Surgical intervention during the pregnancy is not rare and the impact of anesthesia and surgery during the pregnancy is doublefold, because the mother and the fetus in uterus are concerned. The anesthesiologist must know the progressive' maternal changes during the pregnancy and drug action on the fetus. The authors have experienced 50 cases of pregnant women undergoing various kinds of operation and have analyzed those cases according to the type of disease, the duration of gestation, physical status, premedication, anesthetic technics and agent used, and the outcome of the fetus and the patient during the period between March 1972 to August 1978 The results were as follows: 1) The most of patient, 32 cases were operated for the obstetric and gynecological :reason s. 2) 27 cases (54%) had undergone the operation during the second trimester. 3) Physical status class 2 including 28 cases (56%) was the most commonly found physical status of the patients. 4) Halothane was the main anesthetic agent for 39 cases (78%) and there were 3 cases of spinal anesthesia. 5) We could follow 27 cases among 50 cases about the outcome of the fetus. 17 spontaneous vaginal delivery, 8 Cesarean sections, 1 fetal death in uterus and 1 wanted D&C. 6) Among 5 premature deliveries, 2 premature infants died during the hospitalization. 7) The only maternal motality was the case of intrahepatic stone who expired 11 days postoperatively and delivered a 1,300 gm premature 7 days postoperatively.
Anesthesia ; Anesthesia, Spinal ; Cesarean Section ; Dilatation and Curettage ; Female ; Fetal Death ; Fetus ; Halothane ; Hospitalization ; Humans ; Infant, Newborn ; Infant, Premature ; Mothers ; Pregnancy ; Pregnancy Trimester, Second ; Pregnant Women ; Premedication ; Uterus

It is well known that general anesthesia and surgery cause acute depression of renal function. Also, the occurrence of frank bleeding from the urinary tract can form a blood clot which may block an indwelling catheter or even a normal urethra with development of urinary infection. Many studies have reported that prophylactic use of hypertonic mannitol will prevent acute functional renal impairement during general anesthesia and surgery, and reduce the incidence of clot formation and acute pyelonephritis. We believe that diuresis itself is a reneprotective mechanism and polyuria may yield two other advantages; 1. Fewer plugged catheters by decreasing the incidence of clots. 2. Decreased incidence of acute pyelonephritis by preventing stasis and washing out bacteria. since 1972, in our hospital, 100cc or 200cc of 20% mannitol was used for increasing the urine output during operation of urinary stone in 33 patients, We have shown that the prognosis of patients was good.
Anesthesia, General ; Bacteria ; Catheters ; Catheters, Indwelling ; Depression ; Diuresis ; Hemorrhage ; Humans ; Incidence ; Mannitol* ; Polyuria ; Prognosis ; Pyelonephritis ; Urethra ; Urinary Calculi ; Urinary Tract

Myasthenia gravis is a rare disease entity in Korea, and its occurrence with a thymoma is even rarer. Myasthenia gravis has offered many difficult problems for the anesthesiologist because it affects respiratory muscles frequently and perioperative management of these patients is difficult. The authors aensthetized a patient with myasthenia gravis and thymoma. We report this experience with a brief literature review.
Humans ; Korea ; Myasthenia Gravis* ; Rare Diseases ; Respiratory Muscles ; Thymoma*

There is the trend of increasing number of outpatients who are requiring surgical intervention because of medical insurance and general improvement of economic state. Ambulatory surgical clinics are prospering in the United States. Thus we have analyzed 1957 cases of outpatient anesthesia excluding local infiltration performed by surgeons from total of 4302 cases o fout patient surgery during the 5 year period between 1975 and 1979. The results of this analysis were as follows: 1) Ketamine IM or IV was used as a sole agent in 500 cases who were under 12 years of age and mean operation and recovery time were 19.95 and 58. 45 minutes, respectively. 2) Mean operation and recovery time for 1,125 cases of pentothal+N2O+O2, anesthesia were 15. 55 and 108. 23 minutes, respectively. 3) For 321 cases of halothane+N2O+O2, anesthesia, mean operation and recovery time were 40.67 and 145. 94 minutes, respectively. 4) During recovery period there were no serious complications or mortality. 5) The majority of 1,125 among 1,957cases were gynecological outpatients and the rest were distributed among the surgical departments and dermatology, 6) Pentothal, nitrous oxide, halothane and ketamine were used safely for the outpatient anesthesia according to our experiences.
Anesthesia* ; Clinical Study* ; Dermatology ; Halothane ; Humans ; Insurance ; Ketamine ; Mortality ; Nitrous Oxide ; Outpatients ; Surgeons ; Thiopental ; United States

Sudden operative death due to massive tumor embolism occurred during operation. During the course of anesthesia for pneumonectomy, this 54-year-old male patients showed continuous hypotension, weak or absent pulse of radial, external carotid, femoral and doralis pedis artery of the right side. But those of the other side were within normal range and anesthesia went on uneventfully. As the patient failed to gain consciousness postoperatively, immediate emboleetomy under general anesthesia was performed under the impression of massive tumor embolism. Multiple tumor emboli were removed from the innominate arteries, right common carotid and right brachial artery. After operation of embolectomy, arterial blood pressure and pulse measured on the right side were regained. However, the patient failed to return to his consciousness and died due to unexpected cardiac arrest, 2 days later.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Arteries ; Brachial Artery ; Brachiocephalic Trunk ; Consciousness ; Embolectomy ; Heart Arrest ; Humans ; Hypotension ; Lung* ; Male ; Middle Aged ; Neoplastic Cells, Circulating* ; Pneumonectomy ; Reference Values

