Percutaneous cannulatien has become an accepted technique for monitoring central venous pressure and pulmonary wedge pressure via a Swan Gans catheter. The technique is not without hazard. Complications include thrombophlebitis, infection and hydrothorax. These are case reports demonstrating the complications of hydrothorax and broken catehters from central venous catheterization.
Catheterization, Central Venous* ; Catheters* ; Central Venous Catheters* ; Central Venous Pressure ; Hydrothorax* ; Pulmonary Wedge Pressure ; Thrombophlebitis

BACKGROUND: Propofol and ketamine had been used for anesthesia induction and for total intravenous anesthesia. The nature of any hypnotic interactions occurring between propofol and ketamine are unknown. A comparison of maternal and neonatal effects among propofol-ketamine combination, ketamine and propofol were studied when used for anesthesia induction in Cesarean section. METHODS: Forty five patients in ASA class I or II scheduled for Cesarean section randomly assigned to either propofol 2 mg/kg (n=15), ketamine 1 mg/kg (n=15) or propofol 1 mg/kg - ketamine 0.5 mg/kg combination group (n=15) as an induction agent. Maternal systolic and diastolic blood pressure, heart rate, Apgar score and umbilical blood gas analysis were measured. RESULTS: Before intubation, systolic and diastolic pressure were decreased in propofol group but increased in ketamine and propofol-ketamine combination group. Heart rate were increased in all three groups. But there were no significant differences among three groups (p<0.05). After intubation, there were significant increase in systolic, diastolic pressure and heart rate in three groups but no significant differences among three groups (p<0.05). And there was no significant neonatal depression as assessed by Apgar scores and blood gas analyses. CONCLUSIONS: Propofol-ketamine combination was found to be similar to propofol or ketamine only in the effects on the mother and neonate. But propofol-ketamine gained more stable hemodynamic change than propofol or ketamine before intubation. Therefore propofol-ketamine appears to be a suitable alternatives to propofol or ketamine as an induction agent for anesthesia in Cesarean section.
Anesthesia ; Anesthesia, Intravenous ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section* ; Depression ; Female ; Heart Rate ; Hemodynamics ; Humans ; Infant, Newborn ; Intubation ; Ketamine* ; Mothers ; Pregnancy ; Propofol*

BACKGROUND: This study was designed to determine the efficacy of a combined use of oral clonidine and intravenous esmolol for blunting the sympathetic response during tracheal intubation. METHODS: Forty-eight patients for hysterectomy were randomly divided into four groups: placebo A and B in Group I (n = 12), placebo A and esmolol (1.0 mg/kg) in Group II (n = 12), clonidine (4 microgram/kg) and placebo B in Group III (n = 12), and clonidine (2 microgram/kg) and esmolol (0.5 mg/kg) in Group IV (n = 12) were administered respectively. Premedication with oral clonidine or placebo A at 90 minutes before induction and intravenous esmolol or placebo B just prior to induction were given. Patients were induced with thiopental and ventilated with N2O-O2-enflurane (1.5 vol%). Vecuronium was given immediately after administration of thiopental for tracheal intubation. BP and HR were recorded at the resting state before premedication (control), at 1 min before induction (T - 1), immediately after intubation (T + 0), 3 min and 5 min after intubation (T + 3 and T + 5), and were converted into a percentage (%) of the control value (Vcontrol). RESULTS: SBP increased in Group I (T + 0 and T + 3) and decreased in Group III (T + 5) compared with Vcontrol (P < 0.05). HR increased in Group I (T + 0 and T + 3) and Group III (T + 0) compared with Vcontrol (P < 0.05). SBP% of Vcontrol in Groups II, III and IV (T + 0 and T + 3) were lower than that of Group I (P < 0.05). HR% of Vcontrol in Group II and IV (T + 0, T + 3 and T + 5) were lower than those of Groups I and III (P < 0.05). There were one episode of hypotension in Group II at 5 min after intubation and two cases of intraoperative hypotension in Group III. CONCLUSIONS: Combined administration of oral clonidine and intravenous esmolol was effective in attenuating the increase of BP and HR during tracheal intubation without any side effects. This combined method would be an effective method when dose-related side effects of each drug limit their use.
Blood Pressure* ; Clonidine* ; Heart Rate* ; Heart* ; Humans ; Hypotension ; Hysterectomy ; Intubation* ; Premedication ; Thiopental ; Vecuronium Bromide

Arytenoid subluxation or recurrent laryngeal nerve paralysis may result from injury to the larynx following endotracheal intubation or blunt laryngeal trauma. Early diagnosis is important for appropriate treatment and better prognosis. A 62-years-old man was admitted for cholecystectomy. He was intubated without any difficulty and nasogastric tube was inserted with the help of laryngoscope and Magill forcep before surgery. He had a weak voice and hoarseness after atraumatic extubation and those symptoms did not improve even 2 days after. Indirect laryngoscopy, videolaryngotelescopy, electromyography(EMG) and computed tomographic findings revealed anterior, inferior subluxation of left cricoarytenoid cartilage associated with left thyroarytenoid muscle denervation and resultant unilateral vocal cord palsy. Conservative treatment for 40 days after the operation and follow-up examination was done. The voice quality was improved and indirect laryngoscopy examination showed that right vocal cord crossed midline in a attempt to meet its paralyzed counterpart on phonation.
Anesthesia, General* ; Cartilage ; Cholecystectomy ; Denervation ; Early Diagnosis ; Follow-Up Studies ; Hoarseness ; Intubation, Intratracheal ; Laryngeal Muscles ; Laryngoscopes ; Laryngoscopy ; Larynx ; Paralysis* ; Phonation ; Prognosis ; Recurrent Laryngeal Nerve* ; Surgical Instruments ; Vocal Cord Paralysis ; Vocal Cords ; Voice ; Voice Quality

BACKGROUND: Several dermatomes around the skin wound may need to be bldegrees Cked in order to provide pain relief with intercostal bldegrees Ckade after thoracotomy and chest tube insertion. METHODS: Twenty patients who had undergone elective thoracotomy were selected to provide continuous intercostal nerve bldegrees Ck by an extrapleural approach. Before the thoracic cavity was closed, appropriate spaces between parietal pleura and intercostal muscle were made with surgical dilators under direct vision. An epidural catheter was introduced cephalad with the distal end uppermost and in a caudal direction making a U-turn lowermost in the spaces. Bupivacaine 0.25%, with 1 : 200,000 epinephrine was injected in a 10 ml dose about 20 minutes before the end of anesthesia, and infused at a rate of 0.88 mg/kg/hour for 1 hour, 0.35 mg/kg/hour for 23 hours and 0.3 mg/kg/hour for the second day postoperatively. RESULTS: The degree of analgesia with coughing and deep breathing was satisfied with patients and thoracic surgeons. Average numbers of analgesic dermatomes obtained by pinprick test, VAS and Prince Henry pain score were 5.6+/-0.3, 1.8+/-0.3 cm and 1.6+/-0.3 respectively. Changes in mean arterial pressure showed insignificantly and heart rate increased at the postoperative hour of 1 and 4(P value<0.05). FVC and FEV1 were restored up to 71 and 75% of preoperative value at the postoperative hour of 48. CONCLUSIONS: These results suggest that continuous intercostal nerve bldegrees Ck through the extrapleural approach was effective and clinically useful for pain relief following thoracotomy.
Analgesia ; Anesthesia ; Arterial Pressure ; Bupivacaine ; Catheters ; Chest Tubes ; Cough ; Epinephrine ; Heart Rate ; Humans ; Intercostal Muscles ; Intercostal Nerves* ; Pain Management* ; Pleura ; Respiration ; Skin ; Thoracic Cavity ; Thoracotomy* ; Wounds and Injuries

