Hypoxemia during hemodialysis(H.D) was reported 1st in 1974. Many studies have confirmed occurrence of hypoxemia during H.D. We experienced of hypoxemia during H.D in liver transplanted patient who were treating ventilatory care. 1st case, we experienced significant drop of arterial O2 tension and recovered to pre-H.D level after H.D . We prevented drop of arterial O2 tension during H.D by prior supplement of increased inspired O2 in 2nd case. To a group of liver transplanted patients especially having limited cardiac and pulmonary reserve , H.D may produce severe complications. We concluded that monitoring of oxygenation should be done and supplemental O2 should be given before starting H.D in critically illed patients.
Anoxia* ; Humans ; Liver Transplantation* ; Liver* ; Oxygen ; Renal Dialysis* ; Transplantation

BACKGROUND: The development of so-called "Point-of-care" (POC) devices for blood or urine analysis has resulted in many systems that are widely used at home or at the bedside. We evaluated the performance of the I-STAT portable clinical analyzer for measuring blood gases (pH, PCO2, PO2) and whole blood electrolytes (sodium, potassium and ionized calcium) with reference to a conventional blood gas analyzer (Chiron 348 pH/ blood gas/electrolytes). METHODS: Thirty samples from the arterial blood were simultaneously analyzed with I-STAT system and with Chiron 348 pH/blood gas/ electrolytes analyzer. Differences between results of two methods were analyzed by paired t-test (p<0.05). RESULTS: PO2, PCO2 and Na measured with I-STAT system and Chiron 348 PH/ blood gas/ electrolytes analyzer showed no significant differences. pH, calculated HCO3, K and Ca measured by two methods showed significant difference, but observed differences would not affect clinical decisions except ionized calcium. CONCLUSIONS: This study shows that blood gas and electrolyte analysis using the I-STAT portable device is comparable with that performed by a conventional Chiron 348 pH/blood gas/ electrolytes analyzer except ionized calcium.
Calcium ; Electrolytes ; Gases ; Hydrogen-Ion Concentration ; Potassium

Delayed type cerebral vasoconstriction (DCV) following aneurysmal subarachnoid hemorrhage is an important cause of permanent neurological injury and death. The mechanism of DCV remains unknown. Recently many investigators have used a new treatment for DCV involving the use of intraventricular sodium nitroprusside. We report upon a clinical case where a relatively large amount of sodium nitroprusside was intrathecally delivered by intraventricular catheter for the treatment for DCV.
Catheters ; Humans ; Nitroprusside* ; Research Personnel ; Sodium* ; Subarachnoid Hemorrhage ; Vasoconstriction ; Vasospasm, Intracranial*

Nasotracheal intubation is commonly performed for oropharyngeal or facial surgery. Although retropharyngeal dissection is a rare complication of nasotracheal intubation, serious sequelae may result. We report a case of a traumatic retropharyngeal dissection during nasotracheal intubation without untoward sequelae.
Intubation*

Hiccups are due to an intermittent clonic spasm of the diaphragm. In most cases, hiccups are self-limiting disease, but persistent hiccups may be related to the presence of serious underlying systemic disease. Two patients who had persistent hiccups that were not controled by conventional methods and medications were referred to the pain clinic. We administered a single oral medication of gabapentin, and then the hiccups disappeared in both cases. We concluded that gabapentin should be considered as an alternative therapy to control persistent or intractable hiccup. It could be particularly useful for those patients with solid malignancies, either alone or as an "add-on therapy" with other oral agents.
Diaphragm ; Hiccup* ; Humans ; Pain Clinics ; Spasm

OBJECTIVE: Elective surgical approaches and trauma cause changes in the production of different cytokines. The aim of this study was to evaluate the effects of laparoscopic surgery on the immune system of patients with gynecologic diseases. METHODS: We recruited the open surgery group (n=20) and laparoscopic surgery group (n=33). In a prospective study we examined the C-reactive protein (CRP) level, the production of the cytokines Interleukin-1beta (IL-1beta), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-10 (IL-10) and TNF-alpha concentrations by ELISA. In addition the fibrinogen, transferrin, albumin, hemoglobin and hematocrit were measured. Statistical analysis was made by Mann-Whitney U test and Kruskal-Wallis test. RESULTS: There were significant statistical differences in the CRP, IL-6 and IL-8 between the open surgery group and laparoscopic surgery group after surgery. The CRP and IL-8 showed a more distinct increase in open surgery group 24 hours after surgery, the differences between the two surgical approaches were significant (p<0.05). CONCLUSION: Elective surgical approaches cause changes in the immune system, which can be evaluated by the reaction of cytokines. Laparoscopic surgery cause less activation of the CRP and IL-8 than open surgery.
C-Reactive Protein ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Female ; Fibrinogen ; Genital Diseases, Female* ; Hematocrit ; Humans ; Immune System* ; Interleukin-10 ; Interleukin-1beta ; Interleukin-6 ; Interleukin-8 ; Laparoscopy* ; Prospective Studies ; Transferrin ; Tumor Necrosis Factor-alpha

