Isolated situs in versus of the stomach with otherwise normal position of the thoracic and abdominal vescera isan extremely rare anomaly occurring in two distinct forms. Majority of cases are associated with eventration of the diaphragm and are reported as being confused with spontaneous pneumothorax of pyopneumothorax at base of the right lung. The right sided stomach may produce interesting and confusing changes in liver scan. We have experienced 2 cases of the isolated dextrogastria.
Diaphragm ; Liver ; Lung ; Pneumothorax ; Stomach

The differentiation between lung abscess and empyema can be difficult, but has important therapeuticconsequences. Thoracostomy tube drainage is essential therapy for an empyema, whereas prolonged antibiotic therapyand postural drainage often suffice for a lung abscess. Conventional radiographic findings are usually relied onto help make correct indfferentiation between empyema and lung abscess, but overlying lung disease or unfavorablelocation of lesion often results in ambiguous findings. Although ultrasound has proved useful in differentiatingempyema from lung abscess, CT is best accurate diagnostic method. Authors reviewed chest CT of 50 cases(41empyemas, 9 lung abscesses)which were diagnosed by suegery or clinical background during the period from May 1980to June 1985 at Dongsan Medical Center, Keimyung University. The results were as follows: 1) Age and sexdistribution a) Empyema: The incidence was most common in the 6th and 7th decades. Male to female ratio was 3:1.b) Lung abscess: The incidence was most common in the 5th, 6th and 7th decades. Male to female ratio was 2:1. 2)Wall characteristics(empyema 32 cases, lung abscess 9 cases): The 9 cases of 41 empyemas had not defined theirwalls. a) Empyema had at least a part of their wall that was thin (81%), uniform width(84%), and smooth on bothmargins (more than 96%). b) The wall of lung abscess was thick (89%), and irregular margins(100%). 3) Separationof uniformly thickened visceral pleura from parietal pleura("split pleura" sign) was seen only in 68% of allempyemas. 4) Adjacent lung compression was seen only in 88% of all empyemas. 5) Chest wall angle: In 78% of allempyemas had obtuse or mixed angles, wherease in 85% of all lung abscesses had acute angle. 6) Shape oflesion:Empyema had variant shapes from round to crescent, however all lung abscesses had round or ovoid shape. 7)Size of lesion: In 85% of all empyemas had medium(41%) or large (44%) size, but the lung abscess had onlysmall(33%) or medium (67%) size. 8) Air in lesion was seen in 41% empyemas and in 89% lung abscesses. 9) Adjacentlung consolidation showed in 34% empyemas and in all lung abscesses. 10) Free pleural fluid was seen in 12%empyemas and in 89% lung abscesses. 11)Septated lesions were seen in 32% empyemas and in 56% lung abscesses. 12)Multiple lesions were seen in 44% empyemas and in 55% lung abscesses. 13) Mediastinal shifting was seen in 49%enpyemas and in 44% lung abscesses, but which all lung abscesses were coexisted with empyemas. 14) Pleuralcalcification was seen only in 5 cases(12%) of all empyemas. 15) Location of leison: Most(93%) of empyemas werelocated in posterolateral portion of hemithorax, and most (78%) of lung abscesses involved in right lower lobe.
Clothing ; Drainage ; Drainage, Postural ; Empyema ; Female ; Humans ; Incidence ; Lung Abscess ; Lung Diseases ; Lung ; Male ; Methods ; Pleura ; Rabeprazole ; Thoracic Wall ; Thoracostomy ; Tomography, X-Ray Computed ; Ultrasonography

