Angiomyofibroblastoma is a distinctive, hitherto uncharacterized, benign soft tissue tumor of the vulva with histology similar to an aggressive pelvic angiomyxoma. It can be distinguished from an aggressive angiomyxoma by its circumscribed borders, higher cellularity, more numerous blood vessels, the frequent presence of plump stromal cells, minimal stromal mucin, and rarity of erythrocyte extravasation. We experienced a case of angiomyofibroblastoma of the vulva occurring in a 45-year-old woman. The lesion was a well-defined but not encapsulated mass, 4.5x4.2 cm. Histologically the mass was characterized by alternating hypercellular and hypocellular edematous zones in which abundant blood vessels were irregularly distributed. Immunohistochemically, the spindled, plump spindled, and oval stromal cells were reactive for vimentin and desmin, but not for cytokeratin, or S-100 protein.
Female ; Humans

No abstract available.
Chorionic Gonadotropin* ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Humans* ; Progesterone* ; Superovulation*

Unidirectional valve (UDV) malfunction causes rebreathing of expired gas during anesthesia. However, the resultant hypercarbia without hypoxemia by UDV malfunction is not easily detected. We experienced a case of severe hypercarbia which caused by sticking expiratory valve at 45 minutes after the induction of anesthesia, in spite of checking UDV function preoperatively. In this case, expiratory UDV malfunction was diagnosed with the change of capnographic waveform. And so, we recommend monitoring of capnographic waveform during every anesthesia, in addition to preoperative UDV checking.
Anesthesia ; Anoxia

BACKGROUND: Temporary occlusion of hepatic blood inflow and vascular exclusion are effective for reduction of intraoperative bleeding which is a major problem during hepatic resection. But it might be suggested that they resulted in hemodynamic, electrolyte and blood gas changes. This study was designed for investigating those changes during liver resection using portal triad clamping and/or right, left or both hepatic vein clamping. METHODS: Forty one patients, diagnosed as hepatoma and intrahepatic duct stone, were involved in this study. Duration of liver ischemia was 48.7+/-14.8 min. Hemodynamic variables, electrolytes and arterial blood gas were measured before portal triad clamping and at 10, 30 min after clamping, and 10, 30, and 120 min after declamping, and were compared with each other. Bicarbonate was given when its value was below 20 mEq/L. RESULTS: In the changes of hemodynamics, diastolic blood pressure was decreased significantly at 10 and 30 min after declamping compared with before clamping. In the changes of ABG and electrolytes, pH, bicarbonate and chloride ion were changed significantly at 10 min after clamping compared with before clamping. pH at 10 min after declamping was decreased more associated with increasing anion gap without change of the bicarbonate and increased PaCO2. CONCLUSION: From these results, hemodynamic changes are not remarkable but metabolic acidosis is occurred from 10 minutes after portal triad clamping and more acidotic change was developed at 10 min after declamping, immediate treatment of metabolic acidosis is needed.
Acid-Base Equilibrium ; Acidosis ; Blood Pressure ; Carcinoma, Hepatocellular ; Constriction ; Electrolytes ; Hemodynamics ; Hemorrhage ; Hepatic Veins ; Humans ; Hydrogen-Ion Concentration ; Ischemia ; Liver

No abstract available.
Gastrointestinal Tract* ; Leiomyosarcoma*

Since the epidural catheterization has been widely used for the purpose of anesthesia, diagnosis and pain control, there are various undesirable complications and hazards through the technical procedure or catheterization itself. Authors have experienced several hazards of location of the epidural catheter tip which were detected by epidurography performed the 1st. or 2nd. postoperative day with 50% Angiograffin. Hazards were as follows; 1) Single air bubble in the epidural space. 2) Inappropriate placement of the catheter tip. 3) Kinking of catheter in the epidural space. 4) Intravascular placement of the catheter.
Anesthesia ; Catheterization* ; Catheters* ; Diagnosis ; Epidural Space

