• Journal of Yeungnam Medical Science
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• 제33권2호
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• pp.90-97
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• 2016

Background: We have previously found that intra-peritoneal lidocaine instillation before pneumoperitoneum attenuates pneumoperitoneum-induced hypertension. Whether this procedure alters patient's hemodynamic status during operation should be determined for clinical application. This study elucidated the possible mechanism of the attenuation of the pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum. Methods: Thirty-four patients underwent laparoscopic cholecystectomy (LC) were randomly allocated into two groups. After induction of general anesthesia, 200 mL of 0.2% lidocaine (lidocaine group, n=17), or normal saline (control group, n=17) were sub-diaphragmatically instilled 10 minutes before pneumoperitoneum. The changes in systolic blood pressure, heart rate, central venous pressure, stroke volume, cardiac output, and systemic vascular resistance were compared between the groups. The number of analgesics used during post-operative 24 h was compared. Results: Systolic blood pressure was elevated during pneumoperitoneum in both groups (p<0.01), but the degree of elevation was significantly reduced in the lidocaine group than in the control (p<0.01). However, stroke volume and cardiac output were decreased and systemic vascular resistance was increased after induction of pneumoperitoneum (p<0.05) without statistical difference between two groups. The number of analgesics used was significantly reduced in the lidocaine group (p<0.01). Conclusion: These data suggest that intra-peritoneal lidocaine before pneumoperitoneum does not alter patient's hemodynamics, and attenuation of pneumoperitoneum-induced hypertension may be the consequence of reduced intra-abdominal pain rather than the decrease of cardiac output during pneumoperitoneum. Therefore, intra-peritoneal lidocaine instillation before pneumoperitoneum is a useful method to manage an intraoperative pneumoperitoneum-induced hypertension and to control postoperative pain without severe detrimental hemodynamic effects.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권3호
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• pp.276-280
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• 2011

BSSRO (bilateral sagittal split ramus osteotomy) is an effective surgical method for maxillofacial deformities. Rigid fixation using a plate and screws can stabilize bony segments and induce early mouth opening. Though this procedure has a low complication rate, normal function and esthetic recovery is achieved through proper and early management of the complications. Complications consisting of temporomandibular disorders, sensory disturbances due to inferior alveolar nerve damage, open bite, malunion or nonunion, and facial nerve palsy occur, but these rarely develop. Facial nerve palsy causes the muscles involved in facial expression to depress, which results in ocular dryness or retinal damage. When facial nerve palsy develops, early management involving steroid medication and physical therapy is effective. In the case of severe damage, surgical intervention should be considered. A 20-year-male patient came to the oral and maxillofacial surgery department for orthognathic surgery. The mandible was set back by BSSRO under general anesthesia. Facial nerve palsy was observed on the left side of the face: steroid and vitamins were administered early and physical therapy was performed daily. These forms of management can aid in function and allow for gradual esthetic recovery. Presumed causes were excessive soft tissue retraction or soft tissue injury by the osteotome at the horizontal osteotomy of the ramus. Careful dissection, retraction and a precise osteotomy are needed for protection of the facial nerve. If nerve damage is observed, early management can help in the recovery of facial nerve function and esthetics.

• 대한소아치과학회지
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• 제42권1호
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• pp.75-79
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• 2015

폐동맥 고혈압은 좌우단락을 가진 선천성 심장질환의 흔한 합병증으로 폐동맥 고혈압 환자에서 높아진 폐혈관 저항은 생명에 위협을 초래한다. 전신마취시의 양압환기는 폐동맥압을 높이고, 폐혈류량은 감소시키므로 저산소증을 유발할 수 있으며, 이는 폐동맥 고혈압 환자에게서 불리하게 작용할 수 있다. 따라서 폐동맥 고혈압 환자에서는 양압환기보다는 자발호흡이 보다 안전할 것으로 생각된다. 만 5세 남환이 심한 저체중으로 본원으로 의뢰되었으며, 내원 당시 환아의 몸무게는 11 kg이었고, 209년 팔로사징후로 완전 교정 수술을 받은 의과적 병력이 있었으며, 2007년부터 현재까지 고혈압 약을 복용하고 있다고 하였다. 환아는 다발성 우식을 가지고 있었으며, 치료는 경비캐눌라를 사용한 세보플루란 흡입 진정 하에 진행하엿다. 치료 내내 환아는 정상적인 생징후와 자발호흡을 유지하였으며, 이후에도 폐동맥 고혈압과 연관된 다른 합병증은 보이지 않았다. 폐동맥 고혈압 환자에서의 세보플루란 흡입 진정의 안전한 사용 증례를 통해서, 세보플루란 흡입 진정이 심혈관계 질환을 가진 환자들에서 전신마취의 대안으로 사용될 수 있는 가능성을 보여주었다.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.705-707
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• 2010

