Laryngoscopy and endotracheal intubation undergoing general anesthesia cause hypertension and tachycardia with concomitant increases in plasma catecholamine concentration. These transient stress responses are greatly exaggerated in patients with hypertension and cardiovascular diseases and can lead to cardiac arrhythmia, pulmonary edema, cardiac failure and cerebral hemorrhage. Therefore, several attempts have been made to attenuate the hypertensive and tachycardiac responses, but none has been satisfactory. This study was made to alleviate the hemodynamic responses to tracheal intubation using ultra-short acting cardioselective beta-blocker, Esmolol. Following get informed consent in ASA physical status 1 and 2, 28 patients were randomly divided into two groups. Group 1(n=16), control group, and group 2(n=12), esmolol treatment group. Patients on alpha or beta-blockers or agonists were excluded from the study. 12 patients received an infusion of 500 mcg/kg/min esmolol loading dose for 3 min before induction with thiopental and 300 mcg/kg/min for maintenance for 6 additional minutes during the endotra- cheal intubation. The control patients, group 1(n=16), received 5% D/W infusion in place of esmolol with infusion pump. The patients received hydroxyzine 1 mg/kg, nalbuphine 0.1 mg/kg, and glycopyrroate 0.2 mg i. m. 60 minutes before anesthesia. Patients were induced with sodium thiopental 4-5 mg/kg until the disappearance of lid-refex. Succinylcholine 1.0 mg/kg i. v. was used to facilitate endotracheal intubation. As soon as relaxation was complete, laryngoscopy was initiated. After the completion of intubation, nitrous oxide/oxygen=2: 2 L/min with 0.5-1.5 % halothane or enflurane was administered. The blood pressure and heart rate were measured using noninvasive automatic blood pressure manometer Accutorr 1A (Datascope) for 30 minutes per l minute. Blood pressure and heart rate were evaluated at 6 key points; 1) baseline, 2) anesthetic induction, 3) tracheal intubation, 4) I minute postintubation, 5) 2 minutes postintu- bation, and 6) 3 minutes postintubation, Data were analyzed with paired t-tests within the groups. P<0.05 was considered significant. Esmolol infusion significantly prevented the increases in heart rate and rate pressure product caused by laryngoscopy and endotracheal intubation. Esmolol also moderated the increases in pressures. Esmolol infusion may offer an important role in patients in whom an increase in heart rate, blood pressure and/or rate pressure product should be avoided during the endotracheal intubation.
Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Blood Pressure ; Cardiovascular Diseases ; Cerebral Hemorrhage ; Enflurane ; Halothane ; Heart Failure ; Heart Rate ; Hemodynamics* ; Humans ; Hydroxyzine ; Hypertension ; Informed Consent ; Infusion Pumps ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy* ; Nalbuphine ; Plasma ; Pulmonary Edema ; Relaxation ; Sodium ; Succinylcholine ; Tachycardia ; Thiopental

PURPOSE: Testosterone is essential for the prostate gland's normal growth and development and is also a possible risk factor for prostate cancer. This study's aim was to determine the significance of serum testosterone for prostate-specific antigen (PSA) elevation and prostate cancer prediction in high-risk men. MATERIALS AND METHODS: The study included 120 patients with PSA >10 ng/ml who underwent a transrectal-prostate biopsy. Serum testosterone, prostate volume, and PSA density (PSAD) were checked in all patients. Patients were divided into two groups, patients with and those without prostate cancer; and testosterone-related factors, prostate volume, PSA, PSAD, age, prostate cancer prediction rate, and cancer aggressiveness were evaluated. RESULTS: Thirty-five patients (30.2%) were confirmed as having prostate cancer. The average serum testosterone level in patients without and in those with prostate cancer was 452.25+/-154.62 ng/dl and 458.10+/-158.84 ng/dl, respectively; average PSA was 17.58+/-9.02 ng/ml and 18.62+/-6.53 ng/ml, respectively; and average age was 69.02+/-7.52 years and 70.69+/-7.02 years, respectively (p>0.05). Hypogonadal and eugonadal patients showed no significant difference in cancer prevalence (30.3% vs. 32.0%, respectively). The testosterone level did not differ significantly in patients with and those without prostate cancer in either hypogonadal or eugonadal men (p>0.05). Serum testosterone showed no correlation with PSA, PSAD, or age in either group (p>0.05) and was unrelated to prostate cancer risk or aggressiveness (p>0.05). CONCLUSIONS: In our study's results, serum testosterone at the time of diagnosis was unrelated to PSA elevation, prostate cancer risk, and aggressiveness.
Biopsy ; Growth and Development ; Humans ; Male ; Prevalence ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Risk Factors ; Testosterone

