A retrospective analyis was performed on 12,212 pediatric patients who had received operations from 1986 to 1988 in eight operating rooms, Seoul National University Childrens Hospital (SNUCH). The average distribution of the patient by department in descending order was pediatric surgery 24%, cardiothoracic surgery 17%, orthopedic surgery 16%, otolaryngology 13%, plastic surgery 11%, ophthalmology 10%, urology 8%, neurosurgery 3% and others 0.2%. Ophthalmology and urology share one operating room each other, why they have some limitations in performing operations. Total number of operations showed increasing tendency; 3,285 in 1986, 4,185 in 1987 and 4,742 in 1988, which were 27.4% increase in 1987 and 13.3% increase in 1988, compared with the previous year. The average age distribution in descending order was 42% in group between 2 and 5 years, 29% in group between 6 and 10 years, 13% in group between 1 month and 1 year, and over 10 years respectively and 3% in group under 1 month. The male to female ratio was 62% to 38%. Elective and emergency surgeries comprised 92.6% and 7.4%, respectively. Emergency pediatric surgery was the highest in number (16.4% of all surgeries and 48.9% of all emergency surgeries performed in the pediatric operating rooms). Pediatric operating room utility ratios for each departments increased year by year, especially utility ratios for ophthalmology and orthopedic surgery were 118% and 115%, respectively. The number of patients supported by medical insurance showed also increasing tendency; 72.5% in 1986, 74.1% in 1987 and 80.8% in 1988.
Age Distribution ; Child ; Emergencies ; Female ; Humans ; Insurance ; Male ; Neurosurgery ; Operating Rooms ; Ophthalmology ; Orthopedics ; Otolaryngology ; Retrospective Studies ; Seoul ; Surgery, Plastic ; Urology

It is very important for the anesthesiologists to manage this kind of patient during anesthesia because of severe hemodynamic change that is induced by aortic clamping and declamping, and its secondary effect on visce, heart and spinal cord, etc. To minimize the sudden severe hemodynamic change, we used the following agents and techniques in this clinical report. 1) Ethrane anesthesia with intermittent Innovar administration to minimize cardiac irritability. 2) To prevent secondary damage by distal hypotension during aortic clamping and declamping. 1. slight overhydration. 2. mannitol. 3. diuretics. 3) To prevent secondary damage by proximal hypertension during aortic clamping. 1. d-tubocurarine for muscle relaxation. 2. Morphine. 3. Chlorpromazine. 4. phentolamine. More over, we recommend this kind of anesthetic method in some other surgeries such as coarctation of aorta, aortic aneuryam and pheochromocytoma, etc. which may exhibit severe hemodynamic change during anesthesia.
Anesthesia ; Aortic Coarctation ; Chlorpromazine ; Constriction ; Diuretics ; Enflurane ; Heart ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Renovascular* ; Hypotension ; Mannitol ; Morphine ; Muscle Relaxation ; Phentolamine ; Pheochromocytoma ; Spinal Cord ; Tubocurarine

OBJECTIVES: This study sought to evaluate trabecular changes in the mandible using fractal analysis and to explain the transient osteopenia related to rapid orthodontic tooth movement after orthognathic surgery. MATERIALS AND METHODS: Panoramic radiographs were taken of 26 patients who underwent bilateral sagittal split ramus osteotomy. Radiographs taken before the surgery and 1 month after surgery were overlapped, and 40x40 pixel square regions of interest were selected near the mandibular canines and 1st molars. After the image processing procedure, the fractal dimension was calculated using the box-counting method. RESULTS: Fractal dimension after orthognathic surgery decreased in a statistically significant manner (P<0.05). The change in fractal dimension on the canine side had greater statistical significance as compared to that seen on the 1st molar side. CONCLUSION: This study found that bone density decreases after orthognathic surgery due to transient osteopenia related to the regional acceleratory phenomenon. This result can provide a guide to evaluating orthodontic tooth movement after orthognathic surgery.
Bone Density ; Bone Diseases, Metabolic ; Fractals ; Humans ; Mandible ; Molar ; Orthognathic Surgery ; Osteotomy, Sagittal Split Ramus ; Tooth Movement

