It is a well known fact that the major craniofacial operation is a complicated procedure. In this procedure, the operative period is extremely long and blood loss is large, extremely difficult to estimate and continuous into the early postoperative period. The air was should be protected intraoperatively and postoperatively due to frequent airway obstruction. We had experienced of an anesthetic management for correction of hypertelorism. Anesthetic management of this case should focus on reduction intracranial pressure and volume. WE had performed neurolept anesthesia with controlled hyperventilation. The careful monitoring and frequent measuring of blood gas analysis, hematocrit, hourly urine output, electrolytes, body temperature, CVP, ECG, and acid-base balance status are recommended. We report a case of anesthetic management for a patient.
Acid-Base Equilibrium ; Airway Obstruction ; Anesthesia ; Blood Gas Analysis ; Body Temperature ; Electrocardiography ; Electrolytes ; Hematocrit ; Humans ; Hypertelorism* ; Hyperventilation ; Intracranial Pressure ; Postoperative Period

Uterine leiomyomas are the most common uterine tumors. They are estimated to be present in approximately 20% of all women of reproductive age. They may be present in subserosal, intramural, or submucosal in location within the uterus, or located in the cervix, in the broad ligaments, or on a pedicle. Many studies report that the malignant potential of a preexisting uterine leiomyoma is extremely rare, occuring in less than 0.5%. Uterine leiomyomas may cause a range of syptoms, for example, severe anemia from abnormal uterine bleeding, dysmenorrhea, constipation from rectosigmoid compression, dysuria, frequency, residual sensation due to bladder compression. Patients with those symptoms or "cancer phobia" should be treated. Rare but severe symptoms associated with uterine leiomyomas are rectosigmoid compression, with intestinal obstruction, thrombophlebitis of lower extremities from venous stasis, polycythemia, ascites, severe pain from torsion and infection of prolapsed pedunculated submucosal myoma and uterine inversion from prolase of pedunculated submucosal leiomyoma. Now we report a rare case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma, which caused hypovolemic shock due to massive uterine bleeding.
Anemia ; Ascites ; Broad Ligament ; Cervix Uteri ; Constipation ; Dysmenorrhea ; Dysuria ; Female ; Humans ; Intestinal Obstruction ; Leiomyoma* ; Lower Extremity ; Myoma ; Polycythemia ; Prolapse* ; Sensation ; Shock ; Thrombophlebitis ; Urinary Bladder ; Uterine Hemorrhage ; Uterine Inversion* ; Uterus

Intrauterine devices (IUDs) are highly effective, long-term methods of contraception. Although evidences of direct association between IUD use and pelvic inflammatory disease are rare, the frequency of inflammatory complications associated with the use of IUDs ranges from 2% to 8%. Gynecological surgeries on the account of purulent, inflammatory disease associated with IUD are 4-7%. We report one case with spontaneous perforation of uterus due to acute gangrenous myometritis in an old woman with IUD for 40 yrs in pelvic cavity, followed by a review of the literature.
Contraception ; Female ; Gynecologic Surgical Procedures ; Humans ; Intrauterine Devices ; Pelvic Inflammatory Disease ; Uterine Perforation* ; Uterus

