Disseminated intravascular coagulation (DIC) is a pathological syndrome in which activation of coagulation cascade leads to fibrin clot formation, consumption of platelets and coagulation factors, and secondary fibrinolysis. We report a case of severe postoperative hemorrhagic diathesis due to DIC. A 59-year-old man was scheduled for reduction of tibia fracture and anatrophic nephrolithotomy of staghorn calculi. On the fifth postoperative day, second operation was performed for nephrectomy due to perirenal hematoma. Two days later, third operation was performed for hemostasis because of the continuous bleeding. Coagulation tests showed positive DIC profiles of thrombocytopenia, hypofibrinogenemia, increased fibrin degradation products, and prolonged prothrombin time and thrombin time. The patient recovered uneventfully and discharged on the 59th postoperative day.
Blood Coagulation Factors ; Calculi ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Fibrin ; Fibrin Fibrinogen Degradation Products ; Fibrinolysis ; Hematoma ; Hemorrhage* ; Hemorrhagic Disorders ; Hemostasis ; Humans ; Middle Aged ; Nephrectomy ; Postoperative Complications ; Prothrombin Time ; Thrombin Time ; Thrombocytopenia ; Tibia

BACKGROUND: The purpose of this study was to compare prospectively two different anesthetic techniques with isoflurane or propofol for postoperative nausea, vomiting and recovery after tonsillectomy in children. METHODS: Sixty children, ASA physical status I, were assigned randomly to one of two groups. In group I, anesthesia was induced with thiopental 5 mg/kg and maintained with isoflurane 1~1.5 vol%. In group P, anesthesia was induced with fentanyl 1 mcg/kg, propofol 2 mg/kg and maintained with propofol infusion 5~10 mg/kg/hr. Both group received vecuronium 0.1 mg/kg for tracheal intubation and were ventilated with 33% O2 in N2O. The time to extubation, time to eye opening, PACU time, incidence and numbers of postoperative nausea and vomiting, and degree of sedation were recorded as well as perioperative complications. RESULTS: There were no significant difference in the duration of anesthesia and PACU time between two groups. The time to extubation and eye opening of group P were significantly shorter than group I (p<0.05). The degree of sedation and incidence of postoperative nausea and vomiting of group P were significantly lower than group I (p<0.05). But the frequency of intraoperative bradycardia was significantly higher in group P than group I (p<0.05). CONCLUSIONS: Propofol-fentanyl anesthesia results in less nausea and vomiting during postoperative period and more rapid recovery compared to isoflurane anesthesia and may be recommended in children undergoing tonsillectomy and adenoidectomy.
Adenoidectomy ; Anesthesia* ; Bradycardia ; Child* ; Fentanyl ; Humans ; Incidence ; Intubation ; Isoflurane* ; Nausea ; Postoperative Nausea and Vomiting* ; Postoperative Period ; Propofol* ; Prospective Studies ; Thiopental ; Tonsillectomy* ; Vecuronium Bromide ; Vomiting*

PURPOSE: We evaluated a rapid preparation procedures for the labeling and quality control of 99mTc-ECD, MAG3, and MIBI using microwave heating and Sep-Pak cartridges. MATERIALS AND METHODS: 99mTc labeling of ECD, MAG3, and MIBI kit preparation was performed according to the package inserts with microwave heating modification. Heating time was 10-15 sec, and heating was performed with 3 mm plastic bottle with screw cap to prevent radiation contamination. Labeling efficiency was obtained with C18 or Alumina N Sep-Pak cartridges. RESULTS: The radiochemical purity of 93~96% for 99mTc-ECD and 95~99% for 99mTc-MIBI was obtained using Alumina N Sep-Pak cartridge. The optimum irradiation time of microwave method for 3 ml 99mTc-labeled radiopharmaceutical solution was 10 sec for 99mTc-ECD and 99mTc-MIBI, and 15 sec for 99mTc-MAG3. The RESULTS of quality control data with Sep-Pak cartridges were well correlated with TLC method. The total preparation time of these radiopharmcaeuticals was 5~6 min including quality control procedure. CONCLUSION: This study demonstrates that radiopharmaceuticals preparation by microwave heating and quality control by Sep-Pak cartridges can be efficiently utilized as an alternative to the recommended method by manufacturer's manual.
Aluminum Oxide ; Heating* ; Hot Temperature* ; Microwaves* ; Plastics ; Product Labeling ; Quality Control* ; Radiopharmaceuticals ; Technetium Tc 99m Mertiatide

BACKGROUND: We assessed the effectiveness of arthroscopic capsular release for the treatment of adhesive capsulitis. Further, we tried to ascertain the clinical benefits, if any, of pancapsular release over selective capsular release, where the two differ by performing or not performing a posterior capsular release, respectively. METHODS: Thirty-five consecutive patients with either primary or secondary adhesive capsulitis who failed conservative treatment for more than 6 months were enrolled in the study. A total of 16 patients allocated in group 1 received a pancapsular release that comprises the release of the rotator interval, anteroinferior capsular, and the posterior capsular release, whereas 19 patients in group 2 received a selective capsular release that comprises only the release of the rotator interval release and anteroinferior capsular release. The clinical outcomes, visual analogue scale (VAS) score, Constant score, and range of motion, were assessed preoperative and postoperatively. RESULTS: In both groups, the preoperative VAS score, Constant score, and ROM showed a significant improvement by the 6-month follow-up. We found that the immediate postoperative internal rotation was significantly higher in group 1 than group 2. Despite significant differences seen between the two groups at the initial postoperative period, there were no significant differences in Constant score, VAS score, and the ROM at all the subsequent follow-ups between the two groups. CONCLUSIONS: Arthroscopic capsular release for the treatment of adhesive capsulitis is very effective. However, pancapsular release did not show any advantage over selective capsular release in terms of overall clinical outcome.
Bursitis* ; Follow-Up Studies ; Humans ; Joint Capsule Release* ; Postoperative Period ; Range of Motion, Articular

No abstract available.

