BACKGROUND: Respiratory depression with high dose of propofol during induction is one of the major complications. We studied the effects of midazolam as premedicant on frequency and duration of apnea and frequency of loss of consciousness in relation to single dose of propofol. METHODS: We selected 194 adult patients who had clear consciousness and no depression of respiration. We allocated patients randomly to control group and midazolam group. In midazolam group, we injected 0.06mg/kg of midazolam intravenously 10min before induction, and in control group, we did nothing. Under mask oxygenation with 100% oxygen, we administered a bolus of propofol (1, 1.5, 2 mg/kg to subgroup 1, 2, 3 respectively) intravenously. The change of respiration and loss of consciousness were observed. RESULTS: The frequency and duration of apnea increased with the dose of propofol in both control and midazolam group. But there were no difference between groups except frequency of apnea with 1.5 mg/kg of propofol. In control group, frequency of loss of consciousness increased with the increasing dose of propofol. But in midazolam group, nearly all the patients was slept without difference by the dose. CONCLUSIONS: Premedication with midazolam reduce the sleeping dose of propofol to induce anesthesia, so the frequency and duration of apnea which is caused by high dose of propofol can be decreased.
Adult ; Anesthesia ; Apnea* ; Consciousness ; Depression ; Humans ; Masks ; Midazolam* ; Oxygen ; Premedication ; Propofol* ; Respiration ; Respiratory Insufficiency ; Unconsciousness*

PURPOSE:The natural course of Hashimoto' thyroiditis (HT) is so dynamic that the disease progresses to overt hypothyroid or spontaneous recovery. The authors reviewed the clinical course of this disease and analysed the possible predicting factors regarding remission. METHODS:Thirty nine patients with HT (38 girls and 1 boy) were studied retrospectively. Of these patients, 30 were followed for more than 2 years. The possible remission factors were analyzed at initial diagnosis and during follow-up period. RESULTS:The mean age at the diagnosis was 11.8+/-.1 years. Initial thyroid function was euthyroid in 38.5%, compensated hypothyroid in 35.9%, overt hypothyroid in 23.1%, and hyperthyroid in 2.6% of patients. Antithyroglobulin antibody (ATA) was positive in 94.7%, and antimicrosomal antibody (AMA) was positive in 74.4%. The overall remission rate was 53.3% during the follow-up period (51+/-7 months). Initial goiter size, thyroid function status, and autoantibody titer had no relation to the remission rate statistically. Follow-up autoantibody titers in remission group were marginally lower than those in nonremission group (P<0.1), and follow-up AMA titer was significantly higher than initial titers in nonremission group (P<0.05). CONCLUSION: We could not find any predictable remission factors from the initial clinical and autoantibody status. But, during follow-up period, patients with lower autoantibody titers showed slight higher remission, and those with increasing AMA titer showed less remission. Above results suggest that we should monitor antithyroid antibody titer as well as thyroid function regularly.
Adolescent* ; Child* ; Diagnosis ; Female ; Follow-Up Studies ; Goiter ; Humans ; Retrospective Studies ; Thyroid Gland* ; Thyroiditis*

