A case of micronodular cirrhosis of the alcoholic type developed following an intestianl bypass surgery in a 47 year-old nonalcoholic male patient is presented. The patient denied any drug use of a long duration and had no diabetes mellitus. Five years before, a side to side ileo-transverse colon anastomosis had been performed for perforated intestinal tuberculosis at 1 m proximal to the ileocecal valve, bypassing a short segment of ileum (about 1.5 m) and transverse colon. The ileum distal to the perforated site had been found completely stenosed. He was severely lean with evidences of nutritional deficiency such as low serum levels of the albumin and vitamin B12. The liver biopsy showed a fatty change, Mallory bodies and perihepatocellular collagenosis within the cirrhotic nodules. The present case suggests that, when there are blind loop formation and nutritional deficiency, hepatic changes identical to those following jejunoileal bypass could develop even by reduction of a shore segment of the small intestine.
Male ; Humans ; Biopsy

No abstract available.
Female ; Perinatal Mortality* ; Pregnancy ; Pregnancy, Multiple*

No abstract available.
Humans ; Hypothyroidism* ; Siblings*

No abstract available.
Humans ; Quintuplets*

No abstract available.
Beckwith-Wiedemann Syndrome*

Ketamine may increase blood pressure and heart rate and should be avoided in hypertensive patients. However, in hypovolemic and asthmatic patients, ketamine is used as an induction agent because of its cardiovascular stimulating effect and bronchodilating effect. This study aims to assess the effects of clonidine and lidocaine on the cardiovascular response of intravenous ketamine administration during induction of anesthesia. sixty patients were divided into 3 groups as followed: group I: control ( received no lidocaine or no clonidine) group II: received lidocaine (1.5 mg/kg IV) 3 minutes before intubation group IIl: received clonidine (0.3 mg PO) 90 minutes before induction of anesthesia The changes of blood pressure, heart rate and rate pressure product following intubation were measured at different time interval (before induction,before intubation just after intubation, postintubation 1, 3, 5, 10 min) and compared with the value of control (2 hours before induction of anesthesia). The results are as follows 1) Group I and Group II: The systolic and diastolic blood pressure increased significantly compared to the control value from preinduction to 5 minutes after intubation(p<0.05). It recovered to the control value in 10 minutes, but heart rate and rate-pressure product increased significantly for 10 minutes after intubation(p<0.05) 2) Group III: The systolic and diastolic blood pressure, heart rate and rate-pressure product of preinduction and preintubation values decreased significantly compared to control values but 1 minute after intubation,all values increased significantly(p<0.05). The systolic and diastolic blood pressure and rate-pressure product values recovered to control value in 3 minutes after intubation and heart rate recovered in 5 minutes. Comparing group III with group I and II, it showed significant changes(p<0.05). From the above results, it can be concluded that clonidine inhibits cardiovascular stimulating response by ketamine during induction of anesthesia. the above results, it can be concluded that clonidine inhibits cardiovascular stimulating response by ketamine during induction of anesthesia.
Anesthesia* ; Blood Pressure ; Clonidine* ; Heart Rate ; Humans ; Hypovolemia ; Intubation ; Ketamine* ; Lidocaine* ; Premedication*

Blood gas samples are highly susceptible to preanalytic error due to improper methods of obtaining or handling the sample prior to delivery to the laboratory. The errors in the measurement of blood gas analysis are currently derived from the exposure of sample to atmosphere, effects of anticoagulant itself, temperature difference between the measuring electrode and drawn blood and the delay in running the sample. To study the effects of the delay in measuring the sample and the temperature difference between the measuring electrode and drawn blood on values of blood gases and pH, we analyzed the arterial sampling from the 24 patients who were taking elective surgery or on his/her recovery period with indwelling arterial catheter. The plastic sampling syringes were kept at 4 degrees C (refrigerator) or 22-24 degrees C (room temperature) and analyzed at regular intervals (1, 10, 30, 60,120 min) for 120 minutes. The following results were obtained: 1) When the arterial blood drawn from the anesthetized patients were stored at 4 degrees C, partial pressure of oxygen (PaO2) decreased significantly after 20 min, whereas those stored at room temperature decreased significantly after 10 min. 2) When the arterial blood drawn from the recovery patients were stored at 4 degrees C, PaO2 did not decrease significantly through the experimental period of 120 min. Although those stored at room temperature did not decrease significantly through the period of 120 min. 3) Partial pressure of carbon dioxide in the arterial blood (PaCO2,) drawn from the anesthetized patients increased significantly by 120 min. at 4 degrees C, whereas those at room temperature increased significantly after 20 min. 4) PaCO2, of the recovery patients increased signigicantly by 120 min. at 4 degrees C, whereas those at room temperature increased significantly after 30 min. 5) pH of the arterial blood drawn from either anesthetized or recovery patients decreased significantly by 120 min. at 4 degrees C, whereas those at room temperature decreased significantly after 60 min. 6) No significant changes of arterial oxygen saturation (SaO2) and content (CaO2) were noted in either anesthetized or recovery. patients in accordance with time elapsed at 4 degrees C or room temperature. In summary, as the changes of PO2 in particular higher than physiologic PO2 and PCO2 in the arterial blood stored at room temperature are significant in accordance with the delay in measuring, it would be advisable to analyze the sample in a short period of time or to store it in a cool place when the measuring will be delayed.
Atmosphere ; Blood Gas Analysis ; Carbon Dioxide ; Catheters ; Electrodes ; Gases* ; Humans ; Hydrogen-Ion Concentration* ; Oxygen ; Partial Pressure ; Plastics ; Running ; Syringes

