Anesthesia for thoracic surgery is most commonly performed with the patient in the lateral decubitus position, with nondependent hemithorax comprising the operation field. When one-lung ventilation is employed, the nondependent lung is nonventilated and collapsed, while the dependent lung is ventilated. Consequently one-lung ventilation creates an obligatory right to left transpulmonary shunt through the nondependent nonventilated lung. Therefore one-lung ventilation results in a much larger alveolar-arterial oxygen tension-difference P(A-a)O2 and lower PaO2 than does two-lung ventilation. The present study was to evaluate oxygenation effect of selective CPAP to nondependent lung in the 17 thoracic surgical patients. Arterial blood gases were analysed, systolic blood pressures and heart rates were measured at following stages. Stage I; lateral decubitus position before chest opening Stage II; 15 min after chest opening and one lung ventilation stage III; 15 min after application of selective CPAP 5 cmHO to the nondependent lung stage IV; 40 min after application of selective CPAP 5 cmHO to the nondependent lung The results were as follows: 1) In stage II, the value of PaO2 was significantly lower as compared to that in stage I(224.9+/-78.0 vs 418.2+/-63.1 mmHg, P<0.01). 2) In stage III and IV, the values of PaC4 were significantly higher.as compared to that in stage II(333.8+/-97.1, 364.5+/-88.6 vs 224,9+/-78.0 mmHg, P<0.01). 3) In stage III, the value of PaCO2 was significantly lower as compared to that in stage II(37.1+/-2.9 vs 38.2+/-2.7 mmHg, P<0.05). 4) In stage IV, the value of pH was significantly lower as compared to that in stage III(7.37+/-0.05 vs 7.38+/-0.05 P<0.05). 5) Systolic blood pressures and heart rates remained unchanged at all times. We concluded that application of 5 cmHO CPAP to the nondependent lung during one-lung ventilation is one of most efficacious maneuvers to increase PaO2, accompanying less surgical interference.
Anesthesia ; Continuous Positive Airway Pressure* ; Gases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Lung* ; One-Lung Ventilation ; Oxygen* ; Thoracic Surgery ; Thorax ; Ventilation*

A follow up study was made of 59 cases of neonatal hyperbilirubinemia receving blood exchange transfusion at Kwangju Christian Hospital from early 1976 to early 1979, with the following results. 1. 42patients(71.2%) returned for followup: 12 patients(20.3%) did not return; and 5 patients(8.5%) had died. 2. Of those returning, developmental status was studied by D.D.S.T. 38 patients(90.5%) had normal development , 3(7.1%) were retarded, and 1(2.4%) was questionable. 3. There was no retardation among patients exchange-Transfused at the age of 5 days or less, except for one patients with severe dehydration. All the other retarded or dying patients were over 5 days at the time of exchange transfusion. 4. Serum bilirubin level was above 27 mg% in all retarded patients . Of the 5 patients dying, 3 had serum bilirubin levels of over 40mg%, one with S.B. of 25mg% had BET at 10 days of age, and one died of necrotizing enterocolitis without evidence of kernicterus. 5. In patients with normal development, 23 were male, and 15 were female. All females had normal development, whereas all four babies with retardation were male. 6. Because S.B. remained over 25mg%, three patients underwent a second BET, with good results. 7. ABO incompatibility was etiologically responsible in 23 cases (55.9%), followed by idiopathic hyperbilirubinemia in 16 cases (27.4%), Other causes of hyperbilirubinemia were infection, respiratory distress syndrome, immune neonatal thrombocytopenia, enclosed hemorrhage, small-for-date infant, etc. 8. Mean values with standard errors of pre BET serum bilirubin level were as follows. Normal development group: 28.10.69mg% Retarded development group: 30.21.15mg% There was a tendency toward higher S.B. levels in retarded development group. 9. Nine patients who had early signs of kernicterus on admission, developed normally after BET, but those patients , shown later to be retarded, had only transient improvement of early signs of kernicterus at the time of discharge. 10. Thirty-three patients had siblings, among whom 8 also had history of hyperbilirubinemia or mental retardation due to kernicterus, or had undergone blood exchange transfusion. All of the were cases of ABO incompatibility. 11. Motor distrubance was the predominant handicap in all 4 cases of typical cerebral palsy, but no speech disturbance or hearing loss was seen. Choreoathetosis was evident in two patients over 3 years of age, but it was not possible to classify the cerebral palsy in two patients less than 1 1/2years of age.
Bilirubin ; Blood Transfusion* ; Cerebral Palsy ; Dehydration ; Enterocolitis, Necrotizing ; Female ; Follow-Up Studies* ; Gwangju ; Hearing Loss ; Hemorrhage ; Humans ; Hyperbilirubinemia* ; Hyperbilirubinemia, Neonatal ; Infant ; Infant, Newborn* ; Intellectual Disability ; Kernicterus ; Male ; Siblings ; Thrombocytopenia, Neonatal Alloimmune

