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To evaluate the typical appearance and the influence in the image interpretation of the metallic artifact which is known as one of the patient-related field artifacts, we analysed the magnetic resonance (MR) images of 40 patients (the total number of metallic materials were 45) acquired at MR 1.5T unit. All patients were screened for the presence of metal. The metallic implants were surgical wires and clips, orthopedic devices, and the other miscellaneous materials. The artifacts produced by metallic objects can be seen on MRI as the focal loss of signal and/or the local distortion of the image. Regardless of their ferromagnetic properties, metallic implants created regional artifacts in their images. Ferromagnetic materials, such as a lead fragment, showed severe artifacts and nonferromagnetic metals showed mild to moderate artifacts. The conspicuity of artifact was related tot he composition, mass, shape, orientation, and the location of the metallic objects in the body. Under high magnetic field strength, there were no significant differences between the various pulse sequences. Artifacts are particularly prominent on gradient-echo images. Our findings indicate that MR imaging of patients with standard nonferromagnetic metallic materials can be successfully performed and usefully interpretated.
Artifacts* ; Humans ; Magnetic Fields ; Magnetic Resonance Imaging* ; Magnets ; Metals ; Orthopedics

Since the first report by Drury and Szent-Gyorgyi in 1929, the inhibitory influences of adenosine on the heart have repeatedly been described by many investigators. A lot of investigations on the working mechanisms of adenosine have been focused mainly on the effects on the coronary blood flow. However, the cellular mechanisms underlyiag the inhibitory action of adenosine on the SA node are not well understood yet. Furthe-rmore, the physiological role of adenosine in the regulation of the heart beat remains still to be explored. Thus, this study was undertaken to examine the behavior of the rabbit SA node ander the influence of adenosine, and the interactions between adenosine and aminophylline on the SA node, and then to compare these results with those of acetylcholine. At the same dosage range, adenosine suppressed the sinus rate and atrial contractility even in the reserpinized preparation. The spontaneous firing rate of the SA node at 35degrees C (mean+/-SEM, n=16) was 154+/-3.3 beats/min. The parameters of action potential were: maximum diastolic potential(MDP), -73+/-1,7 mV; overshoot(OS), 9+/-1.4 mV; slope of pacemaker potential(SPP), 94+/-3.0 mV/sec. Adenosine suppressed the firing rate of the SA node in a dose-dependent manner. This inhibitory effect appeared at the concentration of 10(-4)M and was potentiated in parallel with the increase in adenosine concentration. Changes in the action potential by adenosine were dose-dependent as show by the increase of MDP and the decrease of SPP until 10(-4)M. Above this concentration, however, the amplitude of the action potential decreased markedly due to the simultaneous decrease of both MDP and OS. Dipyridamole, which is known to block the adenosine transport aross the cell membrane, definately potentiated the action of adenosine. The effects of adenosine on the SA node were inhibited by aminophylline. However, the similar effects of acetylcholine to those of adenosine were not reversed by aminophylline. These results suggest that adenosine suppressed the pacemaker activity by acting dire-ctly on the membrane of the SA node, and the effects of adenosine on SA node are sele-ctively inhibited by aminophylline.
Acetylcholine ; Action Potentials ; Adenosine ; Aminophylline ; Cell Membrane ; Dipyridamole ; Fires ; Heart ; Humans ; Membranes ; Research Personnel

Spontaneous pneumothorax is a known, but relatively rare complication of pulmonary metastases of sarcoma. A 19-year-old man was presented with chest pain and dyspnea for three days and was diagnosed as left pneumothorax. After bleb resection, microscopic examination revealed metastatic osteosarcoma forming subpleural fistula and dystrophic calcification. Four years ago, he had had limb salvage operation and chemotherapy for osteosarcoma of left femur. After two and a half years he had a bleb resection for right pneumothorax without any evidence of metastasis. Six months later, he was found to have a 4x3cm sized lung mass in the right lower lobe. After lobectomy, he was diagnosed as pulmonary metastasis of osteosarcoma. Pneumothorax is the common complication of metastatic osteosarcoma to the lung and it may be presented before the pulmonary metastasis is clinically evident. It is important to recognize a pneumothorax of the patients with osteosarcoma as a possible sign of metastases.
Blister ; Chest Pain ; Drug Therapy ; Dyspnea ; Femur ; Fistula ; Humans ; Limb Salvage ; Lung ; Neoplasm Metastasis* ; Osteosarcoma* ; Pneumothorax* ; Sarcoma ; Young Adult

