No abstract available.
Prostate*

Vacuum disc phenomenon is a collection of gas in the intervertebral disc space but rarely causes nerve compression. However, some rare type of vacuum phenomenon in the spinal canal may bring about posterior gas displacement within the epidural space. The authors describe two patients with symptomatic epidural gas-containing cyst that seem to be originating from vacuum phenomenon in the intervertebral disc, causing lumbosacral radiculopathy. Radiographic studies demonstrated intervertebral vacuum phenomenon and accumulation of gas in the lumbar epidural space compressing the dural sac and the nerve root. The nerve root in both patients was compressed by gas containing cyst that was surrounded by thin walled capsule separable from the gaseous degenerated disc space. The speculative mechanism of the nerve root compression is discussed. The possibility of gas containing cyst should be considered in case of the nerve root compression in which epidural gas is present.
Displacement (Psychology) ; Epidural Space ; Humans ; Intervertebral Disc ; Radiculopathy ; Spinal Canal ; Vacuum

Saccular aneurysms of the distal anterior cerebral artery are relatively rare, ranging from 1.5 to 9.2% of all intracranial aneurysms. A 61-year old woman presented with headache and nuchal rigidity. Cerebral angiographic image demonstrated multiple aneurysms of the distal anterior cerebral artery. We report a case of multiple aneurysms of the distal anterior cerebral artery without other vascular anomalies.
Aneurysm* ; Anterior Cerebral Artery* ; Female ; Headache ; Humans ; Intracranial Aneurysm ; Middle Aged ; Muscle Rigidity

BACKGROUND/AIMS: To reduce the rate of recurrence and to prevent postoperative liver failure, it is necessary to determine the extent of hepatic resection preoperatively in primary liver cancer patients. The aim of this study was to examine the clinical significance and correlation among several preoperative liver function tests. METHODS: Twenty-nine patients who underwent hepatic resection for hepatocellular carcinoma from November 1994 to March 1995 at the Department of Surgery, Seoul National University Hospital were analyzed. Fifteen patients had gross cirrhosis. Major resections were performed in two patients, segmentectomy in 6 patients, subsegmentectomy and limited resection in 21 patients. Maximal removal rate of indocyanine green (ICG Rmax), ICG retention rate at 15 min(ICG R15), oral glucose tolerance test(oral GTT), arterial ketone body ratio(AKBR) and computed tomographic volumetry, as well as conventional liver function test and prothrombin time were done preoperatively. RESULTS: There were significant correlations among Child's class, prothrombin time and ICG R15. AKBR, oral GTT, ICG Rmax, liver volume had no correlations with any other tests. Liver failure occurred in 2 patients(6.9%). No tests, except ICG R15, could predict the patients with liver failure. ICG R15 value of these two patients were 27% and 29%, respectively while those of the remaining 27 patients ranged from 1 to 22% (mean 11.9%). CONCLUSION: Neither standard liver function tests nor hepatic function studies such as AKBR, oral GTT, CT volumetry were useful as preoperative prognostic indicators in hepatic resection. ICG R15 test is a simple test and good predictor of liver failure after hepatic resection.
Carcinoma, Hepatocellular ; Fibrosis ; Glucose Tolerance Test ; Hepatectomy ; Humans ; Indocyanine Green ; Liver ; Liver Failure ; Liver Function Tests ; Liver Neoplasms ; Mastectomy, Segmental ; Prothrombin Time ; Recurrence ; Seoul

