Melorheostosis is a rare entity while causes pain and stiffness in a limb and has an unknown etiology. It is characterized by roentgenographic appearance of melting wax dripping down one side of a candle along the major axis of long bone. The present case represents a melorheostosis of the left tibia accompanied by synovial chondromatosis in the left knee. Good result was obtained by arthrotomy of the left knee and removal of the bony masses in the joint.
Chondromatosis, Synovial ; Extremities ; Freezing ; Joints ; Knee ; Melorheostosis ; Tibia

Vasopressor effects of epinephrine, norepinephrine, ephedrine, phenylephrine, methoxamine and of mephentermine were compared in resrpinized dogs with or without nitrous oxide-oxygen-halothane anesthesia. The results are as follows: (1) Epinephrine and norepinephrine were shown to have the most potent pressor effect in reserpinized and nitrous oxide-oxygen-halothane-anesthetized dogs. Phenylephrine, methoxamine, mephen-termine and ephedrine were less potent in decreasing order. (2) Decrease in mean arterial pressure was less marked in dogs reserpinized and anesthetized with nitrous oxide-oxygen-halothane than in reserpinized but unanesthetized dogs. (3) It revealed that nitrous oxide-oxygen-halothane anesthesia potentiated the vasopressor effects of the sympathomimetic amines studied. Nitrous oxide-oxygen-halothane anesthesia is implicated to exert an sympathomimetic effect.
Anesthesia* ; Animals ; Arterial Pressure ; Dogs* ; Ephedrine ; Epinephrine ; Mephentermine ; Methoxamine ; Norepinephrine ; Phenylephrine ; Sympathomimetics*

To determine the effects of hydrcxyethyl starch upon liver, kidney, serm electrolytes and particularly upon blood coagulation, 500 ml of 6% HES in saline solution was administered intravenously to 15 patients during elective minor surgery. In all cases weighted blood loss was less than 600 ml without replacement. The following laboratory tests were performed immediately before infusion and again 1 hour, 24 hours, 48 hours, and 1 week after the infusion: RBC, WBC, hemoglobin, hematocrit, ESR, platelet, bleeding time, coagulation time, prothrombin time, total protein, albumin, total bilirubin, direct bilirubin, SGOT, SGPT, alkaline phosphatase, BUN, sodium, potassium, and chloride. The results are as follows: 1) No anaphylactic shock or bleeding tendency characteristic of colloids was encountered. 2) No functional disturbance of liver or kidney directly attributable to HES was identified. 3) All laboratory parameters except WBC and ESR decreased after infusion. The decrease was, however, within the normal range and believed secondary to dilational effect of infusion. WBC increased somewhat, but returned to the preinfusion level in a week. 4) Exceptionally erythrocyte sedimentation rate increased notably during the 24 hour period following infusion. As with dextran, this was interpreted not due to direct effect of HES, but due to increased adsorption of fibrinogen, alpha-beta-gamma-glcbulin to red cell surface with changes in electric charge between red cells. 5) Clinical applicability, metabolic aspect, degree of subtitution of hydroxyethyl group and safety with multiple infusion of HES must be carefully determined.
Adsorption ; Alanine Transaminase ; Alkaline Phosphatase ; Anaphylaxis ; Aspartate Aminotransferases ; Bilirubin ; Bleeding Time ; Blood Coagulation ; Blood Platelets ; Blood Sedimentation ; Colloids ; Dextrans ; Electrolytes ; Fibrinogen ; Hematocrit ; Hemorrhage ; Humans ; Kidney ; Liver ; Potassium ; Prothrombin Time ; Reference Values ; Selective Estrogen Receptor Modulators ; Sodium ; Sodium Chloride ; Starch* ; Surgical Procedures, Minor

During massive transfusions especially under pressure, considerable hemolysis has been expected. It had been assumed that hernolysis would increase with increasing age of the bank blood, increasing pressure and with decreasing bore of the needle. Moss and Stauntan, however, found that hemolysis actually increased when blood was forced through larger bore needles. The authors have studied the magnitude of hemolysis according to various needle sizes under ordinary clinical transfusion conditions, and concluded as follows: 1) Hemolysis was maximum when a 18G needle was used and minimum with use of a 22G. needle regardless of the age and temperature of the bank blood, 2) Hemolysis increased with increasing age of the bank blood. 3) When the needle size was constant, hemolysis was not affected by warming of the bank blood.
Clinical Study* ; Hemolysis* ; Needles

