The authors have experienced with two cases of acute pulmonary edema; one underwent an intestinal resection under local anesthesia for panperitonitis due to typhoid perforation, and the other under general anesthesia received splenectomy and mesocaval shunt for portal hypertension and splenomegaly. There are many predisposing factors for acute pulmonary edema, namely, left sided heart failure due to cardiac diseases or overloading, pulmonary capillary endothelial damages from bacterial infections, toxins or irritant gases, oxygen poisoning, water (especially salt water) drowning, rarely central nervous system injuries and pulmonary hypersensitivity reactions. For the cases presented, we believe that overloading was the causative factor. There are many preventive measures and treatment for acute pulmonary edema. However in such cases as these, we conclude that prompt recognition and attention by the anesthesiologisis are the most important preventive measure.
Anesthesia* ; Anesthesia, General ; Anesthesia, Local ; Bacterial Infections ; Capillaries ; Causality ; Central Nervous System ; Drowning ; Gases ; Heart Diseases ; Heart Failure ; Hypersensitivity ; Hypertension, Portal ; Oxygen ; Poisoning ; Pulmonary Edema* ; Splenectomy ; Splenomegaly ; Typhoid Fever ; Water

There were many acceptable theories, which described the etiology, incidence, classification, operation time and operative method for the congenital hand anomalies, but so much troublesomes in these aspects were remained. So authors reviewed 57 cases in 49 patients with the congenital hand anomalies, managed at Department of Orthopaedic Surgery, Hanyang University Hospital from Feb. 1972 to Apr. 1986, and the results obtained were as follows. The sex incidence was 26 male(53%) and 23 female(47%) among 49 patients and the ratio between male and female was 1.1: 1. Right hands were involved in 26 patients (53%), left hands were in 15 patients(31%), and both hands were in 8 patients(16%). 2. The most common anomalies among 59 cases in 49 patients were polydactyly (27 cases, 47%) The next anomalies were trigger thumb (25 cases, 44%), syndactyly (3 cases, 5 %), macrodactyly (1 case, 2%), and cleft hand (1 case, 2%) in that orders. 3. The associated congenital anomalies and the maternal histories during pregnancy were not specific. 4. The treatment was stressed upon the functional improvement than the cosmetic one.
Classification ; Clinical Study ; Female ; Hand ; Humans ; Incidence ; Male ; Methods ; Polydactyly ; Pregnancy ; Syndactyly ; Trigger Finger Disorder

Clinical experience using different anesthetic methods for intravenous regional anesthesia in extremities was compared, To group 1 (22 cases, 20 for upper extremity and 2 for lower extremity surgery, with 5 min. limb elevation) 1.5mg/kg Lidocaine hydrochloride was administered and a single pneumatic tourniquet applied. For both group 2 (15 patients, 10 for upper limb and 5 for lower limb operations with limb elevation) and group 3 (11 cases, all for upper extremity operations, but Esmarch bandages instead of pre tourniquet elevation) 3. 0 mg/kg Lidocaine hydroehloride was used and a second tourniquet placed distal to the first. In all groups the anesthetic concentration was 0. 5 and 0. 25 per cent for the upper and lower extremities respectfully. Pneumatic tourniquet pressure applied was 250 mmHg for the upper limb and 500mmHg for the lower. Excellent anesthesia resulted in 68. 2 per cent in group 1, 73.3 per cent in group 2, and 100 per cent in group 3. No serious complications were encountered. Incidence of incomplete anesthesia and/or tourniquet pain could be decreased by increasing the anesthetic concentration, using a secondary tourniquet, and by selecting the region to be anesthetized (upper extremities in favor of the lower). It is concluded that intravenous regional anesthesia is simple, effective and safe and is recommended for ambulatory patients, emergency operations and for patients for whom general anesthesia is deferred.
Anesthesia ; Anesthesia, Conduction* ; Anesthesia, General ; Bandages ; Emergencies ; Extremities ; Humans ; Incidence ; Lidocaine ; Lower Extremity ; Tourniquets ; Upper Extremity

Two cases of renal infarctions were presented with review of literature.
Infarction*

To estimate the incidence of externally recognizable genitourinary anomalies and associated anomalies in the newborns in Korea, retrospective and prospective studies have been performed. Thirty eight of 48 urology training hospitals participated in this nationwide survey. In this study we have included minor defects or variations in the anomaly to evaluate the incidence of the recognizable genitourinary conditions in the newborns. The incidence of genitourinary anomaly in 1,000 newborn delivery in a year was 11.0 in the prospective study and this figure is about three times higher than the retrospective study and is considered to be close to the true incidence. The incidence of genitourinary anomaly in 1,000 male newborn was 20.4. Hydrocele, cryptorchidism and hypospadias were most commonly observed. The incidence of hydrocele in 1,000 male newborn was 9.89 and the incidence of cryptorchidism was 7.26 and the incidence of hypospadias was 2.13. The incidence of associated anomaly in 100 genitourinary anomaly was 7.9. Congenital heart diseases and anorectal anomalies were commonly associated anomalies. In the newborns with genitourinary anomalies, premature infants account larger portion than is usually reported in total delivery.
Birth Weight ; Congenital Abnormalities/epidemiology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Korea ; Male ; *Urogenital Abnormalities

