During orthotopic liver transplantation (OLT), changes of hemodynamic, electrolytes and acid-base balance are frequently occurred. These changes may influence mortality and prognosis during and after surgery. The purpose of this study was to observe and evaluate the changes of hemodynamics and electrolytes occurring in 14 cases canine OLT. After insertion of endotracheal tube, anesthesia was maintained with 1%enflurane and pancuronium bromide. Swan-Ganz catheter(7.5 Fr.) was inserted into right external jugular vein and 20 gauge angiocatheter was also inserted into left femoral artery. Complete hemodynamic variables and electrolytes were measured 30 minutes after skin incision, anhepatic stage, 5 minutes before reperfusion, 5 and 30 minutes after reperfusion. The results were as follows; On reperfusion of grafted liver, 9 cases(64%) showed postreperfusion syndrome. In 9 cases showing Postreperfusion syndrome, cardiac output, systemic vascular resistance, mean pulmonary arterial pressure were decreased and serum potassium concentration was increased on reperfusion, but there were no significant changes in central venous pressure, pulmonary capillary wedge pressure, heart rate, body temperature and serum ionized calcium concentration when comparing with before reperfusion. Decreased mean arterial pressure during reperfusion in postreperfusion syndrome might be speculated through decrease of myocardial contractility and systemic vascular resistance.
Acid-Base Equilibrium ; Anesthesia ; Animals ; Arterial Pressure ; Body Temperature ; Calcium ; Cardiac Output ; Central Venous Pressure ; Dogs ; Electrolytes ; Femoral Artery ; Heart Rate ; Hemodynamics* ; Jugular Veins ; Liver Transplantation* ; Liver* ; Mortality ; Pancuronium ; Potassium ; Prognosis ; Pulmonary Wedge Pressure ; Reperfusion ; Skin ; Transplants ; Vascular Resistance

BACKGROUND: Portal triad clamping was first described by Pringle in 1908 as a mean of reducing bleeding from the cut surface of the liver during parenchymal resection. More recently some studies have reported that one period of portal triad clamping could be well tolerated for a longer duration, 60~90 minutes. The liver, generally, is believed to be very sensitive to anoxic damage and susceptible to ischemia and decreased hepatic energy charge results in decreasing arterial ketone body ratio (AKBR) during portal triad clamping. METHODS: In order to observe an adverse effects to liver in 30 minutes and 60 minutes of portal triad clamping on AKBR and histologic changes,rabbits were divided into thirty minutes of portal triad clamping in one group (Group I) and 60 minutes of that in the other group (Group II). RESULTS: During clamping, the mean AKBR of group I and II were 0.39 and 0.44, and decreased significantly compared with the mean AKBR (1.08 and 1.02) before clamping. Five minute after declamping, the mean AKBR of group II (0.49) was lower (P<0.05) than that of group I (0.63), but 30 minutes afterdeclamping, the AKBR of two groups had little difference (group I ; 0.57, group II 0.59, P>0.05). Under light microscopic examination of liver biopsy, there was no visible diffrences between two groups during clamping, 5 minutes and 30 minutes after declamping. CONCLUSIONS: It was concluded that there was no difference in hepatic energy change(AKBR) and histologic change under light microscopy after 30 minutes declamping between two groups.
Biopsy ; Constriction ; Hemorrhage ; Ischemia ; Liver ; Microscopy ; Rabbits*

During hemorrhagic shock, liver is susceptible to ischemia and decreased hepatic energy charge results in decreasing arterial ketone body ratio(AKBR). Reperfusion after hemorrhagic shock can greatly amplify the generation of toxic oxygen metabolites. As a result, the fluxes of these highly toxic metabolites can overwhelm the endogenous antioxident defense mechanisms and lead to tissue injury. In order to observe the effect of glutathione(GSH) on the AKBR in hemorrhagic shock, dogs(n=16) were anesthetized with 1% enflurane in 02. We pretreated glutathione (100 mg/kg) intravenously before hemorrhagic shock in glutathione (GSH) group (n=8). Shock was induced with bleeding and mean arterial pressure was maintained 50 mmHg for 30 minutes. Recovery from shock was done with transfusion of preserved blood and maintained for 30 minutes. We measured arterial ketone bodies and ketone body ratio before, during and after shock, and compared them to control group (n=8) which was not pretreated with glutathione. AKBR during and after hemorrhagic shock in GSH group (0.8 and 1.0) were higher than those in control group (0.5 and 0.8). Light microscopic examination of liver biopsy revealed less portal degeneration during and after hemorrhagic shock in GSH group than control group. Pharmacologic modulation of hepatocytic function with glutathione before hemorrhagic shock has shown some beneficial effect with protection of decreased AKBR and histological change during and after hemorrhagic shock.
Animals ; Arterial Pressure ; Biopsy ; Defense Mechanisms ; Dogs* ; Enflurane ; Glutathione* ; Hemorrhage ; Ischemia ; Ketone Bodies ; Liver ; Oxygen ; Reperfusion ; Shock ; Shock, Hemorrhagic*

