No abstract available.
Rectal Neoplasms*

Paraplegia resulting from the operative treatment of scoliosis is a serious complication feared most by orthopedic surgerns. Scoliosis Research Society reported the incidence of acute neurological complications resulting from the treatment of scoliosis as 0.72% in 1975. Thus, the importance of the development of some form of adequate practical spinal cord monitoring during major corrective surgery of the spine has become increasingly recognized as the surgery in this area has accelerated. In order to reduce the incidence of such neurological complications, intraoperative spinal cord monitoring has introduced since nineteen seventies. Monitoring of cortical somatosensory evoked potentials (CSEP) were applied in surgery of 31 cases of scoliosis and 4 cases of cervical spine lesions at Department of Orthopedic Surgery at Seoul National University Hospital, from Jan. 1982 to May 1985, and the following results were obtained. 1) Quantitative analysis of CSEP was done in 31 cases of scoliosis as grouping into preincision, preinstrumentation, postinstrumentation and skin closure periods. From preincision period, P1 and N1 latencies prolonged significantly across all periods but not from preinstrumentation period to subsequent periods. P1-N1 amplitude and P2-N2 amplitude were decreased significantly between preincision period and other periods but no significant change was noted from preinstrumentation period to skin closure period. (P<0.05) 2) Abnormal CSEP findings were noted during operations in 4 cases, in which acute neurological complications were prevented with CSEP monitoring. 3) We experienced a case in which CSEP was abolished on the concave side of the curve while CSEP was normal on the convex side, during distraction. So it is considered that the ankle electrode should be placed on the concave side of scoliosis to detect neurological complication. 4) Correctibility of deformity in scoliosis surgery was increased from 44.1% to 51.3% with the use of intraoperative CSEP monitoring without acute meurological complications. 5) CSEP monitoring during spine surgery is an effective method to prevent neurological complication.
Ankle ; Congenital Abnormalities ; Electrodes ; Evoked Potentials, Somatosensory ; Incidence ; Intraoperative Complications ; Methods ; Orthopedics ; Paraplegia ; Scoliosis ; Seoul ; Skin ; Spinal Cord ; Spine

Subcutaneous emphysema is a complication of the pneumoperitoneum necessary to perform laparoscopy and will be seen more often as laparoscopic techniques are applied to a growing number of intraabdominal procedures. We report a case of subcutaneous emphysema and hypercarbia without pneumothorax or pneumomediastinum during laparoscopic cholecystectomy, which was treated by multiple puncture with 18G needle on emphysematous site. The suspected cause is inadvertent subcutaneous insufflation of carbon dioxide through the trocar sites by increased intra-abdominal pressure for the establishment of pneumoperitoneum. Immediate recognition, evaluation, and treatment of subcutaneous emphysema is necessary since this can be life-threatening complication.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Insufflation ; Laparoscopy ; Mediastinal Emphysema ; Needles ; Pneumoperitoneum ; Pneumothorax ; Punctures ; Subcutaneous Emphysema* ; Surgical Instruments

BACKGROUND: Endobroncheal intubation or extubation may occur accidentally when the patient's neck is flexed or extended even in the appropriate endotracheal intubation. The purpose of this study is to examine the effect of fixation or unfixation of the endotracheal tube at the teeth level on the displacement of its distal end when the patient's neck is extended or flexed. METHODS: This study was conducted in 37 patients who underwent endotracheal general anesthesia. The patients with the evidence of pathology in head, neck and chest were excluded from the study. Individual patient's displacement in endotracheal tube tip compared unfixed cases with fixed cases when the change of neck position. The moved distance was measured by fiberoptic bronchoscope. The data were statistically analyzed by Student's paired t-test. RESULTS: The endotracheal tube moved away from the carina when the patient's neck was extended, while it moved toward the carina when flexed in all cases. When the patient's neck was extended the average distance displaced 1.2 0.7 cm in fixed cases and 1.1 0.9 cm in unfixed cases. when the neck was flexed, they were 1.2 0.5 cm and 1.0 0.8 cm respectively. There were not statistically significant between the fixed and the unfixed cases. CONCLUSIONS: It is concluded that the displacement of the endotracheal tube is not related to its fixation or unfixation at the teeth level and therefore, unfixation does not provide any benefits in terms of the displacement of the distal end of the tube in adult trachea.
Adult ; Anesthesia, General ; Bronchoscopes ; Head ; Humans ; Intubation ; Intubation, Intratracheal ; Neck* ; Pathology ; Thorax ; Tooth ; Trachea

