Toxic methemoglobulinemia is a rare disease and poses great risks in anesthesia because the oxygen carring capacity of the blood is reduced. This condition may be idiopathic or result from exposure to grugs or chemical agents and is treasted by the intravenous injection of methylene blue. This 17 year-old male was admitted to St. Mary Hospital for right nephrectomy because of rupture of the right kidney after accidental ingestion of Diaminodiphenyl sulfate and then falling down. The patient appeared cyanosed and dark brown tinged blood was ween at the site of skin incision. The result of arterial blood gas analysis was relatively normal and no specific problem was detected during anesthesia. This patient was successfully trated with ascorbic acid, methylene blue and oxygenation.
Adolescent ; Anesthesia ; Ascorbic Acid ; Blood Gas Analysis ; Eating ; Humans ; Injections, Intravenous ; Kidney ; Male ; Methemoglobinemia* ; Methylene Blue ; Nephrectomy ; Oxygen ; Rare Diseases ; Rupture ; Skin ; Tolnaftate

No abstract available.
Anesthesia, General* ; Humans ; Infant, Low Birth Weight* ; Infant, Newborn ; Pulmonary Atelectasis*

Ketamine hydrochloride(ketamine) is a non-barbiturate anesthetic agent chemically designated as dl-2-(0-chlorophenyl)2-(methylamino)-cyclohexanone hydrochloride. Ketamine anesthesia has been found distinctively different from that induced by conventional anesthetic agents, as it provides profound analgesia without significant impairment of respiratory function or stimulation of cardiovascular activities thus avoiding hypotension and are preserved the protective pharyngeal and laryngeal reflexes. In addition, ketamine appears to have muscle relaxation properties. This latter clinical finding, however has not been experimentally substantiated since few reports have appeared on the effect of ketamine on muscle relaxation. The present study therefore, was undertaken to determine whether this agent affects the muscle activity during d-tubocurarine block. The experiment was performed on sixteen rabbits weighing 1.8 to 2.5kg and these were divided into two groups; eight rabbits for control and eight for th study group. All animals were intubated through a tracheostomy under general anesthesia with nembutal 40mg/kg given intravenously. Respiration was controlled by means of a Harvard animal respirator. The body temperature was kept at 35 degrees C to 36 degrees C with a thermo-blanket. The common peroneal nerve and anterior tibial muscle was exposed and the nerve stimulator was applied to the nerve muscle preparation. The twhitch height of the muscle contraction was recorded on a biophysiograph through the force displacement transducer. The common peroneal nerve was stimulated supramaximally using a single twitch, square wave of 0.2 msec duration at a frequency of 0.1Hz once every 10 seconds. The degree of neuromuscular block following intravenous injection of d-tubocurarine 1mg/kg was measured in the control group. And in the study group ketamine 5mg/kg was administered intravenously when 25% of twitch height of muscle contraction was obtained spontaneously after the intravenous injection of d-tubocurarine 1mg/kg. The changes of the twitch height of muscle contraction and the time of spontaneous recovery in the study group were compared with those of the control group. The results were as follows: 1) The times and degree of maximal single twitch depression were obtained at 194.8sec and 87.3% in the control group and were at 197.5 sec and 87.8% in study group. No significant difference was observed. 2) Recovery index of the control group was 1,560.0 sec and recovery index of the study group was markedly prolonged to 2,387.5 sec(53.0% prolongation). 3) Mean decrease of single twitch height was 8.8% soon after the intravenous ketamine 5mg/kg when 25% of twitch height was obtained after the intravenous d-tubocurarine 1mg/kg in the study group.
Rabbits ; Animals

