BACKGROUND: Propofol offers the advantages of rapid onset of action and recovery. However, the pharmacokinetics of propofol in children is different from that of adults. Therefore, infusion of propofol by target-controlled infusion (TCI) has same difficulties in use. Also, bispectral index has shown a close relationship with plasma concentration of propofol. In this study, we measured the effect site concentration comparable to Bispectral index (BIS) 50 during induction and the awakening concentration. Furthermore, we tried to demonstrate age-related differences. METHODS: Forty five premedicated (atropine 0.02 mg/kg) children (ASA class I) scheduled for elective surgery were assigned to one of three groups (Group 1: 1-5 years, Group 2: 6-10 years, Group 3: 11-15 years). After intravenous injection of lidocaine 0.5 mg/kg, a propofol infusion was started at a target concentration of 6 microgram/ml by using a Stelpump. Anesthesia was maintained with propofol 4-6 microgram/ml and 67% nitrous oxide in oxygen. During anesthesia induction, we checked the effect site concentration comparable to BIS 50 and plasma/effect concentration for awakening during an emergence period. RESULTS: The effect site concentrations comparable to BIS 50 were 5.7 +/- 0.5 microgram/ml (group 1), 4.9 +/- 0.8 microgram/ml (group 2) and 3.8 +/- 1.1 microgram/ml (group 3), so there are significant differences among the groups (P < 0.05)(Table 2). At the moment of awakening, the current/effect site concentration in group 1 (2.0 +/- 0.1 microgram/ml, 2.6 +/- 0.2 microgram/ml) was significantly higher than those of group 3 (1.6 +/- 0.2 microgram/ml, 2.0 +/- 0.30 microgram/ml). CONCLSIONS: The effect site concentration comparable to BIS 50 showed significantly age-related differences and was higher in younger children. The current/effect site concentration at awakening was highest in group 1.
Adult ; Anesthesia ; Child ; Humans ; Injections, Intravenous ; Lidocaine ; Nitrous Oxide ; Oxygen ; Pharmacokinetics ; Plasma ; Propofol*

Purpose: This study was conducted in order to examine the usefulness of osteoconductive bone substitutes with zeta potential control (geneX® ds; Biocomposites, England) by comparing the complications and radiographic evaluation with or without geneX® ds augmentation for internal fixation with proximal femur nail antirotation (PFNA) for treatment of osteoporotic unstable intertrochanteric fractures. Materials and Methods: A retrospective study of 101 patients who underwent fixation with PFNA in osteoporotic unstable intertrochanteric fractures was conducted from December 2015 to August 2020. The radiographic evaluation and complication rates were compared between patients with geneX® ds (Group A: 41 cases) and those without geneX® ds (Group B: 60 cases). Results: In radiological valuation, the degree of blade sliding from the time immediately after surgery to one year after surgery was 1.4±1.2 mm and 5.8±2.7 mm in Group A and Group B, respectively (P<0.001). During the same time frame, a significant difference of 2.3±2.2° and 7.4±3.1° , respectively (P<0.001), in varus collapse, was observed for Group A and Group B. Conclusion Among patients fixed with PFNA for treatment of unstable intertrochanteric fractures, less blade sliding and varus collapse was observed for those with geneX® ds augmentation compared to those without it. In addition, there was no increase in the incidence of complications. The authors believe it can be regarded as a safe and effective additive for intramedullary fixation for treatment of unstable intertrochanteric fractures.

Gastrointesinal polyp is a premalignant lesion, it is recommanded to be removed. Endoscopic polypectomy has long been considered as a safe and effective method for removal of polyps. One hundred forty eight endoscopic gastrointestinal polypectomy were done in 111 patients who visited Chungnam National University Hospital from January in l991 to August in l993, and clinical character including histopathology were evaluated. (continue...)
Chungcheongnam-do ; Humans ; Pathology ; Polyps

Peptic ulcer bleeding is the most common cause of upper gastromtestinal bleeding. The efficacy of local injection of hypertonic saline-epinephrine(RS-E)solutiom around the base of the bleeding vessels under endoscopy was assessed, During the period between January 1991 and August 1994, 83 patients with active bleeding or stigmata of recent hemorrhage in peptic ulcers were included to this study. The major cause of bleeding in this study consisted of gastric ulcers(60) and duodenal ulcers(23). Twenty patients rebled and seven required emergency surgery and two patients were died. Definitive hemoatasis was achieved in 74(89.3%). Two patients rebled due to mucosal ischemia induced by HS-E injection, other significant complication was not found. We conclude that the endoscopic injection with hypertonic saline-epinephrine solution is one of the effective and safe therapeutic modality in peptic ulcer bleeding.
Christianity ; Emergencies ; Endoscopy ; Epinephrine* ; Hemorrhage* ; Humans ; Ischemia ; Peptic Ulcer ; Ulcer*

