Rapid administration of solution containing dextroae results in marked hyperglycemia and osmotic diuresis hut a balanced electrolyte solution containing maltese does not increase blood sugar. 30 patients were chosen at random and divided into 3 groups j.e, one group received 5% dextrose in water, the second group received Hartmann solution and the third group, 5% maltose in a balanced electrolyte solution. The Patient's blood was collected in the operating room prior to the start l.V. infusion, for the measurement of blood sugar, insulin, osmolarity and electrolrtes in various conditions of N.P.O. Intravenous fluid was administered at a rate of 10 m1/kg/hour while anesthesia was induced and maintained with an endotracheal tube in place. Blood samples were taken one hour. 2 hours and 3 7ours f:on the time 1,V. infusion started, In the of 5% dextrose in water groups, the value of blood sugar and insulin was 88.5+/-12.1 mg% and 14.60+/-7.67 un/ml at NPO, 257.7+/-60.8mg% and 70.75+/-37.55 un/m1 at 1 hour, 298.8+/-84.4mg%: and 143.19+/-50.32 un/ml at 2 hours and 228.6+/-75.8% and 127.71+/-56.98 un/m1 at 3 hours. Although the b1ood sugar and insulin values increased markedly. but potassium and chloride were 4.74+/-0.55 mEq/l and 101.1+/-2.9 mEq/l and 4.11+/-0.31 mEq/l, 107.4+/-2.3 mEq/l and 3.75+/-0.41 mEq/l, 176.4+/-2.7mEq/l and 3.89+/-0.50mEq/l, 106.3+/-2.2 mEq/l and shoewed mild decrease, by the way, osmolarity and serum sodium did not changed. In contrast to the 5% dextrose in water groups, there are no changes in the blood glucose. insulin levels, osmolarity or and electrolrtes in the either Hartmann or Elitol (Elitol=5% maltose contained in a balanced electrolyte solution) groups. There was a slight increase in osmolarity with maltose but it was not significant. Accordingly it is concluded that rapid infusion of harmann or 5% maltose contained ina balanced electrolyte solution affects the blood sugar and insulin levels insignificantly compared to the dextrose cont5aining solution which increase the blood sugar and indulin levels markedly.
Anesthesia ; Blood Glucose* ; Diuresis ; Electrolytes* ; Glucose ; Humans ; Hyperglycemia ; Insulin* ; Maltose ; Operating Rooms ; Osmolar Concentration* ; Potassium ; Sodium ; Water

This is a case of an accidental prolonged tourniquet application on the lower extremity. A 31 year old, well developed male had an open reduction for a clavicle fracture and nerve graft of the injured arm. To obtain the nerve from the leg, a tourniquet was applied and remained on the right lower extremity for 4hours. Post-operatively, he developed severe edema with paralysis of that leg. Thereafter, progressively he had signs of acute tubularnecrosis with oliguria, myoglobinuria, elevation of BUN and creatinine, and finally pulmonary edema. He recovered graually from the renal failure, pulmonary edema and paralysis of the leg as he received intermittent peritoneal dialysis for renal failure and intensive respiratory care for pulmonary edema. He went home in good condition only with a slight residual sensory loss of the injured leg 90 days after his admission.
Adult ; Arm ; Clavicle ; Creatinine ; Edema ; Humans ; Leg* ; Lower Extremity ; Male ; Myoglobinuria ; Oliguria ; Paralysis* ; Peritoneal Dialysis ; Pulmonary Edema ; Renal Insufficiency* ; Tourniquets* ; Transplants

Pelioid hepatocellular carcinoma (HCC), a type of atypical HCC, is a rare histologic type of HCC. The radiologic findings of the pelioid HCC is differ from the typical type of HCC. To our knowledge, this case report is the second literature to show the enhancing features of a pelioid HCC on dynamic computed tomography (CT). Here we describe the dynamic CT findings in a case of surgically confirmed pelioid HCC.
Carcinoma, Hepatocellular

Pulmonary edema in surgical patients is known to be a complication resulting from various causative factors. We have analysed 10 cases observed in the Dong San Medical Center and 18 cases reported in the Journal of the Korean Society of Anesthesiologists in terms of sex, age, causing factor, onset, therapy etc. As a result of this study, the summary is as follows: 1) The most common causes of pulmonary edema in surgical patients were overloading, followed by heart failure, hypoalbuminemia, sepasis, severe trauma and unknown causes in that order. 2) Pulmonary edema can develop in any surgical patient without a direct realtionship to age, sex or type of peration. 3) The incidence tended to be higher in emergency patients than in elective patients because their general condition was worse and the surgical procedures were done in such haste. 4) The onset of pulmonary edema seems to occur commonly at the end of surgery, particularly when the patients were extubated and then followed by endotracheal suction because negative pressure is applled for suction as the positive pressure was removed for extubation. 5) Active therapy for pulmonary edema has been generally successful because of advanced respiratory care with various sophisticated respirators.
Emergencies ; Heart Failure ; Humans ; Hypoalbuminemia ; Incidence ; Pulmonary Edema* ; Suction ; Ventilators, Mechanical

No abstract available.
Byssinosis*

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

Gastric high-grade dysplasia is an important premalignant lesion in gastric epithelial cells and has a high possibility of transforming to adenocarcinoma. Therefore, biopsy-proven high-grade dysplasia should be treated with en bloc resection methods such as endoscopic mucosal resection or endoscopic submucosal dissection (ESD). We report the case of a 63-year-old male patient, diagnosed with gastric high-grade dysplasia at the angle and lesser curvature side of the lower body. The patient was initially treated with ESD, although histopathology subsequently showed horizontal margin involvement. Since the lesion was diffusely edematous and margins were uncertain because of the previous ESD treatment, we chose to treat the patient with laparoscopy-assisted endoscopic full-thickness resection (EFTR). EFTR is a recently developed procedure, which uses both endoscopic and laparoscopic techniques to resect the full-thickness of the tissue. The final pathologic report revealed high-grade dysplasia and a focal intramucosal carcinoma of 0.8x0.7 cm. We conclude that EFTR can be an effective alternative treatment in gastric high-grade dysplasia unsuitable for ESD.
Adenocarcinoma ; Epithelial Cells ; Humans ; Male ; Middle Aged

