This report describes a case of 88-year-old women who developed central venous catheter-related bilateral hydrothorax, in which left pleural effusion, while right pleural effusion was being drained. The drainage prevented accumulation of fluid in the right pleural space, indicating that there was neither extravasation of infusion fluid nor connection between the two pleural cavities. The only explanation for bilateral hydrothorax in this case is lymphatic connections. Although vascular injuries by central venous catheter can cause catheter-related hydrothorax, it is most likely that the positioning of the tip of central venous catheter within the lymphatic duct opening in the right subclavian-jugular confluence or superior vena cava causes the catheter-related hydrothorax. Pericardial effusion can also result from retrograde lymphatic flow through the pulmonary lymphatic chains.
Aged, 80 and over ; Central Venous Catheters ; Drainage ; Female ; Humans ; Hydrothorax* ; Lymphatic System ; Pericardial Effusion ; Pleural Cavity ; Pleural Effusion ; Vascular System Injuries ; Vena Cava, Superior

BACKGROUND: Urinary retention is the most common complication after perianal surgery. The authors tried to evaluate the influence of the types and duration of the operation and the types of anesthesia on the incidence of urinary retention. METHODS: The medical and anesthetic records of 106 patients were reviewed retrospectively. They got perianal surgerys after recieving one of the regional blocks; 0.5% hyperbaric bupivacaine 5~8 mg intrathecally, 0.5% hyperbaric tetracaine 5~8 mg intrathecally, or 2% lidocaine 300 mg with epinephrine 5 g/ml caudally. The incidences of urinary retention were compared with each other by Chi-square test and Student t-test, according to the above mentioned points. RESULTS: Fifty percent of these patients underwent urinary catheterization. The incidence of urinary retention after hemorrhoidectomy (56.6%) was higher than that of other anorectal procedures (p<0.05, Chi-square test). The longer operating time was associated with urinary retention (p<0.05, Student t-test). The influence of local anesthetics (bupivacaine, tetracaine, and lidocaine) was absent (p>0.05, Chi-square test), but the difference between spinal and caudal anesthesia was slightly significant (p<0.05, Chi-square test), i.e. the incidence of urinary retention after caudal anesthesia was low. CONCLUSIONS: Short duration of operation, less traumatized perianal surgery, and caudal anesthesia are thought to lead to the lower incidence of urinary retention.
Anesthesia ; Anesthesia, Caudal ; Anesthesia, Conduction ; Anesthetics, Local ; Bupivacaine ; Epinephrine ; Hemorrhoidectomy ; Humans ; Incidence ; Lidocaine ; Retrospective Studies ; Tetracaine ; Urinary Catheterization ; Urinary Catheters ; Urinary Retention*

Although methidathion is an organophosphate insecticide, it is different from the other organophosphates in terms of toxicity. Because of its relatively high fat solubility, the apparent volume of methidathion distribution throughout the body is very high, indicating that hemoperfusion is not effective in removing this organophosphate from the body. Redistribution of methidathion from fat to blood can also occur when plasma levels diminish. Additionally, acetylcholinesterase aging, which is the loss of an alkyl side chain that prevents reactivation by oximes, is very rapid so that the effective reactivation by oximes is thwarted. Thus, methidathion's effect on acetylcholinesterase inhibition is long lasting, particularly with a high dose. In addition to its parasympatholytic effect and ability to induce muscle paralysis, methidathion poisoning is associated with a profound and long-lasting circulatory collapse due to sympathetic ganglion blockade. This report presents the case of a 55-year-old man who accidentally ingested a high dose of methidathion. He later developed enteroinvasive aspergillosis infection-induced multiple bowel perforations on two separate occasions while on mechanical ventilator support, resulting in a fatal outcome. The renin-angiotensin axis activated by sympathetic ganglion blockade may have reduced the patient's splanchnic blood flow, contributing to translocation of endotoxin. Also, the effect of excessive acetylcholine on non-neuronal acetylcholine receptors may have contributed to the development of fatal enteroinvasive aspergillosis in this patient.
Acetylcholine ; Acetylcholinesterase ; Aging ; Aspergillosis ; Fatal Outcome ; Ganglia ; Ganglia, Sympathetic ; Hemoperfusion ; Humans ; Middle Aged ; Organophosphate Poisoning ; Organophosphates ; Oximes ; Paralysis ; Parasympatholytics ; Plasma ; Poisoning* ; Receptors, Cholinergic ; Shock ; Solubility ; Ventilators, Mechanical

