A 49-year-old man was admitted to Baptist Hospital on September 1, 1990. For mitral valve replacement due to mitral regurgitation. He has been treated by implantation of artificial pacemaker due to complete heart block for 1 year ago. We have experienced anesthetic management above patient who was scheduled of MVR. The patient with a cardiac pacemaker (VVI type) could give anesthesiologist many associated problems during the operation and anesthesia. During anesthesia an anesthesiologist should be able to manage the problems which might occur because of a cardiac pacemaker by various origins. Authors report this case with evaluation of references.
Anesthesia ; Heart Block ; Heart* ; Humans ; Middle Aged ; Mitral Valve ; Mitral Valve Insufficiency ; Pacemaker, Artificial ; Protestantism ; Thoracic Surgery*

Hypoxemia remains one of the most common postoperative problems. It is difficult to detect but potentially lethal, especially in combination with other complications. A case is presented of persistent hypoxemia resulting from pneumothorax in a 44-year-old male patient having surgery for the pancreatic head cancer under general anesthesia. He was catheterized in the right subclavian vein by the infraclavicular approach for the measurement of CVP on the first preoperative day and developed pneumothorax subsequently. This complication was thought to have been aggravated due to inattentive positive pressure ventilation and diffusion on N2O during anesthesia. This patient recovered from postoperative hypoxemia after needle aspiration of air from the pleural cavity without any other problem in the recovery room.
Adult ; Anesthesia ; Anesthesia, General ; Anoxia* ; Catheters ; Diffusion ; Head and Neck Neoplasms ; Humans ; Male ; Needles ; Pleural Cavity ; Pneumothorax* ; Positive-Pressure Respiration ; Recovery Room ; Subclavian Vein

Listeria monocytogenes is a gram-positive rod which can be isolated from soil, vegetation, and many animal reservoirs. Human disease due to Listeria monocytogenes is uncommon but occurs most frequently in the neonatal period, during pregnancy and in elderly or immuno-suppressed patients. Listeriosis in pregnant women may cause spontaneous abortion, fetal distress, preterm labor, fetal death, or neonatal septicemia/meningitis. Maternal infection alone may occur without infection of the infant, especially at the end of pregnancy. One case of septicemia with Listeria monocytogenes in pregnant women at the 35th weeks of pregnancy with fetal distress is presented.
Abortion, Spontaneous ; Aged ; Animals ; Female ; Fetal Death ; Fetal Distress* ; Humans ; Infant ; Listeria monocytogenes ; Listeriosis ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Trimester, Third* ; Pregnant Women ; Sepsis ; Soil

We report 13 chromophobe renal cell carcinomas (10.8%) observed among 120 renal cell carcinomas in adults. The average age was 53 (range: 34-72) years old, and 6 were males and 7 females. The mean tumor size was 10 (range: 5-17) cm, mean nuclear grade 2.4, and mean Robson's stage was 1.9. There were two distinct histologic variants; typical variant (n=9) and eosinophilic variant (n=4). Both of them showed typical light microscopic features and positive reaction with Hale's colloidal iron and carbonic anhydrase II, a marker protein of intercalated cells of renal collecting ducts. A strong positive immunoreactivity for epithelial membrane antigen was noted in the cytoplasm in 12 of 13 tumors. Numerous microvesicles, 180~440 nm in diameter, were identified ultrastructurally. DNA aneuploidy was found in 3 out of 10 cases. Neither local recurrence nor metastasis have been identified during the following period of 4~144 (mean 48) months.
Adult ; Aneuploidy ; Carbonic Anhydrase II ; Carcinoma, Renal Cell* ; Colloids ; Cytoplasm ; DNA ; Eosinophils ; Female ; Humans ; Iron ; Male ; Mucin-1 ; Neoplasm Metastasis ; Recurrence

From march, 1983 to May, 1987, we experienced 17 patients of Marfan syndrome. The clinical profile and course of 17 patients of Marfan syndrome were reviewed. 1) Their ages ranged from 13 to 50 years with a mean age of 30 years and 16 patients were male and 1 patient was female. 2) musculoskeletal features were present in 14(88%) of the 16 examined. Ocular features were found in 5(42%) of 12 examined. Familial features were present in 7(47%) of 15 examined. 3) Among cardiovascular manifestations dissecting aneurysm was present in 10(59%) patients, aortic annuloectasia in 15(94%), MR in 4(24%) and MVP in 1(6%). 4) Modified Bentall operation was performed to 8 patients. Two of them died. The other 8 patients took a conservative medical therapy. Four of them died.
Aneurysm, Dissecting ; Female ; Humans ; Male ; Marfan Syndrome*

The implatnation of malignant cells along the needle tract is an extremely rare complication after a percutaneous fine-needle aspiration biopsy(FNAB). However, it is very serious and may result in a change in the prognosis of lung cancer, especially in the curable early stage(T1-2,N0,M0). Recently, we experienced two cases of such complications. A 43 years old female underwent a fine needle aspiration biopsy and a right middle lobectomy with adjuvant chemotherapy due to an adenocarcinoma(T2N0M0). Two years later, a new tumor developed at the site of the needle aspiration biopsy. It had the same pathological findings as the previous lung cancer. Therefore, it was concluded to be an implantation metastasis, and she was treated successfully by a right pneumonectomy and a resection of the chest wall mall with adjuvant radiotherapy. In another case, a 62 years old man was diagnosed with squamous cell lung cancer by a fine needle aspiration biopsy and underwent a right upper lobectomy(T2N0M0) with adjuvant chemotherapy. eight months later, a protruding chest wall mass developed at the aspiration site. It showed the same pathological findings as the previous lung cancer. Consequently, a total excision of the mass with adjuvant radiotherapy was done. Two years after the second operation, although the right lung was intace a metachronous squamous cell lung cancer was found at the left lower lobe. The two patients were still alive 15 and 37 months after thenresection of the chest wall mass, respectively.
Biopsy ; Biopsy, Fine-Needle* ; Biopsy, Needle ; Chemotherapy, Adjuvant ; Female ; Humans ; Lung Neoplasms* ; Lung* ; Needles ; Neoplasm Metastasis* ; Pneumonectomy ; Prognosis ; Radiotherapy, Adjuvant ; Thoracic Wall* ; Thorax*