Neuroblastoma originate in neural crest and is one of the most frequent tumor next to leukemia and brain tumor in child. The tumor is most highly malignant tumor due to early metastasis at diagnosis. It could be diagnosed by various diagnostic modalities such as roentgenologic examination, laboratory data and confirmed by pathologic diagnosis. Management of neuroblastoma is surgery, radiotherapy and chemotherapy. We experienced a case of adrenal neuroblastoma at age of 20-month male child and report with a brief review of literature
Adrenal Glands ; Brain Neoplasms ; Child ; Diagnosis ; Drug Therapy ; Humans ; Leukemia ; Male ; Neoplasm Metastasis ; Neural Crest ; Neuroblastoma* ; Radiotherapy

Blunt tracheobronchial injuries are rare, and usually lethal without aggressive and appropriate management. Recently, the incidence of tracheobronchial injuries has been increased with the increase of traffic accident and mechanization. We report a case of complete tracheal transection combined with a longitudinal rupture of the membranous portion of the trachea extending to the right main bronchus following blunt chest trauma, and review the anesthetic management.
Accidents, Traffic ; Bronchi ; Incidence ; Rupture ; Thorax ; Trachea

A histologic analysis of 10 cases of Wilms` tumor in the department of Urology, Chosun University Hospital during 11 years periods from January, l975 to December, l985 has been carried out. A classification based on the tumor differentiation and degree of tubular formation are described. A comparison of the histologic findings with the survival was undertaken and it was found that the histologic classification was significantly correlated with survivals. The results were as follows : I. Low grade tumors(grade I) with predominance of differentiated tubules were associated with a better cure rate than high grade tumors(grade IH) composed mainly of undifferentiated spindle elements : 2 year or more survival rate was lOOf6 for grade I but O% for grade III. 2. Cure rate was lower for the low degree of tubular formation than for the high degree of tubular formation : 2-year cure rates were O%, O%, 33.3%, lOO% for group O, +,++ and +++ respectively. 3. 6 patients with the focal or diffuse anaplasia and sarcomatous stroma had a bad prognosis. giving a survival rate of 0%.
Anaplasia ; Classification ; Humans ; Prognosis* ; Retrospective Studies* ; Survival Rate ; Urology

Spontaneous fistula formation between the ureter and duodenum is extremely rare. The underlying cause of fistula between upper urinary tract and GI system is tuberculosis, chronic inflammation, carcinoma and GI diseases. Renal pelvis adenocarcinoma is also rare. We report a case of ureteroduodenal fistula associated with adenocarcinoma of the renal pelvis in 65-year old female with a brief review of literature.
Adenocarcinoma* ; Aged ; Duodenum ; Female ; Fistula* ; Humans ; Inflammation ; Kidney Pelvis* ; Tuberculosis ; Ureter ; Urinary Tract

