The authors have experienced, during general anesthesia with methoxyflurane-nitrous oxide- oxygen for explorative laparatomy to perform appendectomy, a case of acute pulmonary edema, which is rare and it's etiology is various. The patient had no specific past or family history and the only predisposing factor was myocardial ischemia caused by cardio-vascular collapse due to severe dehydration. In this case, the authors believed that pre-existing myocardial ischemia, rapid transfusion of 5% dextrose and myocardial depressants (methoxyflurane and d-tubocurarine) were the causative factors. For this reason at least, myocardial depressants should be avoided in severely dehydrated patients. There are many preventive measures and treatments for acute pulmonary edema during general anesthesia. As in this case, we believe that prompt recognition and attention by the anesthesiologists are the most important preventive and therapeutic measures.
Anesthesia, General* ; Anti-Arrhythmia Agents ; Appendectomy ; Causality ; Dehydration ; Edema* ; Glucose ; Humans ; Myocardial Ischemia ; Oxygen ; Pulmonary Edema

Methoxyflurane was used as the sole inhalational analgesic in the dressing of 76 burns performed on 10 patients. It was used in air by analgizer(method 1) or analgizer with mask(method 2), or used by the semiclosed circle absorber by Pentec vaporizer(Cyprane) in 100% oxygen with the concentration of mathoxyflurane set at 0.5%(method 3) or at 0.7%(method 4). Comparative study concerning the analgesic action gave the following results: 1. Methoxyflurane through on analgizer(method 1) produced poor to good annalgesic action in burned patients. 2. Analgizer with mask(method 2) produced better analgesic action than analgizer alone. 3. 0.5% setting(method 3) was similar to analgizer with mask(method 2). 4. 0.7% setting(method 4) was produced complete analgesia, amnesia and partial loss of consciousness.
Amnesia ; Analgesia ; Bandages* ; Burns* ; Humans ; Methoxyflurane* ; Oxygen ; Unconsciousness

PURPOSE: Voiding function of the neonate is considered to be different from that of adult. Although immaturity in the central nervous system that governs urinary bladder is thought to be the cause, few well-designed physiological studies on the properties of bladder itself have been reported. MATERIALS AND METHODS: Urinary bladders were removed from male Sprague-Dawley rats, 1 to 3-day old neonate and 12 week-old adult. Anterior longitudinal muscle strips without mucosa were obtained and isometric contractions were recorded. Contractile responses induced by carbachol (CCh 0.05-10.0 microM) were obtained. To investigate length-tension relationship between adult and neonate bladder, each strip was stepwise stretched up to 300% L (taking L, 100% length in a resting state) by micropositioner. In each step it was fully permitted to reach steady state in which electrical field stimulations (0.8ms, 50Hz, 2.5s duration) were applied to assess optimal length for contraction. RESULTS: CCh produced a large phasic contraction followed by a sustained tonic contraction superimposed by rapid phasic activities (RPAs) in both group but the patterns were quite different. Neonatal bladder was characterized by its tonic contractions; lesser tone increase with dose increment and taller RPAs of shorter duration. Amplitude of CCh-induced contraction were corrected by tissue weight, neonatal bladder generated greater force than that of adult. Length-tension analysis revealed that the range of active contraction in neonatal bladder according to the stretch were similar, while passive properties were quite different from that of adult bladder. Stress in the muscle strips was derived from tension divided by cross-sectional area of the strip (g/cm2). Steep increase in total tension per area as stepwise stretch was observed in neonatal bladder, which was mainly ascribed to passive properties of the bladder. Optimal length of maximal active force generation was noted in 220% of resting length in both neonatal and adult bladder. CONCLUSIONS: Our results demonstrated that CCh-induced contractile pattern and length-tension relationship in neonatal bladder are quite different from those of adult bladder in the rats, which suggests, aside from the neural immaturity, functional difference exists in the bladder itself. During development, neonatal urinary bladder seems to undergo remarkable changes in both active and passive properties.
Adult* ; Animals ; Carbachol ; Central Nervous System ; Humans ; Infant, Newborn ; Isometric Contraction ; Male ; Mucous Membrane ; Rats* ; Rats, Sprague-Dawley ; Urinary Bladder*

