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1.
Article in Korean | WPRIM | ID: wpr-82999

ABSTRACT

PURPOSE: The purpose of this study was to compare the short-term clinical outcomes of laparoscopy-assisted total gastrectomy (LATG) with conventional open total gastrectomy (OTG) for treating proximal early gastric cancer and to determine the usefulness of the LATG procedure. METHODS: The records of 21 patients who underwent LATG for proximal early gastric cancer from January 2004 to August 2006 were retrospectively reviewed and compared with those records of 20 patients who underwent OTG during the same period. RESULTS: The patient characteristics, including gender, age, body mass index and comorbidities, were similar between the two groups. Combined resections were more frequently done in the OTG group than in the LATG group. The blood loss in the LATG group was significantly less than that in the OTG group. The operating time, time to first flatus and initial oral intake and the postoperative hospital stay were significantly shorter in the LATG group. The number of resected lymph nodes, lymph node metastasis, histologic type, TNM stage, complications, leukocyte counts and serum lactic acid levels were not significantly different between the two groups. CONCLUSION: LATG is a technically safe and feasible procedure for treating proximal early gastric cancer. Prospective multi-center trials are necessary to establish LATG as the standard treatment for proximal early gastric cancer.


Subject(s)
Body Mass Index , Comorbidity , Flatulence , Gastrectomy , Humans , Lactic Acid , Length of Stay , Leukocyte Count , Lymph Nodes , Neoplasm Metastasis , Retrospective Studies , Stomach Neoplasms
2.
Article in Korean | WPRIM | ID: wpr-9882

ABSTRACT

Pulmonary lymphangitic carcinomatosis is a common secondary neoplasm of the lung that may result from hematogenous dissemination to small pulmonary arteries and arterioles followed by invasion of the interstitial space and lymphatics, or from the retrograde spread of tumors from mediastinal or hilar lymph nodes. Radiologically, irregular interlobular septal thickening, bronchovascular interstitial thickening and/or lymph node enlargement are observed. In this report, we describe an atypical radiological manifestation of lymphan-gitic metastasis of stomach cancer in a 37-year-old woman admitted for dyspnea on exertion and a cough which had been present for one month. HRCT scanning revealed bilateral multifocal ground glass opacity or consolidation, mild diffuse axial interstitial thickening, and slight pleural effusion. These findings were thought to indicate the existence of an air-space disease rather than metastasis. Open lung and endoscopic biopsy, however, demonstrated the presence of lymphangitic metastasis from stomach cancer.


Subject(s)
Adult , Arterioles , Biopsy , Carcinoma , Cough , Dyspnea , Female , Glass , Humans , Lung , Lymph Nodes , Neoplasm Metastasis , Pleural Effusion , Pulmonary Artery , Stomach Neoplasms
3.
Article in Korean | WPRIM | ID: wpr-114638

ABSTRACT

Sarcomatoid carcinoma is a rare neoplasm of epithelial origin but consists partly of variable differentiated tumor cells of mesenchymal origin. Accurate diagnosis, including differentiation from adenocarcinoma or gastrointestinal stromal tumor, is difficult. We experienced three cases of sarcomatoid carcinoma of the stomach, and describe the radiological and pathologic findings. One case involved a polypoid mass in the antrum, another a mass with a large ulcer mimicking a Bormann type-II adenocarcinoma in the body, while in the third case, an intraluminal bulky mass arising from the cardia of the stomach was present. This was not differentiated from cancer or stromal tumor.


Subject(s)
Adenocarcinoma , Cardia , Diagnosis , Gastrointestinal Stromal Tumors , Stomach , Ulcer
4.
Article in Korean | WPRIM | ID: wpr-113917

ABSTRACT

E. coli L-asparaginase treatment during induction therapy in acute lymphoblastic leukemia is known to be rarely complicated by thromboembolic events. It causes deficiencies of antithrombin III, plasminogen, fibrinogen, factor IX, XI, protein C and protein S. We recently experienced a case of infarction during induction therapy in a 9-year-old child diagnosed with ALL. After the four dose of L-asparaginase, she had a generalized tonic- clonic seizure and MRI of the head showed both occipital infarction. She had gross recovery of the neurological impairment in 4 days. We report this case with brief review of literature.