PURPOSE: To investigate MR imaging characteristics of the fracture healing process. MATERIALS AND METHODS: We performed MR-pathologic correlation of fractures experimentally produced by the three-point beding system inthe proximal tibias of 24 New Zealand white rabbits. Axial spin echo T1-weighted image(T1WI), T2-weighted image(T2WI) and T1WI after gadopentetate dimeglumine injection were obtained 1-28 days after fracture MR imaging was followed by freezing, sectioning along the MR imaging planes and histopathologic examinations. Changes in MR signal around the fractures were correlated with histopathologic findings. RESULTS: Hematomas and inflammatory tissue around the fractures, noted one day after fracture, showed slightly increased homogeneous signal intensityon T1WI, heterogeneous hyperintensity on T2WI and heterogeneous contrast enhancement. Granulation tissue,cartilage, and immature osteoid, noted 1-4 weeks after fracture, showed iso- or slight hyperintensity on T1WI, hyperintensity on T2WI and contrast enhancement. Hard callus containing ossified osteoid showed hypointensity onboth T1WI and T2WI without contrast enhancement. CONCLUSION: The characteristics of MR signal intensity and contrast enhancing pattern can explain the histopathology of the fracture healing process.
Bony Callus ; Fracture Healing ; Freezing ; Gadolinium DTPA ; Hematoma ; Magnetic Resonance Imaging* ; Rabbits ; Tibia*

No abstract available.
Incontinentia Pigmenti*

This report is concerned with our clincal experiences of sixty one cases of anesthesia for coronary artery bypass grafting at the Dong San Medical Center during the period from Februry 1986 to September 1993. The results were as follows; 1) There were 41 men and 20 women with a mean age of 54 (25 to 79 years). 2) Among 61 cases, 17 cases (28%) were history of myocardial infarction. 3) Among 61 cases, single aortocoronary grafts were placed in 37 patients (60%), double or more grafts in 24 patients (40%). 4) The mean bypass time was 135+/-63.9 minutes and cross-clamp time was 45+/-23.5 minutes. 5) Glycopyrrolate, morphine or demerol, vistaril or lorazepam or veprin were used as premedicants. 6) 2% thiopental or 2% thiopental and fentanyl or midazolam and fentanyl were used as induction agents. 7) We have also used isoflurane and fentanyl as anesthetic agents in conjuction with nitrous oxide. 8) Succinylcholin and pancuronium or vecuronium were used for intubation. 9) Early mortality was 16.4% (10 patients) and poor ejection fraction was significantly associated with mortality rate. 10) perioperative myocardial infarction was most common complication.
Anesthesia ; Anesthetics ; Constriction, Pathologic* ; Coronary Artery Bypass* ; Coronary Vessels* ; Female ; Fentanyl ; Glycopyrrolate ; Humans ; Hydroxyzine ; Intubation ; Isoflurane ; Lorazepam ; Male ; Meperidine ; Midazolam ; Morphine ; Mortality ; Myocardial Infarction ; Nitrous Oxide ; Pancuronium ; Thiopental ; Transplants ; Vecuronium Bromide

No abstract available.
Child* ; Hearing Loss, Sensorineural* ; Humans ; Temporal Bone*

PURPOSE: We evaluated the effectiveness of embolization in the management of congenital vascular malformations(CVMs). METHODS AND MATERIALS: A retrospective analysis was performed in 10 patients who underwent embolotherapy for their soft tissue CVMs(eight arteriovenous malformations, one hemangioma, one venous malformation) involving the extremity or back. In nine patients, intraarterial embolization was performed with multiple embolic agents including Gelfoam, Ivalon, IBCA, ethanol mixed with Lipiodol, and micro-coils. In one patient with venous malformation, direct puncture and embolization of the lesion were performed with absolute ethanol mixed with Lipiodol. RESULTS: In four patients, who subsequently underwent surgery, preoperative embolization decreased operative morbidity and facilitated a thorough extirpation. Five of six patients with inoperable CVMs experienced dramatic reduction of symptoms by single or repeated embolization, with a mean follow-up period of four months. CONCLUSION: We believe that preoperative embolization may decrease operative morbidity and facilitate a thorough extirpation in the patients with extensive but resectable CVMs and repeated embolizations are effective for symptom control in the patients with inoperable CVMs.
Arteriovenous Malformations ; Embolization, Therapeutic ; Ethanol ; Ethiodized Oil ; Extremities* ; Follow-Up Studies ; Gelatin Sponge, Absorbable ; Hemangioma ; Humans ; Punctures ; Retrospective Studies ; Vascular Malformations*