Esophageal carcinoma is a rare malignant neoplasm consisting of about 1.5% of the whole gastrointestinal tract neoplasm and has poor prognosis of which survival rate is below 5%. The squamous cell carcinoma of the esophagus could be multicentric in character and may have occured in 9.5-27% of incidence. The most common site is head and neck region. The metastasis of esophageal carcinoma occur through hematogenous, lymphatic spread, direct invasion and rarely intramural metastasis. Of theses, intramural metastasis has been occured in 7-14.3% of incidence and its presence has been regared to poor prognostic factor due to early regional or distant metastasis. Surgery, chemotherapy, radiotherapy alone or combination of these has been used as treatment modalities of esophageal cancer, but combination chemoradiotherapy with or without operation is prefered method than other at present. Authors report a case of esophageal carcinoma showing intramural metastasis to the gastric wall, which had the complete remission with preoperative chemoradiotherapy.
Carcinoma, Squamous Cell ; Chemoradiotherapy* ; Drug Therapy ; Esophageal Neoplasms* ; Esophagus ; Gastrointestinal Tract ; Head ; Incidence ; Neck ; Neoplasm Metastasis* ; Prognosis ; Radiotherapy ; Stomach* ; Survival Rate

The balloon dilatation or Savary-Gilliard dilatation was performed in 59 patients with benign esophageal stricture in Chungnam National University Hospital from September 1990 to August 1995. We reviewed the effect and the safty of each therapeutic method and the results were as foillows: 1) The cause of stricture were corrosive stricture(28 cases, 49,4%), anastomotic stenosis after gastroesophageal surgery(26 cases, 44.1%), stricture after endoscopic variceal sclerotherapy(3 cases, 5.1%), esophageal web(1 case, 1.7%) or stricture complicated by reflux esophagitis(l case). 2) The overall cure rate of balloon dilatation was 50%(l2/24 cases) and that of Savary-Gilliard dilatation was 77.1%(27/35 cases). The Savary-Gilliard dilatation group had a better result than the balloon group. 3) The perforation after Savary-Gilliard dilatation occurred in 4 cases~(6.7%). One case was treated surgically and three cases wiere treated medically. But there was no fatal complication. 4) The overall cure rate of anastomotic stenosis was 84.6%(32/38 cases) and that of corrosive stricture was 46.4%(13/28 cases). 5) The cure rate of Savary-Gilliard dilatation in corrosive esophageal stricture was 64.7%(ll/17) and that of balloon dilatation was 18.1%(2/11). 6) According to site of stricture, the cure rate of dilatation was 84.2% (32/38) in thoracic esophagus, 42.8%(3/7) in cervical esophagus and 28,5%(4/14) in multiple or long segmented stricture.(continue...)
Chungcheongnam-do ; Constriction, Pathologic ; Dilatation* ; Esophageal Stenosis* ; Esophagus ; Humans

Arteriovenous malformations occur predominantly in the cecum and ascending colon and is not associated with vascular lesions of the skin, central nerveous system. or lung Arteriovenous malformations involving gastrointastinal tract is often to be found to be cause of the recurrent painless bleeding without specific past history and family history and usually diagnosed by selective mesenteric arteriography or colonoscopy, But because of small size of the lesion and local occurence, diagnosis of the arteriovenous malformation is very difficult. Authors exprienced a case of arteriovenous maltormation in the colon. The patient had a history of repeated gastrointestinal bleeding, and were diagnosed by colonoscopy and were treated with colonoscopic resection.
Angiography ; Arteriovenous Malformations* ; Cecum ; Colon* ; Colon, Ascending ; Colonoscopy ; Diagnosis ; Hemorrhage ; Humans ; Lung ; Skin

