Video-Assisted Thoracoscopic Surgery for Patent Ductus Arteriosus: 6 cases report / 대한흉부외과학회지

Surgical interruption through a left posterolateral thoracotomy and percutaneous transcatheter closure of ductus arteriosus were popular procedures of treatment. However, concerns over postthoracotomy syndrome and postoperative pain and complications such as persistent shun-ting, hemolysis, possible migration, and problem of prophylaxis against bacterial endocarditis in residual shunt were reported. Therefore, we present our procedure using video-assisted thoracoscopy for PDA clipping. 6 patients underwent video assisted-thoracoscopic clipping of PDA, but one case was converted into minithoracotomy. Postoperative examination showed the absence of murmur and decreased pulmonary vascularities progressively in all patients. In our series, we had no cases of ductal rupture during operation, incomplete ductal closure, pneumothorax, or hoarseness. Mean hospital stay was 3.4days. Postoperative echocardiography revealed no cases of ductal patency or residual shunt. We concluded that the technique described here is an effective procedure in view of the prevention of postthoracotomy syndrome, successful closure of ductus, cosmetic effect, and a short hospital stay.

Beating Heart CABG under Thoracic Epidural Block Combined with Light General Anesthesia in Renal Transplanted Patient / 대한마취과학회지

Beating heart CABG is defined as a CABG without cardiopulmonary bypass (CPB). Therefore there are no complications associated with CPB. So it is possible to extubate simultaneously with the end of the operation, and also it is effective to reduce the ICU time and the cost. Our team performed a beating heart CABG on a patient who had a history of renal transplantation, to avoid the renal complication due to CPB. We chose the thoracic epidural block combined with light general anesthesia as an anesthetic technique. We managed the patient successfully with consistent hemodynamic stability without the need of any drugs to induce bradycardia. We returned the patient to consciousness before extubation and extubated concurrently with the end of the operation. The patient maintained stable hemodynamics throughout the postoperative period, especially during the ICU stay and we controlled the pain via an epidural catheter with morphine and 0.125% bupivacaine for 3 days. The patient stayed in ICU only one day and was mobile on the second postoperative day. The patient was discharged without any complications, especially renal.

A Case of Eosinophilic Gastritis Mimicking Gastric Submucosal Tumor / 대한소화기내시경학회지

Eosinophilic gastroenteritis is an uncommon disorder characterized by eosinophilic infiltration of the bowel wall, usually associated with peripheral blood eosionphilia. It usually involves the stomach and small intestine simultaneously. If the stomach alone is involved, the lesion can sornetimes be misdiagnosed as a primary gastric neoplasm. We experienced a case of eosionphilic gastritis mistaken for gastric submucosal tumor. A 37-year-old man presented to our hospital with acute epigastric pain. Endoscopy showed gastric submucosal tumor in the antrum of the stomach. Endoscopic ultrasonography(EUS) revealed diffuse thickening of the 3rd and 4th layer of the stomach. The patient underwent gastric surgery under the impression that he had a gastic neoplasm.

Clinical Charateristics of Pyrethroids Poisoning / 대한내과학회지

OBJECTIVES: Pyrethroids are commonly used pesticides, and acute human poisoning by these insecticides is common in Korea. It has a high affinity to the sodium channel on cell membranes causing blockage, which results in neurotoxicity, hyperexcitation, and death. The purpose of this study was to analyze the clinical characteristics of acute pyrethroid poisoning. METHODS: To evaluate the clinical characteristics (age, sex, causative agents, cause of ingestion, severity of poisoning and its clinical feature, prognosis, complication and results of the treatment), we analyzed the clinical reports of 30 patients with pyrethroid poisoning who were admitted to Soonchunhyang Chunan hospital from January 1992 to July 1997. RESULTS: 1) 18 out of 30 patients with pyrethroid poisoning were male and the largest age group was above 60 years old. 2) The most common cause of ingestion was suicide, in 24 cases (80%). 3) There were 7 classes of causative agents of poisoning and all of these were classified into 2 grades according to the degree of WHO toxicity. Fenvlaerate and cypermethrin were the most common agents. 4) The degree of severity was classified into three groups - mild, moderate and life -threatened. Of these groups, mild poisonig was the most common. There was no significant difference in the age, type of pyrethoid and interval between pyrethroid ingestion and arriving at the emergency room between the three groups. However, the amount of ingestion was significantly higher in the life-threatened group. 5) The most common symptom of the patients was vomiting, in 19 patients. The classification were of three types (5 type I, 11 type II and 1 intermediate type) according to clinical characteristics. 6) There is no specific antidote, therefore therapy is generally supportive. There were three deaths, and the cause of death was respiratory failure. 7) The most common complication was pneumonia, in 3 cases (10%), which occured in almost all patients in the life-threatened group. CONCLUSIONS: The most common age group of poisoing was over 60 years old, and suicide was the most common cause of ingestion. Treatment is supportive, and most causal exposures require only decontamination. There were three deaths, and the cause of death was respiratory failure in each case. The most common complication was pneumonia.

