No abstract available.

Retroperitoneal fibrosis sometimes causes urological problem involving the ureter, but the mechanism is uncertain. An aortic aneurysm, including an iliac artery aneurysm, is thought to be one of the mechanisms of retroperitoneal fibrosis. However, cases caused by an isolated iliac artery aneurysm are very rare, and symptoms tend to be non-specific; therefore, no definitive treatment has been established. Herein, we report our recent experience of a patient with a left common iliac artery aneurysm involving the ureter, who underwent successful surgical therapy.
Aneurysm* ; Aortic Aneurysm ; Constriction, Pathologic* ; Humans ; Iliac Artery* ; Retroperitoneal Fibrosis* ; Ureter*

BACKGROUND: Multidrug-resistant tuberculosis(MDR-TB) in patients is mainly caused by acquired drug resistance, However, a small proportion of MDR-TB is caused by initial drug resistance(IDR), which may be somewhat different from acquired drug resistance. This study analyzed the clinical characteristics of IDR in MDR-TB patients to use the results as basic data in managing the disease. METHODS: A retrospective study of 30 IDR cases in MDR-TB patients from Jan. 1995 to Dec. 1998 was perormed. In order to analyzed the clinical charcteristics, the age, sex, family history, duration of negative conversion, number of resistant drugs, treatment regimens, duration of treatment, extent of disease and cavitary lesion on the chest X-ray was examined. In order too analyzed the level of improvement, the extent of the disease and cavitary lesion on the chest X-ray, tested by Wilcoxon signed rank sum test, and the disease free interval rate of 1-year and 4-year was examined using the Kaplan-Meier method. RESULTS: The mean age of the patients was 46.6 years and the sex ratio 1:1. Six(20%) patients had a family history. The mean negative conversin of the sputum AFB stain was 2.6 months. The number of resistant drugs was 7.6 and the number of used drugs 3.6. Twenty-three(67%) patients were treated for less than 12months and 28(93%) patients were treated with first-line drugs. The extent of the disease and the cavitary lesion on the chest X-ray improved after treatment(p<0.05). Among 13 patients who were followed up for 22.6 months, 2(15%) patients relapsed and the disease free interval rate of 1-year and 4-year was 85%. CONCLUSION: It is recommended that the duration of treatment of IDR in MDR-TB with first-line drugs be 9-12 months even if the extent of disease and cavitary lesion on the chest X-ray improves.
Drug Resistance* ; Humans ; Retrospective Studies ; Sex Ratio ; Sputum ; Thorax ; Tuberculosis, Multidrug-Resistant

Articular cartilage have dual functions of shock absorber and bearing surface in a moving joint. Articular cartilage is avascular, so the chondrocytes in mature adult must receive their nourishment solely from synovial-fluid perfusion, and it is known that alteration of synovial-fluid perfusion causes degeneration of articular cartilage. Now, in orthopedic fields, the corrective cast immobilization and traction is in popular use. In order to study the cartilage changes induced by this long-term cast immobilization and traction, compression-immobilization and condylar resection of knee joint in rabbits were performed, and weekly histoiogic examinations of articular cartilage up to 5 weeks were followed. The observations were as follows: 1. Degenerative changes of articular cartilage were observed respectively with compression-immobilization and condylar resection, and the severity of the histologic changes appeared to be proportional to the duration of compression-immobilization and condylar resection. 2. Earlier degenerative changes of articular cartilage in condylar resection group than in compression-immobilization group were noted, and this earlier degenerative changes in condylar resection group suggests that hemarthrosis may play a role in cartilage degeneration. 3. Histologically unchanged calcific cartilage zone and mildly hypertrophied subchondral bone were noted in compression-immobilization group, but vascular invasion to calcific cartilage zone and subchondral osteoporosis were noted in condylar resection group.
Adult ; Cartilage ; Cartilage, Articular ; Chondrocytes ; Hemarthrosis ; Humans ; Immobilization ; Joints ; Knee Joint ; Knee ; Orthopedics ; Osteoporosis ; Perfusion ; Rabbits ; Shock ; Traction

