No abstract available.
Rectal Neoplasms*

Hypertensive encephalopathy is an acute clinical syndrome that shows central nerve dysfunction with sudden and marked elevation in blood pressure. But its pathophysiologic mechanisms, clinical courses and prognosis are still not clear. In order to study clinical manifestations and response to treatment in patients with hypertensive encephalopathy, we reviewed 45 patients with hypertensive encephalopathy who were admitted in Dept. of Internal Medicine, National Medical Center, from January 1975 to December 1984. The following results were obtained: 1) The ratio of male to female was 1.1:1. The peak age of incidence was in the 6th and 7th decade with mean age of 57.5 years. 2) Among 45 patients, only 29 had known history of hypertension and the average duration of hypertension was 8.1+/-3.6 years. 3) The most common sympotm was severe headache (68.9%). And altered consciousness, nausea and/or vomiting, focal neurologic signs and visual disturbance were also common symptoms in decreasing order of frequency. 4) Funduscopic examination showed hypertensive retinopathy in 20 of 24 (91.7%) patients and lumbar puncture revealed increased CSF pressure in 12 of 20 (60%) patients. 5) In most patients, the mean interval to symptomatic improvement was 2.1 days after administration of anti hypertensive agents, but in 6 patients with initial mean arterial blood pressure above 170mmHg, 4 patients showed delayed response and 2 patients were expired.
Antihypertensive Agents ; Arterial Pressure ; Blood Pressure ; Consciousness ; Female ; Headache ; Humans ; Hypertension ; Hypertensive Encephalopathy* ; Hypertensive Retinopathy ; Incidence ; Internal Medicine ; Male ; Nausea ; Neurologic Manifestations ; Prognosis ; Spinal Puncture ; Vomiting

Moyamoya disease is a rare, progressive, occlusive cerebrovascular disorder characterized by bilateral stenosis of the intracranial portion of the internal carotid artery. Symptoms including transient ischemic attacks, seizures, intracranial hemorrhage and cerebral infarction, are variable. There are few case reports of moyamoya disease in pregnancy. Since hyperventilation-induced cerebral ischemia and hypertension are provoked by active labor, cesarean section has been recommended to avoid neurologic complications for pregnant women with moyamoya disease. The optimal anesthetic management for cesarean section in these patients has not been discussed. We report a case of moyamoya disease in a patient presenting for cesarean section at 40 weeks' gestation. Epidural anesthesia was administered using 0.5% bupivacaine and fentanyl. Intraoperative hemodynamic state was stable. The patient has no significant postoperative complications.
Anesthesia* ; Anesthesia, Epidural ; Brain Ischemia ; Bupivacaine ; Carotid Artery, Internal ; Cerebral Infarction ; Cerebrovascular Disorders ; Cesarean Section* ; Constriction, Pathologic ; Emergencies* ; Female ; Fentanyl ; Hemodynamics ; Humans ; Hypertension ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Moyamoya Disease* ; Postoperative Complications ; Pregnancy ; Pregnant Women ; Seizures

No abstract available.
Animals ; Calcium ; Rats* ; Urinary Bladder*

A patient with warm autoimmune hemolytic anemia (AIHA) due to predominance of immunoglobulin A (IgA) with an Rh specificity, considered to be the first case in Korea, is described. A 13-yr-old male patient with severe hemolytic anemia showed a weak reactivity (1+) in the direct antiglobulin test (DAT) by using anti-IgG antiglobulin reagent. This finding, however, could not fully explain the patient's severe AIHA. When anti-IgA reagent was used for the DAT, strong reactivity (4+) was observed and free anti-E and anti-c autoantibodies were also detected by anti-IgA and anti-IgG reagents. The patient's hemoglobin began to rise with the administration of steroids. Because RBCs coated with multiple types of immunoglobulins are associated with more severe hemolysis than those only with IgG, the DATs using anti-IgA and other reagents are needed for the correct diagnosis when the result of DAT is not compatible with patient's clinical manifestations.
Adolescent ; Anemia, Hemolytic, Autoimmune/diagnosis/*immunology ; Antibody Specificity ; Autoantibodies/*blood ; Coombs' Test ; Humans ; Immunoglobulin A/*blood ; Korea ; Male ; Rh-Hr Blood-Group System/immunology

PURPOSE: Unilateral testicular torsion, while harming the ipsilateral testis, may also affect the contralateral testis. A reduction in testicular blood flow, immune reactions and biochemical changes have been reported to affect spermatogenesis. However, physiologic fertility, spermatogenesis, the production of sex hormones and the testicualr blood flow might vary according to age. Therefore, an experimental study was conducted to investigate the effects of testicular torsion on the contralateral testis at various ages in rats. MATERIALS AND METHODS: Sprague-Dawley rats, 2, 5 and 8 weeks old were divided into 4 experimental subgroups in the torsion only, detorsion (torsion followed by detorsion at 1 hour), orchiectomy (torsion followed by an orchiectomy at 24 hours) and a control group. Six weeks later, the changes in the testicular weight, the mean tubular diameter, spermatogenesis and apoptosis of the contralateral testicle were determined. RESULTS: The changes in the testicular weight, mean tubular diameter and spermatogenesis were similar in the 2 weeks group regardless of the experimental methods (p>0.05). In the 5 weeks group, the tubular diameter had decreased significantly in the orchiectomy and torsion only group (p< 0.05), and incomplete spermatogenesis was observed in the torsion only group. In the 8 weeks group, the testicular weight and tubular diameter was significantly lower in the orchiectomy and torsion only group (p< 0.05), but spermatogenesis was relatively well preserved. The apoptotic cell index was significantly higher in the orchiectomy and torsion only group at 5 and 8 weeks group (p< 0.05). CONCLUSIONS: Unilateral testicular torsion causes histological changes and incomplete spermatogenesis in the contralateral testicle. These results suggest that the effect of a unilateral testicualr torsion was predominant in untreated and pubertal rats, but is rarely observed in infantile rats.
Animals ; Apoptosis* ; Fertility ; Gonadal Steroid Hormones ; Orchiectomy ; Rats* ; Rats, Sprague-Dawley ; Spermatic Cord Torsion* ; Spermatogenesis ; Testis*