Subject(s)
Antithrombin III , Asparaginase , Cerebral Infarction , Child , Drug Therapy , Escherichia coli , Factor IX , Fibrinogen , Head , Humans , Infarction , Magnetic Resonance Imaging , Plasminogen , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Protein C , Protein S , Seizures
5.
Article in Korean | WPRIM | ID: wpr-38935

ABSTRACT

The infectious complications after renal transplantation remain as an important causes of both mortality and graft loss. The lung is the most common target for post-transplant infection. We analyzed the causative agents, treatments and outcomes of post-transplant pulmonary infections. From 1990 to 1998, 192 renal allografts were performed at Hallym University Hospital. Seven cases (3.6%) of 5 males and 2 females developed serious pulmonary infections and required hospitalization. The mean age was 42.6 years. The onsets of pulmonary infections were from a month to 6 months in 3 cases, from 6 months to a year in one case and after a year in 3 cases. Triple therapy regimen was used in 4 cases as an immunosuppression therapy. Acute rejections developed in 6 cases. Causative organisms were Cytomegalovirus in 2 cases, Mycobacteria in 2 cases, Aspergillus in a case, Nocardia in a case and unknown in a case. Despite appropriate antibiotics, four patients did not respond to the treatment and died. The early recognition of infection and appropriate therapy is important to reduce fatal consequence.


Subject(s)
Allografts , Anti-Bacterial Agents , Aspergillus , Cytomegalovirus , Female , Hospitalization , Humans , Immunosuppression Therapy , Kidney Transplantation , Kidney , Lung , Male , Mortality , Nocardia , Transplants
6.
Article in Korean | WPRIM | ID: wpr-125341

ABSTRACT

PURPOSE: To evaluate the radiological findings and effectiveness of radiological interventions in patientswith iatrogenic vascular injuries. MATERIALS AND METHODS: We analyzed 50 patients with iatrogenic vascularinjuries treated with radiological intervention. The causes of injuries were surgery(n=20), cardiovascularintervention(n=15), non-cardiovascular radiological intervention(n=14), and endoscopic intervention(n=1). Theinjury had resulted in hemorrhage in 35 cases. The iliac and/or femoral, hepatic, and renal vessels were commonlyinjured. Angiography, ultrasonography with Doppler examination, CT, and CT angiography were performed to diagnosevascular injuries and guide the radiological intervention. The mean follow-up period was 23 months and in 16 caseswas more than one year. RESULTS: The major radiological findings were extravasation, pseudoaneurysm,arteriovenous shunt, or vascular obstruction. To control these lesions, radiological interventions such asembolization(n=36), local urokinase administration, stent insertion, foreign body removal, ultrasonography-guidedcompression, or stent-graft insertion were performed. The clinical problems were immediately controlled by thesingle trials of radiological interventions and did not recur in 40 cases (80%). CONCLUSION: Radiologicalexaminations and interventions are useful in cases with iatrogenic vascular injuries.


Subject(s)
Angiography , Follow-Up Studies , Foreign Bodies , Hemorrhage , Humans , Stents , Ultrasonography , Urokinase-Type Plasminogen Activator , Vascular System Injuries
7.
Article in Korean | WPRIM | ID: wpr-214564

