No abstract available.
Neurilemmoma*

We report here on a new technique using polymethylmethacrylate to manage vertebral osteoporotic compression fractures in three patients. These patients presented with acute back pain that manifested itself after minor trauma. Osteoporotic compression fractures were diagnosed via plain X-ray and magnetic resonance imaging studies. The patients were treated with absolute bed rest and non-steroidal anti-inflammatory drugs. Despite of the conservative treatment, the patients experienced severe, recalcitrant and progressive pain. The vertebrae were collapsed over 50% or kyphotic deformity was seen on the radiologic materials. We performed a new technique called lordoplasty, which is derived from percutaneous vertebroplasty. The patients experienced a reduction in pain after the procedure. The wedge and kyphotic angles of the fractured vertebrae were significantly restored.
Aged ; Female ; Fractures, Compression/radiography/*surgery ; Humans ; Magnetic Resonance Imaging ; Orthopedic Procedures/*methods ; Osteoporotic Fractures/radiography/*surgery ; Spinal Fractures/radiography/*surgery ; Thoracic Vertebrae/*injuries/radiography/surgery

Tachycardia and hypertension are well documented complications of laryngoscopy and tracheal intubation in normal patients(Reid and Brace, 1940; Burstein et al, 1950; King et al 1951; Takeshima et al, 1964; Forbes and Dally, 1970). This phenomenon has been studied in detail in cats by Tomori and Widdicombe(1969), who found it to be associated with an increased impulse traffic in the cervical sympathetic efferent fibers. This nervous activity was especially increased by stimulation of the epipharyngeal and laryngopharyngeal regions, and was accompanied by the largest hypertensive response(Takki et al, 1972). Also various arrhythmias were elicited by vagal stimulation during endotracheal intubation(Burstein et al, 1950: King et al, 1951; Forbes et al, 1970), and it has been known that cardiac arrest could be observed in severe cases(Burstein et al, 1950; Dwyer, 1953; Raffan, 1954; Lander and Mayer, 1965). That hypertension during induction of anesthesia in critically ill patients may be harmful is substantiated by reports of cerebral hemorrhage, left ventricular failure and life threatening cardiac arrhythmia(Forbes and Dally, 1970; Dingle, 1966; Masson, 1964; Katz and Bigger, 1970). Pharmacologic attempts to attenuate these blood pressure and heart rate elevations and appearances of arrhythmia have been tried but theese approaches have been only partially successful. We selected at random 60 adult patients who had received operation under the general anesthesia with intubation at Severance Hospital from August to September, 1979. They were divided into 4 groups. Group l was normotensive without trimethaphan(n=20), Group ll was normotensive with trimethaphan(n=20), Group ll was hypertensive without trimethaphsn(n=10) and Group lV was hypertensive with trimethaphan(n=10). The changes of arterial blood pressure and pulse rate, and appearance of arrnythmia were analyzed and data were compared between groups. The results were as follows; 1. In the trimethaphan injected group, during induction attenuation of increase in blood pressure was not significant in the normotensive group but was statistically significant in the hypertensive group. 2, The effects of trimethaphan on changes of pulse rate were not significant during laryngoscopic insertion under general anesthesia. 3, On EKG of hypertensive patients the trimethaphan injected group revealed fewer abnormal EKG findings than the control group. It is suggested from the above results that intravenous injection of a small amount(0.1 mg/kg) of trimethaphan in a hypertensive patient just before endotracheal intubation can be used as one method to prevent a dangerous hypertensive crisis.
Adult ; Anesthesia ; Anesthesia, General ; Animals ; Arrhythmias, Cardiac ; Arterial Pressure ; Blood Pressure ; Braces ; Cardiovascular System* ; Cats ; Cerebral Hemorrhage ; Critical Illness ; Electrocardiography ; Heart Arrest ; Heart Rate ; Humans ; Hypertension ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Methods ; Tachycardia ; Trimethaphan*

