Abrupt increase in the size of cervico-mediastinal tumor due to infection or spontaneous hemorrhage into cyst can induce severe tracheal compression and therefore sudden death. A 5 year old boy, who had a history of URI, had an enlarging cystic hygroma on the right side of the neck and anterior mediastinum. Under diagnosis of the cervico-mediastinal cystic hygroma, surgical removal was scheduled. After induction of anesthesia, intubation was done without any difficulty. A few minutes later, signs of partial airway obstruction were appeared. And within a very short period, total airway occlusion occurred. The tracheal tube was removed and manual ventilation was performed with positive airway pressure, but ineffective. We attempted to puncture cricothyroid membrane with 14 Gauge needle in order to ventilate manually. As soon as we puncture cricothyroid membrane, straw-colored fluid, not air, gushed out through a needle. After aspiration of about 200ml of cystic fluid, the obstructive signs disappeared and the patency of the airway was maintained. Intraoperatively, no more airway problems occured and vital signs were stable. And postoperatively, patient had no specific complications and discharged on the 7th day after operation.
Airway Obstruction* ; Anesthesia ; Child, Preschool ; Death, Sudden ; Diagnosis ; Hemorrhage ; Humans ; Intubation ; Intubation, Intratracheal* ; Lymphangioma, Cystic* ; Male ; Mediastinum ; Membranes ; Neck ; Needles ; Punctures ; Ventilation ; Vital Signs

We report a case of actinic granuloma in a 39 year-old woman who was presented with multiple anetoderma on non-sun exposed skin such as the neck, upper arms, elbows and calfs. The anetodermic presentation of actinic granuloma has never been reported and the common pathogenesis involving reduction of elastic fibers link the two disorders. Anetoderma secondary due to actinic granuloma should to be included in the list of secondary anetoderma and may suggest one of the possible pathogenesis of anetoderma.
Actins* ; Adult ; Anetoderma* ; Arm ; Elastic Tissue ; Elbow ; Female ; Granuloma* ; Humans ; Neck ; Skin

OBJECTIVES: The purpose of this study is to develop a method of evaluation based on finite element analysis (FEA) using micro-CT images for the measurement of trabecular bone strength. METHODS: The primary compressive trabeculae were obtained from the human femoral head of three cadavers (21 year old male (M/21), 51 year old male (M/51), 51 year old female (F/51). All bone specimens were scanned using micro-CT at 24.9microm of spatial resolution under 70 kV's voltage and current of 141microA. The percent bone volume was calculated from the CTAn (SKYSCAN, Belgium) software, it's represented the bone mineral density (BMD). After scanning, the finite element model was reconstructed based on micro-CT images. All models were applied to be linear elastic, isotropic, and uniform with a tissue modulus of 5.17 GPa and a tissue Poisson's ratio of 0.3. RESULTS: The percent bone volume(%) were 31.819 (+/-0.648), 21.513 (+/-2.489), 20.280 (+/-1.891) and Bone strength (MPa) were 187.741 (+/-13.006), 61.585 (+/-11.094), 61.266 (+/-16.744) in M/20, M/51 and F/51. The trabecular bone strength of the primary compressive trabeculae in M/20 was 3 times more than the trabecular bone strength in M/51 and F/51. The percent bone volume in M/20 was 148% and 157% higher than the percent bone volume in M/51 and F/51. CONCLUSIONS: The finite element analysis is more sensitive than the percent bone volume in reflecting the morphometry index of primary compressive trabeculae. The high resolution FEA reconstructed from high resolution MRI or high resolution CT may improve the evaluation of trabecular bone strength in the medical field.
Bone Density ; Cadaver ; Female ; Finite Element Analysis ; Head ; Humans ; Male

From Feb. 1985 to Aug. 1996, 450 patients underwent open heart surgery with hypothermic cardiopulmonary bypass. In 450 cases of open heart surgery, 222 cases(49.3%) were congenital heart diseases and 228 cases(50.7%) were acquired heart diseases. In 222 cases of congenital heart diseases, there were 201 cases of acyanotic heart disease and 21 cases of cyanotic heart diseases. Among the 228 cases of acquired heart diseases, most cases were valvular heart diseases in which 206 valves were implanted. There were 32 cases of ischemic heart disease and the average graft anastomoses were 2.37 sites per operation. The operative mortality of congenital and acquired disease was 9.0% and 10.1% respectively and then overall mortality rate was 9.6%.
Cardiopulmonary Bypass ; Heart Diseases ; Heart Valve Diseases ; Heart* ; Humans ; Mortality ; Myocardial Ischemia ; Thoracic Surgery* ; Transplants