BACKGROUND: Activated fibrinolysis during cardiopulmonary bypass(CPB) is one of the causes of post CPB coagulopathy. Antifibirinolytics such as tranexamic acid have been administered prophylactically before CPB to decrease postCPB bleeding. However, their routinely application has been challenged as regarding it's thrombotic complication. This study was performed to evaluate the effect of tranexamic acid administered before CPB by thromboelastography. METHODS: 50 open heart surgical patients were randomly selected and devided into two groups, control(N=25) and tranexamic acid group(N=25). In tranexamic acid group. 125mg of tranexamic acid were singly infused before vena caval and aortic cannulation. All of parameters of thromboelastography (TEG) and fibrin degradation products measured before and after CPB were compared between two groups. RESULTS: There were no significant differences in fibrinolytic indexes of TEGs between control group and tranexamic group afte CPB. And there were also no changes in fibrinolysis index between before and after CPB in both groups. The concentration of FDP did not changed after CPB in both groups. CONCLUSIONS: It may be considered that prophylactic administration of tranexamic acid before CPB to reduce post-CPB bleeding would not be recommended routinely.
Catheterization ; Fibrin Fibrinogen Degradation Products ; Fibrinolysis* ; Heart* ; Hemorrhage ; Humans ; Thoracic Surgery* ; Thrombelastography ; Tranexamic Acid*

The syndrome of crocodile tear refers to an abnormal gusto-lacrimal reflex where any gustatory stimulation produces excessive tearing as well as salivation. It is a relatively rare syndrome that has mainly been observed after a recovery from a peripheral facial nerve palsy, surgery of the acoustic neuroma or in a congenital syndrome. The most commonly accepted mechanism for the pathogenesis of the crocodile tear syndrome is that of aberrant regeneration of nerve fibers or that of transaxonal transmission. Crocodile tear syndrome may be effectively treated by intraglandular injections of botulinum toxin. Authors experienced a case of crocodile tear syndrome that occurred after the removal of acoustic neuroma; it was treated successfully by injection of botulinum toxin into the lacrimal gland. We report this case with the related literatures.
Alligators and Crocodiles* ; Botulinum Toxins ; Facial Nerve ; Lacrimal Apparatus ; Nerve Fibers ; Neuroma, Acoustic ; Paralysis ; Reflex ; Regeneration ; Salivation ; Tears*

To identify the long-term survival rate and prognostic factors of AMI in Korea, total 404 patients who presented between Jan 1984 and mar 1989 at Seoul National University Hospotal were followed for and average of 24.9+/-18.2 months(range 1 to 69 months). 50 patients(12.4%) died during the in-hospital period and 25 patients(6.2%) died after discharge. Among the survivors reinfarction developled in 11 patients(3.3%). Overall survival rates were 0.87, 0.85, 0.83, 0.81, 0.79, 0.77 and event-free survival rates were 0.87, 0.84, 0.83, 0.79, 0.77, 0.72 at 1, 6, 12, 24, 36, 48 months respectively. During the in-hospital period sex, age, peak creatine kinase level, Killip class, Q wave in ECG, heart failure, and AV block in anterior infarction were of prognostic value. After discharge age, exercise duration on pre-discharge treadmill test, cardiac index, ejection fraction, and presence of heart failure were significant prognostic factors. Pre-discharge coronary angiographies were performed in 217 cases. There was no statistically significant difference in survival rate between multiple vessel disease and single vessel disease. But the more the number of involved vessels was, the higher the incidence of reinfarction was. In the group with jeopardy score less than 8, event-free survival rate was signigicantly higher. Overall survival rate was higher and reinfarction rate was lower in the group, but both were not statistically significant. On discriminant analysis of in-hospital prognostic factors, Killip class, heart failure and age were independent prognostic factors, but other factors had no additional prognostic value.
Atrioventricular Block ; Coronary Angiography ; Creatine Kinase ; Disease-Free Survival ; Electrocardiography ; Exercise Test ; Heart Failure ; Humans ; Incidence ; Infarction ; Korea ; Myocardial Infarction* ; Seoul ; Survival Rate* ; Survivors