An anesthetic experience with right adrenalectomy for pheochromocytoma in a 24 year-old woman has been reported. Thiopental was used for induction followed by nitrous oxide-oxygen-fluothane supplemented with fractional doses of morphine for analgesia and succinylcholine (0.1 per cent intravenous drip) for muscular relaxation. An endotracheal semi-closed circle absorption technique with controlled ventilation was employed. The patient tolerated the ansthesia and surgery well with appropriate cardiovascular control using Regitine to suppress excessive hypertension and Levophed, whole blood and cortisone to combat hypotension after removal of the tumor. Importance of preoperative preparation, sufficient sedation, smooth induction, complete analgesia, good muscular relaxation, adequate alveoiar ventilation and proper cardiovascular control has been stressed and discussed together with the choice of anesthetic agent and technique.
Absorption ; Adrenalectomy ; Analgesia ; Cortisone ; Female ; Humans ; Hypertension ; Hypotension ; Morphine ; Norepinephrine ; Phentolamine ; Pheochromocytoma ; Relaxation ; Succinylcholine ; Thiopental ; Ventilation ; Young Adult

The effects of unilateral hypoxic ventilation on pulmonary hemodynamics, alveolar-arterial oxygen tension difference (A-aDO2) and intrapulmonary shunt in 10 dogs were studied under unilateral hypoxic ventilation using nitrogen. Hear rate, mean arterial pressure, central venous pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac output, blood gases and hemoglobin were measured during controlled ventilation with 100% oxygen and unilateral hypoxic ventilation. Using the above steps pulmonary hemodynamics, (A-a)DO2 and intrapulmonary shunt were calculated and the following results were obtained. 1) Mean pulmonry arterial pressure significantly increased (20%) from 20.6+/-2.60mmHg to 24.8+/-2.46mmHg(p<0.005) and pulmonary vascular resistance also significantly increased(43%) from 434+/-68.4 dynee. sec/cm(2) to 605+/-81.0 dynes. sec/cm(2)(p<0.005), whereas the cardiac output decreased (8%) from 1.92+/-0.23 l/min to 1.76+/-0.21 l/min(p<0.05) after unilateral hypoxic ventilation. 2) Alveolar-arterial oxygen tension difference significantly increased from 180+/-23.2mmHg to 470+/-31.9mmHg(p<0.005) after unilateral hypoxic ventilation. 3) Intrapulmonary shunt significantly increased from 9.5+/-1.40% to 24.8+/-2.02%(p<0.005) after unilateral hypoxic ventilation, but it was much lower than the mathematically expected value(40% over). The above findings suggest the operation of a protective mechanism, which causes hypoxic pulmonary vasoconstriction in the unilateral hypoxic lung, and diverts blood flow from the hypoxic to the non-hypoxic lung and so minimizes the hypoxic effect on the arterial blood.
Animals ; Arterial Pressure ; Cardiac Output ; Central Venous Pressure ; Dogs* ; Gases ; Hemodynamics* ; Lung ; Nitrogen ; Oxygen ; Pulmonary Wedge Pressure ; Vascular Resistance ; Vasoconstriction ; Ventilation*

Anesthetic experience with thymectomies for two patients with myasthenia gravis has been reported. Both of them talerated the surgical procedures under endotracheal nitrous oxide-oxygen-halothane anesthesia well, but one of tbem expired from cholinergic crisis on the 3rd postoperative day. Chemical diagnosis of myasthenia gravis and the salient clinical features including choice of preanesthetic medication, anesthetic agents, techniques and of neuromuscular blocking agents for myasthenic patients have been discussed. Paramount importance of rigid attention to ventilation, the maintenance of a patent airway and the removal of secretions by bronchoscopy or tracheostomy whenever necessary for the patient safety throughout operative and postoperative period has been stressed. Frequent determinations of pulmonary function and the use of edrophonium test in avoiding cholinergic crisis are advocated.
Anesthesia ; Anesthetics ; Bronchoscopy ; Diagnosis ; Edrophonium ; Humans ; Myasthenia Gravis ; Neuromuscular Blocking Agents ; Patient Safety ; Postoperative Period ; Preanesthetic Medication ; Thymectomy ; Tracheostomy ; Ventilation

It has been emphasized that continuous monitorings of arterial pressure, central venous pressure, electrocardiogram, blood gas analysis, serum electrolytes, body temperature, hematacrit and urinary output are mandatory for the anesthetic management of pheochromocytoma. In addition, it is necessary for the anesthetists to understand pharmacologic effects of drugs which influence the peripheral vascular tone and cardiac excitability. We experienced recently anesthetic management of two cases of pheochromocytoma; one raised problems of ventricular arrhythmias and hypertension that aggravated nature of arrhythrmias by increasing blood pressure and responded favorably to treatment with propranolol and trimetaphan. Tumor of this case originated from abdominal aortic wall. The other was managed by injection of d-tubocurarine which induced narrowing of pulse pressure by depletion of increasing systolic pressure and accompanied tachycardia without cardiac decompensation. We have reported proper anesthetic managements of two cases of pheochromocytoma with N2O O2-halothane anesthesia and reviewed literatures in discussion.
Anesthesia ; Arrhythmias, Cardiac ; Arterial Pressure ; Blood Gas Analysis ; Blood Pressure ; Body Temperature ; Central Venous Pressure ; Electrocardiography ; Electrolytes ; Hypertension ; Pheochromocytoma* ; Propranolol ; Tachycardia ; Trimethaphan ; Tubocurarine

