No abstract available.
Cerebrospinal Fluid* ; Child* ; Humans ; Meningitis* ; Oxidoreductases*

BACKGROUND: Electroconvulsive therapy (ECT) that works by electrically inducing grand mal seizure is an effective therapy for patients with major psychosis and affective disorders. But ECT may produce intense stimulation of the central nervous system resulting in hypertension and tachycardia. Such an acute hyperdynamic state may be undesirable because of possible cardiovascular complications. We compared the ability of different bolus doses of esmolol to blunt the hemodynamic effects of ECT. METHODS: Twenty ASA physical status 1~2 patients were enrolled in a crossover design study to determine the effects of two standard esmolol bolus doses (0.5 mg/kg and 1.0 mg/kg) on the hemodynamic response and seizure duration during ECT. In each patients receiving esmolol or placebo, arterial pressure, heart rate, seizure duration and peripheral oxygen saturation (SpO2) were recorded. RESULTS: The seizure duration with placebo was 43 +/- 9 sec, esmolol 0.5 mg/kg bolus dose was 39 +/- 14 sec and esmolol 1.0 mg/kg bolus dose was 39 +/- 12 sec, but it was not significant. Compared with esmolol 0.5 mg/kg bolus dose, esmolol 1.0 mg/kg bolus dose decreased blood pressure and heart rate during ECT more effectively. CONCLUSIONS: Esmolol 1.0 mg/kg bolus dose was considered to be the better dose in blunting the hyperdynamic response during ECT without shortening of seizure duration.
Arterial Pressure ; Blood Pressure* ; Central Nervous System ; Cross-Over Studies ; Electroconvulsive Therapy* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypertension ; Mood Disorders ; Oxygen ; Psychotic Disorders ; Seizures ; Tachycardia

This study was performed to observe the therapeutic effects of interferon-gamma(IFN-gamma) and gamma-globulin(gamma-globulin) in experimental Pneumocystis carinii pneumonia of immune suppressed mice. After 9 weeks, trimethoprim-sulfamethoxazole(TMP-SMZ; 10-50 mg/mouse/day), mouse IFN-gamma(5 x 10(4) units/mouse/day) and mouse gamma-globulin(20 mg/mouse/day) were administered to the mice for 3 weeks by the experimental group. The therapeutic efficacy was evaluated by body weights, histopathologic and electron microscopic findings of the lungs, and number of P. carinii cysts by Gomori's methenamine silver stain. Body weights of the mice were significantly increased in the group of combination therapy of TMP-SMZ with IFN-gamma or gamma-globulin, and in the group of TMP-SMZ treatment (p < 0.05), however, little effect was found in the group of gamma-globulin alone. Histopathologic findings of P. carinii pneumonia were much improved in the group of combination therapy of TMP-SMZ with IFN-gamma. Treatment with either TMP-SMZ or IFN-gamma significantly reduced the number of cysts in the P. carinii pneumonia, but gamma-globulin alone was ineffective. In electron microscopic findings of P. carinii pneumonia, the number of trophozoites and cysts were reduced by treatment with either TMP-SMZ or IFN-gamma, and most of the cysts were empty or containing one or two intracystic bodies. The present results suggested, that combination therapy of TMP-SMZ with IFN-gamma had synergistic effects in treatment of P. carinii pneumonia in experimental mice.
Drug-Synergism ; Drug-Therapy,-Combination ; English-Abstract ; Gamma-Globulins-administration-and-dosage ; Interferon-Type-II-administration-and-dosage ; Mice- ; Trimethoprim-Sulfamethoxazole-Combination-administration-and-dosage ; *Gamma-Globulins-therapeutic-use ; *Interferon-Type-II-therapeutic-use ; *Pneumonia,-Pneumocystis-carinii-therapy ; Gamma-Globulins ; Trimethoprim-Sulfamethoxazole-Combination ; Interferon-Type-II