Purpose: Tuberculous lymphadenitis constitutes about 30% of all types of extrapulmonary tuberculosis. Cervical lymphadenitis is the commonest form (70%), followed by axillary and inguinal. But inguinal tuberculous lymphadenitis is rare form. Especially isolated inguinal tuberculous lymphadenitis was seldom reported. In Korea, that case was not reported. This case emphasizes the need for awareness of tuberculosis as a possible cause of isolated inguinal adenitis. Methods: We experienced one case of isolated inguinal tuberculous lymphadenitis. We analyzed clinical features, preoperative assessments and method of treatments. Results: A 37-year-old female patient presented with a painless swelling in the left inguinal region of 12 month's duration. There was no history of urethral discharge, dysuria, genital sores, unprotected sexual contacts or trauma. Examination revealed enlarged left inguinal lymph nodes, $2{\times}1\;cm$, non-tender and firm mass. The external iliac, popliteal, right inguinal and other groups of lymph nodes were normal. Serologic tests, urinary tests and chest radiologic test were normal. The excision of mass was performed under the general anesthesia. A excisional biopsy showed chronic granulomatous inflammation with caseous necrosis, consistent with tuberculosis. After excision, the primary repair was done and completely healed on postoperative 25 days. Conclusion: The isolated inguinal tuberculous lymphadenitis was rare form of inguinal suppurative mass. Although medical management is the principal mode of therapy of tuberculous adenitis and surgery is rarely necessary, we didn't consider the possibility of tuberculous lymphadenitis in our case. A high index of suspicion is essential for a diagnosis of isolated inguinal tuberculous lymphadenitis. Our case emphasizes this importance and illustrates the need for awareness of tuberculosis as a possible cause of isolated inguinal adenitis.

• 대한수의학회지
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• 제29권3호
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• pp.373-381
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• 1989

The aim of the present study was to test the efficiency of estrous induction in the premature, metestrous and anestrous bitches. The estrus was induced with prostaglandin $F_{2{\alpha}}$, estradiol-$17{\beta}$, pregnant mare serum gonadotropin (PMSG) and human chorionic gonadotropin(HCG) in the treatment A, and with PMSG and HCG in the treatment B. Day 0 was the first day of estrone injection in the treatment A and the day of PMSG injection in the treatment B. Twenty three of the twenty six bitches were laparotomized under general anesthesia between 11 and 18 days after onset of behavioral estrus, whereas three bitches were not laparotomized and remained until parturition. Ovarian responses were evaluated with the total number of corpora lutea or ovulation sites. The uterine horns were flushed with phosphate-buffered saline added heat treated canine serum(10%), the flushing media was collected into watch glass and the ova were examined under stereomicroscope. The results obtained were as follows: 1. Standing estrus was observed on the day $17.7{\pm}1.5$ after injection of estrone in the treament A, but ovarian responses were not detectable. 2. Standing estrus was observed on the day $12.2{\pm}0.2$ after injection of PMSG in the treament Band 14 of 17 bitches showed ovarian responses. Ova were recovered in 9 of the 14 bitches. 3. Ovarian responses were observed in one of the three premature bitches. two of the three metestrous bitches and all of the 11 anestrous bitches. The average number of the ova collected from 9 bitchs were $12.2{\pm}1.4$. 4. Three bitches in the treament B exhibited behavioural estrus and all of them were mated with fertile male dog, resulting the pregnancy in only one bitch. The pregnant bitch gave the birth of two pups.

• 재활간호학회지
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• 제5권1호
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• pp.18-26
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• 2002

The purpose of this study was to elucidate the effects of inhalation method using essential oils on the preoperative anxiety of hystrectomy patients, and to provide effective and holistic nursing care to them. The research design was a nonequivalent control group non synchronized design. The data were collected from February 1 to March 31, 2002 at D Medical Center in Busan. The subjects were forty one patients that were operated on under general anesthesia for hystrectomy. They were assigned to two groups, twenty one subjects in the experimental group and twenty subjects in the control group. The tool of the Visual Analogue Scale(VAS) was used to anxiety on all patients the day before surgery and the preoperative period. Then systolic and diastolic blood pressure, pulse rate levels were measured the day before surgery and the preoperative period. The experimental group received two treatments of inhalation method using essential oils of with lavender, ylang ylang, and bergamot oil. The data were analyzed by the $X^2$ test and the independent t-test. The results of this study were summarized as follows: 1. Hypothesis 1: It has been supported that the experimental group received inhalation method using essential oils might cause lower level of the preoperative VAS anxiety than that of the control group(t=-2.93, p=.006). 2. Hypothesis 2: It has been rejected that the experimental group received inhalation method using essential oils might cause lower level in the preoperative systolic blood pressure than the control group(t=-.120, p=.905). It has been rejected that the experimental group received inhalation method using essential oils might cause lower level in the preoperative diastolic blood pressure than the control group.(t=1.766, p=.085). 3. Hypothesis 3: It has been supported that the experimental group received inhalation method using essential oils might cause lower level in preoperative pulse rate than the control group(t=5.853, p=.000). According to these results, inhalation method using essential oils can be considered an effective nursing intervention that relieves the preoperative anxiety of hysterectomy patients and stabilizes vital sign partially.