In order to comparatively evaluate the effects of cyclopropane and fluothane upon mean arterial pressure. cardiac output and splanchnic blood flow during hemorrhagic shock a Iaboratory investigation was conducted in the following three successive phases in two groups: Group I (cyclopropane):1l. Observation 60 minutes following Nembutal I .V. injection 2. Observation 30 minutes following acute hemorrhage 3. Observation 30 minutes following cyclopropane anesthesia Group II (fluothane): 1. Observation 60 minutes following Nembutal I .V. injection 2. Observation 30 minutes following acute hemorrhage 3. Observation 30 minutes following fluothane anesthesia Nine mongrel dogs weighing 11.2±1. 2kg composed each group. Immediately following induction of anesthesia with intravenous pentobarbital (Nembutal), all dogs were endotracheally intubated with the aid of intravenous succinylcholine chloride. Spontaneous respiration was allowed during pentobarbital anesthesia, but ventilation was controlled with Ohio Anesthesia Ventilator during cyclopropane or fluothane anesthesia. In order to insure the adepuacy of ventilation, arterial blood samples were drawn at appropriate intervals for analysis of pH and Pco2 by Beckman Blood Gas Measurement System. Ventilation was adjusted so that the pH and Pco were maintained in the range of 7.30~7.35 and 30~35 mmHg. A heating pad was used to maintain the esophageal temperature at the normal leveal (±0.5 ℃). The internal carotid artery and femoral vein were cannulated. Carotid arterial pressure was measured by sensing with a Statham transducer. Lead II of the electrocardiograph and arterial presaure were continuously monitored end recorded on the Beckman RM 4-Channel Monitor/Recorder. The abdomen was opened and the portal vein and common hepatic artery were cannulated with IVM FT-P Blood Flow Transducer and the blood flow was recorded on EMF-120 Electromagnetic Blood Flowmeter. Bleeding amounted to approximately 2per cent of the body weight. Cardiac output was measured by the direct Fick method. Cyclopropane was administered in the concentration of 10 per cent(100cc/min cyclopropane-900cc/min oxygen) and fluothane-was administered in 1 per cent concentration from Mark II Fluotec vaporizer. Both anesthetics were delivered in semiclosed circle carbon dioxide absorption system. The results are summarized in Tables 1~2. In brief both cyclopropane and fluothane caused a further reduction in splanchnic blood flow by 14 per cent and 21 per cent respectively during hemorrhagic hypotension. Mean arterial pressure rose 24 per cent and cardiac output increased 17 per cent by cyclopropane, whereas mean arterial pressure fell 25 per eent and cardiac output decreased 24 per eent by fluothane. Furthermore, five out of nine dogs inhaled fluothane did not survive despite retransfusion after the experiment. All changes were conaistent and atatistically significant (P<0. 001). The reults suggest that for patients with hypovolemie hypotension without blood replacement cyclo- propane would be the inhalation anesthetic of choice, fluothane might be detrimental in such circum-stances, and that the choice of fluothane ahould be reserved for normovolemic vasnconatrictive states.
Abdomen ; Absorption ; Anesthesia* ; Anesthetics ; Animals ; Arterial Pressure ; Body Weight ; Carbon Dioxide ; Cardiac Output ; Carotid Artery, Internal ; Dogs* ; Electrocardiography ; Femoral Vein ; Flowmeters ; Halothane* ; Heating ; Hemorrhage ; Hepatic Artery ; Hot Temperature ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Inhalation ; Magnets ; Methods ; Nebulizers and Vaporizers ; Ohio ; Pentobarbital ; Portal Vein ; Propane ; Respiration ; Shock* ; Shock, Hemorrhagic ; Succinylcholine ; Transducers ; Ventilation ; Ventilators, Mechanical

Changes of alveolar-arterial oxygen tension differences (AaDO2) after 35 cases of open heart surgery were evaluated with durations of extracorporeal circulation and prognosis. Following results were obtained. 1) AaDO2 values of pre-bypass in fatal open great cases were higher than in survival cases. 2) AaDO2 values of post-bypass were similar and noted no correlation to progonsis. 3) Luration of extracorporeal bypass time in fatal cases were longer than in survival cases. 4) Changes of AaDO2 values after extracorporeal circulation were much correlated to AaDO2 of pre-bypass than those of post-bypass.
Extracorporeal Circulation ; Oxygen ; Prognosis ; Thoracic Surgery