Apert's syndrome is rare autosomal dominant defect characterized by craniosynostosis, midface hypoplasia and symmetrical syndactyly. Multiple surgical procedures will be needed for the child with this syndrome. Especially surgery for craniosynostosis is most often performed between 2 and 6 months of life, a period of physiologic anemia. Perioperative complications can occur from numerous sources-massive blood loss, venous air embolism, cerebral edema, hypothermia and hazardous airway management, thus more monitoring, large bored central venous line and early transfusion are recommended. We report a case of 5 month-old female Apert patient undergoing frontal bone advancement and cranioplasty. At the end of uneventful surgery, we removed endotracheal tube in operating room and permitted early feeding because the procedure was limited above the orbital ridge. As soon as feeding the patient presented cyanosis with generalized seizure. Patient was immediately intubated, sucked out secretions and inhaled with oxygen. Blood gas showed moderate hypoxemia which was improved by oxygen therapy. Suspicious aspiration pneumonia was marked on chest film but disappered I week later. The condition was favorable thereafter and discharged without complication. Keypoints in management of Aperts syndrome are close observation, early detection and preventive treatment of possible complications in perioperative period. (Korean J Anesthesiol 1995; 29: 300~303)
Airway Management ; Anemia ; Anoxia ; Brain Edema ; Child ; Craniosynostoses ; Cyanosis ; Embolism, Air ; Female ; Frontal Bone ; Humans ; Hypothermia ; Infant ; Operating Rooms ; Orbit ; Oxygen ; Perioperative Period ; Pneumonia, Aspiration ; Seizures ; Syndactyly ; Thorax

The renin-angiotensin system plays an important role in maintaining blood pressure in various pathologic and physiologic states. To investigate the effects of the sodium nitroprusside (SNP)-induced hypotension on plasma renin activity and serum aldosterone level, SNP 2.0 mg/kg/min was infused to seven unanesthetized rabbits. The mean arterial pressure and heart rate were measured three times; at the start of, 15 and 30 minutes after SNP inusion and 30 minutes after the discontinuation of SNP infusion. The measurement of the plasma renin activity and the serum aldosterone levels during SNP infusion were done by means of radioimmunoassay. The results were as follows: 1) The mean arterial pressure was 117.6+/-6.9 mmHg at zero time ans decreased significantly to 84.0+/-19.6mmHg and 72.9+/-21.6mmHg at 15 and 30 minutes after SNP infusion, respectiely(P<0.01). 2) The heart rate was 124.8+/-9.3 beats/min at zero time and increased significantly to 139.7+/-6.4 beats/minute and 155.6+/-7.9 beats at 15 and 30 minutes after SNP infusion, respectively(P<0.05). 3) The plasma renin activity was 2.31+/-0.53 ng/ml/hr at zero time and increased significantly to 5.17+/-1.39 ng/ml/hr and 4.97+/-1.52 ng/ml/hr in 15 and 30 minutes after SNP infusion, respectively. 4) The serum aldosterone level was 28.8+/-13.5ng/dl at zero time and increased to 42.3+/-14.6ng/dl and 39.5+/-13.9ng/dl at 15 and 30 minutes after SNP infusion and it continued to increase up to 30 minutes after discontinuation of SNP infusion. In conclusion, it was postulated that the plasma renin activity and serum aldosterone level were closely related to the change of the mean arterial pressure and heart rate during SNP-induced hypotension.
Aldosterone* ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Hypotension* ; Nitroprusside* ; Plasma* ; Rabbits ; Radioimmunoassay ; Renin* ; Renin-Angiotensin System ; Sodium*

A case of retrograde intussusception (acute type) of efferent limb into Braun side-to-side jejuno-jejunal anastomosis is presented. Intussusception, though infrequent, is well recognized complication after gastric surgery. Patient was 50 year old man who was admitted with epigastric pain and abdominal mass for 6 hours. Patient had a history of total gastrectomy 2 years before admission due to stage II gastric cancer. Seven hours after admission, hematemesis developed. Emergency fiberopticgastroscopy revealed type 4 jejunogastric intussusception. Segmental resection with end-to-end reanastomosis was performed.
Humans ; Intussusception/*etiology/pathology/surgery ; Jejunal Diseases/*etiology/pathology/surgery ; Male ; Middle Aged ; Postoperative Complications/*pathology ; Stomach/*surgery

BACKGROUND/AIMS: This study evaluated the use and efficacy of chronic oral etoposide plus tamoxifen as a palliative treatment in 30 patients with far-advanced HCC in whom surgical resection, percutaneous ethanol injection or transarterial chemoembolization(TACE) was not possible. METHODS: To be eligible for the study, patients had to have objectively measurable or evaluable tumors, adequate hematologic profiles and hepatorenal functions, had to be between 20 and 75 years of age, and had to have an ECOG performance status of less than or equal to 2. The treatment included etoposide, 50 mg/m2/day, taken orally for 21 days, and tamoxifen, 40 mg/day, taken orally for 21 days. Each cycle was repeated every 5 weeks. RESULTS: Two patients(7%) achieved a partial response(PR) and 16 patients(53%) achieved a stable disease(SD) with a median time-to-progression of 5 months(range: 2-24). Median of patients survival with the response of PR or SD and those patients with the response of progressive disease(PD) was 10 months and 7 months, respectively(p=0.0004). Of the 20 patients with initial elevated serum alpha-fetoprotein(> or =500 ng/ml), 9 patients(45%) experienced a significant(> or =50%) decrease in their values after chemotherapy and all 9 patients achieved objective tumor response of more than or equal to SD. Among the 30 patients in the study, 10 patients(33%) achieved performance status improvements of grade according to the ECOG criteria and 6 patients(20%) experienced improvements of subjective symptoms, such as abdominal pain, abdominal fullness and anorexia. CONCLUSION: Based on our results, the use of chronic oral etoposide plus tamoxifen as a palliative treatment for the far-advanced hepatocellular carcinoma are beneficial. A randomized two-arm study may be warranted to validate the results of this study.
Abdominal Pain ; Anorexia ; Carcinoma, Hepatocellular* ; Drug Therapy ; Ethanol ; Etoposide* ; Humans ; Palliative Care ; Tamoxifen*

BACKGROUND: This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules (18microgram once daily) with a ipratropium metered dose inhaler (2 puffs of 20microgram q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). METHOD: After the initial screening assessment and a two-week run-in period, patients received either tiotropium 18microgram once daily or ipratropium 40microgram four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. RESULT: In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted FEV1 of 42 (12)% were analyzed. The trough FEV1 response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. CONCLUSION: This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.
Adult* ; Albuterol ; Bronchodilator Agents ; Capsules ; Forced Expiratory Volume ; Humans ; Inhalation ; Ipratropium* ; Lung ; Mass Screening ; Metered Dose Inhalers ; Outcome Assessment (Health Care) ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive* ; Surveys and Questionnaires ; Vital Capacity ; Tiotropium Bromide