Since 1954 when the first biodegradable polymer, polyglycolic acid(PGA), was synthesized, many different biodegradable and tissue-tolerant materials have been invested and studied for internal fixation devices. The use of biodegradable materials for the internal fixation of fractures would avoid the need for later removal of the implant. However, problems of a physical and chemical nature have delayed the development of biodegradable implants applicable to fracture management. The authors reviewed 17 cases in which the absorbable pins made of poly-p-dioxanone were used for internal fixation at Seoul National University Hospital between December, 1987 and September, 1989, and report on 11 patients who had at least 6 months follow-up(average 9.1 months). The results were graded as excellent(5 cases), good(4 cases), poor(0 case), and questionable(2 cases). In the 9 cases where the absorbable pins were used for internal fixation of the intraarticular fractures or defects, satisfactory(excellent or good) results were obtained. In the 2 cases where the absorbable pins were used for intramedullary nailing, the role of the pins was questionable. There were no complications such as wound sinus formation, secondary displacement of the fragemts and delayed union or nonunion.
Absorbable Implants ; Fracture Fixation, Intramedullary ; Humans ; Internal Fixators ; Intra-Articular Fractures ; Polymers ; Seoul ; Wounds and Injuries

BACKGROUND: We evaluated laryngeal mask airway (LMA) insertion conditions, hemodynamic changes and bispectral index (BIS) responses during the induction of anesthesia with target controlled infusion (TCI) of propofol. METHODS: Ninety patients (ASA 1 or 2, 18-64 years) were allocated randomly to receive an infusion to achieve and maintain target blood concentration of a 4, 5 and 6micro gram/ml. LMA was inserted after loss of consciousness. LMA insertion conditions, hemodynamic and BIS responses were evaluated. RESULTS: Loss of consciousness and LMA insertion were more rapid in patients with propofol target blood concentration of a 6micro gram/ml than at the other concentrations. Also, full attenuation of larygeal reflexes on the first try was greater in the 6micro gram/ml group than the other groups. CONCLUSIONS: We conclude that propofol administration at a target blood concentration of 6micro gram/ml allow successful insertion of LMA without major hemodynamic changes.
Anesthesia ; Hemodynamics ; Humans ; Laryngeal Masks* ; Plasma* ; Propofol* ; Reflex ; Unconsciousness

After surgical operation in patients with arteriovenous malformation (AVM), normal pressure perfusion breakthrough (NPPB) is one of the major complications. Brain perfusion SPECT with acetazolamide stress was known to be useful to evaluate the vascular reserve in several neurological and neurosurgical conditions. The authors performed acetazolamide brain perfusion SPECT in patients with AVM and compared the brain perfusion in the post-operative clinical courses. The acetazolamide brain perfusion SPECT was helpful in defining the prognosis of the patients with AVM. We describe 4 patients with AVM who had acetazolamide brain perfusion SPECT to examine the prognosis.
Acetazolamide* ; Arteriovenous Malformations* ; Brain* ; Humans ; Perfusion* ; Prognosis* ; Technetium Tc 99m Exametazime ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: To evaluate the clinical course of optic nerve sheath meningioma (ONSM) in Korean patients. METHODS: A retrospective study of 11 eyes of 11 patients with a diagnosis of ONSM between 2002 and 2015 at Severance Hospital. RESULTS: The mean age at symptom onset was 47.6 years. Ten females and 1 male participated in the study and all tumors were unilateral. Patients typically presented with visual loss and proptosis. Three patients complained of limited extraocular movements and seven patients exhibited visual field defects. Three patients who had a greater growth rate with intracranial involvement and two patients who had decreased vision received treatments. Five patients maintained good vision and visual field during the follow-up period. However, one patient who underwent surgical treatment presented significant visual loss and deterioration of visual field defect. One out of two patients who received three-dimensional conformal radiotherapy (3D-CRT) experienced improvement in visual field, and the other showed no change in visual field defect but remained stable with decreased tumor size. One out of two patients who underwent gamma-knife surgery showed aggravated visual field defect and the other presented with visual loss. CONCLUSIONS: ONSM is typically a slow-growing tumor. Deterioration of visual loss and visual field defect can occur after treatment of ONSM. Therefore, management should be considered carefully and should be limited to cases in which progression of the disease is advanced or tumor growth is fast. 3D-CRT can be considered in patients in need of treatment.
Diagnosis ; Exophthalmos ; Female ; Follow-Up Studies ; Humans ; Male ; Meningioma* ; Optic Nerve* ; Radiotherapy, Conformal ; Retrospective Studies ; Visual Fields