Patients vary markedly in their responses to d-tubocurarine chloride. Despite an attempt to diminish the variation in responses to relaxants by standardizing experimental techniques, anesthetic concentration kept constant, acid-base status kept constant, premedication omitted, dosage calculated in terms of mg/sq meter body surface, the marked variation was found to persist. The dose related neuromuscular blocking effect of d-tubocurarine chloride was investigated using a rabbit common peroneal nerve anterior tibial muscle preparation. All experimental rabbits tracheas were intubated through tracheostomy under general anesthesia with Nembutal 40 mg/kg intravenously. Reapiration was controlled by a Harvard animal respirator. The body temperature was kept at 35-37 degrees C by a thermoblanket. The degree of neuromuscular block following intravenous d-tubocurarine chloride was measured by single twitch response. The common peroneal nerve was stimulated supramaximally using a square waves of 0. 2 msec duration at a frequency of 0.1 Hz, and each stimulus was repeated once every 10 seconds. The ratio of the twitch height was calculated. The results were as follows: 1) No neuromuscular blocking effect was observed with 0.1 mg/kg of intravenous d-tubocu- rarine chloride. 2) 100% of neuromuscular blocking effect was observed with more than 1mg/kg of intravenous d-tubocurarine chloride. This is 5 to 10 times higher than the human dose. 3) Dose related prolonged neuromuscular blocking effect was observed from d-tubocurarine chloride in rabbits.
Anesthesia, General ; Animals ; Body Temperature ; Humans ; Muscle, Skeletal ; Neuromuscular Blockade* ; Pentobarbital ; Peroneal Nerve ; Premedication ; Rabbits* ; Trachea ; Tracheostomy ; Tubocurarine ; Ventilators, Mechanical

Recent development of dental implantology has taken an interest in the bone graft procedure. This is a review of literature, published from 1994 to November 1999. This study is provided by MEDLINE search. In this study, 718 patients received 829 graft with placing 2,677 endosseous implants. In mandible, nonvascularized or vascularized block bone grafts provided better results (success rate 95.2%) than particulate grafts(83.6%). But in maxilla, particulate grafts provided better results(93.7%, 86.2%) and more cases especially in sinus elevation. There were many cases using autogenous bone graft and revealed good results, but allogenic or alloplastic bone graft materials also were used by many surgeons.
Humans ; Mandible ; Maxilla ; Transplants*

BACKGROUND: The purpose of this prospective study is to define the effect of cardiopulmonary bypass (CPB) on the concentration of thyroid hormones and metabolites. METHODS: Blood samples were obtained from 15 patients undergoing open heart surgery at 1) pre-induction, 2) after heparinization, 3) during CPB, 4) 2 hours after CPB, 5) 24 hours after CPB and 6) 48 hours after CPB. Thyroid stimulating hormone, albumin, thyroxine (T4), free thyroxine (FT4), triiodothyronine (T3), free triiodothyronine (FT3) and reverse T3 (T3) were measured. RESULTS: Concentration of T3 significantly decreased after infusion of heparin and maintained at the decreased level until postbypass 24 hours. Concentration of FT3 significantly increased after heparin administration but maintained at a control level during CPB and decreased after postbypass 24 , 48 hours (p<0.05). Reverse T3 increased at 24 and 48 hours after CPB (p<0.05). Thyroxine decreased during CPB and return to control level after CPB. Free thyroxine did not change significantly. Thyroid stimulating hormone was significantly depressed at 24 hours after CPB (p<0.05). CONCLUSIONS: This result suggest that the thyroid function is depressed until 48 hours after CPB and it seems to be associated with abnormal metabolism of thyroid hormones.
Cardiopulmonary Bypass ; Heart* ; Heparin ; Humans ; Metabolism ; Prospective Studies ; Thoracic Surgery* ; Thyroid Gland* ; Thyroid Hormones ; Thyrotropin ; Thyroxine ; Triiodothyronine

Various neurotransmitters have been proposed as possible mediators of penile erection. Especially, norepinephrine and serotonin might have a important role in sexual arousal and penile erection. And it could be hypothesized that the psychogenic impotence is associated with the depletion or imbalance of norepinephrine and serotonin from evidences such as the symptomatic manifestation of depression and the antidepressant-induced sexual dysfunction. The authors investigates the association of norepienphrine and serotonin with psychogenic impotence. The psychogenic impotent group(PIG) consisted of twenty-three patients with psychogenic impotence and the controlled group(CG) consisted of twenty-seven patients without psychogenic impotence. PIG had no organic cause accounting for their erectile dysfunction. The Beck Depression Inventory(BDI) and the State-Trait Anxiety Inventory(STAI) were applied to each subject to assess mood, state anxiety(SA) and trait anxiety(TA). Plasma norepinephrine level from systemic blood and 5-hydroxyindoleacetic acid(HIAA) levels from 24-hours urine were measured in each subject. The mean score of BDI of PIG was significantly higher than that of CG(p=0.015). PIG had a tendency of higher TA compared with CG(p=0.054). And also SA was higher in PIG, bud did not show significant difference(p=0.193). The level of norepinephrine was significantly lower in patient with psychogenic impotence(p=0.000). And the level of 24-hours urine 5-HIAA was lower in PIG but did not show significant difference(p=0.494). Although the authors did not exclude depressive disorders in PIG, the present findings suggest that psychogenic impotence might have higher depressive mood and trait anxiety, and be associated with the depletion of norepinephrine in systemic blood.
Anxiety ; Arousal ; Depression ; Depressive Disorder ; Erectile Dysfunction* ; Humans ; Hydroxyindoleacetic Acid ; Male ; Neurotransmitter Agents ; Norepinephrine* ; Penile Erection ; Plasma ; Serotonin*