BACKGREOUND: The ideal drug for treatment of pulmonary hypertension would be a vasodilator which acts preferentially on the pulmonary vascular bed. The aim of this study was to compare the effects of prostaglandin I2 (PGI2) on central hemodynamics and right ventricular function with the more widely used vasodilators, prostaglandin E1 (PGE1) and nitroglycerin (NTG) and to investigate whether PGI2 is more selective to the pulmonary vascular bed compared with PGE1 and NTG in dogs. METHODS: We have used a method for producing sustained pulmonary hypertension in vivo by continuous infusion of U46619 adjusting the infusion rate until a mean pulmonary artery pressure (PAP) exceeded 25 mmHg. And the pulmonary and systemic effects of the three pulmonary vasodilators were compared at doses producing equivalent, lowered approximately 20% of mean arterial pressures (MAP) or mean PAP returned to baseline. RESULTS: After infusion of the three vasodilators, heart rate, cardiac output, and mean PAP/MAP ratio were significantly increased, but there was no statistical significant differences among the three vasodilators. PGI2 and PGE1 significantly increased (worsened) the PVR/SVR ratio, but NTG decreased. However there was no significant difference among the three vasodilators. After infusion of the three vasodilators, the arterial oxygen tension (PaO2), mixed venous oxygen tension (PO2), O2 deliver, and O2 uptake were increased, and shunt ratio (s/t(%)) were significantly decreased, but there were no significant differences among three vasodilators. CONCLUSIONS: PGI2, PGE1, and NTG all decreased both PVR and SVR. None of these vasodilatorswere more selective to the pulmonary vascular bed, myocardial performance, and improved gas exchange.
15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid ; Alprostadil* ; Animals ; Arterial Pressure ; Cardiac Output ; Dogs* ; Epoprostenol* ; Heart Rate ; Hemodynamics* ; Hypertension, Pulmonary* ; Nitroglycerin* ; Oxygen ; Pulmonary Artery ; Vasodilator Agents ; Ventricular Function, Right

We experienced a case of inadvertent partial removal of vdegrees Cal polyp which was expelled through the tube after awake endotracheal intubation with stylet under direct laryngoscopy. The patient was a 73-years-old female suffering from dyspnea on exertion for 5 days and diagnosed bilateral vdegrees Cal polyps which were nearly obstructed vdegrees Cal cords. Awake endotracheal intubation was planned for her operation after preoperative conference with surgeons because she did not want tracheostomy. After topical anesthesia with 4% liddegrees Caine spray on oropharynx and injected midazolam intravenously, endotracheal tube with stylet under direct laryngoscopy was inserted with ease. But immediately after removal of the stylet, coughing was developed and a part of polyp was expelled through the tube. So, it might be suggested that tracheal reflex should be preserved when the patient refused tracheostomy and injury of lesion was worried by any kinds of awake intubation techniques.
Anesthesia ; Cough ; Dyspnea ; Female ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Midazolam ; Oropharynx ; Polyps* ; Reflex ; Tracheostomy

PURPOSE: To understand the structure and character of the right retroperitoneal space by analysis of the extension of retroperitoneal hematoma in patients with traumatic right renal injuries. MATERIALS AND METHODS: We retrospectively reviewed CT scans of 13 patients with right retroperitoneal hematomas caused by right renal injury. At the renal level, we analyzed the relation of a hematoma contacting psoas muscle with other retroperitoneal compartmental hematomas. At the suprarenal level, a perirenal hematoma and a hematoma contacting the diaphragm were analyzed according to their relation with intrahepatic IVC and pericaval hematoma. RESULTS: Below renal hilar level, all hematomas contacting psoas muscle, observed in eight cases, were connected with retrorenal extension of anterior pararenal hematoma. At the suprarenal level, intrahepatic pericaval hematomas were not, in all 13 cases, connected with a hematoma contacting the diaphragm, but with a perirenal hematoma. At the upper suprarenal level, the only pericaval hematomas containing a medial component of perirenal hematoma extended superiorly to the upper one third of the tenth thoracic vertebral body. CONCLUSION: The anterior renal fascia envelops perirenal space except in its medial aspect. In the upper suprarenal region, the anterior and posterior planes of the anterior renal fascia unite to fuse with diaphragmatic fascia, but along the medial aspect they fuse with intrahepatic pericaval connective tissue and posteromedial diaphragm, respectively.
Connective Tissue ; Diaphragm ; Fascia ; Hematoma* ; Humans ; Psoas Muscles ; Retroperitoneal Space* ; Retrospective Studies ; Tomography, X-Ray Computed