We have experienced acute hepatitis after general anesthesia. We guess that acute hepatitis is caused by enflurane anesthesia. We will report this case with references. A 34 year old pregnant woman suffered from preeclamsia. She admitted for emergence repeat cesarean-section due to labor pain. In this operation general anesthesia was performanced with enflurane. The preoperative liver enzyme were normal and other tests were within normal range. She developed high fever, marked elevation of serum glutamic oxaloacetic transaminase(SGOT)/serum glutamic pyrubic transaminase(SGPT)/ alkaline phosphatase(ALP)/total bilirunbin(T-B) on the 2nd postoperative day. She recovered gradually and discharged after 13 day's hospitalization. A possible cause of the acute hepatitis in this case were considered to be the enflurane.
Adult ; Anesthesia ; Anesthesia, General* ; Enflurane* ; Female ; Fever ; Hepatitis* ; Hospitalization ; Humans ; Labor Pain ; Liver ; Pregnancy ; Pregnant Women ; Reference Values

PURPOSE: To investigate the relationship of MIS and cryptorchidism according to the descending level of testis into scrotum, we studied expression degree of MIS by immunohistochemical analysis using anti-human MIS polyclonal antibody in testicular specimen. MATERIALS AND METHODS: MIS were stained in excised testis by trauma on each 8 patients as control group and age-matched abdominal, inguinal and prepubic cryptorchidism. The expression were classified as score 1, 2, 3 and 4 according to stained degree of percentage in randomized 16 fields(x400) under the light microscope. RESULTS: Of the degree of MIS expression in control group, 87.5% were category 3 or more. The mean score was 3.13+/-0.62. 2. Of the degree of MIS expression in abdominal type cryptorchid testis group that underwent orchiectomies, 68.7% were category 1. The mean score, 1.31 +/- 0.48, showed significant difference compared to control group(p<0.05). 3. Of the degree of MIS expression in inguinal type,56.2% were category 3 or more. The mean score, 2.63+/- 0.81, showed no significant difference compared to control group(p>0.05). 4. Of the degree of MIS expression in prepubic type, 75.0% were category 3 or more. And the mean score, 2.88+/-0.62, showed no significant difference compared to control group(p>0.05). CONCLUSIONS: Expression of MIS is different according to descending level of testis and may play a role in physiologic changes of testicular descent.
Cryptorchidism* ; Humans ; Male ; Orchiectomy ; Scrotum ; Testis*

Emergency hysterectomy has been accepted as a life-saving procedure for patients with bleeding at the time of cesarean section. This study analyzed the patients of emergency obstetric hysterectomy performed at CHA hospital for 4 years from January 1990 to December 1993. During the 4 year study there were 32,090 deliveries, 8021 of which were cesarean sections. 42 emergency obstetric hysterectomies were performed; there were 36 cases after normal spontaneous vaginal delivery and 6 cases after cesarean section. The results of this study were as follows ; 1) 42 patients were evaluated, ranging in age from 23 years to 41 years and averaging 32 years. 2) The most common indications for cesarean hysterectomy were atony (35.7%) and placenta previa and accreta (35.7%). 3) Five patients received continuous epidural anesthesia and three of them with initially satisfactory epidural anesthesia required intraoperative induction of general anesthesia. Other patients received general anesthesia. Mean anesthetic time was 2 hours and 37 minutes. 4) Mean units transfused during operation were 11.1 pints. Mean preoperative hemoglobin and hematocrit were 10.3 g/dl and 31.9%. Mean postoperative hemoglobin and hematocrit were 10.5 g/dl and 33.1%. 5) Complications were found in 6 cases, including bladder injury, bleeding at the vaginal cuff area, pulmonary edema and paralytic ileus. Average hospital stay was 8.8 days.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Cesarean Section ; Emergencies* ; Female ; Hematocrit ; Hemorrhage ; Humans ; Hysterectomy* ; Intestinal Pseudo-Obstruction ; Length of Stay ; Placenta Previa ; Pregnancy ; Pulmonary Edema ; Urinary Bladder

