No abstract available.
DNA Topoisomerases* ; DNA*

PURPOSE: To understand the cause of atypical sonograpic findings by analyzing their pathologic correlation tointernal echogenicity of breast fibroadenoma. MATERIALS AND METHODS: Between January 1995 and April 1997, thepresence of 91 fibroadenomas in 81 patients was histopathologically proven. These mass lesions weresonographically interpreted and their descriptive criteria-internal echo content (both strength and homogeneity),the presence of septum, bilateral shadowing, and posterior echo pattern-were tabulated. A pathologist reviewedeach case and independently recorded the following data : cell type, the presence of septum, duct dilatation,calcification, fibrosis, hyalinization, and vascularity. We analyzed the correlation of sonographic withpathologic findings. RESULT: There was significant correlation between increased vascularity and increasedinternal echo strength and between increased fibrosis and decreased internal echo strength. There was nosignificant correlation between internal echo homogeniety or posterior shadowing and vascularity or stromalfibrosis, nor between hyalinization or cell type and internal echo strength, homogeneity or posterior shadowing.There was correlation between absent or thin capsule and the absence of bilateral shadowing. CONCLUSION: Increased vascularity or decreased stromal fibrosis might be the cause of atypical fibroadenoma.
Breast* ; Fibroadenoma* ; Fibrosis ; Humans ; Hyalin ; Shadowing (Histology) ; Ultrasonography

BACKGROUND: During ophthalmologic surgery, various intravenous anesthetic induction agents are used to prevent an intraocular pressure (IOP) increase. This study was designed to compare the effects of etomidate on IOP with those of thiopental sodium and propofol in patients receiving vecronium bromide, and in whom tracheal intubation was performed. METHODS: Forty-five patients undergoing elective surgery were ramdomized to receive etomidate 0.3 mg/kg (E group, n = 15), thiopental sodium 5 mg/kg (T group, n = 15) or propofol 2.5 mg/kg (P group, n = 15). IOP, systolic arterial pressure (SAP) and heart rate (HR) were measured before induction (B), after the adminstration of the induction agents (I1), before intubation (I2) and at 1, 2 and 3 mins after intubation (T1, T2 and T3). RESULTS: The IOP after I1 and I2 in the E , T and P groups were significantly lower than in group B (P < 0.05). The IOP at T1, T2 and T3 in the E, T and P groups were not found to be significantly different from group B. The IOP, SAP and HR at T1, T2, and T3 in the E, T and P groups were significantly higher than at I1 and I2 (P < 0.05). No significant differences were observed between the groups in term of IOP. The SAP and HR at T1, T2 and T3 in the P group were significantly lower than in the other two groups (P < 0.05). CONCLUSIONS: We concluded that etomidate, thiopental sodium and propofol may be useful induction agents for general anesthesia in ophthalmologic surgery but that they do not prevent IOP elevation during endotracheal intubation.
Anesthesia, General ; Arterial Pressure ; Etomidate* ; Heart Rate ; Humans ; Intraocular Pressure* ; Intubation* ; Intubation, Intratracheal ; Propofol* ; Thiopental*

PURPOSE: To compare the detection rate of the patients with retinal nerve fiber layer (RNFL) defect and the amount of RNFL defect according to the patients' age. METHODS: Retrospective chart reviews of 22,811 subjects, who visited the health care center from January 2009 to December 2009 were performed. The detection rate, location and average amount of RNFL defect and the proportions of the patients who were diagnosed with glaucoma through Humphrey visual field (HVF) test or determined as a glaucomatous optic disc were compared according to the patients' age. RESULTS: The proportions of the patients whose RNFL defect were detected was highest in the patients 60 years old or older (2.3%) and was statistically significant (p = 0.012). However, there was no significant difference among the other age groups (under 40 years: 1.7%, 40 thru 49 years: 1.5%, 50 thru 59 years: 2.0%). The proportions of the patients who were determined as glaucoma through the HVF test or glaucomatous optic disc were also highest in the patients 60 years old or older (1.4%), however, there was no statistically significant difference (p = 0.070) among the age groups (under 40 years: 1.1%, 40 thru 49 years: 0.9%, 50 thru 59 years: 1.2%). CONCLUSIONS: The RNFL defect is likely to be detected in subjects less than 40 years of age and the detection rate is similar to subjects in their 40's and 50's. The use of fundus photography to detect RNFL defect in a health care center is recommended in subjects under 40 years of age.
Delivery of Health Care ; Glaucoma ; Humans ; Nerve Fibers ; Photography ; Retinaldehyde ; Retrospective Studies ; Visual Fields

