Fluid resuscitation, hemostasis, and transfusion is essential in care of hemorrhagic shock. Although estimation of the residual blood volume is crucial, the standard measuring methods are impractical or unsafe. Vital signs, central venous or pulmonary artery pressures are inaccurate. We hypothesized that the residual blood volume for acute, non-ongoing hemorrhage was calculable using serial hematocrit measurements and the volume of isotonic solution infused. Blood volume is the sum of volumes of red blood cells and plasma. For acute, non-ongoing hemorrhage, red blood cell volume would not change. A certain portion of the isotonic fluid would increase plasma volume. Mathematically, we suggest that the residual blood volume after acute, non-ongoing hemorrhage might be calculated as 0·25N/[(Hct1/Hct2)-1], where Hct1 and Hct2 are the initial and subsequent hematocrits, respectively, and N is the volume of isotonic solution infused. In vivo validation and modification is needed before clinical application of this model.
Blood Volume ; Hematocrit ; Humans ; Isotonic Solutions/*therapeutic use ; *Models, Theoretical ; Shock, Hemorrhagic/*prevention & control/*therapy

Open carpal tunnel release has been the standard method of sumical treatment of carpal tunnel syndrome. Recently endoscopic carpal tunnel release has been introduced and is heing used by many authors. The advantages of this new technique are less postoperative pain, rapid restoration of power and rapid return-to-work. However many considerate authors, in spite of these advantages. insist that the inevitahle risk of neurovascular injury during the endoscopic procedure should not he underestimated. The purpose of our study is to compare the clinical results of endoscopic carpal tunnel release with those of open release. 20 open carpal tunnel releases in 16 patients and 15 endoscopic carpal tunnel reieases (single-portal technique) in 11 patients were performed hy the first author. Preoperative conditions of both groups are not different. Authors compared the clinical results between the two groups with some parameters. The overall clinical results were not different significantly hetween two groups. Rapid return-to-work(36 days in endoscopic group versus 60 days in open group) and less postoperative scar and pillar pain in endoscopic group were demonstrated. However, the major complication of one median nerve injury in endoscopic group seemed to overweigh these some benefits. We suggest that the standard operative technique for carpal tunnel syndrome should be open carpal tunnel release and more considerations should be takcn in choosing endoscopic method because of its inherent risk.
Carpal Tunnel Syndrome ; Cicatrix ; Humans ; Median Nerve ; Pain, Postoperative ; Return to Work

PACS (Picture Archiving and Communications System) is a computer-based image storage and retrieval system that can store, recall and display medical images rapidly on high resolution workstations. The image acquisition system consists of direct digital interface to computed radiography (CR) system. We reviewed X-rays of 84 patients who had both studies of Dual energy X-ray Absorptiometry (DXA) and AP, lateral views of lumbar vertebrae between January and December of 1995. We tried to verify the clinical implication of pixel values on PACS for DXA by comparing pixel values and bone mineral density (BMD) of the 2nd, 3rd and 4th lumbar vertebrae. They were all female between 44 and 72 years old, average age of 59. Bone mineral density (BMD), represented in DXA of a total of 252 vertebrae were mostly in the range of between 0.228 (22%) and 1.318 (121%). Pixel values of the AP and lateral views of the 2nd, 3rd and 4th vertebrae in the PACS workstation were closely correlated to bone mineral density (p=0.0001). The values of the DXA (bone mineral density and T score) get comparatively lower as the pixel values get smaller. In conclusion, the pixel value on PACS interfaced to CR could be utilized as an easy, speedy and economical tool for screening of osteoporosis.
Absorptiometry, Photon* ; Aged ; Bone Density ; Female ; Humans ; Lumbar Vertebrae ; Mass Screening ; Osteoporosis ; Radiography ; Spine

Return of facial nerve function is important in patients with facial nerve paralysis by trauma. Sometimes, delay in diagnosis of facial nerve paralysis make recovery of facial nerve function difficult. Traumatic facial palsy mostly occur after temporal bone fracture in unilateral. Temporal bone fracture after head trauma are divided into the three group; longitudinal fracture, transverse fracture and mixed fracture. The most common symptoms are hearing impairment, bloody otorrhea, loss of consciousness and facial nerve paralysis. The early care of temporal bone fracture involves facial nerve paralysis. And there has been many discussion and study in the treatment of the immediate or delayed facial palsy ; examply, surgical approach, time and methods. We have managed a patient with unilateral facial nerve paralysis after longitudinal temporal bone fracture in mastoid process and conservative facial nerve decompression was performed. We have obtained good result and report this case with review of literatures.
Craniocerebral Trauma ; Decompression* ; Diagnosis ; Facial Nerve* ; Facial Paralysis* ; Hearing Loss ; Humans ; Mastoid ; Paralysis ; Temporal Bone ; Unconsciousness

