BACKGROUND: Ultrafiltration is a method to reduce capillary leak and the accumulation of extravascular water associated with cardiopulmonary bypass(CPB). There are two techniques of ultrafiltration, conventional and modified techniques. The effect of the former is controversial. The author investigated the effect of ultrafiltration performed in pediatric open heart surgery in our institute. METHODS: The retrospective study was done in 18 children who received surgical correction of congenital heart disease associated with left to right shunt. Eight children undergone ultrafiltration(UF group) were compared with 10 children who did not receive ultrafiltration(non-UF group). Ultrafiltration was performed mainly during rewarming of CPB(conventional UF) with or without modified technique for about 5 minutes immediately after bypass. Hematocrit(Hct), mean arterial pressure(MAP) and platelet count, 24-h blood loss, the amount of transfusion, fluid requirement, time to extubation, duration of ICU stay and the postoperative hospital stay were compared between groups. RESULTS: The volume of ultrafiltrate was 149+/-88 ml and ultrafiltrate/total blood volume(UF/TBV) ratio was 8.6+/-5.3%. The increase of Hct(5.4+/-1.7%) and of MAP(14+/-5.9 mmHg) after rewarming in UF group were significantly greater than 1.5+/-1.7% and 4+/-8.9 mmHg in non-UF group, respectively(p <0.05). There were no significant differences in platelet count, 24-h blood loss, the amount of transfusion, fluid requirement, maximum body temperature, time to extubation, duration of ICU stay and the postoperative hospital stay between groups. CONCLUSIONS: Ultrafiltration performed during open heart surgery in children significantly increases Hct and MAP immediately after ultrafiltration, but does not affect 24-h blood loss, the time to extubation, duration of ICU stay and the postoperative hospital stay.
Body Temperature ; Capillaries ; Child ; Heart Defects, Congenital ; Heart* ; Humans ; Length of Stay ; Platelet Count ; Retrospective Studies ; Rewarming ; Thoracic Surgery* ; Ultrafiltration*

BACKGROUND: The combination of epidural opioids and local anesthetics provides synergistic analgesia and appears to provide superior analgesia with activity. But the effects of both drugs on bowel motility are oppositional. The object of this study is to evaluate the effect of combined epidural-general anesthesia and postoperative epidural analgesia on the recovery of bowel function and on complications in colon surgery. METHODS: 84 patients were allocated to three groups. 29 patients received intraoperative epidural- general anesthesia and continuous epidural analgesia with local anesthetic-opioid for 48 hours postoperatively (Group I). Group II (n = 25) and Group III (n = 30) received intraoperative general anesthesia alone with postoperative epidural analgesia with an intramuscular injection of analgesics, respectively. We compared the pain score and side effects of these analgesic methods, recovery of bowel movements, postoperative complications and postoperative hospital stay among groups. RESULTS: Groups I and II showed better analgesic effects at rest and upon coughing when compared with Group III (P<0.05). There were no significant differences in the incidences of nausea and vomiting, pruritus, motor blockade and the recovery time of bowel movement and postoperative hospital stay among groups. The incidences of ileus/wound complication and dysrhythmia were not different, but the incidence of pulmonary complication in group I (0%) was significantly lower than in group II (12%) and III (20%) (P<0.05). CONCLUSIONS: Combined epidural-general anesthesia and postoperative epidural analgesia results in decreases in the pain score and in the incidence of pulmonary complication. Moreover, epidural analgesia using local anesthetic and opioid does not affect side effects, recovery time of bowel motility, incidences of ileus/wound and dysrhythmia complications.
Analgesia ; Analgesia, Epidural* ; Analgesics ; Analgesics, Opioid ; Anesthesia* ; Anesthesia, General ; Anesthetics, Local ; Colon* ; Cough ; Humans ; Incidence ; Injections, Intramuscular ; Length of Stay ; Nausea ; Postoperative Complications ; Pruritus ; Vomiting

