Pre-eclampain or eclampain is a cause of maternal morbidity and mortality. It is characterized by the triad of maternal hypertension, proteinuria and generlized edema. The etiology of pre-eclampain or eclampsia is thought to be a decreased placental perfusion which results in an increased production of renin, angiotensin, aldosteron, thrombolplastin and a decreased production of prostaglandin. Anesthesiologists have to perform anesthesia technic for high-risk toxemia of pregnancy, and make proper choices of anesthesia method and drugs. Advantages of general anesthesia for Cesarian-section in cases of eclampsia include rapid induction, less hypotension, control of ventilation and fetal oxygenation. Disadvantages include myocardial depression from the anesthetic drugs, hypertension during light anesthesia, the interacion between manesium sulfate and muscle relaxante which might lead to prolonges respiratory paralysis and neonatal depression associated with the general anesthesia. The author used general anesthesis for the Cesarian-section in two severe toxemic patients who had pulmonary edema and bloody sputum because of congestive heartfailure. One patient had cardiac arrest upon arrival at the emergency room and after cardiopulmonary resuscitation the cesarian-section was performed. The mother had complets recovery, but the baby expired in twenty-ninehours. The Mother and twin babies in the other case had complete recovery.
Anesthesia* ; Anesthesia, General ; Anesthetics ; Angiotensins ; Cardiopulmonary Resuscitation ; Depression ; Eclampsia ; Edema ; Emergency Service, Hospital ; Estrogens, Conjugated (USP) ; Female ; Heart Arrest ; Humans ; Hypertension ; Hypotension ; Mortality ; Mothers ; Oxygen ; Perfusion ; Pre-Eclampsia ; Pregnancy* ; Proteinuria ; Pulmonary Edema ; Renin ; Respiratory Paralysis ; Sputum ; Twins ; Ventilation

PURPOSE: Usually papillary microcarcinoma (PMC) grows very slowly with a good prognosis, although it frequently metastasizes to regional lymph nodes and shows multiple tumor formation in the thyroid. Therefore, how to treat papillary microcarcinoma has been controversial. Recently several studies reported that some ultrasonographic features may potentially reflect the biological aggressiveness of a lesion. We investigated which ultrasonographic findings can reflect aggressive characteristics and whether US can helpful in selecting the appropriate surgical treatment of PMC. METHODS: We retrospectively reviewed the preoperative ultrasonographic findings and pathologic risk factors of 68 patients who had undergone surgical treatment for PMC at the Wallace Memorial Baptist Hospital from January 2004 to December 2005. RESULTS: The incidences of multifocality, extrathyroidal extension, and lymph node metastasis of PMC were 42.6%, 48.5% and 20.6%, respectively. The Mean sizes of PMC were no significant differences according to age, multifocality, extrathyroidal extension, lymph node metastasis, stage and AMES risk group, and tumor size more than 5 mm was not linked to pathologic prognostic factors. Cases demonstrating multiple nodules in the unilateral or bilateral lobes, as well as those with fine strong calcifications in the tumor on US, were directly linked to multifocality on pathologic finding. US is insensitive technique for detecting lymph node metastasis and it's sensitivity was only 14.3%, but it's positive predictive value and specificity were high (100%). CONCLUSION: The date suggested that complete surgery with appropriate nodal dissection should be performed in patients with PMC which their US demonstrating multiple nodules in the unilateral or bilateral lobes, fine strong calcifications echoes in tumor and US-detected node metastasis.
Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Protestantism ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Thyroid Gland* ; Ultrasonography*

