No abstract available.
Quality of Life*

Contusions ; Facial Bones ; Facial Nerve ; Facial Nerve Injuries ; Facial Paralysis ; Humans ; Incidence ; Lacerations ; Orbit ; Salivary Glands ; Skin ; Soft Tissue Injuries ; Wounds and Injuries

PURPOSE: To determine whether triple-phase multi-detector-row helical CT images of the liver improves the detection rate of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Forty-one patients with 103 HCCs underwent triple-phase multi-detector-row helical CT imaging of the entire liver after contrast administration. Early and late arterial phase images were obtained serially during a single breath-hold, and portal venous-phase images were then obtained. Each image set was independently assessed for the presence of HCC by two radiologists unaware of the possible presence of tumors, and for each phase the detection rate was determined. For each arterial-phase image, lesion conspicuity (attenuation of a tumor compared with that of its parenchyma) was calculated. RESULTS: For reader 1, the detection rates for the early arterial, late arterial, and portal venous phase were 81%, 77%, and 55%, respectively, and for reader 2 were 83%, 81%, and 68%, respectively (p>0.05). When triplephase imaging findings were combined, the detection rate was significantly higher than when only those of the early or late arterial, and portal venous, phase were used (p<0.05). Mean lesion conspicuity for the late arterial phase was higher than for the early arterial phase, but the difference was statistically insignificant (p>0.05). CONCLUSION: Triple-phase imaging of the liver, involving the early arterial, late arterial, and portal venous phase, and using multi-detector-row helical CT, increases the detection rate of HCC.
Carcinoma, Hepatocellular ; Humans ; Liver* ; Tomography, Spiral Computed*

No abstract available.
Cytosine Deaminase* ; Cytosine* ; Genetic Therapy* ; Osteocalcin* ; Prostate* ; Prostatic Neoplasms*

BACKGROUND: Aspiration of gastric contents into the lungs is one of the most feared complications during anesthesia. Various factors combine to make pediatric patients more susceptible to regurgitation and aspiration than adults. We compared the risk of incidence of acid aspiration in two groups, after examining the pH, and volume of gastric contents in pediatric and adult patients. METHODS: This study was carried out with inpatients scheduled for elective surgery under general anesthesia. Sixty patients from 1 to 13 years old were included in the pediatric age group, and sixty patients from 18 to 60 years old were included in the adult age group. After induction of anesthesia and stabilization of the condition of the patient, gastric contents were collected via a 10 - 18 French Salem Sump tube. Gastric volume and pH were measured. RESULTS: The mean gastric volume in the pediatric group was significantly higher than those in the adult group, whereas, The mean gastric pH in the adult group was significantly higher than those in the pediatric group. CONCLUSIONS: We concluded that pediatric patients have a lower gastric pH but a higher gastric volume than adult patients.
Adolescent ; Adult* ; Anesthesia ; Anesthesia, General ; Child* ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Inpatients ; Lung ; Middle Aged

No abstract available.
Barium* ; Child* ; Humans ; Intussusception* ; Ultrasonography*

