No abstract available.
Breast* ; Humans*

The sieving coefficient(S) representing convective transport of glucose during peritoneal dialysis(PD) with glucose containing dialysis solution has been reported to be anomalous, lower than 0 or higher than 1. During peritoneal dialysis using glucose containing dialysis solution, diffusive transport of glucose is from dialysate to blood, and convective transport in the opposite direction i.e., from blood to dialysate. Glucose intolerance and hyperinsulinemia are well known adverse effects of PD using glucose containing dialysis solutions. Insulin is required for glucose transport from extracelluar fluid to intracelluar fluid in adipocytes and muscell cells. Hyperinsulinemia in PD may alter peritoneal glucose transport. If extra to intracellular glucose transport mediated by insulin is involved in the peritoneal glucose transport during PD with conventional glucose containing dialysis solutions, the diffusive and convective transport characteristics for glucose calculated using membrane model between two well-mixed compartments may not represent true values. S can be calculated best when diffusion is minimized. Male Sprague-Dawley rats were used. To minimize the diffusive transport the glucose isochratic solutions containing approximately the same concentration as in serum were used. To maximize ultrafiltration 3.86% mannitol was used as an osmotic agent. To evaluate the effect of insulin on glucose transport two different glucose concentrations, 100mg/dl(NI) and 300mg/dl(HI), were used. During the dialysis with HI solution glucose clamp technique was performed to keep blood glucose level approximately 300mg/dl. A 2 hour peritoneal dialysis was performed in 13 rats(7 Nl and 6 Hl). Serum and dialysate insulin levels were measured in 3rats in Nl, 2 rats in Hl, and 4 rats without dialysis(NC). Intraperitoneal volume(VD) was calculated using volume marker, RISA, dilution method. The diffusive mass transport coefficient(KBD) and S for urea and glucose were calculated using the modified Babb- Randerson-Farrell model. D/P glucose in Nl was 0.61+/-0.05 due to high blood glucose level 187.2+/-17.9mg/dl vs. 114.3+/-7.6 mg/dl in dialysate and 0.99+/-0.26 in Hl(360.6+/-55.6mg/dl in blood vs. 345.0+/-55.6mg/dl in dialysate). VD did not differ between the two groups. KBD for urea and glucose, and S for urea did not differ between the two groups. S for glucose in Hl was negative value and significantly lower than that in Nl(-0.903+/-0.960 vs. 1.036+/-0.137, P<0.001). Plasma insulin level was significantly higher in Hl compared with values in Nl and NC. Dialysate insulin level was similar in Nl and Hl. Dialysate insulin level in Nl was higher than plasma insulin level. The present result that S for glucose at hyperinsulinemic condition was anomalous indicates that not only simple passive transport but also other transport mechanisms mediated by insulin such as glucose influx into cells may be involved in peritoneal glucose transport. The finding of dialysate insulin level higher than plasma concentration in Nl may suggest direct leakage of insulin from pancreas or portal vein into the peritoneal cavity.
Adipocytes ; Animals ; Blood Glucose ; Dialysis ; Dialysis Solutions ; Diffusion ; Glucose Clamp Technique ; Glucose Intolerance ; Glucose* ; Humans ; Hyperinsulinism ; Insulin ; Male ; Mannitol ; Membranes ; Pancreas ; Peritoneal Cavity ; Peritoneal Dialysis* ; Plasma ; Portal Vein ; Rats ; Rats, Sprague-Dawley ; Ultrafiltration ; Urea

