No abstract available.
Glucose* ; Humans ; Infant, Newborn*

Conjoined twins occur when there is imcomplete fission of the inner cell mass later at approximately 13 to 15 days after fertilization. The earlist case in the literat.ure appears to be that of the Biddenden Maids who were born in England in 1100. since then over two hundred cases of successful separation were reported on literature. And also successful separation cases were reported by Seung et al.(1991) in Korea. Conjoined twins occur between one in 50,000 to 100,000 births but real incidence is one in 200,000 because two thirds are stillbirth or died immediately after birth. The conjoined twins are not associated with maternal age, race or family history and 70 % of them are females. We experienced a case of conjoined twins with omphalopagus and performed surgical separation. A brief review of related literatures was done.
Animals ; Continental Population Groups ; England ; Female ; Fertilization ; Humans ; Incidence ; Korea ; Maternal Age ; Murine Acquired Immunodeficiency Syndrome ; Parturition ; Stillbirth ; Twins, Conjoined*

Rhabdomyolysis has been reported as a cause of acute renal failure (ARF), and it can arise from traumatic and variable non-traumatic events. Rhabdomyolysis-induced ARF is very rare in children. We experienced a case of rhabdomyolysis-induced ARF in a 14-year-old boy who presented with generalized edema and oliguria following trauma, a compressed thigh by a cultivator. Laboratory tests showed marked elevation of muscle enzymes (aspatate aminotransferase, creatine kinase and lactate dehydrogenase), increased serum and urine myoglobin, and other laboratory abnormalities showing ARF. Ten days after continuous arteriovenous hemofiltration using catheterization of the femoral artery and vein, the daily urine output gradually increased and he recoverd. We report this case with brief review of literature.
Acute Kidney Injury* ; Adolescent ; Catheterization ; Catheters ; Child* ; Creatine Kinase ; Edema ; Femoral Artery ; Hemofiltration ; Humans ; Lactic Acid ; Male ; Myoglobin ; Oliguria ; Rhabdomyolysis ; Thigh ; Veins

BACKGROUND: Infants are very different from children and adults in the point of anatomy, physiology, pharmacology and psychology. The mortality rate of infant anesthesia is higher than that of child and adult. So that this study is to analyze the infant's operation and to recognize the tendency and problems of infant's anesthesia and also to improve the outcome. METHODS: A retrospective analysis was performed on 1436 infants who had operations from april 1987 to february 1995 according to age, sex, department, disease, operation time, postoperative complications, mortality rate and anesthetic method. RESULTS: Total number of operation tend to increase annually. The male to female ratio was 67.5% to 32.5%. The distribution of patients by department was 60.6% of general surgery, 21.0% of plastic surgery and small percentage of other department. The distribution of disease was the following : inguinal hernia - the most common; cleft lip and palate, intussusception and others. The postoperative complications developed in 98 of 1436. The most common complication was the respiratory problems, the others were sepsis, electrolyte unbalance, gastrointestinal and CNS problems. The total mortality rate was 3.6%. The emergency operation case was 17.9%. CONCLUSIONS: The most common distribution of age was neonate and the most commm department was general surgery and the most common disease was inguinal hernia. The most common postoperative complication was respiratory problems and the second was infection and sepsis. The mortality rate in preterm infant, neonate, emergency operation and long duration operation was higher than total motality rate.
Adult ; Anesthesia* ; Child ; Cleft Lip ; Emergencies ; Female ; Hernia ; Hernia, Inguinal ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intussusception ; Male ; Mortality ; Palate ; Pharmacology ; Physiology ; Postoperative Complications ; Psychology ; Retrospective Studies* ; Sepsis ; Surgery, Plastic