BACKGROUND: Laparoscopic surgery is associated with a more favorable clinical outcome than that of conventional open surgery. This might be related to the magnitude of the tissue trauma. The aim of the present study was to examine the differences of the neuroendocrine and inflammatory responses between the two surgical techniques. METHODS: Twenty-four patients with no major medical disease were randomly assigned to undergo laparoscopic (n = 13) or abdominal hysterectomy (n = 11). Venous blood samples were collected and we measured the levels of interleukin-6 (IL-6), CRP and cortisol at the time before and after skin incision, at the end of peritoneum closure and at 1 h and 24 h after operation. RESULTS: The laparoscopic hysterectomy group demonstrated less of an inflammatory response in terms of the serum IL-6 and CRP responses than did the abdominal hysterectomy group, and the laparoscopic hysterectomy group had a shorter hospital stay (P < 0.05). The peak serum IL-6 (P < 0.05) and CRP concentrations were significantly less increased in the laparoscopic group as compared with that of the abdominal hysterectomy group (P < 0.05), while the serum cortisol concentration showed a similar time course and changes and there were no significant difference between the groups. The response of interleukin-6 showed a significant correlation with the response of CRP (r = 0.796; P < 0.05). CONCLUSIONS: The laparoscopic surgical procedure leaves the endocrine metabolic response largely unaltered as compared with that of open abdominal hysterectomy, but it reduces the inflammatory response as measured by the IL-6 and CRP levels.
Cytokines ; Humans ; Hydrocortisone ; Hysterectomy ; Interleukin-6 ; Laparoscopy ; Length of Stay ; Peritoneum ; Skin

BACKGROUND: Obesity exacerbates chemically-induced neurodegeneration. N-methyl-D-aspartate (NMDA) antagonists such as ketamine prevent excitotoxicity and are neuroprotective against acute brain injury, but can also be toxic. In low doses they induce reversible neuronal injury, but in higher doses they cause irreversible degeneration of cerebrocortical neurons. This study was designed to evaluate the neurotoxic effect of ketamine on obesity-induced neurotoxicity in the young mouse brain. METHODS: Five-week-old female wild and obese type (C57BL6) mice were randomly allocated into three groups (n=6 each) receiving a single intraperitoneal injection of (i) saline (control); (ii) ketamine (50 mg/kg); (iii) or ketamine (100 mg/kg). Three hours after ketamine administration, their brains were prepared histologically for quantitative assessment of the number of posterior cingulate/retrosplenial (PC/RS) neurons with vacuolation at a specific rostrocaudal level. RESULTS: Pyramidal neurons containing cytoplasmic vacuoles in layers III and IV of the PC/RS cortex were observed in all groups of mice, except wild-type mice that received saline injections. Ketamine produced a dose-dependent vacuolization in both types of mice, which was more prominent in obese mice (P < 0.05). CONCLUSIONS: Administration of ketamine in young obese mice can exacerbate neurotoxicity.
Animals ; Brain ; Brain Injuries ; Cytoplasm ; Female ; Humans ; Injections, Intraperitoneal ; Ketamine ; Mice ; Mice, Obese ; N-Methylaspartate ; Neurons ; Obesity ; Vacuoles

BACKGROUND: The present study was designed to examine the purpose of intensive care unit (ICU) admission and the prevalence of disease in postoperative patients admitted to general surgical-medical ICU. METHODS: Between 1 January 2007 and 31 December 2007, 646 cases of 612 patients admitted to a general postoperative patients admitted to general surgical-medical ICU were examined. The patients were classified into two groups, ICU treatment and ICU monitoring groups according to Knaus' suggestion which defines the kinds of treatment done exclusively in ICU. Patients' demographics, preoperative American Society of Anesthesiologists physical status classification (ASA) grade, prevalence of disease and emergent operation rate were analyzed. RESULTS: 255 patients (39.5%) were included in the ICU treatment group and 391 cases (60.5%) in the ICU monitoring group. The prevalence of respiratory, gastrointestinal, and central nervous diseases was higher significantly in the ICU treatment group. In addition, the average of ASA grade and the duration of operation were higher significantly in the ICU treatment group. CONCLUSION: Admission rate only for monitoring was higher than one for intensive treatment. An alternative strategy should be considered to care for postoperative patients who need just close monitoring.
Demography ; Humans ; Critical Care ; Intensive Care Units ; Prevalence ; Retrospective Studies

