The insulinoma is a rare tumor, usually small, solitary and benign with no prediction for any part of the pancreas. It is amendable to surgical cure but approximately 10percent are malignant and the peak incidence is encountered between ages 40~60. Surgery has been established as the treatment of choice. The reason for electing to operate rather than treat symptomatically is prevention of complications, such as increasing obesity, or prolonged and irreversible episodes of hypoglycemic coma with resultant permanent central nervous damage. During the anesthesia for a patient with insulinoam, the important problems are to recognize and treat hypoglycemia. This is a case report of a patient with insulinoma who underwent surgical treatment. Two years age, under the diagnosis of insulinoma, she was underwent distal pancreatectomy with splenectomy. But 3 months ago, hypoglycemic attacks recurred during fasting periods surgical intervention was performed under the diagnosis of recurrent insulinoma. She was anesthetized with thalamonal-nitrous oxide-oxygen, pancuronium, and 10 percent dextrose solution was administered throughout the operation. We monitered the level of blood sugar intermittently by using a rapie sugar analyser(Glucometer, Ames, Japan). No hypoglycemic episode during anesthesia was observed. We report the case of our anesthetic experience withan insulinoma and review the anesthetic choice and the management of the patient.
Anesthesia* ; Blood Glucose ; Coma ; Diagnosis ; Fasting ; Glucose ; Humans ; Hypoglycemia ; Incidence ; Insulinoma* ; Obesity ; Pancreas ; Pancreatectomy ; Pancuronium ; Splenectomy

Thrombolytic therapy is usually reserved for patients with clinically serious or massive pulmonary embolism. In desperated cases, however, pulmonary embolectomy is recommended despite its high mortality rate. We experienced acute respiraory failure after embolectomy performed under cardiopulmonary bypass in patient with chronic massive pulmonary embolism. The patient recovered sucessfully with postoperative management in the intensive care unit.
Cardiopulmonary Bypass ; Embolectomy* ; Humans ; Intensive Care Units ; Mortality ; Pulmonary Embolism* ; Respiratory Insufficiency* ; Thrombolytic Therapy

Hand assisted laparoscopic donor nephrectomy (HALDN) has recently emerged as a very attractive modality in standard donor nephrectomy because of its many advantages. However, it also has disadvantages, which include gas emboli, subcutaneous emphysema, hypercarbia, pneumothorax and pneumomediastinum. This case involves a male patient who had suffered from temporary hypercarbia due to increased carbon dioxide absorption due to massive subcutaneous emphysema about 1 hour after pneumoperitoneum during HALDN. Following multiple skin punctures with an 18 G disposable needle, chest compliance and blood gas findings improved. Three hours later the operation ended successfully and he was transferred to the recovery room, and show no further problems. We report upon this clinical experience and include a brief review of the literature.
Absorption ; Carbon Dioxide ; Compliance ; Hand* ; Humans ; Male ; Mediastinal Emphysema ; Needles ; Nephrectomy* ; Pneumoperitoneum ; Pneumothorax ; Punctures ; Recovery Room ; Skin ; Subcutaneous Emphysema* ; Thorax ; Tissue Donors*

BACKGROUND: Damage to teeth has long been associated with endotracheal intubation. But, no rules designed to predict dental injuries have been formulated. In this prospective study, we undertook to identify relationships between anatomic airway measurements used customarily in bedside practice, and blade-tooth distance during laryngoscopy, to assess the usefulness of these anatomic measurements as predictors of dental injury. METHODS: Four hundred and eighty-three patients scheduled for elective surgery requiring general anesthesia with endotracheal tube placement were included. During a preoperative visit, a number of measurements and assessments of features that might predict difficult intubation were performed. When optimum visibility of the glottis was obtained during laryngoscopy, the distance between the flange of the blade and the upper incisor was measured. We determined which of the individual airway characteristics correlated with the blade-tooth distance and best predicted the potential of dental injury. RESULTS: The blade-tooth distance was found to correlate with the individual scales of the Mallampati classification (Spearman's correlation coefficient, r = - 0.356, P < 0.01), mandibular protrusion (r = - 0.390, P < 0.01), head and neck movement (r = - 0.276, P < 0.01), interincisor gap (r = - 0.648, P < 0.01), and the condition of the upper teeth (r = - 0.313, P < 0.01). The frequency of direct blade-tooth contact significantly increased as the scales of these five anatomic measurements increased (P < 0.01). CONCLUSIONS: This study shows for the first time that some airway measurements are correlated with blade-tooth distance, and that they can be considered as useful predictors of dental injury during laryngoscopy.
Anesthesia, General ; Classification ; Glottis ; Head ; Humans ; Incisor ; Intubation ; Intubation, Intratracheal ; Laryngoscopy* ; Neck ; Prospective Studies ; Tooth ; Weights and Measures