For lesions like intracranial aneurysms which are located near highly vascularized regions, adequate dissection becomes almost impossible unless local blood flow can be reduced. Deliberate hypotension, purposefully lowering the arterial pressure to a level at which bleeding is no longer a problem, facilitates surgery, allows performance of a better dissection, and shortens the length of the procedure. Currently, the most useful method for induced hypotensive anesthesia is the use of chemical drugs, such as trimethaphan, nitroprusside and halothane. Induced hypotension with halothane has been reported to be a relatively safe and useful method by Murtagh (1960) and Schettini, et al (1967). Halothane has the effect of depression of myocardial contractility, central autonomic inhibition, ganglionic blocking action and suppression of the peripheral actions of norepinephrine and direct vasodilation on the vessel wall. The advantage of halothane is the reduction of mean arterial pressure slowly (1-3 mm Hg/min) and it has a transient effect on EKG, little effect on brain cortical function and appropriate oxygen supply to brain tissue. The halothane induced hypotension in 100 cases of intracranial aneurysm surgery, which were performed at Severance Hospital of the Yonsei University College of Medicine from .1972 to 1977, was investigated clinically. The results of our study were as follows: 1) The locations of intracranial aneurysm in order were the anterior cerebral artery (37 cases), internal carotid artery (35 cases), middle cerebral artery (23 cases) and posterior cerebral artey (2 cases). Three cases of multiple cerebral aneurysm were found in our study. 2) In the hypotensive phase, the mean systolic and diastolic pressures were 73. 45 mmHg+/- 0. 86, 54. 95 mmHg+/- 0. 86 and the mean duration was 34. 74 min+/- l. 60. 3) The blood pressure control by halothane was comparatively easy and there was no cliaical evidence of direct injury to the brain, heart, kidney and liver due to halothane induced hypotension. 4) The mortality rate in the 100 cases of the intracranial aneurysm was 16 percent. From the above observation it may be concluded that the technique of deliberate hypotension induced by halothane anesthesia is a useful method in the surgery of intracranial aneurysm.
Anesthesia ; Anterior Cerebral Artery ; Arterial Pressure ; Blood Pressure ; Brain ; Carotid Artery, Internal ; Depression ; Electrocardiography ; Ganglion Cysts ; Halothane* ; Heart ; Hemorrhage ; Hypotension* ; Intracranial Aneurysm* ; Kidney ; Liver ; Middle Cerebral Artery ; Mortality ; Nitroprusside ; Norepinephrine ; Oxygen ; Trimethaphan ; Vasodilation

Silicone gel breast implants may induce local(fibrous capsular contracture) or systemic(rheumatoid arthritis, systemic sclerosis, etc) complications. The exact mechanism of fibrous capsular contracture has not been fully understood. In the present study, we tried to find out the effect of silicone gel on the fibroblast proliferation which has been known as a major contributing factor in fibrous capsular contracture formation. In vitro, activated macrophages are known to secrete monokines which affect fibroblast proliferation and collagen synthesis. And tumour necrosis factor-alpha(TNF-alpha) and interleukin-6(IL-6), which were released by macrophages, were reported as potent stimulator of fibroblast proliferation. The goal of this study is to investigate the role of macrophages and tumour necrosis factor-alphaor interleukin-6 in the interaction of fibroblasts and silicone gel. We designed four groups, two experimental and two control, using Institute for Cancer Research(ICR) mouse peritioneal macrophage and silicone gel. For the preparation of the conditioned medium of macrophages, peritoneal macrophages were prepared and cultured for 24 hours on the silicone gel-coated and naked (not coated) surface [silicone gel-macrophage conditioned medium(SCM; experimental group) and normal polystyrene-macrophage conditioned medium(NCM; control group) respectively]. To correct the effect of 10% fetal bovine serum which was included in Rapid Prototyping and Manufacturing Institute (RPMI) 1640 medium and draw the effect only by macrophages, the RPMI 1640 medium with 10% fetal bovine serum was cultured by the same method on the silicone gel-coated and naked surface (silicone gel-macrophage free conditioned medium; SFM and normal polystyrene-macrophage free conditioned medium; NFM respectively). Each conditioned medium was added onto NIH 3T3 fibroblasts culture at a final 25% concentration of total culture medium and followed by the cultivation for 24 hours. For antibody neutralizing experiments, each conditioned medium was preincubated with polyclonal rabbit anti-mouse TNF-alpha antibody or polyclonal rat anti-mouse IL-6 antibody for 1 hour and then, conditioned medium with antibody was added to the culture medium of NIH 3T3 fibroblasts by the same method. After 24 hours cultivation, total number of viable fibroblast(cell growth), DNA synthesis and collagen synthesis of fibroblasts with each medium were measured by sulforhodamine B(SRB) assay, 3H-thymidine and 3H-proline incorporation respectively. The results were as follows: 1. In the experiment about the effect of the conditioned medium on the fibroblast activity, the experimental group(SCM), compared with the control group(NCM), showed a significant increase of the cell growth (p<0.01), a significant decrease of DNA synthesis(p<0.001), but no significant difference in the collagen synthesis. 2. In the experiment about the effect of polyclonal rabbit anti-mouse TNF-alpha antibody on the fibroblast activity, after the addition of antibody the experimental group, compared with the control group, showed a significant decrease of the cell growth(p<0.001), a significant increase of DNA synthesis(p<0.01), but no significant difference in the collagen syn thesis. 3. In the experiment about the effect of polyclonal rat anti-mouse IL-6 antibody on the fibroblast activity, after the addition of antibody the experimental group, compared with the control group, showed a significant decrease of the cell growth(p<0.001), a significant increase of DNA synthesis(p<0.0001), but no significant difference in the collagen synthesis. In conclusion, culture supernatants (conditioned medium) of peritoneal macrophages, activated by silicone gel, stimulate the NIH 3T3 fibroblast proliferation. TNF-alpha and IL-6, products of macrophage, are involved in the stimulation of NIH 3T3 fibroblast proliferation in an in vitro condition.
Animals ; Arthritis ; Breast Implants ; Collagen ; Contracture ; Culture Media, Conditioned ; DNA ; Fibroblasts* ; Interleukin-6* ; Macrophages ; Macrophages, Peritoneal* ; Mice ; Monokines ; Necrosis ; Rats ; Scleroderma, Systemic ; Silicone Gels* ; Tumor Necrosis Factor-alpha*

