Sudden Bispectral Index Reduction and Suppression Ratio Increase Associated with Bradycardia in a Patient Undergoing Breast Conserving Surgery

BACKGROUND: The bispectral index (BIS) is a valuable indicator for measuring sedation levels and patient consciousness. Recent reports have highlighted its clinical value as an indicator for anesthesia-related cerebral hypoperfusion and ischemic brain damage. CASE REPORT: A 55-year-old female patient underwent right breast conservation surgery during general anesthesia. During surgery, the patient experienced abrupt bradycardia (heart rate of 36 bpm) without hypotension. During bradycardia, her BIS was severely reduced from 45 to 20 along with elvated suppression ratio (50). After injection of 0.5mg of atropine, her BIS level was recovered, her heart rate was increased, and her suppression ratio was decreased. CONCLUSION: The patient recovered from anesthesia without showing any signs of neurological sequelae based on BIS level monitoring.

Clinical Characteristics of Acute Appendicitis in Children and Elderly Patients

Acute appendicitis is one of the most common diseases of young people that requires emergency operation. This is especially true for those age 10 years old and older. However, the numbers of cases of appendicitis are increasing in both the young and the elderly. The main purpose of this study is to understand the clinical features of acute appendicitis in children and elderly patients. We retrospectively compared clinical characteristics in 4 groups of patients who underwent appendectomy in our hospital. There were 16 patients in the pre-school age group, 9 were males and 7 females. The total number of patients in the juvenile group were 287, 156 were males and 131 females. The total numbers of patients in the adult group were 794, 436 were males and 358 females. The numbers of elderly patients were 189, 91 were males and 98 females. Complicated appendicitis was found in 15 patients (93.7 %) in the pre-school age group, 79 patients (27.5 %) in the juvenile group, 332 patients (41.8 %) in the adult group, and 96 patients (50.7 %) in the elderly group. Four patients (40 %) had generalized panperitonitis in the pre-school group. The occurrence of perforated appendicitis was the highest in the pre-school age group and the lowest in the juvenile group. Since generalized panperitonitis has a higher incidence in the pre-school age group, prudent and careful diagnosis and treatment are required for the pre-school age group.

Expression of Alpha-catenin/E-cadherin and Clinical Significance of Metastatic Factors in Stage III Advanced Colon Cancer

PURPOSE: Among the cell adhesion molecules, alpha-catenin and E-cadherin play an important part in maintaining normal cell structure. The change in expression of cell adhesion molecules affects the invasion and metastasis of a tumor and the prognosis for patients. In this study, we evaluated the relationship between the expression of cell adhesion molecules and the histopathologic characteristics of stage III colon cancer. METHODS: The relationship between the immunohistochemical expression of cell adhesion molecules and tumor progression were statistically analyzed in 40 patients with stage III colon cancer. RESULTS: There were no statistically significant correlations between loss of membranous alpha-catenin and E-cadherin expressions and such variables as histologic differentiation and lymph node disease based on the criteria of the American Joint Committee on Cancer (AJCC). A significant correlation, however, existed between depth of mural invasion and loss of expressions of both alpha-catenin and E-cadherin (P=0.001 and P=0.002, respectively). Expressions of both alpha-catenin and E-cadherin were also significantly decreased in patients showing liver metastases during follow-up (P=0.019 and P=0.015, respectively). CONCLUSION: Immunohistochemical analyses of alpha-catenin and E-cadherin expressions may be available as predictors for distant metastasis, especially in stage III colon cancer. Such analyses may also help to identify appropriate therapeutic strategies and the need for intensive follow-up in patients with stage III colon cancer.

