Neurilemmomas of the trachea are extremely rare. The most common site of them is the distal third of the trachea and the age of the patients at presentation varied from 6 to 78 years old. They usually have a freqeuntly very long natural history, causing symptoms only after they have attained a considerable size. We experienced a case of near-total obstruction of the trachea by an intraluminal sessile neurilemmoma. The patient was a 66-year-old man with 2-year history of progressive exertional dyspnea and had several episodes of pneumonitis associated with productive cough. Grossly, the tumor was a well-circumscribed mass. Microscopically, typical cellular Antoni A and myxoid Antoni B areas were revealed.
Aged ; Cough ; Dyspnea ; Humans ; Natural History ; Neurilemmoma* ; Pneumonia ; Trachea

BACKGROUND: Explicit recall in a cesarean section under general anaesthesia can be a terrifying experience and may cause psychological sequelae. Administering low doses of midazolam, we investigated the changes of the bispectral index (BIS) and the occurrence of explicit recall of specific events after fetal expulsion in a cesarean section under general anesthesia. METHODS: The investigation was carried out on 30 ASA 1 or 2 parturients who underwent a cesarean section under general anesthesia. Anesthesia was maintained with 50% N2O in oxygen and 0.75% of isflurane. We randomly allocated parturients into a control group (n = 10), group A (n = 10), and B (n = 10). Neither midazolam nor any other drugs except oxytocin were administered in the control group. In the group A and B, midazolam 0.02 and 0.03 mg/kg respectively, were injected immediately after umbilical cord clamping. An isolated forearm test were done to all the parturients at 5, 10, and 20 minutes after fetal expulsion. We assessed the changes of the BIS at 1, 2, 3, 4, 5, 10, 15, and 20 minutes after fetal expulsion, at discontinuance of isoflurane administration and extubation. The wav file, "clench your left or right hand" was binaurally played, simultaneously with the isolated forearm test. The wav file, "one, two, three, four, five" was also binaurally played 15 minutes after fetal expulsion. We interviewed all the parturients the next day and assessed the occurrence of explicit recall. RESULTS: The BIS values after fetal expulsion in the control group and group A was maintanied above 60 and group B, below 60 (P < 0.05). The lowest median BIS value was 54.5 in the group A, 36.4 in the group B (P < 0.05). There were two parturients in the control group and in the group A, respectively, who showed explicit recall. The results of the isolated forearm test were negative for all groups. The extubation times and PAR scores failed to show significant differences among the three groups. CONCLUSIONS: The authors confirmed the occurrence of explicit recall for specific events after fetal expulsion. The BIS values after fetal expulsion could be maintained below 60 until the end of surgery,and explicit recall could be prevented when we injected midazolam 0.03 mg/kg immediately after fetal expulsion.
Anesthesia ; Anesthesia, General* ; Cesarean Section* ; Constriction ; Female ; Forearm ; Isoflurane ; Midazolam* ; Oxygen ; Oxytocin ; Pregnancy ; Umbilical Cord

BACKGROUND: In some cases of one-lung ventilation (OLV), hypoxemia may occur secondarily to the obligatory right to left transpulmonary shunt through the collapsed lung. We investigated the efficacy of high frequency jet ventilation (HFJV) to the non-dependent lung which rendered to be manually collapsed by surgeon and not to be reinflated, in improving systemic oxygenation and ventilation during OLV while ventilating the dependent lung with intermittent positive pressure ventilation. METHODS: Investigation was carried out on 20 ASA 2 or 3 patients who underwent thoracotomy in lateral decubitus position. The patients were randomly allocated into HFJV group (n = 11) or CPAP group (n = 9). In HFJV group, 20 minutes after OLV began, HFJV with driving pressure 1.0 bar, Ti 30%, and frequency 150 cycles/min, was applied to the non-dependent lung. In CPAP group, 5 cmH2O of CPAP was applied to the non-dependent lung without re-inflation. We compared the changes of PaO2, PaCO2, AaDO2 and pulmonary shunt, before and after HFJV or CPAP was applied to the non-dependent lung during OLV. RESULTS: AaDO2 and pulmonary shunt were decreased significantly and therefore, PaO2 was increased significantly when HFJV was applied to the non-dependent lung (P < 0.05, respectively). PaO2, AaDO2 and pulmonary shunt were not improved after 5 cmH2O of CPAP was applied to the non-dependent lung without re-inflation. In HFJV group, PaCO2 measured after HFJV was not decreased significantly compared with that before HFJV. CONCLUSIONS: HFJV to the non-dependent lung during OLV improved systemic oxygenation, even after the non-dependent lung collapsed completely but did not enhance CO2 elimination. 5 cmH2O of CPAP to the non-dependent lung, which was completely collapsed and not re-inflated, did not improve systemic oxygenation.
Anoxia ; High-Frequency Jet Ventilation* ; Humans ; Intermittent Positive-Pressure Ventilation ; Lung* ; One-Lung Ventilation* ; Oxygen* ; Thoracotomy ; Ventilation

