Coronary artery bypass grafting (CABG) without extracorporeal circulation (ECC) is now an accepted technique of myocardial revascularization in selective cases of coronary arterial occlusive disease. We experienced a case of CABG without ECC in a 20 year old female patient with complete occlusion of the right coronary artery. Anesthesia was induced and maintained with fentanyl, midazolam and isoflurane. Nitroglycerine and dopamine were given to stabilize the hemodynamics during intra- and post-operative periods. And esmolol was administered with a loading dose of 30 mg over 1 min, followed by a continuous infusion of 50~100 g/kg/min to maintain the heart rate (50~60 beats/min) and systolic blood pressure (60~80 mmHg) during distal anastomosis. The patient was recovered uneventfully and discharged on the 8th postoperative day.
Anesthesia* ; Arterial Occlusive Diseases ; Blood Pressure ; Coronary Artery Bypass* ; Coronary Vessels* ; Dopamine ; Extracorporeal Circulation ; Female ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Isoflurane ; Midazolam ; Myocardial Revascularization ; Nitroglycerin ; Young Adult

This study was undertaken to investigate the morphologic changes following flushing, preservation and reperfusion procedures in a canine lung allotransplantation model. Donor lungs were flushed with modified Euro-Collins (MEC) solution, low potassium dextran glucose (LPDG) solution or University of Wisconsin (UW) solution, then stored at 10oC for 20 hours. Light microscopic and electron microscopic features of the lungs were examined after flushing, preservation and 2 hours after reperfusion. After flushing light microscopy showed focal mild alveolar collapse and interstitial edema. After preservation the lung tissue showed multiple foci of alveolar collapse, consolidation, and alveolar epithelial cell damage. After reperfusion the lung tissue showed diffuse alveolar collapse, consolidation and many destroyed cellular debris in the alveolar lumina. After flushing electron microscopy showed focal alveolar collapse and mild swelling of type I epithelial cells. After preservation both type I epithelial cells and endothelial cells were swollen and destroyed focally. Some type I epithelial cells were detached from the basal lamina. The endothelial cells showed luminal protrusion of tactile-like structure and vacuoles of the cytoplasm. After reperfusion the lung tissue showed fibrin material in the alveoli, prominent type I epithelial cell swelling with fragmented cytoplasmic debris and marked endothelial cell swelling with vacuoles or tactile-like projections. The alveolar macrophages showed active phagocytosis. After preservation scanning electron microscopic examination of the pulmonary arteries showed multiple patchy areas of swelling or conglomerated lesions in the inner surface of the pulmonary arteries. In conclusion, the ultrastructural changes associated with flushing were mild in severity, the donor lungs were injured during the preservation, and further damage occurred during the reperfusion.
Basement Membrane ; Cytoplasm ; Dextrans ; Edema ; Endothelial Cells ; Epithelial Cells ; Fibrin ; Flushing ; Glucose ; Humans ; Lung Transplantation* ; Lung* ; Macrophages, Alveolar ; Microscopy ; Microscopy, Electron ; Perfusion* ; Phagocytosis ; Phenobarbital ; Potassium ; Pulmonary Artery ; Reperfusion* ; Tissue Donors ; Vacuoles ; Wisconsin

BACKGROUND: Serious pulmonary complications after lung surgery increase morbidity and mortality in perioperative period. Ketamine hydrochloride produces strong analgesic effect in spite of the psychomimetic effects. Intravenous anesthesia with ketamine was performed in lung surgery of patients with decreased pulmonary function and compared with inhalation anesthesia with enflurane. METHODS: Sixty patients, scheduled for elective lung surgery, were randomly assigned to two groups. Patients received either enflurane (Group 1, n=30) or ketamine (Group 2, n=30) as main anesthetic drug. Blood pressure and heart rate were compared in preinduction, postinduction, postintubation, postincision, intraoperative period (30 minutes, 60 minutes) and recovery room between groups, and in each group. Arterial blood gas analysis was compared in preoperative period, intraoperative period and recovery room between groups. Postoperative psychological complications evaluated in group 2. RESULTS: Blood pressure and heart rate were significantly different in postinduction, postintubation and recovery room between groups. PaO2 in group 2 was higher than in group 1 during intraoperative period and recovery room. Postoperative psychological complications occured in 4 patients (13%) in group 2. CONCLUSIONS: Ketamine affords advantage over enflurane anesthesia in terms of PaO2 during intraoperative period and recovery room in lung surgery of patients with decreased pulmonary function.
Anesthesia ; Anesthesia, Inhalation* ; Anesthesia, Intravenous* ; Blood Gas Analysis ; Blood Pressure ; Enflurane* ; Heart Rate ; Humans ; Inhalation* ; Intraoperative Period ; Ketamine* ; Lung* ; Mortality ; Perioperative Period ; Preoperative Period ; Recovery Room

