BACKGROUND: Exogenously administered epinephrine under enflurane anesthesia was known to have mild myocardial sensitizing effect. And N2O activates the sympathetic nervous system mildly. We planed this study to confirm cadiovascular effects of clinically administered epinephrine for hemostasis under the enflurane-N2O anesthesia during tonsillectomy. METHODS: Eighty children scheduled to have tonsillectomy were selected randomly and divided into 2 groups as follows; Group E: 1:100,000 epinephrine 2ug/kg and Group EL: 1:100,000 epinephrine containing 1% lidocaine 2 g/kg. Blood pressure, heart rate, and the occurrence of arrhythmia were evaluated before injection, at injection, 1 min, 2 min, 3 min, 5 min and 10 min after injection and 1 min after operation start. RESULTS: In both groups, systolic and diastolic blood pressure and heart rate are increased. But there are no significant statistical differences in each group and between groups. One min after operation, there are significant increases in systolic and diastolic blood pressure and heart rate in both groups (p<0.05), but there is no significant difference between groups. CONCLUSION: Under the enflurane-N2O anesthesia of children, 1:100,000 epinephrine 2ug/kg used for hemostasis could be used comparatively safe without any significant hemodynamic changes. But because there is always the possibility of myocardial sensitization, careful observation is necessary during epinephrine injection under the enflurane-N2O anesthesia.
Anesthesia* ; Arrhythmias, Cardiac ; Blood Pressure ; Child ; Enflurane ; Epinephrine* ; Heart Rate ; Hemodynamics ; Hemostasis* ; Humans ; Lidocaine ; Sympathetic Nervous System ; Tonsillectomy*

Anesthetists use halothane as a popular anesthetic agent, but after halothane anesthesia, hepatitis developed intermittently. However, it is not easy to prove halothane as a causative agent, because there are many factors causing hepatitis. We had a case of acute hepatitis developing after halothane anesthesia. Case: A 29-year-old male had an operation for split thickness skin graft on the right antetibial area under halothane anesthesia. Prior to operation, he was medicated Cefoxitin 1.0gm tid IV to control infection. On the postoperative 11th day, he developed high fever of 40.5 degrees C. Thereafter, skin rashes and jaundice followed. Liver function tests showed marked elevation of SGPT, SGOT, alkaline phosphatase, and eosinophillia. HBsAG(-), HBcAb(-), and HBeAg(-) were reported. There also was negative finding in HVA-IgM. He recovered gradually from the hepatitis and went home in good health on the 34th postoperative day. A possible cause or causes of the hepatitis in this case were considered to be the Cefoxitin adn/or the halothane.
Adult ; Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia* ; Aspartate Aminotransferases ; Cefoxitin ; Exanthema ; Fever ; Halothane* ; Hepatitis* ; Humans ; Jaundice ; Liver Function Tests ; Male ; Skin ; Transplants

We report a case of primary cardiac angiosarcoma in a 35 year-old woman. She presented with dyspnea, facial edema and neck vein distension during 1 month. The oval round large mass(8x4 cm) filling the right atrium infiltrated into the entire thickness of the lateral wall and extended to the vena cava and ventricle. The interatrial septum and pericardium seemed to be intact. Despite the surgical excision and adjuvant chemo-and radiotherapy, the patient died 8 months later due to tumor recurrence. The histologic findings of tumor varied from benign looking capillary proliferation mimicking granulation tissue to sarcoma composed of spindle cells. But anastomosing vascular channels lined by anaplastic polygonal cells and intracytoplasmic lumen containing red blood cells were characteristic findings. These tumor cells showed positive reaction to endothelial cell antigen and factor VIII-related antigen. The intercellular junctional complex and vascular channels formed by cytoplasmic process of tumor cells were identified by the ultrastructural study.
Female ; Humans

