Arotinolol, a now alpha and beta bloking agent, was administered orally in 32 hypertensive patients for 8 weeks in order to evaluate the antihypertensive effects and side effects. The doses were from 20mg to 30mg a day. The serum chemistries and chest X-ray were taken before and after Arotinolol administration. The results were as follows; 1) Blood pressure which was measured in sitting, supine and standing position was 176.37+/-4.73/116.54+/-4.34, 170.14+/-5.35/103.12+/-3.67, 156.37+/-7.54/104.31+/-3.34mmHg in control and 144.63+/-2.78/94.41+/-2.87, 146.47+/-5.41/89.12+/-4.34, 140.71+/-4.47/89.73+/-3.71mmHg in the treatment group. The differences between both blood pressure were statistically significant(P<0.001). 2) There was no significant change in pulse rate before and after medication. 3) There was no significant change in the laboratory findings such as CTR, GOT, GPT, alkaline phosphatase, CPK, creatinine, BUN, uric acid, cholesterol, fasting blood sugar and triglyceride before and after treatment. 4) The side effects of arotinolol were observed in 6 of 32 cases(18.7%), which were not required discontinuing the medication or decreasing the dose.
Alkaline Phosphatase ; Blood Glucose ; Blood Pressure ; Cholesterol ; Creatinine ; Fasting ; Heart Rate ; Humans ; Hypertension ; Thorax ; Triglycerides ; Uric Acid

A 72-year-old non-diabetic man was admitted to the intensive care unit because of liver abscess, cholecystitis, and septic shock. He underwent percutaneous catheter drainage and received intravenous antibiotics. Shock was improved, and the patient’s fever subsided. Klebsiella pneumoniae was isolated in blood and bile cultures. However, he suddenly developed dyspnea and oxygen desaturation. Chest computed tomography scan revealed multifocal ground-glass opacities with consolidation with peripheral preponderance. Appropriate antibiotic therapy was provided for 2 weeks. The patient recovered fully, and cholecystectomy was then performed. Herein, we report a case of K. pneumoniae-induced liver abscess complicated with septic pulmonary embolism in a non-diabetic patient.

We experienced a case of postoperative quadriparesis secondary to operative position in a patient with pre-existing, asymtomatic,cervical neurilemmoma. The patient was admitted with chronic otitis media for mastoidectomy on right side. There was no specific event throughout operation and anesthesia but developed quadriparesis one hour after arrival on ward. With magnetic resonance imaging, the patient was dignosed to have cervical neurilemmoma. On seventh postoperative day the patient had second operation,cervical laminectomy and tumor removal. Ten days after second operation he was discharged without any complication. Eight months later he had mastoidectomy on the left side and was discharged without any sequale.
Anesthesia ; Anesthesia, General* ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Neurilemmoma ; Otitis Media ; Quadriplegia*

BACKGROUND: Epidural and intravenous administration of opioids had been commonly used for postoperative pain management in thoracoscopic surgery. Recently, interpleural analgesia was frequently used. The aim of this study was to compare the effect of an intravenous continuous infusion of fentanyl (F-IV) with interpleural bupivacaine (B-IP) using a continuous infusion system in the management of post-thoracoscopic pain. METHODS: An interpleural continuous infusion of bupivacaine (B-IP group: basal infusion 7(ng/kg/min) was compared with an intravenous continuous infusion of fentanyl (F-IV group: basal infusion 0.33ng/ kg/hr) in forty patients who had undergone elective thoracoscopic surgery. During the postoperative 48 hours, the visual analogue scale (VAS), Prince-Henry score (PHS), heart rate, respiratory rate and peripheral oxygen saturation were measured. RESULTS: The postoperative heart rate in both groups was significantly higher than the preoperative value (P < 0.05 1 h and 4 h after operation), but there were no differences in the respiratory rate and peripheral oxygen saturation between the two groups. There were significant improvement of the degree of pain in VAS and PHS after administration of the analgesic, but there was no significant differences in the two groups during 48 hours. The incidence of adverse effects such as nausea, vomiting, dizziness, urinary difficulty and respiratory depression was higher in the F-IV than the B-IP group. CONCLUSIONS: The interpleural continuous infusion of local anesthetics and intravenous continuous infusion of fentanyl provided effective analgesia in this study. The side effects were significantly lower in the interpleural continuous infusion of local anesthetics than intravenous continuous infusion of fentanyl. Therefore, interpleural continuous infusion of local anesthetics could be a useful alternative for postoperative analgesia after thoracoscopic surgery.
Administration, Intravenous ; Analgesia ; Analgesics, Opioid ; Anesthetics, Local ; Bupivacaine* ; Dizziness ; Fentanyl* ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Interpleural Analgesia ; Nausea ; Oxygen ; Pain, Postoperative ; Respiratory Insufficiency ; Respiratory Rate ; Thoracoscopy* ; Vomiting

