No abstract available.
Cervix Uteri* ; Female

Small cell carcinoma of the ovary has been identified as a specific histopathologic entity. The first II cases were reported by Dickersin et a1, 1982, Since then only 80 cases were reported in literature. This rare and highly aggresive melignancy primarily affeets ehildren and young women(10-40) and grows rapidly, with hypercalcemia occuring frequently. Abscence of effective treatment results in early mortality. Recently we have experienced one case of primary sma11 cell carcinoma of the ovary, which is presented with a brief review of the literature.
Carcinoma, Small Cell* ; Female ; Hypercalcemia ; Mortality ; Ovary*

The etiology of postoperative unconsciousness is p is various in origin. From Jan. 1973 to May 1981, 14 unconscious patients via the emergency room were treated in the intensive care unit at Pusan National University Hospital. The results are summarized as follows: 1) Sex distribution was 5 males and 9 males, and the age distribution was from 7 to 54. 2) The type of surgery were mainly hystrectomy and oophorectomy(6 cases) and the others were appendectomy(4 cases), gastrectomy(1 case), Cholecystectomy(1 case), and anal fistulectomy( 1case). 3) Seven cases were performed under spinal anesthesia, 6 cases were under inhalation anesthesia, and 1 case was done under Ketamine Hcl intravenous anesthesia. 4) On arrival at ICU, 12 patients were fully comatose and the others were semicomatese. 5) Meperidine was injected in 4 cases for the purpose of postoperative pain relief. 6) Ten cases expired, 3 cases recovered and 1 case was discharged without hope.
Age Distribution ; Anesthesia, Inhalation ; Anesthesia, Intravenous ; Anesthesia, Spinal ; Busan ; Coma* ; Emergency Service, Hospital ; Hope ; Humans ; Intensive Care Units ; Ketamine ; Male ; Meperidine ; Pain, Postoperative ; Postoperative Period* ; Sex Distribution ; Unconsciousness

Treatment of pelvic malignancy persistent or recurrent after surgery, radiation therapy or chemot-herapy presents a difficult therayeutie challenge. Those patients with central recurrence can be considered as candidate for radical resection. However we must consider many factors for the choice of treatment modality for advanced or recurrent pelvic rnalignancy as follows; the size and location of the recurrent cancer, dose of radiation therapy given, general conditions of the patient and the experience of the surgeon. Pelvie exenteration, when appropriate, is suecessful treatment for recurrent or persistent pelvic malignancy; 5-year survivai has been reported to be as high as 50%. We experienced seven cases of pelvic exepteration for pelvic malignancy between Mar. 1990 and Feb. 1993, Accordingly we present the cases with a brief review of the literatures. Seung Kew Baik, et al..: PeIlvic Exenteration in Treatment of Pelvic Malignancy: 3 Years Experience
Humans ; Pelvic Exenteration* ; Recurrence

BACKGROUND: Sevoflurane is characterized by the lack of an unpleasant odor, airway irritation and its low blood/gas partition coefficient (0.68), which provides rapid and smooth induction. Inhaled induction with sevoflurane is commonly used in pediatric patients, but not in adult patients. This study was designed to investigate the time to completion of LMA insertion and end-tidal sevoflurane concentration during induction with sevoflurane 8% and N2O 50%, after midazolam administration, in adults. METHODS: Twenty eight patients, aged 20(-60) years, were administered intravenous midazolam 30 microgram/kg and after one minute, sevoflurane 8% and N2O 50% were inhaled with tidal-volume breathing. One minute after loss of consciousness, jaw thrust and mouth opening were checked and an LMA was inserted. The end-tidal concentration of sevoflurane, and the times to loss of consciousness and completion of insertion were recorded. The mean arterial pressure and heart rate were also recorded. RESULTS: From initiation of sevoflurane and N2O inhalation, it took 48 +/- 14 seconds until loss of consciousness, and 143 +/- 19 seconds until the completion of LMA insertion. The end-tidal sevoflurane concentration was 4.1 +/- 0.6% at loss of consciousness, 5.0 +/- 0.7% at one min after loss of consciousness, and 4.1 +/- 0.5% after LMA insertion. In all patients LMA insertion was successful and satisfactory. After LMA insertion, compared to baseline, the mean arterial pressure was reduced and the heart rate increased. CONCLUSIONS: After small-dose of midazolam, inhaled induction with sevoflurane 8% and N2O 50% allowed successful and satisfactory LMA insertion in adults.
Adult ; Arterial Pressure ; Heart Rate ; Humans ; Inhalation ; Jaw ; Laryngeal Masks ; Midazolam* ; Mouth ; Nitrous Oxide ; Odors ; Respiration ; Unconsciousness

