The assessment of the vascular anatomy of the inferior mesenteric artery: an autopsy study / 대한법의학회지

AIMS: The left colon receives its arterial supply from the inferior mesenteric artery (IMA). The detailed anatomical understanding of IMA is important for sigmoid colon or rectal cancer surgery. The aim of this study is to investigate the vascular anatomy of the IMA by measuring the distance from the aortic bifurcation and the length of the IMA in autopsy cases. METHODS: 41 consecutive autopsy cases were enrolled prospectively. 29 cases were males and 12 females. Mean age was 47.7+/-15.6 with a range of 12 to 82 years. The distance from the aortic bifurcation is measured between the angle of abdominal aortic bifurcation and the inferior margin of the IMA. The length of the IMA is measured between the root of the IMA and the proximal border of the first branch of the IMA. Mann-Whitney U test, Pearson's correlation coefficient, and Spearman's rho were used for statistical analysis. RESULTS: The distance from the aortic bifurcation ranged from 3 to 6.3 cm with a mean of 4.4+/-0.71 cm. The length of the IMA ranged from 2.5 to 7 cm with a mean of 4+/-0.8 cm. The distance from the aortic bifurcation and the length of the IMA had no correlations with subject's height and weight. CONCLUSIONS: The vascular anatomy of the IMA in the general population is an important information for colorectal surgeon. Clear anatomical understanding of IMA may help perform oncologically safe colorectal surgery.

A Case Related to Identifying Missing Person by the floods in 2006 / 대한법의학회지

The fifteen persons from In-jae, Kang-won do, were missing by floods on July 2006. In relation to the this case, the two unidentified corpses were found nearby So-yang lake on June and September 2007, respectively. In these cases, autosome short tandem repeats (STR) and Y-STR were used for identification. The AmpFlSTR Identifiler kit (amelogenin and 15 STRs) and the AmpFlSTR Yfiler kit (16 Y-STRs) are analysed by multiplex-PCR and automated fluorescent detection using Perkin Elmer Prism 310 DNA sequencer. Finally we could found identify the two missing persons.

Comparative Study for DNA Extraction Methods from femurs in case of naming unidentified bodies / 대한법의학회지

In historical cases, missing persons' identification, mass disasters, and ancient DNA investigations, bone samples are often the only and always the best biological materials available for DNA typing. There are many protocols for the extraction of DNA from bone samples. In our experiment, we tested three DNA extraction protocols: Ethanol down method, Microcon(R) YM-100 and DNA IQ(TM) system. We have found that ethanol down method is not suitable to extract DNA from bone samples and Microcon(R) YM-100 is the best among these three mothods. DNA IQ(TM) System did not show better result but needed less time and labor than Microcon(R) YM-100. So, we expect using DNA IQ(TM) System is useful in case of bone samples which are not severely contaminated .

A Case Related to Identifying the Missing Person / 대한법의학회지

The application of DNA typing method after amplification by the polymerase chain reaction (PCR) of DNA derived from bone from two missing persons. In this case, short tandem repeats (STR) are used. The AmpFlSTR Identifiler loci (amelogenin and 15 STRs) are analysed by multiplex-PCR and automated fluorescent detection using Perkin Elmer Prism 310 DNA sequencer.

Acute Pulmonary Edema Occurred in a Patient with Hypothyroidism during Emergence from General Anesthesia: A case report / 대한마취과학회지

Anesthesia and surgery in patients with untreated or inadequately treated hypothyroidism carries the risk of potential complications such as prolonged unconsciousness, hypotension, hypoventilation, hyponatremia, precipitation of congestive heart failure, cardiopulmonary arrest and myxedema coma. In addition, these patients have an impaired ability to excrete free water. Therefore, careful attention must be devoted to fluid and electrolyte management to prevent fluid retention and edema. We experienced a case of acute pulmonary edema during emergence from anesthesia in a patient with cured hypothyroidism. The pulmonary edema was completely resolved with ICU care on the 5th postoperative day. We conclude that surgery in the patient with hypothyroidism require thyroid hormone replacement therapy, careful monitoring and management for the cardiovascular status.

A Case of Pulmonary Aspiration during the Anesthetic Induction in the Post Total Gastrectomy Patient / 대한구급학회지

Pulmonary aspiration of gastric contents is a feared complication of anesthetic procedures. But aspiration of intestinal contents is rare, the influences of the aspirated contents and/or the consequnt events in the airway have not been fully settled in its provacative role for causing an acute pulmonary reaction. We experienced a case of pulmonary aspiration of intestinal content. The patinet who had undergone previous total gastrectomy was planed emergency operation due to intestinal obstructon. Aspiration during anesthetic induction occurred accidentally. Immediate endotracheal intubation and suction were followed. Right chest breathing sound was coarse and then it was getting better. Although supplement of O2 by Y-piece, arterial blood gas analysis of patient revealed pH 7.30, PaCO2 36 mmHg, PaO2 58 mmHg after emegence from anesthesia in the recovery room. Chest X-ray showed the focal air space consolidation in right lower lung and ill defined pulmonary opacity in left mid lung and retrocardiac area. The measured pH of aspiration content was 7.8 and nonpathogenic Gram negative bacilli species were cutured. Frequent suction, encouraging expectoration, antimicrobial agents therapy and O2 supplementation by Y-piece were performed in the ICU. Patient normalized following 24 hrs after the episode of aspiration.