• Restorative Dentistry and Endodontics
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• 제16권2호
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• pp.85-98
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• 1991

The aim of this study was to investigate the effect of low - power laser used in the medical field for various purposes to suppress pain responses evoked by noxious electrical or mechanical stimuli. After both inferior alveolar nerves and the left anterior digastric muscle of cats under general anesthesia were exposed, a recording electrode for the jaw opening reflex was inserted into the anterior digastric muscle. The right inferior alveolar nerve was dissected under a surgical microscope until the response of the functional single nerve could be evoked by the electrical stimulation of the dental pulp or oral mucosa. The electrical stimulus was applied with a rectangular pulse of 10 ms duration for measuring the threshold intensity of a single nerve fiber in the inferior alveolar nerve which responds to stimulation of dental pulp and oral mucosa. Then a pulse of 1 ms duration was applied for determination of conduction velocity. A noxious mechanical stimulus to the oral mucosa was applied by clamping the receptive field with an arterial clamp. The Ga-As diodide laser(wave length, 904 nm ; frequency, 1,000 Hz) was irradiated to the prepared tooth cavity, inferior alveolar nerve and oral mucosa as a pulse wave of 2 mW for 6 minutes. This was followed by a continuous wave of 15 mW for 3 minutes. The action potential of the nerve and EMG of the digastric muscle evoked by the noxious electrical stimulus and nerve response to noxious mechanical stimulus were compared at intervals of before, immediately after, and at 5, 10, 20, 40, 60 minutes after laser irradiation. The results were as follows: The conduction velocity of the intrapulpal $A{\delta}$- nerve fiber recorded from the inferior alveolar nerve before irradiation had a mean value of $6.68{\pm}2.07m/sec$. The laser irradiation did not affect the conduction velocity of the AS - nerve fiber and did not change the threshold intensity or amplitude of the action potential either. The EMG of the digastric muscle evoked by noxious electrical stimulation to the tooth was not changed by the laser irradiation, whether in latency, threshold intensity or amplitude. The laser irradiated to the receptive field of the oral mucosa which was subjected to noxious stimuli did not affect the amplitude of the action potential or the frequency either.

• Journal of Chest Surgery
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• 제30권5호
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• pp.512-516
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• 1997

자연성 기흉은 흉부외과 영역에서 흔히 접하게되는 질환으로 대부분의 경우 폐쇄식 흉강삽관술로 잘 치료 되지만 높은 재발율과 지속적인 공기누출로 인한 폐의 팽창부전등의 이유로 개흉술을 시행해야 하는 경우가 많다. 이러한 경우 개흉술로 인한 수술후 통증, 창상감염, 큰 절개흉터등의 문제가 남게되는데 이러한 문제를 해결하는데 효과적인 비디오 흉강경 수술이 현재 각광을 받고 있다. 본 인제대학교 부산백병원 흉부외과학 교실에서는 최근 3년간 자연성 기흉 환자 66명에 대해 비디오 흉강 경을 이용한 수술을 시행하여 다음과 같은 결과를 얻었다. 남녀 비는 63:3으로 남자가 절대적으로 많았으며 연령별로는 10대후반이 36명으로 전체의 55%를 차지하였다. 발생부위는 우측이 30례, 좌측이 36례 였으며 내원시 임상증상은 흉통, 호흡곤란, 흉부 불쾌감 순이였다. 수술적응증으로는 재발성이 36례로 대부분을 차지하였고 기흉 발생후 흉부 X-선상에서 기포가 보인 경우가 15례 였으며 흉관 삽관후 지속적인 공기 누출로 폐 팽창이 않된 경우가 10례였으며, 환자 본인이 수술을 원 하였던 경우가 5례였다. 기포를 포함한 폐부분 절제술을 시행한 경우\ulcorner 2례였고 폐부분 절제술과 더불어 늑막유착술을 동시에 시 행한 경우가 59례로 대부분을 차지하였다. 명백하게 폐기포를 발견할 수 없었던 5례에서는 늑막유착술만을 시행하였다 슬후 합병증은 4례에서 재발성 기흉이 발생하였고 무기폐와 폐렴 Ifl, 투관침 삽관부위 출혈이 1례 발생하였으나 모두 적절한 치료로 해결되었다. 흉강경을 이용한 자연성 기흉 수술은 여러 가지 장점이 많은 효과적인 수술방법으로 사료되어지며 기타 다른 흉부질환에 있어서도 그 적응증이 더욱 늘어나고 앞으로 더욱 발전될 전망이다.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.121-127
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• 1996