No abstract availble

There are some effective methods for removing layers of skin to improve aging face and dermatologic defects : chemabrasion (chemical peeling), dermabrasion(surgical removal), laserabrasion. Chemabrasion, generally performed with a chemical solution, is most useful for removal of fine facial wrinkles and abnormal pigmentation. The application of chemical caustics, especially TCA (trichloroacetic acid), is known to be an effective and is now commonly practiced to improve the surface of the facial skin that has been blemished by pigmentation, wrinkles, solar damage and certain scars. Trichloroacetic acid is a colorless melting crystal and derivatives of acetic acid which das protein precipitating properties. It has specific odor but there is not systemic toxic effect like a phenol. It has heavy caustic effect on skin and mucosa and cause the coagulation necrosis of the skin and therefore, it must be handled carefully and stored in the proper condition. Especially, moderate to high concentrated TCA solution must be treated by well-trained persons. A 46-year-old woman visited a private clinic for removal of fine wrinkles around the lip. She was refered to our department because of acute upper lip coagulation necrosis which was caused by injection of 35% TCA solution mistaken for lidocaine, which was supposed to be used for anesthesia. At her arrival, cental half of upper lip showed severe coagulation necrosis. The lesion was well discriminated in a few days, then debridement and immediate reconstruction was done using an Abbe flap. Chemical peeling is a relatively effective procedure for improvement of aging skin lesion in a lower cost with a short time operation, if the practitioner has much experience and optimal indication is properly selected. But not so as, side effect and complication may be often ocurred in a mistake and as a result irreversible scars are remained. We experienced a rare case of upper lip necrosis which was caused by TCA injection mistaked for lidocaine in a private clinic and so, We report this case with the results of experiment of rabbit model which was observation of macroscopic and microscopic changes of the abdominal skin of the rabbit injected with serially diluted TCA solution.
Acetic Acid ; Aging ; Anesthesia ; Caustics ; Cicatrix ; Debridement ; Female ; Freezing ; Humans ; Lidocaine ; Lip* ; Middle Aged ; Mucous Membrane ; Necrosis* ; Odors ; Phenol ; Pigmentation ; Skin ; Trichloroacetic Acid

It has been widely accepted that complete surgical resection of hepatoblastoma is essential for long-term survival. But unfortunately less that 50% of hepatic tumors in children can be totally removed at the time of diagnosis. This report is to present the experience of successful resection of hepatoblastoma after concurrent radiotherapy with transarterial chemoinfusion in a child. We believe this modality of treatment enables complete resection of unresectable hepatoblastoma, which is resistant to the systemic chemotherapy.
Child ; Diagnosis ; Drug Therapy ; Hepatoblastoma* ; Humans ; Radiotherapy*

PURPOSE: The relationship between menopausal status at diagnosis and the prognosis in breast carcinoma remains uncertain. However, it is widely considered that breast cancer in young women is more lethal than in older patients. We therefore attempted to determine whether menopausal status could be a useful prognostic factor for breast cancer. METHODS: A retrospective study was conducted of premenopausal women who had undergone a definite operation between Jan. 1997 and Dec. 1998 in the Department of Surgery, Samsung Medical Center. Clinical features, histopathologic findings, and prognostic factors were evaluated and compared with those for the equivalent surgical group of postmenopausal women. RESULTS: There were 207 cases (86.3%) of infiltrating ductal carcinomas, 10 (4.2%) of infiltrating lobular carcinomas, 6 (2.5%) of ductal carcinomas in situ, and 16 (6.7%) of special type cancers which showed good prognosis. There were some differences in these incidences from those of the postmenopausal women, but they were not statistically significant (P>0.05). Tumor size and lymph nodal status showed no difference between the two groups (P=0.288), nor were there any significant differences in terms of TNM stage, ER/PR status, nuclear or histologic grade (P>0.05). CONCLUSION: There were little differences in pathologic and prognostic factors between premenopausal and postme no-pausal breast cancer patients. Premenopausal status and young age did not have poorer prognostic factors and were predicted to have not worse prognosis.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Lobular ; Diagnosis ; Female ; Humans ; Incidence ; Prognosis ; Retrospective Studies

