Fatal air embolism can occur during a variety of surgical procedures. We experienced a case of cardiac arrest due to venous air embolism during spinal fusion. A 63-year-old woman underwent spinal fusion for compression fracture on L1 and scolio-kyphosis. Anesthetic induction and initial intraoperative course were completely uneventful until precipitous blood pressure drop occurred, and accompanied by a significant decrease in heart rate and cardiac arrest after use of bone cement. Although more common intraoperative events were presumed and treatment initiated, venous air embolism was considered the etiology of these events when whirring noise was detected by esophageal sthetoscope and a transient decrease in end-tidal carbon dioxide tension was noted by capnometer. We performed cardiac resuscitation with external cardiac compression, various cardiotonic drugs, and removal of air through the right internal jugular venous catheter, but the result was unsuccessful.
Blood Pressure ; Carbon Dioxide ; Cardiotonic Agents ; Catheters ; Embolism, Air* ; Female ; Fractures, Compression ; Heart Arrest ; Heart Rate ; Humans ; Middle Aged ; Noise ; Resuscitation ; Spinal Fusion*

BACKGROUND: The purpose of this study was to find out the effect of hypnotics and analgesics on oxygen saturation by pulse oximetry in surgery patients under spinal anesthesia. METHODS: Sixty-five patients classified ASA physical status 1 or 2 scheduled for surgery under spinal anesthesia were studied. These patients were divided into three groups. The 22 subjects of the first group did not receive either midazolam or fentanyl. The 22 subjects of the second group received midazolam. The 21 subjects of the third group received midazolam (0.03 mg/kg) and fentanyl (1.0 microgram/ kg). Oxygen saturation was measured with a pulse oximetry. Measurements were made before spinal anesthesia, 5 minutes, and 10 minutes after starting of spinal anesthesia, 5 minutes, 10 minutes, 30 minutes, and 60 minutes after the start of the operation or intravenous injection of drugs. In addition, measurements were made on arrival in the recovery room, and 5 minutes, 10 minutes, 20 minutes, and 30 minutes after arrival in the recovery room. RESULTS: There were statistically significant differences in oxygen saturation at 5 minutes after the start of the operation or intravenous injection of drugs. The mean oxygen saturation for the first group was 98.2 +/- 1.8%, for the second group 97.9 +/- 2.6%, and for the third group 92.4 +/- 2.8%. Hypoxia cases at 5 minutes after the start of the operation or intravenous injection of a drug occurred in 4.5% of the first group, 9.1% of the second group, and 57.1% of the third group CONCLUSIONS: We concluded that oxygen saturation monitoring should be done routinely in patients receiving hypnotics and analgesics during spinal anesthesia, and oxygen should be administered to patients who develope hypoxia during spinal anesthesia.
Analgesics* ; Anesthesia, Spinal* ; Anoxia* ; Fentanyl ; Humans ; Hypnotics and Sedatives* ; Incidence* ; Injections, Intravenous ; Midazolam ; Oximetry ; Oxygen ; Recovery Room

There are substantial evidences indiacting that anesthesia and surgery produce significant suppression of immune function. It is generally recognized that immunosuppressive manifestations such as lymphopenia, granulocytosis, decreased transformation to various antigens and impaired neutrophil chemotaxis could be followed by surgical operation. anesthetic agents may also have both direct and hormone-mediated indirect effects on immune systems. Recent evidences indicate that immunosurveillance mechanisms are not only important in the management of emerging infection and malignancy, but also critical to successful elimination of microscopic residual tumor after operation. This study was done to investigate the effeets of halothane anesthesia on T-lymphocyte subpopulations in patients undergoing hysterectomy. Lymphocyte, granulocytes and T-lymphoeyte subpopulations were counted before, during and after anestesia. The results showed that the decrease in the CD4+ cells (helper/inducer T-cells) was bigger than the decrease in the CD8+ cells (suppressor/ cytotoxic T-cells). CD3+ cells (total T-cells) and CD45R+ cells were also decreased. However, these decrease turned to normal values in 5 days. The overall result of this study suggest that anesthesia with halothane may bring temporal suppressive effect on the immunologic responses.
Anesthesia* ; Anesthetics ; Chemotaxis ; Granulocytes ; Halothane* ; Humans ; Hysterectomy ; Immune System ; Lymphocyte Subsets* ; Lymphocytes* ; Lymphopenia ; Monitoring, Immunologic ; Neoplasm, Residual ; Neutrophils ; Reference Values ; T-Lymphocytes

