A 55-year-old female experienced acute left shoulder pain without specific trauma. Radiography showed calcific deposits in the inferior part of the glenoid fossa. Magnetic resonance arthrography showed calcific deposits in the origin of the long head of triceps brachii muscle. Conservative treatment failed to resolve the symptoms; therefore, arthroscopic surgery was performed. The patient experienced immediate and dramatic pain relief, and normal shoulder motion was demonstrated 1 year after surgery. In conclusion, although rare, calcific tendinitis of the triceps brachii muscle, which causes shoulder pain, should be included in the differential diagnosis of acute shoulder pain. Arthroscopic surgery is a treatment option for chronic cases and those resistant to conservative treatment.
Arthrography ; Arthroscopy ; Diagnosis, Differential ; Female ; Head* ; Humans ; Middle Aged ; Radiography ; Shoulder ; Shoulder Joint ; Shoulder Pain ; Tendinopathy*

This is a report of ketamine anesthesia with exploratory laparatmy for ruptured ectopic pregnancy. The Patients preoperative state was as the following: Hb; 4. 0m%, Ht; 12%, BP; undetectable Mentolity; semicomatous In the emergency room, she received 2 pints of whole blood, 1,000 ml of Hartmanns solution and 500 ml of Rheomacrodex via two intravenoues routes. In the operating room, blood pressure was 70/60 mmHg. Intrbatien was perfamed after ketamine induction with d-tubocurarine 3mg (to prevent fascicul- ations) and succinykholine 50 mg intravenously. Anesthesia was maintained with ketamine and d-tubocurarine without trouble. During surgery blood pressure was 110/80 mmg Hg after transfusion of 2 more pints of whole blood. She tolerated the surgery well, and was discharged on the 8th postoperative day in a healthy state.
Anesthesia* ; Blood Pressure ; Dextrans ; Emergency Service, Hospital ; Female ; Humans ; Ketamine* ; Operating Rooms ; Pregnancy ; Pregnancy, Ectopic ; Tubocurarine

Intravenous regional anesthesia is a convenient anesthetic technique of for some cases of surgery to the legs, fingers, or forearms, especially with a full stomach. However as in other anesthesia, we must watch closely and check the equipment for intravenous regional anesthesia carefully. The author had experience with a case of complication of intravenous regional anesthesia with a defective touraiguet which allowed local anesthetic to leak into the general circulation, and the patient developed convulsions, unconciousness, tachycardia, tachypnea, and hypertention about 40 seconds after injection of lidocaine 200 mg (0.5%) into a regional vein just above the wound. The patient was intubated after induction with thiopental sodium 250 mg and succinylcholine 80 mg intravenously. Fortunately the convulsion disappeared and vital signs became stable after injection of thiopeewil sodium. The patient tolerated the surgery well and was discharged in a healthy state on the 6th postoperative day.
Anesthesia ; Anesthesia, Conduction* ; Fingers ; Forearm ; Humans ; Leg ; Lidocaine ; Seizures ; Sodium ; Stomach ; Succinylcholine ; Tachycardia ; Tachypnea ; Thiopental ; Veins ; Vital Signs ; Wounds and Injuries

BACKGROUND: Exogenously administered epinephrine under enflurane anesthesia was known to have mild myocardial sensitizing effect. And N2O activates the sympathetic nervous system mildly. We planed this study to confirm cadiovascular effects of clinically administered epinephrine for hemostasis under the enflurane-N2O anesthesia during tonsillectomy. METHODS: Eighty children scheduled to have tonsillectomy were selected randomly and divided into 2 groups as follows; Group E: 1:100,000 epinephrine 2ug/kg and Group EL: 1:100,000 epinephrine containing 1% lidocaine 2 g/kg. Blood pressure, heart rate, and the occurrence of arrhythmia were evaluated before injection, at injection, 1 min, 2 min, 3 min, 5 min and 10 min after injection and 1 min after operation start. RESULTS: In both groups, systolic and diastolic blood pressure and heart rate are increased. But there are no significant statistical differences in each group and between groups. One min after operation, there are significant increases in systolic and diastolic blood pressure and heart rate in both groups (p<0.05), but there is no significant difference between groups. CONCLUSION: Under the enflurane-N2O anesthesia of children, 1:100,000 epinephrine 2ug/kg used for hemostasis could be used comparatively safe without any significant hemodynamic changes. But because there is always the possibility of myocardial sensitization, careful observation is necessary during epinephrine injection under the enflurane-N2O anesthesia.
Anesthesia* ; Arrhythmias, Cardiac ; Blood Pressure ; Child ; Enflurane ; Epinephrine* ; Heart Rate ; Hemodynamics ; Hemostasis* ; Humans ; Lidocaine ; Sympathetic Nervous System ; Tonsillectomy*

