No abstract available.
Hepatitis B Vaccines* ; Hepatitis B* ; Hepatitis* ; Histocompatibility Antigens* ; Histocompatibility* ; Humans ; Kidney Failure, Chronic* ; Kidney* ; Survival Rate* ; Transplants*

There have been reports of abnormalities in the lumbosacral region involving a lower-than-normal termination of the dural sac, which is caused by disease or anatomical variation. Inadvertent dural puncture or other unexpected complications can occur during caudal epidural block or adhesiolysis in patients with these variations, but only a small number of case reports have described this issue. We report a case of dural puncture by the introducer needle before attempting caudal epidural adhesiolysis, which occurred even though the needle was not advanced upward after penetrating the sacrococcygeal ligament. Dural puncture was caused by a morphological abnormality in the lumbosacral region, with no pathological condition; the dural sac terminal was located more distally than normal. However, dural puncture could have been prevented if we had checked for such an abnormality in the magnetic resonance imaging (MRI) taken before the procedure.
Humans ; Ligaments ; Lumbosacral Region ; Magnetic Resonance Imaging ; Needles ; Punctures

For the treatment of coarction of aorta, surgical intervention has been known as a standard therapy.During last decade balloon angioplasty for coarctation of the aorta has been reported as a successful and safe procedure in about 300 cases. This angioplasty was done mainly in infants and children, and little cases in adults and adolescents. A 22 year-old adult with coarctation of aorta have recieved balloon angioplasty. He visited to emergency room due to severe headache and the blood presure of arm was 240/130mmHg at emergency room. The blood pressure at ward was 168/92mmHg in upper extremities, 104/82mmHg in lower extrimities. His aortogram showed coarctation of thoracic aorta below left subclavian artery. The pressure gradient beween ascending aorta and right femoral artery was decreased from 60mmHg to 0mmHg after balloon dilatation (2 times, balloon diameter 18mm). There were no significant complications. The follow-up magnetic resonance image in 4 month after balloon angioplasty showed no evidence of restenosis or saccular aneurysm. Initial hypertension turned to normal blood pressure in 4 months after balloon angioplasty. This adult case of successful balloon angioplasty for coarctation of aorta is the first case reported in Korea.
Adolescent ; Adult* ; Aneurysm ; Angioplasty ; Angioplasty, Balloon* ; Aorta ; Aorta, Thoracic ; Aortic Coarctation* ; Arm ; Blood Pressure ; Child ; Dilatation ; Emergency Service, Hospital ; Femoral Artery ; Follow-Up Studies ; Headache ; Humans ; Hypertension ; Infant ; Korea ; Subclavian Artery ; Upper Extremity ; Young Adult

BACKGROUND: Transperitoneal laparoscopy for renal surgery is now a common procedure. Previous studies have suggested that retroperitoneal laparoscopy is associated with greater carbon dioxide absorption. We compared carbon dioxide absorption and hemodynamic variables in patients undergoing transperitoneal laparoscopy for renal or adrenal surgery with that of patients undergoing intraperitoneal laparoscopy for colon surgery. METHODS: Thirty two patients undergoing laparoscopic surgery were divided into laparoscopic renal surgery group (n = 16) and laparoscopic colon surgery group (n = 16). We measured hemodynamic changes and arterial blood gases before CO2 insufflation, 10 minutes, 70 minutes after insufflation and 30 minutes after exsufflation in each groups. RESULTS: There was no significant difference in carbon dioxide absorption in patients who underwent transperitoneal laparoscopy compared to intraperitoneal laparoscopy at any interval. CONCLUSIONS: In contrast to previous reports, our study suggests that transperitoneal laparoscopy is not associated with greater carbon dioxide absorption compared to intraperitoneal laparoscopy.
Absorption* ; Carbon Dioxide* ; Carbon* ; Colon ; Gases ; Hemodynamics ; Humans ; Insufflation ; Laparoscopy*

OBJECTIVE: This study was designed to evaluate the relation of leg length discrepancy on ankle muscle strength. METHOD: Twenty four adult women were tested (12 leg length equality and 12 leg length discrepancy). Leg length was measured by tape ruler from anterior superior iliac spine to medial malleolus, three times by three different trained examiners. The muscle strength (bilateral ankle dorsiflexors and plantarflexors) was measured by using Cybex 340 dynamometer at 30 degree/sec and 120 degree/sec. RESULTS: The mean value of leg length discrepancy was 0.89+/-0.24 cm. In leg length discrepancy group, the peak torque of ankle plantarflexor were 44.50+/-20.94 Nm in long leg and 51.83+/-12.75 Nm in short leg at 30 degree/sec angular velocity (p<0.05). CONCLUSION: We concluded that there were significant increase in plantar flexor peak torques of short leg than those of long legs at 30 degree/sec (P<0.05). Perhaps the difference of the muscle strength might be due to compensatory mechanism of short leg in propulsion during gait.
Adult ; Ankle* ; Female ; Gait ; Humans ; Leg* ; Muscle Strength ; Spine ; Torque

