The effect of preanesthetic administration of glycopyrrolate and cimetidine on gastric fluid pH and volume were studied. Forty patients scheduled for elective surgery were fandomly placed into two groups. Patients in group 1 were given glycopyrrolate intramuscularly (0.003 mg/kg) 30-60 minutes before induction of anesthesia, while group 2 patients received glycopyrrolate intramuscularly and 200mg of cimetidine intravenouly 2 hours before induction of anesthesia. Nasogastric tubes were placed and gastric pH and volume were measured. The results showed that patients in group 1 hade a medn gastric pH of 2.428+/-1.378. Twenty five percent of these patients had gastric contents with a pH of 2.428+/-1.378. Twenty five percent of these patients had gastric contents with a pH above 2.5 and a volume greater than 25ml. In contrast, group 2 patients had a mean gastric pH of 5.566+/-1.969, 85 percent had a ph above 2.5 and 15 percent had a volume greater than 25ml. These findings demonstrate that cimetidine markedly increases gastric pH. The authors recoment that patients reciving general anesthesia be given cimetidine preoperatively.
Anesthesia ; Anesthesia, General ; Cimetidine* ; Glycopyrrolate ; Humans ; Hydrogen-Ion Concentration*

The causes of pneumomediastinum during perioperative period are trauma to the airway from intubation or other manipulation, raised airway pressure during anesthesia, rupture of a bleb or other intrapulmonary lesion, upper airway damage during neck surgery, infiltration of the tonsillar fossa or adenoid bed with air under pressure, increased airway pressure after nausea and vomiting, and coughing during awakening. This paper is represents and discusses a case of pneumomediastinum, pneumothorax, extensive subcutaneous and retroperitoneal emphysema which occurred suddenly a few minute after several times of bucking and straining in the intubated state with oxygen catheter after tonsillectomy and adenoidectomy at recovery room. The complieation was thought to be a infiltration of air through tonsillar fossa under pressure or alveolar rupture due to increased airway pressure after coughing. The patient was treated with high concentration of oxygen and recoverd uneventfully.
Adenoidectomy ; Adenoids ; Anesthesia ; Blister ; Catheters ; Cough ; Emphysema ; Humans ; Intubation ; Mediastinal Emphysema* ; Nausea ; Neck ; Oxygen ; Perioperative Period ; Pneumothorax ; Recovery Room ; Rupture ; Subcutaneous Emphysema* ; Tonsillectomy* ; Vomiting

Dosage titration of protamine using a heparin dose response curve for the reversal of heparinization after cardiopulmonary bypass and the factors which affect. ACT were investigate. This study included 170 patients undergoing surgery for congenital or acquired heart diseases. Patients were randomly allocated to 6 griyos according to a protamine dosage of either 0.8, 1.0, 1.3, or 1.5 times the residual heparin amounts, or protamine 3mg/kg. The factors affecting ACT which we investigated were the differences between arterial and venous blood, between men and women, between a hematocrit value less of greater than 40%, and between less or more than 2 hours duration of bypass time. The results are as follows: 1) There were no significant differences in postprotamine ACT among the 5 groups. 2) ACT of arterial blood was more prolonged than that of venous blood(139.85+/-4.77 vs 111.50+/-2.36 sec). 3) ACT in men was more prolonged than in women(638.81+/-32.10 vs 559.08+/-14.33 sec). 4) ACT in which the hematocrit value was less than 40% was more prolonged than that in which it was above 40%. 5) Although there was no difference between less and more than 2 hours duration of bypass time in ACT, additional protamine was needed in latter group.
Cardiopulmonary Bypass ; Female ; Heart Diseases ; Heart* ; Hematocrit ; Heparin* ; Humans ; Male ; Thoracic Surgery*

