Primary carcinoma of the bile duct is uncommon but not rare and its prognosis is poor even though long-termsurvival had been reported. The authors presented 62 cases of bile duct cancer, which were confirmed at YUMC fromJan. 1971 to Dec. 1981. The results were as follows; 1. The most prevalent age group was 6th decade and a male-tofemale ratio was 1.9:1. 2. Jaundice was the most common clinical manifestations(84%), and followed by right
Bile Duct Neoplasms ; Bile Ducts ; Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Diagnosis ; Dilatation ; Hepatomegaly ; Humans ; Jaundice ; Prognosis ; Ultrasonography

The authors report a case of thoracic outlet syndrome in left side. Thoracic outlet syndrome is a collective term in which symptoms and signs are due to bony and soft tissue compression of the neurovascular bundle at the thoracic outlet. It is a rare case in neurosurgical field. So we had experienced one case of thoracic outlet syndrome which was improved by transaxillary approach for resection of first rib. The clinical features, diagnostic test, radiological findings, and operative technique are presented with review of literatures.
Brachial Plexus ; Diagnostic Tests, Routine ; Ribs* ; Thoracic Outlet Syndrome*

BACKGROUND: Pacing-induced atrial electrical remodeling (AER) is characterized by shortening of atrial effective refractory period (A-ERP) and its altered rate adaptation. In paroxysmal atrial fibrillation (AF), periods of AF occur with interveneing normal sinus rhythm (NSR) when atria recover from the preceding AER. Previous episodes of AF may precondition the atrial myocardium and cause different time course of AER in subsequent episodes of AF. But the influence of the preceding AER on the subsequent AER has not been described. METHODS: Four mongrel dogs were anesthetized with enflurane. After thoracotomy, silicon band with 3 pairs of electrodes was sutured to the lateral wall of the left atrium. Atrial pacing was performed after 2 wks of recovery and autonomic blockade. Pacing protocol consisted of rapid atrial pacing (RAP) at 500 bpm (for 60 min) and recovery in NSR (for 60 min) which was repeated three times. A-ERP was measured every 10 min. The same pacing protocol was repeated after pretreatment with verapamil (0.1 mg/kg/hr). RESULTS: 1) With 60 min of RAP, A-ERP decreased significantly (126+/-6 ms vs. 105+/-7 ms, p<0.005). 2) After cessation of pacing, A-ERP returned to 98% of baseline value in 15 minutes. Recovery from AER occurred faster than AER (78 vs 21 ms/h). 3) After pretreatment with verapamil, RAP decreased A-ERP from 127+/-5 ms to 116+/-5 ms. AER, the reduction in A-ERP, was significantly attenuated by pretreatment with verapamil (deltaERp=17+/-7 vs. 9+/-0.2 %, p<0.05). 4) When RAPs were repeated, AER showed a tendency of acceleration, but it was not statistically significant (deltaERp=22 ms, 24 ms, 28 ms at the end of 60 min pacing for the 1st, 2nd, 3rd pacing). CONCLUSION: RAP induced AER in conscious dog atria and it was reduced by pretreatment with calcium channel blocking agent, verapamil. Upon repeated atrial stimulations, AER did not accelerate or decelerate when the atria recovered from the preceding AER.
Acceleration ; Animals ; Atrial Fibrillation ; Atrial Remodeling* ; Calcium ; Calcium Channels ; Dogs* ; Electrodes ; Enflurane ; Heart Atria ; Myocardium ; Silicones ; Thoracotomy ; Verapamil

Endotracheal intubation is the most useful and safe method to keep airway in general anesthesia. But there are many problems such as severe cardiovascular changes, difficult intubation, larygospasm and tracheal stenosis in using laryngoscope and tracheal intubation. Laryngeal mask airway(LMA) is new method to keep airway and has many advantages such as easy insertion, decreasing cardiovascular changes, insertion without muscle relaxant, decreasing damage of pharynx and laynx and useful in difficult intubation. Cinical study of LMA No. 2 was done in 30 children weighted between 8.9-26 kg, about cardiovascular changes, volume and pressure changes of inflaton cuff, problems and complications during insertion and maintaining of LMA. The result, were follows I) The average time taken to insert the LMA was 7.4+/-3.3 second and 12 case were correct placement at the second attempt to use laryngoscope. 2) The volume of inflation cuff without air leak during positive pressure ventilation with 15cmH2O of peak airway pressure was 7.9+/-0.5ml and inflation cuff pressure at insertion was 40.1+/-15.9 mmHg and increased(p<0.05) continously. 3) Mean arterial pressure was increased(p<0.05) compared with preinduction value and normalize within a minute. Heart rate was incresed(p<0.05) compared with preinduction value and increase was sustained. 4) There were no complications except 1 case of gastric disteesion.
Anesthesia, General ; Arterial Pressure ; Child* ; Heart Rate ; Humans ; Inflation, Economic ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks* ; Laryngoscopes ; Pharynx ; Positive-Pressure Respiration ; Tracheal Stenosis

