PURPOSE: The purpose of this study was to analyse the characteristics of acalculous cholecystitis (AC) compared with those of calculous cholecystitis (CC), and also to find the relationship of preoperative radiologic findings to the classification of pathological degree of inflammation of the gallbladder in AC. METHODS: Between March 1996 and June 2000 a total of 163 patients undergoing cholecystectomy for cholecystitis were divided into group AC (21 patients) and group CC (142 patients) and retrospectively studied by analyzing clinical data. RESULTS: The incidence of AC among cholecystitis cases was 12.9%. there was male preponderance in group AC whereas female preponderance in group CC (P<0.036). The pulse rate (P<0.02) and white blood cell count (P<0.003) were significantly elevated in group AC. Possible etiological factors were found in 6 cases (28%) in group AC. The rates of preoperatively observed pericholecystic fluid collection in US (P<0.033) and dilatation of the gallbladder in CT (0.012) were significantly higher in group AC than in group CC. Additionally, the rate of tube drainage during surgery was significantly higher in group AC than group CC (P<0.02). Finally, wall thickness (P<0.05), dilatation (P<0.05) of the gallbladder in CT and the total sum of findings in CT (P<0.01) and US (P<0.05) were strongly related to the degree of inflammation of the gallbladder. CONCLUSION: The majority of AC patients exhibit nonspecific clinical findings, often delaying diagnosis; however, if it develops, AC tends to display more acute and inflammatory characteristics than calculous cholecystitis. laparoscopic surgery cannot be sucessful in cases of delayed diagnosis. US, CT and scintigram are useful diagnostic tools if we interpretate each finding in relation to the severity of inflammation.
Acalculous Cholecystitis* ; Cholecystectomy ; Cholecystitis* ; Classification ; Delayed Diagnosis ; Diagnosis ; Dilatation ; Drainage ; Female ; Gallbladder ; Heart Rate ; Humans ; Incidence ; Inflammation ; Laparoscopy ; Leukocyte Count ; Male ; Retrospective Studies

The internal morphology of the right and left atria of rabbit, cat, pig, and human, particularly on the luminal structures of the auricle, were observed by stereomicroscope improving corrosion casting method using latex. Structures of the right auricular casts markedly differ from those of the left side, consisting of defined surface sturctures with distinct folds and branching patterns. The main atrial region consists of smooth surfaced single mass of the latex, and the auricular region is characterized by well developed branching patte and delicate small folds. The results of this study indicate that auricula have well organized duct-like luminal structures and many small pouches (out-pocketings) expanding the internal wall of the duct-like structures and small pouches. The endocardial nuclear imprints on the surface of the folds in the auricular region appeared larger and deeper than those on the atrium proper region of the atrial cast. These morphological observation will be aid in understanding structures of auricular lumen, regional differences of the endocardium and their function to the secretory process of atrial natriuretic peptide (ANP) release.
Animals* ; Cats ; Corrosion Casting* ; Corrosion* ; Endocardium ; Humans ; Latex ; Methods* ; Phenobarbital* ; Secretory Pathway

