This study was done to determine the attenuating effect of fentanyl, esmolol and labetalol on the undesirable hemodynamic response to endotracheal intubation. Eighty patients, ASA physical status I-II, scheduled for elective surgery, were randomly divided to 4 groups(n=20, respectively), received a preintubation dose of either normal saline, 3 ug/kg fentanyl, 3 ug/kg fentanyl and 2.5 mg/kg esmolol, or 3 ug/kg fentanyl and 0.5 mg/kg labetalol. Controlled blood pressure and heart rate were recorded in the operating room at arrival of patients. Denitrogenation was done and 3 ug/kg fentanyl was administered at minute 0. Either sympathetic blocker was intravenously infused for 1 minute at minute 1. Induction was accomplished by administering 5 mg/kg thiopental sodium at minute 3, Larynogscopy and endotracheal intubation were performed by one investigator at minute 5. Data from patients in whom intubation required more than 15 seconds were excluded. Heart rate and blood pressure were recorded every minute for 10 minutes after administration of fentanyl. Highest value of heart rate and systolic blood pressure in all groups were recorded 1 minute after endotracheal intubation. Maximum percent increase in systolic blood pressure(meanSD) after intubation were significantly lower in fentanyl(4%+/-17%), esmolol and fentanyl(-5%+/-14%), and labetalol and fentanyl(-3%+/-20%) groups than in the normal saline(27%+/-15%) group(P<0.05). Maximal percent increase in heart rate was significantly lower only in esmolol and fentanyl(4%+/- 18%)group than in normal saline(27%+/-23%) group(P<0.05). The authors observed that combined pretreatment with esmolol and fentanyl provided more reliable protection against increases in both heart rate and systolic blood pressure accompanying laryngoscopy and intubation.
Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Intubation, Intratracheal* ; Labetalol* ; Laryngoscopy ; Operating Rooms ; Research Personnel ; Thiopental

Magnetic resonance (MR) imaging of thirteen patients with tuberous sclerosis were reviewed. Seven patients underwent computed tomography (CT). The characteristic MR finding of tuberous sclerosis was those of subependymal nodules which were best seen on short repetition time (TR) spin-echo images. Hypointensities within the nodules consistent with calcification were most evident on long TR images. Contrast enhancing lesions, indicative subependymal giant cell astrocytoma, occurred in four cases. Cortical tubers (n=11) and white matter lesions(n=8) exhibited long T1 and T2 relaxation characteristics although reversed pattern was noted in one newborn patients. Cortical tubers and white matter lesions had more irregular shapes in early childhood patients. MR imaging is the sensitive method in detection of gyral tubers and white matter lesions and also valuable in detecting giant all astrocytoma.
Astrocytoma ; Humans ; Infant, Newborn ; Magnetic Resonance Imaging ; Methods ; Relaxation ; Tuberous Sclerosis* ; White Matter

PURPOSE: To evaluate the safety and efficacy of Hickman catheter placement via the subclavian vein under fluoroscopic guidance with intravenous contrast injection. MATERIALS AND METHODS: During an eleven-month period, 187 Hickman catheters were percutaneously placed in 167 consecutive patients in an interventional radiology suite. Subclavian venous puncture was made with injection of contrast medium into the peripheral venous line. After subclavian venous access had been obtained, a subcutaneous tunnel was created using a peel-away sheath or a tunneler. The Hickman catheters were inserted through a peel-away sheath, the distal tip of which was at the junction of the right atrium and the superior vena cava. RESULTS: One hundred and eighty-six Hickman catheters were successfully placed; the one failure was due to an atomical tortuosity of the vein(0.53%). Complications included one case of subclavian vein occlusion (0.53%); three of line occlusion by thrombus (1.6%); one of oozing at the suture site (0.53%); six of infection or inflammation (3.2%); eight of natural removal (4.2%); one case of air embolism (0.53%) and two of malposition (0.1%). Major complications such as pneumothorax or arterial puncture leading to mediastinal hemorrhage did not, however, occur. CONCLUSION: The authors concluded that radiologic Hickman catheter placement offers advantages over traditional approaches in terms of safety, convenience, and time and cost savings.
Catheters ; Cost Savings ; Embolism, Air ; Heart Atria ; Hemorrhage ; Humans ; Inflammation ; Pneumothorax ; Punctures ; Radiology, Interventional ; Subclavian Vein* ; Sutures ; Thrombosis ; Vena Cava, Superior

A 26 year-old woman was scheduled for right sleeve pneumonectomy and carinal reconstruction using Femoro-femoral extracorporeal circulation to correct tracheal stenosis due to endotracheal tuberculosis. Only 0.2 mg glycopyrrolate was given intramuscularly for premedication. A radial artery cannulation was inserted for blood has sampling and direct arterial pressure monitoring. Under the monitoring for SaO2, ECG and direct radial artery pressure, we conducted continuous epidural anesthesia for the cannulation of extracorporeal circulation. Immediately after establishment of lines for extracorporeal circulation, we injected 15 mg midazolam, 200 ug fentanyl and 50 mg succinylcholine, and then did orotracheal intubation. Under extracorporeal circulation, right sleeve pneumonectomy was performed, and left bronchial intubation was done using another sterile armored tube number 7.0 by surgeon. From skin incision to left bronchial intubation, maintenance of anesthesia was conducted by intermittent injection of fentanyl-midazolam, and after left bronchial intubation, it was done by using conventional inhalation anesthetics, halothane-98% O2. The prime importance in anesthetic management of these patient should be focused on the maintenance of adequate oxygenation and ventilation, and we think it is a kind of safe method to use extracorporeal circulation during carinal reconstruction.
Adult ; Anesthesia ; Anesthesia, Epidural ; Anesthetics, Inhalation ; Arterial Pressure ; Catheterization ; Electrocardiography ; Extracorporeal Circulation ; Female ; Fentanyl ; Glycopyrrolate ; Humans ; Intubation ; Midazolam ; Oxygen ; Pneumonectomy* ; Premedication ; Radial Artery ; Skin ; Succinylcholine ; Tracheal Stenosis ; Tuberculosis ; Ventilation

