The final degrees of education for the third and fourth authors were mutually misplaced.

We report a case of cardiac arrest in a 71 year old male during the Valsalva maneuver that had been performed immediately after completing a pneumonectomy. The patient had a subclinical atrial septal defect (1.08 cm sized) and he previously undergone a left upper lobectomy of the lung without complications 11 months earlier. He underwent a left completion pneumonectomy due to recurrent lung cancer. After surgery a Valsalva maneuver was performed with 35 cmH2O to relocate the mediastinum. During this procedure, the patient experienced a cardiac arrest and was resuscitated with difficulty. It is believed that the cardiac arrest was due to pulmonary hypertension, right ventricular failure and right to left shunt caused by several factors, such as the pneumonectomy, subclinical atrial septal defect (1.08 cm sized), and Valsalva maneuver. In addition, the hypovolemia caused by fluid restriction and the epidural injection of local anesthetics might have contributed to this incident. Although it is a rare complication, it is suggested that subclinical ASD can cause severe hypoxemia, dyspnea even cardiac arrest after pneumonectomy. In order to avoid these complications, ASD should be treated with percutaneous closure or surgical intervention. If these are not possible, care must be taken when anesthetizing the patient, and anything that can increase the pulmonary vascular resistance and right to left shunt should be avoided.
Anesthetics, Local ; Anoxia ; Dyspnea ; Heart Arrest ; Heart Septal Defects, Atrial ; Humans ; Hypertension, Pulmonary ; Hypovolemia ; Injections, Epidural ; Lung ; Lung Neoplasms ; Male ; Mediastinum ; Pneumonectomy ; Valsalva Maneuver ; Vascular Resistance

PURPOSE: We compared the clinical efficacy of Therasonic LTS (piezoelectric type) with that of SDS-5000 (spark gap type) for the management of urinary stones. MATERIALS AND METHODS: We evaluated 516 patients treated with Therasonic LTS, between June 1996 and April 2001, and 314 treated with SDS-5000 between September 2001 and January 2003. We compared the average success rates and shock wave sessions according to the stone sizes and locations, and also verified the complications related to the therapies. RESULTS: The total success rates of Therasonic LTS and SDS-5000 were similar (92.6 and 94.6%, respectively), with no difference according to stone location and size. However, the average shock wave sessions were significantly lower in the group treated with SDS-5000 (2.5 1.8 sessions) compared to the group treated with Therasonic LTS (3.1 1.9 sessions) (p<0.05). The cumulative success rates were 64.3 and 77.1%, respectively, at the completion of session 3, and 82.2 and 88.2%, respectively, at the completion of session 5. The complication rates associated with the therapies were 8.9 and 6.9%, respectively, consisting of pain, gross hematuria, steinstrasse and acute pyelonephritis, most of which were successfully controlled by conservative treatment. CONCLUSIONS: SDS-5000 lithotripsy is more efficient than Therasonic LTS in terms of shock wave sessions.
Calculi ; Hematuria ; Humans ; Lithotripsy ; Pyelonephritis ; Shock ; Urinary Calculi* ; Urinary Tract

Patients suffering from idiopathic or self-induced edema are uniformly characterized by chronic use of furosemide, which leads to vicious cycle of edema. Among chronic furosemide users who don't have any other specific edema forming diseases, 9 patients from the outpatient clinic(OC) and 6 patients examined at the emergency room(ER) used it mainly for weight reduction and for cyclical edema, respectively. All of the ER group patients were presented with severe hypokalemia(2.04+/-0.2mEq/L; range 1.3 to 2.7 mEq/L) and alkalosis(748+/-0.01; range 7.44 to 7.51) but none from the OC group showed such results. Other baseline parameters including Plasma renin activity(PRA) and aldosterone level on recumbency, and FEn(2)were similar in both groups. In contrast, daily working hours(6.1+/-0.5 vs 10+/-0.6hr, p<0.01), average body weight gain between AM and PM(0.4+/-0.1 vs 0.9+/-0.lkg, p<0.01), peak weight gain interval(9+/-0.8 vs 5+/-0.1day, p<0.05), PRA(7.6+/-1.5 vs 23.5+/-7.2ng/ml/h, p<0.05) and aldosterone level(22.1+/-4.2 vs 64.8+/-10.4 ng/dl, p<0.01) on ambulation, and FEk. on normokalemia(ll+/-2A vs 36+/-7.7%, p<0.01) were statistically different between the two groups. In comparison to the OC group, both the amout of urine(617+/-39 vs 358+/-26ml, p<0.01) and the percent change of PRA(-14+/-4 vs -3+/-2%, p<0.05) and al-dosterone level(-17+/-5 vs -4+/-3%, p<0.05) after saline loading(lL over 1hr, IV) following ambulation were smaller in the Elt group. Moat of the ER group patients(5/6) required aldosterone antagonist (spironolactone) added to K+ supplement, but all of the OC group patients were managed to maintain an edema-free status with conservative treatment. In conclusion, patients with idiopathic edema seem to have more fluid transudation out of intravascular space during orthostasis with a prominent degree of deranged renin-aldosterone axis and K+ metabolism than those with self-induced edema.
Aldosterone ; Axis, Cervical Vertebra ; Body Weight ; Dizziness ; Edema* ; Emergencies ; Furosemide* ; Humans ; Metabolism ; Outpatients ; Plasma ; Renin ; Walking ; Weight Gain ; Weight Loss

Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder characterized by innumerable bilateral renal cysts. It has an prevalence rate of one in 200~1,000 individuals and is a relatively common cause of renal failure. As renal function deteriorates, overall renal size usually diminish in patients with chronic renal failure. However, renal size of patients with ADPKD usually continues to increase, even after the initiation of dialysis therapy, because numerous cysts replace renal mass. Attempted methods to reduce the size of enlarged kidneys have included needle aspiration and sclerotherapy, cyst decompression surgery, laparoscopic and surgical nephrectomy. The outcome of these therapy frequently has been suboptimal, and there is a need to develop a more effective therapy. We report a case of renal arterial embolization using 99% ethanol and lipiodol mixture for ADPKD in a hemodialysis pathient, which has not been previously reported.
Decompression ; Dialysis ; Ethanol* ; Ethiodized Oil* ; Humans ; Kidney ; Kidney Failure, Chronic ; Laparoscopy ; Needles ; Nephrectomy ; Polycystic Kidney, Autosomal Dominant* ; Prevalence ; Renal Dialysis* ; Renal Insufficiency ; Sclerotherapy

Paravalvular abscess is a serious complication of infective endocarditis. The aortic valve and its adjacent ring are more susceptible to abscess formation and paravalvular extension than the mitral valve. A 15-years old patient with bicuspid aortic valve presented with staphylococcal tricuspid valve endocarditis complicated by para-aortic abscess that ruptured into the aortic sinus. We report the clinical, laboratory and echocardiographic features and treatment of this patient and conduct a literature review on this subject.
Abscess ; Aortic Valve ; Bicuspid ; Endocarditis ; Heart Valve Diseases ; Humans ; Mitral Valve ; Sinus of Valsalva ; Tricuspid Valve

In our previous study, we demonstrated that immobilization stress blocked estrogen-induced luteinizing hormone(LH) surge possibly by inhibiting the synthesis and release of gonadotropin-releasing hormone (GnRH) at the hypothalamic level and by blocking estrogen-induced prolactin (PRL) surge by increasing the synthesis of dopamine receptor at the pituitary level in ovariectomized rats. The present study was performed to determine whether immobilization stress affects pituitary LH responsiveness to GnRH, and whether endogenous opioid peptide (EOP) and dopamine systems are involved in blocking LH and PRL surges during immobilization stress. Immobilization stress was found to inhibit basal LH release and to completely abolish LH surge. However, the intravenous application of GnRH agonist completely restored immobilization-blocked LH surge and basal LH release. Treatment with naloxone did not exert any effect on immobilization-blocked LH surge but increased basal LH release during immobilization stress. Pimozide did not affect immobilization-blocked LH surge or basal LH release. Naloxone also decreased immobilization-induced basal PRL release, but had no effect on immobilization-blocked PRL surge. Immobilization-increased basal PRL levels were augmented by pimozide treatment and immobilization-blocked PRL surge was dramatically restored by pimozide. We conclude that immobilization stress does not impair pituitary LH response to GnRH, and that the immobilization stress-induced blockage of LH surge is probably not mediated by either the opioidergic or the dopaminergic system. However, immobilization-blockade of PRL surge may be partly mediated by the dopaminergic system.
Animal ; Estradiol/*pharmacology ; Female ; Gonadorelin/*pharmacology ; Immobilization ; Luteinizing Hormone/*secretion ; Naloxone/pharmacology ; Opioid Peptides/physiology ; Ovariectomy ; Prolactin/*secretion ; Rats ; Rats, Sprague-Dawley ; Receptors, Dopamine/physiology ; Stress/*metabolism