PURPOSE: Chronic ureteral obstruction results in changes in renal hemodynamics, tubular function, and subsequently fibrosis of the tubulointerstitium. The pathologic marker of irreversible renal injury is interstitial fibrosis. The degree of interstitial fibrosis is the most useful measure of the degree of renal injury. This study in rats with partial ureteral obstruction was performed to describe and quantify the changes in collagen deposition. MATERIALS AND METHODS: Female Sprague-Dawley rats weighing 300-400g were used. Individual kidneys were obtained from rats at 1, 2, 3, 4 weeks after partial ureteral obstruction and sham operation. The total amount of collagen was measured from its contents of hydroxyproline by assuming that hydroxyproline is 14% in weight of the collagen. Collagen types I, III, and IV were localized by immunohistochemical staining and the distribution of each collagen type was analized using differences of their staining densities. RESULTS: After 2 weeks of partial ureteral obstruction, the total amount of collagen in affected kidney was significantly increased compared to control and 1 week groups(P<0.05). All of the collagen types in the interstitium of the affected kidney was gradually increased parallel to the duration of partial ureteral obstruction. Collagen type IV was increased significantly in tubular basement membrane and interstitium after 2 weeks of partial obstruction compared to control and 1 week groups. CONCLUSIONS: The partial ureteral obstruction causes progressive increase of amount of collagen according to the duration of obstruction, especially after 2 weeks, and tubulointerstitial fibrosis of obstructive nephropathy is closely related to collagen type I, III, and IV. Infiltration of collagen type IV in tubular basement membrane may play a major role in obstructive nephropathy.
Animals ; Basement Membrane ; Collagen Type I ; Collagen Type IV ; Collagen* ; Female ; Fibrosis ; Hemodynamics ; Humans ; Hydroxyproline ; Kidney* ; Rats* ; Rats, Sprague-Dawley ; Ureter* ; Ureteral Obstruction*

PURPOSE: Chronic ureteral obstruction results in changes in renal hemodynamics, tubular function, and subsequently fibrosis of the tubulointerstitium. The pathologic marker of irreversible renal injury is interstitial fibrosis. The degree of interstitial fibrosis is the most useful measure of the degree of renal injury. This study in rats with partial ureteral obstruction was performed to describe and quantify the changes in collagen deposition. MATERIALS AND METHODS: Female Sprague-Dawley rats weighing 300-400g were used. Individual kidneys were obtained from rats at 1, 2, 3, 4 weeks after partial ureteral obstruction and sham operation. The total amount of collagen was measured from its contents of hydroxyproline by assuming that hydroxyproline is 14% in weight of the collagen. Collagen types I, III, and IV were localized by immunohistochemical staining and the distribution of each collagen type was analized using differences of their staining densities. RESULTS: After 2 weeks of partial ureteral obstruction, the total amount of collagen in affected kidney was significantly increased compared to control and 1 week groups(P<0.05). All of the collagen types in the interstitium of the affected kidney was gradually increased parallel to the duration of partial ureteral obstruction. Collagen type IV was increased significantly in tubular basement membrane and interstitium after 2 weeks of partial obstruction compared to control and 1 week groups. CONCLUSIONS: The partial ureteral obstruction causes progressive increase of amount of collagen according to the duration of obstruction, especially after 2 weeks, and tubulointerstitial fibrosis of obstructive nephropathy is closely related to collagen type I, III, and IV. Infiltration of collagen type IV in tubular basement membrane may play a major role in obstructive nephropathy.
Animals ; Basement Membrane ; Collagen Type I ; Collagen Type IV ; Collagen* ; Female ; Fibrosis ; Hemodynamics ; Humans ; Hydroxyproline ; Kidney* ; Rats* ; Rats, Sprague-Dawley ; Ureter* ; Ureteral Obstruction*

