Since succinyl choline was introduced, into clinical anesthesia, it has been used as main muscle relaxant because of its rare side effects and short duration of action. Our interest in the effects of this drug on extraocular muscles and intraocular pressure began in 1957 following reports of vitreous expulsion in patients who received succinylcholine during ocular surgery. The effects of muscle relaxants on the intraocular pressure were studied in 60 healthy human subjects. When succinylcholine was given alone, 20 human subjects had a mean increase in intraocular pressure of 10. 5 mmHg. When gallamine 2. 5 mg/kg or pancuronium 80 ug/kg was used, 20 subjects showed a mean decrease of 3. 1 mm Hg from control. Giving gallamine (20 mg) or dtubo curarine(3 mg) 2-3 minutes prior to the administration of succinylcholine, 20 human subjects had no significant change in intraocular pressure. This simple method prevents the increase in intraocular pressure associated with the use of succinylcholine.
Anesthesia ; Choline ; Gallamine Triethiodide ; Humans ; Intraocular Pressure* ; Methods ; Muscles ; Pancuronium ; Succinylcholine

To determine the effects of hydrcxyethyl starch upon liver, kidney, serm electrolytes and particularly upon blood coagulation, 500 ml of 6% HES in saline solution was administered intravenously to 15 patients during elective minor surgery. In all cases weighted blood loss was less than 600 ml without replacement. The following laboratory tests were performed immediately before infusion and again 1 hour, 24 hours, 48 hours, and 1 week after the infusion: RBC, WBC, hemoglobin, hematocrit, ESR, platelet, bleeding time, coagulation time, prothrombin time, total protein, albumin, total bilirubin, direct bilirubin, SGOT, SGPT, alkaline phosphatase, BUN, sodium, potassium, and chloride. The results are as follows: 1) No anaphylactic shock or bleeding tendency characteristic of colloids was encountered. 2) No functional disturbance of liver or kidney directly attributable to HES was identified. 3) All laboratory parameters except WBC and ESR decreased after infusion. The decrease was, however, within the normal range and believed secondary to dilational effect of infusion. WBC increased somewhat, but returned to the preinfusion level in a week. 4) Exceptionally erythrocyte sedimentation rate increased notably during the 24 hour period following infusion. As with dextran, this was interpreted not due to direct effect of HES, but due to increased adsorption of fibrinogen, alpha-beta-gamma-glcbulin to red cell surface with changes in electric charge between red cells. 5) Clinical applicability, metabolic aspect, degree of subtitution of hydroxyethyl group and safety with multiple infusion of HES must be carefully determined.
Adsorption ; Alanine Transaminase ; Alkaline Phosphatase ; Anaphylaxis ; Aspartate Aminotransferases ; Bilirubin ; Bleeding Time ; Blood Coagulation ; Blood Platelets ; Blood Sedimentation ; Colloids ; Dextrans ; Electrolytes ; Fibrinogen ; Hematocrit ; Hemorrhage ; Humans ; Kidney ; Liver ; Potassium ; Prothrombin Time ; Reference Values ; Selective Estrogen Receptor Modulators ; Sodium ; Sodium Chloride ; Starch* ; Surgical Procedures, Minor

Vasopressor effects of epinephrine, norepinephrine, ephedrine, phenylephrine, methoxamine and of mephentermine were compared in resrpinized dogs with or without nitrous oxide-oxygen-halothane anesthesia. The results are as follows: (1) Epinephrine and norepinephrine were shown to have the most potent pressor effect in reserpinized and nitrous oxide-oxygen-halothane-anesthetized dogs. Phenylephrine, methoxamine, mephen-termine and ephedrine were less potent in decreasing order. (2) Decrease in mean arterial pressure was less marked in dogs reserpinized and anesthetized with nitrous oxide-oxygen-halothane than in reserpinized but unanesthetized dogs. (3) It revealed that nitrous oxide-oxygen-halothane anesthesia potentiated the vasopressor effects of the sympathomimetic amines studied. Nitrous oxide-oxygen-halothane anesthesia is implicated to exert an sympathomimetic effect.
Anesthesia* ; Animals ; Arterial Pressure ; Dogs* ; Ephedrine ; Epinephrine ; Mephentermine ; Methoxamine ; Norepinephrine ; Phenylephrine ; Sympathomimetics*

