We performed ERCP manometry of Sphincter of Oddi(SO) before and after endoscopic sphincterotomy(EST) for evaluation of the effect af EST on the SO. The subjects were postcholecystectomized common bile duct stone patients(n=l2) and EST was performed by major incision. The pressure gradient between common bile duct and duodenum before EST (8.6 + 3.9 mmHg) decreased significantly after EST(2.4 +1.7 mmHg). The length of SO before EST(8.8 + 0.8mmHg) decreased significantly after EST(2.5 + 0.8mm). But in each patient, the pressure gradient between common bile duct and duodenum remained in spite of the major incision. In conclusion, EST alters the function of the sphincter of the Oddi, but does not destroy its all protective function. The positive pressure in the bile duct is preserved in contrast to the absolute loss of pressure following surgical transduodenal sphincteroplasty.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Duodenum ; Humans ; Manometry* ; Sphincter of Oddi* ; Sphincterotomy, Endoscopic* ; Sphincterotomy, Transhepatic

Spontaneous spinal epidural hematoma is a rare entity. Various definitions for spontaneous epidural hematoma have been reported in the literature. The expression of nontraumatic spinal epidural hematoma seems to be less ambiguous and includes idiopathic hematomas and hematomas secondary to coagulopathy, vascular malformations, and tumors. We report three cases of nontraumatic spinal epidural hematomas observed from 1991 to 2000. The causes of the spinal epidural hematomas were not clear in two cases among them, but in the another one case, the cause was determined to be an acquired coagulopathy. We reviewed 24 cases reported in the Korean Journal of Neurosurgery and our three cases with particular emphasis on the various causes such as coagulopathy, vascular malformations and tumors. Among the 27 cases, numerous causes were detected such as three cases of vascular malformation, one case of anticoagulant treatment, five cases of combined lumbar disc herniation, two cases associated with pregnancy and postpartum, one case associated with hypertension, and one case associated with ossification of ligamentum flavum. No causes were detected in the ten cases. The authors reviewed the literature.
Hematoma ; Hematoma, Epidural, Spinal* ; Hypertension ; Ligamentum Flavum ; Neurosurgery ; Postpartum Period ; Pregnancy ; Vascular Malformations

Despite a recent trend toward increased screening and public awareness for colorectal cancer, 30% of patients present with incurable disease. This study was designed to identify objective criteria that might help surgeons decide which patients with incurable colorectal cancer will benefit from palliative resection. Among 33 patients considered incurable colorectal cancer, twenty one patients underwent palliative resection and twelve patients had bypass surgery. Incidence of postoperative complication after palliative resection was 61.9%(13 cases), and after bypass surgery was 58.3%(7 cases). Among patients treated by palliative resection, one patient required reoperation for postoperative bleeding. The operative mortality after palliative resection was 19%(4 cases), and after bypass surgery was 25%(3 cases). The median survival was 11.4 months for patients treated by palliative resection, and was 9.7 months for patients treated by bypass surgery. These results show that palliative resection can be done safely and effectively in patients with incurable colorectal cancer. We believe this approach improved the quality of the remaining life in these patients.
Colorectal Neoplasms* ; Hemorrhage ; Humans ; Incidence ; Mass Screening ; Mortality ; Postoperative Complications ; Reoperation