The idiopathic calcinosis of the scrotum is multiple and asymptomatic nodules of scrotal skin which can onset either in childhood or early adulthood. It increases in size and number, while breakingdown to discharge chalky contents on occasions. We report a case of a 68-year-old-man who was effectively treated with a simple excision of the affected skin with an idiopathic scrotal calcinosis. There is no family history of scrotal calcification. Histopathologically, multiple nodules showed the epidermal cyst with partially degenerated wall and calcium deposits with a foreign body reaction in the dermis in this case. In most reported cases, some intact epidermal cysts are also present, and dystrophic calcification, and possible inflammation and rupture of epidermal cysts regarded as be the main pathogenetic mechanism of the disease.
Calcinosis* ; Calcium ; Dermis ; Epidermal Cyst ; Foreign-Body Reaction ; Humans ; Inflammation ; Rupture ; Scrotum* ; Skin

BACKGROUND: Opioids can produce potent antinociceptive effects by interacting with local opioid receptors in inflamed peripheral tissue. However, reports on pain relief with intra-articular morphine after arthroscopic knee operations are conflicting. In this study we examined the analgesic effects of the intraarticular administration of morphine after knee surgery. METHODS: In a double-blind, randomized trial, we studied 26 patients who had received one of two injections at the end of surgery. The patients in group M(n=11) received 3 mg of morphine intraarticularly; those in group P(n=15), saline 20 ml intraarticularly as a placebo. RESULTS: Patients in the morphine group had significantly lower pain scores throughout the 24-h postoperative period compared with those in the placebo group(P<0.05). There was less requirement for supplementary analgesics in the morphine group. CONCLUSIONS: Low doses of intraarticular morphine can significantly reduce pain after knee surgery without any systemic side effect.
Analgesics ; Analgesics, Opioid ; Humans ; Knee* ; Morphine* ; Postoperative Period ; Receptors, Opioid

BACKGROUND: Protection against ischemia-reperfusion injury is crucial for successful transplantation of the lung. It has been known that nitric oxide has many favorable effects on the donor lungs but at the same time, has some potential side effects of cytotoxicity. In this regards, we investigated whether the administration of nitroglycerin could decrease ischemia-reperfusion injury in isolated rat lung reperfusion model for the confirmation of the effect of nitroglycerin, a donor of nitric oxide, on lung transplantation. MATERIAL AND METHOD: 35 Sprague-Dawley species male white rats were used for this experiment. For nitroglycerin group (n=18), nitroglycerin was administered intravenously followed by mixed in flushing solution for preservation. As a control group (n=17), we used the same amount of normal saline. To evaluate the effect of nitroglycerin on the lung, heart-lung block was obtained, weighed and stored in University of Wisconsin Solution at 10oC for 24 hours. In each group of the isolated lungs, reperfusion was carried out with Krebs-Hensleit-diluted human blood for 60 minutes. As parameters of the state of the isolated lung, peak inspiratory and pulmonary arterial pressures were continuously recorded. Oxygen and carbon dioxide tension of reperfusing blood were measured before and after 30, 60 minutes of reperfusion. After sixty minutes of reperfusion, protein content in bronchoalveolar lavage fluid was measured also for the evaluation of the degree of alveolar flooding. Lung myeloperoxidase activity was determined to verify the accumulation of neutrophils. RESULTS: Although statistically significant differences were not noted in peak inspiratory and pulmonary arterial pressure between control and nitroglycerin group, latter group showed lowering tendency of pulmonary arterial pressure during the entire reperfusion period. Oxygen tension was higher (p<0.05) in nitroglycerin group compared with that of the control group, in contrast, there were no differences in carbon dioxide tension, protein content in bronchoalveolar lavage fluid and myeloperoxidase activity between the groups. In the examination of ultrastructural changes, nitroglycerin denoted the protective effect on the pulmonary architecture compared with that of control group. CONCLUSION: Collectively, on the bases of these experimental results, prior treatment of donor lung with nitroglycerin could result in better preservation of the lung. Consequently, these nitroglycerin preserved lungs are thought to be more suitable for successful transplantation of the lung.
Animals ; Arterial Pressure ; Bronchoalveolar Lavage Fluid ; Carbon Dioxide ; Flushing ; Humans ; Lung Transplantation ; Lung* ; Male ; Neutrophils ; Nitric Oxide ; Nitroglycerin* ; Organ Preservation ; Oxygen ; Peroxidase ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; Tissue Donors ; Wisconsin

