No abstract available.
Ultrasonography*

Twenty patients for abdominal surgery chosen at random were studied for postoperative pain relief with rectus sheath analgesia and meperidine by intramuscular injection. We wished to determine the efficacy of this new method of regional analgesia and to make a comparison it with that of systemic narcotics. At operation after surture of the posterior rectus sheath a specially designed 17 gauge polyethylene tube was positioned within the rectus sheath so that it lay in close proximity to the nerves supplying the surgical wound. The tube was designed to ensure even and uniform distribution of the local analgesics (2% lidocain 5 ml about 6 times on 1 st 24 hrs and 3 times on next 24 hrs) and it was removed after 48 hrs. The rectus sheath analgesia group of 15 patients was compared to a mepridine (50 mg) group of 5 patients. The effect of rectus sheath analgesia on pain relief and the patients ability to cough, to take deep breaths and to sit up were assessed subjectively by the same physician and objectively by each patient. In both groups pulmonary functions were assessed by measurements of arterial gases, tidal volume, minute volume, frequency, vital capacity, timed vital capacity, and peak expiratory flow rate(%). These measurements were assessed before and after operation and on the first and second postoperative days. Rectus sheath analgesia was found to reduce the degree of postoperative lung dysfunction. It is recommended in all debilitated patient with existing airway disease. It is concluded that rectus sheath analgesia is a reliable and simple method of controlling postoperative abdominal pain.
Abdominal Pain ; Analgesia* ; Analgesics ; Cough ; Forced Expiratory Volume ; Gases ; Humans ; Injections, Intramuscular ; Lung* ; Meperidine ; Methods ; Narcotics ; Pain, Postoperative ; Polyethylene ; Tidal Volume ; Vital Capacity ; Wounds and Injuries

To evaluate the possibility of Dacron patch for artificial sclera. Dacron(polyethylene terephthalate) which is readily available, biocompatable, safe, and inert synthetic material was implanted in the area of full-thickness scleral defect in rabbits. The histopathologic examinations showed that fibrovascular tissue invested into all interstices of Dacron filaments and fibroconnective tissue encapsulation around Dacron patch had strong connection with collagen fibers of recipient sclera at 4 weeks after graft There were no adverse reactions such as retinal detachment and fibrous proliferation into the vitreous cavity except mild inflammatory response of surrounding tissue at the early postoperative stage. As a result, Dacron graft showed successful firm adhesion to the recipient sclera without serious complications. Thus, We think that Dacron could possibly be used, instead of donor sclera, as artificial scleral graft material for the surgical treatment of perforating scleral diseases.
Collagen ; Humans ; Polyethylene Terephthalates* ; Rabbits* ; Retinal Detachment ; Sclera ; Scleral Diseases ; Tissue Donors ; Transplants*

No abstract available.
Anemia, Hemolytic, Autoimmune* ; Hepatitis B* ; Hepatitis*

Recently, a hydroxyapatite sphere has been increasingly used as a buried integrated orbital implant for the great improved motility of the prosthesis after enucleation. To allow more rapid ascess of vasculature into the hydroxyapatite implant, Dacron as a new synthetic wrapping material of the implant for anophthalmic sockets had been used and compared histologically with donor sclera in rabbits. At 4 weeks after implantation, fibrovascular ingrowth was found mainly near the scleral windows, where fibrosis extended 2 mm centrally in scleral-wrapped implants. In Contrast, in Dacron-wrapped implants, there was extensive fibrovascular infiltration through Dacron filaments and windows as well, making the hydroxyapatite sphere completely invested with fibrovascular tissue to the center within 4 weeks of implantation. Thus, Dacron as a new wrapping material appears to allow a more rapid vascularization into the hydroxyapatite implant than other collagen material without any serious complications, resulting in early rehabilitation with an artificial eye.
Collagen ; Durapatite* ; Eye, Artificial ; Fibrosis ; Humans ; Orbital Implants ; Polyethylene Terephthalates* ; Prostheses and Implants ; Rabbits ; Rehabilitation ; Sclera* ; Tissue Donors*

PURPOSE: Coronary arterial lesions after Kawasaki disease may cause coronary endothelial dysfunction without initial coronary dilatation, stenosis, and aneurysm. TTE (transthoracic echocardiography) is a non-invasive and widely used method in clinical practice. Adenosine is short acting drug and induces coronary vasodilatation. This study was designed to measure accurate coronary dysfunction by adenosine infusion. Coronary flow reserve(CFR) is defined as "the ratio of peak hyperemic to basal coronary flow velocity(CFV) in the proximal coronary vessel". CFR measurements has provided useful clinical and physiologic information in pediatric patients with congenital or acquired heart disease. METHODS: We examined 29 patients who had a history of Kawasaki disease. 19 patients discontinued low dose aspirin(5 mg/kg/d) after recovered from coronary dilatation and 10 patients have taken low dose aspirin because they had coronary dilatation. Adenosine was infused at 160 microgram/kg/min for 4 min. Diameter, velocity and integral of coronary artery were measured. RESULTS: Diameter and velocity were increased after adenosine infusion in both coronary arteries. A reduced CFR of both coronary arteries was noted in unrecovered group. CONCLUSION: CFR measured by TTE can predict the presence of significant coronary dysfunction in convalescent phase of Kawasaki disease.
Adenosine* ; Aneurysm ; Aspirin ; Constriction, Pathologic ; Coronary Vessels* ; Dilatation ; Echocardiography* ; Heart Diseases ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Vasodilation

