The radial head forms articulation with radial head fossa of proximal ulna and capitellum, and it ditectly contributes pronation and supination of forearm and also flexion and extension of elbow. There were debates in treatment of radial head fracture especially in displaced or communited fracture. From January 1982 to February 1992, we experienced and analysed 29 cases of radial head fracture. They were treated with conservative treatment or operative treatment according to type The results were as follows; 1. We could get better results with open reduction and internal fixation with miniscrew than radial head excision in type 11 radial head fracture. 2. There were unfavorable results of valgus instability, weakness in all cases of radial head excision.
Elbow ; Forearm ; Head ; Pronation ; Supination ; Ulna

BACKGROUND: This study was undertaken to evaluate the hemodynamic response of midazolam-thiopental coinduction technique compared with thiopental or midazolam induction after tracheal intubation. METHODS: 60 patients were divided into 3 groups. Group I thiopental 5 mg/kg induction groups: Group II, midazolam 0.2 mg/kg induction group: Group III 2 mg/kg of thiopental was injected intravenously to each patient 2min after 0.02 mg/kg of midazolam injected. After tracheal intubation, blood pressure and heart rate were measured for 5 minutes at 1 minute interval. Results: There were not significant differences in systolic, diastotic, mean arterial pressure and heart rate in 3 groups. CONCLUSIONS: Low dose midazolam-thiopental coinduction can be a useful method for induction because of same hemodynamic changes as to thiopental or midazolam alone.
Anesthesia* ; Anesthetics ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Midazolam* ; Thiopental*

The intubating laryngeal masK airway is a newly available device designed to allow for blind endotracheal intubation and treatment of patients with difficult airways. Emergency tracheostomies are required for oropharyngeal, hypopharyngeal, and laryngeal tumors acutely obstructing the airway. Patients with an airway obstructive tumor maintain their airway by a very active inspiratory effort in a sitting position. In these patients, it may be impossible to position them for a tracheostomy with shoulder extension. We report a case where a patient was tracheostomized successfully under general anesthesia with blind intubation via ILMA insertion in a sitting position.
Anesthesia, General* ; Emergencies ; Equipment Design ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngeal Masks ; Shoulder ; Tracheostomy*

Anesthetic experience with unilateral adrenalectomy for two patients (ll-year-old and 19- year-old female) with Cushings syndrome due to adrenocortical carcinoma has been reported. Anesthesia was induced with intravenous thiopental followed by nitrous oxide-oxygen-halothane and Pancuronium (Mioblock) for muscular relaxation. An endotracheal semi-closed circle absorption techniqne with controlled respiration was employed. The Patient tolerated well the anesthesia and surgery with appropriate cardiovascular control using hydrocortisone, whole blood and fluid replacement under continuous monitoring of B.P., E.C.G., C.V.P., and urine output. Importance of optimal preparation of the patient with Cushings syndrome, sufficient sedation, smooth induction, complete analgesia, good mucular relaxation, adequate alveolar ventilation and of proper cardiovascular control has been stressed and discussed together with the hazards of postoperative adrenal insufficiency.
Absorption ; Adrenal Insufficiency ; Adrenalectomy ; Adrenocortical Carcinoma* ; Analgesia ; Anesthesia ; Cushing Syndrome* ; Humans ; Hydrocortisone ; Pancuronium ; Relaxation ; Respiration ; Thiopental ; Ventilation

BACKGROUND: Varying results of hemodynamic and oxygen parameters in response to hypoxia and/or hypercarbia have been reported. In this study, the effects of apnea on the hemodynamic parameters and oxygen availability were evaluated using ten healthy mongrel dogs. METHODS: After full oxygenation, apnea was induced by disconnecting animals from mechanical ventilation. Hemodynamic parameters, oxygen delivery, consumption and extraction ratio were measured at one minute intervals until the cardiac output was undetectable via the thermodilution method. RESULTS: Blood pressure (BP) increased continually following apnea. Cardiac output (CO) increased during the early of apnea (2 and 3 minute) but decreased thereafter. Systemic vascular resistance (SVR) decreased in the early phase of apnea but subsequently declined. The indices of preload increased steadily following apnea. Changes in heart rate (HR) were compared with changes in CO and oxygen delivery, and was found to increase during the early phase of apnea (2~3 minutes) and decrease thereafter. The oxygen extraction ratio did not change significantly and remained steady 6 minutes after apnea but increased and became irregular thereafter. CONCLUSIONS: These data suggest that early reflex responses such as increased BP were primarily due to increased CO, whereas the late increase in BP was due to the increase of SVR. We conclude that BP is not meaningful variables in evaluating critical hypoxic condition such as apnea, and bradycardia might be caused by decreased CO and severe hypoxemia.
Anesthesia* ; Animals ; Anoxia ; Apnea* ; Blood Pressure ; Bradycardia ; Cardiac Output ; Dogs ; Halothane* ; Heart Rate ; Hemodynamics* ; Oxygen* ; Reflex ; Respiration, Artificial ; Thermodilution ; Vascular Resistance