BACKGROUND: Postoperative pain control is provided for humanitarian reasons and to alleviate nociception-induced responses, such as endocrine metabolic responses, autonomic reflexes, which have adverse effects on organ function, and other undesirable results. Of the various methods of treatment, patient-controlled analgesia (PCA) is considered the gold standard for the of control postoperative pain. PCA can be administered via intraveous, epidural, or subcutaneous routes. Although patient-controlled epidural analgesia (PCEA) has been compared to IV-PCA, there is no optimal administrative route for the treatment of postoperative pain. This randomized study compared the effectiveness of PCEA and IV-PCA on postoperative pain and the side-effects after gynecologic surgery. METHODS: Ninety-seven patients undergoing gynecologic surgery were randomly assigned to receive either IV-PCA using a mixture of morphine and ketorolac or PCEA using 0.1% bupivacaine and morphine. Pain intensity was tested using a visual analog scale (VAS) until postoperative day 2. Nausea, vomiting, sedation, and pruritus were also measured. RESULTS: Among the 97 patients, 12 patients were excluded during study. Pain relief was better at rest and after coughing in the PCEA group during the 2 postoperative days, except at the first visit. Additional analgesics were used significantly less in the PCEA group, whilst the incidence of other complications was comparable in the IV-PCA and PCEA groups. CONCLUSIONS: After gynecologic surgery, PCEA using bupivacaine and morphine provides better pain relief than IV-PCA using morphine and ketorolac.
Analgesia, Epidural ; Analgesia, Patient-Controlled* ; Analgesics ; Bupivacaine ; Cough ; Female ; Gynecologic Surgical Procedures ; Humans ; Incidence ; Ketorolac ; Morphine ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Pruritus ; Reflex ; Visual Analog Scale ; Vomiting

BACKGROUND: Remifentanil is a novel, ultra-short acting opioid. This study was performed to compare the hemodynamic responses of remifentanil and nitrous oxide under propofol-based anesthesia during the intraoperative period. METHODS: Forty patients undergoing gynecologic surgery were randomly allocated to either remifentanil (R group) or N2O group (N group). In the R group, remfentanil was continuously infused from the induction of anesthesia (0.5 microgram/kg/min) to the end of surgery (0.1-0.5 microgram/kg/min). In the N group, fentanyl (2 microgram/kg) was injected intravenously and N2O was used thereafter. In both groups, target-concentration infusion of propofol was applied. We compared mean arterial pressure (MAP) and heart rate (HR) before and after tracheal intubation and during the rest of anesthetic time between the two groups. Postoperative parameters such as nausea/vomiting, consciousness level and pain at 2 and 24 hours were also compared. RESULTS: The magnitude of MAP and HR after tracheal intubation were significantly smaller and more stable in the R group than in the N group. Hypertensive (systolic blood pressure > 140 mmHg) episodes were significantly less frequent in the R group (3.0%) than in the N group (12.4%) during the operation. R group showed less MAP (76+/-12 mmHg) and HR (61+/-10 bpm) compared with those of N group (86+/-17 mmHg, 63+/-8 bpm, P < 0.05 respectively). Other postoperative measures were comparable between the two groups. CONCLUSIONS: We conclude that the continuous infusion of remifentanil can provide more stable hemodynamic status than N2O without significant adverse effects, in propofol-based general anesthesia.
Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Blood Pressure ; Consciousness ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics ; Humans ; Intraoperative Period ; Intubation ; Nitrous Oxide ; Propofol

