BACKGROUND: Endotoxins play important roles in the pathophysiologic alterations associated with sepsis so the authors examined the effects of hydroxocobalamin, NW-nitro-L-arginine-metyl ester (L-NAME) and aminoguanidine on thiopental-induced contractile responses of lipopolysaccharide (LPS)-treated and control rat aortic rings. METHODS: Aortic ring preparation was obtained from LPS-treated (1.5mg/kg, i.p. for 18h) rats. Cumulative doses of thiopental (10-4~3x10- 3M) were added to construct contraction response curves. Hydroxocobalamin (10-5M), L-NAME (10-6M) or aminoguanidine (10-6M) were added as NO scavenger or as NOS inhibitors. Contraction curves by cumulative doses of thiopental (10-4~3x10-3M) were remeasured after treatment of NO scavenger or NOS inhibitors. Statistical significances (p<00.05) were analyzed according to data characteristics by Student's t-test, paired t-test or ANOVA. RESULTS: The vascular responses of cumulative thiopental (10-4~3x10 3M) administration were dose- dependent contraction and LPS-treated rat was less contracted (p<00.05). There was significant increment on vascular contraction induced by thiopental after hydroxocobalamin pretreatment in LPS-treated rat (p<0.05), in spite of L-NAME, aminoguanidine pretreatment was failed to increase contractile forces in control and LPS-treated rats. CONCLUSIONS: From these results, viewed from maintenance of vasomotor tone in septic state, it is suggested that hydroxocobalamin may be candidate for vasopressor during usual induction of general anesthesia.
Anesthesia, General ; Animals ; Aorta, Thoracic* ; Endotoxins ; Hydroxocobalamin* ; NG-Nitroarginine Methyl Ester ; Rats* ; Sepsis ; Thiopental

Purpose: The goal of study was to evaluate the clinical and radiographic performance of the proximal modular cementless femoral stem for use in revision total hip arthroplasty. Material and method: Fifty seven patients (57 hips) were followed for longer than 24 months or up to 8.4 years after performing revision total hip arthroplasty with using the proximal modular cementless femoral stem between January 1997 and December 2002. The preoperative diagnosis included 45 cases of aseptic loosening, 5 cases of septic loosening (re-revision operation), 6 cases of periprosthetic fracture and 1 case of recurrent dislocation. The bone deficiencies were classified according to the Paprosky classification: there were 27 cases of Type I and II, 19 cases of Type IIIA, 9 cases of Type IIIB and 2 cases of Type IV. Results: The average Harris hip score improved from 47 to 87.6. Clinically satisfactory results were noted in 50 patients (87.7%). Radiographically, distal stable fixation was observed in 54 patients (94.7%). Intraoperative complications included two greater trochanteric fractures and two proximal femur fractures. Postoperative complications included 5 femoral stem subsidences (2hips< 5mm, 3 hips>20mm), 4 deep infections, 2 non-unions of the greater trochanter and the osteotomy site and set screw dissociation was noted in 1 case. 5 proximal component changes were done due to progressive subsidence in two cases, non-union at the osteotomy site and trochanteric displacement in two cases and set screw dissociation in one hip. For the infection cases, the proximal segment was removed and re-revised with a 2nd stage operation. (Ed note: check this.) The subsidence of the femoral stems was showed in 3 Paprosky grade IIIA cases and in 2 cases of grade IIIB or more. There was no postoperative periprosthetic fracture observed at the last follow-up. Conclusion: Revision total hip arthroplasty using the proximal modular cementless femoral stem showed good results in the face of the infection of the proximal component and deficient proximal bony support. This procedure appears to be convenient for the surgeon to correct anteversion of the femoral head and leg length discrepancy.
Arthroplasty, Replacement, Hip ; Classification ; Diagnosis ; Dislocations ; Femur ; Follow-Up Studies ; Head ; Hip ; Hip Fractures ; Humans ; Intraoperative Complications ; Leg ; Osteotomy ; Periprosthetic Fractures ; Postoperative Complications ; Prostheses and Implants*

