Functional lacrimal obstruction is a rare physiologic dysfunction of the lacrimal drainage system without any mechanical obstruction. Twelve eyes of 9 patients were diagnosed by syringing, dacryacystography, and lacrimal scintigraphy. Normal drainge pattern was noticed in syringing and in the initial film of dacryocystography. However slow or non-functioning drainge was disclosed in the delay film of dacryocystography and lacrimal scintigraphy. The causes of functional problem were facial nerve palsy, trauma and idiopathic. Conjunctivodacryocystorhinostomy was performed in all 12 eyes with satisfactory results.
Drainage ; Facial Nerve ; Humans ; Paralysis ; Radionuclide Imaging

Laparoscopic cholecystectomy is a new surgical procedure which worldwidely applicated gallstone disease and is presenting now anesthetic challenges. The advantages of laparoscopic cholecystectomy are shorter hospital stay, more rapid retum to normal activies and less postoperative ileus, compared with open laparotomy. During the laparoscopic surgery to enable visualization of abdominal structures, pneumoperitoneum is made with CO2 insufflation but insufflation of CO2 into abdominal cavity has been reported several consequences. Hypercarbia, high peak airway pressure, cardiac arrhythmia which were all may result from CO2 insufflation. Also, increased intraabdominal pressure from the induced pneumoperitoneum can cause decreased venous return and may result in hypotension. To ascertain the cardiopulmonary effcts of the increased intraabdominal pressure by CO2 insufflation, a clinical study was performed in 80 patients who divided into four groups likes as control group (open cholecystectomy, number:No=20), group I (15 mmHg of pressure of pneumoperitoneum, No=20), group II (20 mmHg, No=20), group III (25 mmHg, No=20). We investigated the effect of CO2 insufflation to mean arterial pressure, heart rate, end-tidal CO2 partial pressure, mean airway pressure, and arterial blood gas components. The measurements were obtained from the time of skin incision(basic value) to 20 min every 5 min interval in all groups. The results are following, I. Mean arterial pressure significantly began to increase (p<0.05) at post-incision 5 min in control, group IIl & at 10 min in group I, II compared with pre-incision value(basic value), but there were no difference between control and other study groups. II. Heart rate(HR) significantly began to differ (p<0.05) at post-incision 5 min in group II, III. compared with control group. Also HR significantly began to increase (p<0.05) at post-incision 5 min in control, group III & to decrease at post-incision 15 min in group compared with basic value. III. There were significant difference in pH between control and study groups, pH change were in normal ranges clinically. PaCO2 was significantly began to decrease (p<0.05) at post-incision 5 min in study groups compared with basic value, but still in normal acceptable ranges. IV. PaCO2 significantly began to increase (p<0.05) at post-incision 10 min in group II & at 15 min in group IIl compared with control group. Also PaCO2 significantly began to increase (p<0.05) at 5 min in group I, II & at 10 min in group III compared with basic value. V. PETCO2 significantly began to increase (p<0.05) at 10 min in group II & at 15 min in group III compared with control group. Also PETCO2 significantly began to increase (p<0.05) at 10 min in group I,II,III compared with basic value. VI. PAW significantly began to increase (p<0.05) at 10 min in group I,II,III compared with basic value. Conclusively, insufflation of CO2 into abdominal cavity during laparoscopic operation was minimal change in cardiopulmonary system and arterial blood gas value at below 20 mmHg intraabdominal pressure.
Abdominal Cavity ; Arrhythmias, Cardiac ; Arterial Pressure ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Gallstones ; Heart ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Ileus ; Insufflation ; Laparoscopy ; Laparotomy ; Length of Stay ; Partial Pressure ; Pneumoperitoneum ; Reference Values ; Skin