Several studies have indicated that the addition of sodium bicarbonate and opioid to soiutions of locl anesthetics shortens the onset time,increases the intensity and prolongs the duration of neural blockade. This study was performed to compare onset times and duration of neural blockade in each groups. Eighty-two parturients scheduled for cesarean section at term under epidural anesthesia were assigned to three groups. Group 1 (n=19) received 1.5% lidocaine hydrochloride (pH 6.32+/-0.01), group 2 (n=26) received 1.5% lidocaine hydrochloride plus fentanyl 50 mcg (pH 6.27+/-0.02) and group 3 (n=37) received l.5% lidocaine hydrochloride plus fentanyl 50 mcg plus 8.4% sodium bicarbonate (sodium bicarbonate l mEq/lidocaine 10 ml)(pH 7.32+/-0.03). All groups were given 22-28 ml of local anesthetic solutions according to their height. Onsei times and duration of sensory blockade were evaluated using pin prick test at two minutes interval after epidural injection at L2, 76, T4 dermatomes. Onset timcs (time between the completion of anesthetic injection and loss of pin prick sensation at each dermatome) of sensory blockade at L2 dermatome were 3.1+/-0.2 minutes in Group 3, which were shorter than 5.0+/-0.3 minutes in Group l and 4.7+/-0.4 minutes in Group 2 (p<0.05). At T6 dermatome, onset times of sensory blockade were 6.9+/-0.6 minutes in Group 3, which were shorter than 15.4+/-1.2 minutes in Group l and 12.9+/-1.0 in Group 2 (p<0.05). At T4 dermatome, onset times of sensory blockade were 10.l+/-0.2 minutes in Group 3, which were shorter than 22.3+/-1.2 minutes in Group 1 and 18.8+/-1.1 in Group 2 (p<0.05). The duration (time between loss of pin prick sensation and complete recovery of pain at each dermatome) of sensory blockade at T4 dermatome in Group 3 were 74.0+/-3.8 min, which were longer than 52.9+/-2.4 minutes in Group 1 and 52.7+/-1.4 minutes in Group 2 (p<0.05). The duration of sensory blockade at L2 dermatome in Group 3 were 119.6+/-4.4 minutes,which were longer than 78.6+/-4.8 minutes in Group 1 and 81.6+/-2.5 minutes in Group 2 (p<0.05). The above results suggested that alkalinization of lidocaine solution is an effective way to shorten the latency and to prolong the duration of epidural block for cesarean section.
Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local* ; Cesarean Section* ; Female ; Fentanyl ; Injections, Epidural ; Lidocaine ; Pregnancy ; Sensation ; Sodium Bicarbonate

The incidence of phrenic nerve block following brachial plexus block, performed above clavicle, have varied widely. However, respiratory difficulty due to unilateral phrenic nerve block is rare complication of brachial plexus blocks, We experienced a case of symptomatic unilateral phrenic nerve block after supraclavicular approsch in thirty-four-year old woman. For brachial plexus block, 30 ml of 1.5% lidocaine and 0.2 mg of epinephrine were injected. Twenty five minutes after injection, she complained of respiratory difficulty. At recovery room, she complained sharp chest pain at apex of heart and epigastrium. We diagnosed her case as right phrenic nerve block because her right diaphragm was normal contour but was markedly displaced upward in portable chest X-ray. Respiratory difficulty was recovered 5 hours after injection and her chest pain was recovered 9 hours after injection.
Brachial Plexus* ; Chest Pain ; Clavicle ; Diaphragm ; Epinephrine ; Female ; Heart ; Humans ; Incidence ; Lidocaine ; Phrenic Nerve* ; Recovery Room ; Thorax

