No abstract available.
Free Tissue Flaps* ; Lower Extremity* ; Soft Tissue Injuries*

It has been suspected that the cannula of the ultrasonic generator became heated during liposuction, and that the heated cannula might possibly damage the soft tissues such as vessels, nerves and muscles. To confirm these suspicions, the actual temperature of the cannula was measured after being switched on, and the influence of the heated cannula on the soft tissues of 30 rabbits was studied macroscopically and microscopically. When the cooling system of ultrasonic generator was not operated, the temperature of a cannula tip increased to 100degrees C in 10 seconds, and the temperature of a cannula shaft did not increase over 40 degrees C. When the cooling system of the ultrasonic generator was operated, the temperature of the cannula tip increased to 70 degrees C in 20 seconds and to 100 degrees C in 1 minute. The stronger ultrasonic power was, the higher the temperature of the cannula tip was. When the heated cannnula tip touched the muscles, vesseles and nerves directly, the arterial and venous walls were perforated in about 20 seconds and 10 seconds, respectively. Gross changes of the muscles, such as color change and depression of the contacted area, were seen in about 30 seconds, and histological changes occurred in about 3 seconds. When adding the Klein solution, an infiltration solution for increasing the destructive effects of the ultrasound, the onset time of tissue damage was significantly shortened in vessels and nerves, but there was no significant difference in muscles. Although there was no finding of damage by the ultrasonic wave itself on the vessels, nerves, and muscles during ultrasonic liposuction, this study confirmed that the heated cannula could damage vessels, nerves, and muscles. Thus we must try to avoid placing the cannula at certain areas for more than 10 seconds douring the ultrasonic liposuction.
Catheters* ; Depression ; Hot Temperature ; Lipectomy* ; Muscles* ; Rabbits ; Ultrasonics* ; Ultrasonography

BACKGROUND: Atelectasis is an important cause of impaired gas exchange during the perioperative period. The administration of 100% oxygen, even for brief periods, is associated with pulmonary absorption atelectasis, and the addition of N2O to the inspired gas may promote atelectasis. The aim of this study was to evaluate the effect of inspired gas composition on postoperative arterial oxygenation in elderly patients. METHODS: Twenty-six female patients with healthy hearts and lungs, and aged 60 yrs, who were scheduled for laparoscopic cholecystectomy, were divided into two groups. All patients received propofol-fentanyl anesthesia. In the N2O group, patients were ventilated with 100% oxygen during induction, 40% oxygen in N2O during mataintenance, and 100% oxygen during emergence. In the air group, patients received 60% oxygen in air during induction, 40% oxygen in air during maintenance, and 60% oxygen in air during emergence. Arterial blood gases were obtained to evaluate arterial oxygenation by analyzing PaO2 and alveolar arterial oxygen tension differences (AaDO2). RESULTS: In both groups, postoperative PaO2 was lower and AaDO2 higher than preoperative values (P < 0.05), but there were no differences between the two groups. CONCLUSIONS: We conclude that absorption atelectasis during anesthesia is not the main cause of postoperative arterial oxygenation impairment in eldery patients, and that any effect of the inspired gas is likely to be of limited clinical significance.
Absorption ; Aged* ; Anesthesia* ; Cholecystectomy, Laparoscopic ; Female ; Gases ; Heart ; Humans ; Lung ; Nitrous Oxide ; Oxygen* ; Perioperative Period ; Pulmonary Atelectasis

No abstract available.
Cryptorchidism* ; Humans ; Infant* ; Male

Myofascial pain syndrome, which has trigger points, is one of the most common causes of acute and chronic musculoskeletal pain. The trigger points formed by damage to the muscle fibers are focal areas of taut bands in the skeletal muscle that are hypersensitive to palpation. When manual pressure is applied over a trigger point, it produces distinct local and referred pain. Although various modalities have been used to treat trigger points, trigger point injection is the most effective treatment modality to inactivate trigger points. This article reviews the diagnosis and treatment of myofascial pain syndrome and the technique of trigger point injection.