The Oriental countries have had long histories and large populations. While they were the civilized country with the profound culture and thoughts, they were backward in material civilization bacause of their delayed development of science. Extending from the end of the 18th century to the 19th century the Western countries perturbed the Eastern countries with their sudden appearance. The Western countries visited the East with their threatening attitudes by giant war vessels and guns. They also strongly demanded to import their advanced daily commodities and the studies including the medical science. Since the most of the Eastern countries were too conservative, they resisted and rejected the Western forces at first. At that time, most Eastern countries located in the southern region of Asian continent were colonized by the West. The other countries in the nortern region came to realize that they were behind the West in material civilization, so had to open their door to the West through the foreign contact. China, Japan and Korea had to accept the Western culture and urged the civilization. Especially Japan adapted herself to new circumstances before others. She accepted the Western culture, thoughts and all studies actively with even reforming her political system. Starting from the yesr of 1868, Japan not only was reborn and formed independent position in the cultural region of China and Korea but also succeeded to construct the first westernized country among the Eastern countries and weekened the influence of China and Russia. Japan provoked and won wars such as the Sino-Japanese War {1894} and the Russia-Japanese War (1904). Follwing up these victories, Japan also occupied Korea in 1910, and the period of colonization had continued for 35 years until 1945 when Japan surrendered to the Allies at the end of the World War II. With these historical cirumstances, the purpose of this research paper is to collect the medical data, especially that of the anesthesia, and show its historical contributions through the documents. The long history of Korea had developed with the traditional and peculiar medical science, such as a herb medical science and a medical science in acupuncture and moxibustion. Korean medical science, however, has been greatly changed since 1876, the year of opening her door to Japan. There were two ways of introducing the Western medical science in Korea. As the indirect import, the japanese Western medical scince through the city of Busan was one. As the direct imports, the American medical science by an American missionary, Allen through the city of Incheon was the other. In these two currents of the Western medical science, it was natural that the Japanese one formed the main stream after 1910, the year of japanese occupation. The field of anestheia science was not an exception. Its developing process was no better than following the path of Japanese anesthesia science history. Comparing the Western developing history of anesthesia to that of Japan in general, there were a few ears difference in the level of quality between the East and the West until about 1930. Japanese anesthesia, however, fell behind over 20 years, comparing to the Western one, in the period from the late of 1930s to 1945. I believe that it is beyond the scope of this paper to explain and it leaves us with meaningful lessons.
Acupuncture ; Anesthesia* ; Asian Continental Ancestry Group ; Busan ; China ; Civilization ; Colon ; Ear ; Firearms ; Humans ; Incheon ; Japan ; Korea* ; Missions and Missionaries ; Moxibustion ; Occupations ; Political Systems ; Rivers ; Russia ; World War II

BACKGOUND: Mass casualties from organophosphorus inhalation die from respiratory depression. Gas supplies and equipment are limited for mechanical ventilation of multiple subjects in emergency situation. Endobronchial insufflation of air (EIA) can be simply performed with air compressor and catheter. The author tried to examine the usefulness of EIA in five apneic dogs induced by tetrodotoxin (TTX) infusion. METHOD: Five anesthetized dogs were intubated with endotracheal tube and endobronchial insufflation catheter and instrumented with arterial catheter and ventilated with controlled mechanical ventilation (CMV) while 12 microgram/kg TTX was infused intravenous over 90 minutes to produce apnea. EIA of 1 microliter/kg/min was delivered through a 35 cm long, 0.8 cm ID catheter with a forked end placed astride the carina. During conventional ventilation, arterial blood gases and pH were measured (base line, BL). The data were measured after confirmation of apnea for 1 minute (time=0, control value), and then measured serially for 4 hours of EIA. RESULT: All animals survived and were alert and neurologically normal within 24 hours. The changes of arterial oxygen tension (PaO2) were no significant difference between control value and 10, 20, 30 minute (p<0.05), and arterial carbon dioxide tension (PaCO2) were significant increase in control value compared to base line (p<0.05), and pH were no significant difference in all values (p<0.05). Spontaneous respiratory efforts slowly returned after 45 minute of EIA and resulted in the improvement of gas exchange. CONCLUSION: EIA recognized as a sort of ventilatory technique is useful only when other equipments could not be available. The EIA catheter can be placed by cricothyroidotomy. EIA is very helpful in supporting ventilation, and it also helps the apneic dogs stay in normal condition.
Animals ; Apnea ; Carbon Dioxide ; Catheters ; Dogs* ; Emergencies ; Equipment and Supplies ; Gases ; Hydrogen-Ion Concentration ; Inhalation ; Insufflation* ; Mass Casualty Incidents ; Oxygen ; Respiration, Artificial ; Respiratory Insufficiency ; Tetrodotoxin ; Ventilation*

BACKGROUND: Pelviscopy has become popular because of the advantage of which less painful, less scarring, and shortening the hospitalizing stays, so to reduce the cost. This procedure require lithotomy- Trendelenburg position and pneumoperitoneum with carbon dioxide(CO2) gas insufflation, that affect arterial blood gas and hemodynamics. We studied the effects of pelviscopy on the PaCO2 and hemodynamics. METHODS: Twenty patients scheduled for pelviscopic hysterectomy were studied. All patients anesthetized with enflurane (2.0 vol%) - nitrous oxide (1.5 L/min) and oxygen (1.5 L/min), and controlled ventilation(tidal volume 10 ml/kg, respiratory rate 12 /min). Central venous pressure, blood pressure, heart rate and PaCO2 measured at postinduction(control), position change with CO2 gas insufflation, and every 15 minutes after pneumoperitoneum. RESULTS: Central venous pressure increased (P<0.05) through the procedure after position change and CO2 gas insufflation. Systolic blood pressure and heart rate decreased at 45min after pneumoperitoneum(P<0.05). Mean arterial pressure decreased at 75 min after pneumoperitoneum. PaCO2 increased at 15 min after position change and pneumoperitoneum(P<0.05). CONCLUSION: In our study, because central venous pressure and PaCO2 increased, we should attend to patients with hypertension, increased intracranial pressure, and increased PaCO2.
Arterial Pressure ; Blood Pressure ; Carbon ; Carbon Dioxide ; Central Venous Pressure ; Cicatrix ; Enflurane ; Head-Down Tilt ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Hysterectomy ; Insufflation ; Intracranial Pressure ; Nitrous Oxide ; Oxygen ; Pneumoperitoneum ; Respiratory Rate

