Changes in arterial blood gases and arterial pressure during laparoscopic cholecystectomy under the general anesthesia (enflurane in N2O/O2 50%) were investigated in 30 patients, who were divided into two groups according to control of minute ventilation. During surgery, minute ventilation was set 100 ml/kg in group I and 150 ml/kg in group II, and intraabdominal pressure was maintained at 15mmHg by CO2 insufflation, in both groups. Variables were measured before CO2 gas insufflation, 15 and 30 minutes after insufflation, just after exsufflation, 15 and 30 minutes after exsufflation and in recovery room. 1. PaCO2 was increased significantly during CO2 gas insufflation and just after exsufflation in both group, and degree of increase (PaCO2) was significantly greater in group I compared to group II. 2. Changes of PaO2 were not statistically significant in comparison to control value and between two groups during CO2 gas insufflation and exsufflation. 3. Blood pH in both groups were lowered significantly compared to control value during CO2 gas insufflation and exsufflation, and group II (increased minute ventilation group), represents lower risk of acidosis compared to group I. 4. Mean arterial pressure and airway pressure were significantly increased compared to control value during CO2 gas insufflation, but there was no significant difference between two groups. These results suggest that minute ventilation during laparoscopic cholecystectomy should be increased up to maintaining normal PaCO2 for prevention of hemodynamic and blood gas changes due to CO2 retention.
Acidosis ; Anesthesia, General* ; Arterial Pressure ; Cholecystectomy, Laparoscopic* ; Gases* ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Insufflation ; Recovery Room ; Ventilation

BACKGROUND: Cytosolic Ca2+ overload and oxygen derived free radicals may contribute to stunned myocardium. The pnt study was aimed to investigate the effects of nicardipine and sodium nitroprusside (SNP) on the functional recovery of postischemic reperfused myocardium. METHODS: Fifty-seven halothane-anesthetized dogs were subjected to 15 minutes of 1eft anterior descending coronary artery (LAD) occlusion and 3 hours of reperfusion. They were randomly assigned to receive either intracoronary nicardipine (n=11) or SNP (n=10) alone or both (nicardipine plus SNP, n=10). Eleven dogs that received saline i.c. served as the controL Regional myocardial contractility was evaluated by systolic shortening (%SS), the preload recruitable stroke work slope (Mw), and intramyocardial pressure (IMPs). Diastolic function was assessed by time constant of myocardial relaxation (IMP-tau) and postsystolic shortening (%PSS), LAD blood flow was measured by a Doppler flowmeter as well. RESULTS: LAD occlusion produced a significant reduction in systolic as well as diasto1ic functions to similar degrees in all groups. However, %SS was significantly higher in the nicardipine, SNP and nicardipine-SNP groups (67%, 56%, and 68% of baseline values, respectively) than in the controls (20%) at 3 hours of reperfusion. Furthermore, Mw recovered to the baseline with the onset of reperfusian in the three experimental groups. IMP-tau was restored to the baseline during early nperfusion in the SNP-treated groups but was significantly prolonged in the control and nicardipine poups throughout the seperfusion. LAD blood flow during reperfusion was higher in the SNP-treated groups in comparison to the control group. CONCLUSIONS: Treatment with either nicardipine or SNP enhances the recovery of mgional contractile function in the canine model of myocardial stunning. SNP not nicardipine is also beneficial in attenuation of early diastolic dysfunction. Nicardipine combined with SNP improved systolic as well as early diastolic functions more significantly when compared to either nicardipine or SNP alane.
Animals ; Coronary Vessels ; Cytosol ; Dogs* ; Flowmeters ; Free Radicals ; Heart ; Myocardial Stunning* ; Myocardium ; Nicardipine* ; Nitroprusside* ; Oxygen ; Pharmacology ; Relaxation ; Reperfusion ; Sodium* ; Stroke

