The main goals of treatment of malignant bone tumor are the prolongation of life survival and the improvement of quality of life. In growing children, however, leg length discrepancy (LLD) is one of major problem in the treatment of malignant bone tumors. Therefore, the precise understanding of growth in children is essential, and the prediction of LLD is critical in deciding the time and options of surgery. In addition, to use the adequate method of growth expectation, periodic follow-up and collaboration with patient's parents are needed.
Child ; Cooperative Behavior ; Humans ; Leg ; Life Support Care ; Parents ; Quality of Life

No abstract available.
Constriction, Pathologic* ; Neurologic Manifestations* ; Spinal Canal*

BACKGROUND: Mixed venous oxygen saturation (SO2) monitoring turned out to be invaluable in following up systemic cardiovascular status. But balloon-tipped flow-directed thermodilution catheter (Swan-Ganz catheter) insertion carries additional inherent risks other than those of central venous catheterization, and it costs much more expense than simple venous catheter. There has been a lot of papers which argue that central venous catheterization may substitute for the Swan-Ganz catheterization. In addition, it may be very difficult or impossible to insert the Swan-Ganz catheter in pediatric patients. This study was performed to determine whether Swan-Ganz catheterization might be replaced by the central venous catheterization in regards to SO2. METHODS: In 17 pediatric open heart surgery (OHS) patients, from the central venous catheter, the tip of which had been located in the center of right atrium (RA) and pulmonary artery, blood samples were drawn for gas analysis simultaneously, which was done immediately after emergence from cardiopulmonary bypass. RESULTS: There were no significant differences between RA blood and mixed venous blood gas analyses except oxygen saturation. The oxygen saturations of both were linearly correlated with each other. The relation was SO2=17 0.8 SRAO2 (R=0.77, p<0.05) CONCLUSIONS: It may be concluded that RA blood may be used for blood gas analysis in place of mixed venous blood immediately after pediatric open heart surgery.
Blood Gas Analysis ; Cardiopulmonary Bypass* ; Catheterization, Central Venous ; Catheterization, Swan-Ganz ; Catheters ; Central Venous Catheters ; Heart Atria ; Heart* ; Humans ; Oxygen* ; Pulmonary Artery ; Thermodilution ; Thoracic Surgery*

BACKGROUND: This was concerned with outbreak investigation of the epidemic keratoconjunctivitis (EKC) which occurred from April to May 1996 in the neonatal intensive care unit (NICU) of Seoul National University Hospital in Seoul, Korea. METHOD: We defined the cases by the clinical signs and symptoms and investigated the possible risk factors of this outbreak by case-control analysis. RESULTS: The number of total cases were 17, including neonates (10 cases) and health care workers (7 cases), The index case was thought to be infected by his family, while the other cases may have been transmitted through contact with nurses who cared for or fed the index case. There were no statistically significant differences between case and non-case (control) neonates. However, for nurses, the total amounts of time spent working in the hospital and in the NICU were identified as significant factors. And the incidence of EKC was higher in the nurses who contacted neonates with EKC more frequently. CONCLUSION: According to our contact precautions, we enforced cohort isolation and emphasized strict hand washing and aseptic technique to the health care workers. All of the equipment, especially eye dips used by the cases, was disinfected or sterilized. Fortunately this outbreak ended after about one week when we recognized and started to investigate this outbreak.
Case-Control Studies ; Cohort Studies ; Delivery of Health Care ; Hand Disinfection ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal* ; Keratoconjunctivitis* ; Korea ; Risk Factors ; Seoul

PURPOSE: We examined the relationship between BIS, sedation score and plasma midazolam concentration to verify the usefulness of BIS to assess the patient's consciousness during sedation. PATIENTS AND METHODS: Twenty-five young, healthy adult volunteers participated in this clinical study. Midazolam was administered intravenously up to 0.08 mg/kg to induce unconsciousness and we monitored the patient's physiological and conscious status until complete recovery from sedation. BIS and sedation score were measured before sedation, 10, 20, 30 minutes after midazolam administration. Plasma midazolam concentration was measured 10 minutes after midazolam administration. BIS was measured using A-2000 BISTM monitor (Aspect Medical Systems, USA) and the degree of sedation was evaluated with the sedation score. RESULTS: The BIS score correlated with the sedation score (r = 0.676, P < 0.05). With the decreased plasma midazolam concentration, the correlation was better with sedation score(r = -0.656).Although BIS values did not correlate with calculated plasma concentration of midazolam (r = 0.467) at 10 minutes after midazolam administration, values after sedation were well distinguished from those before sedation. CONCLUSIONS: BIS is known for an effective predictor of patient's hypnotic state, and it is correlated with the sedation score. But, it doesn't always coincide with the clinical parameters of depth of sedation. So more attention is needed using BIS only during sedation, and it is advisable that the patient's consciousness is monitored with variable sedation score systems every several minutes.
Adult ; Consciousness ; Humans ; Midazolam* ; Plasma* ; Unconsciousness ; Volunteers

