The endoscopic variceal ligation(EVL) has been adopted as a new treatment for acute hemorrhage from esophageal varices that ranks the highest mortality rate in upper gastrointestinal tract bleedings. This treatment method has good effects for the urgent treatment and eradication of varices from acute variceal bleeding in repeated sessions. We enrolled 34 patients with an acute or chronic variceal bleeding episode at the time of admission in this study from Apr. 8, 1992 to June. 2, 1994. Among 34 patients, there were 31 males and 3 females, at ages between 45-66(mean: 52 years). The incidence of symptoms on admission was 10 in tarry stool, 9 in hematemesis 8 in ascites, 4 in hepatic encephalopathy and 3 in nonspecific symptoms. Varices were eradicated or reduced to grade I in 30(88.2%) of the 34 patients by 4-25 bands (mean: 10.8 bands) in 1-7 EVL sessions(mean: 3.1 sessions). After EVL, there are complicated by active bleeding in 3 patients, dysphagia in 3 patienta and transient chest discomfort in 5 patients but subsided during 24 hours. These results indicated that EVL is a safe method for treatment of bleeding from esophageal varices.
Ascites ; Deglutition Disorders ; Esophageal and Gastric Varices* ; Female ; Hematemesis ; Hemorrhage* ; Hepatic Encephalopathy ; Humans ; Incidence ; Ligation* ; Male ; Mortality ; Thorax ; Upper Gastrointestinal Tract ; Varicose Veins

No abstract available.
Wound Healing* ; Wounds and Injuries*

This case was an acquired aplastic anemia patient who required a major operation for excision of a mediastinal mass. The authors previewed that the coagulation abnormalities would be developed due to major operation. Thus we decided to monitoring the coagulation function using the thromboelastography during the perioperative period and checked the complete blood count, concommitantly. The total blood volume lost during operation was 1800 ml, so we gave him a transfusion of 10 U's of platelet concentrate, 10 U's of pheretic platelet rich plasma and 5 U's of whole blood. The thromboelastography was a good guide that helped us to avoid excessive treatment of the coagulation abnormalities. We concluded that the thromboelastograhy was a reliable and effective monitoring system at the intraoperative coagulation management.
Anemia, Aplastic* ; Anesthesia, General ; Blood Cell Count ; Blood Platelets ; Blood Volume ; Humans ; Perioperative Period ; Platelet-Rich Plasma ; Thrombelastography

No abstract available.
Fosinopril* ; Humans ; Hypertension*

Pheochromocytoma stems from the chromaffin cell and mostly is located in the adrenal medulla. It is an important cause of secondary hypertension due to correction of hypertension by a resection of the tumor. Because it produces and secretes catecholamine, it bothers anesthesiologists with excessive hypertension, tachycardia and arrhythmia during the anesthetic period. Therefore, anesthetic management is directed to avoid these conditions. We report a case of bilateral pheochromocytoma successfully managed intraoperatively with an infusion of nicardipine and an intermittent esmolol injection.
Adrenal Medulla ; Arrhythmias, Cardiac ; Chromaffin Cells ; Hypertension ; Nicardipine* ; Pheochromocytoma* ; Tachycardia

No abstract available.
Lupus Nephritis*

BACKGROUND: Antibiotics are used prophylactically in surgery to prevent postoperative infection. However, antibiotics administered in large doses can cause a bleeding diathesis as a result of platelet dysfunction. We wondered whether these antibiotics might impair platelet function by interfering with the initial step of platelet activation: the binding of agonists to their specific receptors on the platelet surface. METHODS: In 30 patients (male 18, women 12) undergoing primary elective knee arthroscopic surgery, the whole blood coagulation system was prospectively evaluated before, and 10 and 40 minutes after administration of 1 g of augmentin. All patients who had abnormal preoperative coagulation profiles or who received anticoagulant or antiplatelet, antibiotics therapy within 7 days prior to surgery were precluded. RESULTS: At 10 minutes after augmentin administration 25 of 30 patients had a significant impairment in all phases of whole blood coagulation as monitored by thromboelastography. In contrast, three of 30 patients had a significantly decreased coagulation time. Two of 30 patients had no significant changes of TEG variables. TEG variables were restored toward baseline in fourty minutes after augmentin administration. CONCLUSIONS: Augmentin can cause a significant but transient change in the viscoelastic properties of blood. Coagulation parameters of the TEG should be measured prior to augmentin administration to prevent and prospect a bleeding diathesis as a result of platelet dysfunction.
Amoxicillin-Potassium Clavulanate Combination ; Anti-Bacterial Agents ; Arthroscopy ; Blood Coagulation ; Blood Platelets ; Disease Susceptibility ; Female ; Hemorrhage ; Humans ; Knee ; Platelet Activation ; Prospective Studies ; Thrombelastography*

No abstract available.
Ear, Middle*

Polycystic ovary disease is a heterogenous endocrinopathy with many interacting causal factors. One potential such factor is chronic hyperinsulinemia. multiple, independent lines of evidence suppart the contention that chronic hyperinsulinemia causes ovarian hyperandragenism. This evidence includes: (1) mutations in the insulin receptor gene that cause severe hyperinsulinemia appear to be associated with ovarian hyperandrogenism, (2) insulin stimulates ovarian thecal and sttomal androgen seaetion in vitro, and (3) in some experimental models, manipulation of circulating insulin concentrations results in changes in circulating androgens. Although the association between hyperinsulinemia and hyperandrogenism remains to be fully explained at the molecular level, chronic hyperinsulinemia appears to be an important cause of hyperandrogenism. We have experienced a case of HAIR AN syndrome showing hyperandrogenism, insulin resistance and acanthosis nigricans in infertile patient. So we report this case with a brief review of literatures.
Acanthosis Nigricans ; Androgens ; Female ; Fibrinogen ; Hair* ; Humans ; Hyperandrogenism ; Hyperinsulinism ; Insulin ; Insulin Resistance ; Models, Theoretical ; Ovary ; Receptor, Insulin

PURPOSE: The authors report a case of orbital sarcoidosis without evidence of systemic involvement. CASE SUMMARY: A 33-year-old female had a 1 month history of erythematous eyelid swelling. On physical examination, a firm and non-tender mass was observed diffusely along the upper, lower and medial canthal areas. A computed tomography (CT) scan showed a diffuse mass in the anterior orbit. We performed an incisional biopsy and histopathological examination revealed non-caseating granulomas and no evidence of a foreign body. Acid-fast-bacilli (AFB), methenamine silver and periodic-acid-schiff (PAS) stain showed no evidence of infection and chest radiograph was normal. Polymerase chain reaction (PCR) and interferon gamma secretion test showed no evidence of tuberculosis. Antinuclear antibody (ANA) and antineutrophil cytoplasmic antibody (ANCA) were negative and angiotensin converting enzyme (ACE) was within the normal range. Further systemic evaluations were compatible with a diagnosis of orbital sarcoidosis and oral prednisone was prescribed. Six weeks later, the erythematous eyelid swelling had disappeared and there was no evidence of recurrence to date.
Adult ; Antibodies, Antineutrophil Cytoplasmic ; Antibodies, Antinuclear ; Biopsy ; Diagnosis ; Eyelids ; Female ; Foreign Bodies ; Granuloma ; Humans ; Interferons ; Methenamine ; Orbit* ; Peptidyl-Dipeptidase A ; Physical Examination ; Polymerase Chain Reaction ; Prednisone ; Radiography, Thoracic ; Recurrence ; Reference Values ; Sarcoidosis* ; Tuberculosis