PURPOSE: Extracorporeal shock wave lithotripsy(SWL) is currently prorposed for the first line treatment of most renal and ureteral stones. In general, SWL is very effective and non-invasive method than open surgery or endoscopic lithotripsy. We experienced 350 cases of SWL for 46 months and announced it. MATERIALS AND METHODS: We retrospectively reviewed the data of 324 patients(350 stones) who had been diagnosed as renal or ureteral stones and underwent SWL using Tripter Compact(R) lithotriptor from September 1994 to July 1998. Male to female ratio was 1.9:1 and patient`s ages ranged from 18 to 82 years(mean 43.7 years). We underwent SWL only with parenteral analgesics for pain control. RESULTS: In 350 stones, renal stones were 90 cases(25.7%) and ureteral stones were 260 cases(74.3%). In 90 renal stones, calyceal stones(include 1 staghorn stone) were 62 cases(68.9%) and renal pelvic stones were 28 cases(31.1%). In 260 ureteral stones, upper ureteral stones were 209 cases(80.4%), mid ureteral stones were 10 cases(3.8%), and lower ureteral stones were 41 cases(15.8%). The stones from 10 to 19mm in diameter were the majority of renal stones(53.3%), whereas in ureter, the stones smaller than 10mm in diameter were most common(41.5%). Less than 3 treatment sessions were needed for 147 cases(93.0%) of stones smaller than 10mm and for 146cases(76.0%) stones larger than 10mm. Less than 3 sessions were needed for 68 cases(75.6%) of renal stones and for 225 cases(86.5%) of ureteral stones. All renal stones were fragmented and the success rate for upper ureteral stones was 93.3%(195/209), for mid ureteral stones was 80.0%(8/10), and for lower ureteral stones was 80.5%(33/41). According to the size of stone, the success rate for the stones smaller than 10mm in diameter was 96.2%(152/158) and for the stones larger than 10mm was 90.6%(174/192). Total success rate was 93.1%(326/350). The complications after SWL were gross hematuria over 24hours(64 cases, 18.3%), flank pain(52 cases, 14.9%), gastrointestinal disturbances(7 cases, 2%), and Steinstrasse(31 cases, 8.9%). The causes of failure were incomplete fragmentation(21 cases, 87.5%) and mucosal impact(3 cases, 12.5%) of stones. Re-treatment rate was 59.7% and auxiliary procedure rate was 8.0%(efficiency quotient was 0.56). CONCLUSIONS: Our experiences shows extracorporeal shock wave lithotripsy is a safe and effective method for the treatment of renal and ureteral stones, and we expect the better outcome by development of techniques and equipments.
Analgesics ; Female ; Hematuria ; Humans ; Lithotripsy* ; Male ; Retrospective Studies ; Shock* ; Ureter ; Urinary Calculi

