Angiodysplasia of small bowel is uncommon and frequently undiagnosed and presents a taxing surgical problem. It is usually diagnosed for unexplained gastrointestinal bleeding. For the surgeon, the main technical problem is that the lesion is impalpable, and invisible to the naked eye, so it usually cannot be identified unless bleeds actively at the time of surgery. Arteriography gives a little information about wax and wane pattern of bleeding in the lesion. Endoscopy is often unfruitful because the majority of lesions are submucosal and rarely exceed a few millimeters in diameter. Transillumination of the intestinal wall from inside of the lumen to the outside in a dark room can define the precise vascular anatomy of the wall. The delicate lesion of the angiodysplasia can be identified by this transillumination method. We described a simple intraoperstive endoscopic translllumination technique used successfully to identify an angiodysplasia in the small bovwel prior to the bowel resecion. This report summarized our experience and review of literature.
Angiodysplasia* ; Angiography ; Endoscopy ; Hemorrhage ; Taxes ; Transillumination*

Angiodysplsia of the small bowel is uncommon, but provably remains frequently undiagnosed. In the small intestine, angiodysplasia presents a taxing surgical problem and is uauslly diagnosed for unexplained gastrointestinal bleeding. For the surgeon, the main technical problem is that even when identified by frequently impalpable, and invisible to the naked eye unless they are actively bleeding at the time of surgery. Ensocopy is often unfruitful because the majority of lesions are submucosal and rarely exceed a few milimeters in diameter. We described a simple intraoperative endoscopic transillumination technique used successfully to identify an angiodysplasia in the jejunum prior to the small bowel resection. This report summarized our experience and review of literature.
Angiodysplasia* ; Hemorrhage ; Intestine, Small ; Jejunum* ; Taxes ; Transillumination*

BACKGROUND: Transillumination of maxillary sinuses was an important method before the invention of X-rays. But as the more precise and valuable methods have been developed, its importance has been reduced in clinical practice. OBJECTIVES: To elucidate the vailidity of the transillumination in diagnosing the maxillary sinus diseases, the transillumination method was compared with the conventional PNS series. MATERIALS AND METHOD: We performed transillumination tests in 100 adults(48 males and 52 females). A fiberoptic cable with halogen light sorce was enough for the examination. The light detected in the face of examinee in the dark room was evaluated. We studied the clinical reliability of transillumination in representing the status of the maxillary sinus. RESULTS: For bilateral sinusitis group(N=48), transillumination matched with the conventinal PNS series in 64.6%(31/48) of the cases, unilateral sinusitis group(N=17) in 82.4%(14/17) and normal group(N=35) in 88.6%(30/35). The overall matched-rate was 75%(75/100). CONCLUSIONS: The transillumination is a helpful non-invasive mothod for clinical evaluation of the maxillary sinus conditions.
Humans ; Inventions ; Male ; Maxillary Sinus* ; Sinusitis ; Transillumination*

We experienced a rare case of traumatic displacement of the globe into the ethmoid sinus. A 66-year-old man sustained trauma of the right eye and orbit, which resulted in displacement of the globe into the ethmoid sinus. One day after injury, surgery was performed to restore the intact globe into position within the orbit. Ten days after the operation, light perception was noticed only when transillumination was placed into orbit. Trace test undergone 45 days after the operation, no sight were measured from right eye, and the movement of right eyeball was not possible in any direction. We believe that the nerve and extraocular muscles were severed against the floor of the orbit or severely traumatized as the globe entered the ethmoid sinus. This case is very rare and never reported in Korea. We treated by replacing the globe in the orbit surgically and reconstructing the orbital floor with acurate diagnosis by the Computed Tomography(CT) scan.
Aged ; Diagnosis ; Ethmoid Sinus* ; Humans ; Korea ; Muscles ; Orbit ; Transillumination

Since being introduced by Gauderer et al. in 1980, percutaneous endoscopic gastrostomy (PEG) has proved to be a safe and effective procedure that has become a popular way to establish long term enteral feeding in situations where oral intake is not possible. Indications of PEG are broad, with a few exceptions such as total obstruction of pharynx or esophagus and poor transillumination conditions. In those cases, percutaneous radiologic gastrostomy (PRG) or surgical gastrostomy is feasible. We reported a case of percutaneous radiologic gastrostomy (PRG) in locked-in syndrome patient.
Deglutition Disorders ; Enteral Nutrition ; Esophagus ; Gastrostomy* ; Humans ; Pharynx ; Quadriplegia* ; Transillumination