A 67 year old male patients was anesthetized with halothane for a open reduction of the fractured right femur shaft. The patient was admitted to the emergency room after he had cerebra1 contusion and fracture of the femoral shaft by a traffic, accident. Anesthesia was continued for one and a, half hours without any problem. At around one and a half hours of anesthesia, the patient developed cardiac arrest and resuscitation was performed immediately. The patient's life was saved by resuscitation and the operation was completed without any further problem. At the time of the resuscitation, a tension pneumothorax was recognized but anesthesia was continued with immediate, proper management. Closed thoracotomy was performed at the recovery room after anesthesia and the patient recovered from anesthesia without any other problem.
Aged ; Anesthesia ; Anesthesia, General* ; Cardiopulmonary Resuscitation* ; Contusions ; Emergency Service, Hospital ; Femur ; Halothane ; Heart Arrest ; Humans ; Male ; Pneumothorax* ; Recovery Room ; Resuscitation ; Thoracotomy

Induced hypotension is a well established adjunct to anesthesia which provides improved operating conditions for a wide variety of surgical procedures without significantly increasing the risk to the patient. Since introduction of hypotensive anesthesia in 1964 by Gardner, there has been a wide choice of methods for inducing hypotension during anesthesia, most of which are based on the concept of arteriolar dilatation. Hypotensive anesthesia was attempted on ten patients for total hip replacements which were done at Gospel Hospital, from Feb. to Oct. in 1979. The patients selected did not have a liver problem, and this was determined by SGOT and SGPT, and without a limit of age or sex. The hypotension was induced with 2~3% halothane, 50% N2O and 50%, O2and the blood pressure averaged for systolic pressure 71. 22 mmHg and for diastolic pressure 50. 09 mmHg, The average duration of the induced hypotension was 57. 0 minutes and the blood loss during operation was 300 ml on average. During the hypotensive anesthesia, the urine output decreased by 27. 0% and during the recovery period from hypotension urine output increased by 20%. On our experience, we can conclude that hypotensive anesthesia provides good operative conditions and can be performed without damage to vital organs and can reduce blood loss during operation.
Alanine Transaminase ; Anesthesia* ; Arthroplasty, Replacement, Hip* ; Aspartate Aminotransferases ; Blood Pressure ; Dilatation ; Halothane ; Humans ; Hypotension ; Liver

Chronic obstructive pulmonary diseases are being increased every year by many factors. But there are two important factors. First of all the atmospheric contamination is due to modern civilization, secondarily, the increase of old age population which is the result of prolonged life span by contribution of modern medicine. For these reasons increasing chronic obstructive pulmonary disease, anesthesiologists have had increased problems to administer anesthesia, because these patients are most difficult to manage for anesthesia. Author have studied for if it could be diminished these problems by comparing of the complications during period of anesthesia induction, maintenance, recovery and 5 postoperative days, with IPPB therapy and other physical therapy. The results of the study are as follows: 1) Pre and postoperative IPPB therapy is more useful to diminish anesthesia problems compared with other physical therapy. 2) Other physical therapy is useful when compared with controlled group. 3) IPPB therapy is the choice of treatment for postoperative atelectasis. Statistical significance was assessed by using student t test.
Anesthesia ; Civilization ; History, Modern 1601- ; Humans ; Intermittent Positive-Pressure Breathing* ; Lung Diseases, Obstructive ; Pulmonary Atelectasis ; Pulmonary Disease, Chronic Obstructive

