Primary Laparoscopic-Assisted Endorectal Pull-Through for Hirschsprung's Disease

The application of laparoscopic techniques for the surgical management of Hirschsprung's disease is the recent trend. We described the surgical technique and postoperative long-term outcomes of the one-stage, laparoscopic-assiseted endorectal pull-through operation for Hirschsprung's disease. The technique uses three to four small abdominal ports. Laparoscopic mobilization of the sigmoid colon and rectum is performed and marginal artery-preserving colon pedicle is prepared. The rectal mobilization is performed using a transanal endorectal sleeve technique. The anastomosis is performed 0.5~1 cm above the dentate line. The age at surgery ranged from 6 days to 4 years. The average operative time was 144 minutes. Almost all of the patients passed stool and flatus within 36 hours of surgery. The average hospital stay after surgery was 6.5 days. Among 42 patients, 32 patients older than 3 years old were evaluated for function on defecation. All 32 patients have been continent, of those who needed laxatives were 11 (34.3%) due to constipation and overflow incontinence. Four children (12.5%) have remained dependent on laxatives. Laparoscopic-assisted endorectal pull-through operation for Hirschsprung's disease appears to be safe, provides the less pain, shorter time to full feeding, shorter hospital stay, and excellent cosmetic outcomes. Helping patients and parents ensure the quality of life, they should be provided with counseling, education, and longer-term follow-up care.

Effects of Dosages of Remifentanil Calculated by Total Body Weight and Ideal Body Weight to Intubation Circumstances and Adverse Hemodynamic Responses

BACKGROUND: Remifentanil presents good intubation conditions and blunting adverse hemodynamic responses following intubation. So, we evaluated to determine optimal dosage of remifentanil for intubation which consider ideal body weight. METHODS: 160 ASA class 1-2 patients were selected and divided 4 groups, which were composed of 40 patients. Group 1 and 2 were administrated dosage calculated by TBW (total body weight). Each group was administrated intravenous continuous infusion dose of 1.0 ug/kg/min of remifentanil during 2 minutes followed by intravenous bolus dose of 2 mg/kg of propofol (Group 1) and 2.0 ug/kg/min of remifentanil followed by same dose of propofol (Group 2). Group 3 and 4 were administerated same dosage of Group 1 and 2 but administrated dosage calculated by IBW (ideal body weight). We didn't use any muscle relaxant. Intubation conditions and postintubation hemodynamic responses were assessed by 5 items based on GCRP (good clinical research practice), MAP (mean arterial pressure) and HR (heart rate). RESULTS: We have done intubation safely 60, 75, 55 and 98% of Group 1, 2, 3 and 4 respectively. Group 1, 3 have 'technically unacceptable' cases, but group 2, 4 have 'clinically unacceptable' cases. Hemodynamic responses of Group 4 were more stable than Group 2, especially obese patients. Obese patients present a problem for the appropriate dosing of remifentanil and profound hypotension and/or bradycardia developed more frequently when administerated agent calculated by total body weight. CONCLUSIONS: The optimal dosage which produce best intubation conditions and least side effects has to be determined according to IBW.

Pneumothorax after Interventional Muscle and Soft Tissue Stimulation Therapy : A case report

Pneumothorax is the presence of gas in the pleural space. Traumatic pneumothorax results from penetrating or nonpenetrating chest injuries and iatrogenic pneumothorax occurs as a consequence of a diagnostic or therapeutic maneuver. When interventional muscle and soft tissue stimulation (IMNS) therapy is performed, iatrogenic pneumothorax is not common, but once it has occurred, it gives suffering and pain to both the patient and physician. We experienced three cases of iatrogenic pneumothorax after IMNS therapy. Commonly, the patients with peumothorax are treated with a tube thoracostomy on admission, but these patients can be simply treated with simple observation, oxygen inhalation and simple aspiration without admission and the results are satisfactory. Although iatogenic pneumothorax after IMNS therapy appears to be an rare, IMNS procedure still must be done with care.

