Laryngeal granuloma is a localized inframmatory response to mucosal loss caused by endolaryngeal trauma. Endotracheal intubation is the most common cause of laryngeal granuloma. Mucosal loss is followed by ulceration and infection and then by an overproduction of reactive granuloma tissue. Granuloma formation is most frequent on the posterior one third of the vocal cord. The authors experienced two cases of laryngeal granuloma after endotracheal intubation for general anesthesia.

A 6-year-old boy was anesthetized with halothane-N2O-O2 for anal fistulectomy. During induction of anesthesia, trismus developed soon after intravenous injection of S.C,C. and persisted for several minutes, associated with increased serum creatinine phosphokinase (C.P.K.) levels and elevated body temperature only up to 37. 8C (without hyperkalemia & myoglobinuria). The operation was postponed and uneventfully performed 4 days later with a normal limit of serum C.P.K. levels, under premedication by intramuscular injection of Valium(diazepam) and induction of anesthesia with halothane-Oplus intravenous injection of Valium for intubation, without any muscular rigidity or increased serum C.P.K. levels. Therefore the authors think there is a difference between this case and malignant hyperpyrexia following anesthesia, and also that the boy had a hyposensitivity predisposition to S.C.C. rather than halothane. Without accurate investigation for predisposition of muscular rigidity, We recommended Valium injection for premedication and induction of anesthesia for prevention of the muscular rigidity.
Anesthesia ; Body Temperature ; Child ; Creatinine ; Diazepam ; Halothane ; Humans ; Hyperkalemia ; Injections, Intramuscular ; Injections, Intravenous ; Intubation ; Male ; Malignant Hyperthermia ; Muscle Rigidity ; Premedication ; Succinylcholine* ; Trismus*

A total of 4757 apparently healthy aged persons over 65 years of age was surveyed for geriatric hypertension. A single blood pressure measurement was taken in the sitting position. Mean systolic blood pressure rose significantly with age in female but didn't in male and mean diastolic blood pressure didn't change with age in both sex. The prevalence of pure systolic hypertension, i.e., a systolic blood pressure greater than or equal to 160 mmhg and a diastolic blood pressure less than 95mmhg, increased with age. The prevalence was slighty lower for female than it was for male, being 7.0% for female and 8.0% for male. The prevalence of classical hypertension-defined as diastolic blood pressure greater than or equal to 95mmhg - was 42.7% for female and 48.2% for male and it rose with age in female. The prevalence of both pure systolic and classical hypertension was 49.7% for female and 56.1% for male.
Blood Pressure ; Epidemiologic Studies* ; Female ; Humans ; Hypertension* ; Korea* ; Male ; Prevalence

The malignant schwannoma is the primary malignant tumor, which originating from the schwann cell. The incidence is markedly rare. This malignancy is not uncommonly accompanied by von Recklinghausen's disease with the worse prognosis. Although lung is the common site of the distant metastasis, bone metastasis is extremely rare. Histologically this malignancy is composed mainly of spindle cells, but occasionally the rare type, called malignant epitheloid schwannoma, which is composed of many epitheloid cells and scant spindle cells, is found as in this case. It is difficult to differentiate the malignant epitheloid schwannoma with the amelanotic melanoma histologically. The authors have experienced one case (16 years old female) of malignant epitheloid schwannoma originating from the scalp on the occipital area and metastasizing to the proximal part of the right humerus.
Humerus ; Incidence ; Lung ; Melanoma, Amelanotic ; Neoplasm Metastasis ; Neurilemmoma ; Neurofibromatosis 1 ; Prognosis ; Scalp