Dopamine receptors in the CNS and other several tissues were identified by physiological, biochemical and radioligand binding techniques. But previous morphological and biochemical studies have been unable to charaterize or determine the tissue distribution of dopamine receptor subtypes because no selective ligands are available yet. Furthermore, the cellular distribution of the dopamine receptor subtypes in the rat kidney is not demonstrated well. The present study utilizes specific antibodies to characterize the renal distribution of this dopamine receptor subtype using light microscopic immunohistochemistry in the rat kidney. In the rat kidney, D1 receptor protein was localized to proximal tubule, distal tubule, renal vessels, medullary collecting tubule, juxtaglomerular apparatus(JGA) and glomerulus. And D2 receptor protein was localized to distal tubule, Henle's loop, proximal tubule, medullary collecting tubules, juxtaglomerular apparatus(JGA) and renal vasculature. The D1 and D2 receptors, which present in the central nervous system, are now identified in the rat kidney. There are some differences in receptors expressing sites on the previous radioligand binding and pharmacologic studies, but these results suggest that at least some of the renal dopamine DA1 and DA2 receptors correspond structually to the central dopamine D1 and D2 receptors.
Animals ; Antibodies ; Central Nervous System ; Dopamine* ; Immunohistochemistry* ; Kidney* ; Ligands ; Rats* ; Receptors, Dopamine ; Tissue Distribution

Ketamine hydrochloride(ketamine) is a non-barbiturate anesthetic agent chemically designated as dl-2-(0-chlorophenyl)2-(methylamino)-cyclohexanone hydrochloride. Ketamine anesthesia has been found distinctively different from that induced by conventional anesthetic agents, as it provides profound analgesia without significant impairment of respiratory function or stimulation of cardiovascular activities thus avoiding hypotension and are preserved the protective pharyngeal and laryngeal reflexes. In addition, ketamine appears to have muscle relaxation properties. This latter clinical finding, however has not been experimentally substantiated since few reports have appeared on the effect of ketamine on muscle relaxation. The present study therefore, was undertaken to determine whether this agent affects the muscle activity during d-tubocurarine block. The experiment was performed on sixteen rabbits weighing 1.8 to 2.5kg and these were divided into two groups; eight rabbits for control and eight for th study group. All animals were intubated through a tracheostomy under general anesthesia with nembutal 40mg/kg given intravenously. Respiration was controlled by means of a Harvard animal respirator. The body temperature was kept at 35 degrees C to 36 degrees C with a thermo-blanket. The common peroneal nerve and anterior tibial muscle was exposed and the nerve stimulator was applied to the nerve muscle preparation. The twhitch height of the muscle contraction was recorded on a biophysiograph through the force displacement transducer. The common peroneal nerve was stimulated supramaximally using a single twitch, square wave of 0.2 msec duration at a frequency of 0.1Hz once every 10 seconds. The degree of neuromuscular block following intravenous injection of d-tubocurarine 1mg/kg was measured in the control group. And in the study group ketamine 5mg/kg was administered intravenously when 25% of twitch height of muscle contraction was obtained spontaneously after the intravenous injection of d-tubocurarine 1mg/kg. The changes of the twitch height of muscle contraction and the time of spontaneous recovery in the study group were compared with those of the control group. The results were as follows: 1) The times and degree of maximal single twitch depression were obtained at 194.8sec and 87.3% in the control group and were at 197.5 sec and 87.8% in study group. No significant difference was observed. 2) Recovery index of the control group was 1,560.0 sec and recovery index of the study group was markedly prolonged to 2,387.5 sec(53.0% prolongation). 3) Mean decrease of single twitch height was 8.8% soon after the intravenous ketamine 5mg/kg when 25% of twitch height was obtained after the intravenous d-tubocurarine 1mg/kg in the study group.
Rabbits ; Animals

Santonin-kainic acid complex was evaluated as a chemotherapeutic of the mass treatment of the Ascaris lumbricoides infection in Korea. The results could be summarized as follows: The negative conversion rate was 82.9% in average in 4 treated groups. Some variations of negative conversion rate among the treated groups were noticed. The egg reduciton rate was 97.7% in average and the results were rather uniform among the three evaluated groups. By the analysis of egg reduction, it seems that the lightly infected cases whose E.P.G. were under 5,000 were resistant to treatment with the less reduced egg output. After the treatment with this complex, the number of egg discharged cases were reduced to 1.84% and the average number of discharge eggs per incompletely treated or untreated cases were reduced to 12.5% compared with the level of before-treatment egg output. The successive observations of the pattern of worm expulsion after drug intake was made. The worms were mostly expelled in the stool within 3 days, and 58.9% of total expelled worms were collected within 24-hour stool. The minimum length of the immature worms expelled was 7.6cm. Among the 659 Ascaris collected in the first-day stool from 91 rural people, 8.5% were in the range of 7.6-12.2 cm-long, immature worms. The sex ratio, male: female= 0.69: 1.
parasitology-helminth-nematoda ; Ascaris lumbricoides ; chemotherapy ; Santonin ; kainic acid

