BACKGROUND: Several dermatomes around the skin wound may need to be bldegrees Cked in order to provide pain relief with intercostal bldegrees Ckade after thoracotomy and chest tube insertion. METHODS: Twenty patients who had undergone elective thoracotomy were selected to provide continuous intercostal nerve bldegrees Ck by an extrapleural approach. Before the thoracic cavity was closed, appropriate spaces between parietal pleura and intercostal muscle were made with surgical dilators under direct vision. An epidural catheter was introduced cephalad with the distal end uppermost and in a caudal direction making a U-turn lowermost in the spaces. Bupivacaine 0.25%, with 1 : 200,000 epinephrine was injected in a 10 ml dose about 20 minutes before the end of anesthesia, and infused at a rate of 0.88 mg/kg/hour for 1 hour, 0.35 mg/kg/hour for 23 hours and 0.3 mg/kg/hour for the second day postoperatively. RESULTS: The degree of analgesia with coughing and deep breathing was satisfied with patients and thoracic surgeons. Average numbers of analgesic dermatomes obtained by pinprick test, VAS and Prince Henry pain score were 5.6+/-0.3, 1.8+/-0.3 cm and 1.6+/-0.3 respectively. Changes in mean arterial pressure showed insignificantly and heart rate increased at the postoperative hour of 1 and 4(P value<0.05). FVC and FEV1 were restored up to 71 and 75% of preoperative value at the postoperative hour of 48. CONCLUSIONS: These results suggest that continuous intercostal nerve bldegrees Ck through the extrapleural approach was effective and clinically useful for pain relief following thoracotomy.
Analgesia ; Anesthesia ; Arterial Pressure ; Bupivacaine ; Catheters ; Chest Tubes ; Cough ; Epinephrine ; Heart Rate ; Humans ; Intercostal Muscles ; Intercostal Nerves* ; Pain Management* ; Pleura ; Respiration ; Skin ; Thoracic Cavity ; Thoracotomy* ; Wounds and Injuries

No abstract available.
Animals ; Clone Cells* ; Cloning, Organism* ; DNA, Complementary* ; Leptin* ; Rats* ; Receptors, Leptin*

Fat embolism is a condition in which fat appears in the circulating blood, not in the fine emulsion of a metabolic lipemia, but in droplets large enough to occlude arterioles and capillaries. It may occur as a complication of fracture, particularly multiple fractures of the long bones, pelvis, and ribs.. Since Zenker described the first case of fat embolism in 1862 there has never been a reliable diagnostic test for this condition. Lipid changes in the blood and demonstration of macroglobules could be used as aids for early post- traumatic fat embolism syndrome. The purpose of the present,study was to analyze the blood lipid changes in the fracture and to determine their value in the early detection of fat embolism syndrome. Twenty-three patients with at least one diaphyseal fracture of the lower extremity or a pelvic and spine fracture were included in the study. The mean age of the patients was 30.3 years. Men outnumbered women by a ratio of 2.9:1. Nineteen of the patients were injured in traffic accidents, two patients in fall, and one in the industrial accident. Ten volunteers were used for the control studies, nine men and one woman. Their mean age was 22.8 years. For determination of blood lipids blood sample was taken from cubital vein. The flrst blood sample was taken from tbe patients less than 2 hours after the iniury, and the later samples were obtained respectively in 12, 24, 48 and 72 hours, and 7 days after injury. The samples were centrifuged immediately (2,500 rpm, 4 min.). After centrifugation, each sample of plasma or serum was divided into two aliquots. The one aliquot was studied without flltering and the other was filtered through 8 microns millipore filter (Watmann No. 40. filter paper). Determination of triglyceride, cholesterol, and phospsolipids in blood was made from the unfiltered aliquot and from the other filtrate. Two groups were formed for comparission of the results; 1) Fracture Group; 2) Non-fracture Group as control. The triglycerides was determined using the technic of the micromethod of Van Handel and Elversmith, and the cholesterol was determined by the technic of Rosenthals color reagent method. For the determination of phospholipids Youngburg, modified method was used of The results of the study lead us to conclude that: 1. The triglycerides, cholesterol, phosphollpids fractions in the unflltered allquot was slightly higher than those of the filtrate. 2. Less than two hours after injury the triglycerides concentration in blood of fracture group was similar to the concentrations of the controls. But the triglycerides and macroglobule concentration in 12 and 24 hours after fracture were higher than those of the control group. 3. The average concentration of blood cholesterol level in fracture group was slightly higher than the control. Especially the serum concentrations of cholesterol in 12, and 24 hours after fracture were much higher than those of the controls. Statistically significant differences between the groups were observed. 4. The average phospholipids concentration in fracture patients was slightly higher than the average phospholipids concentration of the control but no significant differences between the groups were observed. 5. As to the total lipids, the average concentration of fracture group was little bit higher than the concentration of the control. There was no statistical differences between the fracture and the control group. 6. The concentrations of the total lipids gradually increased after 40 years of age. 7. The concentration of total serum lipids was increased in femoral fracture in site, and in multiple fractures than single fracture.
Accidents, Occupational ; Accidents, Traffic ; Arterioles ; Capillaries ; Centrifugation ; Cholesterol ; Diagnostic Tests, Routine ; Embolism, Fat ; Female ; Femoral Fractures ; Fractures, Multiple ; Humans ; Hyperlipidemias ; Lower Extremity ; Male ; Methods ; Micropore Filters ; Pelvis ; Phospholipids ; Plasma ; Ribs ; Spine ; Triglycerides ; Veins ; Volunteers

