Laparoscopy is a frequently used technique in surgery and gaining wide popularity replacing laparotomy. The advantages of laparoscopy are shorter hospital stay, faster recovery, more decreased postoperative pain and smaller scar than laparotomy. But inducing artificial pneumoperitoneum with gas causes various complications. Among them, gas embolism is a rare but fatal complication and may occur more frequently when laparoscopy is performed simultaneously with hysteroscopy. We experienced one case of gas embolism during diagnostic laparoscopy for secondary infertility and hysteroscopic resection of uterine myoma under general anesthesia. Early diagnosis and prompt treatment seem to be the keys to prevent catastrophic outcome and the anesthesiologist should know about it's patho- physiology, preventive methods, diagnosis and treatment.
Anesthesia, General ; Cicatrix ; Diagnosis ; Early Diagnosis ; Embolism, Air* ; Hysteroscopy ; Infertility ; Laparoscopy* ; Laparotomy ; Leiomyoma ; Length of Stay ; Pain, Postoperative ; Physiology ; Pneumoperitoneum, Artificial

OBJECTIVE: The aim of this study is to evaluate the effect of risperidone on cognitive functions in chronic schizophrenic patients after 8 weeks of treatments and determine whether any improvement on cognitive function relates to improvement in psychopathology. METHODS: The subjects were 20 chronic schizophrenic outpatients, who participated in eight-week crossover study from conventional antipsychotics to risperidone. Clinical symptoms were assessed by Positive and Negative Syndrome Scale, Clinical Global Impression and Extrapyramidal Symptom Rating Scale, while they were receiving conventional antipsychotic treatment. Cognitive functions were assessed by K-WAIS digit span and digit symbol substitution test, and vigilance, continuous attention, reaction unit, corsi-block-tapping test. Patients were then reassessed after changing to a new treatment of risperidone. RESULTS: After crossover from conventional antipsychotics to risperidone, positive and negative symptoms and the general psychopathology were significantly improved. The only item of Vienna tests significantly improved after risperidone treatment was corsi-block-tapping test. However, this improvement was not related to the improvement in psychopathology. Backward digit span score, digit span total score, digit symbol substitution score were significantly improved after risperidone treatment. But this improvement was not related to the improvement in psychopathology, except digit span total score. Digit span total score was related to the improvement in negative symptom score and PANNS total score. CONCLUSION: Treatment with risperidone appeared to exert a favorable effect on visuospatial memory and working memory, but long-term and larger sample replication study is necessary.
Antipsychotic Agents ; Cross-Over Studies ; Humans ; Memory ; Memory, Short-Term ; Outpatients ; Psychopathology ; Risperidone* ; Schizophrenia

An asymptomatic 26-year-old man was initially admitted with a suspicious mediastinal mass. On the basis of the contrast-enhanced chest CT findings, aneurysm formation involving the left cervical aortic arch associated with subaortic left innominate vein was diagnosed. The aneurysm was confirmed by MR angiography and DSA. The arch aneurysm was surgically removed. We describe this case, and review the literature.
Adult ; Aneurysm* ; Angiography ; Aorta, Thoracic* ; Brachiocephalic Veins* ; Humans ; Tomography, X-Ray Computed

BACKGROUND: Significant analgesic synergy is obtained when opioids are combined with dilute local anesthetics, but serious side effects of intraspinal opioid can develope. The purpose of this study was to see how much does additional fentanyl make change of hemodynamics and analgesic dermatome according to variation of local anesthetic concentration. METHODS: Thirty patients were divided into three groups who were receiving epidurally 0.33% bupivacaine 15 ml(group 1), 0.33% bupivacaine 15 ml including fentanyl 100 g(group 2), 0.25% bupivacaine 15 ml including fentanyl 100 g(group 3) at the C7-T1 interspace. We observed mean arterial blood pressure, pulse rate and arterial blood gas analysis to be changed. Evaluation of the onset and duration of analgesic action by pin prick test were taken. Also side effects and complications were checked. RESULTS: Decreases of mean arterial blood pressure was statistically significant between 10 and 120 minutes in group 1, between 10 and 50 minutes in group 2, between 10 and 40 minutes in group 3 after drug administration. Decreases of pH and increases of PaCO2 were statistically significant between 30 and 60 minutes in group 1, between 30 and 120 minutes in group 2, 3 after drug administration. In three groups, number of analgesic dermatome was maximal at 40 minutes after drug administraion. The duration of analgesia in C8 dermatome was 153 29 minutes in group 1, 168 21 minutes in group 2, 131 31 minutes in group 3. Inadvertant dural puncture was developed in one patient. Transient pruritus, nausea/vomiting and solmnolence were developed in group 2, 3. CONCLUSIONS: Three groups provided sufficient analgesia for operation. fentanyl affects on hemodynamics, ventilation but not on number of maximal analgesic dermatome. Also it produces side effects such as, mild pruritus, somnolence, nausea/vomiting.
Analgesia ; Analgesics, Opioid ; Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local ; Arterial Pressure ; Blood Gas Analysis ; Bupivacaine* ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Pruritus ; Punctures ; Ventilation

