The purpose of this study was to identify the needs which were perceived by patients who were received spinal anesthesia for surgery. The subjects consisted of 50 adult patients who were admitted to 2 university hospitals and 2 general hospitals in Pusan city and 1 general hospital in Koje City for surgery under spinal anesthesia. Thirty eight percent of subjects received information about anesthesia before the operation. The instrument for this study was developed by the researcher based on literature and a pretest. Data were collected from December 10, 1999 to February 10, 2000 and were analyzed by content analysis. The results were that there were 533 meaningful statements in the needs of spinal anesthesia patients. The needs of spinal anesthesia patients had 51 items (preoperation (6), induction of nesthesia(5), intraoperation (27), postoperation(13)) and 6 categories (information, emotional welfare, physical welfare, post anesthetic management, control of physical environment, humane treatment). From the results, it can be concluded that: 1. In the pre-operation period, we have to explain anesthesia procedures, adequate position of anesthesia, duration before anesthesia wears off and sensation of paralysis. We have to supply emotional support to relieve anxiety because of anesthesia. 2. In induction of anesthesia, we have to support patient's position for anesthesia, and relieve anxiety so that patients participate in induction of anesthesia well. 3. In intra-operative period, we have to check the level of anesthesia, and keep up a comfortable position for operation and care for physical discomfort such as thirst, nausea, vomiting, dyspnea and to maintain body temperature of the patient. Since the patient is conscious, we have to communicate with the patient to relieve anxiety, maintain privacy, inform the patient of the process of the operation and encourage the surgeon to explain the outcome of the operation. The operating team needs the careful about what they say and to place the instrument well. We have to ventilate the room air and reduce noise. 4. In the post-operative period, we have to explain the purpose and duration of bed rest, complications of anesthesia and care for physical discomfort such as pain, dysuria, headache, backache. Also we have to maintain body temperature of the patient and maintain privacy.
Adult ; Anesthesia ; Anesthesia, Spinal* ; Anxiety ; Back Pain ; Bed Rest ; Body Temperature ; Busan ; Dyspnea ; Dysuria ; Gyeongsangnam-do ; Headache ; Hospitals, General ; Hospitals, University ; Humans ; Nausea ; Noise ; Paralysis ; Privacy ; Sensation ; Thirst ; Vomiting

Cerebrovascular accident (CVA) is the most common cause of neurologic disorder accompanying grave prognosisand its mortality above 50%. Prior to introduction of the CT, the diagnosis have been depended on clinicalfindings and spinal puncture. Radiologic diagnostic methods, such as angiography, ventriculography andradioisotope scanning are invasive and less sentitive in diagnosis of CVA than CT. The size, location andextension of the intracranial pathology and ventricular penetration are accureately and rapidly portrayed by CT.Consequently, CT plays impotant role in effective tratement and evaluation of prognosis in CVA. Authors analyzed63 cases of diagnosed CVA who were performed CT scan in Korea General Hospital from November 1981 to April 1982.The results were as follows. 1. The most prevalent age group of CVA was 6th decade, and then 7th and 5th decadesin decreasing order. The sex ration between male and female was 1.2:1. 2. The causes of CVA were hypertensivehemorrhage (50.8%), vascular occlusive disease(22.2%), anurysm ruture (4.8%), arteriovenous malformation (3.2%)and hemorrhage of unknown etiology (19.0%). 3. The most common site of hemorrhage was basal ganglia (34.6%) andthen thalamus(21.8%) and cerebral lobes(20.5%). In infarction, the common sites were the lobes(64.7%) and thebasal ganglia (35.3%) 4. Round or oval shaped hematomas of high density (85.9%) were frequent findings ofhemorrhage and mass effect occured in 75.6%. 5. All infarctions were low in density ; Most of the lesion wasinhomogeneous(70.6%) and the rests were homogeneous. Mass effects were seen in 29.4%.
Angiography ; Arteriovenous Malformations ; Basal Ganglia ; Diagnosis ; Female ; Ganglia ; Hematoma ; Hemorrhage ; Hospitals, General ; Humans ; Infarction ; Korea ; Male ; Mortality ; Nervous System Diseases ; Pathology ; Prognosis ; Spinal Puncture ; Stroke ; Tomography, X-Ray Computed

