No abstract available.
Choledochostomy*

We treated 19 patients with ureteral injuries during the recent 7 years. Gynecologic operations were the most common antecedent surgical procedures(89%). The diagnosis of ureteral injuries was made immediately in 3 patients and was delayed 3 to 78 days in 16 patients. All of the 3 injuries recognized during an operation were repaired at the time of injury. Of the 16 patients with injuries recognized in the postoperative period, 1 patient was managed with percutaneous nephrostomy. 14 patients received corrective surgery successfully, but the corrective surgery in remaining patient was railed and ultimately resulted in a nephrectomy because of avascular necrosis of ureter during operation. Therefore, it is better to do corrective surgery primarily in patients with ureteral injuries recognized postoperatively in order to decrease percutaneous nephrostomy associated morbidity and hospital admission period.
Diagnosis ; Humans ; Necrosis ; Nephrectomy ; Nephrostomy, Percutaneous ; Postoperative Period ; Ureter*

Because of the long intracranial course, the 6th nerve is vulnerable to increased intracranial pressure, trauma to the cranial floor, meningeal edema, inflammation in the base of the skull, and any displacement of the brain stem. The authors had experienced a case of abducens nerve palsy resulting non-concomittent esotropia and lateral gaze palsy due to brain trauma by traffic accident. We had performed modified Jensen procedure that had good result. That procedure is presented to aid in preserving the anterior segment blood supply. The anterior ciliary artery in the lateral rectus is not included in the union. The case report is reviewed with the pertinent literature.
Abducens Nerve Diseases* ; Accidents, Traffic ; Brain Injuries ; Brain Stem ; Ciliary Arteries ; Edema ; Esotropia ; Inflammation ; Intracranial Pressure ; Paralysis ; Skull

The clinical effect of prazosin, an alpha-1-receptor blocking agent, was studied in 31 patients with benign prostatic hypertrophy. The daily dose of 1.5-6 mg of prazosin was given for 2 weeks to 3 months. The efficacy was assessed by using uroflowmetry calculated from maximum flow rate, average flow rate and residual urine volume. The result revealed significant improvement of day time frequency, night time frequency (p<0.05) and maximum and average flow rate (p<0.05). It was suspected that prazosin was the valuable alpha-1-receptor blocker for benign prostatic hypertrophy and worth while to initiate medical treatment before undergoing any surgical intervention or when surgery is contraindicated.
Humans ; Prazosin* ; Prostatic Hyperplasia*

The decision between continued medical therapy and surgical exploration in patients with traumatized scrotum is difficult. We evaluated scrotal ultrasound as a non-invasive aid in such problematic cases. During s 42 months period. 17 patients were hospitalized for treatment of traumatized scrotum. All of them underwent careful physical examination and scrotal ultrasound. The results were as follows.; 1. In the appropriate clinical setting. ultrasound provides objective information supporting the need for surgical intervention in patients with traumatized scrotum and prevents unnecessary operation. 2. The results of treatment in 12 cases of 13 cases who underwent conservative treatment were good. 3. Scrotal ultrasound is necessary as soon as possible in traumatized scrotum and testicular salvage rates are improved markedly when early surgical correction of a ruptured tunica albuginea is performed. 4. Ultrasound is noninvasive and effective single diagnostic method in scrotal injury.
Humans ; Physical Examination ; Scrotum* ; Ultrasonography*

A case of congenital coloboma of the optic nerve head with surrounding choroidal atrophy in left eye, who was 16 years old male, is reported. The most characteristic features of this case were increase in size and shape of the disc, the ectasia of the surface, the depth and the striking whiteness, type of the vessels and their special arrangement. We described the clinical findings and attempted to survey the embryological causes and heredity with brief review of the literatures.
Adolescent ; Atrophy ; Choroid ; Coloboma* ; Dilatation, Pathologic ; Heredity ; Humans ; Male ; Optic Disk* ; Optic Nerve* ; Strikes, Employee