ABSTRACT

PURPOSE: To evaluate radiologic findnings of rhabodmyosarcoma of children in the head and neck concerning theorigin, morphologic characteristics, extent, and the route of intracranial extension on CT and MR. MATERIALS AND METHODS: Twenty cases of pathologically proven rhabdomyosarcoma were analyzed. Fifteen CT scans (postcontrast CT(n=13), precontrast CT (n=2)) and eleven MR scans were obtained. Postcontrast MR scans were performed in the tencases. Six cases had CT and MR scans. Nine cases had only CT scan and five had only MR scans. We retrospectivelyanalyzed the origin, morphologic characteristics (attenuation, signal intensity, margin), extent, intracranialextension, route and clinical staging of rhabdomyosarcoma on CT and MR scans. RESULTS: Out of the twentyrhabdomyosarcomas, sixteen cases were of parameningeal group. Ten cases of parameningeal group located in theinfratemporal fossa which was the most common site of origin. The mass showed iso-density in the 8 cases (62%) andhigh density in the 5 cases (38%) on the postcontrast CT scans compared with the muscle. All cases on the CT scanshowed homogenous attenuation of the tumor except one which showed internal necrosis. Twelve cases (80%) on preandpostcontrast CT scans (n=15) showed moderately-defined margin and the rest showed ill-defined margin. On MR scans,all the cases (n=11) showed iso- and high signal intensity on T1WI and T2WI, respectively. Strong enhancement ofthe mass was seen in all cases (n=10). Nine cases showed homogenous signal intensity of tumor on pre-andpostcontrast MR scan while 2 cases showed inhomogenous signanl intenisty because of hemorrhage(n=1) andnecrosis(n=1). Therefore the margin of rhabdomysarcoma on all pre-and postcontrast MR scans was well-defined. Theextent of rhabdomyosarcoma was various depending on corresponding origin and parameningeal group showed widerextent than other head and neck group. Infratemporal rhabdomyosarcoma showed expansile growth and intracranialextension via foramen ovale. Those in the middle ear invaded intracranium by directly destoying petrous bone andvia internal auditory canal. Those in the nasal cavity extended into intracranium by directly destroying skullbase of frontal lobe. Nasopharyngeal one extended into intracranium mainly by directly destroying base of skull orpartially via foramen ovale. Clinical Stage 1,2 and 3 were one, four and fifteen cases, respectively. CONCLUSION: Rhabdomyosarcoma of children in the head and neck tends to show relatively severe bony destruction of skull baseand various intracranial extension routes can be helpful radiologic findings on the CT or MR scan although its CTdensity or signal intensity of MR was not specific. And it is peculiar that infratempral fossa was the most commonsite of origin of rhabdomyosarcoma.


Subject(s)
Child , Ear, Middle , Foramen Ovale , Frontal Lobe , Head , Humans , Myosarcoma , Nasal Cavity , Neck , Necrosis , Petrous Bone , Rhabdomyosarcoma , Skull , Skull Base , Tomography, X-Ray Computed
8.
Article in Korean | WPRIM | ID: wpr-28324

ABSTRACT

PURPOSE: To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) and stent insertion incentral venous steno-occlusion. MATERIALS AND METHODS: Between August 1992 and January 1998, 11 patients with symptomatic central venous steno-occlusion(six stenoses and five occlusions) underwent pereutaneous treatment. Eleven PTAs were performed and stents were introduced in two patients because of incomplete PTA. During follow-up, a total of eight revisions were performed in five patients with recurrence(six stenoses and two occlusions). Success and long term patency rates were evaluated. The length and degree of the lesion and degree of residualstenosis, as well as pressure gradient through the lesion and decrease of the gradient after PTA, were correlated with patency rates. Complications during the procedures and follow-up period were evaluated. RESULT: The overall success rate was 89.5%; those of primary and revision intervention were 90.9% and 87.5%, respectively. Primary and revision patency rates were 72.7% and 50%, respectively, at 6 months, and 40% and 25% at 12 months. In five patients who underwent revision, primary and secondary patency rates were 80% and 100% at 6 months, 40% and 80% at 12 months, and 0% and 60% at 18 months. Only reduction of the pressure gradient after PTA correlated significantly with patency rates. No significant complications observed during the procedures follow-up period. CONCLUSION: PTA and stent insertion is effective for the treatment of central venous steno-occlusion.


Subject(s)
Angioplasty , Brachiocephalic Veins , Constriction, Pathologic , Follow-Up Studies , Humans , Stents
9.
Article in Korean | WPRIM | ID: wpr-216130

ABSTRACT

PURPOSE: To assess the diagnostic accuracy of dual-phase computed tomography during hepaticarteriography(CTHA) in depicting hypervascular hepatocellular carcinoma. MATERIALS AND METHODS: Forty patientswith hepatocellular carcinoma underwent dual-phase CTHA. First-phase data was obtained 6 seconds after contrastmedia was injected into the common hepatic artery, while second-phase data was obtained 35-40 seconds later.Lipiodol CT was performed 10-17 days after 2mL of lipiodol was injected into the proper hepatic artery. As agold-standard of 172 lipiodol-uptaken nodules seen on lipiodol CT, the detectability and positive predictive valueof the first and second phases, and the simultaneous interpretation of both phases, were analysed. RESULTS: Allnodules were detected by first-phase CTHA, 162 (94%) by second-phase CTHA, and 170 (99%) by simultaneousinterpretation of both phases. The detection sensitivities of first-phase CTHA and simultaneous interpretation ofboth phases were statistically superior to that of second-phase CTHA. Positive predictive values were 87% withfirst-phase CTHA, 96% with second-phase CTHA, and 97% with simultaneous interpretation of both phases. CONCLUSION: Dual-phase CTHA was useful for increasing detectability and accuracy in the diagnosis of hypervascularhepatocellular carcinoma.