PURPOSE: Billroth I and II reconstructions are commonly performed after a distal subtotal gastrectomy. However, both may cause duodenogastric and duodenogastroesophageal reflux, which are conditions reported to have carcinogenic potential. This study investigated which reconstructive procedure would be most effective in prevent bile reflux into the gastric remnant after a distal gastrectomy. METHODS: A group of 43 patients who underwent a curative distal gastrectomy for gastric cancer were assigned to three groups prospectively according to the reconstructive procedure undertaken: 14, Billroth I (B-I); 14, Billroth II with Braun anastomosis (B-II with Braun); and 15 Billroth II (B-II). The bile reflux period (percent time) for the gastric remnant was measured using a Bilitec 2000 under standardized conditions. The endoscopic findings for reflux gastritis were classified into four grades. RESULTS: The mean standard error time of bile reflux in B-I, B-II with Braun and the B-II groups was 30.9+/-3.9%, 32.8+/-5.1% , and 60.9+/-7.0%, respectively. The B-II group showed significantly higher levels of the % time of bile reflux than the B-I or B-II with Braun groups (P<0.001). Regarding the endoscopic classification for reflux gastritis, the remnant stomach after B-II showed significantly more severe and extensive gastritis than that after the B-I and B-II with Braun procedures (P=0.003). There was also a positive correlation between the degree of % time of bile reflux and the extent of gastritis in the gastric remnant (P<0.001). CONCLUSION: After a distal subtotal gastrectomy, a B-II reconstruction is associated with a high reflux of duodenal content, whereas a Braun enteroenterostomy after a B-II reconstruction minimized the reflux at the levels of a B-I reconstruction.
Bile Reflux ; Classification ; Duodenogastric Reflux* ; Gastrectomy* ; Gastric Stump ; Gastritis ; Gastroenterostomy ; Humans ; Prospective Studies ; Stomach Neoplasms

Malignant hyperthermia is defined as a potentially fatal hypermetabolic syndrome characterized by hyperpyrexia, skeletal muscle rigidity, tachycardia, respiratory and metabolic acidosis, cyanosis etx. There is no simple noninvasive test to identify the susceptible individuals. A history of hyperpyrexia and/or muscle rigidity during previous general or a family history of such a condition provides the anesthesiologist with valuable information. Avoidance of potent inhalational anesthetic agents and other triggering agenta, and the selective use of regional anesthesia with either a local anesthetic agent or neuroleptic anesthesia, are the usual acceptable guidelines in the anesthetic management of susceptible individuals. Dentrolene sodium has been shown to be effective in the prevention and treatment of malignant hyperthermia in malignant hyperthermia susceptible swine. We gave Dantrolene sodium orally as a part of the prophylaxia for malignant hyperthermia in a 34yearts-old woman who underwent an emergency bilateral salpingectomy and who had a family history of malignant hyperthermia. We report on this patient with a family history of hyperthermia and reviewed the literature concerning malignant hyperthermia.
Acidosis ; Anesthesia ; Anesthesia, Conduction ; Anesthetics ; Cyanosis ; Dantrolene ; Emergencies ; Female ; Fever ; Humans ; Malignant Hyperthermia* ; Muscle Rigidity ; Muscle, Skeletal ; Salpingectomy ; Sodium ; Swine ; Tachycardia

Pneumothorax was recognized as a potential hazard of mechanical ventilation shortly after the introduction of the technique of tracheal intubation in the 19th century. Because the gases used in anesthesia are delivered from cylinders and wall outlets at higher than atmoshperic pressure, the possibility of damage to the lung is ever present. Immediate, prompt and adequate management of bilateral tension Pneumothorax are essentil, otherwise the patient dies rapidly. We had a case of bilateral tension Pneumothorax in a 3 year-old boy who underwent a B-E amputation of a severely crushed hand. We report this case along with a review of the literature on Pneumothorax.
Amputation ; Anesthesia ; Anesthesia, General* ; Child, Preschool ; Gases ; Hand ; Humans ; Intubation ; Lung ; Male ; Pneumothorax* ; Respiration, Artificial

No abstract available.
Aged ; Carcinoma, Renal Cell/*diagnosis/surgery ; Coronary Angiography ; Creatine Kinase, MB Form/analysis/*metabolism ; Echocardiography ; Electrophoresis ; Enzyme-Linked Immunosorbent Assay ; False Positive Reactions ; Humans ; Kidney Neoplasms/*diagnosis/surgery ; Male ; Nephrectomy