BACKGROUND: As the clinical-end point is not clear-cut in conscious sedation, there are no objective and feedback-providing methods to assess the depth of sedation within the levels appropriate for conscious sedation. METHODS: The investigation was carried out on 19 ASA PS 1 patients. The authors developed a system to measure the reaction time to visual (red colored flash, 40 lux for 30 msec) and auditory (beep, 1,000 Hz, 67.5 dB for 30 msec) stimulations. The authors confirmed the beeps to be audible to all the patients before the test began. When they perceived a visual or auditory stimulation, the authors instructed the patients to signal by pushing a button as soon as possible. The reaction time was defined as the time from the beginning of stimulation to the push of a button. The patients were gradually sedated with propofol TCI. The authors measured the visual and auditory reaction time and BIS after every 0.1 microgram/ml increment of the effect site concentration of propofol. RESULTS: As the effect site concentration of propofol increased, the reaction time to visual and auditory stimulations tended to be prolonged (P < 0.0001, respectively). The estimate was 409 and 498, respectively, which means the slope a in y = ax; x means unit change of the effect site concentration of propofol; y means the estimated values of the reaction time. The BIS values at loss of response to visual and auditory stimulations were 86 +/- 7 and 78 +/- 7 (mean +/- SD). CONCLUSIONS: The responses to visual and auditory stimulations were prolonged and ultimately abolished as the effect site concentration of propofol increased. The loss of response to visual stimulations preceded the loss of response to auditory stimulations. The BIS values at loss of responses to visual and auditory stimulations suggested light and moderate sedation, respectively.
Acoustic Stimulation ; Conscious Sedation* ; Humans ; Photic Stimulation ; Propofol* ; Reaction Time*

Although intramedullary nailing is mostly used in the management of fractures in the long bone shaft, plate fixation is still alternative option in periprosthetic or metaphyseal fractures. For the rigid fixation during plating, sometimes we need wiring. Many surgeons experience slippage of wire resulting in loss of rigid fixation because plate and wire is so slippery and the diameter of bone is changing by level especially in the metaphyseal area. Wiring plate(CHO plate) was designed to prevent slippage. This plate has transverse holes for wires between screw holes on traditionally used dynamic compression plate. Sixteen fractures of long bone shaft were fixed with wiring plate and 11 cases which were followed up for more than one year were evaluated. There were periprosthetic fractures(4 cases), spiral or butterfly fractures(4 cases) and fractures of poor bone quality(two cases of malignancy and one case of osteoporosis). Nine cases were successfully reduced and the healed without loss of fixation. In two cases, delayed union and nonunion were observed due to wire breakage with plate loosening. Preliminarily, wiring plate fixation can be used for the periprosthetic fracture and one of alternative option in butterfly or spiral fracture and fracture in osteoporotic bone or pathologic fracture.
Butterflies ; Fracture Fixation, Intramedullary ; Fractures, Spontaneous ; Periprosthetic Fractures

There are a few case reports describing prolonged myoclonus following propofol. A previously fit 26 year old woman presented for a left knee lateral impingement under general anesthesia as a day case. She had no personal or family history of epilepsy. Induction was smooth and anesthesia was maintained with propofol TCI, nitrous oxide 65% and oxygen 35%. 30 minutes after stopping of the propofol infusion, the patient developed involuntary movement and shivering that recurred intermittently. After drug therapy and psychotic therapy the patient was progressively stabilized. However 4 hours later the patient developed involuntary movement and myoclonus. She was admitted to the department of neurology under the diagnosis of propriospinal myoclonus. Forty days later she was discharged without long term sequelae.
Adult ; Anesthesia* ; Anesthesia, General ; Diagnosis ; Drug Therapy ; Dyskinesias ; Epilepsy ; Female ; Humans ; Knee ; Myoclonus* ; Neurology ; Nitrous Oxide ; Oxygen ; Propofol* ; Shivering

Simultaneous intraoperative measurements of eardiac output were obtained in twenty one patients with thoracic electric bioimpedance(TEB) and transesophageal Doppler, two patients with transesophageal Doppler and thermodilution, one patient with TEB and thermodilution, and three patients with TEB, transesophageal Doppler and thermodilution techniques to evaluate the utility of noninvasive methods. Pairs of measurments were obtained 6S times with TEB and thermodilution, 109 times with transesophageal Doppler and thermodilution, and 373 times with TEB and transesophageal Doppler techniques. Correlation of the measurements was poor, with r=0.39 for TEB and thermodilution, r=0.44 for transesophageal Doppler and thermodilution, and r=0.39 for TEB and transesophageal Doppler. The mean difference between TEB and thermodilution, transesophageal Doppler and thermodilution, and TEB and transesophageal Doppler values was -2.41+/-1.79 L/min(mean+/-SD), -0.98+/-1.70 L/min, and -0.69+/-1.01 L/min, respectively. The scattergrams with confidence band lines showed that 22.0% of the scattergram points fell within +/-20% band and 51.5% within +/-40% band in TEB and thermodilution, 55.0% of the scattergram points fell within +/-20% band and 77.9% within +/-40% band in transesophageal Doppler and thermodilution, and 63.6% of the scattergram points fell within +/-20% band and 90.9 within +/-40% band in TEB and transesophageal Doppler. Therefore, it is concluded that neither noninvasive technique reliably estimated cardiac output as determined by thermodilution.
Cardiac Output* ; Humans ; Thermodilution*

