Classification of Intrahepatic Duct Stones and Analysis of Operation Methods

PURPOSE: Intrahepatic duct stones have been known to be a benign disease but because of the associated serious complications and the high recurrence rate, the management of the hepatolithiasis is very difficult. This purpose of this study was to classify the patterns of intrahepatic duct stones, and to evaluate the effect of surgical treatment according to their type and the residual stones that were present. METHODS: The clinical records of 212 patients who underwent a hepatic resection or drainage procedures between January 1988 and December 2000 were reviewed. RESULTS: We classified the intrahepatic duct stones as being either a localized simple type, a localized complicated type, a diffuse simple type, or a diffuse complicated type. Hepatic resections were performed in 177 (83.5%) cases. Among these we performed a hepatic resection along with drainage procedures in 41 cases (19.3%). In 35 (16.5%) cases, only drainage procedures were performed. Of a total of 25 cases of postoperative residual stones (25 cases), 13 (52%) cases were removed completely or partially by choledochoscopic procedures in 13 (52%) cases and in 15 (60.0%) cases they were removed completely or partially by spontaneous drainages. CONCLUSION: Our conclusions were that the, localized type of the IHD stones were treated successfully by a hepatic resection and the localized complicated type and the diffuse type IHD stones were treated effectively by hepatic resection and drainage procedures which reduced the opportunity for residual stones to develop following an accurate preoperative diagnosis of the location of the stones. Therefore, treatment methods should be individualized for each type of stone and by surgical treatments that combine endoscopic and resolution methods.

The Change in P300 Component of the Long Latency Auditory Evoked Potential with Diazepam Sedation / 대한마취과학회지

BACKGROUND: P300 component of the long latency auditory evoked potentials (LLAEPs) provides information on conscious and cortical funtion. The P300 wave occures only for stimuli that somehow capture the patients attention. Therefore LLAEPs implys a degree of cognitive processing. We studied sedation scale and P300 wave to determine if LLAEPs could be utilized as electrophysiologic predictors of sedation. METHODS: The P300 component of LLAEPs from vertex was recorded from 10 ASA physical status I and II patients undergoing elective surgery while they listened via headphones to a series of clicks which were interrupted unpredictably by a tone burst (2 KHz) before and after diazepam 0.04 mg/kg and 0.08 mg/kg IV. The patients were asked to concentrate on the clicks and to press a button whenever they detected a 2 KHz tone. And sedation scale also was measured. RESULTS: Amplitude of P300 was decreased and latency of P300 was increased in a dose-dependent manner with IV diazepam. Amplitude was greatest and latency was shortest in awake. And sedation scale also was increased according to increased IV diazepam adminstration. CONCLUSIONS: Both amplitude and latency may be highly related to the sedation scale with progressively increasing dose of diazepam. Therefore we conclude that P300 component of LLAEPs can be utilized as an electrophysiologic predictor of awareness and sedation.