Accidental or suicidal fatalities of paraquat (Gramoxon) poisong are occasionally seen in the emergency room or intensive care unit in this country. In most cases, respiratory symptoms and eventual death by respiratory distress occur within several days. The most striking pathologic change is fibrosis of the lung due to widespread proliferation of fibroblastic cell. We experience a 21-year-old woman with huge bulla on left lung and diffuse fibrosis in other site, who ingested paraquat 10 months ago. After thoracoscopic removal of bulla, the patient survive without progression of pulmonary complication till now.
Emergency Service, Hospital ; Female ; Fibroblasts ; Fibrosis ; Humans ; Intensive Care Units ; Lung ; Paraquat ; Pulmonary Fibrosis* ; Strikes, Employee ; Young Adult

BACKGROUND: It has been said that anesthesia and surgery tend to increse 'stress hormone' followed by reduction of GFR and urine flow. We have been noticed a polyuria during mastoidectomy with anesthesia. We hypothesized that a reduction of ADH secretion related to operative procedure might be a cause of a transient polyuria. METHODS: In 41 patients who were in ASA class I, mean arterial pressure (MAP), heart rates (HR), temperature, central venous pressure (CVP) were measured at before induction, just before drilling with irrigation, 30 minutes and 60 minutes after drilling with irrigation, and on arrival in recovery room by groups (room temperatured irrigating fluid and warm fluid were used in group 1 and group 2) during procedures. In 7 of 41, blood samples for antidiuretic hormone (ADH) and plasma osmolalities (Posm) were withdrawn at the same time points. In all patients, fluid were administered with 4 ml/kg/hour throughout the procedures. RESULTS: In group 1, mean urine volume were 5.0 and 6.4 ml/min during anesthesia and drilling with irrigation that was significantly more than in group 2 (3.6 and 4.2 ml/min). In 7 patients, ADH concentration was decreased during surgery compared to pre-induction level, while the Posm were in normal ranges. None of the MAP, HR and CVP showed significant changes. ADH concentrations were not significantly correlated to Posm. CONCLUSIONS: We suggest that a reduction of ADH secretion may have a major role in transient polyuria during mastoidectomy, which might be related to the mechanism that; 1) lowered temperature of hypothalamo-pituitary system by cold irrigating fluid may induce a transient ischemic changes of pituitary gland, 2) absorption of hypoosmolar irrigating fluid to central circulation may reduce central osmotic pressure.
Absorption ; Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Central Venous Pressure ; Heart Rate ; Humans ; Osmolar Concentration ; Osmotic Pressure ; Pituitary Gland ; Plasma* ; Polyuria ; Recovery Room ; Reference Values ; Surgical Procedures, Operative

Papillary carcinoma of the thyroid is a well differentiated neoplasm and usually has a good prognosis. However, a subset of morphologically distinct papillary carcinoma has bad prognoses. The tall cell variant of papillary carcinoma (TCPC), characterized by tall columnar cells with a height at least twice the width, is the one of these. In order to differentiate TCPC from usual papillary carcinoma (UPC) in terms of prognosis, we performed immunohistochemical studies for the expression of p53, bcl-2 and Leu-M1 proteins in 25 cases of TCPC, 26 cases of UPC and 14 cases of poorly differentiated, solid type papillary carcinoma (SPC) with an analysis of clinical parameters. The nuclear expression of p53 was noted in one case each of UPC and TCPC. The cytoplasmic p53 expression of TCPC, UPC, and SPC was observed in 17/25 cases (68%), 14/26 cases (54%), 3/14 cases (21%), respectively. bcl-2 expression was 19/25 cases (76%), 18/26 cases (69%), 5/14 cases (36%), and that of Leu-M1 was 21/25 cases (84%), 18/26 cases (69%), 4/14 cases(29%), respectively. There were no statistical significance in the expression of those immunoproteins among these three groups (p>0.05). The p53 protein was consistently expressed in the cytoplasm rather than nucleus in this study and was very well correlated to bcl-2 positivity (p<0.01). There were no statistical significance in any clinical parameters examined among these three groups (p>0.05). In conclusion, TCPC can not be separated from UPC as a distinct entity in this study and the cytoplasmic expression of p53 protein provides another mechanism of p53 inactivation in tumorigenesis of the thyroid papillary carcinoma, possibly by bcl-2 related mechanism.
Carcinogenesis ; Carcinoma, Papillary ; Cytoplasm ; Immunoproteins ; Prognosis ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND: The afferent and efferent pathways of fentanyl cough response (FCR) and central organization are poorly understood at present. The aim of this study was to investigate the pretreatment effects of morphine, propofol, atropine, and midazolam on FCR. METHOD: The 120 healthy patients were randomly assigned to six equal pretreatment groups. They received 2ug/kg fentanyl rapidly through a peripheral venous catheter. The patients in each group were pretreated before the time necessary for peak plasma levels with different drugs as follows: group 1, no premedication; group 2, morphine 0.05 mg/kg iv; group 3, morphine 0.05 mg/kg iv naloxone 0.01mg/kg iv; group 4, propofol 0.5 mg/kg iv; group 5, atropine 0.01 mg/kg iv; group 6, midazolam 0.05 mg/kg iv. The patients were observed for any coughing or side effects, including oxygen desaturation, bronchoconstriction, chest wall rigidity and seizure. RESULT: 40% of patients in group 1 (control) had a cough response to fentanyl. Group 2 (morphine) and group 3 (morphine naloxone) showed a reduced FCR of 10%. The incidence of coughing was 60% of the patients in group 4 (propofol), 30% in group 5 (atropine), and 40% in group 6 (midazolam). These were not statistically significant. CONCLUSION: FCR is not altered by pretreatment with propofol, atropine, or midazolam, but morphine inhibits cough response and this antitussive effect was not antagonized by naloxone.
Atropine* ; Bronchoconstriction ; Catheters ; Cough* ; Efferent Pathways ; Fentanyl* ; Humans ; Incidence ; Midazolam* ; Morphine* ; Naloxone ; Oxygen ; Plasma ; Premedication ; Propofol* ; Seizures ; Thoracic Wall