Breast cancer is the most common cancer in Korean women since 2001 and needs national interests. The incidence of breast cancer is increasing with new breast cancer cases reaching more than 10,000 cases annually. But, there are some difficulties in breast cancer control; first, the National Cancer Screening Program is ineffective and of low quality, second, the lack of psychosocial care for mastectomized patients, third, the lack of national care for terminal cancer patients. For effective breast cancer control, we need special support for breast cancer awareness campaign, activation of breast cancer registry, development of clinical practice guideline, development of hospice program, breast cancer research, and upgrading its guarantee on breast cancer treatment. The Korean Breast Cancer Society should have the leading role in solving the current problems, but moreover, we cannot overemphasize the need for national support.
Breast Neoplasms* ; Breast* ; Early Detection of Cancer ; Female ; Hospice Care ; Humans ; Incidence

Skin fibrotic disorders are understood to develop under the influence of various cytokines, such as transforming growth factor(TGF)-beta1, connective tissue growth factor(CTGF) and vascular endothelial growth factor (VEGF). To establish an appropriate animal model of skin fibrosis by exogenous application of growth factors, the author investigated the in vivo effects of growth factors by injecting recombinant TGF-beta1 protein and pCMV- Flag5-CTGF into the subcutaneous tissue of Sprague- Dawley rats. A single application of TGF-beta1 protein and CTGF DNA resulted in the formation of transient granulation tissue. Immunohistochemical finding showed increased expression of TGF-beta1 protein after injection of pCMV-Flag5-CTGF. In situ hybridization analysis revealed the expression of CTGF mRNA after injection of TGF-beta1 protein. VEGF expression was not affected by the TGF-beta1 and CTGF injection. These findings suggest TGF-beta1 and CTGF are deeply related with skin fibrosis and it appears that TGF-beta1 may cause the induction of CTGF expression. The animal model on skin fibrosis by exogenous application of TGF-beta1 protein and CTGF DNA developed in this study may be useful for future studies on fibrotic disorders.
Animals ; Cicatrix* ; Connective Tissue ; Connective Tissue Growth Factor ; Cytokines ; DNA ; Fibrosis ; Granulation Tissue ; In Situ Hybridization ; Intercellular Signaling Peptides and Proteins ; Models, Animal ; Rats* ; RNA, Messenger ; Skin ; Subcutaneous Tissue ; Transforming Growth Factor beta1* ; Vascular Endothelial Growth Factor A*

BACKGROUND: Propofol and alfentanil are frequently combined for general anesthesia. The purpose of this study was to characterize the appropriate effect-site concentration of alfentanil combined with an effect-site concentration of propofol of 4 microgram /ml during endotracheal intubation. METHODS: One hundred and thirty patients, aged 40-70 years and scheduled for abdominal surgery were randomly allocated to four groups according to the target effect-site concentrations of alfentanil: 0 ng/ml in the placebo group, 50 ng/ml in the P50 group, 75 ng/ml in the P75 group, and 100 ng/ml in the P100 group. All patients received a computer controlled infusion of propofol with an effect-site concentration of 4microgram/ml. After equilibration between plasma and effect-site was achieved, and the trachea of the patient was intubated. The assessments of hemodynamic changes were usually confined to the measurement of changes in systolic/diastolic blood pressure (SBP/DBP), mean arterial pressure (MAP), and heart rate (HR). Also, we checked the dose requirements of ephedrine and atropine used to correct hypotension and bradycardia. RESULTS: The use of alfentanil (especially 50 or 75 ng/ml) was effective at blunting the SBP increase during the few minutes after intubation. However, the dose requirements of ephedrine and atropine in the P100 group were significantly higher than those in other groups. CONCLUSIONS: The appropriate effect-site concentration of alfentanil combined with an effect-site concentration of propofol of 4microgram/ml during endotracheal intubation lies between 50 and 75 ng/ml.
Alfentanil* ; Anesthesia, General ; Arterial Pressure ; Atropine ; Blood Pressure* ; Bradycardia ; Ephedrine ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypotension ; Intubation ; Intubation, Intratracheal* ; Plasma ; Propofol* ; Trachea