Arterial cannulation for constant monitoring of arterial pressure and blood gase analyses has become commonplace in the care of the critically ill patients. The radial artery is often regarded as causing a negligible complication risk because of extensive collateral arterial flow in the hand. One of other alternative sites for arterial cannulation is femoral artery. Femoral artery cannulation has a high degree of success in very small, critically ill children. It should be considered an acceptable alternative to small-vessel cannulation when the latter is not technically achievable, or in the unstable patient where rapid establishment of reliable artery access is necessary. Arterial cannulation may cause many complications: arterial catheters can directly injure the vessels, resulting in thrombosis, occlusion, distal embolization or ischemia. Local insertion site complications, such as hematoma, hemorrhage, and infection may occur. Arterial catheter may also be a source of systemic sepsis. We report an unusual case of unintentional release of a catheter fragment into the external iliac artery in a 7-month (7.8 kg) male patient with tetralogy of Fallot, which was inadvertently inserted during right femoral artery cannulation. The catheter fragment was successfully retrieved with the Amplatz Goose Neck microsnare under fluoroscopy without any problems.
Arterial Pressure ; Arteries ; Catheterization* ; Catheters* ; Child ; Critical Illness ; Femoral Artery* ; Fluoroscopy ; Hand ; Hematoma ; Hemorrhage ; Humans ; Iliac Artery* ; Ischemia ; Male ; Neck ; Radial Artery ; Sepsis ; Tetralogy of Fallot ; Thrombosis

With the development of gray scale ultrasonography, detection and evaluation of hepatic parenchymal diseaseincluding space occupying lesions are easitly performed and frequently used in the world. Thirty-five cases ofhistopathologically proven and ultrasonographically suggested hepatocellular carcinoma are retrospectivelystudied. The results were as follows; 1. Ultrasonographic findings of hepatocellular carcinoma show hyperechoicpattern in 22 cases (63%), hypoechoic pattern in 2 cases (6%), and mixed pattern in 11 cases (31%). 2. The marginof tumor is ill-defined in 19 cases (54%) and well defined in 16 cases (46%). 3. The size of tumor by sonographicmeasurement was larger than 5cm in diameter in 33 cases (94%). 4. The number of tumor is solitary in 19 cases andmultiple in 16 cases. The sites of involved lobe were right lobe in 22 cases (63%), left lobe in 2 cases (6%), andboth lobes in 11 cases (31%). 5. Associated sonographic findings were hepatomegaly with focal contour change in 25cases (71%), splenomegaly in 16 cases (46%), cirrhosis of liver in 15 cases (43%), ascites in 11 cases (31%) andtumoral thrombosis in portal vein in 8 cases (23%). 6. The sex ratio is 6:1 male predominence and the age rangesfrom 32 to 76 years with highest incidence in 5th and 6th decades.
Ascites ; Carcinoma, Hepatocellular ; Fibrosis ; Hepatomegaly ; Humans ; Incidence ; Liver ; Male ; Portal Vein ; Sex Ratio ; Splenomegaly ; Thrombosis ; Ultrasonography

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most common complaints following laparoscopic surgery, and being female is a risk factor for PONV. Therefore, we conducted this study to determine if the incidence of PONV is associated with variations in the blood concentration of female hormones that occur during different stages of the menstrual cycle. METHODS: We recruited 103 women who were undergoing gynecological laparoscopic surgery under general anesthesia and met all of the inclusion criteria for this study. A menstrual history was taken from each patient during the preoperative anesthetic visit and blood samples were collected from all patients to determine the concentration of female hormones (estradiol, progesterone). We then assessed the nausea rating scale (NRS) and the occurrence of retching and vomiting at 0-2 hours, 2-6 hours, and 6-24 hours postoperatively. RESULTS: The overall incidence of PONV was 60.2% within the first 24 hours following surgery. However, no significant differences in the incidence of PONV were observed in women in different menstrual phases (follicular phase, 63.5% vs. luteal phase, 56.9%). In addition, there was no significant difference observed in the female hormonal concentration of the blood of patients who experienced PONV and those that did not, and there was no correlation between the NRS and the blood concentration of female hormones. CONCLUSIONS: The results of this study suggest that female hormones (estradiol, progesterone) are not associated with the occurrence of PONV following gynecological laparoscopic surgery.
Anesthesia, General ; Estradiol ; Female ; Humans ; Incidence ; Laparoscopy ; Luteal Phase ; Menstrual Cycle ; Nausea ; Postoperative Nausea and Vomiting ; Progesterone ; Risk Factors ; Vomiting

Tuberous sclerosis is reported rarely and is associated with systemic lesions including central nervous system, skin, heart, eye and kidney. Approximately 5-15% of individuals with tuberous sclerosis will develop brain neoplasia, almost invariably subependymal giant-cell astrocytoma (SGCA). We experienced a case of SGCA with tuberous sclerosis operated by the transcallosal approach and report with literature review.
Astrocytoma* ; Brain ; Central Nervous System ; Heart ; Kidney ; Skin ; Tuberous Sclerosis*

