No abstract available.
Intracranial Aneurysm*

An analytical observation was carried out on clinical symptoms, physical findings, etiology, precipitating factors, pulse rate, and blood pressure manifested by 115 patients admitted to the Kyung hee university Hospital under the diagnosis of congestive heart failure for a period of October 1971 to September 1974. The results were as follows: 1. The disease affected female 1.4 times more frequently than male and occured most frequently in the 6th decade (26.1%), and its incidence decreased in the 7th decade (22.6%). 2. The important causes of congestive heart failure were hypertensive heart disease (39.7%), rheumatic heart disease (26.1%), cor pulmonale (13.9%), atherosclerotic heart disease (6.1%), postpartum heart failure (6.1%) and pericardial disease (3.5%). The unknown etiology was 3.5% of all cases. 3. The most common precipitatiog factors of the 106 patients of congestive heart failure were infections (59.5%), especially in the upper respiratory tract infection (37.8%). The physical exertion, pregnancy and labor, psychic stress, angina, myocardial infarction, and discontinuation of Tapazol and digitalis were followed. 4. The most common symptoms and signs were the dyspnea (93%), and the next common were pulmonary rales (65.2%), hepatomegaly (59.1%), distention of cervical vein (55.7%), pitting edema (44.3%) and cardiac murmur (38.3%) on admission. 5. The increased pulse rate over 101/min. was about 38.3%, but less than 60/min. was found in 4.3% only. 6. The electrocardiographic findings were abnormal except one case out of 107 cases. The left ventricular hypertrophy (48.1%), atrial fibrillation (24.5%), and bundle branch block (21.7%) were frequently observed. 7. The range of systolic blood pressure measured in 43 patients who had been suffered from hypertensive heart disease were disclosed that 221-240 mmHg (23.3%), 161-180mmHg (20.9%), and 181-200mmHg (20.9%) in order.
Atrial Fibrillation ; Blood Pressure ; Bundle-Branch Block ; Diagnosis ; Digitalis ; Dyspnea ; Edema ; Electrocardiography ; Estrogens, Conjugated (USP)* ; Female ; Heart Diseases ; Heart Failure* ; Heart Murmurs ; Heart Rate ; Hepatomegaly ; Humans ; Hypertrophy, Left Ventricular ; Incidence ; Male ; Myocardial Infarction ; Physical Exertion ; Postpartum Period ; Precipitating Factors ; Pregnancy ; Pulmonary Heart Disease ; Respiratory Sounds ; Respiratory Tract Infections ; Rheumatic Heart Disease ; Veins

An analytical observation was carried out on clinical symptoms, physical findings, etiology, precipitating factors, pulse rate, and blood pressure manifested by 115 patients admitted to the Kyung hee university Hospital under the diagnosis of congestive heart failure for a period of October 1971 to September 1974. The results were as follows: 1. The disease affected female 1.4 times more frequently than male and occured most frequently in the 6th decade (26.1%), and its incidence decreased in the 7th decade (22.6%). 2. The important causes of congestive heart failure were hypertensive heart disease (39.7%), rheumatic heart disease (26.1%), cor pulmonale (13.9%), atherosclerotic heart disease (6.1%), postpartum heart failure (6.1%) and pericardial disease (3.5%). The unknown etiology was 3.5% of all cases. 3. The most common precipitatiog factors of the 106 patients of congestive heart failure were infections (59.5%), especially in the upper respiratory tract infection (37.8%). The physical exertion, pregnancy and labor, psychic stress, angina, myocardial infarction, and discontinuation of Tapazol and digitalis were followed. 4. The most common symptoms and signs were the dyspnea (93%), and the next common were pulmonary rales (65.2%), hepatomegaly (59.1%), distention of cervical vein (55.7%), pitting edema (44.3%) and cardiac murmur (38.3%) on admission. 5. The increased pulse rate over 101/min. was about 38.3%, but less than 60/min. was found in 4.3% only. 6. The electrocardiographic findings were abnormal except one case out of 107 cases. The left ventricular hypertrophy (48.1%), atrial fibrillation (24.5%), and bundle branch block (21.7%) were frequently observed. 7. The range of systolic blood pressure measured in 43 patients who had been suffered from hypertensive heart disease were disclosed that 221-240 mmHg (23.3%), 161-180mmHg (20.9%), and 181-200mmHg (20.9%) in order.
Atrial Fibrillation ; Blood Pressure ; Bundle-Branch Block ; Diagnosis ; Digitalis ; Dyspnea ; Edema ; Electrocardiography ; Estrogens, Conjugated (USP)* ; Female ; Heart Diseases ; Heart Failure* ; Heart Murmurs ; Heart Rate ; Hepatomegaly ; Humans ; Hypertrophy, Left Ventricular ; Incidence ; Male ; Myocardial Infarction ; Physical Exertion ; Postpartum Period ; Precipitating Factors ; Pregnancy ; Pulmonary Heart Disease ; Respiratory Sounds ; Respiratory Tract Infections ; Rheumatic Heart Disease ; Veins