Changes of body temperature were observed in the esophagus and rectum by telethermometer during extracorporeal circulation in 40 cases of open heart for detection of significant differences in survivals and non-survivals. The following results were obtained; 1) Esophageal and rectal temperature(just prior to extracorporeal circulation) were 36.4+/-0.69 degrees C, 36.8+/-0.8 degrees C respectively in non-survivals and 36.0+/-0.73 degrees C, 36.4+/-0.8 degrees C in survivals after open heart surgery 2) Normal differences between rectal and esophageal temperature came to disappear after 30 minutes of extracorporeal circulation in two groups. 3) Esophageal temperatures were higher than rectal temperatures after extracorporeal circulation for open heart surgery in both groups. 4) Changes of temperature differences between rectum and esophagus have no correlation with mortality because of the variation in two areas in both groups.
Body Temperature* ; Clinical Study* ; Esophagus ; Extracorporeal Circulation* ; Heart* ; Mortality ; Rectum ; Thoracic Surgery*

BACKGROUND: Cardiac anesthesia with cardiopulmonary bypass is associated with an increased risk of awareness. A new approach to intraoperative EEG procession, the bispectral index (BIS), may allow more reliable quantitative assessment of the level of consciousness during anesthesia. We evaluated the relationships between BIS and commonly used indices of depth of anesthesia in children. METHODS: In the isoflurane group, anesthesia was maintained using isoflurane 0.5 1.0 vol% inhalation, whereas the fentanyl group received high dose fentanyl-midazolam infusion. BIS, mean arterial blood pressure, and heart rate were recorded at baseline, at postinduction (Tbaseline), skin incision (Tincis), sternotomy (Tsterno), aortic cannulation (Tcannul), nadir temperature (Tnadir), immediate post-CPB (TpostCPB), sternal wire (Twire), and at skin closure (Tclose). RESULTS: BIS showed a significant change over time (P < 0.001), with significant differences between groups (P = 0.04). BIS increased significantly during the immediate post-CPB phase (TpostCPB versus Tbaseline, Tnadir, P < 0.01). No correlations were found between BIS and changes in heart rate or mean arterial pressure during surgery. BIS was higher in the fentanyl group than in the isoflurane group at Tincis, Tcannul, and Twire (P < 0.05). CONCLUSIONS: Even though BIS was relatively lower in the isoflurane group compared to the fentanyl group, we were still unable to demonstrate a relationship between the BIS and hemodynamic indices depth for any group. While the increase in BIS during the rewarming phase could reflect an increase in conscious level, larger prospective studies with postoperative memory test for awareness are necessary.
Anesthesia ; Anesthetics* ; Arterial Pressure ; Cardiopulmonary Bypass ; Catheterization ; Child* ; Consciousness ; Electroencephalography ; Fentanyl ; Heart Rate ; Heart* ; Hemodynamics* ; Humans ; Inhalation ; Isoflurane ; Memory ; Rewarming ; Skin ; Sternotomy ; Thoracic Surgery*

Hair graying is an obvious sign of human aging. Although graying has been investigated extensively, the mechanism remains unclear. Here, we reviewed previous studies on the mechanism of graying and seek to offer some new insights. The traditional view is that hair graying is caused by exhaustion of the pigmentary potential of the melanocytes of hair bulbs. Melanocyte dysfunction may be attributable to the effects of toxic reactive oxygen species on melanocyte nuclei and mitochondria. A recent study suggests that bulge melanocyte stem cells (MSCs) are the key cells in play. Graying may be caused by defective MSC self-maintenance, not by any deficiency in bulbar melanocytes. Our previous study suggested that graying may be principally attributable to active hair growth. Active hair growth may produce oxidative or genotoxic stress in hair bulge. These internal stress may cause eventually depletion of MSC in the hair follicles. Taken together, hair graying may be caused by MSC depletion by genotoxic stress in the hair bulge. Hair graying may also be sometimes caused by dysfunction of the melanocytes by oxidative stress in the hair bulb. In addition, hair graying may be attributable to MSC depletion by active hair growth.
Aging ; DNA Damage ; Hair Follicle ; Hair* ; Humans ; Melanocytes ; Mitochondria ; Oxidative Stress ; Reactive Oxygen Species ; Rivers* ; Stem Cells