Uterine leiomyomas are the most common uterine tumors. They are estimated to be present in approximately 20% of all women of reproductive age. They may be present in subserosal, intramural, or submucosal in location within the uterus, or located in the cervix, in the broad ligaments, or on a pedicle. Many studies report that the malignant potential of a preexisting uterine leiomyoma is extremely rare, occuring in less than 0.5%. Uterine leiomyomas may cause a range of syptoms, for example, severe anemia from abnormal uterine bleeding, dysmenorrhea, constipation from rectosigmoid compression, dysuria, frequency, residual sensation due to bladder compression. Patients with those symptoms or "cancer phobia" should be treated. Rare but severe symptoms associated with uterine leiomyomas are rectosigmoid compression, with intestinal obstruction, thrombophlebitis of lower extremities from venous stasis, polycythemia, ascites, severe pain from torsion and infection of prolapsed pedunculated submucosal myoma and uterine inversion from prolase of pedunculated submucosal leiomyoma. Now we report a rare case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma, which caused hypovolemic shock due to massive uterine bleeding.
Anemia ; Ascites ; Broad Ligament ; Cervix Uteri ; Constipation ; Dysmenorrhea ; Dysuria ; Female ; Humans ; Intestinal Obstruction ; Leiomyoma* ; Lower Extremity ; Myoma ; Polycythemia ; Prolapse* ; Sensation ; Shock ; Thrombophlebitis ; Urinary Bladder ; Uterine Hemorrhage ; Uterine Inversion* ; Uterus

BACKGROUND: A prospective study was performed to evaluate the preventive effect of intravenous (IV) ondansetron on postoperative nausea and vomiting (PONV) due to epidural morphine for postoperative pain control after major abdominal surgery. METHODS: One hundred patients undergoing elective major abdominal surgery were randomly devided into two groups, group O (n = 50) receiving IV ondansetron and group C (n = 50) receiving IV saline. After bolus epidural morphine were injected to all patients thirty minutes before the end of surgery, group O received ondansetron 8 mg and group C received normal saline intravenously. Incidence and severity of nausea, episodes of vomiting, patient's satisfaction, side effects such as pruritus, headache, dizziness related to epidural morphine were checked at 6, 24 hours after operation. RESULTS: The incidence and severity of nausea were significantly decreased in group O than group C during the first 24 hours after surgery. There were no significant differences in postoperative pain scores and patient's satisfaction between groups. The patients who didn't experienced PONV were significantly more satisfied than those who experienced PONV after surgery. CONCLUSION: Ondansetron decrease the incidence and severity of nausea in patients receiving epidural morphine for postoperative pain control after major abdominal surgery.
Dizziness ; Headache ; Humans ; Incidence ; Morphine* ; Nausea ; Ondansetron* ; Pain, Postoperative ; Postoperative Nausea and Vomiting* ; Prospective Studies ; Pruritus ; Vomiting

The incidence of all malignant tumor in pregnancy is 0.07-0.1%. The most frequent tumors in pregnancy are breast cancer, gynecologic tumors (cervical cancer, ovarian cancer), melanoma and lymphomas. Any malignant tumor in pregnancy has a diagnostic and therapeutic problem. Melanoma is 8% of all malignancies in pregnancy. Surgery is a definitive therapy for early-stage disease. Melanoma in pregnancy metastasize early and rapidly. So we have difficulty in making therapeutic plan. Most frequent metastatic lesions are liver and lung. We experienced melanoma of liver in pregnancy. This report represents melanoma in pregnancy with a review of literature.
Breast Neoplasms ; Incidence ; Liver* ; Lung ; Lymphoma ; Melanoma* ; Ovarian Neoplasms ; Pregnancy* ; Rupture, Spontaneous*

Goldenhar syndrome is a rare congenital disorder of hemicraniofacial and vertebral defects related to the abnormal development of the first and second branchial arches. In some infants, congenital heart disease, and pulmonary and renal defects are also present. Goldenhar syndrome commonly involves an airway which is difficult to manage. Tracheal intubation may be difficult due to a combination of retrognathia, micrognathia, mandibular hypoplasia, palatal defects and vertebral abnormities. We experienced the anesthetic management of an 8-month-old boy with Goldenhar syndrome who received excision and biopsy for conjunctival dermoid and ureteral reimplantation for vesicoureteral reflux under general anesthesia. Airway management, with thiopental, rocuronium and sevoflurane, and tracheal intubation were accomplished successfully in the patient. Surgery was performed uneventfully and the patient was discharged without complication.
Airway Management ; Anesthesia, General ; Biopsy ; Branchial Region ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Dermoid Cyst ; Goldenhar Syndrome* ; Heart Defects, Congenital ; Humans ; Infant ; Intubation ; Male ; Replantation ; Retrognathia ; Thiopental ; Ureter ; Vesico-Ureteral Reflux