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*

The metallic failure is one of the annoying problems after fracture surgery. The seventeen cases of metallic failures after compression plate fixation were treated at the Department of Orthopaedic Surgery. Yonsei University Wonju College of Medicine between January, 1980 and December, 1988. The results were summerized as follows: l. Among 17 cases, 12(70.5%) were under 40 years of age and 14(80%) were male patients. 2. The sites of fracture of the seventeen cases; 12 femurs, 3 tibiae, and 2 radii. Of the cases, there were breakage of plates in 13 cases, bending 1 case and failure of screw in 3 cases. 3. The pattern of fracture: communited fracture
Femur ; Fractures, Bone ; Fractures, Open ; Gangwon-do ; Humans ; Incidence ; Male ; Osteoporosis ; Radius ; Tibia ; Transplants ; Weight-Bearing

The pedicle instrumentation has become a popular way of spinal fixation. Placement of a screw through the pedicle into vertebral body appears to be a very successful way to accomplish spinal fixation. However, the configuration of the pedicle morphometry must be understood. The measurement includes pedicle width, angle of pedicle axis to the transverse plane, ideal screw length, ideal screw entry point and ideal angle. This study was accomplished using computerized axial tomogram(CT) of 704 vertebrae(T10-L5). The results were as follows. 1. Transverse pedicle diameter were narrowest at T10, widest at L5. 2. The pedicle axis is oriented anteromedially at all levels except T11 and T12, then increase from L1 to L5. 3. Screw lengths are fairly constant between all levels, thus the range of screw lengths need is limited. 4. The incidence of pedicle less than 6 mm in the transverse diameter is most common at T10 and followed by levels L1, T12 and L2. Preoperative determination of transpedicular screw diameter and length can be made, by direct measurement from the patient's CT scan.
Incidence ; Thoracic Vertebrae ; Tomography, X-Ray Computed

PURPOSE: Evaluation of clinical and radiologic results of THR using HA-coated femoral stem. MATERIALS AND METHODS: From Jan. 1991 to Dec. 1992, we carried out 177 cases of Total Hip Arthroplasty using hydroxyapatite-coated implants of 167 patients, and among thses, 153 cases in 144 patients were followed up more than 24 months. The implants used were 74 cases of Mallory-Head Hip system, 41 cases of Omnifit system and 38 cases of Profile system. RESULTS: The average Harris Hip Score was 48.3 points preoperatively, 94.7 points at POD 1 year and 95.7 at POD 2 years. Seven patients(5.2%) complained thigh pain at POD 2 years. On the radiologic findings, cancellous condensation was noted around the hydroxyapatite coating region of femoral stem in 84 cases(54.2%), and radiolucent lines were noted at the non-coating region of distal stem in 102 cases(67.7%), but were less than 2mm and not progressive. There was no statistically significant differences among the groups of these three implants(P < 0.05). Comments : This early result of femoral stems with hydroxyapatite-coating was quite satisfactory, however, long-term follow-up studies will be necessary.
Arthroplasty, Replacement, Hip ; Durapatite ; Follow-Up Studies ; Hip ; Humans ; Thigh

Pigmented Bowen's disease (PBD) is a rare variant of Bowen's disease(BD). Most of the reported cases showed pigmented patches or thin plaques. Thus its clinical manifestations may simulated other various pigmented skin lesions. We experienced 2 cases of PBD in patients with multiple BD developed after taking Korean proprietary pills (KPP, "Hwan-Yak"), which were suspected to contain certain amount of arsenics. Both patients also showed arsenical keratosis on their palms and soles. The darker pigmentation of the PBL led us to differentiated them from melanoma.
Bowen's Disease* ; Humans ; Keratosis ; Melanoma ; Pigmentation ; Skin

PURPOSE: To evaluate the US findings of soft tissue hemangiomas in extremities and to correlate the echo-pattern with MR signal characteristics of hemangiomas. MATERIALS AND METHODS: We retrospectively studied forty-two patients either with pathologically proven cases or with characteristic features of hemangiomas on MRI, US and plain film. Hemangiomas were divided into two types according to the locations;subcutaneous and intramuscular. Analytic points on US and MR findings were gross morphology of the mass, internal echo-pattern or signal characteristics. We correlated the echo-pattern with MR signal characteristics in hemangiomas. RESULTS: Subcutaneous hemangiomas revealed homogeneously anechoic mass on US, which were well correlated with MR signal characteristics' homogeneous low singnal intensity(SI) on Tl-weighted image(WI) and high SI on T2-WI. Intramuscular hemangiomas showed heterogeneously mixed echoic masses on US. An anechoic component on US corresponded to dilated vascular channels on MRI. The signal intensity of intramuscular hemangioma was less than that of subcutaneous fat on T1-WI and greater than that of fat on T2-WI. Both types of hemangiomas had tubular or lace-like appearance with interspersed fibrofatty septa. CONCLUSION: The echo-patterns in US were well associated with MR signal characteristics on MRI. Regarding US and MR features, intramuscular hemangiomas were different to subcutaneous hemangiomas.
Extremities* ; Hemangioma* ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Subcutaneous Fat

OBJECTIVE: The purpose of this study was to evaluate the motor recovery of initial and plateau period in the patients with subcortical stroke lesion which were different locations. METHOD: We studied the 42 stroke patients with subcortical lesions who had been admitted to the Department of Rehabilitation Medicine from 1998 to 2000, retrospectively. Patients were divided into four groups according to the information from brain CT or MRI; Group 1: basal ganglia, group 2: anterior limb of internal capsule and/or basal ganglia, group 3: posterior limb of internal capsule and/or basal ganglia and group 4: thalamus only. Quantitative assessments of motor recovery using the Brunnstrom stage and results were correlated with sites of lesion. RESULTS: 1) Brunnstrom stages at initial and plateau period were the highest in the patients with thalamic lesion and the lowest in the patients with posterior limb of internal capsule and/or basal ganglia lesion. The patients with thalamic lesion showed higher stage than the patients with basal ganglia with anterior limb lesion in hand and low extremity (p<0.05). 2) Significant motor recovery was occurred in all patients except the lesion located in thalamus (p<0.05). CONCLUSION: There were significant differences of motor recovery at plateau period in the patients with thalamic lesions comparing with basal ganglia with anterior limb lesion about hands and lower extremities and patients with basal ganglia and/or capsular lesion showed good motor recovery.
Basal Ganglia ; Brain ; Extremities ; Hand ; Humans ; Internal Capsule ; Lower Extremity ; Magnetic Resonance Imaging ; Rehabilitation ; Retrospective Studies ; Stroke* ; Thalamus

No abstract available.
Humans

No abstract available.
Myocardial Infarction*

Transhiatal gastric transpositions were performed in two case of long gap esophageal atresia without tracheoesophageal fistula. The patients were a 12 months old female and an 18 months old male. Stamm type gastrostomies were performed at other hospitals in both cases. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. The proximal and distal esophageal pouches were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up to the neck through esophageal hiatus and posterior mediastinal route. The esophagogastrostomy, the only one anastomosis of this procedure, was performed in the neck. There was no clinical evidence of anastomotic leakage, stricture, regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. Transhiatal gastric transposition seems to be a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.
Anastomotic Leak ; Arteries ; Constriction, Pathologic ; Esophageal Atresia* ; Female ; Gastric Emptying ; Gastroepiploic Artery ; Gastrostomy ; Hoarseness ; Humans ; Infant ; Male ; Neck ; Spleen ; Stomach ; Tracheoesophageal Fistula