PURPOSE: The purpose of this study was to investigate differences between a pulmonary aspiration group and a non-pulmonary aspiration group in glucose concentration of tracheal secretions by measuring time and feeding methods. METHOD: The subjects were 36 ICU patients who were receiving formula via nasogastric tubes and had endotracheal tubes or tracheostomy tubes. Tracheal secretions were collected by connecting suction traps to a suction catheter in three different times(within 1 hour after feeding, between 1 to 2 hours after feeding, and between 2 to 3 hours after feeding) for 2 days, overall six times. Glucose concentration of tracheal secretions was measured with the glucometer(Accucheck II). RESULTS: Glucose concentration of tracheal secretions increased in progression after feeding. The mean of specimens collected last(between two to three hours after feeding) was shown to be the highest value(M= 61.61 mg/dl) in the pulmonary aspiration group. Significantly(p=.000) more subjects(94.44%) in the pulmonary aspiration group received formula via a 50cc syringe than those in the non-pulmonary aspiration group(22.22%). CONCLUSION: Critically ill patients may need more time for head-elevation after tube feeding to prevent pulmonary aspiration. In practice, enteral formula should not be given the patients via a 50cc syringe anymore, instead a feeding bag or infusion pump should be used to prevent pulmonary aspiration.
Catheters ; Critical Illness ; Enteral Nutrition ; Feeding Methods* ; Glucose* ; Humans ; Infusion Pumps ; Suction ; Syringes ; Tracheostomy ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to investigate differences between a pulmonary aspiration group and a non-pulmonary aspiration group in glucose concentration of tracheal secretions by measuring time and feeding methods. METHOD: The subjects were 36 ICU patients who were receiving formula via nasogastric tubes and had endotracheal tubes or tracheostomy tubes. Tracheal secretions were collected by connecting suction traps to a suction catheter in three different times(within 1 hour after feeding, between 1 to 2 hours after feeding, and between 2 to 3 hours after feeding) for 2 days, overall six times. Glucose concentration of tracheal secretions was measured with the glucometer(Accucheck II). RESULTS: Glucose concentration of tracheal secretions increased in progression after feeding. The mean of specimens collected last(between two to three hours after feeding) was shown to be the highest value(M= 61.61 mg/dl) in the pulmonary aspiration group. Significantly(p=.000) more subjects(94.44%) in the pulmonary aspiration group received formula via a 50cc syringe than those in the non-pulmonary aspiration group(22.22%). CONCLUSION: Critically ill patients may need more time for head-elevation after tube feeding to prevent pulmonary aspiration. In practice, enteral formula should not be given the patients via a 50cc syringe anymore, instead a feeding bag or infusion pump should be used to prevent pulmonary aspiration.
Catheters ; Critical Illness ; Enteral Nutrition ; Feeding Methods* ; Glucose* ; Humans ; Infusion Pumps ; Suction ; Syringes ; Tracheostomy ; Surveys and Questionnaires

PURPOSE: We reviewed 5 years worth of experience with peritoneal drainage and dialysis in infants who underwent open heart surgery. The aim of this study was to investigate the effect of peritoneal drainage and peritoneal dialysis on fluid balance and several parameters of intensive care. METHODS: Six(10%) of 60 consecutive infants who underwent open heart surgery required peritoneal dialysis during peritoneal drainage. Simple peritoneal drainage was performed in the remaining 54 infants. The silicone rubber peritoneal dialysis catheter was inserted into the center of abdominal cavity just after operation, and subsequent peritoneal drainage was maintained during intensive care. RESULTS: Mean age of the study group was 0.48+/-0.21 years(M: F=32: 28). Early postoperative mortality amang the infants with congenital heart disease was 1.6%. Total amount of output was 7.0+/-2.28mL/kg/hr, urine output 5.14+/-2.9lmL/kg/hr, pleural fluid 0.80+/-0.5lmL/kg/hr, and peritoneal fluid 1.20+/-0.90mL/kg/hr. The ratio of output to intake(O/I) was 1.06. None of the complications required early termination of peritoneal drainage or peritoneal dialysis. Hemodynamics and pulmonary function were maintained steadily during postoperative intensive care. CONCLUSION: The early institution of peritoneal drainage and peritoneal dialysis in infants with congenital heart disease after cardiac operations not only removes fluid, thus easing fluid restriction, but may also improve cardiopulmonary function.
Abdominal Cavity ; Ascitic Fluid ; Catheters ; Dialysis ; Drainage* ; Heart Defects, Congenital* ; Heart* ; Hemodynamics ; Humans ; Infant* ; Critical Care ; Mortality ; Peritoneal Dialysis ; Silicone Elastomers ; Thoracic Surgery ; Water-Electrolyte Balance

A case of rare subcutaneous sparganosis in thigh treated by surgical excision is reported. In this 49year-old male with a palpable mass on the anteromedial aspect of mid-thigh (5x7x5cm sized) which was misdiagnosed with a soft tissue tumor initially, a sparganosis was suspected by a plain x-rays, bone scan and his past history which he frequently had raw snakes, frogs and raw fishes before but confirmed by MRI and surgical excision. This represents tor warning to some Koreans who have frequently comsumed raw fishes, snakes or frogs etc., and to some doctors because it is easily confused with a soft tissue tumor.
Fishes ; Humans ; Magnetic Resonance Imaging ; Male ; Snakes ; Sparganosis* ; Subcutaneous Tissue* ; Thigh*

