A number of drug administered during anesthesia can provoke pathologic response by immunologic or nonimmunologic mechanisms. Known drugs involved in hypersensitivity reactions are muscle relaxants, local anesthetics, narcotics, barbiturates, contrast media, protamine and antibiotics. Clinical manifestations of anaphylaxis are diverse, but during anesthesia, cardiovascular collapse is predominate. We experienced a case of anaphylactoid reaction with erythema on upper thoracic region, severe hypotension, tachycardia and ventricular fibrillation. After defibrillation, the patient was recovered. During follow-up, we knew that this patient was exposed aprotinin repeatedly, and suspect the possibility of anaphylactoid reaction due to aprotinin.
Anaphylaxis ; Anesthesia ; Anesthetics, Local ; Anti-Bacterial Agents ; Aprotinin ; Barbiturates ; Contrast Media ; Erythema ; Follow-Up Studies ; Heart Arrest* ; Humans ; Hypersensitivity ; Hypotension ; Narcotics ; Tachycardia ; Ventricular Fibrillation

Reexpansion pulmonary edema(RPE) is a complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion or atelectasis, and generally believed to occur ipsilaterally when a chronically collapsed lung is rapidly reexpanded by evacuation of large amount of air or fluid. Clinical manifestations of RPE are dyspnea, tachypnea, cyanosis, frothy blood-tinged sputum, wet rale, and expiratory wheezing. Hypotension and decrease in organ perfusion can occur. We experienced intraoperative tension pneumothorax probably due to positive pressure ventilation or pleural injury during central venous catheterization through internal jugular vein. And bilateral RPE combined with acute renal failure occurs after spontaneous decompression of tension pneumothorax with chest tube insertion, even with brief duration of lung collapse.
Acute Kidney Injury ; Catheterization, Central Venous ; Central Venous Catheters ; Chest Tubes ; Cyanosis ; Decompression* ; Dyspnea ; Edema ; Hypotension ; Jugular Veins ; Lung ; Perfusion ; Pleural Effusion ; Pneumothorax* ; Positive-Pressure Respiration ; Pulmonary Atelectasis ; Pulmonary Edema* ; Respiratory Sounds ; Sputum ; Tachypnea

No abstract available.
DNA* ; Herpesvirus 4, Human* ; Nasopharyngeal Neoplasms* ; Polymerase Chain Reaction*

In so-called primary osteoarthritic knees, there may be secondary osteoarthritis due to the instability from chronic cruciate ligament and/or meniscal tear. The purpose of this study is to compare the findings of bone single-photon emission computed tomography(SPECT) and those of simple radiography in osteoarthritic knees which we consider as primary on the status of anterior cruciate ligament(ACL). We reviewed the preoperative bone SPECT and simple radiography of forty-three osteoarthritic knees in 23 patients who underwent total knee arthroplasty between 1995 and l996. We divided the cases into two groups on the status of ACL: thirty intact ACLs(Group I), thirteen insufficient ACLs(Group II). Meniscal tear and/or ACL insufficiency were found in 38 of 43 knees, As regards with presence of osteophytes and sclerotic changes on simple radiograph, there was no significant differences between group I and II. Joint space narrowing was more prominent and diffuse in group I(medial 29, lateral 24) than group II(medial 7, lateral 6). Bone SPECT showed diffuse uptake in group I(medial 30, lateral 23), but less uptake on the lateral compartment(medial 13, lateral 3) in group II. In ACL-intact osteoarthritic knees, joint space narrowing on simple radiograph and hot uptake on bone SPECT were more prominent and diffuse than in ACL-insufficient knees. Clinical relevance is still uncertain and further investigation is needed.
Anterior Cruciate Ligament* ; Arthroplasty ; Humans ; Joints ; Knee* ; Ligaments ; Osteoarthritis ; Osteophyte ; Radiography* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: To evaluate the usefulness of introital ultrasonography in the assessment of female urinary incontinence. MATERIALS AND METHODS: Introital ultrasonography was performed in fifteen patients with stress urinasy incontinence(mean age 50) and six patients without symptoms of incontinence(mean age 37). Using a sagittalsection of the anterior pelvis in the plane of the symphysis pubib the posterior rethrovesical angle, the pubourethral distance and the pubo-yretgrak abgle were measured at rest and during stree(Valsalva's maneuverstate). The student T-test and the ANOVA test were used in statistical analysis. RESULTS: The posterior urethrovesical angles of the controls were 125.3 degrees (+/- 10.9) at rest and 125.7 degrees (+/-7.6) during stress. In thepatients, the corresponding angles were 135.3 degrees (+/-11.3) and 139.6 degrees (+/-10.8). The posterior urethrovesical angles increased 0.3 degrees (+/-4.7) in the controls and 5.6 degrees (+/-4.0) in the patients(p=0.018). In the controls, thepubo-urethral distances were 21.8mm(+/- 5.8) at rest and 18.2mm(+/-7.1) during stress, while in the patients thesedistances were 18.4mm(+/-3.9) and 12.6mm(+/-4.4). The pubo-urethra distance decreased 3.5mm(+/-1.5) in the controls and 5.8mm(+/-2.3) in the patients(p=0.039). In the patients with mild incontinence(Gradel), the posterior urethrovesical angles increased 3.4 degrees (+/-2.8) : 132.3 degrees (+/-12.5) at rest and 135.6 degrees (+/-12.8) during stress. In the patients with moderate incontinence(Grade II), the angles increased 8.1 degrees (+/-3.8) : 136.0 degrees (+/-6.5) at rest and 144.1 degrees (+/-5.9) during stress. The change of the posterior urethrovesical angle was related to the grade of urinary incontinence in the patients(p<0.05). There was no statistical significancy in the pubo-urethral angle(p=0.315). CONCLUSION: Introital ultrasonography may be useful for assessment of stress urinary incontinence.
Female* ; Humans ; Pelvis ; Ultrasonography* ; Urinary Incontinence*