BACKGROUND: In pregnant woman, the respiratory system is influenced by the hormonal environment and an enlarged gravid uterus. After delivery of the fetus, and contraction of the uterus, changes in the respiratory system produced by the mechanical effect of the gravid uterus may decrease or be reversed. We designed this study to observe changes in the respiratory mechanics in pregnant woman under general anesthesia for cesarean section. METHODS: 15 pregnant women at term, ASA 1 were studied. Induction was performed with thiopental/succinylcholine and maintained with O2, N2O and enflurane until delivery. Just before delivery, enflurane was discontinued. Vecuronium was given at 0.1 mg/kg iv 4 min after induction, and after delivery, 1 mg was given as needed. Inspired tidal volume, expired tidal volume, inspired minute ventilation, expired minute ventilation, airway peak pressure, plateau pressure, expired volume during the first 1 second/expired tidal volume (V1.0), dynamic compliance and end-tidal CO2 were continuously measured just after induction, at delivery and 5, 10, 15, 20, 25, 30, 40 and 50 min after delivery. Blood pressure, heart rate and oxygen saturation were also measured. RESULTS: Compared to the value after induction, values after delivery showed no significant changes in inspired tidal volume or minute volume, but significantly increased in expired tidal volume and minute volume and dynamic compliance, and a significant decrease in airway peak pressure, plateau pressure, V1.0 and end-tidal CO2. Blood pressure and heart rate increased significantly after induction, compared to before induction. Oxygen saturation was maintained at 99-100%. CONCLUSIONS: After delivery, the effects of the gravid uterus on the respiratory system rapidly disappeared, in particular changes of pressure in the airway preceded the respiratory volume changes.
Anesthesia, General* ; Blood Pressure ; Cesarean Section* ; Compliance ; Enflurane ; Female ; Fetus ; Heart Rate ; Humans ; Oxygen ; Pregnancy ; Pregnant Women* ; Respiratory Mechanics* ; Respiratory System ; Tidal Volume ; Uterus ; Vecuronium Bromide ; Ventilation

BACKGROUND: Benzodiazepines have a hypnotic/sedative effect through the inhibitory action of gamma-aminobutyric acid type A receptor. Flumazenil antagonizes these effects via competitive inhibition, so it has been used to reverse the effect of benzodiazepines. Recently, flumazenil has been reported to expedite recovery from propofol/remifentanil and sevoflurane/remifentanil anesthesia without benzodiazepines. Endogenous benzodiazepine ligands (endozepines) were isolated in several tissues of individuals who had not received benzodiazepines. METHODS: Forty-five healthy unpremedicated patients were randomly allocated to either flumazenil or a control groups. Each patient received either a single dose of 0.3 mg of flumazenil (n = 24) or placebo (n = 21). After drug administration, various recovery parameters and bispectral index (BIS) values in the flumazenil and control groups were compared. RESULTS: Mean time to spontaneous respiration, eye opening on verbal command, hand squeezing on verbal command, extubation and time to date of birth recollection were significantly shorter in the flumazenil group than in the control group (P = 0.004, 0.007, 0.005, 0.042, and 0.016, respectively). The BIS value was significantly higher in flumazenil group than in the control group beginning 6 min after flumazenil administration. CONCLUSIONS: Administration of a single dose of 0.3 mg of flumazenil to healthy, unpremedicated patients at the end of sevoflurane/fentanyl anesthesia without benzodiazepines resulted in earlier emergence from anesthesia and an increase in the BIS value. This may indicate that flumazenil could have an antagonistic effect on sevoflurane or an analeptic effect through endozepine-dependent mechanisms.
Anesthesia ; Anesthesia, General ; Benzodiazepines ; Diazepam Binding Inhibitor ; Eye ; Fentanyl ; Flumazenil ; gamma-Aminobutyric Acid ; Hand ; Humans ; Ligands ; Methyl Ethers ; Parturition ; Respiration