BACKGROUND: Nuss procedure used in pectus excavatum repair is preferred, because of its excellent effect from the cosmetic point of view and improved pulmonary function, but it cause severe pain due to thoracic expansion after the operation. This study was designed to evaluate effective fentanyl dose using an intravenous patient-controlled analgesia (IV-PCA) pump for pain control following pectus excavatum repair in pediatric patients. METHODS: Sixty patients undergoing elective thoracic surgery were randomly assigned to received fentanyl 0.5microgram/kg/hr (Group I, n = 20), 0.7microgram/kg/hr (Group II, n = 20), and 1.0microgram/kg/hr (Group III, n = 20) via an IV-PCA pump (basal, 1 ml/h; bolus, 0.5 ml; lock out interval, 30 min) after operation. A blind observer evaluated each patient using the Children's Hospital of Eastern Ontario pain scale (CHEOPS) and the faces scale (FS). Incidences of side effects and pain control satisfaction were assessed at postoperative 48 hrs. RESULTS: There were no significant differences in CHEOPS or FS score between the groups the postoperative 48 hrs period. CHEOPS and FS scores at 4 and 8 hrs in groups II and III were significantly lower than in group I (P<0.05), but all groups showed lower CHEOPS and FS scores during the first postoperative 48 hrs. Satisfaction of pain control assessment by mothers was significantly higher in groups II and III than in group I (P<0.05). CHEOPS and FS scores were highly correlated with each other (P<0.001). CONCLUSIONS: We conclude that infusion of fentanyl at 0.5microgram/kg/hr using an IV-PCA pump is effective for pain control of 5 years of age or older after Nuss procedure.
Analgesia, Patient-Controlled* ; Fentanyl* ; Funnel Chest* ; Humans ; Incidence ; Mothers ; Ontario ; Thoracic Surgery

BACKGROUND: Many factors cause postoperative hepatic dysfunction, and anesthetic agents and type of surgery are belived to contribute to hepatic dysfunction. The authors planned this study to evaluate the effect of different anesthetic agents (sevoflurane, desflurane, enflurane or propofol) on liver enzymes in the patients who undergone laparoscopic cholecystectomy. METHODS: 80 patients were randomly selected from among those who had undergone cholecystectomy and divided into 4 groups; an enflurane group (n = 20), a sevoflurane group (n = 20), a desflurane group (n = 20) and a propofol group (n = 20). Preoperative values of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were compared with those on postoperative days 1 and 3 in all groups. RESULTS: In all groups, ALT and AST were significantly elevated after operation, and then showed a decrease 3 days after operation, but remainrd of above preoperative levels (P < 0.05). However, no differences were observed between the 4 groups (P < 0.05). CONCLUSIONS: We consider that propofol, sevoflurane, desflurane and enflurane are equally usable and that they have little effect on liver function after laparoscopic cholecystectomy.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia* ; Anesthetics ; Aspartate Aminotransferases ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Enflurane* ; Humans ; Liver* ; Propofol*

BACKGROUND: Neostigmine has been added to local anesthetic regimen for epidural or intrathecal block, and this resulted in prolonged and improved analgesia, but evidence of its benefit in intravenous regional anesthesia (IVRA) is controversial. The purpose of this study was to evaluate the effects of neostigmine added to ropivacaine for IVRA. METHODS: Forty patients undergoing hand or forearm surgery were randomly assigned to two groups to receive IVRA: Group I received 40 ml of 0.2% ropivacaine plus 1 ml of normal saline, and group II received 40 ml of 0.2% ropivacaine plus 500microgram (1 ml) of neostigmine. Sensory block onset time, postoperative visual analogue scale (VAS) scores, recovery time from motor block after deflation, mean arterial pressure (MAP), heart rate (HR), and pulse oximeter saturation (SpO2) values were measured. The incidence of side effects was recorded. RESULTS: Group II had a shorter sensory block onset time, a prolonged motor block recovery time, and lower postoperative VAS scores. No significant difference was found between the two the groups in terms of MAP, HR, SpO2 and side effects. CONCLUSIONS: The addition of neostigmine to ropivacaine in IVRA is believed to be a useful effective method for outpatient arm surgery due to a shortened sensory onset time and improved postoperative analgesia.
Analgesia ; Anesthesia, Conduction* ; Arm ; Arterial Pressure ; Forearm ; Hand ; Heart Rate ; Humans ; Incidence ; Neostigmine* ; Outpatients

