BACKGROUND: Preoxygenation is routine prior to rapid sequence induction of general anesthesia for a cesarean section. The aim of this study was to evaluate the preoxygenation techniques of tidal volume breathing (TVB) and deep breathing (DB) for a cesarean section. METHODS: One hundred twenty ASA I and II patients scheduled for a cesarean section under general anesthesia participated in the study. Preoxygenation was performed with 5, 7, and 10 L/min 100% oxygen. The following techniques were tested: 1) normal TVB for a 5-min period (TVB/5 min) and 2) DB for a 2-min period (4 DB/0.5 min, 8 DB/min, 12 DB/1.5 min and 16 DB/2 min). Inspired (FIO2) and end-tidal oxygen fraction (FETO2), end-tidal carbon dioxide pressure (ETCO2) and oxygen saturation (SpO2) were measured at 0.5-min intervals. RESULTS: During TVB, FETO2 increased rapidly between 0.5 and 3.5 min and plateaued by 3.5 min at 78.5%, 83.3% and 90.8% with 5, 7 and 10 L/min 100% oxygen, respectively. Four DB/0.5 min increased FETO2 to 64.7%, 67.2% and 72.3% at 5, 7, and 10 L/min 100% oxygen, respectively. As compared with four DB/0.5 min, the values of FETO2 with TVB/1.5 min and TVB/2 min were high at 7, 10 and 5 L/min 100% oxygen. CONCLUSIONS: We concluded that TVB/2 min was more effective than four DB/0.5 min in achieving preoxygenation but eight DB/min could be used in case of an emergent operation.
Anesthesia, General ; Carbon Dioxide ; Cesarean Section* ; Female ; Humans ; Oxygen ; Pregnancy ; Respiration* ; Tidal Volume*

PURPOSE: To determine by quantitative evaluation of pancreatic and adjacent vascular enhancement during spiral CT, the ideal scan delay for examination of the pancreas. MATERIALS AND METHODS: Dual (n=90) and triple (n=90) phase spiral CT scans of patients whose pancreas showed no pathologic condition were retrospectively evaluated. Dual-phase scans were performed at 43 seconds (early), and 5-6 minutes (delayed) after the injection of 120ml of contrast material at an injection rate of 3ml/sec ; triple-phase scans were performed at 25 seconds (arterial), 60-65 seconds (portal) and 5-6 minutes (delayed) after the injection of 120-140ml of contrast material at an injection rate of 2-4ml/sec, and ten patients also underwent precontrast scanning. CT attenuation values (HU) were measured in the head, body and tail of the pancreas, aorta, and main portal vein during each phase of all scans. Triple-phase protocol was used to measure the effect of different total volumes and injection rates on enhancement of the pancreas and adjacent vessels. RESULTS: There was no significant difference in the degree of enhancement of the pancreas head, body and tail during each phase (p>0.05). The pancreas was maximally enhanced on 43 second delayed scan (132+/-20 HU)(p<0.05), and the aorta, on 25-second delayed scan (269+/-74 HU), but there was no significant difference between this enhancement and that seen at 43 seconds(p>0.05). The main portal vein showed maximum enhancement on 43-second delayed scan (207+/-44 HU)(p<0.05). Different total volume of contrast material did not change the enhancement of the pancreas and adjacent vessels. At an injection rate of 2ml/sec, peak enhancement of the pancreas, aorta and portal vein was obtained on 60-65 second delayed scan, and at 4ml/sec, peak enhancement was obtained on 25 second delayed scan(p<0.05). CONCLUSION: Observing the usual protocols for abdominal spiral CT scanning, the pancreas was most effectively evaluated using a 43-second delayed scan. An increased injection rate resulted in earlier enhancement of the pancreas, aorta and portal vein.
Aorta ; Evaluation Studies as Topic* ; Head ; Humans ; Pancreas* ; Portal Vein ; Retrospective Studies ; Tomography, Spiral Computed*

BACKGROUND: High dose fentanyl anesthesia has been recommended for circulatory stability during coronary artery bypass grafting (CABG), but hypertension and tachycardia in response to noxious stimulation have been noted. The purpose of this study was to evaluate the hemodynamic effects of extensive thoracic epidural analgesia (TEA) combined with general anesthesia (GA). METHODS: The hemodynamic effects in CABG were evaluated in 30 patients. They were randomized into two groups ; the GA group receiving high dose fentanyl (50-70 mcg/kg), the TEA group receiving 10 ml bupivacaine 5 mg ml 1 followed by 5 ml every two hours epidurally GA (N2O-O2). The hemodynamic parameters were evaluated before induction of anesthesia, 20 minutes after induction of anesthesia, after sternotomy, and 30 minutes after end of cardiopulmonary bypass. RESULTS: Heart rate and mean arterial pressure were significantly lower after sternotomy in the TEA group compared to the GA group. Significant increase in cardiac index and decrease in central venous pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure were found after induction of anesthesia and sternotomy in the TEA group compared to the GA group. Especially, the pulmonary vascular resistance was significantly lower during all the period in the TEA group compared to the GA group. No differences were observed in stroke volume index, systemic vascular resistance, left ventricular stroke work index between two groups. CONCLUSIONS: The present study suggests a more effective blockade of the stress response during CABG with TEA than with GA. So, we consider that TEA could be used as an adjunctive anesthetic method during CABG.
Analgesia, Epidural* ; Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Bupivacaine ; Cardiopulmonary Bypass ; Central Venous Pressure ; Coronary Artery Bypass* ; Coronary Vessels* ; Fentanyl ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Pulmonary Wedge Pressure ; Sternotomy ; Stroke ; Stroke Volume ; Tachycardia ; Tea ; Vascular Resistance