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

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

Transitional cell carcinoma is the most common malignant tumor of the urteter, usually presenting as focal ureteral wall thickening or a mass filling the ureter lumen and combined with periureteral infiltration or adjacent lymph node enlargement. Retroperitoneal mass due to exophytic growth of ureteral transitional cell carcinoma has not been described in the literature, and we now report the CT findings in such a case.
Carcinoma, Transitional Cell* ; Lymph Nodes ; Ureter*

PURPOSE: The purpose of this study is to find what medical students think the reward for their future work should be and whether they would keep their ideals or abandon them for prestige and wealth by analyzing the book reports of Cronin's The Citadel. METHODS: Participants were 50 medical students of junior class. A month before the classroom lecture, the book and digital video disk were provided. Students had discussions in groups of seven and wrote book reports which include answers of three questions. RESULTS: Regarding what should be the reward for the medical doctor, two-thirds of students (66.7%) answered with spiritual compensation, while one-third (33.3%) chose material reward. In the situation presented to Manson, three-fifths (60.0%) answered they would keep their ideals (idealist), while the remaining two-fifths (40.0%) decided they would abandon them. Less than one-third of students (30.0%) answered they would reveal the corruptions of the doctor's society, while two-thirds (64.0%) would not. CONCLUSION: The larger number of idealists who prefer spiritual reward rather than a material reward represents the innocence of youth as in portrayed in The Citadel.
Adolescent ; Compensation and Redress ; Humans ; Medicine in Literature ; Reward ; Students, Medical

Background: Postoperative vomiting (POV) is one of the most serious complications in pediatric patients undergoing strabismus surgery. This study was conducted to test the hypothesis that gastric decompression (GD) could prevent POV caused by gastric distension after mask ventilation. Methods: A total of 60 pediatric patients (ASA PS I–II, aged one to 10 years) were randomly allocated to two groups; Group D (n = 30) and Group C (n = 30). Induction of anesthesia was performed with careful face mask ventilation with 100% O2 (3 L/min) and sevoflurane 3 vol% to limit airway pressure below 20 cmH2O. Endotracheal intubation was done after confirming adequate neuromuscular blockade. Then, the patients in Group D received GD, while patients in Group C did not. After the surgery, POV was assessed during the emergence from anesthesia in the operating room and postanesthetic care unit (30 min and 60 min). Results: During the emergence, POV was significantly decreased in Group D compared to Group C (Group D 3.3% vs. Group C 30.0%, P = 0.006). The odds ratio analysis showed a lower incidence of POV in Group D (odds ratio = 0.080; 95% confidence limit: 0.009–0.685) during the emergence period. There was no significant difference in the incidence of POV in the postanesthetic care unit (Group D 6.7% vs. Group C 4.3% at 30 min, P = 1.000; 0% in both groups at 60 min). Conclusions GD reduced the incidence of POV in pediatric patients undergoing strabismus surgery during emergence.

No abstract available.
Sarcoma* ; Uterus*

A clinical observation was made on 239 cases of benign prostatic hypertrophy, admitted to the Department of Urology, Korea University College of Medicine during the period of 9 years and 8 months from Jan. 1972 to Aug. 1981. Following results were obtained. 1. Amount of residual urine from 10 ml to 1,500 ml with average 304 ml. 2. Hypertension in 35 cases (14.8%)and pulmonary diseases in 29 cases (12.1%)were frequently associated with B.P.H. 3. E.K.G. was performed in 171 cases. Abnormal findings included L.V.H. in 38 cases (22.2%), arrhythmia in 11 cases (6.4%), but normal in 118 cases (69%). 4. In blood chemistry, blood urea nitrogen was elevated in 75 cases (31.4%)and creatinine was elevated in 69 cases (28.9%). 5. The most common endoscopic findings were trabeculation in 214 cases (89.5%), inflammation in 192 cases (80.3%), kissing of lateral lobes in 138 cases (58.7%)and elevated interureteric ridge in 71 cases (29.7%). 6. Methods of operative treatment were T.U.R. in 184 cases, retropubic prostatectomy in 7 cases and suprapubic prostatectomy in 3 cases.
Arrhythmias, Cardiac ; Blood Urea Nitrogen ; Chemistry ; Creatinine ; Hypertension ; Inflammation ; Korea ; Lung Diseases ; Prostatectomy ; Prostatic Hyperplasia* ; Urology