No abstract available.

No abstract available.
Anemia, Hemolytic, Autoimmune*

Although there are many peri-operative measures to reduce core temperature loss during operation, rapid drop has been experienced in the first sixty minutes following induction of general anesthesia. Recently, preoperative warming has been emphasized to prevent inadvertant hypothermia during operation. The purpose of this study is to find the effect of preoperative warming on reducing rectal temperature drop in surgical patients. With informed consent, 46 female adult patients, scheduled for total abdominal hysterectomy or salpingo-oophorectomy in the Seoul National University Hospital from September 3, 1996 to September 19, 1996 were divided into two groups. The variables of age and body surface were matched between the two groups as possible. Among them, 24 patients were preparatively covered up to the shoulders with a forced-air warming blanket(WARM TOUCHTM). set between 36-40degrees C for prewarming, and the other 22 patients(control group)were not before the induction of anesthesia. Rectal temperature was measured by mercury thermometer for rectum after admission to the operating room and by rectal probe which was inserted in the rectum just before the induction during the operation. The rectal temperature was monitored and recorded at every fifteen minutes for the first sixty minutes after the induction and each step during the surgery(intubation, surgical draping, peritoneum opening, one hour and the end of the operation) Collected data were analyzed by means of t-test, Repeated Measures Analysis of Variance with PC-SAS. The results of this study are as following. (1) There was no significant difference between the two groups in age, weight, height, room temperature, basal rectal temperature, operation time. (2) Temperature gradient of the rectal temperature in the warming group was less steeper than that in the control roup during the first sixty minutes after general anesthesia. (3) The rectal temperature measured at every fifteen minutes for the first sixty minutes and the end of surgery after the general anesthesia showed the difference between the two groups during surgery. (4) There was no rectal temperature difference during the intubation, however there was significant temperature difference between the two groups from draping to the end of surgery. In conclusion, prewarming of the surgical patient before induction resulted in increased the skin temperature and heat content, which relieved the dangerous core temperature drop which is potential to be provoked within one hour after induction of the surgical patients and kept the rectal temperature higher than that of the control group during surgery. The suggestions from this study shown below : First, further study is needed to find the preventive effect of the core temperature drop in the first sixth minutes after anesthetic induction by preoperative warming for gastrorectal, thoracic surgery patients who man have the core temperature drop during the operation. Second, in other to keep patient normothermia during the surgery, it needs to study whether using pre-and peri-operative warming can prevent hypothermia or not. Finally, the study of the peroperative warming effect on surgical patients' relaxation and thermal discomfort before the operation is needed because most patients in the case group said to have felt thermal comfort ; 'comfortable' and 'good'.
Adult ; Anesthesia ; Anesthesia, General ; Female ; Hot Temperature ; Humans ; Hypothermia ; Hysterectomy ; Informed Consent ; Intubation ; Operating Rooms ; Peritoneum ; Rectum ; Relaxation ; Seoul ; Shoulder ; Skin Temperature ; Thermometers ; Thoracic Surgery

No abstract available.
Fetal Death*

Malignant histiocytosis is a rare, usually fatal malignant neoplasm of reticuloendothelial systems. The disease is associated with fever, malaise, weight loss, hepatosplenomegaly, lymphadenopathy, pancytopenia, jaundice, and purpura. A 44-year-old female patient is described who had multiple, purple crusted nodules and plaques in the skin. In the laboratory study, pancytopenia was noted on the peripheral blood. In addition many atypical histiocytes were seen on the bone marrow aspiration. A lesional biopsy showed nodular infiltrations of atypical histiocytes in the dermis and some erythrophagocytosis was seen. Immunohistochemically, the histiocytes were weakly stained for lysozyme and α-l-antichymotrypsin, but were unstained for S-100 protein, cytokeratin, CEA(carcinoembryonic antigen), pan T/B marker CD30(ki-1), UCHL-1 LCA(leukocyte common antigen), and α-l-antitrypsin.
Adult ; Biopsy ; Bone Marrow ; Dermis ; Female ; Fever ; Histiocytes ; Histiocytic Sarcoma* ; Humans ; Jaundice ; Keratins ; Lymphatic Diseases ; Mononuclear Phagocyte System ; Muramidase ; Pancytopenia ; Purpura ; S100 Proteins ; Skin ; Weight Loss