This study was designed to examine the influences of antioxidants on toxicity of paraquat in male rats. Paraquat and ascorbic acid were given orally ad libitum with tap water containing paraquat 30 ppm and 100 ppm and ascorbic acid 1000ppm for 10 days, respectively, alpha-tocopherol(60 mg/kg) was administered orally by sonde at 2 days intervals for 10 days. Paraquat at given doses produced markedly a dose-related reduction in water-intake, ratio of liver weight/body weight and glutathione along with the increased aspartate aminotransferase, alkaline phosphatase, serum lipid and ratio of lung weight/body weight. However the combined administration of ascorbic acid and paraquat did not affect the toxic effects of paraquat, whereas combined administration of paraquat and alpha-tocopherol showed relative reduction in the toxicities of paraquat. From these experimental results, it could be concluded that alpha-tocopherol has detoxifying effect on paraquat poisoning as the antioxidant, meanwhile ascorbic acid, one of the antioxidance, does not exert any detoxifying effects.
Alkaline Phosphatase ; alpha-Tocopherol ; Animals ; Antioxidants ; Ascorbic Acid ; Aspartate Aminotransferases ; Glutathione ; Humans ; Liver ; Lung ; Male ; Paraquat* ; Poisoning ; Rats* ; Water

PURPOSE: To compare the clinical outcomes between scleral buckling and vitrectomy in the primary management of pseudophakic retinal detachment with an intact posterior capsule. METHODS: The medical records of 63 eyes that underwent scleral buckling (36 eyes) or vitrectomy (27 eyes) as a primary operation of uncomplicated pseudophakic retinal detachment with intact posterior capsules with a follow-up of more than one year were retrospectively reviewed from 2000 to 2005. We compared the clinical outcomes using anatomical and functional success rates at postoperative one year. Anatomical success was defined by a reattachment rate and functional success was measured by a change of more than 0.3 logMAR. RESULTS: Anatomical success rates were 86% in the scleral buckling and 82% in the vitrectomy, respectively (p=0.837). Functional success rates were 81% in the scleral buckling and 70% in the vitrectomy, respectively (p=0.065). There were no significant differences of anatomical and functional success rates according to each surgical procedure. CONCLUSIONS: Either scleral buckling or vitrectomy may be chosen as a primary operation in the management of pseudophakic retinal detachment with intact posterior capsule.
Capsules ; Eye ; Follow-Up Studies ; Medical Records ; Retinal Detachment ; Retinaldehyde ; Retrospective Studies ; Scleral Buckling ; Vitrectomy

BACKGROUND: In an effort t enhance long term patency of coronary bypass grafts, utilization of arterial conduits have been on an icrease. With the same objective, we have been using the right gastroepiploic artery (RGEA) in coronary artery bypass procedures since 1998. The current paper has been undertaken with the aim of assessing the apropriateness, problems, and short term results of using the RGEA as an arterial graft conduit by studying the postoperative clinical results of 100 patients than received coronary artery bypass grafting (CARG) with this artery. MATERIAL AND METHOD: Between May of 1998 and May of 1999, an analysis of the mortality, postoperative myocardial infarction, and the need for IABP insertion as a result of low cardiac output were made between 100 consecutive patients undergoing CABG with the RGEA. There was one postoperative death due to cerebral infarction. Postoperative complications/morbidity comprised myocardial infarction in 2, cerebral infarct in 3, reoperation due to bleeding in 1, mediastinitis in 1, and low cardiac output syndrome necessitating IABP in 3 patients. Complicatons related to harvesting of the arterial grafts were not experienced in any of the patients. CONCLUSION: The results of the current data show that utilization of the RGEA in CABG is not associated with increased mortality/morbidity and demonstrates satisfactory short term results suggesting the usefulnessof this conduit as an arterial graft.
Arteries ; Cardiac Output, Low ; Cerebral Infarction ; Coronary Artery Bypass* ; Coronary Vessels* ; Gastroepiploic Artery* ; Hemorrhage ; Humans ; Mediastinitis ; Mortality ; Myocardial Infarction ; Reoperation ; Transplants

