OBJECTIVE: Vascular endothelial growth factor(VEGF)-C is involved in lymphangiogenesis and spreading of cancer cells via lymphatic vessels. The aim of the present study is to investigate the relationship between the absence of cerebral lymphatic vessels and low metastatic rate of brain tumors. METHODS: Immunohistochemical stains were performed for VEGF-C and VEGF in surgically resected specimens from 57 patients with primary(38 cases, low grade : 10 cases, high grade : 28 cases) and metastatic(19 cases) brain tumor. RESULTS: The expression of VEGF-C was higher in metastatic carcinoma(68%) than in high-grade primary tumor(29%). There was no difference for VEGF expression between high grade brain tumor (71%) and metastatic carcinoma(58%). CONCLUSION: Low VEGF-C expression of primary brain tumors may play a role in low metastatic rate of brain tumors.
Brain Neoplasms* ; Brain* ; Coloring Agents ; Humans ; Lymphangiogenesis ; Lymphatic Vessels ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factor C*

The surgeries based on the outpstient department have increased recently. One of the indications of outpatient surgery is chemical peeling of the face that usually re- quires only deep sedation of short duration. The purpose of this study was to evaluate the effeets of ketamine and midszolam for out patient facial chemical peeling. Fifty-nine unpremedicated patients undergoing chemical peeling of the face were anesthetized with bolus intravenous injection of 1mg/kg of ketamine and 0.1 mg/kg of midazolam. Additional dose of ketamine(10-20mg) was given as needed. During operation, we observed systolic and diastolic blood pressure with noninvasive blood pressure monitor and peripheral oxygen saturation(SpO2) with pulse oximeter. All patients were allowed to breathe spontane- ously without ventilatory support during the operation. There was no case of airway ob- struction and SpO2 value was over 97% in most cases. The systolic and diastolic blood pressure and pulse rate were increased after the injection of ketamine and midazolam. And we observed the untoward effect of anesthetics such as the purposeless movement(6.8%), involuntary phonation(3.4%), skin rash(3.4%) and headache(1.7%). In postoperative analysis about the recall, bad dream, mood, and the degree of satisfaction of this type of anesthesia, the rate of patient's positive acceptance was high(86.4%) and the reeovery time was 58min. We conclude that combination of intravenous ketamine and midszolam can produce satisfactory anesthesia with few complications for outpatient chemical peeling surgery of the face.
Ambulatory Surgical Procedures ; Anesthesia* ; Anesthetics ; Blood Pressure ; Blood Pressure Monitors ; Deep Sedation ; Dreams ; Heart Rate ; Humans ; Injections, Intravenous ; Ketamine* ; Midazolam* ; Outpatients* ; Oxygen ; Skin

Dextran 40, a polysaccharide with molecular weight of 40,000, has been used clinically for expansion of plasma volume, improvement of microcirculation in low flow states and thromboprophylaxis especially in major operation such as vascular and hip surgery. However severe anaphylactoid reaction to dextran 40 can occur rarely. We experienced a case of cardisc arrest due to a severe reaction of dextran 40 in a patient who underwent aortofemoral bypass surgery. The patient was resuscitated immediately and followed up carefully.
Dextrans* ; Heart Arrest ; Hip ; Humans ; Microcirculation ; Molecular Weight ; Plasma Volume

An anesthesiologist should keep in mind the various risk factors during anesthetic man- agement of geriatric patients. Unlike young patients, elderly patients may manifest more than one pathophysiologic process associsted with progressive degenerative changes in various organs. The successful anesthetic management requires detailed information about the cause and severity of the underlying disease, thorough understanding of geriatric specific hemodynamic particularities, and more careful monitoring by experienced personnel. We experienced a case of profound hypotension during general anesthesia for vaginal hysterectomy in a 67 year-old female patient. Anesthesia was induced with thiopental-vecuronium and was maintained with nitrous oxide, oxygen and enflurane. One hundred and five minutes after the induction, profound hypotension and bradycardia with S-T segment depression developed without specific events and were corrected by vigorous therapeutic managements. She discharged from the hospital on 7th postoperative day without complications.
Aged ; Anesthesia ; Anesthesia, General ; Bradycardia ; Depression ; Enflurane ; Female ; Geriatrics ; Hemodynamics ; Humans ; Hypotension* ; Hysterectomy, Vaginal* ; Nitrous Oxide ; Oxygen ; Risk Factors

Dextran 40, a polysaccharide with molecular weight of 40,000, has been used clinically for expansion of plasma volume, improvement of microcirculation in low flow states and thromboprophylaxis especially in major operation such as vascular and hip surgery. However severe anaphylactoid reaction to dextran 40 can occur rarely. We experienced a case of cardisc arrest due to a severe reaction of dextran 40 in a patient who underwent aortofemoral bypass surgery. The patient was resuscitated immediately and followed up carefully.
Dextrans* ; Heart Arrest ; Hip ; Humans ; Microcirculation ; Molecular Weight ; Plasma Volume

