BACKGROUND: To estimate real time concentration of drugs during TIVA is theoretical, but it is not easy and inefficient. To maintain designed target concentration with continuous infusion using methods that account for the multicompartmental pharmacokinetic profile of fentanyl, isoconcentration nomogram is one of the methods. We evaluated the clinical usefulness of the isoconcentration nomogram using two different expected concentration of fentanyl. METHODS: Thirty ASA class I or II adult patients scheduled for spine fusion were randomly allocated into two groups according to 1.5 or 3 ng/ml of expected fentanyl concentration. Using isoconcentration nomogram, fentanyl concentration was adjusted and the propofol concentration was fixed to 3.5 g/ml according to Prys-Roberts method. Vital signs were titrated using variable flow rate of propofol. Fentanyl and propofol were discontinued 15 min before the end of operation. And, IV-PCA using fentanyl were applicated for postoperative pain control. The dosage of propofol and fentanyl, recovery time of consciousness and orientation were checked. Also, first buttoning time and 24hr fentanyl dosage in IV-PCA were checked. RESULTS: Average flow rate of propofol used were 7.5 1.2 mg/kg/hr in group 1, 5.7 1.1 mg/kg/hr in group 2 which was significantly lower than group 1 (p<0.05). Spontaneous eye opening and recovery of orientation was delayed 1.8 times in group 2. First buttoning time and 24hr fentanyl requirement for postoperative pain control using IV-PCA was delayed by 2 and decreased 60% in group 2, respectively. CONCLUSIONS: Isoconcentration nomogram was useful tool to control the expected concentration of fentanyl during TIVA and postoperative pain control using fentanyl IV-PCA.
Adult ; Anesthesia, Intravenous* ; Anesthetics ; Consciousness ; Fentanyl* ; Humans ; Nomograms* ; Pain, Postoperative ; Propofol ; Spine ; Vital Signs

Pseudothrombocytopenia caused by platelet clumping is an in vitro phenomenon that occurs in ethylene-diamine-tetra-acetic acid (EDTA) anticoagulated blood at room temperature. Pseudothrombocytopenia may lead to erroneous diagnosis, unnecessary and costly additional laboratory examinations, and inappropriate medical or surgical therapy. We experienced 75-year old female pseudothrombocytopenia patient scheduled for orthopedic surgery, who showed abnormal thrombocytopenia (35,000/mm3) in preoperative routine platelet count using EDTA anticoagulant, but showed normal platelet count in sodium citrate anticoagulant.
Aged ; Blood Platelets ; Citric Acid ; Diagnosis ; Edetic Acid ; Female ; Humans ; Orthopedics ; Platelet Count ; Sodium ; Thrombocytopenia

No abstract available.
Uterine Prolapse*

No abstract available.
Uterine Prolapse*

No abstract available.

Recurrent or a second attack of acute poststreptococcal glomerulonephritis have been known to be extremely rare. Acute exacerbation in chronic glomerulonephritis and recurrence of acute poststeptococcal glomerulonephritis would be distinguishable clearly by histopathological, immuno-fluorescent and electron microscopic studies from renal biopsy material. Recently we dealt with two cases of a second attack of APSGN in a 9 year old girl and a 12 year old boy and reviewed the literature and the possible mechanism is discussed.
Biopsy ; Child ; Female ; Glomerulonephritis ; Humans ; Male ; Recurrence

No abstract available.
Krukenberg Tumor*

No abstract available.
Krukenberg Tumor*

BACKGROUND: Skin incision has been used as a standard stimulus in most concentration versus response relationship studies for anesthetics. However, skin incision is not the most intense stimulation and inconvenient method during operation. Mean arterial blood pressure, but not heart rate, is convenient and predicts surgical stress as well as propofol blood concentration. We evaluated the effects of different fentanyl concentration on propofol-fentanyl-N20 anesthesia using mean arterial blood pressure as an indicator of surgical stress during operation. METHODS: Eighty ASA I or II patients (age: 20~55 yrs) scheduled for spine fusion were randomly allocated to four groups according to expected fentanyl blood concentration (Group 1, 2, 3, 4: 0, 1.5, 3.0, 4.5 ng/ml respectively, n=20 for each group). Fentanyl was infused according to isoconcentration nomogram, and propofol infusion rate was titrated by changes of mean arterial blood pressure (0~12 mg/kg/hr). Fifteen minutes before expected end of surgery, propofol and fentanyl infusion were discontinued. Thereafter IV-PCA using fentanyl was applied for postoperative pain relief. Average propofol flow rate, recovery of orientation, verbal rating scale were cheked. RESULTS: Group 2, 3, 4 showed decreased average propofol flow rate, delayed recovery and decreased postoperative 24 hr fentanyl requirement for pain relief gradually compared with group 1. Group 4 showed ceiling effect in terms of average propofol flow rate, recovery of orientation and 24 hr fentanyl requirement for postoprerative pain relief compared with group 1~3. CONCLUSIONS: Keep the fentanyl concentration below 3.0~4.5 ng/ml and titrate propofol flow rate was reasonable method for adequate control of drug infusion during a propofol-fentanyl-N20 anesthesia.
Anesthesia* ; Anesthetics ; Arterial Pressure ; Fentanyl* ; Heart Rate ; Humans ; Nomograms ; Pain, Postoperative* ; Propofol ; Skin ; Spine

PURPOSE: To evaluate the usefulness and limitations of power Doppler sonography in determining the tumor vascularity. MATERIALS AND METHODS: Power Doppler sonography was performed on VX2 carcinomas present in rabbit thighs, and the findings were compared with those of microangiography in an almost identical plane. Tumor vascularity was qualitatively analysed on the basis of tumor vessel distribution and density, and the presence of thick and thin vesels ; for a comparison of tumor vascularity as seen on microangiography, tumor blood flow signals shown by power Doppler sonography were graded 3, 2, 1, 0. For quantitative analysis, a comparison was made of the percentage of tumor area occupied by vessels, as shown in each study. Data analysis utilized the Wilcoxon signed-rank test and Spearman correlation test. RESULTS: Mean tumor vascularity scores, as seen on power Doppler sonography and relating to tumor vessel distribution and density, and the presence of thick and thin vessels, were 2.87, 2.73, 2.93 and 2.73, respectively. The means and medians of the percentages of tumor area occupied by vessels were 22.7% & 23.5% and 36.4% & 34.7% on microangiography and power Doppler sonography, respectively. Thus, there was good correlation between these two modes. CONCLUSION: Power doppler sonography could demonstrate the tumor vascularity on microangiography relatively well but tend to overestimate it.
Neoplasms, Experimental ; Statistics as Topic ; Thigh