The use of hyperventilation technique to reduce intracranial pressure for surgical intervention of cerebral aneurysm has been well documented and most common in general practice. The decrease of blood flow with hyperventilation may aggravate pre-existing ischemic region. On this occasion it was suggested that cerebral intracellular metabolic acidosis may be accentuated so that its metabolic status could be measured from the analysis of cerebrospinal fluid gases. Hyperventilation can cause an increase in PH of cerebrospinal fluid due to the decrease of PCO but if hyperventilation is induced chronically, an elevated PH returns gradually to its previous normal value by loss of HCO, from the cerebrospinal fluid. Anesthesia was maintained with hyperventilation throughout the cerebral aneurysm surgery then cerebrospinal fluid and arterial blood gases were measured at regular intervals. PH in cerebrospinal fluid at 1 hour after hyperventilation revealed severe metabolic acidosis and arterial blood gases showed respiratory alkalosis. At 6 hours after hyperventilation the PH in cerebrospinal fluid in-creased markedly but the changes of HCO2were not significant from its control value and accord-ingly metabolic acidosis in cerebrospinal fluid was improved. It was suggested that compensatory mechanism for PH of cerebrospinal fluid to return to its low value by decreasing HCO2was shown. If such mechaniwm does not exist cerebrospinal fluid HCO2must he increased theoretically.
Acidosis ; Alkalosis, Respiratory ; Anesthesia ; Cerebrospinal Fluid ; Gases ; General Practice ; Hydrogen-Ion Concentration ; Hyperventilation* ; Intracranial Aneurysm* ; Intracranial Pressure ; Reference Values

BACKGROUND: Acutely induced hypoxia causes an increase in the mean arterial pressure, cardiac output and oxygen consumption. However, comparisons of hemodynamic changes and oxygen consumption between subjects with and without anesthesia are rare. The purpose of this study was to examine and compare the hemodynamic changes and oxygen availability after acute apnea between the dogs with and without anesthesia. METHODS: Apnea was induced to 19 healthy mongrel dogs. Group 1 (N=10) constituted dogs with anesthesia and group 2 (N=9) constituted dogs without anesthesia. Hemodynamic data and oxygen levels were rapidly measured with 1 minute intervals. RESULTS: The survival time of group 1 was longer than that of group 2. The mean arterial pressure increased in group 1. Although the cardiac outputs in both groups increased at the same time course in early phase of apnea, the preload values increased more rapidly in group 1. Systemic vascular resistance decreased at 2 and 3 minutes of apnea in group 1 but not in group 2. The oxygen extraction ratio increased significantly at 4 and 5 minutes of apnea in group 2. CONCLUSION: In this study the dogs with anesthesia had a prolonged survival time compared to the dogs without anesthesia. Most hemodynamic values did not differ significantly between the two groups, except for an increased mean arterial pressure and decreased systemic vascular resistance in the dogs with anesthesia. It was suggested that the cause of early death in the dogs without anesthesia was decreased oxygen delivery.
Anesthesia* ; Animals ; Anoxia ; Apnea* ; Arterial Pressure ; Cardiac Output ; Dogs ; Hemodynamics* ; Oxygen Consumption ; Oxygen* ; Vascular Resistance