The Effect of Intramuscular Stimulation (IMS) in Cervicogenic Headache / 대한마취과학회지

Cervicogenic headache (CGH) is not universally accepted as terminology used to discuss headaches associated with disorders of the cervical spine. Sjaastad was the first to describe CGH that its definition and diagnosis relied entirely on clinical features. Pain is often triggered by irritation of nociceptors from structures in the cervical spine, and so diagnostic criteria of CGH have been established with agreement that these headaches start in the neck or occipital region and are associated with tenderness of cervical paraspinal tissues. Past history and clinical features are important to detect and diagnose the disease because the significance of radiological findings and advanced diagnostic testing is unclear. Gunn's intramuscular stimulation (IMS) is a treatment modality of CGH upon radiculopathic model. We tried IMS for treatment of 3 patients with CGH. After IMS, the patients were well respond the therapy and the results were satisfactory. Therefore we recommend the IMS for the treatment of CGH.

The Effect of Intramuscular Stimulation (IMS) in Carpal Tunnel Syndrome: A report of 4 cases / 대한마취과학회지

Carpal tunnel syndrome is a common peripheral nerve entrapment syndrome that is characterized by pain, sensory disturbance along the distribution of the median nerve in hands, thenar muscle atrophy, and cervical radiculopathy. Diagnosis mainly depends upon careful examination and symptomatology, because laboratory and radiological tests are unhelpful. Treatments have included wrist immobilization, anti-imflammatory drug, local injection of steroid, nerve block and surgical decompression. Carpal tunnel syndrome is a type of neuropathic pain caused by denervation supersensitivity, and intramuscular stimulation (IMS) is a treatment modality for neuropathic pain. Here, we used IMS for the treatment of 4 patients with carpal tunnel syndrome. After IMS, most patients did not feel numbness or a tingling sensation and results were satisfactory. Therefore, we recommand IMS as a treatment for carpal tunnel syndrome.

The Comparison of Recovery Characteristics Following Anesthesia with Propofol, Sevoflurane or Isoflurane in Adults Undergoing Outpatient Surgery / 대한마취과학회지

BACKGROUND:Outpatient surgery has recently grown in popularity. This trend has affected the practice of anesthesia and has also led to an increasing interest in the development and use of short-acting anesthetic and analgesic agents. METHODS: One hundred fifty patients scheduled for outpatient surgery were randomly allocated to receive propofol, sevoflurane or isoflurane anesthesia with tracheal intubation. Clinical recovery times were analyzed as emergence, recovery, cognition and discharge. All adverse events were noted. RESULTS: Sevoflurane resulted in significantly shorter times to emergence (2.9 min), recovery (4 min), cognition (5.5 min) and discharge (13.4 min) than isoflurane. Propofol resulted in shorter times to emergence (2 min), recovery (2 min), cognition (3 min) and discharge (6.6 min) than isoflurane, but these were not significant. Also, sevoflurane resulted in shorter times to emergence, recovery, cognition and discharge than propofol, but not significantly. Among the adverse events noted, the percentages of postoperative nausea and vomiting (PONV) after anesthesia were 8%, 20% and 24% for the those who received propofol, sevoflurane and isoflurane, respectively. Propofol resulted in a significantly lower incidence of PONV than sevoflurane or isoflurane. There was no significant difference between sevoflurane and isoflurane in this respect. CONCLUSIONS: Sevoflurane and propofol are better anesthetics than isoflurane for outpatient anesthesia because of their rapid recovery times and a lower incidence of postoperative nausea and vomiting.

A Case of AIDS-related Kaposi's Sarcoma / 대한피부과학회지

We report a case of AIDS-related Kaposi's sarcoma in a 47-year-old male. He was diagnosed as HIV-positive 3 years ago. He developed two asymptomatic purple-colored papules on the nose and right elbow. The histopathological finding showed abnormally proIiferated and dilated vessels, vascular slits, spindle shaped cells, and extravasated erythrocytes. In immunohistochemical studies, the cryptic vessels was positive with CD34, but negative with factor XIIIa and factor VIII-related antigen, Human herpesvirus-8 was found by PCR. We think that this is the first reported case of AIDS-related Kaposi's sarcoma in Korean dermatologic literature.

