BACKGROUND: It has been a standard practice in many institutions to combine light general anesthesia with epidural block for abdominal and pelvic surgery. We attempted to prove the effectiveness of prehydration and to find an suitable epidural local anesthetic dose in terms of hemodynamic stability for upper abdominal surgery. METHODS: For preliminary studies, 11 patients scheduled for elective upper abdominal surgery had received general anesthesia immediately after epidural anesthesia. After epidural injection of 10~16 mL of 2% plain lidocaine into the T9~10 intervertebral space, the changes in blood pressure were observed. Thirty-two patients scheduled for elective upper abdominal surgery were divided into two groups. In group A (study group), after prehydration with Hartmann solution (10 mL/kg), 5~7 mL of 2% plain lidocaine was injected into T8~9 or T9~10 intervertebral space and general anesthesia was then induced. Group B (control group) received general anesthesia only. RESULTS: There were no significant differences in hemodynamics between the epidural with general anesthesia and the control group except SVR (systemic vascular resistance). SVR in group A increased in contrast to the group B in which it remained unchanged. CONCLUSIONS: The combined epidural and general anesthesia, using prehydration and 0.5~1 mL/segment of 2% plain lidocaine at the T8~9 or T9~10 intervertebral space was safe without significant hemodynamic changes.
Anesthesia, Epidural ; Anesthesia, General* ; Blood Pressure ; Hemodynamics* ; Humans ; Injections, Epidural ; Lidocaine

No abstract available.
Atrioventricular Block* ; Long QT Syndrome*

The Taylor's approach is a special paramedian approach to enter the L5-S1 interspace. The L5-S1 interspace is the largest in vertebral column. This approach is particularly useful when the interspace has been narrowed by pathologic bone destruction such as rheumatoid arthritis or osteoarthritis. Surgery in geriatric patients is associated with a markedly higher incidence of perioperative complication or mortality rate. Optimal anesthetic management of geriatric patients depends on understanding of the normal anatomy and physiologic changes in response to drug in aging. We studied of 3-geriatric patients with Taylor's approach. These patients had problems with respiratory dysfunction and anatomic constraints, which make other approaches unfeasible.
Aging ; Arthritis, Rheumatoid ; Humans ; Incidence ; Mortality ; Osteoarthritis ; Spine

PURPOSE: To evaluate the outcome of ductal carcinoma in situ (DCIS) patients who underwent surgery followed by radiation therapy (RT). MATERIALS AND METHODS: We retrospectively reviewed 106 DCIS patients who underwent surgery followed by postoperative RT between 1994 and 2006. Ninety-four patients underwent breast-conserving surgery, and mastectomy was performed in 12 patients due to extensive DCIS. Postoperative RT was delivered to whole breast with 50.4 Gy/28 fx. Tumor bed boost was offered to 7 patients (6.6%). Patients with hormonal receptor-positive tumors were treated with hormonal therapy. RESULTS: The median follow-up duration was 83.4 months (range, 33.4 to 191.5 months) and the median age was 47.8 years. Ten patients (9.4%) had resection margin <1 mm and high-grade and estrogen receptor-negative tumors were observed in 39 (36.8%) and 20 (18.9%) patients, respectively. The 7-year ipsilateral breast tumor recurrence (IBTR)-free survival rate was 95.3%. Resection margin (<1 or > or =1 mm) was the significant prognostic factor for IBTR in univariate and multivariate analyses (p < 0.001 and p = 0.016, respectively). CONCLUSION: Postoperative RT for DCIS can achieve favorable treatment outcome. Resection margin was the important prognostic factor for IBTR in the DCIS patients who underwent postoperative RT.
Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Estrogens ; Follow-Up Studies ; Humans ; Mastectomy ; Mastectomy, Segmental ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Outcome*