Pulmonary embolism is a not uncommon perioperative complication that results in substantial morbidity and mortality. However prompt diagnosis is difficult because clinical symptoms and signs of pulmonary embolism are not completely obvious. We report a case of severe pulmonary embolism on the first postoperative day of total abdominal hysterectomy in a patient transfused preoperatively for iron deficiency anemia caused by menorrhagia. We diagnosed pulmonary embolism by echocardiogram and chest spiral computerized tomography and the patient was moved to the intensive care unit. Tissue plasminogen activator was given and followed by continuous heparin infusion but the patient did not improve. He developed multiple organ dysfunction syndrome and died on the seventh postoperative day.
Anemia ; Anemia, Iron-Deficiency ; Female ; Heparin ; Humans ; Hysterectomy ; Intensive Care Units ; Menorrhagia ; Multiple Organ Failure ; Postoperative Complications ; Pulmonary Embolism ; Thorax ; Tissue Plasminogen Activator ; Tomography, Spiral Computed

BACKGROUND: 2.7% sorbitol-0.54% mannitol has been selected as an alternative irrigating fluid during endoscopic surgery for its theoretical advantages. We compared the influence of 2.7% sorbitol-0.54% mannitol (Urosol(TM), CJ Pharma, Seoul, Korea) and 5% glucose as an irrigating solution for hysteroscopic myomectomy & polypectomy in the occurrence of associated complications. METHODS: Thirty patients scheduled for a hysteroscopic operation were included in a prospective randomized trial comparing 2.7% sorbitol-0.54% mannitol solution (Group S, n = 15) and 5% glucose (Group G, n = 15) as an irrigating fluid. We recorded the amount of the irrigating fluids, the amount of fluid intake, and the duration of the procedure. Serum sodium, chloride, potassium, glucose values, and serum osmolality were measured before (just after the induction, T1), during (when 2 L of irrigation fluid was infused, T2), and after (1 h after the end of the operation, T3) the hysteroscopic procedure. RESULTS: The mean volume of absorbed irrigating fluid was 185.0 +/- 73.5 ml in Group G and 175.4 +/- 50.5 ml in Group S. Transient hyperglycemia occurred in one patient of Group G. No differences were found in the intraoperative and postoperative levels of serum sodium, potassium, chloride, glucose and osmolality in both groups. CONCLUSIONS: There was no clinical evidence of hyponatremic hypoosmolality in any of the patients. We found no difference between 2.7% sorbitol-0.54% mannitol and 5% glucose as an irrigating fluid for hysteroscopic procedures with mild to moderate irrigant absorption.
Absorption ; Glucose ; Humans ; Hyperglycemia ; Hysteroscopy ; Mannitol ; Osmolar Concentration ; Plasma ; Potassium ; Potassium Chloride ; Prospective Studies ; Sodium

We describe here a case of difficult intubation due to pseudoankylosis of the temporo-mandibular joint after a pterional craniotomy. A 50-year-old female was admitted to our hospital presenting with severe headache. According to her angiogram, a ruptured aneurysm in left posterior communicating artery (PCoA) and an unruptured right PCoA aneurysm were detected. We the operation in two-steps; the first operation for the left PCoA proceeded without any problem, and the tracheal intubation also was not difficult. Four weeks later, while inducing the general anesthesia for her second operation, severe trismus was detected after the infusion of propofol 120 mg. While ventilating the patient with a well-fitted mask, we performed several attempts of conventional tracheal intubation, and the patient was finally managed using a ProSealTM laryngeal mask airway with controlled ventilation. According to patient's history, trismus has also occurred after her first operation. We think that the reason for her trismus was a result of contracture of the temporalis muscle after her first pterional craniotomy.
Anesthesia, General ; Aneurysm ; Aneurysm, Ruptured ; Arteries ; Contracture ; Craniotomy* ; Female ; Headache ; Humans ; Intubation* ; Joints* ; Laryngeal Masks ; Masks ; Middle Aged ; Propofol ; Trismus ; Ventilation

BACKGROUND: The aim of this study was to investigate the effect of a botulinum toxin type A (BTX-A) injection in the masseter muscle using electromyography (EMG) in an animal model. METHODS: Ten male adult (>3 months of age) New Zealand white rabbits were used. Muscle activity was continuously recorded from 8 hours before to 8 hours after BTX-A injection. The rabbits received unilateral BTX-A injections of either 5 units (group 1, n = 5) or 20 units (group 2, n = 5). RESULTS: The masseter muscle activity of the rabbits was significantly reduced immediately after BTX-A injection (P < 0.05 for both groups). When the results from group 1 were compared with those from group 2, only the peak voltage was significantly decreased in group 2 (P = 0.013). CONCLUSION: Masseter muscle activity measured by EMG was immediately decreased after a BTX-A injection.
Adult ; Botulinum Toxins, Type A* ; Electromyography ; Humans ; Male ; Masseter Muscle* ; Models, Animal* ; Rabbits

Myasthenia gravis (MG) is an autoimmune-mediated disease characterized by weakness and fatigability due to dysfunction of the neuromuscular junction from antibodies directed against the acetylcholine receptor (AchR). The main considerations for the anesthesiologist are the underlying muscle weakness and interactions with various anesthetic drugs. This includes sensitivity to neuromuscular blocking agents and volatile agents, and the risk of postoperative respiratory failure. We report two cases of transsternal thymectomy for MG under general anesthesia with the use of a bispectral index-monitored total intravenous technique using propofol and remifentanil without muscle relaxants.
Acetylcholine ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics ; Antibodies ; Humans ; Muscle Weakness ; Muscles ; Myasthenia Gravis ; Neuromuscular Blocking Agents ; Neuromuscular Junction ; Piperidines ; Propofol ; Respiratory Insufficiency ; Thymectomy