No abstract available.
Arthritis* ; Tendon Entrapment*

The Parasitological investigation on the encysted metacercariae in brackish water fish, Tribolodon taczanowskii, in the downstream of Hyungsan river which is located in Kyungpook Province of Korea, were carried out serially and the following results were obtained. Metacercariae of Pseudexorchis major were found in six fishes(15.8 per cent ) out of 38 examined. Parasitic frequencies of the encysted metacercaria of Psedexorchis major in Tribolodon taczanowskii were 15.8 per cent (6 out of 38) in the scale, 10.5 per cent (4 out of 38) in the fin, 13.2 per cent (5 out of 38) in the gill, 10.5 per cent (4 out of 38) in the oral cavity and 7.9 per cent (3 out of 38) in the flesh. The worms were identified as Pseudexorchis major (Hasegawa, 1935) Yamaguti, 1938 by morphological studies on the metacercariae, excysted metacercariae, adults and eggs, and compared with prereported Pseudexorchis species.
parasitology-helminth-trematoda ; Pseudexochis major ; Tribolodon taczanowskii ; epidemiology

The Parasitological investigation on the encysted metacercariae in brackish water fish, Tribolodon taczanowskii Steindachner , in the downstream of Hyungsan river which is located in Kyungpook province of Korea, were carried out, and the following results were obtained. Metacercariae of Metagonimus species were found in seventy five fishes (40.5 percent) out of 185 examined. Parasitic frequencies of the encysted matacercaria of Metagonimus species in Tribolodon taczanowskii were 23.2 percent (43 out of 185) in the scale, 7.0 percent (13 out of 185) in the gill, and 10.3 percent (19 out of 185) in the flesh. The number of the metacercaria in the scale, gill and flesh were fewer than that of the others. The worms were identified as Metagonimus yokogawai Katsurada, 1912 by morphological studies on the adults and eggs, and compared with prereported Metagonimus species.
parasitology-helminth-trematoda ; Metagonimus yokogawai ; epidemiology ; Tribolodon taczanowskii

Calcific tendinitis of the shoulder joint is common disease causing acute pain, mainly involving the supraspinatus or infraspinatus muscle, and less frequently the teres minor or subscapularis muscle. This study reports on the satisfactory arthroscopic removal of calcium deposits as well as infraspinatus and supraspinatus muscle repair without relapse via minimal incision using suture anchors. This was a case of atypically extensive calcific tendinitis involving the infraspinatus muscle, with a bursal side partial rupture of the supraspinatus muscle in a 61-year-old female whose chief complaint was chronic pain of the right shoulder exacerbated by limited movement.
Acute Pain ; Calcium ; Chronic Pain ; Female ; Humans ; Middle Aged ; Recurrence ; Rupture ; Shoulder Joint ; Shoulder* ; Suture Anchors ; Tendinopathy*

BACKGROUND: Pulmonary hypertension (PH) associated with end stage liver disease is rare but the risk of hemodynamic deterioration during liver transplantation may be high. This study was done to characterize the pulmonary hemodynamics during liver transplantation and to seek the relationship between pulmonary artery pressure (PAP) and other hemodynamic variables. METHODS: One hundred patients undergoing liver transplantation were chosen and we divided patients into normal and PH groups (mean pulmonary artery pressure [MPAP] > 25 mmHg). Hemodynamic data was collected throughout the surgery. Studied variables between groups were analyzed with an unpaired t-test. The relationship between MPAP and other hemodynamic variables was analyzed with a linear regression test. Survival analysis was performed by cumulative survival analysis (Logrank test). RESULTS: Incidence of PH during liver transplantation was 34%, and true PH (pulmonary vascular resistance index [PVRI] > 150 dyne.sec/cm5/m2, MPAP > 25 mmHg) was 7%. MPAP, systemic vascular resistance index, cardiac index, right ventricular ejection fraction, maximum elastance, central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP), and right ventricular end-diastolic volume index were significantly higher in the PH group. In the PH group, right ventricular function curve was abnormal. MPAP correlated significantly with PAOP, and CVP (P < 0.01). One year survival rate showed no significant difference between groups (Logrank test P = 0.49). CONCLUSIONS: Episodes of increased pulmonary artery pressure during liver transplantation was not infrequent. PAP was more dependent on preloads. In patients with high PAP, RV diastolic dysfunction was usually observed. Early mortality rate after liver transplantation was not associated with PH.
Central Venous Pressure ; End Stage Liver Disease ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary ; Incidence ; Linear Models ; Liver Transplantation* ; Liver* ; Mortality ; Pulmonary Artery* ; Stroke Volume ; Survival Rate ; Vascular Resistance ; Ventricular Function, Right

