Subcutaneous emphysema is a complication of the pneumoperitoneum necessary to perform laparoscopy and will be seen more often as laparoscopic techniques are applied to a growing number of intraabdominal procedures. We report a case of subcutaneous emphysema and hypercarbia without pneumothorax or pneumomediastinum during laparoscopic cholecystectomy, which was treated by multiple puncture with 18G needle on emphysematous site. The suspected cause is inadvertent subcutaneous insufflation of carbon dioxide through the trocar sites by increased intra-abdominal pressure for the establishment of pneumoperitoneum. Immediate recognition, evaluation, and treatment of subcutaneous emphysema is necessary since this can be life-threatening complication.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Insufflation ; Laparoscopy ; Mediastinal Emphysema ; Needles ; Pneumoperitoneum ; Pneumothorax ; Punctures ; Subcutaneous Emphysema* ; Surgical Instruments

BACKGROUND: Endobroncheal intubation or extubation may occur accidentally when the patient's neck is flexed or extended even in the appropriate endotracheal intubation. The purpose of this study is to examine the effect of fixation or unfixation of the endotracheal tube at the teeth level on the displacement of its distal end when the patient's neck is extended or flexed. METHODS: This study was conducted in 37 patients who underwent endotracheal general anesthesia. The patients with the evidence of pathology in head, neck and chest were excluded from the study. Individual patient's displacement in endotracheal tube tip compared unfixed cases with fixed cases when the change of neck position. The moved distance was measured by fiberoptic bronchoscope. The data were statistically analyzed by Student's paired t-test. RESULTS: The endotracheal tube moved away from the carina when the patient's neck was extended, while it moved toward the carina when flexed in all cases. When the patient's neck was extended the average distance displaced 1.2 0.7 cm in fixed cases and 1.1 0.9 cm in unfixed cases. when the neck was flexed, they were 1.2 0.5 cm and 1.0 0.8 cm respectively. There were not statistically significant between the fixed and the unfixed cases. CONCLUSIONS: It is concluded that the displacement of the endotracheal tube is not related to its fixation or unfixation at the teeth level and therefore, unfixation does not provide any benefits in terms of the displacement of the distal end of the tube in adult trachea.
Adult ; Anesthesia, General ; Bronchoscopes ; Head ; Humans ; Intubation ; Intubation, Intratracheal ; Neck* ; Pathology ; Thorax ; Tooth ; Trachea

BACKGROUND: The clinicians frequently use crystalloid solutions to manage inpatients and outpatients. Recently Normosol becomes available but there is little understanding of Normosol. So we surveyed residents to assess the level of knowledge about three crystalloid solutions. METHODS: The respondents were 46 residents of internal medicine, general surgery, pediatrics, and anesthesiology. The questionnaire asked for the following information: To list the constituents and their concentrations in each 1 litre of normal saline, Hartmann's solution, and Normosol; to match correct pH and osmolality to each solutions; to describe the metabolism and role of lactate in Hartmann's solution. RESULTS: All 46 (100%) knew that both sodium and chloride ions were present in normal saline. Twenty six (57%) of them knew correct concentration of sodium and chloride. The presence of sodium ion in Hartmann's solution was known by 44 (96%) and its concentration was recognized by 20 (43%). Chloride ion and potassium ion in Hartmann's solution were recognized by 43 (93%) and 42 (91%), respectively. Fifteen (33%) knew correct constituents of Hartmann's solution. Only three (7%) knew correct constituents and their concentration of Hartmann's solution. Thirty six (76%) knew that bicarbonate is formed by metabolism of lactate. No one accurately recorded the correct constituents of Normosol. CONCLUSIONS: The constituents and their concentrations of normal saline are well known to residents but those of Hartmann's solution and Normosol are not. Our survey reveals that there was little understanding of the reasons for including lactate in Hartmann's solution and even less of presence of acetate in Normosol.
Anesthesiology ; Surveys and Questionnaires ; Humans ; Hydrogen-Ion Concentration ; Inpatients ; Internal Medicine ; Ions ; Lactic Acid ; Metabolism ; Osmolar Concentration ; Outpatients ; Pediatrics ; Potassium ; Sodium