PURPOSE: A study was done to assess the incidence, clinical characteristics of urinary tract anomalies for decreasing urinary tract morbidity. METHODS: We review 98 cases of anomaly of urinary tract who were admitted Kyung Hee University Hospital between 1986 and 1995. We analyzed incidence and associated anomalies, associated diseases and treatment modalities. RESULTS: 1) It was composed of 45 cases (45%) of renal anomalies, 37 cases (37.7%) of ureteral anomalies, 7 cases (7.1%) of urethral anomalies, 3 cases Prune-belly syndrome, 3 cases of urachal remnants, 2 cases of bladder exstrophy, 1 cases of VATER syndrome. 2) Anomalies of the kidney were composed of 14 cases of renal agenesis, 11 cases of multicystic dysplastic kidney, 10 cases of hydronephrosis 3 cases of hypoplasia, 3 cases of polycystic kidney, 2 cases of ectopia, 1 case of malrotation and 1 case of horseshoe kidney, 20 cases (44.4%) were diagnosed before 1 month of life. 20 cases were male and 25 casses were female. Bilateral involvement were in 7 cases and 38 cases of unilateral involvement were composed of 23 cases of right side and 15 cases of left side. Operative treatment were performed in 15 cases (30%) of renal anomalies. The common chief complaint of renal anomalies were abnormal finding on urinalysis (24.4%), abnormal finding on fetal ultrasonogram (20%), gastrointestinal tract symptom (15.6%), and fever (9%). 3) Anomalies of the ureter were composed of 26 cases of ureteral duplication, 9 cases of UPJ obstruction, 2 cases of megaureter. Ureteric duplications included 8 cases of male and 18 cases of female and 19 cases were unilateral and 7 cases were bilateral. 19 cases were diagnosed before 5 years old. 19 cases (73.1%) had symptoms associated with urinary tract infection. 11 cases had abnormal finding of ipsilateral kidney on DMSA scan or IVP. Associated abnormalities were hydronephrosis, ureterocele and VUR. UPJ obstruction were mostly diagnosed before 1 month of life, 6 cases were male and 3 cases were female. 2 cases were bilateral and 3 cases were right side involvement and 4 cases were left side. CONCLUSIONS: It seems to be reasonable that we should recommend the patients with the symptoms of urinary tract diseases to do evaluate the possibility of congenital urinary tract anomalies.
Bladder Exstrophy ; Child* ; Child, Preschool ; Female ; Fever ; Gastrointestinal Tract ; Humans ; Hydronephrosis ; Incidence ; Kidney ; Male ; Multicystic Dysplastic Kidney ; Polycystic Kidney Diseases ; Prune Belly Syndrome ; Succimer ; Ultrasonography ; Ureter ; Ureterocele ; Urinalysis ; Urinary Tract Infections ; Urinary Tract* ; Urologic Diseases

BACKGROUND: In searching for a differential spinal block between dependent and nondependent sides, we evaluated the influence of the duration of lateral decubitus on the spread of hyperbaric bupivacaine during spinal anesthesia. METHODS: Spinal anesthesia with 1.2 ml of hyperbaric 0.5% bupivacaine (6 mg) was administered with a 25-gauge Whitacre unidirectional needle to 50 ASA 1 patients undergoing unilateral knee arthroscopy. The patients were allocated randomly to three groups according to the duration of lateral decubitus after spinal injection in the lateral position operation side dependent: Group 1, 10 min in lateral decubitus then supine; Group 2, 20 min in lateral decubitus then supine; Group 3, 30 min in lateral decubitus then supine. Sensory and motor block (pinprick/modified Bromage scale) as well as skin temperature were compared between the dependent and nondependent sides. Circulatory variables were recorded for 10 min after being turned supine. RESULTS: The sensory block between dependent and nondependent sides were significantly different in Group 3. In Group 1, the level of maximum sensory block was higher than Group 3 on nondependent side. There was no difference in the number of patients having achieved Grade 3 and 0 motor block among three groups on dependent and nondependent sides. The skin temperature in lateral decubitus was significantly higher on the dependent side than nondependent side in three groups. In Groups 1 and 2, the skin temperatures of nondependent side were increased after turned supine, but that was maintained during supine position in Group 3. The circulatory variables were stable in all 50 patients. CONCLUSIONS: We conclude that when a small dose of 0.5% hyperbaric bupivacaine is injected into patients in the lateral position, complete unilateral spinal anesthesia is achieved when the patients arekeep in a lateral position for more than 30 min after spinal injection.
Anesthesia, Spinal* ; Arthroscopy ; Bupivacaine* ; Humans ; Injections, Spinal ; Knee ; Needles ; Skin Temperature ; Supine Position