This study was to compare the microshear bond strength (microSBS) of light- and chemically cured composites to enamel coupled with four 2-step self-etch adhesives and also to evaluate the incompatibility between 2-step self-etch adhesives and chemically cured composite resin. Crown segments of extracted human molars were cut mesiodistally, and a 1 mm thickness of specimen was made. They were assigned to four groups by adhesives used: SE group (Clearfil SE Bond), AdheSE group (AdheSE), Tyrian group (Tyrian SPE/One-Step Plus), and Contax group (Contax). Each adhesive was applied to a cut enamel surface as per the manufacturer's instruction. Light-cured (Filtek Z250) or chemically cured composite (Luxacore Smartmix Dual) was bonded to the enamel of each specimen using a Tygon tube. After storage in distilled water for 24 hours, the bonded specimens were subjected to microSBS testing with a crosshead speed of 1 mm/minute. The mean microSBS (n=20 for each group) was statistically compared using two-way ANOVA, Tukey HSD, and t test at 95% level. Also the interface of enamel and composite was evaluated under FE-SEM. The results of this study were as follows; 1. The microSBS of the SE Bond group to the enamel was significantly higher than that of the AdheSE group, the Tyrian group, and the Contax group in both the light-cured and the chemically cured composite resin (p < 0.05). 2. There was not a significant difference among the AdheSE group, the Tyrian group, and the Contax group in both the light-cured and the chemically cured composite resin. 3. The microSBS of the light-cured composite resin was significantly higher than that of the chemically cured composite resin when same adhesive was applied to the enamel (p < 0.05). 4. The interface of enamel and all 2-step self-etch adhesives showed close adaptation, and so the incompatibility of the chemically cured composite resin did not show.
Adhesives* ; Crowns ; Dental Enamel* ; Humans ; Molar ; Water

This study was to compare the microshear bond strength (microSBS) of light- and chemically cured composites to enamel coupled with four 2-step self-etch adhesives and also to evaluate the incompatibility between 2-step self-etch adhesives and chemically cured composite resin. Crown segments of extracted human molars were cut mesiodistally, and a 1 mm thickness of specimen was made. They were assigned to four groups by adhesives used: SE group (Clearfil SE Bond), AdheSE group (AdheSE), Tyrian group (Tyrian SPE/One-Step Plus), and Contax group (Contax). Each adhesive was applied to a cut enamel surface as per the manufacturer's instruction. Light-cured (Filtek Z250) or chemically cured composite (Luxacore Smartmix Dual) was bonded to the enamel of each specimen using a Tygon tube. After storage in distilled water for 24 hours, the bonded specimens were subjected to microSBS testing with a crosshead speed of 1 mm/minute. The mean microSBS (n=20 for each group) was statistically compared using two-way ANOVA, Tukey HSD, and t test at 95% level. Also the interface of enamel and composite was evaluated under FE-SEM. The results of this study were as follows; 1. The microSBS of the SE Bond group to the enamel was significantly higher than that of the AdheSE group, the Tyrian group, and the Contax group in both the light-cured and the chemically cured composite resin (p < 0.05). 2. There was not a significant difference among the AdheSE group, the Tyrian group, and the Contax group in both the light-cured and the chemically cured composite resin. 3. The microSBS of the light-cured composite resin was significantly higher than that of the chemically cured composite resin when same adhesive was applied to the enamel (p < 0.05). 4. The interface of enamel and all 2-step self-etch adhesives showed close adaptation, and so the incompatibility of the chemically cured composite resin did not show.
Adhesives* ; Crowns ; Dental Enamel* ; Humans ; Molar ; Water

Subcutaneous fat necrosis (SFN) in newborns is a rare disease that affects infants in the first few weeks after birth. The lesion involves the back, buttocks, thighs, arms, and cheeks and it appears as a subcutaneous nodule in firm, well-defined, purple-red manifestation. It is a self-limited disorder and follows an uncomplicated course, but serious complications may occur such as thrombocytopenia, hypoglycemia, hypertriglyceridemia, and hypercalcemia. I am reporting a case of ultrasonographic and MR imaging findings of SFN in a 35–day-old girl with hypercalcemia and medullary nephrocalcinosis.