BACKGROUND: Intratracheal pulmonary ventilation (ITPV) is a form of tracheal gas insufflation which enhances the clearance of CO2 from dead space and lungs by a bias gas through a reverse thrust catheter (RTC). After exiting from the catheter tip in the distal trachea, the flow of gas is directed outward away from the lungs. Gas is intermittently re-directed into the lung as a tidal volume by a valve on the expiratory circuit. Hybrid ITPV (hITPV) is a continuous flow ventilatory technique that adopts inspiratory fresh gas from a ventilator and RTC. We hypothesized that hITPV might reduce the dead space/tidal volume ratio as compared with volume controlled ventilation (VCV). METHODS: VCV and hITPV were compared in 6 tracheostomized rabbits. We aimed at maintaining normal partial pressure of arterial CO2 (PaCO2) and minute CO2 clearance (VCO2) while the respiratory rate (RR) was set at 20, 40, 80 or 120/min with an inspiratory to expiratory (I : E) ratio of 1 : 2 or 1 : 1. Blood pressure and airway pressures were monitored and the dead space ratio was calculated. RESULTS: PaCO2, VCO2 and alveolar ventilation were statistically constant with various RR with the same I : E ratio during VCV and hITPV. Mean values of PaO2 were higher than 400 mmHg during the experiment. VT, VD and PIP were lower in hITPV than in VCV under I : E ratios of 1 : 2 and 1 : 1 at the same RR. The VD/VT ratios at an I : E ratio of 1 : 2 were 0.66 +/- 0.07, 0.74 +/- 0.05, 0.81 +/- 0.04, and 0.83 +/- 0.04 during VCV and 0.44 +/- 0.15, 0.56 +/- 0.10, 0.64 +/- 0.08 and 0.67 +/- 0.06 during hITPV at an RR of 20, 40, 80 or 120/min, respectively. The VD/VT ratios at an I : E ratio of 1 : 1 were 0.71 +/- 0.07, 0.73 +/- 0.04, 0.80 +/- 0.04, and 0.83 +/- 0.03 during VCV and 0.50 +/- 0.07, 0.54 +/- 0.10, 0.63 +/- 0.10, and 0.70 +/- 0.08 during hITPV at an RR of 20, 40, 80 or 120/min, respectively. The VD/VT ratio was reduced by the institution of hITPV. CONCLUSIONS: It was concluded that hITPV could be applied to minimize the airway pressures and dead space resulting from VCV.
Bias (Epidemiology) ; Blood Pressure ; Catheters ; Insufflation ; Lung ; Partial Pressure ; Pulmonary Ventilation* ; Rabbits* ; Respiratory Rate ; Tidal Volume ; Trachea ; Ventilation ; Ventilators, Mechanical

A retrospective study was conducted to evaluate the changes in serum creatine kinase (CK) and lactic dehydrogenase (LDH) after coronary artery bypass grafting surgery. We studied 37 patients who had normal liver and kidney functions and who did not have the perioperative acute myocardial infarction. After measuring total serum LDH and isoenzyme 1 to 5, and seum CK and isoenzyme CK-MB, we compared pastoperative values to preoperative value. We also calculated the ratio of LD1 to LD2 (LD1 /LD2). Total LDH increased for postoperative 0 day, 1 day, 2 day, and 4 day. LD1, LD2 LD3 and LD4, increased for postoperative 0 day, 1 day, and 2 day, but LD5 increased for 0 day and 1 day. Total CK increased for 0 day, 1 day, and 2 day, but CK-MB did not increase postoperatively. LD1/LD2 increased at posoperative 2 day. Among the total 113 samples, the number of the cases of LD1/LD2 > 1 is 12.
Coronary Artery Bypass ; Creatine Kinase* ; Creatine* ; Humans ; Kidney ; Liver ; Myocardial Infarction ; Oxidoreductases* ; Retrospective Studies

