The absence of a gallbladder is a very rare anomaly. While it is usually asymptomatic, it can cause biliary colic symptoms. For these reasons, gallbladder agenesis can be misdiagnosed as a hepatobiliary disease and is diagnosed correctly after surgery. This condition may also be detected through an autopsy for other causative diseases. Abdominal ultrasonography is used as a diagnostic method to detect gallbladder agenesis. Hepatobiliary scintigraphy, magnetic resonance cholangiopancreatography, and endoscopic cholangiopancreatography are also used to make a more accurate diagnosis. In the emergency room, however, gallbladder agenesis can still be misdiagnosed as acute or chronic cholecystitis, leading to the detection of gallbladder agenesis in the operating room. Although some cases of gallbladder agenesis detected in adults during surgery have been reported in Korea, there are no reports of gallbladder agenesis in pediatric patients to date. This paper reports a case of gallbladder agenesis in a symptomatic child that was detected incidentally by a radiographic examination.
Adult ; Autopsy ; Child ; Cholangiopancreatography, Magnetic Resonance ; Cholecystitis ; Colic ; Diagnosis ; Emergency Service, Hospital ; Gallbladder ; Humans ; Korea ; Methods ; Operating Rooms ; Pediatrics ; Radionuclide Imaging ; Ultrasonography

No abstract available.
Headache* ; Humans

Caudal epidural anesthesia has become widely accepted as a means of providing postoperative pain relief and mtraoperative supplementation to general anesthesia for children. Caudal anesthesia was given to 63 infants and children under 15 years of age, who received lower abdominal surgery. After thiopental sodium 4-5 mg/kg IV and 1-2Vo1% halothane inhalation, caudal block was performed in the lateral position. Halothane was stopped immediately after caudal block and only 50% NO in oxygen was inhaled through the mask during operation. The patients were randomly divided into four groups: Group 1; 0.33% bupivacaine 0.7 ml/kg, Group 11; 0.33% bupivacaine 1.0 ml/kg, Group III; fentanyl 1 ug/kg combined with 0.33% bupivacaine 1.0 ml/kg, Group IV; 1.5% lidocaine 1.0 ml/kg. The time of onset, duration of analgesia, side effects during and after operation, intial voiding time, and use of analgesics in the ward were observed. The results were as follows: 1) Caudal block was successful at the 1st attempt in most cases. 2) During operation, supplementation of other inhalational anesthesies were need. 3) In all groups, surgical anesthesia could be obtained within 10 minutes. 4) Intraoperative adverse effects were not detected except for minimal movements on skin incision and spermatic cord traction in 12 cases and vomiting in 2 cases. 5) Postoperative analgetic effects were good in all groups, especially in fentanyl group. 6) In most cases, patients ean void within 6 hours without urinary catheterization. 7) Postoperative analgesics were not needed and patients parent's were highly satisfied with caudal anesthesia in all cases. From the above results, it was suggested that caudal anesthesia with 0.33% bupivacaine or 1.5% lidocaine without potent inhalational anesthetics was satisfactory for lawer abdominal surgery and l ug/kg of fentanyl had some benefits in postoperative analgesia in children.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics ; Bupivacaine ; Child ; Fentanyl ; Halothane ; Humans ; Infant ; Inhalation ; Lidocaine ; Masks ; Oxygen ; Pain, Postoperative ; Skin ; Spermatic Cord ; Thiopental ; Traction ; Urinary Catheterization ; Urinary Catheters ; Vomiting

BACKGROUND: Previous studies have suggested synergistic analgesic drug interactions between NSAIDs and opioids in neuropathic and inflammatory pain models. The aim of this study was to investigate the analgesic drug interaction between intraperitoneal (IP) ketorolac and morphine in radiant thermal stimulation rat. METHODS: Initially, we assessed the withdrawal latency time of the hindpaw to radiant thermal stimulation every 15 min for 1 hour and every 30 min for next 1 hour after IP normal saline 5 ml (control group). The latency time was changed into percent maximal possible effect (%MPE). Next, IP dose response curves were established for the %MPE of morphine (0.3, 1, 3, 10 mg/kg) and ketorolac (3, 10, 30 mg/kg) to obtain the ED50 for each agent. And we confirmed that the IP morphine effect was induced by opioid receptor through IP morphine followed by IP naloxone. At last, we injected three doses of IP ketorolac (3, 10, 30 mg/kg) mixed with one dose of morphine (2 mg/kg) for fixed dose analysis. RESULTS: IP morphine delayed the paw withdrawal latency time dose dependently, but not ketorolac. ED50 of IP morphine was 2.1 mg/kg. And the IP morphine effect was reversed to control level by IP naloxone. IP ketorolac + morphine combination showed no further additional effects on paw withdrawal latency time over morphine only group. CONCLUSIONS: IP ketorolac did not produce antinociceptive effect during radiant thermal stimulation. There was neither additional nor synergistic analgesic interaction between IP morphine and ketorolac in thermal stimulation rat.
Analgesics, Opioid ; Animals ; Anti-Inflammatory Agents, Non-Steroidal ; Drug Interactions ; Ketorolac* ; Morphine* ; Naloxone ; Rats* ; Receptors, Opioid