PURPOSE: TATA box mutation/polymorphism in the promoter region of the bilirubin uridinediphosphoglucuronate glucuronosyltransferase 1A1 (UGT-1A1) gene is known to be an etiology of hyperbilirubinemia. This study examined if a TATA box mutation/polymorphism in UGT-1A1 gene promoter could be associated with the development of severe early neonatal jaundice in Korean infants. METHODS: Thirty-nine neonatal jaundice patients and 40 controlled infants were analyzed for UGT-1A1 promoter genotypes by using DNA sequencing. RESULTS: The homozygote for (TA)7TAA mutation was not found in this study. Comparison of the prevalence of UGT-1A1 promoter (TA)7TAA heterozygotes revealed no difference between the group with jaundice and the controlled group (15.4% vs. 10%). The peak bilirubin level was higher and the onset of jaundice was earlier in the jaundice group with (TA)7TAA heterozygote compared to the jaundice group without (TA)7TAA heterozygote (23.2+/-1.0 mg/dL vs. 19.7+/-2.4 mg/dL, P=0.004, 5.0+/-1.5 days vs. 8.3+/-4.1 days, P= 0.057). CONCLUSION: The results of this study showed that TATA box polymorphism in UGT-1A1 gene promoter did not increase the prevalence of severe early neonatal jaundice in Korean infants.
Bilirubin ; Genotype ; Glucuronosyltransferase ; Heterozygote ; Homozygote ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal* ; Infant ; Infant, Newborn ; Jaundice ; Jaundice, Neonatal ; Prevalence ; Promoter Regions, Genetic ; Sequence Analysis, DNA ; TATA Box

Endometriosis is a common gynecologic disease, it occur not only pelvic organ but also anywhere in human body. However inguinal endometriosis is a very rare condition, its incidence is 0.4% of entire endometriosis. Most of inguinal endometriosis are found as inguinal masses in women in 30s and 40s who have history of gynecologic surgery. Majority of the cases are accompanied with pelvic endometriosis. Authors report a case of inguinal endometriosis in patients who has no history of gynecological surgery.
Endometriosis ; Female ; Genital Diseases, Female ; Gynecologic Surgical Procedures ; Human Body ; Humans ; Incidence

By virtus of the development of monitoring system and increasing tendency of critically ill patients. We have performed cannulation of radial artery after Allen's test for the continuous monitoring of arterial pressure. It is very important to measure blood pressure, it gives un many informations in the poor risk patients. During monitoring of blood pressure for several years, we have had much troubles because of damping of arteiral pressure waved due to air bubbles. In this study, we used P25Db pressure tranducer and Spaculab Alpha System for monitering of blood pressure, following cannulation of radial artery. Air bubbles of 0.5ml, 1.0ml, 1.5ml and 2.0ml were inserted into monitering system, i.e. fluid filled catheter respectively. The statistical analysis by paired student T-test showed following results. 1) Systolic blood pressure were decreased significantly from 140+/-14.4 torr of control group to 105+/-15.9 torr, 102 +/-16.1 torr, 99+/-16.2 torr and 99+/-15.2 torr in 0.5ml, 1.0ml, 1.5ml and 2.0 ml air groups respectively. 2) Diastolic blood pressure were increased from 70+/-12.4 torr of control group to 72+/-13.8 torr, 76+/-13.9 torr, 78+/-14.3 torr and 81 +/-13.1 torr in each cases respectively. 3) Pulse pressure were decreased from 40+/-13.3 torr of control group to 33+/-15.4 torr, 26 +/-13.6 torr, 22+/-13.0 torr and 18+/-12.0 torr in each cases respectively. 4) But mean arterial pressure showed no significant changes except in 2.0ml air group. Where showed slight change.

Fibromuscular dysplasia (FMD) is a rare, segmental nonatheromatous angiopathy of unknown etiology affecting small to medium-sized arteries. The most common angiographic pattern is the classic string-of-beads appearance. But the tubular stenosis type of the FMD is a rare finding and has not been reported previously. We report a case who presented with recurrent intracerebral hemorrhages, whose angiographic features were long tubular stenosis type of FMD affecting the both internal carotid arteries associated with terminal carotid occlusions.
Arteries ; Carotid Artery, Internal ; Cerebral Hemorrhage* ; Constriction, Pathologic ; Fibromuscular Dysplasia*