PURPOSE: It is important to differentiate malignant from benign lesions of intraocular masses in choosing therapeutic plan. Biopsy of intraocular tumor is not recommended due to the risk of visual damage. We evaluated the usefulness of F-18-FDG PET imaging in diagnosing intraocular neoplasms. MATERIALS AND METHODS: F-l8-FDG PET scan was performed in 13 patients (15 lesions) suspected to have malignant intraocular tumors. There were 3 benign lesions (retinal detachment, choroidal effusion and hemorrhage) and 10 patients with 12 malignant lesions (3 melanomas, 7 retinoblastomas and 2 metastatic cancers). Regional eye images (256*256 and 128*128 matrices) were obtained with or without attenuation correction. Whole body scan was also performed in eight patients (3 benign and 6 malignant lesions). RESULTS: All malignant lesions were visualized while all benign lesions were not visualized. The mean peak standardized uptake value (SUV) of malignant lesions was 2.64+/-0.57 g/ml. There was no correlations between peak SUV and tumor volume. Two large malignant lesions (>1000 mm3 ) showed hot uptake on whole body scan. But two medium-sized lesions (100-l000 mm3) looked faint and two small (<100 mm3) lesions were not visualized. The images reconstructed with 256*256 matrix showed lesions more clearly than those with 128X128 matrix. CONCLUSION: F-18-FDG PET scan is highly sensitivity in detecting malignant intraocular tumor. For the evaluation of small-sized intraocular lesions, whole body scan is not appropriate because of low sensitivity. A regional scan with sufficient acquisition time is recommended for that purpose. Image reconstruction in matrix size of 256*256 produced clearer images than the ones in 128X128, but it does not affect the diagnostic sensitivity.
Biopsy ; Choroid ; Diagnosis* ; Humans ; Image Processing, Computer-Assisted ; Melanoma ; Orbital Neoplasms ; Positron-Emission Tomography ; Retinoblastoma ; Tumor Burden ; Whole Body Imaging

PURPOSE: A pancreatic ductal adenocarcinoma is one of the most fatal cancers, as the majority of the patients present with locally advanced or metastatic tumors in the late stages of the disease. However, there is no simple, sensitive, noninvasive, and inexpensive test for the early detection of pancreatic ductal adenocarcinomas. In recent studies, S100A4 has emerged as an important protein in the tumorgenesis of pancreatic adenocarcinomas. METHODS: The possibility of the expression of S100A4 as a new tumor marker of pancreatic adenocarcinomas was confirmed using immunohistochemistry to 32-pancreatic ductal adenocarcinomas, 20 IPMN (intraductal papillary mucinous neoplasm), 8 serous cystadenomas, 5 chronic pancreatitis and 3 neuroendocrine tumors. RESULTS: Thirty-one (96.9%) ductal adenocarcinoma cases and 11 (55.5%) IPMN expressed S100A4, whereas all normal pancreatic tissues (47 cases), chronic pancreatitis and endocrine tumors did not. The expression of S100A4 was associated with the degree of dysplasia in IPMN, but not with the differentiation of ductal adenocarcinomas. CONCLUSION: The overexpression of S100A4 in adenocarcinomas and early emerging IPMN may suggest its potential as a diagnostic marker for the early detection of pancreatic ductal adenocarcinomas.
Adenocarcinoma* ; Carcinoma, Pancreatic Ductal ; Cystadenoma, Serous ; Humans ; Immunohistochemistry ; Mucins* ; Neuroendocrine Tumors ; Pancreas* ; Pancreatic Ducts ; Pancreatitis, Chronic ; Biomarkers, Tumor

