A case of severe aseptic meningitis with communicating hydrocephalus following iotrolan myelography is presented. The patient's condition improved very quickly after corticosteroid therapy. Rapid improvement and absence of pathogenic organisms in the CSF culture strongly favor an aseptic meningitis. This is the first reported case of aseptic meningtis with the secondary development of hydrocephalus caused by iotrolan myelography.
Hydrocephalus* ; Meningitis, Aseptic* ; Myelography*

A case of severe aseptic meningitis with communicating hydrocephalus following iotrolan myelography is presented. The patient's condition improved very quickly after corticosteroid therapy. Rapid improvement and absence of pathogenic organisms in the CSF culture strongly favor an aseptic meningitis. This is the first reported case of aseptic meningtis with the secondary development of hydrocephalus caused by iotrolan myelography.
Hydrocephalus* ; Meningitis, Aseptic* ; Myelography*

Congenital hepatic fibrosis is an inherited, congenital disorder of the liver, and is occasionally associated with cystic disease of the liver and kidney. We present a case of congenital hepatic fibrosis with Caroli's disease. A 21-year-old woman had suffered from an episodic fever with headaches for 3 years. In laboratory examination, the liver function test was within the normal limits. Esophageal varix was noted by an endoscopic examination. Hepatosplenomegaly and multiple dilated bile ducts were seen by abdominal CT scanning. An orthotopic whole liver transplantation was done. The liver was fibrotic and enlarged. Multiple cystically dilated intrahepatic ducts were noted. Microscopically, diffuse portal fibrosis and widening with proliferation of bile ductules were seen. Intrahepatic bile ducts were markedly dilated and tortuous. The liver cell cords were well preserved.
Bile ; Bile Ducts ; Bile Ducts, Intrahepatic ; Caroli Disease* ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Esophageal and Gastric Varices ; Female ; Fever ; Fibrosis* ; Headache ; Humans ; Kidney ; Liver ; Liver Function Tests ; Liver Transplantation ; Tomography, X-Ray Computed ; Young Adult

The leading cause of death after anesthesia and operations is cardiac complications, defined as myocardial infarction, unstable angina, congestive heart failure. We experienced a case of transient chest pain mimicking to myocardial ischemia after total intravenous anesthesia using propofol. The patient was 56 year-old female who underwent metatarsal osteotomy and distal soft tissue procedure. There was no specific abnormality on preoperative laboratory tests. Anesthesia induction and intraoperative course were completely uneventful. Immediately after transfered to the recovery room, the patient revealed transient cyanosis and complained anterior chest pain with tightness after fully awakening. In the study of electrocardiogram, there were ST abnormality in II, III, AVF and then T inversion in II, III, AVL, AVF, V2-6 leads. In the simultaneous study of echocardiogram, there was hypokinetic wall movement in the distal septum area. After treatment of nitroglycerine, the pain was subsided and the patient was discharged without any sequelae.
Anesthesia ; Anesthesia, Intravenous ; Angina, Unstable* ; Cause of Death ; Chest Pain ; Cyanosis ; Electrocardiography ; Female ; Heart Failure ; Humans ; Metatarsal Bones ; Middle Aged ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Orthopedics ; Osteotomy ; Propofol ; Recovery Room*

The duration of the phases of left ventricular systole was measured from simultaneous recordings of the electrocardiogram, phonocardiogram and carotid arterial pulse tracing using a multichannel photographic system with paper speed at 100 mm per second. Observations were made in 81 male and 66 female patients with hypertension and 41 healthy males and 38 healthy females who served as controls. All hypertension patients were classified by change in funduscopic finding, EKG and grade of diastolic pressure. STI were measured in each group and analysed. The resutls were as follows: 1. The normal PEP/LVET was 0.293 in male and 0.303 in female. 2. In male & female hypertensive patients, all STI were significantly difference to that of normal control except QA2. 3. In male hypertensive patients, the degree of EKG, funduscopic change and diastolic pressure were positive relation to the increase of PEP/LVET.
Blood Pressure ; Electrocardiography ; Female ; Humans ; Hypertension* ; Male ; Systole*

OBJECTIVE: This study was performed to evaluate the feasibility, safety, and tolerance of early postoperative oral feeding in gynecologic patients who have underwent intra-abdominal surgery. Thus, we investigated the clinical efficacy of early postoperative oral feeding in gynecologic patients, prospectively. METHODS: From September 1998 to March 1999, we studied 80 gynecologic patients undergoing laparotomy at Department of Obstetrics and Gynecology, Yonsei University College of Medicine, prospectively. After surgery, the patients were grouped into two arms; the first early oral feeding group began a clear liquid diet on the first postoperative day and advanced to regular diet as tolerated. the second control group received nothing by mouth until return of bowel function. RESULTS: Although more patients in the study group developed nausea, the incidence of vomiting and abdominal distension were comparable in both groups. Time to development of bowel sound and flatus were significantly shorter in study group. Postoperative complications including pneumonia, atelectasis, wound complications, and febrile morbidity occurred insignificantly in both group. Postoperative changes in hematologic indices and electrolytes were comparable in both group. CONCLUSION: Early postoperative oral feeding in gynecologic patients undergoing intra-abdominal surgery is safe, well tolerated. We believe that re-evaluation of postoperative surgical care may increase our knowledge and better serve our patients.
Arm ; Diet ; Electrolytes ; Flatulence ; Gynecology ; Humans ; Incidence ; Laparotomy ; Mouth ; Nausea ; Obstetrics ; Pneumonia ; Postoperative Complications ; Prospective Studies ; Pulmonary Atelectasis ; Vomiting ; Wounds and Injuries