Our purpose was to evaluate the clinical significance of large (>5cm) placental chorioangioma. Obstetrical and neonatal records which were confirmed chorioangioma in pathology and greater than 5 cm in diameter, were reviewed retrospectively from April. 1, 1991, to March. 31, 1996. 11 cases of placental chorioangioma greater than 5 cm were diagnosed prenatally by ultrasonography except one. I'hey were associated with maternal or fetal complications-6 cases of polyhydramnios, 2 cases of PIH, 1 case of neonatal anemia, 2 cases of preterm birth, 2 cases of neonatal hyperbilirubinemia, 1 case of cardiomegaly, 1 case of IUGR and 1 case of oligohydramnios. Nevertheless, there were not remarkable neonatal morbidity and mortality. These uncommon large tumors were often associated with maternal or fetal complications. But, we could get good neonatal outcome through thorough antenatal surveillance.
Anemia, Neonatal ; Cardiomegaly ; Female ; Fetal Growth Retardation ; Hemangioma* ; Hyperbilirubinemia, Neonatal ; Infant, Newborn ; Mortality ; Oligohydramnios ; Pathology ; Polyhydramnios ; Pregnancy ; Premature Birth ; Retrospective Studies ; Ultrasonography

BACKGROUND AND OBJECTIVES: The transradial approach for coronary intervention has a lower incidence of access site complications and can increase patient comfort after percutaneus tansluminal coronary angioplasty(PTCA). The purpose of this study is to compare procedural success and complication rates of percutaneous transradial coronary stenting which was performed by four operators in two hospitals with those using transfemoral approach. MATERIALS AND METHOD: From September 1998 to July 1999, one hundred seventy five consecutive patients(201 lesions) treated with coronary stent implantation were enrolled for this study : 84 patients underwent transradial coronary stenting(Radial Group), and 91 patients transfemoral coronary stenting(Femoral Group). RESULTS: Seven patients who failed coronary cannulation via radial artery were crossed over to the Femoral Group. The measurements of the radial artery were not done. Patient demographics were similar in both groups. Procedural success was similar in both group(95.2% in Radial Group vs. 97.8% in Femoral Group, p=S). All transradial coronary stenting were possible using conventional guiding catheters which are used in transfemoral intervention. Local vascular complication rates showed a trend toward a reduction in the Radial Group(2.4% vs. 8.8%, p=.06). CONCLUSION: This study showed the similarity in the safety and efficacy of transradial coronary stenting compared to those of transfemoral approach.
Catheterization ; Catheters ; Demography ; Humans ; Incidence ; Radial Artery ; Stents*

BACKGROUND:This study was designed to determine whether remifentanil or sodium nitroprusside (SNP) with sevoflurane anesthesia can induce safe deliberate hypotension (DH) to a target mean arterial pressure (MAP) of 55-65 mmHg in patients with controlled hypertension. METHODS:Thirty patients with controlled hypertension and who were scheduled for posterior lumbar interbody fusion were randomly assigned to receive remifentanil (n = 15, group R) or SNP (n = 15, group S).All the patients received a balanced anesthetic technique including 1.5-2 vol% sevoflurane.Group R received remifentanil by target-controlled infusion.The infusion was initiated with a target concentration at 4 ng/ml and this was adjusted every 1 min by 1 ng/ml to maintain the MAP to the target level of 55-65 mmHg.In group S, the infusion of SNP was initiated at 1 ug/kg/min and this was increased by 0.5 ug/kg/min.Cerebral oximetry was done and the cardiac index was measured with esophageal Doppler. RESULTS:DH was achieved at a MAP = 60 mmHg within 5.7 min for group R and 3.7 min for group S.The intraoperative blood loss was lower in Group R than that in Group S (304 +/- 103 vs 650 +/- 141 ml, P < 0.05).The frequency of added ephedrine injection to control the MAP and discontinuation of the study drug due to a MAP < 60 mmHg were higher in group S than in group R (46% vs 13%, P < 0.05 and 62% vs 20%, P < 0.05, respectively). CONCLUSIONS:Compared to SNP, remifentanil with sevoflurane anesthesia induced safer DH for patients with controlled hypertension.
Anesthesia ; Arterial Pressure ; Ephedrine ; Humans ; Hypertension ; Hypotension ; Methyl Ethers ; Nitroprusside ; Oximetry ; Piperidines ; Sodium