Background: Due to its various advantages, laparoscopic surgery is preferred over laparotomy in patients who require hepatic resection. Carbon dioxide embolism —which occurs approximately ten times more often in laparoscopic hepatectomy than in general laparoscopic surgery—presents with insignificant symptoms and may be overlooked.Case: A 70-year-old male with hepatic cell carcinoma underwent laparoscopic hepatectomy. Though his vital signs were stable during the initiation of surgery, they became unstable during the procedure. The surgeon detected portal vein rupture, and transesophageal echocardiography was subsequently performed. A large amount of gas in the heart chamber and paradoxical embolism through a patent foramen ovale due to a right-to-left shunt were observed. We treated the symptoms, and the surgery was completed without any further issues. Conclusions Active use of transesophageal echocardiography to identify and monitor heart functions during a suspected carbon dioxide embolism can significantly reduce morbidity and mortality associated with that embolism.

Background: Coronavirus disease 2019 (COVID-19) has been an epidemic in the Republic of Korea since the first patient who came in China was confirmed as having the disease on January 19, 2020. Therefore, surgery for COVID-19-related patients is expected to increase.Case: We experienced two cases of COVID-19-related patients who underwent surgery for femur fracture under general anesthesia. In one case, infection control to prevent transmission was achieved, while in the second case, healthcare workers were exposed to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Conclusions In areas where there is COVID-19 epidemic, SARS-CoV-2 RT-PCR should be performed before surgery in patients with symptoms of respiratory infection such as fever, cough, and sputum, or for those in whom the possibility of COVID-19 cannot be completely excluded. Efforts should be made to prevent healthcare worker’s exposure and the contamination of the operating room.

OBJECTIVE: Juvenile rheumatoid arthritis (JRA) may occur in the wake of infection with several viruses including Ebstein-barr virus (EBV). EBV remains an interesting target. To determine the possible role of EBV infections in the clinical course of JRA, we attempt to demonstrate the radiologic changes and the frequency prescription of etanercept rather than classic therapy. METHODS: Total of 87 patients with JRA, who were hospitalized in Hangang Sacred Hospital and Kangnam Sacred Hospital in Seoul from 2002 to 2010, were assessed serologically for EBV infection (anti EBV VCA IgM and IgG) at admission. Patients with JRA were devided 2 groups, one is EBV VCA IgG (+) JRA patients who had been infected before and another is EBV VCA IgG (-) JRA patients who had not. RESULTS: EBV VCA IgG (+) were seen in 55 patients (63.2%). 31 boys (76%) and 24 girls (52%) were infected with EBV. The mean age of patients of EBV (+) JRA was 8.2+/-3.6 years and that of EBV (-) JRA was 5.3+/-3.4 years. 7 of EBV (+) JRA (13%) developed radiologic change within 2 years, compare with none of EBV (-) JRA. 22 of EBV (+) JRA (49%) with JRA did not respond to the classic therapy, compare with 7 of EBV (-) JRA (22%). CONCLUSION: JRA patients with past EBV infection were older in ages, more in male, more radiologic changes, needed more biologic treatment than those without past EBV infection.
Arthritis, Juvenile Rheumatoid ; Child ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Male ; Prescriptions ; Receptors, Tumor Necrosis Factor ; Viruses ; Etanercept

Granulocytic sarcoma is characterized by the formation of clinically apparent invasive and destructive neoplasm composed of immature cells of the granulocytic (myeloid) series. It may arise either during the course of myelogenous leukemia or may precede the leukemic process for weeks to months. Because of its classical greenish appearance productd by a pigmented enzyme called myeloperoxidase, this tumor has long been called chloroma. But the currently preferred terms "granulocytic sarcoma" and "myeloid sarcoma" are more appropriate, as they reflect the cytologic composition of this tumor. Granulocytic sarcoma develops preferentially in bones or periosteum, especially those of the skull, and proptosis attributable to orbital involvement has long been recognized as a classical clinical feature. Children are affected more often than adults, and boys more frequently than girls. In the absence of systemic signs of leukemia, the histopathologic diagnosis may be quite difficult and may be confused with that of lymphoma, rhabdomyosarcoma, metastatic neuroblastoma and histiocytic or inflammatory tumors. Vigorous therapy directed toward the orbital lesion of granulocytic sarcoma may prevent or retard the development of systemic leukemia, a disease that frequently has a rapidly fatal outcome. The authors experienced a case of granulocytic sarcoma of bilateral orbits with exophthalmos and ptosis(O.S.) in a 7-year-old girl, which precede the acute myelogenous leukemia by 3 weeks.
Adult ; Child ; Diagnosis ; Exophthalmos ; Fatal Outcome ; Female ; Humans ; Leukemia ; Leukemia, Myeloid ; Leukemia, Myeloid, Acute ; Lymphoma ; Neuroblastoma ; Orbit* ; Periosteum ; Peroxidase ; Rhabdomyosarcoma ; Sarcoma, Myeloid* ; Skull