BACKGROUND AND OBJECTIVES: The agreement between pure-tone average (PTA) and speech recognition threshold (SRT) has become more important with the increasing demands for medical certification. The purpose of this study was to explore the relationships between the SRT and several variations of PTA, and to determine which PTA formula would provide the best agreement with SRT for different audiometric configurations. SUBJECTS AND METHOD: Audiological data on 783 ears were retrospectively collected. The air-conduction PTAs were calculated using five different formulas: three-frequency average (3FA), weighted three-frequency average (W3FA), four-frequency average (4FA), weighted four-frequency average (W4FA), and six-frequency average (6FA). The audiometric configuration was classified into five categories. The PTA-SRT relationships were analyzed using correlation and simple linear regression for each audiometric configuration. RESULTS: Highest correlation was observed between the SRT and W3FA for all audiometric configurations with the correlation coefficient of 0.964 as a whole. The SRT and 3FA were best-matched in the linear regression models for overall/flat/high frequency gently sloping/low frequency ascending; the SRT and W3FA were best-matched for high frequency steeply sloping (HFSS); the SRT and 4FA were best-matched for miscellaneous audiograms. CONCLUSION: The most stable PTA variations that make the best-matched pairs with SRT for any audiogram are the conventional 3FA and W3FA doubling 1 kHz threshold. The addition of frequencies higher than 2 kHz to a PTA formula seems to have impeded the PTA-SRT agreement, especially for HFSS audiograms. W3FA should be the method of choice in predicting SRT from PTA for HFSS audiograms.
Certification ; Ear ; Hearing Loss, Functional ; Linear Models ; Methods ; Retrospective Studies

Cardiac rhabdomyomas are the most common primary tumor in infancy and childhood and are frequently associated with tuberous sclerosis. Although spontaneous regression of cardiac rhabdomyoma has been reported , prognosis of this tumor associated with subaortic stenosis is still considered to be poor and surgery continues to be indicated. A 4-day-old female was admitted due to tachypnea and cyanosis. Single rhabdomyoma arising from the interventricular septum associated with severe subaortic stenosis was partially removed under cardiopulmonary bypass. Excised tumor size was 0.7 X 0.9 X 0.4 cm in dimension. The postoperative course was uneventful and the infant discharged on the 14th postoperative day.
Cardiopulmonary Bypass ; Constriction, Pathologic ; Cyanosis ; Echocardiography ; Female ; Heart Neoplasms ; Humans ; Infant ; Infant, Newborn* ; Prognosis ; Rhabdomyoma* ; Tachypnea ; Tuberous Sclerosis ; Ventricular Outflow Obstruction*

Cardiac rhabdomyomas are the most common primary tumor in infancy and childhood and are frequently associated with tuberous sclerosis. Although spontaneous regression of cardiac rhabdomyoma has been reported , prognosis of this tumor associated with subaortic stenosis is still considered to be poor and surgery continues to be indicated. A 4-day-old female was admitted due to tachypnea and cyanosis. Single rhabdomyoma arising from the interventricular septum associated with severe subaortic stenosis was partially removed under cardiopulmonary bypass. Excised tumor size was 0.7 X 0.9 X 0.4 cm in dimension. The postoperative course was uneventful and the infant discharged on the 14th postoperative day.
Cardiopulmonary Bypass ; Constriction, Pathologic ; Cyanosis ; Echocardiography ; Female ; Heart Neoplasms ; Humans ; Infant ; Infant, Newborn* ; Prognosis ; Rhabdomyoma* ; Tachypnea ; Tuberous Sclerosis ; Ventricular Outflow Obstruction*

Potassium(K+) balance is achieved by the control of urinary K+ excretion and by the control of K+ absorption from the digestive tract. It has been established that chronic potassium depletion is associated with a remarkable hypertrophy of the outer medullary collecting duct of the kidney. But, there are no morphological studies regarding the intercalated cells during the chronic changes of potassium diet. Electron microscopy was performed to observe the morphological alterations of the intercalated cell of the entire collecting duct in response to chronic changes of potassium diet in rat kidney. By electron microscopy, the characteristic features of normal type A intercalated cell of the cortical collecting duct included numerous micro-projections of the apical plasma membrane, complicated basal infolding, apical cytoplasmic tubulovesicles, evenly distributed mitochondia, and centrally located nucleus. In potasium-depleted type A intercalated cell, microprojections of the apical plasma membrane were increased in length and number, basal infoldings were uncomplicated, tubulovesicles were almostly disappeared, and mitochondria were increased in number. Type A intercalated cell of potassium-loading after restriction was found to be almost normal except longer microprojections and increased mitochondria. The characteristic features of normal intercalated cell of the outer medullarycollecting duct(OMCD) included relatively short micro-projections of the apical plasma membrane, uncomplicated basal infoldings, apical cytoplasmic tubulovesicles, and apically distributed mitochondia. In comparison with normal, potassium-depleted intercalated cell of OMCD was hypertrophy, microprojections of the apical plasma membrane were increased in length and number, basal infoldings were complicated, tubulovesicles were almost disappeared, mitochondria were increased in number, and several lysosomes were appeared. Intercalated cell of OMCD of potassium-loading after restriction was found to be almost normal except increased cell size, longer microprojections, and increased mitochondria and lysosomes compared to control. The characteristic features of normal intercalated cell of the inner medullary collecting duct (IMCD) included very short and scant microprojections of the apical plasma membrane, uncomplicated basal infoldings,apica cytoplasmic tubulovesicles, evenly distributed mitochondia, and some lysosomes. In potasium-depleted intercalated cell of IMCD, cell size was prominently increased, microprojections of the apical plasma membrane were increased in length and number, basal infoldings were complicated, tubulovesicles were almostly disappeared, and mitochondria were increased in number. Intercalated cell of IMCD of potassium-loading after restriction was found to be almost normal except increased cell size and increased microprojections in number and length compared to control. These results suggest that intercalated cells adapt through morphological changes to preserve potassium balance during chronic changes of potassium diet.
Rats ; Animals