No abstract available.
Female ; Ovary* ; Teratoma*

The relation of atopic dermatitis to various manifestations of ocular disease has been documented in the dermatologic literature. Several lines of evidence suggest that patients with atopic dermatitis have defective ceil-mediated immunity and decreased cellular hypersensitivity. In this paper, we presented two cases of atopic dermatitis developing ocular complication and abnormal immune response in vivo and in vitro during the course of atopic dermatitis.
Dermatitis, Atopic* ; Humans ; Hypersensitivity

The goal of this study was of what change in blood glucose the operation area and ageing made during halothane anesthesia. Sixty patients who were chosen randomly were divided into 4 operation groups according to operation site, that is, nil, surface, abdomen and thorax. Again, each operation group was fractionated into the young(below 40 year old), the middle (from 4l to 60) and the old(above 61). The blood sampling was done at preinduction for control value, 15 min, 30 min, 45 min and 60 min after induction for nil, and 15 min, 30 min, 45 min and 60 min after incision for operation-received groups. The results were as follows; 1) In nil, the young and the middle increased, but the old decreased in blood glucose. 2) In operation-received groups, there was no significance in blood glucose change among 3 age fractions. 3) The blood glucose change was larger in operation-received groups than in nil, more prominent in abdomen and thorax groups than in surface group. 4) The blood glucose of preinduction had no significance among 4 operation groups.
Abdomen ; Anesthesia* ; Blood Glucose* ; Halothane* ; Humans ; Thorax

No abstract available.
Drug Therapy* ; Leukemia, Myeloid, Acute* ; Nausea* ; Vomiting*

Balloon dilatation has been applied in treatint of various pathologic narrowing of the hollow viscus. It is now accepted as very effective modality especially in treating esophageal stenosis obviating surgical procedure. We performed 128 balloon dilatations in 29 patients with the number of dilatations in each patient ranging from once to 12 times. The age distribution of the patients was from 3 weeks to 6 years, with the median age of 3 months. Twenty nine patients consisted of 25 postoperative esophageal strictures (21 esophageal atresia with tracheoesophageal fistula, 1 congenital esophageal stenosis, 2 tracheobronchial remnant, and 1 congenital esophageal stenosis with esophageal atresia), 2 achalasia, 1 congenital esophageal stenosis, and 1 corrosive esophagitis. We had successful dilation in 22 patients, who showed subsequent relief of symptoms and improvement in the diameter of stenotic segment. In 4 patients, esophageal perforation occurred during the procedure, one requiring emergency thoracotomy and the other threeconservative management. Seven patients had no improvement in stenotic sites after several balloon dilatations. Failed cases were congenital stenosis, achalasia, corrosive esophagitis and four postoperative strictures. We believe that balloon dilatation is the procedure of choice in the treatment of postoperative esophageal stricture in infants and children and is a safe method as the perforation which can complicate the procedure could be managed conservatively.
Age Distribution ; Child* ; Constriction, Pathologic* ; Dilatation* ; Emergencies ; Esophageal Achalasia ; Esophageal Atresia ; Esophageal Perforation ; Esophageal Stenosis ; Esophagitis ; Humans ; Infant* ; Methods ; Thoracotomy ; Tracheoesophageal Fistula

OBJECTIVES: APL, which characteristically shows t(15:17), accompanies fatal coagulopathy during remission induction with systemic chemotherapy alone. ATRA, a derivative of vitamin A, can differentiate APL cells as well as HL-60 cells in vitro and induce higher rate of complete remission(CR). Hence, we assessed the effect of ATRA on remission induction and coagulopathy in APL patients. METHODS: (1) 42 patients diagnosed histologically in St. mary's hospital from June 1991 to June 1994 were included. (2) We compared the CR rate, the time required for restoration of derranged coagulation profiles, and the amount of coagulation factors including platelets among the chemotherapy group (control) and ATRA group. RESULTS: 1) There was no difference in CR rate between the control group and ATRA group [84.2%(16 out of 19) vs 87.0%(20 out of 23), p>0.05)] and also no difference between two subgroups of ATRA [ATRA with chemotherapy; 83.3%(10 out of 12) vs ATRA without chemotherapy; 90.9%(10 out of 11), p>0.05] 2) In the ATRA group, the CR rate of newly diagnosed patients was 82.4%(14 out of 17). The first relapsed patients (4) and the second (2) were all achieved CR. 3) The mean duration of coagulopathy, time to normalization of PT, aPTT, FDP, fibrinogen level, was 12.0+/-10.4, 11.1+/-10.2, 16.5+/-9.3, 15.4+/-10.2 days after chemotherapy alone and 4.5+/-4.4, 3.7+/-3.7, 8.9+/-6.1, 8.1+/-6.5 days in the ATRA group(p<0.05). The amount of fresh frozen plasma used in the ATRA group for the purpose of correction of coagulopathy were significantly lower than the control group(p<0.05). The incidence of profound coagulopathy during the remission induction treatment in the ATRA group was significantly lower than the control group[40% (8 out of 20) vs 96.7%(13 out of 15), p
Blood Coagulation Factors ; Drug Therapy ; Fibrinogen ; HL-60 Cells ; Humans ; Incidence ; Leukemia, Promyelocytic, Acute* ; Plasma ; Remission Induction* ; Tretinoin* ; Vitamin A