Recently, laparoscopic cholecystectomy becomes a favorite surgical treatment of cholelithiasis instead of traditional open cholecytectomy. The reasons include small wound, small pain and short hospital-stay. But it also has disabvantages by pneumoperitoneum made of carbon dioxide insuffulation. We attempted to investigate the effect on hemodynamics, arterial blood gas parameters and pulmonary function of each surgical technique-laparoscopic(Group I) vs open cholecystectomy(Group II). We randomly selected realative healthy 30 patients for each group and baseline arterial blood gas and pulmonary function test were measured. During the operative proeedure, hemodynamic parameters(blood pressure and heart rate) were measured by 5-minute interval. Postoperatively, arterial blood gas and pulmonary function test were measured. The results are following; 1) In group I, blood pressure was increased to l14.2+/-18.0mmHg significantly(p<0.01) compared to preoperative value 101.4+/-21.5 mmHg. Heart rate was not shown significant change in both technique groups. 2) PaO2 was significantly decreased to postoperative 24hr value 82.2+/-15.8mmHg in group II and 82.3+/-19.4 mmHg in group I compared to preoperative 24hr value 98.7+/-14.8 mmHg and 94.4+/-ll.3mmHg, respectively. There was no significant difference of PaCO2 of between two groups. pH was significantly increased to postoperative 24hr value 7.42+/-0.02 in group II compared to preoperotive 24hr value 7.39+/-0.03 but no significant change in group I compared to preoperative 24hr value 7.39+/-0.03. 3) In group I, FVC and FEV1 were decreased preoperative 24hr value 77.9% and 81.1% to postoperative 24hr value 61.1% and 62.3%, respectively. But in group II, FVC and FEV1 were decreased more significantly, compared preoperative 24hr value 90.8% and 95.6% with postoperative 24hr value 59.4% and 58.6%. FEV1,/FVC value was not changed in two groups. 4) Postoperative analgesics requirement was 53% in group I, 80% in group II at the day of surgery. Also frequency was 1.8 in group I, 2,4 in group II at the day of surgery. 5) Mean Operation time was 43 min in group I, 52 min in group II and mean hospital days were 6 days in group I, 12 days in group II. Conclusively, in case of group I, blood pressure change was more labile than group II. But postoperative pulmonary function derangement, requirement of analgesics and hospital day were reduced in case of group I.
Analgesics ; Blood Pressure ; Carbon Dioxide ; Cholecystectomy* ; Cholecystectomy, Laparoscopic ; Cholelithiasis ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Pneumoperitoneum ; Respiratory Function Tests ; Wounds and Injuries

The left ventricle is realized as the cardiac structure of greatest importance for cardiac pump function, and the role of the right ventricle has been overlooked. However, the right ventricle and the left ventricle are in series and physiologically coupled so that a disturbance in the one ventricular function will influence the behavior of the other. Thus, there ia growing interest in the importance of the right side of the heart, particularly in patients undergoing cardiac surgery. Moreover recently, right ventricular failure has been identified as a cause of progressive deterioration in patients undergoing cardiac operations, and it may limit the overall success of the procedure. This study was performed to investigate right ventricular ejection fraction of the cardiac patients at pre and post-perfusion period. 10 cases were measured and analyzed. The results were as follows: I) There were no singificant differences statistically in demographic data of the patients. 2) Pulmonary capillary wedge pressure(PCWP) of postperfusion 10 min. was significantly increased compared to preperfusion period(p<0.01). 3) Systemic vascular resistance(SVR) of immediate postperfusion period was significantly decreased compared to preperfusion period. 4) Heart rate and central venous pressure(CVP) of postperfusion period were statistically significantly increased, but clinically no significant change compared to preperfusion period. 5) Cardiac output(CO) and right ventricular ejection fraction(RVEF) of postperfusion period were no significant change compared to preperfusion period.
Capillaries ; Heart ; Heart Rate ; Heart Ventricles ; Humans ; Stroke Volume ; Thoracic Surgery* ; Ventricular Function