The effect of epinephrine on epidural biock and blood lidocaine concentration was investigated in women undergoing elective cesarean sections (n=24). Patients were randomly allocated to one of the two groups; one group received 2% lidocaine 20ml plain (group l, n=12), the other group received 2% lidocaine mixed with epinephrine 1 in 200,000 (group 2, n=12). Matemal venous blood samples were obtained 10, 20, 30, 45, 60 and 90 minutes following the injection. The mean blood concentration of lidocaine in group 2 was significantly lower than that of group 1, 20 minutes following the injection (P<0.05). The addition of epinephrine to the lidocaine solution reduced the peak blood concentration by 24% (from 3.93 to 3.01 ug/ml); however, this did not prolong the times at which the peak concentration was reached. The group 1 (plain) needed significantly more supplementary analgesia than group 2. The time from injection to Bromage scale 0 of group 2 (88.2+/-21.3 minutes) was significantly longer than that of group 1 (52.8+/-10.0 minutes). Incidence of matemal hypotension during operation, nausea/vomiting and shivering in the recovery, room did not differ significantly between the two groups. From this we came to the conclusion that epidural epinephrine reduces blood concentration of lidocaine and improves the duration and the quality of epidural anesthesia during cesarean sections.
Analgesia ; Anesthesia, Epidural ; Cesarean Section* ; Epinephrine* ; Female ; Humans ; Hypotension ; Incidence ; Lidocaine* ; Pregnancy ; Shivering

Discrepant results have been reported in terms of detecting bcr-abl transcripts in patients with essential thrombocythemia that are Philadelphia (Ph) chromosome-negative. We present two cases of Ph chromosome-negative essential thrombocythemia in whom bcr-abl gene rearrangement was detected. In the diagnosis of both cases, they lacked the splenomegaly, anemia and basophilia, and had high platelet counts (948X10(3)/L and 1,329X10(3)/microL, respectively) and normal leukocyte alkaline phosphatase (LAP) scores on admission without any evidence of inflammation, infection, or therapy. They lacked the Philadelphia chromosome characteristic of classical chronic myelogenous leukemia (CML) and had b3a2 transcripts.
Alkaline Phosphatase ; Anemia ; Diagnosis ; Gene Rearrangement* ; Humans ; Hydrogen-Ion Concentration ; Inflammation ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukocytes ; Philadelphia Chromosome ; Platelet Count ; Splenomegaly ; Thrombocythemia, Essential*

No abstract available.
Blood Platelets*

Many fungi including Penicillium, Aspergillus, Gliocladium, and Thermoascus produce an epipolythiodioxopiperazine class of fungal metabolite, gliotoxin, which contirbutes the pathogenesis of fungal infection as an immunomodulator and cytotoxic agent. This study is designed to define the mechanism by which gliotoxin exerts the cytotoxic effect of gliotoxin on human promyelocytic leukemic cells, HL-60. Gliotoxin induces the apoptosis of HL-60 cells which is characterized by the ladder pattern fragmentation of DNA. Gliotoxin induces the activation of DEVD-specific cysteine protease in a time- and dose-dependent rnanner. It also increases the phosphotransferase activities of c-Jun N-terminal kinase1 (JNK1) and p38 in gliotoxin-treated HL-60 cells. Furthermore, gliotoxin decreases the activation of transcriptional activator, actiating protein (AP-1) and NF-kB. These results suggest that gliotoxin induces the apoptotic death of HL-60 cells via activation of DEVD- specific caspase as well as mitogen activated protein kinases (MAP kinases) including JNK1 and p38, and inhibition of transcriptional activators, AP-1 and NF-kB.
Apoptosis* ; Aspergillus ; Caspase 3 ; Cysteine Proteases ; DNA ; Fungi ; Gliocladium ; Gliotoxin* ; HL-60 Cells* ; Humans ; Mitogen-Activated Protein Kinases ; NF-kappa B ; Penicillium ; Thermoascus ; Transcription Factor AP-1 ; Transcription Factors

BACKGROUND: Left ventricular hypertrophy is common in chronic renal failure patients and may contribute increased risk of cardiovascular morbidity and mortality. We evaluated the left ventricular morphology and function in renal transplant recipients to find the relationship between hemodynamic changes and morphologic and functional improvement after transplantation. METHODS: Serial echocardiographic evaluations were performed in 27 adults(20 men and 7 women) at the time of transplantaion and posttransplantation 1 month and 4 months. The average duration of hemodialysis was 16+/-24 months(mean+/-S.D.). RESULTS: At the time of transplantation, the hematocrit level was 21+/-6% and posttransplantation 1 month and 4 months, that was increased to 39+/-5% and 42+/-7%, respectively(p<0.001). Left ventricular mass index by echocardiography was decreased significantly from 246+/-87g/m2(pre-KT) to 169+/-38g/m2(post-KT 1 month) and 153+/-40g/m2(post-KT 4 months), respectively (p<0.001). Interventricular septal thickness and left ventricular posterior wall thickness were decreased significantly after 4 months of transplantation. Left ventricular systolic and diastolic dimensions were also decreased significantly after 1 month and 4 months of transplantation. Left ventricular volumes and cardiac output were also decreased significantly. But A/E ratio, ejection fraction and fractional shortening did not change significantly. CONCLUSION: These findings showed that pretransplant high output state was resolved radipidly(within 1 month) but the diastolic function did not improved after transplantation 1 month and 4 months.
Cardiac Output ; Echocardiography* ; Hematocrit ; Hemodynamics ; Humans ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Mortality ; Renal Dialysis ; Transplantation*