PURPOSE: Several studies have suggested that hyperlipidemia might be a causative factor contributing to the progression of initial glomerular injury through the development of glomerulosclerosis. We examined the potential beneficial effect of atorvastatin - which blocks the rate limiting step of cholesterol synthesis by inhibiting HMG-CoA reductase - in PAN- induced nephrosis. MATERIALS AND METHODS: Glomerulosclerosis was induced in Sprague-Dawley male rats by repeated administration of PAN. Sprague-Dawley male rats were divided into 3 groups:group I(control), group II(PAN 20 mg/kg, subcutaneous injection), group III(PAN 20 mg/kg subcutaneous injection and atorvastatin 50 mg/kg/day per oral). On the 11th week, upon sacrifice of the experimental animals, blood sampling, 24-hr urine collection and nephrectomy were performed. RESULTS: Group III had significantly lower BUN and higher serum albumin(30.9+/-17.2 vs. 17.3+/-2.5 mg/dL; 2.3+/-0.1 vs. 2.5+/-0.2 g/dL, P<0.05) compared with group II. In the lipid profiles, group III was associated with a reduction in total cholesterol and LDL(291+/-173 vs. 167+/-72 mg/dL; 57+/-53 vs. 27+/-12 mg/dL, P>0.05) compared with group II. Atorvastatin administration lowered the glomerular sclerosing index significantly(26.2% vs. 13.3%, P<0.05). CONCLUSION: Puromycin-induced glomerulosclerosis could be ameliorated by the reduction of hyperlipidemia with atorvastatin. This suggests that hyperlipidemia contributes to the pathogenesis of glomerulosclerosis.
Animals ; Cholesterol ; Humans ; Hyperlipidemias ; Injections, Subcutaneous ; Male ; Nephrectomy ; Nephrosis* ; Oxidoreductases ; Puromycin* ; Rats* ; Rats, Sprague-Dawley ; Urine Specimen Collection

PURPOSE: We wanted to evaluate whether both the colonic transit time (CTT) and defecography are necessary for diagnosing constipated patients, and we also wanted to assess the defecographic findings of patients with outlet obstruction on CTT. MATERIALS AND METHODS: Over the recent 3 years, 26 patients (21 women and 5 men, mean age: 59 years) underwent both CTT and defecography because of their chronic constipation or defecation difficulty. The mean interval between the 2 studies was 48 days. Colonoscopy, barium enema and manometry were performed in 22, 8 and all the patients, respectively. RESULTS: On CTT, 13 patients (50.0%) were normal and 13 patients (50.0%) were abnormal; the abnormal results were composed of outlet obstruction (n=8, 30.8%), outlet obstruction and colon inertia (n=2, 7.7%), colon inertia (n=2, 7.7%), and outlet obstruction and hindgut dysfunction (n=1, 3.8%). On defecography, 6 patients (23.1%) were normal and 20 patients (76.9%) were abnormal; the results were composed of rectocele (n=8, 30.7%), rectocele and perineal descent syndrome (PDS; n=4, 15.4%), PDS and rectal intussusception (n=3, 11.5%), spastic pelvic floor syndrome (SPFS; n=3, 11.5%), rectocele and SPFS (n=1, 3.8%), and rectal intussusception (n=1, 3.8%). Of the 11 patients with outlet obstruction on CTT, rectocele (n=4, 36.4%), SPFS (n=1, 9.1%), rectocele and PDS (n=1, 9.1%), and PDS and rectal intussusception (n=1, 9.1%) were demonstrated on defecography, except for the 4 normal cases. CONCLUSION: Both CTT and defecography were necessary for diagnosing the patients with chronic constipation in compensation, and 63.6% of the patients with pelvic outlet obstruction showed an abnormal pelvic defecation function.
Barium ; Colon* ; Colonoscopy ; Compensation and Redress ; Constipation* ; Defecation ; Defecography* ; Enema ; Female ; Humans ; Intussusception ; Male ; Manometry ; Muscle Spasticity ; Pelvic Floor ; Rectocele