We report computed tomography (CT) and magnetic resonance (MR) findings of a patient with polyostotic Paget disease and multicentric giant cell tumor (GCT). Brain CT scan showed widening of diploic space, cortical thickening and enhancing soft tissue mass in occiput with underlying calvarial destruction. Ill-defined soft tissue masses were also detected in maxillary sinus and buttock with underlying bony destruction on CT. MR image showed multifocal nodules in wide diploic space with low signal intensity on T1 -weighted image and bright signal intensity on T2-weighted image. Mass in occiput showed homogeneous hypointensity to bone marrow on T1-weighted image and homogeneous iso- intensity on T2-weighted image. Multiple nodules in diploic space and occipital mass showed contrast enhancement following administration of Gd-DTPA. Biopsy was performed at scal p, maxillary sinus and buttock, and histologic analysis revealed GCT.
Biopsy ; Bone Marrow ; Brain ; Buttocks ; Gadolinium DTPA ; Giant Cell Tumors* ; Giant Cells* ; Humans ; Maxillary Sinus ; Tomography, X-Ray Computed

The dislocation of metacarpophalangeal joint of the index is apparently rare injury and produeed by striking of the volar surface of the outstretched index against a resistent object. This injury presents certain characteristics which make it distinctly different from dislocation of the thumb or little finger. The proximal phalanx is displaced over the dorsum of the corresponding metacarpal, the hand is deformed, and the index is inclined toward the middle finger. In 1957 Kaplan reported his study about the pathological anatomy and proper treatment technique in the dislocation of the metacarpophalangeal joint of the index finger. In this type of dislocation, closed reduction, even if performed immediately after the injury, is unsuccessful, and open reduction is mandatory. The authors have experienced a case of dorsal dislocation of the metacarpophalangeal joint of the index finger developed 3 weeks prior to admission on 20 th, May, 1985.
Dislocations ; Fingers ; Hand ; Metacarpophalangeal Joint ; Strikes, Employee ; Thumb

Changes of alveolar-arterial oxygen tension differences (AaDO2) after 35 cases of open heart surgery were evaluated with durations of extracorporeal circulation and prognosis. Following results were obtained. 1) AaDO2 values of pre-bypass in fatal open great cases were higher than in survival cases. 2) AaDO2 values of post-bypass were similar and noted no correlation to progonsis. 3) Luration of extracorporeal bypass time in fatal cases were longer than in survival cases. 4) Changes of AaDO2 values after extracorporeal circulation were much correlated to AaDO2 of pre-bypass than those of post-bypass.
Extracorporeal Circulation ; Oxygen ; Prognosis ; Thoracic Surgery

d-tubocurarine is one of the non-depolarizing muscle relaxants which is most commonly used in clinical situations d-Tc is used as a selective muscle relaxant in hypertensive patients or patients for renal transplantation. The most common side effect of d-Tc is a dose-related fall in arterial pressure. Although the cause of the hypotension is still controversial, the two mechanism most frequently suggested are ganglionic block and histamine release. d-Tc is an active ganglionic blocking agent. Howver, because its potency at the neuromuscular junction is greater than at the ganglia, there is some doubt that a clinical concentration of d-Tc is sufficient to cause hypotension. histamine release may play a role in this blood pressure reduction. Indeed, decrease in blood pressure produced by d-Tc have been shown to be less when the muscle relaxant was preceded by and antihistamine. The amount of histamine release substance depends on plasma levels of the drug achieved and thus on the rapidity of intravenous administration of that drug. If d-Tc produces histamine release, then slow intravenous injection would be associated with minimal histamine release and a resulting attenuation of the typical blood pressure reduction that follows' this drugs injection. Therefore, we measured changes in mean arterial pressure(MAP) and heart rate in patients anesthetized with nitrous oxide-halothane during and after the intravenous injection of d-Tc at varying rates of administration. The results are as follows: 1) Group 1: Maximum reduction in MAP were present 3 minutes following d-Tc injection over 1 second (81+/- 3 torr). Comparative with control group (99+/-6 torr), significant reduction was revealed(18.1%). 2) Group 2: Decrease in MAP 3 minutes after administration of d-Tc over 90 seconds(11.1%) were intermediate between the other injection rates. 3) Group 2: Decrease in MAP 3 minutes after d-Tc administration was significantly less in patients receiving the drug over 180 seconds(5.1%). Heart rate did not change significantly after d-Tc injection regardless of the rate of administration.
Administration, Intravenous ; Arterial Pressure ; Blood Pressure* ; Ganglia ; Ganglion Cysts ; Heart Rate ; Histamine Release ; Humans ; Hypotension ; Injections, Intravenous ; Kidney Transplantation ; Neuromuscular Junction ; Neuromuscular Nondepolarizing Agents ; Plasma ; Tubocurarine*