BACKGROUND: Infants are very different from children and adults in the point of anatomy, physiology, pharmacology and psychology. The mortality rate of infant anesthesia is higher than that of child and adult. So that this study is to analyze the infant's operation and to recognize the tendency and problems of infant's anesthesia and also to improve the outcome. METHODS: A retrospective analysis was performed on 1436 infants who had operations from april 1987 to february 1995 according to age, sex, department, disease, operation time, postoperative complications, mortality rate and anesthetic method. RESULTS: Total number of operation tend to increase annually. The male to female ratio was 67.5% to 32.5%. The distribution of patients by department was 60.6% of general surgery, 21.0% of plastic surgery and small percentage of other department. The distribution of disease was the following : inguinal hernia - the most common; cleft lip and palate, intussusception and others. The postoperative complications developed in 98 of 1436. The most common complication was the respiratory problems, the others were sepsis, electrolyte unbalance, gastrointestinal and CNS problems. The total mortality rate was 3.6%. The emergency operation case was 17.9%. CONCLUSIONS: The most common distribution of age was neonate and the most commm department was general surgery and the most common disease was inguinal hernia. The most common postoperative complication was respiratory problems and the second was infection and sepsis. The mortality rate in preterm infant, neonate, emergency operation and long duration operation was higher than total motality rate.
Adult ; Anesthesia* ; Child ; Cleft Lip ; Emergencies ; Female ; Hernia ; Hernia, Inguinal ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intussusception ; Male ; Mortality ; Palate ; Pharmacology ; Physiology ; Postoperative Complications ; Psychology ; Retrospective Studies* ; Sepsis ; Surgery, Plastic

This study was desinged for compare the efficacy of ephedrine infusion that of crystalloid administration in reducing the incidence of hypotension during spinal anesthesia. Sixty ASA 1 and 2 patients scheduled for transurethral prostatic resection and lower extremity surgery under spinal anesthesia were ramdomly allocated to receive either 15 ml/kg crystalloid (crystalloid group) or an ephedrine infusion (infusion group). Spinal anesthesia was performed using 12-14 mg of 0.4% tetracaine. Analgesic sensory level was T10 in both groups, Thirty patients in the crystalloid group received crystalloid solution (Ringer'lactate solution, 15 ml/kg) within 20 min prior to induction of spinal anesthesia. Thirty patients in the infusion group immediately after induction spinal anesthesia received ephedrine infusion at a rate 5 mg/ min for the first 2 min and then 1 mg/min for the next 18 min. Cardiovascular responses (systolic blood pressure and heart rate) and complications (hypotension, nausea and vomiting) after induction of spinal anesthesia were compared and results were as follows; 1) The incidence of hypotension was ll/30 (36%) in the crystalloid group and 3/30 (10%) in the infusion group (p<0.001). 2) Systolic blood pressure after induction of spinal anesthesia in the crystalloid group significantly decreased from 5 min to 20 min as compared to the infusion group (p<0.05). But, systolic blood pressure did not decrease siginificantly until 9 min after spinal anesthesia in the infusion group. 3) The mean heart rate after induction of spinal anesthesia in the crystalloid group significantly increased at 1 min as compared to infusion group; thereafter, there was no significant difference between the two groups. 4) The incidence of nausea and vomiting was 1/30 in the crystalloid group and 0/30 in the infusion group; The difference between the two groups was not significant. 5) Reactive hypertension or tachycardia did not occur in either group. Considering above results, we conclude that a prophylactic ephedrine infusion is effective for minimizing and managing hypotension associated with spinal anesthesia.
Anesthesia, Spinal* ; Blood Pressure ; Ephedrine* ; Heart ; Heart Rate ; Humans ; Hypertension ; Hypotension* ; Incidence ; Lower Extremity ; Nausea ; Tachycardia ; Tetracaine ; Vomiting

