BACKGROUND: we have evaluated the association of age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases with postoperative pulmonary complications and identified which parameter of preoperative spirometry was a predictor of postoperative pulmonary complications. METHOD: In 270 patients older than 60 years, the postoperative pulmonary complications were evaluated according to age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases and the parameters of preoperative spirometry were analyzed. RESULTS: The postoperative pulmonary complications rates were significant higher among patients older than 70 years, and among those with previous chronic pulmonary diseases or their smoking history. The pulmonary complications were increased among patients with general anesthesia or duration of surgery more than 2 hours. The pulmonary complications rates did not differ according to sex, type of operation. The patients with hypercarbia(PaCO2> 45mmHg) have more increased postoperative complications. The preoperative FEVl less than 1 liter, FVC, MMEFR & MVV less than 50% of predicted respectively were predictive of complications. CONCLUSION: Age 70, history of smoking,duration of operation more than 2 hours, general anesthesia, previous chronic pulmonary disease and hypercarbia (> or=45mmHg) on preoperative arterial blood gas analysis were predictivd of pulmonary complications. Among the parameters of spirometry, FEV1, FVC, MMEFR and MVV were indicator of predicting postoperative pulmonary complications.
Aged* ; Anesthesia ; Anesthesia, General ; Blood Gas Analysis ; Humans ; Lung Diseases ; Postoperative Complications ; Smoke ; Smoking ; Spirometry

Intravenous succinylcholine is often associated with adverse effects, including muscle fasciculation, postoperative myalgia, increased intraocular and intragastric pressure, along with potassium and creatinine phosphokinase, myoglobinuria, and disturbances in cardiac rate and rhythm. Several methods have been used to modify these side effects, the most popular of which has been the of subparalyzing doses of nondepolarizining relaxants prior to injection of succinylcholine. With such pretreatment however satisfactory muscular relaxation is often not achieve, necessitaing use of larger doses of succinylcholine becauses pretreatment renders the endplateless sensitive to succinylcholine; hence large doses of succinylcholine are necessary to ensure adquate degress of relaxation. The present investigation was undertaken to determine the effects of flunitrazepam on the adverse effects of succinylcholine. This paper covers the period from March, 1981 to March, 1982 in the Department of Anesthesiology, Hanyang University Hospital. The 45 subjects were divided into 3 groups: 1) propanidid (8mg/kg) with succinylcholine 2) flunitrazepam(0.03mg/kg) with succinylcholine 3) flunitrazepam(0.06mg/kg) with succinylcholine. None had existing neuromuscular disease nor were any patients receiving diazepam or any drug known to influence myoneural blocking agent. Patients with burns, muscle injury of muscle atrophy were excluded. In each group, the plasma concentration of potassium and creatinie phosphokinase was observed before and 10 minutes after use of succinylcholine. Also succinylcholine in duced myalgia, fasciculation, onset of loss of eyelid reflex and relaxation were observed and compared. The conclusions are as follows: 1) There were no significant changes of plasma concentration of potassium and creatinine phosphokinase in presuccinylcholine and 10 minutes postsuccinylcholine. Also any statistically significant changes were not observed in the comparison of the propanidid group and the flunitrazepam groups. 2) Flunitrazepam significantly diminished the incidence of postoperative muscle pain and it was shown that the degree of fasciculation has no relationship with succinylcholine induced muscle pain. 3) In the propanidid group, the onset of loss of eyelid reflex was most rapid(22+/-13 second). In the flunitrasepam 0.03mg/kg group, the onset of loss of eyelid reflex was statistically significant (p<0.05), as compared with the 0.06mg/kg group(42+/-27 second). 4) In all groups, excellent conditions of intubation were observed. Propanidid and flunitrazepam did not affect the magnitude nor duration of the succinylcholine neuromuscular block.
Anesthesiology ; Burns ; Creatinine ; Diazepam ; Eyelids ; Fasciculation ; Flunitrazepam* ; Humans ; Incidence ; Intubation ; Muscular Atrophy ; Myalgia ; Myoglobinuria ; Neuromuscular Blockade ; Neuromuscular Diseases ; Plasma ; Potassium ; Propanidid ; Reflex ; Relaxation ; Succinylcholine*