BACKGROUND: Caudal block has proved to be a satisfactory method of providing perioperative analgesia for pediatric surgery in inguinal and perineal areas. This study was designed to evaluate the effects of ketamine or clonidine as an adjunctive of caudal block produced by bupivacaine. METHODS: One hundred ninety five children aged 1~10 years, undergoing surgery in inguinal and perineal areas as ambulatory cases, were randomly allocated to one of four groups after the induction of general anesthesia; 0.25 % bupivacaine 1 ml/kg(group B), 0.25 % bupivacaine 1 ml/kg with ketamine 0.5 mg/kg(group K), 0.25 % bupivacaine 1 ml/kg with clonidine 1 microgram/kg(group C), and local infiltration group(group L). Postoperative pain was assessed using an objective pain scale and the incidence of side effects, such as urinary retention and nausea/vomiting was observed after surgery. RESULTS: In the group B and L, OPS score was higher and analgesics were more frequently administered than group K and C at the recovery room and at home after discharge(p<0.05). There was no difference between the groups in the incidence of nausea and vomiting but urinary retention at the recovery room was more frequent in group C than other groups(p<0.05). CONCLUSIONS: Caudal block provided more effective postoperative analgesia than local infiltration. In caudal block, the addition of ketamine or clonidine prolongs the duration of postoperative analgesia without significant increase in side effects.
Ambulatory Surgical Procedures* ; Analgesia* ; Analgesics ; Anesthesia, General ; Bupivacaine* ; Child ; Clonidine* ; Humans ; Incidence ; Ketamine* ; Nausea ; Pain, Postoperative ; Recovery Room ; Urinary Retention ; Vomiting

BACKGROUND: Epidural block is known to block sympathetic efferent nerve fiber, resulting in the decrease of catecholamine. We examined the effects of thoracic epidural block on DFT, neuroendocrine responses and hemodynamic changes in dogs. METHODS: Twenty one dogs were divided into three groups. The control group (N = 7) was anesthesized with only alpha-chloralose for general anesthesia, and a high thoracic epidural (T; N = 7) while the thoracolumbar epidural groups (TL; N = 7) were put under general anesthesia with high thoracic or thoracolumbar epidural blocks, respectively. The DFT was determined at 30 mins after surgical manipulation in the control group and at 10 mins after the epidural blocks in the two epidural groups. Four hemodynamic variables, catecholamine, cAMP and lactate were measured at 30 mins after the surgical manipulation (resting period), at 10 mins after epidural blocks and after defibrillation. RESULTS: 1) The DFT levels were significantly higher in the T (6.4 +/- 2.2 J) and TL groups (11.2 +/- 9.3 J) than in the control group (3.2 +/- 1.6 J)(P < 0.05). In the TL group, epinephrine-induced second DFT was lower (3.0 +/- 1.5 J) than the first DFT (11.2 +/- 9.3 J)(P < 0.05). 2) Catecholamine levels and hemodynamic variables including heart rate, mean arterial pressure, and cardiac output significantly decreased in the TL group compared with the control group after epidural block and defibrillation (P < 0.05). The DFT showed a significant correlation with plasma epinephrine levels after the epidural block (r = 0.56, P < 0.05). CONCLUSIONS: Our results show, an increase in transmyocardial DFT by the epidural block which may be caused by a decrease in catecholamine, especially epinephrine.
Anesthesia, General ; Animals ; Arterial Pressure ; Cardiac Output ; Chloralose ; Dogs* ; Epinephrine ; Heart Rate ; Hemodynamics ; Lactic Acid ; Nerve Fibers ; Plasma

Nodular hepatic involvement of multiple myeloma is very rare. We report here on a case of nodular hepatic involvement of multiple myeloma that mimicked intrahepatic cholangiocarcinoma. In patients with multiple myeloma, hepatic involvement of the multiple myeloma might be included in the differential diagnosis of hepatic mass.
Cholangiocarcinoma* ; Diagnosis, Differential ; Humans ; Liver* ; Multiple Myeloma*

Nodular hepatic involvement of multiple myeloma is very rare. We report here on a case of nodular hepatic involvement of multiple myeloma that mimicked intrahepatic cholangiocarcinoma. In patients with multiple myeloma, hepatic involvement of the multiple myeloma might be included in the differential diagnosis of hepatic mass.
Cholangiocarcinoma* ; Diagnosis, Differential ; Humans ; Liver* ; Multiple Myeloma*

Monoclonal gammopathies are associated with a wide range of renal diseases, including cast nephropathy, light chain amyloidosis, monoclonal immunoglobulin deposition diseases, and so on. We describe seven cases of monoclonal gammopathies involving kidney. The mean age was 61.6+/-3.6 years and male to female ratio was 1:1.3. Among 7 patients, diagnoses were cast nephropathy with light chain deposition disease, two light chain deposition diseases, three light chain amyloidosis and light chain deposition disease with light chain amyloidosis. Two cases were monoclonal gammopathy of undetermined significance and three cases were multiple myeloma in five cases underwent bone marrow biopsy. It showed that renal function was severly decreased in light chain deposition disease. It is clear that monoclonal gammopathies show various renal disease and clinical course in our cases. It is necessary to do renal biospy for adequate diagnosis and treatment even to old patients suspecting monoclonal gammopathy.
Amyloidosis ; Biopsy ; Bone Marrow ; Diagnosis ; Female ; Humans ; Immunoglobulins ; Kidney* ; Male ; Monoclonal Gammopathy of Undetermined Significance ; Multiple Myeloma ; Paraproteinemias*