PURPOSE: To assess the efficacy of recombinant human granulocyte-macrophage colony-stimulatin g factor(GM-CSF) in the neutropenia by radiotherapy. MATERIALS AND METHODS: Eleven patients with various solid tumor were treated with a daily subcutaneous dose of GM-CSF(3-7 microgram/kg) for 5 days during the radiotherapy. Before and during the course of the study all the patients were monitored by the recording of physical examination, the complete blood count with differential and reticulocyte count and liver function test. Eight patients received patients received prior or concurrent chemotherapy. RESULTS: In 10 patients, the neutrophilic nadir was significantly elevated and the length of time that patients had a neutrophil count below 103/mm3, a threshold known to be critical to acquiring infective complications was shortened following GM-CSF injection. A significant rise (two fold or greater) of neutrophil count was seen in 10 of 11 patients. In most patients, discountinuation of GM-CSF resulted in a prompt return of granulocyte counts toward baseline. However the neutrophil count remained elevated over 103/mm3 during radiation therapy, and radiotherapy delays were avoided. Other peripheral blood components including monocytes and platelets also increased after GM-CSF treatment. No siginificant toxicity was encountered with subcutaneous GM-CSF treatment. CONCLUSION: GM-CSF was well tolerated by subcutaneous route and induced improvement in the neutropenia caused by radiotherapy.
Blood Cell Count ; Drug Therapy ; Granulocyte-Macrophage Colony-Stimulating Factor* ; Granulocytes ; Humans ; Liver Function Tests ; Monocytes ; Neutropenia* ; Neutrophils ; Physical Examination ; Radiotherapy* ; Reticulocyte Count

Breakage of epidural catheter during insertion and removal is a rare but dilemmatic complication. Although it is favorable to remove a broken catheter entrapped in tissue, there is a controversy about whether retained fragments should be managed even in asymptomatic patients. We experienced two cases of breakage of epidural catheter in patients with thoracic epidural analgesia. One case happened during removing of the entire catheter and needle together and the other, during the removal of the catheter alone. Because neurologic or infective complications were not detected until 14 days after the events, surgical interventions were withheld. In both cases, there were no sequelae on long-term follow up.
Analgesia ; Analgesia, Epidural ; Catheterization ; Catheters ; Follow-Up Studies ; Humans ; Needles

Thoracic outlet syndrome has neurologic symptoms caused by compression of brachial plexus, blood vessel symptoms are caused by compression of the artery or vein. The authors report a case of sudden decrease in blood pressure of the left arm after turning the patient from supine position to prone position. They confirmed that the patient had thoracic outlet syndrome after performing computed tomography.
Arm ; Arterial Pressure ; Arteries ; Blood Pressure ; Blood Vessels ; Brachial Plexus ; Glycosaminoglycans ; Humans ; Neurologic Manifestations ; Prone Position ; Supine Position ; Thoracic Outlet Syndrome ; Veins

BACKGROUND: Cough reflex in response to extubation of the endotracheal tube is common; however, the effect of remifentanil on cough reflex is uncertain. Therefore, we evaluated the effect of lidocaine and remifentanil on cough reflex following extubation. METHODS: Forty adult patients scheduled to undergo elective surgery in two hours were enrolled in this study. All patients received a standard anesthetic protocol. Following surgery, the patients were randomly divided into two groups, Group L (n = 20), which received 1.5 mg/kg of 2% lidocaine intravenously, and Group R (n = 20), which received 0.5 microgram/kg remifentanil intravenously. Treatment was administered immediately after the patients opened their eyes, after which extubation was performed. We then evaluated breath holding and recorded the number of coughs at 5 minutes, 15 minutes and 30 minutes after extubation. In addition, we checked for sore throat 30 minutes after extubation. RESULTS: The number of coughs was significantly lower in Group R than in Group L at 5 minutes after extubation. However, there was no significant difference in the number of coughs in Group R and Group L at any other times evaluated. CONCLUSIONS: There are no significant differences in suppression of the cough reflex in response to treatment with lidocaine and remifentanil.
Adult ; Breath Holding ; Cough ; Eye ; Humans ; Lidocaine ; Pharyngitis ; Piperidines ; Reflex

BACKGROUND: Emergence agitation is a common problem after sevoflurane anesthesia in children. Tropisetron, a 5-HT3 antagonist, significantly reduces the incidence of emergence agitation after sevoflurane anesthesia. This study evaluated the effect of ondansetron on emergence agitation after sevoflurane anesthesia in children undergoing a tonsillectomy. METHODS: Eighty children, aged 3-9 years (ASA physical status I) undergoing tonsillectomy, were randomly enrolled in this study. Group O received 0.1 mg/kg of ondansetron, and group S received 0.1 ml/kg of saline during the operation. Anesthesia was induced with 5 vol% sevoflurane and maintained with 2-2.5 vol% sevoflurane. The agitation score was recorded when they arrived at the postanesthesia care unit, and 10 minutes after that. RESULTS: The incidence of emergence agitation was 30% in group O and 27.5% in group S at arrival (P = 1.00). Ten minutes after arrival, the incidence was 12.5% in group O and 25% in group S (P = 0.25). CONCLUSIONS: Ondansetron 0.1 mg/kg does not reduce the incidence of emergence agitation after sevoflurane in children.
Anesthesia* ; Child ; Dihydroergotamine* ; Humans ; Incidence ; Ondansetron* ; Serotonin 5-HT3 Receptor Antagonists ; Tonsillectomy*