Pediatric Inguinal Hernia Surgery 2,230 Cases Performed with Ketamine and Lidocaine

Ketamine is a safe and effective drug for pediatric anesthesia, sedation and analgesia. We hoped to identify that surgeons could operate a pediatric hernia with the ketamine anesthesia without general anesthesia. The study was a consecutive case series of 2230 inguinal hernia patients aged 1 months to 17 years in a Joo's day-surgical clinic during 11-year period. The patients had pediatric inguinal hernia surgery without general anesthesia under the day-surgery system. We retrospectively analyzed the medical record of patients who were registered with the Diagnosis Related Group (DRG) system. All patients received ketamine (5mg/kg) and atropine (0.01mg/kg) intramuscularly before surgery. After anesthesia, we injected 1~2% lidocaine (Less than 5ml) subcutaneously at the site of incision and started operation. The surgical method was the high ligation method of the hernia sac.) In total 2230 patients, male were 1756 and female were 474. 2076 patients were a unilateral inguinal hernia at the time of surgery and 154 were bilateral hernia patients. Less than three months, depending on the age of the patients was 391, and less than 12 months the patient was 592 people (26.5%). After surgery, there were no accidents or long term complications associated with ketamine anesthesia. We think the surgeon can safely do the pediatric inguinal hernia surgery using ketamine and lidocaine without anesthesiologist through 11 years of our surgical experiences.

STIMULATION OF OSTEOBLASTIC PHENOTYPES BY STRONTIUM IN PERIOSTEAL-DERIVED CELLS

Analysis of Long-Term Survivors after Resection for Hilar Bile Duct Cancer

PURPOSE: Although considerable progress has been made in the management of hilar bile duct cancer, the long-term outlook for most patients remains poor. This study was conducted to analyze the long-term survival (more than 5 years) after resection for hilar bile duct cancer focusing on the clinicopathological factors influencing the outcome, and to develop an optimal strategy to achieve long-term survival after a resection. METHODS: A retrospective review was performed for 68 patients with hilar bile duct cancer who underwent surgical resection between 1988 and 2000. Survival rates and prognostic factors were assessed. Clinical and pathological factors of patients who survived more than 5 years were compared with patients whose survival was less than 5 years. Clinicopathological features characterizing the long-term survivors were also reviewed. RESULTS: Seventeen patients survived longer than 5 years after resection. The actual 5-year survival rate was 25.0%. Perineural invasion and resection margin were identified as independent prognostic factors. When prognostic factors were compared between the long-term and short-term survivors, tumor depth, TNM stage, perineural invasion, and resection margin showed a significant correlation with long- term survival. Long-term survivors had early TNM stages with negative lymph node metastasis and absence of perineural invasion. Six of 17 long-term survivors exhibited a positive resection margin. CONCLUSION: Long-term survivors showed characteristic features of early TNM stages with absence of perineural invasion and negative resection margin. As long-term survival can be expected even in patients with bad prognostic factors, aggressive surgical resection should be attempted for patients with resectable disease.

Expressions and Clinical Significances of c-met, c-erbB-2, COX-2, and IL-6 in the Biliary Tract Cancers / 대한소화기학회지

BACKGROUND/AIMS: c-met, c-erbB-2, interleukin (IL)-6, and cyclooxygenase (COX)-2 expressions are considered to be implicated in the carcinogenesis and progression of cholangiocarcinoma, but the molecular pathogenesis of cholangiocarcinoma is still poorly understood. We aimed to analyze the expressions of each marker and their relationships with clinicopathologic factors. METHODS: One hundred and fourteen tissue samples were obtained from surgically resected specimens from patients with billiary tract cancer. The expressions of c-met, c-erbB-2, COX-2, and IL-6 were examined by immunohistochemically. The expression of each marker and correlations between these markers and clinicopathologic factors were analyzed. RESULTS: The expression rates of each maker were as follows: c-met 34/112 (30.4%), c-erbB-2 5/112 (4.5%), COX-2 53/113 (46.9%), and IL-6 68/113 (60.2%), respectively. c-met expression was more frequently observed in cases with invasion through the adjacent connective tissues (p=0.0263). IL-6 overexpression was more frequently observed in cases with absent lymph node metastasis (p=0.0325). Either c-erbB-2 expression or COX-2 expression was significantly associated with lymph node metastasis (p=0.0442). CONCLUSIONS: The expression of c-met was closely related to the invasiveness of cholangiocarcinoma. Co-expression of c-met, COX-2 and, IL-6 showed a significant correlation with invasiveness and lymph node metastasis and these could be useful marker to guide clinical outcome in patients with cholangiocarcinoma.