BACKGROUND: It has been known that arterial carbon dioxide tension is 4~5 mmHg higher than end-tidal carbon dioxide tension in healthy adults during general anesthesia. But negative arterial to end-tidal PCO2 difference was reported in pregnant patients undergoing cesarean section. The purpose of this study was to elucidate the difference between arterial and end-tidal PCO2 in anesthetized patients with reduced functional residual capacity. METHODS: 90 patients were divided into 3 groups i.e. control group (n=30), obese group (n=20, body weight more than 20% greater than ideal weight), pregnant group (n=40). All patients had no cardiac or respiratory abnormalities and never smoked. Arterial blood gas analysis and measurement of end-tidal PCO2 were done 20 minutes after induction of anesthesia in control and obese group and just before uterine incision and 20 minutes after fetal delivery in pregnant group. RESULTS: There were significant correlations between arterial and end-tidal PCO2 in all groups. The incidences of negative arterial to end-tidal PCO2 difference were 10% in control group, 40% in obese group, 42.5% in pregnant group (p<0.05). CONCLUSION: From this study, it is concluded that patients with reduced functional residual capacity have more incidences of negativity than normal patients in the values of arterial to end-tidal PCO2 difference during general anesthesia. So when the tight control of PaCO2 is required in patients with reduced FRC, we recommend to measure PaCO2 for better anesthetic management.
Adult ; Anesthesia ; Anesthesia, General ; Blood Gas Analysis ; Body Weight ; Carbon Dioxide* ; Carbon* ; Cesarean Section ; Female ; Functional Residual Capacity* ; Humans ; Incidence ; Pregnancy ; Smoke

From July 1989 to August 1991, we performed 146 cases of endoscopic sphincterotomy(EST). In our series, 9 early complications occurred in 146 cases(morbidity rate: 6.2%), and no fatalities were recognized(mortality rate:0). Four cases with late complications consisted of 2 cases of acute cholecystitis, one case of chalaagitis and restenosis. There were 36 with the gallbladder with stone(11 cases) or without stone(25 cases). Two cases with chalecystitis after EST occurred in the patients with gallbladder stones. EST gives the sufficient result in diagnosis and treatment for various disease of biliary tract. Furthermore, EST was found to be a safe procedure from low rates of complications and fatalities.
Biliary Tract ; Cholecystitis, Acute ; Diagnosis ; Gallbladder ; Humans ; Sphincterotomy, Endoscopic*

Prostaglandin E1(PGE1) is a potent vasodillator of the systemic and coronary circulatory system, and when used in adult respiratory distress syndrome, PGE1 produces a decrease in pulmonary arterial pressure(PAP) and pulmonary vascular resistance(PVR), and increases cardiac output(CO) and arterial oxygen tension(PaO2). Another vasodilator hydralazine in patients with pulmonary hyertension and heart failure produces a decrease in PVR, and an increase in CO and inspite of an increase in CO, hydralazine maintains or increases the PaO2. The authors made a comparative studies on the effects of PGE1 and hydralarine on hemodynamics and gas exchange in experimentally induced acute lung injury. Oleic acid was infused in 8 dogs in order to induce acute lung injury and the effects on hemodynamics and gas exchange were measured every 30 minutes for 2hrs. After measuring Pre-PGE1 and Pre-hydralazine values, PGE1 and hydralazine were administered intravenously in order to evaluate and compare their effects. Doses for PGE1 and hydralazine were titrated until CO increased by 25%, heart rate(HR) increased by 15%, or mean arterial pressure(MAP) decreased by more than 20% from Pre-PGE1 and prehydralazine values. In PGE1 group, CO increased by 21%(p<0.01). MAP decreased by 14%(p<0.01). PVR decreased by 19%(p<0.01) and systemic vascular resistance(SVR) decreased by 29%(p<0.01). As CO increased with PGE1, intrapulmonary shunt(Qs/Qt) increased from 37% to 49%(p<0.01) and PaO2 fell from 109mmHg to 88mmHg(p<0.01). In hydralazine group, MAP, PVR, SVR and pulmonary capillary wedge pressure(PCWP) all decreased by 9%(p<0.01), 10%(p<0.05), 30%(p<0.0), 28%(p<0.01), respectively. CO increased by 41%(p<0.01) but the increase in Qs/Qt was only 5% inspite of a remarkable increase in CO, consequently PaO2 increased by 10% rising from 86mmHg to 94mmHg(p<0.01). Comparing the two groups, hydralazine resulted in a minor increase in Qs/Qt while there was a remarkable increase in CO. Moreover, it caused an increase in PaO2 and decrease in PCWP. The above results suggest that the effects of hydralazine are superior to those of PGE1 on the effects of hemodynamics and gas exchange in acute lung injury in dogs.
Acute Lung Injury* ; Alprostadil* ; Animals ; Capillaries ; Dogs ; Heart ; Heart Failure ; Hemodynamics* ; Humans ; Hydralazine* ; Lung Injury ; Oleic Acid* ; Oxygen ; Respiratory Distress Syndrome, Adult