A reliable intravenous route is extremely important not only in surgical patients for prolonged administration of fluid and massive transfusion but also in patients with peripheral vascular collapse for hyperalimentation and critical patients. Since the subclavian vein catheterisation in a supraclavicular approach was introduced by J.K. Jeon in 1974 in our institution, it has been extremely popular for prolonged intravenous administration of fluids ratehr than for the measurement of central venous pressure. Therefore, the method of supraclavicular cannulation was modified by was of a more simple and easier method, using a 2inch Angiocath instead of an 8 inch intracath. We had 300 cases of supraclavicular subclavian vein cannulation which were done in various surgical patients of all ages. We have observed the following advantages of this method(2inch Angiocath) over the previous method. 1) No bleeding around the catheter 2) Simple and easy technique 3) Easy to fix the catheter 4) No need to wear gloves 5) Less complications such as air and catheter embolism 6) Bigger internal diasmeter in the Angiocath even with the sam size 7) Easy to keep the catheter open 8) Cheaper The subclavian vein is located within the costo-clavicular-scalene triangle and is approximately 3 to 4cm long and 1 to 2 cm in diameter in adults. The patient is placed in a supine and trendelenburg position to allow the subclavian vein to distend and to help prevent an air compolism when the vessel is cannulated. Follwing the preparation of the supraclavicular foses, a 2 inch Anglocath with a 10 cc syringe attached is inserted and advanced in the direction of the innominate vein, approximately 1cm from the junction of the clavicle and the lateral border of the sternocleidomastoid muscle(Clavisternomastoid angle. Fig.2). It is important to maintain a negative pressure while advancing the needle until a free flow of blood is observed in the syringe. When blood is observed in the syringe, a catheter is inserted and threaded all the way to the end then the needle is removed. The tip of the catheter is connected to the intravenous solution and fixed with adhesive tape. There is no need to press the puncture site or change the position in order to prevent bleeding around the catheter. The complications of a subclavian vein cannulation with an Anglocath are the same as with an Intracath. Those are pneumothorax, hydrothorax, hemothorax, catheter embolism, thrombosis and sepsis but the incidence is lower in this method. In the supraclavicular cannulation in our series, we have not experienced any of the above complications among the 300 cases done her due to the fact that only a few well qualified doctors have performed this technique.
Adhesives ; Administration, Intravenous ; Adult ; Brachiocephalic Veins ; Catheterization* ; Catheters ; Central Venous Pressure ; Clavicle ; Embolism ; Head-Down Tilt ; Hemorrhage ; Hemothorax ; Humans ; Hydrothorax ; Incidence ; Needles ; Pneumothorax ; Punctures ; Sepsis ; Subclavian Vein* ; Syringes ; Thrombosis

Morphine anesthesia for cardiac surgery became very popular since Lowenstein at al. reported that 1.5~3.0mg/kg of morphine administered intravenously during ventilating with 100% oxygen did not alter cardiovascular dynamics in patients without heart disease and improved them in patients with aortic valve disease. However, morphine anesthesia soon appeared to cause significant disadvantages and many problems such as intraoperative awareness, histamine reactions marked increases in intraoperative blood pressure and prolonges postoperative respiratory depression. This study was primarily undertaken to evaluate the effects of intraspinal morphine anesthesia and compare them with the problems resulting from intravenous morphine anesthesia. We had 25 patients scheduled for open heart surgery. They were anesthetized mainly by intraspinal morphine and intravenous tranquilizers. Spinal tapping using Whitacre pencil point needle was performed in a sitting position at a level between L2-L4 and spinal fluid was drawn and mixed with morphine by a 10cc syringe and was administered rapidly with barbotage 3 times. Then the patient was given pentothal and anectin, and was intubated, followed by intravenous administration of Ativan or valium. The patient's respiration was controlled with 100% oxygen throughout the entire surgery. 1) The dosages of intraspinal morphine ranged between 6~10mg which was bridfly calculated by 0.1mg/kg with some variation according to heights and patients conditions. 2) Activan or valium was administered intravenously to eliminate intraoperative awareness. Ativan was preferred to valium for valve surgery. 3) Cardiovascular dynamics appeared stable throughout the intraoperative, recovery and ICUcare periods. 4) Respiratory depression seemed to be most serious between 12~16hour after intraspinal injection of morphine. Therfore this technique is recommended only in patients who need a controlled respiration for more than 12 hours because respiratory arrest occurs more commonly at that hour. 5) Respiratory care in the ICU was very effective satisfactory without any further medication for synchronisation between patient and respiratior becauses of the length of respiratory depression. 6) Somnolence lasts 24~36hours with no inadvertent reactions. 7) Well documented complications such as respiratory depression, pruritis and urinary retention were not problems in patients for open heart surgery. 8) The anesthesia induced by intraspinal morphine injection was satisfactory in anesthesia practice for open heart surgery. Therefore, we have called this procedure which has not been reported yet intraspinal morphine anesthesia.
Administration, Intravenous ; Anesthesia* ; Aortic Valve ; Blood Pressure ; Diazepam ; Heart Diseases ; Heart* ; Histamine ; Humans ; Injections, Spinal ; Intraoperative Awareness ; Lorazepam ; Morphine* ; Needles ; Oxygen ; Pruritus ; Respiration ; Respiratory Insufficiency ; Spinal Puncture ; Syringes ; Thiopental ; Thoracic Surgery* ; Urinary Retention