BACKGROUND: There is little data about the intravascular ultrasound (IVUS) findings in the patients with vasospastic angina, especially with respect to patterns of vascular remodeling. METHODS: Coronary spasm was documented by angiography and ECG evidence of ischemia in 36 patients after administration of ergonovine (cumulative doses up to 350 microgram). After relief of spasm using 1,000 microgram of intracoronary nitroglycerin, IVUS imaging was performed and analyzed using standard methodology. The 36 focal spasm sites were compared to the proximal and distal reference segments. RESULTS: The angiographic baseline minimum lumen diameter measured 1.78+/-0.66mm, which decreased to 0.66+/-0.38mm with ergonovine provocaton (p<0.0001), increased to 2.66+/-0.64mm after intracoronary nitroglycerin (p<0.0001 compared to baseline and post-ergonovine), and did not change after the IVUS imaging (2.66+/-0.63mm, p=.9). Coronary artery spasm was observed in angiographically normal segments in 6 patients and near normal segments (<10% angiographic diameter stenosis by visual estimate) in 30. Atherosclerotic lesions were observed at all coronary spasm sites; the mean plaque burden measured 56% at the spasm site and 35% at the reference site. The plaque composition of spasm site was hypoechoic in 31 and hyperechoic, noncalcific in 5; there was no calcium. Positive remodeling (spasm site arterial area>proximal reference) was present in 5; intermediate remodeling (proximal reference >spasm site >distal reference arterial area) was present in 7; and negative remodeling (spasm site arterial area Angiography ; Atherosclerosis ; Calcium ; Constriction, Pathologic ; Coronary Vessels ; Electrocardiography ; Ergonovine ; Humans ; Incidence ; Ischemia ; Nitroglycerin ; Spasm* ; Ultrasonography*

BACKGROUND: It is often difficult to make a diagnosis of cardiac ischemia in patients attending emergency department (ED) with symptoms of acute coronary syndromes (ACS) because existing cardiac markers are not sensitive for reversible myocardial ischemia. Ischemia modified albumin (IMA) has recently been shown to be an early and sensitive marker of myocardial ischemia. We investigated the usefulness of ischemia modified albumin (IMA) as an early triage marker for ACS and tried to establish a newly standardized albumin-adjusted IMA index which has been expected to be more sensitive and accurate than conventional IMA value. METHODS: We enrolled 209 consecutive patients (men 95, women 114) who presented to the ED with symptoms suggestive of ACS from June to July, 2005. All patients were classified to ACS group (n=42) and others (n=167) based on diagnosis of cardiologists. The ideal cutoff value of IMA was calculated by the receiver operating characteristic (ROC) curve analysis and diagnostic utilities of combination tests (myoglobin, CK-MB, troponin T and EKG) were compared with those of IMA. The albumin-adjusted IMA index was calculated and applicated from the results of correlation assay between serum albumin concentration and IMA value. RESULTS: Mean IMA level (U/mL) of ACS group was significantly higher than that of non-ACS group (P<0.05) and sensitivity and specificity was 92.9% and 35.9% at a cutoff value of 85.1 U/mL, respectably. In combination with conventional cardiac markers, the sensitivity increased to 96.3%. IMA value had a negative lnear relationship with serum albumin concentration (YIMA= -23.1Xalbumin+200, R=0.99) and albumin-adjusted IMA index was calculated as [IMA index = serum albumin conc. (g/dL) x 23 + IMA (U/mL) -100]. The sensitivity and specificity was 97.6% and 34.1% at a cutoff value of 83.3 IMA index, respectively. CONCLUSIONS: IMA is a useful sensitive marker for the identification of ACS in patients with normal cardiac markers and EKG finding and follow-up combination testing may be required to rule out other diseases. The calculated albumin-adjusted IMA index is recommended to make a diagnosis of ACS more sensitively.
Acute Coronary Syndrome* ; Diagnosis ; Electrocardiography ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Humans ; Ischemia* ; Mass Screening* ; Myocardial Ischemia ; ROC Curve ; Sensitivity and Specificity ; Serum Albumin ; Triage ; Troponin T