In contrast to younger patients, geriatric patients are generally considered to be a poor risk for anesthesia and surgery and greater care should be taken in anesthetic management, because many have chronic systemic diseases in addition to a decrease in physiologic function. To evaluate geriatric anesthetic experiences, we received clinical records of 1,062 patients aged over 65 out of 21,656 surgical cases performed at Korea University Hye-Wha Hospital from January 1980 to December 1986. The cases were analysed according to age, sex, department, preoperative physical status, anesthetic techniques and agents, duration of anesthesia, operation site, length of hospital stay, laboratory data(Chest X-ray, EKG), associated diseases, postoperative complications and mortality. The results are as follows: 1) Of the 1,062 geriatric surgical patients, 516 cases(48.6%) were 65~69 years of age. 2) The number of geriatric surgical cases was 1,062 of which 672(63.3%) were male and 390(36.7%) were female. 3) Most surgical cases were general surgery(401 cases, 37.8%). 4) The rate of elective and emergency surgery was 78.0%(829 cases) and 22.0%(233 cases), respectively. The ratio of insurance patients (737 cases, 69.4%) versus noninsurance patients(325 cases, 30.6%) was approximately 2:1. 5) The number of general anesthesia cases was 777 (73.2%), spinal anesthesia 244( 23.0%), epidural anesthesia, 21(.20%), and brachial plexus block, 5( 0.5%). The anesthetics were thalamonal and meperidine hydrochloride(238 cases, 22.4%), halothane(204 cases, 19.2%) and tetracaine(244 cases, 23.0%). 6) The duraion of anesthesia was within 1hour in 88 cases( 8.3%), 1~2 hours in 421 cases(39.6%), and 2~3 hours in 291 cases(27.4%). 7) The number of lower abdominal surgery cases was 497 (46.8%) and the number of upper abdominal surgery cases was 188(17.7%). 8) Preoperative laboratory findings were as follows: The findings of preoperative chest X-rays revealed that 219 cases(21.4%) were within normal mits. 182 cases(17.8%) had hypertensive heart, and 208 cases(20.4%) had atherosclerosis. The EKG, which was done on 90.8% of the patients, revealed that 333 cases (34.5%) were within normal limits, 77 cases(8.0%) showed left ventricular hypertrophy, 65 cases(6.7%) showed sinus bradycardia, and 27 cases(2.8%) showed myocardial ischemia. 9) Hypertension(88cases, 49.4%) was the most commonly associated disease. 10) The total number of postoperative complication cases was 73(6.9%). Seventeen cases showed wound infection and delayed skin closure, 19 cases showed pneumonia, and 7 cases showed atelectasis. 11) The total number of postoperative deaths was 18 cases(1.7%).
Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Anesthetics ; Atherosclerosis ; Brachial Plexus ; Bradycardia ; Electrocardiography ; Emergencies ; Female ; Heart ; Humans ; Hypertrophy, Left Ventricular ; Insurance ; Korea ; Length of Stay ; Male ; Meperidine ; Mortality ; Myocardial Ischemia ; Pneumonia ; Postoperative Complications ; Pulmonary Atelectasis ; Skin ; Thorax ; Wound Infection

In ocular surgery, many studies have been carried but in order to evaluate intraocular pressure chance during induction and maintenance of anesthesia. In this study, Vecuronium (Norcuron), new monoquaternary analogue of pancuronium, has been used in a group of patient undergoing elective sugery in order to evaluate its influe-nce on intraocular pressure. 40 patients without a history of eye digease, in age from 20 to 60 years, were evaluated. Their condition fell into ASA class l. On arrival, initial measurement of intraocular pressure(as control value) was taken with Shiotg tonometer after instilling a 0.5% pontocaine into conjuntival sac. Subsequent measurements were taken after thiopental injeotion as soon at the lid reflex was lost, then 2 minutes after Vecuronium injection, 1,3,5,10 and 20 minutes after endot-racheal intuhation. Blood pressure and pulse rate were measured together. The results were as follows, 1. At 2 minutes after intubation, intraocular pleasure was decreased as compared with the control value. 2. At 1 minute after intutation, intraocular pressure was more increased than the value of 2 minutes after vecuronium injection. but was not significantly changed as compared with control valule. 3. All values measured followed 3 minutes after intubation were significantly derceased. 4. Mean arterial pressure and pulse rate were increased at 1 minute after intubation but all the other values were not significantly changed as compared with control value.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Humans ; Intraocular Pressure* ; Intubation ; Pancuronium ; Pleasure ; Reflex ; Tetracaine ; Thiopental ; Vecuronium Bromide*