No abstract available.
Sarcoma* ; Uterus*

Microfluidics is considered an important technology that is suitable for numerous biomedical applications, including cancer diagnosis, metastasis, drug delivery, and tissue engineering. Although microfluidics is still considered to be a new approach in urological research, several pioneering studies have been reported in recent years. In this paper, we reviewed urological research works using microfluidic devices. Microfluidic devices were used for the detection of prostate and bladder cancer and the characterization of cancer microenvironments. The potential applications of microfluidics in urinary analysis and sperm sorting were demonstrated. The use of microfluidic devices in urology research can provide high-throughput, high-precision, and low-cost analyzing platforms.
Diagnosis ; Lab-On-A-Chip Devices* ; Microfluidics* ; Neoplasm Metastasis ; Prostate ; Prostatic Neoplasms ; Spermatozoa ; Tissue Engineering ; Tumor Microenvironment ; Urinary Bladder Neoplasms ; Urology*

It is difficult to determine respiratory criteria of fitness for surgery and anesthesia in patients with intractable chronic obstructive pulmonary disease (COPD), who have high mortality and morbidity in the perioperative period. Also, it is commonly assumed that general anesthesia carries a greater risk of perioperative pulmonary complications than regional anesthesia in patients with COPD. A 79-yr-old COPD female patient complaining of right hip pain due to fracture of right femur neck and dyspnea on rest was admitted for surgery. Even after aggressive medical management for COPD during the preoperative period, dyspnea on rest and expiratory wheezing were not improved. The results of the pulmonary function test and the immediate preoperative arterial blood gas analysis were as follows: FVC 0.97 L, FEV1 0.38 L, FEF25-75% 0.11 L/sec, PaO2 47.6 mmHg, and PaCO2 68 mmHg. We report the anesthetic considerations for the epidural block for the severe COPD patient associated with hypoxemia and hypercarbia.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, General ; Anoxia ; Blood Gas Analysis ; Dyspnea ; Female ; Femur Neck ; Hip ; Humans ; Mortality ; Perioperative Period ; Preoperative Period ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Function Tests ; Respiratory Sounds

Purpose: To retrospectively compare the fixation methods for reattaching a trochanteric fragment in a pertrochanteric fracture treated with bipolar hemiarthroplasty. Materials and methods: Forty cases of an unstable femur pertrochanteric fracture were analyzed and followed up for average of 19(6~40) months. There were 18 cases fixed with tension band wiring (group 1), 7 cases treated using modified tension band wiring with K-wires (group 2) and 15 cases treated with the GTRD (Greater Trochanteric Reattachment Device) (group 3). Result: Group 1 was treated with simple a surgical procedure and the results were good. The second group had firm fixation postoperatively but required additional surgery in two cases to remove the K-wires because of wire migration after ambulation. Group 3 had relatively good results but required more dissection and a longer operating time. Conclusion: Tension band wiring or GTRD are good fixation methods for reattaching trochanteric fragments in pertrochanteric fractures. Moreover, tension band wiring is recommended for old osteoporotic patients due to a simple procedure and firm fixation. The use of modified tension band wiring using K-wire or a Steinmann-pin should not be used due to the possibility of distant migration.
Femur* ; Hemiarthroplasty* ; Humans ; Retrospective Studies ; Walking

Background: Many Korean women with single eyelids wish to have their eyes enlarged through double eyelidplasty, and many of them also want to have additional procedures in order to have a larger perceived size of their eyes, with the desire for their eyes to resemble those with inborn double eyelids. Thus, in this study, we performed eye measurements and evaluated the usefulness of the eyeball exposure area to differentiate the overall eye size according to the nature of double eyelids (inborn or operated). Methods: This study involved 92 eyes with natural double eyelids (group A) and 76 eyes with only double eyelidplasty (group B). The two groups were compared through measurements of the exposed eyeball area (EEA) and palpebral fissure height (PFH). To compare the usefulness of the EEA for the perceived eye size, the PFH value was also measured by adjusting it to a percentage value. Results: The mean value of the PFH was 9.95±0.67 mm in group A and 8.48±1.04 mm in group B. The adjusted percentage value of the PFH relative to the corneal diameter (11.3 mm) was 88.05% in group A and 75.04% in group B. The EEA was 85.59%±3.25% in group A and 82.89%±6.36% in group B. The difference between the two groups was 13.01% in terms of PFH and only 2.7% in terms of EEA. Conclusions The values of PFH and EEA were higher in group A, but EEA was more useful for evaluating the perceived eye size between the two groups.