Cortical blindness is characterized by visual sensation loss with retention of pupillary reaction to light, and a normal fundoscopic examination. The suggested causes are emboli, profound hypotension, anemia, and infarction of watershed areas in the parietal or occipital lobe. We experienced a case of cortical blindness with severely reduced visual acuity after penile cancer surgery under general anesthesia. In the acute stage, visual acuity was slightly improved, but over the course of several months, no further improvement in visual acuity occurred. In this case there was no severe hypotension or anemia during the operation. Two days after the operation, electroencephalography (EEG) was performed during the period of blindness and the recording obtained was abnormal, with no alpha rhythm. Biparieto-occipital lucency was found by magnetic resonance imaging (MRI). Therefore parieto-occipital infarction due to seizure, embolus, or thrombosis could be considered a possible etiology. We concluded that cortical blindness can unexpectedly develop perioperatively and postoperatively, and that close monitoring of the patient and adequate management are essential.
Alpha Rhythm ; Anemia ; Anesthesia, General* ; Blindness ; Blindness, Cortical* ; Electroencephalography ; Embolism ; Humans ; Hypotension ; Infarction* ; Magnetic Resonance Imaging ; Male ; Occipital Lobe ; Penile Neoplasms ; Rabeprazole ; Seizures ; Sensation ; Thrombosis ; Visual Acuity

We report a 45-year-old female who presented with azotemia, pancytopenia, pericardial effusion, hypothyroidism, decreased complement and positive ANA and was diagnosed as systemic lupus erythematosus (SLE). She referred to our hospital for the evaluation of azotemia. Bone marrow findings were compatible with aplastic anemia and Hashimoto's thyroiditis was diagnosed. After 3 days of methylprednisolone pulse therapy, the aplastic anemia responded and started to improve. She is visiting our clinic on a regular interval and showing good response to maintenance therapy. Hashimoto's thyroiditis is not rare in SLE, and aplastic anemia is relatively rare in SLE but, SLE that is combined with Hashimoto's thyroiditis and aplastic anemia simultaneously, has not been reported as far as our knowledge concerned. So, we report a case of successful treatment of SLE combined with Hashimoto's thyroiditis and aplastic anemia by steroid and thyroxine.
Anemia, Aplastic* ; Azotemia ; Bone Marrow ; Complement System Proteins ; Female ; Hashimoto Disease ; Humans ; Hypothyroidism ; Lupus Erythematosus, Systemic* ; Methylprednisolone ; Middle Aged ; Pancytopenia ; Pericardial Effusion ; Thyroid Gland* ; Thyroiditis* ; Thyroxine

BACKGROUND: Hip replacement arthroplasty (HRA) is highly traumatic and performed in a lateral position for several hours and dead-space ventilation may increase. So, the difference between arterial and end-tidal PCO2 was investigated depending on the changes in the patient's posture during HRA in elderly patients. METHODS: Forty-three patients scheduled for a HRA were divided into two groups; Adult Group (n = 21, A-Group) and Elderly Group (n = 22, E-Group). Mean arterial pressure (MAP), heart rate (HR), PaO2, PaCO2, and end-tidal carbon dioxide tension (P(ET)CO2) were simultaneously measured at 10 min after anesthesia in a supine position (S[10]), at 30 min intervals from 30 min (L[30]) to 180 min (L[180]) in a lateral position and at 10 min in a supine position after the end of surgery (ES[10]) in both groups. The PaCO2-P(ET)CO2 gradient (P[a-ET]CO2) and dead space ventilation (Vd/ Vt) were calculated. RESULTS: At S(10), P(a-ET)CO2 in the A- and E-Groups was 7.0 +/- 5.0 and 7.2 +/- 3.3 mmHg respectively. From L(30) to ES(10), the P(a-ET)CO2 and the ratio of Vd/Vt in both groups increased significantly and progressively (P < 0.05 vs the control value) and the slope in the E-Group rose two times as compared to that in the A-Group. The correlation coefficient between P(a)CO2 and P(ET)CO2 was very significant from S(10) to L(90) and ES(10) in the A-Group, and from S(10) to L (60) in the E-Group (P < 0.01). CONCLUSIONS: For maintaining adequate ventilation of the elderly patient during HRA, PaCO2 should be measured intermittently along with the position changes after anesthesia in addition to the constant monitoring of PETCO2.
Adult ; Aged* ; Anesthesia ; Arterial Pressure ; Arthroplasty, Replacement, Hip* ; Carbon Dioxide ; Heart Rate ; Hip* ; Humans ; Posture ; Supine Position ; Ventilation