Surgical intervention during the pregnancy is not rare and the impact of anesthesia and surgery during the pregnancy is doublefold, because the mother and the fetus in uterus are concerned. The anesthesiologist must know the progressive' maternal changes during the pregnancy and drug action on the fetus. The authors have experienced 50 cases of pregnant women undergoing various kinds of operation and have analyzed those cases according to the type of disease, the duration of gestation, physical status, premedication, anesthetic technics and agent used, and the outcome of the fetus and the patient during the period between March 1972 to August 1978 The results were as follows: 1) The most of patient, 32 cases were operated for the obstetric and gynecological :reason s. 2) 27 cases (54%) had undergone the operation during the second trimester. 3) Physical status class 2 including 28 cases (56%) was the most commonly found physical status of the patients. 4) Halothane was the main anesthetic agent for 39 cases (78%) and there were 3 cases of spinal anesthesia. 5) We could follow 27 cases among 50 cases about the outcome of the fetus. 17 spontaneous vaginal delivery, 8 Cesarean sections, 1 fetal death in uterus and 1 wanted D&C. 6) Among 5 premature deliveries, 2 premature infants died during the hospitalization. 7) The only maternal motality was the case of intrahepatic stone who expired 11 days postoperatively and delivered a 1,300 gm premature 7 days postoperatively.
Anesthesia ; Anesthesia, Spinal ; Cesarean Section ; Dilatation and Curettage ; Female ; Fetal Death ; Fetus ; Halothane ; Hospitalization ; Humans ; Infant, Newborn ; Infant, Premature ; Mothers ; Pregnancy ; Pregnancy Trimester, Second ; Pregnant Women ; Premedication ; Uterus

A clinical review was made on 48 cases with cor pulmonale who were admitted to medical department, National Medical Center, between 1973 and 1982, and the results were as follows : 1) Teh age of subjects ranged from 26 to 88, and their mean was 51. male to female ratio was 1.6:1 and majority of them were in their 6th and 7th decade. 2) COPD was the most common cause of cor pulmonale but pulmonary tuberculosis had also a considerable portion. Less commonly it was caused by chest deformity which was mainly from spine tuberculosis and kyphoscoliosis. 3) Almost all patients were admitted with over heart failure. 4) Laboratory features showed indirect evidence of heart failure and pulmonary hypertension in chest X-ray films, RVH patterns in EKG and hypoxia and hypertcapnea with metabolic compensation in arterial gas analysis. 5) The case fatality rate was one-forth and that from kyphoscoliosis was especially high(80%).
Anoxia ; Compensation and Redress ; Congenital Abnormalities ; Electrocardiography ; Female ; Heart Failure ; Humans ; Hypertension, Pulmonary ; Male ; Mortality ; Pulmonary Disease, Chronic Obstructive ; Pulmonary Heart Disease* ; Spine ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary ; X-Ray Film

Reconstructive surgeries for old ligament injuries of the knee vary according to the site and nature of injury as well as the age, health, physical demand and cartilage condition of the patients. No single best procedure is present for any old ligament injuries, but the most adaptable technique should be applied according to accurate diagnosis and experiences of surgeon. We reviewed our experiences of several reconstructive surgeries for the 38 cases with chronic ligamentous instabilities and summarized as following. 1) The most prevalent age of the patients was the third decades and males were 5.3 times more common than females. 2) Traffic accidents was the most common cause. 3) Tear of anterior cruciate ligament and medial collateral ligament appeared to be the most common injury. 4) Results at final follow up was not seemed to be affected by severity or location of ligament injury. 5) Intraarticular reconstruction without combined extraarticular reconstruction was not considered to be effective enough for anterior cruciate ligament deficient knee. 6) Although the number of cases was not large enough, we reviewed various reconstructive surgical techniques for comparison and evaluated the effects.
Accidents, Traffic ; Anterior Cruciate Ligament ; Cartilage ; Collateral Ligaments ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Male ; Tears

