An accurate and relatively simple method for estimating the amount of acute blood loss is essential in the hemorrhagic shock patients. Conventional physiologic parameters, blood pressure, pulse rate and CVP, could not serve for evaluation of the adequate oxygen transport in the tissue. Pulmonary artery catheter is a best tool for evaluating the cardiopulmonary function and the oxygen transport system, and mixed venous oxygen saturation(SvO2) monitoring have made a great advances for early detection of cardiovascular dysfunction and the changes in peripheral tissue oxygenation. But pulmonary artery catheterization is complicated procedure in emergency setting. Although the central venous oxygen saturation(ScvO2) cannot completely replace the SvO2 value, it has a close relation with SvO2 change in variable clinical situations. We testify the usefulness of ScvO2 monitoring in 24 patients of the hemorrhagic shock. Initial resuscitation was performed with ATLS standard and continuous ScvO2 was monitored. Systolic blood pressure and pulse rate were recorded for one hour from initial resuscitation in each 15 minutes. Nineteen patient was traumatic hemorrhagic shock and five was non traumatic. Twelve of 19 patients was blunt trauma, and remains were stab in injury mechanism. Mortality rate was 29.2%. Initial ScvO2 of nonsurvivor was 43.6%, and 51.3% in survivor groups(p>0.05). In the group of stab wound and non-traumatic hemorrhage, the ScvO2 was gradually increase by time. But ScvO2 in survivors of blunt trauma was increased first 30 minutes and decrease afterthen. Continuous monitoring of ScvO2 may by partly useful in resuscitation for hemorrhagic shock. It is more valuable in the blunt trauma than in the penetrating injury or non-traumatic hemorrhage.
Blood Pressure ; Catheterization, Swan-Ganz ; Catheters ; Emergencies ; Heart Rate ; Hemorrhage ; Humans ; Mortality ; Oxygen* ; Pulmonary Artery ; Resuscitation ; Shock, Hemorrhagic* ; Survivors ; Wounds, Stab

No abstract available.
Humans ; Spinal Cord*

We experienced a case of clipping of an intracranial aneurysm of a 63 year old male with a subarachnoid hemorrhage under general anesthesia. Preoperative electrocardiography showed complete Left Bundle Block (LBBB) without subjective symptoms. Among the intraventricular blocks, bundle branch block is the most common type and in particular, complete LBBB may progress to the more serious condition of complete heart block. Consideration of anesthetic management in such patients requires a knowledge of normal cardiac physiology, neurophysiology, the circulatory effects of various anesthetic agents and the pathophysiology of these diseases, to prevent any hypertension in response to intubation and surgery. We report upon the anesthetic management of a patient for clipping of an intracranial aneurysm with complete LBBB, which was performed successfully without complication.
Anesthesia, General ; Anesthetics ; Bundle-Branch Block* ; Electrocardiography ; Heart Block ; Humans ; Hypertension ; Intracranial Aneurysm* ; Intubation ; Male ; Middle Aged ; Neurophysiology ; Physiology ; Subarachnoid Hemorrhage

STUDY DESIGN: A case report. OBJECTIVES: Lumbar burst fracture was treated with operation, which delayed recollapse of L1 and led to conus medullaris syndrome. SUMMARY OF LITERATURE REVIEW: After operation, conus medullaris syndrome causing by delayed recollapse is not frequently reported. MATERIALS AND METHODS: A 56-year-old male was admitted with lower back pain caused by a fall. Radiologic findings showed L1 burst fracture with about 42% of height loss. There was no neurologic deficit. Posterior fusion was performed using instrumentation. Five weeks after the operation, the patient was admitted for urination and defecation difficulty. Radiologic findings showed that the L1 had recollapsed with about 38% of height loss. To resolve the problem, anterior surgery was performed. RESULTS: Two years after surgery, bladder and anal sphincter dysfunction wasn't recovered. CONCLUSIONS: Lumbar burst fracture should be follow up carefully until union of the fracture because burst fracture leads to delayed recollapse.
Anal Canal ; Defecation ; Humans ; Low Back Pain ; Male ; Middle Aged ; Neurologic Manifestations ; Spinal Cord Compression* ; Urinary Bladder ; Urination

BACKGROUND:Outpatient surgery has recently grown in popularity. This trend has affected the practice of anesthesia and has also led to an increasing interest in the development and use of short-acting anesthetic and analgesic agents. METHODS: One hundred fifty patients scheduled for outpatient surgery were randomly allocated to receive propofol, sevoflurane or isoflurane anesthesia with tracheal intubation. Clinical recovery times were analyzed as emergence, recovery, cognition and discharge. All adverse events were noted. RESULTS: Sevoflurane resulted in significantly shorter times to emergence (2.9 min), recovery (4 min), cognition (5.5 min) and discharge (13.4 min) than isoflurane. Propofol resulted in shorter times to emergence (2 min), recovery (2 min), cognition (3 min) and discharge (6.6 min) than isoflurane, but these were not significant. Also, sevoflurane resulted in shorter times to emergence, recovery, cognition and discharge than propofol, but not significantly. Among the adverse events noted, the percentages of postoperative nausea and vomiting (PONV) after anesthesia were 8%, 20% and 24% for the those who received propofol, sevoflurane and isoflurane, respectively. Propofol resulted in a significantly lower incidence of PONV than sevoflurane or isoflurane. There was no significant difference between sevoflurane and isoflurane in this respect. CONCLUSIONS: Sevoflurane and propofol are better anesthetics than isoflurane for outpatient anesthesia because of their rapid recovery times and a lower incidence of postoperative nausea and vomiting.
Adult* ; Ambulatory Surgical Procedures* ; Analgesics ; Anesthesia* ; Anesthetics ; Cognition ; Humans ; Incidence ; Intubation ; Isoflurane* ; Outpatients* ; Postoperative Nausea and Vomiting ; Propofol*

