies ; Trimethaphan

No abstract available.
Magnetic Resonance Imaging*

PURPOSE: This study compared the results of PFC Sigma RP-F(R) total knee arthroplasty with those of conventional total knee arthroplasty using PFC Sigma PS(R) in order to assess the clinical results including the maximal flexion angle after a follow up of at least 2 years. MATERIALS AND METHODS: Forty one cases of total knee arthroplasty were performed with PFC Sigma RP-F(R), and the clinical results were analyzed after a follow up of at least 2 years. The patients were compared with a control group consisting of 41 cases, who underwent total knee arthroplasty with PFC Sigma PS(R) using the following parameters: gender, preoperative diagnosis, and preoperative range of motion, and postoperative range of motion. RESULTS: The mean follow up period was 26.7 months. The KSS score improved from 53.2 preoperatively to 95.6 postoperatively. The KSFS score also improved from 49.7 preoperatively to 96.1 postoperatively. The range of motion increased from 124.3degrees to 128.2degrees. The subjective pain score using visual analogue scale improved from 7.6 preoperatively to 1.4 postoperatively. The group with the PFC Sigma RP-F(R) showed similar clinical results to the PFC Sigma PS(R) except for the range of motion. CONCLUSION: Total knee arthroplasty with PFC Sigma RP-F(R) showed similar clinical results to other models, as well as excellent and predictable results of range of motion at the short-term follow up. A long term follow up study will be needed to demonstrate its effects on increasing the longevity.
Arthroplasty ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Range of Motion, Articular

Median nerve injury after elbow dislocation is uncommon. The diagnosis of median nerve entrapment is often delayed. Median nerve paralysis is caused by entrapment within the elbow joint. If median nerve paralysis occurs following elbow dislocation or if it occurs following closed reduction, entrapment should be suspected. Optimal management of this problem consists of early surgical exploration and decompression. We report a case of a child who had entrapment of the median nerve in the elbow joint after closed reduction of posterior dislocation with fracture of the medial epicondyle. The diagnosis was made ten weeks after injury at surgical exploration. This case showed a characteristic radiologic sign in the anteroposterior radiograph. We released the entrapped median nerve with a successful result.
Child ; Decompression ; Diagnosis ; Dislocations ; Elbow Joint ; Elbow ; Humans ; Median Nerve ; Paralysis

BACKGROUND: Leukapheresis has commonly been used to obtain the cell products intended for clinical cell therapy. Hypocalcemia related to citrate toxicity and some circulatory effects such as hypovolemia and hypotension are well-known complications of leukapheresis. In this study, we analyzed the gene expression profiles of peripheral blood mononuclear cells (PBMCs) obtained before and after leukapheresis to determine if the hemodynamic changes can affect the gene expression profiles of leukocytes. METHODS: PBMCs were isolated from EDTA blood from 5 healthy donors collected before and immediately after apheresis. RNA was isolated, amplified, and analyzed using a cDNA microarray with 17,500 genes. Hierarchical clustering analysis was performed to evaluate the differences of gene expression profiling. RESULTS: Hierarchical clustering separated PBMCs from different donors with each other, but did not separate PBMCs collected before and after leukapheresis. Comparison of gene expression by PBMCs collected before and after leukapheresis found only 25 genes were differentially expressed (15 were up-regulated and 10 were down-regulated after leukapheresis) (F-test, P<0.005). Stress induced apoptosis-related genes, ANXA3, DEDD, and ATXN2L, and cytokine-related genes, IL13RA1 and IK, which were also related to stress, were up-regulated after leukapheresis. Genes involved in DNA and protein binding, such as CLSTN3, LRBA, SATB2, and HSPA8, were down-regulated. CONCLUSIONS: Leukapheresis had little effect on gene expression of PBMCs. Some genes showing differences between before and after leukapheresis were mainly involved in stress-related reactions.
Adult ; Aged ; Down-Regulation ; Female ; *Gene Expression Profiling ; Humans ; *Leukapheresis ; Leukocytes, Mononuclear/*metabolism ; Male ; Middle Aged ; Oligonucleotide Array Sequence Analysis ; Up-Regulation

