Uterine inversion is a rare but a potentially fatal complication of labor, and may occur in the third stage of labor. Because it can lead to shock and hemorrhage, immediate management should be attempted to replace the inverted uterus. We report a case in which uterine inversion was not replaced by manual manipulation, but which was successfully replaced by the induction of general anesthesia.
Anesthesia, General* ; Hemorrhage ; Shock ; Uterine Inversion* ; Uterus

BACKGROUND: The isolated lung model is a very useful model in investigation of hypoxic pulmonary vasoconstriction (HPV), and angiotensin II is extensively used in this model. But the exact role of angiotensin II in HPV is not clear in the isolated rabbit lung. Thus we were concerned about the role of angiotensin II in the blood-perfused rabbit lung. METHODS: New Zealand white rabbits (n = 28) lungs were isolated and perfused with a constant pulmonary perfusate flow; acid-base status and temperature were maintained at constant levels. Deoxyglucose (DOG group, n = 7), angiotension II and deoxyglucose (AG-DOG group, n = 7), calcium (CA group, n = 7), angiotensin II and calcium (AG-CA group, n = 7) were administered, and then hypoxic responses were measured. Three ratios were calculated and compared (P alpha: ratio of hypoxic response to pulmonary arterial pressure at normoxia, P beta: ratio of hypoxic response to baseline hypoxic response, P gamma: ratio of pulmonary arterial pressure at hypoxia to pulmonary arterial pressure at baseline). RESULTS: Angiotensin II increased the pulmonary arterial pressure by 14%, and increased HPV. Baseline pulmonary pressure was increased in the AG-DOG group and in the AG-CA group (P<0.05). P gamma significantly increased in the AG-DOG and AG-CA groups (P<0.05). The first HPV increased but the second HPV decreased in the AG-DOG group (P alpha: P<0.05) and in the AG-CA group. P beta showed no difference between groups. CONCLUSIONS: Angiotensin II resulted in an increase of pulmonary arterial pressure in the isolated rabbit lung. One may misinterpret this as an potentiation of HPV, but HPV was not changed by angiotensin II. Therefore we deny the necessity for angiotensin II in the isolated rabbit lung model.
Angiotensin II* ; Angiotensins* ; Anoxia ; Arterial Pressure ; Calcium ; Deoxyglucose ; Lung* ; Rabbits ; Vasoconstriction*

To determine whether mitomycin-C[MMC]treatment induces apoptosis in cultured keratocytes. Cultured rabbit keratocytes were exposed to MMC[up to 0.4 milligram/milliliter]or phosphate-buffered saline[PBS]for 5 minutes. Light and transmission electron microscopic examination, DNA electrophoresis, and flow cytometric analysis with propidium iodide staining were performed 24 hours after MMC or PBS treatment. A characteristic findings consistent with apoptosis were observed under both light and electron microscopic examination and DNA ladder pattern was shown on electrophoresis. The average percentages of apoptosis measured by flow cytometric analysis were as follows;0.16 +/-0.08%in PBS, 0.23 +/-0.13%in 0.1 milligram/milliliter MMC, 0.50 +/-0.13%in 0.2 milligram/milliliter M M C , and 6.50 +/-1.57%in 0.4 milligram/milliliter MMC. Significant differences were shown in the percentage of apoptosis among the groups based on Kruskal-Wallis test[p=0.005]. Clinically relevant doses of MMC induces apoptosis in cultured keratocytes proportionally. This results suggest that MMC may modulate corneal wound healing process by accelerating the resolution phase of wound healing.
Apoptosis* ; DNA ; Electrophoresis ; Mitomycin* ; Propidium ; Wound Healing

