, Gwang Ha Kim, Bong Eun Lee, Moon Won Lee, Cheolung Kim Subepithelial tumors in the upper gastrointestinal (GI) tract are often detected during nationwide endoscopic gastric cancer screening in Korea. Most GI lipomas are asymptomatic and do not necessitate further treatment. However, large tumors may lead to complications such as bowel obstruction, intussusception, and bleeding. These GI lipomas require endoscopic or surgical resection. On radiological examination, GI lipomas typically manifest as hypodense lesions with similar density to that of fat tissue. White-light endoscopy generally reveals a yellowish subepithelial tumor exhibiting a positive cushion sign, while endoscopic ultrasonography shows a homogeneous hypoechoic mass within the third layer of the GI tract. We present the case of an 81-year-old woman with symptomatic duodenal lipoma following endoscopic resection.
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.
, Sung Hak Kim Improvements in microsurgical and neuroanesthesiological have resulted in an increasing number of operation for aneurysm clipping in elderly patients. It is the purpose of this article to evaluate surgical outcome of elderly patients(stand point of three groups), considering neurologic grade on admission, amount of subarachnoid hemorrhage(SAH) on computerized tomography(CT) findings and timing of surgery.
The subjects of the present study are 34 patients who were admitted to department of neurosurgery and treated surgically between 1991 and 1997 in Mok-Dong and Tongdaemun hospital. All the patients in this study were verified as having aneurysmal SAH on CT scanning followed b cerebral argiography. The patients were classified by age into three groups : 65 to 70 years(24 cases), 76 years(7 cases) and 76 years or older(3 cases). On admission, the clinical condition of patients was graded according to the scals of Hunt and Hess and the amounts of SAH was graded according to grading system of Fisher. The day 7 SAH was defined as Day O. the timing of operation was divided into three. 1-3 days ; 3-7 days; 8-days.
The surgical mortality according to the different age groups, Hunt-hess grade, grading system of Fisher and timing of operation was analised.
Overall, 11 of the 34 patients died, for a mortality rate 32%. The mortality rate by age groups was 21% for 65 to 70 years, 57% for 71 to 75 years and 20% for 76 years of older. The mortality rate by Hunt-Hess grade was 35%, in I-II, 33% in III and 20% in IV-V, and the mortality rate as related to grading system of Fisher was 0% in 1, 36% in 2, 36% in 3 and 25% in IV. The mortality rate according to timing of operation was 31% in 1-3 days, 25% in 3-7 days and 25% in over days.
In recent years, with improvement in surgical technique and neuroanesthesia, the number of operation for ruptured aneurysm have increased in elderly patient. A more aggressive treatment in elderly patients is justified.
, Dong Been Park Intraperitoneal hemorrhage during reproductive age usually result from ruture of ectopicpregnancy, corpus luteum, and endometrioma.
The symptom and sign of the corpus luteum hemorrhage is lower abdominal pain and tenderness so differential diagnosis with ectopic pregnancy is needed.
The sonographic findings of corpus luteum hemorrhage is free blood in cul de sac and adnexal mass. In the case of hemorrhagic corpus luteum of the considerable size with evidence ofintraperitoneal hemorrhage, operative intervention may be necessary. But operation is complicated and have some hazard.
So we reported these cases of hemorrhagic corpus luteum with intraperitoneal hemorrhagetreated by transvaginal sonogrphy successfuly.
This paper reports a study on 246 cases of upper gastrointestinal(UGT) hemorrhage thatwere treated in the Department of Internal Medicine of the Ewha Womans University(Mokdong Hospital) over a period of 18 months from September of 1993 to May of 1995.
The results were as follows.
1) The causes of UGI hemorrhage were 156 peptic ulcer cases(63.4%) including 71 gastriculcer,82 duodenal ucler, and 3 marginal ulcer ; 44 esophageal varix cases(17.9%) ; 18 MalloryWeiss syndrome cases(7.3%) : 15 stomach cancer cases(6,1%) ; 7 acute gastric mucosal lesioncases(2.8%) ; 2 unknown causes ; and 4 other causes.
2) There were 204 males and 42 females(4.8 : 1). The age distribution was 51 in fifties(20.7%),49 in forties(19.9%), 44 in thirties(17.9%), 40 in sixties(16.2%), 24 in twenties(9.5%), and 24 in seventies(9.8%) resulting in 58.5% of the total cases from the thirties to fifties. Agedistribution of duodenal ulcer and Mallory-Weiss tear was younger than stomach cancer andgastric ucler(P<0.05).
3) The seasonal distribution showed spring 78 cases(31.7%), summer aS cases(10.1%), autum67 cases(27.2%), and winter 74 cases(30.1%) with peak incidence in spring.
4) The severity of UGI hemorrhage according to Palumbo's criteria was mild bleeding in 71 cases(28.8%), moderate bleeding in 115 cases(46.7%), and massive bleeding in 60 cases(24.4%)
5) The mean amount of transfusion for treatment was 4.2±2.4 unit for peptic ulcer, 3.2±1.8unit for varix, 5.9±3.1 unit for stomach cancer, and 0.3±0.2 unit for Mallory-Weiss tear.
6) Ninety one peptic ulcer was received endoscopic treatment(58.4%). Among them, therewere 13 rebleeding cases(14.3%) and 9 cases required surgical opertaion(9.8%). Thirly fivevarix cases received endoscopic treatment(79.5%) and there were 3 rebleeding cases(8.6%).
7) The motality was 4.1%(10 cases). The main causes of deaths were 1 sepsis case, 3 hepaticcoma cases, and 6 hepatoma intraperitoneal rupture cases.
