No abstract available.
Lymphocytes* ; Macrophages* ; Nitric Oxide*

BACKGROUND: Combined spinal epidural anesthesia (CSE) often produces a more extensive spinal block than expected. This study was designed to evaluate the effects of CSE on subarachnoid block in patients undergoing lower extremity surgery. METHODS: Thirty-three patients who undergone lower extremity surgeries were randomly allocated to three groups of 11 patients each. Using needle through needle technique, all patients received a subarachnoid injection of hyperbaric 0.5% bupivacaine 1.6~2.0 ml through a 25G Whitacre spinal needle. Group 1 received no extradural injection for 25min, but group 2 and 3 received extradural saline 10 ml and bupivacaine 10 ml 5min after the subarachnoid injection, respectively. Levels of sensory and motor block were assessed at 4, 6, 8, 10, 15, 20, and 25 min after subarachnoid injection. RESULTS: The median values of maximum sensory block level were T7 in all groups. Levels of sensory blockade and the time to onset of maximum sensory blockade were similar among the three groups. There was no significant difference in the degree of motor block among three groups. CONCLUSIONS: This study suggests that extradural saline 10 ml or 0.5% bupivacaine 10 ml which injected 5min after subarachnoid injection does not significantly influence the level of subarachnoid block in lower extremity surgical patients. However, further study is required to declare the safety or optimal dose of extradural injection during CSE.
Anesthesia, Epidural* ; Bupivacaine ; Humans ; Injections, Epidural ; Lower Extremity* ; Needles

To find out the differences between periodontal ligament cells (PDL cells) and gingival fibroblast cells (GFB cells), alkaline phosphatase, a marker enzyme for osteoblast, was used to measure the activities and 45CaCl2 isotope was used to find out cellular and release of 45Ca, a requisite for bone formation,. PDL cells and GFB cells from 1 to 5 passages were also measured in alkaline phosphatase activity assay. By the use of above methods, followings were concluded that the PDL cells and the GFB cells have characteristics that are different from each other. In that PDL cells showed large amount of calcium uptake and large amount of calcium release in initial stage, they seem to possess characteristics which are similar to osteoblast-like cells. 1. The PDL cells, in contrast to the gingival fibroblast, showed exceedingly high alkaline phosphatase activity which was highest at the second passage, decreasing thereon. But gingival fibroblasts cells showed no distinct differences in alkaline phosphatase activity as the passage were elapsed. 2. For both PDL cells and GF cells, the 45Ca uptake was greatest at 2 hours period. The PDL cells showed higher measuring than GFB cells through out the whole time period. 3. Whereas the GFB cells showed slow increase of 45Ca release as time relapsed, the PDL cells showed rapid increase of 45Ca release.
Alkaline Phosphatase ; Calcium ; Fibroblasts ; Humans* ; Osteoblasts ; Osteogenesis ; Periodontal Ligament*

Amniotic fluid embolism (AFE) is a rare but devasting obstetric emergency. We experienced a case of AFE during dilatation and curettage (D & C) in a 15 2/7 weeks pregnant woman, age 30, who was diagnosed as having a missed abortion. Sudden rapid hypoxemia, low SpO2, hypotension, low PETCO2, high CVP, and tachycardia, right axis deviation and right bundle branch block in 12 leads ECG were developed during D &C under general anesthesia, and signs of disseminated intravascular coagulation (DIC) followed after the operation, which are consistent with the findings of AFE. Even though there was no definite pathologic and radiologic confirmation of AFE, laboratory findings showed 100 times higher level of alpha-fetoprotein in her central venous blood than same weeks of missed abortion woman's blood. Though it is rare, the anesthesiologist should always suspect the possibility of AFE, when the patient shows an unexplained collapse, cyanosis, low PETCO2, high CVP, low SpO2, ECG change and DIC during any kind of obstetric procedure.
Abortion, Missed ; alpha-Fetoproteins ; Amniotic Fluid* ; Anesthesia, General ; Anoxia ; Axis, Cervical Vertebra ; Bundle-Branch Block ; Cyanosis ; Dacarbazine ; Dilatation and Curettage* ; Dilatation* ; Disseminated Intravascular Coagulation ; Electrocardiography ; Embolism, Amniotic Fluid* ; Emergencies ; Female ; Humans ; Hypotension ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnant Women ; Tachycardia

