We report a rare case of suture material-related colon perforation. A 60-year-old woman visited clinics because of the nonspecific abdominal discomfort for several months. There were no specific medical history except previous laparoscopic myomectomy 15 years ago. Colonoscopy and abdomen-pelvis computed tomography revealed an unknown foreign body penetrating the sigmoid colon wall adjacent to the uterus. We performed laparoscopic exploration with foreign body removal and primary colon wall repair. The foreign body was identified as a non-absorbable suture material suggestive of used in previous myomectomy. With recent trends for minimally invasive procedures in the field of pelvic organ surgery, surgeons, especially those without sufficient training have to pay attention to selecting the proper surgical suture materials. (Ewha Med J 2022;45(3):e7)

PURPOSE: To investigate the effects of a delay in finger temperature recovery rate on the hand cold provocation test (HCPT) and a nocturnal dip greater than 10% (dipper) on the progression of glaucomatous visual field (VF) defects in open-angle glaucoma patients when the intraocular pressure (IOP) was well controlled lower than the target pressure. METHODS: 30 patients (58 eyes) with normal tension glaucoma (NTG) and 13 patients (24 eyes) with primary open angle glaucoma, and 12 normal controls (24 eyes) were retrospectively enrolled in this study. We performed HCPT, 24 hour ambulatory blood pressure monitoring (24-hr ABPM), Goldmann applanation tonometer measurements, and VF tests on all subjects. The delay in finger temperature recovery rate was defined as a delay longer than 15% of the mean finger temperature of normal controls over 2 intervals among 5, 10, 15, and 20 minutes after the immersion of cold water. We examined the relationships among the delay in finger temperature recovery rate, dipper, and the progression of glaucomatous VF defects. RESULTS: The finger temperature recovery rate in NTG patients was significantly delayed more than that of normal controls at 5, 10, and 15 minutes after the immersion. The delay in finger temperature recovery rate significantly correlated with dipper in NTG patients. Glaucomatous VF defects were significantly progressed in the presence of dipper in NTG patients. Delay in finger temperature recovery rate was significantly related to the progression of glaucomatous VF defects in NTG patients. In the binary logistic regression test, delay in finger temperature recovery rate was the only factor that was strongly related to the progression of glaucomatous visual field in NTG patients. CONCLUSIONS: When glaucomatous VF defects progressed despite the IOP being well controlled, 24-hr ABPM and HCPT for detecting vascular dysregulation might be helpful for diagnosis and treatment of glaucoma.
Blood Pressure Monitoring, Ambulatory ; Diagnosis ; Fingers* ; Glaucoma* ; Glaucoma, Open-Angle ; Hand ; Humans ; Immersion ; Intraocular Pressure ; Logistic Models ; Low Tension Glaucoma ; Retrospective Studies ; Visual Fields ; Water

In recent years the use of epidural opiates has increased and although this method of pain relief has shown good results in clinical practice it is still subject to certain drowba-cks, the most serious of which appears to be delayed respiratory depression. Since ketamine administered systemically is unlikely to produce respiratory depression it seemed worthwhile to investigate the possibility of exploiting the potent analgesic property to ketarnine by its epidural administration. The analgesic effect of ketamine 4 mg, administered epidural space, was evaluated. The duration of pain relief varied from less than 3 hours in 20% to over 24 hours in 30 % of the cases. In 62.5% of the cases pain relief exceeded 6 hours. There was no evidence of respiratery depression, and there no postoperative neurologic sequelae. The present results indicated the need for farther studios to compare the efficacy and safety of epidural ketamine with the response to epidural opioids for the relief of posto- peratiue pain.
Analgesics, Opioid ; Depression ; Epidural Space ; Ketamine* ; Pain, Postoperative* ; Respiratory Insufficiency

The MERA-F breathing circuit is a light in weight, disposable, multi-purpose breathing system corsisting of double coaxial tubes ; inner tube for inspiration and outer corrugate tube for expiration. This circuit is especially effective on head and neck operations that may lead to :Iccidental disconnection or extubation. And the circuit provides effective carbon dioxide elimination with only conventional total fresh gas flow(70 ml/kg/minute) and appropriate maintenance of heat and humidity of the airway mucosa.
Carbon Dioxide ; Head ; Hot Temperature ; Humidity ; Mucous Membrane ; Neck ; Respiration*

Sick sinus syndrome(SSS) is an important condition for anesthesiologists to recognize. The clinical manifestations of the SSS may be quite difficult to recognize as they may be intermittent, protracted, and multifared. SSS is defined by severe bradycardia and by sinus pause of arrest with escape. An imp-ulse originating in the sinus sode that is blocked before it can depolarize the atrium is referred to as sinoatrial(SA) lock. Physiologically, most signs and srmptoms result from hrpoperfusion of vital sign. The brain, heart, and kidneys are most prominently affected. While it can be mild, producing syncope, it is a frequent symptom and requires permanent pacemaker implantation. We experienced one case of anesthetic management of SSS using spinal anesthesia.
Anesthesia, Spinal* ; Bradycardia ; Brain ; Heart ; Kidney ; Sick Sinus Syndrome* ; Syncope ; United Nations ; Vital Signs