We present a case of annular polycylic type of subacute lupus erythematosus which fulfilled the criteria of systemic lupus erythematosus and was associated with protein losing enteropathy. A 37-year-old male had erythematous annular rashes with several painful, scattered ulcers and a generalized edematous appearance. Abnormal laboratory findings were hypoalbuminemia, low complement, positive Anti-Ro, La, and ANA in a speckled pattern. Tc-99m human serum albumin scintigraphy revealed extravasation within the small bowel. The histopathologic findings showed vacuolar degeneration, upper dermal edema and cleft with perivascular lymphocytic infiltration. Direct IF revealed granular deposition of IgG along the dermo-epidermal junction. The patient was treated with intravenous steroids and oral hydroxychloroquine.
Adult ; Complement System Proteins ; Edema ; Exanthema ; Humans ; Hydroxychloroquine ; Hypoalbuminemia ; Immunoglobulin G ; Lupus Erythematosus, Cutaneous* ; Lupus Erythematosus, Systemic ; Male ; Protein-Losing Enteropathies* ; Radionuclide Imaging ; Serum Albumin ; Steroids ; Ulcer

Castleman's disease, also known as angiofollicular lymphoid hyperplasia or giant lymph-node hyperplasia, is an unusual form of a lymphoproliferative disorder, and is divided clinically into a solitary and a multicentric form. The multicentric form of Castleman's disease is almost always of the plasma cell type. This can coexist with Kaposi's sarcoma in some cases. Kaposi's sarcoma is a multicentric, proliferative, vascular tumor involving cutaneous and visceral tissue. Iatrogenically-developed, immunosuppression-associated Kaposi's sarcoma is usually the result of immunosuppressive therapy. A 61-year-old man diagnosed as the plasma cell type of Castleman's disease, who had been treated with prednisolone for 2 years, was referred to the department of dermatology with numerous skin lesions consisting of confluent, violaceous-colored papules and plaques on his palm and soles. Histologic examination of the cutaneous lesions showed consistency with Kaposi's sarcoma. We report a rare case of Kaposi's sarcoma associated with multicentric Castleman's disease.
Dermatology ; Giant Lymph Node Hyperplasia* ; Herpesvirus 8, Human ; Humans ; Hyperplasia ; Lymphoproliferative Disorders ; Middle Aged ; Plasma Cells ; Prednisolone ; Sarcoma, Kaposi* ; Skin

Childhood minimal change nephrotic syndrome (MCNS) has often been associated with allergic symptoms such as urticaria, bronchial asthma, atopic dermatitis, allergic rhinitis and elevated IgE levels and referred to involve immune dysfunction. Fc epsilon RII is known to be involved in IgE production and response. Interleukin-4 is being recognized as a major cytokine up-regulating IgE production. Hence the present study is aimed at investigating the role of interleukin-4 and Fc epsilon RII in the pathogenesis of MCNS. IgE was measured by ELISA. Fc epsilon RII was analyzed by fluorescence activated cell scanner (FAC-scan) by double antibody staining with anti Leu16-FITC and anti Leu20-PE. Soluble IgE receptor was measured by ELISA using anti CD23 antibody (3-5-14). Interleukin-4 activities were measured by CD23 expression on purified human tonsillar B cells. Serum IgE levels were significantly higher in MCNS (1,507 +/- 680 IU/dl) than in normal controls (123 +/- 99.2 IU/dl). A significantly higher expression of membrane Fc epsilon RII was noted for MCNS (41 +/- 12%) than that in normal controls (18 +/- 6.2%) (p < 0.001). Soluble CD23 levels were also significantly higher in MCNS (198 +/- 39.3%) than in normal controls (153 +/- 13.4) (p < 0.01). Interleukin-4 activity in sera of MCNS (12U/ml) was also significantly higher than normal controls (4.5U/ml). These results indicate that increased production of Fc epsilon RII and interleukin-4 may play an important role in the pathogenesis of MCNS.
B-Lymphocytes/immunology ; Child ; Humans ; Immunoglobulin E/blood ; Interleukin-4/*physiology ; Nephrosis, Lipoid/*etiology/physiopathology ; Receptors, IgE/biosynthesis/*physiology ; Solubility

