A case of eavernous hemangiomatosis involving alI tendon sheath of flexors and median nerve of the right forearm is reported. This case was a 22 year old Korean male who complained of painful swelling of the flexor side of right wrist region, limited motion of wrist joint, loss of pinching and opposition with tingling sensation on the admission. Roentgenographic examination revealed fusiform swelling of the soft tissues in flexor aspect of the right wrist region, with phlebolith, 3mm. in diameter. The tumor mass looked like strawberry in shape, and was scattered into all tendon sheath of flexors of the forearm, median nerve, the distal half of pronator quadrtus and other surrounding soft tissues. The specimen was confirmed as cavernous hemangioma in microscopic examination. The right long arm splint was applied for 3 weeks, and then the patient was treated with physical therapy for 4 months. Pinching, opposition, and motion of the right wrist joint recovered almost completly, and no evidence of the recurrence of hemangiomatosis was seen until 8 months after surgery.
Arm ; Forearm ; Fragaria ; Hemangioma, Cavernous ; Humans ; Male ; Median Nerve ; Recurrence ; Sensation ; Splints ; Tendons ; Wrist ; Wrist Joint

No abstract available.
Animals ; Jaundice, Obstructive* ; Liver Regeneration* ; Liver* ; Rats*

The effect of flunitrazepam on circulation and respiration as an anesthetic induction agent was studied in 28 patiens(11women, 17men) undergoing open heart surgery and sortocoronary bypass graft surgery. The body weight varied between 30~69kg and the age ranged from 10~79yrs. They patients were premedicated with diasepam, triflupromasine, hydroxysine, pethidine and atropine in 19 cases, and morphine, hydroxysine and morphine, hydroxysine and atropine in 9 cases. Before the induction of anesthesia, Hartmann's solution was injected to maintaman adequated preload(CVP). Anesthesia was induced with flunitrazepam 0.03mg/kg and pressure pulse and respiratory rate were continuously monitored for 3 mintues. There after morphine 0.3mg/kg and pancuronium 0.1~1.15mg/kg were injected for endotracheal intubation. AFter the injection of flunitrazepam, spontaneous breathing in room ari was maintained in 19 cases even though the respiratory rate was somewhat decreased. The remaining cases were assisted in this respiration with oxygen because of severe respiratory depression or for prophylaxis of hypoxia in angina cases. Arterial blood gas tension showed normal ranges in all cases 3 min after flunitrazepam injection. Pulse rate, systolic and diastolic blood pressure were decreased 8.66%, 16.32%, and 15.9% respectively: however these are still within normal range. And those parameters were increased transiently following intubation as when other induction agents are used. From the above results, it can be concluded that flunitrasepam can be used safely as an induction agent in cardiac anesthesia with adequate preload and ventilation maintenance.
Anesthesia ; Anoxia ; Atropine ; Blood Pressure ; Body Weight ; Flunitrazepam* ; Heart Rate ; Humans ; Intubation ; Intubation, Intratracheal ; Meperidine ; Morphine ; Oxygen ; Pancuronium ; Reference Values ; Respiration ; Respiratory Insufficiency ; Respiratory Rate ; Thoracic Surgery* ; Transplants ; Ventilation