BACKGROUND: It has been recommended that lightwand tracheal intubation be used for cases in which there is difficult airway management. Transillumination of the soft tissue of the neck by the lightwand can lead to successful intubation; however, this depends on skin color, obesity, head position, angle and the bent length of the lightwand. The goal of this study was to compare the success rates of intubation on the first attempt and complications of lightwand orotracheal intubation that occurred when using the lightwand at angles of 60 degrees and 90 degrees. METHODS: One hundred forty eight patients of ASA physical status 1 or 2 were enrolled in this study. Patients in whom intubation had previously been difficult as well as patients who had the potential for difficult intubation were excluded from this study. Patients were randomly assigned to one of two groups: The lightwand bent in 60 degrees (LW60) group and the lightwand bent in 90degrees (LW90) group. Anesthesia was performed using propofol (2 mg/kg), fentanyl (1microg/kg) and rocuronium (0.9 mg/kg), and lightwand orotracheal intubation was attempted 2 minutes after the induction of anesthesia. The success rates of intubation, the number of attempts and their duration, as well as hemodynamic changes, resistance to the tube and complications that occurred during the procedure were recorded. RESULTS: In the LW90 group, resistance to the tube during lightwand intubation occurred in a significant number of patients (P < 0.05), however, there were no significant differences observed between the two groups with regard to the intubation success rates on the first attempt, the duration of intubation, hemodynamic changes and complications. CONCLUSIONS: Their were no significant differences observed between intubation success rates on first attempt and complications when using a lightwand bent to 60 degrees or 90 degrees in patients without any previously known airway abnormalities.
Airway Management ; Anesthesia ; Fentanyl ; Head ; Hemodynamics ; Humans ; Intubation* ; Neck ; Obesity ; Propofol ; Skin ; Transillumination

This case report involves tracheal intubation using i-gel(R) in combination with a lightwand in a patient with a difficult airway, classified as Cormack-Lehane grade 3. I-gel(R) was used during anesthesia induction to properly maintain ventilation. The authors have previously reported successful tracheal intubation on a patient with a difficult airway through the use of i-gel(R) and a fiberoptic bronchoscope. However, if the use of a fiberoptic bronchoscope is not immediately available in a patient with a difficult airway, tracheal intubation may be performed by using i-gel(R) and a lightwand in a patient with difficult airway, allowing the safe induction of anesthesia.
Airway Management ; Anesthesia ; Bronchoscopes ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngeal Masks ; Transillumination ; Ventilation

PURPOSE: There are several new surgical techniques for varicose vein surgery. Transilluminated Powered Phlebectomy (TIPP) and Endovenous Laser Therapy (EVLT) are accepted as useful surgical procedures for varicose veins. However, these techniques have some associated problems such as complications, remnant varicosities and are relatively expensive. We compared some of the new techniques with conventional methods and introduce new technique called Transillumination assisted EVLT (T-EVLT). METHOD: We reviewed cases with primary varicose veins involving the lower extremity in 217 patients managed by TIPP, EVLT and T-EVLT in the department of Surgery, Presbyterian Medical Center, from January 2003 to January 2007. RESULT: The distribution of age was the fifth decade (38.4%), fourth (23.8%) and third (15.2%), in order frequency. The male to female ratio was 1:1.43. The TIPP procedure had the lowest frequency of remnant varicosities (6.0%) but the second highest complication rate (17.9%). The EVLT procedure had a relatively low complication rate (9.5%) and good cosmetic results but the longest operation time and the highest frequency of remnant varicosities (21.6%). The T-EVLT procedure had the shortest operation time and the lowest frequency of remnant varicosities (19.5%) compared to the EVLT. CONCLUSION: Each of the operation methods had risks and benefits. The EVLT procedure had good cosmetic results and was easy to learn. However, had a relatively long operation time and many remnant varicosities. These problems may be overcome by the T-EVLT.
Female ; Humans ; Laser Therapy ; Lower Extremity* ; Male ; Protestantism ; Risk Assessment ; Transillumination ; Varicose Veins*