Moyamoya disease is a cerebrovascular disease of unknown etiology, which is characterized by bilateral stenosis or occlusion at terminal portion of internal carotid artery and at proximal portion of anterior cerebral artery and/or middle cerebral artery and abnormal vascular network in the vicinity of the arterial occlusions. It occurs frequently in Asian countries, particularly in Korea and Japan, but is rare in Western countries. To establish the etiology of moyamoya disease, much about the pathology from autopsies, factors involved in its pathogenesis, and its genetics have been studied. It may occur at any age from childhood to adulthood and in general, initial manifestation is cerebral ischemic symptoms in children and intracranial hemorrhage symptoms in adults. Because it progress and cause recurrent stroke, early diagnosis and proper management has been recognized. Cerebral angiography is essential for definitive diagnosis and treatment plan. Magnetic resonance imaging/magnetic resonance angiography is useful for diagnosis and follow-up tools after revascularization. Evaluation of the cerebral hemodynamics by single photon emission computed tomography and positron emission tomography is useful for diagnosis and assessment of the severity of cerebral ischemia in moyamoya patients. Surgical revascularization is effective for moyamoya disease manifesting as ischemic symptoms, to prevent further ischemia and infarction. In hemorrhagic type moyamoya disease, revascularization can be considered. Direct bypass, indirect synangiosis and combined methods are used. Outcomes of revascularization are excellent in preventing transient ischemic attacks in most patients.
Citations
, Eun Mi Song, Doo Hyun Beak, Hyun Jung Oh, Hyun Kyung Kim, Min Young Choi, Kyung Joo Kwon, Hye Won Kang, Seo Woo Kim, Unjin Shim, Yeon Ah Sung, Young Sun Hong Propylthiouracil(PTU) is a commonly used antithyroid drug in the management of hyperthyroidism. However, it is associated with a variety of side effects. Antineutrophil cytoplasmic antibody( ANCA)-positive vasculitis is an extremely rare side effect of PTU. We report a case of a patient with diffuse pulmonary hemorrhage while being treated with PTU. A 28-year-old woman was admitted due to fever and abdominal pain. She was diagnosed as Graves' disease 4 years before the admission, and was taking PTU intermittently. Thyroid storm was suspected and we treated her with PTU, hydrocortisone, lugol solution and propranolol. However, coughing was aggravated, with chest X-ray and computed tomography revealing diffuse alveolar hemorrhage. Perinuclear-ANCA was positive. After discontinuation of PTU, all symptoms resolved. In conclusion, ANCA-positive diffuse alveolar hemorrhage is a rare but a potential side-effect of PTU. Therefore, early awareness of this complication is important.
, Do Sang Cho, Sung Hak Kim, Dong-Been Park , Do Sang Cho, Sung Hak Kim, Dong-Bin Park , Kyu-Man Shin Chronic hydrocephalus is a frequent occurrence after aneurysmal subarachnoid hemorrhage. 14 patients with chronic hydrocephalus and treating with shunting procedure were retrospectively reviewed. Chronic hydrocephalus after aneurysmal subarachnoid hemorrhage was usually recognized when gradual deterioratsm of consciousnes, unexplanied aggrvation of occuring neurologic defists, especially urinary incontinence.
Two-hundred consecutive patients with aneurysmal SAH were admitted to the neuro-surgical department Ewha Womans university Mok-Dong Hospital between fanuary 1994 and fanuary 2001, in all the patients aneurysms clipping was carried out. Among then 14 patient to chronic hydrocephalus following aneurysmal SAH and treating with shunting procedure were reviewed according to consionsnes level(Hunt-Hess classification), amonts of SAH(grading system of Fisher), sites and incidence. The chronic hydrocephalus was diagnosed CT findings in the clinical findings ; deterioration of level of consiousness, aggravation of neurologic deficits and urinary incontinence.
The average age of patients was 51 and predominant in women(man : woman=4 : 10). The incidence of chronic hydrocephalus was 7% and the aneurysmal sites were followings : posterior communicating artery(7), anterior communicating artery(4), and internal carotid artery bifuncation, middle cerebral artery and superior cerebellar artery were 1 respectiviy. According Hunt-Hess Grades were following ; grade I, II, III and IV=1, 6, 3 and 4. The number of patients according to Fisher's grading system were following ; grade 2, 3, and 4=6, 7, and 1. The outcomes by Glasgow assessment were the followings ; Score 5 and 4=9 and 5.
The response to shunting procedure in symptomatic patients of Chronic hydrocephalus following aneurysmal SAH. good in all patients.
, Myung-Hyun Kim, Jun-Hyeok Song, Sung-Hak Kim Despite of recent advances in pharmacological treatment and improvement surgical and anesthetic techniques, subarachnoid hemorrhage(SHA) from ruptured intracranial aneurysms with poor clinical grades still carries unacceptably high morbidity and mortality rates. Recently surgery for aneurysmal SAH with poor clinical grade has increased interest.
The authors experienced 57 patients with poor clinical grade (Hunt and Hess grade IV-V) after ancurysmal SAH. Among them 25 patients were treated with immediate CSF drainage via ventriculostomy, blood pressure control, early angiography(except 3 patients) and surgery within 12 hour of admission.
The outcomes of patients were categorized using a four-tiered scale :
1) independent and working
2) impaired but independent
3) severly impaired and dependent
4) dead
The average age was 48(13-75) and the male to female ratio was 7:18 in surgical group. The average time to admission and surgery was 12 hours or less among the 25 patients. Among them 9 cases were dead, 2 cases were severly impaired and dependent, 3 cases were impaired but dependent, and 11 cases were independent and working. In this patient all cases, exception one could be ligated with a clip.
The above results suggest that the acute aggressive surgery based on appropriate selection in poor aneurysmal SAH patients can reduce of the mortality.
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