BACKGROUND: Many autopsy studies have shown that the extent of extracranial carotid and coronary artherosclerosis is correlated and B-mode ultrasonographic intima-media thickness(IMT) and histologic IMT have been good correlation. In recent years. as it has been reported that IMT of carotid artery had something to do with risk factors of atherosclerosis and occurrence of coronary artery disease, in this study, we tried to investigate if the grade of atherosclerosis in B-mode ultrasonography of carotid artery could predict coronary artery disease and have something to do with the severity of coronary artery disease. METHODS: We classified the patients who were examined coronary angiography into control group without significant(>50%) stenosis(11 patients) and coronary artery disease(CAD) group(45 patients) according to the existence of significant stenosis, and we subdivided CAD group into single vessel disease(SVD) group(25 patients) and multivessel disease(MVD) group(20 patients). Practicing B-mode ultrasonography of common carotid artery(CCA), carotid artery bifurcation(BIF) and internal carotid artery(ICA), we measured IMT and IMT/L(lumen diameter) of each segment. Adding all values of each segment, we got mean aggregated IMT and mean aggregated IMT/L. RESULTS: 1) As IMT of left BIF in both six segments, control group was 0.55+/-0.16mm, SVD group was 0.71+/-0.36mm and MVD group was 1.02+/-0.61mm. So compared with control group and SVD, MVD group were significantly thick. As IMT/L, control group was 0.07+/-0.02, SVD group 0.08+/-0.05 and MVD group was 0.13+/-0.08. So compared with control group and SVD, MVD group was ignificantly high. 2)IMT of BIF in three segments, control group was 0.59+/-0.16mm, CAD group was 0.82+/-0.47mm and MVD group was 0.90+/-0.54mm. So compared with control group and CAD, MVD group were significantly thick. Also as IMT/L of BIF, compared with control group(0.07+/-0.02) and CAD(0.10+/-0.06), MVD(0.11+/-0.07) group was high.= 3) As mean aggregated IMT, control group was 0.57+/-0.34mm, CAD group was 0.69+/-0.45mm, SVD group was 0.63+/-0.12mm and MVD group was 0.74+/-0.21mm. So CAD group was thicker than control group and MVD group was thicker than SVD group. As mean aggregated IMT/L, control group was 0.07+/-0.03, CAD group was 0.10+/-0.05, SVD group was 0.09+/-0.01 and MVD group was 0.11+/-0.03. So CAD group was higher than control group and MVD group was higher than SVD group. CONCLUSION: These data support use of the mean aggregated B-mode ultrasonographic IMT and IMT/L in carotid bifurcation for correlation with the status of coronary atherosclerosis.
Atherosclerosis ; Autopsy ; Carotid Arteries* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Risk Factors ; Ultrasonography

Alveolar Process ; Follow-Up Studies ; Humans ; Maxillary Sinus ; Osteotomy ; Transplants

BACKGROUND: Caudal anesthesia has gained wide acceptance in pediatric anesthesia as a technique for providing postoperative pain relief and reducing general anesthetic requirement for surgical procedures below umbilicus. Although blood pressure has been shown to be well maintained with caudal anesthesia in pediatrics, little is known about the change in hemodynamics with combined general and caudal anesthesia. This study was designed to investigate the hemodynamic changes of combined general and caudal anesthesia for lower abdominal surgery in children. METHODS: Sixty children scheduled for lower abdominal surgery were involved. They were randomly divided into 2 groups: group G (n = 30); anesthesia with enflurane and N2O, and the group GC (n = 30); anesthesia with combined caudal block using 1% lidocaine 1 ml/kg and enflurane. Systolic (SBP), diastolic (DBP), mean blood pressure (MBP), and heart rate (HR) were measured at the 6 different time periods; at before induction (T1), just before skin incision (T2), just after skin incision (T3), 5 min (T4), 10 min (T5), and 30 min (T6) after skin incision. RESULTS: There were no significant differences in variables of hemodynamics between both group. Compared with the values at T1, those of SBP, DBP, and MBP at T2, T3, T4, T5, and T6 were decreased in both groups. However, there were no difference in those values at the same time periods between the two groups. The values of SBP, DBP, and MAP at T3, T4, T5, T6 in group G were higher compared with those at T2. CONCLUSIONS: From these results, we concluded that there were no significant changes in hemodynamics by combined general and caudal anesthesia in pediatric patients.
Anesthesia ; Anesthesia, Caudal* ; Blood Pressure ; Child* ; Enflurane ; Heart Rate ; Hemodynamics* ; Humans ; Lidocaine ; Pain, Postoperative ; Pediatrics ; Skin ; Umbilicus

