No abstract available.
Colon* ; Rectum*

BACKGROUND: It has been a standard practice in many institutions to combine light general anesthesia with epidural block for abdominal and pelvic surgery. We attempted to prove the effectiveness of prehydration and to find an suitable epidural local anesthetic dose in terms of hemodynamic stability for upper abdominal surgery. METHODS: For preliminary studies, 11 patients scheduled for elective upper abdominal surgery had received general anesthesia immediately after epidural anesthesia. After epidural injection of 10~16 mL of 2% plain lidocaine into the T9~10 intervertebral space, the changes in blood pressure were observed. Thirty-two patients scheduled for elective upper abdominal surgery were divided into two groups. In group A (study group), after prehydration with Hartmann solution (10 mL/kg), 5~7 mL of 2% plain lidocaine was injected into T8~9 or T9~10 intervertebral space and general anesthesia was then induced. Group B (control group) received general anesthesia only. RESULTS: There were no significant differences in hemodynamics between the epidural with general anesthesia and the control group except SVR (systemic vascular resistance). SVR in group A increased in contrast to the group B in which it remained unchanged. CONCLUSIONS: The combined epidural and general anesthesia, using prehydration and 0.5~1 mL/segment of 2% plain lidocaine at the T8~9 or T9~10 intervertebral space was safe without significant hemodynamic changes.
Anesthesia, Epidural ; Anesthesia, General* ; Blood Pressure ; Hemodynamics* ; Humans ; Injections, Epidural ; Lidocaine

Acute multifocal hemorrhagic retinal vasculitis is a disorder of abrupt onset, of unilateral or bilateral visual loss associated with mild anterior uveitis multifocal retinal vasculitis, retinal hemorrhage, retinal capiHary nonperfusion,papillitis, vitritis. After the onset of the disease, recurrent episode of intraocular inflammation, vasculitis, and visual loss ate commonly seen associated with the late complications of secondary vitreous hemorrhage, neovascular glaucoma, and epiretinal membrane formation. In 1988, Blumenkranz and associates were the first to report 7 cases of this disease in America. The mode of presentation, associated symptoms, and fundus findings are suggestive of herpes class virus infection, although the etiology remains unknown. We experienced a case of acute multifocal hemorrhagic retinal vasculitis associated with multifocal retinal vasculitis, retinal hemorrhage and neovascu lar complications.
Americas ; Epiretinal Membrane ; Glaucoma, Neovascular ; Inflammation ; Retinal Hemorrhage ; Retinal Necrosis Syndrome, Acute ; Retinal Vasculitis* ; Retinaldehyde* ; Uveitis, Anterior ; Vasculitis ; Vitreous Hemorrhage

Although rare, agranulocytosis is the most serious, potentially fatal side effect of antithyroid drug. We experienced a 13-year-old girl who developed methimazole-induced agranulocytosis at 1 month after the initiation of treatment. Her granulocyte count recovered after discontinuation of methimazole and treatment with broad spectrum-antibiotics, G-CSF, and methylprednisolone. After recovery from agranulocytosis she was treated with radioiodine ablation therapy. Early detection and proper management of antithyroid drug-induced agranulocytosis is very important.
Adolescent ; Agranulocytosis* ; Female ; Granulocyte Colony-Stimulating Factor* ; Granulocytes* ; Humans ; Methimazole ; Methylprednisolone*