BACKGROUND: To evaluate the effect of the balloon dilatation in tuberculous bronchial stenosis, we performed balloon dilatation in 13 cases which had airway obstruction in main bronchus with the impairment of pulmonary function. MATERIAL AND METHODS: Thirteen women with tuberculous bronchial stenosis(9cases: left main bronchus, 4 cases: right main bronchus) underwent fluoroscopically guided balloon dilatation under the local anesthesia. Among the these patient, 9 cases were active endobronchial tuberculosis, and 4 cases were inactive. Immediate and long term follow-up(average 15.6months) assessments were done focused on change on PFT. The increase of FVC or FEV1 more than 15% after the procedure was considered effective. Complications after dilatation were evaluated in all patients. RESULT: 1) There were an decrease of self-audible wheezing in 75%(6/8), improvement of dyspnea in 62.5%(5/8), improvement of cough and expectoration in 50%(3/6), and improvement of chest discomfort in 50%(l/2). 2) Significant improvement of PFT was noted in 42.9%(3/7) of which respiratory symptoms duration was below 6 months. But, significant improvement of PFT was noted in only 25% (1/4) of which respiratory symptoms duration was above 12 months. 3) Active stage was 69.2%(9/13) and inactive was 30.8%(4/13). There was an significant improvement of PFT in 44.4%(4/9) of active stage, but, only 25%(l/4) of inactive stage was improved. 4) In 61.5%(8/13), FVC and FEV1 were increased to 35.5%, and 22.2% at post-dilatation 7 days. After 1 month later, FVC and FEV1 were increased to 54.7%, and 31.8% in 5 cases(38.5%). 4 cases in which long-term follow-up(average 19.8months) was possible the improvement of FVC, and FEV1 were 30.5%, and 10.1%. . 5) Just after balloon dilatation therapy, transient leukocytosis or fever was noted in 30.8%(4/13), and blood-tinged sputum was noted in 30.8%(4/13). However, serious complication, such as pneumothorax, pneumomediastinum or mediastinitis, was not noted. CONCLUSION: We conclude that tuberculous bronchial stenosis, which is on active stage, and short dulation of respiratory symptoms was more effective on balloon dilatation than inactive stage or long duration of respiratory symptoms. Furthermore, balloon dilatation is easier, much less invasive and expensive than open surgery, and cryotherapy or photoresection. Because of these advantage, we think that balloon dilatation could be the first choice for treating bronchial stenosis and could be done at first in early stage if unresponsiveness with steroid therapy is observed.
Airway Obstruction ; Anesthesia, Local ; Bronchi ; Constriction, Pathologic* ; Cough ; Cryotherapy ; Dilatation* ; Dyspnea ; Female ; Fever ; Humans ; Leukocytosis ; Mediastinal Emphysema ; Mediastinitis ; Pneumothorax ; Respiratory Sounds ; Sputum ; Thorax ; Tuberculosis*

BACKGROUND: To evaluate the effect of the balloon dilatation in tuberculous bronchial stenosis, we performed balloon dilatation in 13 cases which had airway obstruction in main bronchus with the impairment of pulmonary function. MATERIAL AND METHODS: Thirteen women with tuberculous bronchial stenosis(9cases: left main bronchus, 4 cases: right main bronchus) underwent fluoroscopically guided balloon dilatation under the local anesthesia. Among the these patient, 9 cases were active endobronchial tuberculosis, and 4 cases were inactive. Immediate and long term follow-up(average 15.6months) assessments were done focused on change on PFT. The increase of FVC or FEV1 more than 15% after the procedure was considered effective. Complications after dilatation were evaluated in all patients. RESULT: 1) There were an decrease of self-audible wheezing in 75%(6/8), improvement of dyspnea in 62.5%(5/8), improvement of cough and expectoration in 50%(3/6), and improvement of chest discomfort in 50%(l/2). 2) Significant improvement of PFT was noted in 42.9%(3/7) of which respiratory symptoms duration was below 6 months. But, significant improvement of PFT was noted in only 25% (1/4) of which respiratory symptoms duration was above 12 months. 3) Active stage was 69.2%(9/13) and inactive was 30.8%(4/13). There was an significant improvement of PFT in 44.4%(4/9) of active stage, but, only 25%(l/4) of inactive stage was improved. 4) In 61.5%(8/13), FVC and FEV1 were increased to 35.5%, and 22.2% at post-dilatation 7 days. After 1 month later, FVC and FEV1 were increased to 54.7%, and 31.8% in 5 cases(38.5%). 4 cases in which long-term follow-up(average 19.8months) was possible the improvement of FVC, and FEV1 were 30.5%, and 10.1%. . 5) Just after balloon dilatation therapy, transient leukocytosis or fever was noted in 30.8%(4/13), and blood-tinged sputum was noted in 30.8%(4/13). However, serious complication, such as pneumothorax, pneumomediastinum or mediastinitis, was not noted. CONCLUSION: We conclude that tuberculous bronchial stenosis, which is on active stage, and short dulation of respiratory symptoms was more effective on balloon dilatation than inactive stage or long duration of respiratory symptoms. Furthermore, balloon dilatation is easier, much less invasive and expensive than open surgery, and cryotherapy or photoresection. Because of these advantage, we think that balloon dilatation could be the first choice for treating bronchial stenosis and could be done at first in early stage if unresponsiveness with steroid therapy is observed.
Airway Obstruction ; Anesthesia, Local ; Bronchi ; Constriction, Pathologic* ; Cough ; Cryotherapy ; Dilatation* ; Dyspnea ; Female ; Fever ; Humans ; Leukocytosis ; Mediastinal Emphysema ; Mediastinitis ; Pneumothorax ; Respiratory Sounds ; Sputum ; Thorax ; Tuberculosis*