OBJECTIVE: The laparoscopic appendectomy was developed as an alternative procedure to be used in acute appendicitis. Some surgeons dispute the advantages of laparoscopic procedures for acute appendicitis. Specifically, there are many controversies associated with perforated appendicitis. We reviewed the results of appendectomies to assess the feasibility of a laparoscopic appendectomy in acute appendicitis that included perforated appendicitis. METHODS: Three hundred thirty-nine consecutive patients with laparoscopic appendectomies, which include 27 patients with perforated appendicitis, were analysed. This study considered the lengths of the operation and the hospital stay. Differences in complications between non-perforated and perforated appendicitis were also evaluated. RESULTS: A total of 388 patients underwent appendectomies, 339 patients with laparoscopy and 49 patients with conventional open appendectomies, from April 1994 to June 1996. The mean duration of laparoscopic appendectomies was 48.9 minutes. This was slightly longer than that of open appendec tomies (44.9 minutes) in the same hospital. The duration of hospital stay was on the average of 4.9 days. Six patients (1.8%) were converted to conventional surgery because of difficult mobilization in 4 patients and uncontrollable bleeding in the remaining two. The surgeries on patients who were converted to conventional surgery were performed by rotating residents without staff supervision. Minor complications developed in eight patients (2.4%). In comparing the results between non-perforated and perforated appendicitis, durations of operation (47.3 vs. 78.3 minutes) and the hospital stay (4.6 vs. 8.6 days) were longer in perforated appendicitis. However, the complication rate (2.6 vs. 0%) was unexpectedly found to be lower in perforated appendicitis. CONCLUSIONS: The laparoscopic appendectomy is a safe, feasible procedure for acute appendicitis. It is an excellent procedure for perforated appendicitis and has minor complications compared to an open appendectomy with its large incision that is followed by a high rate of wound infection and/or post operative adhesion. There aree various reports on prospective randomized studies evaluating the benefits of a laparoscopic appendectomy compared to a conventional open appendectomy. The reports by laparo scopic surgeons in various centers are different with regard to operative time, postoperative recovery, morbidity, and postoperative complications. For complicated appendicitis, most surgeons are not in agree ment with the laparoscopic approach. We obtained excellent results with laparoscopic appendectomies in perforated appendicitis which included periappendiceal abscesses.
Abscess ; Appendectomy* ; Appendicitis ; Dissent and Disputes ; Hemorrhage ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Organization and Administration ; Postoperative Complications ; Prospective Studies ; Wound Infection

We evaluated the corneal topography of 109 eyes which have 1 diopter or more astimatism, with computer-assisted videokeratography(Eye Sys CAS). There was 11% with round pattern, 17.4% with oval pattern, 49.5% with symmetric bow-tie pattern, 19.3% with assymmetric bow-tie pattern, 2.8% with irregular pattern. 70% of subjects had right and left eyes classified into the same group. There was statistically significant difference among the patterns for keratometric astigmatism and difference among the groups which were classified by the location of the area of highest refractive power for keratometric and total astigmatism. The mean angular separation between flat and steep meridian was 89.2 degrees and ranged from 78.61 degrees to 100.67 degrees. The mean residual astigmatism was 0.547 diopter. In the with-the rule astigmatism type, when the total astigmatism less than 1.89 diopter, residual astigmatism neutralize the corneal astigmatism, but when the total astigmatism increase more than 1.89 diopter, residual astigmatism tend to increase the total astigmatism.
Astigmatism* ; Classification* ; Corneal Topography*

No abstract available.

Fifteen patients with 38 compression fractures of the spine underwent magnetic resonance(MR) imaging. We retrospectively evaluated MR images in these benign compression fractures. MR images showed four patterns in T1-weighted images. MR imaging patterns were normal signal(21), band like low signal(8), low signal with preservation of peripheral portion of the body(8), and diffuse low signal through the vertebral body(1). The low signal portions were changed to high signal intensities in T2-weighted images. In 7 of 15 patients(11 compression fractures). There was a history of trauma, and the remaining 8 patients(27 compression fractures) had no history of trauma. Benign compression fractures of trauma, remained 8 patients(27 compression fractures) were non-traumatic. Benign compression fractures of the spine reveal variable signal intensities in MR imagings. These patterns of benign compression fractures may be useful in interpretation of MR imagings of the spine.
Fractures, Compression* ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Spine*

OBJECTIVE: To describe normal postoperative MR findings and MR findings of postoperative discitis in patients who underwent operation due to herniated intervertebral disc. MATERIALS AND METHODS: We retrospectively reviewed normal postoperative MR findings and MR findings of discitis in 30 patients(21-61yrs.) (13 cases dignosed as discitis and 17 cases as normal) who previonsly underwent laminectomy and discectomy, or bony fusion. We analyzed signal intensity of end plate and disc, end plate destruction, and enhancement of end plate and disc on T1- and T2-weighted images(WI) of 1.5T MRI. RESULTS: Among 14 out of 17 patients with no evidence of discitis, 7 patients showed high signal of the posterior portion of disc on T1- and T2-WI and 11 patients revealed enhancement at the same sites. In all 13 patients suspected of having discitis, end plate and disc showed low signal on T1-WI, high signal on T2-WI, heterogeneous enhancement, and irregular destruction of end plate. Meanwhile, 3 cases with no evidence of postoperative discitis clinically who underwent bony fusion showed similiar findings to those of the above 13 patients, except for homogeneous enhancement of end plate and vertebral body. CONCLUSION: The MR findings of postoperative discitis were low signal on T1-WI, high signal on T2-WI, and heterogeneous enhancement of and plate and disc, and destruction of end plate.
Discitis* ; Diskectomy ; Humans ; Intervertebral Disc* ; Laminectomy ; Magnetic Resonance Imaging ; Retrospective Studies