PURPOSE: Unilateral testicular torsion, while harming the ipsilateral testis, may also affect the contralateral testis. A reduction in testicular blood flow, immune reactions and biochemical changes have been reported to affect spermatogenesis. However, physiologic fertility, spermatogenesis, the production of sex hormones and the testicualr blood flow might vary according to age. Therefore, an experimental study was conducted to investigate the effects of testicular torsion on the contralateral testis at various ages in rats. MATERIALS AND METHODS: Sprague-Dawley rats, 2, 5 and 8 weeks old were divided into 4 experimental subgroups in the torsion only, detorsion (torsion followed by detorsion at 1 hour), orchiectomy (torsion followed by an orchiectomy at 24 hours) and a control group. Six weeks later, the changes in the testicular weight, the mean tubular diameter, spermatogenesis and apoptosis of the contralateral testicle were determined. RESULTS: The changes in the testicular weight, mean tubular diameter and spermatogenesis were similar in the 2 weeks group regardless of the experimental methods (p>0.05). In the 5 weeks group, the tubular diameter had decreased significantly in the orchiectomy and torsion only group (p< 0.05), and incomplete spermatogenesis was observed in the torsion only group. In the 8 weeks group, the testicular weight and tubular diameter was significantly lower in the orchiectomy and torsion only group (p< 0.05), but spermatogenesis was relatively well preserved. The apoptotic cell index was significantly higher in the orchiectomy and torsion only group at 5 and 8 weeks group (p< 0.05). CONCLUSIONS: Unilateral testicular torsion causes histological changes and incomplete spermatogenesis in the contralateral testicle. These results suggest that the effect of a unilateral testicualr torsion was predominant in untreated and pubertal rats, but is rarely observed in infantile rats.
Animals ; Apoptosis* ; Fertility ; Gonadal Steroid Hormones ; Orchiectomy ; Rats* ; Rats, Sprague-Dawley ; Spermatic Cord Torsion* ; Spermatogenesis ; Testis*

The pathological lesion in spinal injury is usually more severe in the central gray matter and spreads centrifugally to surrounding white matter. Opiate antagonists, naloxone, by blocking the pathophysiologic effect of endorphins, should increase both mean arterial pressure and spinal cord blood flow and limit neurologic injury. Naloxone produce increase of lateral column blood flow and ameliorate the central gray matter ischemia. We have investigated the effects of naloxone on histopathological change in cats subjected to thoracic cord contusion. The histopathological evaluation of the injured spinal cords in naloxone-treated cats had less tissue damage than would be observed in time-matched standards. The acute histopathology in saline-treated cats had lesions typical of what we would expect in untreated cats, but the chronic histopathology had slightly better than typical that.
Animals ; Arterial Pressure ; Cats ; Contusions ; Endorphins ; Ischemia ; Naloxone* ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Injuries

No abstract available.
Amikacin* ; Cefuroxime* ; Hysterectomy* ; Sodium*

Nowdays the number of geriatric patients has increased gradually and the risk for anesthesia and surgery is poor compared with younger patients because of chronic systemic diseases and aging of physiologic function. We analyzed 982 cases of geriatric anesthesia patients aged over 65 years performed at Presbyterian Medical Center from January 1992 to December 1993. The patients were evaluated according to age, sex, preoperative physical status, preoperative laborative findings, concurrent illness, anesthetic consult, department, operation site, anesthesia type, duration of anesthesia, intraoperative events, postoperative complications and mortality. The results were as follows; 1) The number of the cases older than 65 years was 982 cases(8.4%) out of total 11,629 cases. There were 548 cases(55.8%) of male and 434 cases(44.2%) of female. 2) By the classification of physical status of American Society of Anesthesiologist, the most common evidence was class 2 in 587 cases(59.8%) and emergency operation was performed in 237 cases(24.1%). 3) 520 cases(53.0%) had concurrent illness and hypertension was most common in 129 cases(24.8%). 4) Preoperative anesthetic consult was performed in 421 cases(42.9%) and the frequent consult problem was cardiovascular in 155 cases(36.8%). 5) The most common department and operation site was general surgery in 461 cases(47.0%), lower abdominal region in 265 cases(27.0%) respectively. 6) The anesthetic technique employed was usually general anesthesia; 710 cases(72.3%). 7) The intraoperative events and postoperative complications were revealed in 244 cases(24.8%), 225 cases (22.9%) respectively and hypertension was leading problem. 8) Overall mortality rate was 1.9%(19 cases). The mortality rate was 0.7% in elective cases and 5.9% in emergency cases. In conclusion, anesthesiologists should attention to perioperative management of geriatric patients to decrease the morbidity and mortality.
Aging ; Anesthesia* ; Anesthesia, General ; Classification ; Emergencies ; Female ; Humans ; Hypertension ; Male ; Mortality ; Postoperative Complications ; Protestantism