BACKGROUND: Several studies have demonstrated that ephedrine shortens the onset time of muscle relaxants, and it does so probably by increasing the cardiac output. However, elevation of the systemic blood pressure through alpha adrenergic stimulation via ephedrine may affect the onset of muscle relaxants during the induction of anesthesia. We investigated the effect of phenylephrine, which is a selective alpha-1 agonist, on the onset time of rocuronium and the intubating conditions in adults after the administration of propofol. METHODS: Sixty-four patients were randomly assigned to two groups. Phenylephrine (0.9 microgram/kg) (P group) or the same volume of saline (S group) was injected before rocuronium (0.6 mg/kg) administration. Anesthesia was induced with fentanyl 2 microgram/kg and propofol 2 mg/kg. The onset time was defined as the time from the end of rocuronium injection to the time when a single twitch height gets to 0% or the minimum level. A well-trained anesthesiologist who was 'blinded' to the treatment groups evaluated the intubating conditions. The mean arterial pressure and heart rate were recorded before induction, before intubation, immediately after intubation and 1 minute and 2 minutes after intubation. RESULTS: The onset time was 84 +/- 18 sec in the P-group and 72 +/- 14 sec in the S-group. There was no difference of the intubating conditions, the mean arterial pressure and the heart rate between the two groups. CONCLUSIONS: A small dose of phenylephrine, which has a limited effect on blood pressure, delayed the onset time of rocuronium after the administration of propofol, and the vasoconstriction effect of phenylephrine may affect the prolongation of the rocuronium onset time at the induction of anesthesia with using propofol.
Adult ; Androstanols ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Cardiac Output ; Ephedrine ; Fentanyl ; Heart Rate ; Humans ; Intubation ; Muscles ; Phenylephrine ; Propofol ; Vasoconstriction

Mucopolysaccharidoses are a group of inherited disorders of metabolism resulting in the deposition of mucopolysaccharide in various tissues. This leads to organ dysfunction and anatomical abnormalities which can be important to the anesthetist. These abnormalities result in airway difficulty and difficult intubation. We successfully performed endotracheal intubation in a case of mucopolysaccharidoses in a 9-year-old female patient using fiberoptic laryngoscopy.
Child* ; Female ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy* ; Metabolism ; Mucopolysaccharidoses

PURPOSE: Acute diverticulitis of the right colon is not rare in Korea and the clinical presentation is indistin guishable from acute appendicitis. Cecal diverticulitis has led to a controversy in the management of disease. METHODS: Thirty-one cases of acute cecal diverticulitis who underwent operation for suspected acute appendicitis were reviewed retrospectively from January 1995 to December 1998. RESULTS: There were 17 men & 14 women. Ages ranged from 9 to 69 (mean: 37.5) years. All patients presented with signs and symptoms as acute appendicitis. All patients were explored through a transverse incision in the right lower quadrant under the impression of acute appendicitis. An appendectomy and drainage was performed in 13 patients, and resection of the lesion was performed in 18 patients (12 ileocecal resection, one partial cecectomy including appendix, one partial cecectomy and an appendectomy, 4 diverticulectomy and appendectomy), depending on the location of diverticulitis, severity of inflammation, and surgeon. Staples (TA(R), GIA(R)) were used in all cecal resection cases except for diverticulectomy. Five complications were observed, 3 in cecal resection cases (one wound seroma, one wound infection and one bleeding), and 2 in appendectomy and drainage cases (two wound infections). There was no postoperative mortality. The average length of the postoperative stay was 10.2 days in the drainage group and 8.8 days in the cecal resection group. Two recurrences were observed. One was the patient who had diverticulectomy performed. The other was a patient who had had appendectomy and drainage. CONCLUSION: We concluded that the preferred surgical management of an acute cecal diverticulitis operated for a presumed acute appendicitis is cecectomy using staples depending on its location and severity of inflammation. It was safe, relatively easy to do through the same incision, and could be a definitive treatment.
Appendectomy* ; Appendicitis ; Appendix ; Colon ; Diverticulitis* ; Drainage ; Female ; Humans ; Inflammation ; Korea ; Male ; Mortality ; Recurrence ; Retrospective Studies ; Seroma ; Wound Infection ; Wounds and Injuries