Forty eight female Sprague-Dawley rats received a subcutaneous implant containing 12.5 mg estradiol ant the age of 3 weeks. Three rats were killed in 1, 2, 3, 4, 6 weeks and in every month during 2~12 months after implantation, and the breasts were examined by light microscope. In all rats, enlargement of terminal end buds was obseved in 1~2 weeks, maximum development of hyperplastic alveolar nodules in 3 weeks, and marked dilatation and secretion of alveoli or ducts in 1~12 months after implantation. Ductal epithelial hyperplasia was observed in 27 rats and carcinomas developed in 23 rats in 2~12 months after implantation. It was thought that the changes induced by estradiol are more similar to the human breast lesions, compared with changes induced by chemical carcinogens such as dimethylbenzanthracene(DMBA), because breast carcinomas developed in close relationship with ductal epithelial hyperplasia in both estradiol-treated rats and humans, but not in DMBA-treated rats.
Female ; Humans ; Rats ; Animals ; Carcinogens

The internal jugular and subclavian veins are considered as satisfactory intravenous routes for rapid blood and fluid replacement. To determine whether these venous pressures can be used as reliable guides for central venous pressure monitoring, simultaneous measurements of the Rt. internal jugular venous pressure and central venous pressure (CVP), or Rt. subclavian venous pressure and CVP using long 14 gauge catheter were made in 20 patients undergoing cardiac anesthesia. The results were as follows: l. Each mean value of the Rt. internal jugular venous pressure and CVP was 10.64+/-5.43 cm H2O and 10.05+/-5.55cm H2O (Mean+/-SD) respectively in first 10 patients. Pressure difference was 0.59+/-0.39cm H2O (p<0.005). 2. Each mean value of the Rt. subclavian venous pressure and VP was 7.77+/-3.37 cm H 0 and 7.05+/-3.49cm H2O (Mean+/-SD) respectively in second 10 patients. Pressure difference was 0.73+/-0.59cm H2O (p<0.005). 3. There were significant correlations between Rt. internal jugular venous pressure and CVP (r=0. 99, p<0.005) as well as between Rt. subclavian venous pressure and CVP (r=0.98, p<0.005). The results suggest that Rt. internal jugular or subclavian vein catheterized with short intravenous catheter during Anesthesia can be used as effective and reliable guides for CVP monitoring because pressure differences with CVP were small and consistant.
Anesthesia ; Catheters ; Central Venous Pressure* ; Humans ; Subclavian Vein ; Venous Pressure

BACKGROUND: Sufficient accumulations of local anesthetics in the extrapleural space promotes effective access to several intercostal nerves and, consequently, analgesia. The total volume of leakage of these anesthetics from the space can depend on the technique of extrapleural catheter insertion which is chosen. METHODS: Twenty patients due for thoracotomy were randomly selected to be provided with postoperative pain relief by an extrapleural approach. Before the thoracic cavity was closed, appropriate spaces between parietal pleura and intercostal muscle were made with surgical dilators under direct vision. An epidural catheter was introduced at a longitudinal lie in a cephalad direction, before the thoracic cavity was closed. Bupivacaine 0.25%, with 1 : 200,000 epinephrine was injected in a 10 ml dose about 20 minutes before the end of anesthesia, and infused at a rate of 0.88 mg/kg/hour for 1 hour, 0.35 mg/kg/hour for 23 hours and 0.3 mg/kg/hour for the second day postoperatively. RESULTS: The degree of analgesia with coughing and deep breathing was satisfactory to patients and thoracic surgeons. The average numbers of analgesic dermatomes obtained by pinprick tests, VAS, and Prince Henry pain scores were 5.2 0.5, 2.0 0.5 cm and 1.6 0.6, respectively. Changes in mean arterial pressure were insignificant, and heart rate increased at the postoperative hours of 1, 4 and 8 (P value < 0.05). FVC and FEV1 were restored to levels up to 67.2 and 71.0% of their preoperative values at the postoperative hour of 48. CONCLUSIONS: These results suggest that the technique of a catheter introduced at a longitudinal lie in a cephalad direction was effective and clinically useful for pain relief following thoracotomy regardless of some leakage of bupivacaine.
Analgesia ; Anesthesia ; Anesthetics ; Anesthetics, Local ; Arterial Pressure ; Bupivacaine ; Catheters* ; Cough ; Epinephrine ; Heart Rate ; Humans ; Intercostal Muscles ; Intercostal Nerves ; Pain Management* ; Pain, Postoperative ; Pleura ; Respiration ; Thoracic Cavity ; Thoracotomy*