No abstract available.
Typhlitis*

Interstitial lung disease (ILD) is often observed in connective tissue diseases (CTDs), frequently in rheumatoid arthritis, systemic sclerosis, primary Sjögren’s syndrome, and inflammatory myositis. Early detection of ILDs secondary to rheumatic diseases is important as timely initiation of proper management affects the prognosis. Among many imaging modalities, high-resuloution computed tomography (HRCT) serves the gold standard for finding early lung inflammatory and fibrotic changes as well as monitoring afterwards because of its superior spatial resolution. Additionally, lung ultrasound (LUS) and magnetic resonance imaging (MRI) are the rising free-radiation imaging tools that can get images of lungs of CTD-ILD. In this review article, we present the subtypes of ILD images found in each CTD acquired by HRCT as well as some images taken by LUS and MRI with comparative HRCT scans. It is expected that this discussion would be helpful in discussing recent advances in imaging modalities for CTDILD and raising critical points for diagnosis and tracing of the images from the perspective of rheumatologists.

BACKGROUND: Quality of recovery, assessed by patients, is related to patients' satisfaction, and even to quality of life. Of numerous patient-based measures to evaluate the quality of recovery, a '40-item-quality of recovery (QoR-40)' has proved to be valid and reliable. Using this questionnaire, we evaluated the quality of recovery in the gynecological patients and tried to identify factors affecting the quality of recovery. METHODS: Patients undergoing gynecological surgery were asked to fill a questionnaire 8 to 9 p.m the day after the completion of anesthesia. Questionnaires were prepared after translation to Korean from 40-item-quality of recovery. From the anesthetic and recovery room records we collected data about patient's age, surgery types, anesthetic and surgical duration, recovery room stay, main anesthetic agents, and recovery room complications. RESULTS: A total of 383 patients completed the questionnaires. Patients aged under 40 got significantly lower QoR-40 scores than those aged over 40, especially in the dimension of pain (P < 0.05). Patients who had undergone laparoscopic surgery got higher scores than those had undergone non-laparoscopic surgery (P < 0.05). Patients who answered the questionnaires in more than 30 hours after the completion of anesthesia showed lower total scores than those who did in less than 30 hours, especially in the dimensions of emotional state and pain (P < 0.05). CONCLUSIONS: In gynecological patients, laparoscopic surgery improved quality of recovery. Quality of recovery was affected by age and survey time. Postoperative pain contributed to the decrease of the quality of recovery.
Aged ; Anesthesia ; Anesthesia, General ; Anesthetics ; Female ; Gynecologic Surgical Procedures ; Humans ; Laparoscopy ; Pain, Postoperative ; Quality of Life ; Recovery Room

BACKGROUND: The aim of this study was to investigate the neuroprotective effects of sevoflurane after severe forebrain ischemic injury. We also examined the relationship between the duration of ischemia and neuronal cell death. METHODS: Male Sprague-Dawley rats (300-380 g) were subjected to 6 (each n = 6) or 10 min (each n = 10) of near-complete forebrain ischemia while anesthetized with either 50 mg/kg of zoletil given intraperitoneally or inhaled sevoflurane (2.3%). Ischemia was induced by bilateral common carotid artery occlusion plus hemorrhagic hypotension (26-30 mmHg). Histologic outcomes were measured 7 days after ischemia in CA1 pyramidal cells of the rat hippocampus. RESULTS: The mean percentage of necrotic cells in the hippocampal CA1 area decreased in the sevoflurane group compared to the zoletil group (25% vs. 40% after 6 min ischemia, respectively: P = 0.004 and 44% vs. 54% after 10 min of ischemia, respectively P = 0.03). The percentage of apoptotic cells was similar in all groups. The percentage of necrotic cells in each anesthetic groups was significantly higher in the 10 min ischemia group compared to the 6 min ischemia group (P = 0.004 in the sevoflurane group, P = 0.03 in the zoletil group). CONCLUSIONS: The present data show that sevoflurane has neuroprotective effects in rats subjected to near-complete cerebral ischemia. Longer duration of ischemia is associated with more neuronal injury when compared to ischemia of shorter duration.
Anesthetics, Inhalation ; Animals ; Brain Ischemia ; Carotid Artery, Common ; Drug Combinations ; Hippocampus ; Humans ; Hypotension ; Ischemia ; Male ; Methyl Ethers ; Neurons ; Neuroprotective Agents ; Prosencephalon ; Pyramidal Cells ; Rats ; Rats, Sprague-Dawley ; Tiletamine ; Zolazepam