No abstract available.
Anemia, Hypoplastic, Congenital*

PURPOSE: Lipiodol CT is a important modality for the diagnosis of hepatocellular carcinoma and compared is usually performed at 2-3 week after Lipiodol injection. Therefore, we assessed and the diagnostic value and merits of immediate CT after chemoembolization from there of 2-3 week delayed Lipiodol CT. MATERIALS AND METHODS: Thirty three cases of chemoembolization which were performed both immediate CT after chemoembolization and 2-3 week delayed Lipiodol CT were reviewed retrospectively. They were divided into four grades according to pattern of lipiodol uptake by three radiologists. The diagnostic value of immediate Lipiiodol CT was compared to delayed Lipiodol CT. RESULTS: Grade 0 was two cases(3.0%) and Grade 1 was seven cases(21.2%). In the cases of Grade 2(23/33, 69.7%) tumor uptake could be dishng wished from parenchymal uptake of Lipiodol by its density and pattern. Tumor uptake showed dense and homogeneous pattern, but parenchymal uptake revealed less dense and hepatoram-like wedge shaped pattern. Lipiodol uptake of tumor in Grade 3(1/24, 3.0%) was equal to that in delayed Lipiodrl CT. Grade 3 and 2(72.7%) of the immediate Lipiodol CT were not inferior to delayed Lipiodol CT in its diagnostic value. CONCLUSION: The immediate Lipiodol CT could make rapid establishment of treatment plan and are expected to be more convenient than delayed CT for the patients.
Carcinoma, Hepatocellular* ; Diagnosis ; Ethiodized Oil ; Humans ; Retrospective Studies

BACKGROUND: To assess and report the outcomes of resuscitation, we apply the 1997 published In-Hospital Utstein Style to an actual emergency department. This study was designed to develope the data base for comparing and studing the outcomes of resuscitation. METHODS: This study was carried out in a tertiary hospital from July 1998 to June 1999. The subjects were adult patients over the age of 20 years who received resuscitation at the emergency department. After making out the protocol for the In-Hospital Utstein Style, we gathered data prospectively. RESULTS: Among 51,347 patients, 36 patients received 42 resuscitations. Forty-two(42) cases(100%) had witnessed arrest. Advance life support(ALS) intervention at the time of cardiac arrest included intravenous catheterization, 41cases(97.6 %); intravenous drug injection, 20 cases(47.6%); endotracheal intubation, 20 cases(47.6%); and artificial ventilation, 12 cases(28.6%). Immediate causes of cardiac arrest were respiratory depression, 11 cases(26.2%); hypotension, 11 cases(26.2 %); metabolic, 9 cases(21.4%); and myocardial ischemia/infarction, 5 cases(11.9%). Initial EKG ryhthms were pulseless electrical activity, 31 cases(73.8 %); ventricular tachycardia/fibrillation, 6 cases(14.3%); and asystole, 5 cases(11.9%). the average interval from cardiac arrest to initial defibrillation was 1.8+/-2.2 minutes, and the average interval from cardiac arrest to epinephrine injection was 2.6+/-3.1 minutes. The average duration of resuscitation was 22.6+/-18.4 minutes. Return of spontaneous circulation occured in 26 cases/42 case(61.9%). Of the 2 survivng patients who were discharged, 1 patient is still alive after 6 months, and the other is still alive after 1 year. CONCLUSION: Although the In-Hospital Utstein Style has many complementary factors, its results were very objective thus use of the In-Hospital Utstein Style is recommended for determining the outcomes of resuscitation.
Adult ; Catheterization ; Catheters ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Epinephrine ; Heart Arrest ; Humans ; Hypotension ; Intubation, Intratracheal ; Prospective Studies ; Respiratory Insufficiency ; Resuscitation* ; Tertiary Care Centers ; Ventilation

BACKGROUND: Succinylcholine is metabolized by plasma cholinesterase (PChE). When it was pretreated by small doses of nondepolarizing muscle relaxants in order to minimize the side effects, there are evidences to be associated with alteration in the duration of action. This study is investigated whether the responses would be related to the enzymatic activities. METHODS: In 21 adult patients, ASA class I or II, PChE levels were measured by the modified Garry method after induction of anesthesia (control value) and at 3, 10, 20 and 30 min following administration of pancuronium 0.1 mg/kg, vecuronium 0.1 mg/kg and atracurium 0.5 mg/kg. Data were expressed as mean (SEM). RESULTS: The levels of PChE were significantly lower (p<0.05) than the control values at 3, 10, 20 and 30 min after given pancuronium as 4764 (270), 4777 (261), 4796 (306) and 4740 (332) IU/L respectively and after given vecuronium as 5004 (341), 5051 (329), 4969 (340) and 4960 (340) IU/L respectively whereas enzyme levels after given atracurium were not significant differences to compare the control values as 5153 (336), 5136 (320) 5124 (312) and 5151 (275) respectively. CONCLUSIONS: The results of present study show that both pancuronium and vecuronium may possibly inhibit PChE activity but this was not affected by atracurium.
Adult ; Anesthesia ; Atracurium* ; Cholinesterases* ; Humans ; Pancuronium* ; Plasma* ; Succinylcholine ; Vecuronium Bromide*

