No abstract available.
Animals ; Cricetinae* ; Cryopreservation* ; Oocytes*

Pheochromocytoma remains one of the great challenges to anesthesiologists during anesthesia and postoperative period. Virtually all anesthetic agents and techniques have been used with success but associated with a high rate of transient intraoperative arrhythmia and hypertension. We now report one case who was given thoracic epidural block and neuroleptic anesthesia for resection of right adrenal and presacral pheochromocytoma. Blood pressure and heart rate were stable during induction, tumor manipulation and postoperative intensive care unit with out the use of vasodilating or antiarrhythmic druas. While this report describes only one encouraging case, the potential advantages of thoracic epidural & general anesthesia in pheochromocytoma appear to warrant the further trial.
Anesthesia ; Anesthesia, General* ; Anesthetics ; Arrhythmias, Cardiac ; Blood Pressure ; Heart Rate ; Hypertension ; Intensive Care Units ; Pheochromocytoma* ; Postoperative Period

Intrathecal and epidural narcotics have been widely used since 1979 to relieve pain and provide postoperative analgesia. Ketamine hydrochloride, a potent analgesic and anesthetic, has also been studied to its usefulness in epidural administration for postoperative pain relief devoid of the respiratory depression caused by morphine. This study was performed to evaluate whether a large dose of ketamine is effective for postoperative pain relief and the results were compared with those of epidural morphine. Forty patients undergoing lower abdominal and extremity surgery were randomly assigned in two groups of twenty. No patient was receiving narcotics or analgesic at the time of study. The operative anesthesia was provided by continuous epidural anesthesia with 27 ml of 1.5% lidocaine with 1:200,000 epinephrine. Ketamine 30mg or morphine 3-4 mg was administered about 30 minutes before the end of operation through the epidural catheter respectively. Patients were monitored every 15 minutes during the first hour and every hour during first 24 hours. Pain complaint, respiratory rate, heart rate, blood pressure, SaO2 and potential side effects were recorded. The results were as follows; 1) Two cases in the ketamine group and nine cases in the morphine group did not need the additional analgesics after operation. The duration of pain relief in the ketamine group varied from 1.83 hour to over 48 hours (less than 3 hours in 50% of patients). Mean analgesic time in the morphine group was 28.3+/-5.6 hours. 2) Dissociative anesthesia with hypotension (one), sedation (fifteen), dizziness (seven), nausea (six) and vomiting (six) in the ketamine group, whereas nausea (nine), and vomiting (five) in the morphine group were developed. We conclude that ketamine 30 mg administered epidurally, which had a more central actions and less analgesic effect than morphine, is inadequate for postoperative pain relief after lower abdomimal and extremity surgery.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia, Epidural ; Blood Pressure ; Catheters ; Dizziness ; Epinephrine ; Extremities ; Heart Rate ; Humans ; Hypotension ; Ketamine* ; Lidocaine ; Morphine ; Narcotics ; Nausea ; Pain, Postoperative* ; Respiratory Insufficiency ; Respiratory Rate ; Vomiting

No abstract available.

No abstract available.
Epidemiology* ; Hip Fractures* ; Hip*

Metastatic infections were rare complications of Klebsiella p neumoniae liver abscess and bacteremia. However, over the past 15 years, they have become prevalent infectious complications in diabetic patients in Taiwan. A 72-year old man was admitted to Kyung-Hee University Hospital with fever, chill, dysuria, and frequency. On rectal examination the prostate gland was tender. Abdominal sonogram showed liver abscess. On hospital day 3, orbital pain, eyelid edema, conjunctival chemosis, hypopyon, and absence of light perception were noted in the right eye. K. pneumoniae was isolated from blood culture. The antimicrobial susceptibility test showed susceptibility to all antibiotics, except ampicillin. He was treated with ceftriaxone and astromicin intravenously for 3 weeks and follow up-transrectal sonogram revealed formation of prostatic abcess. We report a case of K. p neumoniae liver abscess complicated with bacteremia, endophthalmitis, and prostatic abscess.
Abscess* ; Aged ; Ampicillin ; Anti-Bacterial Agents ; Bacteremia* ; Ceftriaxone ; Dysuria ; Edema ; Endophthalmitis* ; Eyelids ; Fever ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess* ; Liver* ; Orbit ; Pneumonia ; Prostate ; Taiwan