We analyzed 1468 cases of anesthesia for emergency operation which were performed at the department of anesthesiology, Yongsan hospital from January 199l to December 1992. The patients were evaluated according to clinical department, age, sex, disease, ASA classification of physical status, day month, beginning time of operation, anesthetic method, duration of operation or anesthesia, perioperative patient care, past history of operation, operator and insurance. The results were as follows; 1) The percentage of anesthesia for emergency operation was 17.8 % of total anesthetic cases. 2) The departmental distribution was general surgery(47.3%), obstetrics and gynecology(19.0%), neurosurgery(14.6%) and orthopedic surgery(l1.2%). The greatest number of patients was found in the 20-29 years of age consisting of 30.9% of the patients. The male patients comprised of 51.6% while the female patients comprised of 48.4 % of the patients. 3) Most common diseases were appendicitis(57.8%) in general surgery, Cesarean section(50.2%) and ectopic pregnancy(30.8%) in obstetrics and gynecology, ICH(38.3%), EDH(20.1%) and SDH(20.l%) in neurosurgery, tendon rupture(11.0%) and tibia frature(9.8%) in orthopedic surgery. 4) The majority of patients were classified as ASA 2E comprising of 58.6% of the patients. 5) The greatest number of emergency operations was performed on Saturday(16.8%) and in August(10.3%). 6) 45% of emergency operations was performed during 12-18 oclock. 7) The anesthetic methods for emergency operation were inhalational anesthesia(94.3%), regional anesthesia(4.6%) and intravenous anesthesia(l.1%). 8) The percentage of duration of anesthesia and operation which was less than one hour was 70.1% and 77.7%, respectively. 9) 81.1% of patients who underwent the emergency operation was cared in the emergency room preoperatively, and 78.3% of operated patients was transferred to ward. 10) Concerning the past operation history 66.3% of patients never had the operation history, and 26.0% of them underwent operation once, 11) 84.6% of emergency operations was performed by staff doctors, arid 15.4% of them was performed by residents. 12) Concerning the classification of insurance the percentage of medical insurance was 83.4%, and 10.1% of the patients didnt reeeive favors of any type of insurance. Conclusively, in proportion as patients for emergency operation are incresing, the importance of anesthetic management for them is being emphasued. Therefore anesthesiologists have to focus on perioperative anesthetic management and postoperative care in recovery room and ICU to decrease the incidence of complications, morbidity and mortality of emergency operation.
Anesthesia* ; Anesthesiology ; Classification ; Emergencies* ; Emergency Service, Hospital ; Female ; Gynecology ; Humans ; Incidence ; Insurance ; Male ; Mortality ; Neurosurgery ; Obstetrics ; Orthopedics ; Patient Care ; Postoperative Care ; Recovery Room ; Tendons ; Tibia

Intracranial lipomas located in the cerebellopontine angle are extremely rare. These tumors are maldevelopmental lesions which can cause slowly progessive neurological symptoms. The clinical management of these tumours differs significantly from other lesions in this region. A 45 year old man presented with a 3-month history of vertigo and tinnitus in the left ear. In T1-weighted magnetic resonance imaging, the lesion was hyperintense and did not enhance after application of gadolinium. The patient was treated with medical therapy with good response. We present a review of the literature, with particular regard to management. Conservative treatment is recommended and limited surgery is usually indicated if the patients suffer from disabling neurological symptoms and signs e.g., vertigo, nausea, trigeminal neuralgia, facial weakness or facial spasm.
Cerebellopontine Angle ; Ear ; Gadolinium ; Humans ; Lipoma* ; Magnetic Resonance Imaging ; Middle Aged ; Nausea ; Spasm ; Tinnitus ; Trigeminal Neuralgia ; Vertigo