Clinical Study and Factors Influencing Postoperative Morbidity in Perforated Peptic Ulcer Patients

PURPOSE: After the introduction of peptic ulcer medication, a marked decrease took place in the number of patients with uncomplicated peptic ulcers subjected to elective surgery. This decline, however, was not associated with a decrease in the number of patients admitted with peptic ulcer perforation. Also, the morbidity and mortality were increased because the perforated peptic ulcers mostly occurred in elderly patients with medical illnesses. The purpose of this study was to evaluate the postoperative morbidity in patients with a perforated peptic ulcer. METHODS: Between January 2000 and December 2005, 110 consecutive patients, who underwent surgery for perforated peptic ulcer at Seoul Red Cross Hospital department of general surgery, were retrospectively reviewed. RESULTS: The overall morbidity and the mortality rates were 23.6 and 5.45%, respectively. The most common postoperative complication was postoperative ileus, followed by wound infections and pulmonary complications. The most common cause of death was sepsis. A univariate analysis showed sex, age, a delayed operation, site and size of perforation, the size of crater, comorbid diseases, and type and duration of operation were associated factors; however, the multivariate analysis showed age, a delayed operation, size of perforation, comorbid diseases, and type and duration of operation were independent risk factors. CONCLUSION: Age, a delayed operation, size of perforation, comorbid diseases, and type and duration of operation were independent risk factors for a perforated peptic ulcer. Therefore, to decrease the postoperative morbidity, comorbid diseases must be treated during the perioperative period, perforated peptic ulcer must be correctly diagnosed immediately and short time consuming operative procedures must be performed.

Management of Enterocutaneous Fistula

PURPOSE: The aim of this study was to help access the treatment of enterocutaneous fistula patients. METHODS: We experienced 35 cases of enterocutaneous fistulas at Seoul Red Cross Hospital from January 1993 to December 1997 and we reviewed the patient's charts retrospectively. RESULTS: The ratio of men and women was 1.7 : 1. The most prevalent age group was the 7th decade (12 cases, 34.3%). The most frequent site of the enterocutaneous fistula was the large colon (11 cases,31.4%). The etiology of the all cases was postoperative complication. The most common underlying disease was malignancy (11 cases, 31.4%). The latent period of the fistula after an operation was most commonly 6 to 10 days (18 cases, 51.4%). Fistulography was the most accurate diagnostic method (90.9%). According to the amount of daily drainage, high output fistulas occurred in 10 cases (28.6%), and low output fistulas in 25 cases (71.4%). Twenty five (25) patients (71.4%) were treated conservatively, 10 patients (28.6%) were treated surgically. The methods of operation were bowel resection and anastomosis (6 cases), an fistulectomy (2 cases), and a bypass procedure (2 cases). The overall mortality was 3 cases (8.6%). The most common cause of death was sepsis and multiple organ failure. CONCLUSION: Prevention of an enterocutaneous fistula is of utmost importance, but once it occurs early detection, which is essential to improve the patient's general condition, avoidance of infection, and proper judgment as to the time of operation are important to the survival rate.

Clinical Review of Laparoscopic Cholecystectomy

BACKGROUND: Gallstones have been one of the most common gastrointestinal diseases to surgeons which open cholecystectomy has been the standard operation for the past one hundred years. Recently, operations with a laparoscope have become popular and are spreading worldwide. METHODS: A clinical analysis of 200 cases who had been treated by laparoscopic cholecystectomy for gallstone disease in Seoul Red Cross Hospital for 4 years from July 1993 to June 1997 was done according to age, sex, advantage, and complication. RESULTS: The results were as follows. 1) Among the 200 cases, there were 69 male patients and 131 female patients, with a female to male ratio of 1.9:1. The most prevalent age group was the 6th decade with 59 cases (29.5%) and the 7th decade with 43 cases (21.5%), the 5th decade with 41 cases (20.5%) and the 4th decade with 29 cases (14.5%) in order of frequency. 2) The associated diseases were hypertension with 25 cases (12.5%), diabetes mellitus with 12 cases (6.0%), cardiopulmonary disease with 11 cases (5.5%), and hepatitis with 10 cases (5.0%) in order of frequency. 3) The cases of previous abdominal operations were 75 cases (37.5%). The most frequent operations were appendectomy with 33 cases (16.5%), C-section with 12 cases (6.0%), laparoscopic tubal ligation with 11 cases (5.5%), salphingo- oophorectomy with 8 cases (4.0%) and T.A.H with 8 cases (4.0%) in order of frequency. 4) The most frequent pathologic diagnosis was chronic cholecystitis with 187 cases (93.5%). 5) The operation time ranged from 30-180 minutes with an average of 81 minutes. The operation time for the first 10 cases was 77 minutes, but it was been reduced to 58 minutes in the last 10 cases. 6) Conversion to an open cholecystectomy during the operation was done in 6 cases (3.0%), and the cause of conversion were uncontrolled bleeding with 2 cases (1.0%), severe adhesion with 2 cases (1.0%) and GB empyema with 2 cases (1.0%). 7) Postoperative analgesics were needed in 81 cases (40.5%) on the operative day, 71 cases (35.5%) on the 1st postoperative day, 26 cases (12.5%) on the 2nd postoperative day, 6 cases (3.0%) on the 3rd postoperative day, and 3 cases (1.5%) on the 4th postoperative day, and the use of analgesics was reduced as times went by. 8) The length of hospital stay ranged from 2 to 10 day with an average of 4.13 day, and 74 cases (37.0%) experienced a 3 to 6 day hospitalization, which was the most common hospital stay. 9) The total postoperative complication rate was 5.0% (n=10) with 2 cases (1.0%) of wound infection and 2 cases (1.0%) of ileus, and there was no postoperative mortality.