PURPOSE: An adrenalectomy is needed in about 10 to 25% of Cushing's syndrome cases due to adrenal adenoma, hyperplasia, or carcinoma. The purpose of this study is to compare the postoperative compli cations of an adrenalectomy between Cushing's and non-Cushing's patients. METHODS: Data were collected by reviewing the hospital charts of patients treated at Korea University from July 1987 to Jan. 1998 the clinical data were compared using statistical method. RESULTS: An adrenalectomy was performed in 77 patients, and the causes of the adrenalectomy were primary aldosteronism (25 cases), pheochr mocytoma (23 cases), Cushing's syndrome (20 cases), adrenal carcinoma (5 cases), non-functioning adre nal adenoma (2 cases), ganglioneuroma (1 case), and neuroblastoma (1 case). The causes of Cushing's syndrome were adenoma (16 cases), nodular hyperplasia (3 cases), and carcinoma (1 case). The types of adrenalectomy used were anterior (60 cases), posterior (14 cases), and lateral (3 cases). Postoperative complications were atelectasis, pneumonia, wound infection, paralytic ileus, intra-abdominal abscess, intra-abdominal bleeding, acute renal failure and psychosis, in order of frequency. The rate of post operative complications in patients with Cushing's syndrome was 85%, which was higher than rate of 31.6% (p=0.02). Postoperative respiratory complications, such as atelectasis and pneumonias, were more common for patients with Cushing's syndrome (p=0.02). In patients of Cushing's syndrome, the devel opment of postoperative complication was related to the length of the operation, the size of the tumor, the weight of the tumor, the site of the tumor, the pathology and the method of approach (p>0.05). CONCLUSION: The patients with Cushing's syndrome were prone to postoperative complications, and respiratory complications were the most common postoperative complication. Careful preoperative and postoperative respiratory management should reduce the complications of an adrenalectomy in patients with Cushing's syndrome.
Abdominal Abscess ; Acute Kidney Injury ; Adenoma ; Adrenalectomy* ; Cations ; Cushing Syndrome* ; Ganglioneuroma ; Hemorrhage ; Humans ; Hyperaldosteronism ; Hyperplasia ; Intestinal Pseudo-Obstruction ; Korea ; Neuroblastoma ; Pathology ; Pneumonia ; Postoperative Complications* ; Psychotic Disorders ; Pulmonary Atelectasis ; Wound Infection

PURPOSE: An adrenalectomy is needed in about 10 to 25% of Cushing's syndrome cases due to adrenal adenoma, hyperplasia, or carcinoma. The purpose of this study is to compare the postoperative compli cations of an adrenalectomy between Cushing's and non-Cushing's patients. METHODS: Data were collected by reviewing the hospital charts of patients treated at Korea University from July 1987 to Jan. 1998 the clinical data were compared using statistical method. RESULTS: An adrenalectomy was performed in 77 patients, and the causes of the adrenalectomy were primary aldosteronism (25 cases), pheochr mocytoma (23 cases), Cushing's syndrome (20 cases), adrenal carcinoma (5 cases), non-functioning adre nal adenoma (2 cases), ganglioneuroma (1 case), and neuroblastoma (1 case). The causes of Cushing's syndrome were adenoma (16 cases), nodular hyperplasia (3 cases), and carcinoma (1 case). The types of adrenalectomy used were anterior (60 cases), posterior (14 cases), and lateral (3 cases). Postoperative complications were atelectasis, pneumonia, wound infection, paralytic ileus, intra-abdominal abscess, intra-abdominal bleeding, acute renal failure and psychosis, in order of frequency. The rate of post operative complications in patients with Cushing's syndrome was 85%, which was higher than rate of 31.6% (p=0.02). Postoperative respiratory complications, such as atelectasis and pneumonias, were more common for patients with Cushing's syndrome (p=0.02). In patients of Cushing's syndrome, the devel opment of postoperative complication was related to the length of the operation, the size of the tumor, the weight of the tumor, the site of the tumor, the pathology and the method of approach (p>0.05). CONCLUSION: The patients with Cushing's syndrome were prone to postoperative complications, and respiratory complications were the most common postoperative complication. Careful preoperative and postoperative respiratory management should reduce the complications of an adrenalectomy in patients with Cushing's syndrome.
Abdominal Abscess ; Acute Kidney Injury ; Adenoma ; Adrenalectomy* ; Cations ; Cushing Syndrome* ; Ganglioneuroma ; Hemorrhage ; Humans ; Hyperaldosteronism ; Hyperplasia ; Intestinal Pseudo-Obstruction ; Korea ; Neuroblastoma ; Pathology ; Pneumonia ; Postoperative Complications* ; Psychotic Disorders ; Pulmonary Atelectasis ; Wound Infection

BACKGROUND AND OBJECTIVE: By assessing unilateral utricular function at the acute unilateral vestinuloneuritis (Acute UVN), we sought to determine the ability of the subjective visual vertical (SVV) during eccentric rotation (dynamic SVV) in localizing the site of the lesion in unilateral vestibular neuritis (UVN). METHODS: The static SVV and dynamic SVV of fifteen patients diagnosed with acute UVN were enrolled within 10 days of onset (average 7 days). First, the static SVV was measured in a dark booth without rotation. The dynamic SVV was measured during rotation with an eccentric displacement of the head to 3.5 cm from the vertical rotation axis during a constant velocity of 300 degrees/s. RESULTS: In the acute stage of UVN, the static SVV showed an increase in deviation to the side of the lesion compared to those of normal subjects. Also, we found 73% of abnormal findings in Acute UVN patients by assessing static conventional SVV. The dynamic SVV had a statistically significant increase in deviation to the side of the lesion compared to those of normal subjects and 93% patients showed beyond normal range. CONCLUSIONS: The dynamic SVV would be an effective method in the diagnosis and localization of acute unilateral vestibularneuritis.
Axis, Cervical Vertebra ; Displacement (Psychology) ; Head ; Humans ; Vestibular Neuronitis

Localized nodular synovitis of the knee joint is a rare benign tumorous condition, and should be differentially diagnosed with pigmented villonodular synovitis. We report a case of localized nodular synovitis in the knee that was noted to have a pedicle and characteristic findings on MR image.
Knee Joint ; Knee* ; Magnetic Resonance Imaging* ; Synovitis* ; Synovitis, Pigmented Villonodular