BACKGROUND: A tourniquet is commonly used to achieve a bloodless field in surgery of the extremities. However, the anesthesiologist is concerned about the adverse effects of hypertension which occur during general anesthesia. In this study, we assessed the effects of lidocaine infiltration in the tourniquet site on blood pressure and heart rate during tourniquet inflation under general anesthesia. METHODS: Forty patients of ASA class I or II, scheduled for knee surgery, were randomly divided into two groups. In group 1 underwent general anesthesia and in group 2 also underwent general anesthesia and combined with 1% lidocaine infiltration in the tourniquet site. The changes of systolic and diastolic blood pressure and heart rate were measured before and after toumiquet inflation, after skin incision and 30 min after inflation. RESULTS: Comparing group 1 with group 2, there were significant increases after tourniquet inflation to 30 min after inflation in systolic and diastolic blood pressure in group 1 (p<0.05). However, there were no significant changes in heart rates in either group. CONCLUSIONS: The above results demonstrate that patients who received lidocaine infiltration in the tourniquet site showed less increase in blood pressure during tourniquet inflation.
Anesthesia, General ; Anesthetics ; Blood Pressure* ; Extremities ; Heart Rate* ; Heart* ; Humans ; Hypertension ; Inflation, Economic ; Knee ; Lidocaine* ; Skin ; Tourniquets*

Pneumothorax was recognized as a potential hazard of mechanical ventilation during anesthesia. Because the gases used in anesthesia are delivered from cylinder and wall outlets at higher than atmospheric Pressure, the possibility of damage to the lung is over present. Alveolar rupture may occur when there is free transmission of high pressure to the alveoli during tracheal intubation at the start of anesthesia. We had a case of tension pneumothorax developed during the use of Jackson-Rees modification with Ayres T-piece for primary closure of laceration on right hand in 4 years old child under general anesthesia. The patient was presented of acute respiratory distress resulting from pneumothorax and subcutaneous emphysema just after tracheal intubation. The tension pneumothorax was noticed on chest X-ray. This complication was the result of undesirable alveolar ventilation with high fresh gas flow by accidental using of oxygen flush valve. With the prompt decision of diagnosis of tension pneumothorax and aggresive treatment, the patient recovered uneventfully and discharged 7 days later.
Anesthesia ; Anesthesia, General ; Atmospheric Pressure ; Child ; Child, Preschool ; Diagnosis ; Gases ; Hand ; Humans ; Intubation ; Lacerations ; Lung ; Oxygen ; Pneumothorax* ; Respiration, Artificial ; Rupture ; Subcutaneous Emphysema ; Thorax ; Ventilation

BACKGROUND: Tracheal extubation, as well as intubation, causes hypertension and tachycardia. The aim of this study was to compare the effect of verapamil, lidocaine to lidocaine-verapamil combination in attenuating the cardiovascular changes following tracheal extubation and emergence from anesthesia. METHODS: Eighty patients (ASA physical status 1) were randomly assigned to one of four groups (n=20 each) ; saline (control), 1 mg/kg lidocaine, 0.05 mg/kg verapamil and lidocaine-verapamil combination. These medication were given intravenously 2 min before tracheal extubation. Changes in blood pressure and heart rate were measured following tracheal extubation. RESULTS: Lidocaine, verapamil and their combination all attenuated the changes of heart rate and blood pressure. The inhibitory effect on changes of heart rate and blood pressure were miximum in group of the combination of lidocaine and verapamil. CONCLUSION: We conclude that the verapamil 0.05 mg/kg and lidocaine 1 mg/kg given iv concomitantly 2 min before tracheal extubation is a more effective prophylaxis than verapamil or lidocaine for attenuating the cardiovascular changes associated with tracheal extubation.
Airway Extubation* ; Anesthesia ; Blood Pressure* ; Heart Rate* ; Heart* ; Humans ; Hypertension ; Intubation ; Lidocaine* ; Tachycardia ; Verapamil*

