A review was made four cases for intraoperative or immediate postoperative cardiac arrest which occurred during the period from Jan. 1. 1980 to May 31. 1981 and resulted in death. The probable causes of death were: Case l: inadequate monitoring, hemorrbage, body fluid loss, lengthy operation and sepsis. Case ll: untoward effect of succinylcholine or an underlying cardiac problem. Case lll: cardiac failure due to cardiopulmonary dysfunction caused by kyphoscoliosis. Case lV: peripheral circulatory failure due to massive hemorrhage.
Body Fluids ; Cause of Death ; Heart Arrest* ; Heart Failure ; Hemorrhage ; Sepsis ; Shock ; Succinylcholine

OBJECTIVES: The early detection of ectopic tubal pregnancy in unruptured state is increased as the transvaginal sonography and sensitive serum hCG test are available. For this unruptured tubal pregnancy, the medical treatment using methotrexate via various routes and dosage is being tried. Our study was to evaluate the efficacy of single systemic injection of methotrexate in the treatment of unruptured tubal pregnancies. Material and METHODS: From the January 1997 to July 1999, of 152 ectopic pregnancy patients, 22 patients who were diagnosed as unruptured tubal pregnancies were treated with single-dose systemic methotrexate injection (50 mg/m2/IM). Exclusion criteria were unstable vital signs with hemoperitoneum, adnexal mass > 5-6 cm. Serum hCG titers were checked before injection and 4, 7 day after injection. If serum hCG titer declined more than 15% on 7 day after injection compared with titer on 4 day, the weekly hCG titer was followed until it was <10 mIU/ml .If the hCG titer did not decline more than 15 %, a second dose was given. If hCG titer was not decreased or vital signs became unstable after 1-2 injections, the treatment was considered failure and surgery was done. RESULTS: 18 cases (82%) of 22 were successfully treated with single-dose methotrexate. The mean size of ectopic mass and initial serum hCG titers were 2.7+/-1.3 cm (range, 1.5-5.4 cm) and 3,298+/-1,007 mIU/ml (range, 132-12,239), respectively. Of 22, 6 cases (28%) needed second dose of methotrexate. The mean time to resolution of serum beta-hCG titer was 27.5+/-13.6 days (range, 8-53 days). Elevation of liver enzyme did not occurred in all cases during treatment. Initial hCG titer was more important prognostic factor than ectopic mass size for successful medical treatment. CONCLUSION: Single-dose methotrexate appears to be an effective medical treatment for the unruptured tubal pregnancy. However, patients selection using strict criteria is needed to increase its success rate.
Female ; Hemoperitoneum ; Humans ; Liver ; Methotrexate* ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal* ; Vital Signs

Postoperative total blindness was seen in a 48 year old male who had a laparotomy for traumatic perforation of intestine. General inhalation anesthesia of ether-oxygen-mask with semiclosed system was applied after initial ketamine administration. This unhappy ocular complication could be occur secondary to excessive prolonged external compression to eyeballs with mask or/and prolonged postoperative hypotension.
Anesthesia, General* ; Anesthesia, Inhalation ; Blindness* ; Humans ; Hypotension ; Intestines ; Ketamine ; Laparotomy ; Male ; Masks