The ICU at Severance Hopital was opened with 7 beds on October 18, 1968 and expanded to 19 beds on February 2, 1981. From 1970-977, We statistically analyzed 3,072 ICU patients. During the period of years from March 1975 to February 1982, We have analyzed clinically 4,348 ICU patients. The Results were as Follows: 1) During the 7 years the total number of patients was 4,383. ln 1981, 1063 patients were admitted to the ICU: this number being almost twice that of in 1980. 2) During the 7 years, the overall mortality was 15.1%, highest in 1976(30.1%) and lowest in 1979(11.5%). It has decreased annually, 12.4% in 1980, 12.3% in 1981. 3) Total admission days in ICU were 18,148 days, the average patient stay in ICU being 4.17 days. The majority of the patients(81.2%) stayed in ICU less than 5 days. The number of patients staying in ICU more than 6 days increased every year from 14.2% in 1975 to 22% in 1981. 4) About 50% of the patients admitted were under the forties-age group. The number under the teens old group was 19%, this group representing the highest number of patients admitted to the ICU. The highest mortality(18.5%) occurred in the 1 to 10 yearold-age group. 5) The number of patients admitted to the department of internal medicine was 1,574 cases, which was the highest among all departments. The mortality rate was highest in the neurosurgery department(41.9%). In 1981, the number of ICU patients in cardiac surgery and pediatrics was increased three time compared with that of 1975. 6) All ICU patients have been divided into two categories, operative and non-operative cases. The operative cases were 2,150, non-operative cases 2,198 cases. Mortality rate was 10% in operative cases, 20% in non-operative cases. 7) Case expired from march 1981 to February 1982: The number of expired parients including those with a poor prognosis was 183 cases. The number of patients that expired under the 10-year-age group was the highest, 78 cases. The cases that expired in internal medicine and pediatrics were 63 and 58 cases respectively. The causes of death were due to damage of central nervous system, cardiovascular system, respiratory system in that order. From the above results, it can be concluded that in spite of an increase in patients, the mortality rate has decreased annually.
Adolescent ; Cardiovascular System ; Cause of Death ; Central Nervous System ; Humans ; Intensive Care Units* ; Critical Care* ; Internal Medicine ; Mortality ; Neurosurgery ; Pediatrics ; Prognosis ; Respiratory System ; Thoracic Surgery

The infection by Helicobacter pylori(H.pylori) is known to be closely related with chronic gastritis, gastroduodenal ulcer and gastric cancer, although there is no direct evidence that shows clear "cause and effect" relationship between H.pylori and gastric cancer. The authors evaluated the infection rate by H.pylori in 45 gastric cancer patients who underwent resection for 1 month period of June 1996. Preoperatively, we checked for the presence of anti-H.pylori IgG by blood sampling of 45 patients. At operation, we excised 2 pieces of gastric mucosa from resected gastric specimen as soon as the stomach was resected, and embedded the pieces of mucosa in the commercially available CLO kit for urease test. The specimen was sent to pathologist for detection of H.pylori as well as staging of the tumor. 35 cases out of total 45 patients showed seropositivity for anti-H.pylori IgG (77.8% seroprevalence rate). But only 23 patients(51.1%) were positive by CLO test. The authors think the low detection rate by CLO test was due to 1)disappearance of H.pylori from the atrophic mucosa surrounding the cancer tissue, 2)inadequate tissue sampling from gastric specimen 3)delayed sampling after inactivation of the organisms, or 4)insufficient number of organisms in obtained tissue. The detection rate by pathologists with tissue stain was also low(12/45, 26.7%). Therefore, we conclude that the detection of H.pylori infection in gastric cancer patients can best be done by serological evlauation of anti-H.pylori antibodies.
Antibodies ; Gastric Mucosa ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin G ; Mucous Membrane ; Peptic Ulcer ; Seroepidemiologic Studies ; Stomach ; Stomach Neoplasms* ; Urease

Hexamethonium with propranolol was used to produce hypotension in 3 selected patients, ages 45 to 56, for neck deasection with thyroidectomy, Mile's operration and total laryngectomy with radical neck dissection. These cases were promedicated by lorazepam, anesthesia was induced and intubated following propranolol, morphine, diazepam and alcuroninum, and maintained with halothane, nitrous oxide and oxygen. Respiration was controlled by an anesthesia ventilator. Following elevation of the operation site, small amount of hexamethonium was injected to produce a dry surgical field. Systolic blood pressure was maintained around 80mmHg. Average doses of hexamethonium used were 0.12mg/kghr and propranolol 0.5 to 1 mg respectively. Judicious administration of sufficient doses of propranolol to lower the heart rate before and during hexamethonium induced hypotension reduces both the hexamethonium dose requirement and also the likelihood of developing individual variations in its effect.
Anesthesia* ; Blood Pressure ; Diazepam ; Halothane ; Heart Rate ; Hexamethonium* ; Humans ; Hypotension ; Laryngectomy ; Lorazepam ; Morphine ; Neck ; Neck Dissection ; Nitrous Oxide ; Oxygen ; Propranolol* ; Respiration ; Thyroidectomy ; Ventilators, Mechanical

