Polycythemia vera is a hematologic malignancy characterized by excessive proliferation of erythroid, myeloid and megakaryocytic elements within bone marrow, resulting in increased red cell mass, frequently leukocytosis and thrombocytosis. Patients with absolute erythrocytosis can be categorized into primary; those in whom excessive production of red cells results from a disorder intrinsic to the erythroid progenitor cells of bone marrow, or secondary; from excessive stimulation of an otherwise normal marrow by substance such as erythropoietin. Polycythemia vera is a disease process in which control prior to surgery decreases the frequency of perioperative complications. Surgery was postponed on an 61-year-old female patient found to have a hematocrit of 59%. She was phlebotomized and treated with hydroxyurea. Her hematocrit was decreased to 43%. General anesthesia was maintained with N2O-O2-enflurane after tracheal intubation. No thrombotic or bleeding problem was developed and she was discharged without complication at 14th day after operation.
Anesthesia, General ; Bone Marrow ; Erythrocyte Volume ; Erythroid Precursor Cells ; Erythropoietin ; Female ; Hematocrit ; Hematologic Neoplasms ; Hemorrhage ; Humans ; Hydroxyurea ; Intubation ; Leukocytosis ; Middle Aged ; Polycythemia Vera* ; Polycythemia* ; Shoulder Joint* ; Shoulder* ; Thrombocytosis

The percutaneous transhepatic biliary drainage (PTBD) is an effective intervention as a palliative therapy for relieving a jaundice and cholangitis. It may be used in place of Endoscopic retrograde cholangiopancreatography (ERCP) in the obstructive biliary disease. Recently, by developing invasive procedures, the incidence of the complications such as bleeding and perforation has been increasing in the diagnosis and treatment of hepatobiliary disease. We report here on a case of remained drawstring after PTBD in a 85-year-old man. The patient was conducted PTBD for relieving a jaundice and cholangitis. And then the patient had complained of abdominal pain constantly. A few days later, we removed PTBD and attempted ERCP for removal of CBD stone. The ERCP showed remained drawstring around ampulla of vater and we removed it by IT knife. The drawstring was successfully removed.
Abdominal Pain ; Aged, 80 and over ; Ampulla of Vater ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Diagnosis ; Drainage* ; Hemorrhage ; Humans ; Incidence ; Jaundice ; Palliative Care

Anesthetic management for aortic arch aneurysm (AAA) surgery employing deep hypothermic circulatory arrest in a Jehovah's Witness (JW) patient is a challenge to anesthesiologist due to its complexity of procedures and their refusal of allogeneic transfusion. Even in the strict application of intraoperative acute normovolemic hemodilution (ANH) and intraopertive cell salvage (ICS) technique, prompt timing of re-administration of salvaged blood is essential for successful operation without allogeneic transfusion or ischemic complication of major organs. Cerebral oximetery (rSO2) monitoring using near infrared spectroscopy is a useful modality for detecting cerebral ischemia during the AAA surgery requiring direct interruption of cerebral flow. The present case showed that rSO2 can be used as a trigger facilitating to find a better timing for the re-administration of salvaged blood acquired during the AAA surgery for JW patient.
Aneurysm ; Aorta, Thoracic ; Brain Ischemia ; Circulatory Arrest, Deep Hypothermia Induced ; Disulfiram ; Hemodilution ; Humans ; Oximetry ; Spectrum Analysis ; Wit and Humor as Topic

Anesthetic management for aortic arch aneurysm (AAA) surgery employing deep hypothermic circulatory arrest in a Jehovah's Witness (JW) patient is a challenge to anesthesiologist due to its complexity of procedures and their refusal of allogeneic transfusion. Even in the strict application of intraoperative acute normovolemic hemodilution (ANH) and intraopertive cell salvage (ICS) technique, prompt timing of re-administration of salvaged blood is essential for successful operation without allogeneic transfusion or ischemic complication of major organs. Cerebral oximetery (rSO2) monitoring using near infrared spectroscopy is a useful modality for detecting cerebral ischemia during the AAA surgery requiring direct interruption of cerebral flow. The present case showed that rSO2 can be used as a trigger facilitating to find a better timing for the re-administration of salvaged blood acquired during the AAA surgery for JW patient.
Aneurysm ; Aorta, Thoracic ; Brain Ischemia ; Circulatory Arrest, Deep Hypothermia Induced ; Disulfiram ; Hemodilution ; Humans ; Oximetry ; Spectrum Analysis ; Wit and Humor as Topic

We report a case using cerebral oxygen saturation (rCbO2) for off-pump coronary artery bypass graft (OPCAB) surgery in a patient with co-existing Moyamoya disease. The rCbO2 with the routine monitoring for OPCAB surgery were monitored intraoperatively. In spite of infusing nimodipine (0.2 microgram/kg/min) and maintaining the end-tidal CO2 tension at 35-40 mmHg, a sudden reduction in the right-side rCbO2 from the base line value of 70-80%/78-83% (Left/Right) to 70-72%/65-70% was developed during the harvesting of the vascular graft. We increased the rate of phenylephrine infusion to increase systemic and cerebral perfusion pressure, and both rCbO2 values were elevated to 80%/70% within 3 minutes. However, the preferential reduction in the right-side rCbO2 compared with the left-side value was not corrected. While suspecting cerebral ischemia due to cerebral vascular spasm, we administered nimodipine 2 mg bolus and increased infusion rate to 0.5 microgram/kg/min. Finally, the preferential rCbO2 reduction in the right-side was corrected and both rCbO2 reached 84%/91%. We concluded rCbO2 monitoring is useful for detecting an intraoperative episode of cerebral ischemia and maintaining the optimal cerebral perfusion during OPCAB surgery with Moyamoya disease.
Brain Ischemia ; Coronary Artery Bypass, Off-Pump ; Humans ; Moyamoya Disease ; Nimodipine ; Oxygen ; Perfusion ; Phenylephrine ; Spasm ; Transplants