A Case of B-cell Lymphoma and Early Kaposi's Sarcoma in an AIDS Patient / 감염

B cell lymphoma and Kaposi's sarcoma are the most common tumors in AIDS patients. They show more aggressive behavior and poor prognosis in AIDS patients than in the general population. Lymphoma and Kaposi's sarcoma in AIDS patients are associated with Epstein-Barr virus and human herpesvirus 8, respectively. We reported herein a case of lymphoma and Kaposi's sarcoma in an AIDS patient. He presented with a mass on the tongue base and a red papule on the posterior wall of the oropharynx. On the basis of his- tologic findings, immunohistochemical study, and PCR, his illnesses were diagnosed as B cell lymphoma, combined with early Kaposi's sarcoma. Unfortunately, he did not receive any treatment and died of malnutrition 1 month later. To the best of our knowledge, this is the first report of coexisting lymphoma and Kaposi's sarcoma from an AIDS patient in Korea.

Severe and Atypical Manifestation of Molluscum Contagiosum in AIDS Patients / 대한피부과학회지

Molluscum contagiosum is caused by a DNA virus from the poxvirus family. With the advent of new populations of immunocompromised individuals-especially those infected with HIV-molluscum contagiosum has emerged as an important cause of morbidity and disfigurement. Molluscum contagiosum in AIDS, although not life-threatening, is often a marker of late-stage disease and may lead to atypical clinical features and a progressive course that is recalcitrant to treatment. We report two cases of AIDS-related molluscum contagiosum in a 45 year-old male and a 30 year-old male. They were diagnosed as HIV-positive 3 years ago and 1 year ago, respectively. Physical examination revealed asymptomatic numerous skin-colored papules, nodules and tumorous masses on the face and neck. The histopathological finding showed characteristic features of molluscum contagiosum. We think that this is the first report of severe AIDS-related molluscum contagiosum in Korean literature.

Factors Influencing Korean Psoriasis Patients: An analysis in relation to Extent and Disease activity / 대한피부과학회지

BACKGROUND: Psoriasis is a chronic relapsing disorder which is influenced by various external factors. A study involving a large number of patients with objective assessment methods may help us to elucidate correlations between external factors and the course of psoriasis. OBJECTIVE: Our purpose was to investigate the basic demographic data of psoriasis in a large number of Korean patients and to correlate disease activity, area of involvement with various external factors known to improve or worsen psoriasis. METHODS: Epidemiological and clinical data with particular reference to the extent and activity of the condition in 1,600 psoriasis patients between 1982 and 1998 were collected and analysed. RESULTS: 1. Patients in their twenties were most common(28.7%). There were no sexual predominance in our patients. 2. With reference to the extent of this skin condition, 43.4% of patients were mild cases, 38.3% were moderate and 18.3% were severe. 3. With reference to the activity, 42.9% of patients were mild cases, 26.5% were moderate and 30.6% were severe. 4. The most common morphological features were nummular types(55.8%), followed by large plaque types(23.4%) and guttate types(14.5%). 5. 57% of patients experienced a11eviation of their lesions in summer while 65% of patients experienced aggravation in winter. 6. 55% of the patients experienced improvement of their lesions in sunlight exposure whereas 7% of the remainder experienced aggravation. 7. 64% of the patients replied that their lesions tend to aggravate after a stressful event. 8. Among those who experienced pregnancy, 40% replied that their lesions improved while being pregnant. On the other hand, 19% experienced aggravation. 9. Severe forms were overwhelming in large plaque types in relation to extent and activity (p<0.05). 10. Among the external factors investigated, stress showed statistically signficant association with the severity of psoriasis classified by extent and severity(p<0.05). CONCLUSION: We investigated the epidemiological and clinical features of psoriasis in a large number of Korean patients in relation to various external factors. The condition in more than half of the patients was moderate or severe with reference to the extent and activity. Among external factors, stress seemed to have significant correlations with increased frequency in severe psoriasis patients.