The ultimate goal of periodontal therapy is the regeneration of periodontal tissue which has been lost due to destructive periodontal disease, and numerous kinds of materials and techniques have been developed to achieve this goal. Bone grafts include autografts, allografts, xenografts and synthetic grafts. Among the synthetic grafts, bioactive glass has been used in dentistry for more than ten years and Fetner reported improved new bone formation and more amount of new attachment after grafting PerioGlas , a kind of bioactive glass, in 2-wall defects of monkeys in 1994. It is well known that 1-wall defects have less osteogenic potential and more epithelial migration, so we need to study the effect of bioactive glass in 1-wall defects in dogs. The present study evaluates the effect of bioactive glass on the epithelial migration, alveolar bone regeneration, cementum formation and gingival connective tissue attachment in intrabony defects of dogs. Four millimeter deep and four millimeter wide 1-wall defects were surgically created in the mesial aspects of premolars. The test group received bioactive glass with a flap procedure and the control underwent flap procedure only. Histologic analysis after 8 weeks of healing revealed the following results: 1. The height of gingival margin was 1.30+/-0.73mm above CEJ in the control and 1.40+/-0.78mm in the test group. There was no statistically significant difference between the two groups. 2. The length of epithelial growth(the distance from CEJ to the apical end of JE) was 1.74+/-0.47mm in the control and 1.12+/-0.36mm in the test group. There was a statistically significant difference between the two groups(P<0.01) 3. The length of new cementum was 2.06+/-0.73mm in the control and 2.62+/-0.37mm in the test group. There was no statistically significant difference between the two groups. 4. The length of new bone was 1.83+/-0.74mm in the control and 2.39+/-0.59mm in the test group. There was no statistically significant difference between the two groups. These results suggest that the use of bioactive glass in 1-wall intrabony defects has significant effect on the prevention of junctional epithelium migration, but doesn't have any significant effect on new bone and new cementum formation.
Allografts ; Animals ; Autografts ; Bicuspid ; Bone Regeneration ; Connective Tissue ; Dental Cementum ; Dentistry ; Dogs* ; Epithelial Attachment ; Glass* ; Haplorhini ; Heterografts ; Osteogenesis ; Periodontal Diseases ; Regeneration ; Tooth Cervix ; Transplants

Obstruction of the common bile duct (CBD) by direct extension of a tumor is occasionally found in patients with a hepatic neoplasm, but a bile duct tumor embolus caused by intrabiliary transplantation of a free floating tumor is a rare complication of a hepatocellular carcinoma. A patient of ours was recently observed with a fragment of tumor from a primary hepatocellular carcinoma (HCC) that obstructed the distal CBD. A-46-year-old man was admitted to our hospital with a distal CBD mass, measuring 1.2x1.5 cm, found by a biliary computed tomography (CT) scan. Four month prior to his admission, he had undergone a right hemihepatectomy for a HCC accompanied by direct intrahepatic bile duct invasion, without obstructive jaundice. On admission, there were no abnormal findings in the physical and laboratory examinations. An Endoscopic retrograde cholangiopancreatography and papillotomy had been performed, which showed an irregular shaped filling defect in the distal CBD. Endoscopic nasobiliary drainage (ENBD) was carried out for biliary decompression. Partially extracted soft tissue from the CBD by ERCP revealed a HCC. On performed a pylorus- preserving pancreaticoduodenectomy, a 1cm sized tumor remnant was found attached to the mucosa of the intrapancreatic portion of the bile duct, but without any invasive growth into the submucosa. The tumor may have been an intrabiliary transplantation from the HCC in the right lobe through the bile duct. When an obstructive mass is found in the distal CBD, tumor embolus should be considered, and a radical pancreaticoduodenectomy can be adopted as a safe and effective treatment modality.
Bile Ducts ; Bile Ducts, Intrahepatic ; Carcinoma, Hepatocellular* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Decompression ; Drainage ; Embolism* ; Humans ; Jaundice, Obstructive ; Liver Neoplasms ; Mucous Membrane ; Neoplastic Cells, Circulating ; Pancreaticoduodenectomy

PURPOSE: To identify the necessity of more reasonable diagnostic criteria and the possibility of early prediction of coronary involvement in the higher risk group, we investigated and compared clinical and laboratory findings in the acute phase and coronary involvements in those younger (n=17) and older(n=53) than one year of age in Kawasaki disease(KD). METHODS: Retrospective chart reviews were performed on 70 patients with KD who were admitted to the Chung-Ang University Hospital from April 1997 to May 2001. RESULTS: Male were significantly higher in the younger age group(M : F ratio 3.3 : 1 vs. 1.0 : 1, P=0.004). Fever durations before intravenous immunoglobulin(IVIG) and echocardiography were significantly shorter in the younger group(4.6+/-1.3 vs. 6.2+/-2.5, P=0.004 vs. 0.01, respectively). Cases meeting typical diagnostic criteria were significantly less in the younger group(P=0.006). In the laboratory findings, serum albumin, BUN and K+ levels in the acute febrile phase were significantly higher in the younger group(P=0.002, 0.006, <0.001, respectively) and incidences of coronary artery dilatation in the acute phase were significantly higher in the younger group(P=0.01). CONCLUSION: Although less met the typical diagnostic criteria of KD, infants younger than one year of age are more susceptible to coronary artery change in the acute febrile phase. Therefore, KD should be entertained as a diagnostic possibility in young infants with prolonged fever without distinct fever focus, and echocardiography should be considered as part of the evaluation of these patients, and then early diagnosis and prompt IVIG should be conducted.
Coronary Vessels ; Dilatation ; Early Diagnosis ; Echocardiography ; Fever ; Humans ; Immunoglobulins, Intravenous ; Incidence ; Infant ; Male ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies ; Serum Albumin