BACKGROUND: Propofol and ketamine had been used for anesthesia induction and for total intravenous anesthesia. The nature of any hypnotic interactions occurring between propofol and ketamine are unknown. A comparison of maternal and neonatal effects among propofol-ketamine combination, ketamine and propofol were studied when used for anesthesia induction in Cesarean section. METHODS: Forty five patients in ASA class I or II scheduled for Cesarean section randomly assigned to either propofol 2 mg/kg (n=15), ketamine 1 mg/kg (n=15) or propofol 1 mg/kg - ketamine 0.5 mg/kg combination group (n=15) as an induction agent. Maternal systolic and diastolic blood pressure, heart rate, Apgar score and umbilical blood gas analysis were measured. RESULTS: Before intubation, systolic and diastolic pressure were decreased in propofol group but increased in ketamine and propofol-ketamine combination group. Heart rate were increased in all three groups. But there were no significant differences among three groups (p<0.05). After intubation, there were significant increase in systolic, diastolic pressure and heart rate in three groups but no significant differences among three groups (p<0.05). And there was no significant neonatal depression as assessed by Apgar scores and blood gas analyses. CONCLUSIONS: Propofol-ketamine combination was found to be similar to propofol or ketamine only in the effects on the mother and neonate. But propofol-ketamine gained more stable hemodynamic change than propofol or ketamine before intubation. Therefore propofol-ketamine appears to be a suitable alternatives to propofol or ketamine as an induction agent for anesthesia in Cesarean section.
Anesthesia ; Anesthesia, Intravenous ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section* ; Depression ; Female ; Heart Rate ; Hemodynamics ; Humans ; Infant, Newborn ; Intubation ; Ketamine* ; Mothers ; Pregnancy ; Propofol*

No abstract available.

No abstract available.
Anesthesia, Local* ; Diagnosis* ; Pneumothorax* ; Thoracoscopy*

Impetigo herpetiformis is a rare pustular eruption that may be seen in late pregnancy. It is associated with severe maternal and fetal complications in case of misdiagnosis and delayed treatment. The patient was a 25-years-old multigravida with psoriasis in her past history. At 20weeks gestation, she had been developed erythematous scaly annular patchs with papules and pustules on inner thigh. At 37weeks' gestation, the patient was suffered from a severely pruritic pustular rash with fever and leukocytosis. The skin of the affected areas was biopsied and showed intraepidermal pustular abscess with a neutrophilic infiltrate. Treatment commenced with intravenous fluids, antibiotics, systemic prednisone, steroid creams, and phototherapy(UVB) under the careful fetal well being monitoring. Cesarean section was done due to fetal distress, and a normal healthy male infant was delivered, following which the patient's condition improved rapidly.
Abscess ; Anti-Bacterial Agents ; Cesarean Section ; Diagnostic Errors ; Exanthema ; Female ; Fetal Distress ; Fever ; Humans ; Impetigo* ; Infant ; Leukocytosis ; Male ; Neutrophils ; Prednisone ; Pregnancy* ; Psoriasis ; Skin ; Thigh

A fetal rhabdomyomatous nephroblastoma is considered to be a predominantly monophasic mesenchymal variant of Wilms' tumor, which acts less aggressively than a conventional Wilms' tumor despite its much larger size. Bilaterality of this tumor in a nine month-old girl, however, may negatively affect the overall prognosis. A radical nephrectomy for bulky masses in the left kidney and a partial nephrectomy for right kidney with five small tumor masses was performed at the same time. Two small tumor masses in the upper part of right kidney were left behind because of preserving minimal renal functional capacity. Pathological study revealed a mixed type of nephroblastoma which was composed predominantly of mesenchymal components with fetal rhabdomyomatous differentiation. After post-operative chemotherapy with vincristine, actinomycin D and adriamycin, and radiotherapy(2,130 rad), residual tumor masses became a single tumor 5 cm in diameter and well demarcated, which was resected at 15 months after first operation when the size and renal function of remained right kidney was appropriate to resect out the residual tumor. The tumor resected out at second operation was entirely composed of scattered differentiated fetal skeletal muscle cells in the fibrovascular tissue. Only a few entrapped epithelial components were seen but no blastemal cornponents were present. Follow up abdominal CT and ultrasonographic examinations revealed no evidence of tumor recurrence. The girl has developed normally without disease.

No abstract available.

No abstract available.
Sinusitis*

No abstract available.
Aneurysm*

To define the effect of alkalinization of bupivacaine 0.5% in supraclavicular approch of brachial plexus bock, the onset of sensory and motorblock were determined. Fourty physical status ASA 1 were randomly allocated to two groups.: Group 1 (n=20); bupivacaine 0.5% 20 ml (pH 6.0-6.2). Group 2 (n=20); alkalinized buivacaine 0.5% 20 ml (pH 6.9-7.2). Onest of sensory blockade were determined by pinprick in the C4 - T2 skin dermatome, and extend of sensory block was assessed by the number of dermatomes blocked while motor blockade was assessed by scoring on a scale: Grade 1; inability to flex the elbow against resistance. Grade 2; inability to flex the elbow against gravity. Grade 3; inability to flex the wrist against gavity. The results were as follows. 1) The average time for sensory blockade of five dermatonies was significantly more rapid in group 2 (within 15 min) than those in group 1 (over 25 min). 2) The average time of motor blockade was significantly more rapid in group 2 (Grade 1: 2 min 43 sec, Grade 2: 11 min 36 sec) than those in group 1 (Grade 1: 5 min 4 sec, Grade 2: 18 min 36 sec). 3) There was no pneumothorax, phrenic nerve paralvsis and general seizure or other side effects but Horners syndrome in 10 cases and hematoma in 2 cases were observed. The results indicate that alkainized bupivacaine for supraclavicular approch of rachial plexus block has more rapid onset than plain bupivacaine.
Brachial Plexus* ; Bupivacaine* ; Elbow ; Gravitation ; Hematoma ; Horner Syndrome ; Phrenic Nerve ; Pneumothorax ; Seizures ; Skin ; Wrist