BACKGROUNG AND OBJECTIVES: It was reported that low molecular weight heparin (LMWH) was more effective than unfractionated heparin in patients with acute coronary syndrome. Recent studies have shown that the pathophysiology of restenosis in stented lesions was different from those of nonstented lesions. Treatment strategies designed to limit cellular proliferation that were ineffective in nonstented lesions may be efficacious in reducing in-stent restenosis. This study was aimed to compare the clinical and angiographic results of LMWH (nadroparin) after coronary stenting with those of conventional ticlopidine regimen. MATERIALS AND METHODS: Patients were eligible for inclusion if they had angina and/or objective evidence of myocardial ischemia, and a significant (>50%) stenosis that was documented on a recent coronary angiogram. After stenting, prospective randomized comparison study was performed. Patients were randomly assigned to either nadroparin (200 IU/kg, sc, bid) or ticlopidine (250 mg bid) plus aspirin (200 mg qd) treatment groups. Repeat coronary angiography (KERN=*)was performed at 236+/-90days after stenting, and quantitative coronary angiographic analysis (QCA) was done. RESULTS: Intracoronary stent implantation was performed in eighty five lesions in eighty one patients (ticlopidine:40, nadroparin:41). There was no significant difference in any baseline clinical/angiographic variables between the two treatment groups. There were no subacute stent thrombosis, infarction and death in both groups. Six-month event-free survival was 36 (90%) in the ticlopidine group and 35 (85.4%) in the nadroparin group. Follow-up quantitative angiographic data such as late loss (1.35+/-0.70 vs 1.32+/-0.69), loss index (0.53+/-0.70 vs 0.56+/-0.23) and restenosis rate (36% vs 25.8%) were not different between ticlopidine and nadroparin groups. CONCLUSION: Effects of nadroparin were not different from those with ticlopidine therapy in the prevention of restenosis and subacute stent thorombosis after coronary stenting. Clinical outcomes between two strategies were similar. Low molecular weight heparin may be an alternative to ticlopidine in patients that ticlopidine cannot be administered because of severe adverse effects.
Acute Coronary Syndrome ; Aspirin ; Cell Proliferation ; Constriction, Pathologic ; Coronary Angiography ; Disease-Free Survival ; Follow-Up Studies ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Infarction ; Myocardial Ischemia ; Nadroparin* ; Prospective Studies ; Stents* ; Thrombosis ; Ticlopidine*

36 consecutive cases of major limbs replantation and 81 consecutive cases of finger replantation performed at Kyung Hee University Medical Center from Oct. 1975 through Sept. 1979 were reviewed. In 19 cases, amputation had occurred in wirst or palm. In 11 cases, amputation had occurred between forearm and shoulder. In 4 cases, amputation had occurred in thigh and leg. In 26 cases, amputation had occurred in thumb, and in 47 cases in index. The youngest was 4, the oldest was 52 in limb amputation, but from 5 through 38 in finger amputation. All amputed parts were cooled while awaiting replantation. Ischemic period was from 4 hours and 30 minutes to 29 hours and 35 minutes in limb amputation. And circulation was reestablished from 4 hours and 30 minutes to 29 hours and 35 minutes in limb replantation, and from 4 hours and 40 minutes to 15 hours and 10 minutes in finger replantation. In all cases bone was shortened from 2 to 5 cm in limb replantation, and from 0.3 to 0.8 cm in finger replantation and stabillzed by means of skeletal fixation. Dicision regarding primany repair of nerves and tendons depended upon the level and extent of local injury, but most cases performed primary repair. The success rate were 80.6% (29/36) in limb replantation, and 88.9% (72/81) in finger replantation respectively. Main cases of failure were thrombosis at anastomosed vessel, tissue crushing at distal part, and too long ischemic period. Surgical technique, type and level of amputation, number of artery and vein anastomosis, and ischemic period had direct relationship to success rate. But degree of amputation, patients age, infection in amputed part, and systemic heparinization had no relationship to success rate. In limb replantation, 25 cases were achieved follow up study from 6 months to 43 months. All cases except two were satisfied wlth replanted Iimbs, and were fully independent carrying out activities of daily living. All cases show cold intolerance. In finger replantation, 59 cases were achieved follow up study from 6 months to 47 months. All cases were satisfied wlth replanted digits, and used their replanted digits for grip, pinch, and hook. 46 cases (80%) had return of two polnt discrimination of less than 10 mm and useful finger Joint motion. Early and aggressive rehabilitation can be achieved good functional result in replanted limb and digit.
Academic Medical Centers ; Activities of Daily Living ; Amputation ; Arteries ; Discrimination (Psychology) ; Extremities ; Finger Joint ; Fingers ; Follow-Up Studies ; Forearm ; Fracture Fixation ; Hand Strength ; Heparin ; Humans ; Leg ; Rehabilitation ; Replantation ; Shoulder ; Tendons ; Thigh ; Thrombosis ; Thumb ; Veins

Sixteen microvasular free flap transfers have performed during recent two years in this department, which was first attempt in Korea. Neurovascular free flap was nine and vascular free flap was seven. The donor flaps were thirteen dorsalis pedls falps, two groin flaps and one latissimus dorsi flap respectively. The recipient sites were heel pad loss, vital organ exposure and scar contracture lesions in extremity. Their main cause of soft tissue defect was traumatic in all. All patients have experienced more than two times of split thickness skin graft before free flap transfer. The success rate of vascular free flap transfer was 94%. The only one failure case was due to venous thrombosis, but secondary split thickness skin graft performed with satisfactory result. The follow up period was from 5 months to 20 months. Sweating in transferred free flap was found at all neurovascular free flap within postoperative 4 months. Adequate 2-point discrimination was obtained at six patients of nine neurovascular free flaps and protective sensation seems to progressively improve in remained three patients. Two point discrimination was shortened at hand after neurovascular dorsalis pedis flap transfer in two cases. The weight bearing function at heel pad region and tactile sensation at hand have satisfactorily recovered after free flap transfer. Free flap transfer have many advantages compare to conventional skin graft, such as shorter therapeutic time, lesser physical and economic burdens, primary covering to vital organs and protective sensation of neurovascular free flap transfer. The most important factors are meticulous microvascular operation technique and anatomic knowledge.
Cicatrix ; Contracture ; Discrimination (Psychology) ; Extremities ; Follow-Up Studies ; Free Tissue Flaps ; Groin ; Hand ; Heel ; Humans ; Korea ; Microsurgery ; Sensation ; Skin ; Superficial Back Muscles ; Sweat ; Sweating ; Tissue Donors ; Transplants ; Venous Thrombosis ; Weight-Bearing