A Clinical Review of Gallbladder and Biliary Tract Stones

In Korea, the incidence and modality of gallstones have changed, since meal have become westernized and the socioeconomic state has improved. Choledocholithiasis, which has a high incidence rate in Koreans is difficulty to treat as a result of retained stones. This report deals with a clinical analysis of recent trends in gallstone disease and approaches to ideal method of treatment. A retrospective analysis was done on 192 gallstone patients who had undergone an operations at the Department of Surgery, Seoul Red Cross Hospital, from January 1992 to December 1996. The results are as follows: 1) The male to female ratio was 1:1.7, and the most common age group was the 6th and 7th decade (50.0%). 2) The most common symptom and physical finding were RUQ pain (83.9%) and RUQ tenderness (73.3%). 3) The most common positive laboratory finding was leukocytosis (40.4%). 4) Bile culture tests were done in 117 cases and were positive in 55 cases (47.0%). The most common bacteria was E.coli in 35 cases (29.9%). 5) The locations of stone were the GB in 146 cases (76.0%), the GB and CBD in 26 cases (13.5%), the GB and CBD and IHD in 14 cases (7.3%), the CBD only in 5 cases (2.6%), and the GB and IHD in 1 case (1.3%). 6) The incidence of retained stones was 15.1% (29 out of 192 cases) and the prevalent site was the CBD in 11 out of 29 cases (37.9%). 7) A complete choledochoscopic stone removal of retained stones was possible in 19 out of 25 cases, showing a 76.0% success rate. 8) The most common postoperative complication was wound infection (13.5%), and the postoperative mortality rate was 1.0%.

Surgical Treatment of Peptic Ulcer Disease

We reviewed the 161 cases who had undergone surgery for peptic ulcer disease at the Department of Surgery, Seoul Red Cross Hospital, from Mar.1990 to Feb.1995. 1)The most common one was duodenal ulcer(64.6%).Gastric ulcer and combined gastroduodenal ulcer was 30.4% and 5.0%, respectively. 2)The peak incidence of age was 3rd and 5th decades and mean age was 44.4 years. The mean age of duodenal ulcer was 40.9 years and gastric ulcer was 52.4 years. 3) The male and female sex ratio 12:1 in duodenal ulcer and 7.5:1 in gastric ulcer. 4) In indication of operation, the most common one was perforation in duodenal ulcer and bleeding in gastric ulcer. 5) The percentage of emergency operation was low in H2 receptor antagonist group (28.7%) than nonuse group(51.8%). 6) The positive rate of subdiaphragmatic free air was 72.4% in duodenal ulcer and 64.7% in gastric ulcer. 7) The most common operative procedure was subtotal gastrectomy in gastric ulcer and vagotomy and pyloroplasty in duodenal ulcer. 8) The postoperative complication was 18.6% in emergency operation and 12.5% in elective operation. 9) The postoperative mortality was 2.5% in total patients and 3.1% in emergency operation and absent in elective operation.

A clinical study of traumatic hemoperitoneum

No abstract available.

A comparative study of DNA ploidy pattern by flow cytometry and AG-NORs in colon adenocarcinoma

No abstract available.

A clinical study on acute appendicitis in children

No abstract available.

A study of referral patterns in Dept. of family medicine

No abstract available.