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

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

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

No abstract available.
Gastrointestinal Tract* ; Leiomyosarcoma*

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

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

The purpose of this study was to prevent the dilutional effect of excessive absorption of irrigating solution by using furosemide intraoperatively during transurethral resection of the prostate. Thirty patients, classified as ASA ps 2 or 3, were selected randomly and divided them into two groups as follows: Group l(N=15); Not-administrated furosemide(control group) Group 2(N=15); Administrated furosemide(Experimental group) All patients were premedicated with hydroxyzine(1 mg/kg, IM) and were performed continuous epidural anesthesia with 2/ lidocaine(1-1.5 mg/segment). 5% D-sorbitols were used for irrigating solution, and Hartmans solutions were given for maintenance fluid. And fixed the irrigating container to 60 cm in height from symphysis pubis. With the starting of operation, 20 mg furosemide was administrated to experimental group. The blood samples for serum Na+, K+, glucose and BUN were obtained at preoperation, 10 min, 20 min, 30 min after the stating of operation and immediate postoperative period, and serum osmolality and effective osmolality were calculated. The results were as follows: l) The values of sodium concentration of control group were decreased significantly at 10 min, 20 min, 30 min after the starting of operation and immediate postoperative period as compared with the preoperative value(p<0.05). But those of experimental group were not changed significantly. 2) The values of serum osmolality and effective osmolality were decreased significantly at 30 min after the starting of operation and immediate postoperative period as compared with the preoperative value(p<0.05). But those of experimenta1 group were not changed significantly. These results show that the dilutional effect of excessive absorption of irrigating solution might be prevented by using furosemide intraopertively. So we would like to recommend the use of furosemide during TURP, especially in patients with congestive heart failure or renal failure.
Absorption ; Anesthesia, Epidural ; Electrolytes* ; Furosemide* ; Glucose ; Heart Failure ; Humans ; Osmolar Concentration* ; Postoperative Period ; Prostate* ; Renal Insufficiency ; Sodium ; Transurethral Resection of Prostate

Subclavian venous catheterization is common technique for a variety of purposes, but this procedure is associated with complications that include damage to the lung, pleura, thoracic duct, nerve and subclavian artery. We recently encountered a case of the tracheal puncture and endotracheal cuff perforation during the subclavian catheterization in a 67-year-old female who was scheduled for tracheal reconstruction. Tidal volume was escaping from around the endotracheal tube during the subclavian catheterization, however, repeated inflation of the cuff failed to maintain the necessary cuff pressure to seal the trachea. After the operation, by using the fiberoptic bronchoscope and injecting dye into the cuff, we confirmed the site of tracheal puncture and endotracheal cuff perforation which caused by the introducer needle of the central venous kit. We suggest that tracheal puncture and endotracheal cuff perforation be added to the list of complication of subclavian catheterization. This complication should be suspected whenever the cuff pressure cannot be maintained during or after an subclavian catheterization.
Aged ; Bronchoscopes ; Catheterization* ; Catheters* ; Female ; Humans ; Inflation, Economic ; Lung ; Methods ; Needles ; Pleura ; Punctures* ; Subclavian Artery ; Subclavian Vein* ; Thoracic Duct ; Tidal Volume ; Trachea ; United Nations

BACKGROUND: As the clinical application of non-invasive shunt estimation to operation under one-lung ventilation has not been reported, this study was carried out to evaluate the validity and accuracy of the non-invasive shunt estimations in one-lung ventilation with hemodilution. METHODS: Following general anesthesia with enflurane 0.5 1 vol.% and 100% oxygen in ten Mongrel dogs (B.W. around 16 kg), tracheostomy and insertion of left-side endobronchial tube and one-lung ventilation were performed. Acute normovolemic hemodilution was produced by sequential hemodilution with hydroxyethyl starch. The intrapulmonary shunt (QS/QT) was calculated by the classic shunt equation, by the oxygen contents-based estimated shunt equation, and by oxygen tension-based estimations such as alveolar to arterial oxygen difference (P(A-a)O2), respiratory index (RI, P(A-a)O2/PaO2), arterial oxygen tension to alveolar oxygen ratio (PaO2/PAO2), and PaO2 to FiO2 ratio. To assess the quantitative accuracy of the estimated shunt, the data were divided arbitrarily into two groups on the basis of the mean arteriovenous oxygen content difference (C(a-v)O2) being 3.6 ml/dl or greater (group 1) and less than 3.6 ml/dl (group 2). Relationships to QS/QT were analyzed by simple linear regression. RESULTS: In 104 measurements, the correlation between QS/QT and non-invasive shunt were poor (r = 0.66 - 0.76). However, in group 1 (n = 45), the correlation between QS/QT and the estimated shunt were very good (r = 0.93) and good for P(A-a)O2 (r = 0.83), RI (r = 0.87), PaO2/PAO2 (r = - 0.84), and PaO2/FiO2 (r = - 0.85). In group 2 (n = 58), the correlation between QS/QT and non-invasive shunt were worse than in group 1. Group 2 had lower hematocrit (20.6% vs 26.7 %, P < 0.001), higher cardiac output, and lower pulmonary and systemic vascular resistance than group 1 (P < 0.05). The difference between the estimated shunt and the classic shunt in group 1 remained constant when the classic shunt was increased further. However, the difference in group 2 was enhanced by the increment of the classic shunt. CONCLUSIONS: We conclude that even if the non-invasive shunt estimation might be affected by hemoglobin and cardiac output, it is a viable method in mild hemodiluted patients with good cardiovascular reserve.
Anesthesia, General ; Animals ; Cardiac Output ; Dogs* ; Enflurane ; Hematocrit ; Hemodilution ; Humans ; Linear Models ; One-Lung Ventilation ; Oxygen ; Starch ; Tracheostomy ; Vascular Resistance