BACKGROUND: The rat is generally accepted as an ideal experimental animal. A limitation of rat surgery is the need for microsurgical techniques. Especially, the bile duct of a rat is so slender that it is almost impossible to perform primary microsuture anastomosis of the bile duct. The aim of the present study was to investigate the impact of various bile-duct surgical procedures after temporary ligation, a method which dilates the bile duct without permanent obstruction. METHODS: Temporary ligation of the bile duct with 6-0 chromic cat-gut sutures makes it constantly dilated. Twenty-five ligated rats were divided into three experimental groups: primary end-to-end anastomosis (PA), Roux-en-Y choledochoenterostomy in auxiliary liver transplantation (LT), and sham operation (C). RESULTS: After surgery, the serum levels of glutamate oxalacetic transferase (GOT) were normalized at 5 days in the PA and the C groups, and within 10 days in the LT group. Serum bilirubin and gamma-GTP were not elevated in the three groups. Morhologic examinations of the anastomotic sites in the PA and LT groups at two weeks after surgery showed them to be well healed with good anastomotic patency. CONCLUSIONS: A bile duct dilated by temporal ligation is of great use without high magnification in various bile-duct surgical procedures.
Animals ; Bile Ducts* ; Bile* ; Bilirubin ; Glutamic Acid ; Ligation* ; Liver Transplantation ; Rats* ; Sutures ; Transferases

Esperson, a new topieal steroid ointment containing 0. 25% 17-desoxymethasone, w as used in several kinds of dermatoses. Total 32 patients including 8 cases of contact dermatitis, 2 of atopic dermatitis, 5 of seborrheicdennatitis, 3 of neurodermatitis, 4 of nummular eczema, 2 of hand eczema, 1 of chronic eczema, 1 of perioral dermatitis, 5 of psoriasis and 1 of pityriasis rosea were treated with Esperson. Among these 32 patients, we observed excellent effects in 11 patients (34.4%), good effects in 16 patients (50%) and fair effects in 4 patients (12. 5%). Namely, among these 32 patients, 27 patients (84. 4%) revealed excellent to good therapeutic effects on their skin conditions with Esperson. In some details, 22 out of 26 patients (84.6%) with eczema and 4 out of 5 patients (80%) with psoriasis revealed excellent to good therapeutic effects respectively. No untoward side effect was noted in all subjects treated with Esperson.
Dermatitis, Atopic ; Dermatitis, Contact ; Dermatitis, Perioral ; Desoximetasone ; Eczema ; Hand ; Humans ; Neurodermatitis ; Pityriasis Rosea ; Psoriasis ; Skin ; Skin Diseases*

The cardiovascular and CNS effects of MIDAZOLAM 0.25 mg/kg were studied in 40 patients, randomised and emergency operations(20 males and 20 females). The effects of the administration of MIDAZOLAM intravenously on the cardiovascular and central nervous system were determined. The results were as follows: 1) It had short duration of action and absence of vascular irritation compared with MIDAZOLAM. 2) Three minutes after injection, mean systolic pressure decreased from 132+/-16 mmHg to 115+/-18 mmHg and diastolic pressure from 87+/-11mmHg to 77+/-13 mmHg. One minute after injection heart rate increased from 89+/-19 beat/min to 95+/-20 beat/min and after three minutes returned to prior level. 3) Our study shows that the intraveous administration of MIDAZOLAM 0.25mg/kg produces. a statistically significant, but clinically unimportant, decrease in blood pressure and an increase in heart rate. 4) The effects of MIDAZOLAM on the central nervous system were determined from the time of onset of injection. Spontaneous eye closure, loss of eyelash reflex and apnes were observed at 113+/-66 sec, 133+/-65 sec, and 147+/-58 sec, after injection of MIDAZOLAM. 5) MIDAZOLAM as an induction agent for anesthesia is not indicated for in out-patient surgery due to the extended duration of drowsiness losting over 3 hours in the recovery room. 6) MIDAZOLAM was sufficient as an induction agent for general anesthesia.
Anesthesia* ; Anesthesia, General ; Blood Pressure ; Central Nervous System ; Emergencies ; Heart Rate ; Humans ; Male ; Midazolam ; Outpatients ; Recovery Room ; Reflex ; Sleep Stages