OBJECTIVE: The purpose of this study was to assess rotational patterns of dentofacial structures according to different vertical skeletal patterns by cone-beam computed tomography (CBCT) and analyze their influence on menton deviation in skeletal Class III deformity with mandibular asymmetry. METHODS: The control group consisted of 30 young adults (15 men, 15 women) without any severe skeletal deformity. The asymmetry group included 55 adults (28 men, 27 women) with skeletal Class III deformity and at least 3-mm menton deviation from the midsagittal plane; it was divided into the hyperdivergent and hypodivergent subgroups using a mandibular plane angle cutoff of 35degrees. Fourteen rotational variables of the dental arches and mandible were measured and compared among the groups. Correlations between menton deviation and the other variables were evaluated. RESULTS: The asymmetry group showed significantly larger measurements of roll and yaw in the mandible than the control group. The hypodivergent subgroup showed significant differences in maxillary posterior measurements of yaw (p < 0.01) and maxillary anterior shift (p < 0.05) compared with the hyperdivergent subgroup. All the mandibular measurements had significant correlations with menton deviation (p < 0.01). Most measurements of roll were positively correlated with one another (p < 0.01). Measurements of yaw and roll in the posterior regions were also positively correlated (p < 0.05). CONCLUSIONS: Menton deviation in skeletal Class III deformity with mandibular asymmetry is influenced by rotation of mandibular posterior dentofacial structures. The rotational patterns vary slightly according to the vertical skeletal pattern.
Adult ; Cone-Beam Computed Tomography* ; Congenital Abnormalities* ; Dental Arch ; Facial Asymmetry ; Humans ; Male ; Mandible ; Young Adult

We report an unusual case of multiple glomangioma showing the histopathologic findings of focal leiomyomatous component. A 23-year-old man complained of multiple, bluish, soft nodules, 0.5 to 2cm in diameter, which were distr ibuted on the back and both upper limbs. Histologic examination revealed some foci composed of spindle-shaped smooth muscle cells with abundant eosinophilic cytoplasm and blunt ended nuclei as well as cells with features intermediate between glomus cells and fully differentiated myocytes. It was confirmed by immunohistochemical and ultrastructural studies.
Cytoplasm ; Eosinophils ; Glomus Tumor* ; Humans ; Leiomyoma* ; Muscle Cells ; Myocytes, Smooth Muscle ; Upper Extremity ; Young Adult

PURPOSE: The aim of this study was to clarify the clinicopathological differences between T1N1M0 and T2N0M0, particularly the survival rates, and the role of chemotherapy in the stage Ib gastric cancer. METHODS: From January 1992 to December 1999, 118 cases were confirmed as having stage Ib gastric cancer in the Korea University Medical Center. Among them 31 patients were classified as being T1N1M0 and the other 87 cases were T2N0M0. The clinicopathological features and the prognosis were evaluated retrospectively. RESULTS: The overall 5-year survival rate of the stage Ib gastric cancer patients was 94%. Overall 5-year survival rates in T1N1M0 and T2N0M0 were 100% and 91%, respectively. Though T1N1M0 group showed better prognosis, there was no significant difference between two groups (P=0.14). D1, D2, and D2+alpha resections were performed in 28 cases (23.7%), 81 (68.6%), and 9 (7.6%), respectively, and there was no difference in the survival rate (P>0.05). The 5-year survival rates were analyzed according to whether or not they had received chemotherapy. There was a 98% 5-year survival rate with those who had chemotherapy and a 90% 5-year survival rate with those who had not had chemotherapy, but there was no significant difference between them (P=0.18). In the T2N0M0 group, the 5 year survival rates of patients with or without chemotherapy were 97% and 86%, respectively, but there was no significant difference (P=0.16). CONCLUSION: Though T1N1M0 group showed a better prognosis than the T2N0M0 group, there was no significant difference between the two groups (P=0.14). There was no significant survival difference between D1, D2, or D2+alpha procedures. It appears that post operative intravenous chemotherapy does not affect the prognosis of stage Ib gastric cancer, and the role of the chemotherapy in patients with T2N0M0 diseases is minimal.
Academic Medical Centers ; Drug Therapy ; Humans ; Korea ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate