Aspiration of gastric content is always a threat in emergency operations. The consequences of pulmonary aspiration are connected with both the volume and the character of the material inhaled, but perhaps the most serious consequences result from the relative acidity of gastric secretions. Inhalation of materiaI with a pH less than 2.5 causes an immediate iatense bronchoconstriction, epithelial degeneration of the bronchi, pulmonary edema and hemorrhage. Once the aspiration of material from the stomach is thought to have occurred, the airway should be cleared as soon as possible and any aspirated material remaining in the oropharynx should be cleared by means of suction. This experimental study was carried out to assess the therapeutic effect of suction on pulmonary aspiration of hydrochloric acid and the changes in chest X-ray findings caused by aspiration of the acid. The condition of oxygenation of the animals were studied by blood gas analysis. In this experiment,24 rabbits weighing 1.8-2.2 kg were used and divided into 4 groups each group consisting of 6 rabbits. Group I: No suction after aspiration Group II: Immediate suction after aspiration Group III: Suction 5 seconds after aspiration Group IV: Suction 10 secoads after aspiration Each of the four groups in the state prior to aspiration served as a control. All experimental animals were anesthetized by intravenous injection of ketamine 75 mg/kg and HC1 (pH: l.0, 2 ml/kg) was instilled into the trachea through a tracheostomy tube while the animals were fixed in a head-up position. Suction was made 5 times vigorously through a tracheostomy tube using an electric suction apparatus in the suction groups. Spontaneous respiration was maintained in room air throughout the experiment. To see cehange in the findings of the lung, chest X-ray was taken 24 hours after the aspiration of HCL. The sample of arterial blood was taken from the femoral artery and analyzed for blood gas 5 minutes, 10 minutes, 30 minutes, 1 hour and 2 hours after the aspiration of HCl. The results were as follows:1) In all rabbits except one in group II, the findings of radioopacity was visible in the lungs 24 hours after the aspiration of HCL. 2) In the chest X-ray findings, group I revealed radioopacity in the area of 74.76+/-8.93% of the whole lung field, group II in the area of 9.13+/-5.84%, group III in the area of 40.67+/-15.89% and group IV in the area of 58.96+/-6.65%. 3) In blood gas analysis, PaO2 decreased to 52.2% of control at 5 minutes in all aspiration groups (P<0.01) and 2 hours later, the recovery of PaO2 values observed were 73.2% of the control in group I, 88.7% in group II, 82.7% in group II and 77.1% in group IV, The value of the PaCO2, was significantly decreased at 10 minutes, 30 minutes, 1 hour and 2 hours in group II(P<0.01) after aspiration but in the other groups, the changes were insignificant. The value of pH shown insignificant decrease in group I and group IV, and insignificant increase in group II and group III. From the above findings, the pulmonary changes after the aspiration of hydrochloric acid seemed not to be lessened by suction treatment after 10 seconds following aspiration of the acid.
Animals ; Blood Gas Analysis ; Bronchi ; Bronchoconstriction ; Emergencies ; Femoral Artery ; Hemorrhage ; Hydrochloric Acid ; Hydrogen-Ion Concentration ; Inhalation ; Injections, Intravenous ; Ketamine ; Lung ; Oropharynx ; Oxygen ; Pulmonary Edema ; Rabbits* ; Respiration ; Stomach ; Suction* ; Thorax ; Trachea ; Tracheostomy

No abstract available.
Snake Bites* ; Snakes*

Dislocation of the temporomandibular joint(TMJ) is fairly frequent but backward dislocation of TMJ during induction of anesthesia is rarely reported. The causes include congenital weakness of the capsule or malformation of the condyles of both. The physical causes are as follows ; The joint may be strained or injured during general anesthesia, 1) possible straing or injureyto the joint, 2) yawning, 3) attempts by children to insert large objects into the mouth, 4) and positional pressures during sleep. Acase of backward dislocation of TMJ occureed during induction of anesthesia and treated with nanual reduction and subsequent intermaxillary fixation.
Anesthesia* ; Anesthesia, General ; Child ; Dislocations* ; Humans ; Joints ; Mouth ; Temporomandibular Joint* ; Yawning

There are various etilogic factors concerned in the formation of pulmonary edema but it is rare that pulmonary edema is elicited as a consequence of direct current shock. The cause of this complication is unknown. The mechanism of pulmonary edema is suspected that acute alteration or disparities in atrial or ventricular mechanical function of the heart consequent to the application of electrical discharge precipitate pulmonary congestion. A case of acute pulmonary edema following the use of direct current shock during anesthesia for mitral commissurotomy was experienced. The patient was treated with oxygen, diuretics, steroid, continuous positive pressure ventilation and partial cardiopulmonary bypass. The patient recovered without further event.
Anesthesia ; Cardiopulmonary Bypass ; Diuretics ; Estrogens, Conjugated (USP) ; Heart ; Humans ; Oxygen ; Positive-Pressure Respiration ; Pulmonary Edema* ; Shock* ; Thoracic Surgery*