Tension pneumothorax occurred in a 42 year old man with pulmonary tuberculosis during induction of general anesthesia for left lobectomy. Rupture of emphysematous bullse, presumably due to positive pressure ventilation employed during induction, was identified by immediate thoracotomy. The patient made an uneventful recovery.
Anesthesia, General* ; Humans ; Pneumothorax* ; Positive-Pressure Respiration ; Rupture ; Thoracotomy ; Tuberculosis, Pulmonary

Sudden operative death due to massive tumor embolism occurred during operation. During the course of anesthesia for pneumonectomy, this 54-year-old male patients showed continuous hypotension, weak or absent pulse of radial, external carotid, femoral and doralis pedis artery of the right side. But those of the other side were within normal range and anesthesia went on uneventfully. As the patient failed to gain consciousness postoperatively, immediate emboleetomy under general anesthesia was performed under the impression of massive tumor embolism. Multiple tumor emboli were removed from the innominate arteries, right common carotid and right brachial artery. After operation of embolectomy, arterial blood pressure and pulse measured on the right side were regained. However, the patient failed to return to his consciousness and died due to unexpected cardiac arrest, 2 days later.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Arteries ; Brachial Artery ; Brachiocephalic Trunk ; Consciousness ; Embolectomy ; Heart Arrest ; Humans ; Hypotension ; Lung* ; Male ; Middle Aged ; Neoplastic Cells, Circulating* ; Pneumonectomy ; Reference Values

BACKGROUND: There is difference between isoflurane and enflurane in the myocardial sensitization to catecholamines, and their actions on the heart. Enflurane reduces cytoplasmic calcium more than isoflurane. The hypothesis could be suggested that these two volatile anesthetics might cause the different incidences and natures of cardiac arrhythmias. METHODS: The anesthesia was induced by the intravenous injection of thiopental(6 mg, kg-1) and pipecuronium(0.1 mg, kg-1). Two groups were randomly allocated to the patients(n=80) in the maintenance: Group I inhaled isoflurane(1~2%), O2(2 L), and N2O(2 L), Group II, enflurane (1.5~2.5%). Continuous electrocardiographic recordings with Holter monitor were made of those undergoing tympanoplasty during anesthesia. The tapes recorded were scanned using analyzer, and we read out ECG complexes on the screen. Results were categorized as induction, maintenance, and emergence, and inferred from unpaired t-test, and X2-test with p<0.05 considered significant. RESULTS: The results were as follows: 1) The total incidence of cardiac arrhythmias was 65.0%. Isoflurane(52.5%) was lower than enflurane(77.5%) in the incidence. 2) During maintenance and emergence, isoflurane was lower than enflurane in the frequency of supraventicular arrhythmias. 3) Ventricular arrhythmias most frequently occurred in induction. 4) The frequency of supraventricular arrhythmias was more than two times that of ventricular ones. The arrhythmias at the AV junction were the most common, and VPC's the second. CONCLUSIONS: Greatest caution should be paid during peri-induction. It could be suggested that compared to enflurane, isoflurane better be administered for those to whom arrhythmias could be harmful.
Anesthesia ; Anesthetics ; Arrhythmias, Cardiac* ; Calcium ; Catecholamines ; Cytoplasm ; Electrocardiography ; Enflurane* ; Heart ; Incidence* ; Injections, Intravenous ; Isoflurane* ; Tympanoplasty