BACKGROUNDS: There is difference of blood flow between right and left lung, and it is also affected by positional change. The purpose of this study is to compare hemodynamics and arterial blood gas changes between two lungs in thoracoscopic surgery with CO2 insufflation METHODS: Fourteen thoracoscopic-surgical patient were randomly selected and divided into two groups; Group I : right lung ventilation, Group II: left lung ventilation. Blood gas analysis, blood pressure and heart rate were measured at three stages in lateral position; stage I: 10minutes after two-lung ventilation, stage II: 10minutes after one-lung ventilation and CO2 insufflation, stage III: 10minutes after two-lung ventilation and CO2 deflation. RESULTS: In both groups, blood pressure and heart rate were slightly increased at stage II, pH was decreased, PaO2 and PaCO2 were increased at stage II and stage III. But changes of pH and PaCO2 were greater in left lung ventilation. Arterial oxygen saturation and base excess did not change in all stages. CONCLUSIONS: Thoracoscopic surgery with CO2 insufflation did not increase the risk of hypoxemia if FiO2 is 1.0. However blood CO2 retension is higher in left lung ventilation than in right one. So we have to observe PaCO2 more carefully when the left lung is ventilated.
Anoxia ; Blood Gas Analysis ; Blood Group Antigens ; Blood Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Insufflation* ; Lung* ; One-Lung Ventilation ; Oxygen ; Thoracoscopy* ; Ventilation*

Histiocytic necrotizing lymphadenitis(HNL), also known as Kikuchi-Fujimoto Disease(KFD) is a disease which mainly invades cervical lymph node without any particular reason. Lymphadenopathy can be unilaterally or bilaterally with mild pain and be accompanied with high fever, malaise and skin rashes. At times it shows hepatosplenomegaly, leukopenia and lymphatic cyst. These symptoms will be gone spontaneously without any specific treatments in several weeks or months, so the prognosis is comparatively satisfactory. It is confirmed only by excisional biopsy and must be differentiated from other diseases such as lymphoma, inflammatory and granulomatous lymphadenopathy, etc. Authors report the clinicopathologic findings of 4 cases of HNL with a review of literature.
Biopsy ; Exanthema ; Fever ; Histiocytic Necrotizing Lymphadenitis ; Leukopenia ; Lymph Nodes ; Lymphatic Diseases ; Lymphocele ; Lymphoma ; Prognosis

PURPOSE: Since Caffey et al. first described the anomaly in pelvis among the Down patients, decreased iliac and pelvic indexes have been helpful in diagnosing the syndrome. For Korean cases, however, no definitive data are available as yet, prompting us to evaluate the pelvic changes in Korean Down's patients. METHODS: Subjected to this study were 68 children with Down's syndrome. As the control group served 126 patients with other diseases that do not affect the pelvis. The acetabular angle (AA) and the iliac angle (IA) were measured, and the iliac and pelvic indexes wer calculated from the following equations : Iliac index (Ii) = X + Y: pelvic index (Pi) = 0.3X + 0.42Y (where X is the mean of both acetabular angles, and Y is the mean of both iliac angles) RESULTS: 1) The sex ratio of the patients was 1.5 to 1, male prepondering. Their ages ranged from 1 day to 13 years, with the mean of 9.5 months, the majority (55.9%) falling under 1 month. The karyotype most frequently found in them was 21-trisomy (97%), followed by translocation (3%). 2) The AA of the Down patients was 18.49+/-4.92 (M+/-SD), significantly lower than that of the control group with 25.21+/-5.73; and the IA of the affected measured 43.53+/- 5.97, also signficantly (p<0.001) lower than the control (52.68+/-7.93). 3) The Ii and Pi of the Down groups were calculated as 62.01+/-9.04 and 23.83+/-3.38; both values were significantly lower than those of the control with 77.87+/-11.28 and 29.69+/-4.26, respectively. 4) The maximum likelihood estimate of Ii for Down syndrome was found to be 64, and at that level, the specificity 87.30%, and the sensitivity 66.18%. 5) In the Neonatal and infantile period, all parameters of Down syndrome were very significantly lower values when compared with those of the control of corresponding age In the childhood age, however, the AA of both groups did not significantly differ from each other, but the Down children had significantly lower values in the other parameters. The Ii decreased in relation to the increasing age in the control group, while no significant correlation was noted in the Down patients. 6) In the control group, a significant gender difference was found in the Ii, with females having higher values. In the Down patients, however, both sex did not significantly differ in the Ii. CONCLUSIONS: Decreased iliac and pelvic indexes manifested in Korean Down cases were quantitively evaluated in this study and it was found that an iliac index below 64 strongly supports the diagnosis of Down syndrome. For the Down cases, the Ii did not signficantly correlate with age, nor did both sexes differ in the Ii, in contrast to the control group which showed an age-related decrease and higher female values.
Acetabulum ; Child ; Diagnosis ; Down Syndrome* ; Female ; Humans ; Karyotype ; Korea* ; Likelihood Functions ; Male ; Pelvis ; Sensitivity and Specificity ; Sex Ratio