Anesthesiologists may encounter pulmonary thromboembolism during the perioperative period. However, the diagnosis of pulmonary thromboembolism is difficult because clinical symptoms and signs are not specific, and specialized diagnostic tools are not readily available in the operating room. We report a case of pulmonary thromboembolism during modified radical mastectomy. A 52 year old female patient underwent modified radical mastectomy under general anesthesia. 90 minutes after induction there were a sudden increase of peak airway pressure and a decrease of oxygen saturation. We treated symptomatically under the impression of pulmonary edema during operation. After operation, pulmonary thromboembolism was diagnosed and treated successfully with oxygen therapy and anticoagulant therapy. After 26th days of operation she was no longer suffered from hypoxia. At the 36th day after operation, she was discharged without any sequelae.
Anesthesia, General ; Anoxia ; Diagnosis ; Female ; Humans ; Mastectomy, Modified Radical* ; Middle Aged ; Operating Rooms ; Oxygen ; Perioperative Period ; Pulmonary Edema ; Pulmonary Embolism*

A 70-yr-old woman complained of left sided chest pain and non-bilious vomiting for four days after taking a gastric bloating agent for an upper gastrointestinal study. The chest radiography revealed gastric air-fluid levels and bowel loops in the left thoracic cavity. An emergency thoracotomy was performed. The abdominal organs (stomach, spleen, splenic flexure of the colon) were in the left thorax and the entire left hemidiaphragm was absent. There were no diaphragmatic remnants visible for reconstruction of the left diaphragm. We provided warm saline irrigation and performed a left lower lobe adhesiotomy. Thirteen days after surgery, the chest radiography showed improvement in the herniation but mild haziness remained at the left lower lung field. Here we present the oldest case of congenital diaphragmatic agenesis presenting with transient gastric volvulus and diaphragmatic hernia.
Aged ; Diagnosis, Differential ; Diaphragm/*abnormalities/radiography/surgery ; Female ; Hernia, Diaphragmatic/*diagnosis/radiography/surgery ; Humans ; Stomach Volvulus/*diagnosis/surgery ; Tomography, X-Ray Computed

A 70-yr-old woman complained of left sided chest pain and non-bilious vomiting for four days after taking a gastric bloating agent for an upper gastrointestinal study. The chest radiography revealed gastric air-fluid levels and bowel loops in the left thoracic cavity. An emergency thoracotomy was performed. The abdominal organs (stomach, spleen, splenic flexure of the colon) were in the left thorax and the entire left hemidiaphragm was absent. There were no diaphragmatic remnants visible for reconstruction of the left diaphragm. We provided warm saline irrigation and performed a left lower lobe adhesiotomy. Thirteen days after surgery, the chest radiography showed improvement in the herniation but mild haziness remained at the left lower lung field. Here we present the oldest case of congenital diaphragmatic agenesis presenting with transient gastric volvulus and diaphragmatic hernia.
Aged ; Diagnosis, Differential ; Diaphragm/*abnormalities/radiography/surgery ; Female ; Hernia, Diaphragmatic/*diagnosis/radiography/surgery ; Humans ; Stomach Volvulus/*diagnosis/surgery ; Tomography, X-Ray Computed

The inverse correlation of appendectomy and ulcerative colitis is well known, but the effect of appendectomy on the clinical course of ulcerative colitis remains unclear. Although the majority of opinions were negative for the therapeutic advantage of appendectomy in patients with ulcerative colitis, advocates for positive effect of appendectomy have been proposed in a few case reports and a prospective study from Western countries. We herein report a case of ulcerative colitis who experienced clinical remission after appendectomy for acute appendicitis. The patient was 35 year old male and had been managed with immunosuppressant before appendectomy. The very acute change in clinical course and a long period of remission after appendectomy highly suggest the therapeutic effect of appendectomy for ulcerative colitis.
6-Mercaptopurine/therapeutic use ; Adult ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; *Appendectomy ; Colitis, Ulcerative/*diagnosis/drug therapy/surgery ; Colonoscopy ; Humans ; Immunosuppressive Agents/therapeutic use ; Male ; Mesalamine/therapeutic use ; Tomography, X-Ray Computed ; Treatment Outcome