The ICU at Severance Hopital was opened with 7 beds on October 18, 1968 and expanded to 19 beds on February 2, 1981. From 1970-977, We statistically analyzed 3,072 ICU patients. During the period of years from March 1975 to February 1982, We have analyzed clinically 4,348 ICU patients. The Results were as Follows: 1) During the 7 years the total number of patients was 4,383. ln 1981, 1063 patients were admitted to the ICU: this number being almost twice that of in 1980. 2) During the 7 years, the overall mortality was 15.1%, highest in 1976(30.1%) and lowest in 1979(11.5%). It has decreased annually, 12.4% in 1980, 12.3% in 1981. 3) Total admission days in ICU were 18,148 days, the average patient stay in ICU being 4.17 days. The majority of the patients(81.2%) stayed in ICU less than 5 days. The number of patients staying in ICU more than 6 days increased every year from 14.2% in 1975 to 22% in 1981. 4) About 50% of the patients admitted were under the forties-age group. The number under the teens old group was 19%, this group representing the highest number of patients admitted to the ICU. The highest mortality(18.5%) occurred in the 1 to 10 yearold-age group. 5) The number of patients admitted to the department of internal medicine was 1,574 cases, which was the highest among all departments. The mortality rate was highest in the neurosurgery department(41.9%). In 1981, the number of ICU patients in cardiac surgery and pediatrics was increased three time compared with that of 1975. 6) All ICU patients have been divided into two categories, operative and non-operative cases. The operative cases were 2,150, non-operative cases 2,198 cases. Mortality rate was 10% in operative cases, 20% in non-operative cases. 7) Case expired from march 1981 to February 1982: The number of expired parients including those with a poor prognosis was 183 cases. The number of patients that expired under the 10-year-age group was the highest, 78 cases. The cases that expired in internal medicine and pediatrics were 63 and 58 cases respectively. The causes of death were due to damage of central nervous system, cardiovascular system, respiratory system in that order. From the above results, it can be concluded that in spite of an increase in patients, the mortality rate has decreased annually.
Adolescent ; Cardiovascular System ; Cause of Death ; Central Nervous System ; Humans ; Intensive Care Units* ; Critical Care* ; Internal Medicine ; Mortality ; Neurosurgery ; Pediatrics ; Prognosis ; Respiratory System ; Thoracic Surgery

PURPOSE: To identify Bacterial translocation (BT) from the gut to the blood in the critically ill patients by using the polymerase chain reaction (PCR) to confirm the sensitivity of PCR in the detection of intestinal bacterial deoxyribonucleic acid (DNA) in human blood. Further, to determine the relationship between the identification of BT and the prognosis of these patients. METHODS: The oligonucleotide primers used to amplify bacterial DNA from whole blood were the beta-galactosidase (BG) gene of E. coli, DNA coding for 16S ribosomal RNA (16S rRNA), and the glutamine synthase gene of Bacteroides fragilis (BFR). DNA was extracted from the blood of 45 cases of critically ill patients and 10 controls. PCR techniques were used to amplify the genes from E. coli, Bacteroides fragilis, and a region of 16S ribosomal RNA found in many gram-negative and positive bacteria. RESULTS: Bacterial DNA genes were not detected in any of the controls, but were found all in 6 cases of patients with positive blood cultures. Of the 39 cases with no growth in their blood culture, 11 cases in BG and BFR, and 13 cases in 16S rRNA had positive findings in bacterial DNA PCR. Fifteen cases (33%) in BG, 19 cases (42%) in BFR, and 16 cases (35.5%) in 16S rRNA of the critically ill patients had detectable bacterial DNA in their blood. Of those with a positive PCR, MOF developed in 11 cases (57.9%) and of these, 10 subsequently died of MOF. One case (3.8%) in the negative PCR was developed and died of MOF. Patients having positive translocated bacterial DNA had a worse prognosis than the group with a negative DNA. CONCLUSION: In order to confirm BT, the PCR method for detecting bacterial DNA in the blood of critically ill patients is more sensitive than blood cultures. BT from the gut can be a major factor in the development of multiple organ failures in critically ill patients. Therefore, early detection of BT with PCR can play a major role in the treatment of critically ill patients.
Bacteria ; Bacterial Translocation* ; Bacteroides fragilis ; beta-Galactosidase ; Clinical Coding ; Critical Illness* ; DNA ; DNA Primers ; DNA, Bacterial ; Glutamine ; Humans ; Multiple Organ Failure ; Polymerase Chain Reaction ; Prognosis* ; RNA, Ribosomal, 16S