Subject(s)
Angiography , Carcinoma, Hepatocellular , Diagnosis , Ethiodized Oil , Hepatic Artery
10.
Article in Korean | WPRIM | ID: wpr-122825

ABSTRACT

PURPOSE: To compare various breath-hold T2 weighted sequences in imaging normal pancreas with a phased-arraycoil. MATERIALS AND METHODS: Eighteen patients without pancreatic disease were studied with breath-hold turbo spinecho (TSE) (TR/TE/ETL, 3500/138/29), TSE with fat suppression (FS-TSE), half-Fourier acquisition single-shot turbospin echo (HASTE) (TE/ETL, 87/128) and HASTE with fat suppression (FS-HASTE) at 1.0T magnet strength and using aphased-array coil. Signal difference-to-noise ratio (SD/N) between the pancreas and peripancreatic fat wasmeasured ; the delineation of the pancreatic border and pancreatic duct, and the amount of artifact were evaluatedby two radiologists who reached a consensus. RESULTS: HASTE showed a higher SD/N than TSE or FS-HASTE (p < 0.01),TSE was superior to FS- TSE or HASTE in the delineation of pancreatic border(p < 0.001). HASTE was superior to TSEin the delineation of pancreatic duct(p < 0.001). TSE showed more artifacts than FS-TSE(p < 0.001) ; HASTE andFS-HASTE showed no artifact. CONCLUSION: TSE is better than HASTE for the delineation of pancreatic margin but HASTE shows less artifacts and a more conspicuous pancreatic duct. Fat suppression decreases artifacts but makes the pancreatic margin indistinct.


Subject(s)
Artifacts , Consensus , Humans , Magnetic Resonance Imaging , Pancreas , Pancreatic Diseases , Pancreatic Ducts
11.
Article in Korean | WPRIM | ID: wpr-122818

ABSTRACT

PURPOSE: To evaluate the frequency, number and signal intensity of fluid-fluid levels of musculoskeletaldiseases on MR images, and to determine the usefulness of this information for the differentiation ofmusculoskeletal diseases. MATERIALS AND METHODS: We retrospectively reviewed 30 cases in which fluid-fluid levelwas seen on MR images; they were diagnosed histopathologically(24/30), clinically(5/30) orclinicopathologically(1/30). To differntiate these diseases, we determined their frequency, the number offluid-fluid levels and the signal intensity of fluid. RESULTS: MR images revealed fluid-fluid levels in thefollowing diseases : giant cell tumor(6), telangiectatic osteosarcoma(4), aneurysmal bone cyst(3), synovialsarcoma(3), chondroblastoma(2), soft tissue tuberculous abscess(2), hematoma(2), hemangioma(1), neurilemmoma(1),metastasis(1), malignant fibrous histiocytoma(1), bursitis(1), pyogenic abscess(1), and epidermoid inclusioncyst(1). Fourteen benign tumors and ten malignant, three abscesses, and two hematomas were included. Unlike truetumors, hematomas, tuberculous abscesses and the epidermoid inclusion cyst showed only one fluid-fluid level in aunilocular cyst. On T1-weighted images, the signal intensities of fluid varied, but on T2-weighted images,superior layers were in most cases more hyperintense than inferior layers. CONCLUSION: Because fluid-fluid layersare a nonspecific finding, it is difficult to specifically diagnose each disease according to the number offluid-fluid levels or signal intensity of fluid. In spite of the nonspecificity of fluid-fluid levels, they werefrequently seen in cases of giant cell tumor, telangiectatic osteosarcoma, aneurysmal bone cyst, and synovialsarcoma. Nontumorous diseases such as abscesses and hematomas also demonstrated this finding.