Unusual peripheral osteomas: Report of 2 cases

Osteoma is defined as a benign neoplasm of bony tissue. Osteomas are divided into two groups: central and peripheral by origin, compact and cancellous by histopathologic findings. Solitary osteoma of jaw bone, not related with Gardner syndrom, is relatively uncommon. We present two cases of huge solitary peripheral osteomas: compact type exophyting osteoma on the inferolingual side of mandibular angle and cancellous type on the residual ridge of posterior maxilla, which is extremely rare.

A Study for The Nature of Pigmentation Adjacent to Titanium Miniplate Osteosynthesis

The titanium miniplate osteosynthesis system has been used for fixation of bone fragments in the maxillofacial areas due to easy manipulation and even has been proposed for unnecessity of miniplate removal because of the biocompatibility and the corrosion resistance. But recently, there have been some suggestions for its removal, on the basis of findings that there have been pigmentations around the adjacent tissues during miniplate removal procedure and they are the depositions of metal particles. Purposes of this study are to ascertain the presence and nature of pigmentation observed within tissues adjacent to titanium miniplate, and to suggest possible causes of it. We could observe the black pigmentation during miniplate removal procedure for recent about 1.5 year. Pigmented tissues were stained with hematoxylin-eosin(H-E) for light microscophic(LM) examination to investigate the black pigmentations and the histomorphology around them. The scanning electron microscopy(SEM) with energy dispersive X-ray(EDX) analysis was used to examine the ultrastructural nature of pigmentations. Many metal particles with variable sizes and shapes were seen in the connective tissue by SEM and were identified as titanium by EDX.

A Clinico-Statistical Analysis On The Fascial Space Infections Of Oral And Maxillofacial EGION

We have conducted a retrospective study of 224 patients with the diagnosis of oral and maxillofacial infection who had been treated between 1988 and 1999 at Gyeong-Sang National University Hospital. This study was aimed to furnish the data of oral and maxillofacial infection and to aid diagnosis and treatment. The most common fascial space involved, as determined by clinical, radiologic, and operative findings, were the submandibular space(39.4%). The most frequent cause of oral and maxillofacial infection was odontogenic 68.8%. In the odontogenic cause, dental caries was the most common cause. Two-hundred three patients required surgical drainage of the abscess. Seventeen patients needed tracheostomy for airway control. The overall mortality was 0.9% despite aggressive anti-microbial therapy and early surgical intervention. All other patients had an uneventful recovery without major complication except osteomyelitis case(6.0%). The combination of early radiologic diagnosis, effective antimicrobial therapy, and intensive surgical management contributed to the good prognosis.

A clinicostatistical analysis of mandibular fractures in the west of gyeongsangnamdo

Managements Of Liver Cirrhosis Patients In Oral And Maxillofacial Surgery -Case Reports

To evaluate the pathophysiology and surgical considerations for liver cirrhosis in the field of oral and maxillofacial surgery, 4 cases with maxillofacial traumas or infections in different stages of liver cirrhosis were reviewed. Although appropriate medical cares were ensured, 2 patients were died due to complications of the liver disease. Each cases were classified by the Pugh's classification system and analyzed with reference to laboratory findings and hospital courses. For improved understandings of pathophysiology of liver cirrhosis, the congulopathies, the lowered detoxification, the hepatic encephalopathy, the hepatorenal syndrome, the sepsis, other conditions-ascites, esophageal varix, portal hypertension, etc-and pre or postoperative complications were reviewed. And special emphases were made at the staging of liver cirrhosis in oral and maxillofacial surgery, preoperative preparations, and prevention of intraoperative or postoperative complications.