Epilepsy surgery is performed in patients with epilepsy of focal origin and seizures which are refractory to medical treatment. Electrophysiologic mapping of the epileptic foci and other cortical areas (e.g., language, memory, sensorimotor) is frequently used to maximize the resection of the epileptogenic lesion while minimizing the neurologic deficits. For language area mapping, general endotracheal anesthesia can not be used because a patient can not vocalize. So awake craniotomy is frequently used. However, during awake craniotomy for language area mapping with local infiltration anesthesia and intravenous sedation and narcotics supplementation analgesia, respiratory arrest or depression and hypoxemia may occur. The airway securement is crucial to the patients. As an alternative to tracheal tubes, laryngeal mask airway can secure the airway and does not interference the vocalization. We could successfully performed the language area mapping in a 17-year-old male patient with laryngeal mask airway under deep intravenous anesthesia with local infiltration anesthesia of the scalp.
Adolescent ; Analgesia ; Anesthesia ; Anesthesia, Intravenous ; Anesthesia, Local ; Anoxia ; Craniotomy ; Depression ; Epilepsy ; Humans ; Laryngeal Masks* ; Male ; Memory ; Narcotics ; Neurologic Manifestations ; Scalp ; Seizures

Epilepsy surgery is performed in patients with epilepsy of focal origin and seizures which are refractory to medical treatment. Electrophysiologic mapping of the epileptic foci and other cortical areas (e.g., language, memory, sensorimotor) is frequently used to maximize the resection of the epileptogenic lesion while minimizing the neurologic deficits. For language area mapping, general endotracheal anesthesia can not be used because a patient can not vocalize. So awake craniotomy is frequently used. However, during awake craniotomy for language area mapping with local infiltration anesthesia and intravenous sedation and narcotics supplementation analgesia, respiratory arrest or depression and hypoxemia may occur. The airway securement is crucial to the patients. As an alternative to tracheal tubes, laryngeal mask airway can secure the airway and does not interference the vocalization. We could successfully performed the language area mapping in a 17-year-old male patient with laryngeal mask airway under deep intravenous anesthesia with local infiltration anesthesia of the scalp.
Adolescent ; Analgesia ; Anesthesia ; Anesthesia, Intravenous ; Anesthesia, Local ; Anoxia ; Craniotomy ; Depression ; Epilepsy ; Humans ; Laryngeal Masks* ; Male ; Memory ; Narcotics ; Neurologic Manifestations ; Scalp ; Seizures

BACKGROUND: Video assisted thoracic sympathectomy or sympathicotomy is a safe and effective therapy for the treatment of palmar hyperhidrosis with immediate symptomatic imporvement. However the degree of satisfaction may diminish with time due to cmpensatory sweating or excessive hand dryness. Therefore by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathectomy or sympathicotomy at various levels we aim to determine the optimal level of sympathetic nerve block which will result in minimal side effects and maximal benefit. MATERIAL AND METHOD: Among 194 patients having undergone video assisted thoracic sympathectomy or sympathicotomy between January 1996 and June 1999, 137 patients who responded to either telephone interview or questionnaire were included in the current study. The patients were divided into three groups. Group I(n=61) ; patients having undergone T2,3,4 sympathectomy group II(35) ; patients having undergone T2 sympathicotomy and group III(41) ; patients having undergone limited T2 sympathicotomy which consist of block of interganglionic neuronal fiber on the third rib. The parameters studied comprised of pre- and post-operative palmar temperature change treatment satisfaction the degree of compensatory sweating or discomfort from palmar dryness postoperative complication and changes in plantar sweating. RESULT: There was no difference in age and sex among the groups and the mean postoperative elevation in palmar temperature was 21.59degrees C without any differences among the groups. Patients expressing satisfaction were 65.6%, 62.9% and 90.24% in groups I, II and III, respectively(p<0.05) Moderate to severe compensatory sweating was present in 65.6% 51.4%, and 24.39%, in group I, II, and III, respectively (p<0.05) Slight but comfortable amount of palmar humidness was expressed in decreasing order group III(41.6%) group I(24.6%) and group II(5.7%) (p<0.05) Ineffectiveness or recurrence was present in 5patients in group I(8.2%) 1 patient in group II(2.9%) and none in group III. With regards to plantar sweating decrease in sweating was expressed in 43 patients(31.4%) while similar degree of sweating in 61 patients(44.5%) and increase in sweating in another 33 patinets(24.1%). CONCLUSION: Limited T2 sympathicotomy resection of the lower interganglionic neuronal fiber of the second sympathetic ganglion on the third rib showed immediate effect in palmar hyperhidrosis and caused lesser compensatory sweating and hand dryness.
Autonomic Nerve Block ; Ganglia, Sympathetic ; Hand ; Humans ; Hyperhidrosis* ; Interviews as Topic ; Neurons ; Postoperative Complications ; Surveys and Questionnaires ; Recurrence ; Ribs ; Sweat ; Sweating ; Sympathectomy

