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BACKGROUND: Propofol and alfentanil are frequently combined to provide total intravenous anesthesia (TIVA). The goals of this study were to determine the target plasma concentration (predicted plasma concentration) of propofol required to provide satisfactory anesthesia in the presence of nitrous oxide over a range of alfentanil infusions for analgesia and to determine the dosing rates required to achieve adequate anesthesia. METHODS: Sixty patients undergoing plastic surgery were anesthetized with 50% nitrous oxide, alfentanil (0 [A0 group] or 5ng/kg loading followed by 0.12ng/kg/min [A5 group] or 10ng/kg loading followed by 0.25ng/kg/min [A10 group] or 20ng/kg loading followed by 0.5ng/kg/min [A20 group]) and propofol using a target-controlled infusion (TCI). The mean target concentration and infusion rate of propofol, and induction and recovery time according to changes of the alfentanil regimen were checked. RESULTS: Induction and recovery time were prolonged in the A0 group more than other groups, and recovery time was shortened in the A10 group more than the other three groups (P < 0.05). The infusion rate and mean target concentration of propofol had significant impact among the groups (P < 0.05). Side effects did not differ among the groups. CONCLUSIONS: The optimal target plasma propofol concentrations and infusion rates of alfentanil, both with satisfactory intraoperative anesthetic conditions and speed of recovery, are 3.51, 3.02, 2.35ng/ml and 0.12, 0.25, 0.5ng/kg/min with 5, 10, 20ng/kg loading in plastic surgery patients. We recommand 0.25ng/kg infusion with 10ng/kg loading of alfentanil combined with 3.02ng/ml of target plasma concentration of propofol as the best combination dosage to shorten recovery time.
Alfentanil* ; Analgesia ; Anesthesia ; Anesthesia, Intravenous ; Humans ; Nitrous Oxide ; Plasma ; Propofol* ; Surgery, Plastic*

BACKGROUND: Ketamine is a noncompetitive antagonist that blocKs the ion channel coupled to the N-methyl-D-aspartate receptor. This class of drugs may be useful for treatment of acute postoperative pain due to prevention of central sensitization of nocieceptors. We examined the effect of adding Ketamine to a patient-controlled epidural analgesia (PCEA) regimen. METHODS: Sixty parturients undergoing a Cesarean section received lumbar epidural anesthesia using 0.75% ropivacaine with 50ng of fentanyl and a PCEA using 0.15% ropivacaine and 50ng/mL of butorphanol with the addition of Ketamine 50 mg (K50, n = 20), 100 mg (K100, n = 20), or without (control, n = 20). The PCEA device was programmed to deliver 4 mL of a regimen (total 300 mL of solution with 0.15% ropivacaine plus 50ng/mL of butorphanol) with a 10 minute locKout interval. Visual analogue pain score, side effects and PCEA drug consumption were checKed during 48 hours postoperatively. RESULTS: PCEA drug consumption and incidence of nausea and vomiting were decreased by 25% and 25% (K50) and 35% and 29% (K100) compared with the control group. The severity of sedation was increased in the K50, and K100 groups more than the control group (P < 0.05). There were no differences in visual analogue pain score and other side effects among the groups. CONCLUSIONS: We conclude that adding low-dose Ketamine in a PCEA regimen using ropivacaine and butorphanol decreases the consumption of the PCEA drug and the incidence of nausea and vomiting and increases the severity of sedation.
Analgesia, Epidural ; Anesthesia, Epidural ; Butorphanol ; Central Nervous System Sensitization ; Cesarean Section ; Female ; Fentanyl ; Incidence ; Ion Channels ; Ketamine* ; N-Methylaspartate ; Nausea ; Pain, Postoperative ; Pregnancy ; Vomiting

We measured serum levels of CA-125 and Tissue polypeptide antigen(TPA) in 135 patients with pelvic tumors(129 benign pelvic tumors and 6 malignant ovarian tumors) preoperatively. Each tumor marker was measured by immunoradiometric assay. Serum CA-125 levels of 35.0U/ml, 65.0U/ml and TPA levels of 80.0U/ml, 100.0U/ml were determined as cut-off values. The results were evaluated by each tumor marker and two tumor markers coincidently. The results were as follows : (continue)
Humans ; Immunoradiometric Assay ; Biomarkers, Tumor

PURPOSE: To evaluate the radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies. MATERIALS AND METHODS: Thirteen patients with fourteen cases of carotid-vertebrobasilar anastomosis collectedfrom January 1992 to December 1997 were reviewed. Clinical diagnosis refered for cerebral angiography werecerebral infarction(n=3), intracranial hemorrhage(n=2), subarachnoid hemorrhage(n=1), brain tumor(n=3),arteriovenous malformation(n=3) and trigeminal neuralgia(n=1). Cerebral angiograms and clinical symptoms wereretrospectively analyzed. RESULTS: The fourteen carotid-vertebrobasilar anastomsis consisted of eleven cases ofpersistent trigeminal artery and three cases of type I proatantal intersegmental artery. Persistent trigeminalarteries were associated with anterior communicating artery aneurysm(n=1), posterior fossa arteriovenousmalformation(n=2) and persistent trigeminal artery variant(n=5). Type I proatantal intersegmental arteries wereassociated with hypoplastic vertebral arteries(n=2) : only proximal segment in one, and proximal and distalsegments in one case. Only one patient had clinical symptom related to the carotid-vertebrobasilar anastomosiswhich was trigeminal neuralgia. CONCLUSION: Knowledge of the anatomical and radiologic findings ofcarotid-vertebrobasilar anastomosis and associated anomalies will aid in the accurate diagnosis of neurovasculardisease and prevent possible complications during surgical and interventional procedures.
Arteries ; Brain ; Cerebral Angiography ; Diagnosis ; Humans ; Trigeminal Neuralgia