BACKGROUND: For anesthesia in cesarean section N2O and low concentrations of inhalation anesthetics are regarded as the anesthetic agent of choice. But a low level of anesthesia frequently leads to increased maternal hemodynamic responses and awareness. The effects of a 3 microgram/kg fentanyl bolus injection after umbilical cord clamping was evaluated in 20 full-term parturients, scheduled for elective cesarean section, versus to 20 parturients without fentanyl. METHODS: The forty parturients (ASA physical status 1, 2) scheduled for cesarean section were randomized to either a N2O-enflurane (E group) or a N2O-enflurane-fentanyl (F group). Thiopental sodium (4 mg/kg) and succinylcholine (1.5 mg/kg) were administered intravenously for the induction and endotracheal intubation. Anesthesia was maintained with 50% N2O and 1% enflurane in oxygen until delivery. After delivery, the intravenous injection of 0.5 mg/kg of atracurium was administered, controlled ventilation was applied to maintain PetCO2 at 30 to 35 mmHg with N2O (3 L/min) and O2 (1.5 L/min). Immediately after clamping the umbilical cord, 3 microgram/kg of fentanyl (F group only) was administered. Heart rate, blood pressure, awareness, recovery time, postoperative complication and recall were evaluated. RESULTS: Heart rate values at 10 and 20 min after umbilical cord clamping and 5 min after extubation, and mean arterial pressure at 5, 10 and 20 min after umbilical cord clamping in group F were found to be significantly lower than in group E. CONCLUSIONS: We conclude that N2O-enflurane-fentanyl at 3 microgram/kg is clinically satisfactory in anesthesia for cesarean section, having no adverse effects on the mother.
Anesthesia ; Anesthesia, General ; Anesthetics, Inhalation ; Arterial Pressure ; Atracurium ; Blood Pressure ; Cesarean Section* ; Constriction* ; Enflurane ; Female ; Fentanyl* ; Heart Rate ; Hemodynamics ; Humans ; Injections, Intravenous ; Intubation, Intratracheal ; Mothers ; Oxygen ; Postoperative Complications ; Pregnancy ; Succinylcholine ; Thiopental ; Umbilical Cord* ; Ventilation

Based on the review of literatures, this article discussed the frequency and timing of rebleeding after initial subarachnoid hemorrhage (SAH), and the risk factors and preventive strategy for rebleeding. In view of the active policy of early aneurysm surgery, the peak interval for rebleeding was the first 24 hours after the aneurysmal SAH. Patients with poor grades, ventricular drainage, angiography within 6 hours post-SAH, time interval between the last attack and admission, and reduced platelet function were proposed as a risk factor of rebleeding. Rebleeding from giant aneurysms occurred at a rate comparable to that associated with smaller aneurysm. The efficacy of short-term antifibrinolytic drugs was expected to minimize ultraearly rebleeding. When ventriculostomy is necessary, intracranial pressure should be maintained between 15 and 25 mmHg to minimize transmural pressure gradients. Securing ruptured aneurysm on an emergency basis remained open to debate.
Aneurysm ; Aneurysm, Ruptured ; Angiography ; Blood Platelets ; Drainage ; Emergencies ; Humans ; Intracranial Pressure ; Risk Factors ; Subarachnoid Hemorrhage* ; Ventriculostomy

OBJECTIVE: Age is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital. METHODS: We collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3-8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator. RESULTS: Types of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares. CONCLUSION: Ethical training and developing decision-making skills are necessary including shared decision making.
Aged* ; Brain Injuries ; Coma ; Craniocerebral Trauma* ; Decision Making* ; Humans ; Medical Records ; Missions and Missionaries ; Mortality ; Patient Participation ; Prognosis ; Pupil ; Retrospective Studies

Acute neurologic deterioration is not a rare event in the surgical decompression for thoracic spinal stenosis. We report a case of transient paraparesis after decompressive laminectomy in a 50-yr-old male patient with multi-level thoracic ossification of the ligamentum flavum and cervical ossification of the posterior longitudinal ligament. Decompressive laminectomy from T9 to T11 was performed without gross neurological improvement. Two weeks after the first operation, laminoplasty from C4 to C6 and additional decompressive laminectomies of T3, T4, T6, and T8 were performed. Paraparesis developed 3 hr after the second operation, which recovered spontaneously 5 hr thereafter. CT and MRI were immediately performed, but there were no corresponding lesions. Vascular compromise of the borderlines of the arterial supply by microthrombi might be responsible for the paraparesis.
*Cervical Vertebrae/pathology/surgery ; Decompression, Surgical/adverse effects ; Humans ; Laminectomy/*adverse effects ; *Ligamentum Flavum/pathology/surgery ; *Longitudinal Ligaments/pathology/surgery ; Male ; Middle Aged ; *Ossification, Heterotopic ; Paraparesis/*etiology