BACKGROUND: To assess the efficacy of functional electrical stimulation(FES) with multi-joints coordinate movement compared to electric muscular stimulation for mono-joint movement in enhancing the upper extremity motor and functional recovery of hemiplegic survivors. METHODS: Forty patients with hemiplegia were divided into two groups. The FES group received FES to produce hand grip, elbow flexion, elbow extension and hand release in sequence with voluntary movement. Control group received electrical stimulation to produce wrist extension without voluntary movement. All groups received for 20 minutes per session, twice a day, 5 days a week during 4 weeks and under the same occupational and physical therapies during 4 weeks. Outcomes were assessed in a blinded manner with the upper extremity component of the Fugl-Meyer Motor Assessment, the self-care component of the Modified Barthel Index(MBI), Upper extremity muscle strength, Wolf Motor Function Test(WMFT), spasticity, and Range of motion(ROM) of shoulder before and after treatment. RESULTS: There were significant improvements of the power at shoulder & elbow flexion, WMFT, Fugl-Meyer, hand grip, and MBI in both group(p<0.05). ROM of shoulder, the power of wrist extension, and pinch improved only at the FES group(p<0.05). The FES group had better effects at WMFT, Fugl-Meyer, hand grip, pinch, MBI, shoulder ROM, and spasticity after treatment(p<0.05). CONCLUSION: This study showed that FES and multi-joints coordinate movements are better than electric muscular stimulation for mono-joint movement to enhance the upper extremity functional recovery in hemiplegia.
Arm ; Elbow ; Electric Stimulation ; Hand ; Hand Strength ; Hemiplegia ; Humans ; Muscle Spasticity ; Muscle Strength ; Muscles ; Self Care ; Shoulder ; Upper Extremity ; Wolves ; Wrist

No abstract available.

No abstract available.
Hemorrhage*

Pheochromocytoma is one of the surgically curable hypertensive diseases and can arise wherever chromaffin cells are located. Herein, a case of extra-adrenal pheochromocytoma developed in a 51 year-old male is presented with brief review of literatures.
Chromaffin Cells ; Humans ; Male ; Middle Aged ; Pheochromocytoma*

BACKGROUND: Opioids are the most widely used drugs to minimize the increase of blood pressure and heart rate in endotracheal intubation during the induction of anesthesia. The purpose of this study was to compare the effects of fentanyl, alfentanil, and remifentanil on the cardiovascular response to laryngoscopic endotracheal intubation. METHODS: Eighty ASA I-II patients were randomly allocated to four groups. The patients received 10 ml intravenous saline (control group), 3microgram/kg fentanyl (fentanyl group), 10microgram/kg alfentanil (alfentanil group) or 0.5microgram/kg remifentanil followed by an infusion of 0.1microgram/kg/min remifentanil (remifentanil group). Anesthesia was induced with propofol and rocuronium and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. The noninvasive blood pressure and heart rate were recorded before induction (baseline), after induction, before intubation, and at 1 min intervals until 5 min after endotracheal intubation. RESULTS: Arterial pressure and heart rate after endotracheal intubation were lower in the fentanyl, alfentanil, and remifentanil groups than in the control group (P < 0.05). There were no significant differences for arterial pressure or heart rate in the fentanyl, alfentanil, and remifentanil groups at any time. There were no significant differences for the incidence of hypotension and bradycardia among the four groups. CONCLUSIONS: Administration of 3microgram/kg fentanyl, 10microgram/kg alfentanil and 0.5microgram/kg remifentanil followed by an infusion of 0.1microgram/kg /min remifentanil have a similar effect in the suppression of the cardiovascular response to laryngoscopic endotracheal intubation during the induction of general anesthesia.
Alfentanil ; Analgesics, Opioid ; Androstanols ; Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Bradycardia ; Fentanyl ; Heart Rate ; Humans ; Hypotension ; Incidence ; Intubation ; Intubation, Intratracheal ; Methyl Ethers ; Nitrous Oxide ; Oxygen ; Piperidines ; Propofol