The management of subtrochanteric fracture of the femur is one of the most difficult problems. Subtrochanteric area is predominantly composed of cortical bone and highly concentrating portion of stress. So, there is high incidence of Complication after treatment of subtrochanteric fractures. The results were as follows :l. Of 56 cases, 45 occurred in male, 11 in female. 2. The fractures occured mainly between 20 to 40 years of age(55.4%) and mean age was 41.4 years. 3. The most common cause of fracture was traffic accident.(67.9%) 4. According to the Seinsheimer classification, 16 cases were type IIb(most common), 13 type IIIa and 9 type IIIb. 5. 49 cases with treated wutg open reduction and internal fixation and 7 cases conservatively. 6. The average weight bearing time was 14.0 weeks; 13 weeks in operatively treated group and 18.3 week in conservative group. 7. Radiological union was obtained in average 25.1 weeks ; shortest group was type IIc(16 weeks) and longest group was type IV(30 weeks). 8. Complication were as follows; 8 cases of delayed union, 3 nonunion, 4 metallic failures, 7 varus deformities and 1 nail migration. 9. In the cases treated by Judet plate or compression hip screw, there was no complications and relatively short duration of bony union than other implants. So, they are one of the good implant for the treatment of subtrochanteric fracture of the femur.
Classification ; Congenital Abnormalities ; Female ; Femur ; Hip ; Hip Fractures ; Humans ; Incidence ; Male ; Weight-Bearing

Purpose: To define and evaluate the short-term clinical outcomes of the four-flanged technique for scleral fixation of a dislocated four-eyelet intraocular lens (IOL). Methods: Eleven eyes of 11 patients who underwent scleral fixation of dislocated four-eyelet intraocular lenses using a four-flanged technique were studied retrospectively. We measured the best-corrected visual acuity (BCVA), corneal endothelial cell density, intraocular pressure (IOP), spherical equivalent, astigmatism, IOL tilt and decentration, and postoperative complications. Results: The BCVA was 0.25 ± 0.11 logarithm of the minimal angle of resolution (logMAR) before surgery and 0.14 ± 0.12 logMAR 6 months later (p < 0.001). The corneal endothelial cell count was 2,427 ± 384 and 2,367 ± 298/mm2 before and after surgery, respectively (p = 0.285). The spherical equivalent was 6.02 ± 4.90 and 0.11 ± 0.36 before and after surgery, respectively. There was no significant difference in astigmatism before and after surgery. The mean IOL tilt and decentration were 2.44 ± 1.68° and 0.23 ± 0.09 mm, respectively. The refractive difference was 0.11 ± 0.24 diopters (D). Postoperative complications occurred in one eye; one flange lay outside the scleral tunnel, triggering hyperemia and conjunctival inflammation. Conclusions The four-flanged scleral fixation technique for a dislocated four-eyelet IOL improved the BCVA but did not significantly affect corneal endothelial cell loss. The procedure significantly reduced postoperative IOL tilt, decentration, and astigmatism, and may be a useful alternative to scleral fixation of a dislocated four-eyelet IOL.

Identification of the presence of chronic obstructive pulmonary disease in the elderly patient who was scheduled for surgery is vitally important. If appropriate therapeutic and preventive measures should not be instituted, tracheal intubation of the patient should be associated with a number of complications. We experienced a case of acute attack of asthma and pulmonary collapse during endotracheal intubation. A 54-year-old male who was scheduled for an emergency of primary corneo-scleral suture have had history of bronchial asthma. On the preoperative physical examination, there was no specific finding except expiratory wheezing. After endotracheal intubation with the aid of ketamine 2 mg/kg, pancuronium bromide 0.1 mg/kg and lidocaine 2 mg/kg, iv, acute asthmatic attack was appeared. Breathing sounds on the both lung fields can not be audible during manual ventilation and SpO(2) was dropped to 70% at F(1)O(2) 1.0. To relieve asthmatic attack, epinephrine(1: 1.000) 0.5 ml, sc, aminophylline 4 mg/kg, iv and methyprednisolone 1 mg/kg, iv were injected. Erosion of tracheal mucosa, blood clots and mucous plugs were found by the fibroptic bronchoscopy. After removal of blood clots and mucus, lung compliance and SpO2 were improved. The patient was discharged 7 days later without any complications or sequelae.
Aged ; Aminophylline ; Asthma* ; Bronchoscopy ; Emergencies ; Humans ; Intubation* ; Intubation, Intratracheal ; Ketamine ; Lidocaine ; Lung ; Lung Compliance ; Male ; Middle Aged ; Mucous Membrane ; Mucus ; Pancuronium ; Physical Examination ; Pulmonary Disease, Chronic Obstructive ; Respiratory Sounds ; Sutures ; Ventilation