In this paper, the philosophy and the content of medicinal philosophy of Lee Jae-Ma were illuminated through the history and philosophy of the late Choseon times from 1837 to 1900. Some conclusions were as follows: 1. Lee Jae-Ma was a philosopher as well as a doctor, and his philosophical background was well appeared in the book of . 2. Although the philosophy of Lee Jae-Ma and its terms were derived from the Kyunghakseol of Confucianism, the concept of these terms was different from the Neo-confucianism of Song Dynasty in China. 3. The four phases of the philosophy of Lee Jae-Ma was originated from the four important trigrams, however, he did not take the meanings of the changes and development of the trigrams in , but also took the four components of construction of cosmos similar to the Western theory of four component. 4. It is unreasonable that he is categorized in the group of the scholars of anti-Chu-tzu and neo-confucianist since the theory of the four phases was originated from the Kyunghakseol of Confucianism and also neo-Confucianism. 5. Dong Mu took the dualistic theory of mind and body in Ho Chun's as the core of his thought, but Dong Mu's method of the explanation was not based on the Taoism, the key of the thought of , but based on the Kyunghakseol of Confucianism. 6. Dong Mu wrote the two medicinal books and based on the thought of regimen of . But the philosophy of his books was based on the thought of Confucianism, not on of the nature of Taoism.
English Abstract ; History of Medicine, 19th Cent. ; Korea ; Philosophy, Medical/*history

BACKGROUND: Nasotracheal intubation is commonly and safely used in the anesthetic management of patients undergoing head and neck surgeries. There are some kinds of reports about complications associated with nasotracheal intubation which are related to long intubation period in the intensive care unit. But there are few reports about complications after nasotracheal intubation in surgery patients. A prospective study was carried out to evaluate the incidence and outcome of complications of nasotracheal intubation in oral and maxillofacial surgery patients in the Seoul National University Dental Hospital. METHODS: We studied 317 nasally intubated patients over 8 months. Endotracheal tubes softened by soaking in hot normal saline were used. After general anesthesia, we followed the hospital course of patients from the view point of the incidence and outcome of complications associated with nasotracheal intubation. RESULTS: The overall complication rate was 27.1%. Nasal bleeding and benign nasal obstruction were the most frequent events, accounting for a mean of 15.5% and 9.8%, respectively. Other low incidence complication was ulceration of the nose. None of the complications were fatal or resulted in serious sequelae. There was a slight relationship between complications and age or intubation period. CONCLUSIONS: These results suggest that short term use of nasotracheal intubation may be as safe as orotracheal intubation. Complications may be associated with elderly patients and long intubation duration over than 24 hours in surgery patients.
Aged ; Anesthesia, General ; Epistaxis ; Head ; Humans ; Incidence ; Intensive Care Units ; Intubation* ; Nasal Obstruction ; Neck ; Nose ; Prospective Studies* ; Seoul ; Surgery, Oral* ; Ulcer

No abstract available.

Dermatofibrosarcoma protuberans is an uncommon, locally aggressive fibroblastic tumor, characterized by infrequent metastasis and a marked tendency of local recurrence after excision. Histologically, it shows large uniformed spindle shaped cells arranged in a cartwheel or storiform pattern. We report a case of dermatoribrosarcoma protuberans on the lower abdomen of a man aged of thirty, treated with Mohs micrographic surgery and purse-string suture repair.
Abdomen ; Dermatofibrosarcoma* ; Fibroblasts ; Mohs Surgery* ; Neoplasm Metastasis ; Recurrence ; Sutures*

Although the endotracheal intubation using laryngoscope can usually be performed under general anesthesia, it may be very difficult in situations such as head and neck trauma, hemorrage, or deformity. Recently we performed antegrade fiberoptic nasotracheal intubation with a guide wire. A 15-month aged female child with mandibular fracture was scheduled for open reduction and internal fixation under general anesthesia. She was anticipated difficult intubation due to displacement of the fracture site. After induction of anesthesia, we passed an adult fiberoptic bronchoscope (O.D. 3.8 mm, LF-2, Olympus optical co, Japan) to vocal cord via right nostril. Then a guidewire was inserted through the suction port of bronchoscope, and bronchoscope was removed in a state of guidewire in situ. We slid the endotracheal tube over guidewire according to Seldinger's technique. We think that nasotracheal intubation using an adult fiberoptic bronchoscope and a guidewire is good for children under 2 years old who are expected the difficult intubation.
Adult ; Anesthesia ; Anesthesia, General ; Bronchoscopes* ; Child ; Child, Preschool ; Congenital Abnormalities ; Female ; Head ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngoscopes ; Mandibular Fractures* ; Neck ; Suction ; Vocal Cords