In contrast to younger patients, old peoples frequently mainfest more than one pathologic process, mainly degenerative diseases and neoplasia. Nearly all have some degree of arteriosclerosis, even if this is not clinically diagnosed, and many have associated chronic cardiac, renal, hepatic, or pulmonary disease. The surgeon and the anesthesiologist must see theat their clinical decisions are tied to a physiologic understanding based on exact quantification of the specific hemodynamic, respiratiory, renal, and metabolic factors which may play a decisive role in influencing the final outcome to a major operative procedure. From May 1972 to Dec 1980, the Department of Anesthesiology, Hanyang University, College of Medicine had 517 geriatric patients(above 65 years) who received anesthesia and these were analyzed clinically according to age, sex, department, physical status, anesthetic technique and agent, anesthesia time, length of admission, laboratory studies(chest X-ray, EKG, arterial blood gas), and postoperative complications(mortality and causes of deathe). The results are as follows. 1) Out of 25,857 anesthetized patients 517(2.0%) were over 64 years of age and 290 were males(56.1%) and 227 females(43.9%). 2) In the surgical group, 246 cases (47.6%) were from general sugery: 81 cases(15.7%), orthopedic surgery: 78 cases (15.1%), urology: and 67 cases (12.9%), neurosurgery respectively. 3) In the classification of physical status, 33 cases(6.4%) were class 1, 269 cases(52.0%) class 2, 181 cases (35.0%) class 3, 28 cases (5.4%) class 4, and 6 cases (1.2%) class 5. Emergency cases were 137 cases(26.5%) and 380 cases (73.5%) were elective. 4) Concerning premedication-150cases(29.0%) were premedicated with atropine sulfate plus valium and 93 cases had no premedication. 5) There were 425 cases of general anesthesia (82.2%) and 92 cases of regional anesthesia (17.8%). The major anesthetic was halothane, 362 cases (70.0%). The technic in 419 cases( 81.0%) was circle type with endotracheal intubation. Anesthesia duration was within 1hour for 70 cases(13.5%), within 2 hours for 158 cases(30.0%), and within 3hours in 144 cases(27.9%). 6) Preoperative laboratory findings were as follows: The chest X-ray suggested that 199 cases (45.9%) were within normal limits, 56 cases (12.9%) had hypertensive heart disease, 56 cases (12.9%) had pulmonary tuberculosis, and 38 cases (5.1%) had senile lung fibrosis. The EKG which was done on 85% of the patients, ravealed that 193 cases (44.0%) were within normal limits, 61 cases(13.9%) showed left ventricular hypertrophy, and 38 cases(8.7%) had myocardial ischemia. In the preoperative arterial blood gas studies of 56 cases the results were almost all within normal limits. 7) Postoperative complications were as follows: 52 cases showed wound infection or bleeding, 20 cases had pneumonia, and 18 cases atelectasis. There were a number of miscellaneous complications. 8) The overall mortality rate was 5.8%. The difference of mortality rate related to the age was not statistically significant,(p>0.1) and the mortality rate related to physical status was statistically significant(p<0.005). 9) As the cause of death-11 cases (36.7%) had transtentorial herniation, 2 cases (6.7%) sepsis, 2 cases (6.7%) hypovolemia, and 1 case (3.3%) had pulmonary edema.
Anesthesia* ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesiology ; Arteriosclerosis ; Atropine ; Classification ; Diazepam ; Electrocardiography ; Emergencies ; Fibrosis ; Halothane ; Heart Diseases ; Hemodynamics ; Hemorrhage ; Humans ; Hypertrophy, Left Ventricular ; Hypovolemia ; Intubation, Intratracheal ; Lung ; Lung Diseases ; Mortality ; Myocardial Ischemia ; Neurosurgery ; Orthopedics ; Pneumonia ; Postoperative Complications ; Premedication ; Pulmonary Atelectasis ; Pulmonary Edema ; Sepsis ; Surgical Procedures, Operative ; Thorax ; Tuberculosis, Pulmonary ; Urology ; Wound Infection

Thrombotic thrombocytopenic purpura (TTP) and the related hemolytic uremic syndrome (HUS) are disorders characterized by thrombocytopenia, microangiopathic hemolytic anemia, a variable degree of impairment of renal function and fluctuating neurological symptoms, which are thought to be due to platelet activation and subsequent formation of thrombi in the microcirculation. The fact that there was no clear-cut clinical and laboratory features that differentiate HUS from TTP has lead to view these two syndromes as a clinical continuum. Microvascular thrombosis is the typical lesion and closely related with endothelial injury and platelet activation. Pathologic alterations of the brain parenchyma are mainly manifested by small multiple infarcts. Numerous cases of CNS complications of these syndromes have been evaluated by using CT, but few reports have mentioned the MR findings. We experienced a case of TTP-HUS that had clinical features of cortical blindness and the brain lesion was confirmed by MRI showing cerebral infarct at the occipital area but it was reversible course. So we report this case with a brief review of literature.
Anemia, Hemolytic ; Blindness, Cortical* ; Brain ; Hemolytic-Uremic Syndrome* ; Magnetic Resonance Imaging* ; Microcirculation ; Platelet Activation ; Purpura, Thrombotic Thrombocytopenic* ; Thrombocytopenia ; Thrombosis

