No abstract available.
Multiple Organ Failure*

Acute renal failure refers to a rapid reduction in renal function that usually occurs in an individual with no known previous renal disease. Development of a complication of acue renal failure in critically ill surgical patients is not unusual, and it causes high morbidity and mortality. Acute renal failure can be divided as Pre-renal (functional), Renal (organic), and Postrenal (obstructive) azotemia according to their etiologies. Early recognition and proper correction of pre-renal conditions are utter most important to prevent an organic damage of kidney. These measures include correction of dehydration, treatment of sepsis, and institution of shock therapy. Prolonged exposure to ischemia or nephrotoxin may lead a kidney to permanent parenchymal damage. A differential diagnosis between functional and organic acute renal failure may not be simple in many clinical settings. Renal functional parameters, such as FENa+ or renal failure index, are may be of help in these situations for the differential diagnosis. Provocative test utilizing mannitol, loop diuretics and renovascular dilators after restoration of renal circulation will give further benefits for diagnosis or for prevention of functional failure from leading to organic renal failure. Converting enzyme blocker, dopamine, calcium channel blocker, and propranolol are also reported to have some degree of renal protection from bioenergetic renal insults. Once diagnosis of acute tubular necrosis has been made, all measures should be utilized to maintain the patient until renal tubular regeneration occurs. Careful regulation of fluid, electrolyte, and acid-base balance is primary goal. Hyperkalemia over 6.5 mEq/l is a medical emergency and it should be corrected immediately. Various dosing schedules for medicines excreting through kidney have been suggested but none was proved safe and accurate. Therefore blood level of specific medicines better be checked before each dose, especially digoxin and Aminoglycosides. Indication for application of ultrafiltration hemofilter or dialysis may be made by individual base.
Acid-Base Equilibrium ; Acute Kidney Injury* ; Aminoglycosides ; Appointments and Schedules ; Azotemia ; Calcium Channels ; Convulsive Therapy ; Critical Illness ; Dehydration ; Diagnosis* ; Diagnosis, Differential ; Dialysis ; Digoxin ; Dopamine ; Emergencies ; Energy Metabolism ; Humans ; Hyperkalemia ; Ischemia ; Kidney ; Mannitol ; Mortality ; Necrosis ; Propranolol ; Regeneration ; Renal Circulation ; Renal Insufficiency ; Sepsis ; Sodium Potassium Chloride Symporter Inhibitors ; Ultrafiltration

As the result of a significant improvement in the economic situation and development of scientific techniques in Korea during the last 20 years, the life expectancy of Korea people has lengthened considerably and as a result the number of old aged people has markedly increased. Such an increase of the number of aged people brought about many problems. Authors would like to take a medical look at the “Problem of old aged people” presently facing us in Korea. Currently the number of people over 65 has increased rapidly and is 1,620,000, 4% of total population. But it is still much lower than 8.9% in Japan, 10.7% in U.S.A., and 14.9% in the United Kingdom. Over 25% of these aged people were found to have at least more than one disease which requires medical care. Diseases occur in the circulatory system, 30.9%, respiratory system, 17.1%, digestive system 8.6%, metal disorders, 8.4%, malignant neoplasms, 7.0%. About 51% of the aged over 65 are under medical security benefit, mostly with partial coverage plan. Their clinic visit rate was very low (2.0% in 1981), which might be due to financial reasons. Since diseases affecting the aged progress chronically, early detection and long term care are utter most important. However there is almost no special facility, long term care center or geriatric specialist. For proper management of medical problems in the growing population of the Korea elderly expansion of medical security coverage, greater number of specialized facilities, education of geriatric special manpower and efficient operating system should be established.
Aged ; Ambulatory Care ; Digestive System ; Education ; Great Britain ; Humans ; Japan ; Korea ; Life Expectancy ; Long-Term Care ; Respiratory System ; Specialization

No abstract available.
Breast Neoplasms* ; Breast* ; Humans*

Congenital duodenal obstruction in the newborn infant may be due to a variety of causes. Duodenal obstruction often presents with bilious vomiting and upper abdominal distention. Diagnosis is usually established on plain x-ray of the abdomen by the classic finding of the double-bubble. In the period July 1986 to June 1990, 16 patients with congenital duodenal obstruction were operated and the following results were obtained. 1. Sixteen patients were comprised of 11 males and 5 females, the ratio of male and female was 2.2:1. 2. Thirteen patients (81%) had been admitted to our hospital during one month of life. 3. Congenital duodenal obstruction was in 16 cases; malrotation in eight (50%), annular pancreas in six (38%), type 1 atresia in one (6%), and wind-sock anomaly in one (6%). 4. There were two premature patients and six patients of small for gestational age. 5. Overall, bilious vomiting, occurring in three fourths, was the single most frequent presenting complaint. 6. Polyhydramnios occurred in two of the patients. 7. Diagnosis was possible with clinical symptom and simple abdomen. 8. The operative procedures performed were; duodenoduodenostomy in five, duodenojejunostomy in two, excision of wind-sock membrane in one, and Ladd's procedure in eight. 9. A total of ten associated congenital anomalies were found in six patients. 10. Postoperative complications occurred in five cases (31%).
Abdomen ; Clinical Study* ; Diagnosis ; Duodenal Obstruction* ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Male ; Membranes ; Pancreas ; Polyhydramnios ; Postoperative Complications ; Surgical Procedures, Operative ; Vomiting

No abstract available.
Diagnosis ; Venous Thrombosis

No abstract available.
Extremities ; Limb Salvage ; Polytetrafluoroethylene ; Transplants

No abstract available.
Arteries ; Subclavian Steal Syndrome ; Transplants

No abstract available.

Insulinoma is the most frequent endocrine tumor of the pancreas and the first of the endocrine-secreting tumor of the gut to be recognized by Nicholls in 1902. Recurrent episodes of hypoglycemia is the main cause of the symptoms and signs which were sweating, pallor, dizziness, habitual change, convulsion and coma. In 1935, Whipple and Frants were described so-called “Whipple's triad”: the patient's symptoms occur with fasting or exercise; at the time of symptoms, the serum glucose in 50mg/dl or less; and the symptoms are relieved by the administration of glucose. While these criteria were timely, they proved to be rather nonspecific and may be found in other conditions that result in fasting hypoglycemia. We experienced a 44-year-old female patient who had repeated attacks of convulsion, unconsciousness and coma for 3 years. Although she has been treated with anticonvulsant, the symptoms and signs were not disappeared. At the time of administration, she was a full coma state due to hypoglycemia and was dramatically reversed by intravenous administration of the glucose solution. The preoperative test such as provocative test, abdominal CT and celiac angiography revealed insulinoma and after enucleation the pathologic diagnosis was the same. We like to report an adult female patient with insulinoma and the review of literatures briefly.
Administration, Intravenous ; Adult ; Angiography ; Blood Glucose ; Coma ; Diagnosis ; Dizziness ; Fasting ; Female ; Glucose ; Humans ; Hypoglycemia ; Insulinoma* ; Pallor ; Pancreas ; Seizures ; Sweat ; Sweating ; Tomography, X-Ray Computed ; Unconsciousness