Enteroviruses are the most common agents of myocarditis and have been implicates in the pathogenesis of dilated cardiopmyopathy. There are still discrepancies in the association of enterovirus and myocardial disease, partially due to lack of data on detection of virus antigen or viral culture in the tissue. For the treatment of fulminant myocarditis, aggressive hemodynamic support is warranted because of its excellent long-term prognosis. This 16 year-old girl was admitted because of anterior chest pain for a day. She had flu-like symptoms such as fever, sore throat and cough at 2 weeks ago. Electrocardiogram showed sinus tachycardia and ST segment elevations in lead II, III, aVF and V1-V4. Troponin T was positive and creatinine phosphokinase was elevated (1323 IU/L) at emergency room. On emergency echocardiogram, inferior wall motion was decreased and the ejection fraction (EF) was 70%. Coronary angiogram showed no thrombus and no significant stenosis in coronary artery, and spasm was not induced with ergonovine. Conventional treatment for congestive heart failure with digoxin (0.25 mg daily) and furosemide (20 mg t.i.d) was started under the impression of myocarditis. On the first hospital day, pulmonary edema and signs of shock were developed. The whole left ventricular(LV) wall motion were markedly decreased and EF was less than 20% on echocardiogram. Despite of intra-aortic balloon pump (IABP) for 4 hours, shock and pulmonary edema was progressed. Mechanical circulatory support was started with left ventricular assist device (LVAD, Bio-pump, Medtronic Bio-Medicus, USA). At the time of operation, central venous pressure was 24cmH20, systolic blood pressure was 75mmHg, left atrium(LA) and LV was dilated and the whole wall of LV showed almost akinesia , and LA appendage was biopsied. After 126 hours of LVAD, LV wall motion was restored and EF was 79% on echocardiogram. LVAD was removed 10 days after operation and she was discharged on 23 days of hospitalization without any heart failure symptoms. Immunohistochemistry of LA showed enteroviral VP1 capsid protein (primary antibody; NoVo Castra Laboratory, UK) over the entire LA wall. Her serum neutralized coxsackievirus B3 (CVB3, H3 variant of Woodruff strain) in neutralization test using horse anti-CVB3 (Nancy strain) antibody (ATCC, V030-501-560) as a positive control. The titer of neutralization Ab in her serum of 21 days increased more than 4 times than that of 2 days.
Adolescent ; Blood Pressure ; Capsid Proteins ; Cardiomyopathies ; Central Venous Pressure ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Cough ; Creatinine ; Digoxin ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Enterovirus ; Ergonovine ; Female ; Fever ; Furosemide ; Heart Failure ; Heart-Assist Devices* ; Hemodynamics ; Horses ; Hospitalization ; Humans ; Immunohistochemistry ; Myocarditis* ; Neutralization Tests ; Pharyngitis ; Prognosis ; Pulmonary Edema ; Shock ; Spasm ; Tachycardia, Sinus ; Thrombosis ; Troponin T

PURPOSE: This study was designed to investigate differences in ultrasonographic findings between malignant and benign mammary duct ectasia. METHODS: From January 2003 to June 2005, 54 surgically proven mammary duct ectasia lesions depicted on sonograms were included in this study. We evaluated the ultrasonographic (US) findings in terms of involved ductal location, size, margin, intraductal echogenicity, presence of an intraductal nodule, calcification, ductal wall thickening and echo changes of the surrounding breast parenchyma. The US findings were correlated with the pathological features. RESULTS: Of the 54 lesions, 46 lesions were benign and eight lesions were malignant. Benign lesions included an inflammatory change (n=7), ductal epithelial hyperplasia (n=7), fibrocystic change (n=18), intraductal papilloma (n=11), atypical ductal hyperplasia (n=2) and sclerosing adenosis (n=1). Malignant lesions included ductal carcinoma in situ (DCIS) (n=6), infiltrating ductal carcinoma (n=1) and mucinous carcinoma (n=1). On US images, the peripheral ductal location, an ill-defined margin, ductal wall thickening and a hypoechoic change of the surrounding parenchyma were features significantly associated with malignant duct ectasia. CONCLUSION: For ill-defined peripheral duct ectasia with ductal wall thickening and surrounding hypoechogenicity as depicted on US, the possibility of malignancy should be considered and radiologists should not hesitate to recommend a prompt biopsy.
Adenocarcinoma, Mucinous ; Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Dilatation, Pathologic ; Hyperplasia ; Papilloma, Intraductal ; Ultrasonography, Mammary

In off-pump coronary artery bypass grafting (CABG), multiple proximal anastomosis may increase the risk of cerebral embolism (air, debris) and aortic injury (dissection, pseudoaneurysm). Radial artery (RA) has no intraluminal valve such as saphenous vein. We applied Cabrol technique using aortic root replacement for proximal anastomosis in off-pump CABG. Cabrol technique using RA graft can reduce numbers of proximal anastomosis and reduce number of aortic manipulation in off-pump CABG. We report a Cabrol technique for proximal anastomosis in off-pump CABG with RA graft.
Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Intracranial Embolism ; Radial Artery* ; Saphenous Vein ; Surgical Procedures, Minimally Invasive ; Transplants*