PURPOSE: To compare the efficacy and safety of photorefractive keratectomy with laser epithelial keratomileusis, for low to moderate myopia. METHODS: Patients with a manifest refraction less than -6.0 diopters were enrolled in this study. Patients were treated with photorefractive keratectomy (47 eyes) or laser epithelial keratomileusis (42 eyes). Preoperative and postoperative uncorrected visual acuity, refractive errors, keratometry, residual central corneal thickness, epithelial healing time, and corneal haze were evaluated for a 1 year follow-up period. RESULTS: There were no significant differences between photorefractive keratectomy and laser epithelial keratomileusis in uncorrected visual acuity, refractive errors or correction of refractive errors. Residual central corneal thickness increased until 6 months postoperative and thereafter in both photorefractive keratectomy and laser epithelial keratomileusis groups. There were no significant changes in keratometry after postoperative 1 month. Epithelial healing time of photorefractive keratectomy was shorter than that of laser epithelial keratomileusis. Corneal haze score had a peak at 1 month postoperative and then decreased rapidly until 3 months postoperative, it was stable after 6 months. Corneal haze score at 1 month was less than 0.5 in both groups and did not disturb visual acuity. CONCLUSIONS: Photorefractive keratectomy and laser epithelial keratomileusis have an equal effect in correction of visual acuity and refractive errors. They have equivalent levels of safety as measured by postoperative residual central corneal thickness and corneal haze. Both procedures are effective methods to correct low to moderate myopia.
Follow-Up Studies ; Humans ; Myopia* ; Photorefractive Keratectomy* ; Refractive Errors ; Visual Acuity

BACKGROUNDS: Authors evaluated the quantitative culture of bronchoalveolar lavage fluid(BALF) in patients who were being treated with antimicrobial agents and the characteristics of isolated microorganism. METHOD: A prospective study was done with 25 patients under mechanical ventilation and antimicrobial treatment in ICU and NCU of Yongdong Severance Hospital from Apr. to Sep. 1999. Patients were classified into two groups: control group (n=5) and patients with VAP (n=20). The threshold of quantitative culture of BAL fluid in the diagnosis of VAP was 104 cfu/ml. RESULTS: 1) In gram staining of BALF, one patient in the control group and four in the VAP group showed positive results. Quantitative culture of BALF showed no organisms in the patients in the control group and in 9 VAP patients. Therefore the overall sensitivity was 43.8%. 2) Frequency of isolated organisms cultured above diagnostic threshold was in the following other : E. cloacae, S. aureus, K. pneumoniae, and A. baumani. S. aureus and Staphylococcus coagulase(-) were all resistant to oxacillin. Seven out of 10 isolated G (-) organisms were suspected to be organisms producing extended spectrum β-lactamase (ESBL). 3) The concurrence between gram staining of sputum aspiration and that of BALF was only in 1 case. And the concurrence of culture results was observed in 3 cases. CONCLUSION: The sensitivity of gram staining and quantitative culture of BALF from patients under antibiotic therapy and the concordance rate between conventional tracheal aspiration and BAL were low, facts which were important in interpretation the data. Since the frequency of drug resistance organisms was not different from that of foreign data, antibiotics must be prudently selected and used.
Anti-Bacterial Agents ; Anti-Infective Agents ; Bronchoalveolar Lavage Fluid* ; Bronchoalveolar Lavage* ; Cloaca ; Diagnosis* ; Drug Resistance ; Humans ; Oxacillin ; Pneumonia* ; Prospective Studies ; Respiration, Artificial ; Sputum ; Staphylococcus ; Ventilators, Mechanical*

PURPOSE: To evaluate the efficacy and safety of fibrin bioadhesive in conjunctivolimbal autograft surgery for primary pterygium. METHODS: Thirty-six eyes in 34 patients were reviewed with nasal primary pterygium who were treated with pterygium excision with superior conjunctivolimbal transplantation with fibrin bioadhesive. Surgical durations were recorded and the patients were followed up on the first day after surgery and then at 1, 2, 4, 8 and 12 weeks postoperatively. The graft-recipient site attachments were examined and subjective symptoms of patients were recorded at every follow-up examinations. RESULTS: The mean patient age was 57.9+/-10.1 (ranging from 33 to 83) years. The mean follow-up period was 22.05+/-5.78 weeks. The mean surgery time was 18.04+/-5.65 minutes. The subjective symptoms (pain, foreign body sensation, tearing and discomfort) disappeared in 23 of 36 eyes (64%) in one week after surgery, and all discomforts subsided within two weeks after surgery in all patients. The conjunctivolimbal autograft was correctly positioned and fixed in 34 of 36 eyes (94.4%) throughout the follow-up period. Graft dehiscence was seen in two eyes (5.6%), one eye was treated with remedial sutures, and the other eye showed a spontaneous healing without remedial sutures. Transient graft edema occurred in four eyes (11.2%) but subsided spontaneously within a month. There were no cases of pterygium regrowth or complications due to the fibrin bioadhesive. CONCLUSIONS: The use of fibrin bioadhesive in conjunctivolimbal autograft surgery in primary pterygium simplifies surgical techniques, shorten surgical duration, and produce less postoperative subjective symptoms . Therefore, the fibrin bioadhesive is a safe and effective tool to attach conjunctivolimbal autograft in primary pterygium surgery.
Adult ; Aged ; Aged, 80 and over ; Conjunctiva/*transplantation ; Female ; Fibrin Tissue Adhesive/*therapeutic use ; Follow-Up Studies ; Humans ; *Limbus Corneae ; Male ; Middle Aged ; Postoperative Complications ; Pterygium/*surgery ; Tissue Adhesives/*therapeutic use ; Transplantation, Autologous