BACKGROUND: There is a strong evidence that administration of anti-tumor drugs triggers apoptotic death of target cells. Therefore, quantitation of the 0early apoptotic cells could provide a very useful information for clinicians planning anti-tumor strategies. Therefore, we measured the amount of early apoptotic cells using annexin-FITC/PI dual fuorescence method by which early changes of apoptotic cell membrane could be detected. We also measured DNA content of apoptotic cells by PI single stain and performed DNA fragment assay simultaneously. METHODS: HL-60 cell line were cultured under 100, 200 ng/mL adriamycin for 12, 24, 36, 48 hours. Quantitation of the early apoptotic cells was done using flow cytometry with annexin-FITC and Propidium iodide (PI) dual fluorescence stain. And DNA content of the HL-60 cells was measured using PI single stain after fixing the cells. DNA ladder assay was also performed by agarose gel electrophoresis. RESULTS: The early apoptotic cells were 40.5% at adriamycin 100 ng/mL, after 24 hours culture and the secondary necrotic cells were 94.7% at adriamycin 200 ng/mL after 48 hours culture. There was a good correlation between annexin-PI stain and DNA content analysis. We could find DNA fragmentation on agarose gel electrophoresis. CONCLUSION: Quantitation of the early apoptotic cells using flow cytometry with annexin-PI dual fluorochrome stain and the DNA content analysis with PI single stain could be a good parameter for anti-apoptotic strategies.
Cell Membrane ; DNA ; DNA Fragmentation ; Doxorubicin ; Electrophoresis, Agar Gel ; Flow Cytometry* ; Fluorescence ; HL-60 Cells ; Humans ; Propidium

This study is to compare the accuracy of evaluation regarding the volume of the prostate, which three-dimensional volume rendering was produced the shape of protrusion, by measuring two kinds of craniocaudal length from the top of the protrusion and from the exclusion of the protrusion as the starting points. For the imaginary protrusion prostate models, total of 10 models were roughly made by using devils-tongue jelly and changing each of the 10 ml of capacity from 10 ml to 100 ml. For the protrusion prostate models aimed at estimating the real volume, through 64 cannel computed tomography (CT) and 3.0 tesla magnetic resonance image (MRI) were conducted by planimetry technique from three-dimensional volume rendering. And then we performed to evaluate on significance of these volumes by wilcoxon signed rank test. Also the obtained volumes data by ellipsoid volume formula were measured the volume of protrusion prostate models two times with each method using the two kinds of craniocaudal length from top of the protrusion and from exclusion of the protrusion as the starting points. Finally, the significance of differences using wilcoxon signed rank test was evaluated between the real volume by planimetry technique and the measured volume by ellipsoid volume formula from three-dimensional volume rendering. The average of the protrusion length on the models was 0.90+/-0.18 mm in CT and was 0.75+/-0.11 mm in MRI. There were not statistically significant difference between MRI and CT from the volume of protrusion prostate models (p=0.414). In MRI (p=0.139) and CT (p=0.057), there were not statistically significant difference between the real volume by planimetry technique and the measured volume by ellipsoid volume from exclusion of the protrusion as the starting points. While, there were statistically significant difference between the real volume by planimetry technique and the measured volume by ellipsoid volume from top of the protrusion as the starting points in MRI (p=0.005) and CT (p=0.005). For the accurate measurement of the protrusion prostate models, the craniocaudal length of the prostate should be measured from the exclusion of the protrusion as the starting points.
Magnetic Resonance Spectroscopy ; Prostate

Mishaps related to valve malfunction in a self-inflating bag-valve unit can lead to fatal complications. We report a case of severe hypotension that resulted from the locking of the Laerdal valve in the inspiratory position during transport in the operating room. A 36 year old man had undergone an off-pump coronary artery bypass graft. Immediately before leaving the operating room, severe hypotension developed abruptly. But an EKG showed only a reduction of heart rate. We started closed cardiac massage with an intravenous bolus injection of epinephrine 0.5 microgram and reconnected the anesthesia breathing circuit. The patient was manually ventilated using the anesthesia reservoir bag. Vital signs immediately recovered. At that time, the patient's abdomen was distended and we suspected an expiratory abnormality. The self-inflating bag-valve unit was tested with an anesthesia reservoir bag as a test lung. Expiration did not occur. Another self-inflating bag-valve unit was substituted and normal ventilation was restored. It is essential that before use, a self-inflating bag-valve unit should be tested for proper function during both expiration and inspiration using a test lung such as, an anesthesia reservoir bag.
Abdomen ; Adult ; Anesthesia ; Coronary Artery Bypass, Off-Pump ; Electrocardiography ; Epinephrine ; Heart Massage ; Heart Rate ; Humans ; Hypotension* ; Lung ; Operating Rooms ; Respiration ; Resuscitation ; Transplants ; Ventilation ; Vital Signs