BACKGROUND: Although Lightwand and Glidescope have both shown high success rates for intubation, there has been no confirmation as to which device is most effective for difficult endotracheal intubation. We compared the Glidescope and Lightwand devices in terms of duration of intubation and success rate at the first attempt in a simulated difficult airway situation. METHODS: Fifty-eight patients were randomized to undergo tracheal intubation with either the Glidescope (Glidescope group, n = 29) or the Lightwand (Lightwand group, n = 29). All patients were fitted with a semi-hard cervical collar in order to simulate a difficult airway, and intubation was attempted with the assigned airway device. The data collected included the rate of successful endotracheal intubation, the number of attempts required, the duration of the intubation, as well as the interincisor distance, hemodynamic variables, and adverse effects. RESULTS: There was no difference between Glidescope group (92.6%) and Lightwand group (96.4%) in terms of success rate for the first attempt at intubation. The duration of successful intubation for the first tracheal intubation attempt was significantly longer in Glidescope group than in Lightwand group (46.9 sec vs 29.5 sec, P = 0.001). All intubations were completed successfully within two intubation attempts. The incidence of hypertension was significantly higher in Glidescope group than in Lightwand group (51.9% vs 17.9%, P = 0.008). CONCLUSIONS: In a simulated difficult airway situation, endotracheal intubation using Lightwand yielded a shorter duration of intubation and lower incidence of hypertension than when using Glidescope.
Airway Management ; Hemodynamics ; Humans ; Hypertension ; Incidence ; Intubation* ; Intubation, Intratracheal ; Laryngoscopes ; Transillumination

OBJECTIVETo assess the value of video-urodynamic study (VUD) in the identification of lower urinary tract voiding dysfunction in female.

METHODSA total of 126 female patients with sign and symptoms of lower urinary tract voiding dysfunction underwent VUD from December 2008 to January 2011 in Beijing Chaoyang Hospital. The causes of voiding dysfunction were analyzed based on VUD findings.

RESULTSNeurogenic voiding dysfunction was found in 30 patients (23.8%), non-neurogenic voiding dysfunction was found in 96 patients (76.2%). The 72 patients suffered from recurrent urinary tract infection (57.1%) and 23 patients suffered from hydronephrosis (18.3%). Based on special characteristics of video-urodynamic study, a total of 126 patients were classified as: (1) Bladder outlet obstruction (BOO) was found in 65 patients. Of them, bladder neck obstruction in 40 patients (61.5%), their VUD showed "high pressure-low flow" obstructive curve and synchronic image showed bladder neck did not open in a funnel shape and no contrast was found in urethra. Distal urethral stricture in 22 patients (33.8%), VUD showed "high pressure-low flow" obstructive curve and synchronic image showed bladder neck open in a funnel shape, proximal urethra dilated and no contrast was found in distal urethral. Urethral sphincter obstruction in 3 patients (including detrusor-sphincter dyssynergia in 1 and sphincterismus in 2 patients), VUD showed "high pressure-low flow" obstructive curve and synchronic image showed bladder neck open in a funnel shape, sphincteric urethra did not open, proximal urethra dilated and no contrast was found in distal urethral. (2) Detrusor areflexia (DA) was found in 39 patients (2 patients with hydronephrosis), the VUD finding was: no voluntary detrusor contraction in voiding phase, and abdominal pressure voiding pattern. (3) OAB was found in 3 patients, which VUD findings was frequent involuntary detrusor contraction at storage period with or without urine leakage. (4) Low compliance bladder was found in 17 patients (13.5%), 16 patients with hydronephrosis, the VUD showed that increased bladder storage pressure with significantly decreased bladder safe capacity and compliance, appearance of the bladder as "Christmas tree", with or without ureteral reflux. (5) And stress urinary incontinence (SUI) was in 2.

CONCLUSIONSThe main causes of female BOO may be non-neurogenic conditions or organic obstruction. VUD would offer valuable information for confirmed diagnosis of voiding dysfunction in female patients.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Middle Aged ; Transillumination ; Urination Disorders ; diagnosis ; Urodynamics ; Young Adult