Subcutaneous emphysema is one of the rare complication of tracheal intubation and it's mechanism has been known as airleakage to subcutaneous tissue from the perforated site of larynx, trachea and esophagus by the trauma of laryngoscopic blade, stylet and endotracheal tube. We experienced a case of subcutaneous emphysema during unexpected difficult endotracheal intubation. At the initial laparoscopic examination, the patient's laryngeal view was grade IV of Cormack and Lehane's calssification. After several trial of the intubation, cervical subcutaneous emphysema developed by the trauma of laryngoscopic blade, stylet and endotracheal tube, even though failed to confirm the perforated site at postanesthesia one day.
Esophagus ; Intubation ; Intubation, Intratracheal* ; Larynx ; Subcutaneous Emphysema* ; Subcutaneous Tissue ; Trachea

Crohn's disease can cause intestinal strictures, perforations, fistulas, or abscesses. Although fistulas and abscesses are common complications of Crohn's disease, a presacral abscess with neuromuscular complications is very unusual. A delayed diagnosis and treatment may increase morbidity. The diagnosis is frequently delayed, because the clinical features of presacral abscess are variable and nonspecific. We experienced a case of a presacral abscess with bilateral sciatica in a 25-year-old male patient. He was diagnosed with Crohn's disease of the terminal ileum 2 months previously and has been managed with mesalazine. He visited our hospital due to pain in the buttocks and severe neuralgia in both thighs. We confirmed enteric fistulas, resulting in a presacral abscess, which extended symmetrically through both sciatic notches and the gluteus medius muscles. He was managed with antibiotics after a small bowel segmentectomy, right hemicolectomy, fistulectomy, and surgical drainage. The bilateral radicular pain resolved completely within 2 weeks of surgery. The patient has remained in remission and asymptomatic 1 year after surgery.
Abscess ; Adult ; Anti-Bacterial Agents ; Buttocks ; Constriction, Pathologic ; Crohn Disease ; Delayed Diagnosis ; Drainage ; Fistula ; Humans ; Ileum ; Male ; Mastectomy, Segmental ; Mesalamine ; Muscles ; Neuralgia ; Sciatica ; Thigh

Subclavian venous catheterization is common technique for a variety of purposes, but this procedure is associated with complications that include damage to the lung, pleura, thoracic duct, nerve and subclavian artery. We recently encountered a case of the tracheal puncture and endotracheal cuff perforation during the subclavian catheterization in a 67-year-old female who was scheduled for tracheal reconstruction. Tidal volume was escaping from around the endotracheal tube during the subclavian catheterization, however, repeated inflation of the cuff failed to maintain the necessary cuff pressure to seal the trachea. After the operation, by using the fiberoptic bronchoscope and injecting dye into the cuff, we confirmed the site of tracheal puncture and endotracheal cuff perforation which caused by the introducer needle of the central venous kit. We suggest that tracheal puncture and endotracheal cuff perforation be added to the list of complication of subclavian catheterization. This complication should be suspected whenever the cuff pressure cannot be maintained during or after an subclavian catheterization.
Aged ; Bronchoscopes ; Catheterization* ; Catheters* ; Female ; Humans ; Inflation, Economic ; Lung ; Methods ; Needles ; Pleura ; Punctures* ; Subclavian Artery ; Subclavian Vein* ; Thoracic Duct ; Tidal Volume ; Trachea ; United Nations