Mesenchymal chondrosarcoma is a rare malignant tumor of skeletal and extraskeletal origin, and which shows aggressive local behavior as well as a high metastatic potential. We report 3 cases of mesenchymal chondrosarcoma. Two cases were male and one was female. The ages ranged from 25 to 32 years(mean: 28 years). Tissue was obtained by wide excision in two patients, and incisional biopsy in one. The mass locaterd in the rib(case 1), orbital floor(case 2), and abdominal wall(case 3). Roentgenographically, the tumor resembles ordinary chondrosarcoma, showing osteolytic and obstructive appearance with stippled calcification. Grossly, the tumor was lobulating, solid fish-fleshy like mass with calcification and ossification. Histologically, the tumor shows characteristic bimorphic pattern composed of islands of well differentiated hyaline cartilage admixed with a cellular area of undifferentiated small cells. The small cells usually displayed a hemangiopericytoid or an alveolar pattern.
Biopsy ; Chondrosarcoma ; Chondrosarcoma, Mesenchymal* ; Female ; Humans ; Hyaline Cartilage ; Islands ; Male ; Orbit ; Ribs

We report a case of lipoid pneumo nia in a 57-year-old man who had a history of ingestion of green perilla oil and residual neurologic deficit of cerebral infarction with right hemiparesis. Lipoid pneumonia was diagnosed by bronchoalveolar lavage.
Bronchoalveolar Lavage ; Cerebral Infarction ; Eating* ; Humans ; Middle Aged ; Neurologic Manifestations ; Paresis ; Perilla* ; Pneumonia*

Anomalous pancreaticobiliary ductal union (APBDU) is an uncommon anomaly, defined as the junction between the common bile duct and the pancreatic duct outside the duodenal wall and beyond the influence of the sphincter of Oddi. This anomaly, which has been recognized frequently since the introduction of ERCP, is believed to be associated with biliary tract lesions such as congenital biliary dilatation, biliary tract carcinoma, and pancreatic lesions such as pancreatitis new paragraph. A 28-year-old male was admitted due to sudden abdominal pain and vomiting. An ERCP revealed a peculiar type of APBDU; the duct of Wirsung and CBD fused and formed a long common channel before entering the major papilla, and the duct of Santorini connected to the duct of Wirsung is patent. So, when contrast dye was inserted into the minor papilla, both the CBD and the duct of Wirsung were made visible. This case of the peculiar type of APBDU which showed characteristic ERCP findings are herein reported.
Abdominal Pain ; Adult ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Dilatation ; Humans ; Male ; Pancreatic Ducts ; Pancreatitis ; Sphincter of Oddi ; Vomiting

BACKGROUND AND AIMS: Zinc is an essential, mostly intracellular, trace element which participates in many oxidative or deoxidative reactions and in a protective action on liver cell activity. Plasma zinc levels are known to decrease in patients with liver disease including chronic viral hepatitis. The aim of this study was to reveal whether hepatic zinc concentrations have a correlation with grades of necroinflammation or stages of fibrosis in the patients with chronic viral hepatitis. METHODS: This study consisted of 50 subjects (43 chronic hepatitis B, 4 chronic hapatitis C, and 3 cirrhosis). Each specimen of liver tissue was classified with the grade of lobular inflammation, portal/periportal inflammation, and stage of fibrosis according to Scheuer's method. Hepatic zinc concentration was determined by ICP-Atomic Emission Spectrometry. RESULTS: The mean hepatic zinc concentration in the 50 chronic viral hepatitis patients was 233.66 g/g dry weight of liver tissue. The hepatic zinc levels were significantly correlated with the grades of portal/periportal inflammation (rs=-0.385, p=0.006), and grades of lobular inflammation(rs=-0.342, p=0.015). The stages of fibrosis were also negatively related (rs=-0.423, p=0.002). The zinc concentrations differed significantly among grades of lobular inflammation (p=0.013) and among stages of fibrosis (p=0.044). CONCLUSIONS: Hepatic zinc concentrations showed negative correlation with grades of portal/periportal inflammation, lobular inflammation, and stage of fibrosis in the patients of chronic viral hepatitis. These results suggest that decreased hepatic zinc concentration might be associated with severe hepatic injury and reflect decreased protective activity on liver cell injury.
Fibrosis ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Inflammation ; Liver ; Liver Diseases ; Plasma ; Spectrum Analysis ; Zinc*

Gastritis Cystica Profunda is a rare condition showing multiple small cysts in the mucosa and submucosa of the stomach. These lesions have been found not only at the site of a gastroenterostomy but also in tbe stomchs of patients without any previous surgery. Recently, We witnessed a 56-year old e wale gastritis cystica profunda who had not undergone previous gastric surgery. The UGI and EGD revealed a 3.0 * 4.5 cm sized submucosal mass on the posterior wall of the antrum, and endoscopic ultrasonography(EUS) discovered a thickening of the third layer in which well-defined, round and nearly anechoic areas with posterior enhancement were gathered. They were thought to be cystic lesions. We report a case of gastritis cystica profunda without having had any previous surgery, the diagnosis was made based on findings from the EUS and histologic findings through surgery.
Diagnosis ; Gastritis* ; Gastroenterostomy ; Humans ; Middle Aged ; Mucous Membrane ; Stomach