BACKGROUND: Conventional pelviscopic surgery requires pneumoperitoneum with CO2 gas insufflation and lithotomy-Trendelenburg position. Pneumoperitoneum and Trendelenburg position may influence intraoperative respiratory mechanics in anesthetic management. This study was conducted to investigate the influence of pneumoperitoneum and Trendelenburg position on respiratory compliance and ventilation pressure. METHODS: Twenty-five patients scheduled for elective gynecologic laparoscopy were evaluated. The patients had no preexisting lung or heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, lidocaine, rocuronium, and sevoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO2 were measured before and after creation of pneumoperitoneum with an intraabdominal pressure of 12 mmHg, then after 10 minutes and 30 minutes in the 20degrees Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was then calculated. RESULTS: Following creation of pneumoperitoneum, there was a significant increase in peak inspiratory pressure (6 cmH2O), plateau pressure (7 cmH2O), and end-tidal CO2 (5 mmHg), while dynamic lung compliance decreased by 12 ml/cmH2O. Overall, the Trendelenburg position induced no significant hemodynamic or pulmonary changes. CONCLUSIONS: The effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters.
Androstanols ; Anesthesia, General ; Compliance ; Head-Down Tilt ; Heart Diseases ; Hemodynamics ; Humans ; Insufflation ; Laparoscopy ; Lidocaine ; Lung ; Lung Compliance ; Methyl Ethers ; Pneumoperitoneum ; Respiratory Mechanics ; Thiopental ; Ventilation

Intracranial subdural hematoma is an exceptionally rare complication of spinal anesthesia. An 88-year-old female patient diagnosed with grade V uterine prolapse with rectocystocele received a vaginal hysterectomy and anteroposterior repair under spinal anesthesia. At 4 days postoperatively, she appeared to have decreased orientation, inappropriate behavior, and right side weakness grade III. Brain MR diffusion and CT revealed a bilateral subdural hematoma. She was improved after burr hole drainage. We report a case of intracranial subdural hematoma developing after spinal anesthesia, a rare complication.
Aged, 80 and over ; Anesthesia, Spinal ; Brain ; Diffusion ; Drainage ; Female ; Hematoma, Subdural ; Hematoma, Subdural, Intracranial ; Humans ; Hysterectomy, Vaginal ; Orientation ; Uterine Prolapse

Sick sinus syndrome (SSS) is an abnormality of sinus nodal impulse formation by intrinsic or extrinsic causes. Patients with SSS often are asymptomatic, or have mild or nonspecific symptoms, including dizziness, palpitations, fatigue, and confusion related to the decreased cardiac output. SSS can rarely cause conditions like syncope, congestive heart failure, thromboembolism, pulmonary edema, cardiac arrest, or sudden death. We report here on a severe bradycardia during general anesthesia for aneurysmal clipping and tachycardia-bradycardia syndrome followed by cardiac arrest postoperatively in the ICU, which was subsequently diagnosed as SSS with 24-hour Holter monitoring.
Anesthesia, General ; Aneurysm ; Bradycardia ; Cardiac Output ; Death, Sudden ; Dizziness ; Edema, Cardiac ; Electrocardiography, Ambulatory ; Fatigue ; Heart Arrest ; Heart Failure ; Humans ; Pulmonary Embolism ; Sick Sinus Syndrome ; Syncope

BACKGROUND: Propofol(2,6 diisopropylphenol) is a potent hypnotic currently formulated as an oil-in-water emulsion. Although previous studies reported decreases in arterial pressures and heart rate, no detailed studies of hemodynamic effects of propofol administration alone are available in Korea. This study is to determine the hemodynamic changes induced by doses of propofol. METHODS: Sixty patients(ASA physical status 1 or 2) were divided randomly into three groups as follows: group I, pmpofol 1.5 mg/kg; group 2, propofol 2.0 mg/kg; group 3, propofol 2.5 mg/kg. Heart rate and mean arterial pressure were measured by Datascope 2200I, and cardiac index(CI) and systemic vascular resistance index(SVRI) were obtained by doppler cardiac output monitor(Datascope Accucom 2) at the suprasternal notch before and after induction of propofol. RESULTS: Statistically significant decreases in mean arterial pressure were observed since 2 min after induction. CI was decreased from 2.94+/-0.51 to 2.35+/-0.57 L/min/m(2) at 6 min after induction of propofol 2.5 mg/kg, and no differences among groups. CI was also decreased in group 1 and 2 but without any significance. SVRI was decreased in all groups but there were no significance, and no differences among groups. CONCLUSIONS: The data suggest that the usual doses of propofol do not significantly cause hemodynamic changes, and a decrease in mean arterial pressure is a result of decreased CI and reduced SVRI.
Anesthetics ; Arterial Pressure ; Cardiac Output ; Heart Rate ; Hemodynamics* ; Korea ; Propofol* ; Vascular Resistance