The vagina is an infrequent site of primary sarcomas, which are less than 2% of all malignant vaginal neoplasm. The most common malignant mesenchymal tumor of the vagina is rhabdomyosarcoma, but leiomyosarcoma is rare type tumor of the vagina. Microscopically, spinle cells with pleomorphic nuclei and mitotic figures were frequently noted, but cross-striations were not found in the tissue. Alpha-smooth muscle actin and desmin were positive, but sarcomeric actin was negative in the tumor cells. The authors report a case of primary leiomyosarcoma of the vagina with brief literature review.
Actins ; Desmin ; Leiomyosarcoma* ; Rhabdomyosarcoma ; Sarcoma ; Vagina* ; Vaginal Neoplasms

BACKGROUND: This study was designed to compare the antiemetic effects of propofol, ondansetron, droperidol and metoclopramide for the prevention of postoperative nausea and vomiting (PONV) in patients undergoing middle ear surgery. METHODS: One-hundred-twenty patients were scheduled for middle ear surgery (tympanomastoidectomy and tympanoplasty). Patients received propofol (0.5 mg/kg), ondansetron (60microgram/kg), droperidol (20microgram/kg) or metoclopramide (0.2 mg/kg) intravenously at the end of the surgical procedure. The assesment of PONV was performed during 3 periods after receiving anesthesia; 0 to 2 hours in the postanesthetic care unit, 2 to 12 hours and 12 to 24 hours in the ward. RESULTS: The percentage of no emesis during the 0 to 2 hour period after receiving anesthesia was 93% for the those who received propofol, 73% for the those who received ondansetron, 70% for the those who received droperidol, and 70% for the those who received metoclopramide. The respective corresponding incidence during the 2 to 12 hour period after receiving anesthesia was 86%, 66%, 63%, and 63%, and the respective corresponding incidence during the 12-24 hour period after receiving anesthesia was 90%, 66%, 66%, and 66%. No clinically adverse events were observed in any of the groups. CONCLUSIONS: A small dose of propofol is a better antiemetic than ondansetron, droperidol or metoclopramide for prevention of postoperative nausea and vomiting after middle ear surgery.
Anesthesia ; Antiemetics* ; Droperidol* ; Ear, Middle* ; Equidae ; Humans ; Incidence ; Metoclopramide* ; Ondansetron* ; Postoperative Nausea and Vomiting ; Propofol* ; Vomiting

Merkel cell carcinoma is a rare aggressive primary skin cancer which mostly occurs in the elderly on sun-exposed skin. It usually presents as a solitary dome-shaped red or purple nodule on the head, neck and extremities. The mortality rate is higher than the rate for malignant melanoma because its local recurrence is common. Agent Orange, an herbicide widely used as a defoliant in the Vietnam War, contains dioxin contaminants and can cause several dermatoses and skin cancers. We report a case of multiple Merkel cell carcinoma in a 65-year-old male with lesions on the head and neck, who had been exposed to Agent Orange during Vietnam War.
2,4,5-Trichlorophenoxyacetic Acid ; 2,4-Dichlorophenoxyacetic Acid ; Aged ; Carcinoma, Merkel Cell ; Citrus sinensis ; Extremities ; Head ; Humans ; Male ; Melanoma ; Neck ; Recurrence ; Skin ; Skin Diseases ; Skin Neoplasms ; Tetrachlorodibenzodioxin ; Veterans ; Vietnam

A 45-year-old female with psychosis complained urological symptom of urinary incontinence and voiding difficulty with abdominal pains and expansion during her psychiatric hospitalization and suddenly collapsed at the 14th day of the admission. At autopsy, the urinary bladder showed a focal perforation and the abdominal cavity was filled with massive urinary ascites. The both lower lobes and the right upper lobe of the lung were accompanied by atelectasis. The death mechanism of this case could be explained that an increased abdominal pressure produced by massive uroperitoneum with spontaneous bladder rupture led to respiratory failure. The so-called abdominal compartment syndrome was manifested by massive uroperitoneum and caused a death. This would be the first forensic medical case that an undiagnosed spontaneous bladder rupture resulted in death of a psychiatric illness patient.
Abdominal Cavity ; Abdominal Pain ; Ascites ; Autopsy ; Female ; Hospitalization ; Humans ; Intra-Abdominal Hypertension ; Lung ; Middle Aged ; Psychotic Disorders ; Pulmonary Atelectasis ; Respiratory Insufficiency ; Rupture* ; Urinary Bladder* ; Urinary Incontinence

Acute epiglottitis is a local bacterial infection of the supraglottic area. Epiglottitis is generally caused by organisms which invoke an inflammatory response that develops rapid obstructive edema. The disease rarely progresses to abscess stage, either because medical intervention is sought or death by asphyxiation ensues. A 38-year-old, mentally ill but physically healthy woman died of airway obstruction caused by acute epiglottitis forming an abscess. She died unexpectedly and suddenly showing only minor nonspecific symptoms.
Abscess* ; Adult ; Airway Obstruction ; Bacterial Infections ; Death, Sudden* ; Edema ; Epiglottitis ; Female ; Humans ; Mentally Ill Persons