In order to study the effect of spinal nareotics on postoperative pulmonary function and ventilatory reserve after upper abdominal surgery, small preoperative doses of morphine were administrated into the subarachnoidal space and the changes in FVC, FEVi.e., MMEF and FEVi.e./FVC with the SC-20 spirometric computer wer evaluated. The results were as follows: 1) On the 1st day postoperatively FVC of the control group was 56% of the preperative value, 2.94+/-0.68(1/sec), and that of the morphine group was 66% of the preoperative value, 2.99+/-0.73(1/sec).(p<0.05) On the 2nd and 3rd day postoperatively the control group was 64% and 65% and that of the morphine group was 82% and 87%. (p<0.05) 2) On the 1st and 2nd postoperative day FEVi.e. of the control group was 52% and 57% of the preoperative value, 2.49+/-0.43(1/sec), and that of the morphine group was 61%, and 65% of the preoperative value, 2.42+/-0.68(1/sec). (p<0.05) On the 3rd postoperative day the FEVi.e. of the control group was 65% and that of the morphine group was 80%. (p<0.05) 3) On the 1st and 2nd postoperative day the MMEF of the control group was 56%, and 61% of the preoperative value, 2.45+/-0.77(1/sec). In the 3rd postoperative day the MMEF on the control group was 63% and that of the morphine group was 78%. (p<0.01) 4) The preoperative FEVi.e./FVC of the control group was 84.3% and that of the morphine group was 78.7%. in the postoperative period, there were no significant differences between the control and morphine group.
Morphine* ; Postoperative Period

Postoperative total blindness was seen in a 48 year old male who had a laparotomy for traumatic perforation of intestine. General inhalation anesthesia of ether-oxygen-mask with semiclosed system was applied after initial ketamine administration. This unhappy ocular complication could be occur secondary to excessive prolonged external compression to eyeballs with mask or/and prolonged postoperative hypotension.
Anesthesia, General* ; Anesthesia, Inhalation ; Blindness* ; Humans ; Hypotension ; Intestines ; Ketamine ; Laparotomy ; Male ; Masks

We analyzed 20 cases of traumatic carotid cavernous fistula(CCF) during the recent 10 years The results are summarized as follows: 1) In 18 cases(90%), the clinical symptoms & signs of CCF occurred within 2 months after trauma. 2) The sites of fistulae were common in horizontal segment(40%) and at the junction(30%) between horizontal segment and posterior ascending segment of cavernous portion of internal carotid artery. 3) The main draining veins of CCF were the superior ophthalmic vein(90%) and the inferior petrosal sinus(70%). 4) The methods of treatment were occlusion of fistula with balloon(9 cases), occlusion of cavernous ICA with balloon(2 cases), ligation of cervical ICA with Poppen's clamp(4 cases) and trapping(2 cases). Two patients were not treated and another patient was healed spontaneously. 5) The frequency and severity of complication was significantly decreased in cases treated by detachable balloon occlusion than by direct cervical ICA ligation or trapping procedures. 6) The procedure using the self-sealed goldvalve balloon was simple, but had a risk of premature separation and premature deflation.
Balloon Occlusion ; Carotid Artery, Internal ; Fistula* ; Humans ; Ligation ; Veins

To evaluate amoebicidal efficacy of various disinfectants, we treated ten ocular isolates of Acanthamoeba with polyhexamethylene biguanide(PHMB), chlorhexidine and hexamidine. Acanthamoeba cysts were collected from axenic nonnutrient agar plates from 4 week culture. Cyst suspension(100microliter) was inoculated on 96-well microplate with concentration of 105 cys/ml. Each well was treated with two-fold diluted hexamidine, PHMB and chlorhexidine(100microliter each, 8 and 48hrs). Each well was examined under the inverted microscope until 7 days after treatment. Minimal cysticidal concentration(MCC) of each disinfectant qas measured after five experiments. MCC of hexamidine, chlorhexidine and PHMB against ten ocular isolates ranged 6.07-500microgram/ml, 3.12-12.50microgram/ml, 1.17-4.68microgram/ml respectively in 48hr treatment. In 8hr treatment, MCC of PHMB and chlorhexidine ranged 4.42-12.50microgram/ml and 4.67-17.71microgram/ml, but hexamidine did not demonstrate cysticidal effect. For proper disinfection of contact lens, disinfectants having cysticidal efficacy should be included in the composition of contact lens solution. Among the currently used topical amoebicidal agents, PHMB showed the greatest cysticidal activity on ten ocular strains of Acanthamoeba in invitro study.
Acanthamoeba* ; Agar ; Chlorhexidine* ; Contact Lens Solutions ; Disinfectants ; Disinfection