OBJECTIVE: The aim of this study is to verify the clinical outcome of staging surgery with and (or) without bilateral salpingo-oophorectomy (BSO) in clinical stage I-II endometrial cancer patients. METHODS: We reviewed the medical records of 178 surgically treated patients in clinical stage I-II endometrial cancer between January 1994 and December 2004. Overall survival (OS) and disease free survival (DFS) were analyzed by using data gathered from the National Statistics Office. The clinical outcome was compared between patients who underwent hysterectomy with and without BSO. RESULTS: One hundred sixty patients were in clinical stage I, and 18 patients were in clinical stage II. Most of the cases showed endometrioid (93.8%) in histology and G1 (56.1%) in differentiation. BSO was performed in 142 patients. Surgico-pathological features of two group are not different but the group without BSO were younger (40.7 vs. 55.8 years old) and less myometrial invasion than the group with BSO. After mean 39.27 months follow up, we found no difference in OS and DFS between the two groups with BSO and without BSO. No factors except stage were significantly related with OS and DFS by multivariate Cox regression analysis. The rate of pelvic and paraaortic lymph node metastasis was not different between two groups. CONCLUSION: The retrospective data in the study reveals that staging surgery with and without BSO does not affect OS and DFS in clinical stage I-II endometrial cancer patients. In limited cases, such as young women, omitting BSO can be considered carefully.
Disease-Free Survival ; Endometrial Neoplasms* ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Retrospective Studies

Malignant neoplasm of the fallopian tube is the rarest of the gynecologic cancers. Vaginal bleeding, vaginal discharge, and pelvic pain are the most common symptoms. Because of these non-specific symptoms, the diagnosis of this least common neoplasm is rarely made before laparotomy. The tumor is typically unilateral and has histologic subtypes, endometrioid and serous adenocarcinoma being the most common subtypes. Surgery, clearly the mainstay of treatment, is also the first approach to diagnosis. The procedure of choice is total abdominal hysterectomy with bilateral salpingo-oopho-rectomy. We had experienced one patient with primary tubal cancer, successfully evaluated with laparoscopy. And then we intend to report the case of the above patient and have a brief discussion about that.
Adenocarcinoma ; Diagnosis ; Fallopian Tube Neoplasms ; Fallopian Tubes ; Female ; Humans ; Hysterectomy ; Laparoscopy* ; Laparotomy ; Pelvic Pain ; Uterine Hemorrhage ; Vaginal Discharge

