Crouzon's disease, first described by Crouzon in 1912, is characterized by craniosynostosis, exorbitism and midface hypoplasia. As well, it has been known to be transmitted as an autosomal dominant trait. Clinically, Crouzon's disease not only has aesthetic problems, but also many functional disabilities, such as increased intracranial pressure, hydrocephalus, visual disturbance. difficulty in nasal breathing and malocclusion. The surgical correction of Crouzon's disease includes: 1) frontal bone advancement and release of the craniosynostosis; 2) correction of the midface retrusion; and 3) other ancillary procedures for better aesthetic results. The authors performed Le Fort III advancement for the correction of midface retrusion in 5 cases of Crouzon's disease. These advancements were performed at about the age of 15 in consideration of facial bone growth disturbance, psychosocial effects, and the recurrence of class III malocclusion after operation. The average advancement of the midface was 9. 2 mm. We experienced favorable aesthetic and functional results without severe complication in all cases or relapse of the advanced segment.
Craniofacial Dysostosis* ; Craniosynostoses ; Facial Bones ; Frontal Bone ; Hydrocephalus ; Intracranial Pressure ; Malocclusion ; Recurrence ; Respiration

Laparoscopic cholecystectomy is a new surgical procedure which worldwidely applicated gallstone disease and is presenting now anesthetic challenges. The advantages of laparoscopic cholecystectomy are shorter hospital stay, more rapid retum to normal activies and less postoperative ileus, compared with open laparotomy. During the laparoscopic surgery to enable visualization of abdominal structures, pneumoperitoneum is made with CO2 insufflation but insufflation of CO2 into abdominal cavity has been reported several consequences. Hypercarbia, high peak airway pressure, cardiac arrhythmia which were all may result from CO2 insufflation. Also, increased intraabdominal pressure from the induced pneumoperitoneum can cause decreased venous return and may result in hypotension. To ascertain the cardiopulmonary effcts of the increased intraabdominal pressure by CO2 insufflation, a clinical study was performed in 80 patients who divided into four groups likes as control group (open cholecystectomy, number:No=20), group I (15 mmHg of pressure of pneumoperitoneum, No=20), group II (20 mmHg, No=20), group III (25 mmHg, No=20). We investigated the effect of CO2 insufflation to mean arterial pressure, heart rate, end-tidal CO2 partial pressure, mean airway pressure, and arterial blood gas components. The measurements were obtained from the time of skin incision(basic value) to 20 min every 5 min interval in all groups. The results are following, I. Mean arterial pressure significantly began to increase (p<0.05) at post-incision 5 min in control, group IIl & at 10 min in group I, II compared with pre-incision value(basic value), but there were no difference between control and other study groups. II. Heart rate(HR) significantly began to differ (p<0.05) at post-incision 5 min in group II, III. compared with control group. Also HR significantly began to increase (p<0.05) at post-incision 5 min in control, group III & to decrease at post-incision 15 min in group compared with basic value. III. There were significant difference in pH between control and study groups, pH change were in normal ranges clinically. PaCO2 was significantly began to decrease (p<0.05) at post-incision 5 min in study groups compared with basic value, but still in normal acceptable ranges. IV. PaCO2 significantly began to increase (p<0.05) at post-incision 10 min in group II & at 15 min in group IIl compared with control group. Also PaCO2 significantly began to increase (p<0.05) at 5 min in group I, II & at 10 min in group III compared with basic value. V. PETCO2 significantly began to increase (p<0.05) at 10 min in group II & at 15 min in group III compared with control group. Also PETCO2 significantly began to increase (p<0.05) at 10 min in group I,II,III compared with basic value. VI. PAW significantly began to increase (p<0.05) at 10 min in group I,II,III compared with basic value. Conclusively, insufflation of CO2 into abdominal cavity during laparoscopic operation was minimal change in cardiopulmonary system and arterial blood gas value at below 20 mmHg intraabdominal pressure.
Abdominal Cavity ; Arrhythmias, Cardiac ; Arterial Pressure ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Gallstones ; Heart ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Ileus ; Insufflation ; Laparoscopy ; Laparotomy ; Length of Stay ; Partial Pressure ; Pneumoperitoneum ; Reference Values ; Skin

Functional lacrimal obstruction is a rare physiologic dysfunction of the lacrimal drainage system without any mechanical obstruction. Twelve eyes of 9 patients were diagnosed by syringing, dacryacystography, and lacrimal scintigraphy. Normal drainge pattern was noticed in syringing and in the initial film of dacryocystography. However slow or non-functioning drainge was disclosed in the delay film of dacryocystography and lacrimal scintigraphy. The causes of functional problem were facial nerve palsy, trauma and idiopathic. Conjunctivodacryocystorhinostomy was performed in all 12 eyes with satisfactory results.
Drainage ; Facial Nerve ; Humans ; Paralysis ; Radionuclide Imaging

