Cryoglobulinernia occurs in about 5% of the cases of multiple myeloma. The most common finding in patient with cryoglobulinemia is ulceraticn that oceurs about ankle, hands, and occasionally the ears, upon prolonged exposue to cold. A 59-year old male had had 5 years of pain in his ears. There were black or dark brown colored ischemic ulcerations on his both helix. He also had mottled purpuric patches on his both ankles. A test for cryoglobulinema was positive. X-ray examination of the skull showed multiple punched but lesions. The bone marrow study revealed myeloma cell infiltration.
Ankle ; Bone Marrow ; Cryoglobulinemia* ; Ear ; Hand ; Humans ; Male ; Middle Aged ; Multiple Myeloma* ; Skull ; Ulcer

Bony defect is one of the most common problems in craniomaxillofacial surgery. Although aurogenous bone graft is the best choice for the treatment of bone defect, it provides many problems such as donor site morbidity, irregular absorption, and limited amount of harvest. To overcome the shortcomings of autogenous bone graft many bone substitutes have been introduced. The ideal bone substitution is to have characteristics such as cheap, easy to obtain, rapid fusion to recipient bone, hard structure, long maintenance of shape and volume, low infection rate, and low exposure rate. Among those bone substitutes which have been widely used we chose lyophilized cartilage allograft because of low antigenecity, low resorption rate, easiness of carving and ling term preservation. From August 1993 to August 1997, 66 patients had been performed craniomaxillofacial reconstruction with lyophilized cartilage allograft. Orbital wall reconstruction and correction of enophthalmos were 24, correction of cleft lip and nose deformity were 19, temporal augmentations were 7, and others 16. Complications such as infection, exposure were not common. And partially removed cartilage was proved some calcification. Radiologic follow-up presented well positioned lyophilized cartilage allograft. Two radiologic works revealed haziness of bone density at the site of cartilage allograft. This suggests the ossification of lyophilized cartilage allograft. Together with liw infection rate, low exposure rate, and good framework for osteoconduction, lyophilized cartilage allograft are regarded as one of the good bone substitutes.
Absorption ; Allografts* ; Bone Density ; Bone Regeneration ; Bone Substitutes ; Cartilage* ; Cleft Lip ; Congenital Abnormalities ; Enophthalmos ; Follow-Up Studies ; Humans ; Nose ; Orbit ; Tissue Donors ; Transplants

Continuous epidural block was used for pain control during and after operation and for herpes zoster in two cases. A 63 year old male patient with herpes zoster on the right T 12 level for 2 weeks was treated by continuous epidural block. After 10 days, elective right inguinal hernioplasty was performed under epidural blocks by the previously inserted catheter. Postoperative pain and herpes zoster have been controlled in the same manner. Two weeks later, he was discharged without post-herpetic sequelae. The second case, a 82 year old man, was admitted with dysuria and also herpes zoster on the right T 10 level for 10 days. Using only continuous epidural block, suprapubic prostatectomy was done and post-operative pain was controlled. Two days later, the catheter was removed by the urological department. However, two weeks after operation, post-herpetic neuralgia developed and continuous epidural block was restarted for 2 weeks. Then epidural methylprednisolone injection, 2 times, and transcutaneous electrical stimulations were required for 3 more months for complete recovery. This indicated that continuous epidural block was beneficial not only for the treatment of herpes zoster but also for the prevention of post-herpetic neuralgia.
Catheters ; Dysuria ; Electric Stimulation ; Herniorrhaphy ; Herpes Zoster* ; Humans ; Male ; Methylprednisolone ; Neuralgia ; Pain, Postoperative ; Prostatectomy

A 27 year-old male patient, who had cervical tracheal stenosis due to accidental inhalation of zinc dichloride gas, underwent tracheal reconstruction (tracheal resection and end to end anastomosis). Preoperatively, a special radiologic study (tracheography), pulmonary function tests and arterial blood gas analysis were performed for accurate diagnosis (to determine the location, degree and extent of the stricture) and to detect any associated abnormalities in the lung-function. Atropine and diazepam were given for premedication. After intramuscular injection of ketamine and succinylcholine, orotracheal intubation was done above the lesion, and N2O and halothane were added for maintenance of anesthesia. Respiration was assisted or controlled when necessary with gallamine. The lesion was approached through an anterior transverse cervical incision. The trachea. was dissected clear and transected distal to the lesion. The distal tracheal segment was then intubated through the operating field with a sterile cuffed endotracheal tube (the 2nd tube). This was connected to the anesthetic machine. After resection of the lesion and anastomosis. of the posterior tracheal wall, the 2nd tube was removed and orotracheal tube was pushed into the distal trachea. After complete anastomosis the orotracheal tube was placed above the suture line.Continuous arterial blood gas analysis during and after anesthesia was helpful for evaluation of the state of arterial blood oxygenation and ventilation.
Adult ; Anesthesia* ; Atropine ; Blood Gas Analysis ; Diagnosis ; Diazepam ; Gallamine Triethiodide ; Halothane ; Humans ; Inhalation ; Injections, Intramuscular ; Intubation ; Ketamine ; Male ; Oxygen ; Premedication ; Respiration ; Respiratory Function Tests ; Succinylcholine ; Sutures ; Trachea ; Tracheal Stenosis ; Ventilation ; Zinc