Subject(s)
Abscess , Aneurysm , Bone Cysts , Giant Cell Tumors , Giant Cells , Hematoma , Musculoskeletal Diseases , Osteosarcoma , Retrospective Studies
12.
Article in Korean | WPRIM | ID: wpr-123948

ABSTRACT

We had experienced anesthetic management of two patients with bilateral pheochromocytoma. They had been treated with phenoxybenzamine for 4 weeks preoperatively. Anesthesia was managed with thiopental sodium for induction,enflurane-N2O-O2 for maintenance, vecuronium for muscle relaxation, and sodium nitroprusside for controlling severe hypertension. After tumor resection, severe hypotension was controlled by rapid transfusion, fluid and dopamine infusion. A tolerable blood pressure and pulse rate were maintained throughout the procedure. Preoperative preparation, sufficient sedation, smooth anesthetic induction, complete analgesia, good muscle relaxation, adequate ventilation and proper cardiovascular control are required in resection of pheochromocytoma.


Subject(s)
Analgesia , Anesthesia , Blood Pressure , Dopamine , Heart Rate , Humans , Hypertension , Hypotension , Muscle Relaxation , Nitroprusside , Phenoxybenzamine , Pheochromocytoma , Thiopental , Vecuronium Bromide , Ventilation
13.
Article in Korean | WPRIM | ID: wpr-188365

ABSTRACT

Broncho-gastric fistula caused by benign gastric ulcer perforation after esophagectomy is very rare. In general anesthesia of a patient with broncho-gastric fistula, in spite of hyperventilation, leakage of the anesthetic gases through fistula may make the patient hypercapneic, and positive pressure ventilation may increase the risk of the pulmanary aspiration by the regurgitation of gastric fluid by stomach distension. For that reason, in this patient, denitrogenation was performed during patient's voluntary respiration with 100% oxygen for 5 minutes, and induction was performed without positive pressure ventilation, and one lung ventilation was carried out. Hypoxemia was followed by one lung ventilation because his pulmonary function was moderate obstructive type and his lung was damaged by aspiration of gastric fluid via broncho-gastric fistula. A low level of continuous positive airway pressure (CPAP) has no significant hemodynamic effect and can maintain the patency of nonventilated lung, so hypoxemia induced by one lung ventilation may be reduced. Thus we carried out one lung ventilation with CPAP (10 cmH2O) in nonventilated lung and blocked broncho-gastric fistula with a bronchial blocker for prevention of both regurgitation of gastric fluid and leakage of anesthetic gases. One lung anesthesia was performed without any problem in this case.


Subject(s)
Anesthesia , Anesthesia, General , Anesthetics, Inhalation , Hypoxia , Continuous Positive Airway Pressure , Esophagectomy , Fistula , Hemodynamics , Humans , Hyperventilation , Lung , One-Lung Ventilation , Oxygen , Positive-Pressure Respiration , Respiration , Stomach , Stomach Ulcer
14.
Article in Korean | WPRIM | ID: wpr-32167

ABSTRACT

PURPOSE: To evaluate the clinical and radiologic findings of coronary artery fistula (CAF) by reviwing adult patients in whom this condition had been diagnosed by coronary angiogram. MATERIALS AND METHODS: We retrospectively analysed the clinical findings, chest X-rays and angiographic findings of 37 adult CAF patients treated at three institutes over a period of is 15 years. RESULTS: On coronary angiogram, the origin of CAF was found to be the left coronary artery (LCA) in 20 cases (54%), the right coronary artery (RCA) in five (14%), and both in 12 (32%). By subdividing the coronary artery into four segments [RCA, left main coronary artery, left anterior descending artery(LAD), and left circumflex artery(LCX)], the origin of CAF (total 55 cases) was found to be the LAD in 23 cases (42%), the LCX in 12 (22%), the left main coronary artery in three (5%), and the RCA in 17 (31%). The draining site of CAF was the right heart [right atrium, right ventricle, and main pulmonary artery (MPA)] in 28 cases (75%) the left heart (left atrium and left ventricle) in 8 (22%), and both in one (3%). The fistula drained to the cardiac chamber in 12 cases (33%), the MPA in 23 (62%), and both in 2 (5%). Among 55 cases, the total number of fistulas to the MPA was 35, and their origin was the RCA in nine instances (26%), and the left coronary artery in26 (74%). CAF to the MPA was classified into four types : Type I (single, tortuous and not dilated) was seen in six patients (17%), type II (single, tortuous and dilated) in three (9%), type III (multiple and fine plexus) in 21 (60%), and type IV (multiple and dilated plexus) in five (14%). Eighteen cases (49%) were associated with the other cardiac disease. CONCLUSION: In these Korean adults, CAF originated most commonly from the LCA, especially from the LAD segment of this artery, and most frequently drained to the right cardic chamber, especially to the MPA. The morphology of the CAF to the MPA was mostly multiple and fine plexus. We suggest that to ensure the most suitable treatment, and for better prognosis, patients with other cardiac disease should be evaluated for the presence of CAF.