To analyze the infectious causes and clinical symptoms of febrile infants aged less than 3 months presenting to a Pediatric Emergency Medical Center (PEMC) and to propose more efficient, evidence-based management and treatment. We conducted a retrospective study of 462 febrile infants aged less than 3 months who visited PEMC at Keimyung University Dongsan Medical Center from January 2015 to June 2016. Infants' sex, age, fever duration, and laboratory findings, including bacterial or viral pathogens, were recorded. To evaluate clinical signs, one point per sign was given for grunting, decreased activity, and the presence of cyanosis; total scores were compared between the bacterial infection (BI) and non-bacterial infection (NBI) groups. BI was diagnosed in 118 (25.5%) infants, and no BI was diagnosed in 344 (74.5%) infants. Escherichia coli was the most frequently isolated pathogen, accounting for 80.5% (n = 95) of all infections (n = 118). Statistically significant differences in sex, the duration of fever, sign scores, white blood cell count, neutrophil count, lymphocyte count, and C-reactive protein (CRP) level were found between the BI and NBI groups. The cut-off value for CRP was 1.445 mg/dL, with sensitivity and specificity values of 76.3% and 75.9%, respectively, in BI patients, as determined by the receiver operating characteristic curve. As more PEMCs are being built in Korea, hospital accessibility is better; thus, it may be possible to perform outpatient management of young, febrile infants aged younger than 3 months without antibiotics and lumbar puncture using individual sign scores and laboratory findings.
Anti-Bacterial Agents ; Bacterial Infections ; C-Reactive Protein ; Cyanosis ; Emergencies ; Escherichia coli ; Fever ; Humans ; Infant* ; Korea ; Leukocyte Count ; Lymphocyte Count ; Neutrophils ; Outpatients ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Spinal Puncture

BACKGROUND: The purpose of this study is to examine the effect of Desflurane on myocardial contractility and cellular electrophysiologic behabior in isolated guinea pig and rat right ventricular papillary muscle. METHODS: The isometric force of a guinea pig ventricular papillary muscle was studied in normal and 26 mM Tyrode's solution at various stimulation rates. Experiments using rat papillary muscles under normal Tyrode's solution at resting-state (RS) and using guinea pig papillary muscles under low Na Tyrode's solution (25 mM) were performed to evaluate the effect on Ca2+ release from the sarcoplasmic reticulum (SR). Normal and slow action potentials (APs) were evaluated by using a conventional microelectrode technique. Effects of desflurane on SR function in situ were examined by its effect on rapid colling contractures (RCCs). 1 MAC (end-tidal concentration: 6%) and 2 MAC desflurane were applied. RESULTS: Desflurane equivalent to 6% and 12% depressed guinea pig myocardial contractions in the control to -70% and -40% from RS to 3 Hz stimulation rates. Contractile force after rest in rat and guinea pig myocardium under low Na Tyrode's solution showed modest depression. In the partially depolarized, beta-adrenergically stimulated myocardium, 6% and 12% desflurane caused marked depression of late force (6%: -60%, 12%: -80%) with moderate changes of early peak force (6%: -20%, 12%: -40%). RCCs were abolished at 6% concentration. CONCLUSIONS: The direct myocardial depressant effects of desflurane is slightly greater to those seen with isoflurane. The rapid initial release of Ca2+ from the SR by depolarization seems to be modestly depressed, although certain release pathways induced by rapid colling appear to be markedly depressed.
Action Potentials ; Animals ; Contracture ; Depression ; Guinea Pigs ; Isoflurane ; Microelectrodes ; Myocardial Contraction ; Myocardium ; Papillary Muscles ; Rats ; Sarcoplasmic Reticulum*