Patients vary markedly in their responses to d-tubocurarine chloride. Despite an attempt to diminish the variation in responses to relaxants by standardizing experimental techniques, anesthetic concentration kept constant, acid-base status kept constant, premedication omitted, dosage calculated in terms of mg/sq meter body surface, the marked variation was found to persist. The dose related neuromuscular blocking effect of d-tubocurarine chloride was investigated using a rabbit common peroneal nerve anterior tibial muscle preparation. All experimental rabbits tracheas were intubated through tracheostomy under general anesthesia with Nembutal 40 mg/kg intravenously. Reapiration was controlled by a Harvard animal respirator. The body temperature was kept at 35-37 degrees C by a thermoblanket. The degree of neuromuscular block following intravenous d-tubocurarine chloride was measured by single twitch response. The common peroneal nerve was stimulated supramaximally using a square waves of 0. 2 msec duration at a frequency of 0.1 Hz, and each stimulus was repeated once every 10 seconds. The ratio of the twitch height was calculated. The results were as follows: 1) No neuromuscular blocking effect was observed with 0.1 mg/kg of intravenous d-tubocu- rarine chloride. 2) 100% of neuromuscular blocking effect was observed with more than 1mg/kg of intravenous d-tubocurarine chloride. This is 5 to 10 times higher than the human dose. 3) Dose related prolonged neuromuscular blocking effect was observed from d-tubocurarine chloride in rabbits.
Anesthesia, General ; Animals ; Body Temperature ; Humans ; Muscle, Skeletal ; Neuromuscular Blockade* ; Pentobarbital ; Peroneal Nerve ; Premedication ; Rabbits* ; Trachea ; Tracheostomy ; Tubocurarine ; Ventilators, Mechanical

Left atrial myxoma is well-known mimicker of systemic vasculitis. In general, however, these patients showed some symptoms and signs of cardiovascular disease. We experienced a patient with left atrial myxoma who first presented as vasculitis without any symptoms and signs suggesting cardiovascular disorders. A 45 year-old lady showed tender skin nodules, livedo reticuiaris-like skin lesions, severe constitutional symptoms, multiple cerebral infarctions, and elevated ESR and globulin. Skin biopsy findings were thought to be consistent with polyarteritis nodosa. Echocardiography was performed as a routine test for evaluating suspected vasculitis patients and it revealed left atrial myxoma. However, we were not able to detect any auscultation abnormality, even after echocardiography, After echocardiography, we found the tumor emboli in skin biopy specimen with deeper section. This case demonstrated the importance of suspecting the possibility of left atrial myxoma when performing diagnostic work-up for vasculitis.
Auscultation ; Biopsy ; Cardiovascular Diseases ; Cerebral Infarction ; Echocardiography ; Humans ; Middle Aged ; Myxoma ; Polyarteritis Nodosa ; Skin ; Systemic Vasculitis ; Vasculitis

During anesthesia and surgery, body homeostasis and tissue oxygen demand/supply balance is disrupted and blood lactate concentration in increased. We have studied the changes of blood lactate concentrations and arterial, venous oxygen contents during open heart surgery in 15 patients. Samplings were done at 1) before anesthetic induction, 2) after induction, 3) after sternotomy, 4) onset of cardiopulmonary bypass, 5) duing hypothermic cardiopulmonary bypass, 6) after cardiopulmonary bypass and 7) after operation. Blood lactate concentrations were inereased signifieantly at the onset of, during and after cardiopulmonary bypass and after operation(p<0.001). Arterial oxygen contents were decreased significantly at the onset of, during and after cardiopulmonary bypass(p<0.05). Venous oxygen contents were decreased significantly at the during and after cardiopulmonary bypass and after operation(p<0.05). There were significant negative correlations between arterial, venous oxygen contents and blood lactate concentrations. Changes of venous oxygen saturation, mean arterial pressure and pH had not significant relationships with the lactate concentrations.
Anesthesia ; Arterial Pressure ; Cardiopulmonary Bypass ; Heart* ; Homeostasis ; Humans ; Hydrogen-Ion Concentration ; Lactic Acid* ; Oxygen ; Sternotomy ; Thoracic Surgery