Artificial Intelligence ; Diagnostic Imaging ; Learning

BACKGROUND: Several Studies from western institutes were done on the clinical characteristics and long-term prognosis of patients with variant angina. In these reports, 61-92% of patients had significant coronary artery disease, and survival without myocardial infarction at 1 year was approximately 70-83%. These results differ from our clinical experiences with Korean patients with variant angina;however, no detailed study has been reported in Korea. The purpose of this study was to describe the clinical characteristics and long-term follow-up data of our Korean patients with variant angina. METHODS: Two hundred four consecutive patients with variant angina(M/F;166/38, mean age 53+/-10 year) were included. The diagnosis of variant angina was made by spontaneous spasm in 53, positive intravenous ergonovine(iv Erg) provocation in 52, intracoronary acetylcholine(ic Ach) provocation in 55, simultaneous iv Erg and ic Ach provocation in 48 and bedside intravenous ergonovine with 2-dimensional echocardiography in 33. The clinical and angiographic characteristics were examined in 204 patients and mean 1.5 year(6 month to 3.5 year) follow-up could be done in 165 for the evaluation of long-trem prognosis. RESULTS: The Korean patients with variant angina were characterized by relatively low prevalences of significant coronary stenosis(25%), myocardial infarction and rate of cardiac death. Futhermore, survival and survival without myocardial infarction for the entire group were significantly better in our observation(1 year survival without myocardial infarction, 98%) than in other studies. During the follow-up period, 4(2%) out of 165 patients died, 1 developed myocarddial infarction and ventricular fibrillation occurred in 2. Three of 4 death caused by stopping medication abruptly. Thirteen patients were angina free after discontinued medications during the follow-up. CONCLUSION: The overall prognosis of variant angina may be better in Korean patients. We believe that less severe coronary atherosclerotic disease and a high rate of treatment with calcium blockers may have contributed to the lower rate of cardiac death and myocardial infarction on our patients compared with those in previous studies.
Academies and Institutes ; Calcium ; Coronary Artery Disease ; Death ; Diagnosis ; Echocardiography ; Ergonovine ; Follow-Up Studies* ; Humans ; Infarction ; Korea ; Myocardial Infarction ; Prevalence ; Prognosis ; Spasm ; Ventricular Fibrillation

Methylmalonic acidemia (MMA) is an autosomal recessive metabolic disease. MMA results from a deficiency of L-methylmalonyl-CoA mutase (encoded by MUT), its cofactor 5-deoxyadenosylcobalamin (MMAA, MMAB, and MMADHC), or a deficiency of methylmalonyl CoA-epimerase (MCEE). We report the case of a 5-day-old infant with MMA in which a missense and a novel nonsense mutation in MUT were present. Direct sequencing analysis of MUT revealed a heterozygous c.1106G>A (p.Arg369His) mutation in exon 6 and a heterozygous c.362_368dupAGTTCTA (p.Tyr123*) mutation in exon 2; the latter results in a premature stop codon.
Codon, Nonsense ; Exons ; Female ; Humans ; Infant* ; Metabolic Diseases

PURPOSE: Idiopathic granulomatous mastitis is a rare benign inflammatory breast disease of an unknown etiology and the optimal treatment remains controversial. The aim of this study is to evaluate the efficacy of surgically complete excision in patients with idiopathic granulomatous mastitis. METHODS: Between March 2005 and November 2008, we treated 14 cases that were diagnosed with idiopathic granulomatous mastitis. Prospectively, we treated the cases with complete surgical excision with or without steroid therapy in all patients. RESULTS: The mean age of the patients was 36 years (range 30 to 53 years). All cases performed were complete excision with or without steroid therapy. The median follow up period was 26 months (range 5 to 50 months) and all cases had no recurrence. 13 patients out of the 14 were satisfied with the cosmesis of the treated breast. CONCLUSION: We conclude that the treatment of choice for idiopathic granulomatous mastitis is surgically complete excision.
Breast ; Breast Diseases ; Follow-Up Studies ; Granulomatous Mastitis ; Humans ; Prospective Studies ; Recurrence