It is well known that increasing tendency of emergency surgery of congenital snomalies such as tracheoesophageal fistu1a, esophageal atresia, esophageal hiatal hernia, hypertrophic pyloric stenosis,intestinal obstruction, imperforated anus, omphalocele, and meconium ileus by virtue of improvement of pediatric surgical procedure, anesthetic agent, and anesthetic method. The possibility of a low gastric pH and the resultant pulmonary damage if aspirated must be considered in the initial care of the newborn with poor muscle tone or reflex activity as well as in the anesthetic management of neonates. We became interested in the factors determining neonatal gastric pH in this point of view, and have measured gastric pH in 75 unselected neonates, 55 of whom were born vaginally and 20 by cesarean section. In premature infants, pH was high regardless of mode of delivery. In mature infants, pH was 1) significantly lower after vaginal delivery than after cesarean section; 2) tended to be lower after section preceded by labor than after elective section; and 3) was lowest after precipitate delivery. There was no correlation between neonatal gastric pH and duration of rupture of membranes, birth weight, or Apgar score. It was concluded that the mature human fetus produces gastric acidity in response to stresses associated with labor and vaginal delivery.
Anal Canal ; Apgar Score ; Birth Weight ; Cesarean Section ; Emergencies ; Esophageal Atresia ; Female ; Fetus ; Gastric Acid* ; Hernia, Hiatal ; Hernia, Umbilical ; Humans ; Hydrogen-Ion Concentration ; Ileus ; Infant ; Infant, Newborn ; Infant, Premature ; Meconium ; Membranes ; Pregnancy ; Reflex ; Rupture ; Virtues

Corticosteroids have endowed the organism with the capacity to resist many types of noxious stimuli, and enviromental changes. Although many anesthetic agents and surgical stress have been shown to have some influence on adrenocortical function in man, there is no report on the effect of flunitrazepam-morphine-nitrous oxide anesthesia on endocrine activity. The present investigation was undertaken to study to what extent flunitrazepam-morphine-nitrousoxide anesthesia nfluences adrenocortical function by judging its effect on plasma cortisol levels in peripheral venous blood in man. Fifteen patients, ranging in age from 17 to 48 years (average 33 years) and in weight from 46kg to 73kg(average 58kg) who underwent various surgical operations, were free from endocrine, neurological, hepatic, renal and cardiopulmonary disease. Each patient was premedicated with atropine sulfate(0.01mg/kg) and Valium(0.15mg/kg) i.m. one hour before the induction of anesthesia. Anesthesia was induced at 9:00 a.m. with flunitreazepam(0.05+/-0.01mg/kg) and morphine(0.29+/-0.04mg/kg) was given by intreavenous injection. Pancuronium bromide(0.09+/-0.013 mg/kg) was given intreavenously for endotracheal intubation. General anesthesia was maintained with nitrous oxide 2L/min. and oxygen 1L/min. controlled ventilaration was carried on throughout the procedure. A moderate depth of anesthesia was maintained by clinical judgment based on signs including blood pressure and pulse rate. Blood samples were obtainesd at the following times: 1) the control group at 9:00 a.m. just prior to induction. 2) 30 min after anesthesia only. 3) 30 min. after the start of operation. Venous blood(5ml) was drawn into an aseptic syringe previously rinsed with heparin. The plasma was separated within 30 min. in a refrigerated centrifuge, then frozen at -40 degrees C. for storage. the cortisol levels in plasma were determined by a Gamma coat I 125 cortisol radiommunoassay kit. The plama cortisl level at 9:00 a.m. just prior to induction in the control group was 12.64+/-3.77 ug/ml. It decreased slightly (about 20%) but no significantly(p>0.01) to 10.11+/-2.47 ug/100ml at 30 min. after the anesthesia alone. At 30 min. after the start of operation it was elevated slightly (about 24%) but not significantly(p>0.1) to 15.42+/-6.88 ug/100ml. This finding indicated that flunitrazepam-nitrous oxide anesthesia has a depressing effect on adrenal cortical function, but did not block the influence on adrenal cortical function of surgical stress.
Adrenal Cortex Hormones ; Anesthesia ; Anesthesia, General ; Anesthetics ; Atropine ; Blood Pressure ; Flunitrazepam* ; Heart Rate ; Heparin ; Humans ; Hydrocortisone ; Intubation, Intratracheal ; Judgment ; Morphine* ; Nitrous Oxide* ; Oxygen ; Pancuronium ; Plasma ; Syringes

PURPOSE: To evaluate the dose under lung block as a function of depth and the effectiveness of a block as a function of block width. MATERIALS AND METHODS: Field size of mantle field was 22.8 x 32.4 cm2 . Dose distribution of the mantle field was measured with two dimensional water phantom system. To analyze the effectiveness of the lung block, central axis plane, 5cm off-axis plane, and 10cm off-axis plane were studied. RESULTS: The dose under the lung block was recorded with maximum at the depth between , 5cm and 10cm . In the central axis plane, dosimetric block width was 10-15% les than physical block width. In the 5cm off-axis plane. Dosimetric block width was 4-9% less than physical block width. In the 10cm off-axis plane, dosimetric block width was 2% less than physical block width. CONCLUSION: Depth dependence of the dose under the lung block was founded. Also, block width dependence of the lung block was founded. To induce the accurate relation between the physical block width and the "effective" block width, it needs more detailed understanding of the variables involved.
Axis, Cervical Vertebra ; Lung* ; Water

A preterm female infant born at 27 weeks of gestation with a birth weight of 990 g developed acute hypotonia, apnea, hypotension and bradycardia mimicking septic shock syndrome at 14h after birth. Laboratory tests indicated a severe hypermagnesemia of 45 mg/dL. The renal function, complete blood count and maternal blood concentrations of magnesium were normal, and the blood cultures were negative. The patient recovered with treatment including exchange transfusion. However, the etiology of the severe hypermagnesemia remains unknown.
Apnea ; Birth Weight ; Blood Cell Count ; Bradycardia ; Female ; Humans ; Hypotension ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Magnesium ; Muscle Hypotonia ; Parturition ; Pregnancy ; Shock, Septic