A Case of Bronchial Foreign Body Removal During Trans-Laryngeal Mask Airway Fiberoptic Bronchoscopy / 결핵

Bronchial foreign body is not a rare disease in children and it is urgently necessary to remove this foreign body from the airway to relive life or to prevent further damages and complications. But the innate small size of airways in infants makes it difficult to access by interventional methods such as intubation or bronchoscopy and etc. Laryngeal mask airway is a new way of method of airway management which is relatively recently introduced into medical practice. It gives way to access to airways without reducing the size of airway or incresing airway pressure during procedure through it and have many other advantages compared to the previous traditional endotracheal intubation, especially in infants. We successfully removed a case of bronchial foreign body, peanut, via laryngeal mask airway during fiberoptic bronchoscopy and by this method we can avoid the unnecessary tracheostomy in this 1 year old infant.

The Parascalene Technique of Brachial Plexus Block for the Operation of the Upper Extremity and Shoulder / 대한마취과학회지

BACKGROUND: Brachial plexus is invested by a fascial envelope, which forms a perineural and perivascular space that extends all the way from the cervical intervertebral foramen to the distal axilla. Therefore a single injection of a local anesthetic into any sites of this space can provide anesthesia of the entire brachial plexus. Nowadays many methods of brachial plexus block have been developed but there are some severe complications and they can't prevent tourniquet pain completely. METHODS: We have performed parascalene technique for brachial plexus block in 206 cases from Jan., 1992 to Dec.,1994. We studied the cases retrospectively by reviewing patients' anesthesia records. The technique for parascalene block is the injection of local anesthetic solution into the lower part of the posterior triangle of the neck at the point 1.5~2.0 cm above the clavicle at the lateral border of the anterior scalene muscle. RESULTS: We could provide the proper anesthesia for the upper extremity and shoulder operation without any remarkable complications except Honor's syndrome of 3 cases. And there were no tourniquet pain in all 96 cases who had used tourniquet. CONCLUSIONS: The parascalene approach is the useful, safe and reliable method for brachial plexus block.

Effect of Lysodren(R) on the Ultrastructural Changes in the Rat Adrenal Corex: Immunohistochemical staining for anti-ACTH antibody on the adenohypophysis

The toxicity and adrenostatic effect of o,p'-DDD, a derivative of the insecticidal DDT, on the adrenal cortex were well known. It known that the toxicity was based on the blocking of steroid biopsynthesis when cholesterol was converted to pregnenolone. Lysodren(R) was also known to be capable of producing a regression of adrenocortical carcinoma and its metastases, and this drug became one of useful choice for the treatment of unoperable adrenocortical carcinomas. Recently, fine structural effect of o,p'-DDD on the adrenocortical carcinoma show that the mitochondria is the primary target organelle. o,p'-DDD was dissolved in corn oil and it was orally administered for 28 days to investigate the ultrastructural effects of zona fasciculata of rat adrenal cortex. The results obtained were as follow: 1) The body weight was decreased after feeding o,p'-DDD. 2) Light microscopic examination showed no remarkable change except increased fine lipid droplets of zona fasciculata in group I (o,p'-DDD 75 mg/kg feeding). Moderately increased intracytoplasmic lipid droplets and pyknotic nuclei bearing membrane indentations were seen in group II (o,p'-DDD 150 mg/kg feeding). Large sized lipid droplet aggregates, pyknotic nuclei with severe nuclear membrane indentations and karyorrhexis in focal area were evident in group III. 3) Immunohistochemical staining for ACTH in pituitary gland showed increasing number of ACTH secretory cell and increasing intensity of staining property according to the dosage of o,p'-DDD. 4) Ultrastructural examination showed increased intracytoplasmic lipid droplets and mild increased peroxisome. There was no remarkable ultrastructural changes in mitochondria in group I. Moderately increased lipid droplets and clusters formation, compressed mitochondria, partial disappearance of mitochondrial cristae, increased peroxisome and nuclear membrane indentations were seen in group II. In group III, nuclear membrane showed prominent indentation. Numberous cytoplasmic vacuolation, double membrane ring in mitochondria, disappearance of mitochondrial cristae, myelin figure formation in mitochondrial matrix, and fatty changes in mitochondrial matrix were seen. These findings showed that the primary target organelle of attack by o,p'-DDD on zona fasciculata of adrenal gland in rat is mitochondria and it was developed from double ring formation in mitochondrial matrix.