BACKGROUND: Autonomic neuropathy is frequently developed in patients with diabetets mellitus (DM) and is associated with increased perioperative hemodynamic instability. This study investigated the effect of DM on vasoconstrictor requirement and hemodynamic parameters in patients undergoing off pump coronary artery bypass graft surgery (OPCAB). METHODS: Seventy four patients undergoing OPCAB were divided into two groups; patients without DM (control, n = 51) and patients with DM (n = 23). Hemodynamic parameters were recorded at 10 min after induction of anesthesia (T1), at 10 min after stabilizer application for anastomosis of the left anterior descending coronary artery (T2), the obtuse marginalis branch (T3) and the right coronary artery (T4) and at 10 min after sternum closure (T5). The amount of norepinephrine requirement during the period of induction of anesthesia and grafting was also recorded. RESULTS: Pulmonary capillary wedge pressure (PCWP) and mean pulmonary arterial pressure at T3, PCWP and central venous pressure at T4 were significantly higher in the DH group. Mixed venous oxygen saturation at T2 and T4 and cardiac output at T3 were also significantly lower in the DH group. Significantly greater amount of norepinephrine was infused during the induction of anesthesia in the DH group. CONCLUSIONS: Patients with coronary artery occlusive disease and concomitant DM required significantly greater amount of vasoconstrictor during the induction of anesthesia to maintain stable mean arterial pressure. In addition, more pronounced hemodynamic instability was observed during the period of grafing in these patients undergoing OPCAB.
Anesthesia ; Arterial Pressure ; Cardiac Output ; Central Venous Pressure ; Coronary Artery Bypass, Off-Pump* ; Coronary Vessels ; Diabetes Mellitus* ; Hemodynamics* ; Humans ; Norepinephrine ; Oxygen ; Pulmonary Wedge Pressure ; Sternum ; Transplants*

There are many methods for achieving one-lung ventilation (OLV) during thoracic surgery in neonates and the accuracy of OLV may affect postoperative outcome. The authors have performed OLV using a 5 Fr Arndt endobronchial blocker (AEB, Cook Inc., Bloomington, IN, USA) on a neonate diagnosed with congenital cystic adenomatoid malformation and respiratory distress syndrome (RDS) associated with marked mediastinal shift. In spite of sufficient preoxygenation, sudden and severe fall in oxygen saturation had occurred. Since neonates with RDS may develop sudden and severe desaturation, rapid intubation with anticipation of potential difficulty is necessary as well as sufficient preoxygenation.
Anoxia ; Cystic Adenomatoid Malformation of Lung, Congenital ; Humans ; Infant, Newborn ; Intubation ; One-Lung Ventilation ; Oxygen ; Thoracic Surgery

BACKGROUND AND PURPOSE: Altered blood pressure (BP) and heart rate variations (HRVs) have been reported in Alzheimer's disease (AD). However, it is unclear how these two manifestations are associated with AD. Therefore, the objective of this study was to investigate BP and heart rate variability in AD compared to that in normal controls, patients with subjective memory impairment (SMI), and patients with mild cognitive impairment (MCI). METHODS: Case-control comparisons were made among AD (n=37), MCI (n=24), SMI (n=17), and controls (n=25). All patients underwent clinical and neuropsychological assessments with 24-h ambulatory BP and Holter monitoring. RESULTS: Patients with AD had higher pulse pressures than those in other groups. In addition, AD patients experienced blunted nocturnal BP dipping associated with declining cognitive status. AD patients also had larger ranges of HRV in parasympathetic domains compared to other groups, especially at night. CONCLUSIONS: Our results suggest that diurnal sympathetic and parasympathetic cardiac variability were significantly disturbed in mild cholinesterase-naive AD patients. This may be an indirect sign of disturbed integrity to the sleep-wake cycle in mild AD.
Alzheimer Disease* ; Blood Pressure* ; Case-Control Studies ; Electrocardiography, Ambulatory ; Heart Rate* ; Heart* ; Humans ; Memory ; Mild Cognitive Impairment

The I-gel(TM) is a single-use supraglottic airway device introduced in 2007 which features a non-inflatable cuff and allows passage of a tracheal tube owing to its large diameter and short length of the airway tube. In this case, the authors experienced a difficult airway management on a 4-year-old boy with underlying Goldenhar syndrome who underwent a tonsillectomy. Intubation using a laryngoscope was unsuccessful at the first attempt. In the following attempt, we used the I-gel(TM) supraglottic airway for ventilation and were able to achieve successful intubation with a cuffed tube by using fiberoptic bronchoscope through the I-gel(TM) supraglottic airway. The authors suggest that I-gel(TM) is a useful device for ventilation and it has many advantages for tracheal intubation in pediatric patients with difficult airway.
Airway Management ; Bronchoscopes ; Goldenhar Syndrome ; Humans ; Intubation ; Laryngeal Masks ; Laryngoscopes ; Tonsillectomy ; Ventilation