No abstract available.
Nipples*

No abstract available.
Neurofibroma* ; Peripheral Nerves*

BACKGROUND: Bupivacaine is a amide type local anesthetic agent, widely used for its excellent quality of analgesia and long duration of action. But unintended intravenous injection causes severe complication such as convulsion and cardiovascular collapse, which is known for its difficulty in resuscitation. With all the study, the exact mechanism is still unclear and there are much debate on the method of resuscitation. METHOD: We studied the effect of clonidine pretreatment on bupivacaine-induced cardiac toxicity and resuscitation in anesthetized dog. Twelve dogs were divided into two groups. : saline pretreatment group (control, N=6) and clonidine pretreatment group (clonidine group, N=6). The dogs were anesthetized with N2O-O2-enflurane and vecuronium. Thoracotomy was done in 4th or 5th intercostal space for open cardiac massage. After confirming stability of vital signs, we administered clonidine (10 mcg/kg) or saline, and then administered bupivacaine with the rate of 2 mg/kg/min. When the electeocardiogram showed asystole, 20 mcg/kg of epinephrine was administered via central venous line and open cardiac massage with the rate of 120 beat/min. was performed. We observed electrocardiogram (lead II), arterial blood pressure, heart rate, dose of infused bupivacaine to be required for QRS widening and arrest, required time and administered dose of epinephrine for resuscitation. RESULTS: Clonidine group showed significant decrease of heart rate after pretreatment (p<0.05). There was no significant difference in required dose for QRS widening between two groups. The dose administered for inducing arrest was less in clonidine group than control group (p<0.05). The time required for resuscitation was shorter in clonidine group than control group (p<0.05). The total dose of epinephrine required for resuscitation was less in clonidine group than control group (p<0.05). The blood concentration of catecholamine did not showed significant difference during the whole course of experiment. CONCLUSIONS: Above results demonstrated that clonidine, a central nervous system-mediated sympatholytic agent, facilitated cardiac arrest when bupivacaine was infused intravenously and cardiac rescucitation.
Analgesia ; Animals ; Arterial Pressure ; Bupivacaine ; Clonidine* ; Dogs* ; Electrocardiography ; Epinephrine ; Heart Arrest ; Heart Massage ; Heart Rate ; Injections, Intravenous ; Resuscitation* ; Seizures ; Thoracotomy ; Vecuronium Bromide ; Vital Signs

Eight infants or children with congenital heart disease underwent coorrective cardiac surgery suing hypothemia, cardioulmminary bypass, and total circulatory arrest. Threr were no signisifants change in pH, PaiP2, and arterial bicarbonate ion concentraion between pre-arrest and post-arrest times.
Bicarbonates ; Blood Gas Analysis* ; Child ; Heart Defects, Congenital ; Heart* ; Humans ; Hydrogen-Ion Concentration ; Hypothermia* ; Infant ; Thoracic Surgery*

Eight infants or children with congenital heart disease underwent coorrective cardiac surgery suing hypothemia, cardioulmminary bypass, and total circulatory arrest. Threr were no signisifants change in pH, PaiP2, and arterial bicarbonate ion concentraion between pre-arrest and post-arrest times.
Bicarbonates ; Blood Gas Analysis* ; Child ; Heart Defects, Congenital ; Heart* ; Humans ; Hydrogen-Ion Concentration ; Hypothermia* ; Infant ; Thoracic Surgery*

The authors studied the priming effects of the nondepolarizing neuromuscular blockers on the frequency of discomfort, intubation condition and the time interval between the administration of nondepolarizing neuromuscular blockers and endotracheal intubation. Thirty two patients were divided randomly into four groups: the patients administered vecuronium priming dose, 0.02mg/kg and intubating dose, 0.06mg/kg (Group I), vecuronium customary single dose, 0.1 mg/kg (Group II), pancuronium priming dose, 0.02 mg/kg and intubation dose, 0.06mg/kg (group III) and pancurnium customary single dose, 0.1 mg/kg (group IV). The results were as follows. 1) Seven patients complained discomfort after administration of priming dose in the priming groups. (Group I and III) 2) There was better intubating condition in the priming groups than the customary single dose groups. 3) The time intervals between the administration of intubating dose and the maximum depression of single twitch response were revealed 57.9+/-14.6 seconds, 115.5+/-27.2 seconds, 74.5+/-30.0 seconds and 101.4+/-13. 7 seconds in I, II, III and IV group respectively. The time interval in group I was significantly shorter than group II (p< 0.05). And the interval in group III was also significantly shorter than group IV (p<0.05). With the above results we conclude that the priming groups provide smooth and rapid intubation condition than the customary single dose group, in spite of small total intubating dose.
Depression ; Humans ; Intubation ; Intubation, Intratracheal ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents* ; Pancuronium ; Vecuronium Bromide