We Performed 1,662 anesthesia for emergency surgery at Maryknoll Hospital from January 1985 to December 1989, these surgeries were analyzed clinically and statistically according to age, sex, preoperative status, insurance and noninsurance, frequency of emergency operation, presence of full stomach, department, operation site, anesthetic techniques and agents, time & duration of anesthesia, amount of transfusion. The results were as follows: 1) More than half of the total cases were patients in the third and fourth decade of age. 2) The ratio of male to female numbered 0.83: 1. 3) According to the A.S.A.classification of physical status, patients in emergency class 1 were 38.5%. 4) The ratio of insurance patients (1,113 cases, 67%) versus noninsurance parients (549 cases, 33%) was approximately 2:1. 5) Emergency surgery was 6.1% of total surgical cases. 6) 6.7% patients of emergency surgery had full stomach. 7) The most frequent emergency operations were done by general surgery (43.5%), and obstetrics & gynecology (28.6%). 8) Most common diseases in order, were appendicitis (457 cases), Cesarean section (335 cases), intracranial hematoma (202 cases), repair of tendon, nerve, vessels (71 cases). 9) The most common anesthetic technique for emergency surgery was general anesthesia (94.6%) followed by spinal anesthesia (3.5%). 10) 47.5 percent of emergency operations were performed during the 6 hours from midday to 6 p. m. 11) The duration of anesthesia was up to 2 hours in 1165 cases (70.1%). 12) The cases requiring transfusion during operation were 21.4% (355 cases) of the total cases (1, 662 cases).
Anesthesia* ; Anesthesia, General ; Anesthesia, Spinal ; Appendicitis ; Cesarean Section ; Emergencies* ; Female ; Gynecology ; Hematoma ; Humans ; Insurance ; Insurance Coverage ; Male ; Obstetrics ; Pregnancy ; Stomach ; Tendons

Myasthenia Gravis is a chronic disorder of neuromuscular transmission characterized by weakness, fatigue of voluntary muscles, especially exacerbations and remissions, a rare disease in Korea. Special considerations are required in the anesthetic management of the myasthenic patients undergoing surgery under general anesthesia and in the postoperative respiratory management by anesthesi olgists. Authors report 8 cases of anesthesia, using N20-02-Enflurane without using nondepolarizing and depolarizing muscle relaxants for thymectomy, experienced during the year 1986~1990.
Anesthesia ; Anesthesia, General ; Fatigue ; Humans ; Korea ; Muscle, Skeletal ; Myasthenia Gravis ; Neuromuscular Depolarizing Agents ; Rare Diseases ; Thymectomy*

BACKGROUND: This study evaluated the accuracy of smoking habit from the data obtained from the medical records of lung cancer patients against the data obtained form face-to-face interview questionnaires METHODS: The smoking habits of 225 lung cancer patients were categorized into never smoked, ex-smoker and current smoker in face-to-face interview questionnaire and medical record taken at the time of admission for a diagnosis. The overall agreement between two sources was evaluated. The factors affecting the disagreement between two sources and the level of data omission of the smoking habits in medical records were analyzed suing multiple logistic regression. RESULTS: The smoking habit between two sources showed moderate overall agreement(Kappa (kappa)=0.60). The lowest agreement was observed in the ex-smokers(kappa=0.49). Multivariate analysis revealed an age of 65 or older to be a statistically significant factor associated with the increasing disagreement risk compared with those 64 or younger (OR 3.02; 95% CI 1.58-5.80). The omission rate of smoking habits in the medical records was 18.2%. Adenocarcinoma was shown to be a statistically significant factor of associated with an increasing omission rate compared with squamous cell carcinoma (OR 3.00; 95% CI 1.19-7.59). CONCLUSION: The smoking habits obtained from medical record moderately reflect their true behavior. However, the smoking habit data from medical record should be used with caution when being used in a clinical study or cohort study of lung cancer.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Cohort Studies ; Diagnosis ; Humans ; Logistic Models ; Lung Neoplasms* ; Lung* ; Medical Records* ; Multivariate Analysis ; Questionnaires* ; Smoke* ; Smoking*