BACKGROUND: We observed fentanyl known as centrally-acting antitussive agents provoke a cough response in some patients at induction of anesthesia. This may be of clinical importance. METHOD: 121 patients (ASA class I) were assigned randomly to 4 groups. Each group was given different doses of fentanyll Group 1 (n=30); 0.5ug/kg, Group 2 (n=30); 1ug/kg, Group 3 (n=33); 2ug/kg, Group 4 (n=28); 4 g/kgl, within 1 second through a peripheral venous cannula before induction of anesthesia. All patients were observed carefully in order to detect a cough response and any side effects. RESULT: The incidences of FCR (Fentanyl Cough Response) were 0% in Group 1, 10.0% in Group 2, 30.3% in Group 3, and 39.3% in Group 4. The ED50 of FCR was 4.25ug/kg. The mean onset-time from the end of fentanyl administration to the beginning of coughing was 12.5 seconds. FCR was decreased with aging, but not affected by weight, height, or smoking. Other serious side effects were not accompanied. CONCLUSION: Fentanyl can evoke the pulmonary chemoreflex dose-dependently and the ED50 was 4.25 g/kg.
Aging ; Anesthesia ; Antitussive Agents ; Catheters* ; Cough* ; Fentanyl* ; Humans ; Incidence ; Reflex* ; Smoke ; Smoking

Applied TNM-system for determination and prognostic classification of the cancer patients of Oral and Maxillofacial region does, however, only partly justice, if at all, to the nature of the tumor disease. And the TNM-system implies among other defects a crude simplification of the complex pattern of the tumor disease. But in clinical practice, the prognosis must be determined on the bases of a specific combination of clinical factors under consideration of various therapeutical conditions. For more reliable and objective prognosis determination for the cancer patients of Oral and Maxillofacial region, `Retrospective DOSAK(German-Austrian-Swiss Association for Head and Neck Tumors) study' introduced Treatment-dependent Prognosis Index TPI in 1982. Treatment-dependent Prognosis Index TPI gives the clinician an opportunity to determine the prognosis before starting therapy at the time of the first admission of the patient, during the therapy and immediately after complete of the therapy. The fundamental purpose of the TPI can be summarized as follows. 1) In clinical-therapeutical cancer research the TPI provides a sound basis for the planning and verification of therapy studies. 2) In clinical practice the TPI allows a reliable and objective determination of the prognosis for the individual patient and thus provides the clinician valuable assistance in planning the treatment. The authors estimated the survival curves of the 179 cases of squamous cell carcinoma from 1985.1.1 to 1992.8.31 in the Department of Oral and Maxillofacial Surgery, Seoul National University Hospital according to Treatment-dependent Prognosis Index TPI of Retrospective DOSAK study and compared with the survival curves observed in long term study on prognosis of patients.
Carcinoma, Squamous Cell* ; Classification ; Head ; Humans ; Neck ; Prognosis* ; Retrospective Studies ; Seoul ; Social Justice ; Surgery, Oral