Eighty seven cases of ocular adnexal tumors were excised and studied histologically between January 1, 1967 and March 31,1974 at Department of Ophthalmology, Dong San Presbyterian Medical Center. The incidence of ocular adnexal tumors among 22,420 out-patients was 0.38%. The Sexual distribution revealed 49 males (56.3%) and 38 females (43.7%). The benign tumors were more frequent in 2nd and 3rd decades, but the malignant tumors, on the other hand, after 5th decade. Location-wise, the eye-lid was largest in number (38 cases, 43.7%) followed by the conjunctiva (24 cases, 27.6%), orbit (23 cases, 26.4%) and lacrmal apparatus (2 cases, 2.3%) in order. As asingle disease, the nevus, pseudotumor and malignant melanoma were impressively high in incidence. Over all incidence of malignant tumors was 31% (27 cases) and that of benign tumors 69% (60 cases). Of malignant tumors the eye lid tumors were largest in number (12 cases), the orbit 9 cases and conjunctiva 6 cases.
Conjunctiva ; Female ; Hand ; Humans ; Incidence ; Male ; Melanoma ; Nevus ; Ophthalmology ; Orbit ; Outpatients ; Protestantism

BACKGROUND: Video-assisted thoracic surgery (VATS) is being used as a therapeutic modality in many diseases in which thoracotomy has been used. We studied that the VATS can substitute the thoracotomy in benign esophageal disease. MATERIAL AND METHOD: Group I (n=18) underwent video-assisted thoracic surgery, and group II (n=19) thoracotomy. Group I includes 14 leiomyomas and 4 achalasias. Group II includes 16 leiomyomas and 3 achalasias. Operative technique is enucleation in the leiomyoma and modified Heller's myotomy in the achalasia. Analyzing factors of operation-efficacy are anesthetic time, operation time, hospital stay, chest tube drainage amount and chest tube removal day. The degree of the postoperative pain is assessed by the frequency of opioid analgesics injection. RESULT: There was no death in both groups. There were 5 complications in the group I and 2 in the group II. Prolonged pleural effusion and restenosis of achalasia occurred to 1 patient in each group. In the group I, there were 1 temporaty vocal cord palsy and 2 mucosal tear leading to thoracotomy. There were no differences in anesthesia time, operation time, hospital stay, total chest tube drainage amount, chest tube removal day and frequency of opioid analgesics injection. The amount of the chest tube drainage at POD 1 day was significantly lower in group I (155.6+/-77.8cc) than in group II (572.8+/-280.1cc) (p<0.05). CONCLUSION: The results of our data showed that video-assisted thoracic surgery for benign esophageal disease is as effective as thoracotomy and in addition, cosmetic effect is much better. We concluded VATS may be a substitute for thoracotomy in benign esophageal disease.
Analgesics, Opioid ; Anesthesia ; Chest Tubes ; Drainage ; Esophageal Achalasia ; Esophageal Diseases* ; Humans ; Leiomyoma ; Length of Stay ; Pain, Postoperative ; Pleural Effusion ; Thoracic Surgery, Video-Assisted* ; Thoracotomy* ; Vocal Cord Paralysis

The glomus tumor is a distinctive benign neoplasm with a small painful nodule, occurs most commonly in extremities but may be found elsewhere in the body. Its occurrence in the trachea or lung parenchyme has been recognized with extreme rarity and there has not been any report, to our knowledge, of its occurrence in the main bronchial glomus tumor. We report a case of a glomus tumor in the left main bronchus in a 67-year-old man who was presented with blood-tinged sputum and dyspnea, which was completely relieved by surgical resection.
Aged ; Bronchi* ; Bronchial Neoplasms ; Dyspnea ; Extremities ; Glomus Tumor* ; Humans ; Lung ; Sputum ; Trachea