Purpose: The prevalence of Group B Streptococcus (GBS) colonization in pregnant Korean women is increasing; however, nationwide studies are lacking. Therefore, we aimed to analyze regional colonization rates and antimicrobial susceptibility for GBS in pregnant Korean women through a nationwide survey. Materials and Methods: From January 2018 to December 2020, data from the Seoul Clinical Laboratories on vaginal swab cultures were retrospectively analyzed to detect maternal GBS carriers. Each swab specimen was inoculated onto a 5% blood agar plate and incubated at 35°C–37°C in a 5% CO 2 incubator for 24 h. GBS isolates were identified using a Microflex MALDI Biotyper. Antimicrobial susceptibility tests were performed using the Vitek 2 automated system. Results: The overall nationwide GBS colonization rate in pregnant Korean women was found to be 10.6% (3578/33721). The maternal GBS colonization rates ranged from 10.5%–10.8% over the 3-year study period. The GBS colonization rates by province, in descending order, were as follows: Jeolla-do, 13.2%; Gangwon-do, 12.0%; Chungcheong-do, 11.8%; Gyeonggi-do, 11.3%; Seoul, 10.2%; and Gyeongsang-do, 9.6%. During the study period, the resistance rates against chloramphenicol, levofloxacin, clindamycin, erythromycin, and tetracycline were 2.6%–2.7%, 18.2%–19.6%, 33.4%–35.7%, 35.6%–36.8%, and 50.5%–53.3%, respectively. Conclusion In pregnant Korean women, GBS colonization rates were in the range of 9.6%–13.2%, with Gyeongsang-do being the lowest and Jeolla-do the highest. The resistance rate against clindamycin was high (33.4%–35.7%). GBS colonization rates during pregnancy should be studied nationwide according to the Centers for Disease Control and Prevention-recommended guidelines with periodic antimicrobial resistance monitoring.

No abstract available.
Amniocentesis* ; Cytogenetics*

PURPOSE: Nitric oxide (NO) has recently been identified as the main neurotransmitter involved in the nonadrenergic-noncholinergic (NANC) pathway and is responsible for penile erection. Nitric oxide synthase (NOS)-containing nerve regeneration can be seen 6 months after unilateral cavernosal nerve neurotomy in rats. However its molecular mechanism is still unknown. It is believe that growth factors are involved in this phenomenon. In this study I investigated the change of NOS containing nerve fibers and the RNA expression of insulin like growth factor (IGF)-I, nerve growth factor (NGF), transforming growth factor (TGF)-alpha, TGF-beta 1, TGF-beta 2, TGF-beta 3, vascular endothelial growth factor(VEGF), nNOS and eNOS on the penis after cavernosal neurotomy in rats. MATERIALS AND METHODS: Male rats were divided into three groups: sham operation (n=12); unilateral neurotomy of a 5-mm segment of the cavernosal nerve (n=18); and bilateral neurotomy (n=18). Electrostimulation of the cavernosal nerve of pelvic ganglion was performed at 1,3 and 6 months. Nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase staining was used to identify NOS in the penile nerve fibers. The gene expressions for growth factors, nNOS and eNOS were investigated in corporal tissue by reverse transcriptase-polymerase chain reaction (RT-PCR) using specific oligonucleotide primers. RESULTS: One month after neurotomy, both unilateral and bilateral neurotomy groups showed significant decreases in NOS-containing nerve fibers on the dorsal and intracavernosal nerves on the side of neurotomy and significantly lower mRNA expressions of nNOs, IGF-I and TGF-beta 2, and the unilateral neurotomy group showed higher mRNA expression of eNOS and VEGF189. At 3 months, the number of NOS-containing nerve fibers in the unilateral neurotomy group increased only slightly but at 6 months, those in the intracavernosal nerve increased in a significant amount (p<0.0001),however mRNA expressions of nNOs, IGF-I and TGF-beta . , showed significant increases as early as at 3 months, After bilateral neurotomy, the NOS-positive nerve fibers in the dorsal and intracavernosal nerve were significantly decreased at 1 month and remained so at 6 months; no erectile response could be elicited by pelvic ganglion stimulation. In the unilateral neurotomy group at 6 months, more NOS-positive neurons in the pelvic ganglia were found on the intact side than on the side of the neurotomy (p<0.005), indicating that the regeneration derived from pelvic ganglion neurons on the intact side. Furthermore, electrostimulation in the unilateral neurotomy group revealed a greater maximal intracavernosal pressure and a shorter latency period at 6 months than at 1 month (p<0.001, p<0.001, respectively). CONCLUSION: These data suggest that IGF-I and TGF-beta 2, may play a key role in regeneration of NOS-containing nerve fibers in the dorsal and intracavernosal nerves, and eNOS increases temporarily in the intracavernosum involving VEGF189 after unilateral cavernosal nerve injury.
Animals ; DNA Primers ; Ganglia ; Ganglion Cysts ; Gene Expression ; Humans ; Insulin ; Insulin-Like Growth Factor I ; Intercellular Signaling Peptides and Proteins* ; Latency Period (Psychology) ; Male ; NADP ; Nerve Fibers ; Nerve Growth Factor ; Nerve Regeneration ; Neurons ; Neurotransmitter Agents ; Nitric Oxide ; Nitric Oxide Synthase ; Penile Erection ; Penis ; Rats* ; Regeneration* ; RNA ; RNA, Messenger ; Transforming Growth Factor beta ; Transforming Growth Factors