No abstract available.
Adenoma* ; Common Bile Duct*

An intracranial hemorrhage is a fatal complication associated with general anesthesia. It can occur in patients with an intracranial aneurysm, hypertension, cerebral vascular malformation, and blood dyscrasia, etc. A sudden hemodynamic change during intubation and extubation in general anesthesia is dangerous, particularly in these patients. We encountered an intraventricular hemorrhage in a 42 year old pregnant woman after a cesarean section. The patient was induced with 300 mg of thiopental and 45 mg of rocuronium. The anesthesia was maintained with N2O/O2 and sevoflurane after endotracheal intubation. Five hours after surgery, the patient had a seizure at the ward. A MRI and CT scan of the brain showed a right intraventricular and basal ganglia hematoma. The CT 3-D brain angiography showed an unruptured small aneurysm on the right posterior communicating artery.
Adult ; Anesthesia ; Anesthesia, General* ; Aneurysm ; Angiography ; Arteries ; Basal Ganglia ; Brain ; Cerebral Hemorrhage ; Cesarean Section* ; Female ; Hematoma ; Hemodynamics ; Hemorrhage* ; Humans ; Hypertension ; Intracranial Aneurysm ; Intracranial Hemorrhages ; Intubation ; Intubation, Intratracheal ; Magnetic Resonance Imaging ; Pregnancy ; Pregnant Women ; Seizures ; Thiopental ; Tomography, X-Ray Computed ; Vascular Malformations

Recent evidence suggests that surgical incision and other noxious perioperative events may induce prolonged changes in central neural function that later contribute to postoperative pain, Inhibition of these changes may be of value in the reduction of postoperative pain. Several clinical studies have shown that pretreatment with local anesthetics, opioids, NASAIDs and N-methyl-D-aspartate(NMDA) antagonist are effective in relieving postoperative pain. We compared the efficacy of pre-emptive and post-incisional epidural analgesia with morphine 2 mg in 0.25% bupivacaine(8 ml) on the postoperative pain. Seventy patients (ASA physical status I, 2) scheduled for elective lower abdominal surgery were randomized to one of two groups of equal size and prospectively studied in a double-blind manner. Group I received epidural morphine(2 mg, in 8 ml 0.25% bupivacaine) before surgical incision followed by epidural normal saline(8 ml) just before termination of the surgery. Group 2 received epidural normal saline(8ml) before surgical incision, followed by epidural morphine(2 mg, in 8 ml 0.25% bupivacaine) just before termination of the surgery. Anesthesia was induced with thiopental sodium(4~6 mg/kg) and maintained with N2O/O2 and enflurane. Paralysis was achieved with pancuronium. Percentage of maximal possible effect(MPE) was significantly higher(P<0.05) in group 1 (85.3%) than in group 2 (70.8%). Secondary analgesic requirement was less in group 1(9/35 patients, 25.7%) than in group 2 (15/35 patients, 42.9%). Visual analog scale pain and mood score and Prince-Henry pain score are not significantly different between two groups. We conclude that pre-emptive epidural analgesia with morphine and bupivacaine may be more effective in relieving postoperative pain than post-incisional analgesia in lower abdominal surgery.
Analgesia* ; Analgesia, Epidural ; Analgesics, Opioid ; Anesthesia ; Anesthetics, Local ; Bupivacaine ; Enflurane ; Humans ; Morphine* ; Pain, Postoperative ; Pancuronium ; Paralysis ; Prospective Studies ; Thiopental ; Visual Analog Scale

PURPOSE: The aim of this pilot study was to determine the relationship between the beta-fibrinogen G/A-455 single nucleotide polymorphism and the risk of ischemic stroke in Korea because there are racial differences in polymorphisms and Koreans have never been studied before. METHODS: From March to September 2003, we compared 80(male : female=1.2 : 0.8) patients who were diagnosed with ischemic stroke at Kyung Hee university hospital emergency center had been to 150 control subjects. The genotypes of the beta-fibrinogen G/A-455 polymorphism were confirmed by using the polymerase chain reaction (PCR) followed by HaeIII restriction enzyme digestion. RESULTS: The results showed that the patient group had a much higher rate of heterozygotism (GA or AG). A statistical analysis of the genotype frequency showed chi2 to be 6.24, indicating a significant difference between the patient and the control groups (p=0.044). For the allele frequency, the odds ratio was 1.88(95% CI 1.16-3.04), indicating a significant difference between the two groups, and also allele frequency in ischemic stroke patient with or without hyperfibrinogenemia, male sex and smoking history showed odds ratio to be 2.38(95% CI 1.26~4.49), 1.78(95% CI 1.01~3.14)and 1.94(95% CI 1.12~3.35) indicating significant difference. CONCLUSION: The high rate of polymorphisms of the AA genotype of beta-fibrinogen G/A-455 in ischemic stroke patients in our study leads us to the belief of the possibility that beta-fibrinogen G/A-455 polymorphisms in males with a smoking history and hyperfibrinogenemia, if found in advance, could lead to an improved prognosis and reduced clinical expenses by allowing early diagnosis and preventive management.
Digestion ; Early Diagnosis ; Emergencies ; Gene Frequency ; Genetics ; Genotype ; Humans ; Korea ; Male ; Odds Ratio ; Pilot Projects* ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Prognosis ; Smoke ; Smoking ; Stroke*