An intravaginal foreign body of long duration can lead to infection and ulceration. Foul-smelling, bloody vaginal discharge, and pelvic pain may indicate the presence of an intravaginal foreign body and symptoms may be referred to the bladder or rectum. But these clinical features are nonspecific and a number of diagnostic modalities may fail to detect the presence of the foreign body. Moreover, long-standing intravaginal foreign body may be difficult to distinguish from an advanced cervical cancer especially in uninformed cases. We present a case of a 41-year-old female who suffered from an aggravating chronic pelvic pain and malodorous dirty vaginal discharge. Initially the advanced cervix cancer complicated with recto-vaginal fistula was suspected. But results of repeated biopsies were benign and symptoms were improved by intravenous antibiotics. Finally the embedded foreign body in the posterior fornix was detected and successfully removed. It was proved as the grip of an umbrella. We concluded that a high index of suspicion is very important for the correct diagnosis of long-standing vaginal foreign body especially in uninformed cases.
Adult ; Anti-Bacterial Agents ; Biopsy ; Diagnosis ; Female ; Fistula ; Foreign Bodies ; Hand Strength ; Humans ; Pelvic Pain ; Rectum ; Ulcer ; Urinary Bladder ; Uterine Cervical Neoplasms* ; Vagina ; Vaginal Discharge

PURPOSE: The increased expression of cyclooxygenase (COX)-2 has been implicated in the development and progression of human cancer. This study investigated the COX-2 expression in colorectal cancer, and its relationships with tumor angiogenesis and the clinicopathological factors. MATERIALS AND METHODS: The expression of the COX-2 protein and microvessel density were evaluated, using immunohistochemical methods, in 21 normal colonic mucosa and 190 human colorectal carcinomas. Correlations between COX-2 expression and microvessel density, as well as various clinicopathological factors, were studied in colorectal carcinomas. RESULTS: The COX-2 protein expression in epithelial cells was increased in 169 of the 190 adenocarcinoma cases (88.9%), but in only 1 of the 21 (4.8%) normal mucosa cases. The COX-2 expression was significantly increased in the differentiated compared with the undifferentiated colorectal carcinomas (p<0.05), and significantly correlated with the depth of invasion and microvessel density (p<0.05). Rectal cancers had more COX-2 positive cases than the colon cancers (p<0.05). However, there were no significant differences in the tumor size and the presence of lymphatic or vascular invasion. CONCLUSION: The overexpression of cyclooxygenase-2 in colorectal carcinomas seems to play a role in the invasion and angiogenesis of the tumors, so may be a useful marker of the prognosis. The prominent expression was also demonstrated in differentiated colorectal cancers.
Adenocarcinoma ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Cyclooxygenase 2* ; Epithelial Cells ; Humans ; Microvessels* ; Mucous Membrane ; Prognosis ; Prostaglandin-Endoperoxide Synthases ; Rectal Neoplasms

The associations between storm events, urban runoff and costal water quality have not been well investigated in Korea. A temporal and spatial analysis during summer, 2015 was conducted to determine associates between urban runoff and fecal indicator bacteria (Escherichia coli, Enterococcus) levels at two popular coastal beaches (Gwanganri beach and Haundae beach) in Busan. In this study, a clear relationship between rainfall and elevated number of indicators was observed. Two beaches met the costal beach water health standards after less than 3.0 mm of rain. Only for storms less than 2.5 mm was no observable rainfall effect. Our results revealed that exceedances were greatest in 5 hours following 41.0~45.5 rainfall, then declined the bacterial concentrations in 8 hours after the storm and they generally returned to levels below water health standards within 10~14 hours. But it took 2.7 days to get the level of water quality of dry days. The time required for water quality recovery depends on the intensity and duration of rainfall. In the event of intense rainfall issuance of beach closure by public authorities is warranted to protect public health.
Bacteria ; Busan ; Enterococcus ; Korea ; Public Health ; Rain ; Spatial Analysis ; Swimming* ; Water Quality* ; Water*

