It is well known that changes in end-tidal carbon dioxide partial pressure (PETCO2) can reflect changes in cardiac output during cardiopulmonary resuscitation. The present study was performed to evaluate quantitative relationship between the changes in PETCO2 and cardiac output in the acute hemorrahagic dogs.
Six anesthetized(isoflurane 1.0%), paralyzed, and mechanically constant ventilated dogs submitted to hemorrhage were studied. The dogs were hemorrhaged by progressive withdrawal of 50% of blood volume. After withdrawal of each 10% of blood volume, PETCO2, arterial carbon dioxide partial pressure(PaCO2), mean arterial pressure and cardiac output were measured.
After 40% blood loss, the percent decrease in PETCO2 decreased significantly. The percent decrease in PETCO2 correlated with the percent decrease in cardiac output(slope=0.33, r=0.7, P<0.001). The percent decrease in PETCO2 correlated with the percent decrease in cardiac output(slope=0.35, r=0.55, P<0.05).
There is a linear correlation between the percent decrease in PETCO2 and cardiac outpit with the ratio approximately 1:3 during acute hemorrhage in the constant tidal volume ventilation. The cause of PETCO2 change induced by cardiac output might be change in PaCO2. This finding suggests that PETCO2 monitoring can easily detect a critical reduction in cardiac output when ventilationis constant.
, Mi Ae Lee, Ho Jung Kang, Jeong Hee Hahm Contact dermatitis is a common clinical problem and frequently caused by cosmetics. Detection of causative allergen is important in prevention and treatment of this disease. Patch rest has been accepted as the only reliable diagnostic method to detect allergens. We analyzed patch test results of dermatologic outpatients and evaluated common new antigens producing cosmetic and noncosmetic contact dermatitis.
We reviewed patch test results of the 324 patients with suggestion contact dermatitis who had visited our department from May 1985 to February 1996. We divided the patients in two groups(cosmetic contact dermatitis group and non-cosmetic contact dermatitis group)and compared the results.
1) High positive reaction rate to nickel sulfate(14.7%), fragrance mix(11.0%), and mercury ammonium chloride(9.6%) was seen in cosmetic contact dermatitis group. Lip cosmetics and make-up preparation were the products to which patients reacted the most. Among the cosmetic products, skin care products ranked the first in positive reaction rate.
2) Nickel sulfate(21.7%) was the most common allergen, followed by cobalt chloride(13.3%), mercury ammonium chloride(10.0%), and fragrance mix(8.3%) in noncosmetic contact dermatitis.
Consmetic contact dermatitis was more common than noncosmetic contact dermatits. Nickel sulfate, mercury ammonium chloride, cobalt chloride and fragrance mix were found to be the most common allergens of cosmetic and noncosmetic contact dermatitis.
To find out differential points between benign and malignant pleural disease.
We retrospectively analyzed the CT scans of 33 patients(20 men and 13 women ; mean age, 56) with pleural diseases including 12 malignant diseases(lung cancer(n=10), metastasis(n=2)) and 21 benign diseases(tuberculous empyema(n=12), bacterial empyema(n=7), hemothorax related exudate(n=2)).
In malignant diseases, irregular(n=3) or nodular(n=3), and mediastinal pleural thickening(n=6) were observed but extrapleural fat accumulation or pleural calcification were not.
In benign diseases, irregular pleural thickening was not observed in bacterial empyema but in tuberculous empyema(n=3) and hemothorax related exudate(n=1). Mediastinal pleural thickening and extrapleural fat accumulation were observed in tuberculous(n=5, 5) and bacterial(n=2, 2) empyema and hemothorax related exudate(n=1, 2) and pleura calcification was observed in tuberculous(n=3) and bacterial(n=2) empyema.
Findings of irregular or nodular pleural thickening were observed only in malignant disease with exception of tuberculous empyma and hemothorax related exudate. Extrapleural fat accumulation and pleural calcification were observed only in benign disease.
To correlate findings of chest radiograph with those of CT scan in aortic dissection.
We retrospectively analyzed findings of chest radiograph and CT scan of 10 aortic dissection patients(for men and six women ; aged 51-79 years old(mean 64 years)) and correlate findings of chest radiograph with those of CT scan.
Chest radiograph showed abnormal findings in nine cases(90%) with widening of wuperior mediastinum in nine(90%), disparity in size of ascending and descending aorta in four (40%), change in aortic configuration between successive examination in three (30%), bilateral pleural effusion in one(10%), and cardiomegaly in five(50%). CT scan showed atherosclerotic effusion in two(20%), pericardial effusion in one(10%), and mediastinal hematoma in two(20%). All patients with widening of superior mediastinum on chest radiograph showed aneurysm of ascending aorta and/or aortic arch on CT scan.
Chest radiograph is usually abnormal and the most common finding is wdening of superior mediastinum caused by aneurysm of ascending aorta and/or aortic arch. But normal chest radiograph may be observed in aortic dissection with mild degree aneurysm
, Kyu-Man Shin, Jun-Hyeok Song Video-assisted thoracic surgery(VATS) is a developing technique that can be used in diagnosis and treatment of pleural and lung disease, with minimal incision. This article is aimed to describe the results of initial series of 96 VATS procedures, from October 1993 to May 1997.