In this study, the effect of surface modification of polymethylmethacry-late[PMMA]by grafting of poly[ethylene glycol][PEG]on cell adhesion was investigated. PMMA surface was treated with ozone and then PEG-acry-late[PEGA]was graft-polymerized. Ozone treatment of the surface was car-ried out at room temperature by applying constant flow of oxygen[4.5liter/min]and 1 bar pressure. After ozone treatment, PMMA was immersed immediately in 20 wt%aq. PEG-acrylate solutions in glass ampoules. After degassing, the ampoule was sealed and kept at 60 degrees C for 24 hours to complete the graft polymerization. PMMA surface grafted with PEG revealed the enhanced oxygen content at ESCA analysis and the decreased dynamic receding contact angles. The adhesion of keratocytes onto modified PMMA was investigated. Keratocytes[4 x105cells/milliliter ]were layered on each PMMA discs which were glued to the bottom of 24-well culture plates, and cultured in a CO2 incubator for 24 hours. The adherent cells onto the surfaces were harvested by trypsinization and counted. The mean numbers of keratocytes on untreated PMMA, PEG-grafted PMMA with 1hour ozone treatment and PEG-grafted PMMA with 2 hour were 72.5 x104 and 6.5 x104 and 7.6 x104cells respectively, and there was a significant statistical difference [p=0.002], irrespective of ozone treatment period. This result suggests that surface modification of PMMA using PEG grafting may reduce etroprosthetic membrane formation of artificial cornea.
Cell Adhesion ; Cornea ; Glass ; Incubators ; Membranes ; Oxygen ; Ozone ; Polymerization* ; Polymers* ; Polymethyl Methacrylate ; Transplants ; Trypsin

Peripartum cardiomyopathy (PPCM) is a rare form of cardiomyopathy associated with a significant morbidity and mortality. The anesthetic management of a Cesarean section in patients with PPCM has not been well defined. Herein, our experience of a 31-year-old multipara, with recurrent PPCM and congestive heart failure, who presented for an elective cesarean section, is reported. Combined spinal-epidural anesthesia was successfully employed as the anesthetic technique for the procedure. The intra-arterial blood pressure and central venous pressure were monitored throughout the procedure. In addition, the patient's postoperative pain was markedly reduced with the use of epidural PCA. Combined spinal-epidural anesthesia is suggested to be a reliable technique, which provides minimal hemodynamic changes, and a lower failure rate than epidural anesthesia only, and is also highly effective with a low dose of local anesthetic drug.
Adult ; Anesthesia* ; Anesthesia, Epidural ; Blood Pressure ; Cardiomyopathies* ; Central Venous Pressure ; Cesarean Section* ; Female ; Heart Failure ; Hemodynamics ; Humans ; Mortality ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Peripartum Period* ; Pregnancy

BACKGROUND: Systemic inflammatory response after open heart surgery has an adverse effect on the postoperative course of patient, and results from the release of cytokines by leukocytes activated by cardiopulmonary bypass (CPB). TNF-alpha has an important role in inflammatory response-it has clinical effects such as fever, tachycardia, and hypotension, and also induces other cytokines. However studies about the change of blood concentration of TNF-alpha after CPB show differing results, and so have been up to now inconclusive, we have therefore endeavored to investigate the change of TNF-alpha level after CPB and its relationship with the postoperative course of patients. METHODS: We studied 20 children undergoing open heart surgery. Serum TNF-alpha was detected after induction (control), 5 minutes after onset of CPB (T1), 5 minutes after release of aortic cross clamp (T2), and 30 minutes after CPB (T3) by enzyme-linked immunosorbent assay. We compared the concentration of TNF-alpha and the duration that patients stayed in intensive care unit (ICU) and were supported by mechanical ventilator in group I (CPB time 60 minutes, n = 10). RESULTS: TNF-alpha levels of S2 and S3 were significantly lower than those of S1 and S4 (P = 0.001), but no difference was detected between group I and II. No statistical relationship was found linking TNF-alpha levels with the duration in ICU, or time supported by mechanical ventilator. Three children with postoperative complications showed higher level of TNF-alpha than others (P = 0.002). CONCLUSIONS: We concluded that TNF-alpha levels decreased during CPB, did not increased after CPB, and had no relationship to such postoperative courses as postoperative ICU time and intubation time, but there was a correlation with postoperative complications.
Cardiopulmonary Bypass* ; Child ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Fever ; Humans ; Hypotension ; Intensive Care Units ; Intubation ; Leukocytes ; Postoperative Complications ; Tachycardia ; Thoracic Surgery ; Tumor Necrosis Factor-alpha* ; Ventilators, Mechanical