No abstract available.
Animals ; Horns* ; Kidney*

No abstract available.
Malignant Atrophic Papulosis*

BACKGROUND: To analyze hemodynamic changes during single catheter technique of hepatic venous isolation and extracorporeal charcoal hemoperfusion for malignant liver tumor. METHODS: Drugs for chemotherapy were infused to the liver through hepatic artery. With 4-lumen- 2-balloon (4L-2B) catheter, hepatic venous blood was circulated to the extracorporeal charcoal system. During extracorporeal charcoal system circulation, drugs were eliminated and the blood was reinfused to supra-hepatic vein-IVC. At the same time, IVC was clamped. Systemic vascular resistance index (SVRI), cardiac index (CI), stroke volume index (SVI), mean arterial pressure (MAP), heart rate (HR) and arterial blood gas were measured after 4L-2B catheter insertion (T1), during test circulation (T2), after 20min chemotherapy (T3) and after 10min reperfusion (T4). RESULTS: MAP was decreased at T3 compared to T1 and increased at T4 compared to T3. CI was decreased at T3 and increased at T4 compared to T1. SVRI was decreased at T4 compared to T1. HR was increased at T2 and T3 compared to T1. SVI was decreased at T2 and T3 compared to T1. CONCLUSIONS: During clamping of IVC, MAP is decreased by decreased SVI in spite of increased HR. After IVC is released and the stagnated blood of lower extremity is recirculated, the MAP is returned to the value of after catheter insertion by increased SVI in spite of decreased SVRI.
Arterial Pressure ; Blood Pressure ; Carcinoma, Hepatocellular* ; Catheters ; Charcoal ; Constriction ; Drug Therapy ; Heart Rate ; Hemodynamics* ; Hemoperfusion* ; Hepatic Artery ; Liver* ; Lower Extremity ; Reperfusion ; Stroke Volume ; Vascular Resistance

The challenges of successful nasal reconstruction, which are related to the anatomical complexity of the region, have been extensively studied. Revisional operations are often required to achieve proper nasal reconstruction, with results resembling the premorbid nasal status. This is necessary to ensure the quality of life of skin cancer patients. Fundamental nasal reconstruction requires both proper soft tissue coverage and proper function. However, earlier studies in the field primarily focused on the functional aspect of nose reconstruction, although the cosmetic aspect is also an important factor to consider. In response to this need, many recent studies on nose reconstruction have proposed various refinement strategies to improve aesthetic satisfaction. Most plastic surgeons accept the nasal aesthetic subunit principle as a standard for nasal reconstruction. This review outlines the commonly used surgical refinement options and management strategies for postoperative complications based on the subunit principle. In patients with nasal defects, a proper technical strategy might help minimize revision operations and optimize the long-term results.

Purpose: To analyze prognostic factors for morphological and functional recovery after vitrectomy in patients with idiopathic epiretinal membrane (ERM). Methods: We conducted a retrospective analysis of patients with ERM who underwent vitrectomy. Postoperative outcomes were evaluated in terms of functional and morphological changes, assessing best-corrected visual acuity (BCVA) and central macular thickness (CMT) after 6 months. Logistic regression was used to identify factors influencing postoperative outcomes. Results: This study included 77 patients (35.1% men). Thirty-eight patients underwent combined vitrectomy and cataract surgery. Logistic regression revealed that better preoperative BCVA was associated with improved postoperative BCVA (p = 0.002). Among the 38 eyes that underwent combined surgery, longer preoperative axial length was linked to better visual outcomes in univariate analysis (p = 0.043), although the association was not statistically significant in multivariate analysis (p = 0.064). Younger age and thinner preoperative CMT were associated with better morphological outcomes (p = 0.034 and p = 0.001, respectively). Conclusions Preoperative BCVA, age, preoperative CMT, and axial length are predictive factors for functional and morphological outcomes after vitrectomy in patients with ERM. These findings may facilitate treatment planning and prognosis prediction before surgery.

Purpose: To analyze prognostic factors for morphological and functional recovery after vitrectomy in patients with idiopathic epiretinal membrane (ERM). Methods: We conducted a retrospective analysis of patients with ERM who underwent vitrectomy. Postoperative outcomes were evaluated in terms of functional and morphological changes, assessing best-corrected visual acuity (BCVA) and central macular thickness (CMT) after 6 months. Logistic regression was used to identify factors influencing postoperative outcomes. Results: This study included 77 patients (35.1% men). Thirty-eight patients underwent combined vitrectomy and cataract surgery. Logistic regression revealed that better preoperative BCVA was associated with improved postoperative BCVA (p = 0.002). Among the 38 eyes that underwent combined surgery, longer preoperative axial length was linked to better visual outcomes in univariate analysis (p = 0.043), although the association was not statistically significant in multivariate analysis (p = 0.064). Younger age and thinner preoperative CMT were associated with better morphological outcomes (p = 0.034 and p = 0.001, respectively). Conclusions Preoperative BCVA, age, preoperative CMT, and axial length are predictive factors for functional and morphological outcomes after vitrectomy in patients with ERM. These findings may facilitate treatment planning and prognosis prediction before surgery.