Patients with advanced pulmonary tuberculosis suffer from chronic obstrutive pulmonary disease, making them poor risks for anesthesia. Also, general anesthesia for patients with active hepatitis or arteriosclerotic cardiovascular disease complicates the intraoperative and postoperative course. Inhalation anesthetics, along with the assissted ventilation used in general anesthesia, further complicate the intraoperative and postoperative course. Although regional anesthetic techiques have been used extensively for pelvic and limbic surgery to avoid the complications of general anesthesia, thoracic epidural anesthesia has not been common for upper abdominal surgery because of the fear of damage to the spinal cord. But compared with the lumbar.approach, the danger of accidental damage to the spinal cord has been exaggerated. Thoracic epidural anesthesia has been employed in a number of cases of upper abdominal surgery at Y.U.W.M.C wish remarkable success. We have in describe the use of thoracic epidural anesthesia for upper abdominal surgery.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Anesthetics, Inhalation ; Cardiovascular Diseases ; Hepatitis ; Humans ; Lung Diseases ; Spinal Cord ; Tuberculosis, Pulmonary ; Ventilation

Patients with advanced pulmonary tuberculosis suffer from chronic obstrutive pulmonary disease, making them poor risks for anesthesia. Also, general anesthesia for patients with active hepatitis or arteriosclerotic cardiovascular disease complicates the intraoperative and postoperative course. Inhalation anesthetics, along with the assissted ventilation used in general anesthesia, further complicate the intraoperative and postoperative course. Although regional anesthetic techiques have been used extensively for pelvic and limbic surgery to avoid the complications of general anesthesia, thoracic epidural anesthesia has not been common for upper abdominal surgery because of the fear of damage to the spinal cord. But compared with the lumbar.approach, the danger of accidental damage to the spinal cord has been exaggerated. Thoracic epidural anesthesia has been employed in a number of cases of upper abdominal surgery at Y.U.W.M.C wish remarkable success. We have in describe the use of thoracic epidural anesthesia for upper abdominal surgery.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Anesthetics, Inhalation ; Cardiovascular Diseases ; Hepatitis ; Humans ; Lung Diseases ; Spinal Cord ; Tuberculosis, Pulmonary ; Ventilation

Changes in serum potassium concentration following administration of succinylcholine (1.5mg/kg) were evaluated in 15 cases of donors and 20 cases of reciepients in kidney transplantation.There were no changes prior to and follwing administration of succinrlcho-line in serum potassium levels in the donors and recipients. Changes in serum potassium concentration were also eyaluated in livining-related recipients, in which the donor kidney was flushed with cold Ringer's lactate solution with the amount of about 750 ml. The mean vascular clamping time was 39.5+/-71.8 minutes. There were no difference between before clamping and following release of the vascular clamp in spite of the interruption of blood flow to the clamped leg. We suggest that succinylcholine in this dose is not contraindicated in patients with chronic renal failure and in the living related recepients who received dornor kidnie which was flushed with Ringer's lactate solution and there is no risk of potassium elevation after relesaing vascular clamp.
Constriction ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Lactic Acid ; Leg ; Potassium* ; Succinylcholine* ; Tissue Donors

The desire to better recognized such malignancies, which may be difficult to distinguish from inflammation or trauma, has accelerated the development of endoscopy with new optical technologies. Narrow-band imaging is a novel endoscopic technique that may enhance the accuracy of diagnosis using narrow-bandwidth filters in a red-green-blue sequential illumination system. Autofluorescence imaging is based on the detection of natural tissue fluorescence emitted by endogenous molecules. I-scan technology using a digital filter that modifies normal images through software functions, is the newly developed image-enhanced endoscopic technology from PENTAX. Flexible spectral imaging color enhancement enhances the visualization of mucosal structure and microcirculation by the selection of spectral transmittance with a dedicated wavelength. Confocal laser endomicroscopy images were collected with an argon beam with a scanning depth of 0 (epithelium) to 250 microm (lamina propria) and analyzed using the reflected light.
Argon ; Endoscopy ; Enzyme Multiplied Immunoassay Technique ; Fluorescence ; Inflammation ; Light ; Lighting ; Microcirculation ; Optical Imaging

Emergency hysterectomy has been accepted as a life-saving procedure for patients with bleeding at the time of cesarean section. This study analyzed the patients of emergency obstetric hysterectomy performed at CHA hospital for 4 years from January 1990 to December 1993. During the 4 year study there were 32,090 deliveries, 8021 of which were cesarean sections. 42 emergency obstetric hysterectomies were performed; there were 36 cases after normal spontaneous vaginal delivery and 6 cases after cesarean section. The results of this study were as follows ; 1) 42 patients were evaluated, ranging in age from 23 years to 41 years and averaging 32 years. 2) The most common indications for cesarean hysterectomy were atony (35.7%) and placenta previa and accreta (35.7%). 3) Five patients received continuous epidural anesthesia and three of them with initially satisfactory epidural anesthesia required intraoperative induction of general anesthesia. Other patients received general anesthesia. Mean anesthetic time was 2 hours and 37 minutes. 4) Mean units transfused during operation were 11.1 pints. Mean preoperative hemoglobin and hematocrit were 10.3 g/dl and 31.9%. Mean postoperative hemoglobin and hematocrit were 10.5 g/dl and 33.1%. 5) Complications were found in 6 cases, including bladder injury, bleeding at the vaginal cuff area, pulmonary edema and paralytic ileus. Average hospital stay was 8.8 days.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Cesarean Section ; Emergencies* ; Female ; Hematocrit ; Hemorrhage ; Humans ; Hysterectomy* ; Intestinal Pseudo-Obstruction ; Length of Stay ; Placenta Previa ; Pregnancy ; Pulmonary Edema ; Urinary Bladder

