No abstract available.
Down Syndrome* ; Myeloproliferative Disorders*

No abstract available.
Pregnancy*

A 28-yr-old woman, weighing 61 kg with bleeding myoma of uterus was scheduled for total abdominal hysterectomy. There was no history of cardiac arrhythmia or syncope. She was not premedicated. The heart rate was 115 beats/min and arterial pressure was 155/95 mmHg, immediately before the induction of anesthesia. Under the preoxygenation, anesthesia was induced with IV injection of thiopental sodium 250 mg followed by succinylcholine 75 mg. About 20 seconds after the succinylcholine bolus, the ECG showed an abrupt change from sinus rhythm to asystole without any stimulus including laryngoscopy. After a precordial thump and atropine 0.5 mg IV, tracheal intubation and ventilation with 100% O2 were quickly accomplished. Normal sinus rhythm with heart rate of 87 beats/min returned during laryngoscopy and intubation. The interval from the sinus arrest to the reestablishment of normal sinus rhythm was only 15 seconds. Surgery proceeded uneventfully and the patient recovered without any complication.
Anesthesia ; Arrhythmias, Cardiac ; Arterial Pressure ; Atropine ; Electrocardiography ; Female ; Heart Arrest* ; Heart Rate ; Hemorrhage ; Humans ; Hysterectomy ; Intubation ; Laryngoscopy ; Myoma ; Succinylcholine* ; Syncope ; Thiopental ; Uterus ; Ventilation

No abstract available.
Lymphangioma* ; Mediastinal Cyst*

PURPOSE: To assess long-term changes in intraocular pressure (IOP) and the development of glaucoma after early phacoemulsification in acute primary angle closure. METHODS: Retrospective chart review of acute primary angle closure patients treated with phacoemulsification in attack eyes versus fellow eyes. Within a month after the angle closure attack, all subjects underwent cataract surgery and were divided into two groups: group A received cataract surgery on their attack eyes. Group B also received cataract surgery on their fellow eye after phacoemulsification of the attack eyes. Study outcomes were the prevalence of IOP rise (occurrence of IOP >21 mmHg) and the incidence of newly developed glaucoma. RESULTS: Eighty-nine eyes were included, with 62 attack eyes in group A and 27 fellow eyes in group B. Group A (14 eyes, 22.58%) had a higher cumulative rate of IOP rise than group B (3 eyes, 11.11%) at 12 months (p = 0.001). Newly developed glaucoma was not observed in group B; however, 6 patients in group A developed glaucoma during the 12-month follow-up period (p < 0.001). CONCLUSIONS: The attack eyes treated with phacoemulsification showed a significantly higher prevalence of IOP rise and newly developed glaucoma than fellow eyes that received phacoemulsification. These findings suggest that there is a possibility of IOP rise and development of glaucoma even when angle closure and successful IOP control have apparently been achieved after phacoemulsification.
Cataract ; Follow-Up Studies ; Glaucoma ; Glaucoma, Angle-Closure ; Humans ; Incidence ; Intraocular Pressure* ; Phacoemulsification* ; Prevalence ; Retrospective Studies

Global aphasia without other focal neurologic lateralizing signs (GWLS) is an uncommon stroke syndrome. The pathogenesis of GWLS has been thought as the result of multiple cardioembolism. However, a few cases of GWLS with a single lesion have been reported. We report an unusual case of GWLS with a single left superior temporal infarction. A 73-year-old right handed man was admitted with receptive and expressive language impairment without other focal neurologic lateralizing signs. The patient's global aphasia symptom has being 4 weeks after symptom onset. Brain CT showed only one lesion of left superior temporal lobe. Our case notes that the multiple lesions of the speech area are not only necessary to produce GWLS, and it is not necessarily imply a double lesion or an embolic causes.
Aged ; Aphasia* ; Brain ; Hand ; Humans ; Infarction ; Stroke ; Temporal Lobe