One Hundred and eight patients received operation for acute subdural hematoma were evaluated in prognostic factors. They were admitted to the Neurosurgical Department in S.R.C.H during the 3 years from January, 1986 to December, 1988. The results were as follows ; 1) The patients were consist of 85 male patients and 23 female patients with the sex ratio 3.7 : 1. 2) Evaluated prognostic factors were age and sex, preoperative Glasgow coma scale(GCS), preoperative pathological physical findings, time interval from injury to operation, type of injury, midline shift, location of hematoma, thickness of hematoma, and operative procedure. 3) On the statistical analysis, factors of GCS and midline shift were considerable significant factors. 4) In the overall results of 108 patients, 47 patients(43.5%) had good recovery, 9 patients(8.3%) had moderate disabled state, 2 patients(1.9%) were severe disabled state, 4 patients(3.7%) were vegetative state, and 46 patients(42.6%) died.
Coma ; Female ; Hematoma ; Hematoma, Subdural, Acute* ; Humans ; Male ; Persistent Vegetative State ; Sex Ratio ; Surgical Procedures, Operative

We experienced a rare case of sacral meningeal cyst so called sacral perineurial cyst(Tarlov cyst). A 15 years old girl was admitted to the hospital because of sudden severe low back pain and Lt. sciatica for about one week. We performed delayed myelography and spinal computeized tomographic myelography(C.T.M) for differential diagnosis. Delayed filling of contrast media in the cyst was significant in diagnosis of sacral meningeal cyst type II. Laminectomy of sacrum(S1) was performed for partial excision of cystic wall and plastic suture. Operative finding was typical sacral perineurial cyst(Tarlov cyst) which was recently clssified as sacral meningeal cyst type II. The classification of spinal meningeal cysts in the literature was indistinct and confused. We also agree with Nabors et. al, in current classificcation of spinal meningeal cysts, in which the spinal meningeal cysts, in which the spinal meningeal cysts were divided into 3 groups as extradural spinal Mcs Type I(Diverticulum), Type II(perineurial cyst), intradural spinal Mcs(arachnoid cyst).
Adolescent ; Classification ; Contrast Media ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Laminectomy ; Low Back Pain ; Myelography ; Plastics ; Sciatica ; Sutures

The authors have analyzed the factors influencing the outcome of the 168 patients with acute epidural hematoma who had been managed in our hospital for 3 years from July 1986 to June 1989. 1) Sex incidence showed that male patients were 4.8 times more commonly affected than females, and the most commonly affected age group was the 3rd decade. 2) The most common cause of injury was motor vehicle accidents. The patients with unknown cause of injury which probably suggested significant delay in starting the clinical managements had a higher mortality rate. 3) The most common site of hematoma was the FTP convexity(63.6%). The patients with diffuse hematoma in the fronto-temporo-parietal region had a high mortality and deteriorated level of consciousness. 4) Skull fractures were not seen only in 9.5% of the patients with acute epidural hematoma. 5) The main factors associated with the higher mortality rate were rapid development of hematoma, pupillary dilatation, low score in Glasgow Coma Scale on arrival, and more midline shifting on brain CT. 6) The patients with concomitant intracranial lesions had a high mortality rate(25.8%), and the patients with acute epidural hematoma alone had a low rate(2%), and the overall mortality rate of the patients with acute epidural hematoma was 11.3%.
Brain ; Consciousness ; Dilatation ; Female ; Glasgow Coma Scale ; Hematoma* ; Humans ; Incidence ; Male ; Mortality ; Motor Vehicles ; Skull Fractures

Small cell carcinoma of the kidney is very rare, but lethal due to early metastasis and rapid progression. We report a case of the primary small cell carcinoma of the kidney with large rena1 calculus resulting in spontaneous rupture of the kidney, and was managed by total nephrectomy and evacuation of retroperitoneal hematoma and calculus. Immunohistochemical studies revealed the positive staining for cytokeratin and neuron-specific enolase, and dense-core neurosecretory granules were identified in the cytoplasm by electron microscopy. This report is the first case of the primary small cell carcinoma of the kidney resulting in spontaneous rupture of the kidney.
Calculi ; Carcinoma, Small Cell* ; Cytoplasm ; Hematoma ; Keratins ; Kidney* ; Microscopy, Electron ; Neoplasm Metastasis ; Nephrectomy ; Phosphopyruvate Hydratase ; Rupture, Spontaneous*

In this study, We have tried to evaluate with a Pulse oximeter the changes of SaO2Pulse, and Temperature in the recovery period. We divided 75 patients into the following 5 groups according to operation sites and anesthetic methods. 1) Lower aMominal operation (Group 1) 2) Upper abdominal operation (Group 2) 3) Head and Neck operation (Group 3) 4) Extremity operation (Group 4) 5) Subarachnoid Block (Group 5) We measured the values preoperatively, on arrival at the recovery room, and at 5 minutes 10 minutes, 20 minutes, and 30 minutes later. The SaO2was decreased in all groups on arrival, significantly in group 2 and 4, but progressively increased toward normal range. The Temperature dropped significantly in groups 2, 4, and 5 on arrival, the pulse was significantly decreased only in group 5. As a result of this study, We recommend supplementel oxygen and thermoregulation for immediate postanesthetic patient care.
Body Temperature Regulation ; Extremities ; Head ; Humans ; Neck ; Oxygen* ; Patient Care ; Recovery Room ; Reference Values