Although the incidence of bleeding complications during extracorporeal membrane oxygenator (ECMO) support has decreased in various trials, bleeding is still the most fatal complication. We investigated the ideal dosage and efficacy of nafamostat mesilate for use with ECMO in patients with acute cardiac or respiratory failure. We assessed 73 consecutive patients who received ECMO due to acute cardiac or respiratory failure between January 2006 and December 2009. To evaluate the efficacy of nafamostat mesilate, we divided the patients into 2 groups according to the anticoagulants used during ECMO support. All patients of nafamostat mesilate group were male with a mean age of 49.2 yr. Six, 3, 5, and 3 patients were diagnosed with acute myocardial infarction, cardiac arrest, septic shock, and acute respiratory distress syndrome, respectively. The mean dosage of nafamostat mesilate was 0.64 mg/kg/hr, and the mean duration of ECMO was 270.7 hr. The daily volume of transfused packed red blood cells, fresh frozen plasma, and cryoprecipitate and the number of complications related to hemorrhage and thrombosis was lower in the nafamostat mesilate group than in the heparin group. Nafamostat mesilate should be considered as an alternative anticoagulant to heparin to reduce bleeding complications during ECMO.
Acute Disease ; Anticoagulants/*administration & dosage ; Dose-Response Relationship, Drug ; *Extracorporeal Membrane Oxygenation ; Female ; Guanidines/*administration & dosage ; Heart Failure/diagnosis/mortality/therapy ; Heparin/administration & dosage ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis/mortality/therapy ; Respiratory Distress Syndrome, Adult/diagnosis/mortality/therapy ; Retrospective Studies ; Shock, Septic/diagnosis/mortality/therapy ; Survival Analysis

Extracorporeal membrane oxygenation (ECMO) provides mechanical cardiopulmonary support and has been used for children with severe respiratory failure, intractable heart failure, sepsis, pulmonary hypertension, and as a bridge to heart transplantation. There have been few reports of the use of ECMO to provide cardiac support in children with low cardiac output as a result of arrhythmias. We report the case of a 15-year-old female with circulatory collapse due to refractory ventricular arrhythmia after one and a half repair in Ebstein's anomaly, who was successfully resuscitated using ECMO.
Adolescent ; Arrhythmias, Cardiac ; Cardiac Output, Low ; Child ; Ebstein Anomaly* ; Extracorporeal Circulation ; Extracorporeal Membrane Oxygenation* ; Female ; Heart Failure ; Heart Transplantation ; Humans ; Hypertension, Pulmonary ; Respiratory Insufficiency ; Sepsis ; Shock ; Tachycardia, Ventricular*

OBJECTIVES: Recently high dose chemotherapy with autologous peripheral blood stem cell transplantation (APBSCT) has been investigated with the hope of maximizing tumor response and increasing survival. The purpose of this study is to evaluate the effect, feasibility, and toxicity of high-dose cyclophosphamide, thiotepa, and carboplatin (CTCb) with APBSCT in patients with metastatic or high risk primary breast cancer. METHODS: Four cases of high-risk primary breast cancer (with more than 10 involved axillary nodes) and three cases of metastatic disease in complete or partial response were enrolled. Peripheral blood stem cells were mobilized by G-CSF plus chemotherapy, and median number of collected mononuclear cells was 5.44 X 108/kg(range, 1.95-7.08 X 108/kg). High-dose chemotherapy of cyclophosphamide (1,500mg/m2/day), thiotepa (125mg/m2/day) and carboplatin (200mg/m2/day) was administered for 4 days and peripheral blood stem cells were reinfused to the patients 72 hours after the completion of chemotherapy. RESULTS: The median days of recovery for neutrophil (over 500/mm3) and for platelet (over 50,000/mm3) were 10 (range, 8 to 33) and 30 (range, 10 to 40). One patient suffered from seizure attack and grade 3 hepatotoxicity during high dose chemotherapy, There were no treatment-related death. Four patients with high-risk primary breast cancer remained disease-free at 2, 8, 12 and 19 months post-transplant. In one patient with bone metastasis, complete response was induced following APBSCT. All three patients with metastatic disease remained progression-free at 8, 18 and 19 months post-transplant. CONCLUSION: High-dose chemotherapy and autologous peripheral blood stem cell transplantation was feasible and would be a potentially effective treatment modality in high risk and metastatic breast cancer.
Blood Platelets ; Breast Neoplasms* ; Breast* ; Carboplatin* ; Cyclophosphamide* ; Drug Therapy* ; Granulocyte Colony-Stimulating Factor ; Hope ; Humans ; Neoplasm Metastasis ; Neutrophils ; Peripheral Blood Stem Cell Transplantation* ; Seizures ; Stem Cells ; Thiotepa*