BACKGROUND/AIMS: Patients undergoing Billroth II (B II) gastrectomy are at higher risk of perforation during endoscopic retrograde cholangiopancreatography (ERCP). We assessed the success rate and safety of forward-viewing endoscopic biliary intervention in patients with B II gastrectomy. METHODS: A total of 2,280 ERCP procedures were performed in our institution between October 2008 and June 2011. Of these, forward-viewing endoscopic biliary intervention was performed in 46 patients (38 men and 8 women with B II gastrectomy). Wire-guided selective cannulations of the common bile duct using a standard catheter and guide wire were performed in all patients. RESULTS: The success rate of afferent loop entrance was 42 out of 46 patients (91.3%) and of biliary cannulation after the approach of the papilla was 42 out of 42 patients (100%). No serious complications were encountered, except for one case of small perforation due to endoscopic sphincterotomy site injury. CONCLUSIONS: When a biliary endoscopist has less experience and patient volume is low, ERCP with a forward-viewing endoscope is preferred because of its ease and safety in all patients with prior B II gastrectomies. Also, forward-viewing endoscope can be used to improve the success rate of biliary intervention in B II patients.
Catheterization ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Endoscopes ; Female ; Gastrectomy ; Gastroenterostomy ; Humans ; Male ; Sphincterotomy, Endoscopic

OBJECTIVE: To evaluate the pattern of right gastric venous drainage by use of digital subtraction angiography. MATERIALS AND METHODS: A series of 100 consecutive patients who underwent right gastric arteriography during transcatheter arterial chemoembolization for hepatocellular carcinoma were included in this study. Angiographic findings were retrospectively analyzed with respect to the presence or absence of the right and aberrant gastric veins, multiplicity of draining veins, aberrant right gastric venous drainage sites, and the termination pattern of aberrant right gastric veins (ARGVs). We also compared the relative size of the right and left gastric veins. RESULTS: A total of 49 patients collectively had 66 ARGVs. The common drainage sites for the ARGVs included the hepatic segment IV (n = 35) and segment I (n = 15). The termination pattern of ARGV could be classified into 4 different types. The most common type was termination as a superficial parenchymal blush formation in small areas without demonstrable portal branches. A statistically significant difference was found for the dominancy of the right gastric vein in gastric venous drainage between the two groups with or without ARGV (p < 0.05, Fisher's exact test). In the group of patients without ARGV (n = 51), the right gastric vein was equal to (n = 9) or larger than (n = 17) the left gastric vein in 26 patients (26 of 51, 51%). CONCLUSION: The incidence of ARGV is higher than expected with four distinct types in its termination pattern. The right gastric vein may play a dominant role in gastric venous drainage.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction/*methods ; Carcinoma, Hepatocellular/therapy ; Chemoembolization, Therapeutic/methods ; Contrast Media/diagnostic use ; Female ; Humans ; Iohexol/analogs & derivatives/diagnostic use ; Liver Neoplasms/therapy ; Male ; Middle Aged ; Stomach/*blood supply ; *Veins

BACKGROUND/AIMS: In chronic inflammatory conditions such as ulcerative colitis (UC), the migration of granulocytes and monocytes/macrophages from the circulation into the colonic mucosa is especially important in maintaining inflammation. The aim of this trial was to assess safety and efficacy of granulocyte and monocyte adsorption apheresis in patients with moderate-to-severe UC refractory to conventional drug therapies. METHODS: Twenty-seven patients with moderate (55.6%) to severe (44.4%) active UC refractory to conventional drug therapies who had no changes in their conventional therapy regimen in the past two weeks before the recruitment were enrolled in an open-label trial. Concomitant medications were allowed, and steroids were tapered down according to the clinical activity during the course. We used an adsorptive type extracorporeal column (Adacolumn(R); JIMRO, Takasaki, Japan), which selectively adsorb granulocytes and monocytes. Patients took five apheresis sessions, each with 60 minutes duration for 5 consecutive weeks. The primary efficacy variables were clinical disease activity, short inflammatory bowel disease questionnaire (SIBDQ), C-reactive protein (CRP), and endoscopic scores. These variables were scored at regular intervals, and analyzed at week 7 on an intention-to-treat (ITT) principles. RESULTS: At 7 weeks, 70.4% of patients showed overall improvement. Clinical disease activity (p<0.0001), endoscopic score (p<0.001), and the quality of life as assessed by SIBDQ (p<0.0001) were significantly improved after the therapy. In 56.3% of concomitant steroid users, tapering down or discontinuation of steroids was possible. Treatment was well tolerated, and no severe adverse events were observed. CONCLUSIONS: Adacolumn was very efficacious in patients with moderate-to-severe active UC refractory to conventional drug therapy, but further assessment is needed.
Adult ; Colitis, Ulcerative/*therapy ; English Abstract ; Female ; *Granulocytes ; Humans ; *Leukapheresis ; Male ; *Monocytes