PURPOSE: Purpose: To compare the diagnostic accuracy of ferumoxides-enhanced MR with that of combined CT during arterial portography (CTAP) and CT hepatic arteriography (CTHA) in the preoperative detection of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: For preoperative evaluation, 20 patients with HCC underwent ferumoxides-enhanced MR and combined CTAP and CTHA. The MR protocol included fat-suppressed respiratory-triggered fast spin echo, T2*-weighted fast multiplanar gradient-recalled acquisition in the steady state, proton density-weighted fast multiplanar spoiled gradient-recalled echo, and breath-hold in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo. In all patients, laparotomy was performed. The presence or absence of HCC was confirmed by pathologic examination in the resected liver and by intraoperative ultrasonography of remaining liver, or by follow up. Images were reviewed by three radiologists working independently; regarding the presence or absence of HCC in each segment, each observer assigned one of five confidence levels. A receiver operating characteristic (ROC) curve was fitted to these confidence ratings, and the diagnostic accuracy of each modality was evaluated by calculating the Az value (area under the ROC curve) and compared with that of other modalities. The sensitivity and specificity of each modality in the detection of HCC were also calculated and compared, and using a κstatistic, inter-observer agreement for each modality was assessed. RESULTS: In 28 of 160 liver segments, 30 HCCs were present. For ferumoxide-enhanced MR the mean Az value was 0.958, and for combined CTAP and CTHA this value was 0.948. The difference was not statistically significant. The mean sensitivities of ferumoxide-enhanced MR and combined CTAP and CTHA were 92.9% and 90.9%, respectively, the difference being statistically insignificant. The mean specificities of these modalities were, respectively, 98.9% and 93.6%. The difference was statistically significant. For both ferumoxide-enhanced MR and combined CTAP and CTHA, interobserver agreement was excellent. CONCLUSION: In the preoperative detection of HCC, ferumoxide-enhanced MR imaging of the liver showed a diagnostic accuracy similar to that of combined CTAP and CTHA. Its specificity, however, was higher.
Angiography* ; Carcinoma, Hepatocellular* ; Follow-Up Studies ; Humans ; Iron ; Laparotomy ; Liver ; Liver Neoplasms ; Magnetic Resonance Imaging ; Portography* ; Protons ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: The purpose of this study was to report the CT findings of four patients with hepatic abscess secondary to perforated acute cholecystitis. MATERIALS AND METHODS: We retrospectively reviewed the CT findingsof four patients with surgically proven hepatic abscess secondary to perforated acute cholecystitis. CT findings were analysed with respect to the observation of the gallbladder, pericholecystic space, hepatic lesions, and peritoneal cavity. All patients underwent cholecystectomy, with drainage of the hepatic abscess. RESULTS: CT findings of hepatic abscess secondary to perforated acute cholecystitis were hypodense mass formation in the pericholecystic space(n=3), irreguarity and wall defect of Gallbladder(n=4), thickened Gallbladder wall(n=4),stone with debris(n=4), and local or diffuse infiltration of the pericholecystic area(n=3), omentum, and mesentery. CONCLUSION: CT was helpful in diagnosing the hepatic abscess secondary to perforated acutecholecystitis.
Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute* ; Drainage ; Gallbladder ; Humans ; Liver Abscess* ; Omentum ; Retrospective Studies

T cell mediated immunity amlifies macrophage capacities to kill and digest the bacilli through production of interferon-gamma (IFN-gamma). The secreted cytokines of Th1 and Th2 cells can mutually regulate and inhibit each other's function. Therefore, the fine balance between the secreted cytokines is important for the resulting nature of tuberculosis. In this study, activation marker and cytokine production profiles were compared in patients with active tuberculosis and healthy control, and according to degree of radiographic extent and pleural involvement. METHOD:Forty-four patients with active pulmonary tuberculosis and 25 normal controls were recruited. We measuerd soluble interleukin-2 receptor(sIL-2R), IFN-r, IL-4 and IL-5 produced from blood mononuclear cells in vitro stimulation with phytohemagglutinin by ELISA. RESULTS: The sIL-2R and IFN-gamma from patients with active pulmonary tuberculosis were significantly lower than normal control, while IL-4 and IL-5 were not different between two group. The sIL-2R and IFN-r decreased in proportion to the extent of pulmonary involvement, and the sIL-2R and IFN-r from pulmonary tuberculosis with pleural effusion were significantly lower than those without pleural effusion. CONCLUSION: At the level of systemic T cells, development of tuberculosis is associated with diminished Th1 but not enhanced Th2 response.
Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunity, Cellular ; Interferon-gamma ; Interleukin-2 ; Interleukin-4 ; Interleukin-5 ; Macrophages ; Pleural Effusion ; T-Lymphocytes ; Th2 Cells ; Tuberculosis ; Tuberculosis, Pulmonary

Intracranial epidermoid cysts usually show homogeneous hypodensity on CT scans, hypointensity on T1-weighted MR images and hyperintensity on T2-weighted MR images. Most of them arise in the cerebellopontine angle and parasellar areas. We report a case of middle cranial fossa epidermoid tumor with unusual image findings. The entire tumor mass showed inhomogeneous low density, without any enhancing solid portion on the CT scans. The lateral portion of the tumor showed homogeneous T1 low signal intensity and T2 high signal intensity. The medial portion of the tumor showed heterogeneous T1 and T2 intermediate to high signal intensity. On the gadolinium enhanced MR images, enhancement of the thickened dura was observed behind the tumor. Surgery and pathologic examination revealed the presence of an extradural epidermoid cyst.
Cerebellopontine Angle ; Cranial Fossa, Middle* ; Epidermal Cyst* ; Gadolinium ; Tomography, X-Ray Computed