BACKGROUND: The present study was done to elucidate the effects of acute normovolemic hemodilution (ANH) on intrapulmonary shunt (Qs/Qt) and systemic oxygen delivery balance during one lung ventilation (OLV). METHODS: To induce one lung ventilation, an atelectasis of the right lung was produced in anesthetized mongrel dogs. In 6 dogs with OLV, ANH was produced by sequential hemodilution with hydroxyethyl starch. ANH was divided into 3 stages (ANH0: no hemodilition, ANH1: first hemodilution, ANH2: second hemodilution). Qs/Qt was measured by using blood gas analysis. Various hemodynamic parameters, oxygen delivery, and consumption were measured or calculated indirectly. RESULTS: After hemodilution, hemoglobin levels at each stage were 9.9 +/- 1.3 g/dl (ANH0), 7.0 +/- 1.0 g/dl (ANH1), and 5.2 +/- 0.7 g/dl (ANH2). The Qs/Qt of ANH2 stage increased from 25.0 11.4% of ANH0 to 35.4 9.2% (P < 0.05). Cardiac output of ANH2 increased from 2.4 +/- 0.8 ml/min of ANH0 to 3.2 +/- 0.8 ml/min (P < 0.05). Pulmonary and systemic vascular resistance measurements in ANH2 were lower than those of ANH0 (P < 0.05). The changes in pH and carbon dioxide tension and mixed venous oxygen tension by ANH were not significant in comparison with ANH0 (P > 0.05). Global oxygen delivery was markedly decreased by hemodilution in OLV (P < 0.05), whereas global oxygen consumption was maintained. CONCLUSIONS: We conclude that global oxygen delivery balance is preserved by ANH in this study. However, extreme ANH has a deleterious effect on pulmonary gas exchange, possibly through the attenuation of hypoxic pulmonary vasoconstriction during one-lung ventilation. On the basis of this study, increased cardiac output generated by ANH might be the cause of inhibition or blunting of hypoxic pulmonary vasoconstriction.
Animals ; Blood Gas Analysis ; Carbon Dioxide ; Cardiac Output ; Dogs* ; Hemodilution* ; Hemodynamics ; Hydrogen-Ion Concentration ; Lung ; One-Lung Ventilation* ; Oxygen Consumption ; Oxygen* ; Pulmonary Atelectasis ; Pulmonary Gas Exchange ; Starch ; Vascular Resistance ; Vasoconstriction

BACKGROUND: Venous lidocaine retention with tourniquet has a possibility to prevent propofol injection pain efficiently. We performed the study to assess the efficacy of various intravenous lidocaine pretreatment methods with tourniquet on reducing propofol-induced injection pain, especially the effect of varying the concentration and dose of lidocaine. METHODS: In order to know the effect of lidocaine pretreatment with tourniquet on prevention of propofol-induced injection pain, one hundred patients were divided into four groups by the method of pretreatment; 1% lidocaine of 1 mg/kg (lidocaine pretreatment, LPT1 n = 25); 0.5% lidocaine of 1 mg/kg (LPT2, n = 25); 1% lidocaine of 0.5 mg/kg (LPT3, n = 25); 5 ml of saline pretreatment (saline pretreatment, SPT, n = 25). After 5 minutes of pretreatment, propofol-induced pain was measured immediately after injection of 1 mg/kg propofol with tourniquet inflation and after deflation of tourniquet, and after a second injection of 1 mg/kg propofol by use of the numerical rating scale and pain score of four categories. We selected maximal values of three times measurement for comparison. RESULTS: All groups of lidocaine pretreatment (pain incidence of LPT1; 20%, LPT2; 16% and LPT3; 36%, respectively) significantly reduced the incidence of propofol-induced injection pain compared to the saline pretreatment group (96%) (P <0.05). Lidocaine pretreatment groups had dramatically lower intensity of pain compared with saline pretreatment (P <0.05). However, there were no differences among the lidocaine pretreatment groups (P > 0.05). CONCLUSIONS: This result indicates that lidocaine pretreatment with tourniquet has an effect on the prevention of propofol-induced injection pain. However, we recommend pretreatment with 0.5 1% lidocaine of 1 mg/kg by use of tourniquet and propofol injection immediately after deflation of the tourniquet in practice.
Humans ; Incidence ; Inflation, Economic* ; Lidocaine* ; Propofol* ; Tourniquets*