No abstract available.
Heart Septal Defects, Atrial* ; Mitral Valve Stenosis* ; Myxoma*

Intracardiac thrombus during cardiopulmonary bypass (CPB) with full heparinization is very rare but fatal. A 60-year-old woman was scheduled for aortic and mitral valve repairs with a maze procedure for mixed aortic and mitral valvular heart disease with atrial fibrillation. Preoperative transthoracic echocardiography and cardiac computed tomography showed moderate aortic regurgitation and moderate mitral stenosis with regurgitation. There was no intracardiac thrombus. Aortic and mitral valve repairs with the maze procedure were successfully performed without unexpected events. During CPB weaning, a mobile hyper-echogenic mass in the left atrium was detected on transesophageal echocardiography. After cardiac arrest, it was surgically removed. On completion of the operation, weaning from CPB was accomplished uneventfully. The patient fully recovered and was discharged from the intensive care unit on her third postoperative day.
Aortic Valve Insufficiency ; Atrial Fibrillation ; Cardiopulmonary Bypass ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart Arrest ; Heart Atria ; Heart Valve Diseases ; Heparin ; Humans ; Intensive Care Units ; Middle Aged ; Mitral Valve ; Mitral Valve Stenosis ; Thrombosis ; Weaning

Transesophageal echocardiography (TEE) can provide real time information about anatomic and hemodynamic state and guide management in cardiac surgery.Despite greater technical advances, TEE has artifacts and pitfalls.This report describes a 68-year-old female patient underwent mitral valve replacement and Maze operation.After the procedures, TEE found right atrial mass which did not exist before cardiopulmonary bypass.After discussing with operator, right atrium was explored because it was thought to be a thrombus attached on pulmonary arterial catheter.However, it was revealed as folding of right atrium.The pitfalls of TEE resulted in misdiagnosis and unnecessary procedure.Therefore, authors reviewed echocardiographical artifacts and pitfalls in right atrium which could be misdiagnosed.
Aged ; Artifacts ; Diagnostic Errors ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart Atria ; Hemodynamics ; Humans ; Mitral Valve ; Thrombosis

BACKGROUND: Risk for injuries resulting from overinflated or underinflated endotracheal tube cuff warrants adequate cuff inflation technique. Thus, this study was designed to measure the actual intracuff pressures obtained by new estimation techniques. METHODS: 95 adult surgical patients requiring tracheal intubation were randomized to two groups with respect to the endotracheal tube model: Portex(R) (n = 55) and Euromedical(R) (n = 40). After induction of anesthesia, the cuff was inflated using new estimation techniques with two different syringes: PR10 or PR20 (passive release technique using a 10-ml or 20-ml syringe, respectively). Subsequently, an aneroid manometer was used to measure the actual intracuff pressures. These inflation techniques were repeated two times. A direct cuff measurement range of 25 to 40 cmH2O was used as a reference for optimal intracuff pressure. Size 7.0 mm internal diameter (ID) tubes were used for women and size 7.5 mm ID for men. RESULTS: 88 eligible patients were studied: Portex group (n = 50) and Euromedical group (n = 38). With respect to the rate of optimal cuff inflation, PR10 was significantly higher than PR20 in both groups (56% vs. 10% in Portex group; 63.2% vs. 0% in Euromedical group, respectively) (P < 0.05). CONCLUSIONS: When direct intracuff measurement is not available, a new method, named "passive release technique" using a 10-ml syringe, is a useful alternative cuff inflation method.
Adult ; Anesthesia ; Female ; Humans ; Inflation, Economic ; Intubation ; Intubation, Intratracheal ; Male ; Statistics as Topic ; Syringes

BACKGROUND: Inducible heat shock protein 70s (iHSP70) are expressed by stressful stimuli that result in protein denaturation, and are thought to assist in the maintenance of cellular integrity and viability. In addition, iHSP70 is known to be a sensitive marker of neuronal injury. To my best knowledge, no previous studies have been documented on iHSP70 induction by nociceptive impulse transmission through peripheral nerves not by direct neural damage. The purpose of this study was to examine the hypothesis that iHSP70 can be expressed in the nervous system, which is related to the dental nociceptive pathway, by tooth pulp inflammation. METHODS: The pulp of rat mandibular molars was exposed. Animals were sacrificed at 1, 4, and 7 days after pulpal exposure, and the pulps were evaluated histologically. Also, iHSP70 levels were examined in the Gasserian ganglion (GG) and the trigeminal sensory nucleus (TSN). RESULTS: At 4 days after pulpal exposure, iHSP70 was significantly more expressed in the ipsilateral GG than in the contralateral GG. In the histological study, inflammation was found in the entire pulp tissue at 4 days. There were no significant differences in iHSP70 levels between the ipsilateral TSN and the contralateral TSN. Also, there were no significant differences in iHSP70 expression of GG and TSN between both sides at 1 and 7 days after pulpal exposure. CONCLUSIONS: These results suggest that iHSP70 can be expressed in the GG at 4 days after pulpal exposure by nociceptive impulses due to pulpal inflammation.
Animals ; Heat-Shock Proteins* ; Hot Temperature* ; HSP70 Heat-Shock Proteins* ; Inflammation ; Molar ; Nervous System ; Neurons ; Peripheral Nerves ; Protein Denaturation ; Rats* ; Tooth ; Trigeminal Ganglion