Down syndrome is perhaps the most common genetic condition associated with mental retardation. In cytogenetic examination, trisomy 21 is in 95% of Down syndrome, and the others are mosaicism, translocation or deletion. There are many associated diseases with Down syndrome such as, thyroid function abnormality, congenital heart disease, intestinal blockage, and so on. Hypothyroidism appeared in 15% before adolescent in Down syndrome patients. In Korea, there were several reports of Down syndrome with hypothyroidism in childhood but not in adulthood. And we had three cases of hypothyroidism with Down syndrome in adulthood. Cytogenetic examination revealed trisomy 21 in the 2 cases and 1 case of mosaicism. Antithyroid antibody was positive in one case. None of these cases was admitted due to symptoms of hypothyroidism. It is very difficult to make the diagnosis of hypothyroidism in Down syndrome because of similarity in symptoms between Down syndrome and hypothyroidism. Thus, periodic thyroid function test should be made in Down syndrome, and this could be a part of improving quality of life in Down syndrome.
Adolescent ; Adult* ; Congenital Abnormalities ; Cytogenetics ; Diagnosis ; Down Syndrome* ; Heart Diseases ; Humans ; Hypothyroidism* ; Intellectual Disability ; Korea ; Mosaicism ; Quality of Life ; Thyroid Function Tests ; Thyroid Gland

Since 1949, lithium has been widely used for treatment of manic depressive disorder. It has also been used for agranulocytosis after anticaneer chemotherapy and partially for hyperthyroidism. But it is well known that the long term administration of this drug is associated wih various antithyroid effects such as hypothyroidism, simple goiter, nodules and even thyrotoxicosis. Although the exact mechanism for leading hypothyroidism or goiter is still unknown, the incidence of lithium-induced hypothyroidism is 1-37% during lithium atment. We had an experience of newly developing goiter with or without hypothyroidism during lithium treatment in 4 MDP patients. Among our patients, the duration of lithium administration was from 0.7 months to 11 years, and the development of thyroid abnormality was impossible to predict. They were treated with thyroxine while lithium was discontinued causing favorable outcome. We suggest that routine thyroid function test include thyroid autoimmune antibody screening in patients planning to undergo lithium treatment.
Agranulocytosis ; Antithyroid Agents ; Depressive Disorder ; Drug Therapy ; Goiter* ; Humans ; Hyperthyroidism ; Hypothyroidism ; Incidence ; Lithium Carbonate* ; Lithium* ; Mass Screening ; Thyroid Function Tests ; Thyroid Gland ; Thyrotoxicosis ; Thyroxine

Although the popliteal arterial entrapment syndrome is rare, it is important disease of the arterial insufficiency in younger patients. This 24 years old male patient had complained of calf pain in walking and exercise from 3~4 months ago. The symptom of left extremity was severe during exercises, but that of right was unremarkable. The operation of this case composed of myomectomy of medial head of left gastrocnemius m. and interposition graft with left lesser saphenous vein. Asymptomatic, right extremitiy was left without operation.
Exercise ; Extremities ; Head ; Humans ; Male ; Popliteal Artery* ; Saphenous Vein ; Transplants ; Walking ; Young Adult