A case of low-grade endometrial stromal sarcoma resembling ovarian sex-cord tumor in the uterus of a 43-year-old woman is described. This tumor belongs to the group II category of uterine tumors resembling ovarian sex-cord tumor described by Clement and Scully, and the epithelial-like elements show prominent smooth muscle differentiation, proved by immunoreactivity for desmin and actin. The patient did not receive any adjuvant therapy; she is alive and well without recurrence 8 months postoperatively.
Female ; Humans

E-cadherin is a calcium-dependent epithelial adhesion molecule which plays a role in the initial step of invasion of cancer cells. The step that follows the migration of separated tumor cells is a proteolytic lysis of basement membrane and extracellular matrix by protease of epithelial and endothelial cells such as matrix metalloproteinase (MMP). Vascular endothelial growth factor (VEGF) is known to be an endothelial cell-specific powerful mitogen as well as a vascular permeability factor. This study is aimed to evaluate the correlation between expression of these factors and pathologic or clinical variables and the roles and prognostic significance of those factors in squmous cell carcinoma and adenocarcinoma of the lung. Immunohistochemical stains were performed for E-cadherin, MMP-2, and VEGF in surgically resected specimens from 90 patients with squmous cell carcinoma and adenocarcinoma of the lung. Mean age of the patients was 59.7 years. Histologic type was categorized into 56 cases of squamous cell carcinoma and 34 cases of adenocarcinoma. Mean survival period of the 35 patients was 54 months. The immunohistochemical stains for E-cadherin, MMP-2, and VEGF revealed positive reaction in 67 cases (74.4%), 43 cases (47.8%), and 34 cases (37.8%), respectively. The expression of E-cadherin was higher in adenocarcinoma (82.4%) than in squamous cell carcinoma (69.6%). MMP-2 was expressed in the tumor cells, especially those invading into the surrounding stroma. The expression of MMP-2 was significantly correlated with the survival rate (p<0.05). The expression of VEGF in the tumor cells was significantly higher in cases with lymph node metastasis (p<0.05). In conclusion, these findings suggest that the expression of MMP-2 and VEGF predict poor prognosis of patients with squmous cell carcinoma and adenocarcinoma of the lung and that VEGF may play a role in tumor metastasis.
Adenocarcinoma* ; Basement Membrane ; Cadherins* ; Carcinoma, Squamous Cell* ; Coloring Agents ; Endothelial Cells ; Extracellular Matrix ; Humans ; Lung* ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Survival Rate ; Vascular Endothelial Growth Factor A*

PURPOSE: This study was designed to define normal values for a nongeometric MPI in children and evaluate the utility of m%cardial performance index(MPI) in congenital heart disease with distorted ventricular geometry. METHODS: The study population consisted of 44 normal patients and 28 patients with atrial septal defect(ASD) with dilated right ventricle and paradoxical septal motion. Right ventricular(RV) and left ventricular(LV) isovolumic contraction time, isovolumic relaxation time, ejection time, ejection fraction and pre-ejection period/ejection time(PEP/ET) were measured using conventional echo- Doppler methods. The MPI measures the ratio of total time spent in isovolumic activity(isovolumic contraction time and isovolumic relaxation time) to ejection time. RESULTS: In normal children, the RV MPI was 0.33+/-0.09 and the LV MPI was 0.36+/-0.04. In the ASD group, LV function seemed grossly normal but LV EF was significantly lower than normal children(57+/-3% vs 67+/-4%, P<0.05), but both LV and RV MPI had no statistically significant difference. After correction of ASD, RV MPI was increased and LV EF(57+/-3% vs 64+/-3%, P<0.05) as wll as the RV PEP/ET(0.27+/-0.05 vs 0.38+/-0.06, P<0.05) were significantly greater than the normal or the preoperation group. CONCLUSION: Components of the MPI are easily measured with conventional Doppler technique using standard echocardiographic examination. These results suggest that the MPI is useful as a means of quantitative assessment of ventricular performance in patients with complex ventricular geometry, particularly RV.
Child ; Echocardiography ; Heart Defects, Congenital ; Heart Septal Defects, Atrial* ; Heart Ventricles ; Humans ; Reference Values ; Relaxation ; Ventricular Function*