No abstract available.
Molecular Biology*

PURPOSE: To evaluate the outcomes of minimal anterior approach and thumb assisted technique, in children with Gartland type III supracondylar humerus fracture, who were operated by this technique. MATERIALS AND METHODS: Forty two children with Gartland type III supracondylar fractures of the humerus with severe swelling were taken up for minimal open reduction and K-wire fixation. The technique used was a minimal incision in the cubital fossa and thumb assisted reduction of the fracture. Stabilization of fractures was done with 1.6 mm Kirschner wires. RESULTS: The outcomes were excellent in 40 cases good in 2 cases. No complications including malunion or scar contracture were seen. CONCLUSION: This technique is safe, effective and can be used for irreducible, displaced supracondylar fractures of the humerus in children
Bone Wires ; Child* ; Cicatrix ; Contracture ; Humans ; Humerus* ; Thumb

PURPOSE: Treatment options for patients with advanced gastric cancer remain limited. Few studies have investigated the efficacy and tolerability of the combination regimen of oxaliplatin and 5-fluorouracil with leucovorin for patients with advanced gastric cancer. The goal of this study was to examine the efficacy and toxicity of a modified FOLFOX-6 (mFOLFOX-6) regimen as a first-line chemotherapy regimen for patients with advanced gastric cancer. MATERIALS AND METHODS: From March, 2006, to December, 2007, 82 patients with advanced gastric cancer received 100 mg/m2 oxaliplatin and 100 mg/m2 leucovorin on the first day of treatment, followed by 2,400 mg/m2 of 5-fluorouracil on the first and second days of treatment every 2 weeks as a first-line treatment. RESULTS: The median age of the enrolled patients was 62 years (range; 30~75). Out of 82 patients, 34 cases (41.5%) were recurrent cases after curative resection, and the other 48 cases were unresectable or non-curative resectable cases. Their response was evaluated every 6 weeks. The overall response rate was 40.2%, with 2 (2.4%) complete response and 31 (37.8%) partial responses. The median time to progression (TTP) and overall survival (OS) time were 6.0 months (95% confidence interval [CI]: 4.69~7.31) and 13.0 months (7.99~18.0), respectively. The grade 3~4 hematologic toxicities observed included neutropenia (34.1%), thrombocytopenia (7.3%), and anemia (1.2%). The gastrointestinal toxicities observed included grade 3~4 nausea (9.8%) and vomiting (7.3%). Six patients (7.3%) experienced grade 3 neuropathy. No treatment-related deaths were recorded. CONCLUSION: The modified FOLFOX-6 regimen is effective and well tolerated as a first-line chemotherapy regimen for patients with advanced gastric cancer.
Anemia ; Antineoplastic Combined Chemotherapy Protocols ; Chemotherapy, Adjuvant ; Fluorouracil ; Humans ; Leucovorin ; Nausea ; Neutropenia ; Organoplatinum Compounds ; Retrospective Studies ; Stomach Neoplasms ; Thrombocytopenia ; Vomiting

Arteriovenous malformation(AVM) is the rare cause of neonatal intracranial hemorrhage. It is a congenital vascular lesion that can arising anywhere in the body. We report here on an unusual case of AVM in a full-term newborn infant who has no symptoms except enlarged bulging anterior fontanelle. AVM of other organs or adult cases were reported occasionally, but postoperative surviving intracranial AVM in a newborn infant has not been reported in Korea so far. The hematoma which was in the cortex of left temporal area, was removed surgically and the baby is living well under regular neurological check up.
Adult ; Arteriovenous Malformations ; Cerebral Hemorrhage* ; Cranial Fontanelles ; Hematoma ; Humans ; Infant, Newborn* ; Intracranial Hemorrhages ; Korea