BACKGROUND: The maintenance of low central venous pressure (LCVP) induced by fluid restriction and nitroglycerin administration reduces the overall blood loss during major hepatic resections. We studied the postoperative renal function in hepatectomized patients under LCVP maintenance with nitroglycerin. In addition, the renal effect of low dose dopamine combined with nitroglycerin was evaluated. Methods: A total of 60 patients were randomly divided into two groups: a nitroglycerin group (n = 30), and a nitroglycerin and dopamine group (n = 30). During the Pringle maneuver the central venous pressure (CVP) was maintained at < 5 mmHg in both groups. The nitroglycerin group received 0.5-1microgram/kg/min nitroglycerin before and during the Pringle maneuver, but in nitroglycerin and dopamine group, 3microgram/kg/min dopamine was administered with nitroglycerin. Mean arterial pressure, CVP, and urine output were measured before, during, and after the Pringle maneuver. BUN and serum creatinine were measured on postoperative days 1 and 3. Results: No significant differences were observed between the mean arterial pressures, CVPs, or urine outputs of the two groups. In both groups, urine output reduced after the Pringle maneuver but increased more in the nitroglycerin and dopamine group than in the nitroglycerin control group after anesthesia. There was no overall statistical change in either BUN or creatinine in either group. Conclusions: We conclude that LCVP induced by nitroglycerin with the Pringle maneuver during hepatectomy does not cause postoperative renal dysfunction, and that the use of low dose dopamine with nitroglycerin has no meaning in terms of preventing renal dysfunction in this situation.
Anesthesia ; Arterial Pressure ; Central Venous Pressure* ; Creatinine ; Dopamine* ; Hepatectomy* ; Humans ; Nitroglycerin

This study analyzed the factors causing the angular deformity as the tibia fracture below isthmus were treated with interlocking nails. For this purpose, we observed 70 cases of tibia fractures in the Gil General Hospital as subjects. Of the 70 cases under the treatment, 32(45.7%) showed the angulation of over one degree, and 11(15.7%) showed that of 5-10 degrees in any plane. According to the outcomes of this studies, the degree of angulation seemed to have close relation to the length of fracture line. Also, if the fracture line reached to the isthmus, angulation was apt to be caused. Even though most angulated cases had concomitant fibular fracture, fibular fracture, itself, seemed to have no direct relation to angulation. In consequence, the intramedullary interlocking nailing needs special carefulness in the case of breakage of cortical buttress such as long fracture line, butterfly fragment and fracture including isthmus.
Butterflies ; Congenital Abnormalities* ; Hospitals, General ; Tibia*

PURPOSE:To investigate the changes of abnormal signal intensity of liver infarction in scheduled intervals after ligation of portal vein in rabbit livers with histopathologic correlation. MATERIALS AND METHODS:Liver infarction were induced by selective ligation of the posterior branch of right portal vein in 12 rabbits. T1- and T2-weighted MRI at 2.0T with spin-echo techniques as well as contrastenhanced Tl-weighted MRI with Gd-DTPA(0.1 mmol/kg) were performed 3 hours, 6 hours, 1 day, 3 days, 1 week, and 2 weeks after ligation using two rabbits at each interval. Histopathologic specimens were prepared from six removed livers for comparing the MR findings with the histopathologic findings. The other six rabbits were sectioned transversely in frozen state for comparing MR findings with the macroscopic findings of pathologic areas of the liver. RESULTS: The signal intensity of pathologic hepatic segment showed more hyperintense signal than that of normal segments of the liver on TI-, proton density-, and T2-weighted MR images at every interval after ligation, except both T2WI of 3 hours interval and one T1WI of 2 weeks interval. Main histopathologic findings 3 hours, 6 hours, 1 day, 3 days, and 1 week after ligation were congestion, hemorrhage with necrosis, coagulation necrosis, complete necrosis, and necrosis with scar tissues, respectively. Microscopic specimens with Prussian blue stain 6 hours, and 1 week after ligation showed bluish hue indicating the existence of methemoglobin, and blue particles in giant cells and monocytes indicating engulfing hemosiderin, respectively. CONCLUSION: Changes of the signal intensities on sequential MR images of acutely induced hemorrhagic liver infarction might be due to the rapid oxidative denaturation of hemoglobin in hemorrhages and high signal intensity on Tl-weighted images from the hyperacute stage of a hemorrhagic liver infarction could be due to methemoglobin. Therefore, acutely induced hemorrhagic liver infarction should be included in the differential diagnoses of the hyperintense liver lesions on Tl-weighted images.
Cicatrix ; Diagnosis, Differential ; Estrogens, Conjugated (USP) ; Giant Cells ; Hemorrhage ; Hemosiderin ; Infarction ; Ligation* ; Liver* ; Magnetic Resonance Imaging* ; Methemoglobin ; Monocytes ; Necrosis ; Portal Vein* ; Protons ; Rabbits*