BACKGROUND: Sufficient accumulations of local anesthetics in the extrapleural space promotes effective access to several intercostal nerves and, consequently, analgesia. The total volume of leakage of these anesthetics from the space can depend on the technique of extrapleural catheter insertion which is chosen. METHODS: Twenty patients due for thoracotomy were randomly selected to be provided with postoperative pain relief by an extrapleural approach. Before the thoracic cavity was closed, appropriate spaces between parietal pleura and intercostal muscle were made with surgical dilators under direct vision. An epidural catheter was introduced at a longitudinal lie in a cephalad direction, before the thoracic cavity was closed. Bupivacaine 0.25%, with 1 : 200,000 epinephrine was injected in a 10 ml dose about 20 minutes before the end of anesthesia, and infused at a rate of 0.88 mg/kg/hour for 1 hour, 0.35 mg/kg/hour for 23 hours and 0.3 mg/kg/hour for the second day postoperatively. RESULTS: The degree of analgesia with coughing and deep breathing was satisfactory to patients and thoracic surgeons. The average numbers of analgesic dermatomes obtained by pinprick tests, VAS, and Prince Henry pain scores were 5.2 0.5, 2.0 0.5 cm and 1.6 0.6, respectively. Changes in mean arterial pressure were insignificant, and heart rate increased at the postoperative hours of 1, 4 and 8 (P value < 0.05). FVC and FEV1 were restored to levels up to 67.2 and 71.0% of their preoperative values at the postoperative hour of 48. CONCLUSIONS: These results suggest that the technique of a catheter introduced at a longitudinal lie in a cephalad direction was effective and clinically useful for pain relief following thoracotomy regardless of some leakage of bupivacaine.
Analgesia ; Anesthesia ; Anesthetics ; Anesthetics, Local ; Arterial Pressure ; Bupivacaine ; Catheters* ; Cough ; Epinephrine ; Heart Rate ; Humans ; Intercostal Muscles ; Intercostal Nerves ; Pain Management* ; Pain, Postoperative ; Pleura ; Respiration ; Thoracic Cavity ; Thoracotomy*

Several growth factors and polypeptides are not commonly yet used for regenerators of bone tissue or alveolar bone because of the insufficiency of studies on their side effects, genetic engineering for mass production and stability for clinical application. Recently, many herbal medicines, which have advantage of less side effects and possibility of long-term use, have been studied for their capacity and effects of anti-bacterial, anti-inflammatory and regenerative potential of periodontal tissues. Morindae Radix, Cibotium Barometz (L.), Albizziae Cortex, Cistandhis Herba have been traditionally used as medicines for treatment of bone disease in Eastern medicine. The objective of the present study is to examine the ability of alkaline phosphatase (ALP) activity of human fetal osteoblast (hFOB1) when several natural medicines were supplemented. hFOB1 were cultured with Dulbecuo's Modified Eagle's Medium Nutrient Mixture F-12 HAM ( DMEM/F-12 1:1 Mixture, Sigma, USA) and negative control, dexamethasone (positive control), and each natural medicines for 3 days. And then ALP activity was measured by spectrophotometer for enzyme activity and Alizarin red S staining for morphometry. Among the natural medicines of this study, Morindae Radix, Cibotium Barometz (L.) and Cistanchis Herba induced higher activity of ALP synthesis than negative controls in all experimental group. Albizziae Cortex showed mild increases than negative control group. According to measurement of positively stained area, all of the natural medicines of this study increased compared to negative control. Especially, Cibotium Barometz (L.) and Cistanchis Herba showed statistical significance compared to negative control (p<0.05). These results indicate that Morindae Radix, Cibotium Barometz (L.), Albizziae Cortex, Cistandhis Herba have an inducing ability of ALP synthesis on osteoblast.
Albizzia ; Alkaline Phosphatase* ; Bone and Bones ; Bone Diseases ; Dexamethasone ; Genetic Engineering ; Humans* ; Intercellular Signaling Peptides and Proteins ; Morinda ; Osteoblasts* ; Peptides