OBJECTIVE: We designed this study to understand the physiologic effects and secretory pattern of IGF-I and IGF-II in human serum and changes in expression of IGF-I and IGF-II in human ovarian tissues during menstrual cycle, and to know which one is more important on human ovarian function between IGF-I and IGF-II, related to FSH, LH and estradiol. METHODS: IGF-I, IGF-II, FSH, LH and estradiol levels were measured in 80 serum samples by ELISA from normal reproductive women. We also examined the immunohistochemical staining of the IGF-I and IGF-II in the ovarian tissues of 14 normal reproductive women. The mean age was 35.6+/-9.15 years-old, ranged from 20 to 45. The average menstrual cycle was 27 to 29 days. RESULTS: 1. The average serum concentration of IGF-I was 204.43+/-50.92 ng/mL, and that of IGF-II was 1381.56+/-292.56 ng/mL. 2. The regular pattern or relationship on serum IGF-I and IGF-II concentrations were not observed (P=0.19). 3. To cross-correlation of serum concentrations of FSH, LH, estradiol and IGF-I, IGF-II, IGF-II was thought to effect on human ovarian menstrual cycles, affected by action of FSH (P=0.048). 4. In the normal reproductive ovaries, we observed immunohistochemical staining for IGF-I in primary, secondary, mature follicle, corpus luteum and stroma, but not in corpus albicans. 5. In the normal reproductive ovaries, we observed immunohistochemical staining for IGF-II in primary, secondary, mature follicle, and corpus luteum but not in corpus albicans and stroma. 6. Stronger immunohistochemical staining was observed in ovaries for IGF-II, rather than IGF-I. CONCLUSION: IGF-I and IGF-II were produced by ovarian tissues, and participated in ovarian folliculogenesis according to menstrual cycles by paracrine, autocrine functions. IGF-II, rather than IGF-I, was thought to effect greater on human ovarian menstrual cycles, affected by action of FSH.
Corpus Luteum ; Enzyme-Linked Immunosorbent Assay ; Estradiol ; Female ; Humans ; Immunohistochemistry ; Insulin-Like Growth Factor I* ; Insulin-Like Growth Factor II ; Menstrual Cycle* ; Ovarian Follicle ; Ovary

BACKGROUND: Electrical breathing pacing has many advantages over mechanical ventilation. However, clinically permanent diaphragmatic pacing has been applied to limited patients and few temporary pacing has been reported. Our purpose is to investigate the feasibility of temporary electrical diaphragm pacing in explothoracotomy canine cases. METHODS: Five dogs were studied under the general anesthesia. Left 5th intercostal space was opened. Self designed temporary pacing leads were placed around the left phrenic nerve and connected to the myostimulator. Chest wall was closed after tube insertion with underwater drainage. Millar catheter was introduced to the aorta and right atrium. Swan-Ganz catheter was introduced to the pulmonary artery. When the self respiration was shallow with deep anesthesia, hemodynamic and tidal volume were measured with the stimulator on. RESULTS: Tidal volume increased from 143.3 +/- 51.3 ml to 272.3 +/- 87.4 ml(p=0.004). Right atrial diastolic pressure decreased from 0.7 +/- 4.0 mmHg to -10.5 +/- 4.7 mmHg(p=0.005). Pulmonary arterial diastolic pressure decreased from 6.1 +/- 2.5 mmHg to 1.2 +/- 4.8 mmHg(p<0.001). The height of water level in chest tube to show intrathoracic pressure change was from 10.3 +/- 6.7cmH2O to 20.0 +/- 5.3 cmH2O. CONCLUSION: Temporary electrical diaphragmatic pacing is a simple method to assist respiration in explothoracotomy canine cases. Self designed pacing lead is implantable and removable. Negative pressure ventilation has favorable effects on the circulatory system. Therefore, clinical application of temporary breathing pacing is feasible in thoracotomy patients to assist cardiorespiratory function.
Anesthesia ; Anesthesia, General ; Animals ; Aorta ; Blood Pressure ; Catheters ; Chest Tubes ; Diaphragm ; Dogs ; Drainage ; Heart Atria ; Hemodynamics ; Humans ; Phrenic Nerve ; Pulmonary Artery ; Respiration ; Respiration, Artificial ; Thoracic Wall ; Thoracotomy ; Tidal Volume ; Ventilation ; Water

Metastatic carcinoma that causes appendicitis is extremely rare. To our knowledge, metastatic cholangiocarcinoma in the appendix has been reported in only 1 case in the English literature. We report herein the case of an 87-year-old woman who presented with abdominal pain and jaundice. Advanced cholangiocellular carcinoma and a proximal appendiceal mass with appendicitis were detected on contrast-enhanced computed tomography and positron emission tomography/computed tomography. After elective laparoscopic appendectomy and wedge resection of the cecum, pathologic results revealed metastatic adenocarcinoma from extrahepatic cholangiocellular carcinoma in the appendix.
Abdominal Pain ; Adenocarcinoma ; Aged, 80 and over ; Appendectomy ; Appendicitis* ; Appendix ; Cecum ; Cholangiocarcinoma* ; Electrons ; Female ; Humans ; Jaundice ; Neoplasm Metastasis