PURPOSE: To assess the role of the preoperative portal vein embolization (PVE) in patients in need of major hepatectomy. MATERIALS AND METHODS: Total of 11 cases consisted of Klatskin tumor (n:6), gallbladder cancer (n=2), and hepatocellular carcinoma (n=3). After percutaneous transhepatic puncture of portal vein (right:7, left:4), the embolization of 1st order branch of right portal vein was done with Gentamicin soaked Gelfoam cubes. Radiologically, the angle between the middle hepatic vein and the inferior vena cava was measured on pre- and post-PVE CT (F/U :10 days) to evaluate the hypertrophy of the left lobe. Clinically, amount and nature of the drained bile through the PTBD tube of both lobes were analyzed in 5 patients with Klatskin tumor. The interval between PVE & operation was 10-24 days. Operative findings & the changes of postop. total bilirubin were analyzed and the complication after procedure was checked. RESULTS: There was decrease in mean angle between the middle hepatic vein and the inferior vena cava from 35.9 degree to 23.9 degree, but it was insignificant statistically (p=0.09). The embolization of right portal vein was done and there was increase in amount of drained bile from the nonembolized left lobe by 2-3 folds 8-14 days after PVE. The color and consistency between both lobes were significantly different; right lobe was darker in color and softer in consistency. Postoperative total bilirubin increased by 2-3 folds 1 to 4 days after PVE and normalized 10 to 14 days after PVE. Most of the patients had mild abdominal pain and fever after PVE and 1 patient had localized hematoma at puncture site which was subsided spontaneously. CONCLUSION: The preoperative portal vein embolization is a useful method for minimizing postoperative liver failure in patients in need of major hepatectomy.
Abdominal Pain ; Bile ; Bilirubin ; Carcinoma, Hepatocellular ; Fever ; Gallbladder Neoplasms ; Gelatin Sponge, Absorbable ; Gentamicins ; Hematoma ; Hepatectomy* ; Hepatic Veins ; Humans ; Hypertrophy ; Klatskin's Tumor ; Liver Failure ; Portal Vein* ; Punctures ; Vena Cava, Inferior

No abstract available.
Electroconvulsive Therapy* ; Prolactin*

Background: The present study was to compare the potential impact of remifentanil-based propofol-supplemented anesthesia regimen vs. conventional sevoflurane-sufentanil balanced anesthesia on postoperative recovery of consciousness indicated by c) values in patients undergoing cardiac surgery. Methods: Patients undergoing cardiac surgery were randomly allocated to get the remifentanil-based propofol-supplemented anesthesia employing target-controlled infusion (TCI) of remifentanil and propofol (Group-PR, n = 15) or a balanced-anesthesia employing sevoflurane-inhalation and TCI-sufentanil (Group-C, n = 19). In Group-PR, plasma concentration (Cp) of TCI-remifentanil was fixed at 20 ng/ml, and the effect-site concentration of TCI-propofol was adjusted within 0.8–2.0 μg/ml to maintain BIS value of 40–60. In Group-C, sevoflurane dosage was adjusted within 1–1.5 minimum alveolar concentration to maintain BIS of 40–60, and Cp of TCI-sufentanil was fixed at 0.4 ng/ml. The inter-group difference in the time for achieving postoperative BIS > 80 (T-BIS80) in the intensive care unit was determined as the primary outcome. The inter-group difference in the extubation time was determined as the secondary outcome. Results: T-BIS80, was shorter in Group-PR than Group-C (121.4 ± 64.9 min vs. 182.9 ± 85.1 min, respectively; the difference of means –61.5 min; 95% CI –115.7 to –7.4 min; effect size 0.812; P = 0.027). The extubation time was shorter in Group-PR than in Group-C (434.7 ± 131.3 min vs. 946.6 ± 393.3 min, respectively, P < 0.001). Conclusions Compared with the conventional sevoflurane-sufentanil balanced anesthesia, the remifentanil-based propofol-supplemented anesthesia showed significantly faster postoperative conscious recovery in patients undergoing cardiac surgery.

OBJECTIVES: This study was carried out to investigate the clinical availability of topographic auditory event related potential P300 as a biological marker in children with attention deficit hyperactivity disorder(ADHD). METHODS: The subjects were composed of children with ADHD(n=22:16 boys, 6 girl s:mean age=89.8+/-17.1months) and normal controls(n=20:12 boys, 8 girls:mean age=90.6+/-16.8months). Topographic auditory event related potential was measured by "oddball paradigm", and the latencies and amplitudes of P300 of both groups were determined by Global Field Power Measurement. After 8 weeks treatment with methylphenidate, P300 of ADHD children were also measured. RESULTS: Both P300 latency and amplitude were not different between ADHD children after treatment and normal controls, but significantly different between ADHD children before treatment and normal controls, and between before and after treatment of ADHD children. CONCLUSIONS: The results implicate that the latency and amplitude of P300 may be considered as state markers of ADHD.
Attention Deficit Disorder with Hyperactivity* ; Biomarkers ; Child* ; Evoked Potentials* ; Female ; Humans ; Methylphenidate