Brain Computerized Tomography(CT) and cerebral angiography were reviewed in thirty-six patients with multiple intracranial aneurysms(22.5%) among the 160 consecutive surgical cases of intracranial aneurysms. The prevalent sites of multiple aneurysms were the middle cerebral artery(37.0%), posterior communicating artery(22.2%), and internal carotid artery(14.8%) in sequence. However, the vertebrobasilar system(83.3%), anterior communicating artery(63.6%), and posterior communicating artery(50.0%) had higher probability of rupture than internal carotid artery(8.3%) or middle cerebral artery(33.3%). Based on CT and angiographic information, the site of rupture can be predicted with a high degree of reliability. These factors were the presence of localized hemorrhage on CT, focal vasospasm, size and irregularity of aneurysms, and relative hyperplasia of parent artery.
Aneurysm ; Arteries ; Brain ; Cerebral Angiography ; Hemorrhage ; Humans ; Hyperplasia ; Intracranial Aneurysm ; Parents ; Rupture

BACKGROUND: We addressed the problem of the circadian changes in neural control of the circulation in ambulant hypertensive subjects. With spectral analysis of heart rate variability the tonic sympathetic and vagal activities and their changes are respectively assessed by the power of 0.050 - 0.015Hz(low frequency, LF) and 0.150 - 0.350Hz(respiratory linked, high frequency, HF) components of the spectrum of the beat by beat variability of RR interval. METHODS: Heart rate variability(HRV) and its circadian rhythm were evaluated in 15 patients with hypertension. By using 24-h Holter monitoring, HRV and its spectral components were measured. Finding were compared with 15 age-matched normal controls. RESULTS: The 24-hour plot of the SDs revealed that heart rate variability was significantly lower in the hypertensive patients, and the differences reached statistical significance during hours 2, 3, 9, 13, 16, 18, 19, and 23(p<0.05). Spectral analysis showed that power in the high-frequency range(0.150 to 0.350Hz) was lower among the hypertensive patients than among the normal controls during 22 of 24 hours but that the difference was statistically significant only during 2 hours(p<0.05). Power in the low frequency range(0.050 to 0.150Hz) was low at night, increased in the morning, and high during the day among controls ; this circadian rhythm was absent among hypertensive patients. CONCLUSIONS: Among hypertensive patients, HRV is decreased with a partial withdrawal of parasympathetic tone, and the circadian rhythm of sympathetic/parasympathetic tone is altered.
Circadian Rhythm ; Electrocardiography, Ambulatory ; Heart Rate ; Humans ; Hypertension

Twenty patients with a major thoracolumbar or lumbar spine fractures were treated with various kinds of internal fixation device through anterior or posterior approach during last 2 years. Anterior spinal surgery(10 patients) applied to the patients who had a major fracture of anterior compartment with neural canal impingement and condisted of anterior decompression through vertebrectomy and stabilization with Kaneda device. Posterior spinal surgery(9 patients) applied to mainly posterior compartment injury and consisted of stabilization with Harrington instrument(3 patients) and Roy-Camille plate system(6 patients). The other one patient was treated with a combined approach of anterior decompression and posterior Harrington instrumentation. No patients showed neurological deterioration after surgery and 15 patients(75%) improved postoperatively with entering the next Frankel subgroup. Radiologic evaluation showed the correction of the fracture deformity with satisfactory outcome postoperatively. There was no significant difference between anterior and posterior spinal surgery regarding operative result.
Congenital Abnormalities ; Decompression ; Decompression, Surgical* ; Humans ; Internal Fixators ; Neural Tube ; Spine*

Intracranial pressure was monitored in 23 patients, either who exhibited an increase in pressure or who were considered at risk for the developement of intracranial hypertention. The intracranial pressure was measured while the patient was in the position from supine to 50 degree of head elevation. The intracranial pressure was decreased during head elevation, but 8 cases(34.8%) were not changed. The maximal cerebral perfusion pressure was seen at 50 degree of head elevation(52.2%), next 30 degree(21.7%) and 40 degree(7.4%) in orders. The changes of vital sign were not significant during head elevation. To control the intracranial pressure, the patient who were managed in the position of 30degrees and 50degrees head elevation showed most effective cerebral perfusion pressure without any significant changes of the vital sign and central venous pressure.
Central Venous Pressure ; Head* ; Humans ; Intracranial Pressure* ; Perfusion* ; Vital Signs*

Cerebrospinal fluid lactate and intracranial pressure were measured in 24 severely head-injured patients with Glasgow coma scale below 8. Cerebral perfusion pressure, vital sign and CVP were also measured simultaneously. Severely head-injured patients revealed increased CSF lactate and intracranial pressure which have been significantly correlated with outcome. But changes of vital sign, cerebral perfusion pressure and CVP were not correlated with outcome. The elevation of intracranial pressure checked on arrival was statistically significant in correlation to outcome. And the elevation of CSF lactate were correlated with statistically significance in correlation with outcome and lactate level checked on time interval(arrival, 12hr, 24hr, 48hr after trauma). And so CSF lactate levels are statistically more significant than intracranial pressure in predicting prognosis. We will expect good prognosis in severely head-injured patient by reducing intracranial pressure and CSF lactate, oxygenation and increasing cerebral perfusion.
Cerebrospinal Fluid ; Glasgow Coma Scale ; Humans ; Intracranial Pressure ; Lactic Acid* ; Oxygen ; Perfusion ; Prognosis* ; Vital Signs

Nonsurgical management of four cases of the parasagittal epidural hematoma were experienced. Patients were mildly symptomatic or minimal neurological disturbances on admission. Patients were treated conservatively because of stable neurologic sign. All patients had who diastatic fracture and / or suture have become a complete neurological recovery with satisfactory absorption of EDH over a period of 5 to 12 weeks.
Absorption ; Hematoma* ; Humans ; Neurologic Manifestations ; Sutures