No abstract available.
Calcium* ; Lidocaine* ; Neuroglia* ; Reperfusion*

PURPOSE: The present study was carried out to determine day-to-day differences in cortisol levels and the molar cortisol-to-dehydroepiandrosterone (DHEA) ratio (molar C/D ratio) in working subjects. MATERIALS AND METHODS: The cortisol and DHEA levels were measured from saliva samples collected 30 minutes after awakening for 7 consecutive days in full-time working subjects that worked Monday through Saturday. To determine the day-to-day differences within subjects, the collected data was analyzed using variance (ANOVA) for a randomized complete block design (RCBD). RESULTS: The cortisol levels from samples collected 30 minutes after awakening on workdays were similar to each other, but were significantly different from the cortisol levels on Sunday. The DHEA levels were not significantly different between the days of week. The DHEA levels on Monday and Tuesday were relatively lower than the levels on the other weekdays. The DHEA levels on Thursday and Friday were relatively higher than the other days. The molar C/D ratios on Sunday were significantly lower than those on workdays. The molar C/D ratios on Monday and Tuesday were significantly higher than those on Wednesday or other workdays. CONCLUSION: The cortisol levels and the molar C/D ratios demonstrate differences in adrenocortical activities between workdays and non-workdays, but the molar C/D ratio additionally represents differences in adrenocortical status between the first two workdays and other workdays. Thus, it is possible that the day-to-day differences in the cortisol levels and the molar C/D ratio represent the adrenal response to upcoming work-related stress.
Adult ; Analysis of Variance ; Dehydroepiandrosterone/*metabolism ; Female ; Humans ; Hydrocortisone/*metabolism ; Male ; Middle Aged ; Saliva/chemistry ; Work/*physiology

BACKGROUND: Due to severe pain after open thoracotmy, the postoperative pain control is essential to decrease pulmonary complications, and improve a patient's recovery. This study compared the surgical outcome of patients who had undergone open thoracotomy, and been managed with two different analgesic methods. METHODS: A retrospective chart review was carried out regarding 81 patients who had undergone open thoracotomy due to lung cancer. 41 of these patients has received continuous thoracic epidural analgesia with 0.1% bupivacaine and 0.3 mg/ml morphine at a rate of 2 ml/hr for postthoracotomy pain control (CTEA group). The remaining 40 patients has received intravenous patient-controlled analgesia with 1% meperidine (IV-PCA group). We compared the effects of the postoperative pain control in the two groups and the outcomes, including the pulmonary complications and durations of hospital stay. RESULTS: There were no significant differences in demographic data between the two groups. Supplemental analgesic requirements and postoperative pulmonary complications were significantly lower in the CTEA group than in the IV-PCA group. There were no significant statistical differences between the two groups in the durations of their hospital stay. CONCLUSIONS: We conclude that the continuous thoracic epidural infusion provided better postthoracotomy analgesia and surgical outcomes than intravenous patient controlled analgesia.
Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled ; Bupivacaine ; Humans ; Length of Stay ; Lung Neoplasms ; Meperidine ; Morphine ; Pain, Postoperative ; Retrospective Studies ; Thoracotomy*

Acetates ; Bone and Bones ; Calcium ; Calcium Compounds ; Glycerophosphates ; Mandible ; Osseointegration ; Osteogenesis ; Phosphoric Acids ; Sulfur ; Sulfuric Acids ; Titanium

BACKGROUND: Since the Independence in 1945, the Republic of Korea (ROK) has maintained fundamentally the liberal health care system by the influence of U.S.A. Therefore, as in the case of U.S.A., the primary health care system of ROK has fallen in the chaos. Recently, the new government of ROK seems to retry the introduction of 'Family Doctor Registration System (FDRS)' in spite of the 1996's failure. In order to conduct FDRS efficiently, there should be a thorough investigation on the opinions of doctors and people in the community. This study was conducted with a view to collecting necessary information regarding the implementation of FDRS. METHODS: By mailing, the self-administered questionnaires were collected twice during March 18 to May 12 in 1998. The questionnaire had been prepared through several discussions, pretest, and final correction by five family physicians and two health care policy professors. The subjects consisted of 2,093 family physicians. RESULTS: Though the overall response rate was only 28.2% (591) subjects, age distribution for the study subjects was similar to that of average family physicians. The subjects consisted of 451 males and 138 females. The number of those whose age was less than 40 was 49.9% (195). "The group that agrees with the introduction of FDRS" was 58.5% of all respondents; "the group that objects 14.4%; and the group undetermined" 24.7%. The 73.6% of all respondents had negative opinion on increased administrative work. Only 21.3% expected their net income to increase. On multiple logistic regression analysis, relatively large city rather than metropolitan Seoul, the smaller number of visiting patients a month, regular resident training experience, and male sex resulted in having a significant positive relationship with the introduction of FDRS. Further analyses are called for to identify differences of opinions between family physicians and single specialty medical practitioners. CONCLUSIONS: The results of this survey should be reflected into the health care policy when retrying to implement FDRS in Korea.
Age Distribution ; Surveys and Questionnaires ; Delivery of Health Care ; Female ; Humans ; Korea* ; Logistic Models ; Male ; Physicians, Family ; Postal Service ; Primary Health Care ; Republic of Korea ; Seoul ; Specialization*