It is notoriously difficult to obtain a sound bony union of congenital paeudarthrosis of tbe tibia with conventional methods. This paper is the results of using the free vascularized fibular graft for congenital pseudarthorsis of the tibia in 7 patients since 1978 in this hospital, which is the first attempt in Korea. During the follow-up periods from 9 months to 32 months, 5/7 patients(71%) had good or excellent bony union, 2 patients had bone resorption at tbe distal site of grafted bone and required a second supplementary cancellous bone graft with electrode insertion. So it is thought that the free vascularized fibular graft is one of good methods of treatment for congenital pseudarthrosis of the tibia.
Bone Resorption ; Electrodes ; Follow-Up Studies ; Humans ; Korea ; Pseudarthrosis ; Tibia ; Transplants

It is notoriously difficult to obtain a sound bony union of large segmental bone defects secondary to trauma or following tumor resection, infected nonunion, congenital pseudarthrosis of the tibia, and avascular necrosis of the femoral head with conventional methods. Recent advances in microsurgery have made it possible to provide a continuing circulation of blood in bone grafts so as to ensure viability. With the nutrient blood supply preserved, healing of the graft to the recipient bone is facilitated without the usual replacement of the graft by creeping substitution. Thus, the grafted bone is achieved more rapid stabilization of bone fragments separated by a large defect without sacrificing viability. Thirty nine cases of the free vascularized fibular graft had been performed in the Department of Orthopedic Surgery, Kyung Hee University Hospital during the period of 3 years from October 1978 to December 1981. Of these, ll cases were congenital pseudarthrosis of the tibia, 4 cases were tuberculous spondylitis, 4 cases were infected nonunion, 7 cases were large segmental bone defects secondary to trauma, 9 cases were avascular necrosis of the femoral head and the other was one case. The results were obtained as follows: 1. The advantages of free vascularized living fibular graft are one stage procedure, resistance of torsion and angular stress, union with rapid hypertrophy of the graft, a shorter immobilization period and more rapid incorporation of the graft into the recipient area. 2. Free vascularized fibular graft can be widely used in the field of Orthopedic surgery. 3. The fibula is the bone best suited for reconstruction of a defect in a long bone. 4. In children, distal tibiofibular synostosis must be performed. 5. For prevention of clawing toe, the muscles around the bone is meticulously dissected, 6. Evaluation by selective arteriography and isotopic scanning both before and after operation may be used to assess the viability of the fibula graft.
Angiography ; Animals ; Child ; Fibula ; Head ; Hoof and Claw ; Humans ; Hypertrophy ; Immobilization ; Microsurgery ; Muscles ; Necrosis ; Orthopedics ; Pseudarthrosis ; Spondylitis ; Synostosis ; Tibia ; Toes ; Transplants

PURPOSE: In this study, we reviewed 16 cases of adrenalectomy, focusing specifically on the surgical outcomes and clinical courses.METHODS: The data from 16 patients who underwent an adrenalectomy at our hospital between January 2007 to December 2016 were retrospectively analyzed based on their medical records. Data available for each patient included age, sex, tumor location, length of postoperative hospital stay, tumor size, tumor pathology, final diagnosis, operation time, operative blood loss, and type of operation.RESULTS: The study population consisted of eight males and eight females, with a mean age of 58.00±11.34 years (range, 33–76 years). The mean tumor size was 2.78±2.02 cm (range, 0.5–7 cm). Fourteen patients were diagnosed with functional adrenal tumors and two with nonfunctional adrenal tumors. Compared to laparoscopic adrenalectomy, open surgery resulted in a statistically significantly longer operating time, increased operative blood loss, and a longer postoperative hospital stay.CONCLUSION: If the hormonal activity of adrenal tumors is not confirmed, the tumor should be considered functional when accompanied by related symptoms and an adrenalectomy should be performed. In addition, we suggest that a laparoscopic adrenalectomy is superior to an open adrenalectomy in terms of recovery after surgery, despite the small number of cases evaluated. Open adrenalectomy should be considered following comprehensive consideration of the patient's condition, such as accompanying surgery or metastatic cancer.
Adrenal Glands ; Adrenalectomy ; Diagnosis ; Female ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Male ; Medical Records ; Operative Time ; Pathology ; Retrospective Studies

No abstract available.
Hemochromatosis* ; Humans ; Renal Dialysis*