PURPOSE: The relationship between menopausal status at diagnosis and the prognosis in breast carcinoma remains uncertain. However, it is widely considered that breast cancer in young women is more lethal than in older patients. We therefore attempted to determine whether menopausal status could be a useful prognostic factor for breast cancer. METHODS: A retrospective study was conducted of premenopausal women who had undergone a definite operation between Jan. 1997 and Dec. 1998 in the Department of Surgery, Samsung Medical Center. Clinical features, histopathologic findings, and prognostic factors were evaluated and compared with those for the equivalent surgical group of postmenopausal women. RESULTS: There were 207 cases (86.3%) of infiltrating ductal carcinomas, 10 (4.2%) of infiltrating lobular carcinomas, 6 (2.5%) of ductal carcinomas in situ, and 16 (6.7%) of special type cancers which showed good prognosis. There were some differences in these incidences from those of the postmenopausal women, but they were not statistically significant (P>0.05). Tumor size and lymph nodal status showed no difference between the two groups (P=0.288), nor were there any significant differences in terms of TNM stage, ER/PR status, nuclear or histologic grade (P>0.05). CONCLUSION: There were little differences in pathologic and prognostic factors between premenopausal and postme no- pausal breast cancer patients. Premenopausal status and young age did not have poorer prognostic factors and were predicted to have not worse prognosis.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Lobular ; Diagnosis ; Female ; Humans ; Incidence ; Prognosis ; Retrospective Studies

Hemangiopericytoma is a rare mesenchymal neoplasm, accounting for about 1% of vascular tumor. Hemangiopericytoma is known to be derived from the vascular pericyte and occurs most commonly lower extremities, pelvis and retroperitoneum. Surgical radical excision is the treatment of choice. Because of malignant features of hemangiopericytoma, long term and close follow-up is important. We report a case of successfully resected retroperitoneal hemangiopericytoma.
Accounting ; Follow-Up Studies ; Hemangiopericytoma ; Lower Extremity ; Pelvis ; Pericytes

The prognostic factors for extrahepatic biliary atresia (EHBA) after Kasai portoenterostomy include the patient's age at portoenterostomy (age), size of bile duct in theporta hepatis (size), clearance of jaundice after operation (clearance) and the surgeon's experience. The aim of this study is to examine the most significant prognostic factor of EHBA after Kasai portoenterostomy. This retrospective study was done in 51 cases of EHBA that received Kasai portoenterostomy by one pediatric surgeon. For the statistical analysis, Kaplan-Meier method, Logrank test and Cox regression test were used. A p value of less than 0.05 was considered to be significant. Fifteen patients were regarded as dead in this study, including nine cases of liver transplantation. There was no significant difference of survival to age. The age is also not a significant risk factor for survival in this study (Cox Regression test; p = 0.63). There was no significant difference in survival in relation to the size of bile duct. However, bile duct size was a significant risk factor for survival (Cox Regression test; p = 0.002). There was a significant difference in relation to survival and clearance (Kaplan-Meier method; p = 0.02). The clearing was also a significant risk factor for survival (Cox Regression test; p = 0.001). The clearance of jaundice is the most significant prognostic factor of EHBA after Kasai portoenterostomy.
Bile Ducts ; Biliary Atresia* ; Humans ; Jaundice ; Kaplan-Meier Estimate ; Liver Transplantation ; Prognosis ; Retrospective Studies ; Risk Factors

Trichoblastic fibroma is a benign trichogenic tumor that has both epithelial and mesenchymal components and exhibits partial follicular induction. We studied 4 cases of trichoblastic fibroma and reviewed their clinical and histologic features. Two tumors were present in the face. The remaining two were in the vulva and perianal area, respectively. The age of the patients ranged from 53 to 68 years, with an average age of 62. All were female. Histologically, the lesions showed a well circumscribed mass, located at dermo-subcutaneous junction in three patients and subcutaneous in one. They demonstrated mesenchymal induction evidenced by hair germ-like structure and perifollicular sheath. There was no connection between the tumor and epidermis. Differentiation toward hair structure led to the formation of the infundibulum through inner root sheath. Trichoblastic fibroma may be confused clinically and/or histologically with basal cell carcinoma. Identification of the mixed epithelial and mesenchymal components, and the absence of epidermal connection and cleft within the stroma are important in differentiating this benign neoplasm from basal cell carcinoma.
Carcinoma, Basal Cell ; Epidermis ; Female ; Fibroma* ; Hair ; Humans ; Vulva