Broncho-gastric fistula caused by benign gastric ulcer perforation after esophagectomy is very rare. In general anesthesia of a patient with broncho-gastric fistula, in spite of hyperventilation, leakage of the anesthetic gases through fistula may make the patient hypercapneic, and positive pressure ventilation may increase the risk of the pulmanary aspiration by the regurgitation of gastric fluid by stomach distension. For that reason, in this patient, denitrogenation was performed during patient's voluntary respiration with 100% oxygen for 5 minutes, and induction was performed without positive pressure ventilation, and one lung ventilation was carried out. Hypoxemia was followed by one lung ventilation because his pulmonary function was moderate obstructive type and his lung was damaged by aspiration of gastric fluid via broncho-gastric fistula. A low level of continuous positive airway pressure (CPAP) has no significant hemodynamic effect and can maintain the patency of nonventilated lung, so hypoxemia induced by one lung ventilation may be reduced. Thus we carried out one lung ventilation with CPAP (10 cmH2O) in nonventilated lung and blocked broncho-gastric fistula with a bronchial blocker for prevention of both regurgitation of gastric fluid and leakage of anesthetic gases. One lung anesthesia was performed without any problem in this case.
Anesthesia ; Anesthesia, General* ; Anesthetics, Inhalation ; Anoxia ; Continuous Positive Airway Pressure ; Esophagectomy ; Fistula* ; Hemodynamics ; Humans ; Hyperventilation ; Lung ; One-Lung Ventilation ; Oxygen ; Positive-Pressure Respiration ; Respiration ; Stomach ; Stomach Ulcer

The injured skull bone may be contaminated in compound frontal skull fracture, so definitely left out for the prevention of infectious complications in the classic concept. The efficacy of primary replacement and resection of the injured bony fragments in the treatment of compound depressed frontal skull fractures was studied in 33 patients who could be followed up over one year during a recent 5-year period. The patients was divided into a group I which took a primary replacement of injured bony fragments and group II which left out the injured bony fragments in immediate operation. The results are summarized as follows : 1) The age incidence was more frequent in the 3th and 4th decades. The sex distribution was more frequent in male(87%). 2) The motor vehicle accident was most frequent in the injury mechanism. 3) The conscious level on admission was 53% in 13~15 GCS group, 12% in 9~12 group, 26.6% in 6~8 group and 8.4% in 3~5 group. 4) The incidence of an extending fractures was 42% to orbital roof, 35% into frontal sinus, 25% into cribriform plate and 16% into nasal bone. 5) The incidence of intracranial injury was 65% in dural laceration and 51% in cerebral laceration. Of cases of dural laceration the cerebral laceration was associated in 78%. 6) The time duration from injury to operation was under 12 hours in most cases(84%). 7) The incidence of a complication was 36.1% in total group, 27.7% in group I and 47.2% in group II. The infectious complication was not a significant difference between group I(14.9%) and group II(16.7%). In conclusion the infectious morbidity of which were most dangerous complications due to compound depressed frontal skull fractures was not a significant difference in two compared group. The author believe that immediate bone replacement for compound depressed frontal fractures with or without extension to frontal sinus, orbit, or cribriform plate os both practical and safe procesures.
Ethmoid Bone ; Frontal Sinus ; Humans ; Incidence ; Lacerations ; Motor Vehicles ; Nasal Bone ; Orbit ; Sex Distribution ; Skull Fractures* ; Skull*

We had experienced anesthetic management of two patients with bilateral pheochromocytoma. They had been treated with phenoxybenzamine for 4 weeks preoperatively. Anesthesia was managed with thiopental sodium for induction,enflurane-N2O-O2 for maintenance, vecuronium for muscle relaxation, and sodium nitroprusside for controlling severe hypertension. After tumor resection, severe hypotension was controlled by rapid transfusion, fluid and dopamine infusion. A tolerable blood pressure and pulse rate were maintained throughout the procedure. Preoperative preparation, sufficient sedation, smooth anesthetic induction, complete analgesia, good muscle relaxation, adequate ventilation and proper cardiovascular control are required in resection of pheochromocytoma.
Analgesia ; Anesthesia ; Blood Pressure ; Dopamine ; Heart Rate ; Humans ; Hypertension ; Hypotension ; Muscle Relaxation ; Nitroprusside ; Phenoxybenzamine ; Pheochromocytoma* ; Thiopental ; Vecuronium Bromide ; Ventilation

No abstract available.
Angina Pectoris* ; Electrocardiography* ; Pheochromocytoma*