The Oriental countries have had long histories and large populations. While they were the civilized country with the profound culture and thoughts, they were backward in material civilization bacause of their delayed development of science. Extending from the end of the 18th century to the 19th century the Western countries perturbed the Eastern countries with their sudden appearance. The Western countries visited the East with their threatening attitudes by giant war vessels and guns. They also strongly demanded to import their advanced daily commodities and the studies including the medical science. Since the most of the Eastern countries were too conservative, they resisted and rejected the Western forces at first. At that time, most Eastern countries located in the southern region of Asian continent were colonized by the West. The other countries in the nortern region came to realize that they were behind the West in material civilization, so had to open their door to the West through the foreign contact. China, Japan and Korea had to accept the Western culture and urged the civilization. Especially Japan adapted herself to new circumstances before others. She accepted the Western culture, thoughts and all studies actively with even reforming her political system. Starting from the yesr of 1868, Japan not only was reborn and formed independent position in the cultural region of China and Korea but also succeeded to construct the first westernized country among the Eastern countries and weekened the influence of China and Russia. Japan provoked and won wars such as the Sino-Japanese War {1894} and the Russia-Japanese War (1904). Follwing up these victories, Japan also occupied Korea in 1910, and the period of colonization had continued for 35 years until 1945 when Japan surrendered to the Allies at the end of the World War II. With these historical cirumstances, the purpose of this research paper is to collect the medical data, especially that of the anesthesia, and show its historical contributions through the documents. The long history of Korea had developed with the traditional and peculiar medical science, such as a herb medical science and a medical science in acupuncture and moxibustion. Korean medical science, however, has been greatly changed since 1876, the year of opening her door to Japan. There were two ways of introducing the Western medical science in Korea. As the indirect import, the japanese Western medical scince through the city of Busan was one. As the direct imports, the American medical science by an American missionary, Allen through the city of Incheon was the other. In these two currents of the Western medical science, it was natural that the Japanese one formed the main stream after 1910, the year of japanese occupation. The field of anestheia science was not an exception. Its developing process was no better than following the path of Japanese anesthesia science history. Comparing the Western developing history of anesthesia to that of Japan in general, there were a few ears difference in the level of quality between the East and the West until about 1930. Japanese anesthesia, however, fell behind over 20 years, comparing to the Western one, in the period from the late of 1930s to 1945. I believe that it is beyond the scope of this paper to explain and it leaves us with meaningful lessons.
Acupuncture ; Anesthesia* ; Asian Continental Ancestry Group ; Busan ; China ; Civilization ; Colon ; Ear ; Firearms ; Humans ; Incheon ; Japan ; Korea* ; Missions and Missionaries ; Moxibustion ; Occupations ; Political Systems ; Rivers ; Russia ; World War II

No abstract available.
Osteomyelitis*

BACKGOUND: Mass casualties from organophosphorus inhalation die from respiratory depression. Gas supplies and equipment are limited for mechanical ventilation of multiple subjects in emergency situation. Endobronchial insufflation of air (EIA) can be simply performed with air compressor and catheter. The author tried to examine the usefulness of EIA in five apneic dogs induced by tetrodotoxin (TTX) infusion. METHOD: Five anesthetized dogs were intubated with endotracheal tube and endobronchial insufflation catheter and instrumented with arterial catheter and ventilated with controlled mechanical ventilation (CMV) while 12 microgram/kg TTX was infused intravenous over 90 minutes to produce apnea. EIA of 1 microliter/kg/min was delivered through a 35 cm long, 0.8 cm ID catheter with a forked end placed astride the carina. During conventional ventilation, arterial blood gases and pH were measured (base line, BL). The data were measured after confirmation of apnea for 1 minute (time=0, control value), and then measured serially for 4 hours of EIA. RESULT: All animals survived and were alert and neurologically normal within 24 hours. The changes of arterial oxygen tension (PaO2) were no significant difference between control value and 10, 20, 30 minute (p<0.05), and arterial carbon dioxide tension (PaCO2) were significant increase in control value compared to base line (p<0.05), and pH were no significant difference in all values (p<0.05). Spontaneous respiratory efforts slowly returned after 45 minute of EIA and resulted in the improvement of gas exchange. CONCLUSION: EIA recognized as a sort of ventilatory technique is useful only when other equipments could not be available. The EIA catheter can be placed by cricothyroidotomy. EIA is very helpful in supporting ventilation, and it also helps the apneic dogs stay in normal condition.
Animals ; Apnea ; Carbon Dioxide ; Catheters ; Dogs* ; Emergencies ; Equipment and Supplies ; Gases ; Hydrogen-Ion Concentration ; Inhalation ; Insufflation* ; Mass Casualty Incidents ; Oxygen ; Respiration, Artificial ; Respiratory Insufficiency ; Tetrodotoxin ; Ventilation*