BACKGROUND: The purpose of this study is to evaluate the immediate survival, complication and follow-up results of aortic dissection and to analyze the risk factors that determine the prognosis after aortic dissection. METHODS: 29 patients(M : 12, Age : 59.0+/-11 yrs) with aortic dissection were reviewed retrospectively. Any dissection involving the ascending aorta was classified as proximal dissection and the dissection was considered to be acute if time from clinical onset of the dissection to admission was less than 2 weeks. The immediate survival rate and follow-up results of aortic dissection was compared by type, onset and mode of treatment. RESULTS: 1) The studied patient were 29(Acute onset : 24, Proximal type : 14) and 17 patients(Proximal type : 14) were surgically treated. 2) Five of 10 patients with proximal dissection and 4 of 12 patients with distal dissection, who were managed by medical treatment, died, and 1 of 4 patients with proximal dissection and none of 3 patients with distal dissection, who were managed by surgical treatment, died at hospital. There was no significant statistical difference in mortality according to type, onset and mode of treatment. 3) Nine of 14 patients with proximal dissection and 8 of 15 patients with distal dissection had one or more complications. 4) The cause of death could be established in 10 patients. The most frequent cause of death was aortic rupture including cardiac tamponade(4 of 6 patients for proximal dissection, 2 of 3 patients for distal dissection). 5) The most of death, 8 of 10 deaths occurred within 2 weeks of onset of disease. there was a good life expectancy for the discharged patient regardless of type, onset and mode of treatment. CONCLUSION: These data showed that there was equivalent outcomes in patients with aortic dissection regardless of type, onset and mode of treatment. But these data would not be applied to general population with aortic dissection because of limited number of the study.
Aorta ; Aortic Rupture ; Cause of Death ; Follow-Up Studies* ; Humans ; Life Expectancy ; Mortality ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Rate

BACKGROUND: Some types of ventricular tachycardia(VT), so called verapamil-sensitive ventricular tachycardia, occur in healthy young people without organic heart disease. The mechanism of the above VT is not established yet. The most possible mechanism is a triggered activity but reentry is also possible mechanism. We studied the possible mechanism and the eletrophysiologic properties of the verapamil-sensitive VT in 6 patients. METHODS: The patients included in this study were patients with documented ventricular tachycardia response to intravenous verapamil and complete RBBB morpholgy. As noninvasive tests, treadmill test, echocardiography and MUGA scan were performed and endomyocardial biopsy was perfomed in all patients in all patients and in patients with inducible VT, the electrophysiologic study was repeated on next day. The response to various antiarrhythmic agents was also studied. RESULTS: Total studied patients were 6(M : F=5 : 1, mean age=22). The noninvasive tests were normal in all patients and the VT was not induecd during treadmill test. The average cycle length of VT was 370msec and the 12-lead ECG during VT showed complete RBBB. The endomyocardial biopsy showed a mild focal infiltration of inflammatory cell in one patient and moderate small vessel vasculosclerosis in one patient. The clinical VT was induced in 5 patients by programmed electrical stimulation(PES). VT was induced in 5 by ventricular stimulation and in 1 by atrial stimulation. The induction and termination modes changed in 4 of 5 on next day. The cycle length dependency of PVC could be measured in 3 patients and the relationship was same direction in 2 patients and inverse direction in another patient. Intravenous procainamide was effective in 2 of 4 patients and IV adenosine was effective in 1 of 5 patients and IV propranolol was not effective in all 3 patients. CONCLUSION: The verapamil-sensitive ventricular tachycardia is a unique VT showing characteristics of both reentry and triggered activity but in one patient of our study, the most possible mechanism is triggered activity. A further cellular electrophysiologic study is needed for the genesis of verapamil-sensitive ventricular tachycardia.
Adenosine ; Biopsy ; Echocardiography ; Electrocardiography ; Exercise Test ; Heart Diseases ; Humans ; Procainamide ; Propranolol ; Tachycardia, Ventricular* ; Verapamil

Right atrial metastasis occurs in 1 to 4% of patients with hepatoma. and the extention to intracavitary or metastasis of tumor as a large mass rare. However, the high risk of progressive heart failure and sudden death from the tricuspid valve obstruction necessitates prompt diagnosis of intracavitary extension, and adequate intervention is needed to prolong a patient's life. A 49 year-old female was referred to our hospital for further evaluation of a liver mass, which was identified at a local clinic. The liver mass was confirmed as hepatocellular carcinoma with CT and celiac angiographic finding. She was treated with transarterial chemoembolization. Thirty-four months after discharge, a low density right atrial mass was noted incidentally with chest computed tomography while investigating massive right pleural effusion for possible pulmonary metastasis. Echocardiography showed a huge inhomogenous echogenic mass at the right atrium. The present report describes a case of primary hepatocellular carcinoma with a intracavitary cardiac mass detected with two dimensional echocardiography.
Carcinoma, Hepatocellular* ; Death, Sudden ; Diagnosis ; Echocardiography ; Female ; Heart Atria ; Heart Failure ; Humans ; Liver ; Middle Aged ; Neoplasm Metastasis ; Pleural Effusion ; Thorax ; Tricuspid Valve