This 17 year-old male patient had an experience of a difficult intubation problem on miniplate removal operation after orthognathic surgery, but he didn't have the same problem on a previous orthognathic surgery 1 year before. He suffers from mental retardation and speaking disability due to congenital brain damage. I think difficult exposure of the larynx was caused by the imbalance of neck muscle force and jaw instability, as result from surgery. The preoperative airway evaluation is very important because findings may dictate choice of intubation technique. A flexible fiberoptic laryngoscope may be the most useful aid to awake intubation in the patient with a known difficult airway.
Adolescent ; Brain ; Humans ; Intellectual Disability ; Intubation* ; Jaw ; Laryngoscopes ; Larynx ; Male ; Neck Muscles ; Orthognathic Surgery

Systemic lupus erythematosus is a systemic disorder which has frequent involvement of gastrointestinal tract. Non specific symptoms such as anorexia, nausea, diarrhea and abdominal pain are well known symptoms when the gastrointestinal tract is involved. The most feared gastrointestinal complication of systemic lupus erythematosus is lupus enteritis. The pathological change in lupus enteritis is usually a result of mesenteric vasculitis. Major complications such as intestinal bleeding and perforation may occur and sometimes result in sugery. Because of high mortality rate in case of major complications, early diagnosis and appropriate treatment is very important. We experienced three patients with lupus enteritis who presented with severe abdominal pain and dirrhea. They were diagnosed by characteristic radiographical findings of small bowel series and barium study. All radiographical findings has been resolved completely with the steroid therapy. Conclusively we can induce complete remission by steroid therapy alone, if we diagnose lupus enteritis in the early period of disease course.
Abdominal Pain ; Anorexia ; Barium ; Diarrhea ; Early Diagnosis ; Enteritis* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Lupus Erythematosus, Systemic ; Mortality ; Nausea ; Vasculitis

OBJECTIVETo investigate the immune effects of three different programs for revaccination among adults of non- and hypo-responders to recombinant Hepatitis B vaccine.

METHODSThose who were once immunized with recombinant Hepatitis B vaccine more than one standard schedule (0, 1, and 6 months) in two years and negative for Hepatitis B markers were randomly given three-different projects for revaccination. 34 adults of A group were given GM-CSF 300 microg by subcutaneous injection for the first day, then 10 microg each time by intramuscular route for routine immune method. 33 adults of B group were given Hepatitis B vaccine 20 microg each time. 33 adults of C group were given Hepatitis B vaccine 10 microg each time. The blood samples were collected before the first injection and in 1, 2 and 8 months following the first injection to test Anti-HBs.

RESULTSAt T1, the anti-HBs positive conversion rate of group A, B and C was 26.47%, 48.48% and 18.18% respectively (chi-2 = 7.20, P = 0.027). At T8, the anti-HBs positive conversion rate of group A (64.71%) and group B (75.76%) were higher than group C (39.39%), and there was significant difference (chi-2 = 9.07, P = 0.011). At T1, the anti-HBs level of group B (417.00 +/- 69.36) was higher than that of group A (203.74 +/- 79.56). At T2, the anti-HBs level of group B (458.17 +/- 64.09) was higher than that of group C (257.86 +/- 76.60). At T8, the anti-HBs level of group A (501.48 +/- 70.00) and group B (532.73 +/- 68.82) were higher than those of group C (256.12 +/- 75.39) (t =4.27, P = 0.0173).

CONCLUSIONSchemes of augmentation doses of Hepatitis B vaccine and being combined with GM-CSF should be in effect for non- and hypo-responders to Hepatitis B vaccine.

Adolescent ; Adult ; Antibody Formation ; Female ; Granulocyte-Macrophage Colony-Stimulating Factor ; immunology ; Hepatitis B Antibodies ; blood ; Hepatitis B Vaccines ; administration & dosage ; immunology ; Humans ; Male ; Middle Aged ; Young Adult