To evaluate the metabolic changes in normal adult brains due to alterations SENSE and NEX (number of excitation) by multi voxel MR Spectroscopy at 3.0 Tesla. The study group was composed of normal volunteers (5 men and 8 women) with a mean (+/- standard deviation) age of 41 (+/-11.65). Their ages ranged from 28 to 61 years. MR Spectroscopy was performed with a 3.0T Achieva Release Version 2.0 (Philips Medical System-Netherlands). The 8 channel head coil was employed for MRS acquisition. The 13 volunteers underwent multi voxel spectroscopy (MVS) and single voxel spectroscopy (SVS) on the thalamus area with normally gray matter. Spectral parameters were as follows: 15 mm of thickness; 230 mm of FOV (field of view); 2000 msecs of repetition time (TR); 288 msecs of echo time (TE); 110x110 mm of VOI (view of interest); 15x15x15 mm of voxel size. Multi voxel spectral parameters were made using specially in alteration of SENSE factor (1~3) and 1~2 of NEX. All MRS data were processed by the jMRUI 3.0 Version. There was no significant difference in NAA/Cr and Cho/Cr ratio between MVS and SVS likewise the previous results by Ross and coworkers in 1994. In addition, despite the alterations of SENSE factor and NEX in MVS, the metabolite ratios were not changed (F-value : 1.37, D.F : 3, P-value : 0.262). However, line-width of NAA peak in MVS was 3 times bigger than that in SVS. In the present study, we demonstrated that the alterations of SENSE factor and NEX were not critically affective to the result of metabolic ratios in the normal brain tissue.
Adult ; Brain ; Head ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Spectrum Analysis ; Thalamus

OBJECT: To determine whether to use surgical or medical therapy in treatment of infectious intracranial aneurysms, we reviewed two recent cases of infectious intracranial aneurysms and others known previous reports of aforementioned cases. Hence, we attempted to compare the validity and effectiveness of surgical and medical treatment. METHOD: Recently, we treated two cases of ruptured infectious intracranial aneurysms. In former case, the aneurysm was located distal to the middle cerebral artery in a patient with mild mitral regurgitation of the heart. In latter case, the aneurysm was multiple with varying hemorrhage. The hemorrhage was located bilaterally and a moderate mitral regurgitation and infective endocarditis were accompanied in this patient. RESULT: Due to the large size of the intracranial hematoma, stable medical condition, and easy resectability, we treated the former patient surgically. And, because of successive hemorrhage by multiple aneurysmal rupture, and the risk of heart failure, we treated the latter patient medically with serial follow-up angiography. Both patients are at present in good health. CONCLUSION: Because of the variability in associated factors, such as the patient's health, the number of lesions, location, anatomy of the aneurysms and the causative organism, each patient's care must be individualized and tailored to the patient's particular clinical situation.
Aneurysm ; Angiography ; Endocarditis ; Follow-Up Studies ; Heart ; Heart Failure ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Mitral Valve Insufficiency ; Rupture

BACKGROUND: Propofol and alfentanil are frequently combined for general anesthesia. However, hypotension and bradycardia are common during anesthetic induction and maintenance. The purpose of this study was to compare the response of different doses of ephedrine to investigate an optimal dose of ephedrine for attenuation of the hemodynamic changes. METHODS: Eighty patients of ASA physical status 1 or 2 were assigned to one of four groups. Each patient received normal saline (E0), ephedrine 0.15 mg/kg (E15), 0.2 mg/kg (E20), 0.25 mg/kg (E25) after assessment of baseline hemodynamic values. If hemodynamic parameters are stabilized after intubation, baseline values were assessed by average during 3 minutes. Then each dose of ephedrine was given to each patient. The changes in systolic/diastolic blood pressure (SBP/DBP), mean arterial pressure (MAP), and heart rate (HR) were measured every one minute for 10 minutes. RESULTS: The use of ephedrine was effective for attenuation of the hemodynamic changes. E15, E20, and E25 showed statistical difference in BP and HR compared with E0. There was no statistical difference between E20, E25. Moderate hypertension (SBP 160-179 or DBP 100-109) is occurred each 4, 6 cases in E20, E25. CONCLUSIONS: All group of ephedrine injection resulted in elevation of BP, but did not caused HR change. Injection of ephedrine 0.2 mg/kg or 0.25 mg/kg led to excessive blood pressure elevation. Therefore, we consider more than 0.15 mg/kg of ephedrine is not necessary to minimize hemodynamic changes during propofol-alfentanil anesthesia.
Alfentanil ; Anesthesia* ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Bradycardia ; Ephedrine* ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Hypotension ; Intubation ; Propofol