Air can be used as a carrier for volatile agent, ether, with a clear airway, normal pulmonary function and normal oxygenation. In 1858 John Snow, the Father of British Anesthesia stated in his book on Chloroform and Other Anesthetics that he believed it to be almost impossible for death to occur from ether administered with ordinary intelligence and attention. Today ether is probably still the safest anesthetic drug we possess. Ether is cheap and easily obtained; with controlled respiration 3% is adequate. Recovery smooth and rapid. Vomiting may be no different from other agents. Most machines depend upon cylinders of oxygen and other gases, and there are difficulties of refilling cylinders and the cost of transporting them. In such circumstances the E.M.O. Inhaler, allowing ether to be vaporized in known concentrations in air, has many advantages as an alternative to the open method administration. From all types of patients chosen at random 22 patients were studied for ether-air anesthesia. Anesthesia was induced with intravenous thiopental and subsequent endotracheal intubation was performed within 30 seconds with the aid of intravenous succinylcholine. SatO2, PaO2, pH, and Base E. were measured 3 times during pre-anesthesia, immediately after the intubation, and post-operatively by Radiometer, using the oxy-hemoglobin dissociation curve and the Siggard-Anderson alignment nomogram. Vital signs were recorded every 5 minutes. It is the purpose of this paper to present this series of 22 anesthetics by the use of the E.M.O. Inhaler with air and to discuss the possibility of hypoxia, advantages and limitations that became apparent. The results obtained may be summarized as follows. 1. It is essential that endotracheal intubation by carried out rapidly and that everything necessary be ready and immediately at hand before starting the anesthetic. 2. In all patients ventilated room air during anesthetic induction, no significant decreases of PaO2 and SatO2 were observed immediately after the endotracheal intubation. 3. The duration of any period of complete apnea inflicted on the patient must be carefully controlled. 4. 100% oxygen prevented the possibility of hypoxia on extubation after all the reflexes had returned. 5. Ether-air anesthesia is recommended without hesitation for use where economy and portability of anesthetic machine are needed.
Anesthesia* ; Anesthetics ; Anoxia ; Apnea ; Chloroform ; Ether ; Fathers ; Gases ; Hand ; Humans ; Hydrogen-Ion Concentration ; Intelligence ; Intubation ; Intubation, Intratracheal ; Nebulizers and Vaporizers ; Nomograms ; Oxygen ; Reflex ; Respiration ; Snow ; Succinylcholine ; Thiopental ; Vital Signs ; Vomiting

No abstract available.
Gallstones* ; Lithotripsy* ; Ultrasonography*

Human untreated costal cartilage was compared with lyophilized human costal cartilage which was treated with defatting solution for 48 hours and freeze drying for 72 hours (-70degree C, 10??bar) on the tendency of distortion. All cartilages, which were taken from six cadavers, were carved 5x5x30mm in size on principle of the balanced cross section. Their distortions were evaluated by two methods at intervals of one week, one month, three months, six months after experiment. At first, the degree of distortion was grossly graded with four steps: grade O; no distortion / grade I; minimal distortion / grade II; moderate distortion / grade III; severe distortion. Second method is measurement and quantification of distortion in the horizontal and vertical plane of cartilage.Untreated cartilage is shown to be an unsatisfactory material, with only three(12%) of the 25 cartilages being cosmetically acceptable(grade 0 and 1) after 6 months. In lyophilized cartilage, 18(94%) of the 19 cartilages were cosmetically acceptable(grade 0 and 1) at 6 months. This figure is highly significant(p<0.01). In another method, distortion in the horizontal(h) and vertical (v) planes of cartilage were measured, and mean values of ???? were calculated. In untreated group, the mean values of ???? were 0.82 at 1 week, 0.91 at 1 month, 1.13 at 3 months, and 1.31 at 6 months. In lyophilized group, the mean values were 0.27 at 1 week, 0.29 at 1 month, 0.40 at 3 months and 0.47 at 6 months. All values were statistically significant(p<0.01).
Cadaver ; Cartilage* ; Freeze Drying ; Humans