Rhabdomyolysis is a rare but potentially lethal clinical syndrome that results from acute muscle fiber necrosis with leakage of muscle constituents into blood. This devastating disease could be due to muscle compression caused by urologic positioning for a lengthy nephrectomy. In this regard, laparoscopic renal surgery may be a risk for the development of rhabdomyolysis. This phenomenon of massive muscle necrosis can produce secondary acute renal failure. The risk factors have to be managed carefully during anesthetic management. Here, we report a case of a patient with rhabdomyolysis that developed in the flexed lateral decubitus position during laparoscopic nephrectomy.
Acute Kidney Injury ; Humans ; Muscles ; Necrosis ; Nephrectomy ; Rhabdomyolysis ; Risk Factors

BACKGROUND: Advances in the field of interventional and diagnostic radiology have resulted in anesthesiologists becoming involved in angiographic suites. In the present study, we evaluated the characteristics of patients and the anesthetic management in an angiographic suite, to determine what factors influenced the patient outcome. METHODS: Data pertaining to patients that were anesthetized at an angiographic suite in a university hospital between 1 January 2007 and 31 December 2007 were evaluated retrospectively. Specifically, we evaluated the patient characteristics and the types of anesthesia administered, to determine which factors were related to patient outcome. RESULTS: Sixty-four percent of the patients enrolled in this study were women. Cases involving coiling for unruptured and ruptured aneurysm, embolization for intracranial arteriovenous malformation and fistula, pediatric diagnostic angiography, embolization for extracranial arteriovenous malformation, and implantable cardioverter-defibrillator (ICD) implantation all required the involvement of anesthesiologists. Major postoperatve complications included pneumonia, atelectasis, and hydrocephalus. In addition, GCS, net fluid balance, and anesthesia time had influence on patient outcome. CONCLUSIONS: We evaluated the characteristics of patient groups, procedures, and postoperative complications in an angiographic suite. The results of our analysis revealed that a through understanding of nervous and vascular pathology, as well as knowledge of current interventional radiology, neuroanesthesia and vascular anesthesia techniques is essential for development of safe and effective care.
Anesthesia ; Aneurysm ; Aneurysm, Ruptured ; Angiography ; Arteriovenous Malformations ; Defibrillators, Implantable ; Female ; Fistula ; Humans ; Hydrocephalus ; Intracranial Arteriovenous Malformations ; Pneumonia ; Postoperative Complications ; Pulmonary Atelectasis ; Radiology, Interventional ; Retrospective Studies ; Water-Electrolyte Balance

Here we report, along with a review of the literature, our experience with a patient suffering from a cerebral aneurysm and developed volume overloading pulmonary edema during endovascular coiling. A 51-year-old female patient who had an aneurysm in the basilar artery tip and subarachnoid hemorrhage was scheduled for endovascular embolization under general anesthesia. She developed pulmonary edema during the procedure. Coiling failed so neurosurgeon performed aneurysmal clipping under general anesthesia. The massive intraarterial infusion and flushing with heparinized saline may have triggered the pulmonary edema. We monitored diuresis and hemodynamics following surgery, as a high degree of vigilance, including monitoring of arterial blood gas and electrolyte evaluation, of patients undergoing prolonged endovascular embolization and receiving many intra-arterial fluids may help recovery.
Anesthesia, General ; Aneurysm ; Basilar Artery ; Diuresis ; Female ; Flushing* ; Hemodynamics ; Heparin* ; Humans ; Infusions, Intra-Arterial* ; Intracranial Aneurysm* ; Middle Aged ; Pulmonary Edema* ; Subarachnoid Hemorrhage