A 69 years old, otherwise healthy male pt. was admitted and soheduled for subtotal gastrectomy under the Dx. of stornach Ca. The induction of anesthesia and beginning of Operation were smooth and unevntful. After peritoneal opening, the surgeon complained of distended stomach which was synch- ronous with ventilation. With repeating tracheogram and endoscopic examination, the authors fecund unsuspected tracheo-esophageal fistula on the low-middle esophagus. Durins convalescenee the pt, had not suffered any pulmonary complication.
Aged ; Anesthesia ; Anesthesia, General* ; Esophagus ; Fistula* ; Gastrectomy ; Humans ; Male ; Stomach ; Ventilation

It is very important for the anesthesiologists to manage this kind of patient during anesthesia because of severe hemodynamic change that is induced by aortic clamping and declamping, and its secondary effect on visce, heart and spinal cord, etc. To minimize the sudden severe hemodynamic change, we used the following agents and techniques in this clinical report. 1) Ethrane anesthesia with intermittent Innovar administration to minimize cardiac irritability. 2) To prevent secondary damage by distal hypotension during aortic clamping and declamping. 1. slight overhydration. 2. mannitol. 3. diuretics. 3) To prevent secondary damage by proximal hypertension during aortic clamping. 1. d-tubocurarine for muscle relaxation. 2. Morphine. 3. Chlorpromazine. 4. phentolamine. More over, we recommend this kind of anesthetic method in some other surgeries such as coarctation of aorta, aortic aneuryam and pheochromocytoma, etc. which may exhibit severe hemodynamic change during anesthesia.
Anesthesia ; Aortic Coarctation ; Chlorpromazine ; Constriction ; Diuretics ; Enflurane ; Heart ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Renovascular* ; Hypotension ; Mannitol ; Morphine ; Muscle Relaxation ; Phentolamine ; Pheochromocytoma ; Spinal Cord ; Tubocurarine

BACKGROUND: Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. METHODS: Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. RESULTS: Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analogue scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. CONCLUSION: The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function.
Aged* ; Analgesia ; Analgesia, Patient-Controlled* ; Fentanyl ; Humans ; Meperidine ; Morphine ; Passive Cutaneous Anaphylaxis

BACKGROUND: Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. METHODS: Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. RESULTS: Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analogue scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. CONCLUSION: The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function.
Aged* ; Analgesia ; Analgesia, Patient-Controlled* ; Fentanyl ; Humans ; Meperidine ; Morphine ; Passive Cutaneous Anaphylaxis

Tympanic membrane (TM) perforation is common. Acute persistent or chronic TM perforations require surgical interventions such as myringoplasty or tympanoplasty. Current strategies of tissue engineering are focused on the regeneration of TM perforation instead of surgical interventions. To regenerate TM tissue or restore acoustic-mechanical property, bioscaffold or growth factors are necessary that will act as a temporary matrix for cell proliferation and extracellular matrix deposition, with subsequent ingrowths. In recent years, various scaffolds, biomolecules have been used for TM tissue engineering. Cells in combination with supportive scaffolds have rarely reported. TM regeneration by tissue engineering approach may be considered the greatest advances in otology. This review examines the current evidence for their use and the limitations of knowledge.
Cell Proliferation ; Extracellular Matrix ; Intercellular Signaling Peptides and Proteins ; Myringoplasty ; Otolaryngology ; Regeneration* ; Tissue Engineering* ; Tympanic Membrane* ; Tympanoplasty

Kerion celsi is an inflammatory type of tinea capitis, which occurs chiefly in children between the ages of 4 and 14 years. We report a case of kerion celsi caused by Trichophyton(T.) mentagrophytes in 69 year-old man, who showed a 8x8 cm sized, erythematous boggy mass with pustules and crusts on the right occipital scalp. Cultures from scalp lesion and infected hair on Sabouraud dextrose agar media showed T. mentagrophytes. Histopathologic findings showed inflammatory cell infiltration in entire dermis and many spores around the hair shaft. The skin lesion was successfully treated with terbinafine (250 mg/ day) for 8 weeks. This case is reported with three interesting facts: Kerion celsi caused by T. mentagrophytes has been rarely reported in Korean literatures; Kerion celsi is occuring in an aged man with decreased cellular immunity after chemotherapy; Kerion celsi caused by T. mentagrophytes responded well to oral terbinafine.
Agar ; Aged ; Child ; Dermis ; Drug Therapy ; Glucose ; Hair ; Humans ; Immunity, Cellular ; Scalp ; Skin ; Spores ; Tinea Capitis* ; Trichophyton*