To delineate the coronary anatomy and left ventricular function during early myocardial infarction, coronary arteriography and left ventriculogrphy were performed, prospectively in 23(22%) of 105 patients who were admitted to the coronary care unit at Masan Koryo Hospital from June 1986 to June 1988 within 4 weeks after the onset of symptoms(medium:21 days, range:18 days to 25 days). 1) Among 23 patients, male is 20 patients and female is 3 patients. The ratio of male to female was 6.6:1. The mean age was 55.4+/-10.3 years(range:34-77 years). 2) Coronary artery narrowing state which related to myocardial infarction was as follows; 2 patients(7%) had normal, 1 patients(4%) had insignificant narrowing(below 50%) 5 patients(22%) had moderate narrowing(50-75%), 10 patients(43%) had severe narrowing(75-99%), 5 patients(22%) had complete occlusion(100%). 3) The range of coronary artery disease was as follows; 9 patients had one vessel disease, 10 patients had two vessel disease, 1 patients had three vessel disease, and ejection fraction had no significant difference among 3 groups but lowest in three vessel disease. Among 23 patients, 13 patients had anterior infarction, 10 patients had inferior infarction. 4) Left ventricular ejection fraction and multiple vessel disease had no significant difference between i) the young(under 45 years old) and the old(over 45 years old) age groups, ii) presence or non presence of previous angina, iii) Killip classification I, II and III, IV) anterior infarction and inferior infarction. 5) In left ventriculography, akinesis and dyskinesis were shown at similar ratio in anterior infarction and inferior infaraction. Dyskinesis was shown in 27% of patients who have 0-1 vessel disease, 50% of patients who have 2-3 vessel disease, 62% of patients who have collateral circulation, 26% of patients who dose not have collateral circulation. 6) Collateral circulation was found in 8 patients(35%). Age and left ventricular ejection fraction were high in patients without collateral circulation than with collateral circulation, but there is no significant difference and collateral circulation exists regardless of infarction site and range of coronary artery disease. 7) As for the complication of angiocardiography in this study, there was ventricular tachycardia in 3 patients(13%) without mortality. It is concluded that coronary arteriography can be safely performed in early stage after acute myocardial infarction. Also good prognosis is anticipated since three vessel disease and complete occlusion were low in acute myocardiaol infarction of Korean People. Since these are not much case performed study, however more study on this area is required.
Angiocardiography ; Angiography* ; Classification ; Collateral Circulation ; Coronary Angiography ; Coronary Artery Disease ; Coronary Care Units ; Coronary Vessels ; Female ; Humans ; Infarction ; Male ; Mortality ; Myocardial Infarction* ; Prognosis ; Prospective Studies ; Stroke Volume ; Tachycardia, Ventricular ; Ventricular Function, Left

The sclerotium of Poria cocos Wolf, which grows on the roots of pine trees, has long been used as a sedative, diuretic, and anti-inflammatory agent. The accumulating data revealed that certain ingredients of the sclerotium of Poria cocos showed anti-tumor activities. Although the mechanism of anti-tumor activity is not known, the polysaccharides may potentiate the host defense mechanism through the activation of immune system. In the present study we show that PCSC22, a polysaccharide isolated from the sclerotium of Poria cocos with one percent sodium carbonate, significantly induces nitric oxide (NO). Immunohistochemical staining of inducible NO synthase (iNOS) showed that the increase of NO was due to the induction of iNOS production. To further study the mechanism responsible for the induction of iNOS gene expression, we investigated the effect of PCSC22 on the activation of p38 kinase, which is important in the gene expression of inflammatory cytokines including iNOS. Western blot assay showed that PCSC22 produced phosphorylation of p38 kinase. In conclusion, we demonstrate that PCSC stimulates macrophages to express iNOS gene through the activation of p38 kinase.
Blotting, Western ; Carbon ; Cocos* ; Cytokines ; Gene Expression ; Immune System ; Macrophages* ; Nitric Oxide ; Nitric Oxide Synthase ; Phosphorylation ; Phosphotransferases ; Pinus ; Polysaccharides ; Poria* ; Sodium ; Wolves

We had a case of respiratory difficulty following tracheal extubation due to bilateral vocal cord paralysis. The patient was a 66-year-old woman undergoing craniotomy for cerebellopontine angle meningioma. Anesthesia was uneventful. Spontaneous respiration resumed after reversal of neuromuscular blockade. Following extubation she showed inspiratory stridor, tachypnea, and chest retraction. Reintubation was done and then tracheostomy was performed. Every factor contributing vocal cord paralysis such as pressure on the nerve by an overexpanded endotracheal tube cuff, unique posture of the neck during the operation, and female gender, long operating time(about 11 hours) were seemed to be possible causes and we considered the interaction of these combinations responsible for the bilateral vocal cord paralysis. Eight weeks later, the patient's vocal cord function had returned to normal.
Aged ; Airway Extubation* ; Anesthesia ; Cerebellopontine Angle ; Craniotomy ; Female ; Humans ; Meningioma ; Neck ; Neuromuscular Blockade ; Posture ; Respiration ; Respiratory Sounds ; Tachypnea ; Thorax ; Tracheostomy ; Vocal Cord Paralysis* ; Vocal Cords*