Ketamine is a safe and effective drug for pediatric anesthesia, sedation and analgesia. We hoped to identify that surgeons could operate a pediatric hernia with the ketamine anesthesia without general anesthesia. The study was a consecutive case series of 2230 inguinal hernia patients aged 1 months to 17 years in a Joo's day-surgical clinic during 11-year period. The patients had pediatric inguinal hernia surgery without general anesthesia under the day-surgery system. We retrospectively analyzed the medical record of patients who were registered with the Diagnosis Related Group (DRG) system. All patients received ketamine (5mg/kg) and atropine (0.01mg/kg) intramuscularly before surgery. After anesthesia, we injected 1~2% lidocaine (Less than 5ml) subcutaneously at the site of incision and started operation. The surgical method was the high ligation method of the hernia sac.) In total 2230 patients, male were 1756 and female were 474. 2076 patients were a unilateral inguinal hernia at the time of surgery and 154 were bilateral hernia patients. Less than three months, depending on the age of the patients was 391, and less than 12 months the patient was 592 people (26.5%). After surgery, there were no accidents or long term complications associated with ketamine anesthesia. We think the surgeon can safely do the pediatric inguinal hernia surgery using ketamine and lidocaine without anesthesiologist through 11 years of our surgical experiences.
Analgesia ; Anesthesia ; Anesthesia, General ; Atropine ; Child ; Diagnosis ; Female ; Hernia ; Hernia, Inguinal* ; Hope ; Humans ; Ketamine* ; Lidocaine* ; Ligation ; Male ; Medical Records ; Retrospective Studies

The autogenous fascia graft has been used for various surgical purposes because it has good durability, a gliding capacity, elasticity and a high survival rate. However, few studies have reported histological changes of the graft in various situations. This study attempted to determine histomorphologic changes after autogenous fascia graft in various surgical conditions. The results revealed were as follows: 1. The tension applied to grafts plays the key role in the survival rate of autogenous fascia grafts. 2. Rolling the fascia reduced the volume and weight after autogenous graft due to fibrosis and central fatty degeneration. 3. Autogenous fascia graft covering silicone blocks showed its fascial structure and reduction of the formation of fibrous capsule around the silicone.
Elasticity ; Fascia ; Fibrosis ; Silicones ; Survival Rate ; Transplants*

No abstract available.
Balloon Valvuloplasty* ; Child* ; Constriction, Pathologic* ; Humans

BACKGROUND: Genus of Aspergilli are ubiquitous saprophytic molds in nature, but its change from a saprophytic fungus to a pathogenic organism has occurred since the use of various antibiotics. The fungus affects the chronically ill and debilitated population. Recently frequency of the fungal infection is increasing in Korea with abuse of antibiotics and glucocorticoids. METHOD: We analyzed medical records of 52 patients with pulmonary aspergillosis seen at Hanyang University Hospital from 1980 to 1994. The results were as follows; RESULTS: 1) Ages ranged between second to eighth decades with majority(50%) in the fourth to fifth decades. The male to female ratio was 1.1:1. 2) Hemoptysis and productive cough, the leading symptoms, occurred in 42.3% and 25% respectively. 3) On chest X-ray fingings, the characteristic 'fungus ball' pattern were observed in 53.8% of the 52 cases. 4) Sputum culture for aspergilli were positive in 21.6% of the cases. We performed foe needle aspiration in 22 patients and the diagnostic yield was 100%. 5) Thirty-six patients had history of treatment with antituberculous drugs under diagnosis of pulmonary tuberculosis for an average of 27.3 months. But sputum analysis for acid-fast bacilli were positive in 5.6%(2cases of 36cases), and postoperative pathologic findings showed that 38.9% (12 cases of 28cases) were combined with tuberculosis. 6) Right upper and left upper lobes were predominantly involved(34.6% and 19.2% respectively) and lobectomies were performed in 21 cases. 7) Underlying diseases were present in 47 cases and 48.9% of them were pulmonary tuberculosis. CONCLUSION: These results showed that pulmonary aspergillosis usually develops in patients with open cavitary pulmonary tuberculosis. And we must consider the possibility of pulmonary aspergillosis in a patient with hemoptysis and cavitary lung lesion.
Anti-Bacterial Agents ; Aspergillus ; Chronic Disease ; Cough ; Diagnosis ; Female ; Fungi ; Glucocorticoids ; Hemoptysis ; Humans ; Korea ; Lung ; Male ; Medical Records ; Needles ; Pulmonary Aspergillosis* ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

No abstract available.
Endoderm* ; Endodermal Sinus Tumor*

To cover soft tissue defect, various types of flaps have been used. Although lateral supramalleolar flap has been used as rotation flaps or reversed island flaps to cover defects around the foot and ankle, there has been no report about its application as a free flap. The lateral supramalleolar island flap has proves to be supplied constantly by the terminal branch of the peroneal arterys perforating branch. The free lateral supramalleolar flap has the same skin territory. Its vascular pedicle can be extended to the main peroneal artery and vena comitans, which can be obtained by dissecting the peroneal vessels between the distal tibia and fibula through the interosseous membrane. We have successfully transferred this free flap in eight patients from April 1994 to February 1995. All of the patients had full thickness skin defects which were caused by contact thermal burn, electrical burn, flame burn or traffic accident. There were no complications. From our experience, we feel that this new free flap have some advantages, induding vascular anatomy and long pedicle with large diameter and a relatively thin flap with minimal morbidity of donor site.
Accidents, Traffic ; Ankle ; Arteries ; Burns ; Fibula ; Foot ; Free Tissue Flaps* ; Humans ; Membranes ; Skin ; Surgical Flaps ; Tibia ; Tissue Donors

