BACKGROUND: The reduction in hematocrit (Hct) by hemodilution tends to cause an increase in cardiac output and a proportional decrease in arterial oxygen content. Additionally the reduction of systemic oxygen delivery (DO2) leads to significant differences in regional blood flow. It is therefore important to characterize the effects of hemodilution on regional oxygen metabolism in individual organs. This study was undertaken to evaluate and compare the effects of acute normovolemic anemia induced by hemodilution. METHODS: Six dogs were anesthetized and mechanically ventilated. Catheters were inserted in the right femoral and pulmonary arteries for blood sampling, and a gastric tonometer catheter was inserted into the gastric lumen. Baseline measurements of systemic hemodynamics, arterial ketone body ratio (AKBR), gastric intramucosal pH (pHi) and arterial lactate were recorded. Hemodilution was then begun by 6% pentastarch and was made in four levels of hematocrit values of 20%, 15%, 10% and 6%. RESULTS: Mean arterial pressures of Hct 10% and 6% was decresaed (P < 0.05) and Hct 15% and 10% increases in cardiac output and pulmonary capillary wedge pressure (PCWP) were observed. Central venous pressure and mean pulmonary arterial pressure were incresed (P < 0.05) at Hct 15%, 10% and 6%. DO2 progressively decreased (P < 0.05). AKBR and pHi began to decreased at Hct 15%. Arterial lactate decrease at Hct 15% and was above 7.4 mmol/L at Hct 6%. CONCLUSIONS: By the measurements of AKBR and pHi, the disturbance of splanchnic oxygenation can be detected early compared to those of O2 in terms of oxygen metabolism and the critical point of DO2 during acute normovolemic anemia induced by hemodilution.
Anemia* ; Animals ; Arterial Pressure ; Cardiac Output ; Catheters ; Central Venous Pressure ; Dogs* ; Hematocrit ; Hemodilution* ; Hemodynamics ; Hydrogen-Ion Concentration* ; Hydroxyethyl Starch Derivatives ; Lactic Acid* ; Metabolism ; Oxygen Consumption* ; Oxygen* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Regional Blood Flow

Congenital diaphragmatic anomaly is a rare congenital malformation and is found more frequently on the left side than right side. We had experienced two cases of comgenital diaphragmatic anomaly on the right side. One case was 8 months old male with congenital Bochdalek hernia and the other case was 17 months old female with congenital eventration of the diaphagm. The diagnosis was established by physical examination, chest X-ray, upper G-I series and other special studies. A brief review of the related literature was also presented.
Diagnosis ; Female ; Hernia ; Humans ; Infant ; Male ; Physical Examination ; Thorax

Hepatocellular carcinoma (HCC) is a common neoplasm, and its metastasis to the head and neck area is rare. We herein describe a unique case of HCC metastasis to the dorsal tongue. A 54-year-old male who was already diagnosed with HCC visited our hospital complaining of dysphagia and a progressively enlarging dorsal tongue mass. We operated to excise on the mass using CO₂ laser including mucosal margin and deep margin. The diagnosis of HCC metastasis was confirmed immunohistochemically. After 2 weeks of follow-up, the patient did not exhibit any evidence of complication and could eat orally without any problem. Further treatment to the other metastatic lesion was rejected, and the patient was followed up for more than six months. We introduce this first case of metastatic HCC in the dorsal tongue. With the extended life expectancy of HCC patients, the incidence of rare metastasis is expected to increase.
Carcinoma, Hepatocellular* ; Deglutition Disorders ; Diagnosis ; Follow-Up Studies ; Head ; Humans ; Incidence ; Life Expectancy ; Male ; Middle Aged ; Neck ; Neoplasm Metastasis* ; Tongue*