BACKGROUND: This study was designed to establish the optimal timing of administration of ondansetron for prevention of postoperative nausea and vomiting (PONV) during intravenous patient-controlled analgesia (IV-PCA). METHODS: Eighty women undergoing a total abdominal hysterectomy under general anesthesia were randomized to receive a placebo (n = 20, group 1), ondansetron 2 mg before induction and 2 mg after surgery (n = 20, group 2), ondansetron 4 mg before induction (n = 20, group 3), or ondansetron 4 mg after surgery (n = 20, group 4). An IV-PCA using butorphanol and ketorolac was connected to the patients after waking from the anesthesia. The incidences and severity of nausea and vomiting were recorded for 48 hr postop. RESULTS: The incidences of nausea and vomiting in group 1 (75%, 40%) were significantly decreased after ondansetron administration but there were no significant differences among the ondansetron groups (group 2; 45%, 20%, group 3; 45%, 15%, group 4; 40%, 10%) (P < 0.05). CONCLUSIONS: The prophylactic administration of ondansetron is effective in preventing PONV during IV-PCA, but the timing of ondansetron administration has no effect on its efficacy.
Analgesia, Patient-Controlled* ; Anesthesia ; Anesthesia, General ; Butorphanol ; Female ; Humans ; Hysterectomy ; Incidence ; Ketorolac ; Nausea* ; Ondansetron* ; Postoperative Nausea and Vomiting ; Vomiting*

No abstract available.
Acute Kidney Injury* ; Hemoglobinuria, Paroxysmal*

An age-dependent cellular change of DNA contents in the testis of Sprague-Dawley rats was investigated by flow-cytometric method. Testicular cell suspensions at the age of 4, 5, 6, 7, 8, 10, 12, 16 and 26 weeks were prepared and stained with propidium iodide. The relative proportions in the number of mature and immature haploid (1n), diploid (2n), S-phase and tetraploid (4n) cells were calculated. The proportion in the number of mature haploid cells was sharply increased to the age of 10 weeks (about 38%), thereafter increased slightly to the level of 42% at the age of 26 weeks. The proportion of immature haploid cells was dramatically increased to the age of 6 weeks, then maintained at the level of 20 to 30% thereafter. The proportion of diploid cells was 64% at the age of 4 weeks, then decreased gradually through the age of 26 weeks. The proportion of S-phase cells was increased to the age of 4 weeks, then maintained at a plateau level to the age of 26 weeks. The proportion of tetraploid cells were about 26% at the age of 4 weeks, then decreased gradually to the age of 26 weeks. These results suggest that the proportions of testicular cells may depend on the age of the rat and that the flow cytometric method may be useful in the evaluation of the spermatogenic status with regard to accuracy and sensitivity.
Animals ; DNA/*analysis/genetics ; Diploidy ; Flow Cytometry/methods/veterinary ; Haploidy ; Male ; Rats ; Spermatogenesis ; Testis/chemistry/*growth & development

PURPOSE: Percutaneous nephrolithotomy (PCNL) is the procedure of choice for treating large renal stones. Pneumatic lithotripsy (Lithoclast(R)) is effective regardless of the stones' composition, and ultrasonic lithotripsy allows the aspiration of small debris during lithotripsy. We investigated the efficacy and safety of PCNL via Lithoclast(R) alone or combined with ultrasonic lithotripsy. MATERIALS AND METHODS: Thirty-five (group A) and 39 (group B) patients underwent Lithoclast(R) PCNL and combination therapy, respectively, from May 2001 to March 2010, and the two groups were compared in terms of stone size, location, and composition; operative time; average number of treatments; hospital days; hemoglobin loss; ancillary procedures; rate of device failure; and initial and total stone-free rates. RESULTS: The two groups did not differ significantly in preoperative stone size, location, or composition; the average number of treatments; or the initial and overall stone-free rates. However, combination therapy was associated with a significantly lower operative time (181+/-50 vs. 221+/-65 min, respectively, p=0.004), number of hospital days (11.6+/-3.8 vs. 14.2+/-4.4 days, respectively, p=0.009), and average hemoglobin loss (1.12+/-0.61 vs. 1.39+/-1.02 g/dl, respectively, p=0.013). Transfusions were required in 6 patients (4 and 2 in each group, respectively), but there were no significant complications related to percutaneous access. There were 2 (5.7%) mechanical failures (Lithoclast(R) probe fracture) in the group A and 5 (12.8%) in the group B (2 cases of suction tube obstruction, 3 cases of overheating). CONCLUSIONS: The combination of ultrasonic lithotripter and Lithoclast(R) is more effective than Lithoclast(R) alone because it significantly decreases operative time, hemoglobin loss, and the hospital stay. This may reflect the superior power of Lithoclast(R) and the ability to aspirate the debris during ultrasonic lithotripsy.
Hemoglobins ; Humans ; Kidney Calculi ; Length of Stay ; Lithotripsy ; Nephrostomy, Percutaneous ; Operative Time ; Suction ; Ultrasonics