Peripheral nerve injury occurs mostly by trauma and is usually associated with fracture of bone and joint, muscular injury and tendon injury and it also evokes paralysis and anesthesia. When treatment of peripheral nerve injury is considered,, the modality of treatment is decided by the general condition of the patient, type of injury, associated injuries and the condition of wound. To get the maximum results, surgical treatment and reconstruction and rehabilitation should all go in hand-in-hand. From January 1985 to December 1994, we observed 61 patients that had operation without reconstruction due to peripheral nerve injury with a follow-up period of more than 1 year. Among the 61 patients, 44 were men(72%) and 17 were women(28%). Follow-up period was average 19 months. Age distribution was mostly in their twenties with a mean age of 28 years. Time interval of operation after injury was average 11 months. Trauma was the main cause of peripheral nerve injuries with a proportion of 87%. 31 patients had neurorrhaphy, in which case 14 patients had stay suture and 17 patients did not. 14 patients had nerve graft, and 16 patients had neurolysis. We used our scales to compare the results of surgery on the basis of British Research Council System. We gave scores to every sensory and motor scale to estimate functional improvement and emphasized on motor functional improvement. The total score = sensory score + ($2{\times}motor$ score). We considered 8-9 points as excellent, 6-7 points as good, 2-5 points as fair, 0-1 points as poor result. We considered excellent and good as much improved. Excellent and good results were obtained in 13 out of 14 neurorrhaphy with stay suture(93%), 12 out of 17 neurorrhaphy without stay suture(71%), 6 out of 14 nerve graft(43%), 12 out of 16 neurolysis(75%). Among the patients with neurorrhaphy done within 3 months, 11 out of 14(86%) showed improvement, but among the patients after 4 months 3 out of 17(76%) showed improvement. 84% of improvement was observed in the patients with time interval from injury to surgery within 3 months, and 64% in the patients with time interval after 4 months. In the aspect of age, 77% with the age below 20 years, 70% with the age between 21 and 30 years, 66% with the age above 31 years showed improvement. We conclude that considering degree of injury, time interval from injury and age with the adequate method of treatment, we can obtain good results from surgery.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.985-994
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• 2000

Objective : There are some advantages of trigeminal evoked potential(TEP) recording compared to other somatosensory evoked potential(SSEP) recordings. The trigeminal sensory pathway has a pure sensory nerve branch, a broader receptive field in cerebral cortex, and a shorter pathway. Despite these advantages, there is little agreement as to what constitutes a normal response and what wave forms truly characterize the intraoperative TEP. This study presents the normative data of TEP recorded on the epidural surface of the rat with a platinum ball electrode. Materials & Methods : Under general anesthesia with urethane, the adult Sprague-Dawley male rats(300-350g) were given electrical stimulation with two stainless steel electrodes which were inserted into the subcutaneous layer of the area around whiskers. A reference electrode was positioned in the temporalis muscle ipsilateral to the recording site. Results : TEPs were recorded in the Par I area of somatosensory cortex and recorded most apparently on the point of 2mm posterior from the bregma and 6mm lateral from the midline. The typical wave form consisted of 5 peaks (N1-P1-N2-P2-N3 according to emerging order, upward negativity). Each latency to corresponding peaks was not influenced by the different intensities of stimulation, especially from 1 to 5mA. Average latencies of 5 peaks were in the following order ; 7.7, 11.1, 15, 22.3, 29.4ms. There was also no significant difference between latencies before and after administration of muscle relaxant(pancuronium). For the electrophysiological localization of recorded waves, the action potential of a single unit was recorded with glass microelectrode(filled with 2M NaCl, $3-5M{\Omega}$) in the thalamus of rat. A sharp wave was recorded in the VPM nucleus, in which the latency was shorter than that of N1. This suggests that all 5 peaks were generated by neural activities in the suprathalamic pathway. Conclusion : In terms of recording near-field potentials, our data also suggests that TEP in the rat may be superior to other SSEPs. In overall, these results may afford normative data for the studies of supratentorial lesions such as hydrocephalus or cerebral ischemia which can have an influence on near-field potentials.