BACKGROUND: Coronary artery bypass graft with cardiopulmonary bypass is the standard surgical coronary revascularization procedure; however, there are many adverse effects such as air embolism, and high rate of neurologic and coagulation complications. In this article, we describe hemodynamic alterations during coronary bypass grafting (CABG) without cardiopulmonary bypass but using a medical tissue stabilizer. METHODS: Thirty patients were included in our study who underwent an off-pump CABG (OPCAB) between 1/1999 and 12/1999. RESULTS: We created 73 anastomoses. Movement of the heart to reach the target site of anastomosis caused hemodynamic alterations. These could be corrected by anesthetic interventions such as fluid load and low dose inotropics. Complications included postoperative panperitonitis (one patient), and delirium tremens (one patient). On the other hand, major complications, such as intraoperative myocardial infarction and stroke did not occur. The median postoperative length of hospital stay was 14 days. Overall operative mortality was 3.3% (one patient). CONCLUSIONS: On the basis of the present data, off-pump coronary artery bypass grafting appeared to be a safe and effective technique in selected patients with appropriate coronary lesions. Off-pump CABG surgery requires anesthetic interventions because hemodynamic alterations are caused by the presentation of the heart to the surgeon.
Alcohol Withdrawal Delirium ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Embolism, Air ; Hand ; Heart ; Hemodynamics ; Humans ; Length of Stay ; Mortality ; Myocardial Infarction ; Stroke ; Transplants*

Currently-available imaging techniques provide accurate localization of a tumor in patients with pheochromocytoma. The precision of this information allows the use of a more selective surgical approach to the tumor, such as by laparoscopy. We describe a case of a 54-year-old female who underwent resection of pheochromocytoma by a laparoscopic approach. Two events resulted in significant hemodynamic changes; the creation of the pneumoperitoneum and adrenal gland manupulation. Preoperative preparation with alpha-adrenergic blocking agents and adequate fluid loading before insufflation attenuated intraoperative cardiovascular changes, while titration of sodium nitroprusside and phentolamine allowed easy and quick control of the hemodynamic aberrances related to these processes. As a result, the operation was carried out safely, and the postoperative course was unremarkable.
Adrenal Glands ; Adrenalectomy* ; Adrenergic alpha-Antagonists ; Female ; Hemodynamics ; Humans ; Insufflation ; Laparoscopy ; Middle Aged ; Nitroprusside ; Phentolamine ; Pheochromocytoma* ; Pneumoperitoneum

BACKGROUND: The purpose of the study was to evaluate the effect of postural change on hemodynamics using thoracic eletrical bioimpedance (TEB) device during general anesthesia with enflurane-N2O-O2 and lumbar epidural anesthesia. The TEB device is safe, reliable and non-invasive way to measure hemodynmic values continuously. METHODS: General anesthesia (twenty patients) was induced by administration of pentotal sodium 5 mg/kg and succinylcholine 1 mg/kg intravenously, and was maintained with 1 vol% of enflurane, N2O-O2 (2 l/min-2 l/min) and vecuronium 0.1 mg/kg. Epidural anesthesia (twenty patients) was performed at the level of L3-4 epidural space using 20 ml of 2% xylocaine mixed with epinephrine (5 microgram/ml). Hemodynamic changes were measured before induction, 1 and 5 minutes after intubation or epidural injection, 1, 5, 10, 20, 30 minutes after head- down tilt and 1, 5, 10 minutes after returning to the supine position. RESULTS: HR and LVSWI were minimaly affected in group E with epidural anesthesia compared to group G with general anesthesia. BP (SBP, DBP, MAP) and SVRI were remarkably increased in group G compared to group E. BP and SVRI showed rapid increse 1 minutes after head-down tilt in group G (p<0.01) and decreased gradually thereafter. SI and CI were decreased significantly in group G compared to group E (p<0.001). SI was unchanged but CI was decreasd significantly after head-down tilt in group E (p<0.05). EDI and ACI showed lower values decreased in general significantly in group G compared to group E (p<0.05). CONCLUSIONS: All hemodynamic changes were more predictable, gradual, less variable, and stable in the group with epidural anesthesia compared to the group with general anesthesia for hysterectomy.
Anesthesia, Epidural* ; Anesthesia, General ; Enflurane ; Epidural Space ; Epinephrine ; Head-Down Tilt ; Hemodynamics* ; Humans ; Hysterectomy* ; Injections, Epidural ; Intubation ; Lidocaine ; Mortuary Practice* ; Sodium ; Succinylcholine ; Supine Position ; Vecuronium Bromide

A 25-year-old female came in for an explo-laparotomy. The operation was performed under epidural anesthesia. Potassium chloride (40 mEq20 ml) instead of 2% lidocaine mixed with 1:200,000 epinephrine was accidently injected via a Tuohy needle into the epidural space. The patient showed an unexpected prolonged motor and sensory paralysis below the T, cord level for about 8 hours after the epidural injection. The patient recovered without a permanent neurologic sequale after 8 hours. However, the patient developed pulmonary edema resulting from rapid fluid therapy for unusual hypotension which developed 12 hours after the potassium chloride injection. The pulmonary edema was treated by oxygen therapy using a nonrebreathing oxygen mask, a dopamine drip and an intravenous injection of lasix 20 mg. The patient completely recovered from the pulmonary edema on the 3rd postoperative day and went home with no complaints.
Adult ; Anesthesia, Epidural ; Dopamine ; Epidural Space ; Epinephrine ; Female ; Fluid Therapy ; Furosemide ; Humans ; Hypotension ; Injections, Epidural ; Injections, Intravenous ; Lidocaine ; Masks ; Needles ; Oxygen ; Paralysis ; Paraplegia* ; Potassium Chloride* ; Potassium* ; Pulmonary Edema