No abstract available.
Wilms Tumor*

Continuous assessment of arterial oxygenation is important in the clinical management of critically ill patients. Analysis of arterial blood gas is reliable but is invasive and only provides intermittent informations. In order to determine the accuracy of pulse oximeters in ICU patients, arterial oxygen saturation was measured in 58 patients in ICU using two kinds of pulse oximeters (Ohmeda, CSI), while simutaneously analyzing arterial blood gases. The relationship between the pulse oximeters saturation (SpO2) and arterial oxygen saturation (SaO2) was evaluated, Group l consisted of 102 samples of SpO2 using an Ohmeda pulse oximter in 45 of 72 patients. Group ll included 102 samples of SpO2 using a CSl pulse oximeter in 45 of 72 patients. Both Ohmeda and CSI pulse oximeters were applied to 32 patients. Group lll had 204 samples, thE Sum of Groups l and ll. The results were as follow ; 1) The correlation coefficients of SpO2 to SaO2 in Groups l, ll and lll were 0.97, 0.90 and 0.96 (p < 0.775). 2) Mean difference between SaO2 and SpO2 in Groups l, ll and lll were almost within the limit of 1%. 3) The correlation coefficient of SpO2 between Ohmeda andcsr pulse oximeter was 0.79, and there was no mean difference between them in the 32 patients who were tested with both the Ohmeda and the CSI pulse oximeters. In conclusion, a pulse oximter is an accurate noninvasive device which assesses arterial oxygenation and provides information continuously. Wider clinical indication will follow.
Critical Illness ; Gases ; Humans ; Oximetry* ; Oxygen

The authors have experienced 9 cases of postgastrectomy efferent loop obstruction during the past 16 months' period and analyzed the clinical features, radiological findings, causes, and types of obstruction. The incidence of efferent loop obstruction was 1.3%(9/673). Among the 9 cases, eight patients were male and one patient was female. Median age was 60 years and more than half(5 out of 9 cases) of the patients were obese(defined by more than 110% of ideal body weight). None of the cases showed signs of strangulation, including persistent pain, fever, focal abdominal tenderness, and/or leukocytosis. Gastrointestinal anastomoses were done using a GIA stapler in 6 cases, and manually in 3 cases. The diagnoses were made on the basis of clinical symptoms and signs, further supported by radiologic contrast studies. All the patients were initially treated with conservative measures, including nasogastric drainage and fluid therapy for about 2 weeks in average. 7 cases underwent re-laparotomy using separate left subcostal incisions as conservative management had failed. Among the relaparotomy cases, adhesiolysis and side to side jejunojejunostomy were performed in 5 patients, Roux-en-Y gastrojejunostomy in 1 patient, and gastrojejunostomy revision in 1 patient. Causes of the obstruction in the seven re-opened cases were confirmed as postoperative adhesion. The authors have analyzed the pattern of obstruction and classified the patterns into 4 types. One of the remaining two patients underwent balloon dilatation successfully and the other was managed with prolonged nasogastric decompression. The average hospital stay was 32 days. Adequate omentectomy, gentle tissue handling during dissection, avoidance of ischemia along the suture line of anastomosis, and the use of biologically inert suture material would prevent this kind of postoperative adhesive obstruction.
Adhesives ; Decompression ; Diagnosis ; Dilatation ; Drainage ; Female ; Fever ; Fluid Therapy ; Gastric Bypass ; Humans ; Incidence ; Ischemia ; Length of Stay ; Leukocytosis ; Male ; Stomach Neoplasms ; Sutures

We had examined the invasive blood pressure monitoring of superficial temporal, radial and femoral artery in two eases of Takayasus syndrome with mitral regurgitation and acute renal artery infarction. Mitral valve replacement and aorto-renal bypass graft were done by using cardiopulmonary bypass and one-lung ventilation respectively, The results are ; 1) Superficial temporal artery monitoring was more reliable and less fluctuant than femoral and radial artery monitoring in blood pressure. But we dont know the relationship of adequate cerebral perfusion pressure and superficial temporal artery pressure. 2) The femoral artery pressure monitoring was not adequate when the patients had a problem with ascending and descending aorta patency. 3) We had good results in the patient management by the monitoring of superficial temporal artery pressure.
Aorta, Thoracic ; Blood Pressure Monitors* ; Blood Pressure* ; Cardiopulmonary Bypass ; Femoral Artery ; Humans ; Infarction ; Mitral Valve ; Mitral Valve Insufficiency ; One-Lung Ventilation ; Perfusion ; Radial Artery ; Renal Artery ; Temporal Arteries ; Transplants