The use of interlocking intramedullary nail is accepted one of treatment choices in the comminuted fractures of humeral shaft. The insertion of distal interlocking screws remains technically problematic. The use of intrageon's hands during the procedure. In order to reduce technical difficulty and radiation exposure, it is necessary to compare the rigidity of intramedullary nail according to the number of distal interlocking screws. The purpose of study is to compare the stability of interlocking intramedullary nail according to the number of distal screws by means of torsional compliance measurements in the simulated humeral shaft fractures. Simulated fractures were made in 20 humora from 10 cadavera at the mid-junction of humeral shaft. All humora were fixated with titaium humeral nail system. Interlocking screws were placed at proximal and distal screw holes by standard procedure. Group I consisted of 10 humora fixated with one distal interlocking screw and group II consisted of 10 humora fixated with two distal intterlocking screws. Torsional compliance was measured with single-end of 10 humora fixated with two distal interlocking screws. Torsional compliance was measured with single-end double arm torquing machine. The torsional compliance analog was 0.0294+/-0.0033 mm/N mm for one screw and 0.0241+/-0.0045 mm/N mm for two distal screws. The torsional compliance analog between two groups was found to be statistically insignificant(p=0.23). In conclusion, One distal interlocking screw was not inferior to two interlocking screws in terms of biomechanical characteristics, especially torsional compliance analog.
Arm ; Compliance ; Fracture Fixation, Intramedullary* ; Fractures, Comminuted ; Hand

Reconstructing the ear with autogenous rib cartilage is one of the most preferred methods for microtic ear reconstruction. Sometimes, when using this method, the skin envelope size is not large enough for the cartilage framework. With tissue expansion, a more adequately sized hairless skin envelope can be developed. Usually we recommend that canaloplasty be delayed after external ear reconstruction. But when the external ear canal has been reconstructed before external ear reconstruction, the remaining hairless skin for an envelope is so deficient that even though using tissue expansion, it is nearly impossible to develop well-qualified hairless skin envelope. From January, 1996 to December, 1998, we reconstructed auricles using tissue expansion, followed by excision of hair-bearing skin and grafting of full-thickness skin in five microtic patients whose external ear canals had been reconstructed before external ear reconstruction. The skin donor area was the contralateral postauricular area. Two to three weeks after the skin graft, autogenous cartilage grafts followed. No graft was lost. Color and texture was well matched, and the hair-bearing tissue portions were almost completely removed. Our method has several advantages: 1) it uses local tissue maximally; 2) it leaves the capsule intact, which can improve flap circulation; 3) it may thin the flap as much as it can be, which can reveal well defined cartilage framework; 4) it allows easy removal of hair-bearing tissue portions; 5) it provides a well-vascularized bed for graft survival and preserves the temporoparietal fascia, which can be used for secondary reconstruction if necessary; 6) Tissue expansion can reduce the amount of hair-bearing portion which should be removed.
Cartilage ; Ear ; Ear Canal ; Ear, External ; Fascia ; Graft Survival ; Hair* ; Humans ; Ribs ; Skin* ; Tissue Donors ; Tissue Expansion* ; Transplants*