BACKGROUND/AIMS: Acute exacerbation (AE) of chronic hepatitis B (CHB) can occur spontaneously, and may be followed by HBeAg clearance. HBeAg seroconversion often coincides with the normalization of liver biochemical tests and clinical remission. The purpose of this study was to identify the etiology and the clinical consequence of severe AE in Korean patients with CHB. METHODS: The medical records of CHB patients with severe AE (defined by the sudden increase of ALT above 400 IU/L) who were admitted to Kyung Hee University Hospital between January 1992 and December 2001, were reviewed retrospectively. Forty-four patients were included in the severe AE group. RESULTS: The most common etiology of severe AE was spontaneous exacerbation (77%). Drugs (16%), alcohol (5%), and HCV coinfection (2%) were suspected of causing AE in the remaining patients. HBeAg seroconversion at 12, 18, and 24 months following severe spontaneous AE was 18.5%, 40.7%, and 48.1%, respectively. These were significantly higher compared to CHB patients without AE (4.3%, 4.3%, and 10.9%, respectively). Seroconversion within 3 months, however, occurred in only 15% of CHB patients with AE. There was a tendency to progress to liver cirrhosis more frequently in the patients with AE as compared to the patients without AE (17.6% vs. 5.5%, P<0.08). CONCLUSIONS: Severe AE in patients with CHB is mainly caused by spontaneous exacerbation. Although HBeAg seroconversion occurs frequently in these patients, the rates are relatively low compared to those reported in other countries and early seroconversion is expected only in a small proportion. Further studies will be warranted to determine the efficacy of the early use of antiviral agents at the time of AE.
Acute Disease ; Adult ; Alanine Transaminase/blood ; English Abstract ; Female ; Hepatitis B e Antigens/blood ; Hepatitis B, Chronic/*complications/diagnosis/virology ; Humans ; Male ; Middle Aged

In the anesthesia for the Cesarean section, the anesthetists should select the agent and technique carefully which is safe for both the mother and baby. If a light plane of general anesthesia is chosen for fetal safety and rapid recovery, there may be increased incidence of maternal recall and intraoperative pain perception. We studied the effect of nalbuphine(N group) and fentanyl(F group) used as main analgesics in balanced anesthesia in 60 full term parturients, ASA physical status class I or II, scheduled for elective Cesarean section. The patients were questioned for recall, pain perception and unpleasant dreams during anesthesia. The results were as follows, 1) The 12 patients had positive reactions. Among them, 3 patients(10%) were in the N group and 9 patients(30%) in the F group. 2) The sedation was more in the N group(30%) than in the F group(6.6%). We concluded that the balanced anesthetic technique using nalbuphine caused less maternal recall and pain perception with more sedation than using fentanyL.
Analgesics ; Anesthesia ; Anesthesia, General ; Anesthetics ; Balanced Anesthesia* ; Cesarean Section* ; Dreams ; Female ; Fentanyl* ; Humans ; Incidence ; Mothers ; Nalbuphine* ; Pain Perception ; Pregnancy

PURPOSE: we often find variable degrees of FDG uptake and patterns in stomach, which can make difficult to distinguish physiologic uptake from pathologic uptake on FDG PET. The purpose of this study was to find out the significant findings of stomach on FDG PET. MATERIALS AND METHODS: Thirty-eight patients who underwent both FDG PET and endoscopy within one week from Jun. 2003, to Aug. 2004 were included in this study. We reviewed 38 patients (18 for medical check up, 15 for work up of other malignancies, and 5 for the evaluation of stomach lesion). Their mean age was 56 years old (range: 32~79), men and women were 28 and 10, respectively. Two nuclear physicians evaluated five parameters on FDG PET findings of stomach with a consensus: 1) visual grades 2) maximum SUV (max.SUV) 3) focal 4) diffuse and 5) asymmetric patterns. We correlated the lesions of FDG PET findings of stomach with those of endoscopy. We considered more than equivocal findings on FDG PET as positive. RESULTS: The six of 38 patients were proven as malignant lesions by endoscopic biopsy and others were inflammatory lesions (ulcer in 3, chronic atrophic gastritis in 12, uncommon forms of gastritis in 5), non-inflammatory lesions (n=3), and normal stomach (n=9). By the visual analysis, malignant lesions had higher FDG uptake than the others. The max.SUV of malignant lesions was 7.95 4.83 which was significantly higher than the other benign lesions (2.9 0.69 in ulcer, 3.08 1.2 in chronic atrophic gastritis, 3.2 1.49 in uncommon forms of gastritis (p=0.044) ). In the appearance of stomach on FDG PET, malignant lesions were shown focal (5 of 6) and benign inflammatory lesions were shown diffuse (9 of 20) and asymmetric (14 of 20). Benign lesions and normal stomach were shown variable degrees of uptake and patterns. Some cases of benign inflammatory lesions such as ulcer and gastritis were shown focal and mimicked cancerous lesion (4 of 15). CONCLUSION: Gastric malignant lesions had higher FDG uptake and focal pattern. However, benign inflammatory lesions had moderate degrees of uptake and diffuse and asymmetric patterns rather than focal. It is difficult to differentiate between benign lesions including normal.
Biopsy ; Consensus ; Electrons* ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography* ; Stomach* ; Ulcer