No abstract available.
Hematoma*

PURPOSE: To investigate ultrastructural changes of the mouse lung induced by whole lung gamma irradiation and to evaluate the effect of prophylactic administration of steroid against acute lung injury. MATERIALS AND METHODS: One hundred and twenty ICR mice were used and whole lung was irradiated with telecobalt machine. Whole lung doses were 8 and 12Gy, and 10mg of methyl prednisolone was administrated intraperitoneally for two and four weeks. At the end of the observation period, mice were sacrificed by cervical dislocation. The lungs were removed and fixed inflated. Histopathological examination of acute radiation injuries were performed by light microscopic and transmission electron microscopic examination. RESULTS: Control group with 8Gy is characterized by damage to the type I pneumocyte and the endothelial cell of the capillary, edema of alveolar wall and interstitium, and fibroblast proliferation. Control group with 12Gy is characterized by more severe degree of type I pneumocyte damage and more prominant inflammatory cell infiltration. Destructed cell debris within the alveolar space were also noted. After steroid administration, 8Gy experimental group showed decreased degree of inflammatory reactions but fibroblast proliferation and basal lamina damages were unchanged. Experimental group with 12Gy showed lesser degree of inflammatory reactions similar to changes of 8Gy experimental group. CONCLUSION: These studies suggest that the degree of interstitial edema and inflammatory changes were related to radiation dose but proliferation of the fibroblast and structural changes of basal lamina were not related to radiat- ion dose. Experimental administration of steroid for 2 to 4 weeks after whole lung irradiation suggest that steroid can suppress alveolar and endot- helial damages induced by whole lung irradiation but proliferation of the fibroblast and structural changes of basal lamina were not related to administration of steroid.
Acute Lung Injury* ; Animals ; Basement Membrane ; Capillaries ; Dislocations ; Edema ; Endothelial Cells ; Fibroblasts ; Lung* ; Mice* ; Mice, Inbred ICR ; Pneumocytes ; Prednisolone ; Radiation Injuries

BACKGROUND/AIMS: Since the laparoscopic cholecystectomy has been introduced, minimally invasive techniques have been applied to the management of various intraabdominal lesions. Laparoscopic resection of benign gastric tumor has several advantages compared to open surgery; such as reduced postoperative discomfort, early hospital discharge and less complications. METHODS: We performed laparoscopic gastric resection for 6 benign gastric leiomyomas and 3 heterotropic gastric pancreases diagnosed by gastric endoscopy and did endoscopic ultrasonography routinely to find out the exact location of mass and depth of invasion. RESULTS: 1) Male to female ratio was 2: 7 and mean age was 48 years. 2) The masses were located at posterior wall of body in 5 cases, fundus in 2 cases, anterior wall of antrum in 1 case, and enterior wall of body, lesser curvature in 1 case. 3) Resection of benign gastric tumors were readily achieved laparoscopically, aided by disposable stapling instruments. 4) Mean operation time was 120 minutes and mean hospital stay was 5.1 days. CONCLUSIONS: The benign gastric tumors can be managed laparoscopically with good results and this procedure provides another choice for the resection of them.
Cholecystectomy, Laparoscopic ; Endoscopy ; Endosonography ; Female ; Humans ; Leiomyoma ; Length of Stay ; Male ; Pancreas

BACKGROUND: The cause of blood pressure (BP) variation is difficult to identify because genes and environment interact to produce the BP phenotype. Different genetic background and culture in a population make different gene frequency and environment for hypertension. Therefore, we studied the determinants of BP with reference to genes, metabolic factors and environmental factors in Korean population. METHODS: A study was carried out in two hundred fifty- eight patients (mean age 49, females 74%) with newly detected hypertension. Twenty-four hour ambulatory blood pressure monitoring (Accutracter II, Suntecr) was performed as an index of the magnitude of BP. The contributory factors studied were angiotensin-converting enzyme (ACE), angiotensinogen (AGT ; T174M and M235T) gene as a genetic factor, alcohol and smoking habitus, exercise, sodium intake as an environmental factor, and body mass index (BMI), insulin, lipid, renin, and aldosterone as a intermediate phenotype. RESULTS: 1) Genetic factors : There were no significant associations between ACE and AGT polymorphisms and the magnitude of BP. 2) Environmental factors : Alcohol and weight were significantly correlated with daytime systolic BP (r=.13, p=.04 and r=.15, p=.02), diastolic BP (r=.17, p=.01 and r=.12, p=.05), and nighttime diastolic BP (r=.15, p=.02 and r=.11, p=.01). Sodium intake, as assessed by fasting spot urine Na/K ratio in the morning, was not related to the magnitude of BP. 3) Intermediate phenotype : Plasma aldosterone level was significantly correlated to daytime diastolic BP (r=.16, p=.03), nighttime systolic BP (r=.17, p=.03), and nighttime diastolic BP (r=.16, p=.04). In women, plasma aldosterone was reversely correlated to urine Na/K ratio (r=-.42, p=.001). CONCLUSIONS: The magnitude of blood pressure in essential hypertension seems to be mainly determined by weight, alcohol intake, and plasma aldosterone level.
Aldosterone ; Angiotensinogen ; Blood Pressure Monitoring, Ambulatory ; Blood Pressure* ; Body Mass Index ; Fasting ; Female ; Gene Frequency ; Humans ; Hypertension* ; Insulin ; Phenotype ; Plasma ; Renin ; Smoke ; Smoking ; Sodium