Although it has been suggested that the calcium antagonist verapamil has beneficial effects on ischemic myocardium, its effect during coronary reperfusion has not been studied in detail. The purpose of this study was to investigate the inhibitory effect of verapamil on myocardial damage quantitatively using 111 In-anticardiac myosin antibody (ACM Ab) and qualitatively using electronmicroscopic method. Anesthetized open-chest dogs were subjected to 1 hour of occlusion of the left anterior descending coronary artery (LAD) followed by 90 minutes of reperfusion. Regional myocardial blood flow was determined by injecting 85Sr-microsphere prior to LAD reperfusion, and regional myocardial damage was measured by injecting 111In-ACm Ab at 30 minutes after LAD reperfusion. Six dogs were randomly selected as saline control and verapamil-treated (0.6 mg/kg. hr) groups each. Saline or verapamil was infused at 40 minutes after LAD occlusion and continued through the experiment. 1) Verapamil produced significant (P<0.05 by Wilcoxon rank sum test) decrease in heart rate, mean arterial blood pressure and double product. There was no significant change in pulmonary hemodynamics or cardiac output. 2) Stroke volume was reduced significantly (P<0.05 by Wilcoxon rank sum test) after 30 minutes of LAD reperfusion in the control group, but it was preserved in the verapamil-treated group. 3) There was an inverse exponential relationship between 111In-ACm Ab localization and regional blood flow in both control (r=-0.86) and verapamil treated (r=-0.71) groups. Significant difference between the two groups was found in exponential curve (p[t]<0.05). 4) A lesser uptake of 111in-ACM Ab was observed in the verapamil treated group compared with that in the control group in the region where the regional blood flow was lower than 30+/- of normal. 5) In the control group, the myocardium showed swelling, contraction bands, and electron dense granules in the mitochondria which were proven to be calcium aggregates. In the verapamiltreated grooup, the myocardium showed fewer electro dense granules and mild degree of contraction bands. This study supports the concept that verapamil reduces the myocardial damage following coronary reperfusion in myocardial infarction and may reduce contraction band necrosis.
Animals ; Arterial Pressure ; Calcium* ; Cardiac Output ; Coronary Vessels ; Dogs ; Heart Rate ; Hemodynamics ; Mitochondria ; Myocardial Infarction* ; Myocardial Reperfusion* ; Myocardium* ; Myosins ; Necrosis ; Regional Blood Flow ; Reperfusion ; Stroke Volume ; Verapamil

No abstract available.

PURPOSE: Doppler-guided hemorrhoidal artery ligation and recto-anal repair (DG-HAL & RAR) is known for low recurrence, high patient satisfaction, and less postoperative pain. The purpose of this study is to analyze the 1-year follow-up results in patients who underwent a DG-HAL & RAR and to establish the benefits of the procedure. METHODS: Among the hemorrhoid patients who were admitted to our hospital from March 2008 to May 2010 and who underwent a DG-HAL & RAR, 97 patients who were followed up for a year were investigated. Recurrence, complications, admission period, difference in preoperative and postoperative pain, operation time, and time to return to daily activities were investigated. RESULTS: The average admission period was 1.6 +/- 1.1 days. Pain at postoperative day 7 showed no significant difference from preoperative pain (P > 0.05). The operation time was 34.0 +/- 7.3 minutes on average, and return to daily activities was timed at 2.3 +/- 2.0 days postoperatively. At the one year follow-up, no serious complications were noted, and preoperative symptoms recurred only in 14 patients (14.4%). CONCLUSION: In most patients with hemorrhoids, excluding those with severe prolapsed hemorrhoids, less pain, no serious complications, and good long-term outcome can be expected from a DG-HAL & RAR.
Arteries ; Follow-Up Studies ; Hemorrhoids ; Humans ; Ligation ; Pain, Postoperative ; Patient Satisfaction ; Recurrence