Introduction: Anesthesiologists have been aware of the dangers of diffusion hypoxia in the early postoperative period after nitrous oxide anesthesia, but it was suggested of a little clinical significance in healthy patients. Goal of this study is to re-evaluate the possibility of diffusion hypoxia. METHODS: Eighty patients who were scheduled for vitrectomy were allocated to two groups by normal and abnormal chest X-ray findings and each group was divided into two subgroups by N2O concentration (1-a, 2-a; 50%, 1-b, 2-b; 60%). One and half hours after anesthesia, end-tidal alveolar concentration of oxygen (et-O2), N2O (et-N2O), and PaO2 were measured for 10 minutes after the inspired gases were changed to room air 2 L/minute with controlled ventilation in group 1-a. Those parameters were re-measured after re-administration of O2 and N2O of 50% of each for an hour and the inpired gases were changed to room air again. RESULTS: In group 1-a, there was no significant differences of et-N2O and PaO2 after 5 minutes by air flow. And there was no differences of et-N2O and PaO2 between group 1-a and 1-b by et-N2O after 4 minutes. In group 1-b, PaO2 was in normal range at 10 minutes after, although et-O2 was decreased to 14.9%. However, group 2-b showed peripheral arterial saturation lower than 96% after 6 minutes and mild hypoxemia (PaO2 75.3 mmHg) at 10 minutes. CONCLUSIONS: We suggest that hypoxemic episode during spontaneous breathing of room air in early postoperative period after nitrous oxide anesthesia may be occur due to decreased ventilatory function rather than diffusion of nitrous oxide. However, in patients with minimal abnormal chest X-ray findings even without clinical symptoms, it would be better to avoid high concentration of nitrous oxide.
Anesthesia* ; Anesthetics ; Anoxia* ; Diffusion* ; Gases ; Humans ; Nitrous Oxide* ; Oxygen ; Postoperative Period ; Reference Values ; Respiration ; Thorax ; Ventilation ; Vitrectomy

A 46-year-old female was admitted to Soon Chun Hyang University hospital with a complaint of intermittent epigastric pain. X-ray and endoscopic pictures showed diffase irregular shallow depression which is similar to the macroscopic pattern of the type IIc early gastric cancer. But endoseopic biopsy showed no malignant cell infiltration. Hndoaeopic biopsy plays an important role in excluding the possibility of carcinoma. But operation shoud be considered inspite of biopsy result because malignant lymphoma ean not be completely ruled out. Histopathologic diagnosis was pseudolymphoma of stomach.
Biopsy ; Depression ; Diagnosis ; Female ; Humans ; Lymphoma ; Middle Aged ; Pseudolymphoma* ; Stomach ; Stomach Neoplasms

The mechanism of vasodilation induced by fentanyl was investigated using isolated rat thoracic aortic rings. Rings were contracted with norepinephrine(10(-7) M, NE) and potassium chloride(40 mM, KC1) with and without endothelium Fentanyl (10(-9)-10(-5) M) produced dose-dependent relaxation and had no significant effect from endothelium(intact and denuded rings, test with 3X10(-4) M LNAME, N-nitro-L-arginine methyl ester). Pretreatment of indomethacin(2.5X10(-3) M, inhibitor of cyclooxygenase) failed to influence of cumulative dose-response curves. RD(50)(50% relaxation dose) and KC1/NE ratio as potency difference of fentanyl, verapamil(10(-8)-10(-5) M, Ca2+ channel blocker), nitroglycerin(10(-10)-10(-5) M, activator of guanylate cyclase) were not similar. Fentanyl and control(distilled water) were not demonstrated any different contraction produced by incremental addition of Ca2+ to aortic rings exposed to Ca2+ free, K+ -depolarized(100 mM KCl) solution(extracellular Ca2+ influx). But fentanyl had effect on intracellular Ca2+ release elicited by caffeine(20 mM) and NE(10(-7) M) indicated by dose-dependent inhibition of contraction in Ca2+ free solution. We conclude that, in rat aorta, fentanyl-induced relaxation is endothelium-independent but mediated by inhibition of alpha-adrenoceptors operated intracellular Ca2+ release (inhibition of contraction by NE) and caffeine-induced Ca2+ release from store.
Animals ; Aorta* ; Endothelium ; Fentanyl* ; Muscle, Smooth* ; Potassium ; Rats* ; Relaxation* ; Vasodilation

We have done survival analysis of the EKG monitor(from March, 1976 to February, 1993) and anesthetic machine(from February, 1915 to February, 1993) retrospectively in operating room at Severance hospital. Thirty eight EKG monitors and twenty eight anesthetic machines were included. Also EKG monitors were divided into two groups(one group was made in foreign country and another was made in Korea) and its survival function were compared. All statistics were treated with Product-limited estimate of survival function(Kaplan and Meier, 1958) with BMDP 1L. Mean survival time(+/-S.E) of all EKG monitor was 113.61(+/-5.70) months and the EKG made in foreign country was 106.65(+/-8.22) months and made in Korea was 113.35(+/-8.97) months. But there was no statistical differences between two groups. And mean survival time of anesthetic machine was shown to be 189.45(+/-6.09) months. It is advisable to replace aging machine before malfunction and failure to protect patients from mishaps stem from equipment failure. We conclude that life cycle of equipment for proper time to replace the equipment is not underestimated to reduce the accident by aging machine failure.
Aging ; Electrocardiography* ; Equipment Failure ; Humans ; Korea ; Life Cycle Stages ; Operating Rooms* ; Retrospective Studies ; Survival Analysis* ; Survival Rate