PURPOSE: Central venous catheters are used to deliver antibiotics, chemotherapeutic agents, and parenteral nutrition for a extended period of time as well as to draw samples in immunocompromised patients to minimize the discomfort with sampling and the risk of introducing infections. Hickman/Broviac catheters or implantable devices have been used in pediatric patients. This study is aimed to evaluate the safety and clinical efficacy of subclavian catheterization which has advantages of low cost without need of general anesthesia or skillful surgeon. METHODS: Between August 1994 and October 1995, subclavian venous catheters were inserted in 22 patients. The age ranged from 3 months to 17 years (median 9 years 5 months). Patients weight ranged from 5.7kg to 57.0kg (median 27.5kg). Nineteen patients had various malignancies. Arrow multi-lumen/ two-lumen central venous catheters were used. Without general anesthesia, pediatricians inserted the subclavian catheters by blind puncture at bedside after administering 0.035mg/kg of midazolam and 0.05mg/kg of morphine sulfate. Emla cream was applied at the puncture site one hour prior to the procedure. We retrospectively evaluated the patient characteristics and complications associated with catheter placement and maintenance. RESULTS: The median duration of catheter placement was 53 days, with a range of 6 to 175 days. In early series, 2 cases of pneumothorax and a case of hemothorax occured during the catheter insertion. Occlusion and infection of catheters occured in 11 and 6 patients, respectively. Twenty catheters were removed: no need to continue, 7; patient death, 4; inadvertent removal, 4; complete occlusion 3 and 2 cases of catheter-related infections. CONCLUSIONS: Subclavian catheterization is a safe, cost-effective, easy-to-perform technique of providing long-term venous access which can be done by pediatrician at bedside without the risk of general anesthesia.
Anesthesia, General ; Anti-Bacterial Agents ; Catheter-Related Infections ; Catheterization* ; Catheters* ; Central Venous Catheters ; Hemothorax ; Humans ; Immunocompromised Host ; Midazolam ; Morphine ; Parenteral Nutrition ; Pneumothorax ; Punctures ; Retrospective Studies

Maxillofacial injuries are less common in children than in adolescents and adults. This lower incidence is a result of the relatively small size of mandible, the resilient nature of the bones, and a relatively protected environment, which distinguish the treatment principles of pediatric mandibular fractures from those of the adult. The bone of child is malleable, so pediatric fractures tend to be less displaced and rarely comminuted. Moreover, high regeneration potential of the wound allows more conservative treatment modalities for the pediatric mandibular fracture. High risk of damaging unerupted tooth bud renders many clinicians to resort to more conservative treatment modality for the reduction of displaced segments. This case report describes two successful treatment cases using the circummandibular wiring which was applicated to the fracture on parasymphysis of mandible. Circummandibular wiring can protect the tooth buds, and there is no need for intermaxillary fixation so that it prevents the possible complications of intermaxillary fixation such as the temporomandibular joint ankylosis and the facial growth disturbances. The acrylic splint was removed after 3 weeks, which showed clinically good union across the fracture line without complications. They showed complete clinical and radiological bone healing with an optimum occlusion.
Adolescent ; Adult ; Ankylosis ; Child ; Health Resorts ; Humans ; Incidence ; Mandible ; Mandibular Fractures ; Maxillofacial Injuries ; Regeneration ; Splints ; Temporomandibular Joint ; Tooth ; Tooth, Unerupted

No abstract available.
Herpes Simplex* ; Simplexvirus*

OBJECTIVES: Since Mountain proposed the new staging system of non-small cell lung cancer in 1986, the indications for operation of NSCLC have been extended. However, operative mortality is from 3 to 6%. Therefore it is important to reduce unnecessary operation and to evaluate unresectability of tumor correctly, preoperatively The purpose of this study is to find out the causes of unresectability in patients who were initially thought to be resectable preoperatively. METHODS: By retrospective analysis, 64 patients out of 291 NSCLC patients who were undergone operation for curative resection in Seoul National University Hospital from Jan. of 1987 to Dec. of 1991, ware found to be unresectable at operating roost were selected for this study. Out of 64 patients,42 were evaluable. The analysis was focused on the change of pre- & post-operative staging and the causes of unresectability of tumors. RESULTS: Among B2 patients with unresectable tumor who could be evaluated, preoperative CT finding showed resectable tumors in 55% (23 patients) and suspicious for unresectable tumors in 45% (19 patients). The causes of unresectability were technically unresectable T3 lesions in 7% (3 patients), T4 lesions in 62% (26 patients), N2 lesions in 17% (7 patients) and N3 lesions in 14% (6 patients). CONCLUSION: The major causes of unresectability of NSCLC were pulmonary artery invasions. It is suggested that careful evaluation of mediastinal structure, especially great vessels by additional imaging technique other than CT (like MRI) is indicated in selected NSCLC cases.
Carcinoma, Non-Small-Cell Lung* ; Humans ; Mortality ; Pulmonary Artery ; Retrospective Studies ; Seoul