Necrotizing enterocolitis is a severe inflammatory disease of the intestine and is the main cause of death in infants, mostly occurring in premature infants. Intestinal obstruction may occur during the medical treatment of necrotizing enterocolitis. A common cause of intestinal obstruction is intestinal stricture, and entero-enteric fistulas may form in the proximal portion of the intestinal stricture. Several mechanisms may be suggested for the development of entero-enteric fistula. Intestinal ischemia and subsequent necrosis do not become intestinal perforation over time, causing an inflammatory reaction, and are attached to the adjacent intestine, forming a fistula. Alternatively, a subacute perforation may be sealed off by the adjacent intestine, resulting in fistula formation. Entero-enteric fistulas are closely related to distal stricture and occurs when there is a localized perforation rather than a generalized perforation. Fistulas can be diagnosed via contrast enema examination or distal loopogram, and surgical resection is required. Here, I report a case of a preterm infant with an entero-colonic fistula secondary to necrotizing enterocolitis. The patient had abdominal distention and bloody stool and was confirmed to have rotavius enteritis. Plain abdominal radiographs showed pneumatosis intestinalis. The patient received medical treatment for necrotizing enterocolitis. While the symptoms were improving, he vomited again, and intestinal obstruction was suspected. Gastrografin enema was performed due to intestinal obstruction, and an enterocolonic fistula was found.

No abstract available.

Subcutaneous emphysema is one of the rare complication of tracheal intubation and it's mechanism has been known as airleakage to subcutaneous tissue from the perforated site of larynx, trachea and esophagus by the trauma of laryngoscopic blade, stylet and endotracheal tube. We experienced a case of subcutaneous emphysema during unexpected difficult endotracheal intubation. At the initial laparoscopic examination, the patient's laryngeal view was grade IV of Cormack and Lehane's calssification. After several trial of the intubation, cervical subcutaneous emphysema developed by the trauma of laryngoscopic blade, stylet and endotracheal tube, even though failed to confirm the perforated site at postanesthesia one day.
Esophagus ; Intubation ; Intubation, Intratracheal* ; Larynx ; Subcutaneous Emphysema* ; Subcutaneous Tissue ; Trachea

Amniotic fluid embolism (AFE) is a rare but devasting obstetric emergency. We experienced a case of AFE during dilatation and curettage (D & C) in a 15 2/7 weeks pregnant woman, age 30, who was diagnosed as having a missed abortion. Sudden rapid hypoxemia, low SpO2, hypotension, low PETCO2, high CVP, and tachycardia, right axis deviation and right bundle branch block in 12 leads ECG were developed during D &C under general anesthesia, and signs of disseminated intravascular coagulation (DIC) followed after the operation, which are consistent with the findings of AFE. Even though there was no definite pathologic and radiologic confirmation of AFE, laboratory findings showed 100 times higher level of alpha-fetoprotein in her central venous blood than same weeks of missed abortion woman's blood. Though it is rare, the anesthesiologist should always suspect the possibility of AFE, when the patient shows an unexplained collapse, cyanosis, low PETCO2, high CVP, low SpO2, ECG change and DIC during any kind of obstetric procedure.
Abortion, Missed ; alpha-Fetoproteins ; Amniotic Fluid* ; Anesthesia, General ; Anoxia ; Axis, Cervical Vertebra ; Bundle-Branch Block ; Cyanosis ; Dacarbazine ; Dilatation and Curettage* ; Dilatation* ; Disseminated Intravascular Coagulation ; Electrocardiography ; Embolism, Amniotic Fluid* ; Emergencies ; Female ; Humans ; Hypotension ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnant Women ; Tachycardia

We report a relapsed case of a 25 year-old man with multi-drug resistant Salmonella serovar Typhi (MDRST) bacteremia who had recently returned from travel in India. Due to unresponsiveness to ciprofloxacin and ceftriaxone, we examined the strain's resistance to quinolones and extended-spectrum beta-lactamases (ESBLs). The strain had a single gyrA mutation at codon 83 (Ser83Phe), which explains its decreased susceptibility to fluoroquinolone and resistance to nalidixic acid. In the screening tests of ESBLs, TEM-1 was positive, which is beta-lactamase but not ESBL. The patient was finally successfully treated with meropenem and aztreonam. In the presence of clinical unresponsiveness despite favorable sensitivity tests, further laboratory evaluations are needed, which should include studies of genes related to antibiotic resistance and ESBLs. In addition, further prospective trials should be done about the possible inclusion of antibiotics not yet mentioned in the current guidelines. With MDRST on the rise worldwide, the most optimal and effective line of antibiotic defense needs to be devised.
Adult ; Anti-Bacterial Agents/*administration & dosage ; Aztreonam/*administration & dosage ; Bacteremia/drug therapy/microbiology ; Drug Resistance, Bacterial/genetics ; Drug Resistance, Multiple/genetics ; Drug Therapy, Combination ; Humans ; Male ; Salmonella typhi/*drug effects/genetics ; Thienamycins/*administration & dosage ; Typhoid Fever/*drug therapy