BACKGOUND: The barrier can be altered by a number of insults to the brain (e.g., hypertension, freezing, trauma, drug). But the effect of the blood brain barrier distruction immediately after the neural change is unknown. In the present study, we focused on the BBBD after cervical sympathetic chain block. METHODS: 13 male Sprague-Dawley rats were divided into 2 groups. Group 1 (N=7) was blocked with 0.5% bupivacaine on the right cervical sympathetic chain and group 2 (N=6) was blocked with 0.5% bupivacaine on the bilateral cervical sympathetic chain. All rats received 37degrees C, 25% mannitol (1.75 g/kg) via right carotid artery and then, the effect of cervical sympathetic chain block on blood-brain barrier disruption of four cerebral compartment using 99mTc-human serum albumin and Evans blue was evaluated. RESULTS: Both groups showed blood-brain barrier disruption and there was no significant difference between group 1 and group 2 in the anterior and posterior hemisphere of the right side brain. But group 2 showed significant blood-brain barrier disruption than group 1 in anterior and posterior hemisphere of the left brain (p<0.01). CONCLUSIONS: This results suggest that cervical sympathetic chain block can increase the degree of mannitol-induced blood-brain barrier disruption via neural arch or blood flow change.
Anesthetics ; Animals ; Autonomic Nerve Block* ; Blood-Brain Barrier* ; Brain ; Bupivacaine ; Carotid Arteries ; Evans Blue ; Freezing ; Humans ; Hypertension ; Male ; Mannitol* ; Rats* ; Rats, Sprague-Dawley ; Technetium Tc 99m Aggregated Albumin

Purpose: The purpose of this study was to identify the clinical utility of circulating tumor DNA (ctDNA) from ascites and serial plasma samples from epithelial ovarian cancer (EOC) patients. Materials and Methods: Using targeted next-generation sequencing, we analyzed a total of 55 EOC samples including ctDNA from ascites and serial plasma and gDNA from tumor tissues. Tumor tissues and ascites were collected during debulking surgeries and plasma samples were collected before and after the surgeries. Because one EOC patient underwent secondary debulking surgery, a total of 11 tumor tissues, 33 plasma samples, and 11 ascites samples were obtained from the 10 patients. Results: Of the 10 patients, nine (90%) contained somatic mutations in both tumor tissues and ascites ctDNA. This mutational concordance was confirmed through correlation analysis. The mutational concordance between ascites and tumor tissues was valid in recurrent/progressive ovarian cancer. TP53 was the most frequently detected gene with mutations. ctDNA from serial plasma samples identified EOC progression/recurrence at a similar time or even more rapidly than cancer antigen 125, an established serum protein tumor marker for EOC. Conclusion Our data suggest that ascites ctDNA can be used to identify the mutational landscape of ovarian cancer for therapeutic strategy planning.

Most T-cell lymphomas arise from mature alpabeta T-cells and commonly involve the nodes. Lymphomas bearing the gamadelta T-cell receptor (TCR) are very rare, and involve the lymph nodes minimally, if at all. Hepatosplenic gamadelta T-cell lymphoma is a recently identified, rare entity in which lymphoma cells bearing the gamadelta TCR infiltrate the sinusoids of the liver, splenic red pulp, and bone marrow. Its leukemic transformation is even more rare. Recently, we experienced a case of hepatosplenic gamadelta T-cell lymphoma in a 19-year-old woman who presented with epigastric pain, fever, massive splenomegaly, andpancytopenia. The splenectomy specimen and excisional biopsy of the liver revealed the infiltration of atypical T lymphocytes with the immunophenotypic markers of CD3 (+), CD45RO (pan-T antigen) (+), TIA-1(+), CD4(-),CD8 (-), CD56 (-), and S100 (-) in the sinusoids of the liver and splenic red pulp. Polymerase chain reaction (PCR) showed that these cells had the expression of the TCR gama gene rearrangements. Though the pancytopenia had improved after the splenectomy, the response of chemotherapy was transient. Her disease progressed rapidly and she expired in the leukemic phase. We report a case of hepatosplenic gamadelta T-cell lymphoma that developed in a young woman, along with a brief review of the literature.
Biopsy ; Bone Marrow ; Drug Therapy ; Female ; Fever ; Gene Rearrangement ; Glycogen Storage Disease Type VI ; Humans ; Liver ; Lymph Nodes ; Lymphoma ; Lymphoma, T-Cell* ; Pancytopenia ; Polymerase Chain Reaction ; Receptors, Antigen, T-Cell ; Splenectomy ; Splenomegaly ; T-Lymphocytes* ; Young Adult