BACKGROUND AND OBJECTIVES: Various surgical approaches have been employed for the complete resection of inverted papilloma (IP) of the nose and paranasal sinus. Sacrificing the inferior turbinate (IT) and nasolacrimal duct (NLD) is often unavoidable due to the anatomy of maxillary sinus. However, the prelacrimal recess approach (PLRA) provides a wider entrance to the maxillary sinus without the ablation of NLD and IT. We present seven cases of IP successfully treated by the PLRA.SUBJECTS AND METHOD: We collected data from seven different cases involving patients who underwent resection of IP by means of the PLRA from 2016 to 2017. If the lesion could not be removed first via middle meatal antrostomy (MMA), then PLRA was attempted. The surgical specimens were all confirmed to be IP. RESULTS: Preoperative imaging studies demonstrated that the lesions of IP were located mainly in the maxillary sinus. All of the seven patients had unilateral lesions and all tumors were completely resected via PLRA. The follow-up ranged from 3 to 24 months, during which no recurrence or complications were observed in any of the seven patients. CONCLUSION PLRA provides an adequate operation field without unfavorable scars. It allows the preservation of sinus structure and function. PLRA is feasible and can be used for the diffuse maxillary sinus IP.

Sialolithiasis is the most common disorder associatd with major salivary glands. It may form in any salivary glands or ducts, but is reported to occur more often in the submandibular gland than in the parotid or sublingual gland. Although the pathogenesis is not perfectly revealed, there appear to be several factors that predispose the submandibular gland duct to be a common site of sialolithiasis. Sialolithiasis occurs as a consequence of the precipitation of calcium salts around a central nidus of desquamated epithelial cells, inflammatory cells, mucoid gels or foreign body. However, it is not a common thing that foreign body entered into the salivary duct through duct orifice may act as the initiating factor. We have recently experienced a case in a 52-year-old female, in which sialolithiasis seems to have formed due to a a foreign body, a fish bone, in the right submandibular gland duct.
Calcium ; Epithelial Cells ; Female ; Foreign Bodies ; Gels ; Humans ; Middle Aged ; Salivary Ducts ; Salivary Gland Calculi ; Salivary Glands ; Salts ; Sublingual Gland ; Submandibular Gland*

BACKGROUND AND OBJECTIVES: Various surgical approaches have been employed for the complete resection of inverted papilloma (IP) of the nose and paranasal sinus. Sacrificing the inferior turbinate (IT) and nasolacrimal duct (NLD) is often unavoidable due to the anatomy of maxillary sinus. However, the prelacrimal recess approach (PLRA) provides a wider entrance to the maxillary sinus without the ablation of NLD and IT. We present seven cases of IP successfully treated by the PLRA. SUBJECTS AND METHOD: We collected data from seven different cases involving patients who underwent resection of IP by means of the PLRA from 2016 to 2017. If the lesion could not be removed first via middle meatal antrostomy (MMA), then PLRA was attempted. The surgical specimens were all confirmed to be IP. RESULTS: Preoperative imaging studies demonstrated that the lesions of IP were located mainly in the maxillary sinus. All of the seven patients had unilateral lesions and all tumors were completely resected via PLRA. The follow-up ranged from 3 to 24 months, during which no recurrence or complications were observed in any of the seven patients. CONCLUSION: PLRA provides an adequate operation field without unfavorable scars. It allows the preservation of sinus structure and function. PLRA is feasible and can be used for the diffuse maxillary sinus IP.
Cicatrix ; Follow-Up Studies ; Humans ; Maxillary Sinus ; Methods ; Nasolacrimal Duct ; Nose ; Papilloma, Inverted ; Recurrence ; Turbinates