BACKGROUND: Fulminant hepatic failure is characterized by rapid progressive liver failure with the onset of encephalopathy within a few weeks of the appearance of jaundice. This illness is frequently complicated by hemodynamic instability, multiple organ dysfunction and intracranial hypertension associated with cerebral edema, which is the most common cause of death in this condition. We reviewed 8 cases of liver transplantation with fulminant hepatic failure with respect to anesthetic management and neurologic monitoring. METHODS: We analyzed anesthetic management, intracranial pressure (ICP), cerebral perfusion pressure (CPP), jugular venous oxygen saturation (SjvO2) and hemodynamics retrospectively during liver transplantation in 8 patients with fulminant hepatic failure. Intracranial hypertension was defined as an ICP >or= 20 mmHg for at least 5 minutes. The goal of management is to keep the CPP above 40 - 50 mmHg and ICP below 30 - 40 mmHg. There were 3 cases of hepatorenal syndrome and continous veno-venous hemodiafiltration (CVVHD) was used in 2 cases. RESULTS: All patients showed characteristic hyperdynamic circulation with severe vasodilation and vasopressive drugs were needed to maintain CPP. The episodes of intracranial hypertension occurred in all patients during transplantation. To decrease ICP, medical therapy with mannitol, furosemide and thiopental infusion were required. Intracranial hemorrhagic complications occurred in 3 cases. SjvO2 decreased transiently below 60% in 3 cases. However, it was improved with an increase of PaCO2 by hypoventilation and maintained above 60 - 80% in all cases. CONCLUSIONS: This data suggests that there is a risk of brain injury secondary to elevated ICP and low CPP during liver transplantation. ICP, CPP and SjvO2 monitoring in patients with fulminant hepatic failure can be useful for the prompt recognition of intracranial hypertension and for guiding therapy. However, correction of the coagulopathy before placement of the ICP tranducer must be performed to prevent hemorragic complications.
Anesthesia* ; Brain Edema ; Brain Injuries ; Cause of Death ; Furosemide ; Hemodiafiltration ; Hemodynamics ; Hepatorenal Syndrome ; Humans ; Hypoventilation ; Intracranial Hypertension ; Intracranial Pressure* ; Jaundice ; Liver Failure ; Liver Failure, Acute* ; Liver Transplantation* ; Liver* ; Mannitol ; Oxygen* ; Perfusion ; Retrospective Studies ; Thiopental ; Transplantation ; Vasodilation

Cardiac tamponade is a life-threatening predicament which demands early recognition and immediate treatment. We report a case of iatrogenic intraoperative cardiac tamponade during an orthotopic liver transplantation. A 55 year-old man was scheduled for an orthotopic liver transplantation due to hepatocellular carcinoma. During the anhepatic period, the patient's vital signs remained stable, but the central venous pressure and pulmonary artery diastolic pressure were increased. However, immediately after reperfusion, sudden hypotension and tachycardia developed. Fluid volume resuscitation and epinephrine injection led only to a transient improvement of the blood pressure. It took approximately 30 minutes to realize the possibility of the cause of hypotension might be due to cardiac tamponade rather than post-reperfusion syndrome. After an emergent transdiaphragmatic pericardiocentesis, we found that the cause of the cardiac tamponade was tearing of an epicardial coronary vein. Evacuation of a massive hematoma resulted in a rapid improvement in the patient's cardiovascular status. The patient has made an uneventful recovery.
Blood Pressure ; Carcinoma, Hepatocellular ; Cardiac Tamponade* ; Central Venous Pressure ; Coronary Vessels ; Epinephrine ; Hematoma ; Humans ; Hypotension ; Liver Transplantation* ; Liver* ; Middle Aged ; Pericardiocentesis ; Pulmonary Artery ; Reperfusion* ; Resuscitation ; Tachycardia ; Vital Signs