Nitrous oxide is the most commonly used inhaled anesthetic in the part of anesthesia and used up to 75% of concentrations. Diffusion hypoxia among the disadvantages or harmful damages due to nitrous oxide exposure must be prevented by moderate flow (4-6 liters/minute) of oxygen for a few minutes. This study was investigated the effect of the amount of oxygen flow on the speed of removal of exposed nitrous oxide followed by oxygen flow rate of 2, 4, and 6 liters/minute when halted the administration of nitrous oxide. These variables were taken in 57 patients of 16 to 60 years old, who were performed the elective surgery. All patients were anesthetized with the 0.5-1.5 MAC of enflurane or isoflurane combined with nitrous oxide(2 liters/minute) and oxygen(2 liters/minute), and paralyzed with IV route pancuronium 0.07-0.08 mg/kg. Ventilation was controlled with Ohmeda 7000 ventilator (BOC Health Care Inc, Madison, USA), using a constant tidal volume of 10 ml/Kg of ideal body weight. Ventilatory rate was adjusted 12 times/minute to maintain the end-tidal CO2 of 20-35 mmHg. After 60 to 90 minutes of anesthesia, the nitrous oxide/oxygen mixture was changed to 100% oxygen, but ventilation being held constant. The results were as follows; 1) After the first 30 seconds, the end-tidal nitrous oxide concentration was 39.6+/-+3.7% in 2 liters/minute of oxygen flow, 28.2+/-5% in 4 liters/minute and 23.4+/-6.3% in 6 liters/minute. 2) After the 2 minutes, the end-tidal nitrous oxide concentration was 29.1+/-3.6% in 2 liters/minute of oxygen flow, 14.4+/-3.2% in 4 liters/minute and 10.13+/-2% in 6 liters/minute. 3) After the 5 minutes and 30 seconds, the end-tidal nitrous oxide concentration was 16.4+/-3.3% in 2 liters/minute of oxygen flow, 5.5+/-1.9% in 4 liters/minute and 4.0+/-1.7% in 6 liters/minute. 4) After 15 minutes, the end tidal nitrous oxide was 7.5+/-2.1% in 2 liters/minute of oxygen flow, 2.3+/-0.7% in 4 liters/minute and 2.0+/-0.8% in 6 liters/minute. In conclusion, the larger size of oxygen flow, the more rapid elimination of nitrous oxide. The removal rate of nitrous oxide was greatest at first 30 seconds after halting the nitrous oxide administration in all cases.
Anesthesia* ; Anoxia ; Delivery of Health Care ; Diffusion ; Enflurane ; Humans ; Ideal Body Weight ; Isoflurane ; Middle Aged ; Nitrous Oxide ; Oxygen* ; Pancuronium ; Tidal Volume ; Ventilation ; Ventilators, Mechanical

Recently, laparoscopic cholecystectomy becomes a favorite surgical treatment of cholelithiasis instead of traditional open cholecytectomy. The reasons include small wound, small pain and short hospital-stay. But it also has disabvantages by pneumoperitoneum made of carbon dioxide insuffulation. We attempted to investigate the effect on hemodynamics, arterial blood gas parameters and pulmonary function of each surgical technique-laparoscopic(Group I) vs open cholecystectomy(Group II). We randomly selected realative healthy 30 patients for each group and baseline arterial blood gas and pulmonary function test were measured. During the operative proeedure, hemodynamic parameters(blood pressure and heart rate) were measured by 5-minute interval. Postoperatively, arterial blood gas and pulmonary function test were measured. The results are following; 1) In group I, blood pressure was increased to l14.2+/-18.0mmHg significantly(p<0.01) compared to preoperative value 101.4+/-21.5 mmHg. Heart rate was not shown significant change in both technique groups. 2) PaO2 was significantly decreased to postoperative 24hr value 82.2+/-15.8mmHg in group II and 82.3+/-19.4 mmHg in group I compared to preoperative 24hr value 98.7+/-14.8 mmHg and 94.4+/-ll.3mmHg, respectively. There was no significant difference of PaCO2 of between two groups. pH was significantly increased to postoperative 24hr value 7.42+/-0.02 in group II compared to preoperotive 24hr value 7.39+/-0.03 but no significant change in group I compared to preoperative 24hr value 7.39+/-0.03. 3) In group I, FVC and FEV1 were decreased preoperative 24hr value 77.9% and 81.1% to postoperative 24hr value 61.1% and 62.3%, respectively. But in group II, FVC and FEV1 were decreased more significantly, compared preoperative 24hr value 90.8% and 95.6% with postoperative 24hr value 59.4% and 58.6%. FEV1,/FVC value was not changed in two groups. 4) Postoperative analgesics requirement was 53% in group I, 80% in group II at the day of surgery. Also frequency was 1.8 in group I, 2,4 in group II at the day of surgery. 5) Mean Operation time was 43 min in group I, 52 min in group II and mean hospital days were 6 days in group I, 12 days in group II. Conclusively, in case of group I, blood pressure change was more labile than group II. But postoperative pulmonary function derangement, requirement of analgesics and hospital day were reduced in case of group I.
Analgesics ; Blood Pressure ; Carbon Dioxide ; Cholecystectomy* ; Cholecystectomy, Laparoscopic ; Cholelithiasis ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Pneumoperitoneum ; Respiratory Function Tests ; Wounds and Injuries