BACKGROUND: As the clinical application of non-invasive shunt estimation to operation under one-lung ventilation has not been reported, this study was carried out to evaluate the validity and accuracy of the non-invasive shunt estimations in one-lung ventilation with hemodilution. METHODS: Following general anesthesia with enflurane 0.5 1 vol.% and 100% oxygen in ten Mongrel dogs (B.W. around 16 kg), tracheostomy and insertion of left-side endobronchial tube and one-lung ventilation were performed. Acute normovolemic hemodilution was produced by sequential hemodilution with hydroxyethyl starch. The intrapulmonary shunt (QS/QT) was calculated by the classic shunt equation, by the oxygen contents-based estimated shunt equation, and by oxygen tension-based estimations such as alveolar to arterial oxygen difference (P(A-a)O2), respiratory index (RI, P(A-a)O2/PaO2), arterial oxygen tension to alveolar oxygen ratio (PaO2/PAO2), and PaO2 to FiO2 ratio. To assess the quantitative accuracy of the estimated shunt, the data were divided arbitrarily into two groups on the basis of the mean arteriovenous oxygen content difference (C(a-v)O2) being 3.6 ml/dl or greater (group 1) and less than 3.6 ml/dl (group 2). Relationships to QS/QT were analyzed by simple linear regression. RESULTS: In 104 measurements, the correlation between QS/QT and non-invasive shunt were poor (r = 0.66 - 0.76). However, in group 1 (n = 45), the correlation between QS/QT and the estimated shunt were very good (r = 0.93) and good for P(A-a)O2 (r = 0.83), RI (r = 0.87), PaO2/PAO2 (r = - 0.84), and PaO2/FiO2 (r = - 0.85). In group 2 (n = 58), the correlation between QS/QT and non-invasive shunt were worse than in group 1. Group 2 had lower hematocrit (20.6% vs 26.7 %, P < 0.001), higher cardiac output, and lower pulmonary and systemic vascular resistance than group 1 (P < 0.05). The difference between the estimated shunt and the classic shunt in group 1 remained constant when the classic shunt was increased further. However, the difference in group 2 was enhanced by the increment of the classic shunt. CONCLUSIONS: We conclude that even if the non-invasive shunt estimation might be affected by hemoglobin and cardiac output, it is a viable method in mild hemodiluted patients with good cardiovascular reserve.
Anesthesia, General ; Animals ; Cardiac Output ; Dogs* ; Enflurane ; Hematocrit ; Hemodilution ; Humans ; Linear Models ; One-Lung Ventilation ; Oxygen ; Starch ; Tracheostomy ; Vascular Resistance

BACKGROUND: Core hypothermia after the induction of general anesthesia results largely from core-to- peripheral redistribution of body heat and anesthetic-induced inhibition of tonic thermoregulatory vasoconstriction. Because most metabolic heat is lost via the skin surface, covering the skin surface with an insulator is a way of minimizing heat loss. We therefore evaluated core and peripheral temperature changes with and without wrapping the lower extremity in cotton and elastic bandages during open abdominal surgery under general anesthesia. METHODS: Eighty-five patients of ASA physical status 1 or 2 who underwent open abdominal surgery under general anesthesia were investigated in this study. They were randomly assigned based on wrapping of the lower extremity in cotton and elastic bandages (group 2, n = 37) or not (group 1, n = 48). Anesthesia in both groups was induced with propofol and maintained with enflurane and 50% nitrous oxide in oxygen. The temperatures of the nasopharynx, forehead, chest, back, palm and sole were measured before and 10, 30, 60, 90, 120, 150 and 180 min after induction. RESULTS: Core temperature decreased significantly after the induction of anesthesia in both groups (P <0.05), but no significant difference was found between the groups in terms of core, palm, back and forehead skin temperature changes. However, the core and chest temperatures of group 2 at 150 and 180 min after induction were significantly lower than those of group 1 (P <0.05), and sole temperature changes were significantly different between the groups (P <0.05). CONCLUSIONS: Wrapping the lower extremity in cotton and elastic bandages during open abdominal surgery under general anesthesia was not effective at preventing the core temperature from decreasing. It is possible that wrapping the lower extremity causes peripheral vasodilation before anesthesia, stimulating the barorecepter, and shifting the body core temperature threshold for hypothermia inducing peripheral vasoconstriction to lower the body core temperature.
Anesthesia ; Anesthesia, General* ; Body Temperature Regulation ; Compression Bandages ; Enflurane ; Forehead ; Hot Temperature ; Humans ; Hypothermia ; Lower Extremity* ; Nasopharynx ; Nitrous Oxide ; Oxygen ; Propofol ; Skin ; Skin Temperature ; Thorax ; Vasoconstriction ; Vasodilation

No abstract available.
Animals ; Herpes Simplex* ; Mice* ; Simplexvirus* ; Skin* ; Vagina*