Ankylosis ; Arthroplasty ; Humans ; Jaw ; Joint Diseases ; Mandibular Condyle ; Prostheses and Implants ; Temporomandibular Joint Disorders ; Temporomandibular Joint

Parathyroid carcinoma is very rare malignant neoplasm, accounting for less than 0.005% of all cancers. Most parathyroid carcinoma is a functioning tumor that causes hyperparathyroidism, leading to hypercalcemia. We report a parathyroid carcinoma case that was suspicious for spontaneous infarction of cancer, leading to resolution of hypercalcemia. A 29-year-old male visited our hospital presenting with right neck swelling and pain. He has been experiencing frequent urolithiasis for four years but laboratory tests showed normal serum calcium level. Right vocal cord paresis was identified with laryngoscopy. Ultrasonography revealed a 3.7 × 3.5 cm mass in the right thyroid containing a focal cystic portion. Computed tomography confirmed the presence of a low-density right thyroid mass. Right thyroid lobectomy was performed and pathological evaluation revealed parathyroid carcinoma with central necrosis. We report this very rare case with a literature review.

PURPOSE: To assess regional cerebral blood volume and perfusion rate by MR imaging. MATERIALS AND METHODS:Eight normal volunteers and one patient underwent MR imaging after bolus injection of a double dose ofgadoinium(0.2mMol/kg). Gradient-echo EPI pulse sequencing was used, with TR/TE 1500/40msec, flip angle 90o, matrixsize 256X128. One hundred sequential images at the same level were obtained. The time-signal intensity curve wasplotted and converted to a time-concentration ( R2) curve. Relative cerebral blood volume was determined, withintegration of time-concentration curve pixel by pixel. Perfusion rate was determined by calculating maximal slopeof the R2 curve and the time taken to attain this. RESULTS: On volume maps, clear differentiation of gray matter,white matter and major vessels was established. The mean gray and white matter ratio of blood volume was2.78+/-0.43. Slope and volume maps were similar, but in one patient perfusion was apparently greater on the ratemap than on the volume map. CONCLUSION: Cerebral blood volvme and slope map images reflect changes in cerebralhemodynamics. It is thought that these findings can be clinically applied to the determination of vascularity inbrain tumors and acute cerebral ischemia
Blood Volume* ; Brain Ischemia ; Healthy Volunteers ; Humans ; Magnetic Resonance Imaging ; Perfusion*

An ectopic parathyroid gland is a major cause of persistent and recurrent hyperparathyroidism. Surgical success depends on accurate preoperative localization of the parathyroid adenoma. We herein report the case of a 52-year-old male patient who suffered from primary hyperparathyroidism for several years. He initially presented with urinary frequency, hypercalcemia, and a ureter stone. Ultrasonography and a 99mTc-sestamibi scan were performed, but failed to localize the parathyroid lesion. Four years later, the patient revisited our hospital, complaining of general weakness, headache, dyspepsia, and recurrent urinary symptoms secondary to persistent primary hyperparathyroidism. In addition, renal function was decreased and severe osteoporosis was found. We performed a 99mTc-sestamibi scan with single photon emission computed tomography (99mTc-MIBI SPECT) and contrast-enhanced neck CT, and detected an ectopic parathyroid adenoma in the upper anterior mediastinum. In conclusion, the combination of both 99mTc-MIBI SPECT and neck CT could permit better preoperative parathyroid localization, especially for mediastinal adenomas.
Adenoma ; Dyspepsia ; Headache ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Male ; Mediastinum ; Middle Aged ; Neck ; Osteoporosis ; Parathyroid Glands ; Parathyroid Neoplasms ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon ; Ureter

Squamous cell carcinoma (SCC) is the most common malignant tumor in the oral cavity, and it accounts for about 90% of all oral cancers. Several risk factors for oral SCC have been identified; however, SCC associated with odontogenic keratocysts have rarely been reported. The present study describes the case of a 36-year-old man with SCC of the right ramus of the mandible, which was initially diagnosed as a benign odontogenic cyst. He underwent enucleation at another hospital followed by segmental mandibulectomy and fibular free flap reconstruction at our institution. In this case, we introduce a patient with oral cancer associated with odontogenic cyst on the mandible and report a satisfactory outcome with wide resection and immediate free flap reconstruction.
Adult ; Carcinoma, Squamous Cell* ; Free Tissue Flaps ; Humans ; Mandible ; Mandibular Osteotomy ; Models, Anatomic ; Mouth ; Mouth Neoplasms ; Odontogenic Cysts* ; Risk Factors