PURPOSE: To elucidate the effects of pentoxifylline and diltiazem on the late response of the salivary glands of the rat after irradiation. MATERIALS AND METHODS: Sixteen Sprague-Dawley rats were divided into 4 groups : (a) irradiation alone (b) irradiation with pentixifylline (PTX) (c) irradiation with diltiazem (DTZ) (d) irradiation with both PTX and DTZ. Irradiation was given in a single fraction of 16 Gy using 4 MV photon energy through an anterior port encompassing the left side of the salivary gland leaving the right side of salivary gland as a contol. PTX, 20 mg/kg and/or DTZ, 50 mg/kg were infused intraperitoneally before irradiation. Two rats from each group were sacrificed on the 10th week and the rest was sacrificed on the 16th week after irradiation. Histopathologic examinations were undertaken for each section and the proportion of vacuolated cells out of the total number of cells under light microscopic fields was calculated. The statistical significance in the difference of the proportion of the vacuolated cells among the experimental groups was evaluated by a x2-test. RESULTS: Irradiated salivary glands of the 10th week group revealed markedly increased number of vacuolated cells compared to those of unirradiated control. The proportion of vacuolated cells was significantly reduced in both the PTX group (p value=0.001) and the combined PTX and DTX group compared to those of irradiation alone group. The DTZ alone group did not reveal the significant reduction of vacuolated cells compared to those of irradiation alone group (p value, >0.05). The 16th week groups revealed similar findings to those of the 10th week group, but the degree of chronic inflammatory cell infiltrates and interstitial fibrosis was increased and the number of acinar cells was reduced compared to those of the 10th week group. CONCLUSIONS: PTX significantly reduced the late radiation response of salivary glands, but DTZ did not reduce the same degree as PTX did. Taking the positive results of this study into consideration, it seems reasonable to apply PTX into the clinical trial for the head and neck irradiation to reduce the late radiation sequelae of salivary glands in the near future. At the same time the further experiment to clarify the subcellular mechanisms involved in PTX should be preceded.
Acinar Cells ; Animals ; Diltiazem* ; Fibrosis ; Head ; Neck ; Pentoxifylline* ; Rats* ; Rats, Sprague-Dawley ; Salivary Glands*

A case of congenital diaphragmatic eventration on the right and central tendinous portion with accessory hepatic lobe causing direct compression of the right heart is presented. We have performed the video assisted thoracoscopic plication of the right hemidiaphragm and eliminated the mass effect of the accessory hepatic lobe.
Diaphragmatic Eventration* ; Heart ; Thoracoscopy

BACKGROUND: The interscalene brachial plexus block is widely used for pain control and anesthetic purposes during shoulder arthroscopic surgeries and surgeries of the upper extremities. However, it is known that interscalene brachial plexus block is not appropriate for upper limb surgeries because it does not affect the lower trunk (C8-T1, ulnar nerve) of the brachial plexus. METHODS: A low approach, ultrasound-guided interscalene brachial plexus block (LISB) was performed on twenty-eight patients undergoing surgery of the upper extremities. The patients were assessed five minutes and fifteen minutes after the block for the degree of block in each nerve and muscle as well as for any complications. RESULTS: At five minutes and fifteen minutes after the performance of the block, the degree of the block in the ulnar nerve was found to be 2.8 +/- 2.6 and 1.1 +/- 1.8, respectively, based on a ten-point scale. Motor block occurred in the median nerve after fifteen minutes in 26 of the 28 patients (92.8%), and in all of the other three nerves in all 28 patients. None of the patients received additional analgesics, and none experienced complications. CONCLUSIONS: The present study confirmed the achievement of an appropriate sensory and motor block in the upper extremities, including the ulnar nerve, fifteen minutes after LISB, with no complications.
Analgesics ; Arthroscopy ; Brachial Plexus* ; Humans ; Median Nerve ; Shoulder ; Ulnar Nerve ; Ultrasonography* ; Upper Extremity*

Surgical fires require an ignition source, oxidizer, and fuel. The pulsed dye laser (PDL) has been shown to be effective in the treatment of hypertrophic scars and keloids in dermatology. With the increasing number of applications of CO2, laser as ignition source has been associated with operating room fires in the otorhinolaryngologic field. There have been many case reports on PDL-induced fires in dermatology, but until now, there were no reports in the larynx. We describe a 57-year-old patient diagnosed with laryngeal hyperkeratosis treated by PDL-assisted laryngomicrosurgery. In this case, we experienced incidental PDL tip flaring during pulsed dye laser vaporization.
Cicatrix, Hypertrophic ; Dermatology ; Fires ; Humans ; Keloid ; Larynx ; Lasers, Dye* ; Microsurgery ; Middle Aged ; Operating Rooms ; Volatilization