A 29 years old man was scheduled for carinal resection & tracheobronehial reconstruction under the diagnosis of malignant tumor in the carina. 1 ml of morphine-scopolamine was given intramusculary for premedication. After induction with pentothal-Na and succinylcholine, anesthesia was maintained with halothane, N2O, and flaxedil (Gallamine). Radial artery cannula was inserted for blood gas analyze sampling, and EKG was monitored continuously. Tumor mass was infiltrated from carina to right upper lobe opening and right lower lobe had severe bronchiectatic change. Right pneumonectomy, resection of carina and end to end anastomosis of trachea and left bronchus were performed without any trouble. During this procedure, anesthesia had been continued with left bronchial tube which was intubated through operating field. Left bronchial ventilation had increased resistance, elevated PCO2, and lowered pH & PO2. Partial ohstruction of left upper bronchial opening was suspected during this left bronchial ventilation due to deep bronchial intubation.
Adult ; Anesthesia* ; Bronchi ; Catheters ; Diagnosis ; Electrocardiography ; Gallamine Triethiodide ; Halothane ; Humans ; Hydrogen-Ion Concentration ; Intubation ; Pneumonectomy ; Premedication ; Radial Artery ; Succinylcholine ; Trachea ; Ventilation

Thirty two patients wha had undergone operations were given a slow extradural narcotic injection. Patients were divided into three groups: First Group: extradural administration of pentazocine 30 mg to 10 adult patients. Second Group: extradural administration of pethidine 50 mg to 10 adult patients. Third Group: extradural administration of low-dose morphine(2 mg) in 10 ml of poysiologic saline to 12 adult patients. The epidural catheter had been left in situ and the patients instructed to request further analgesia in the postoperativly as neded. All case had considered amelioration of pain which became evident with in 2 to 15 minutes and was effective from 1 hour to complete relieve. They had also received an intramuscular injection of atropine sulfate(0.01 mg/kg) and valium (0.2 mg/kg) for premedication 30 minutes prior to sending to the operating room. The conclusions are as follows: 1) The morphine(2 mg) administered by continuous epidural injection is superior to other groups for relief of pain. It suggested that analgesic effect was concerned with drug dosage (Table 4). 2) Third group(morphine) was signficantly higher than other groups in statistical mean analgesic score analysis compared with the other groups. It suggested that significantIy high analgesic score was concerned with the pharmacologic action of the drug effect. 3) Before and after epidural injection of drugs, a statistical pulse change in the second group was significant but the other vital sign changes in all the group was not significant (Table 7). It suggested that significant pulse change was concerned with direct drug action and operative stress. 4) The subject requires study for mechanism, adverse effect and its prevention of narcotic administration in epidural space. Consequently it is suggested that continuous epidural injection of pethidine or' pentazoine is the optimum method of postoperative pain relief, only that when morphine is given, contin-uous epidural injection should be the method of choice.
Adult ; Male ; Female ; Humans

BACKGROUND: Analysis of the species and antimicrobial susceptibility trend of bacterial and fungal isolate from blood can provide the clinicians with important informations for the treatment of the patients. METHODS: We analyzed the species and antimicrobial susceptibility trends of microorganisms isolated from blood cultures from 1986 to 1996 at Kyunghee Medical Center. Identification of organism was based on conventional methods or commercial kit systems. Antimicrobial susceptibility test was done by the NCCLS disk diffusion method. RESULTS: The positive blood culture was obtained from 3,559 patients. Among the patients 95.6% showed aerobic and facultative anaerobic bacteria, 0.9% anaerobes, and 3.6% fungi. Escherichia coli was isolated most frequently, followed by Coagulase-negative staphylococcus, Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus, alpha- hemolytic Streptococcus and Serratia. The proportion of patients with E. coli decreased from 34.5% in 1986 to 22.1% in 1996, while that of S. aureus increased from 9.7% to 13.9%. Proportion of methicillin-resistant S. aureus and the third generation cephalosporin-resistant K. pneumoniae increased during the study period. CONCLUSIONS: We conclude that E. coli is the most common cause of bacteremia at Kyunghee Medical Center. The third generation cephalosporin-resistant K. pneumoniae and methicillin- resistant S. aureus are increasing in proportion.
Bacteremia ; Bacteria* ; Bacteria, Anaerobic ; Diffusion ; Enterococcus ; Escherichia coli ; Fungi* ; Humans ; Klebsiella pneumoniae ; Methicillin Resistance ; Pneumonia ; Pseudomonas aeruginosa ; Serratia ; Staphylococcus ; Staphylococcus aureus ; Streptococcus

