BACKGROUND: Desflurane is known to causes hypertension and tachycardia when its inspired concentration is rapidly increased. We determined whether nitrous oxide (N2O) or remifentanil alters cardiovascular responses to intubation and/or inhalation of high concentrations of desflurane during induction of anesthesia. METHODS: Sixty patients were assigned randomly into three groups (n = 20 each). Anesthesia was induced with thiopental 5 mg/kg followed by saline (control and N2O groups) or remifentanil 1microg/kg (remifentanil group). Tracheal intubation was facilitated with intravenous vecuronium 0.12 mg/kg and 12% desflurane was given soon after the intubation. In addition, 75% N2O was given beginning 3 min before the intubation in the N2O group. Systolic arterial pressure (SAP), heart rate (HR), and plasma catecholamine concentrations were determined. RESULTS: The intubation resulted in an immediate increase and an additional second increase of SAP and HR at 3 to 5 min after intubation in all groups. SAP but not HR in the N2O group and both SAP and HR in the remifentanil group at first and second peak responses were lower than in the control group. Norepinephrine increased at 1 min after intubation and increased further at 5 min in the control and N2O groups but only increased at 5 min in the remifentanil group. CONCLUSIONS: A biphasic pressor and tachycardiac response in response to intubation and desflurane were noted. Although N2O did not affect tachycardiac response, it suppressed the pressor responses and augmented norepinephrine release. However, remifentanil significantly attenuated hemodynamic and catecholamine responses to endotracheal intubation and desflurane.
Anesthesia ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Inhalation ; Intubation ; Intubation, Intratracheal ; Isoflurane ; Nitrous Oxide ; Norepinephrine ; Piperidines ; Plasma ; Tachycardia ; Thiopental ; Vecuronium Bromide

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare, autosomal-recessive disorder characterized by the clinical triad of indifference of pain, anhidrosis and heat intolerance.Because of their lack of autonomic response to noxious stimuli, the determination of adequate depth of anesthesia in the CIPA patient undergoing surgery is a major challenge.We experienced a patient with CIPA who had minor procedures three times under the general anesthesia, in which bispectral index (BIS) was maintained at 40-50 by adjusting sevoflurane concentrations with 50% nitrous oxide.The low end-tidal sevoflurane concentrations (<1.2 vol%) were required to keep the target BIS while vital signs remained stable throughout the surgery in each operation.BIS monitor may be a valuable tool to guide the depth of anesthesia in patients with CIPA.
Anesthesia ; Anesthesia, General ; Hereditary Sensory and Autonomic Neuropathies ; Hot Temperature ; Humans ; Hypohidrosis ; Indoles ; Methyl Ethers ; Organothiophosphorus Compounds ; Propionates ; Vital Signs

Undifferentiated sarcoma is one of the rare primary malignant tumor of the liver typically occur ring in later childhood. It has also been referred to embryonal sarcoma or malignant mesenchymoma. In Korea, three child and two adult cases have been reported to date in liter ature. We experienced a case of undifferentiated sarcoma in a 65- year- old female who presented with abdominal pain and right upper quadrant mass . Contrast-enhanced abdominal CT scan revealed a well demarcated mass with low at tenuation and sept ation at left lobe of the liver and the mass showed hypovas cular pattern on hepatic angiography. On cross section, the tumor was well demarcated from the adjacent liver by afibr ouspseudocapsule and showed cystic degener ation. Pathologically, the tumor was consistent with an undifferentiated sarcoma of the liver.
Abdominal Pain ; Adult* ; Angiography ; Child ; Female ; Humans ; Korea ; Liver* ; Mesenchymoma ; Sarcoma* ; Tomography, X-Ray Computed

Ingested foreign bodies usually pass through the digestive system uneventfully. The diagnosis of inadvertently swallowed foreign bodies is usually delayed. It often induces serious complications, such as perforation, enterocolic fistula, abscess formation, or aortointestinal fistula. Therapeutic colonoscopy has replaced to a significant degree the need for traditional open surgical procedures to extract foreign bodies from the colon. Various foreign bodies may be extracted from the colon by a number of endoscopic techniques. We describe a case of a patient who presented with abdominal pain, loose stool during 3 months due to the impaction of a chicken bone in the sigmoid colon. The chicken bone was successfully removed by using balloon dilatation during colonoscopy.
Abdominal Pain ; Abscess ; Chickens* ; Colon ; Colon, Sigmoid* ; Colonoscopy ; Diagnosis ; Digestive System ; Dilatation* ; Fistula ; Foreign Bodies ; Humans

BACKGROUND: The purpose of this study was to investigate the ultrastructural relation of H. pylori and gastric epithelial cells in their adhesion. METHODS: Endoscopic biopsy of gastric antrum and body was performed from 15 patients (9 men, 6 women) with chronic gastritis. These specimens were processed and observed by transmission electron microscope (Hitachi H-600). RESULTS: On the basis of morphological appearances, the different types of adhesion of the organism with the epithelial cells were categorized as filamentous connection, adhesion pedestals, membrane fusion. Coccoid and intermediate forms were associated with filamentous connection whereas bacillary forms were associated with adhesion pedestals and membrane fusion. CONCLUSION: Various types of adhesion were associated with H. pylori and gastric epithelium. Further studies are needed to investigate biophysiologic influence to epithelial cells by ultrastructural relationship.(Korean J Med 60:16-21, 2001)
Biopsy ; Epithelial Cells* ; Epithelium ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Male ; Membrane Fusion ; Microscopy, Electron ; Pyloric Antrum

BACKGROUND/AIMS: Efficacy of triple therapy with omeprazole, amoxicillin, and clarithromycin (OAC) for Helicobacter pylori (H. pylori) varies among different geographic regions and patient populations. And, there is no full consensus on how long this treatment should be maintained. We assessed the efficacy of the OAC regimen according to the treatment duration (7, 10 or 14 days) using 13C-urea breath test (13C-UBT). METHODS: Two hundred fifty five H. pylori positive patients with peptic ulcer were randomly assigned to a OAC (omeprazole 20 mg b.d., amoxicillin 1.0 g b.d. and clarithromycin 500 mg b.d.) 7, 10 or 14 days regimen. Eradication of H. pylori was assessed by 13C-UBT 4 weeks after the completion of therapy. RESULTS: 140 male and 115 female (mean age, 51.3) patients were enrolled. The overall eradication rate of H. pylori in each group was significantly higher in OAC 14 days regimen than OAC 7 and 10 days regimen (91.9% in OAC 14 days, 74.4% in OAC 7 days, and 80.2% in OAC 10 days, respectively, p<0.05). CONCLUSIONS: The overall eradication rate of H. pylori was highest in OAC 14 days regimen in our study. We have found significant differences in eradication rates with previous reports, using CLO and histology, in Korea. Thus, further studies focusing on the treatment period may be warranted.
Amoxicillin ; Breath Tests* ; Clarithromycin ; Consensus ; Female ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea ; Male ; Omeprazole ; Peptic Ulcer

Acute pancreatitis in cancer patients can be secondary to the malignant process itself or a complication of antineoplastic agent administration. However, acute pancreatitis caused by metastatic carcinoma of the pancreas is an uncommon condition with a poor prognosis. We report a case of a 63-year-old man with small cell carcinoma of the lung, who developed acute pancreatitis lately. Thirteen months earlier, he developed small cell carcinoma of the lung and received 6 cycles of chemotherapy. Abdominal CT scan showed swelling of the pancreas with multiple masses. The patient was managed conservatively and pancreatitis subsided. This case indicates that metastasis induced acute pancreatitis can be a manifestation of lung cancer, especially in small cell carcinoma.
Carcinoma, Small Cell/secondary* ; Carcinoma, Small Cell/radiography ; Carcinoma, Small Cell/pathology ; Case Report ; Human ; Lung Neoplasms/radiography ; Lung Neoplasms/pathology* ; Male ; Middle Age ; Pancreatic Neoplasms/secondary* ; Pancreatitis/radiography ; Pancreatitis/pathology* ; Tomography, X-Ray Computed