We report one case of bilateral naviculo-medial cuneiform coalition in ten year old girl. She complained of pain in the medial aspect of the mid-foot related to long periods of standing and activity. Routine roentgenographs, specifically lateral views showed a bony bridge between the navicular bone and medial cuneiform. A biopsy revealed as fibrocartilaginous tissue. The bony bridge consists about one third in lateral view and 30 degree cephalad tilting in the antero-posterior view. Bilateral resection arthroplasty, with interposing flesh muscle fibers of the abductor hallucis, was performed for restoration of motion in the naviculo-medial cuneiform joint and relief of localized pain. Four months after surgery, pain around the mid-foot had almost complete subsided. One year postoperative, neither recurrence nor disability was observed. We will discuss the diagnosis and treatment of this rare case of bilateral naviculo-medial cuneiform coalition.
Arthroplasty ; Biopsy ; Diagnosis ; Female ; Humans ; Joints ; Recurrence

Extraperitoneal inguinal endometriosis often presents as an inguinal mass in women of reproductive age, Approximately 40 cases of inguinal endometriosis have been documented in the sutgical and gynecological literature. The overall incidence is in the range of 0.4% of patients with endometriosis. The right side is much more commonly involved than the left (almost 90% of the time in one series of 23 patients), and rarely is the condition bilateral. The most frequent complaint of patients with inguinal endometriosis is an inguinal mass, followed by pain and enlargement of the mass near menstruation. Authors have experienced two cases of endometriosis of the extraperitoneal portion of the round ligament of uterus and report with a brief literature review.
Endometriosis* ; Female ; Humans ; Incidence ; Menstruation ; Round Ligament of Uterus* ; Uterus

BACKGROUND: Most current reseatch using prognostic scoring systems in critically ill patients have focused o prediction using the first intensive care unit(ICU) day data or daily updated data. Usually the mean ICU length of stay in Korea is longer than in the western world. Consequently, a more cost-effective and practical prognostic parameter is required. The principal aim of this study was to assess the prognostic value of the seventh day(7th day : the average mean ICU length of stay) APACHE III score in a medical intensive care unit. METHODS: 241 medical ICU patients from July 1997 to April 1998 were enrolled. The 1st and 7th scores were measured by using the APACHE III scoring system and compared between survivors and non-survivors. Logistic regression analysis was performed to determine the relationship between the 1st and 7th APACHE III scores and the mortality risk. RESULTS: 1) The mean length of stay in the ICU was 10.3±13.8 days. 2) The mean 1st and 7th day APACHE III scores were 59.7±30.9 and 37.9±27.7. 3) The mean 1st day APACHE III scores was significantly lower in survivors than in non- survivors(49.9±23.8 vs 86.3±32.3 P<0.0001). 4) The mean 7th day APACHE III scores was significantly lower in survivors than in non- survivors(30.1±18.5 vs 80.1±30.4, P<0.0001). 5) The odds ratios among the 1st and 7th day APACHE III scores and the mortality rate were 1.0507 and 1.0779 respectively. CONCLUSION: These results suggest that the seventh day APACHE III scores is as useful in predicting the outcome as is such like the first day APACHE III score. Therefore, in comparison to the daily APACHE III score, measuring the 1st and 7th day APACHE III scores are also useful for predicting the prognosis of critically ill patients in terms of cost-effectiveness. It is suggested that the 7th day APACHE III score is useful for predicting the clinical outcome.
APACHE* ; Critical Illness ; Humans ; Intensive Care Units* ; Critical Care* ; Korea ; Length of Stay ; Logistic Models ; Mortality ; Odds Ratio ; Prognosis ; Survivors ; Western World

Intestinal tuberculosis is an infectious disease which is still prevalent in the developing countries including Korea. It may occur insidously, have a vague clinical marofestation, and take a chronic course. We have analyzed 101 cases of intestinal tuberculosis. proven by clinical and histopathologic diagnosis for 10yrs since 1977. The results are as follows: 1) Intestinal tbc was prevalent in the age of 20-30 and the male to female ratio was 1:1.7. 2) Among clinical manifestations, abdominal pain, and tenderness, general malaise and abdominal mass were observed in order of frequency. 3) Active pulmonary lesion was associated in 73 cases (73.3%). 4) Ileocecal region was the most frequent site of involvement in barium study and in colonoscopy. 5) The most frequent colonoscopic finding was multiple ulceration and pseudopolyposis and chronic granulomatous inflammation was noted in 58% on hitopathology. 6) Ulcerative type was the most common type 45.4% by intestinal x-ray and colonofiberscopic examination
Abdominal Pain ; Barium ; Colonoscopy ; Communicable Diseases ; Developing Countries ; Diagnosis ; Female ; Humans ; Inflammation ; Korea ; Male ; Tuberculosis* ; Ulcer