PURPOSE: To determine the effect of intraluminal brachytherapy on stent patency and survival after metallic stent placement in patients with primary bile duct carcinoma. MATERIALS AND METHODS: Twenty-seven patients with primary bile duct carcinoma underwent metallic stent placement; in 16 of the 27 intraluminal brachytherapy with an iridium-192 source (dose, 25 Gy) was the performed. Obstruction was due to either hilar (n=14) or non-hilar involvement (n=13). For statistical comparison of patients who underwent/did not undergo intraluminal brachytherapy, stent patency and survival were calculated using the Kaplan-Meier method and an independent t test. RESULTS: The mean durations of stent patency and survival were 9.1 and 10.0 months respectively in patients who underwent intraluminal brachytherapy, and 4.2 and 5.0 months in those who did not undergo this procedure (p<0.05). The mean durations of stent patency and survival among the 22 patients who died were 7.6 (range, 0.8 -16.1) and 8.3 (range, 0.8-17.3) months, respectively, in the eleven patients who underwent intraluminal brachytherapy, and 4.2 (range, 0.9-8.0) and 5.0 (range, 0.9-8.4) months in those whom the procedure was not performed (p<0.05). CONCLUSION: Intraluminal brachytherapy after stent placement extended both stent patency and survival in patients with primary bile duct carcinoma.
Bile Ducts* ; Bile* ; Brachytherapy* ; Humans ; Stents*

BACKGROUND/AIMS: Common bile duct stones are associated with the extent of dilation of the common bile duct as well as its angulation. Multidetector computed tomography (MD CT) has a good resolution for the definition of the anatomical features of the common bile duct. METHODS: The multiplanar reformation images of 398 patients that underwent multidetector CT for the diagnosis of disorders not related to the bile duct were examined. The diameter and angulation were categorized by gender and age. RESULTS: The average diameter and angulation of the common bile duct was 6.7 mm and 132.6degrees. There was a statistically significant correlation between age and the common bile duct diameter. The Pearson correlation analysis for age and diameter resulted in a value of 0.415 (p<0.001). And the common bile duct (CBD) diameter in people older than 51 years of age showed a significant difference compared to the subjects younger than 50 years of age (p<0.01). However, the degree of angulation has no correlation with age. CONCLUSIONS: We suggest that CBD diameters in patients more than 50 years of age can be more than 7 mm and be within normal limits.
Bile Ducts ; Common Bile Duct ; Humans ; Multidetector Computed Tomography

Leiomyosarcoma of the penis is a rare malignant tumor that arises from smooth muscle elements within the structure of the penis with less than 30 reported cases in the literatures. We report a case of leiomyosarcoma of penis with a review of the literatures.
Leiomyosarcoma* ; Male ; Muscle, Smooth ; Penis*

A 60-year-old man with biliary ascariasis accompanied by choledocholithiasis and biliary pancreatitis, is herein reported. His chief complaints were epigastric pain, nausea, and vomiting. He had a past history of eating raw fish and vegetables. An endoscopic retrograde cholangiopancreatography (ERCP) revealed multiple CBD stones and a live ascaris adult worm in the common bile duct which was not detected by an abdominal CT. The management of biliary obstruction caused by Ascaris lumbricoides has usually been surgical, but this report describes the endoscopic removal of the ascaris located in the common bile duct.
Adult ; Ascariasis* ; Ascaris ; Ascaris lumbricoides ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis* ; Common Bile Duct ; Eating ; Humans ; Middle Aged ; Nausea ; Pancreatitis* ; Tomography, X-Ray Computed ; Vegetables ; Vomiting

BACKGROUND/AIMS: The aim of this study was to determine whether the margin of early to be detected gastric cancer (EGC) and gastric adenoma is easier to be detected with autofluorescence imaging (AFI) than with white-light endoscopy (WLE). METHODS: A total of 102 lesions (48 EGCs and 54 gastric adenomas) found in 98 patients were removed endoscopically or surgically. The measured length of each pathology specimen was compared with the lengths estimated using WLE, AFI, and chromoendoscopy. RESULTS: The lesions could be discriminated from surrounding mucosa by AFI in 86 cases (84.3%). The detection rates were similar for elevated lesions (85.1%) and flat/depressed lesions (82.9%, p=0.770). In terms of histology, the detection rate was slightly higher for adenomas (90.7%) than for cancer (77.1%, p=0.058). The estimated length was shorter than the pathologic length in 31.4% of cases when using WLE and 22.1% of cases when using AFI (p=0.168). The resection range was larger for EMR than for AFI in 24 of 80 cases (30.0%). CONCLUSIONS: WLE tends to underestimate the size of EGCs, whereas AFI tends to overestimate their size.
Adenoma ; Endoscopy ; Fluorescence ; Humans ; Mucous Membrane ; Optical Imaging ; Prospective Studies ; Stomach Neoplasms