A pathologic rupture of the flexor pollicis longus tendon secondary to Kienbock disease is extremely rare with only three cases being reported in the literature. We encountered a case of a pathological rupture of the flexor pollicis longus tendon secondary to longstanding Kienbock disease. The treatment included tendon ball insertion after excising the collapsed lunate and a flexor pollicis longus tendon reconstruction with autogenous palmaris longus tendons. Satisfactory results with a restoration of the active motion of the interphalangeal joint of the thumb, maintenance of the preoperative active range of motion of the wrist and markedly reduced pain was achieved after a one year follow up. We describe this case with a review of the relevant literature.
Follow-Up Studies ; Joints ; Osteonecrosis ; Range of Motion, Articular ; Rupture* ; Tendons* ; Thumb ; Wrist

Streptococcal toxic shock syndrome (STSS) is an acute, progressive illness that manifests with fever, hypotension, and accelerated multi-organ failure. It is usually caused by Group A Streptococcus (Streptococcus pyogenes). STSS due to non-group A streptococci is rare, but its incidence has recently increased. We report here on two cases of STSS caused by Group B Streptococcus (Streptococcus agalactiae) and Group G Streptococcus (Streptococcus dysagalactiae).
Fever ; Hypotension ; Incidence ; Shock, Septic ; Streptococcus ; Streptococcus agalactiae

The introduction of muscle relaxants was an epoch-making event in the development of clinical anesthesia and their use has hecame essential to anesthesia practice. Vecuronium, one of the newest muscle relaxants, many advantages; it is .apid acting, non-accumulating, has minimals side reactions and is promptly antagonized by anticholinesterases. However, its pharmacological effect, like other conventional muscle relaxants depends upon the dose and is influenced br many factors including body temperature, blood flow, interaction with other drugs, antibiotics, diuretics and so forth, To obtain a dose-response relationship which is important for clinical use, the effect of the vecuronium in various doses on the neuromuscular block in rabbits was investigated. The results were as follows. 1) In the vecuronium 0.025 mg/kg group, maximal twitch depression was varied between 75 to 92% with a mean value of 84,9%. The spontaneous recovery index was 141.0 seconds (2.35 min). 2) In the vecuranium 7.75 mg/kg group, the mean maximum twitch depression and spontaneous recovery index were 98.4% and 218.6 seconds (3.64 min.) respectively. 3) In the vecuronium 7.1 mg/kg group, maximum twitch depression was 177% and the spontaneous recovery index was markedly prolonged to 627.8 seconds (10.35 min).
Anesthesia ; Anti-Bacterial Agents ; Body Temperature ; Cholinesterase Inhibitors ; Depression ; Diuretics ; Neuromuscular Blockade* ; Rabbits* ; Vecuronium Bromide*

The transport proteins such as thyroxine-binding-globulin (TBG), albumin and transthyretin carry over 99% of circulating thyroid hormones. TBG is a major thyroid hormone transport protein in serum. Although TBG deficiency does not have metabolic consequences, it has diagnostic implications as it can lead to an incorrect interpretation of thyroid function tests. We experienced a case that a man who had an abnormal thyroid function showed unexpectedly low concentrations of serum total thyroxine. We detected the low TBG in his serum and he was diagnosed the TBG deficiency. We report this case along with a review of the related literature.
Carrier Proteins ; Prealbumin ; Thyroid Function Tests ; Thyroid Gland ; Thyroid Hormones ; Thyroxine