PURPOSE: To investigate the influence of water-shed zone (WSZ) and nocturnal dip (ND) on the progression of the glaucomatous visual field (V/F) defects in open-angle glaucoma (OAG) patients when the intraocular pressure (IOP) was maintained under the target pressure. METHODS: We performed fluorescence angiography (FAG), 24-hour ambulatory blood pressure monitoring (24-hr ABPM), and V/F tests. We examined the relationships among WSZ in early-FAG, ND over 10% (dip), and the progression of the glaucomatous V/F defects using chi-square, Fisher's exact, and multivariate logistic regression tests. A p-value < 0.05 was considered statistically significant. RESULTS: When considering the correlation between WSZ and dip, statistical significance was found in OAG (p = 0.024, odds ratio (OR) = 3.308) and normal tension glaucoma (NTG) (p = 0.029, OR = 4.364) patients. In patients with dip, glaucomatous V/F defects significantly progressed (OAG: p = 0.003, OR = 5.938, NTG: p = 0.005, OR = 13.929). In patients with WSZ, the glaucomatous V/F defects progressed in all groups (OAG: p = 0.002, OR = 5.156, NTG: p = 0.024, OR = 4.750, primary open angle glaucoma (POAG): p = 0.021, OR = 8.750). In the patients with WSZ involving optic nerve head, the glaucomatous V/F defects had progressed in OAG (p = 0.004, OR = 5.958) and NTG (p = 0.009, OR = 8.333) groups. Based on binary logistic regression analysis, dip (p = 0.010, OR = 6.227) significantly affected V/F progression only in OAG patients. CONCLUSIONS: In the OAG and NTG groups, ND over 10% influenced the progression of the glaucomatous V/F defects. The patients with WSZ tended to have ND over 10% in OAG and NTG groups and glaucomatous V/F defects progressed in all patients. Therefore, performing early FAG and 24-hr ambulatory blood pressure monitoring may be helpful for glaucoma patients with progressing glaucomatous V/F defects even when the IOP was maintained under the target pressure.
Blood Pressure Monitoring, Ambulatory ; Fluorescein Angiography ; Glaucoma ; Glaucoma, Open-Angle* ; Humans ; Intraocular Pressure ; Logistic Models ; Low Tension Glaucoma ; Odds Ratio ; Optic Disk ; Visual Fields*

No abstract available.
Humans ; Liver Cirrhosis* ; Liver* ; Sepsis* ; Vibrio cholerae* ; Vibrio*

Tumor DNA content measured by flow cytometry may be a predictor in the prognosis of epithelial ovarian cancer, but the results have been inconsistent. It is recognized that these conflicting results are at least partly due to the variation of DNA content between the samples from the same patient(i.e., intratumoral DNA heterogeneity). The purposes of this retrospective study were to investigate the frequency and the nature of DNA heterogeneity in epithelial ovarian cancer and to evaluate the prognostic significance of DNA heterogenetiy itself. Thirty-two patients with stage II to IV epithelial ovarian cancer who were managed at Asan Medical Center between May 1993 and April 1996 were analysed. Measurements of the nuclear DNA content were performed on samples from primary and metastatic lesion using paraffin embedded archival tissues by Epics(Coulter Inc.) flow cytometry. In two cases, the metastatic tumor was minute and did not reveal a separable peak on repeated examination. DNA heterogeneity was defined as different ploidy pattern or difference of the DNA indices than 0.15 between primary and metastatic tumors. DNA heterogeneity was found in 11 cases(36.7%), and the number of cases with homogeneous diploid and that with homogeneous aneuploid tumor were 5(16.7%) and 14(46.7%) respectively. In evaluation of prognostic significance of DNA heterogeneity using correlation with serum CA 125 level after second course of chemotherapy and residual tumor size after cytoreductive surgery among these three groups, the patients with DNA heterogeneity were considered to show intermediate prognosis between those with homogeneous diploid and homogeneous aneuploid tumor. In conclusion, DNA heterogeneity in epithelial ovarian cancer is considerable in frequency and may have prognostic value.
Aneuploidy ; Chungcheongnam-do ; Diploidy ; DNA* ; Drug Therapy ; Flow Cytometry ; Humans ; Neoplasm, Residual ; Ovarian Neoplasms* ; Paraffin ; Ploidies* ; Population Characteristics* ; Prognosis ; Retrospective Studies

no abstract available.

Postoperative pain relief and the side effects of epidurally injected morphine were investigated in 164 patients who received various types of operation including abdominal, genitourinary and lower extremities. Epidural morphine injection was given via an epidural catheter after operation. In 58% of total patients, pain relief was considered excellent, good in 30% and fair in 12%. The analgesia of each dose of epidural morphine lasted for 13 hours with everage. The side effects of epidural morphine were few and mild but urinary retention was in 9.8% of total patients, respiratory depression, pruritus, vomiting, catheter obstruction, catheter dislogement and bleeding through the catheter in one case respectively.