Until recently edrophonium has not been used in clinical anesthesis because of its short duration of action and poor anticholinesterase activity. However there has been a renewed interest in the use of edrophonium for the reversal of the new intermediate acting relaxants, vecuronium and atracurium, which have a fast spontaneous recovery rate. Edrophonim in sufficient dosages may produce a fast onset of antagonism of non-depolarizing neuromuscular blockade with minimal muscarinic side effects. The porpose of this study was therefore to compare the efficiency of edrophonium and neostigmine in reversal of a profound neuromuscular blockad following continuous infusion of vecuronium (0.06 mg/kg/hr). Recovery of T1 and T4 twitch height, change of heart rate and mean arterial pressure were obsered after antagonism with control mixture group (n=10): neostigmine 0.04mg/kg and atropin 0.02 mg/kg, and experimental mixture group (n=9): edrophoninm 0.5mg/kg and atropine 0.007 mg/kg were evaluated respectively at the 10% spontaneous recovery of T1 twitch height. Recovery of T1 was more faster in the edrophonium group than in the neostigmine group but it was significant until 5 minutes after antagonism (p<0.05) and recovery of T4 was also significantly faster in the edrophonium group until 5 minutes after antagonism but thereafter, conversly faster in the neostigmine group than in the edrophonium(p<0.05). Changes of heart rate with +/-5% after edrophonium administration were observed. We conclude that edrophonium provides a more rapid antagonism within 5 minutes after antagonizing vecuronium infusion, and small change in heart rate, but no other any advantage in using edrophomine instead of neostigmine for reversal after 5 minutes.
Arterial Pressure ; Atracurium ; Atropine ; Edrophonium* ; Heart Rate ; Neostigmine* ; Neuromuscular Blockade ; Vecuronium Bromide*

We recently observed a pancreatic islet cell adenoma with nesidioblastosis in a neonate which was confirmed after subtotal pancreatectomy. A nesidioblastosis, a term coined by Laidlaw in 1938 to describe the neoformation of islet tissue by differentiation of tortipotent pancreatic duct cell, is extremely rare as a cause of neonatal hypoglycemia. Persistent hypoglycemia which was temporarily responsive to hypertonic glucose therapy, convulsion, and apnea were noted frequently. Blood insulin level was elevated inappropriately with respect to the blood glucose level. Preoperative CBC, urinslysis, chest X-ray, serum electrolytes, and ECG were normal except low blood glucose leve(21mg%). The patient was not permedicated. With infusion of 15% D/W, anesthesia was induced by tracheal intubation with 3mg/kg of succinylcholine and was maintained by controlled ventilation with O2(3L/min)-N2O(3L/min)-halothane(1%) and pancuronium. Hyperglycemia and hypoinsulinemia were developed after pancreatectomy, these were controlled satisfactorily by administration of regular insulin. The patient was discharged with normal blood glucose level and no requirement of insulin at 38 days of postoperation.
Adenoma ; Anesthesia ; Apnea ; Blood Glucose ; Electrocardiography ; Electrolytes ; Glucose ; Humans ; Hyperglycemia ; Hypoglycemia ; Infant, Newborn* ; Insulin ; Intubation ; Islets of Langerhans ; Nesidioblastosis* ; Numismatics ; Pancreatectomy ; Pancreatic Ducts ; Pancuronium ; Seizures ; Succinylcholine ; Thorax ; Ventilation

Vecuronium induced intense neuromuscular blockade was evaluated in 40 USA class l, ll adult patients using the post tetanic count (PTC) and train-of-four(TOF) methods. All patients were anesthetized with thiopental sodium, nitrous oxide(50%), and enflurane(1~2%). Neuromuscular monitoring commended immediately after administration of thiopental sodium. The ulnar nerve was stimulated using surface electrodes and the mechanical response of the adductor policis muscle recorded using the Acclograph, neuromuscular transmission monitor. TOF nerve stimulation was used every 15s. After supramaximal stimulation was achieved a bolus of vecuronium 0.1mg/kg was injected intravenously. The traches was intubated when TOF response was depressed to 95% or above to control twitch height and the lungs ventilated with a tidal volume of 10ml/kg and a rate of 14 b.p.m. The patients were allocated randomly to two groups of 20 patients each. Patients in control group were allowed to recover TOF response spontaneously, and in PTC group were applied tetanic stimulation(50Hz for 5s) at 7 minutes intervals during no TOF response. In PTC group, the tetanic stimulation was preceded by a 30s period of 1Hz stimulation on each occasion, which was continued after the 3s pause. Duration of no TOF response in each group, and relationship between first post tetanic twitch height of PTC and time to first reaction to TOF nerve stimulation in PTC group were measured. In the results, duration of no TOF response was shortened by tetanic stimulation(p<0.01). There was a close inverse correlation between first post tetanic twitch height or PTC and time to first reaction to TOF nerve stimulation (p<0.01). It was concluded that PTC method appeared to be a valuable supplement to TOF nerve stimulation in assessment and trend for vecuronium induced intense neuromusclular blockade.
Adult ; Electrodes ; Humans ; Lung ; Neuromuscular Blockade* ; Neuromuscular Monitoring ; Thiopental ; Tidal Volume ; Ulnar Nerve ; Vecuronium Bromide*

No abstract available.
Bronchi* ; Ethanol* ; Humans