Comparison of D-PUVA with Conventional PUVA in the Treatment of Korean Psoriasis Patients / 대한피부과학회지

BACKGROUND: PUVA photochemotherapy has been accepted as an effective mode of treatment for psoriasis. Many combination therapies have been tried to reduce the possible adverse effects of long-term exposure to UV radiation. OBJECTIVE: This study was performed to compare calcipotriol-PUVA combination therapy(D-PUVA) with conventional PUVA in the treatment of Korean psoriasis patients. METHODS: We treated 38 Korean psoriasis patients with conventional PUVA and 12 with D-PUVA. We compared the total number, duration and total UVA dose of PUVA therapy to reach grade 4 between the two groups. We categorized each patient into clearing, improvement, or failure groups based on the therapeutic efficacy, and measured the PASI score at each of the patients visits. RESULTS: The total cumulative dose of D-PUVA phototherapy was significantly smaller than PUVA phototherapy. CONCLUSION: Combining PUVA with a vitamin D analogue, calcipotriol, in the treatment of psoriasis may lead to lowering the risk of long-term exposure to UV radiation with higher efficacy.

A Comparision of Hemodynamic Changes of Total Intravenous Anesthesia (TIVA) and Isoflurane for Tonsillectomy in Children / 대한마취과학회지

BACKGROUND: In anesthesia for tonsillectomy in children, deep general anesthesia, rapid recovery to consciousness and the return of protective airway reflexes are desirable. This study was designed to estimate the efficacy of TIVA with propofol and fentanyl compared with isoflurane-N2O. METHODS: Forty pediatric patients in ASA class I for tonsillectomy were allocated randomly to either TIVA with propofol and fentanyl (n=20, T) or isoflurane-N2O (n=20, I) group. Anesthesia was induced with propofol 1 mg/kg, fentanyl 3 microgram/kg IV and was maintained by continuous infusion of propofol 6~10 mg/kg/hr, fentanyl 6~10 microgram/kg/hr in T group and was induced with thiopental 5 mg/kg IV and maintained by inhalation of 1.2~2.5 vol% isoflurane in I group. The changes of hemodynamics, recovery time and complications were evaluated. RESULTS: Systolic and diastolic pressure were increased in I group than T group at 1 min after intubation (p<0.05). Heart rate was increased in I group than T group at 1 min after intubation, 1 min and 5 min after incision, changing tube, end of operation and 5 min after end of operation (p<0.05). The recovery time was shorter in T group than I group (p<0.05). Pain on injection was more frequent in T group than I group (p<0.05), and excitatory effect during emergence was more frequent in I group than T group (p<0.05). CONCLUSIONS: TIVA with fentanyl and propofol is better than isoflurane-N2O for anesthesia of tonsillectomy in children in view of small hemodynamic change, early and gentle recovery pattern and side effects.

The Effect of Anesthesia with Propofol-N2O on Neonate and Maternal Awareness during Cesarean Section / 대한마취과학회지

BACKGROUND: In anesthesia for cesarean section, there is an increased incidence of maternal awareness because a light plane of general anesthesia is chosen for fetal safety and rapid recovery. Propofol may be the choice if smooth induction and rapid maternal recovery are desired. Authors tried to know that propofol has properties which suggest that it might be useful alternative to thiopental and enflurane. METHODS: Forty patients in ASA class I or II scheduled for cesarean section were allocated randomly to either propofol (n=20) (P) or thiopental-enflurane (n=20) (T-E) group. Anesthesia was induced with propofol 2 mg/kg IV and maintained by continuous infusion of propofol 8 mg/kg/hr in P group and was induced with thiopental 4 mg/kg IV and maintained by inhalation of 1 vol% enflurane in T-E group. All patients received vecuronium 0.1 mg/kg and 50% N2O-O2. Blood pressure, heart rate, Apgar score, umbilical arterial blood gas analysis and the incidence of maternal awareness using the isolated forearm technique (IFT) were evaluated. RESULTS: Diastolic pressure was decreased in P group than T-E group at 10 min after delivery. Heart rate was increased in P group than T-E group at immediate after extubation (p<0.05). For apgar score, umbilical artery gas analysis and maternal awareness there were not significant differences between two groups. CONCLUSIONS: In comparison with thiopental-enflurane, propofol infusion (8 mg/kg/hr) coupled with N2O was proved to be clinically satisfactory anesthesia for cesarean section with no adverse effects on both mother and neonate.