In the anesthesia for Cesarean section, the anesthetists should select the agent and technique which is safe for both the morther and baby. It seems to be a general tendency that delivery by Cesarean section has been increasing because of the development of anesthetic techniques and agents with which one can give a safter anesthesia than before and in turn, has led to increased anesthetic dependence. A small dose of ketamine with nitrous oxide was tried for the induction of anesthesia for Cesarean section in the first group. In the second group, thiopental was given intravenously and anesthesia was maintained with 2% halothane in 100% oxygen for the delivery. After delivery, morphine, diazepam, and muscle relaxant were added to 0.5~1.0% halothane if necessary. These two groups were compared with conventional thiopental N2O-O2 anesthesia and the results were as follws: 1) Changes in blood pressure were similar aspect in each group, but in the hypertensive mother, the ketamine caused a higher blood pressure than the other agents. 2) Changes in pulse rate also had a similar pattern in each group. 3) I-D and U-D interval was the shortest in the halothane group. 4) The Apgar score at 1 min after delivery wasrelatively higher in the ketamine and halothane group than in the thiopental group, while the score at 5 min was almost the same in each group. 5) The analgesic effect of ketamine was superior to that of other agents. The above data suggest that halothane seems to be superior when the fetal position is abnormal or in case when complicated intrauterine manipulation is expected. A small dose of ketamine with nitrous oxide is better in the hypertensive mother or when fetal distress exists.
Anesthesia* ; Apgar Score ; Blood Pressure ; Cesarean Section* ; Diazepam ; Female ; Fetal Distress ; Halothane ; Heart Rate ; Humans ; Ketamine ; Morphine ; Mothers ; Nitrous Oxide ; Oxygen ; Pregnancy ; Thiopental

We have made a clinical analysis of emergency operations which were performed from January to December 1983 at the Chonbuk National University Hospital. The Clinical analysis compared sex and age distribution, physical status, frequency of emergency operation, department, anesthetic method, time, and seasonal distribution. The results were as follows: 1) About forty-eight percent of emergency patients were between 20 to 40. 2) Emergency operative cases were about forty-one percent of all anesthetized patients. 3) About forty-three percent of emergency operations were performed by the Department of General Surgery and the most common surgical operation was appendectomy. 4) Emergency operations in the winter were significantly less common than those of other seasons. 5) About forty percent of emergency operations were performed during daytime office hours.
Age Distribution ; Anesthesia* ; Appendectomy ; Emergencies* ; Humans ; Jeollabuk-do ; Seasons

Many studies have been performed in order to evaluate intraocular pressure changes during induction and maintenance of anesthesia in ocular surgery. Use of the laryngeal mask airway permits the maintenance of a clear airway without laryngoscopy. To evaluate the effect of laryngeal mask airway placement with/withaut laryngoscopy on intraocular pressure, sixty patients were randomly allocated to one of three groups; a tracheal intubation group with laryngoscopy (TI, n=20); a laryngeal mask airway placement group with laryngoscopy (LMA-L, n=20); a laryngeal mask airway placement group with blind technique (LMA, n=20). The authors compared the intraocular pressure and hemodynamic responses to the laryngeal mask airway insertion with (LMA-L group) and without (LMA group) laryngoscope to those of tracheal intubation (TI group) in 60 patients during a standardized anesthetic pratice. Baseline measurements of intrao- cular pressure, heart rate, and arterial blood pressures were recorded and repeated at one minute after insertion of the airway device in each group. Insertion of the laryngeal mask airway required significantly more time (LMA-L group, 15.5 sec; LMA group, 14.3 sec) in comparison with that for the tracheal intubation (9.1 sec). The laryngeal mask airway placement did not increase intraocular pressure, or arterial blood pressures except for heart rate above baseline values. However, tracheal intubation was associated with significant increases of intraocular pressure, heart rate, and arterial blood pressure at one minute compared to the baseline values. The mean intraocular pressures at one minute after airway instrumentation in TI group were significantly different from those of LMA or LMA-L group. The authors suggest that a laryngeal mask airway may be a good alternative to tracheal intubation in intraocular surgery if a laryngeal mask airway is not contraindicated.
Anesthesia ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intraocular Pressure* ; Intubation* ; Laryngeal Masks* ; Laryngoscopes ; Laryngoscopy