BACKGROUND: High frequency jet ventilation has been extensively evaluated by clinicians and is considered reliable technique for assisted ventilation, occupying a specific place in the wide range of ventilatory support techniques available for anesthesia and critical care. Thanks to the transtracheal high frequency jet ventilator, it is now possible to assure a free laryngeal endoscopic operative field. The transtracheal catheter is introduced percutaneously through the cricothyroid membrane into the trachea and connected to a high frequency jet ventilator. The purpose of this study is to evaluate the application of percutaneous transtracheal HFJV for suspension micro laryngeal surgery under total intravenous anesthesia. METHODS: The patients were divided into two groups. In transtracheal group (group TT, n=7), jet ventilation was done with 14 gauge angiocatheter introduced into the trachea through the cricothyroid membrane and in endotracheal intubation group (group ET, n=7), jet ventilation was done with endotracheal tube which has a 5 mm of internal diameter. RESULTS: The blood pressures were not significantly changed except postincision 5 minute in group ET and TT. The heart rate was not significantly changed in group ET and TT. The arterial blood gases were not significantly changed in group ET and TT. CONCLUSIONS: From the above results, jet ventilation by transtracheal catheter, if properly used, should provide safe airway, an adequate ventilation and improved visual field. So we suggest that transtracheal technique should provide an alternative to conventional endotracheal technique for micro laryngeal surgery.
Anesthesia ; Anesthesia, Intravenous ; Catheters* ; Critical Care ; Gases ; Heart Rate ; High-Frequency Jet Ventilation ; Humans ; Intubation, Intratracheal ; Membranes ; Trachea ; Ventilation* ; Ventilators, Mechanical ; Visual Fields

Clinical analysis was performed on 660 cases of the intussusception treated at the Masan Fatima Hospital from January 1981 to December 1995. Also the frequency of the intussusception in the central area of Kyung Nam province from January 1991 to December 1995 was studied. The results were as follows. 1) The intusssusception was most commonly occured between 6 months to 9 months of age(28.6%). Male to female ratio was 2.06 : 1. 2) The frequent symptoms and signs were abdominal pain(80.9%), bloody stool(68.3%), vomiting(63.9%), and palpable abdominal mass(43.6%). 3) The incidence of types of intussusception were ileo-colic(50.0%), ileo-ileo-colic(41.2%), ileo-cecal(6.3%), colo-colic(2.1%) and ileo-ileal(0.4%) in order. 4) The chance of intestinal resection was increased in the case of symptom duration over 24 hours(P<0.01). 5) Barium reduction was attempted in 660 cases(100%) and achieved successful reduction in 364 cases(55.2%). Operative treatment was performed in 296 cases(44.8%), of which manual reduction was carried out in 267 cases(90.2%), intestinal resection in 17 cases(5.8%) and spontaneous reduction was noted in 12 cases(4.0%). 6) Wound infection developed in 12 cases(4.0%) was the most commonly observed postoperative complication. 7) The recurrent rates of the barium enema and operation were 9.1% and 7.1%, resepctively. 8) The operative mortality was 0.2%. 9) The incidence of intussusception in Kyung Nam central area from 1991 to 1995 were as followings : 5.55/1000 live birth in 1991, 5.65/1000 live birth in 1992, 5.03/1000 live birth in 1993, 5.00/1000 live birth in 1994 and 4.03/1000 live birth in 1995.
Barium ; Child* ; Enema ; Female ; Humans ; Incidence* ; Infant* ; Intussusception* ; Live Birth ; Male ; Mortality ; Postoperative Complications ; Wound Infection

Assessment of the adequacy and effectiveness of oxygen therapy is a matter of clinical evaluation and blood gas measurement as long as the administration of oxygen is consistent and predictable. Normal variances in the distribution of ventilation and pulmonary blood flow make the measurement of alveolar oxygen concentrations impratical and complex. To certify the relationship between the fractional inspired oxygen concentration (F1O2) and arterial oxygen tension(PaO2), we performed the blood gas analysis of the anesthetized surgical patients whose inspired oxygen concentrations were 20 to 100% (compressed medical-O2). This paper reports our findings and a discussion of their possible significance. Results were as follows ; 1) There were no differences in systolic, diastolic and mean arterial pressure in the range of 0.2 to 1.0 of F1O2. 2) There was no clinically significant difference in heart rate from 0.2 to 1.0 of F. 3) In the arterial blood gas analysis, PaCO2 and pHa revealed normal value from F1O2 0.2 to 1.0 but PaO2 progressively increased significantly. Patients didn,t reveal arterial hypoxemia and acid-base imbalance from 0.2 to 1.0 of F1O2.
Acid-Base Imbalance ; Anoxia ; Arterial Pressure ; Blood Gas Analysis ; Gases* ; Heart Rate ; Humans ; Oxygen ; Reference Values ; Ventilation