The tibia is the most commonly fractured bone of all the long bones. In this age of vehicular accidents, the tibia is frequently subjected to high energy trauma. Anatomically the tibia has poor soft tissue coverage and poor blood supply. Therefore severe injury on the tibia can lead to severe complication and major disability. 41 adult patients with comminuted fracture of the tibial shaft were treated by OR/IF with D.C.P. and bone graft at the Department of Orthopedic Surgery, Kyungpook University Hospital from January 1978 to June 1986. These were analysed according to mechanism of injury, degree of comminution, timing of operation, soft tissue injury and operation time. Bone union and end results of treatment were reviewed. The results were as follows Of 41 cases, causes of injury were vehicular accident in 32 cases. 34 cases had associated injury on other part of body and average injury per case was 1.7 injuries. Based on the classification of Johner and Wruhs, the B group with butterfly fragment was 27 cases and C group was 14 cases. Among the B group, B2 was most common as 14 cases. Average union time was 18 weeks and delayed union and nonunion were 6 cases. Degree of comminution of fracture might be important fractor to bone union. According to the end result of Johner and Wruhs, excellent and good were 31, fair and poor were 10. Of the 41 cases, 10 cases had permanent disability. 4 cases had angular and rotational deformity alone and 1 case had shortening of tibia more than 1 cm, 1 case had both of them. Limited R.O.M. of ankle joint (>50%) occured in 4 cases. The post-operative infection occured in 6 cases, 3 were superficial infection but 3 cases were osteomyelitis. OR/IF with D.C.P. on comminuted tibial shaft fracture was a risk operation. Therefore proper method of treatment should be selected according to degree of comminution, timing of operation, presence or abscence of open wound and associated injury.
Adult ; Ankle Joint ; Butterflies ; Classification ; Clinical Study ; Congenital Abnormalities ; Fractures, Comminuted ; Gyeongsangbuk-do ; Humans ; Methods ; Orthopedics ; Osteomyelitis ; Soft Tissue Injuries ; Tibia ; Transplants ; Wounds and Injuries

Soft tissue defect on dorsum of hand requires immediate soft tissue cover to achieve early wound closure and to minimize wound infection and scarring. If the tendon or bone was exposed and the deep structures were absent, flap was required to provide adequate protection and allow proper function of the underlying structures. Small size in skin loss can easily be covered with local flaps but major defects involving the dorsal aspect of the hand should be coverd with distant flaps, free flaps or radial forearm flaps. Techniques in distant flaps require staged procedures and free flap transfer to obtain soft tissue cover in a single stage require microsurgical techniques. The reverse radial forearm flap is a fasciocutaneous flap based on the radial artery which together with its two venae comitantes lies invested in a condensation of the deep fascia known as the lateral intermuscular septum. The authors had treated 5 cases of distally based reverse forearm flap for soft tissue reconstruction on 2 patients of crushing injury with soft tissue defect on hand, a patient with Marjolin's ulcer on dorsum of hand due to previous burn scar and a patient with soft tissue necrosis on dorsum of both hands due to extravasation of adriamycin during chemotherapy. It has proved to be one of the saftest, simple and effective one-stage method of soft tissue reconstruction in hand without long term immobilization. The results of these operation in cover of soft tissue defect have been satisfactory.
Burns ; Cicatrix ; Doxorubicin ; Drug Therapy ; Fascia ; Forearm ; Free Tissue Flaps ; Hand ; Humans ; Immobilization ; Methods ; Necrosis ; Radial Artery ; Skin ; Tendons ; Ulcer ; Wound Infection ; Wounds and Injuries

Primary aldosteronism is present in approximately 1% of unselectd hypertensive patients. Adrenal adenoma is a known as one of the surgically curable form of the hypertension. Hypertension is one of the contributing factors for the development of aortic dissection. Cincurrence of aortic dissection in patient with primary aldosteronism is extemely rare. Only one case wasconfirmed by autopsy and reported in the world literature. We report a case of DeBakey type 3 anortic aneursm in a 49-year old hypertensive female patient with primary aldosteronism due to left adrenal adenoma. She underwent left adrenalectomy uneventfully after stabilization of her blood pressure with maximal medical management including nitroprusside, aldactone, enalapril and inderal.
Adenoma ; Adrenalectomy ; Autopsy ; Blood Pressure ; Enalapril ; Female ; Humans ; Hyperaldosteronism ; Hypertension ; Middle Aged ; Nitroprusside ; Propranolol ; Spironolactone