No abstract available.
Cerebral Infarction ; Diffusion Magnetic Resonance Imaging ; Polycythemia ; Polycythemia Vera

BACKGROUND: The purpose of this study is to compare the effectiveness of thoracic epidural anesthesia (TEA) and general anesthesia (GA) in terms of side effects, postoperative pain control and the cost of anesthesia for breast mass excision surgery. METHODS: Forty-three patients rated as ASA physical status class 1 or 2 who underwent breast mass excision surgery were included in the study. In the TEA group (n = 20), 2% lidocaine (3 ml) and 0.5% bupivacaine (3 ml) were administered via the epidural route. Blood pressure and heart rate were measured before and at 3, 6, 9, 12, 15, 18 21, 24, 27 and 30 minutes after epidural injection. In the GA group (n = 23) patients were maintained by general anesthesia with enflurane and 50% nitrous oxide in oxygen. After the operation, patients were given NSAID-diclofenac sodium as they wanted. Analgesic requirement, satisfaction score, and anesthesia-related side effects were recorded 1 day after surgery. Satisfaction scores of the surgeons and patients were recorded as excellent (4 point), good (3 point), fair (2 point), and unacceptable (1 point). RESULTS: Overall satisfaction scores and side effects were not significantly different between the TEA group and the GA group. Anesthesia cost (80,883.2 +/- 3956.9 vs 32,284.8 +/- 1209.4 won) were significantly lower in the TEA group than in the GA group. CONCLUSIONS: There were not significant differences in satisfaction scores and postoperative side effests between the TEA and GA groups. TEA provided lower anesthesia cost than GA for breast mass excision surgery.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General* ; Blood Pressure ; Breast* ; Bupivacaine ; Enflurane ; Heart Rate ; Humans ; Injections, Epidural ; Lidocaine ; Nitrous Oxide ; Oxygen ; Pain, Postoperative ; Sodium ; Tea

BACKGROUND: Recent studies suggested that preoperative block of N-methyl-D-aspartate (NMDA) receptor with NMDA antagonists may reduce postoperative pain. In this double-blind study, we administered magnesium sulfate, a natural NMDA receptor antagonist, to investigate the preemptive effect of magnesium sulfate on postoperative pain. METHODS: Seventy-three patients scheduled for gastrectomy were randomly assigned to one of three groups. Groups 2 and 3 received intravenous magnesium sulfate (Group 2: 50 mg/kg bolus, 7.5 mg/kg/h for 20 h, preoperatively, Group 3: 50 mg/kg bolus, 7.5 mg/kg/h for 20 h, postoperatively). Group 1 received normal saline as the control group. Visual analog scale (VAS) for postoperative pain and mood, cumulative analgesic comsumption, recovery of pulmonary function and side effects were evaluated at 6, 24, 48 and 72 hours after the operation. RESULTS: In groups 2 and 3, plasma concentration of magnesium were significantly higher than group 1 after 6 and 20 hours after infusion. There were no significant differences in the pain, mood, cumulative analgesic comsumption, and recovery of pulmonary function and the incidence of side effects at 6, 24, 48 and 72 hours after the operation among the three groups. CONCLUSIONS: We conclude that intravenous infusion of magnesium is not effective in reducing postoperative pain.
Double-Blind Method ; Gastrectomy* ; Humans ; Incidence ; Infusions, Intravenous ; Magnesium Sulfate* ; Magnesium* ; N-Methylaspartate ; Pain, Postoperative* ; Plasma ; Receptors, N-Methyl-D-Aspartate ; Visual Analog Scale

In an attermpt to aviod the deleterious effects of cardiopulmonary by pass such as pulmonary complication neurologic complication and renal failure off-pump CABG has been rediscovered and developed. We experienced off-pump CABG in 2 cases with unstable angina complicated with COPD and report herein the cases with review of literature.
Angina, Unstable* ; Coronary Artery Bypass ; Pulmonary Disease, Chronic Obstructive* ; Renal Insufficiency