Balloon-tipped, flow-directed (Swan-Ganz) catheters are used commonly for monitoring of cardiac function in patients undergoing cardiac surgical procedures. We report a case of pulmonary hypertension with hypoxemia which may be caused by incorrect positioning of pulmonary artery catheter (PAC) during CABG. Pulmonary arterial pressure (PAP) of 70/40 mmHg which was nearly high as systemic pressure was measured when we tried to wean patient from cardiopulmonary bypass. But, TEE (transesophageal echocardiography) showed nonspecific finding. PAP decreased soon and maintained about 33/16 mmHg for a few minutes. But, the PAP elevated high to 70/40 mmHg again and the arteral oxygen tension (PaO2) decreased to 61.2 mmHg. When we withdrew the PAC to the depth of 35 cm, the PAP and systolic pressure returned to normal range and PaO2 elevaed to 320 mmHg. End tidal CO2 was elevated from 30 mmHg to 35 mmHg.
Anoxia* ; Arterial Pressure ; Blood Pressure ; Cardiac Surgical Procedures ; Cardiopulmonary Bypass ; Catheters* ; Coronary Artery Bypass* ; Coronary Vessels* ; Humans ; Hypertension, Pulmonary* ; Oxygen ; Pulmonary Artery ; Reference Values

No abstract available.

BACKGROUND: Paraquat, a widely used herbicide, is extremely toxic, causing multiple organ failure in humans. Paraquat especially leads to irreversible progressive pulmonary fibrosis, which is related to oxygen free radicals. However, its biochemical mechanism is not clear. Natural mechanisms that prevent damage from oxygen free radicals include changes in glutathione level, G6PDH, superoxide dismutase(SOD), catalase, and glutathione peroxidase. The authors think catalase is closely related to paraquat toxicity in the lungs METHOD: The effects of 3-amino-1,2,4-triazole(aminotriazole), a catalase inhibitor, on mice administered with paraquat were investigated. We studied the effects of aminotriazole on the survival of mice administered with paraquat, by comparing life spans between the group to which paraquat had been administered and the group to which a combination of paraquat and aminotriazole had been administered. We measured glutathion level, glucose 6-phosphate dehydrogenase(G6PDH), superoxide dismutase(SOD), catalase, and glutathione peroxidase(GPx) in the lung tissue of 4 groups of mice: the control grouts, group A(aminouiazole injected), group B(paraquat administered), group C(Paraquat and aminotriazole administered). RESULTS: The mortality of mice administered with paraquat which were treated with aminotriazole was significantly increased compared with those of mice not treated with aminotriazole. Glutathione level in group B was decreased by 20%, a significant decrease compared with the control group. However, this level was not changed by the administration of aminotriazole(group C). The activity of G6PDH in all groups was not significantly changed compared with the control group. The activities of SOD, catalase, and glutathione peroxidase(GPx) in the lung tissue were significantly decreased by paraquat administration(group B); catalase showed the largest decrease. Catalase and GPX were significantly decreased by aminotriazole treatment in mice administered with paraquat but change in SOD activity was not significant.(group C). CONCLUSION: Decrease in catalase activity by paraquat suggests that paraquat toxicity in the lungs is closely related to catalase activity. Paraquat toxicity in mice is enhanced by aminotriazole administration, and its result is related to the decrease of catalase activity rather than glutathione level in the lungs. Production of hydroxyl radicals, the most reactive oxygen metabolite, is accelerated due to increased hydrogen peroxide by catalase inhibition and the lung damage probably results from nonspecific tissue injury of hydroxyl radicals.
Amitrole* ; Animals ; Catalase ; Free Radicals ; Glucose ; Glutathione ; Glutathione Peroxidase ; Humans ; Hydrogen Peroxide ; Lung* ; Mice* ; Mortality ; Multiple Organ Failure ; Oxygen ; Paraquat* ; Pulmonary Fibrosis ; Superoxides

Previous applications of laser bone and cartilage ablation have focused largely on the CO2 and the Nd:Yag lasers, using both the continuous wave and rapid superpulsed mode, which revealed severe thermal damage such as tissue necrosis and carbonization of the remaining tissue. In contrast, Excimer lases have provided better histologic results with minimal or no thermal damage, but the ablation rate and cutting efficiency have remained unsatisfactory. Though arthroscopic partial menisectomy has become the accepted technique for dealing with tears in menisci, division of the meniscus is sometimes difficult in the confined joint space of the knee and is associated with iatrogenic injury to the articular cartilage. The ability to quickly and safely divide or remove meniscal tissue would be a distinct advantage. The Holmium:Yag laser has many potential advantages over the CO2 laster, the Nd:Yag laser and the Excimer laser. Its principal advantages include minimal mechanical trauma to the articular cartilage, greater access to tight or restricted area of the knee joint, and its ability to function in a saline medium and to resect meniscus with minimal tissue necrosis. We have evaluated the effectiveness of the Holmium:Yag laser 74 partial menisectomies of 57 patients. Among 74 meniscal tears, there were 35 medial and 39 lateral meniscal tears. The average operation time was 33 minutes in the menisectomy and hospital stay was average 3 days. There was no significant carbonization on the surrounding tissue. Menisectomy of the posterior horn was safe and easy and there was minimal iatrogenic articular cartilage damage.
Animals ; Carbon ; Cartilage ; Cartilage, Articular ; Holmium ; Horns ; Humans ; Joints ; Knee ; Knee Joint ; Lasers, Excimer ; Lasers, Solid-State ; Length of Stay ; Necrosis ; Tears