Cytomegalovirus(CMV) commonly infects immunocompromised patient, including those with malignant disease, immunosuppression (particularly that induced by steroid therapy), organ transplantation AIDS. Involvement of the gastrointestinal tract is often associated with disseminated infection. Enteric involvement is expressed by inflammation, hemorhage, and ulceration. CMV is postulated to cause submucosal capillary and arteriolor vasculitis that can result in ischemic injury. CMV induced gastritic and colonic ulcers have not previously been reported in Korea. We report a patient of malignancy who had gastric and colonic ulcers assoicated with CMV infection whieh showed chracteristic histological finding of CMV infection in biopsed specimen.
Capillaries ; Colon ; Gastrointestinal Diseases* ; Gastrointestinal Tract ; Humans ; Immunocompromised Host ; Immunosuppression ; Inflammation ; Korea ; Organ Transplantation ; Transplants ; Ulcer ; Vasculitis

We had a 16-month-old male presented for a surgery for degloving injury of left lower extremity. He had no considerable past or family history. High fever and increased end-tidal CO2 with tachycardia was revealed after induction of general anesthesia with thiopental sodium, vecuronium, isoflurane-N2O and O2. Arterial blood gas analysis showed a severe mixed acidosis. Under the suspicion of malignant hyperthermia, all anesthetics were discontinued. Anesthesia was maintained with fentanyl and midazolam. The patient was managed with surface cooling, gastric lavage with cold saline, sodium bicarbonate and diuretics. Dantrolene sodium 50 mg was administered. The patient survived without any sequelae and discharged after 9 days. The etiologic factors, incidence, clinical features, prevention and treatments of malignant hyperthermia are discussed.
Acidosis ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Blood Gas Analysis ; Child* ; Dantrolene ; Diuretics ; Fentanyl ; Fever ; Gastric Lavage ; Humans ; Incidence ; Infant ; Lower Extremity ; Male ; Malignant Hyperthermia* ; Midazolam ; Sodium Bicarbonate ; Tachycardia ; Thiopental ; Vecuronium Bromide

BACKGROUND: Somato-sensory evoked potential (SSEP) monitoring has been used to help minimize neurologic morbidity during spinal surgery. However, SSEP is affected by anesthetics, technical errors and physiologic aspects. We reviewed 50 cases of spinal surgery done with total intravenous anesthesia under SSEP monitoring. METHODS: Fifty patients, ASA class I-II, free of neurologic disease and scheduled for elective spinal surgery were randomly selected for the study. All of the operations were performed under general anesthesia employing the method of total intravenous anesthesia with propofol and fentanyl (Group I, P-F) or ketamine (Group II, P-K), and monitored by SSEP. We checked the changes of blood pressure and heart rates during the operation, recorded latency and amplitude of SSEP in the pre-induction, post-induction, during screw insertion and post-distraction periods. Also, we checked the number transfers to the ICU and application of a ventilator. RESULTS: Systolic and diastolic blood pressure were increased significantly in the propofol-ketamine group (P < 0.05), but there was no difference in heart rate between both groups. In addition there were no statistical differences in latencies and amplitudes of SSEP. The number of patients transferred to the ICU and placed on a ventilator showed no statistical difference. CONCLUSIONS: We think that the combination of propofol and fentanyl or ketamine used for total intravenous anesthesia is a very useful method in spinal surgery under SSEP monitoring.
Anesthesia* ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics ; Blood Pressure ; Evoked Potentials* ; Fentanyl ; Heart Rate ; Humans ; Ketamine ; Propofol ; Spine* ; Ventilators, Mechanical