An anesthesiologist should keep in mind the various risk factors during anesthetic man- agement of geriatric patients. Unlike young patients, elderly patients may manifest more than one pathophysiologic process associsted with progressive degenerative changes in various organs. The successful anesthetic management requires detailed information about the cause and severity of the underlying disease, thorough understanding of geriatric specific hemodynamic particularities, and more careful monitoring by experienced personnel. We experienced a case of profound hypotension during general anesthesia for vaginal hysterectomy in a 67 year-old female patient. Anesthesia was induced with thiopental-vecuronium and was maintained with nitrous oxide, oxygen and enflurane. One hundred and five minutes after the induction, profound hypotension and bradycardia with S-T segment depression developed without specific events and were corrected by vigorous therapeutic managements. She discharged from the hospital on 7th postoperative day without complications.
Aged ; Anesthesia ; Anesthesia, General ; Bradycardia ; Depression ; Enflurane ; Female ; Geriatrics ; Hemodynamics ; Humans ; Hypotension* ; Hysterectomy, Vaginal* ; Nitrous Oxide ; Oxygen ; Risk Factors

We experienced a case of postoperative quadriparesis secondary to operative position in a patient with pre-existing, asymtomatic,cervical neurilemmoma. The patient was admitted with chronic otitis media for mastoidectomy on right side. There was no specific event throughout operation and anesthesia but developed quadriparesis one hour after arrival on ward. With magnetic resonance imaging, the patient was dignosed to have cervical neurilemmoma. On seventh postoperative day the patient had second operation,cervical laminectomy and tumor removal. Ten days after second operation he was discharged without any complication. Eight months later he had mastoidectomy on the left side and was discharged without any sequale.
Anesthesia ; Anesthesia, General* ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Neurilemmoma ; Otitis Media ; Quadriplegia*

The most important factor in clinical development of respiratory care has been the clinical availabiTity of blood gas and pH measurement and it is important to get the accurate values of those. There can be an error to get the value of PCO2, PO2 and pH by dilutional effect of liquid-Naheparin that is usally used as an anticoagulant. We compared values of 20 arterial blood gases sampled with 1 cc plastic syringe utilizing liquid-Na-heparin with those ones sampled with 1 cc arterial blood gas kits which were pre-filled with dry-Lithium-heparin. The results were as follows; 1) There are no difference in values of PO2 and pH between two groups. 2) The value of PCO2 sampled with 1 cc plastic syringe utilizing liquid-Na-heparin is 1.62 torr less than the value of that with 1 cc arterial blood gas kits which were pre-filled with dry-Lithium-heparin (p<0.05).
Blood Gas Analysis* ; Gases ; Hydrogen-Ion Concentration ; Plastics ; Syringes*

BACKGROUND: Sometimes hypoxemia occurs in the postoperative recovery room because of postoperative residual curarization (PORC). Some reports show that postoperative residual curarization is common. PORC occurs after the use of the long-acting muscle relaxants. It has been recommended to use intermediate-acting muscle relaxants and a TOF monitor to decrease PORC. The purpose of this study was to examine whether the use of the TOF monitor during propofol anesthesia affects the incidence of postoperative residual curarization. METHODS: 38 ASA I or II patients were divided randomly into two groups of 19 each. They received propofol-fentanyl-nitrous oxide for anesthesia. Pancuronium (80 100 microgram/kg) was used to facilitate tracheal intubation and additional doses were used to maintain surgical relaxation. The requirement for incremental doses of pancuronium and adequacy of recovery following reversal were assessed, either with (control group:n = 19) or without (experimental group:n = 19) TOF monitoring. Fifteen minutes after the arrival at the recovery room, neuromuscular function was assessed clinically and by using TOF. RESULTS: There were no statistical differences in body weight, age, or duration of operation between the two groups. There was no statistical difference in the total dose of pancuronium and total dose of pancuronium relative to body weight and duration of operation. There were statistical differences in TOF ratio in the recovery room (0.73 vs. 0.86). The incidence of PORC was 47% in the control group and 5% in the experimental group. CONCLUSIONS: Though the monitoring of TOF did not effect the dose of muscle relaxant, it may have reduced the incidence of PORC. However, the PORC had no clinical significance because the mean TOF ratio in the two groups was over 0.7 and there were no clinical signs of residual muscle weakness.
Anesthesia* ; Anoxia ; Body Weight ; Humans ; Incidence ; Intubation ; Muscle Weakness ; Pancuronium ; Propofol* ; Recovery Room ; Relaxation

A 36-year-old woman (para 1-0-2-1) was transferred to Korea University Hospital at 38 weeks gestation for dyspnea and chest pain. On admission, her blood pressure ranged from 130/ 70 to 230/130 mmHg, the heart rate was 144 beats/min and respiratory rate was 36/min. The ECG pattern, serum creatinine phosphokinase and lactic dehydrogenase levels were consistent with acute myocardial infarction. The baby was delivered by cesarean section under general anesthesia with nitroglycerin and propranolol support, After delivery, the patient was diagnosed as having pheochromocytoma by hormone study, abdominal magnetic resonance imaging, and computerized tomography scan. Removal of tumor was suceessfully done under combined general and epidural anesthesia after preoperative preparation with phenoxybenzamine and propranolol for two weeks. Postanesthetic recovery was uneventful.
Adult ; Anesthesia, Epidural ; Anesthesia, General ; Blood Pressure ; Cesarean Section ; Chest Pain ; Creatinine ; Dyspnea ; Electrocardiography ; Female ; Heart Rate ; Humans ; Korea ; Magnetic Resonance Imaging ; Myocardial Infarction* ; Nitroglycerin ; Oxidoreductases ; Phenoxybenzamine ; Pheochromocytoma* ; Pregnancy ; Pregnant Women* ; Propranolol ; Respiratory Rate