BACKGROUND: Postoperative pain control is provided for humanitarian reasons and to alleviate nociception-induced responses, such as endocrine metabolic responses, autonomic reflexes, which have adverse effects on organ function, and other undesirable results. Of the various methods of treatment, patient-controlled analgesia (PCA) is considered the gold standard for the of control postoperative pain. PCA can be administered via intraveous, epidural, or subcutaneous routes. Although patient-controlled epidural analgesia (PCEA) has been compared to IV-PCA, there is no optimal administrative route for the treatment of postoperative pain. This randomized study compared the effectiveness of PCEA and IV-PCA on postoperative pain and the side-effects after gynecologic surgery. METHODS: Ninety-seven patients undergoing gynecologic surgery were randomly assigned to receive either IV-PCA using a mixture of morphine and ketorolac or PCEA using 0.1% bupivacaine and morphine. Pain intensity was tested using a visual analog scale (VAS) until postoperative day 2. Nausea, vomiting, sedation, and pruritus were also measured. RESULTS: Among the 97 patients, 12 patients were excluded during study. Pain relief was better at rest and after coughing in the PCEA group during the 2 postoperative days, except at the first visit. Additional analgesics were used significantly less in the PCEA group, whilst the incidence of other complications was comparable in the IV-PCA and PCEA groups. CONCLUSIONS: After gynecologic surgery, PCEA using bupivacaine and morphine provides better pain relief than IV-PCA using morphine and ketorolac.
Analgesia, Epidural ; Analgesia, Patient-Controlled* ; Analgesics ; Bupivacaine ; Cough ; Female ; Gynecologic Surgical Procedures ; Humans ; Incidence ; Ketorolac ; Morphine ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Pruritus ; Reflex ; Visual Analog Scale ; Vomiting

Uterine rupture is usually associated with previous uterine scar. Although intrapartum rupture of unscarred uterus is very rare, it may cause catastrophic outcomes to both the mother and the newborn infant compared with that of a scarred uterus. The present case describes our experience of anesthesia for an emergency cesarean section due to the arrest of fetal descent in a 36-year-old parturient who had undergone external cephalic version for the breech presentation of her fetus. We detected the rupture of her unscarred uterus during the operation under epidural anesthesia, which was changed to general anesthesia. Despite the uterine rupture the newborn infant survived uneventfully. At the postoperative twelfth day she was discharged from hospital with her baby.
Adult ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Breech Presentation ; Cesarean Section* ; Cicatrix ; Emergencies ; Female ; Fetus ; Humans ; Infant, Newborn ; Mothers ; Oxytocin ; Pregnancy ; Rupture* ; Uterine Rupture ; Uterus* ; Version, Fetal

Cryoneurolysis to peripheral neuralgia has been tried in selected postoperative pain and chronic pain patient; post-thoracotomy pain, post-herniorrhapy pain and trigeminal neuralgia. Here we report first two cases those were effectively controlled by percutaneous cryoneurolysis. Intercostal neuralgia was confirmed by intercostal nerve block with 1% mepivacaine and then we applied cryoneurolysis. Those pains could be relieved for more than two or three months. We suggest that cryoneurolysis can be an useful, simple and safe neurolytic method to intercostal neuralgia in outpatient pain clinic.
Chronic Pain ; Humans ; Intercostal Nerves ; Mepivacaine ; Neuralgia* ; Outpatients ; Pain Clinics ; Pain, Postoperative ; Trigeminal Neuralgia

Autonomic dysreflexia is a syndrome of uninhibited sympathetic spinal reflexes in response to stimuli below the level of injury in the patients with high spinal lesions. During labor, it can cause uteroplacental vasoconstriction resulting in fetal distress or devastating maternal complications including retinal hemorrhage, cerebrovascular accident and hypertensive encephalopathy. Neuraxial blockade has proven to be an effective method to attenuate or prevent it. We present a case detailing the use of epidural analgesia in managing the delivery of a quadriplegic parturient with a history of autonomic dysreflexia.
Analgesia, Epidural* ; Autonomic Dysreflexia ; Fetal Distress ; Humans ; Hypertensive Encephalopathy ; Reflex ; Retinal Hemorrhage ; Spinal Cord Injuries* ; Spinal Cord* ; Stroke ; Vasoconstriction