Treatment of multiple rib fracture and flail chest with Judet's strut: 105 Case Report / 대한흉부외과학회지

There were 105 patients with multiple rib fracture or flail chest who had underwent surgical rib fixation using Judet's strut from Aug. 1989 to Aug. 1995. They were 86 men and 19 women, and the age distribution was from 17 to 77(mean 48+/-12). The most common cause of accident was a traffic accident(81%). The mean number of rib fracture was 5.5 and the distribution of patient were flail chest(72, 64.7%), severe displaced rib Fracture(18, 17.1%), traumatic chest wall deformity(10, 95%) and others(5, 4.7%). The operative mortality was 1 patient(0.96%) and the incidence of postoperative complication were 13 patients(12.3%). The duration of perioperative artificial ventilator therapy was 90.5+/-22.6 hours. Our method allowed shorter duration of an artificial ventilation and decreased a functional sequelae. We find this technique to be better than previously published methods, since it provides better stabilization and immobilization of the ribs and thus obviates the need for artificial ventilation and prevents post-traumatic chest deformity.

A Case of Trichorhinophalangeal Syndrome

Trichorhinophalangeal syndrome is a genetic disease and divided into three differen types. Trichorhinophalangeal syndrome type I is characterixed by alopecia, a bulbous pear-shaped nose and cone-shaped epiphyses in the hand. Diverse clinical manifestations can be observed such as short stature, mandibular abnormality, winged scapula, etc. It is inherited in an autosomal manner, and may cause grave joint abnormalities which should be corrected early in life. We describe a 23-year-old woman with diverse clinical manifestations of trichorhinophalangeal syndrome type I, including prognathism and a winged scapula, two features which have not been previously described in the Korean literature.

Treatment of Pemphigus / 대한피부과학회지

BACKGROUND: Pemphigus is a rare, chronic blistering disease of the skin and mucous membranes with severe morbidity and occasional mortality. The clinical data of Korean pemphigus patients are quite limited, and an appropriate treatrnent regimen is not yet established. OBJECTIVE: Our purpose was to analyze the clinical characteristics of, and establish an appropriate treatment regimen for Korean pemphigus patients. METHODS: A retrospective analysis was conducted for 24 pemphigus patients seen between 1992 and 1996. RESULTS: Pemphigus vulgaris(PV) was the most common type with 17 cases, followed by seven cases of pemphigus foliaceus(PF). There were no sexual preferences, and the average age at onset for PV and PF was 46 and 50 years old, respectively. Mucosal involvement was noted in 14 cases(82%) of PV and only in one case(14/o) of PF. There was no correlation between the extent of involvement and the titer of anti ICS(intercellular substance) antibody. Most patients received prednisolone of lmg/kg, and 12 PV patients also received immunosuppressive agents. Systemic side effects were noted in 10 cases of PV, and seven PF cases did not manifest any systemic side effects. CONCLUSIONS: The clinical manifestations and results of imrnunofluorescent studies of 24 Korean pemphigus patients were similar to those of the previous studies. For treatment of pemphigus, the lowest possible doses(less than 1mg/kg) of corticosteroid in combination with immunosuppressive agents appears to be more effective and less toxic than high doses of corticosteroid. We propose a regimen for treatment of Korean pemphigus patients based on these experiences. Further rnulti-center clinical trials are advocated to confirm an effective management protocol for Korean pemphigus patients.

A Case of Linear Psoriasis / 대한피부과학회지

Linear psoriasis is a rare form of psoriasis and is characterized by the linear distribution of the psoriatic lesions. It should be differentiated clinically and histopathologically from inflammatory linear verrucous epidermal nevus(ILVEN) or psoriasis occuring as part of the Koebner phenomenon. A 41-year-old female is described, who had developed linearly arranged psoriatic lesions in the right lower extremity over the last 10 years. Not only pathological and immunohistochemical studies but also the clinical response to therapies reveal that this is the first case of linear psoriasis in Korea.

Treatment of flail chest with Judet's strut: 56 case report / 대한흉부외과학회지

No abstract available.

Treatment of flail chest with Judet's strut / 대한흉부외과학회지

No abstract available.