A 72-year-old man undergoing emergency arthroscopic irrigation and debridement of the left knee joint due to pyogenic arthritis developed cauda equina syndrome after spinal anesthesia with 0.5% hyperbaric tetracaine mixed with epinephrine. Epinephrine was added to local anesthetic to prolong the duration and to increase the quality of spinal anesthesia. There was no paresthesia on needle placement. We injected anesthetics twice because the first subarachnoid injection failed. The patient experienced impaired sensation in the perineal region and alterations in bowel and urinary habits. Magnetic resonance imaging revealed spondylolisthesis and disc protrusion (L4-5), with spinal stenosis (L5-S1), but did not show suspicious lesions such as hematoma and abscess. We suggest the causative factors are temporary neural compression due to his spinal diseases and spinal cord ischemia due to decreased spinal blood flow because of epinephrine. We also cannot rule out the tetracaine neurotoxicity.
Abscess ; Aged ; Anesthesia, Spinal ; Anesthetics ; Arthritis ; Cauda Equina ; Debridement ; Emergencies ; Epinephrine ; Hematoma ; Humans ; Hypesthesia ; Knee Joint ; Magnetic Resonance Imaging ; Needles ; Paresthesia ; Polyradiculopathy ; Spinal Cord Ischemia ; Spinal Diseases ; Spinal Stenosis ; Spondylolisthesis ; Tetracaine

No abstract available.
Broad Ligament* ; Female ; Leiomyoma* ; Leiomyosarcoma*

BACKGROUND: Maintenance of normal arterial carbon dioxide tension (PaCO2) is not generally a problem if the same tidal volume can be maintained when changing from two-lung(TLV) to one-lung ventilation(OLV). However, there have been a few studies on the use of capnography in monitoring the adequacy of ventilation during one-lung anesthesia. We have therefore studied how closely end-tidal PCO2 (PETCO2) values reflect changes in PaCO2 in patients undergoing thoracoscopic sympathectomy during TLV and after transition to OLV. METHODS: We have measured arterial oxygen tension(PaO2), PaCO2, PETCO2, and (PaCO2-PETCO2) in 24 adult, either sex, patients by infra-red spectrometry. They were measured after induction of anesthesia, in supine position(TLVsup), after a lateral decubitus position(TLVlat), at 15 minutes after left OLV(OLVLt), after right OLV(OLVRt), and at 10 minutes in the supine position re-positioned at the end of the operation(TLVrep). Data were analyzed with a one-way analysis of variance with repeated measures followed by multiple comparision. The correlation between PaCO2 and PETCO2 were tested using linear regression. RESULTS: PaCO2 did not significantly change, whereas PETCO2 significantly decreased at OLVLt, OLVRt compared with TLVsup value (OLVLt, 29.7 mmHg OLVRt, 30.5 mmHg and TLVsup, 33.6 mmHg; P< 0.05). Compared with TLVsup(0.2 mmHg), (PaCO2-PETCO2) significantly increased at OLVLt, OLVRt, TLVrep(3.7 mmHg, 2.3 mmHg, 3.5 mmHg). The correlation between PaCO2 and PETCO2 in these series is consistent. (r>0.65, P<0.0006) CONCLUSIONS: In the patients undergoing thoracoscopic sympathectomy with TLV or OLV in the lateral decubitus position, PETCO2 is a reliable estimate of the PaCO2. However, when the operative time is prolonged the arterial PCO2 may be more reliable than PETCO2.
Adult ; Anesthesia ; Capnography ; Carbon Dioxide ; Humans ; Linear Models ; One-Lung Ventilation* ; Operative Time ; Oxygen ; Spectrum Analysis ; Supine Position ; Sympathectomy ; Thoracoscopy* ; Tidal Volume ; Ventilation

In 25 aortic regurgitation patients relationship between degree of aortic regurgitation graded by 2-D color Doppler echocardiography and diastolic fluttering of anterior mitral leaflet on M-mode echocardiography was evaluated. The results were that all 13 aortic regurgitation patients, not associated with mitral stenosis, showed diastolic fluttering of anterior mitral leaflet; but only 3 patients among 12 patients (25%), associated with mitral stenosis, had characteristic mitral fluttering. On the whole, regardless of associated mitral stenosis, the sensitivity was 64%. In severe aortic regurgitation (Grade 3, 4 group) 12/13 patients revealed diastolic fluttering of anterior mitral leaflet (sensitivity of 92%); in mild to moderate aortic regurgitation (Grade 1, 2 group), only 4/12 patients (sensitivity of 33%). In conclusion, 2-D color Doppler echocardiography is a very useful method for detection of aortic regurgitation without difficulty. And in aortic regurgitation, not associated with mitral stenosis, fine fluttering of anterior mitral leaflet is a very sensitive sign of existence of aortic regurgitation, though there may be some false positive findings in normal individuals.
Aortic Valve Insufficiency* ; Echocardiography ; Echocardiography, Doppler, Color* ; Humans ; Mitral Valve Stenosis