Hepatopulmonary syndrome is essentially the triad of liver disease, pulmonary vascular dilations and abnormal arterial oxygenation, which can result in severe hypoxia. We managed two cases of 9 and 49-year-old males for liver transplantation with hepatopulmonary syndrome. Preoperative evaluation showed decreased diffusion capacity of carbon monooxide and severe hypoxemia, while breathing room air (PaO2 < 60 mmHg) but they responded to oxygen therapy. The pulmonary vascular resistance was low, consistent with an intrapulmonary vascular shunt but the pulmonary artery pressure was normal, reflecting a high cardiac output. Intraoperative oxygenation was satisfactory (PaO2 of 100 - 200 mmHg) in spite of a high shunt fraction (Qs/Qt 18.5 +/- 9.2%). This means that the impairment in gas exchange is not the result of a true shunt, suggesting the presence of a functional shunt, which is characterized by diffusion-perfusion impairment. The intraoperative course was uneventful in the two patients and they are in a successful postoperative course. In case 1, the hypoxemia was resolved promptly, but in case 2, it was persistent for sixteen months after transplantation. The hypoxemia itself in hepatopulmonary syndrome is not regarded as a contraindication to liver transplantation. (Korean J Anesthesiol 2001; 40: 677 ~ 683)
Anesthesia* ; Anoxia ; Carbon ; Cardiac Output, High ; Diffusion ; Hepatopulmonary Syndrome* ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Male ; Middle Aged ; Oxygen ; Pulmonary Artery ; Respiration ; Vascular Resistance

Protein C exerts anticoagulant effects by inactivating factor Va and VIIIa and stimulating fibrinolysis. The homozygous protein C deficiency is extremely rare and often results in life threatening thrombosis and purpura fulminans with necrotic cutaneous lesions. A child with homozygous protein C deficiency was treated at 6 months by a living-related liver transplantaion. After induction of anesthesia, we started an FFP infusion for protein C replacement and a low molecular weight heparin continuous infusion to prevent thrombosis. A complete reconstitution of protein C activity and resolution of the thrombotic condition occured postoperatively. So we report this case with a brief review of the literature.
Anesthesia* ; Child ; Factor Va ; Fibrinolysis ; Heparin, Low-Molecular-Weight ; Humans ; Liver Transplantation* ; Liver* ; Protein C Deficiency* ; Protein C* ; Purpura Fulminans ; Thrombosis

BACKGROUND: Living related liver transplantation (LRLT) was developed to alleviate the mortality resulting from the scarcity of suitable cadevaric grafts. The purpose of this study is to review 30 cases of pediatric living-related liver transplantation, and to find the proper anesthetic management for this operation. METHODS: We retrospectively analyzed the medical records of 23 cases (body weight < 15 kg) of liver transplantation from living related donors between August 1995 and May 1998. RESULTS: Mean age and body weight were 14 (range; 6-29) months, 8.7 (range: 5.4-12.2) kg, respectively. The most common cause of end stage liver disease was biliary atresia. After reperfusion there were significant decreases of mean arterial pressure and body temperature, and increases of central venous pressure (P< 0.05), whereas the change of heart rate was not significant. The incidence of postreperfusion syndrome was 26%. Serum Na levels increased significantly (P< 0.05) from 133 3 to 144+/-3 mEq/L, and K level decreased from 4.1+/-0.7 to 3.2+/-0.5 mEq/L during surgery. Hematocrit was 26+/-3.5%, platelet 10.3+/-7.2 x 104/mm3 at the time of peritoneal closure. Wide inter-individual RBC and FFP requirements were observed, 43+/-40 (range: 5-133) mL/kg, 108+/-82 (range: 22-300) mL/kg, respectively. CONCLUSIONS: We conclude that anesthetic management for pediatric LRLT and LRLT in recipients less than 15 kg in body weight can be carrid out, through with some precautions.
Arterial Pressure ; Biliary Atresia ; Blood Platelets ; Body Temperature ; Body Weight ; Central Venous Pressure ; End Stage Liver Disease ; Heart Rate ; Hematocrit ; Humans ; Incidence ; Liver Transplantation* ; Liver* ; Medical Records ; Mortality ; Reperfusion ; Retrospective Studies ; Tissue Donors ; Transplants