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

Unidirectional valve (UDV) malfunction causes rebreathing of expired gas during anesthesia. However, the resultant hypercarbia without hypoxemia by UDV malfunction is not easily detected. We experienced a case of severe hypercarbia which caused by sticking expiratory valve at 45 minutes after the induction of anesthesia, in spite of checking UDV function preoperatively. In this case, expiratory UDV malfunction was diagnosed with the change of capnographic waveform. And so, we recommend monitoring of capnographic waveform during every anesthesia, in addition to preoperative UDV checking.
Anesthesia ; Anoxia

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

The incidence of phrenic nerve block following brachial plexus block, performed above clavicle, have varied widely. However, respiratory difficulty due to unilateral phrenic nerve block is rare complication of brachial plexus blocks, We experienced a case of symptomatic unilateral phrenic nerve block after supraclavicular approsch in thirty-four-year old woman. For brachial plexus block, 30 ml of 1.5% lidocaine and 0.2 mg of epinephrine were injected. Twenty five minutes after injection, she complained of respiratory difficulty. At recovery room, she complained sharp chest pain at apex of heart and epigastrium. We diagnosed her case as right phrenic nerve block because her right diaphragm was normal contour but was markedly displaced upward in portable chest X-ray. Respiratory difficulty was recovered 5 hours after injection and her chest pain was recovered 9 hours after injection.
Brachial Plexus* ; Chest Pain ; Clavicle ; Diaphragm ; Epinephrine ; Female ; Heart ; Humans ; Incidence ; Lidocaine ; Phrenic Nerve* ; Recovery Room ; Thorax

The effect of anesthetic duration of epinephrine and morphine mixture with hyperbaric tetracaine on spinal anesthesia was studied at Tague Catholic University Hospital. Fifty-two pa- tients, ASA physical status I-II, were selected randomly and divided them into 4 groups as follows: Group A; Only 0.5% hyperbaric tetracaine 14 mg injection. Group B; Mixture of 0.5% hyperbaric tetracaine 14 mg and morphine 0.15 mg injection. Group C; Mixture of 0.5% hyperbaric tetracaine l4 mg and epinephrine 0.2 mg injection. Group D; Mixture of 0.5% hyperbaric tetracaine 14 mg, morphine 0.15 mg and epinephrine 0.2 mg injection. The results of motor block onset, motor block duration, sensory block onset and sensory block duration were as follows: 1) Motor block onset; There were no statistical differences between each groups. 2) Motor block duration; The duration of motor blocks were significantly longer in group C and D than group A. The duration of motor block was significantly longer in group D than group B. 3) sensory block onset; There were no statistical differences between each groups. 4) Sensory block duration, The duration of sensory blocks were significantly longer in group D than group A, B and C. These results suggested that the effect of anesthetic duration of epinephrine and morphine mixture with local anesthetics simultaneously on spinal anesthesia were more prolonged than tetracaine injeetion only and injection of tetracaine, epinephrine mixture.
Anesthesia, Spinal* ; Anesthetics, Local* ; Epinephrine* ; Morphine* ; Tetracaine