VATS were performed in 64 pneumothorax, 18 hyperhidrosis 3 mediastinal tumor, 2 bronchiolitis obliterans organizing pneumonia, 2 lung carcinoma, 2 thoracic injury, 1 idiopathic pulmonary fibrosis, 1 sarcoidosis, 1 T spine tumor, 1 Hodgkins disease with pericardial effusion and 1 chronic tuberculous empyema. Procedures included 64 bullectomy, 18 thoracic sympathectomy, 4 wedge resection biopsy of lung, 3 resection of mediastinal tumor, 2 diagnostic thoracoscopy in thoracic injury, 1 closure of dehiscenced postpneumonectomy bronchial stump, 1 biopsy of mediastinal lymph node in lung carcinoma, 1 biopsy of T spine, 1 pericadoromy in pericardial effusion and 1 debridement in chronic tuberculous empyema.
3 complications were developed(2 bleedings and 1 lung parenchymal injury) but no mortality. VATS is a safe and effective alternative to thoracotomy with minimal risk.
, Jong In Han, Rack Kyung Chung, Gui Yong Lee, Jong Hak Kim, Chi Hyo Kim, Choon Hi Lee The head-down tilt(HDT) position infuses changes in cerebral blood flow, intracranial pressure, hemodynamic and respiratory system. This study was performed to evaluate the changes in cerebral blood flow and the onset of autoregulation according to the different degree of HDT.
The subjects were 12 healthy adult female volunteers. They were divided two groups : 10° HDT(group 1) and 15° HDT(group 2). The systolic, diastolic and mean blood pressure, heart rate, end-tidal CO2 concentration and cerebral blood flow velocity on middle cerebral artery by transcranial Doppler were measured before positioning and 1,2,3,5,7,9,11 minute after positioning.
There was no significant changes in cerebral blood flow velocities statistically according to the HDT under 15 degrees. In group 1, vean arterial blood pressure were increased at 5 minutes and returned to control value at 7 minutes after HDT with statistical significances. Diastolic blood pressure in group 1 were increased at 1 and 2 minutes after HDT with statistical significances. In froup 2, systolic blood pressure were increased at 5,7,9,11 minutes after HDT statistically significantly.
There were no significant changes of cerebral blood flow under less than 15° HDT. But systolic blood pressure were increased with 15° HDT in the healthy adults statistically significantly(p<0.05) not but clinically. So, we suggested that if HDT is required, we should take care of the partients more than 10 minutes after HDT.
, Ki Pung Sung, Jong Ki Kim, Young Yo Park Wilms' tumor is the most frquent malignant abdominal tumor in children but is rare in adults. Adult Wiulms' tumor is less than 1% of all wilms' tumor, and has poor prognosis than childhood Wilms' tumor. Wilms' tumor in children classically demonstrate the curative potential of combined modality cancer therapy. However, guide line for management in adult Wilms' tumor is less clear.
We reported a case of adult Wilms' tumor developed in 18 year-old male patient which was presented with right flank pain after slip-down for 1day.
, Chong-Nahm Kim, Soon-Kwan Hong, Ji-Ae Lee, Ok-Kyung Chung, Moon-Jung Kim Rhinocerebral mucormycosis is a well-described fulminant fungal infection that typically presents in a rapidly fulminant manner. This condition is more likely to occur among patient with diabetes mellitus, malignant tumors, who have long-term steroid treatment, or who suffer from some debilitating diseases.
We report 3 cases of rhinoorbitocerebral mucormycosis, all suffered from diabetes mellitus. In all 3 cases, endoscopic sinus surgery was done and the antifungal agent(amphotericin B) was administered intravenously, and two patients died. One survivor who had focal extension of paranasal sinus and orbit, required one surgical intervention without orbital exenteration and he is alive without recurrence disease.
The severity of the disease is probably dependent upon the gost resistance to the invasion of phycomycetes. Early diagnosis and immediate, effective treatment are the key for cure of the disease.
, Jong Hak Kim, Chi Hyo Kim, Choon Hi Lee Pneumothorax can occur during general anesthesia by various mechanism.
Because tension pneumothorax may be manifested by unexplained hypotension or wheezing during anesthesia, prompt diagnosis of the complication is often difficult.
The incidence of iatrogenic pneumothorax seems to ve increasing, for the procedure associated with pneumothorax such as internal jugular or subclavian venipuncture, intercostal or interscalene nerve blocks, laparoscopy, operator should be prepated to treat this potential complication without delay.
We presented one case of tension pneumothorax developed during general anesthesia perhaps resulting from inadvertent lung injury during internal jugular vein puncture.
, Chi Hyo Kim, Jong Hak Kim, Choon Hi Lee The infant or child with a difficult airway is easily recognized, either by symptomatology or anatomic features. However, in a small but significant number of cases, a difficult airway is unrecognized during the preanesthetic assessment, and becomes recognized only upon the induction of anesthesia.
We report a case of difficult airway with congenital tracheal stenosis in neonate. We performed tracheal intubation with small sized tube by using technique to bring head forward slightly while trying to advance tube.
, Won Hee Yoon, Hyum Sook Kim, Mi Young Park, Young Ju Kim, Jung Ja Ahn, Bock Hi Woo Down syndrome is the most common autosomal abnormality disease which has multiple congenital anomalies, occurring in 1 of every 800 liveborn infants. Neonates who are affected with this disease comprise majority of the mentally retarded children. To prevent the birth of this congenital anomaly, prenatal diagnosis of Doen syndrome is important. We experienced a case of Down syndrome, diagnosed by fluorescence in situ hybridization(FISH) in pregnancy for 15 weeks 6 days. We report here eith a brief review of the literatures.
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