BACKGROUND: The aim of this prospective study was to evaluate the usefulness of PCR-based restriction fragment length polymorphism (RFLP) analysis for differentiating H. pylori strains after the triple therapy in patients with duodenal ulcer. METHODS: Following a 1-2 week regimen of omeprazole 40 mg, amoxicillin 2.0 g, and clarithromycin 1.0 g, twice daily, twenty patients with duodenal ulcer were enrolled. Ten patients (group 1) were not successfully treated, and another 10 patients (group 2) exhibited recurrence of infection. Follow-up diagnosis was performed by Giemsa stain and CLO test. RFLP profiles of antral and midbody biopsy specimens were compared before and after therapy. PCR products using the ureC gene were digested with restriction enzymes Hha I, Mbo I, and Hind III, and the fragments generated were analyzed by agarose gel electrophoresis. RESULTS: Hha I, Mbo I, and Hind III digestion produced 13, 7, and 2 distinguishable digestion patterns, respectively. There was no difference in RFLP profiles before and after the therapy in 17 duodenal ulcer patients, while different RFLP profiles following therapy were discovered in 3 patients. Following treatment, one (group 2) patient differed in Mbo I, and two (one each from both groups) patients differed in Hha I and Mbo I RFLP patterns. CONCLUSION: This study supports the hypothesis that PCR-based RFLP analysis can be useful for differentiating reinfection and recrudescence of H. pylori strains following triple therapy.
Amoxicillin ; Azure Stains ; Biopsy ; Clarithromycin ; Diagnosis ; Digestion ; Drug Therapy ; Duodenal Ulcer ; Electrophoresis, Agar Gel ; Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Omeprazole ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length* ; Prospective Studies ; Recurrence

BACKGROUND: The proper staging of advanced gastric cancer has crucial role in determining resectability and operative method, to prevent unnecessary operation and to predict the prognosis and survival rate. Although marked improvements have been made in computed tomography (CT) technology and endoscopic ultrasonography (EUS) in recent years, reassessment of the laparoscopy for gastric cancer is required as a preoperative staging tool. Therefore, we determined the usefulness of laparoscopy for staging of advanced gastric cancer without distant metastasis in CT and EUS. METHODS: Staging laparoscopy was performed in 48 patients with advanced gastric cancer staged T3 or T4 by CT and EUS. Laparoscopy was carried out with the patients under local anesthesia, and included visual inspection of abdomen, and biopsies for suspicious metastatic lesions. Laparoscopic results were compared with the postoperative pathologic findings. RESULTS: Laparoscopy was performed successfully in 48 patients. Laparoscopy disclosed unrecognized distant metastases in 7 patients (14.6%) judged to be eligible for potentially curative resection by CT and EUS. Preoperative laparoscopy showed an accuracy of 74% for serosal infiltration. CONCLUSION: Our results suggest that laparoscopy is an effective means of evaluating resectability of advanced gastric cancer staged T3 or T4 and can provide valuable help in planning surgical approach.
Abdomen ; Anesthesia, Local ; Biopsy ; Endosonography ; Humans ; Laparoscopes* ; Laparoscopy ; Neoplasm Metastasis* ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms* ; Survival Rate ; Tomography, X-Ray Computed*

BACKGROUND/AIMS: It is suggested that diffuse esophageal spasm (DES), nutcracker esophagus (NUT), and hypertensive lower esophageal sphincter (HLES) could be re-classified together as a spastic esophageal motility disorder of similar clinical backgrounds. However, there were no studies to evaluate the pathophysiological characteristics of these motor abnormalities. The aim of the study was to evaluate the changes of esophageal motor function depending on the different types of the bolus (water vs semi-solid bolus). METHODS: Twenty-one healthy subjects and 42 subjects with primary esophageal motility disorders (4 DES, 12 NUT, 5 HLES, 12 nonspecific esophageal motility disorders, 9 normal) underwent a perfusion manometry with a low compliance pneumo-hydraulic capillary infusion system. Consecutively, each patient had 10 swallows of water and 10 swallows of Jello, 5 ml each. RESULTS: In the healthy controls, the Jello swallow showed an increased amplitude and duration of distal esophageal contractions, and the velocity of peristalsis was decreased (p < 0.05). Among all patients diagnosed by manometry with the water swallow, 2 cases diagnosed with HLES (40%) and 4 with NUT (33%) were changed to a diagnoses of DES after the Jello swallow. Moreover, HLES was found in 1 patient with DES (25%) and in 6 patients with NUT (50%). CONCLUSIONS: Semi-solid bolus swallows increase the contractile force of the esophagus more than water swallows. A conventional manometric diagnosis could be changed to a different spastic motility disorder of the esophagus after a semi-solid bolus swallow. It is suggested that DES, NUT, and HLES can be considered as a spectrum of spastic esophageal motility disorders sharing a similar pathophysiology.
Capillaries ; Compliance ; Diagnosis ; Esophageal Motility Disorders ; Esophageal Spasm, Diffuse ; Esophageal Sphincter, Lower ; Esophagus ; Humans ; Manometry ; Muscle Spasticity ; Nuts ; Perfusion ; Peristalsis ; Swallows ; Water