The authors studied the effect of insufflation of oxygen at 5 cmH2O into the nonventilated lung on the arterial oxygenation in the thoracotomy patients(n=14) who showed PaO2 below 100 mmHg or oxygen saturation below 95% during one-lung ventilation. When applying CPAP 5 cmH2O to the collapsed lung, we inflated the collapsed lung with reservoir bag that is one of the equipment of self made CPAP device. Hemodynamic parameter(mean arterial pressure and heart rate), arterial blood gas analysis and calculated shunt fraction was collected 10, 20, 30min after applying CPAP. PaO2 was significantly increased from 76+/-20mmHg to 180+/-66 (mean+/-SD) and shunt fraction was significantly decreased from 43.5+/-5.6% to 31.5+/-4.9% at CPAP 10 min. There was no significant difference in the PaO2 and shunt fraction between CPAP 10, 20 and 30 min. Heart rate was also significantly decreased with CPAP compared to pre-CPAP value. Other parameter(mean arterial pressure, PaCO2) was not changed with CPAP. The authors conclude that CPAP 5 cmH2O to the nonventilated lung is effective to improve oxygenation when hypoxemia occurs during one-lung ventilation.
Anoxia ; Arterial Pressure ; Blood Gas Analysis ; Continuous Positive Airway Pressure* ; Heart ; Heart Rate ; Hemodynamics ; Insufflation ; Lung* ; One-Lung Ventilation* ; Oxygen* ; Thoracotomy

No abstract available.

We studied two intraabdominal desmoplastic small cell tumors. The patients were two men, 37 and 23 years old, with jaundice and palpable abdominal masses. On exploratory laparotomy, each patient revealed a huge mass in the greater omentum with disseminated peritoneal seeding, measuring 32 cm and 11 cm in its greatest dimension, respectively. The tumor involved the diaphragm, rectal shelf, and cul de sac in case 1, and it involved the porta hepatis, retroperitoneum, and serosal surface of the ascending and transverse colon in case 2. Omentectomy of the huge mass and satellite masses was performed in each patient. Both tumors showed nearly the same histopathologic features. The histologic pattern was suggestive of a metastatic small cell carcinoma, but there was no specific, single primary site. The tumors consisted of variably sized, discrete islands of epithelial-like small cells in dense desmoplastic stroma. The tumor cells revealed divergent epithelial, mesenchymal, and neural differentiation by histologic, immunohistochemical, and electron microscopic observations. Only one cycle of chemotherapy including cisplatin and VP-16 was given in case 1 because of a subsequent hepatic problem, who, thereafter, showed massive intraabdominal recurrent tumors 6 months after diagnosis. In case 2, the poor condition of the patient had made chemotherapy and radiotherapy impossible. Case 2 died of disseminated intravascular coagulation following progressive cachexia 7 months after diagnosis.
Neoplasm Metastasis

Recurrent episode of meningitis in infants and children frequently constitute a frustrating and distressing, both in determination of course and treatment. The authors are reporting a infected case of congenital dermal sinus with dermoid cyst in the subarachnoid space of cauda equina and conus medullaris which was cured after complete removal of cyst and sinus tract.
Cauda Equina ; Child ; Conus Snail ; Dermoid Cyst ; Humans ; Infant ; Meningitis ; Spina Bifida Occulta* ; Subarachnoid Space

No abstract available.
Microvascular Decompression Surgery*

PURPOSE:There are some cases of false positive in neonatal screening for congenital adrenal hyperplasia. To understand its significance of the increased 17 alpha-hydroxyprogesterone(17 alpha-OHP) levels in the cases of positive result, we followed its levels during infancy. METHODS:From July 1997 to June 1998, totally 1,730 babies were screened for congenital adrenal hyperplasia(CAH) measuring 17 alpha-hydroxyprogesterone(17 alpha- OHP) using an enzyme immunoassay(EIA) on dried blood spots. In infants of positive result, the radioimmunoassay(RIA) was used measuring 17 alpha-OHP in serum. And we followed up the levels of 17 alpha-OHP during infancy. Cortisol and ACTH were also measured and followed up in the morning simultaneously. RESULTS:No CAH was detected during the study period. With the 13 ng/mL cutoff limit for 17 alpha-OHP before March 1998, the recall rate was 3.09%. With the 20 ng/mL cutoff limit after March 1998, the recall rate was decreased to 1.58%. Follow-up of the high levels of 17 alpha-OHP in positive cases showed a sharply decreased curve according to age. CONCLUSION: In clinically normal neonates, the high levels of 17 alpha-OHP at screening decreased continuously during infancy.
17-alpha-Hydroxyprogesterone* ; Adrenal Hyperplasia, Congenital ; Adrenocorticotropic Hormone ; Follow-Up Studies ; Humans ; Hydrocortisone ; Infant ; Infant, Newborn ; Mass Screening ; Neonatal Screening*