Consecutive anesthesia records of transurethral resection. (TUR) on 97 patients have been reviewed. The patients' anesthetic management and complications were discussed. Operations in this series were classified as follows: 65 cases of TUR of the benign prostate hypertrophy(BPH), 8 cases of TUR of prostate ca, 24 cases of TUR of the bladder tumor. Of all the 97 cases of TUR, 62 cases had some systemic disease. Circulatory diseases, such as hypertension, abnormal EKG and ischemic heart disease were encountered most frequently, namely in 24 cases(26%). The patients who underwent TUR of the BPH had the highest mean age(70 years old). Spinal anesthesia was given 79.4%, and general anesthesia in 18. 6%. Complications did not occur during or after TUR. There was no death associated with anesthesia and operation in this study.
Anesthesia* ; Anesthesia, General ; Anesthesia, Spinal ; Electrocardiography ; Humans ; Hypertension ; Myocardial Ischemia ; Prostate ; Urinary Bladder Neoplasms

Anesthesia, General ; Cleft Palate ; Congenital Abnormalities ; Electrocoagulation ; Emergencies ; Fistula ; Hemorrhage ; Humans ; Infant ; Critical Care ; Palate, Soft ; Shock ; Uvula ; Wounds and Injuries

The authors experienced a case of myoglobinuria accompanied by generalized myalgia and mild fever that developed 3 hours 30 minutes after general anesthesia. Tracheal intubation was done smoothly 5 minutes after injection of thiopental sodium(275 mg) and pancuronium bromide(6 mg), and anesthesia was maintained with ethrane/N2O/O2(1.5-2%/21/21/min). There was no specific event except tachycardia and fluctuation of blood pressure throughout operation. In this case, we assume that the myoglobinuria is a presentation of the sign of an abortive type of malignant hyperthermia. However, it was not confirmed. We had good patient outeome with the supportive measures of hydration and diuresis. The patient was discharged twenty three days after operation without any complication.
Anesthesia ; Anesthesia, General* ; Blood Pressure ; Diuresis ; Fever ; Humans ; Intubation ; Malignant Hyperthermia ; Myalgia ; Myoglobinuria* ; Pancuronium ; Tachycardia ; Thiopental

Choroid plexus papilloma is a very rare disease in children. The manifestations of the disease differ according to the tumor size and the location. Increased CSF production by the tumor, hydrocephalus and symptoms of increased ICP are the main symptoms. The first line of treatment is surgical excision, but sometimes excision itself is very difficult due to the site and the size of the mass. Adjunctive radiation therapy or chemotherapy is not recommended. Since gross total resection without adjunctive therapy offers highest likelihood of success. Significant prognostic factors are sex, age, time of diagnosis, the duration between the appearance of symptoms and diagnosis, tumor volume, tumor site and the extent of surgery. We report a case of choroid plexus papilloma, in a child with anorexia and failure to thrive.
Anorexia* ; Child* ; Choroid Plexus* ; Choroid* ; Diagnosis ; Drug Therapy ; Failure to Thrive* ; Humans ; Hydrocephalus ; Papilloma, Choroid Plexus* ; Rare Diseases ; Tumor Burden