PURPOSE: Atopic Dermatitis (AD) is a chronically relapsing inflammatory skin disease. Generally, aeroallergens and food allergens can exacerbate symptoms in AD. Currently they are divided into two groups: one is an IgE mediated form and the other is a non-IgE mediated form. This study focused upon clinical manifestations of two distinct forms of AD. METHODS: We evaluated 110 patients (male: 58, female: 52) with AD. All patients had visited Masan Samsung Hospital from June 2002 to February 2005. The patients were divided into 2 sub-groups according to their serum total IgE and specific IgE levels. The serum total IgE and specific IgE to Dermatophagoides pteronyssinus, Dermatophagoides farinae, Egg white, Cow's milk and Soybean were measured by the Pharmacia CAP-FEIA system. Metacholine provocation tests were conducted to reveal bronchial hyper-responsiveness and ARIA guidelines for diagnosis of AR were applied. RESULTS: Our study showed more female predominance in non IgE-mediated atopic dermatitis patients and showed higher total eosinophil count in IgE-mediated atopic dermatitis. (P< 0.05) There was no difference in frequency of asthma between two groups (P> 0.05), but allergic rhinitis was significantly predominant in non IgE-mediated atopic dermatitis patients. (P< 0.05) CONCLUSION: Female was more predominant in non IgE-mediated atopic dermatitis patients and IgE-mediated atopic dermatitis patients showed higher total eosinophil count and more frequency of allergic rhinitis.
Allergens ; Asthma ; Child* ; Classification* ; Dermatitis, Atopic* ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Diagnosis ; Egg White ; Eosinophils ; Female ; Humans ; Hypersensitivity, Immediate ; Immunoglobulin E* ; Milk ; Rhinitis ; Skin Diseases ; Soybeans

The clinical utility of transcranial doppler ultrasonography (TCD) in cerebrovascular disease has been extended recently. Although number of studies have been performed to define normal reference values of TCD measurements, they have some limitations to be used as reference values which include relatively small number of subjects, lack of data about some cerebral vessels and/or parameters. This study was aimed to obtain clinically useful reference values of TCD measurements with consideration of the influence of age and sex in Korean adults, particularly who are in stroke-prone age group. We measured flow velocities, pulsatility indecies, side-to-side differences and vasomotor reactivities of all intra-and extracranial cerebral arteries using TCD in 209 normal Korean adults (age, 23-78 years; 94 men and 115 women), and analyzed the influence of age and sex on those measurements. With advancing age, subjects showed significant reduction in velocity measurements and increase in pulsatility indecies of most examined arteries. Females showed hight velocities of middle cerebral, internal carotid, vertebral and basilar artery and lower pulsatility indecies of middle cerebral arteries compared with males. Asymmetry measurements including side-to-side differences and asymmetry index, and ,breath holding index testing vasomotor reactivity were also measured and the normal range of those parameters were calculated. Since present study included large number of subjects, and checked paramenters of TCD in both extra- as well as intracranial cerebral arteries, we are convinced that these results can be used as a reference data of TCD measurements in Korean adults.
Adult* ; Arteries ; Basilar Artery ; Breath Holding ; Cerebral Arteries ; Female ; Humans ; Male ; Middle Cerebral Artery ; Reference Values* ; Ultrasonography, Doppler, Transcranial

Serum creatine kinase (CK) and lactic dehydrogenase (LD) isoenzyme concentrations were studied in 44 patients during orthopedic operations that required the application of a pneumatic tourniquet. CK and LD isoenzymes were measured at preoperation, during tourniquet, and after tourniguet release. In the general anesthesia patients, LD isoenzyme values were not significantly changed during and after touniguet release. CK-BB was more significantly increased (p<0.05) after tourniguet (2.65+/-5. 40IU/l) than at preoperation (0.36+/-1.17IU/l). In the regional block patients, LD isoenzyme values were not significantly changed during and after tourniguet application. CK-BB was more significantly increased (p<0.05) at after tourniguet (0.90+/-1.95IU/l) than at preoperation (0.12+0.48IU/l). But regardleas of tourniguet application time, the values of LD isoenzymes were not significantly changed. CK-BB values were more significantly (p< 0.05) increased after tourniguet release than at preoperation, regardless of tourniguet application time.
Anesthesia, General ; Creatine Kinase ; Humans ; Isoenzymes* ; Orthopedics ; Oxidoreductases ; Tourniquets*