To define the effectiveness of surgical management of the mallet finger deformity due to extensor tendon injury in children, we analyzed 9 patients who had operative treatment of mallet finger deformity in children from Jan. 1994 to Mar. 1997. The types of tendon injury in this series were as follows: 7 cases with tendon laceration, 1 case with crushing injury and 1 case with unknown injury The average period of follow up were ranged 2 years and 1 month. The clinical results were evaluated hy Kanies seale12) and Crawford scale5). An excellent result was obtained in 4 cases(44%), a good result in 5 cases(56%) according to Crawford scale and excellnt result in 9 cases(I00%) in Kanies scale, consecutively. Meticulous surgical repair of the lacerated tendon provided good result.
Child* ; Congenital Abnormalities* ; Fingers* ; Follow-Up Studies ; Humans ; Lacerations ; Tendon Injuries* ; Tendons*

In an attempt ultrastructural study of alcohol-induced gastric mucosal change, we selected sixty Sprague-Dawley rats. The rats were administrated with 4 ml of 10% and 40% ethanol enterically and examined by light and electron microscopy. Light microscopically, the thickness of the mucus layer of both 10% and 40% ethanol groups was decreased. The antral mucosa revealed focal inflammatory infiltrates, disturbed glandular arrangements, and significant decrease of mucosal thichness and proper glands. On scanning electron microscopy, flattened or swollen mucosal epithelium and irregularly distributed gastric pits were seen in both experimental groups, and these changes were more severe in the groups of higher concentration and longer duration. On transmission electron microscopy, mitochondrial abnormalities with myelin-like materials and dilatation of endoplasmic reticulum and cytoplasmic blebs were observed. Also the mucus cells show significantly decreased mucus globules, increased fat vacuoles, and large autophagic vacuoles. These alterations were similar to those produced by ethanol in the liver and small intestine. This study indicates that, prolonged administration of ethanol induced chronic gastritis, especially chronic atrophic gastritis.
Rats ; Animals

Coronary artery bypass grafting (CABG) without extracorporeal circulation (ECC) is now an accepted technique of myocardial revascularization in selective cases of coronary arterial occlusive disease. We experienced a case of CABG without ECC in a 20 year old female patient with complete occlusion of the right coronary artery. Anesthesia was induced and maintained with fentanyl, midazolam and isoflurane. Nitroglycerine and dopamine were given to stabilize the hemodynamics during intra- and post-operative periods. And esmolol was administered with a loading dose of 30 mg over 1 min, followed by a continuous infusion of 50~100 g/kg/min to maintain the heart rate (50~60 beats/min) and systolic blood pressure (60~80 mmHg) during distal anastomosis. The patient was recovered uneventfully and discharged on the 8th postoperative day.
Anesthesia* ; Arterial Occlusive Diseases ; Blood Pressure ; Coronary Artery Bypass* ; Coronary Vessels* ; Dopamine ; Extracorporeal Circulation ; Female ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Isoflurane ; Midazolam ; Myocardial Revascularization ; Nitroglycerin ; Young Adult

Dynamic cardiomyoplasty is a recently introduced surgical method to improve myocardial performance. It consists of a placement of a skeletal muscle flap around the heart and stimulation of the flap in synchrony with ventricular contraction. We experienced a case of cardiomyoplasty in a 25 year old male patient with congestive heart failure. Anesthesia was induced and maintained with fentanyl, midazolam and isoflurane. The operation was performed for 8hrs without cardiopulmonary bypass and the patient was transferred to the intensive care unit. He was mechanically ventilated electively overnight and extubation was done 18hrs postoperatively. The patient was discharged home on the 40days after operation and improved in exercise tolerance. We report the anesthetic management and hemodynamic changes in a patient who underwent dynamic cardiomyoplasty.
Adult ; Anesthesia ; Cardiomyoplasty* ; Cardiopulmonary Bypass ; Exercise Tolerance ; Fentanyl ; Heart ; Heart Failure ; Hemodynamics ; Humans ; Intensive Care Units ; Isoflurane ; Male ; Midazolam ; Muscle, Skeletal

BACKGROUND: Thromboembolism is the major complication in patients with the insertion of cardiac prosthetic valves. The purpose of this study is evaluate the risk factors about the formation of left atrial thrombi after cardiac valve replacement. METHOD: Transesophageal(TEE) and transthoracic echocardiography(TTE) were done to evaluate postoperative cardiac condition in 98 patients with cardiac prosthetic valves from Jan. 1991 to Oct 1991. Several clinical and echocardiographic parameters were analyzied to evaluate the relationship with the formation of left atrial thrombi. RESULT: In univariate analysis, important factors related to the formation of left atrial thrombi are type of operation (p=0.027), postoperative left ventricular function(p=0.003), preoperative(p=0.037) and postoperative systolic ventricular size(p=0.024). However, in multivariate analysis postoperative left ventricular size(p=0.017), presence of previous thrombi(p=0.014), preoperative left atrial size(p=0.014) and postoperative left atrial size(p=0.014) are significant factors. CONCLUSION: Patients with high risk and low risk for the formation of left atrial thrombi after valve replacement can be identified by readily available clinical and echocardiographic variables.
Echocardiography ; Heart Valves ; Humans ; Multivariate Analysis ; Risk Factors* ; Thromboembolism