17 cases of acute myocardial infarction with no or insignificant narrowing of major coronary arteries on angiogram and without any-other types of heart disease were found in a series of 133 consecutively studied patients with acute myocardial infarction(12,7%). There were no differences in risk factors between groups. Although the infarction site were similar in both groups, the patients with normal coronary arteries had fewer complications during hospitalization(p<0.05) and lesser ST segment change during the exercise test before discharge(p<0.05). In the hemodynamic fingings, cardiac index, left ventricualr and diastolic pressure and resional wall motion were similar in both groups of the patients, but ejection fraction was higher(p<0.05) in the patients with the normal coronary arteries. In conclusion, it could be predicted that the acute myocardial infarction with the normal coronary arteries would have the better prognosis. And a transient coronary occlusion, as the most likely pathogenic mechanism of the acute mtocardial infarction with normal coronary arteries, might be studied in the aspect of the thrombosis following lysis, the coronary artery spasm and the platelet aggregation.
Angiography* ; Blood Pressure ; Coronary Occlusion ; Coronary Vessels ; Exercise Test ; Heart Diseases ; Hemodynamics ; Humans ; Infarction ; Myocardial Infarction* ; Platelet Aggregation ; Prognosis ; Risk Factors ; Spasm ; Thrombosis

Pendipronil(R) overdose is uncommon in Korea. Pendipronil(R) is a selective herbicide used to control most annual grasses and certain broadleaf weeds in field corn, potatoes, rice, etc. and is the substance including pendimethalin and propanil. Pendimethalin is slightly to practically nontoxic by ingestion but may be mildly to moderately irritating to the linings of the mouth, nose, throat, and lungs. Propanil toxicity is evidenced by varying clinical pictures ranging from deep cyanosis in an otherwise alert normal appearing individual to restlessness, dyspnea, extensive hemolytic anemia, methemoglobinemia, sulfhemoglobinemia and serious central nervous system dysfunction. For the treatment of methemoglobinemia, gastric lavage, activated charcoal, methylene blue and exchange transfusion should be used. We experienced a case of acute massive Pendipronil(R) intoxication in 31 years old woman due to voluntary ingestion of 48g of this drug as a suicide attempt. A moderate methemoglobinemia developed, accompanied by drowsy mental status, nausea, vomiting, headache, intensive cyanosis. The patient recovered completely after intravenous methylene blue injection and cellulose coated hemoperfusion charcoal (Adsorba 300C(R)) and conservative treatment.
Adult ; Anemia, Hemolytic ; Cellulose ; Central Nervous System ; Charcoal ; Cyanosis ; Dyspnea ; Eating ; Female ; Gastric Lavage ; Headache ; Hemoperfusion* ; Humans ; Korea ; Lung ; Methemoglobinemia ; Methylene Blue* ; Mouth ; Nausea ; Nose ; Pharynx ; Poaceae ; Poisoning* ; Propanil ; Psychomotor Agitation ; Solanum tuberosum ; Suicide ; Sulfhemoglobinemia ; Vomiting ; Zea mays

Brain meningioma, the most common benign brain tumor, has been reported to account for 13-26% of all intracranial tumors, with a crude incidence rate of 2.3 per 100,000 persons for all types of meningiomas. The prevalence of neuropsychiatric lupus erythematosus is 15-91% and its clinical manifestations are diverse: from mild cognitive dysfunction to serious neurological or psychiatric symptoms. Here, we report the first Korean patient with brain meningioma and systemic lupus erythematosus who had undergone surgical tumor resection.
Brain Neoplasms ; Brain* ; Headache ; Humans ; Incidence ; Lupus Erythematosus, Systemic* ; Meningioma* ; Prevalence

BACKGROUND/AIMS: The purpose of this study was to determine the clinical parameters for a differential diagnosis between a malignant and benign stricture of the ampulla of Vater with a grossly normal appearance and to evaluate the diagnostic accuracy of the use of an endoscopic biopsy for the prognosis of ampulla of Vater cancers. METHODS: Medical records and cholangiograms were retrospectively reviewed. In order to determine the clinical parameters useful for a differential diagnosis, clinical manifestations, laboratory findings and the common bile duct diameter were compared between malignant and benign strictures. The diagnostic accuracy of the use of an endoscopic biopsy and the clinical features of patients with an ampulla of Vater cancer were analyzed. The survival rate after management was also evaluated. RESULTS: Nine patients with a benign stricture and 15 patients with a malignant stricture were included in this study. The levels of serum bilirubin, alkaline phosphatase and alanine aminotransferase were significantly higher in patients with a malignant stricture than in patients with a benign stricture (p<0.05). Of the patients who underwent surgical management, 93% had stage I or II disease. All of the patients were alive up to a mean follow-up period of 50 months. CONCLUSIONS: Liver function tests and the use of an endoscopic biopsy are useful in the differential diagnosis of a stricture of the ampulla of vater with a grossly normal appearance. Cancer patients typically present with an early stage and the prognosis is relatively good.
Alanine Transaminase ; Alkaline Phosphatase ; Ampulla of Vater ; Bilirubin ; Biopsy ; Common Bile Duct ; Constriction, Pathologic ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Liver Function Tests ; Medical Records ; Prognosis ; Retrospective Studies ; Survival Rate