Clinical Study of the Onset Time of Esmolol / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the time course of the bradycardia and hypotensive effects of esmolol. METHODS: Thirty patients who undergoing gynecologic operation were anesthetized with nitrous oxide and enflurane. After the steady state of anesthesia was achieved, esmolol 500microgram/kg for 1 minute followed by 25, 50, or 100microgram/kg/min for 60minuts infused by intravenous catheter. Heart rate, mean arterial pressure, cardiac index, stroke volume, and systemic vascular resistance was measured by 1, 3, 5, 10, 15, 20, 25, 30, 45, and 60 minutes. RESULTS: Heart rate was changed abruptly within 3 to 5 minutes, and decreased rapidly for 15minutes. Mean arteral pressure was decreased rapidly for 30 minutes, but slower than heart rate. Cardiac index was decreased rapidly for 20 minutes and differed significantly on the dose of 25, 50, 100microgram/kg. Stroke volume was decreased for 30 minutes, and systemic vascular resistance was increased rapidly for 10 minutes. It was decided the onset time that was expressed 90% of ultimate response of esmolol effect, and was calculated in each group. The onset time of heart rate of esmolol 25, 50, 100microgram/kg were 8.0 +/- 4.1, 4.8 +/- 2.3, 8.1 +/- 4.4 minutes, the time of mean arterial pressure were 30.0 +/- 7.5, 21.1 +/- 6.2, 19.9 +/- 7.8 minutes, and the time of cardiac index were 25.1 +/- 4.7, 14.8 +/- 5.0, 14.2 +/- 4.6 minutes. Thus heart rate, mean arterial pressure, cardiac index, stroke volume, and systemic vascular resistance responses of administration of esmolol did not occur with equal rapidity. CONCLUSIONS: Thus although esmolol has an ultrashort kinetic half life, only the heart rate effect can be considered to have an ultrashort onset.

The Effect of Acetaminophen Rectally Administered before Operation on Postoperative Pain and Behavior after Tonsillectomy in Small Children / 대한마취과학회지

BACKGROUND: Prostaglandin inhibitors have been successfully used to inhibit some types of postoperative pain and reduce opioids requirements in others. Antiprostaglandin activity may be ineffective unless the preparations are given at the appropriate time before surgery. This study aimed to determine if the intrarectal administration of acetaminophen immediately before surgery would markedly reduce pain in the postoperative period. METHODS: The children were divided to two groups. Each group was consisted of 15 children. The children in control group were administered intramuscularly glycopyrrolate(0.004 mg/kg) 20 minute. The children in experimental group were administered glycopyrrolate(0.004 mg/kg) intramuscularly and were administered acetaminophen(250 mg) rectally 20 minute before the children were taken to the operating theatre. RESULTS: In the recovery room, the children who had recived acetaminophen were signifcantlly quieter (p<0.01), agitated less(p<0.01) and cried less(p<0.01) painless(p<0.01) than those nonadministered group. There were no obvious differnces between the groups in intra-operative bleeding (as estimated by the surgeon), or in measured blood loss. No postopertive complications become evident. CONCLUSIONS: The preoperative rectal administration of acetaminophen for pain relief after tonsillectomy is safe and effective.

Effect of 5-fluorouracil on carcinoma of the bladder / 대한비뇨기과학회지

5-Fluorouracil was used for the treated of 4 cases of carcinoma of the bladder along with electrocoagulation, X-ray radiation, Cobalt teletherapy and estrogen and its effectiveness was evaluated Further experience with this druy is necessary for detailed evaluation, though the cases reported herein seems to have responded to this chemotherapy to some extent.

Ectopic Ureter Associated with Congenital Hypoplasia of the Kidney / 대한비뇨기과학회지

A 14-year old girl presented with urinary incontinence along with normally secured voluntary voiding. Careful physical examination revealed leakage of urine through a small opening near the vestibule, ventral to the urethral meatus. Cystoscopically, the right ureteral orifice was absent but otherwise normal. Nonfunctioning right kidney was found on excretory urography. A #4 ureteral catheter was inserted into the ectopic opening as high as 10cm, and the retrograde pyelogram showed dilated right ureter ending blindly at the level of lumber vertebra II with stricture at the level of the tip of the catheter. After the right nephroureterectomy, she became dry and was discharged on the 12th postoperative day. The removed kidney weighed only 8 Gm. and pathological diagnosis was congenital hypoplasia of the right kidney with ectopic ureteral opening.