The authors analysed retrospectively, 69 cases of chronic subdural hematoma admitted to the Department of Neurological Surgery, from January 1992 to February 1995. All hematomas were operated on by one burr hole trephination and continuous closed-system cather drainage system. The results were as follows: 1) Male was more frequently involved than female with ratio of 5.3:1 and the incidence was prredominent in the patients whose ages were over 50. 2) History of head trauma was found in 52 cases(75.4%), among which habitual alcoholism was found in 6 cases(8.7%). 3) The major symptoms and signs at admission were headache(55.1%), hemiparesis(44.9%), and mental changes(30.4%). 4) On the brain CT scan, hematoma showed low, iso, mixed, and high in density, and the shapes of hematoma were crescenteric, biconvex, planoconvex, and concave in order of frequency. 5) We have found a significant relationship between the neurological grade at admission and the prognosis, and noted full recovery in 45 cases(65.2%) and no d eath as a result of 1-burr hole trephination.
Alcoholism ; Brain ; Craniocerebral Trauma ; Drainage ; Female ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Incidence ; Male ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed ; Trephining

Although talus fractures are uncommon, proper management is important because they are often associated with severe complications. Talar neck and body fractures occupy most of the talar fractures. It remains controversial whether talar neck fractures require emergent or elective treatment. Elective definitive fixation, however, may reduce risks of wound complications. Many surgeons recommend dual surgical approaches—anteromedial and anterolateral—to allow accurate visualization and anatomic reduction. Although there are various methods of fixation, the use of plates is necessary in comminuted talar fractures. Outcomes may vary and will be dependent on the degree of the initial fracture displacement. It is necessary to restore articular congruency and axial alignment for normalizing hindfoot function. Common complications include posttraumatic arthritis, avascular necrosis, malunion, and nonunion.
Arthritis ; Neck ; Necrosis ; Surgeons ; Talus* ; Wounds and Injuries

Ulcerative colitis (UC) is a chronic inflammatory disorder of the colonic mucosa that characteristically affects the rectum and involves the large bowel in a contiguous distribution. Upper gastrointestinal inflammation was not believed to be present in UC, but a few recent studies have reported a high incidence of gastroduodenal inflammation in patients with UC, although such occurrences are apparently rare and the stomach and duodenum are not generally considered target organs in UC. Here, we present the case of a 29.year.old man with UC who was found to have diffuse ulcerative duodenitis with endoscopic and histologic features identical to UC
Colitis, Ulcerative ; Colon ; Duodenitis ; Duodenum ; Humans ; Incidence ; Inflammation ; Mucous Membrane ; Rectum ; Stomach ; Ulcer

Intense pulsed light (IPL) is a high-intensity pulsed light source emitting polychromatic, non-coherent, and defocused light with a broad wavelength spectrum. However, IPL can similarly work as a conventional laser with the help of variable cut-off filters. It enables selective destruction of target chromophores based upon the theory of selective photothermolysis. Clinicians can combine variable factors including wavelengths, pulse durations, and fluences in IPL systems, which allow great versatility in treating wide ranges of dermatologic diseases and flexibility in optimizing individual treatment parameters according to different skin types or indications. These properties are of great advantage for skilled and experienced clinicians but can be a source of unwanted serious adverse effects for untrained ones at the same time. Therefore, we summarized the basic principles and clinical application of IPL devices to provide the practical guidance. In addition, critical diagnostics, a great deal of experience, and a thorough knowledge of skin pathology and physiology are required for an effective and safe IPL treatment.
Enzyme Multiplied Immunoassay Technique ; Imidazoles ; Light ; Nitro Compounds ; Pliability ; Skin

Immunohistochemical staining was used to evaluate the presence of nitricoxide synthase (NOS) family enzymes in the rat penis and major pelvic ganglion.We used three kinds of antisera which are brain(neuronal), endothelial cell andmacrophge(inducible) enzymes of NOS. Many brain NOS positive neurons wereobserved in the major pelvic ganglion, especially in the initial portion of thecavenous nerve. In the penile erectile tissue, many delicate, beaded or linearbrain NOS-positive fibers were observed on the bundle of smooth muscles,adventitia of helicine artery and wall of cavernous space. Brain NOS-positiveimmunoreactivity were also seen on the encapsulated nerve ending and adventitiaof dorsal vessels of penis. Endothelial cell NOS immunoreactivity was exclusivelyin the urethral epithelium of corpus spongiosum. There was no inducible NOSimmunoreactivity in rat penis and major pelvic ganglion. These results suggestthat NO related to penile erection in rat was made from brain NOS rather thanendothelia1 cell or inducible NOS.
Animals ; Arteries ; Brain ; Endothelial Cells ; Epithelium ; Ganglion Cysts* ; Humans ; Immune Sera ; Male ; Nerve Endings ; Neurons ; Nitric Oxide Synthase* ; Nitric Oxide* ; Penile Erection ; Penis* ; Protein Isoforms* ; Rats*

BACKGROUND: Clinical concern and incidence of mycotic keratitis in ophthalmic practice has been increasing. OBJECTIVE: The purpose of this study was to investigate clinical and mycological feature of mycotic keratitis. METHODS: We evaluated the clinical and mycological aspect of mycotic keratitis in 14 patients from October 1993 to March 1997 in Dongguk Unversity Hospital. RESULTS AND CONCLUSION: Mycotic keratitis showed high incidence in fifth (42.9%), sixth (35.7%), and fourth decade (14.3%). The ratio of male to female patient was 1:3.6. The seasonal prevalence was highest in autumn. A scratch or abrasion from vegetation was the most common type of the eye trauma in mycotic keratitis. The positive rate of KOH examination and culture was 92.9%, respectively. The common causative organisms of mycotic keratitis were Fusarium sp. (38.5%) and Alternaria sp. (38.5%), followed by Curvularia sp. (7.7%), Aspergillus flavus (7.7%) and Acremonium sp. (7.7%).
Acremonium ; Alternaria ; Aspergillus flavus ; Female ; Fusarium ; Humans ; Incidence ; Keratitis* ; Male ; Prevalence ; Seasons