Topical fibronectin, autologous and homologous, was used to treat nine patients (eleven eyes) with persistent corneal epithelial defects and corneal ulcers that failed to improve with standard therapy. The fibronectin was purified from autologous and homologous plasma by gelatin-Sepharose 4B affinity chromatography and administered topically, 500 micrograms/ml five times a day, for three weeks. Complete or nearly complete reepithelialization was achieved in all patients regardless of the source of fibronectin, autologous or homologous. But healing times varied. The average healing time was 41.7 +/- 14.7 days (35.7 +/- 12.4 days for autologous, 50.8 +/-14.4 days for homologous). Ocular symptoms were relieved significantly, and no side effects were observed. Over an average follow-up period of 5.2 months, no recurrences were noted. The results showed that homologous, as well as autologous, fibronectin was effective in patients with persistent corneal epithelial defects and corneal ulcers.
Administration, Topical ; Adult ; Aged ; Blood Proteins/isolation & purification ; Chromatography, Affinity ; Corneal Diseases/*drug therapy ; Corneal Ulcer/*drug therapy ; Epithelium/drug effects ; Female ; Fibronectins/administration & dosage/isolation & purification/*therapeutic use ; Humans ; Male ; Middle Aged ; Visual Acuity ; Wound Healing/drug effects

A 63-year-old woman was referred to a breast surgeon with a breast mass discovered incidentally during follow-up study after colon cancer surgery. Invasive adenocarcinoma was revealed on core needle biopsy. Wide excision of the breast including the tumor was performed. On standard histological examination the tumor showed features of moderately differentiated adenocarcinoma. The immunohistochemistry study revealed positive results for cytokeratin (CK)20 and CDX2, but negative for CK7. These are typical characteristics for colon cancer. Considering her history of subtotal colectomy for sigmoid colon cancer, it is presumable that the mass in the breast was of colonic origin, and it was an extremely rare case of metastasis to the breast from primary colorectal neoplasm. Although the instance is rare, clinicians should keep the possibility of breast metastasis from colorectal cancer in mind for early and correct diagnosis.
Adenocarcinoma ; Biopsy, Large-Core Needle ; Breast ; Colectomy ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratins ; Middle Aged ; Neoplasm Metastasis ; Sigmoid Neoplasms

To attempt a rigorous definition of the structure of the accessory spleen (AS) in the Chinese hamster, we examined twenty-one animals, and found AS in 5 animals (23.8%), which were over 7-month-old. The AS had no connection with the main spleen and was seen as a dark red oval organ (0.7 mm x 1.5 mm), which was embedded in the adipose tissue near the tail of the pancreas. It was demarcated from the adipose tissue and some pancreatic tissue. The organ was encapsulated by thin collagenous connective tissue and smooth muscle fibers, and contained lymphatic nodules, reticular fibers, nodular central arterioles, macrophages and megakaryocytes. Notably the incidence of AS appeared to increase with age in the Chinese hamsters.
Adipose Tissue/anatomy & histology ; Age Factors ; Animals ; Connective Tissue/anatomy & histology ; Cricetinae ; Cricetulus/*anatomy & histology ; Erythrocytes/cytology ; Lymphocytes/cytology ; Muscle, Smooth/anatomy & histology ; Pancreas ; Spleen/*anatomy & histology/cytology

A 46-year-old female was admitted to Soon Chun Hyang University hospital with a complaint of intermittent epigastric pain. X-ray and endoscopic pictures showed diffase irregular shallow depression which is similar to the macroscopic pattern of the type IIc early gastric cancer. But endoseopic biopsy showed no malignant cell infiltration. Hndoaeopic biopsy plays an important role in excluding the possibility of carcinoma. But operation shoud be considered inspite of biopsy result because malignant lymphoma ean not be completely ruled out. Histopathologic diagnosis was pseudolymphoma of stomach.
Biopsy ; Depression ; Diagnosis ; Female ; Humans ; Lymphoma ; Middle Aged ; Pseudolymphoma* ; Stomach ; Stomach Neoplasms

Proliferative vitreoretinopathy (PVR) is the main cause of failure in retinal reattachment surgery, Vitrectomy combined with pharmacologic therapy to inhibit proliferating and contracting epiretinal membranes appears to be a promismg approach in the management of PVR. We investigated the inhibitory effect of intravitreal 5-fluorouracil (5-FU) on experimental PVE induced by intravitreal injection of homologous dermal fibroblast in pigmented rabbits. At 6 weeks after intravitreal injection, Goup I (fibroblast only), Group II (early treatment with 1mg of 5-FU), and Group Ill (delayed treatment with 1mg of 5-FU) developed the retinal detachment in 85.7%, 33.3%, and 58.3% respectively. The rate of retinal detachment was lower in treatment groups than in non-treatment group, but there was a statistically significant difference only between non-treatment group (Group I) and early-treatment group (Group II) (p<0.05). In the group that only 5-FU was injected (Group IV), the retinas were preserved in normal clinically and pathologically. These results show that 5-FU may exert a significant anti proliferative effect on intraocular proliferative disorders including PVR especially if the drug is administered more earlier.
Epiretinal Membrane ; Fibroblasts ; Fluorouracil* ; Intravitreal Injections ; Rabbits ; Retina ; Retinal Detachment ; Retinaldehyde ; Vitrectomy ; Vitreoretinopathy, Proliferative*

Gastric adenocarcinoma in childhood is an extremely rare disease with poor prognosis. We experienced a case in which a 14 year old female patient who was admitted with complaints of abdominal pain, indigestion and obstipation. Her physical examination revealed positive Blumer's rectal shelf, positive ascitic fluid cytology and typical radiologic and endoscopic findings suggesting gatric adenocarcinoma. She showed symptomatic improvement with combination chemotherapy. Thus we report a case of gastric adenocarcinoma with a brief review of literatures.
Abdominal Pain ; Adenocarcinoma* ; Adolescent ; Ascitic Fluid ; Drug Therapy, Combination ; Dyspepsia ; Female ; Humans ; Physical Examination ; Prognosis ; Rare Diseases