BACKGROUND: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. METHODS: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. RESULTS: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). CONCLUSIONS: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
Advance Directives ; Cardiopulmonary Resuscitation ; Consent Forms ; Critical Illness* ; Hospital Mortality ; Humans ; Intensive Care Units ; Resuscitation Orders* ; Retrospective Studies ; Shock, Septic

Our purpose is to describe a successful twin pregnancy and delivery after intracytoplasmic sperm injection (ICSI) followed by calcium ionophore with spermatozoa from a globozoospermic man. On the second attempt of ICSI, all of eight metaphase II oocytes were fertilized with treatment with calcium ionophore. Day 3 transfer of six normally developing embryos resulted in an ongoing twin pregnancy, and two preterm healthy babies were born in the 33th week of gestation. To the best of our knowledge, this is the first report of pregnancy and delivery after ICSI followed by calcium ionophore with spermatozoa from a globozoospermic man in Korea.
Calcium* ; Embryonic Structures ; Humans ; Metaphase ; Oocytes ; Pregnancy ; Pregnancy, Twin* ; Sperm Injections, Intracytoplasmic* ; Spermatozoa*

NSAID-induced upper gastrointestinal (GI) damage occurs easily in people with a prior history of complicated or uncomplicated ulcers. Many recent clinical studies have proved the benefit of Helicobacter pylori eradication in NSAID users; however, the exact pathophysiologic relationship between concomitant H. pylori infection and NSAID use has not yet been fully elucidated. Testing and eradication of H. pylori are generally recommended in patients who are at a high risk for NSAID-induced GI damage. However, in high-risk patients, ulcer prophylaxis with proton pump inhibitor or misoprostol is needed even if H. pylori has been successfully eradicated. In low-risk patients, it is still questionable whether or not eradication of H. pylori can reduce upper GI damage. However, in western countries, due to its cost effectiveness, testing and eradication of H. pylori is recommended before starting aspirin or NSAID irrespective of the risk level. In regions with a high prevalence of H. pylori infection (>20%), the usefulness of testing and eradication of H. pylori has not yet been determined.
Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Aspirin/therapeutic use ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Peptic Ulcer/*etiology ; Proton Pump Inhibitors/therapeutic use ; Risk Factors

No abstract available.
Bile Duct Neoplasms* ; Bile Ducts* ; Bile*

Sodium thiopental is a popular intravenous anesthetic that has been used extensively throughout the world. The rare adverse reactions to thiopental consist mainly of anaphylactic shock, bronchospasm, and local thrombophlebitis. The reported incidence of presumed anaphylactic reaction (Type l hypersensitivity) to thiopental are extremely rare. Although the mechanism of these adverse reactiona is unclear, the clinical features (generalized erythema, hypotension, edema and bronchspasm) are thought to result from massive discharge of histamine and other vasoactive substance from basophils and mast cells. Since such reactions are life threatening, they must be recognized immediately and the appmpriate treatment given. The successful management of anaphylaxis requires a thorough understanding of this syndrome and the application of therapeutic agents. The authors report a case of anaphylactoid response to thiopental in a 34 years old healthy male patient and briefly review the literature.
Adult ; Anaphylaxis ; Basophils ; Bronchial Spasm ; Edema ; Erythema ; Histamine ; Humans ; Hypotension ; Incidence ; Male ; Mast Cells ; Sodium ; Thiopental* ; Thrombophlebitis

The hemostatic effect of endoscopic microwave coagulation method for upper gastrointestinal bleeding was evaluated clinically. Hemostasis over 72 hours was achieved in 18 of 20 cases (90%) with upper gastrointestinal bleeding by the endoscopic microwave coagulation method. It is noteworthy that this method was effective in all 4 cases of pulsatile bleeding from exposed vessels. We conclude that this method is useful for emergency endoscopic hemostasis on upper gastrointestinal bleeding, especially bleeding from exposed vessels.
Emergencies ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Microwaves*