Subject(s)
Academies and Institutes , Adult , Arteries , Coronary Angiography , Coronary Vessels , Fistula , Heart , Heart Atria , Heart Diseases , Humans , Prognosis , Pulmonary Artery , Retrospective Studies , Thorax
15.
Korean Journal of Urology ; : 1387-1390, 1997.
Article in Korean | WPRIM | ID: wpr-67950

ABSTRACT

We report a case of Castleman`s disease of the hyaline-vascular type which was located in retroperitoneum. A 20-year-old girl was admitted because of a history of postprandial epigastric discomfort. Computed tomography of the abdomen demonstrated a solid 7 x 7 cm mass between the abdominal aorta and the left kidney in the retroperitoneum. At surgery, a solid 9 x 8 x 6 cm tumor was resected. Pathologic diagnosis was Castleman`s disease of the hyaline-vascular type.


Subject(s)
Abdomen , Aorta, Abdominal , Diagnosis , Female , Humans , Kidney , Young Adult
16.
Article in English | WPRIM | ID: wpr-76639

ABSTRACT

PURPOSE: The purpose of this study is to describe the imaging characteristics of oligodendroglioma in childhood. MATERIALS AND METHODS: Eight CT scans and 12 MR images were retrospectively reviewed in 12 children (mean age, 9.5 years) with pathologically-proven oligodendroglioma. The most frequent symptoms were seizure and headache, with a mean duration before diagnosis of 21 months. Location, MR signal intensity, calcification,intratumoral hemorrhage, cystic change, peritumoral edema and contrast enhancement were retrospectively analyzed. RESULTS: The supratentorial location was most frequent (9/12, 75%) and the majority of tumors were located peripherally or subcortically (7/9, 78%). On MR, most tumors demonstrated low signal intensity on T1WI and high signal intensity on T2WI ; cystic change was frequent (10/12, 83%). Tumor enhancement was seen in 60% of cases (6/10), with various enhancement patterns. Intratumoral hemorrhage was seen in two cases. On CT, the tumors were usually hypodense and calcification was noted in two cases (2/8, 25%). Peritumoral edema and mass effect of the tumor were seen in five (5/12,42%). Hydrocephalus was associated in two cases. CONCLUSION: In childhood, most oligodendrogliomas demonstrate a peripherally located supratentorial mass, with frequent cystic change. Calcification or intratumoral hemorrhage were less frequent than in previously reported adult series.


Subject(s)
Adult , Child , Diagnosis , Edema , Headache , Hemorrhage , Humans , Hydrocephalus , Oligodendroglioma , Retrospective Studies , Seizures , Tomography, X-Ray Computed
17.
Article in Korean | WPRIM | ID: wpr-108638