BACKGROUND: The purpose of this study is to investigate the frequency of and errors in citation of references in articles from the Korean Journal of Anesthesiology (KJA) from the first application of the present contribution rules (1996) to 1998 and to suggest a clue to improve the quality of our journal. METHODS: All references cited from KJA were reviewed using a computerized searching system. If any differences are found during the review, we compare it with the original article. Errors on the contribution rules were examined according to the instructions for the authors revised in 1995. RESULTS: Overall 74% of the articles had more than one reference cited from KJA. The average number of the references cited from KJA per article was 1.73. In such references, citation errors were found in 48% of articles published in 1996, 44% in 1997, and 43% in 1998. The percentages of general errors and errors involving the contribution rules were 62% and 38%, respectively. Common general errors were found in titles (164 cases), pages (102 cases), and name (60 cases). Those involving the contribution rules found in the notation of name (120 cases), pages (54 cases), and inadequate notation of the number of issue (49 cases). CONCLUSIONS: Despite numerous efforts, the incidence of citation errors was still high when the articles of KJA were cited as references. Improvement in the quality of our journal will be possible only by rigid adherence to contribution rules, thorough review of the articles, and a lucid explanation of contribution rules.
Anesthesiology* ; Incidence

We report a redo coronary artery bypass grafting (CABG) in a 55-year-old man. Angina recurred 7 years after the initial surgery. Coronary angiography showed all patent grafts except a faint visualization of the in situ right gastroepiploic artery (RGEA) graft, which was anastomosed to the posterior descending coronary artery, associated with celiac axis stenosis. Redo-CABG was performed at postoperative 10 years because of aggravated angina and decreased perfusion of the inferior wall in the myocardial single photon emission computed tomography. The saphenous vein graft was interposed between the 2 in situ grafts used previously; the right internal thoracic artery and RGEA grafts. Angina was relieved and myocardial perfusion was improved.
Arteries ; Axis, Cervical Vertebra ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Vessels ; Gastroepiploic Artery ; Humans ; Mammary Arteries ; Middle Aged ; Myocardial Ischemia ; Perfusion ; Reoperation ; Saphenous Vein ; Tomography, Emission-Computed, Single-Photon ; Transplants

BACKGROUND: The purpose of this study was to determine the incidence of side effects, rate of recovery, and maintenance of anesthesia when using a mixture of propofol and thiopentone as compared with propofol alone. METHODS: Fifty ASA Physical Status I or II patients aged between 12 and 60 years scheduled for minor surgical procedures were randomly allocated to group P (propofol) or group PT (propofol mix with thiopentone) in which a loading dose of propofol 2 mg/kg (group P) or propofol 1 mg/kg and thiopentone 2.5 mg/kg (group PT) was applied. At induction of anesthesia, an independent anesthesiologist graded the incidence and severity of pain. After administering the induction dosage, he also checked spontaneous movements. The duration of operation time and the duration of anesthesia were also noted. RESULTS: There was a significant decrease of the incidence of pain on injection and spontaneous movements in group PT compared with group P (P < 0.05). The propofol maintenance dose was also significantly decreased (P < 0.05). There were no significant differences in recovery indexes between the two groups except delay in time to eye opening. CONCLUSIONS: Our data indicate that a propofol-thiopentone mixture for induction, maintenance and recovery are satisfactory during anesthesia undergoing minor surgery. In addition, there were significant reductions in pain on injection, spontaneous movement, and cost-effectiveness.
Anesthesia ; Humans ; Incidence ; Propofol* ; Surgical Procedures, Minor ; Thiopental