BACKGROUND: Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications, unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. METHODS: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. RESULTS: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion [p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortality in univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. CONCLUSIONS: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered important predictors of mortality.
Abdomen* ; Body Mass Index ; Humans ; Critical Care ; Intensive Care Units ; Length of Stay ; Mortality ; Postoperative Complications ; Prognosis* ; Respiration, Artificial ; Retrospective Studies ; Serum Albumin ; Ventilation

Angiosarcoma of the bone is rare with an incidence of 0.13%. It may be solitary or multiple. Its cytologic findings by FNA have rarely been reported. We report a case of angiosarcoma of the rib in a 66 year-old man. FNA revealed single or clusters of round to oval shaped cells in a hemorrhagic and myxoid background. The large central nuclei had irregular nuclear membrane, chromatin clumping and prominent nucleoli. The cytoplasm was scanty with an eosinophilic distinct cytoplasmic border. Erythrophagocytosis by malignant cells was also found. Histopathologic examination confirmed the diagnosis of angiosarcoma revealing irregular and com- plex anastomosing vascular channels lined by malignant round tumor cells, protruding into the lumen. Immunohistochemical staining revealed diffuse strong positive reaction to factor VIII-related antigen and CD31.
Aged ; Biopsy, Fine-Needle* ; Chromatin ; Cytoplasm ; Diagnosis ; Eosinophils ; Hemangiosarcoma* ; Humans ; Incidence ; Nuclear Envelope ; Ribs* ; von Willebrand Factor

A 2600 gm term female baby was born through Caesarean section at Baptist Hospital to 29-year-old, primigravda woman who had pregnancy induced hypertension(PIH), HBsAg carrier, and chronic glomerulonephritis. Apgar scores were 5 at one minute and 7 at five minutes. There was extreme respiratory distress in the nursery and she was diagnosed as congenital diaphramatic hernia. At operation, there was a left sided foramen of Bochdalek hernia with hypoplasia of left lung. The diaphragmatic hernia was reduced and cardiac evaluation revealed no evidence of congenital heart disease (CHD) by clinical examination. There also noted no right to left shunt via patent ductus arteriosus. After operation, endotracheal tube was left in place and the patient returned to the nursery where she received respiratory care with infant ventilator. The major determinants of outcome in patients with CHD are the extent of pulmonary hypoplasia and the degree of pulmonary hypertension. So pre- and postoperative management of the pulmonary hypertension is as important as surgical correction of the CHD. The patient tolerated anesthesia and surgery well, and was discharged one month later.
Adult ; Anesthesia ; Cesarean Section ; Ductus Arteriosus, Patent ; Female ; Glomerulonephritis ; Heart Defects, Congenital ; Hepatitis B Surface Antigens ; Hernia ; Hernia, Diaphragmatic* ; Humans ; Hypertension, Pulmonary ; Infant ; Lung ; Nurseries ; Pregnancy ; Protestantism ; Ventilators, Mechanical

A 49-year-old man was admitted to Baptist Hospital on September 1, 1990. For mitral valve replacement due to mitral regurgitation. He has been treated by implantation of artificial pacemaker due to complete heart block for 1 year ago. We have experienced anesthetic management above patient who was scheduled of MVR. The patient with a cardiac pacemaker (VVI type) could give anesthesiologist many associated problems during the operation and anesthesia. During anesthesia an anesthesiologist should be able to manage the problems which might occur because of a cardiac pacemaker by various origins. Authors report this case with evaluation of references.
Anesthesia ; Heart Block ; Heart* ; Humans ; Middle Aged ; Mitral Valve ; Mitral Valve Insufficiency ; Pacemaker, Artificial ; Protestantism ; Thoracic Surgery*