Extravasation necrosis due to intravenously administered fluids and drugs is an increasing problem in hospital practice. The incidence of extravasation is variable but skin necrosis is a potentially devastating complication of intravenous therapy. Local injection of hyaluronidase has been recommended for several types of infusion extravasations. The previous studies found hyaluronidase to be effective in the prevention of necrosis following intradermal nafcillin, 12% dextrose, sodium bicarbonate, aminophylline or vince alkaloids.The objectives of the study are to determine the dosage of hyaluronidase which is effective in reducing extravasation necrosis caused by 10% calcium-gluconate and to establish how soon after this extravasation it must be given to retain its effectiveness.Study I evaluated control versus only normal saline group and normal saline with hyaluronidase groups (dose:75,150,300,450 units; all in volume 2 ml, treatment delay:immediate, 15-minutes delay, half hour delay, one hour delay, three hour delay). Size and rate of eschar were compared between groups. Study II was undertaken to examine the evolution of calcium-gluconate induced soft tissue injury in the rabbit. The histologic findings of extravasation sites were compared between groups. A statistically significant protective effect was found in the treated group versus the nontreated group within 15 minutes to 30 minutes. The most effective protection was achieved by the immediate injection of 300 units dosage of hyaluronidase.In conclusion, in the 10% calcium gluconate-induced extravasation, the given data suggest that one can expect the most protective effect with a 300 units dosage of hyaluronidase and within half-hour delay in the treatment group.
Aminophylline ; Calcium* ; Glucose ; Hyaluronoglucosaminidase* ; Incidence ; Nafcillin ; Necrosis* ; Skin ; Sodium Bicarbonate ; Soft Tissue Injuries

We report a case of staphylococcal septicemia with skin lesions characteristic of septic emboli in a 55-year-old man. Examination of the skin revealed small pustules surrounded by wide ring of erythema on the trunk and extremities. Histopathologic examination of a pustule showed subcorneal pustule and Gram positive septic emboli within blood vessels. There were neutrophilic infiltration and numerous extravasated erythrocytes within dermis. Staphylococcus aureus was isolated on the bacterial culture of blood and small pustules, He was treated with cloxacillin, but died due to respiratory distress syndrome.
Blood Vessels ; Cloxacillin ; Dermis ; Erythema ; Erythrocytes ; Extremities ; Humans ; Middle Aged ; Neutrophils ; Sepsis* ; Skin* ; Staphylococcus aureus

No abstract available.
Paraffin* ; Silicones*

No abstract available.
Female ; Pregnancy ; Pregnancy, Multiple*

On the 59 cases of staghorn calculi treated at our institution with either ESWL monotherapy or initial percutaneous nephrolithotomy followed by ESWL between July 1987 and June 1988, 50 cases(22 complete and 28 partial staghorns) have adequate follow up. Using a retrospective cohort design, patients were matched for age, sex, stone size, stone complexity, renal function, urinary tract infection and urinary tract obstruction. Twenty five pairs of combination therapy and ESWL monotherapy patients with complete data were matched. The groups were not significantly different in the matching parameters. A significantly higher stone free rate follows combination therapy versus ESWL monotherapy for complete staghorns(25% vs. 0% in the case of 1 time ESWL treatment : 76% vs. 40% at 3 months follow up visit but the difference is slight for partial staghorns(54% vs. 47% in the case of 1 time ESWL treatment ; 85% vs. 73% at 3 months follow up visit). Both have similar length of hospital stay for complete staghorns(15 days vs. 14 days), but a significantly longer hospital stay follows combination therapy for partial staghorns(13 days vs. 6 days). The morbidity of the combination approach is not greater than that of ESWL monotherapy(40% vs. 36%), where as the need for axillary procedures is significantly lower in this group(16% vs. 36%). Our results indicate that virtually all staghorn calculi are best treated with initial percutaneous nephrolithotomy followed by ESWL. This approach allows for chemolysis and secondary procedures. But small volume partial staghorns in nondilated systems may be considered for ESWL monotherapy with ureteral stenting.
Calculi* ; Cohort Studies ; Follow-Up Studies ; Humans ; Length of Stay ; Lithotripsy* ; Nephrostomy, Percutaneous* ; Retrospective Studies ; Shock* ; Stents ; Ureter ; Urinary Tract ; Urinary Tract Infections

BACKGROUND: The nature of operation alters the volume of distribution at steady state (Vdss) of drug. The hepatic extraction ratio of midazolam (0.3~0.7) could be influenced by hepatic blood flow (HBF), and hepatic enzyme activity. The pharmacokinetics of intravenous midazolam were determined in patients undergoing lung surgery. METHODS: Midazolam, 0.2 mg/kg, was administered to five patients undergoing lung surgery at 30 minutes after induction of anesthesia. Anesthesia was maintained with O2-enflurane for one lung ventilation. Blood samples from artery were drawn at increasing intervals for 12 h. Plasma midazolam concentrations were measured by gas chromatography. Computer simulations of the times required for 20%, 50%, and 80% decreases in midazolam concentrations were performed. RESULTS: A three compartment model best described the concentration versus time data. The volume of the central compartment (Vc) and volume of distribution at steady state (Vdss) were 4.3 2.8 l and 59.9 20.1 l, respectively. The elimination half-life was 3.4 2.2 h. Simulations indicate that under all the situations, the concentrations would decrease more rapidly in our patients in spite of similar Vdss and elimination half-life of patients undergoing minor gynecological surgery. CONCLUSION: The elimination half-life was in the range of previously reported values. The shorter recovery time is apparently due to relatively faster redistrubution, and relatively greater capacity for redistribution.
Anesthesia ; Arteries ; Chromatography, Gas ; Computer Simulation ; Female ; Gynecologic Surgical Procedures ; Half-Life ; Humans ; Lung* ; Midazolam* ; One-Lung Ventilation ; Pharmacokinetics* ; Plasma