This study was performed to assess the accuracy of 31P magnetic resonance spectroscopy(MRS) in the evaluation of myocardial ischemia in cats. Twelve cats underwent myocardial ischemia and reperfusion induced by 90 minutes ligation followed by 90 minutes recirculation of the left anterior descending coronary artery (LAD). MRS was performed using a 4.7T Biospec MRS/MRI system (Bruker, Switzerland). An inner diameter 1.5cm-sized doubly tuned surface coli was used for the collection of the MR signal. The coli was implanted to the epicardial surface at the expected area of infarction. 31P MRS was acquired before and during the periods of ischemia and reperfusion with 5-minute to 30-minute of intervals. After completion of the 31P MRS study, animals were sacrificed and the hearts were excised for 2,3,5-triphenyl tetrazolium chloride (TTG0 histochemical staining. The area of infarct was measured on the photographs of TTG stained heart slices using a computer programmed planimetry and the results were compared with those of the 31P MRS study. The level of phosphocreatine (PCr) was decreased to 28.2±6.9% of the baseline level 90 minutes after occlusion and recovered to 43.8±4.8% of the baseline level at the end of the reperfusion. A 50% depletion of PCr was reached 5 minutes after the LAD occlusion. The ATP was decreased to a 26.6±3.6% of the baseline level 90 minutes after occlusion and recovered to a 35.9±6.0 of the baseline level 90 minutes after reperfusion. The decreasing rate of ATP was slower than that of PCr showing a 50% of depletion 15 minutes after occlusion. The PCr/ATP ratio was 1.16±0.09 at the baseline, decreased to 0.88±0.07 at 30 minutes of occlusion, and then progressively increased during the late ischemic and reperfused periods. The ratio of the infarcted area to the effective signal area of the surface coli was inversely correlated to the ATP (r=0.68) and PCr (r=0.40) levels obtained at the end of reperfusion. In conclusion, 31P MRS reflects the changes in myocardial high energy phosphorous metabolism during the actue ischemia and reperfusion. If on adequate localization technique is feasible, 31P MRS can be used clinically in the diagnosis and monitoring of the patients with acute myocardial infarction.
Adenosine Triphosphate ; Animals ; Cats* ; Coronary Vessels ; Diagnosis ; Heart ; Humans ; Infarction ; Ischemia ; Ligation ; Metabolism ; Myocardial Infarction* ; Myocardial Ischemia ; Phosphocreatine ; Polymerase Chain Reaction ; Reperfusion ; Spectrum Analysis*

No abstract available.
Dermatitis, Atopic*

We report a case of acute cerebral infarction after general anesthesia. A 55-year-old man underwent total gastrectomy and splenectomy for advanced gastric cancer. Preoperatively, he has complained headache and dizziness for a year but neurologist, internist and anesthesiologist could not find any sign of cerebrovascular diseases. General anesthesia was induced with thiopental and maintained with 50% N2O and 1.5-2% enflurane in oxygen. After approximately 4h in the recovery room, he was not regained his consciousness. On physical examination, there was right hemiplegia. Immediate brain CT revealed acute cerebral infarction in left MCA and ACA territory. He was transported SICU. The following day he had a carotid Doppler ultrasonography that showed complete obstruction of both ICA. Neurologic examination showed negative eye reflex and pupil full dilation. He was discharged in a hopeless situation.
Anesthesia, General* ; Brain ; Cerebral Infarction* ; Consciousness ; Dizziness ; Enflurane ; Gastrectomy ; Headache ; Hemiplegia ; Humans ; Middle Aged ; Neurologic Examination ; Oxygen ; Physical Examination ; Pupil ; Recovery Room ; Reflex ; Splenectomy ; Stomach Neoplasms ; Thiopental ; Ultrasonography, Doppler

No abstract available.
Osteosarcoma* ; Sphenoid Bone*