A Clinical study was made of 88 pediatric patients with miliary tuberculosis, who were admitted to the Pediatric Department of Kwangju Christian Hospital during the period of January, 1971 through December, 1980. 1) The incidence of miliary tuberculosis in children was 0.6%(88 cases) of the total pediatric admission cases(13969), and 12.5% (88 cases) of the total pediatric tuberculous patiens(705). 2) The highest incidence was found in those under the age of 3 years, comprising 63.7%(56 cases) of all cases. The sex ratio of male to female was 1.5:1, which is not significant. 3) The most prevalent season was Spring, with 34.1% (30 cases). 4) The source of infection was found within their family in 36.3% (32cases). 5) Only 14.8% (13 cases) had received BCG innoculation. 6) Predisposing factors were found in 24.9% (21 cases) and these were measles, chicken pox, pertussis, typhoid fever in decreasing order of frequency. 7) Chief complaints on admission in the order of frequency were:fever (72.7%), coughing (68.2%), general weakeness (37.5%), vomiting (35.2%). 8) Principal clinical features on admission were marked adnormal auscltatory findings (68.2%), emaciation (54.5%), adnormal neurologic sings (42.0%), cervical lymphaderopathy (39.8%) and hepatosplenmegaly (22.7%). 9) Tuberculin skin test was done in 55 cases and positive reaction was obtained in 21.8% (12 cases). 10) Hematologic findings revealed a mild degree of anemia in 52.3% of all patients and leukocytosis in 75.0%. 11) AFB smear was positive in only 19.3% (17 cases/88), and the highest positive rate was found in sputum (40.0%). 12) Tuberculous meningitis was the most most common disease associated with miliary tuberculosis. 40.9% (36 cases( of all miliary tuberculosis cases were complicated by tuberculous meningitis, with the highest incidence of 72.2% (56 cases) under the age of 3 years. 13) The usual treatment was the triple regimen of INH, PAS and SM, though PAS was replaced by EMB or Rifampin in recent cases, Corticosteroids were added in complicated cases. 14) In 21.6% (19 cases) of total cases, the clinical symptoms and the miliary density on X-ray disappeared after 3 months of treatment. 15) The mortality rate was 10.2% (9 cases/88).
Adrenal Cortex Hormones ; Anemia ; Causality ; Chickenpox ; Child* ; Cough ; Emaciation ; Female ; Gwangju ; Humans ; Incidence ; Leukocytosis ; Male ; Measles ; Mortality ; Mycobacterium bovis ; Rifampin ; Seasons ; Sex Ratio ; Skin Tests ; Sputum ; Tuberculin ; Tuberculosis, Meningeal ; Tuberculosis, Miliary* ; Typhoid Fever ; Vomiting ; Whooping Cough