With the advent of metagenomics and 16S ribosomal RNA sequencing, growing attention has been dedicated to the endometrial microbiome. Research involving a relatively large cohort of healthy female participants has reported Lactobacillus dominance (LD) in the endometrial microbiome. Multiple studies have also shown that the loss of LD and/or increased microbial diversity within the endometrium are associated with reproductive failure. This phenomenon may stem from the loss of the immunomodulatory effects of Lactobacillus and the rise of proinflammatory responses triggered by pathogenic proliferation. Recent research has employed personalized antibiotic therapy followed by probiotic supplementation, tailored to the endometrial microbial composition of women with repeated implantation failure. The findings suggest that metagenomic analysis of the endometrial microbiome could be a valuable tool in addressing reproductive failure.

With the advent of metagenomics and 16S ribosomal RNA sequencing, growing attention has been dedicated to the endometrial microbiome. Research involving a relatively large cohort of healthy female participants has reported Lactobacillus dominance (LD) in the endometrial microbiome. Multiple studies have also shown that the loss of LD and/or increased microbial diversity within the endometrium are associated with reproductive failure. This phenomenon may stem from the loss of the immunomodulatory effects of Lactobacillus and the rise of proinflammatory responses triggered by pathogenic proliferation. Recent research has employed personalized antibiotic therapy followed by probiotic supplementation, tailored to the endometrial microbial composition of women with repeated implantation failure. The findings suggest that metagenomic analysis of the endometrial microbiome could be a valuable tool in addressing reproductive failure.

With the advent of metagenomics and 16S ribosomal RNA sequencing, growing attention has been dedicated to the endometrial microbiome. Research involving a relatively large cohort of healthy female participants has reported Lactobacillus dominance (LD) in the endometrial microbiome. Multiple studies have also shown that the loss of LD and/or increased microbial diversity within the endometrium are associated with reproductive failure. This phenomenon may stem from the loss of the immunomodulatory effects of Lactobacillus and the rise of proinflammatory responses triggered by pathogenic proliferation. Recent research has employed personalized antibiotic therapy followed by probiotic supplementation, tailored to the endometrial microbial composition of women with repeated implantation failure. The findings suggest that metagenomic analysis of the endometrial microbiome could be a valuable tool in addressing reproductive failure.

OBJECTIVE: Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. METHODS: We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. RESULTS: SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m², respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. CONCLUSION: Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery.
Body Mass Index ; Cystectomy ; Female ; Follow-Up Studies ; Humans ; Laparoscopy* ; Laparotomy ; Medical Records ; Minimally Invasive Surgical Procedures ; Operative Time ; Ovary ; Postoperative Complications ; Retrospective Studies

Chikungunya infection is caused by an arbovirus transmitted by the Aedes mosquito. A 19-year-old man who had traveled to the Republic of Surinam to perform volunteer work complained of a fever, arthralgia, articular stiffness, and a skin rash on both the arm and trunk. Chikungunya fever was diagnosed using a Chikungunya virus specific IgM antibody in an enzyme-linked immunosorbent assay (ELISA) using blood samples obtained during follow-up visits. In this report, we describe a case of imported Chikungunya fever that presented with arthralgia and a skin rash, with islands of normal skin, that occurred following travel to Surinam, South America.
Aedes ; Arboviruses ; Arm ; Arthralgia ; Chikungunya virus* ; Culicidae ; Enzyme-Linked Immunosorbent Assay ; Exanthema ; Fever ; Follow-Up Studies ; Humans ; Immunoglobulin M ; Islands ; Skin ; South America* ; Suriname* ; Volunteers ; Young Adult

OBJECTIVE: It is well known that fresh blastocyst transfer results in better pregnancy outcomes with a smaller number of transferred embryos compared with cleavage stage embryo transfer. However, in terms of frozen-thawed blastocyst transfer, only a few studies are available. We aimed to evaluate clinical outcomes of frozen-thawed embryo transfer (FET) with blastocysts. METHODS: Retrospective analysis of FET cycles with blastocysts (B-FET) between Jan 2007 and June 2009 was performed. Age-matched FET cycles with cleavage stage embryos (C-FET) during the same period were collected as controls. A total of 58 B-FET cycles were compared with 172 C-FET cycles and also compared with those of post-thaw extended culture blastocysts from frozen pronuclear stage embryos (22 cycles). RESULTS: There was no difference in the patient characteristics of each group. The embryos' survival rates after thawing were comparable (>90%) and there was no difference in the implantation rate or clinical and ongoing pregnancy rate among the three groups. CONCLUSION: In FET, blastocyst transfers may not present better pregnancy outcomes than cleavage stage embryo transfers. A further large-scale prospective study is needed.
Blastocyst ; Embryo Transfer ; Embryonic Structures ; Female ; Humans ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies ; Survival Rate