The halogenated anesthetics, halothane, enflurane and isoflurane undergo biotransformation in man. They produce inorganic fluoride ion as a metabolite, which is well known as the cause of methoxyflurane induced nephrotoxicity. This study was done to investigate the rapidity and extent of biotransformation of volatile anesthetics for 2 hours of operation. Thirty patients were randomly divided into halothane, enflurane and isoflurane group according to anesthetics. Blood and urine sampling was done before operation, post-induction 10 min, 20 min, 30 min, 1 hour, 1 hour 30 min and 2 hours for the measurement of inorganic fluoride ion. Aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen and creatinine levels were measured before and 24 hours after operation. The results were as follows ; 1) The values of blood fluoride ion in halothane and isoflurane group were decreased with time during operation and there was no change in enflurane group. 2) The values of urine fluoride ion in three groups were increased with time during operation. The rate of increase was the greatest in enflurane group. 3) There were no changes in the value of AST, ALT, BUN and creatinine. The above results suggest that the biotransformation of volatile anesthetics to inorganic fluoride ion was the greatest in enflurane, but the level was insufficent to cause renal dysfunction during 3.18 hour operation.
Alanine Transaminase ; Anesthetics* ; Aspartate Aminotransferases ; Biotransformation* ; Blood Urea Nitrogen ; Creatinine ; Enflurane ; Fluorides ; Halothane ; Humans ; Isoflurane ; Metabolism ; Methoxyflurane

BACKGROUND: Both ketamine and priming may accelerate the onset time of neuromuscular blocking agents. We investigate the effect of low dose ketamine and cisatracurium priming on the intubating condition and onset time of cisatracurium. METHODS: After Institutional Review Board approval, 120 consecutive patients undergoing general anesthesia were randomly assigned to one of 4 groups. All patients were injected one of normal saline (group C), cisatracurium 0.01 mg/kg (group P), ketamine 0.5 mg/kg (group K) and combination of cisatracurium 0.01 mg/kg, and ketamine 0.5 mg/kg (group PK) diluted into a 5 ml solution, followed 3 minutes later by cisatracurium 0.15 mg/kg in group C and K, and 0.14 mg/kg cisatracurium in priming group. Onset time was recorded the electromyographical responses using single twitch and intubating conditions were evaluated at 60 seconds after cisatracurium administration. RESULTS: The mean onset time was most significantly accelerated in Group PK and was also significantly more accelerated in Group P and K compared with Group C (P < 0.008). It was 112.7 +/- 13.2, 91.4 +/- 17.9, 84.9 +/- 12.7 and 76.4 +/- 8.3 seconds in Group C, P, K, and PK, respectively. Intubating conditions were significantly improved in Group P, K and PK than Group C (P < 0.008). Especially, Group PK showed most significant improvement of intubating conditions. CONCLUSIONS: The combination of the low dose ketamine and cisatracurium priming accelerated the onset time and was improved the intubating conditions.
Anesthesia, General ; Atracurium ; Ethics Committees, Research ; Humans ; Intubation ; Ketamine ; Neuromuscular Blocking Agents

Insulinoma is clinically characterized by fasting hypoglycemia, various neuropsychiatric symptoms, and these caused by secondary to hypoglycemia.Of patients with insulinoma, 80 percent have single benign tumors, 11 percent have multiple benign tumors, 6 percent have single malignant tumors, and the remainder have multiple malignant tumors or islet hyperplasia according to Service's statement.A 42 year-old male chemical engineer who had insulinoma associated with regional lymph node metastasis has been successfully performed with curative resection and consecutive postoperative therapy with streptozotocin.He entered to this hospital because of frequent occasion of bizarre behavior and language, transient unconsiousness and syncopal episode, and sweating associated with hypoglycemia especially in night four months prior to addmission in November 1992. Those symptoms and hypoglycemia were controlled by intravenous glucose injection and/or oral feeding of glucose riched stuffs.No physical abnormalities were found except neuropsychiatric symptoms. On admission the fasting blood glucose level was 10 mg/dl, plasma immunoreactive plasma insulin level was 125.23 uU/ml, and plasma C-peptide level was 10.24 ng/ml, respectively.Abdominal CT was suggestive of retroperitoneal tumor just behind the pancreas. Selective celiac axis angiography demonstrated hypervascular mass supplied by dorsal pancreatic artery which was compatible with insulinoma. Surgical intervention including distal pancreatectomy, as well as splenectomy and parital omental resection were performed successfully. Consecutive postoperative treatment of streptozotocin was done without any side effects.His condition is very good and enjoyed his life with full activity to date.
Angiography ; Arteries ; Blood Glucose ; C-Peptide ; Fasting ; Glucose ; Humans ; Hyperplasia ; Hypoglycemia ; Insulin ; Insulinoma ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Pancreas ; Pancreatectomy ; Plasma ; Splenectomy ; Streptozocin ; Sweat ; Sweating ; Syncope