BACKGROUND: This study was to investigate the feasibility of real-time 3-dimensional echocardiography (RT3DE) for the analysis of biventricular ejection fractions and volume measurements in patients with cor pulmonale and the correlations of RT3DE results with 64-slice multi-detector cardiac computed tomography (64-MDCT) results. METHODS: This study included a total of 22 patients (59.3 +/- 16.6 years of age; 10 males and 12 females) who showed flattening or reverse curvature of the interventricular septum and severe pulmonary hypertension [mean right ventricular (RV) systolic pressure = 66.8 +/- 19.7 mmHg] on 2-dimensional transthoracic echocardiography due to cor pulmonale. Biventricular end-diastolic and end-systolic volumes were measured by RT3DE and 64-MDCT. The severity of D-shaped deformation was evaluated by using left ventricular (LV) eccentricity index (ratio of diameters parallel/perpendicular to the interventricular septum on parasternal short axis images of the papillary muscle level). RESULTS: There were moderate correlations between biventricular volumes measured by RT3DE and 64-MDCT except for LV end-systolic volume (59.8 +/- 17.1 vs. 73.2 +/- 20.2 mL, r = 0.652, p = 0.001 for LV end-diastolic volume; 30.6 +/- 9.1 vs. 30.8 +/- 12.5 mL, r = 0.361, p = 0.099 for LV end-systolic volume; 110.1 +/- 42.9 vs. 171.1 +/- 55.3 mL, r = 0.545, p = 0.009 for RV end-diastolic volume; and 80.9 +/- 35.0 vs. 128.7 +/- 45.1 mL, r = 0.549, p = 0.005 for RV end-systolic volume respectively). CONCLUSION: This study suggests that RT3DE may be a modest method for measuring distorted biventricular end-systolic and end-diastolic volumes in patients with cor pulmonale.
Axis, Cervical Vertebra ; Blood Pressure ; Echocardiography ; Echocardiography, Three-Dimensional ; Humans ; Hypertension, Pulmonary ; Male ; Papillary Muscles ; Pulmonary Heart Disease

Takotsubo cardiomyopathy, also called apical ballooning syndrome or stress-induced cardiomyopathy, is a unique reversible cardiomyopathy that is frequently precipitated by a stressful event, and is described as a typical form of acute transient left ventricular dysfunction. The classic situation is postmenopausal women presenting with chest pain or dyspnea. The overall prognosis is favorable. We report a case of a 75-year-old female patient who came to our hospital with dizziness, which was found to be caused by transient apical ballooning following permanent pacemaker implantation.
Aged ; Atrioventricular Block ; Cardiomyopathies ; Chest Pain ; Dizziness ; Dyspnea ; Female ; Humans ; Life Change Events ; Pacemaker, Artificial ; Porphyrins ; Prognosis ; Takotsubo Cardiomyopathy ; Ventricular Dysfunction, Left

BACKGROUND: This study was designed to compare the effect of dexmedetomidine and remifentanil used in anesthetic induction on hemodynamic change after direct laryngoscopy and tracheal intubation. METHODS: A total of 90 ASA class 1 or 2 patients were randomly assigned to one of 3 groups to receive one of the following treatments in a double-blind manner: normal saline (Group C, n = 30), dexmedetomidine 1 microg/kg (Group D, n = 30), remifentanil 1 microg/kg (Group R, n= 30). Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.6 mg/kg and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. In group D, dexmedetomidine 1 microg/kg was infused for 10 min before tracheal intubation. Patients in group R was received 1 microg/kg of remifentanil 1 minute before tracheal intubation. The systolic blood pressure, diastolic blood pressure and heart rate were recorded from entrance to operation room to 5 min after tracheal intubation. RESULTS: The percent increase in systolic and diastolic blood pressure due to tracheal intubation in group D and R were significantly lower than that of group C (P < 0.05). The heart rate 1 min after tracheal intubation was lower in groups R and D than in the group C (P < 0.05). CONCLUSIONS: In healthy normotensive patients, the use of dexmedetomidine during anesthetic induction suppressed a decrease in blood pressure due to anesthetic induction and blunted the hemodynamic responses to endotracheal intubation.
Androstanols ; Anesthesia ; Blood Pressure ; Dexmedetomidine ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Methyl Ethers ; Nitrous Oxide ; Oxygen ; Piperidines ; Propofol

Achondroplasia is the most common non-lethal skeletal dysplasia. Underdevelopment and premature ossification of bones result in characteristic craniofacial and spinal abnormalities. Achondroplastic dwarfs have low fertility rates and require delivery by cesarean section due to their cephalo-pelvic disproportion. Controversy exists regarding the ideal anesthesia for an achondroplastic parturient dwarf for urgent cesarean section. Anesthesia, whether general or regional, presents many potential problems during cesarean section. We report the experience of the epidural anesthesia in an achondroplastic dwarf undergoing elective cesarean section.
Achondroplasia ; Anesthesia ; Anesthesia, Epidural ; Birth Rate ; Cesarean Section ; Female ; Pregnancy