1. A Case of osteosarcoma is reported which arose 8 years after synovima of the knee had been locally excised. The patient is a 51-year-old housewife who had received irradiation therapy upon her knee for 30 days post-operatively. Following irradiation, asymptomatic latent period lasted 8 years when mass appeared on the site, which was biopsied and diagnosed as osteosarcoma one year later. 2. This case generally suffices the McKennas criterias for irradiation-induced osteosarcoma, 3. It seems to be worthwhile to keep an eye upon the prognosis of this possible case of irradiation- induced osteosarcoma, which is largely reported to be very grave.
Humans ; Knee ; Middle Aged ; Osteosarcoma ; Prognosis ; Sarcoma, Synovial

BACKGROUND: A combined administration of epidural opioid and local anesthetic using patient- controlled epidural analgesia (PCEA) produces effective postoperative analgesia, but often causes profound motor and sensory blockade. The purpose of this study is to investigate the effect the location of the catheter insertion site has on total dose requirements and troublesome side effects including motor and sensory blockade after surgery. METHODS: 140 patients who had undergone obstetric and gynecologic surgery were randomly assigned to receive either L2-3 (Group L2-3) or T12-L1 (Group T12-L1) epidural catheter. All patients received meperidine and bupivacaine by PCEA. Patients were assessed with respect to total dose requirements, visual analogue scores and side effects. RESULTS: Total dose requirements, motor and sensory blocks were significantly lower in group T12-L1 compared with group L2-3. There were no significant differences in VAS, pruritus, nausea/vomiting, or patient's satisfaction. CONCLUSIONS: When the epidural placement level is closer to the dermatomes of the surgical incision in lower abdominal surgery, the total dose requirements can be reduced, and motor blocks that interfere with early ambulation and sensory block can also be reduced.
Analgesia ; Analgesia, Epidural* ; Bupivacaine* ; Catheters ; Early Ambulation ; Female ; Gynecologic Surgical Procedures* ; Humans ; Meperidine* ; Pruritus

STUDY DESIGN: This is a retrospective study analyzing the clinical results of various surgical methods for the treatment of delayed posttraumatic kyphosis. OBJECTIVES: The purposes of this study are to define the risk factors of delayed postraumatic kyphosis and to establish a rational therapeutic guideline for the treatment of established kyphosis. METHODS: Sixteen cases of surgically treated delayed posttraumatic kyphosis were analyzed. Their initial injuries were burst type in 10, flexion-distraction in 5 and uncertain in l. Initial treatments were conservative in 10 and surgical in 6. Treatments for established kyphosis were posterior fusion in 2, anterior fusion in 5, combined anterior-posterior fusion in 9. Anterior decompression was carried out in 5 treated with anterior fusion and in 4 treated with combined anterior-posterior fusion. RESULTS: Mean follow-up was 2.7 years. The mean preoperative kyphosis of 28.6。 was reduced to 18.5。 (35.3% correction) with most pronounced correction in the group with combined anterior and posterior stabilization(44.8% correction). Early loss of correction averaged 2.7。 (18.5%) with least loss in the combined anterior-posterior group. Neurological improvement was related to the duration of the symptoms(P < 0.05). Back pain was improved in all patients. CONCLUSIONS: Thoracolumbar fractures with initial three column injuries or those rendered unstable by laminectomy are highly susceptible to development of delayed posttraumatic kyphosis; Combined anterior and posterior fusion offered the most satisfactory result in correction and stabilization of the deformity; Neurologic improvement was more pronounced with shorter duration of the symptoms.
Back Pain ; Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Humans ; Kyphosis ; Laminectomy ; Retrospective Studies ; Risk Factors