BACKGROUND: The afferent and efferent pathways of fentanyl cough response (FCR) and central organization are poorly understood at present. The aim of this study was to investigate the pretreatment effects of morphine, propofol, atropine, and midazolam on FCR. METHOD: The 120 healthy patients were randomly assigned to six equal pretreatment groups. They received 2ug/kg fentanyl rapidly through a peripheral venous catheter. The patients in each group were pretreated before the time necessary for peak plasma levels with different drugs as follows: group 1, no premedication; group 2, morphine 0.05 mg/kg iv; group 3, morphine 0.05 mg/kg iv naloxone 0.01mg/kg iv; group 4, propofol 0.5 mg/kg iv; group 5, atropine 0.01 mg/kg iv; group 6, midazolam 0.05 mg/kg iv. The patients were observed for any coughing or side effects, including oxygen desaturation, bronchoconstriction, chest wall rigidity and seizure. RESULT: 40% of patients in group 1 (control) had a cough response to fentanyl. Group 2 (morphine) and group 3 (morphine naloxone) showed a reduced FCR of 10%. The incidence of coughing was 60% of the patients in group 4 (propofol), 30% in group 5 (atropine), and 40% in group 6 (midazolam). These were not statistically significant. CONCLUSION: FCR is not altered by pretreatment with propofol, atropine, or midazolam, but morphine inhibits cough response and this antitussive effect was not antagonized by naloxone.
Atropine* ; Bronchoconstriction ; Catheters ; Cough* ; Efferent Pathways ; Fentanyl* ; Humans ; Incidence ; Midazolam* ; Morphine* ; Naloxone ; Oxygen ; Plasma ; Premedication ; Propofol* ; Seizures ; Thoracic Wall

BACKGROUND: We observed fentanyl known as centrally-acting antitussive agents provoke a cough response in some patients at induction of anesthesia. This may be of clinical importance. METHOD: 121 patients (ASA class I) were assigned randomly to 4 groups. Each group was given different doses of fentanyll Group 1 (n=30); 0.5ug/kg, Group 2 (n=30); 1ug/kg, Group 3 (n=33); 2ug/kg, Group 4 (n=28); 4 g/kgl, within 1 second through a peripheral venous cannula before induction of anesthesia. All patients were observed carefully in order to detect a cough response and any side effects. RESULT: The incidences of FCR (Fentanyl Cough Response) were 0% in Group 1, 10.0% in Group 2, 30.3% in Group 3, and 39.3% in Group 4. The ED50 of FCR was 4.25ug/kg. The mean onset-time from the end of fentanyl administration to the beginning of coughing was 12.5 seconds. FCR was decreased with aging, but not affected by weight, height, or smoking. Other serious side effects were not accompanied. CONCLUSION: Fentanyl can evoke the pulmonary chemoreflex dose-dependently and the ED50 was 4.25 g/kg.
Aging ; Anesthesia ; Antitussive Agents ; Catheters* ; Cough* ; Fentanyl* ; Humans ; Incidence ; Reflex* ; Smoke ; Smoking

Core tissue for histologic study is believed by many pathologists to be more diagnostic than material from needle aspiration. Recently introduced automated biopsy gun simplifies core biopsies with increased quantity and quality of samples. Authors performed 38 percutaneous biopsies from 38 patients with 18G automated biopsy guns under US guide. Diagnostic target tissues were obtained in 33 biopsies(87%), inadequate tissues in 4 (11%), and adequate but not of target tissue in 1(3%). There was no major complication requiring treatment, but pain needing analgesics and pain with nausea/vomiting were experienced in 2 and 1 biopsies respectively. Average number of needle passes was 1.5(1-5) We concluded that US-guided gun biopsy was a easy and safe way to obtained tissue samples of good quantity and quality, especially useful in hospitals without constant availability of specialists in cytopathology.
Analgesics ; Biopsy* ; Firearms ; Humans ; Needles ; Specialization

PURPOSE: To evaluate the prevalence and the patterns of sterile gas shown at computed tomography(CT) after transarterial embolization(TAE) for primary hepatic tumor. MATERIALS AND METHODS: Among 102 patients who performed TAE for hepatoma, thirty-four in whom follow-up CTwas underwent constituted the basis of our study. At CT, we evaluated the patterns and locations of intratumoral gas. We also reviewed the clinical data to exclude an infectious origin of intratumoral gas. RESULTS: Of 34 patients, intratumoral gas was detected in 11 patients(32%), in all of whom Gelfoam was used as an embolic material. The initial tumor size measured at pre-TAE CT was larger in patients with intratumoral gas than in patients without it(p < 0.005). No specific patterns or locations of intratumoral gas were noted on CT scans. No patients had clinical signs and symptoms that suggested infection. CONCLUSION: Intratumoral gas formation without clinical evidence of infection is not an infrequent finding after TAE for hepatoma, especially when Gelfoam is used and when the tumor is large in size. This finding may be a part of postinfarction syndrome and should not be misinterpreted as an postprocedural abscess formation.
Abscess ; Carcinoma, Hepatocellular ; Follow-Up Studies ; Gelatin Sponge, Absorbable ; Humans ; Prevalence ; Tomography, X-Ray Computed