Tracheoesophageal fistula (TEF) is a rare disease, which develops as a result of congenital or acquired causes. Moreover, TEF can be caused by an overinflated cuff during respiratory care with a ventilator in the ICU. So, a low pressure high volume cuff is being used to prevent injury of the tracheal mucosa by the endotracheal tube. The use of a low pressure high volume cuff has decreased respiratory complications, but TEF is still being reported. This case concerns a 78-year-olds woman with heart failure. She was hospitalized for hemiarthroplasty because of a right femur fracture. On the day after admission, she had apnea due to heart failure, but recovered on receiving respiratory care by using a ventilator in the ICU. Thereafter, she began to show symptoms such as paroxysmal coughing, vomiting, and aspiration. We investigated using computed tomography, bronchoscopy and esophagography. We observed a 2-3 cm sized fistula along the posterior wall of the trachea. It was located about 10 cm upper side from the carina on bronchoscopy, perfomed was found in the ICU. She was found to have a TEF and was treated surgically. After her symptoms had improved, she was given hemiarthroplasty under epidural anesthesia. However, 4 days after the operation, the TEF relapsed, but was not as severe as it had been previously. She was alert, but ambulation was not possible because of a general weakness due to long-term hospitalization. Even with the danger of aspiration pneumonia, she left the hospital upon her guardian's request. We report upon this clinical experience and include a brief review of the literature.
Aged ; Anesthesia, Epidural ; Apnea ; Bronchoscopy ; Cough ; Female ; Femur ; Fistula ; Heart Failure ; Hemiarthroplasty ; Hospitalization ; Humans ; Mucous Membrane ; Pneumonia, Aspiration ; Rare Diseases ; Trachea ; Tracheoesophageal Fistula* ; Ventilators, Mechanical ; Vomiting ; Walking

BACKGROUND: The Pentax-AWS is a newly developed rigid video laryngoscope. In comparison to the Macintosh laryngoscope, it offers a significantly improved laryngeal view and facilitates endotracheal intubation. The present study was performed to compare the general efficiency and the cardiovascular responses generated by Macintosh and Pentax-AWS systems during endotracheal intubation. METHODS: This study included 120 patients with American Society of Anesthesiologists (ASA) physical status class 1 or 2 requiring tracheal intubation for elective surgery. All patients were randomly allocated into two groups: Pentax-AWS (group P) and Macintosh (group M). Induction of anesthesia was performed using fentanyl, thiopental and succinylcholine intravenously. Systolic, mean and diastolic blood pressure (SBP, MBP, DBP) and heart rate (HR) were recorded just prior to induction, 1, 3, and 5 minutes after intubation. RESULTS: There were no significant differences in SBP, MBP, DBP and HR between both groups. However, group P showed a higher POGO (Percentage of Glottic Opening) score than group M during endotracheal intubation. CONCLUSIONS: Use of Pentax-AWS in endotracheal intubation did not increase hemodynamic changes compared to the use of Macintosh laryngoscope. Furthermore, Pentax-AWS offered an improved laryngeal view during endotracheal intubation.
Anesthesia ; Blood Pressure ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopes ; Succinylcholine ; Thiopental