The Humphrey circuit system function with the efficiency of the Lack system for spontaneous respiration and of the Bain system for controlled ventilation. It is designed to incorporate into a single system the advantages of the Mapleson A, D, and E type systems and to be available in coaxial and non-coaxial forms. This study was done to study the functions of a new anesthetic breathing system and to evaluate the adequacy of the recommended fresh gas flow. For spontaneous and controlled ventilation the system required a low fresh gas flow to achieve normocarbia(In the Lack circuit system, 60ml/min., is useded and in the Bain circuit system, 70ml/min.). The advantage of this system was that it was simple to operate and maintain, more easily sterilized and applicable in academic use. Further more the non-coaxial form of the circuit overcame the hazard of the inner tube complication. But this form was thought to have the problem of humidifying the inspired gas which still has to be sutdied. This multicircuit system was used satisfactorily with low fresh gas flow under spontaneous and controlled ventilation maintaining normal range of arterial carbon dioxide. It may become one of the preferred semiclosed breathing systems because of simplicity, multipurpose usefulness and other advantages.
Carbon Dioxide ; Reference Values ; Respiration ; Ventilation

Common peroneal neuropathy during normal delivery is associated with instrumentation and prolonged time spent in a certain position. We report a case of unilateral common peroneal neuropathy in a vaginal delivery patient under labor analgesia with the combined spinal-epidural technique. A 29-year-old woman complained of weakness and numbness of the left foot two days after vaginal delivery. Neurologic examination and electrodiagnostic testing confirmed left common peroneal neuropathy. The patient was referred for rehabilitation, which substantially improved her mobility and function, and prevented secondary damage. The patient had not fully recovered at three months after the delivery. The possible etiology of the postpartum common peroneal neuropathy was most likely prolonged and excessive pressure around the knee by assistants. Excessive compression during delivery should be minimized or avoided. Patient education and awareness among the labor and delivery team will prevent this complication. Neurologic complications related to epidural analgesia should also be ruled out in these patients.
Adult ; Analgesia* ; Analgesia, Epidural ; Female ; Foot ; Humans ; Hypesthesia ; Knee ; Labor, Obstetric ; Neurologic Examination ; Patient Education as Topic ; Peroneal Neuropathies ; Postpartum Period ; Pregnancy ; Rehabilitation

Spinal anesthesia is a relatively ease and useful technique and provides excellent analge-sia and relaxation for a great number of surgical procedures. It has been used widelr until the introduction of Muscle relaxant to the general anesthesia. However, complications, including hypotension, nausea, postspinal headache, neurologic sequelae, and death have been reported. In addition to those problems, number of failures after administration of spinal anesthetic haute been reported. We collected the 316 cases of spinal anesthesia given between January to May, 1986.the incidence of failure and the int-errelationships between the incidence and technical factors were reuiewed. Variables exam-ined including the patient population, the technical aspects of performing subarachnoid tap and subsequent blockade, and the level 7f training of anesthetist. Total number of patients with administration of anesthesia for 5 monthes was 2075; 316 patients in spinal anesthesia(15.237). We found a 4, l1% incidence of spinal failure, defined as the need to use general anesthesia or frequent administration of anlgesics during the surgical procedures. The technical factors(position of patients, approach method, puncture sites, needle gauge, agents type, and the performer) were insignificantlr contributed to the failure rate, but the amount of local anesthetic was showed statistical significance.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal* ; Headache ; Humans ; Hypotension ; Incidence* ; Nausea ; Needles ; Punctures ; Relaxation

Hexamethonium with propranolol was used to produce hypotension in 3 selected patients, ages 45 to 56, for neck deasection with thyroidectomy, Mile's operration and total laryngectomy with radical neck dissection. These cases were promedicated by lorazepam, anesthesia was induced and intubated following propranolol, morphine, diazepam and alcuroninum, and maintained with halothane, nitrous oxide and oxygen. Respiration was controlled by an anesthesia ventilator. Following elevation of the operation site, small amount of hexamethonium was injected to produce a dry surgical field. Systolic blood pressure was maintained around 80mmHg. Average doses of hexamethonium used were 0.12mg/kghr and propranolol 0.5 to 1 mg respectively. Judicious administration of sufficient doses of propranolol to lower the heart rate before and during hexamethonium induced hypotension reduces both the hexamethonium dose requirement and also the likelihood of developing individual variations in its effect.
Anesthesia* ; Blood Pressure ; Diazepam ; Halothane ; Heart Rate ; Hexamethonium* ; Humans ; Hypotension ; Laryngectomy ; Lorazepam ; Morphine ; Neck ; Neck Dissection ; Nitrous Oxide ; Oxygen ; Propranolol* ; Respiration ; Thyroidectomy ; Ventilators, Mechanical