Polymyalgia rheumatica is characterized by pain and stiffness of the shoulder and pelvic girdles, morning stiffness, constitutional symptoms and an elevated erythrocyte sedimentation rate. We have experienced a 45-year-old female patient with polymyalgia rheumatica who presented with pain and stiffness of the shoulder and pelvic girdle, an elevated erythrocyte sedimentation rate and dramatic response to low-dose steroids. To our knowledge, thes is the second case of polymyalgia rheumatica with a brief review of literature.
Blood Sedimentation ; Female ; Humans ; Middle Aged ; Polymyalgia Rheumatica* ; Shoulder ; Steroids

BACKGROUND: The main disadvantage of rocuronium is the pain associated with vascular injection. We evaluated the efficacy of palonosetron for reducing pain after rocuronium injection. METHODS: Eighty patients scheduled for elective surgery were randomly divided into two groups: Group C (normal saline 1.5 ml, n = 40) and Group P (palonosetron 0.075 mg, n = 40). Anesthesia was induced with thiopental 5 mg/kg and the test drug was injected over 10 seconds. Thirty seconds after the injection of the test drug, rocuronium 0.6 mg/kg was injected over 30 seconds and the response was recorded. Injection pain was graded using a 4-point scale. The grade was 0 points for no movement, 1 point for wrist movement, 2 points for elbow or shoulder movement, and 3 points for whole body movement. Mean arterial pressure and heart rate were recorded on arrival in the operating room and before and 30 seconds after rocuronim injection. RESULTS: There was no significant difference in the grade 1 response between the two groups; however, the grade 2 and 3 responses in Group P were 5 (12.5%) and 4 (10%), respectively, which were significantly lower than in Group C, with 13 (32.5%) responses for each grade. There were no significant differences in hemodynamic changes within each group. However, the difference in mean arterial pressure before and after the injection of rocuronium was significantly larger in Group C compared to Group P. CONCLUSIONS: Pretreatment with palonosetron 0.075 mg reduced the incidence and severity of withdrawal movement after rocuronium administration.
Anesthesia ; Arterial Pressure ; Elbow ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Operating Rooms ; Shoulder ; Thiopental ; Wrist

Propofol(Diprivan, England ICI) is a new intravenous anesthetic agent chemically unrelated to barbiturates or other intravenous anesthetic agents. It was found to produce rapid onset of anesthesia and early recovery similar to that Obtained with pentothal sodium. The purpose of the present study is to compare the cardiovascular and respiratory effect of propofol with the cardiovaseular and respiratery effeet of pentothal sodium. Sixty patients of ASA class l or 2 scheduled to undergo gynecological, orthopedic and abdominal procedures were classified randomly into 3 Groups. Group A were injected with pentothal sodium 5.0 mg/kg and Group B, C received propofol 2.0 mg/kg, 2.5 mg/kg respectively. The results were as follows, 1) Change of the systolic arterial pressure. Propofol 2.5 mg/kg produced the greatest decrease in systolic blood pressure when compared with other groups. 2) Change of the heart rate. Change of the heart rate was minimal after both doses of prepofol when compared with pentothal sodium. 3) Respiratory effect. Respiratory measurement in 20 unpremedicated surgical patients who received an induction dose of propofol 2.5 mg/kg showed significant respiratory depression. 4) Side effect. Excitatory effects and pain on injection were more frequent in propofol group than pentothal sodium group. Nausea, vomiting were more frequent in pentothal sodium group than propofol group.
Anesthesia ; Anesthetics ; Arterial Pressure ; Barbiturates ; Blood Pressure ; England ; Heart Rate ; Humans ; Nausea ; Orthopedics ; Propofol* ; Respiratory Insufficiency ; Sodium ; Thiopental ; Vomiting