Cutaneous squamous cell carcinoma is the second most common tumor in humans, and its incidence is increasing. In cutaneous squamous cell carcinoma, lymph node and distant metastases are rare, and bone invasion in the lower limbs is uncommon. A 67-year-old male presented with a solitary erythematous plaque on the fifth toe, accompanied by swelling. A shave biopsy was performed. The diagnosis of bone-invaded squamous cell carcinoma with aggressive behavior was made by combining the histopathological, immunohistochemical staining, and magnetic resonance imaging results. Mohs micrographic surgery was performed to remove the skin lesion and tumor-invaded bone. However, 2 months later, squamous cell carcinoma relapsed in the same area. After confirming the absence of lymph node metastasis, additional treatment, including ray amputation, was performed. Adjuvant radiotherapy was not administered. We present a rare case of squamous cell carcinoma that relapsed after Mohs surgery and was subsequently treated with ray amputation.

There are various methods for reconstructing defects caused by Mohs micrographic surgery (MMS). However, there are limits to the reconstruction methods that can be used if the defect is large. An 85-year-old woman presented with a 2.4×2.2 cm hyperkeratotic plaque on her right temple for 2 years. A skin biopsy was performed for a diagnosis. Histopathology confirmed squamous cell carcinoma, and MMS was performed to completely remove the tumor. A total of three MMS stages were performed intraoperatively to confirm margin clear, resulting in a skin defect measuring 5.0×4.5 cm. To reconstruct the large defect, a splitted full thickness skin graft was performed, taking into account the site, size, and function of the defect. Each skin graft was harvested from the submental area and a tie-over bolster dressing was applied to the recipient site. To date, the surgical site has remained free of surgical complications or tumor recurrence.

There are various methods for reconstructing defects caused by Mohs micrographic surgery (MMS). However, there are limits to the reconstruction methods that can be used if the defect is large. An 85-year-old woman presented with a 2.4×2.2 cm hyperkeratotic plaque on her right temple for 2 years. A skin biopsy was performed for a diagnosis. Histopathology confirmed squamous cell carcinoma, and MMS was performed to completely remove the tumor. A total of three MMS stages were performed intraoperatively to confirm margin clear, resulting in a skin defect measuring 5.0×4.5 cm. To reconstruct the large defect, a splitted full thickness skin graft was performed, taking into account the site, size, and function of the defect. Each skin graft was harvested from the submental area and a tie-over bolster dressing was applied to the recipient site. To date, the surgical site has remained free of surgical complications or tumor recurrence.

There are various methods for reconstructing defects caused by Mohs micrographic surgery (MMS). However, there are limits to the reconstruction methods that can be used if the defect is large. An 85-year-old woman presented with a 2.4×2.2 cm hyperkeratotic plaque on her right temple for 2 years. A skin biopsy was performed for a diagnosis. Histopathology confirmed squamous cell carcinoma, and MMS was performed to completely remove the tumor. A total of three MMS stages were performed intraoperatively to confirm margin clear, resulting in a skin defect measuring 5.0×4.5 cm. To reconstruct the large defect, a splitted full thickness skin graft was performed, taking into account the site, size, and function of the defect. Each skin graft was harvested from the submental area and a tie-over bolster dressing was applied to the recipient site. To date, the surgical site has remained free of surgical complications or tumor recurrence.