Many studies have been performed in order to evaluate intraocular pressure changes during induction and maintenance of anesthesia in ocular surgery. Use of the laryngeal mask airway permits the maintenance of a clear airway without laryngoscopy. To evaluate the effect of laryngeal mask airway placement with/withaut laryngoscopy on intraocular pressure, sixty patients were randomly allocated to one of three groups; a tracheal intubation group with laryngoscopy (TI, n=20); a laryngeal mask airway placement group with laryngoscopy (LMA-L, n=20); a laryngeal mask airway placement group with blind technique (LMA, n=20). The authors compared the intraocular pressure and hemodynamic responses to the laryngeal mask airway insertion with (LMA-L group) and without (LMA group) laryngoscope to those of tracheal intubation (TI group) in 60 patients during a standardized anesthetic pratice. Baseline measurements of intrao- cular pressure, heart rate, and arterial blood pressures were recorded and repeated at one minute after insertion of the airway device in each group. Insertion of the laryngeal mask airway required significantly more time (LMA-L group, 15.5 sec; LMA group, 14.3 sec) in comparison with that for the tracheal intubation (9.1 sec). The laryngeal mask airway placement did not increase intraocular pressure, or arterial blood pressures except for heart rate above baseline values. However, tracheal intubation was associated with significant increases of intraocular pressure, heart rate, and arterial blood pressure at one minute compared to the baseline values. The mean intraocular pressures at one minute after airway instrumentation in TI group were significantly different from those of LMA or LMA-L group. The authors suggest that a laryngeal mask airway may be a good alternative to tracheal intubation in intraocular surgery if a laryngeal mask airway is not contraindicated.
Anesthesia ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intraocular Pressure* ; Intubation* ; Laryngeal Masks* ; Laryngoscopes ; Laryngoscopy

Epidural anesthesia for cesarean section requires sensory blockade up to T4 level. 18 to 20 ml of 0.5% bupivacaine, 1.5 to 2.0% lidocaine, or 3.0% chloropmcaine usually produces an adequate sensory blockade to T4 level. However, when we used that amount of local anesthetics, most of the patients often complained of mild to moderate pain or discomfort during delivery of baby, manipulation of peritoneum or the uterus. So we feeled the need of increase in dosage of local anesthetics and we used 26 ml of local anesthetics or local anesthetic-fentanyl mixture. This study was undertaken to measure plasma concentration of lidocaine and observe the possible systemic toxicity of local anesthetics with the total dosage of beyond maximum recom-mended dose. Epidural anesthesia were performed with a 17 gauge Tuohy needle and local anesthetics were injected as follows. Group 1 (n;17): 0.5% bupivacaine 100 mg+2% lidocaine 80 mg+fentanyl 100 ug (50 ug/ml) Group 2 (n; 15): 2% lidocaine 520 mg without epinephrine Group 3 (n; ll): 2% lidocaine 480 mg + fentanyl 100 ug All groups were received 26 ml of local anesthetics or local anesthetic-fentanyl mixture. We checked the level of anesthesia, length of spinal column, cardiovascular changes, plasma concen- tration of lidocaine, toxic systemic reactions and patient's complaints. The plasma concentration of lidocaine were measured by immunofluorescence assay at 2, 5, 7, 10, 12 and 15 minutes after injection of local anesthetics. The results were as follows; 1) The peak plasma concentration of lidocaine were measured 12 minutes after administration of local anesthetics in the group 2 and 3. 2) Sensory blockade up to T4 level could be accomplished within 10 minutes after epidural anesthesia in the group l. 3) In the group 2 and 3, onset of action was more rapid. These groups had a tendency to fall in blood pressure than the group 1, but recovered soon with small dose of ephedrine. 4) In one patient, maximum peak plasma concentration of hdocaine was 6.8 ug/ml, but no adversereaction was observed. Above results suggested that 26 ml of local anesthetics in all groups could be used for appropriate anesthesia for cesarean section with minimal camplications and patient's satisfaction.
Anesthesia ; Anesthesia, Epidural* ; Anesthetics, Local* ; Blood Pressure ; Bupivacaine ; Cesarean Section* ; Ephedrine ; Epinephrine ; Female ; Fentanyl ; Fluorescent Antibody Technique ; Humans ; Lidocaine ; Needles ; Peritoneum ; Plasma* ; Pregnancy ; Spine ; Uterus