PURPOSE: Due to its size and locatin, the liver is frequently injured in abdominal trauma. Recently, nonoperative management for liver injuries has been extended due to the development CT imaging, intensive care units, and their equipment and techniques. Herein, patients with traumatic liver injury were analyzed to evaluate its treatment and prognostic factors. METHODS: From 2001, January to 2003, July, 65 patients at our facility were confirmed to have traumatic liver injury. The operative or nonoperative managements were decided on the basis of the systolic blood pressure if no peritoneal irritation sign was noted. If the systolic blood pressure was stable, or recovered to within the normal range following hydration and transfusion at the emergency room, patients were managed nonoperatively. Hemodynamically unstable patients were managed operatively. The data were analysed using the SPSS program (Chi-squared tests and logistic regression analyses). RESULTS: 48 patients were treated nonoperatively, with 3 mortalities. The overall mortality rate was 15.8%, but only 6.4% in the nonoperative management group, compared to 67% in operative management group. In a Multivariate analysis the systolic blood pressure was found to be a reliable factor in traumatic liver injury and the mentality and ISS (injury severity score) reliable in finding complications in the nonoperative management group. The mentality was found statistically reliable for determining mortality in the operative management group, with the exception for the systolic blood pressure. CONCLUSION: The systolic blood pressure was an important indicator when considering the treatment plan in traumatic liver injury. An extensive study will be required that incorporates both nonoperative and operative management groups.
Blood Pressure ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Liver* ; Logistic Models ; Mortality ; Multivariate Analysis ; Reference Values

Infantile hemangioendothelioma of the liver is a common vascular tumor in infancy. The tumor is usually multinodular or diffuse and classified into two types. We present a case of infantile hemangioendothelioma of the liver, which predominantly consists of type 2. A 4-month-old female was admitted for an evaulation of an abdominal distension. A CT scan of the liver showed a multinodular mass. The right lobectomy was done. Grossly, the mass consisted of round nodules ranging from 2cm to 5cm in diameter. Microscopically, the tumor revealed proliferation of small vascular channels lined by endothelial cells. Bizarre cells and mitotic cells were frequently noted. Vesicular nuclei and multilayering of the endothelial cells were also noted.
Endothelial Cells ; Female ; Hemangioendothelioma* ; Humans ; Infant ; Liver* ; Tomography, X-Ray Computed

Arytenoid cartilage dislocation is a very rare complication of endotracheal intubation. This change can occur as a result of compressing the cryco-arytenoid joint by inflated cuff of endotracheal tube. A 21-year old male, ASA physical status I with chronic otitis media underwent tympanoplasty with mastoidectomy. Anesthesia was induced with thiopental-succynylcholine and was maintained with nitrous oxide-oxygen-enflurane. On the first postoperative day, the patient complained of hoarseness, and on the second postoperative day, the right arytenoid was found dislocated under indirect laryngoscopy. Five days postoperatively, endoscopic reduction was performed under direct laryngoscopy, thereafter his symptom gradually disappeared.
Anesthesia ; Anesthesia, General* ; Arytenoid Cartilage ; Dislocations ; Hoarseness ; Humans ; Intubation, Intratracheal ; Joints ; Laryngoscopy ; Male ; Otitis Media ; Tympanoplasty ; Young Adult