Albinism is an inherited ongenital disarder in which there is sgr neralized decrease or absence of pigrnent in the eyes, skin, and hair. There are two general groups (1) Oculocutneou albinism, (2) Ocular albinism. Skin cancers in albinos are rare in ternperate clirnats and t.hey occur rnostly on sun ex posed areas. We present a case of recurrance of squarnous cell carcinoma ir a Korean albinoid on both sides of the neck and right ear. On liistopathologic examination, we find I or pearls, and irregular mases of epidermal cells that proliferite downward into the devmis. The invaing cell masses are composed of atypical squamous cells.
Albinism ; Albinism, Ocular ; Carcinoma, Squamous Cell* ; Ear ; Hair ; Neck ; Skin ; Skin Neoplasms ; Solar System

BACKGROUND: Due to the paucity of suitable donor organs for lung allotransplantation, a number of techniques have been developed to improve the lung preservation. Ultrastructural studies of the morphologic changes of the flushing, preservation and reperfusion injury in donor lungs have rarely been reported. METHODS: Adult dogs (n=46) were matched as donors and recipients for the single lung transplantation. The donor lungs were preserved after flushing with preservation solution and transplanted after 20-hours of preservation at 10degrees C. Ult rastructural features of the lung were examined after flushing, preservation and 2 hours after lung transplantation (reperfusion) respectively. RESULTS: Electron microscopy after flushing showed focal alveolar collapse and mild swelling of type I epithelial cells. After preservation both type I epithelial cells and endothelial cells were swollen and destroyed focally. The endothelial cells showed protrusion of tactile-like structure into the lumina, bleb or vacuole of the cytoplasm. After reperfusion the lung tissue showed fibrin material in the alveoli, prominent type I epithelial cell swelling with fragmented cytoplasmic debris and marked endothelial cell swelling with vacuoles or tactile-like projections. The alveolar macrophages showed active phagocytosis. Scanning electron microscopic examination of the pulmonary parenchyma showed focally alveolar collapse and focal consolidation after the preservation and more prominent changes after the reperfusion procedure. CONCLUSION: The ultrastructural changes associated with flushing were mild in severity, the donor lungs were injured during the preservation, and further damage was occurred during the reperfusion. The reperfusion injury resulted in prominent pulmonary parenchymal alterations with a pattern of acute lung injury.
Acute Lung Injury ; Adult ; Animals ; Blister ; Cytoplasm ; Dogs ; Endothelial Cells ; Epithelial Cells ; Fibrin ; Flushing* ; Humans ; Lung Transplantation ; Lung* ; Macrophages, Alveolar ; Microscopy, Electron ; Phagocytosis ; Reperfusion Injury ; Reperfusion* ; Tissue Donors ; Vacuoles

BACKGROUND: Due to the paucity of suitable donor organs for lung allotransplantation, a number of techniques have been developed to improve the lung preservation. Ultrastructural studies of the morphologic changes of the flushing, preservation and reperfusion injury in donor lungs have rarely been reported. METHODS: Adult dogs (n=46) were matched as donors and recipients for the single lung transplantation. The donor lungs were preserved after flushing with preservation solution and transplanted after 20-hours of preservation at 10degrees C. Ult rastructural features of the lung were examined after flushing, preservation and 2 hours after lung transplantation (reperfusion) respectively. RESULTS: Electron microscopy after flushing showed focal alveolar collapse and mild swelling of type I epithelial cells. After preservation both type I epithelial cells and endothelial cells were swollen and destroyed focally. The endothelial cells showed protrusion of tactile-like structure into the lumina, bleb or vacuole of the cytoplasm. After reperfusion the lung tissue showed fibrin material in the alveoli, prominent type I epithelial cell swelling with fragmented cytoplasmic debris and marked endothelial cell swelling with vacuoles or tactile-like projections. The alveolar macrophages showed active phagocytosis. Scanning electron microscopic examination of the pulmonary parenchyma showed focally alveolar collapse and focal consolidation after the preservation and more prominent changes after the reperfusion procedure. CONCLUSION: The ultrastructural changes associated with flushing were mild in severity, the donor lungs were injured during the preservation, and further damage was occurred during the reperfusion. The reperfusion injury resulted in prominent pulmonary parenchymal alterations with a pattern of acute lung injury.
Acute Lung Injury ; Adult ; Animals ; Blister ; Cytoplasm ; Dogs ; Endothelial Cells ; Epithelial Cells ; Fibrin ; Flushing* ; Humans ; Lung Transplantation ; Lung* ; Macrophages, Alveolar ; Microscopy, Electron ; Phagocytosis ; Reperfusion Injury ; Reperfusion* ; Tissue Donors ; Vacuoles