PURPOSE: Surgical procedures using robot-assisted surgery, including pancreatic surgery, have recently become popular. This study aimed to report our initial experiences with distal pancreatectomy procedures using the robot-assisted surgery system. METHODS: The clinical records of 28 patients who underwent robot-assisted distal pancreatectomy (RDP) between July 2012 and January 2016 were reviewed. RESULTS: Of the 28 patients, 5 (17.9%) were male and 23 (82.1%) were female. Their ages ranged from 11 to 78 years, with a median age of 44.5 years. The mean diameter of the pancreatic tumors was 3.6 cm. The median operative time was 192.5 (range, 100~390) minutes, and the median blood loss was 200 (range, 50~1,900) ml. All of the 28 RDPs were successfully completed. Spleen preservation was achieved in 16 (57.1%) patients. Clinically significant postoperative pancreatic fistula was detected in 4 (14.3%) patients. Postoperative complications were evident in 5 (17.9%) of the 28 patients. CONCLUSION: Our experiences suggest that RDP is feasible for patients with benign or borderline tumors at the body or tail of the pancreas. It may be considered as an effective surgical procedure for benign or borderline tumors of the pancreas in the future; however, further studies to confirm this are warranted.
Female ; Humans ; Male ; Operative Time ; Pancreas ; Pancreatectomy* ; Pancreatic Fistula ; Postoperative Complications ; Spleen ; Tail

BACKGROUND: Viral myocarditis is considered as a cause of dilated cardiomyopathy. At present, two pathogenic mechanisms may be involved in the pathogenesis of viral myocarditis and subsequent cardiomyopathy. First, the virus infection of myocyte may directly lead to either cell death or persistent metabolic dysfunction. Second, virus-induced immune or autoimmune mechanism may play a role. METHODS: To test the therapeutic efficacy of immunosuppression with cyclophophamide(CYP) on coxsackievirus B3(CB3) myocarditis, 10-14 week-old Balb/c mice were inoculated with 4000 plaque-forming units of CB3. In experiment 1, CYP (100mg/kg/day subcutaneous injection, s.c) was administrated daily on days 1-7(group 2, n=16). In experiment 2, CYP 30mg/kg/day s.c(group 3, n=32) or CYP 100mg/kg/day s.c(group 4, n=32) were administrated on days 8-14. The animals of infected controls(group 1, n=26) and group 2, 3, 4 were dissected at days 4, 7, 15, 22 and spleen, heart, thymus and body weights were measured. RESULTS: In experiment 1. survival rate in group 2 on day 7, 15 were low compared with group 1(85%, 0% vs 100%, p<0.05). and myocardial virus titers in group 2 on day 4 was 50 times, and on day 7, 1000 times higher compared with group 1, Histologically, on day 7, focal cellular infiltrations were prominent findings in group 1, but diffuse myocardial necrosis without cellular infiltration were observed in group 2. In experiment 2, survival rate, cardiac histopathology myocardial virus titer and serum neutralizing antibody titers did not differ among groups 1, 3 and 4. In experiment 1 and 2, the spleen-to-body-weight and thymus-to-body-weight ratios were significantly lower in CYP treated groups than those in controls and marked cellular depletions in spleens and thymus were observed in CYP treated groups. CONCLUSIONS: As the results of above, it can be concluded that the immunosuppression during viremic phase of murine viral myocarditis aggravated the myocardial necrosis, and during aviremic phase, the administration of CYP didnot affect the process of viral myocarditis. Thus, direct viral mechanisms in the production of cardiomyocyte injury in CB3-infected mice appear to bo more important than cell mediated immune mechanism. To understand relevant pathogenic mechanisms of clinical myocarditis and dilated cardiomyopathy resulting from viral infection, the experimental study expanding into nonmurine animals and into various models using other infectious agents may be required.
Animals ; Antibodies, Neutralizing ; Body Weight ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cell Death ; Cyclophosphamide* ; Heart ; Immunosuppression ; Injections, Subcutaneous ; Mice ; Muscle Cells ; Myocarditis* ; Myocytes, Cardiac ; Necrosis ; Spleen ; Survival Rate ; Thymus Gland ; Viral Load

Wilms' tumor is the most common renal malignancy in childhood. However Wilms' tumor originating in horseshoe kidney is rare. We present a case of Wilms' tumor arising from the isthmus of horseshoe kidney, and aim to highlight the problems faced in the diagnosis and management.
Diagnosis ; Kidney* ; Wilms Tumor*