No abstract available.
Corpus Callosum*

The Laugier-Hunziker syndrome is a rare syndrome characterized by macular hyperpigmentation of the lips and buccal mucosa associated with melanonychia. Onset is usually in adult life and no consistent systemic associations have been reported. Here we report a 39-year-old wonam with a longitudinal pigmented band on a finger and pigmented macules on the lip. We suggest that this is the first report in Korea and the syndrome is presumably more common than recognized.
Adult ; Fingers ; Humans ; Hyperpigmentation ; Korea ; Lip ; Mouth Mucosa

Kimura's disease is a benign, uncommon, chronic inflammatory condition that usually presents with painless subcutaneous nodules or plaques. Head and neck are the most frequently involved sites in Kimura's disease. Mandible is the most commonly involved, followed by neck, cheek, scalp and forehead. Other possible sites are oral cavity, inguinal area and extremities, but there have been no reports involving the nose, especially the one that looks like a rhinophyma. We describe a case of Kimura's disease presenting like a rhinophyma.
Cheek ; Extremities ; Forehead ; Head ; Mandible ; Mouth ; Neck ; Nose ; Rhinophyma ; Scalp

BACKGROUND: Interactions between nimodipine, a calcium channel blocker, used perioperatively for the treatment of subarachnoid hemorrhage, and vecuronium, rocuronium, and atracurium were studied with phrenic nerve-hemidiaphragm preparations of rats. METHODS: Male 200-300 g Sprague-Dawley rats were randomly allocated into four groups (control, NMD(5), NMD(50) and NMD(500) group, n = 10, respectively) according to the nimodipine concentration, and three groups (control, NMD(2D) and NMD(7D), n = 10, respectively) according to the pretreatment duration. A square wave 0.1 Hz supramaximal stimuli was applied to the phrenic nerve-hemidiaphragm preparation and the twitch height response was recorded with mechanomyography. The dose-response curves were measured, and ED(5), ED(50), ED(90), and ED(95) of each vecuronium, rocuronium, and atracurium in different concentrations of nimodipine of 5, 50, and 500 ng/ml and rocuronium in pretreatment with nimodipine 2.5 mg/kg/d for 2 and 7 days were calculated using an inhibitory sigmoid Emax model. RESULTS: The dose-response curves of rocuronium and atracurium were significantly shifted to the left in NMD(500) group, and significantly shifted to the right in NMD(7D) group (P < 0.05). In NMD(500) group, ED(50), ED(90), and ED(95) of rocuronium and atracurium were significantly reduced, and those of rocuronium in NMD7D group were significantly increased compared with the control group (P < 0.05). CONCLUSIONS: Nimodipine 500 ng/ml in the phrenic nerve-hemidiaphragm preparation of rat increased sensitivity to rocuronium and atracurium, and the dose-response curve was significantly shifted to the left, but following pretreatment for 7 days, nimodipine decreased the potency of rocuronium, and the dose-response curve was significantly shifted to the right.
Animals ; Atracurium* ; Calcium Channels ; Colon, Sigmoid ; Humans ; Male ; Nimodipine* ; Rats* ; Rats, Sprague-Dawley ; Subarachnoid Hemorrhage ; Vecuronium Bromide*

BACKGROUND: Ketamine, a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, is known to inhibit "wind-up" and hence central hyperexcitability of dorsal horn neurons. However the results of clinical studies for its preemptive analgesic effect are controversial. The object of this study is to evaluate the effects of preincisional and postincisional low-dose ketamine on postoperative pain. METHODS: In a randomized, double-blind study, postoperative pain was assessed in 60 patients undergoing spinal fusion with general anesthesia who were allocated to three groups. Twenty patients were received 0.15 mg/kg of ketamine and the same volume of saline 5 min before and 15 min after surgical incision, respectively (group I). Patients in group II received 0.15 mg/kg of ketamine and the same volume of saline 15 min after and 5 min before surgical incision, respectively (n = 20), and in control group, patients received saline 5 min before and 15 min after surgical incision (n = 20). IV patient-controlled analgesia (PCA) with a morphine-ketorolac mixture was started in all patients at skin closure. Visual numerical scale (VNS) pain score, total analgesic consumption, and side effects were recorded at 1, 3, 6, 12, 24 and 48 h postoperatively. RESULTS: No significant intergroup differences were seen in the VNS pain scores, total analgesic consumption and incidence of side effects at 1, 3, 6, 12, 24 and 48 h postoperatively. CONCLUSIONS: This result indicates that postoperative pain cannot be decreased when ketamine in low doses is added to general anesthesia before and after surgical stimulation.
Analgesia, Patient-Controlled* ; Anesthesia, General* ; Double-Blind Method ; Humans ; Incidence ; Ketamine* ; N-Methylaspartate ; Pain, Postoperative* ; Posterior Horn Cells ; Skin ; Spinal Fusion