BACKGROUND: The deleterious cardiopulmonary side effects immediately after positioning in reverse Trendelenburg and CO2 intra-abdominal insufflation during a laparoscopic cholecystectomy are well tolerated in healthy patients but can lead to serious morbidity and mortality in patients with a limited cardiopulmonary reserve. Using a continuous and non-invasive cardiac output monitor based on partial CO2 rebreathing method, we investigated the immediate cardiopulmonary changes caused by positioning in reverse Trendelenburg and CO2 intra-abdominal insufflation during a laparoscopic cholecystectomy, and assessed the applicability of the partial CO2 rebreathing method for the measurement of cardiac output in a laparoscopic cholecystectomy. METHODS: The investigation was carried out on 11 patients undergoing a laparoscopic cholesystectomy. The control values of cardiac index (CI), cardiac output (CO), mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), systemic vascular resistance (SVR), dynamic compliance (Cdyn), airway resistance (Raw), peak inspiratory pressure (PIP) and end tidal CO2 partial pressure (PETCO2) were measured in the supine position after induction with target-controlled infusion of propofol (5 microgram/ ml). Five minutes after positioning in reverse Trendelenburg and CO2 insufflation, the same cardiopulmonay variables were measured and compared with the control values. RESULTS: CI, CO and CVP were reduced 33.3%, 31.9% and 29.0%, respectively (P < 0.05). MAP and SVR were increased 39.8% and 154.1%, respectively (P < 0.05). Cdyn was reduced 38.0% (P < 0.05). Raw and PIP were increased 22.8%, and 34.8%, respectively (P < 0.05), whereas HR and PETCO2 remained unchanged. CONCLUSIONS: The non-invasive cardiopulmonary monitor using partial CO2 rebreathing method, could be used with ease and safety in a laparoscopic cholecystectomy.
Airway Resistance ; Arterial Pressure ; Cardiac Output ; Central Venous Pressure ; Cholecystectomy, Laparoscopic ; Compliance ; Heart Rate ; Humans ; Insufflation ; Mortality ; Partial Pressure ; Propofol ; Respiratory System* ; Supine Position ; Vascular Resistance

BACKGROUND: Nausea and vomiting are among the most common postoperative complaints. There is high incidence of emesis after middle ear surgery and opioids increase the prevalence of postoperative nausea and vomiting. METHODS: Sixty six adult patients undergoing routine tympanomastoidectomy under general anesthesia were divided into two groups to study the incidence and effect of intraoperative fentanyl as supplements on postoperative nausea and vomiting. Patients in group 1 received medical air instead of N2O about 15 minutes before grafting, while patients in group 2 received not only medical air instead of N2O, but also intravenous fentanyl (1~1.5 microgram/kg). RESULTS: The incidences of nausea and vomiting in the group 1 and 2 were 19.4% and 22.9%, respectively. There was no significant difference of postoperative nausea and vomiting between the group 1 and group 2 (P=0.73). CONCLUSION: The incidence of nausea and vomiting after tympanomastoidectomy in adult was not higher than comprehensive that of recent other reports and a small dose of fentanyl, given intraoperatively for supplementation, did not increase the prevalence of nausea and vomiting.
Adult ; Analgesics, Opioid ; Anesthesia, General ; Ear, Middle ; Fentanyl* ; Humans ; Incidence ; Nausea* ; Postoperative Nausea and Vomiting ; Prevalence ; Transplants ; Vomiting*

BACKGROUND: Nausea and vomiting are among the most common postoperative complaints. There is high incidence of emesis after middle ear surgery and opioids increase the prevalence of postoperative nausea and vomiting. METHODS: Sixty six adult patients undergoing routine tympanomastoidectomy under general anesthesia were divided into two groups to study the incidence and effect of intraoperative fentanyl as supplements on postoperative nausea and vomiting. Patients in group 1 received medical air instead of N2O about 15 minutes before grafting, while patients in group 2 received not only medical air instead of N2O, but also intravenous fentanyl (1~1.5 microgram/kg). RESULTS: The incidences of nausea and vomiting in the group 1 and 2 were 19.4% and 22.9%, respectively. There was no significant difference of postoperative nausea and vomiting between the group 1 and group 2 (P=0.73). CONCLUSION: The incidence of nausea and vomiting after tympanomastoidectomy in adult was not higher than comprehensive that of recent other reports and a small dose of fentanyl, given intraoperatively for supplementation, did not increase the prevalence of nausea and vomiting.
Adult ; Analgesics, Opioid ; Anesthesia, General ; Ear, Middle ; Fentanyl* ; Humans ; Incidence ; Nausea* ; Postoperative Nausea and Vomiting ; Prevalence ; Transplants ; Vomiting*