Mesenchymal hamartoma of the liver is a rare benign tumor, usually presenting in early childhood. Five children with mesenchymal hamartoma of the liver pathologically verified at Seoul National University Children's Hospital between 1978 and 2000 were analyzed retrospectively. There were two girls and three boys, and their mean age at the operation was 16.0months (range, 4 - 32 months). Three patients presented with abdominal distension. A patient was detected incidentally, and another was detected by prenatal ultrasongraphic examination. Tumor size ranged from 10x8.5cm to 34x29cm. Three tumors were located in the right lobe and two in the left lobe. Four cases underwent complete surgical resection, and the other one underwent incomplete surgical resection and marsupialization. Recurrence or malignant transformation was not noted. Five patients survived without evidence of disease for 35, 36, 38, 142 and 228 months. In conclusion, although mesenchymal hamartoma of the liver is benign lesion, it may be confused, and mixed with embryonal sarcoma. A recent report showed recurrence or malignant transformation after partial excision of the tumor. Therefore, complete excision of the tumor with surrounding normal liver tissue is recommended.
Child ; Female ; Hamartoma* ; Humans ; Liver* ; Recurrence ; Retrospective Studies ; Sarcoma ; Seoul

Rosiglitazone is a thiazolidinedione-class antidiabetic drug that reduces blood glucose and glycated hemoglobin levels. We here investigated the interaction of rosiglitazone with Kv3.1 expressed in Chinese hamster ovary cells using the wholecell patch-clamp technique. Rosiglitazone rapidly and reversibly inhibited Kv3.1 currents in a concentration-dependent manner (IC 50 = 29.8 µM) and accelerated the decay of Kv3.1 currents without modifying the activation kinetics. The rosiglitazonemediated inhibition of Kv3.1 channels increased steeply in a sigmoidal pattern over the voltage range of –20 to +30 mV, whereas it was voltage-independent in the voltage range above +30 mV, where the channels were fully activated. The deactivation of Kv3.1 current, measured along with tail currents, was also slowed by the drug. In addition, the steady-state inactivation curve of Kv3.1 by rosiglitazone shifts to a negative potential without significant change in the slope value. All the results with the use dependence of the rosiglitazone-mediated blockade suggest that rosiglitazone acts on Kv3.1 channels as an open channel blocker.

OBJECTIVE: Despite increased awareness of the fatality of mesenteric ischemia, the diagnosis seldom is made prior to the onset of gangrene. The multiplicity of etiologic factors, the many varied presentations, and splanchnic vasoconstriction all affect the extent of ischemic injury, adding to the complexity of the clinical problem. Extensive acute processes are still catastrophic illnesses with a high mrotality, but there is a potential for both better diagnisis and therapy with an improved outcome. Discussion of the pathophysiology, diagnosis, and treatment of this entity will be presented. METHODS: A Retrospective review of our experience with ischemic bowel disease was made. Ten consecutive clinical cases admitted in ChungNam National University Hospital from October 1990 to April 1994 were observed. RESULTS: 1) We experienced 5 patients with arterial embolic occlusion, 1 patient with venous thrombosis and 4 patients with colonic ischemia. 2) The peak ages were 6th decade and 8th decade. 3) The major clincal symptoms and signs were abdominal pain (100%), abdominal tenderness (70%), melena (70%), nausea (60%), fever (50%), vomiting (40%) and abdominal distension (30%). 4) On laboratory findings, there were leukocytosis (80%) and thrombocytopenia (20%) 5) In plain film, there were ileus (70%), edematous intestinal wall (50%), mucosal edema (30%), thumb printing (10%) and gasless abdomen (10%). Among the 5 cases performed abdominal CT, there were thickening of intestinal wall in 4 cases, narrowing of intestinal lumen in 2 case and ascites in 3 cases. 6) Bowel resections were perfomed in 7 cases and supportive care was performed in 3 cases. 7) The overall mortality rate was 30%, CONCLUSION: An oggressive approach in patients suspected of having ischemic bowel is indicated if the diagnosis is to be made before necrosis has occurred. A high index of suspicion, early angiography, correction of the underlying cardiac disease, treatment of splanchnic vasoconstriction, surgical revascularization, and resection of gangrenous bowel are necessery if there is to be a significant reduction in the high mortality rates associated with mesenteric ischemia.
Abdomen ; Abdominal Pain ; Angiography ; Ascites ; Catastrophic Illness ; Chungcheongnam-do ; Colon ; Diagnosis ; Edema ; Fever ; Gangrene ; Heart Diseases ; Humans ; Ileus ; Ischemia ; Leukocytosis ; Melena ; Mortality ; Nausea ; Necrosis ; Retrospective Studies ; Thrombocytopenia ; Thumb ; Tomography, X-Ray Computed ; Vasoconstriction ; Venous Thrombosis ; Vomiting