BACKGROUND: The number of illegal migrant workers has been increasing in Korea since late 1997 in what was called the IMF era. This study was conducted to evaluate and to recognize the medical utilization and health Status for migrant workers in Korea. The goal of this study was to understand the epidemiological characteristics of the migrant workers and family physician's role as a health provider and gate keeper to them and to provide basic data for public health policy. METHODS: In September 1999, self-administered questionnaires were distributed to the migrant workers in Seoul, Sung-Nam, Pucheon and An-Yang. We classified the reasons for clinical encounters and the prescribed drugs by reviewing the medical records of all patients who visited a clinic of shelter for migrant workers in Sung-Nam from January to December 1998 and analysed the report according to death certification of the shelter for migrant workers in Sung Nam from 1994 to September 1999 RESULTS: The major distribution of nationality were from China, Mongo, and Bangladesh (86.9 %). They were mostly between 30 and 39 years old, males are, and unmarried. Most had high school education. The average income was 756,700 won and the average working hours were 11.5 hours per day in migrant workers being in worse condition than those of Korean workers. Classified according to systems, the respiratory(21.2%), musculoskeletal (20.6%), digestive(15.8%), and cardiovascular(12.5%) symptoms were common. Repayment for death was different between before (87.7%) and after IMF era (13.0%), in late 1997. Average medical expenditure was 43,552 won comprising 5% of the total income of subjects only. Most of them did not benefit from medical insurance. CONCLUSION: Migrant workers' situation seemed poor. The patterns of the disease' were similar to those who visit family medicine clinics in general. Family physicians should take more interest in providing a more effective and better care to migrant workers.
Adult ; Bangladesh ; Certification ; China ; Education ; Ethnic Groups ; Gyeonggi-do ; Health Expenditures ; Humans ; Insurance ; Korea* ; Male ; Medical Records ; Physician's Role ; Physicians, Family ; Public Health ; Seoul ; Single Person ; Transients and Migrants* ; Surveys and Questionnaires

Acute occlusion of the artery to a single functioning kidney is a rare but surgically correctable cause of acute renal failure. A young-aged woman with acute renal failure and anuria due to a thromboembolism of the right renal artery was surgically treated 2 hours after the onset of anuria. Revascularization resulted in the reversal of renal failure and complete recovery of renal function. An aggressive diagnostic and therapeutic approach is important whenever occlusion of the renal artery is suspected during surgery in Takayasu arteritis patients.
Acute Kidney Injury ; Anuria ; Arteries ; Female ; Humans ; Kidney ; Renal Artery* ; Renal Insufficiency ; Takayasu Arteritis ; Thromboembolism* ; Transplants*

BACKGROUND: Carbon dioxide is a potent cerebral vasodilator. The change of carbon dioxide partial pressure may influence the intracranial pressure and the patients' neurological outcome. There are few reports about the influence of end-tidal CO2 (ETCO2), arterial CO2 (PaCO2) and its pressure difference P(a-ET)CO2 during a craniotomy on the Glasgow coma scale (GCS) score for evaluation of neurological status. In this study, authors tried to discover the influence of PaCO2, PETCO2, and P(a-ET)CO2 on neurological outcome. METHODS: The data of PaCO2 and PETCO2 and P(a-ET)CO2 during a craniotomy was saved. The correlations between each parameter, the GCS score and rCoBF were analyzed. To prevent a direct effect on carbon dioxide tension, blood pressure and body temperature were maintained within a normal range. At the same time, we inserted a probe of the thermal diffusion flowmetry monitor in the subdural space to monitor the regional cortical cerebral blood flow (rCoBF). All the data was saved simultaneously, at the moment of dura closure. RESULTS: There was a fair correlation between the PaCO2 and PETCO2. A low PaCO2 level correlated well with a good GCS score but, not with PETCO2. The mean P(a-ET)CO2 value was 4.4 +/- 3.1 mmHg. The high P(a-ET)CO2 level correlated well with a poor GCS score. High rCoBF correlated well with a good GCS score. However, the changes of PaCO2 and PETCO2 showed no correlations with the rCoBF. CONCLUSIONS: As a result, if we decrease the PaCO2 level by hyperventilation and increase the rCoBF level through proper management during anesthesia, we can improve the patients' neurological outcome.
Anesthesia ; Blood Pressure ; Body Temperature ; Carbon Dioxide ; Craniotomy* ; Glasgow Coma Scale ; Humans ; Hyperventilation ; Intracranial Pressure ; Partial Pressure ; Prognosis* ; Reference Values ; Rheology ; Subdural Space ; Thermal Diffusion