The malignant fibrous histiocytoma (MFH) was first introduced in 1963 to refer to a group of soft-issue tumors characterized by a storiform or cartwheel-ike growth pattern and predominantly fibroblastic appearance. It was postulated that they were derived from histiocytes that could assume the appearance and function of fibroblasts. MFH has been recognized to be the most common sarcoma in the soft tissue of late adult life which involves the deep fascia or skeletal muscles of the extremities or retroperitoneum. It has been noted in other organs, however, it rarely arises in the liver. We report two cases of primary malignant fibrous histiocytoma of the liver histopathologically confirmed after surgical resection-storiform pleomorphic and myxoid subtypes in the 55 year old male and 49 year old female patients, respectively, and describes the clinical courses, characteristics and pathologic aspects with review of the related literatures.
Adult ; Extremities ; Fascia ; Female ; Fibroblasts ; Histiocytes ; Histiocytoma, Malignant Fibrous* ; Humans ; Liver* ; Male ; Middle Aged ; Muscle, Skeletal ; Sarcoma

BACKGORUND: The goal was to investigate hormonal responses, propofol dose and hemodynamic responses during propofol-fentanyl-ketamine anesthesia compared with propofol-fentanyl-N2O anesthesia. METHODS: Twenty adult female patients undergoing total abdominal hysterectomy under general anesthesia were enrolled. They were randomly divided into 2 groups according to anesthetic agents; propofol-fentanyl-N2O for group PFN and propofol-fentanyl-ketamine for group PFK. Target plasma concentrations of propofol were controlled to maintain a bispectral index between 40 and 60. Hemodynamic and hormonal responses (cortisol, prolactin, growth hormone, insulin and glucose) were measured before induction, pre-intubation (only for hemodynamic responses), 2 min after intubation, 2 min after skin incision, at closure of the peritoneum and 5 min after extubation. Administered dose, plasma and effect site concentration of propofol were also evaluated. RESULTS: Pre-intubation mean arterial pressure (MAP) in group PFK decreased less than that in group PFN significantly (PFK; 88+/-2.9%, PFN; 78+/-2.9%)(P<0.05). There were no significant differences in the administered dose and plasma concentrations of propofol between the two groups. Hormonal responses showed similar changes in both groups except for significant differences in cortisol (PFK; 78+/-3.1%, PFN; 67+/-2.4%) 2 min after skin incision and in insulin (PFK; 225+/-69.5%, PFN; 103+/-21.6%) and glucose (PFK; 127+/-4.5%, PFN; 110+/-5.7%) 5 min after extubation. CONCLUSiONS: Propofol-fentanyl-ketamine anesthesia can prevent severe decreases in pre-intubation MAP and with respect to hormonal change and required propofol dose, can be a good substitute for propofol-fentanyl-N2O anesthesia.
Adult ; Anesthesia* ; Anesthesia, General ; Anesthetics ; Arterial Pressure ; Female ; Fentanyl ; Glucose ; Growth Hormone ; Hemodynamics ; Humans ; Hydrocortisone ; Hysterectomy ; Insulin ; Intubation ; Ketamine ; Nitrous Oxide ; Peritoneum ; Plasma ; Prolactin ; Propofol ; Skin

No abstract available.
Vena Cava, Superior*