BACKGROUND/AIMS: The aims of this study were to determine the H. pylori re-infection rate in patients that underwent endoscopic mucosal resection (EMR) due to a gastric adenoma and gastric adenocarcinoma, and to define the correlation between H. pylori re-infection and the presence of metachronous lesions. METHODS: An endoscopic examination with a biopsy was performed at six months, 12 months, and every year thereafter to determine if H. pylori re-infection occurred and if metachronous lesions were present in patients that had undergone EMR (EMR group). At least a three-year follow-up examination was performed, and patients with an on-site recurrent lesion were excluded. The re-infection rate was compared to the rate in patients with peptic ulcers (control group). RESULTS: Six patients (24%) among the 25 patients included in this study had H. pylori re-infection, an indication of a high re-infection rate as compared to the rate in patients with peptic ulcers (p=0.03). Two patients (33.3%) who were re-infected with H. pylori had metachronous lesions (p=0.009). CONCLUSIONS: Determination of the H. pylori status during a follow-up study after EMR is essential and re-eradication therapy is recommended in patients with H. pylori re-infection to prevent metachronous lesions.
Adenocarcinoma ; Adenoma ; Biopsy ; Follow-Up Studies ; Helicobacter ; Helicobacter pylori ; Humans ; Peptic Ulcer

BACKGROUND AND OBJECTIVES: In order to verify that apoptosis is one of the possible mechanisms of human neonatal vascular remodeling during transition from fetal to neonatal circulation, we identified apoptosis and analyzed its mechanism by evaluating apoptosis-related genes in umbilical vessel versus ascending aorta, ductus arteriosus (DA) versus adjacent pulmonary artery and aorta, and aorta versus its branching arteries. MATERIALS AND METHODS: Twenty-two umbilical cords, six ductus arteriosus with adjacent aortae and pulmonary arteries, and four aortic arches with their branching great arteries, were obtained from neonates. The presence of apoptotic cells was demonstrated by electron microscopy (EM) and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL). Immunohistochemical staining and Western blotting were used for the analysis of the proteins of apoptosis-related gene. RESULTS: Apoptosis of the smooth muscle cells of the umbilical vessels were identified in all UC, which were examined by electron microscopy and TUNEL. The expressions of Bax and Bcl-X were shown by immunohistochemistry to be stronger in umbilical artery than in the neonatal aorta, but Bcl-2 was weak in both arteries. In the immunoblot analysis of UC, the expression of the proapoptotic short isoform of Bcl-X was stronger than in other tissue, and caspase-3 was selectively activated whereas it was not in the other components of the cardiovascular system. However, the expression patterns of the Fas Ag and Fas ligand (i.e. positive Fas Ag and negative Fas ligand), were similar in umbilical artery and aorta. This Bax-associated apoptosis was also observed in other vascular sites which undergo dramatic hemodynamic changes during birth, such as, the ductus arteriosus and the branching points of the great arteries from the aortic arch. CONCLUSIONS: Apoptosis is involved in the closure and regression of human umbilical vessels and the ductus arteriosus and in the remodeling of the branching great arteries during the neonatal period, where the Bax/Bcl-2/Bcl-X system, not Fas Ag/Fas ligand system, is likely to play a key role.
Aorta ; Aorta, Thoracic ; Apoptosis* ; Arteries ; Blotting, Western ; Cardiovascular System ; Caspase 3 ; Ductus Arteriosus ; Fas Ligand Protein ; Hemodynamics ; Humans* ; Immunohistochemistry ; In Situ Nick-End Labeling ; Infant, Newborn ; Microscopy, Electron ; Myocytes, Smooth Muscle ; Parturition ; Pulmonary Artery ; Umbilical Arteries ; Umbilical Cord