Pseudohypoxic brain swelling (PHBS) is known to be an uncommon event that may occur during and following an uneventful brain surgery, when negative suction drainage is used. The cerebrospinal fluid loss related to suction drainage can evoke intracranial hypotension that progress to PHBS. The main presentations of PHBS are sudden unexpected circulatory collapses, such as severe bradycardia, hypotension, cardiac arrest, consciousness deterioration and diffuse brain swelling as seen with brain computerized tomography (CT). We present a stuporous 22-year-old patient who underwent cranioplasty under general anesthesia. The entire course of the general anesthesia and operation progressed favorably. However, the time of scalp suture completion, sudden bradycardia and hypotension occurred, followed by cardiac arrest immediately after initiation of subgaleal and epidural suction drainage. After successful resuscitation, the comatose patient was transferred to the neurosurgical intensive care unit and PHBS was confirmed using brain CT.
Anesthesia, General ; Bradycardia ; Brain Edema* ; Brain* ; Cerebrospinal Fluid ; Coma ; Consciousness ; Heart Arrest* ; Humans ; Hypotension ; Intensive Care Units ; Intracranial Hypotension* ; Resuscitation ; Scalp ; Shock ; Stupor ; Suction* ; Sutures ; Young Adult

A right-sided aortic arch (RAA) is a rare congenital anomaly, and Stanford type B dissection aneurysms involving this anomaly is also uncommon. Surgical approaches to dealing with an RAA are complicated by the unusual anatomical features of the condition. Here we report the case of a 47-year-old male who had a type B dissecting aneurysm involving an RAA with Kommerell's diverticulum. Graft replacement was successfully performed with an uneventful postoperative course.
Aneurysm, Dissecting/radiography/*surgery ; Aorta, Thoracic/*abnormalities/radiography/*surgery ; Aortic Aneurysm, Thoracic/radiography/*surgery ; Blood Vessel Prosthesis Implantation/methods ; Diverticulum/radiography/*surgery ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

BACKGROUND: Bupivacaine blocks the sodium channels and inhibits the depolarization of myocardium. The inward sodium current (INa) could be activated by decreasing potassium in the extracellualr spaces. We hypothesized that the bupivacaine dose which creates the cardiac toxicity may have the correlation with serum potassium concentration which is in the normal range. METHODS: After the dogs were anesthetized with pentobarbital, 0.5% bupivacaine was administrated at a rate of 0.5 mg/kg/min until SvO2 decreased to 60% or less, which was defined as the point of cardiac depression in this study. Mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), SvO2, ETCO2, arterial blood gas analysis, serum electrolytes (Na+ , K+ , Ca2+ ), and ECG were taken at baseline and cardiac depression point. Infused bupivacaine dose and blood concentration to make cardiac depression were taken. RESULTS: PaO2, PaCO2, pH, serum electrolytes (Na+ , K+ , Ca2+ ) were within nornal range at baseline and cardiac depression point. MAP, HR, CO, SvO2, and ETCO2 were within normal range at baseline point but decreased significantly at cardiac depression point. Bupivacaine made QRS duration on EKG to prolong significantly. Infused bupivacaine dose to make cardiac depression had an strong negative correlation with concentration of serum potassium (P < 0.05, rs: -. 501). CONCLUSIONS: We conclude that the increase of serum potassium concentration enhances the cardiotoxic effects of bupivacaine, even though it is in the normal range.
Anesthetics ; Animals ; Arterial Pressure ; Blood Gas Analysis ; Bupivacaine ; Cardiac Output ; Depression ; Dogs* ; Electrocardiography ; Electrolytes ; Heart Rate ; Hydrogen-Ion Concentration ; Myocardium ; Pentobarbital ; Potassium* ; Reference Values ; Sodium ; Sodium Channels