The authors presented an analysis non-operative management on 20 epidural hematomas(EDH's) management who had been admitted from June, 1986. to May, 1988. The results were summarized as follows: 1) A number of EDH patients(17/20) with neurologically minor deficits could be successfully managed by conservative management, whereas we underwent surgical evacuation on 3 other cases with clot volume over 50cc. 2) Serial Brain CT scans on 20 patients revealed mostly two types of resolution pattern: One with an intervening expansile phase preceding net resorption(5 cases; 25%), and the other without this phase(15 cases; 75%). 3) All of patients presented mild symptoms and signs(Glasgow Coma Score>13). However, the common complaints were headache and vomiting. 4) The mean period from admission to discharge was 5.6 weeks, and the mean number of followup CT scan was 4.2 times.
Brain ; Coma ; Follow-Up Studies ; Headache ; Hematoma* ; Humans ; Tomography, X-Ray Computed ; Vomiting

The Health Post Project in Gang Wha Gun is part of the Yonsei University Medical College's Community Health Teaching Project. Two townships, Son Won Myun and Nae Ga Myun, with a total population of 14,000 are being guided through a planned change process in order to raise health consciousness in the community based education of medical and other health manpower through demonstration of relevant community health principles and provision of entry points for applied teaching. The key to community access is provided through village based Family Health Workers (FHW) who, according to carefully designed selection procedures, functions, service package, training and implementation plan now serve as semi-independent village health representatives. The FHW is supervised by the government employed township health workers who in turn received re-orientation as multi-purpose workers. Their functions were re-designed according to project needs. Thus the government health services in the target area have been extended to the household level through FHW activities in MCH, TB care and Family Planning. The Health Post Project provides a statistically controlled environment with a base line survey and constantly incoming data. It also provides communication channels for reciprocal understanding of the health issues and problems between traditional villagers and city educated faculty and students. Moreover, the Health Post Project provides motivation for the communities to solve their health problems with existing resources to the highest degree possible. Finally, the development of grass-root level services in cooperation with the communities has potential for long term benefits. These include relevant training of health manpower regarding principles and practice of rural community health. It also includes the study and development of health manpower and service packages, streamlining of administrative and evaluation procedures, and information urgently needed for health planning.
Community Health Services* ; Delivery of Health Care* ; Human ; Korea ; Rural Health*

A 13-year-old male developed cardiac arrest and pulmonary edema during an elective surgery for chronic mastoiditis following a local injection of 0. 1 ml of 1: 1000 adrenaline under general anesthesia. After several days, 14-year-old male developed same episode during tonsillectomy under local anesthesia at ENT out patient department. They showed an immediate and favorable response to treatment with CPPB, rapid digitalization, fluid therapy, etc. The clinical course and pathophysiology of adrenaline induced pulmonary edema will be discussed.
Adolescent ; Anesthesia, General ; Anesthesia, Local ; Epinephrine* ; Fluid Therapy ; Heart Arrest ; Heart Arrest, Induced* ; Humans ; Male ; Mastoid ; Mastoiditis ; Pulmonary Edema* ; Tonsillectomy

Myasthenia Gravis is a chronic disease of disputed etiology, possibly an auto-immune reaction to the moter end-plate, characterized by exacerbations and remissions, a rare disease entity in Korea. Myasthenia Gravis has offered many anesthetic problems because it affects respiratory muscles occasionally and bronchial secretion from preoperative anticholinesterase therapy. The chief concern is to ensure adequate respiration both during and after operation. During the year 1976-1982, we have experienced the anesthetic management of 8 patients with myasthenia gravis and thymectomy. From our experiences, we conclude that respiratory care and disuse of relaxants is the key to successful management.
Chronic Disease ; Humans ; Korea ; Myasthenia Gravis* ; Rare Diseases ; Respiration ; Respiratory Muscles ; Thymectomy

A total of 82 pediatric renal transplants treated with cyclosporine and low dose prednisolone as the main immunosuppressive agents were used as the subjects of this study to find the risk factors whitch might influence the pediatric renal allograft survival in a single center from Feb. 1984 to Mar. 1996. The mean age of the recipients was 14.7 years ranging from ages 3.9 to 19.9. There were 19 cases of graft loss, and 3 recipient death. The major causes of the graft loss were acute and/or chronic rejection, poor compliance and patient's death. The 1-, 3- and 5-year graft survival were 94.9%, 86.2% and 70.7% respectively. The original renal deseases of ESRD were FSGS (14 cases), chronic pyelonephropathy and VUR (11 cases) and IgA nephropathy (8 cases) in order frequency. The significant risk factors for the outcome were the ABO incompatibility (ABO identical 89.6% vs compatible 26.9%, P=0.001) and development of more than 1 episode of acute rejection within 1 year (P=0.002) and after 1 year (P=0.004). Other factors such as recipient's age, donor-recipient relationship and type and duration of dialysis modalities before trasplantation (P>0.05). In conclusion, for the successful outcome of pediatric renal transplantation, strict ABO matching and development and application of more effective immunosuppressive agents such as mycophenolate or FK- 506 to combat the acute and/or chronic rejection is required in near future.
Allografts* ; Compliance ; Cyclosporine* ; Dialysis ; Glomerulonephritis, IGA ; Graft Survival ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation ; Prednisolone ; Risk Factors* ; Transplants