Jehovah,s Witnesses who require operation represent a challenge to the physician because of the patient,s refusal to accept blood transfusion. An orthotopic heart transplantation was succesfully performed in a 40-year old Jehovah,s Witness without use of any blood product. During the operation, cell saver was used for shed blood and aprotinin was administered intravenously. The use of blood conserving methods, meticulous operative technique and brisk postoperative diuresis has added to the efficacy of heart transplantation in this patient. Total postoperative drainage was 860 ml and the lowest hemoglobin level was 11.8 g%. The patient recovered uneventfully and discharged on the 60th postoperative day.
Adult ; Anesthesia* ; Aprotinin ; Blood Transfusion ; Disulfiram ; Diuresis ; Drainage ; Heart Transplantation* ; Heart* ; Humans ; Transplantation

No abstract available.
Thromboangiitis Obliterans*

BACKGROUND: Serious pulmonary complications after lung surgery increase morbidity and mortality in perioperative period. Ketamine hydrochloride produces strong analgesic effect in spite of the psychomimetic effects. Intravenous anesthesia with ketamine was performed in lung surgery of patients with decreased pulmonary function and compared with inhalation anesthesia with enflurane. METHODS: Sixty patients, scheduled for elective lung surgery, were randomly assigned to two groups. Patients received either enflurane (Group 1, n=30) or ketamine (Group 2, n=30) as main anesthetic drug. Blood pressure and heart rate were compared in preinduction, postinduction, postintubation, postincision, intraoperative period (30 minutes, 60 minutes) and recovery room between groups, and in each group. Arterial blood gas analysis was compared in preoperative period, intraoperative period and recovery room between groups. Postoperative psychological complications evaluated in group 2. RESULTS: Blood pressure and heart rate were significantly different in postinduction, postintubation and recovery room between groups. PaO2 in group 2 was higher than in group 1 during intraoperative period and recovery room. Postoperative psychological complications occured in 4 patients (13%) in group 2. CONCLUSIONS: Ketamine affords advantage over enflurane anesthesia in terms of PaO2 during intraoperative period and recovery room in lung surgery of patients with decreased pulmonary function.
Anesthesia ; Anesthesia, Inhalation* ; Anesthesia, Intravenous* ; Blood Gas Analysis ; Blood Pressure ; Enflurane* ; Heart Rate ; Humans ; Inhalation* ; Intraoperative Period ; Ketamine* ; Lung* ; Mortality ; Perioperative Period ; Preoperative Period ; Recovery Room

Ganglioneuroma is a very rare benign tumor, arising from the mature sympathetic ganglion cells. The majority of ganglioneuroma are diagnosed in patients older than 10 years and are mostly often located in the posterior mediastinum, followed by the retroperitoneum. Ganglioneuroma is fully differentiated tumor that contains no immature elements. In general, ganglioneuroma is found incidentally, and no symptoms manifested. Complete surgical excision of ganglioneuroma is the treatment of choice. Herein, we report one case of ganglioneuroma arising from the retroperitoneal sympathetic chains in a 52 years old female patients.
Female ; Ganglia, Sympathetic ; Ganglioneuroma* ; Humans ; Mediastinum ; Middle Aged

The pulmonary microvasculatures of rats were studied by injection replicas prepared from Mercox. This medium enabled us to easily obtain consistent, stable, and complete injected replicas of the pulmonary vasculature. In order to investigate the three dimensional structures of the tributaries of the bronchial artery, such as the capillary plexus and vasa vasorum, we performed a scanning electron microscopic(SEM) study of the vascular casts, using Mercox CL-2B as a media. The alveolar capillaries revealed hexagonal or pentagonal rings of vascular networks. In some areas, the vascular rings composed a square network, The bronchial tree was supplied by the bronchial arteries which form a coarse capillary extending as far as the terminal bronchioles. Occasionally the capillary plexus was connected with adjacent capillary networks in and around the alveolar walls. The walls of the pulmonary artery revealed only a single layer of the vasa vasorum, but those of the pulmonary vein were surrounded by more complicated and well developed vasa vasorum than the pulmonary arterial side. The mean diameters of the venous vasa vasorum are greater than the arterial vasa vasorum.
Rats ; Animals