No abstract available.
Diagnosis* ; Pancreas* ; Ultrasonography*

BACKGROUND: Laryngeal mask airway (LMA) is a useful instrument for routine anesthesia. It permits spontaneous or positive pressure ventilation but its use in obstetric anesthesia has not been described. In this study, we evaluated the effectiveness and the side effects of the LMA during elective cesarean sections. METHODS: Institutional approval and patients' permission were obtained. One thousand sixty-seven patients scheduled for elective an cesarean section, that have been NPO for more than 6 (6-48) hours were evaluated. They were premedicated with an H2 receptor blocker (ranitidine 50 mg i.m.) 1 hour before the operation. They were anesthetized with penthotal sodium (3-4 mg/kg), vecuronium (1 mg/10 kg i.m.) and then a 3 or 4 LMA was inserted after the mask ventilation with 100% oxygen for 1 min. The cuff was inflated with air 15.3 +/- 2.6 ml. On auscultation, air entry was good in both lungs. Anesthesia was maintained by 50% oxygen in N2O with 0.7 - 1.0% enflurane. Analgesics (tramadol 30 mg i.v.) was given incrementally after delivery of the baby. Manual assisted ventilation was used throughout the procedure. The number of insertion attempts, cuff volume and the incidences of complications were evaluated. RESULTS: In 1051 patients, the LMA was inserted on the first attempt. In 16 patients more than 2 attempts were needed and change to endotracheal intubation were needed in 7 cases. The mean cuff volume was 15 +/- 2.6 ml at insertion and increased to 18.5 +/- 3.2 ml after removal. The average airway pressure was 20 cmH2O during positive pressure ventilation, above that pressure air leakage was detected in 16 cases. Complications noted were mild sore throat in 5 cases, and blood tinged after removal of LMA in 3 cases but gastric distention was not detected. No incidence of aspiration was noted. CONCLUSIONS: In this study, the LMA proved to be a useful tool for the management of patients presenting for elective an cesarian section. There is the remote possibility of aspiration which did not happen in our study.
Analgesics ; Anesthesia ; Anesthesia, Obstetrical ; Auscultation ; Cesarean Section* ; Enflurane ; Female ; Humans ; Incidence ; Intubation, Intratracheal ; Laryngeal Masks* ; Lung ; Masks ; Oxygen ; Pharyngitis ; Positive-Pressure Respiration ; Pregnancy ; Sodium ; Tolnaftate ; Vecuronium Bromide ; Ventilation

The Wada test was performed for lateralization of language and memory function, using intracarotid injection of Sodium Amytal. But, the internal carotid artery(ICA) Wada test has some limitations for testing memory function. The posterior cerebral artery(PCA) Wade test has been designed to modify to modify the ICA Wada test for testing memory function selectively. In our study, 10 patients out of 12 patients with intractable seizure underwent only the ICA Wada test and the other 2 patients underwent both are ICA and the selective PCA Wada test In all 12 patients undergoing the ICA Wada test, we succesfully localized speech and language dominace. Four of 12 patients who underwent the ICA Wada test for evaluation of memory function displayed superior memory functions in one hemisphere, but the other hemisphere also significantly contributed to memory. The selective PCA Wada test, performed in 2 patients, showed successful results of memory function test in both patients. Four of 12 patients underwent temporal lobectomy and there was no major post-operative language or memory deficits. We conclude that the ICA and PCA Wada tests are useful for preoperative evaluation of medically intractable epilepsy, and the PCA Wada test is valuable in memory evaluation in some patients who have hight risk of postoperative global amnesia after temporal lobectomy following equivocal results of memory function by the ICA Wada test.
Amnesia ; Amobarbital ; Drug Resistant Epilepsy* ; Humans ; Memory Disorders ; Memory* ; Passive Cutaneous Anaphylaxis ; Seizures