We present a retrospective study on the patients with coma without mass lesion on CT scan after non-missile head injury. We reviewed various clinical and radiological features of these 53 cases and compared the outcome at one month with several variables which may affect the prognosis. The patients were selected by the following criteria;the patients had lost consciousness at least for 6 hours, the Glasgow coma scores were below B, and the CT scan did not demonstrate a mass lesion but might have small contusion, subarachnoid hemorrhage and pneumocephalus that caused no mass effect. Characteristic CT findings for the diffuse axonal injury-small intracerebral hemorrhage on corpus callosum, white mater, basal ganglia or around the third ventricle-were observed in only 21 of 53 cases(39.6%). Thus diffuse axonal injury can be diagnosed by clinical features not by the CT findings at present and the CT scan was required for ruling out any mass lesions. The mortality rate was 32.1%. However, 37.7% was remained in the vegetative state or severe disability. Only 30.2% could obtain functional recovery. The changes of pupil, duration of coma, Glasgow coma score, skull fracture and collapsed lateral ventricle on CT scan were identified as important features in determining the outcome(p<0.05). Age, systolic BP, PaO2 and obliteration of basal cistern and third ventricle on CT scan had no statistical significance.
Axons ; Basal Ganglia ; Cerebral Hemorrhage ; Coma* ; Consciousness ; Contusions ; Corpus Callosum ; Craniocerebral Trauma* ; Diffuse Axonal Injury ; Head* ; Humans ; Lateral Ventricles ; Mortality ; Persistent Vegetative State ; Pneumocephalus ; Prognosis ; Pupil ; Retrospective Studies ; Skull Fractures ; Subarachnoid Hemorrhage ; Third Ventricle ; Tomography, X-Ray Computed*

We present a retrospective study on the patients with coma without mass lesion on CT scan after non-missile head injury. We reviewed various clinical and radiological features of these 53 cases and compared the outcome at one month with several variables which may affect the prognosis. The patients were selected by the following criteria;the patients had lost consciousness at least for 6 hours, the Glasgow coma scores were below B, and the CT scan did not demonstrate a mass lesion but might have small contusion, subarachnoid hemorrhage and pneumocephalus that caused no mass effect. Characteristic CT findings for the diffuse axonal injury-small intracerebral hemorrhage on corpus callosum, white mater, basal ganglia or around the third ventricle-were observed in only 21 of 53 cases(39.6%). Thus diffuse axonal injury can be diagnosed by clinical features not by the CT findings at present and the CT scan was required for ruling out any mass lesions. The mortality rate was 32.1%. However, 37.7% was remained in the vegetative state or severe disability. Only 30.2% could obtain functional recovery. The changes of pupil, duration of coma, Glasgow coma score, skull fracture and collapsed lateral ventricle on CT scan were identified as important features in determining the outcome(p<0.05). Age, systolic BP, PaO2 and obliteration of basal cistern and third ventricle on CT scan had no statistical significance.
Axons ; Basal Ganglia ; Cerebral Hemorrhage ; Coma* ; Consciousness ; Contusions ; Corpus Callosum ; Craniocerebral Trauma* ; Diffuse Axonal Injury ; Head* ; Humans ; Lateral Ventricles ; Mortality ; Persistent Vegetative State ; Pneumocephalus ; Prognosis ; Pupil ; Retrospective Studies ; Skull Fractures ; Subarachnoid Hemorrhage ; Third Ventricle ; Tomography, X-Ray Computed*