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

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*

No abstract available.
Corpus Callosum*

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

BACKGROUND: The purpose is to determine the efficacy of additional intravenous patient-controlled analgesia (IV-PCA) by comparing the analgesic effects between interscalene block (ISB) combined with IV-PCA and single ISB after arthroscopic shoulder surgery. METHODS: A total of 213 patients who underwent arthroscopic shoulder surgery were divided into two groups based on the type of perioperative anesthesia. The single ISB group included 100 patients, while the IV-PCA group included 113 patients. The visual analogue scale for pain (VAS pain) scores were assessed at 12, 24, and 48 hours postoperatively in accordance with shoulder pathology. Postoperative narcotics-related complications and consumption of additional non-steroidal anti-inflammatory drugs between the two groups were compared. RESULTS: VAS pain showed no significant difference between the two groups at most points of the postoperative timeline, regardless of shoulder pathology, except in patients with rotator cuff repair at postoperative 24 hours. Although the IV-PCA group showed a statistically lower VAS pain score than the ISB group at postoperative 24 hours (p=0.04), the difference in the VAS pain score was only 9.0 mm in patients with rotator cuff repair. Narcotics-related complications were observed more frequently in the IV-PCA group than in the ISB group for patients with rotator cuff repair. CONCLUSIONS: Additional IV-PCA demonstrated no booster effect for immediate pain control in patients undergoing arthroscopic shoulder surgery with preoperative single ISB. Furthermore, patients with IV-PCA experienced greater narcotics-related complications.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia ; Arthroscopy ; Humans ; Pathology ; Prospective Studies* ; Rotator Cuff ; Shoulder*

No abstract available.

No abstract available.
Vena Cava, Superior*

BACKGROUND: Intradermal test is a useful diagnostic method for acute anaphylactoid or anaphylactic reactions induced by anesthetic drugs. We analyzed the responses of intradermal test for anesthetic drugs in patients who did not show anaphylactoid or anaphylactic reactions. METHODS: The authors performed intradermal test for anesthetic drugs (thiopental, midazolam, fentanyl, atracurium and vecuronium) in 224 adult patients one hour before induction of anesthesia. The responses were interpreted as measuring the size of wheal and flare. We also did history taking for past allergic history. RESULTS: There were no patient that showed positive reaction. The rate of false positive reaction for atracurium (12.5%) was significantly higher than other anesthetic drugs (p<0.05). And the rate of false positive reaction for atracurium in patients under the age of 40 (20%) was significantly higher than those above the age of 40 (3.8%) (p<0.05). But the difference of the rate of false positive reaction for atracurium between male (8%) and female (15.3%) was not significant statistically. The differences of the rates of false positive reaction for anesthetic drugs between past allergic history group and no past allergic history group were not statistically significant. CONCLUSIONS: In intradermal test for anesthetic drugs, the rate of false positive reaction for atracurium was significantly higher than thiopental, vecuronium, fentanyl and midazolam. Especially, it was significantly higher in patients under the age of 40. So in performing intradermal test to search for causative anesthetic drug, we have to consider the high rate of false positive reaction for atracurium.
Adult ; Anaphylaxis ; Anesthesia ; Anesthetics* ; Atracurium ; False Positive Reactions ; Female ; Fentanyl ; Humans ; Intradermal Tests* ; Male ; Midazolam ; Thiopental ; Vecuronium Bromide

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