Epidural anesthesia for cesarean section requires sensory blockade up to T4 level. 18 to 20 ml of 0.5% bupivacaine, 1.5 to 2.0% lidocaine, or 3.0% chloropmcaine usually produces an adequate sensory blockade to T4 level. However, when we used that amount of local anesthetics, most of the patients often complained of mild to moderate pain or discomfort during delivery of baby, manipulation of peritoneum or the uterus. So we feeled the need of increase in dosage of local anesthetics and we used 26 ml of local anesthetics or local anesthetic-fentanyl mixture. This study was undertaken to measure plasma concentration of lidocaine and observe the possible systemic toxicity of local anesthetics with the total dosage of beyond maximum recom-mended dose. Epidural anesthesia were performed with a 17 gauge Tuohy needle and local anesthetics were injected as follows. Group 1 (n;17): 0.5% bupivacaine 100 mg+2% lidocaine 80 mg+fentanyl 100 ug (50 ug/ml) Group 2 (n; 15): 2% lidocaine 520 mg without epinephrine Group 3 (n; ll): 2% lidocaine 480 mg + fentanyl 100 ug All groups were received 26 ml of local anesthetics or local anesthetic-fentanyl mixture. We checked the level of anesthesia, length of spinal column, cardiovascular changes, plasma concen- tration of lidocaine, toxic systemic reactions and patient's complaints. The plasma concentration of lidocaine were measured by immunofluorescence assay at 2, 5, 7, 10, 12 and 15 minutes after injection of local anesthetics. The results were as follows; 1) The peak plasma concentration of lidocaine were measured 12 minutes after administration of local anesthetics in the group 2 and 3. 2) Sensory blockade up to T4 level could be accomplished within 10 minutes after epidural anesthesia in the group l. 3) In the group 2 and 3, onset of action was more rapid. These groups had a tendency to fall in blood pressure than the group 1, but recovered soon with small dose of ephedrine. 4) In one patient, maximum peak plasma concentration of hdocaine was 6.8 ug/ml, but no adversereaction was observed. Above results suggested that 26 ml of local anesthetics in all groups could be used for appropriate anesthesia for cesarean section with minimal camplications and patient's satisfaction.
Anesthesia ; Anesthesia, Epidural* ; Anesthetics, Local* ; Blood Pressure ; Bupivacaine ; Cesarean Section* ; Ephedrine ; Epinephrine ; Female ; Fentanyl ; Fluorescent Antibody Technique ; Humans ; Lidocaine ; Needles ; Peritoneum ; Plasma* ; Pregnancy ; Spine ; Uterus

473 patients who underwent orthopedic surgery of the upper extremities from July 1978 to August 1983 were studied and the results are as follows. 1) Among 473 patients 294 patients given general anesthesis. Axillary brachial piexus block(141 cases), intraveonus regional anesthesia(10 cases), interscalene block(2 cases) and continuous brachial plexus block were given to the rest of the patients. 2) 267 patients were male and 106 patients were female. Age distribution was from 2 to 74 years. 3) Physical status of the patients was A.S.A. (American Society of Anesthesiologists) class 2(52.5%), class 1(43.4%), class 3(4.4%) in the order. 47.2% of the patients underwent emergency operation. 4) There was a tendency that regional anesthesis has been increasing year by year. 5) The type of operations were open reduction(160cases), tendon repair(112cases), and surgery for neuropathy(65 cases). 6) The operations for upper arm, elbow, and forearm were performed mostly under general anesthesia, while regional anesthesia prevailled for hand, wrist, and digits operations. 7) Brachial plexus block was considered as a method of choice for upper extremity surgery, especially for emergency surgical procedures in patients with significant medical problems. 8) A new method was tried in which a flexible disaposable intravenous catheter was introduced into the neurovascular sheath in the axilla and used for injection of local anesthetic solutions to block the axillary brachial plexus. The catheter method constitutes an interesting alternative to the conventional needle techniques and offers a continuous axillary block and a method for postoperative pain relief.
Age Distribution ; Anesthesia, Conduction ; Anesthesia, General ; Arm ; Axilla ; Brachial Plexus ; Catheters ; Elbow ; Emergencies ; Female ; Forearm ; Hand ; Humans ; Male ; Needles ; Orthopedics ; Pain, Postoperative ; Tendons ; Upper Extremity* ; Wrist