ABSTRACT

BACKGROUND: Crucial to the success of fiberoptic awake tracheal intubation is proper preparation of the patient; this technique will work well in most patients when they are quiet and cooperative and have a larynx nonreactive to physical stimuli. We have attempted to ascertain how well these conditions are achieved with a low-dose infusion of propofol, because of its pharmacological profile. METHODS: Thirty patients, physical status by American Society of Anesthesiologists (A. S. A.) I-II, scheduled for oral and maxillofacial surgery, were randomly assigned to receive either propofol infusion 1 mg kg-1 h-1 preceded by a 1 mg kg-1 bolus (Group P) or intravenous fentanyl 1ug kg-1 and midazolam 0.05 mg kg-1 (Group F). These two groups were compared in terms of hemodynamic profile, sedation score, condition for intubation, coughing and swallowing. RESULTS: There were no statistically significant differences in mean arterial blood pressures according to time between two groups. But in Group F, heart rates were significantly increased in immediately after transtracheal injection of lidocaine, immediately before the fiberoscopy was started, 1, 2 minutes after start of fiberoscopy, compared to Group P (p<0.05). The patients in Group P were more sedated than those in Group F (p<0.05) but there were no significant differences in condition for intubation, reflex of coughing and swallowing, duration of fiberoptic intubation. CONCLUSIONS: We conclude that propofol is useful sedative agent in fiberoptic awake intubation with similar efficacy to midazolam and fentanyl but with more profound sedation and stable hemodynamic profile. These represent significant advantages for severe anxious or hypertensive patients and prolonged procedure of intubation.


Subject(s)
Arterial Pressure , Cough , Deglutition , Fentanyl , Heart Rate , Hemodynamics , Humans , Intubation , Larynx , Lidocaine , Midazolam , Propofol , Reflex , Surgery, Oral
18.
Article in Korean | WPRIM | ID: wpr-194379

ABSTRACT

PURPOSE: To evaluate the types, follow-up studies, and management of local vascular complications of the puncture site in transfemoral angiography. MATERIALS AND METHODS: Fourteen patients who suffered local vascular complications during angiography of postangiographically were evaluated. We reviewed their clinical findings, radiological follow-up studies(Doppler-USG, angiography), treatment and final outcomes. RESULTS: The complications were three cases of perforation which needed emergency treatment, three cases of thrombosis which occurred several hours after angiography, two cases of arteriovenous fistula and two cases of arteriovenous fistula combined with pseudoaneurysm which appeared a few days after angiography, and four cases of pseudoaneurysm that showed variable detection time, from a few days to several months. The causes of complication were faulty puncture sites, carelessness and vascular fragility due to underlying vascular diseases such as diabetes mellitus and atherosclerosis. The complications were evaluated by angiography or doppler-USG and eight cases were treated successfully by interventional methods(manual compression, USG-guided compression, coil embolization,thrombolysis). Five cases needed surgical intervention. It was decided not to treat one case, but only to observe it. CONCLUSION: Local vascular injuries are serious complications occurring during angiography or postangiographically. They may, however, be properly controlled by various interventional techniques. It is important to be aware of their occurrence, findings and method of management.


Subject(s)
Aneurysm, False , Angiography , Arteriovenous Fistula , Atherosclerosis , Emergency Treatment , Follow-Up Studies , Humans , Punctures , Thrombosis , Vascular Diseases , Vascular System Injuries
19.
Article in Korean | WPRIM | ID: wpr-113770

ABSTRACT

PURPOSE: To review the type, incidence and radiologic findings and to evaluate the clinical significance of intrahepatic duct dilatation of choledochal cysts in children. MATERIALS AND METHODS: Ultrasonography and operative cholangiography of 49 consecutive children with surgically confirmed choledochal cyst were reviewed and classified according to the Todani's classification. Patients with intrahepatic duct dilatation in preoperative evaluation were routinely followed by ultrasonography after surgery of extrahepatic bile duct. The status of bileduct was evaluated by comparing with the preoperative ultrasonography. RESULTS: According to the preoperative evaluation, there were 19 cases(39%) of type Ia, three cases(6%) of type Ib, ten cases(20%) of type Ic, 15 cases(31%) of type IVa, two cases(4%) of type V, but no case of the type II, III, IVb in Todani's classification.In twelve of 13 patients (five cases of type I and eight cases of type IVa) who had been followed up after surgery of choledochal cyst, the previously noted intrahepatic ductal dilatation were no longer seen. CONCLUSION: The incidence of the types of choledochal cysts by Todani's classification shows no significant difference between our result and the other authors'. The intrahepatic ductal dilatation seems to be reversible and mainly secondary to extrahepatic obstruction by choledochal cyst. Thus, postoperative follow up examination is more important than preoperative classification of bile duct dilatation.


Subject(s)
Bile Ducts , Bile Ducts, Extrahepatic , Child , Cholangiography , Choledochal Cyst , Classification , Dilatation , Follow-Up Studies , Humans , Incidence , Ultrasonography
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