Congentally corrected transposition of the great vessels can best be defined as a malformation in which the aorta and pulmonary artery are transposed in relation to each other but in which the flow of blood is in the physiologic direction. And in addition to the malposition of great vessels, there is an inversion of the ventrice,. Unfortunately this basic malformation seldom exists withot complicating cardiovascular anomalies. We had experienced a case of congenitally corrected transposition of the great vessels associated with itral?insufficiency in 13year-old boy, who presented the most above mentioned findings. We have made diagnosis by cardiac catheterization and selective angiocardiographic study.
Aorta ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Humans ; Male ; Pulmonary Artery ; Transposition of Great Vessels*

Pulmonary thromboembolism is a leading cause of morbidity and mortality. Many patients dying of pulmonary thromboembolism have serious underlying illness such as cancer and congestive heart failure. Cancer patients are prone to both thrombotic and tumor embolism. In cancer patients, tumor pulmonary embolism and thrombotic pulmonary embolism can be associated with dyspnea, cor pulmonale and pulmonary hypertension. We presented a female patient of 63 year-old age of a hepatoma with inferior vena cava thrombosis. She had been transferred to the intensive care umt in state of refractory hypoxemia with 100% oxygen inhalation. Perfusion scan showed 60.71% defect in right lung and 39.28% defect in left lower lung field. Heparin infusion was done with the impression of pulmoary embolism without effect. Initial hemodynamic data with insertion of pulmonary ery catheter showed that cardiac index, 1.62 L/minute/M2, right atrial pressure, 28 mmHg, pulmonary capillary wedge pressure 14 mmHg. Cardiac index did not increase in spite of dobutamine and dopamine infusion. Right atrial pressure increased to 29 mmHg but pulmonary capillary wedge pressure was 11 mmHg with fluid administration. Echocardiogram revealed that mass, 7X8 cm of size, was in right heart in connection to inferior vena cava thrombus. Tumor embolism from hepatoma would be suspected in our patient, but we did not confirm that case with the biopsy or autopsy. Echocardiography with pulmoary artery catheter insertion would be helpful to diagnose the disease which was suspected of pulmonary embolism and tumor embolism in cancer patient.
Anoxia ; Arteries ; Atrial Pressure ; Autopsy ; Biopsy ; Carcinoma, Hepatocellular* ; Catheters ; Dobutamine ; Dopamine ; Dyspnea ; Echocardiography ; Embolism ; Female ; Heart Failure ; Heart* ; Hemodynamics ; Heparin ; Humans ; Hypertension, Pulmonary ; Inhalation ; Critical Care ; Lung ; Middle Aged ; Mortality ; Neoplastic Cells, Circulating* ; Oxygen ; Perfusion ; Pulmonary Embolism ; Pulmonary Heart Disease ; Pulmonary Wedge Pressure ; Thrombosis* ; Vena Cava, Inferior*

BACKGROUND: Experience of wakefulness and pain perception during general anesthesia can be distressful to patients. For cesarean section, a light plane of general anesthesia is chosen for fetal safety and rapid recovery; there is an increased incidence of maternal wakefulness. Propofol may be the choice if smooth induction and rapid maternal recovery are desired. We compared propofol with thiopental sodium as an induction agent of anesthesia in cesarean section, noting in particular the patients wakefulness during operation. METHODS: Twenty six patients who underwent cesarean section received either thiopental sodium 4 mg/kg (n=13) or propofol 2.5 mg/kg (n=13) as an induction agent. To assess intraoperative wakefulness, a tourniquet was applied before the administration of succinylcholine for maintaining motor function in one arm. Wakefulness during anesthesia could be assessed by asking the patient to move her hand. RESULTS: Although the changes in blood pressure and heart rate were similar in both groups, the propofol group had a less increasing systolic blood pressure from the period immediately and 1 minute after intubation (P<0.05). The patients administered with propofol showed significantly higher incidences of "followed commands" and "made reaching movements" (P<0.05). The incidence of dreams was higher in the propofol group than thiopental sodium group. CONCLUSIONS: Propofol was similar to thiopental sodium in hemodynamic effects on mother, but incidence of intraoperative wakefulness was significantly increased in the propofol groups.
Anesthesia ; Anesthesia, General ; Anesthetics ; Arm ; Blood Pressure ; Cesarean Section* ; Dreams ; Female ; Hand ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Intubation ; Memory ; Mothers ; Pain Perception ; Pregnancy ; Propofol* ; Succinylcholine ; Thiopental* ; Tourniquets ; Wakefulness*