The stress distribution generated in the surrounding bone was calculated and compared for various geometry of the dental implants by means of the finite element methods. The models were designed to represent the screw type endosseous implants (varing the size, shape, direction of the screw thread and the angle of the body) with supporting bone and the cylinder type endosseous implants (varing the lower portion-Round type, tapered type) with supporting bone. Static mean bite forces were applied 100N vertically and 25N horizontally on the center of the implant and three dimensional finite analysis was undertaken using software ANSYS 5.1 Version. The result demonstrated that different implant shape leads to significant variations in stress distribution in the bone. In the case of variation of the screw size, direction and shape the implant model with normally directional and triangular screw implied lower stress than with upper directional or lower directional and quadrangular screw but among models a different screw size, within a variation of 0.2mm there was no meaningful difference in maximum stress. In the case of variation of angle of body the straight implied lower stress than the tapered. As a result of analysis of cylinder type, the implants with larger radius of curvature of the round form and larger diameter of the tapered form implied lower stress.
Bite Force ; Dental Implants ; Radius

Nevus lipomatosus cutaneous superficialis(NLCS) is a rare nevoiri anomaly characterized by ectopic adipose tissue in the dermis without predilection. In this disease two clinical types are distinguished: The classic type consists of asymptomatic linear or zosteriform coliection of soft, flesh colored to yellowish, papules or nodules that often coalesce into plaque. It is usually located in the pelvic girdle and lumbar area but has been repeted on the abdomen, thorax, thigh, and scalp. The solitary form usually appears later in life and can occur at any site. There is no sexurl irredilection or hereditary trend. There are no assoeiated abnor malities. The authors experienced three cases of typical NLCS including thia silitary type that had several solitary nodules irregularly. The first case was a 24-year-old female which has had multiple, flesh to dark brown-colored, confluent nodules over the left upper thigh for 5-years. The second case is the solitary type that a 56-year-old female has had discrete bean sized to what sized nodules on the right buttock for 13-years. The third case was a 23-year-old female who had soft, yellowish skin colored, cerebriform tumor on the right buttock for 10-yesrs. Diagnos was confirmed by clinical and histopathologic findings.
Abdomen ; Adipose Tissue ; Buttocks ; Dermis ; Female ; Humans ; Middle Aged ; Nevus* ; Scalp ; Skin ; Thigh ; Thorax ; Young Adult

To repair bony defects with transplanted bone in the body, fresh autogenous bone is undoubtly. A retrospective study was made of a consecutive patient who underwent mandibular reconstruction with PMCB and allogeneic mandibular crib in November 1996. Free autogenous iliac bone in the form of particulate cancellous bone and marrow was densely packed into the allogenous mandibular crib that was adapted to bridge the mandibular discontinuity defect. Freeze dried allogenous mandibular bone was traded by Wonkwang bone bank. Freeze dried allogenous mandibular bone was used as allogeneic crib carrying the PMCB. This case was undergone successful healing with the formation of a continuous bony union with the remaining mandible. The rate of resorption was assessed by sequeal panoramic radiographs, that is, a day of postoperative period, 3 months of postoperative period, 6 months of postoperative period, 12 months of postoperative period. The mean horizontal dimension of the mandibular defect was 58mm and the mean vertical dimension of the reconstructed segments was 30mm. The bony height reconstructed segments retained about 78% of the bony height of a 1-year period. We estimated that autogenous PMCB grafts and allogenous crib grafts were the most successful and esthetic grafts in mandibular discontinuity reconstruction.
Bone Banks ; Bone Marrow ; Humans ; Infant Equipment ; Mandible* ; Mandibular Reconstruction* ; Postoperative Period ; Retrospective Studies ; Transplants ; Vertical Dimension

The soleal line in 115 (left; 61, right; 54) cases of tibiae was studied morphometrically by the method of Mysorekar and Nandedkar. 1. The soleal line showed a uniform character throughout in 26 cases and a mixed characters in 89 cases. The bones showing uniform character were seen generally as a lineal line or wide line. 2. The soleal line having mixed characters divided into three parts. In the upper and middle thirds, the major type of line was wide line. In the lower third, the line was commonly seen as a lineal line. In about 12% of the bones examined the line was seen as a groove, particularly in the middle and lower thirds. 3. The soleal line commenced 1-2cm below the fibular facet In about 61% of cases. 4. The length of the soleal line was 10.5cm, and the ratio to that of the tibia was about 30%. The results of this study provide the characters of the soleal tne of the tibia in Korean. The soleal line, unlike the textbook description, generally shows mixed characters of a line.
Methods ; Tibia*