PURPOSE:There are some cases of false positive in neonatal screening for congenital adrenal hyperplasia. To understand its significance of the increased 17 alpha-hydroxyprogesterone(17 alpha-OHP) levels in the cases of positive result, we followed its levels during infancy. METHODS:From July 1997 to June 1998, totally 1,730 babies were screened for congenital adrenal hyperplasia(CAH) measuring 17 alpha-hydroxyprogesterone(17 alpha- OHP) using an enzyme immunoassay(EIA) on dried blood spots. In infants of positive result, the radioimmunoassay(RIA) was used measuring 17 alpha-OHP in serum. And we followed up the levels of 17 alpha-OHP during infancy. Cortisol and ACTH were also measured and followed up in the morning simultaneously. RESULTS:No CAH was detected during the study period. With the 13 ng/mL cutoff limit for 17 alpha-OHP before March 1998, the recall rate was 3.09%. With the 20 ng/mL cutoff limit after March 1998, the recall rate was decreased to 1.58%. Follow-up of the high levels of 17 alpha-OHP in positive cases showed a sharply decreased curve according to age. CONCLUSION: In clinically normal neonates, the high levels of 17 alpha-OHP at screening decreased continuously during infancy.
17-alpha-Hydroxyprogesterone* ; Adrenal Hyperplasia, Congenital ; Adrenocorticotropic Hormone ; Follow-Up Studies ; Humans ; Hydrocortisone ; Infant ; Infant, Newborn ; Mass Screening ; Neonatal Screening*

PURPOSE: The purpose of this study is to evaluate the findings of magnetic resonance imaging(MRI) of posterior fossa hemangioblastoma and usefulness of contrast enhancement with Gd-DTPA. MATERIALS AND METHODS: Seven patients with posterior fossa hemangioblastoma were studied with both pre- and post-enhanced MRI. The MR images were reviewed regarding the location, size, signal intensities of cysts and mural nodules, and their contrast enhancement pattern. RESULTS: Five tumors were located in cerebellar hemisphere, one in vermis, and one in posterior part of medulla. One patient with von HippeI-Lindau disease had a medullary hemangioblastoma with multiple pancreatic cysts. In 6 cases, the major portion of the tumor was cysts and had small mulkal nodules. The solid portion was relatiely lange in one case, cemprising half of the tumor Cysts were oval shaped and their sizes were 3--6.7cm in diameter. In five cases(71%), septations were noted within the cysts. Cysts were isointense or slightly hyperintense on Tl-weighted image and hyperintense on T2-weighted image compared with cerebrospinal fluid. Mural nodules were oval or rounded appearance in five cases and flattened appearance in two, and their size was 0.5--2.5cm in diameter. Mural nodules were isointense to gray matter. They were detected in five cases on Tl-weighted images and one case on T2-weighted images. In two cases, vascular signal void area was noted in mural nodules. On contrast-enhanced Tl-weighted images, all mural nodules were intensely enhanced. CONCLUSION: MRI proved to be a good diagnostic method to detect and characterize posterior fossa hemangioblastoma. The most common finding is Cystic posterior fossa lesion with enhancing mural nodule. Contrast enhancement is essential for specific diagnosis.
Cerebrospinal Fluid ; Diagnosis ; Gadolinium DTPA ; Hemangioblastoma* ; Humans ; Magnetic Resonance Imaging* ; Pancreatic Cyst

The free flaps have been used for reconstruction of the head and neck because of their superior results comparing with other types of flaps. Among them, radial forearm free flap has many advantages, its thinness, pliablilty, long vascular pedicle, large sensory flap, and compound flap including tendons and bone. We report 28 cases of head and neck reconstruction with radial forearm free flap between March 1991 and March 1997. Patient's age ranged from 21 to 76 years(mean 50.5 years). There were 23 men and 5 women. Mean follow-up period was 14 months. The most common cause was malignant tumor of the head and neck, especially squamous cell carcinomas(18 cases). We used this flap to reconstruct the oral cavity in 13 cases, the hypopharyngoesophagus in 6 cases, external surface of the head and neck in 7 cases, and the orbit in 2 cases. All of these flaps survived without complication. Two cases of fistula developed, in which forearm flaps were used for tongue and hypopharyngoesophageal reconstruction, and they were treated with conservative manners. Partial losses of skin graft at donor site of the forearm developed in 3 cases. They healed with split-thickness skin graft or local flap. The function of reconstructed upper aerodigestive tract and eye socket was good. The cosmetic result was not good in cases of reconstruction for external surface of the face with this flap, but it was better than other free flaps. So, we concluded the radial forearm free flap is available for reconstruction of the head and neck.
Female ; Fistula ; Follow-Up Studies ; Forearm* ; Free Tissue Flaps* ; Head* ; Humans ; Male ; Mouth ; Neck* ; Orbit ; Skin ; Tendons ; Thinness ; Tissue Donors ; Tongue ; Transplants

Congenital lobar emphysema has the clinical features of an air block' syndrome with- out the evidence of pulmonary infection or intrabronchial foreign body. The hyperinflated lung causes a compression of uninvolved lobes creating respiratory distress, cyanosis within the first weeks of life. We experienced a case of congenital lobar emphysema diagnosed incidentally by chest reontgenogram in an infant with frequent upper respiratory infection within a few weeks of life. Chest X-ray revealed extensive emphysematous changes in the left upper lobe, shifting of heart and medistinum to the right and compression of the right lung. Respiratory distress, cyanosis and chest wall retraction ensued and left upper lobe Lobectomy was performed successfully.
Cyanosis ; Emphysema* ; Foreign Bodies ; Heart ; Humans ; Infant ; Lung ; Thoracic Wall ; Thorax