BACKGROUND: The mechanism of the closure of umbilical vessels is known to be multifactorial. In order to verify that apoptosis is one of the possible closure mechanisms, we studied to identify apoptosis in umbilical vessels and evaluate its mechanism by studying apoptosis-related gene and the relationship between the pattern of apoptosis and gestational age (GA). METHODS: Twelve umbilical cords of GA of 37-42 weeks were obtained immediatly (less than 10 min. for minimal ongoing external influences) after birth. The presence of apoptotic cells was demonstrated by electron microscopy (EM) and terminal deoxynucleotidyl transferase- mediated dUTP nick end labeling (TUNEL). Immunohistochemical staining and Western blotting were used for the analysis of the proteins of apoptosis-related gene. RESULTS: Apoptosis of the smooth muscle cells of media and intima of umbilical vessels was identified at EM, regardless of GA from 37 to 42 weeks. The proportion of TUNEL (+) cells was 80% in intima, 40% in media, 80% in connective tissue of umbilical cord. The expressions of bax-alpha, bcl-Xs/L were strong in intima, in media and connective tissue, but those of bcl-2 were detected in only in connective tissue, regardless of GA in immunohistochemistry. The ratios of expressions of bax-alpha to bcl-2, bcl-Xs to bcl-XL, did not change with increasing GA from 37 to 42 weeks in Western blotting. CONCLUSION: Apoptosis was identified in umbilical vessels. The closure of umbilical vessels can be explained by apoptosis where the ratios of bax-alpha/bcl-2, bcl-Xs/ bcl-XL play an important role. The fact that there were no differences in the extent of apoptosis and the expressions of bax-alpha/bcl-2, bcl-Xs/bcl-XL according to GA, suggests that apoptosis of umbilical vessels is more dependent on the external stimuli during delivery than GA.
Apoptosis* ; Blotting, Western ; Connective Tissue ; Gestational Age ; Humans* ; Immunohistochemistry ; In Situ Nick-End Labeling ; Microscopy, Electron ; Myocytes, Smooth Muscle ; Parturition* ; Umbilical Cord

BACKGROUND AND OBJECTIVES: The burden of heart failure has increased in Korea. This registry aims to evaluate demographics, clinical characteristics, management, and long-term outcomes in patients hospitalized for acute heart failure (AHF). SUBJECTS AND METHODS: We prospectively enrolled a total of 5625 consecutive subjects hospitalized for AHF in one of 10 tertiary university hospitals from March 2011 to February 2014. Descriptive statistics were used to determine the baseline characteristics of the study population and to compare them with those from other registries. RESULTS: The mean age was 68.5±14.5 years, 53.2% were male, and 52.2% had de novo heart failure. The mean systolic and diastolic blood pressures were 131.2±30.3 mmHg and 78.6±18.8 mmHg at admission, respectively. The left ventricular ejection fraction was ≤40% in 60.5% of patients. Ischemia was the most frequent etiology (37.6%) and aggravating factor (26.3%). Angiotensin converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, and aldosterone antagonists were prescribed in 68.8%, 52.2%, and 46.6% of the patients at discharge, respectively. Compared with the previous registry performed in Korea a decade ago, extracorporeal membrane oxygenation (ECMO) and heart transplantation have been performed more frequently (ECMO 0.8% vs. 2.8%, heart transplantation 0.3% vs. 1.2%), and in-hospital mortality decreased from 7.6% to 4.8%. However, the total cost of hospital care increased by 40%, and one-year follow-up mortality remained high. CONCLUSION: While the quality of acute clinical care and AHF-related outcomes have improved over the last decade, the long-term prognosis of heart failure is still poor in Korea. Therefore, additional research is needed to improve long-term outcomes and implement cost-effective care.
Demography ; Extracorporeal Membrane Oxygenation ; Follow-Up Studies ; Guideline Adherence ; Heart Failure* ; Heart Transplantation ; Heart* ; Hospital Mortality ; Hospitals, University ; Humans ; Ischemia ; Korea* ; Male ; Mineralocorticoid Receptor Antagonists ; Mortality ; Peptidyl-Dipeptidase A ; Prognosis ; Prospective Studies ; Quality of Health Care ; Registries ; Stroke Volume ; Treatment Outcome