Muscle pain following succinylcholine chloride(SCC) is well documented, as are elevated serum potassium and increased creatine phosphokinase(CPK) levels. Pretreatment with a subparylsing dose of a non-depolarizing muscle relaxant before SCC is standard and accepted clinical practice in prevention of SCC induced fasciculation and associated sequlae but pretreatment redners the end-plate less sensitive to SCC: hence larger doses of SCC: hence larger doses of SCC are necessary to ensure adequate degree of relaxation. Recontly fahmy et al showed in a study that small doses of diazepam suppressed the fasciculation as well as the increase in serum potassium and creatine phosphokinase(CPK). Our study was undertaken to evaluate the effect of pretreatment with diazepam on the potential side effects of SCC. Eight cases were studied in four different groups. In the first group(control group): no diazepam was used, secoun group: with diazepam 0.05mg/kg, third group:: with diazepam 0.1mg/kg, grouth group: with diazepam 0.2mg/kg. As a result of this study, we can summarize as follows: 1) Diazepam pretreatment groups had no significant change in the prevention of muscle fasciculation following SCC than control groups. 2) Conditions for intubation were assessed as excellent to good in diazepam pretreatment and control groups. 3) The increase in serum potassium and CPK produced by SCC was not inhibited by diazepam pretreatment. 4) In the prevention of incidence of muscle pain, there were no significant difference between the control and diazepam pretreatment groups.
Creatine ; Diazepam* ; Fasciculation ; Incidence ; Intubation ; Myalgia ; Potassium ; Relaxation ; Succinylcholine

Previous molecular genetic studies of laryngeal squamous cell carcinoma (SCC)have shown certain chromosomal regions with recurring alterations. But studies of sequential molecular alterations and genetic progression model of laryngeal SCC have not been clearly defined. To identify the chromosomal alterations associated with the carcinogenesis of laryngeal SCC, we analyzed genomic DNA from microdissected squamous metaplasia, squamous dysplasia, invasive SCC, and metastatic carcinoma samples from 22 laryngeal SCC patients for loss of heterozygosity (LOH) at microsatellite loci. Ten microsatellite markers on chromosome 3p, 8p, 9p, and 17p were used. LOH at 9p21 was observed in the all stages including squamous metaplasia, squamous dysplasia, invasive SCC and metastatic carcinoma. LOH at 17p13.1, 3p25 and 3p14.2 was observed from the squamous dysplasia, invasive SCC and metastatic carcinoma. LOH at 8p21.3-p22 was observed mainly from the invasive SCC and metastatic carcinoma. The results suggest that 9p21 in the early event, 17p13.1, 3p25 and 3p14.2 in the intermediate event and 8p21.3- p22 in the late event may be involved in the laryngeal carcinogenesis.
Carcinoma, Squamous Cell/*genetics/pathology ; Chromosome Mapping ; *Chromosomes, Human, Pair 17 ; *Chromosomes, Human, Pair 3 ; *Chromosomes, Human, Pair 8 ; *Chromosomes, Human, Pair 9 ; Disease Progression ; Human ; Laryngeal Neoplasms/*genetics ; Larynx/pathology ; *Loss of Heterozygosity ; Lymphatic Metastasis ; Metaplasia/pathology ; Microsatellite Repeats ; Neoplasm Metastasis

BACKGROUND/AIMS: The elderly patients with reflux esophagitis are less likely to feel or report their symptoms than the younger patients, even though they are more prone to complications such as bleeding, stricture or Barrett's esophagus. In this study we tried to investigate risk factors in the elderly patients who had endoscopically diagnosed reflux esophagitis. METHODS: Clinical data of six hundred and eighty seven patients with reflux esophagitis were reviewed. RESULTS: Among the 687 patients with reflux esophagitis, two hundred and thirteen (31%) were 60 or more than 60 years old. The frequency of accompanying hiatal hernia in the elderly group (age>or=60) was significantly higher than the younger group (age<60) (16.9%, 36/213 vs. 3.4%, 16/474, p<0.05). There was significant difference according age in the female group (0.9%, 1/114 vs. 22.7%, 22/97, p<0.05). The frequency of atropic gastritis was significantly higher in the elderly group than in the younger group , while other factors such as smoking, H. pylori and peptic ulcer disease were not different between the two groups. CONCLUSION: Among the risk factors of reflux esophagitis, the existence of hiatal hernia seems to be suggested more relevant to the development of this condition in the elderly group.
Aged* ; Barrett Esophagus ; Constriction, Pathologic ; Esophagitis, Peptic* ; Female ; Gastritis ; Hemorrhage ; Hernia, Hiatal ; Humans ; Middle Aged ; Peptic Ulcer ; Risk Factors* ; Smoke ; Smoking